Effectiveness and Safety of CT-Guided &lt;sup&gt;125&lt;/sup&gt;I Brachytherapy for Lung Metastasis from Hepatocellular Carcinoma

Yongxin Chen,Sheng Peng,Yingjie Huang,Fei Gao,Lin Chen,Yao Wang

doi:10.4236/ojrad.2013.33026

Abstract

To retrospectively evaluate effectiveness and safety of CT-guided 125I brachytherapy in patients with lung metastasis from hepatocellular carcinoma, sixty lung metastatic lesions in 29 patients were percutaneously treated in 34 125I brachytherapy sessions. Each metastatic lesion was treated with computed tomographic (CT) guidance. Follow-up contrast material-enhanced CT scans were reviewed and the efficacy of treatment was evaluated. Months are counted from the first time of 125I brachytherapy and the median duration of follow-up was 11 months (ranging from 6 - 17 months). The local control rates after 3, 6, 10 and 15 months were 86.2, 71.4, 60.9 and 50.0% respectively. At the time of writing, ten patients are alive without evidence of recurrence at 11 - 15 months. The 10 patients presented good control of local tumor and no systemic recurrence, and survived throughout the follow-up period. Other 11 patients died of multiple hematogenous metastases 5 - 15 months after brachytherapy. A small amount of local hematoma occurred in 5 patients that involved applicator insertion through the lung. Four patients presented pneumothorax with pulmonary compression of 30% - 40% after the procedure and recovered after drainage. Two patients had minor displacement of radioactive seeds. Severe complications such as massive bleeding and radiation pneumonitis did not occur. So CT-guided 125I brachytherapy is effective and may be safely applied to lung metastasis from hepatocellular carcinoma.

Highlights

Hepatocellular carcinoma (HCC) is a very highly invasive tumor that metastasizes hematogenously and lymphogenously to distant sites
Months are counted from the first time of 125I brachytherapy and the median duration of follow-up was 11 months
Treatment of lung metastasis from hepatocellular carcinoma is usually challenging because the previous therapies limit the options available for subsequent treatment. 125I brachytherapy has been widely applied for tumor treatment in clinic with significant efficacy providing promising results for local control of solid tumors such as prostate carcinoma, lung cancer, HCC, liver metastasis and pancreatic cancer [3,4,5,6,7,8,9,10]

Summary

Introduction

Hepatocellular carcinoma (HCC) is a very highly invasive tumor that metastasizes hematogenously and lymphogenously to distant sites. 125I brachytherapy has been widely applied for tumor treatment in clinic with significant efficacy providing promising results for local control of solid tumors such as prostate carcinoma, lung cancer, HCC, liver metastasis and pancreatic cancer [3,4,5,6,7,8,9,10]. The specific effect of 125I radiation on tumor cells can efficiently inhibit the proliferation and repair of tumor cells, while the surrounding normal tissue only receives less than 25% of the doses received by the tumor cells [8]. The slow emission of radiation from the 125I seeds allows the surrounding normal tissue that receives sub-lethal or potentially lethal dose of radiation to have sufficient time for repair and recover [10]

Methods

Results

Conclusion