Percutaneous Computed Tomography-guided High-Dose-Rate Brachytherapy Ablation of Breast Cancer Liver Metastases: Initial Experience with 80 Lesions

Purpose: To analyze initial experience with computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) ablation of breast cancer liver metastases (BCLM). Materials and Methods: Between January 2008 and December 2010,37 consecutive women with 80 liver metastases were treated with CT-HDRBT in 56 sessions. Mean age was 58.6 years (range, 34-83 y). Treatment was performed by CT-guided applicator placement and high-dose-rate brachytherapy with an iridium-192 source. The mean radiation dose was 18.57 Gy (standard deviation 2.27). Tumor response was evaluated by gadoxetic acid-enhanced liver magnetic resonance (MR) imaging performed before treatment, 6 weeks after treatment, and every 3 months thereafter. Results: Two patients were lost to follow-up; the remaining 35 patients were available for MR imaging evaluation for a mean follow-up time of 11.6 months (range 3-32 mo). Mean tumor diameter was 25.5 mm (range 8-74 mm). Two (2.6%) local recurrences were observed after local tumor control for 10 months and 12 months. Both local progressions were successfully retreated. Distant tumor progression (new metastases or enlargement of nontreated metastases) occurred during the follow-up period in 11 (31.4%) patients. Seven (20%) patients died during the follow-up period. Overall survival ranged from 3-39 months (median 18 months). Conclusions: CT-HDRBT is a safe and effective ablative therapy, providing a high rate of local tumor control in patients with BCLM.