Local tumor control of intermediate and advanced stage hepatocellular carcinoma after local ablative treatment with image-guided interstitial high-dose-rate brachytherapy: A subgroup analysis of 286 HCC nodules.

PURPOSE: Image-guided interstitial high-dose-rate brachytherapy (iBT) has been demonstrated to offer high local tumor control rates (LTC) of >90% after local ablation of intermediate and advanced hepatocellular carcinoma (HCC; BCLC B and C). The purpose of this study was to show the efficacy of iBT stratified by subgroups and to identify clinical characteristics associated with superior local tumor control (LTC) based on a highly heterogenous patient population METHODS AND MATERIALS: A cumulative number of 286 HCC nodules in 107 patients were retrospectively analyzed. Clinical and imaging follow-ups were conducted every 3 months after treatment. Analyzed clinical factors were: etiology, presence of liver cirrhosis, radiographic features, lesion size, pretreatment, administered dose, presence of portal hypertension, portal vein thrombosis, and level of alpha-fetoprotein (AFP). RESULTS: LTC rate was 88.8% for a median follow-up of 14.3 months (range 3-81 months; 95% CI: 85-92%). Median minimal enclosing tumor dose (D100) was 16.1 Gy (range 7.1-30.3 Gy; reference dose 15 Gy). Subgroup analysis showed significant fewer local recurrences for alcoholic liver disease (ALD)-related HCCs compared to those related to other causes of liver cirrhosis (nonalcoholic fatty liver disease, virus-related liver cirrhosis and other causes) (p = 0.015). LTC was significantly lower after prior surgical resection (p = 0.046). No significant variance was observed for the applied D100 in each group or for all other clinical factors tested. CONCLUSIONS: IBT achieves high LTC rates across treated subgroups. However, further studies should particularly address the possible impact of underlying etiology on local recurrence with emphasis on a possible higher radiosensitivity of ALD-related HCCs.

Image-guided Interstitial Brachytherapy in the Management of Metastasized Anal Squamous Cell Carcinoma.

BACKGROUND/AIM: Interstitial brachytherapy (IBT) has been shown to provide high tumor control rates in metastatic colorectal carcinoma. Our aim was to evaluate efficacy and safety of IBT in patients with metastatic anal squamous cell carcinoma (mASCC). PATIENTS AND METHODS: Seven patients with a total of 38 unresectable ASCC metastases (28 liver, nine lung, one nodal metastases) were treated with computed tomographic or open magnetic resonance imaging-guided IBT using an iridium-192 source. Clinical and image-based follow-up were performed every 3 months after treatment. RESULTS: Local tumor control rate was 97.4% during a median follow-up of 15.2 months. Median progression-free survival was 3.3 months (range=2.5-32.6 months). Median overall survival after IBT was 25.2 months (range=6.5-51.0 months). No severe adverse events (grade 3 or more) were recorded. CONCLUSION: Image-guided IBT is a safe and particularly effective treatment in patients with mASCC and might provide a well-tolerated therapeutic option in a multidisciplinary setting.