Hypofractionated accelerated computed tomography–guided interstitial high-dose-rate brachytherapy for liver malignancies

Abstract

To report our results of computed tomography (CT)-guided interstitial high-dose-rate (HDR) brachytherapy (BRT) in the local treatment of inoperable primary and secondary liver malignancies. Between 2000 and 2009, 31 patients underwent a total of 42 BRT procedures for 36 hepatic lesions exceeding 4 cm and located adjacent to the liver hilum and bile duct bifurcation. The median tumor volume was 99 cm(3) (range, 46-1348 cm(3)). The median age was 64 years (range, 27-85 years). The HDR-BRT delivered a median total physical dose of 13.0 Gy (range, 7.0-32.0 Gy) in twice daily fractions of median 7.0 Gy (range, 4.0-10.0 Gy) in 14 patients and in once daily fractions of median 8.0 Gy (range, 7.0-14.0 Gy) in 17 patients. The median followup was 13.3 months with an overall survival rate of 66% at 1 year. The local control rate for patients with metastatic lesions was 79%, 59%, and 59%, and for the subgroup with primary hepatic tumors 88%, 50%, and 50% at 1, 2, and 3 years, respectively. Severe side effects occurred in 4.7% of BRT procedures with no treatment-related deaths. Our results confirm CT-guided interstitial HDR-BRT to be a safe procedure for the local treatment of inoperable liver malignancies unsuitable for thermal ablation.