CT-guided, interstitial brachytherapy
The CT-guided interstitial brachytherapy is a special subtype of brachytherapy .
definition
Image-guided interstitial HDR (high-dose-rate) brachytherapy in afterloading technology is a therapeutic option for various malignant diseases . The main focus of CT-guided brachytherapy is the minimally invasive treatment of primary and secondary tumors of the liver, lungs, kidneys and adrenal glands as well as lymph nodes. The most common tumor diseases include hepatocellular carcinoma, cholangiocellular carcinoma and renal cell carcinoma as well as metastases from colorectal carcinoma, breast carcinoma, renal cell carcinoma, bronchial carcinoma and neuroendocrine tumors.
Image-guided brachytherapy can be used individually or as a supplement to systemic chemotherapy / immunotherapy and surgery. Related procedures in interventional local ablation therapy are radio frequency ablation , microwave ablation and laser ablation and, in a broader sense, transarterial chemoembolization and radioembolization .
Mode of action
The effect of interstitial brachytherapy is based on a single high-dose irradiation, which aims to kill all tumor cells detected. Due to the physical conditions, the dose drops very steeply towards the surroundings, so surrounding healthy tissue can be spared.
Depending on the type of tumor with its respective radiation sensitivity, the target dose around the tumor is 15 - 25 Gray , with this an ablation can be achieved in most cases .
Indications
Depending on the mode of action, CT-guided brachytherapy can basically be used for all forms of solid tumors and their metastases. Typically, treatment is given when surgical removal is clinically or technically impossible, and often in addition to chemotherapy or when it is no longer effective.
Image-guided brachytherapy has been included in the European guideline for the therapeutic management of metastatic colorectal cancer since 2016 and is listed in this guideline on an equal footing with other minimally invasive methods for the treatment of non-resectable metastases.
In the case of hepatocellular carcinoma, it can be used as an alternative or in addition to transarterial chemoembolization, usually in the BCLC B disease stage. Image-guided brachytherapy is also being discussed as an alternative to radiofrequency ablation or transarterial chemoembolization in bridging treatment up to liver transplantation.
Therapy process
The irradiation catheter is first placed in the tumors to be treated via a puncture from the outside, which is carried out with the help of computed tomography (more rarely also magnetic resonance tomography or sonography). This involves local anesthesia in the area of the puncture site and additional analgesic sedation with the administration of painkillers and sedatives.
After the irradiation catheter has been placed and fastened , the patient is taken to radiation therapy and the high-dose irradiation of the tumors from the inside with an Iridium 192 source takes place via the catheter .
After the end of the irradiation, the radiation source and then the catheters are completely removed.
Side effects and limitations
Acute complications are typically related to catheter placement. As with other image-guided puncture procedures, bleeding, infection, or tissue damage can occur. Chronic damage is caused by the effects of radiation and affects both the target organ and radiation-sensitive neighboring organs such as the stomach or intestines, the proximity of which can occasionally limit the radiation dose that can be applied.
Individual evidence
- ↑ Tina Bretschneider, Jens Ricke, Bernhard Gebauer, Florian Streitparth: Image-guided high-dose-rate brachytherapy of malignancies in various inner organs - technique, indications, and perspectives . In: Journal of Contemporary Brachytherapy . tape 8 , no. 3 , June 2016, ISSN 1689-832X , p. 251–261 , doi : 10.5114 / jcb.2016.61068 , PMID 27504135 , PMC 4965506 (free full text).
- ↑ Jens Ricke, Peter Wust: Computed tomography-guided brachytherapy for liver cancer . In: Seminars in Radiation Oncology . tape 21 , no. 4 , October 2011, ISSN 1532-9461 , p. 287-293 , doi : 10.1016 / j.semradonc.2011.05.005 , PMID 21939858 .
- ↑ J. Ricke, P. Wust, S. Hengst, G. Wieners, M. Pech: [CT-guided interstitial brachytherapy of lung malignancies. Technique and first results] . In: The Radiologist . tape 44 , no. 7 , July 2004, ISSN 0033-832X , p. 684-686 , doi : 10.1007 / s00117-004-1077-x , PMID 15221154 .
- ↑ K. Mohnike, K. Neumann, P. Hass, M. Seidensticker, R. Seidensticker: Radioablation of adrenal gland malignomas with interstitial high-dose-rate brachytherapy: Efficacy and outcome . In: Radiotherapy And Oncology: Organ of the German X-ray Society… [et Al] . tape 193 , no. 8 , August 2017, ISSN 1439-099X , p. 612-619 , doi : 10.1007 / s00066-017-1120-2 , PMID 28341865 .
- Jump up ↑ F. Collettini, AC Schippers, D. Schnapauff, T. Denecke, B. Hamm: Percutaneous ablation of lymph node metastases using CT-guided high-dose-rate brachytherapy . In: The British Journal of Radiology . tape 86 , no. 1027 , July 2013, ISSN 1748-880X , p. 20130088 , doi : 10.1259 / bjr.20130088 , PMID 23659925 , PMC 3922177 (free full text).
- ^ E. Van Cutsem, A. Cervantes, R. Adam, A. Sobrero, JH Van Krieken: ESMO consensus guidelines for the management of patients with metastatic colorectal cancer . In: Annals of Oncology: Official Journal of the European Society for Medical Oncology . tape 27 , no. 8 , August 2016, ISSN 1569-8041 , p. 1386-1422 , doi : 10.1093 / annonc / mdw235 , PMID 27380959 .
- ↑ Timm Denecke, Lars Stelter, Dirk Schnapauff, Ingo Steffen, Bruno Sinn: CT-guided Interstitial Brachytherapy of Hepatocellular Carcinoma before Liver Transplantation: an Equivalent Alternative to Transarterial Chemoembolization? In: European Radiology . tape 25 , no. 9 , September 2015, ISSN 1432-1084 , p. 2608–2616 , doi : 10.1007 / s00330-015-3660-0 , PMID 25735513 .