First report on extended distance between tumor lesion and adjacent organs at risk using interventionally applied balloon catheters: a simple procedure to optimize clinical target volume covering effective isodose in interstitial high-dose-rate brachytherapy of liver malignomas

Hass, Peter; Steffen, Ingo G.; Powerski, Maciej; Mohnike, Konrad; Seidensticker, Max; Meyer, Frank; Brunner, Thomas; Damm, Robert; Willich, Christoph; Walke, Mathias; Karagiannis, Efstratios; Omari, Jazan; Ricke, Jens

doi:10.5114/jcb.2019.84798

Cited by 13 publications

(3 citation statements)

References 37 publications

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“…This also explains, why a more extensive radiation of a large CTV is not reasonable. One approach could be distancing the CTV from adjacent OARs by interventionally applied balloon catheters in order to extend the distance in-between to simultaneously allow a higher D100 and protect OARs (38).…”

Section: Discussionmentioning

confidence: 99%

Interstitial Brachytherapy for Limited (<4 cm) and Large (≥4 cm) Hepatic Metastases from Rare and Less Common Cancers

et al. 2020

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Background/Aim: Interstitial brachytherapy (iBT) seems to achieve higher local tumor control rates for lesions limited in size. The objective was to evaluate the efficacy and safety of iBT in the treatment of limited and large liver metastases from rare or less common cancers (RLCC). Patients and Methods: A total of 194 unresectable liver metastases categorized as limited (<4 cm, n=153, subgroup A) and large lesions (≥4 cm, n=41, subgroup B) were treated. Clinical and image-based follow-up was conducted every 3 months after iBT. Results: Cumulative local recurrence (CLR) rate was 9.8% (19 recurrences; A: n=16; B: n=3). No significant difference in CLR was noted between subgroup A and B (A:10.5%, B:7.3%, p=0.339). Median follow-up was 6.2 months (range=2.2-92.9 months). Complication assessment revealed 5 severe adverse events (grade 3: 4.3%, grade 4 and 5: 0%) with 4 events in A and 1 event in B. Conclusion: IBT is a feasible, effective, and safe minimally invasive treatment for small and large liver metastases from RLCC.According to the RARECAREnet project, rare cancers belong to a defined group of diseases with an incidence rate of <6/100,000, whereas less common cancers could be defined by an incidence of ≥6/1,000,000 outside the common or frequent cancers, such as breast, colorectal, lung and prostate (1, 2). Taken together, these two groups of neoplasms add up to 47% of all newly diagnosed malignancies (2). Since treatment experience is limited even in major cancer centers, rare or less common cancers (RLCC) are a significant challenge to clinical practice with varying survival rates among European countries (3). In particular, developing adequately powered clinical trials for advanced-stage cancer is demanding due to the low number of patients; therefore, evidence for effectiveness of new therapeutic methods is difficult to provide, leading to limited therapy options. Hence, for advanced/metastasized RLCC, research is frequently confined to case reports or small retrospective series.From a theoretical oncological perspective, metastases limited in number and distribution (i.e. oligometastases) are increasingly considered suitable for localized therapy aiming for disease control and prolongation of life in selected patients, as shown for colorectal cancer (CRC). In fact, for CRC patients with oligometastatic disease (OMD) confined to one organ, i.e. most commonly the liver, 5-year survival rates of 25-40% are reported after complete metastasectomy, furthermore, after a survival of 10 years post-surgery, patients are even considered cured (4-6). However, effective surgical resection is applicable to a limited number of cases, as the ability to perform complete macro-and microscopic resection of multiple liver metastases relies on the capacity of the future liver remnant to minimize the risk of posthepatectomy liver failure. Resectability is limited by the distribution and accessibility of metastases, consequently, curative resection of liver metastases is not possible in up to 80% of CRC patients (7).However, ...

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Section: Discussionmentioning

confidence: 99%

Interstitial Brachytherapy for Limited (<4 cm) and Large (≥4 cm) Hepatic Metastases from Rare and Less Common Cancers

et al. 2020

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“…We recommend using the tighter and more extensively studied constraints into clinical practice ( Table 3 ). For cases where the dose to the stomach, duodenum, jejunum, ileum or colon is a limiting factor, balloon catheters can be used ( 48 ).…”

Section: Techniquementioning

confidence: 99%

Narrative Review of High-Dose-Rate Interstitial Brachytherapy in Primary or Secondary Liver Tumors

et al. 2022

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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.

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“…Although IRT lessens radiation damage to healthy tissue due to precise targeting, radiation delivery and protection of radiosensitive organs such as the stomach or intestines are mandatory. To improve the protection of OARs, some groups reported early experience with the successful use of inflatable tissue separation devices [68]. Following IRT in very large tumors, the necrosis may cause temporary fever, chills, and nausea.…”

Section: Interstitial Interventional Radiotherapy (Brachytherapy Irt)mentioning

confidence: 99%

Critical review of multidisciplinary non-surgical local interventional ablation techniques in primary or secondary liver malignancies

Kovács¹,

Iezzi²,

Cellini³

et al. 2019

jcb

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Local non-surgical interventional percutaneous ablation represents nowadays an important part of the potential treatment strategies. Although surgical ablation represents the gold standard, in the past decade there was an expansion in the use of non-surgical ablative techniques: radiofrequency, microwave, laser, cryoablation, irreversible electroporation, and interventional radiotherapy (brachytherapy) in primary as well as secondary liver cancers. With the growing experience in the field, there was implemented a new pillar for cancer treatment, together with surgery, chemotherapy as well as radiotherapy, so-called interventional oncology (IO). To date, there are no published papers regarding a comparative interdisciplinary evaluation of all these non-surgical interventional local ablation therapies. Our paper offers a critical interdisciplinary overview of the treatments in both primary and secondary liver tumors, including from a cost-effective point of view. Furthermore, the present status of education in IO and a comparison of actual economic aspects of the treatments are also provided.

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First report on extended distance between tumor lesion and adjacent organs at risk using interventionally applied balloon catheters: a simple procedure to optimize clinical target volume covering effective isodose in interstitial high-dose-rate brachytherapy of liver malignomas

Cited by 13 publications

References 37 publications

Interstitial Brachytherapy for Limited (<4 cm) and Large (≥4 cm) Hepatic Metastases from Rare and Less Common Cancers

Interstitial Brachytherapy for Limited (<4 cm) and Large (≥4 cm) Hepatic Metastases from Rare and Less Common Cancers

Narrative Review of High-Dose-Rate Interstitial Brachytherapy in Primary or Secondary Liver Tumors

Critical review of multidisciplinary non-surgical local interventional ablation techniques in primary or secondary liver malignancies

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