Adverse Events in iBT and Their Clinical Management

Mohnike K, Corradini S (2021)

Publication Type: Authored book

Publication year: 2021

Publisher: Springer International Publishing

ISBN: 9783030780791

Abstract

Interstitial brachytherapy (iBT) is a procedure that allows substantial sparing of healthy liver tissue. Classical radiation-induced liver disorders (RILDs) have not been reported in the literature; only atypical cases of icteric elevation of liver enzymes and ascites have been reported in individual cases. For large, centrally located liver tumors, clinically relevant biliary duct complications are rare and have not been associated with a reduction in overall survival in available study reports. The excellent treatability of central liver tumors is a unique feature of iBT as compared with other local-therapeutic procedures, including surgical resection. There is evidence of a strong correlation between severe bleeding events and (1) the secondary diagnosis of an advanced liver cirrhosis, e.g., in patients with hepatocellular carcinoma, and (2) the peri-interventional administration of low-molecular-weight heparin. In terms of mortality, a bleeding event of CTCAE Grade ≥3 is overall very rare but remains a serious complication with a potentially fatal outcome. There is evidence that a history of biliodigestive anastomosis or papillotomy are risk factors for post-interventional development of cholangitis or liver abscesses. Clinically important organs at risk, apart from the liver, are the stomach and the duodenum, which are at risk of gastroduodenal ulceration above a dose exposure of 14–15 Gy (D1 cm³). In clinical routine, this means that proton-pump inhibitors are prescribed at a relevant gastroduodenal dose exposure. Furthermore, angiographic occlusion balloons can be placed between the stomach wall and the liver to avoid a significant dose exposure of the stomach. Lung brachytherapy is associated with a low rate of severe adverse events, whereas mild pneumothorax without the need of a chest tube placement is reported in up to 20% of treatments. iBT of the kidneys, the adrenal glands, and the pancreas seems to be safe for the vast majority of patients, although the reported evidence on safety and outcome is still limited. The overall risk of extrahepatic puncture-tract metastases is very low, and in the case of puncture-tract recurrence after iBT, it does not affect overall survival. Moreover, in appropriately designed studies, iBT has successfully been used for treating local recurrences.

Involved external institutions

Ludwig-Maximilians-Universität (LMU)

Germany (DE)

How to cite

APA:

Mohnike, K., & Corradini, S. (2021). Adverse Events in iBT and Their Clinical Management. Springer International Publishing.

MLA:

Mohnike, Konrad, and Stefanie Corradini. Adverse Events in iBT and Their Clinical Management. Springer International Publishing, 2021.

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