Publication

Abstract : Introduction: The evolution of brachytherapy has been refined over years, but many of the techniques remain unchanged. The limited utilisation of brachytherapy in comparison to conformal external radiotherapy may be due to its invasive approach, operative risk, technical challenge, time consuming, long learning curve and poor technological advancements. However, there is growing evidence for practicing hypo-fractionated regimes in many solid malignancies. The present article focus on the similar roles of image guided - robotic interstitial high dose rate brachytherapy with hepatocellular carcinoma (HCC) as prototype. Materials and methods: The robotic brachytherapy safety, commissioning and quality assurance should follow American Association of Physicists in Medicine (AAPM) task group - 43 and the Groupe Européen de Curiethérapie - European Society for Radiotherapy & Oncology (GEC ESTRO) report of task group 192 recommendations. The patient selection criteria, pre-treatment planning, technique and treatment of image guided - robotic interstitial brachytherapy for liver malignancy are outlined. We used the image guided robotic interstitial high dose rate brachytherapy to treat a large sized paediatric un-resectable HCC; not suitable for transplant/ resection/ RFA and refractory to medical treatment. Results: There were no intra-operative or immediate post-operative complications and at 6 weeks post-procedure assessment, we achieved near complete response with no symptoms. Conclusions: This is the first study in usage of image based robotic interstitial high dose rate brachytherapy for liver malignancies. The technique described is simple, safe, fast, precise and effective treatment modality for hepatocellular carcinoma. We also emphasis the image guided robotic interstitial brachytherapy as an exciting platform for its similar role to ablate liver metastases or other site malignancies.