12 april 2011: ik ben kanker-actueel aan het herzien en laat onderstaand artikel staan omdat dit nog steeds relevant is. Brachytherapie in combinatie met LITT behandeling  blijkt succesvol bij levertumoren aldus fase II studie.

d.d. 3 mei 2004: Bron: Int J Radiat Oncol Biol Phys. 2004 Apr 1;58(5):1496-505.

Een combinatie van brachytherapie met LITT behandeling (zie ook dr. Vogl) van levertumoren blijkt uiterst succesvol aldus fase II studie uitgevoerd in Berlijn. Hier het Engelse abstract zoals uit Pubmed gehaald.

CT-guided interstitial brachytherapy of liver malignancies alone or in combination with thermal ablation: phase I-II results of a novel technique.

Ricke J, Wust P, Stohlmann A, Beck A, Cho CH, Pech M, Wieners G, Spors B, Werk M, Rosner C, Hanninen EL, Felix R.

Klinik fur Strahlenheilkunde, Charite Virchow-Klinikum Medical Faculty of the Humboldt-University Berlin, Berlin, Germany. jens.ricke@charite.de

PURPOSE: To assess the safety and efficacy of CT-guided brachytherapy alone or in combination with laser-induced thermotherapy (LITT) in patients with liver malignancies.

METHODS AND MATERIALS: Thirty-seven patients presented with 36 liver metastases and two primary liver carcinomas. Twenty-one patients were treated with CT-guided high-dose-rate brachytherapy alone using a 192Ir source. Sixteen patients received brachytherapy directly after MRI-guided LITT. The indications for brachytherapy alone were a tumor size >5 cm, adjacent central bile duct or adjacent major vessels causing unfavorable cooling effects for thermal ablation, and technical failures of LITT. The dosimetry for brachytherapy was performed using three-dimensional CT data acquired after percutaneous applicator positioning. On average, a minimal dose of 17 Gy inside the tumor margin was applied (range, 10-20 Gy).

RESULTS: The mean tumor size was 4.6 cm (range, 2.5-11 cm). The mean liver volume receiving > or =5 Gy was 16% (range, 2-40%) of the total liver. Severe complications were recorded in 2 patients (5%). One patient developed acute liver failure possibly related to accidental continuation of oral capecitabine treatment. Another patient demonstrated obstructive jaundice owing to tumor edema after irradiation of a metastasis adjacent to the bile duct bifurcation. A commonly encountered moderate increase of liver enzymes was greatest in patients with combined treatment. The local control rate after 6 months was 73% and 87% for combined treatment and brachytherapy alone, respectively.

CONCLUSION: CT-guided brachytherapy using three-dimensional CT data for dosimetry is safe and effective alone or in combination with LITT. Brachytherapy as a stand-alone treatment displayed genuine advantages over thermal tumor ablation.


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