Patient with multiple resections and chemotherapy in early 2023 presented in December 2023 with two hypoperfused CRLMs in segments V/VI and V/VII. Interstitial HDR brachytherapy with a palliative intent was decided over ablation to both preserve as much liver tissue as possible, and to avoid a secondary bilioma. In an innovative, first-ever scenario, four applicators were placed with CAS-One IR to ensure optimal placement. A follow-up MRI was performed 2 days afterwards to confirm there were no intraprocedural complications.
3-applicator planning of the first treatment in MPR view
3-applicator planning of the first treatment in MPR view
Applicator verification of the first treatment with <1mm lateral error
Dose planning of the two treatments (first planning - top row, second planning - bottom row)
Name: Prof. Dr. Attila Kovács, Prof. Dr. Michael Pinkawa
Institution: Robert Janker Klinik, Bonn, Germany
Patient sex: Male
Initial condition:
- Initial diagnosis of Rectal Carcinoma cT3 cN2 pM1 in December 2022 with two primary liver metastases
- Hemihepatectomy, and metastasectomies followed by neoadjuvant chemotherapy and resection of primary tumor
- Continued systemic therapy was implemented following the identification of additional liver metastases during follow-up, with adjustments made to the treatment protocol in response to disease progression.
- Liver MRI from November 2023 showed
- Two metastases in segment V/VI and V/VII (15 – 25 mm, hypoperfused)
- No hepatic secondary complications.
Treatment:
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In December 2023, the international patient was admitted for interstitial HDR-Brachytherapy with a palliative intent. This method was preferred over thermal ablation because Brachytherapy:
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enables the safe treatment of larger metastases while maximizing the preservation of healthy liver tissue.
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avoids the risk of secondary bilioma.
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Based in intraprocedural CT, trajectories for the administration of a tumor-encapsulating dose of 20 Gy (IR 912) were determined.
- Under guidance of the CAS-One IR system, a total of four applicators were positioned with sub-millimeter precision in the first treatment:
- 3 Applicators for segment V/VII
- 1 Applicator for segment V/VII
Result:
- Applicators were successfully inserted and treatment was administered. A follow-up MRI conducted two days post-procedure confirmed the absence of complications
- This case demonstrates the effective integration of CAS-One IR within the context of Brachytherapy to precisely position applicators, facilitating highly localized treatment delivery
Learn more about the capabilities of CAS-One IR.
