Radioablation of Upper Abdominal Malignancies by CT-Guided, Interstitial HDR Brachytherapy: A Multivariate Analysis of Catheter Placement Assisted by Ultrasound Imaging

Abstract

Purpose To evaluate the use of ultrasound (US) during catheter placement in interstitial brachytherapy (iBT) of abdominal malignancies as an alternative to computed tomography (CT) fluoroscopy.

Materials and Methods Catheter placement for CT-guided iBT was, if US visibility was sufficient, assisted by sonography in 52 consecutive patients with 82 lesions (liver N = 62; kidney N = 16; peritoneum N = 4) of various malignancies. We collected data on lesion visibility, location, depth, size, and dosimetry. Comparison of CT fluoroscopy versus US-assisted catheter placement was performed by Fisher’s exact test for frequencies and U-test for lesion visibility and dosimetric data. Factors predicting the utility of sonography were determined in a lesion-based multivariate regression analysis. A p-value < 0.05 was regarded as statistically significant.

Results 150 catheters (1 to 6 per lesion; mean diameter 3.6 ± 2.4 cm) were implanted. CT fluoroscopy was used for 44 catheters, and US was used for 106 catheters. Lesion visibility assessed by 5-point Likert scale was significantly better in US (median 2 vs. 3; p = 0.011) and effective dose was significantly reduced if US guidance was applicable (median 1.75 vs. 8.19 mSv; p = 0.014). In a multivariate regression analysis, we identified increased lesion size and caudal location within the target organ to independently predict the utility of ultrasound in catheter placement for iBT.

Conclusion Sonography is a helpful technique to assist CT-guided interstitial brachytherapy of upper abdominal malignancies. Especially for larger lesions localized in the lower liver segments or lower half of the kidney, superior visibility can be expected. As the effective dose of the patient is also reduced, radiation exposure of the medical staff may be indirectly lowered.

Key Points: 

• Ultrasound-assisted catheter placement in CT-guided brachytherapy of upper abdominal malignancies significantly improves lesion visibility.

• Predictors of successful ultrasound application are larger lesions within the lower portion of the liver and kidney.

• By reducing the need for CT fluoroscopy during intervention, radiation exposure to the medical staff may be indirectly lowered.

Citation Format

• Damm R, Damm R, Heinze C et al. Radioablation of Upper Abdominal Malignancies by CT-Guided, Interstitial HDR Brachytherapy: A Multivariate Analysis of Catheter Placement Assisted by Ultrasound Imaging. Fortschr Röntgenstr 2022; 194: 62 – 69

Zusammenfassung

Ziel Evaluierung der Ultraschallbildgebung (US) zur Katheterplatzierung bei der interstitiellen Brachytherapie (iBT) abdomineller Malignome als Alternative zur computertomografischen (CT) Fluoroskopie.

Material und Methoden Die Katheteranlage zur iBT erfolgte nach Möglichkeit mittels Sonografie bei 52 konsekutiven Patienten mit 82 abdominellen Tumoren (Leber n = 62, Niere n = 16, Peritoneum n = 4) unterschiedlicher Entitäten. Es wurden Läsionssichtbarkeit, Lokalisation, Tiefe und Größe sowie Dosimetrie erfasst. Der Vergleich zwischen CT- und ultraschallassistierter Katheteranlage erfolgte mittels Fisher’s exaktem Test für Häufigkeiten und U-Test für Sichtbarkeit und Dosimetrie. Faktoren für die Anwendung der Sonografie wurden in einer multivariaten Regression bestimmt. p < 0,05 wurde als signifikant betrachtet.

Ergebnisse 150 Katheter (1–6 pro Läsion, mittlerer Diameter 3,6 ± 2,4 cm) wurden eingebracht, CT-Fluoroskopie wurde bei 44 Kathetern und Ultraschall bei 106 Kathetern angewendet. Die Sichtbarkeit war anhand einer 5-Punkte-Likert-Skala signifikant besser (median 2 vs. 3; p = 0,011) und die effektive Dosis wurde signifikant reduziert, wenn Ultraschallführung anwendbar war (median 1,75 vs. 8,9mSv; p = 0,014). In der multivariaten Regressionsanalyse konnten ein größerer Läsionsdiameter sowie eine kaudale Lokalisation im Zielorgan als Faktoren zur Vorhersage der Ultraschallanwendung bei der iBT identifiziert werden.

Fazit Die Sonografie ist eine nützliche Bildgebungsmodalität bei der Katheteranlage zur CT-gesteuerten Brachytherapie abdomineller Malignome. Bei größeren Läsionen in den kaudalen Lebersegmenten oder der unteren Nierenhälfte können eine bessere Läsionssichtbarkeit und reduzierte Dosis erwartet werden.

Kernaussagen: 

• Die ultraschallgestützte Katheterplatzierung bei der CT-geführten Brachytherapie abdomineller Malignome erhöht signifikant die Läsionssichtbarkeit.

• Prädiktoren einer erfolgreichen Ultraschallanwendung sind größere Läsionen in den unteren Segmenten der Leber und Nieren.

• Durch die Reduzierung der CT-Fluoroskopie kann die Strahlenexposition des medizinischen Personals indirekt gesenkt werden.

Key words

brachytherapy - local ablative treatment - sonography

Publication History

Received: 15 April 2021

Accepted: 29 June 2021

Article published online:
14 October 2021

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