Quality Ablation Redefined: Precision Brachytherapy with CAS-One IR

Quality Ablation Redefined: Precision Brachytherapy with CAS-One IR


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.


Screenshot 2024-04-24 2049193-applicator planning of the first treatment in MPR view

Screenshot 2024-04-24 2050223-applicator planning of the first treatment in MPR view

Screenshot 2024-04-24 205505Applicator verification of the first treatment with <1mm lateral error

topcaseaprilDose 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.


  • 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:
    • enables the safe treatment of larger metastases while maximizing the preservation of healthy liver tissue.
    • avoids the risk of secondary bilioma.
  • 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


  • 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.

Subscribe to our newsletter