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1.
Strahlenther Onkol ; 195(11): 982-990, 2019 Nov.
Article in English | MEDLINE | ID: mdl-31346674

ABSTRACT

PURPOSE: In this pilot trial, we investigate the safety of CT-guided high-dose-rate brachytherapy (HDR-BT) as a local ablative treatment for renal masses not eligible for resection or nephrectomy. METHODS: We investigated renal function after irradiation by HDR-BT in 16 patients (11 male, 5 female, mean age 76 years) with 20 renal lesions (renal cell carcinoma n = 18; renal metastases n = 2). Two patients had previous contralateral nephrectomy and two had ipsilateral partial nephrectomy. Six lesions had a hilar localization with proximity to the renal pelvis and would have not been favorable for thermal ablation. Renal function loss was determined within 1 year after HDR-BT by renal scintigraphy and laboratory parameters. Further investigations included CT and MRI every 3 months to observe procedural safety and local tumor control. Renal function tests were analyzed by Wilcoxon's signed rank test with Bonferroni-Holm correction of p-values. Survival and local tumor control underwent a Kaplan-Meier estimation. RESULTS: Median follow-up was 22.5 months. One patient required permanent hemodialysis 32 months after repeated HDR-BT and contralateral radiofrequency ablation of multifocal renal cell carcinoma. No other patient developed a significant worsening in global renal function and no gastrointestinal or urogenital side effects were observed. Only one patient died of renal tumor progression. Local control rate was 95% including repeated HDR-BT of two recurrences. CONCLUSION: HDR-BT is a feasible and safe technique for the local ablation of renal masses. A phase II study is recruiting to evaluate the efficacy of this novel local ablative treatment in a larger study population.


Subject(s)
Brachytherapy/methods , Carcinoma, Renal Cell/radiotherapy , Kidney Neoplasms/radiotherapy , Radiofrequency Ablation/methods , Radiotherapy Dosage , Radiotherapy, Image-Guided/methods , Tomography, X-Ray Computed , Aged , Aged, 80 and over , Female , Follow-Up Studies , Humans , Kaplan-Meier Estimate , Kidney/radiation effects , Kidney Function Tests , Kidney Neoplasms/secondary , Male , Patient Safety , Pilot Projects , Radiation Injuries/etiology
2.
Strahlenther Onkol ; 193(8): 612-619, 2017 Aug.
Article in English | MEDLINE | ID: mdl-28341865

ABSTRACT

PURPOSE: To assess the efficacy, safety, and outcome of image-guided high-dose-rate (HDR) brachytherapy in patients with adrenal gland metastases (AGM). MATERIALS AND METHODS: From January 2007 to April 2014, 37 patients (7 female, 30 male; mean age 66.8 years, range 41.5-82.5 years) with AGM from different primary tumors were treated with CT-guided HDR interstitial brachytherapy (iBT). Primary endpoint was local tumor control (LTC). Secondary endpoints were time to untreatable progression (TTUP), time to progression (TTP), overall survival (OS), and safety. In a secondary analysis, risk factors with an influence on survival were identified. RESULTS: The median biological equivalent dose (BED) was 37.4 Gy. Mean LTC after 12 months was 88%; after 24 months this was 74%. According to CTCAE criteria, one grade 3 adverse event occurred. Median OS after first diagnosis of AGM was 18.3 months. Median OS, TTUP, and TTP after iBT treatment were 11.4, 6.6, and 3.5 months, respectively. Uni- and multivariate Cox regression analyses revealed significant influences of synchronous disease, tumor diameter, and the total number of lesions on OS or TTUP or both. CONCLUSION: Image-guided HDR-iBT is safe and effective. Treatment- and primary tumor-independent features influenced survival of patients with AGM after HDR-iBR treatment.


Subject(s)
Adrenal Gland Neoplasms/radiotherapy , Brachytherapy/mortality , Carcinoma/prevention & control , Carcinoma/secondary , Dose Fractionation, Radiation , Neoplasm Recurrence, Local/mortality , Adrenal Gland Neoplasms/pathology , Adult , Aged , Aged, 80 and over , Carcinoma/mortality , Female , Germany/epidemiology , Humans , Male , Middle Aged , Neoplasm Recurrence, Local/prevention & control , Prevalence , Radiotherapy Dosage , Radiotherapy, Image-Guided , Risk Factors , Survival Rate , Treatment Outcome
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