Abstract
Simple SummaryLocal ablative treatments have emerged as a promising treatment strategy for patients with oligometastatic disease. Interstitial brachytherapy (iBT) is one of the locally ablative treatment options for unresectable liver metastases in oligometastatic disease. We report the feasibility and oncologic outcome of 141 iBT treatments of 244 oligometastatic liver metastases performed in patients with limited tumor burdens in a high-volume center. iBT was feasible, safe and effective in the treatment of oligometastatic liver metastases with good local control rates and low toxicity. Histology and total tumor volume had an impact on local control rates.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.
Highlights
Patients with solid tumors who develop distant metastases with a low metastatic burden represent a unique clinical scenario that requires an adaption and optimization of traditional treatment strategies
We present our experience as a high-volume center with a total of 244 liver metastases treated in patients with oligometastatic disease from various primary tumors
29 interstitial brachytherapy (iBT) treatments were applied in patients with CCC, 86 in patients with HCC and 167 in patients with liver metastases
Summary
Patients with solid tumors who develop distant metastases with a low metastatic burden represent a unique clinical scenario that requires an adaption and optimization of traditional treatment strategies. The term “oligometastatic disease” has become wellestablished in recent years. While the exact definition of oligometastatic disease remains controversial, with several recommendations being published [1,2], there is general agreement that more aggressive local treatments are desirable in patients with a low metastatic burden. Oncologic benefits of this strategy have been found for several cancer entities. A recent randomized study investigated the use of radiation-based local ablative treatments using stereotactic ablative radiotherapy (SABR) for the treatment of oligometastatic disease of various histologies
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