Authors: Gero Wieners Maciej Pech Bert Hildebrandt Nils Peters Annett Nicolaou Konrad Mohnike Max Seidensticker Marcin Sawicki Peter Wust Jens Ricke
Publish Date: 2009/05/27
Volume: 32, Issue: 5, Pages: 937-945
Abstract
The aim of this study was to evaluate the feasibility safety and efficacy of combined treatment with hepatic interstitial brachytherapy HIB and hepatic arterial infusion HAI of chemotherapy after interventional implantation of port catheter systems Thirtythree patients with unresectable “liveronly” metastases of colorectal cancer were treated with both HIB and HAI during the course of their disease All 33 patients had recurrent disease and 27 had received previous chemotherapy Of these 15 received HAI first and were then consolidated with HIB 9 started with HIB and were continued with HAI and 9 received first HIB and subsequently HAI after hepatic disease progression Patients were evaluated for treatment characteristics side effects and efficacy Comparisons between treatment groups were also performed The median tumor diameter of metastases treated with brachytherapy was 46 cm range 1–12 cm The median minimal irradiation dose inside the tumor margin was 18 Gy administered to a mean of two metastases in 69 interventions Minor n = 4 and major n = 3 complications occurred in 10 of interventions WHO grade III adverse events of the regional chemotherapy were observed in seven patients grade IV in one patient At a median followup of 28 months range 7–74 months the median time to disease progression after first treatment was 105 months range 1–35 months Of 138 metastases treated by brachytherapy 16 local recurrences were seen mean 123 months range 3–45 months No signs of hepatic failure were observed in any of our patients In conclusion combinations of two minimally invasive therapeutic methods are feasible with acceptable complication rates and provide promising results in colorectal cancer patients with unresectable hepatic metastases
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