Hepatocellular carcinoma: computed-tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of large (5-7 cm) and very large (>7 cm) tumours

Objectives Evaluate the clinical outcome of CT-guided high-dose-rate-brachytherapy (CT-HDRBT) of hepatocellular carcinoma (HCC) larger than 5 cm in diameter with the goal of local tumour control (LTC). Methods Thirty-five patients with 35 unresectable HCCs ranging in size from 5 to 12 cm (mean: 7.1 cm) were treated with CT-HDRBT. Tumours were classified into two groups according to diameter: large lesions (5-7 cm) and very large lesions (>7 cm). Tumour response was evaluated by Gd-EOB-DTPA-enhanced liver magnetic resonance imaging (MRI) performed before, 6 weeks after, and then every 3 months after treatment. Endpoints included local tumour control (LTC), progression-free survival (PFS) and overall survival (OS). Results Nineteen tumours were classified as large and 16 as very large. Complete tumour enclosure was achieved in all patients after the first CT-HDRBT session. Five patients were lost to follow-up. At a mean follow-up of 12.8 months, two patients had local progression (6.7%), one in each group. Nine patients (30%) experienced distant progression, five (26.3%) in the large and four (25%) in the very large group. No patients died during the follow-up period. No major complications were recorded. Conclusions CT-HDRBT is a promising therapy for HCCs that exceed indications for thermal ablation. Key Points Computed Tomography guided high-dose-rate brachytherapy offers new therapeutic options for hepatocellular carcinoma CT-HDRBT can be safely practised in HCCs exceeding 5 cm in diameter CT-HDRBT offers high rate of local control where thermal ablation is impossible CT-HDRBT could be a valid alternative to TACE for intermediate stage HCC