MR guided catheter-based radiotherapy/brachytherapy of liver tumours – first experience and feasibility

Aim: To show feasibility and safety of MR guided catheter-based radiotherapy/brachytherapy of primary or secondary liver tumours.

Methods: Between June 2023 and April 2024, 27 patients with 54 liver lesions were treated within a prospecitve single-center trial (MR BRIGHT trial). Treatments were performed under conscious sedation and LA using a 1.5T MRI system. Gadoxetic acid was administered for contrast enhancement, followed by insertion of an coaxial needle and navigation to the lesion via real-time gradient-echo fluoroscopy sequences. The needle was exchanged for a 6F angiography sheath with a brachytherapy catheter. 3D T1-weighted sequences were sent to the radiation department for brachytherapy with an IR192 high-dose-rate (HDR) afterloading unit. Target doses ranged from 15 to 25 Gy, depending on tumor type (HCC, CRC, GIST, NET, and other metastases). Catheters were removed after BT, and the tract sealed with gelatin sponge.

Results: The average lesion diameter was 13±6 mm, whereas the average clinical target volume (CTV) was 3.0±2.9 cm3. The average room time was 74±35 minutes, the average time for catheter placement was 19±11 minutes. The mean dose administered per lesion (D100) was 18.9±3.6 Gy. Complications during and after BT were rare with only 2 patients having a minor bleeding without need for blood transfusion or intervention.

Conclusions: Overall, MR-guided catheter-based radiotherapy for liver tumours is feasible and safe, particularly for small lesions. With low complication rates and precise dosimetry achieved through advanced imaging, this approach holds promise for effective tumour management.

Publication History

Article published online:
20 January 2025