High Dose Rate Brachyablation of Primary Liver Lesions

• Patients must have histologic or radiographic proof of a primary liver malignancy suitable for radiation therapy.
• Lesion size ≥ 3cm in maximum dimension.
• Predicted survival of >6 months.
• KPS ≥ 60 (See Appendix B).
• Age ≥ 18 years old.
• Women of child-bearing potential and men must agree to use adequate contraception (hormonal or barrier method of birth control; abstinence) prior to study entry, for the duration of study participation, and for 90 days following completion of therapy. Should a woman become pregnant or suspect she is pregnant while participating in this study, she should inform her treating physician immediately.

• A female of child-bearing potential is any woman (regardless of sexual orientation, having undergone a tubal ligation, or remaining celibate by choice) who meets the following criteria:

  • Has not undergone a hysterectomy or bilateral oophorectomy; or
  • Has not been naturally postmenopausal for at least 12 consecutive months (i.e., has had menses at any time in the preceding 12 consecutive months).
• Ability to understand and the willingness to sign a written informed consent.
• Formal evaluation by the Liver Tumor Program at UTSW: All patients should be fairly and prudently informed of their treatment options. To this end, all patients must be evaluated by the Liver Tumor Program at conference before brachytherapy treatment for discussion and consideration of other options for treatment of liver cancer including surgical resection.

Exclusion Criteria:

• Patients with a history of prior irradiation or other treatment to the liver or abdomen who after treatment on this protocol would have a cumulative dose to the liver or other normal tissues greater than the protocol defined constraints.
• Need or plans for concomitant antineoplastic therapy (including surgery, cryotherapy, radiofrequency ablation, chemo-embolization, conventionally fractionated radiotherapy, stereotactic body radiation therapy, and hepatic artery chemotherapy) for the protocol treated lesions except at progression. Adjuvant systemic therapy before and after the protocol therapy per section 4.4.1, and surgery or other ablative therapy is allowed for lesions appearing after enrollment to this protocol as per section 4.4.2 and 4.4.3 is allowed. At least 4 weeks must have passed since the last directed intervention to the protocol-treated lesion.
• Germ cell or hematologic malignancies.
• History of Crohn's Disease or Ulcerative Colitis.
• Active peptic ulcer disease for lesions within 5cm of the stomach.
• Underlying hepatic cirrhosis with Child-Pugh class B9 or C
• A major psychiatric illness which would limit understanding of the proposed protocol treatment and consent process.
• Men and women of reproductive potential may not participate unless they agree to use an effective contraceptive method.
• Pregnant or lactating women.
• Patients with parahepatic extension of disease with direct non-liver visceral involvement.

• Abnormal laboratory chemistries

  • Albumin \< 2.5
  • Alkaline Phosphatase > 5 X upper limits of normal (ULN)
  • LT/AST > 5 X ULN
  • Total bilirubin > 5

• Abnormal complete blood count refractory to treatment. Any of the following:

  • Platelet count \< 75,000/ml
  • Hb level \< 8 gm/dl
  • ANC \< 500/ml

• Abnormal coagulation profile: INR > 2 and/or PTT > 80

  • Patients who are on anticoagulation medication that may not be safely held for the procedure (≥ 5 days for antiplatelet agents and warfarin; ≥ 24 hours for low-molecular weight heparin formulations) will be excluded.
• Contraindications to general anesthesia
• Subjects receiving any other investigational agents.