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ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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4/2019
vol. 11
 
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abstract:
Original paper

Treatment of hepatic pancreatic ductal adenocarcinoma metastases with high-dose-rate image-guided interstitial brachytherapy: a single center experience

Ralph Drewes
1
,
Jazan Omari
1
,
Matthias Manig
1
,
Max Seidensticker
2
,
Peter Hass
1
,
Jens Ricke
2
,
Maciej Powerski
1
,
Maciej Pech
1, 3

  1. Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany
  2. Clinic and Department of Radiology, Munich University, Munich, Germany
  3. 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland
J Contemp Brachytherapy 2019; 11, 4: 329–336
DOI: https://doi.org/10.5114/jcb.2019.87269
Online publish date: 2019/08/20
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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 192Ir 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.

keywords:

PDAC, interstitial brachytherapy, local ablation, local tumor control, salvage

  
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