Brachytherapy represents a valued therapeutic alternative in the treatment of liver metastases, especially in patients who are not candidates for surgery. The management of liver metastases is a complex clinical scenario in oncology. Primary liver tumours and secondary spread of tumours to the liver requires therapeutic strategies that achieve effective local control of the disease while preserving residual liver function. In this context, significant innovations have emerged in the field of interventional oncology. Among these, brachytherapy stands out as a highly effective local ablative treatment modality. Today, in the blog, we will review its rationale, benefits and clinical applications.
Targeted solutions for liver metastases
Liver metastases are a frequent secondary manifestation in various types of cancer, such as colorectal, breast or lung cancer. Their appearance usually indicates disease progression and requires a specific and personalized therapeutic approach. The growth rate of liver metastases can vary significantly depending on the type of tumor and the patient’s general condition. Some evolve slowly and allow aggressive local treatments to be considered, while others grow rapidly and require urgent and targeted interventions.
Faced with a diagnosis of a liver metastases, the main objective is to destroy the tumor cells while preserving as much healthy liver tissue as possible. Systemic therapies, such as chemotherapy, travel throughout the body and, although effective, can generate considerable toxicity. For this reason, current oncology is increasingly focused on local and targeted treatments.
These precision approaches are crucial, especially because the symptoms of liver metastases (such as fatigue, weight loss, abdominal pain or jaundice) often appear in advanced stages, when effective tumour control is a priority. Brachytherapy stands as one of the most sophisticated solutions within this paradigm, concentrating the full power of the treatment directly where it is needed.
What is brachytherapy? A precision oncological treatment
Brachytherapy is an internal radiotherapy technique that consists of direct placement of a radioactive source inside or very close to the tumor. In the context of primary liver cancer and liver metastases, this technique allows a high dose of radiation to be administered in a very localized manner, minimizing damage to the surrounding healthy liver tissue.
The procedure, performed by a multidisciplinary team of specialists, involves the insertion of fine catheters into the liver tumour under imaging guidance (usually CT). Through these catheters, a radioactive isotope is temporarily introduced which destroys the cancerous cells from within. Because it is such a targeted therapy, the application of brachytherapy to liver cancer and metastases minimizes damage to surrounding healthy tissues, such as the rest of the liver parenchyma, the kidneys or the stomach.
Why consider brachytherapy for liver metastases?
Brachytherapy is an especially valuable therapeutic option in complex clinical scenarios. It should be considered in the following cases:
- Inoperable tumours: for patients whose metastases cannot be removed by surgery due to their number, size or location close to vital structures.
- Resistance to other treatments: when liver metastases have not responded adequately to chemotherapy or other systemic therapies.
- Rapid and potent tumour control: the speed of growth of liver metastases can be a determining factor. Brachytherapy offers very potent tumor ablation in a short period of time, which can be crucial in slowing disease progression.
- Bridging or consolidation therapy: can be used to reduce the size of a tumor prior to possible surgery or to treat residual lesions after another treatment.
Recent studies have shown that brachytherapy for liver metastases can achieve local control rates of over 90% in single or limited lesions, with very low toxicity. In addition, it preserves liver function and maintains the patient’s quality of life.
Benefits over traditional therapies
Scientific evidence supports a number of advantages of hepatic brachytherapy over other treatment modalities:
- Maximum dose, minimum damage: it administers a radiation dose up to 10 times higher than that which could be safely applied with external techniques, guaranteeing a high probability of local tumour control.
- Less systemic toxicity: as it is an eminently local treatment, systemic toxicity is practically nil, so there is a reduction of side effects such as nausea, fatigue or diffuse hepatic toxicity. Side effects are usually limited to mild and transient local reactions.
- Short treatment duration: treatment is usually completed in a single fraction, as opposed to the multiple weeks that fractionated external radiotherapy may require (short hospital stay).
- Preservation of liver function: protecting healthy liver tissue is vital. The high precision of brachytherapy makes it possible to treat tumours while maintaining the functionality of the rest of the organ.
- Independence from respiratory movement: unlike external radiation therapy, once the catheters are implanted, treatment is not affected by the movement of the liver during breathing, ensuring pinpoint accuracy.
Recovery and aftercare
One of the great benefits of brachytherapy is that, being a minimally invasive procedure, recovery is usually rapid. After treatment, the patient remains under hospital observation for a short period, usually 24-48 hours. Possible side effects are local and manageable, such as mild discomfort at the puncture site or transient fatigue.
Aftercare includes clinical and imaging follow-up, liver function monitoring and, in some cases, nutritional support or liver physiotherapy. The standard follow-up protocol includes assessment of tumour response by serial imaging tests (usually MRI). Response is assessed according to standardized radiological criteria to quantify tumour size reduction and tumour viability. The management of possible late side effects, although infrequent, is a fundamental part of long-term follow-up.