CT-guided high-dose-rate brachytherapy of unresectable hepatocellular carcinoma

Strahlentherapie und Onkologie - The purpose of the present study was to evaluate the clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) in patients with unresectable...     

Diagnostic Accuracy of Split-Bolus Single-Phase Contrast-Enhanced Cone-Beam CT for the Detection of Liver Tumors before Transarterial Chemoembolization

Purpose

To evaluate detectability of hepatocellular carcinoma (HCC) using split-bolus cone-beam CT in intraindividual comparison between cone-beam CT and contrast-enhanced MR imaging.

Percutaneous ablation of lymph node metastases using CT-guided high-dose-rate brachytherapy

Objective:

To assess the technical feasibility, safety and clinical outcome of CT-guided high-dose-rate brachytherapy (CT-HDRBT) for achieving local tumour control (LTC) in isolated lymph node metastases.

Methods:

From January 2008 to December 2011, 10 patients (six males and four females) with isolated nodal metastases were treated with CT-HDRBT. Five lymph node metastases were para-aortic, three were at the liver hilum, one at the coeliac trunk and one was a left iliac nodal metastasis. The mean lesion diameter was 36.5 mm (range 12.0–67.0 mm). Patients were followed up by either contrast-enhanced CT or MRI 6 weeks and then every 3 months after the end of treatment. The primary end point was LTC. Secondary end points included primary technical effectiveness rate, adverse events and progression-free survival.

Results:

The first follow-up examination after 6 weeks revealed complete coverage of all nodal metastases treated. There was no peri-interventional mortality or major complications. The mean follow-up period was 13.2 months (range 4–20 months). 2 out of 10 patients (20%) showed local tumour progression 9 and 10 months after ablation. 5 out of 10 patients (50%) showed systemic tumour progression. The mean progression-free interval was 9.2 months (range 2–20 months).

Conclusion:

CT-HDRBT is a safe and effective technique for minimally invasive ablation of nodal metastases.

Advances in knowledge:

CT-HDRBT of lymph node metastases is feasible and safe. CT-HDRBT might be a viable therapeutic alternative to obtain LTC in selected patients with isolated lymph node metastases.Metastatic spread to lymph nodes is a common event in the course of many thoracic and abdominal malignancies and has considerable clinical implications [1]. The management of metastatic disease is complex, and treatment modalities reported in the literature are heterogeneous, depending largely on the localisation of metastatic nodes as well as the patient’s performance status and treatment history. Hence, the optimal management for patients with isolated lymph node metastasis has not yet been established.Although the results of several studies suggest a potential benefit to the cytoreduction of isolated nodal disease among patients with ovarian, hepatocellular, renal or colorectal carcinoma, data on the role of repeated surgical resection of confined lymph node metastases are limited, and response rates of nodal metastases to chemotherapy are inconsistent [2–7].Over the past decades, interventional oncology has expanded its role, and minimally invasive tumour ablation techniques have become a cornerstone in the multimodal treatment of oncological patients. The clinical success of thermal ablation techniques, such as radiofrequency ablation (RFA), has generated a large body of literature on the treatment of liver and lung tumours, while data on its use for the treatment of lymph node metastases remain scarce. CT-guided high-dose-rate brachytherapy (CT-HDRBT) is a radio-ablative technique that was established about 10 years ago to overcome the limitations of thermal ablative techniques [8]. Features such as high accuracy in dose distribution and applicability regardless of tumour diameter and location have contributed to the attractiveness of this technique. In recent years, several studies have reported encouraging results for the treatment of lung and liver tumours as well as extrahepatic and extrapulmonary malignancies [9–12]. The purpose of the present study is to report the results of CT-HDRBT for achieving local tumour control (LTC) in the treatment of isolated lymph node metastases.     

Ischemic-type biliary lesions after ortothopic liver transplantation: diagnosis with magnetic resonance cholangiography

Purpose

To determine the accuracy of magnetic resonance (MR) cholangiography for detection of ischemic-type biliary lesions (ITBL) following orthotropic liver transplantation (OLT).

Materials and methods

MR cholangiography was performed in 16 patients with established diagnosis of ITBL following OLT. Two blinded observers reviewed all images in consensus and recorded diagnostic features including presence of intrahepatic and extrahepatic biliary strictures, dilatations, beading, pruning, and filling defects. Sensitivity, specificity, positive predictive value, and accuracy of MR cholangiography were calculated. Final diagnosis was established at endoscopic retrograde cholangiography.

Results

MR cholangiography proved to be a valuable tool for the detection of stenoses and dilatations in patients with ITBL following OLT. Sensitivity of the different diagnostic features ranged between 71% and 100%, specificity between 50% and 100%, accuracy between 81% and 100%, and positive predictive value between 87% and 100%.

Conclusion

MR cholangiography proved to be an accurate imaging technique to noninvasively detect biliary complications in patients with ITBL after OLT.     

Zervixkarzinom

The treatment of uterine cervical carcinoma is largely dependent on the tumor stage. Despite significant inaccuracies in the clinical examination, uterine cervical cancer remains the only gynecological form of cancer still largely staged according to clinical findings. Although imaging is still not included in the staging the recently published revised FIGO (Fédération International de Gynécologie et d'Obstétrique) system encourages the use of modern cross-sectional imaging (magnetic resonance imaging MRI and computed tomography CT). Due to its high soft tissue contrast MRI allows excellent non-invasive assessment of the cervix with direct tumor delineation as well as assessment of the prognosis based on morphological factors. Studies in the literature report an accuracy of 93% for MRI in the preoperative assessment of tumor size and in the differentiation of operable from advanced cervical cancer. Therefore MRI is considered to be the optimal modality for diagnostic evaluation starting from FIGO stage IB1, for radiation therapy planning, and for exclusion of recurrence in follow-up. In this paper we give an overview of the role of magnetic resonance imaging in preoperative staging of uterine cervical cancer.     

Initial Experience with CT–Guided High-Dose-Rate Brachytherapy in the Multimodality Treatment of Neuroendocrine Tumor Liver Metastases

Purpose

To evaluate efficacy of computed tomography (CT)–guided high-dose-rate brachytherapy (HDRBT) of neuroendocrine liver metastases (NELM) with the goal of local tumor control (LTC).