[Update on Interstitial Brachytherapy]

Overview

Journal Radiologe

Specialty Radiology

Date 2012 Jan 18

PMID 22249704

Citations 1

Authors

T Bretschneider

N Peters

P Hass

J Ricke

Affiliations

Soon will be listed here.

Abstract

Clinical/methodical Issue: Minimally invasive treatment procedures, such as image-guided local tumour ablation have gained increasing relevance in oncologic concepts. Limitations of thermal ablation procedures have led to the development of percutaneous, computed tomography (CT) guided brachytherapy.

Standard Radiological Methods: Thermal ablation procedures, such as radiofrequency ablation (RFA) and laser-induced thermotherapy (LITT) show limitations regarding maximum tumour size (<5 cm), cooling effects of adjacent vessels and surrounding risk structures.

Methodical Innovations: The image-guided interstitial brachytherapy allows the single application of high-dose rate (HDR) irradiation with an extensive protracted cytotoxic effect. Adjacent risk structures play a minor role due to the steep dose gradient outside the clinical target volume.

Performance: Studies using CT-guided brachytherapy resulted in a local tumour control rate of approximately 90% after 12 months in the treatment of hepatocellular carcinoma (HCC) and 70-90% in the treatment of colorectal metastases or cholangiocellular carcinoma (CCC). Similar response rates were also seen in the treatment of metastases of renal cell carcinoma (RCC), non-small cell lung cancer (NSCLC) or neuroendocrine tumours. In colorectal liver metastases and HCC the method has proven to have a positive impact on prognosis.

Achievements: In contrast to thermal ablation the method can be used without restriction with respect to tumour location. Cooling effects do not play a role. It has already been applied in more than 5,000 cases and it is used in clinical routine.

Practical Recommendations: Image-guided brachytherapy is safe and effective and has found its way into the clinical routine.

Citing Articles

Stereotactic Percutaneous Electrochemotherapy as a New Minimal Invasive Treatment Modality for Primary and Secondary Liver Malignancies.

Luerken L, Goetz A, Mayr V, Zhang L, Schlitt A, Haimerl M Biomedicines. 2025; 12(12.

PMID: 39767776 PMC: 11673152. DOI: 10.3390/biomedicines12122870.

[Focal therapy for small renal masses : Observation, ablation or surgery].

Wendler J, Friebe B, Baumunk D, Blana A, Franiel T, Ganzer R Urologe A. 2016; 55(5):594-606.

PMID: 27119957 DOI: 10.1007/s00120-016-0075-8.

References

Steinke K, Sewell P, Dupuy D, Lencioni R, Helmberger T, Kee S . Pulmonary radiofrequency ablation--an international study survey. Anticancer Res. 2004; 24(1):339-43. View

Streitparth F, Pech M, Bohmig M, Ruehl R, Peters N, Wieners G . In vivo assessment of the gastric mucosal tolerance dose after single fraction, small volume irradiation of liver malignancies by computed tomography-guided, high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2006; 65(5):1479-86. DOI: 10.1016/j.ijrobp.2006.02.052. View

Fischbach F, Thormann M, Seidensticker M, Kropf S, Pech M, Ricke J . Assessment of fast dynamic imaging and the use of Gd-EOB-DTPA for MR-guided liver interventions. J Magn Reson Imaging. 2011; 34(4):874-9. DOI: 10.1002/jmri.22691. View

Ricke J, Wust P, Stohlmann A, Beck A, Cho C, Pech M . 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. 2004; 58(5):1496-505. DOI: 10.1016/j.ijrobp.2003.09.024. View

Dick E, Taylor-Robinson S, Thomas H, Gedroyc W . Ablative therapy for liver tumours. Gut. 2002; 50(5):733-9. PMC: 1773197. DOI: 10.1136/gut.50.5.733. View

Pech M, Wieners G, Kryza R, Dudeck O, Seidensticker M, Mohnike K . CT-guided brachytherapy (CTGB) versus interstitial laser ablation (ILT) of colorectal liver metastases: an intraindividual matched-pair analysis. Strahlenther Onkol. 2008; 184(6):302-6. DOI: 10.1007/s00066-008-1815-5. View

