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

High-dose-rate interstitial brachytherapy for liver metastases: first study from India

“…However, it has limitations concerning the number, localization, as well as size and shape of the LM, with the risk of complications ranging from 8-35% [15, 16]. CT guided HDRIBT is a new treatment for LM with only limited studies [7–12] in the literature reporting local control rates of 87-93%; similar to other ablative therapies [2]. Unlike RFA, HDRIBT is not affected by nearby blood vessel or size of the lesion.…”

“…Table 4 summaries the results of various studies [7–12] published so far relating to use of HDRIBT in LM. The results of our study may not be strictly compared with others in the literature due to small sample size and short follow up.…”

“…As compared to external beam radiation therapy (EBRT) techniques like 3D-CRT and SBRT, high-dose-rate interstitial brachytherapy (HDRIBT) can potentially provide better dosimetry since tumor movement due to breathing, unlike in EBRT, does not affect dose distribution. Limited experiences through small studies [7–12] exist in the literature regarding the role of HDRIBT in LM and primary hepato-cellular carcinoma, and have shown efficacy and safety. We conducted a prospective trial to study the feasibility of HDRIBT in LM at our institute.…”

Image guided robotic interstitial brachytherapy, a new innovative treatment for malignancies

“…The role of interstitial radiotherapy has been an area of active research in last two decades. In the past, two similar approaches have been described for liver brachytherapy namely seldinger catheter replacement technique and proguide round needle technique with mean local tumour control of 88-100% at 1year follow up and severe toxicity occurred in less than 5% of patient [5,6]. But there has been a challenge to use these techniques amongst radiation oncologists due to the complex technique, lack of precision in brachytherapy catheter insertion and placement,…”

“…A recent meta-analysis showed the pooled local control rates of SBRT and charged particle therapy to be 87% and 86%, respectively, and the rates of acute hepatic toxicities of grade >3 to be 4.9% and 3.1%, respectively [4]. Similar to precise SBRT and charged particle radiotherapy, investigators have used computer tomography (CT) guided Interstitial High Dose Rate Brachytherapy to treat unresectable liver tumours which showed increasing median survival to 14-36months with 11-20% mild and <5% severe complication rate [5,6]. The CT guided iHDRBT for HCC may be an effective alternative modality for non-transplant candidates, unresectable cases and patients unsuitable/ refractory for radiofrequency ablation (RFA), SBRT, Trans-Arterial Chemo-Embolisation (TACE) or sorafenib.…”