“New” Kid on the Block: Interstitial Brachytherapy

The presented case is a 5-cm solitary hepatocellular carcinoma (HCC), Child-Pugh Score A (5 points), in close proximity to the stomach in a patient with a history of cirrhosis. 1 Reddy AV Meyer J Bulky, Solitary Hepatocellular Carcinoma. Int J Radiat Oncol Biol Phys. 2023; 115: 276 Abstract Full Text Full Text PDF PubMed Scopus (5) Google Scholar Because the patient is not eligible for surgery, local ablative procedures of the so-called “toolbox of ablative treatment options” are the preferred treatment of choice in Barcelona Clinic Liver Cancer stage A. Usually, thermal ablation is the first-line treatment in early-stage HCC. However, despite its high efficacy in small tumors, radiofrequency ablation has certain limitations, such as decreased local control rates in larger lesions (>3 cm). In addition, thermal ablation is suboptimal near large vessels (heat sink effect) or in proximity to organs at risk (eg, stomach), as in the presented case in segment 2/3. Bulky, Solitary Hepatocellular CarcinomaInternational Journal of Radiation Oncology, Biology, PhysicsVol. 115Issue 2PreviewA 72-year-old man with a history of alcohol-related cirrhosis, coronary artery disease, hypertension, chronic obstructive pulmonary disease, hyperlipidemia, and chronic lymphocytic leukemia on surveillance presented with abdominal pain. Computed tomography of the abdomen/pelvis showed a mass in the left lobe of the liver. Magnetic resonance imaging confirmed a solitary, exophytic 5.1-cm mass in the left lobe, involving segments 2 and 3, with arterial-phase enhancement, washout on delayed phase imaging, and pseudocapsule, consistent with a diagnosis of hepatocellular carcinoma (HCC) by meeting Liver Imaging and Reporting Data System (LI-RADS) 5 criteria (Fig. Full-Text PDF