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Observations on Staging and Interstitial Treatment of Unresectable Liver Metastases

Russell J. Nauta, MD; Edward K. Heres, MD; David S. Thomas, MD; K. William Harter, MD; James E. Rodgers, PhD; Richard W. Holt, MD; Thomas C. Lee, MD; Daniel B. Walsh, MD; Anatoly Dritschilo, MD

Arch Surg. 1987;122(12):1392-1395.

Abstract
• Fourteen patients with a history of colonic cancer were evaluated for metastatic disease and were thought to have unresectable disease confined to the liver. Exploratory surgery revealed that two patients had extensive extrahepatic disease, and the procedure was terminated. In 12 patients, closed-end needles (diameter, 2.1 mm) were introduced into each nodule and connected to a 370-MBq (10-Ci) aferloading iridium source. Radiation doses were dependent on nodule size, providing minimum doses of 20 Gy (2000 rad) to the lesion's periphery with rapid radiation falloff avoiding toxic effects to adjacent normal tissue. The maximum number of nodules treated in one patient was 11. The largest nodule treated measured 9 x 6.5 x 6 cm. Cholecystectomy in four patients allowed precise implantation and obviated biliary fistula. Preoperative computed tomography underestimated the number of hepatic metastases in all cases but one, and treatment-induced computed tomographic alterations further limited its utility. Radiation treatment was well tolerated, and the median hospitalization was eight days. Of ten patients whose preoperative carcinoembryonic antigen values exceeded 10 ng/dL, the values in six patients decreased postoperatively.

(Arch Surg 1987;122:1392-1395)

Author Affiliations
From the Departments of Surgery (Drs Nauta, Heres, Holt, Lee, and Walsh), Radiation Medicine (Drs Thomas, Harter, and Dritschilo), and Radiation Physics (Dr Rodgers), Georgetown University Hospital, Washington, DC.

Footnotes
Accepted for publication Sept 23, 1987.

Read before the Annual Meeting of the Society of Surgical Oncology, London, April 30, 1987.

Reprint requests to Department of Surgery, Georgetown University Hospital, Fourth Floor N, 3800 Reservoir Rd NW, Washington, DC 20007 (Dr Nauta).

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