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Purpose: To assess efficacy, safety, and outcome of computed tomography (CT)-guided high-dose-rate (HDR) interstitial brachytherapy in patients with oligometastatic lymph node metastases of the retroperitoneal space., Material and Methods: 24 patients with a total of 47 retroperitoneal lymph node metastases from different primary tumors were treated with CT-guided interstitial brachytherapy using an 192 Ir source (single fraction irradiation). Every three months after treatment, clinical and imaging follow-up were conducted to evaluate local control and safety., Results: Median follow-up was 9.6 months (range, 2.9-39.0 months). Local tumor control rate was 95.7%. The median diameter of the gross tumor volume was 2.2 cm (range, 1-8.6 cm), treated with a median D 100 (minimal enclosing tumor dose) of 14.9 Gy (range, 4.5-20.6 Gy). One severe adverse event (grade three) was recorded.Cumulative median progression-free survival was 4.2 months (range, 1.4-23.7 months), and cumulative median overall survival after interstitial brachytherapy was 15.9 months (range, 3.8-39.0 months)., Conclusions: CT-guided HDR interstitial brachytherapy is a safe and feasible method for local ablation of oligometastatic lymph node metastases of the retroperitoneal space, and might provide a well-tolerated additional therapeutic option in the multidisciplinary management of selected patients., Competing Interests: The authors report no conflict of interest., (Copyright: © 2019 Termedia Sp. z o. o.)

Purpose: To evaluate the efficacy and safety of image-guided (computed tomography/magnetic resonance imaging - CT/MRI) high-dose-rate (HDR) interstitial brachytherapy (iBT) as a salvage maneuver for the treatment of hepatic metastases originating from hepatic pancreatic ductal adenocarcinoma (PDAC). PDAC metastases present a major and unresolved problem, and any surgical approach or local therapeutic intervention remains extremely controversial., Material and Methods: A cumulative number of 45 hepatic PDAC metastases in 16 patients were treated and retrospectively analyzed. Synchronous metastatic spread was observed in five patients, metachronous in eleven. 14 patients had resection of the pancreatic primary prior to iBT: eight Whipple/PPPD and six distal pancreatectomy procedures. The hepatic metastases were progressing under chemotherapy, thus iBT was applied as a salvage maneuver with the intention of local tumor control and prolonged survival. iBT is applied interstitially, with temporarily introduced 192 Ir source in a single fraction HDR irradiation regime to eradicate vital tumor cells. Response to treatment was assessed clinically with CT/MRI every three months., Results: Local tumor control was achieved in 87% of all treated metastases. The median diameter of the irradiated lesions was 2.2 cm (range, 1-11.2 cm), the median irradiation dose was 21 Gy (range, 5-29.1 Gy). Median progression-free survival (PFS) after iBT was 3.4 months (range, 1.5-19.6 months), the median overall survival (OS) after iBT was 8.9 months (range, 3.1-29.3 months). Three major complications (CTCAE grade 3) occurred following iBT: three cases of liver abscess, which were successfully resolved with drainage and antibiotics., Conclusions: Overall, iBT is a safe procedure, which enables excellent rates of local tumor control and presents a viable anti-neoplastic treatment option as a salvage therapy for metastatic PDAC patients., Competing Interests: Authors report no conflict of interest.

