Erschienen in:
29.02.2016 | Original Article
Radioablation of liver malignancies with interstitial high-dose-rate brachytherapy
Complications and risk factors
verfasst von:
Dr. med. Konrad Mohnike, Dr. med. Steffen Wolf, Dr. med. Robert Damm, PD Dr. med. Max Seidensticker, Dr. med. Ricarda Seidensticker, Prof. Dr. med. Frank Fischbach, Nils Peters, Dr. med. Peter Hass, Prof. Dr. med. Günther Gademann, Prof. Dr. med. Maciej Pech, Prof. Dr. med. Jens Ricke
Erschienen in:
Strahlentherapie und Onkologie
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Ausgabe 5/2016
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Abstract
Background
To evaluate complications and identify risk factors for adverse events in patients undergoing high-dose-rate interstitial brachytherapy (iBT).
Material and methods
Data from 192 patients treated in 343 CT- or MRI-guided interventions from 2006–2009 at our institution were analyzed. In 41 %, the largest tumor treated was ≥ 5 cm, 6 % of the patients had tumors ≥ 10 cm. Prior to iBT, 60 % of the patients had chemotherapy, 22 % liver resection, 19 % thermoablation or transarterial chemoembolization (TACE). Safety was the primary endpoint; survival data were obtained as the secondary endpoints. During follow-up, MRI or CT imaging was performed and clinical and laboratory parameters were obtained.
Results
The rate of major complications was below 5 %. Five major bleedings (1.5 %) occurred. The frequency of severe bleeding was significantly higher in patients with advanced liver cirrhosis. One patient developed signs of a nonclassic radiation-induced liver disease. In 3 patients, symptomatic gastrointestinal (GI) ulcers were detected. A dose exposure to the GI wall above 14 Gy/ml was a reliable threshold to predict ulcer formation. A combination of C-reactive protein ≥ 165 mg/l and/or leukocyte count ≥ 12.7 Gpt/l on the second day after the intervention predicted infection (sensitivity 90.0 %; specificity 92.8 %.) Two patients (0.6 %) died within 30 days. Median overall survival after the first liver treatment was 20.1 months for all patients and the local recurrence-free surviving proportion was 89 % after 12 months.
Conclusions
Image-guided iBT yields a low rate of major complications and is effective.