Mohnike K, Wieners G, Schwartz F, Seidensticker M, Pech M, Ruehl R . Computed tomography-guided high-dose-rate brachytherapy in hepatocellular carcinoma: safety, efficacy, and effect on survival. Int J Radiat Oncol Biol Phys. 2010; 78(1):172-9. DOI: 10.1016/j.ijrobp.2009.07.1700. View

Curley S, Izzo F . Radiofrequency ablation of primary and metastatic hepatic malignancies. Int J Clin Oncol. 2002; 7(2):72-81. DOI: 10.1007/s101470200010. View

Vogl T, Muller P, Mack M, Straub R, Engelmann K, Neuhaus P . Liver metastases: interventional therapeutic techniques and results, state of the art. Eur Radiol. 1999; 9(4):675-84. DOI: 10.1007/s003300050732. View

10.

Wieners G, Pech M, Rudzinska M, Lehmkuhl L, Wlodarczyk W, Miersch A . CT-guided interstitial brachytherapy in the local treatment of extrahepatic, extrapulmonary secondary malignancies. Eur Radiol. 2006; 16(11):2586-93. DOI: 10.1007/s00330-006-0241-2. View

11.

Solbiati L, Livraghi T, Goldberg S, Ierace T, Meloni F, Dellanoce M . Percutaneous radio-frequency ablation of hepatic metastases from colorectal cancer: long-term results in 117 patients. Radiology. 2001; 221(1):159-66. DOI: 10.1148/radiol.2211001624. View

12.

Tacke J, Adam G, Speetzen R, Brucksch K, Bucker A, Heshel I . MR-guided interstitial cryotherapy of the liver with a novel, nitrogen-cooled cryoprobe. Magn Reson Med. 1998; 39(3):354-60. DOI: 10.1002/mrm.1910390304. View

13.

Peters N, Wieners G, Pech M, Hengst S, Ruhl R, Streitparth F . CT-guided interstitial brachytherapy of primary and secondary lung malignancies: results of a prospective phase II trial. Strahlenther Onkol. 2008; 184(6):296-301. DOI: 10.1007/s00066-008-1718-5. View

14.

Hosten N, Stier A, Weigel C, Kirsch M, Puls R, Nerger U . [Laser-induced thermotherapy (LITT) of lung metastases: description of a miniaturized applicator, optimization, and initial treatment of patients]. Rofo. 2003; 175(3):393-400. DOI: 10.1055/s-2003-37830. View

15.

Silverman S, Tuncali K, Adams D, Vansonnenberg E, Zou K, Kacher D . MR imaging-guided percutaneous cryotherapy of liver tumors: initial experience. Radiology. 2000; 217(3):657-64. DOI: 10.1148/radiology.217.3.r00dc40657. View

16.

Ricke J, Wust P, Wieners G, Hengst S, Pech M, Lopez Hanninen E . CT-guided interstitial single-fraction brachytherapy of lung tumors: phase I results of a novel technique. Chest. 2005; 127(6):2237-42. DOI: 10.1378/chest.127.6.2237. View

17.

Ricke J, Mohnike K, Pech M, Seidensticker M, Ruhl R, Wieners G . Local response and impact on survival after local ablation of liver metastases from colorectal carcinoma by computed tomography-guided high-dose-rate brachytherapy. Int J Radiat Oncol Biol Phys. 2010; 78(2):479-85. DOI: 10.1016/j.ijrobp.2009.09.026. View

18.

Pech M, Werk M, Beck A, Stohlmann A, Ricke J . [System continuity and energy distribution in laser-induced thermo therapy (LITT)]. Rofo. 2002; 174(6):754-60. DOI: 10.1055/s-2002-32217. View

19.

Wieners G, Mohnike K, Peters N, Bischoff J, Kleine-Tebbe A, Seidensticker R . Treatment of hepatic metastases of breast cancer with CT-guided interstitial brachytherapy - a phase II-study. Radiother Oncol. 2011; 100(2):314-9. DOI: 10.1016/j.radonc.2011.03.005. View

20.

Galandi D, Antes G . Radiofrequency thermal ablation versus other interventions for hepatocellular carcinoma. Cochrane Database Syst Rev. 2002; (3):CD003046. DOI: 10.1002/14651858.CD003046. View