Abstract
The optimal management of intrahepatic malignancies involves a multidisciplinary approach. Although surgical resection has been considered the only curative approach, the use of several minimally invasive ablative techniques has dramatically increased the last two decades, mainly due to the fact that they provide similar oncological results with significantly decreased morbidity. Among these modalities, interstitial liver brachytherapy, probably the most flexible liver ablative method, with excellent clinical data on its safety and effectiveness, is frequently not even mentioned as an option in the current peer reviewed literature and guidelines. Brachytherapy is a type of radiotherapy utilizing radionuclides that are directly inserted into the tumor. Compared to external beam radiation therapy, brachytherapy has the potential to deliver an ablative radiation dose over a short period of time, with the advantage of a rapid dose fall-off, that allows for sparing of adjacent healthy tissue. For numerous malignancies such as skin, gynecological, breast, prostate, head and neck, bladder, liver and soft-tissue tumors, brachytherapy as a monotherapy or combined with external beam radiation therapy, has become a standard treatment for many decades. This review article aims to describe the high-dose-rate liver brachytherapy technique, its selection criteria, present its advantages and disadvantages, as well as the available clinical data, in order to help physicians to explore and hopefully introduce liver brachytherapy into their clinical routine.
Highlights
With primary liver cancer being the seventh most commonly diagnosed cancer worldwide [1], while liver is the most common site of metastasis in patients with colorectal cancer [2], primary and secondary liver malignant tumors are frequently encountered
Twenty-one patients were treated with computed tomography (CT)-guided HDR-BT alone, while sixteen patients received brachytherapy directly after magnetic resonance imaging (MRI)-guided laserinduced thermotherapy (LITT) due to suspected incomplete thermal ablation, mainly because of tumor size or location
They reported local control rates of 87% for the HDR-BT-group and 73% for the LITT followed by HDR-BT-group at 9 months and an OS rate of 69% at 12 months for all patients combined
Summary
With primary liver cancer being the seventh most commonly diagnosed cancer worldwide [1], while liver is the most common site of metastasis in patients with colorectal cancer [2], primary and secondary liver malignant tumors are frequently encountered. The majority of patients (80-90%) are poor surgical candidates due to age and comorbid medical conditions, functional status, severity of hepatic decompensation, unfavorable anatomical lesions location, insufficient future liver remnant, extent of metastases, history of extensive abdominal surgery or patient’s preferences [4–8]. Against this background, over the last decades, several minimally invasive liver directed treatment modalities, including image-guided ablative and trans-arterial techniques [9], have been developed and are being used alone or in combination with traditional and newer systemic treatments, improving patient outcomes. All the above can lead to excellent local disease control with minimal toxicity
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