Abstract
Objectives
Evaluate the clinical outcome of CT-guided high-dose-rate-brachytherapy (CT-HDRBT) of hepatocellular carcinoma (HCC) larger than 5 cm in diameter with the goal of local tumour control (LTC).
Methods
Thirty-five patients with 35 unresectable HCCs ranging in size from 5 to 12 cm (mean: 7.1 cm) were treated with CT-HDRBT. Tumours were classified into two groups according to diameter: “large lesions” (5–7 cm) and “very large lesions” (>7 cm). Tumour response was evaluated by Gd-EOB-DTPA-enhanced liver magnetic resonance imaging (MRI) performed before, 6 weeks after, and then every 3 months after treatment. Endpoints included local tumour control (LTC), progression-free survival (PFS) and overall survival (OS).
Results
Nineteen tumours were classified as “large” and 16 as “very large”. Complete tumour enclosure was achieved in all patients after the first CT-HDRBT session. Five patients were lost to follow-up. At a mean follow-up of 12.8 months, two patients had local progression (6.7%), one in each group. Nine patients (30%) experienced distant progression, five (26.3%) in the “large” and four (25%) in the “very large” group. No patients died during the follow-up period. No major complications were recorded.
Conclusions
CT-HDRBT is a promising therapy for HCCs that exceed indications for thermal ablation.
Key Points
• Computed Tomography guided high-dose-rate brachytherapy offers new therapeutic options for hepatocellular carcinoma
• CT-HDRBT can be safely practised in HCCs exceeding 5 cm in diameter
• CT-HDRBT offers high rate of local control where thermal ablation is impossible
• CT-HDRBT could be a valid alternative to TACE for intermediate stage HCC
Similar content being viewed by others
References
Bruix J, Llovet JM (2009) Major achievements in hepatocellular carcinoma. Lancet 373(9664):614–6
Lencioni R (2010) Loco-regional treatment of hepatocellular carcinoma. Hepatology 52:762–73
Goldberg SN, Gazelle GS, Compton CC, Mueller PR, Tanabe KK (2000) Treatment of intrahepatic malignancy with radiofrequency ablation. Cancer 88:2452–2463
Goldberg SN (2002) Comparison of techniques for image-guided ablation of focal liver tumors. Radiology 223:304–307
Lencioni R, Cioni D, Crocetti L, Franchini C, Pina CD, Lera J et al (2005) Early-stage hepatocellular carcinoma in patients with cirrhosis: long-term results of percutaneous image-guided radiofrequency ablation. Radiology 234:961–7
Castells A, Bruix J, Bru C, Fuster J, Vilana R, Navasa M et al (1993) Treatment of small hepatocellular carcinoma in cirrhotic patients: a cohort study comparing surgical resection and percutaneous ethanol injection. Hepatology 8:1121–1126
Gournay J, Tchuenbou J, Richou C, Masliah C, Lerat F, Dupas B et al (2002) Percutaneous ethanol injection vs resection in patients with small single hepatocellular carcinoma: a retrospective case–control study with cost analysis. Aliment Pharmacol Ther 16:1529–1538
Chen MS, Li JQ, Zheng Y, Guo RP, Liang HH, Zhang YQ et al (2006) A prospective randomized trial comparing percutaneous local ablative therapy and partial hepatectomy for small hepatocellular carcinoma. Ann Surg 243:321–8
Ricke J, Wust P, Stohlmann A, Beck A, Cho CH, Pech M et al (2004) CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: phase I-II results of a novel technique. Int J Radiat Oncol Biol Phys 58:1496–505
Mohnike K, Wieners G, Schwartz F, Seidensticker M, Pech M, Ruehl R et al (2010) Computed tomography-guided high-dose-rate brachytherapy in hepatocellular carcinoma: safety, efficacy, and effect on survival. Int J Radiat Oncol Biol Phys 78:172–9
