28 Primary and secondary liver malignancies

Primary and secondary liver malignancies

12

THE GEC ESTROHANDBOOKOF BRACHYTHERAPY | Part II Clinical Practice Version 1 - 15/07/2022

catheter path after removal. When the Seldinger technique is used, it is possible to perform catheter tract embolisation by applying gelatine sponge sealing (see chapter "technique") during stepwise withdrawal of the angiography sheath. In addition, standardised follow-up is important for early detection of complications (e.g. ultrasound after 1–2 hours) and routine monitoring (noninvasive blood pressure, heart rate, oxygenation and ECG) should be ensured over the first 4 post-interventional hours. Ideally, patient monitoring after removal of the catheters can be performed in a dedicated and adequately staffed monitoring area and patients are not brought to ward prior to documentation of normal vital observations over 2 hours.

Figure 8: Connection of the transfer tubes to the brachytherapy catheters prior to dose delivery.

TABLE 2 PLANNING AIM AND ORGANS AT RISK (OAR) CONSTRAINTS [1,49,58,59] Planning aim D 100% OAR constraints D 0.1 cm³

D 1.0 cm³

Metastases of colo-rectal cancer 25 Gy

Oesophagus

15 Gy 15 Gy 15 Gy 15 Gy 15 Gy 22 Gy

12 Gy 12 Gy 12 Gy 12 Gy 12 Gy

Cholangiocellular Carcinoma Hepatocellular Carcinoma

Stomach

20 Gy 15 Gy 20 Gy

Duodenum Small bowel Large bowel

Other metastases

Heart

Great vessels (Aorta, Vena cava inferior) 37 Gy Gall bladder 20 Gy Spinal canal 12 Gy

10 Gy

Skin surface Main bile duct

10 Gy 20 Gy

18 Gy

V 10Gy < 33% of healthy liver volume V 5Gy < 66% of healthy liver volume

Liver

Liver

TABLE 3 PUBLISHED LITERATURE OF PRIMARY LIVER LESIONS

Treated lesions (number)

Median overall survival (range)

D 100% (range)

Study (Year)

Lesion size (range) 4.4 cm (1-15 cm) 7.1 cm (5-12 cm) 5 cm (1.8-12 cm) 4.5 cm (3-6.5cm) 5.2 cm (1-18 cm)

Entity

Study design Patients (% male)

Local control

Mohnike (2010) [63] Collettini (2012) [79] Collettini (2015) [40] Mohnike (2019) [80] Schnapauff (2012) [61] Jonczyk (2018) [43]

Prospective, single-center 83 (79.5%) 140

15 Gy (12-15 Gy) 15.8 Gy (15-20 Gy)

Hepatocellular

95% at 12 m

19.4 m

Retrospective, single-center 35 (83%)

93.3% at 12.8 m mean FU 91.5% at 20 m median FU Time to untreated progression: 67.5% at 12 m

35

15.4 m

Retrospective, single-center 98 (83.7%) 192

16.5 Gy

29.2 m

Randomized phase II, single-center

37 (84%)

n/a

15 Gy

78.4% at 12 m

Cholangiocellular carcinoma

Retrospective, single-center 15 (33%) Retrospective, single-center 61 (62%)

20 Gy (15-20 Gy)

22

10 m (1-25 m)

14 m

2 cm (1-3.8 cm) versus 6.9 cm (4-14.8 cm)

15.5 m (<4 cm) versus 10 m (>4 cm)

142

20 (15-20 Gy) 87% (<4 cm) versus 78% (>4 cm) at 12 m