Ricke Jens, Wust Peter, Stohlmann Anna, Beck Alexander, Cho Chie Hee, Pech Maciej, Wieners Gero, Spors Birgit, Werk Michael, Rosner Christian, Hänninen Enrique Lopez, Felix Roland
Klinik für Strahlenheilkunde, Charité Virchow-Klinikum Medical Faculty of the Humboldt-University Berlin, Berlin, Germany.
Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1496-505. doi: 10.1016/j.ijrobp.2003.09.024.
To assess the safety and efficacy of CT-guided brachytherapy alone or in combination with laser-induced thermotherapy (LITT) in patients with liver malignancies.
Thirty-seven patients presented with 36 liver metastases and two primary liver carcinomas. Twenty-one patients were treated with CT-guided high-dose-rate brachytherapy alone using a 192Ir source. Sixteen patients received brachytherapy directly after MRI-guided LITT. The indications for brachytherapy alone were a tumor size >5 cm, adjacent central bile duct or adjacent major vessels causing unfavorable cooling effects for thermal ablation, and technical failures of LITT. The dosimetry for brachytherapy was performed using three-dimensional CT data acquired after percutaneous applicator positioning. On average, a minimal dose of 17 Gy inside the tumor margin was applied (range, 10-20 Gy).
The mean tumor size was 4.6 cm (range, 2.5-11 cm). The mean liver volume receiving > or =5 Gy was 16% (range, 2-40%) of the total liver. Severe complications were recorded in 2 patients (5%). One patient developed acute liver failure possibly related to accidental continuation of oral capecitabine treatment. Another patient demonstrated obstructive jaundice owing to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. A commonly encountered moderate increase of liver enzymes was greatest in patients with combined treatment. The local control rate after 6 months was 73% and 87% for combined treatment and brachytherapy alone, respectively.
CT-guided brachytherapy using three-dimensional CT data for dosimetry is safe and effective alone or in combination with LITT. Brachytherapy as a stand-alone treatment displayed genuine advantages over thermal tumor ablation.
评估CT引导下近距离放射治疗单独应用或联合激光诱导热疗（LITT）治疗肝恶性肿瘤患者的安全性和有效性。
37例患者，其中有36例肝转移瘤和2例原发性肝癌。21例患者单独接受CT引导下高剂量率近距离放射治疗，使用铱-192源。16例患者在MRI引导下LITT后直接接受近距离放射治疗。单独进行近距离放射治疗的指征为肿瘤大小>5 cm、邻近中央胆管或邻近大血管导致热消融冷却效果不佳以及LITT技术失败。近距离放射治疗的剂量测定使用经皮施源器定位后获取的三维CT数据进行。平均在肿瘤边缘内给予最小剂量17 Gy（范围10 - 20 Gy）。
平均肿瘤大小为4.6 cm（范围2.5 - 11 cm）。接受≥5 Gy的平均肝脏体积占全肝的16%（范围2 - 40%）。2例患者（5%）出现严重并发症。1例患者发生急性肝衰竭，可能与意外继续口服卡培他滨治疗有关。另1例患者在照射胆管分叉附近的转移瘤后因肿瘤水肿出现梗阻性黄疸。联合治疗的患者中常见的肝酶中度升高最为明显。联合治疗和单独近距离放射治疗6个月后的局部控制率分别为73%和87%。
使用三维CT数据进行剂量测定的CT引导下近距离放射治疗单独应用或联合LITT是安全有效的。近距离放射治疗作为一种单独治疗方法相对于热肿瘤消融显示出真正的优势。
