CT-Guided High-Dose-Rate Brachytherapy of Liver Tumours Does Not Impair Hepatic Function and Shows High Overall Safety and Favourable Survival Rates

Computed tomography-guided high-dose-rate brachytherapy (CT-HDRBT) is an emerging therapeutic option for irresectable liver tumours. However, its potentially negative effect on liver function has not yet been investigated. The aim of this study was to evaluate CT-HDRBT for potential liver damage and functional impairment by means of quantitative liver function tests, patient safety, and survival. Sixty-nine patients receiving hepatic CT-HDRBT were investigated in a prospective study. The liver function was determined before and after intervention, and 6 and 12 weeks later. The study visits included liver function assessment by conventional biochemical parameters, the liver function capacity test based on 13C-Methacetin (MA) kinetics in A mu g/kg/hr (LiMAx test), and the indocyanine green plasma disappearance rate test. Tumour progression was re-staged by magnetic resonance imaging (MRI) twice. The 2-year-survival was analysed. A significant alteration of biochemical liver parameters was observed for liver enzymes and bilirubin directly after intervention, all biochemical parameters had normalised at the 6-week follow-up. There were no changes in LiMAx test values after the intervention, showing no effect on metabolic liver function capacity. In approximately two-thirds of the patients, MRI re-staging revealed a significant tumour response, and no local tumour recurrence occurred. No patient developed a radiation-induced liver disease. CT-HDRBT for local tumour treatment has little impact on total liver function capacity by high patient safety and encouraging survival rates. Thus, it should be an important option in treating patients without a surgical alternative, especially when liver function is impaired due to previous surgery or chronic liver disease.