Effectiveness and Safety of Computed Tomography-Guided High-Dose-Rate Brachytherapy in Treating Recurrent Hepatocellular Carcinoma Not Amenable to Repeated Resection or Radiofrequency Ablation
Menée auprès de 38 patients atteints d'un carcinome hépatocellulaire récidivant ne pouvant être traité par résection répétée ou ablation par radiofréquence (âge moyen : 70 ans ; durée moyenne de suivi : 33,1 mois), cette étude évalue l'efficacité et la sécurité d'une curiethérapie à haut débit de dose guidée par tomodensitométrie
Purpose: To assess the efficacy and safety of computed tomography (CT)-guided high-dose-rate HDR) brachytherapy in treating recurrent hepatocellular carcinoma (HCC) not amenable to repeated resection or radiofrequency ablation. Materials and Methods: From January 2010 to January 2022, 38 patients (mean age, 70.1 years; SD± 9.0 years) with 79 nodular and four diffuse intrahepatic HCC recurrences not amenable to repeated resection or radiofrequency ablation underwent CT-guided HDR brachytheapy in our department. Tumor response was evaluated by cross-sectional imaging 6 weeks after CT-guided HDR brachytherapy and every 3 months thereafter. Local tumor control (LTC), progression-free survival (PFS) and overall survival (OS) were assessed using Kaplan-Meier curves (KPCs). Severity of procedure-related complications (PRCs) was classified as recommended by the Society of Interventional Radiology (SIR). Results: Patients were available for MRI evaluation for a mean follow-up of 33.1 months (SD, ±21.6mm, range 4–86 months; median 29 months). Patients had a mean of 2.3 (SD, ±1.4) intrahepatic tumors. Mean tumor diameter was 43.2 mm (SD, ±19.6mm). 13 of 38 (34.2%) patients showed local tumor progression after CT-guided HDR brachytherapy. Mean LTC was 29.3 months (SD, ±22.1). Distant tumor progression was seen in 12 patients (31.6%). The mean PFS was 20.8 months (SD, ±22.1). Estimated 1-, 3-, and 5-year PFS rates were 65.1%, 35.1% and 22.5%, respectively. 13 patients died during the follow-up period. Mean OS was 35.4 months (SD, ±21.7). Estimated 1-, 3-, and 5-year OS rates were 91.5%, 77.4% and 58.0%, respectively. SIR grade 1 complications were recorded in 8.6% (5/38) and SIR grade 2 complications in 3.4% (2/58) of interventions. Conclusion: CT-guided HDR brachytherapy is a safe and efficient therapeutic option for managing large or critically located HCC recurrences in the remaining liver after prior hepatic resection.