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01-09-2015 | Interventional

CT-guided Interstitial Brachytherapy of Hepatocellular Carcinoma before Liver Transplantation: an Equivalent Alternative to Transarterial Chemoembolization?

Authors: Timm Denecke, Lars Stelter, Dirk Schnapauff, Ingo Steffen, Bruno Sinn, Eckart Schott, Ricarda Seidensticker, Gero Puhl, Bernhard Gebauer, Enrique Lopez Hänninen, Peter Wust, Peter Neuhaus, Daniel Seehofer

Published in: European Radiology | Issue 9/2015

Abstract

Objectives

Transarterial chemoembolization (TACE) is established as bridging therapy of HCC listed for transplantation (LT). CT-guided brachytherapy (CTB) has not been evaluated as a bridging concept. We compared CTB and TACE for bridging before LT in HCC patients.

Methods

Twelve patients with HCC received LT after CTB (minimal tumour dose, 15–20 Gy). Patients were matched (CTB:TACE, 1:2) by sex, age, number and size of lesions, and underlying liver disease with patients who received TACE before transplantation. Study endpoints were extent of necrosis at histopathology and recurrence rate after OLT.

Results

There were no significant differences between the CTB and TACE groups regarding Child-Pugh category (p = 0.732), AFP (0.765), time on waiting list (p = 0.659), number (p = 0.698) and size (p = 0.853) of HCC lesions, fulfilment of Milan-criteria (p = 0.638), or previous liver-specific treatments. CTB achieved higher tumour necrosis rates than TACE (p = 0.018). The 1- and 3-year recurrence rate in the CTB group was 10 and 10 % vs. TACE, 14 and 30 % (p = 0.292).

Conclusions

Our data show comparable or even better response and post-LT recurrence rates of CTB compared to TACE for treating HCC in patients prior to LT. CTB should be further evaluated as an alternative bridging modality, especially for patients not suited for TACE.

Key Points

• CT-guided interstitial brachytherapy (CTB) is a promising alternative to transarterial chemoembolization (TACE).

• CTB instead of TACE is possible for bridging to liver transplantation in HCC patients.

• HCC recurrence was not associated with CTB despite potential tumour seeding.

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Title: CT-guided Interstitial Brachytherapy of Hepatocellular Carcinoma before Liver Transplantation: an Equivalent Alternative to Transarterial Chemoembolization?
Authors: Timm Denecke
Lars Stelter
Dirk Schnapauff
Ingo Steffen
Bruno Sinn
Eckart Schott
Ricarda Seidensticker
Gero Puhl
Bernhard Gebauer
Enrique Lopez Hänninen
Peter Wust
Peter Neuhaus
Daniel Seehofer
Publication date: 01-09-2015
Publisher: Springer Berlin Heidelberg
Published in: European Radiology / Issue 9/2015
Print ISSN: 0938-7994
Electronic ISSN: 1432-1084
DOI: https://doi.org/10.1007/s00330-015-3660-0

Keynote webinar | Spotlight on medication adherence

Springer Medicine

CT-guided Interstitial Brachytherapy of Hepatocellular Carcinoma before Liver Transplantation: an Equivalent Alternative to Transarterial Chemoembolization?

Abstract

Objectives

Methods

Results

Conclusions

Key Points

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Objectives

Methods

Results

Conclusions

Key Points

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