Treatment of metastatic, imatinib refractory, gastrointestinal stroma tumor with image-guided high-dose-rate interstitial brachytherapy.

Autor:	Omari J; Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany., Drewes R; Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany. Electronic address: ralph.drewes@med.ovgu.de., Matthias M; Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany., Mohnike K; Diagnostisch Therapeutische Zentrum (DTZ), Berlin, Germany., Seidensticker M; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, München, Germany., Seidensticker R; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, München, Germany., Streitparth T; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, München, Germany., Ricke J; Klinik und Poliklinik für Radiologie, Klinikum der Universität München, München, Germany., Powerski M; Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany., Pech M; Department of Radiology and Nuclear Medicine, Otto-von-Guericke University, Magdeburg, Germany; 2nd Department of Radiology, Medical University of Gdansk, Gdansk, Poland.
Jazyk:	angličtina
Zdroj:	Brachytherapy [Brachytherapy] 2019 Jan - Feb; Vol. 18 (1), pp. 63-70. Date of Electronic Publication: 2018 Oct 29.
DOI:	10.1016/j.brachy.2018.09.006
Abstrakt:	Purpose: Evaluation of efficacy and safety of CT- or MRI-guided high-dose-rate interstitial brachytherapy (iBT) in the treatment of advanced, imatinib refractory, metastatic gastrointestinal stroma tumors (GISTs) was the objective of this retrospective study. Methods and Materials: A cumulative number of 40 unresectable metastases (30 hepatic, 10 peritoneal) were treated with iBT in 10 selected patients with histologically proven GISTs. Six patients had peritoneal disease, and 5 patients were even progressing under sunitinib (second line)-thus iBT was applied as a salvage maneuver. IBT uses an interstitially introduced 192 iridium source in a high-dose-rate irradiation regime to destroy vital cells in a single fraction. Response to treatment was assessed clinically and with acquisition of MRI/CT every 3 months. Results: Local tumor control was reached in 97.5% of all treated metastases during a median time of 25 months-only one local relapse was observed during followup. The median diameter of the irradiated lesions was 2.4 cm (range 0.6-11.2 cm); a median dose of 15 Gy (range 6.7-21.96 Gy) was applied. The median progression-free survival after iBT was 6.8 (range 3.0-20.2) months; the median overall survival was 37.3 months (range 11.4-89.7). Two major complications (Common Terminology for Adverse Events grade 3) occurred following the intervention: local hemorrhage and pneumothorax, successfully dealt with by angiographic embolization and pleural drainage, respectively. Conclusions: In selected patients with metastatic, imatinib refractory GISTs, iBT safely enables high rates of local tumor control and presents an alternative, anti-neoplastic treatment option even in a salvage situation. (Copyright © 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.)
Databáze:	MEDLINE
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