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

  • Interventional
  • Published:
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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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Acknowledgments

The scientific guarantor of this publication is Dr. Timm Denecke. The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article. The authors state that this work has not received any funding. One of the authors has significant statistical expertise. Institutional review board approval was not required because of the retrospective nature of this study. Written informed consent was obtained from all subjects (patients) in this study. Methodology: retrospective, case–control multicenter study.

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    Authors and Affiliations

    1. Klinik für Radiologie, Charité, Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

      Timm Denecke, Lars Stelter, Dirk Schnapauff, Ingo Steffen, Bernhard Gebauer, Enrique Lopez Hänninen & Peter Wust

    2. Institut für Pathologie, Charité – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

      Bruno Sinn

    3. Medizinische Klinik m.S. Hepatologie und Gastroenterologie, Charité 2 – Universitätsmedizin Berlin, Campus Virchow-Klinikum, Augustenburger Platz 1, 13353, Berlin, Germany

      Eckart Schott

    4. Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum der Otto-v.-Gericke-Universität, Leipziger Str. 44, 39120, Magdeburg, Germany

      Ricarda Seidensticker

    5. Klinik für Allgemein-, Viszeral- und Transplantationschirurgie, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, Campus Virchow-Klinikum, 13353, Berlin, Germany

      Gero Puhl, Peter Neuhaus & Daniel Seehofer

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    1. Timm Denecke
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    Correspondence to Timm Denecke.

    Additional information

    Timm Denecke and Lars Stelter contributed equally to this work.

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    Denecke, T., Stelter, L., Schnapauff, D. et al. CT-guided Interstitial Brachytherapy of Hepatocellular Carcinoma before Liver Transplantation: an Equivalent Alternative to Transarterial Chemoembolization?. Eur Radiol 25, 2608–2616 (2015). https://doi.org/10.1007/s00330-015-3660-0

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