Purpose: Organs at risk (OARs), which are very close to a clinical target volume (CTV), can compromise effective tumor irradiation. The present study investigated the feasibility and safety of a novel approach, in particular, the extent of the dosimetric effect of distancing CTV from adjacent OARs by means of interventionally applied balloon catheters., Material and Methods: Patients with peripheral hepatic malignancies, in whom the critical proximity of an OAR to the CTV in the assessment by contrast-enhanced magnetic resonance imaging (MRI) scans and the preplanning process were included. Additionally, patients underwent placement of an interventional balloon catheter during computed tomography (CT)-guided application of interstitial brachytherapy (iBT) catheters inserted into the tissue between hepatic capsule and adjacent OAR. The virtual position of an OAR without balloon catheter was anticipated and contoured in addition to contouring of CTV and OAR. The calculated dose values for CTV as well as 1 cc of the relevant OAR (D 1cc ) with and without balloon were recorded. The D 1cc of the realized irradiation plan was statistically compared to the D 1cc of the virtually contoured OARs., Results: In 31 cases, at least one balloon catheter was administered. The mean D 1cc of the OAR in the group with balloon(s) was 12.6 Gy compared with 16 Gy in the virtual cohort without the device, therefore significantly lower ( p < 0.001). Overall, there were no acute complications. Severe (> 2 CTCAEv4.03) late complications observed in 3/31 (9.6%) patients during follow-up period after brachytherapy were most certainly not due to the balloon application. Side effects were probably associated with pre-existing serious diseases and potentially additional local late effects of the irradiation in general rather than with the balloon catheters., Conclusions: The distancing of the adjacent OARs allows a higher D 100 value of CTV, therefore allowing for more efficient local control., Competing Interests: Authors report no conflict of interest. Dr. Hass reports personal fees from Merck Serono and BMS outside the submitted work. Dr. Seidensticker reports personal fees from Bayer, grants and personal fees from SIRTEX Medical, personal fees from Cook Medical, personal fees from BTG, outside the submitted work.

Purpose: Needle track seeding in the local treatment of hepatocellular carcinoma (HCC) is not yet evaluated for catheter-based high-dose-rate brachytherapy (HDR-BT), a novel local ablative technique., Material and Methods: We report a retrospective analysis of 100 patients treated on 233 HCC lesions by HDR-BT (using 588 catheters in total). No needle or catheter track irradiation was used. Minimum required follow-up with imaging was 6 months. In case of suspected needle track seeding (intra- and/or extrahepatic) in follow-up, image fusion of follow-up CT/MRI with 3D irradiation plan was used to verify the location of a new tumor deposit within the path of a brachytherapy catheter at the time of treatment., Results: We identified 9 needle track metastases, corresponding to a catheter-based risk of 1.5% for any location of occurrence. A total of 7 metastases were located within the liver (catheter-based risk, 1.2%), and 2 metastases were located extrahepatic (catheter-based risk, 0.3%). Eight out of 9 needle track metastases were successfully treated by further HDR-BT., Conclusions: The risk for needle track seeding after interstitial HDR-BT of HCC is comparable to previous reports of percutaneous biopsies and radiofrequency ablation (RFA), especially in case of extrahepatic needle track metastases. To compensate for the risk of seeding, a track irradiation technique similar to track ablation in RFA should be implemented in clinical routine.

Purpose: To evaluate the efficacy of computed tomography (CT)- and magnetic resonance imaging (MRI)-guided interstitial high-dose-rate brachytherapy (HDR IBT = IBT) in patients with metastatic esophageal squamous cell carcinoma., Material and Methods: Eleven patients with 21 unresectable metastases of histologically proven esophageal squamous cell carcinoma were included in this retrospective study. Fourteen visceral and 7 lung metastases were treated with image-guided (CT or open MRI guidance) IBT using a 192 Iridium source (single fraction irradiation). Clinical and imaging follow-up were performed every 3 months after treatment. Primary endpoint was local tumor control (LTC) and safety. Furthermore, we analyzed safety, progression-free survival (PFS), and overall survival (OS)., Results: The median diameter of the target lesions was 2.2 cm (range: 0.7-6.8 cm), treated with a median D 100 of 20.1 Gy (range: 10-25 Gy). During a median follow-up of 6.3 months (range: 3-21.8 months), three patients displayed local recurrences, resulting in LTC of 85.7%. Median PFS was 3.4 months and median OS after IBT was 13.7 months. No severe adverse events (grade 3+) requiring hospitalization or invasive intervention were recorded., Conclusions: Image-guided IBT is a safe and effective treatment in patients with metastasized esophageal squamous cell carcinoma.