• Jens Ricke, Konrad Mohnike, Maciej Pech, Max Seidensticker, Ricarda Rühl, Gero Wieners, Gunnar Gaffke, Siegfried Kropf, Roland Felix, and Peter Wust.
• Klinik für Radiologie und Nuklearmedizin, Universitätsklinikum Magdeburg, Germany. jens.ricke@med.ovgu.de
• Int. J. Radiat. Oncol. Biol. Phys. 2010 Oct 1; 78 (2): 479-85.

PurposeTo determine local tumor control after CT-guided brachytherapy at various dose levels and the prognostic impact of extensive cytoreduction in colorectal liver metastases.Methods And MaterialsSeventy-three patients were treated on a single-center prospective trial that was initially designed to be randomized to three dose levels of 15 Gy, 20 Gy, or 25 Gy per lesion, delivered in a single fraction. However, because there was a high rate of cross-over of subjects from higher to lower dose levels, this study is better understood as a prospective trial with three dose levels. No upper size limit for the metastases was applied. We assessed time to local progression, progression-free survival, and overall survival.ResultsAccording to safety constraints cross-over was performed. The final assignment was n = 98, n = 68, and n = 33 in the 15-Gy, 20-Gy, and 25-Gy groups, respectively. Median diameter of the largest tumor lesion in each patient was 5 cm (range, 1-13.5 cm). Estimated mean local recurrence-free survival for all lesions was 34 months (median not reached). The group assigned to 15 Gy after cross-over displayed 34 local recurrences out of 98 lesions; 20 Gy, 15 out of 68 lesions; 25 Gy, 1 out of 33 lesions. The difference between the 25-Gy and the 20-Gy or 15-Gy group was significant (p < 0.05). Repeated local tumor ablations were the most prominent factor for increased survival and dominated additional systemic antitumor treatments.ConclusionsLocal tumor control after CT-guided brachytherapy of colorectal liver metastases demonstrated a strong dose dependency. The role of extensive minimally invasive tumor ablation in metastatic colorectal cancer needs to be further established.2010 Elsevier Inc. All rights reserved.

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