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

Omari, Jazan; Drewes, Ralph; Matthias, Manig; Mohnike, Konrad; Seidensticker, Max; Seidensticker, Ricarda; Streitparth, Tina; Ricke, Jens; Powerski, Maciej and Pech, Maciej (2019): Treatment of metastatic, imatinib refractory, gastrointestinal stroma tumor with image-guided high-dose-rate interstitial brachytherapy. In: Brachytherapy, Vol. 18, No. 1: pp. 63-70

Abstract

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. (C) 2018 American Brachytherapy Society. Published by Elsevier Inc. All rights reserved.

• Item Type: Journal article
• Faculties: Medicine
• Subjects: 600 Technology > 610 Medicine and health
• ISSN: 1538-4721
• Language: English