Abstract
Simple SummaryClinical management of advanced stages of primary and secondary liver tumors remains challenging. Combining different treatment approaches to create the most effective therapy for patients is, however, often necessary. With this study we aim to analyze the efficacy and safety of a combined intrahepatic treatment of transarterial radioembolization and CT-guided high-dose-rate interstitial brachytherapy. Our study showed that patients not responding to systemic chemotherapy or suffering from tumor relapse after surgical resection might benefit from a combined minimal-invasive treatment.Purpose: Treatment of patients with primary and secondary liver tumors remains challenging. This study analyzes the efficacy and safety of transarterial radioembolization (TARE) combined with CT-guided high-dose-rate interstitial brachytherapy (CT-HDRBT) for the treatment of primary and secondary liver tumors. Patients and Methods: A total of 77 patients (30 female) with various liver malignancies were treated. Primary endpoints were median overall survival (OS) and time to untreatable progression (TTUP). Additionally, subgroup analyses were performed in consideration of diagnosis and procedure sequence. Median OS and TTUP prediction were estimated using Kaplan–Meier analysis and hazard ratios (HR) were calculated using a multivariate Cox proportional hazard model. Results: A total of 115 CT-HDRBT and 96 TARE procedures were performed with no significant complications recorded. Median OS and TTUP were 29.8 (95% CI 18.1–41.4) and 23.8 (95% CI 9.6–37.9) months. Median OS for hepatocellular carcinoma (HCC)-, cholangiocarcinoma carcinoma (CCA) and colorectal cancer (CRC) patients was 29.8, 29.6 and 34.4 months. Patients starting with TARE had a median OS of 26.0 (95% CI 14.5–37.5) compared to 33.7 (95% CI 21.6–45.8) months for patients starting with CT-HDRBT. Hazard ratio of 1.094 per month was shown for patients starting with CT-HDRBT. Conclusion: Combining TARE and CT-HDRBT is effective and safe for the treatment of advanced stage primary and secondary liver tumors. Our data indicate that early TARE during the disease progression may have a positive effect on survival.
Highlights
Besides advancements in oncological therapies, the management of primary and secondary liver malignancies remains challenging
The study population included 30 women and 47 men ranging in age from 22 t
The study population included 30 women and 47 men ranging in age from 22 to years
Summary
Besides advancements in oncological therapies, the management of primary and secondary liver malignancies remains challenging. Incidences for primary liver cancer have decreased in the last three decades, they still remain high [2]. In 2018, liver cancer was found to be responsible for approximately 780,000 deaths worldwide, accounting for 8% of all cancer-related deaths [3]. For primary malignancies such as hepatocellular carcinoma (HCC) and cholangiocarcinoma carcinoma (CCA), surgical resection remains the therapy of choice but is often impossible due to inaccessibility, number of lesions and tumor distribution [4]. Despite advances in systemic therapies, local treatment approaches using minimally invasive therapies (MIT) have proven to significantly prolong overall survival (OS) in patients with limited metastatic disease to the liver, supporting the concept of oligometastatic disease [7,8]
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