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CT-Guided High-Dose-Rate Brachytherapy of Liver Tumours Does Not Impair Hepatic Function and Shows High Overall Safety and Favourable Survival Rates

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background or Purpose

Computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) is an emerging therapeutic option for irresectable liver tumours. However, its potentially negative effect on liver function has not yet been investigated. The aim of this study was to evaluate CT-HDRBT for potential liver damage and functional impairment by means of quantitative liver function tests, patient safety, and survival.

Methods

Sixty-nine patients receiving hepatic CT-HDRBT were investigated in a prospective study. The liver function was determined before and after intervention, and 6 and 12 weeks later. The study visits included liver function assessment by conventional biochemical parameters, the liver function capacity test based on 13C-Methacetin (MA) kinetics in µg/kg/hr (LiMAx test), and the indocyanine green plasma disappearance rate test. Tumour progression was re-staged by magnetic resonance imaging (MRI) twice. The 2-year-survival was analysed.

Results

A significant alteration of biochemical liver parameters was observed for liver enzymes and bilirubin directly after intervention, all biochemical parameters had normalised at the 6-week follow-up. There were no changes in LiMAx test values after the intervention, showing no effect on metabolic liver function capacity. In approximately two-thirds of the patients, MRI re-staging revealed a significant tumour response, and no local tumour recurrence occurred. No patient developed a radiation-induced liver disease.

Conclusion

CT-HDRBT for local tumour treatment has little impact on total liver function capacity by high patient safety and encouraging survival rates. Thus, it should be an important option in treating patients without a surgical alternative, especially when liver function is impaired due to previous surgery or chronic liver disease.

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Disclosure

Martin Stockmann is the inventor of the LiMAx test and he has capital interest in Humedics, the company marketing the LiMAx test.

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Authors and Affiliations

  1. Department of Radiology, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Georg Brinkhaus MD, Timm Denecke MD, PhD, Bernd Hamm MD & Bernhard Gebauer MD

  2. Department of General, Visceral and Transplantation Surgery, Charité – Universitätsmedizin Berlin, Berlin, Germany

    Johan Friso Lock MD, Maciej Malinowski MD, PhD, Peter Neuhaus MD & Martin Stockmann MD, PhD

  3. Department of General-, Visceral-, Vascular- and Paediatric Surgery, University Hospital of Würzburg, Würzburg, Germany

    Johan Friso Lock MD

Authors
  1. Georg Brinkhaus MD
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  2. Johan Friso Lock MD
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  3. Maciej Malinowski MD, PhD
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  4. Timm Denecke MD, PhD
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  5. Peter Neuhaus MD
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  6. Bernd Hamm MD
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  7. Bernhard Gebauer MD
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  8. Martin Stockmann MD, PhD
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Corresponding author

Correspondence to Georg Brinkhaus MD.

Additional information

Georg Brinkhaus, Johan Friso Lock, Bernhard Gebauer and Martin Stockmann contributed equally to this work.

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Brinkhaus, G., Lock, J.F., Malinowski, M. et al. CT-Guided High-Dose-Rate Brachytherapy of Liver Tumours Does Not Impair Hepatic Function and Shows High Overall Safety and Favourable Survival Rates. Ann Surg Oncol 21, 4284–4292 (2014). https://doi.org/10.1245/s10434-014-3835-y

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  • DOI: https://doi.org/10.1245/s10434-014-3835-y

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