Ricke J, Wust P, Stohlmann A, Beck A, Cho CH, Pech M et al (2004) CT-Guided brachytherapy. A novel percutaneous technique for interstitial ablation of liver metastases. Strahlenther Onkol 180:274–80
Therasse P, Arbuck SG, Eisenhauer EA et al (2000) New guidelines to evaluate the response to treatment in solid tumors. European Organization for Research and Treatment of Cancer, National Cancer Institute of the United States, National Cancer Institute of Canada. J Natl Cancer Inst 92:205–216
Ricke J, Thormann M, Ludewig M, Jungnickel K, Grosser O, Wybranski C et al (2010) MR-guided liver tumor ablation employing open high-field 1.0 T MRI for image-guided brachytherapy. Eur Radiol 20:1985–93
Goldberg SN, Grassi CJ, Cardella JF, for the Society of Interventional Radiology et al (2009) Technology Assessment Committee and the International Working Group on Image-guided Tumor Ablation. Image-guided tumor ablation: standardization of terminology and reporting criteria. J Vasc Interv Radiol 20:S377–90
Mazzaferro V, Regalia E, Doci R, Andreola S, Pulvirenti A, Bozzetti F et al (1996) Liver transplantation for the treatment of small hepatocellular carcinomas in patients with cirrhosis. N Engl J Med 334:693–9
Mazzaferro V, Llovet JM, Miceli R, Bhoori S, Schiavo M, Mariani L et al (2009) Predicting survival after liver transplantation in patients with hepatocellular carcinoma beyond the Milan criteria: a retrospective, exploratory analysis. Lancet Oncol 10:35–43
Ayav A, Germain A, Marchal F, Tierris I, Laurent V, Bazin C et al (2010) Radiofrequency ablation of unresectable liver tumors: factors associated with incomplete ablation or local recurrence. Am J Surg 200:435–9
Huang J, Hernandez-Alejandro R, Croome KP, Yan L, Wu H, Chen Z et al (2011) Radiofrequency ablation versus surgical resection for hepatocellular carcinoma in childs A Cirrhotics-a retrospective study of 1,061 Cases. J Gastrointest Surg 15:311–20
Yin XY, Xie XY, Lu MD, Xu HX, Xu ZF, Kuang M et al (2009) Percutaneous thermal ablation of medium and large hepatocellular carcinoma: long-term outcome and prognostic factors. Cancer 115:1914–23
Crocetti L, de Baere T, Lencioni R (2010) Quality improvement guidelines for radiofrequency ablation of liver tumours. Cardiovasc Intervent Radiol 33:11–7
Yang WZ, Jiang N, Huang N, Huang JY, Zheng QB, Shen Q (2009) Combined therapy with transcatheter arterial chemoembolization and percutaneous microwave coagulation for small hepatocellular carcinoma. World J Gastroenterol 15:748–52
Veltri A, Moretto P, Doriguzzi A, Pagano E, Carrara G, Gandini G (2006) Radiofrequency thermal ablation (RFA) after transarterial chemoembolization (TACE) as a combined therapy for unresectable non-early hepatocellular carcinoma (HCC). Eur Radiol 16:661–9
Llovet JM, Bruix J (2008) Molecular targeted therapies in hepatocellular carcinoma. Hepatology 48:1312–27
Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF et al (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359:378–90
Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS et al (2009) Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol 10:25–34
Llovet JM, Real MI, Montaña X, Planas R, Coll S, Aponte J et al (2002) Arterial embolisation or chemoembolisation versus symptomatic treatment in patients with unresectable hepatocellular carcinoma: a randomised controlled trial. Lancet 359:1734–9
Lo CM, Ngan H, Tso WK, Liu CL, Lam CM, Poon RT et al (2002) Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Randomized controlled trial of transarterial lipiodol chemoembolization for unresectable hepatocellular carcinoma. Hepatology 35:1164–7
