eISSN: 2081-2841
ISSN: 1689-832X
Journal of Contemporary Brachytherapy
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vol. 10
Original paper

Needle track seeding in hepatocellular carcinoma after local ablation by high-dose-rate brachytherapy: a retrospective study of 588 catheter placements

Robert Damm, Ingo Zörkler, Bela Rogits, Peter Hass, Jazan Omari, Maciej Powerski, Sigrfried Kropf, Konrad Mohnike, Maciej Pech, Jens Ricke, Max Seidensticker

J Contemp Brachytherapy 2018; 10, 6: 516–521
Online publish date: 2018/12/17
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Needle track seeding in the local treatment of hepatocellular carcinoma (HCC) is not yet evaluated for catheter-based high-dose-rate brachytherapy (HDR-BT), a novel local ablative technique.

Material and methods
We report a retrospective analysis of 100 patients treated on 233 HCC lesions by HDR-BT (using 588 catheters in total). No needle or catheter track irradiation was used. Minimum required follow-up with imaging was 6 months. In case of suspected needle track seeding (intra- and/or extrahepatic) in follow-up, image fusion of follow-up CT/MRI with 3D irradiation plan was used to verify the location of a new tumor deposit within the path of a brachytherapy catheter at the time of treatment.

We identified 9 needle track metastases, corresponding to a catheter-based risk of 1.5% for any location of occurrence. A total of 7 metastases were located within the liver (catheter-based risk, 1.2%), and 2 metastases were located extrahepatic (catheter-based risk, 0.3%). Eight out of 9 needle track metastases were successfully treated by further HDR-BT.

The risk for needle track seeding after interstitial HDR-BT of HCC is comparable to previous reports of percutaneous biopsies and radiofrequency ablation (RFA), especially in case of extrahepatic needle track metastases. To compensate for the risk of seeding, a track irradiation technique similar to track ablation in RFA should be implemented in clinical routine.


hepatocellular carcinoma, local ablative treatment, needle track seeding

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