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

Abstract Purpose To report our results of computed tomography (CT)–guided interstitial high-dose-rate (HDR) brachytherapy (BRT) in the local treatment of inoperable primary and secondary liver malignancies. Methods and Materials Between 2000 and 2009, 31 patients underwent a total of 42 BRT procedures for 36 hepatic lesions exceeding 4 cm and located adjacent to the liver hilum and bile duct bifurcation. The median tumor volume was 99 cm 3 (range, 46–1348 cm 3 ). The median age was 64 years (range, 27–85 years). The HDR-BRT delivered a median total physical dose of 13.0 Gy (range, 7.0–32.0 Gy) in twice daily fractions of median 7.0 Gy (range, 4.0–10.0 Gy) in 14 patients and in once daily fractions of median 8.0 Gy (range, 7.0–14.0 Gy) in 17 patients. Results The median followup was 13.3 months with an overall survival rate of 66% at 1 year. The local control rate for patients with metastatic lesions was 79%, 59%, and 59%, and for the subgroup with primary hepatic tumors 88%, 50%, and 50% at 1, 2, and 3 years, respectively. Severe side effects occurred in 4.7% of BRT procedures with no treatment-related deaths. Conclusions Our results confirm CT–guided interstitial HDR-BRT to be a safe procedure for the local treatment of inoperable liver malignancies unsuitable for thermal ablation.