Lammer J, Malagari K, Vogl T, Pilleul F, Denys A, Watkinson A et al (2010) Prospective randomized study of doxorubicin-eluting-bead embolization in the treatment of hepatocellular carcinoma: results of the PRECISION V study. Cardiovasc Intervent Radiol 33:41–52
Riaz A, Kulik L, Lewandowski RJ, Ryu RK, Giakoumis Spear G, Mulcahy MF et al (2009) Radiologic-pathologic correlation of hepatocellular carcinoma treated with internal radiation using yttrium-90 microspheres. Hepatology 49:1185–1193
Kooby DA, Egnatashvili V, Srinivasan S, Chamsuddin A, Delman KA, Kauh J et al (2010) Comparison of yttrium-90 radioembolization and transcatheter arterial chemoembolization for the treatment of unresectable hepatocellular carcinoma. J Vasc Interv Radiol 21:224–230
Sangro B, Carpanese L, Cianni R, Golfieri R, Gasparini D, Ezziddin S et al (2011) Survival after Yttrium-90 resin microsphere radioembolization of hepatocellular carcinoma across barcelona clinic liver cancer stages: A European evaluation. Hepatology 26. doi:10.1002/hep.24451
Grosso M, Vignali C, Quaretti P, Nicolini A, Melchiorre F, Gallarato G et al (2008) Transarterial chemoembolization for hepatocellular carcinoma with drug-eluting microspheres: preliminary results from an Italian multicentre study. Cardiovasc Intervent Radiol 31:1141–9
Takeda A, Takahashi M, Kunieda E, Takeda T, Sanuki N, Koike Y et al (2008) Hypofractionated stereotactic radiotherapy with and without transarterial chemoembolization for small hepatocellular carcinoma not eligible for other ablation therapies: Preliminary results for efficacy and toxicity. Hepatol Res 38:60–69
Louis C (2010) Stereotactic radiotherapy of hepatocellular carcinoma: preliminary results. Technol Cancer Res Treat 9(5):479–87
Seo YS, Kim MS, Yoo SY, Cho CK, Choi CW, Kim JH et al (2010) Preliminary result of stereotactic body radiotherapy as a local salvage treatment for inoperable hepatocellular carcinoma. J Surg Oncol 102:209–14
Tse RV, Hawkins M, Lockwood G, Kim JJ, Cummings B, Knox J et al (2008) Phase I study of individualized stereotactic body radiotherapy for hepatocellular carcinoma and intrahepatic cholangiocarcinoma. J Clin Oncol 26:657–664
Lin SM, Lin CJ, Lin CC, Hsu CW, Chen YC (2004) Radiofrequency ablation improves prognosis compared with ethanol injection for hepatocellular carcinoma <4 cm. Gastroenterology 127:1714–1723
Malagari K, Pomoni M, Kelekis A, Pomoni A, Dourakis S, Spyridopoulos T et al (2010) Prospective randomized comparison of chemoembolization with doxorubicin-eluting beads and bland embolization with BeadBlock for hepatocellular carcinoma. Cardiovasc Intervent Radiol 33:541–51
Wieners G, Pech M, Wust P, Miersch A, Streitparth F, Berg T et al (2005) CT-gestützte Brachytherapie bei hepatozellulärem Karzinom (HCC): Ergebnisse einer prospektiven Phase-II-Studie. Fortschr Röntgenstr doi:. doi:10.1055/s-2005-867648
Mohnike K, Wieners G, Pech M, Seidensticker M, Rühl R, Lopez-Haenninen E et al (2009) Image-guided interstitial high-dose-rate brachytherapy in hepatocellular carcinoma. Dig Dis 27:170–4
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Collettini, F., Schnapauff, D., Poellinger, A. et al. Hepatocellular carcinoma: computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of large (5–7 cm) and very large (>7 cm) tumours. Eur Radiol 22, 1101–1109 (2012). https://doi.org/10.1007/s00330-011-2352-7
Received:
Revised:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00330-011-2352-7