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. 2021 Dec 13;13(24):6250.
doi: 10.3390/cancers13246250.

Interstitial High-Dose-Rate Brachytherapy of Liver Metastases in Oligometastatic Patients

Franziska Walter  1 , Maya Rottler  1 , Lukas Nierer  1 , Guillaume Landry  1 , Justus Well  1 , Paul Rogowski  1 , Konrad Mohnike  2 , Max Seidensticker  3 , Jens Ricke  3 , Claus Belka  1 , Stefanie Corradini  1
Affiliations

Interstitial High-Dose-Rate Brachytherapy of Liver Metastases in Oligometastatic Patients

Franziska Walter et al. Cancers (Basel). .

Abstract

Local ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Among others, interstitial brachytherapy (iBT) is an upcoming treatment option for unresectable liver metastases. We report the feasibility and oncologic outcome of iBT of oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. Patients undergoing iBT between August 2017and March 2019 were included. A retrospective analysis of patient outcomes and treatment complications was performed. Patients treated for metastatic colorectal carcinoma (CRC) were compared to other histologies. A total of 141 iBT procedures were performed in 106 patients (male:52; female:54) and 244 liver metastases. Overall, 51% (54/106) of patients had a diagnosis of metastatic CRC. The median follow-up was 9 months, and overall survival (OS) was 92.3% at 6 months and 76.3% at 12 months. Local-relapse-free survival (LRFS) was 88.4% at 6 months and 71.5% at 12 months, with a significant difference between patients with CRC (84.1% and 50.6%) versus other histologies (92.4% and 92.4%, p < 0.001). A sub-group analysis showed a significant advantage in patients with CRC receiving a minimal dose (D100) of 20 Gy to the planning target volume. Treatments of smaller total liver-tumor volumes (<18 ccm) resulted in better LRFS rates. iBT is a safe and effective treatment approach for oligometastatic liver disease. A higher treatment dose is needed for patients with CRC. Moreover, lower metastatic burdens may be favorable for LRFS. Prospective studies are needed to assess the role of iBT in the oligometastatic setting as an alternative to other local ablative treatment approaches in patients with liver metastases.

Keywords: brachytherapy; liver; local control; metastases; outcome; radiotherapy; survival.

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Conflict of interest statement

C.B., G.L. and S.C. have received research grants from Elekta. S.C. and C.B. have received speaker honoraria/travel support from Elekta. The other authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Patient example of interstitial brachytherapy in multiple lesions. (A,B) Axial views of multiple liver lesions in different liver segments; (C) sagittal view of multiple liver lesions; (D) reconstruction of liver volume with multiple lesions and multiple catheters in place.
Figure 2
Figure 2
Oncologic outcome of interstitial brachytherapy. (A) Overall survival; (B) overall survival CRC vs. mixed histology; (C) local-recurrence-free survival; (D) local-recurrence-free survival CRC vs. mixed histology; (E) progression-free survival; (F) progression-free survival CRC vs. mixed histology.
Figure 3
Figure 3
Local-recurrence-free survival for histology of colorectal carcinoma (CRS) stratified by dose.
Figure 4
Figure 4
Local-recurrence-free survival stratified by total treated volume.
See this image and copyright information in PMC

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