Computed tomography-guided brachytherapy for liver cancer.

Limitations of thermal liver cancer ablation have led to the development of percutaneous, catheter-based brachytherapy for the treatment of liver malignancies. Computed tomography (CT)-guided brachytherapy has been used to treat primary and metastatic liver cancers, including very large tumors >10 cm. Cooling effects by adjacent blood vessels are not a concern in brachytherapy, and the method may be used safely in tumors unsuitable for thermal ablation that are close to the liver hilum due to the relatively high radiation tolerance of bile duct. CT scanning is used for dosimetry planning after catheter implantation and also to guide the catheter placement itself. Major complications, including postinterventional bleeding, are rare despite frequent application of this technique in a salvage situation. Patients with liver cirrhosis have an increased risk for complications. Prospective trials of CT-guided brachytherapy have been performed with promising survival rates for liver metastases and hepatocellular carcinoma, respectively. In this article, the radiobiological and technical properties of CT-guided brachytherapy, appropriate patients for treatment, and prospective trials that have been published to date are reviewed.

[1]  P. Wust,et al.  In Vivo Assessment of Dose Volume and Dose Gradient Effects on the Tolerance Dose of Small Liver Volumes after Single-Fraction High-Dose-Rate 192Ir Irradiation , 2009, Radiation research.

[2]  Peter Wust,et al.  CT-Guided Interstitial Brachytherapy of Primary and Secondary Lung Malignancies , 2008, Strahlentherapie und Onkologie.

[3]  P. Wust,et al.  Radiobiological restrictions and tolerance doses of repeated single-fraction hdr-irradiation of intersecting small liver volumes for recurrent hepatic metastases , 2010, Radiation oncology.

[4]  P. Tekkis,et al.  Quantification of risk of a positive (R1) resection margin following hepatic resection for metastatic colorectal cancer: an aid to clinical decision-making. , 2008, Surgical oncology.

[5]  P. Wust,et al.  In vivo assessment of the gastric mucosal tolerance dose after single fraction, small volume irradiation of liver malignancies by computed tomography-guided, high-dose-rate brachytherapy. , 2006, International journal of radiation oncology, biology, physics.

[6]  D. Donath,et al.  Brachytherapy in the treatment of solitary colorectal metastases to the liver , 1990, Journal of surgical oncology.

[7]  P. Wust,et al.  Local response and impact on survival after local ablation of liver metastases from colorectal carcinoma by computed tomography-guided high-dose-rate brachytherapy. , 2010, International journal of radiation oncology, biology, physics.

[8]  S. Rustgi,et al.  Intraoperative radiation therapy of hepatic metastases: technical aspects and report of a pilot study. , 1988, International journal of radiation oncology, biology, physics.

[9]  Richard Pötter,et al.  Patterns of care for brachytherapy in Europe: updated results. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[10]  H. Amthauer,et al.  Hepatocellular Carcinoma and Liver Cirrhosis: Assessment of the Liver Function after Yttrium-90 Radioembolization with Resin Microspheres or after CT-Guided High-Dose-Rate Brachytherapy , 2009, Digestive Diseases.

[11]  Peter Wust,et al.  Computed tomography-guided high-dose-rate brachytherapy in hepatocellular carcinoma: safety, efficacy, and effect on survival. , 2010, International journal of radiation oncology, biology, physics.

[12]  L. Lehmkuhl,et al.  CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies , 2006, European Radiology.

[13]  Hyun-Cheol Kang,et al.  3D CT-based high-dose-rate brachytherapy for cervical cancer: clinical impact on late rectal bleeding and local control. , 2010, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[14]  P. Wust,et al.  CT-Guided Brachytherapy (CTGB) versus Interstitial Laser Ablation (ILT) of Colorectal Liver Metastases , 2008, Strahlentherapie und Onkologie.

[15]  P. Wust,et al.  Treatment of hepatic metastases of breast cancer with CT-guided interstitial brachytherapy - a phase II-study. , 2011, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[16]  J. Bruix,et al.  Novel advancements in the management of hepatocellular carcinoma in 2008. , 2008, Journal of hepatology.

[17]  Peter Wust,et al.  Safety margin in irradiation of colorectal liver metastases: assessment of the control dose of micrometastases , 2010, Radiation oncology.

[18]  C. Bokemeyer,et al.  A systematic review on the clinical benefit and role of radiofrequency ablation as treatment of colorectal liver metastases. , 2009, European journal of cancer.

[19]  Frank Fischbach,et al.  MR-guided liver tumor ablation employing open high-field 1.0T MRI for image-guided brachytherapy , 2010, European Radiology.

[20]  Peter Wust,et al.  CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: phase I-II results of a novel technique. , 2004, International journal of radiation oncology, biology, physics.

[21]  Dimos Baltas,et al.  CT-Guided Interstitial HDR Brachytherapy for Recurrent Glioblastoma Multiforme , 2007, Strahlentherapie und Onkologie.

[22]  W. Lees,et al.  Five-year survival in 309 patients with colorectal liver metastases treated with radiofrequency ablation , 2009, European Radiology.

[23]  P. Wust,et al.  In vivo assessment of the tolerance dose of small liver volumes after single-fraction HDR irradiation. , 2005, International journal of radiation oncology, biology, physics.

[24]  Steven A. Curley,et al.  Radiofrequency Ablation Versus Resection for Resectable Colorectal Liver Metastases: Time for a Randomized Trial? , 2007, Annals of Surgical Oncology.

[25]  P. Wust,et al.  CT-guided interstitial single-fraction brachytherapy of lung tumors: phase I results of a novel technique. , 2005, Chest.

[26]  J. Rodgers,et al.  Intraoperative high‐dose rate interstitial irradiation of hepatic metastases from colorectal carcinoma. Results of a phase I–II trial , 1993, Cancer.

[27]  G. van Kaick,et al.  Assessment of focal liver reaction by multiphasic CT after stereotactic single-dose radiotherapy of liver tumors. , 2003, International journal of radiation oncology, biology, physics.

[28]  P. Wust,et al.  Liver malignancies: CT-guided interstitial brachytherapy in patients with unfavorable lesions for thermal ablation. , 2004, Journal of vascular and interventional radiology : JVIR.

[29]  E. Berber,et al.  Predictors of survival after radiofrequency thermal ablation of colorectal cancer metastases to the liver: a prospective study. , 2005, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[30]  E. Lopez Hänninen,et al.  Brachytherapy of liver metastases. , 2008, Recent results in cancer research. Fortschritte der Krebsforschung. Progres dans les recherches sur le cancer.