Pathological complete Response with Immunotherapy and Brachytherapy to 15 Metastatic Liver Lesions in a Single Patient

Figures & data

Figure 1. Timeline showing the PET-CT scan, high-dose rate interstitial brachytherapy liver for the 15 lesions and surgery.

Figure 2. High-dose rate interstitial brachytherapy plans of the 15 lesions treated (A) and the maximum intensity projectionimages of ¹⁸F-¹⁸F-FDG PET-CT performed serially from April 2019 till December 2020 (B).

Figure 3. Changes in left lobe liver volume.

HDR-IBT: High-dose rate interstitial brachytherapy.

Figure 4. Trends of AST, ALP and ALT (A) and total bilirubin, albumin (B).

AST: Aspartate aminotransferase; ALP: Alkaline phosphatase; ALT: Alanine transaminase.

Figure 5. Fused PET-CT axial image demonstrates a larger metabolically active lesion in segment VII/VIII with central necrosis (red arrow) (A) and right hepatectomy specimen (B).

Table 1. Dose statistics to the liver and diaphragm for the seven fractions of high-dose rate interstitial brachytherapy to liver and external beam radiotherapy to pancreatic bed.

	Liver			Diaphragm
	5 Gy (%)	8 Gy (%)	10 Gy (%)	0.2 cc (Gy)	0.5 cc (Gy)	EBRT (3-Aug-19) liver dose
3 February	34.46	21.93	17.31	40.26	37.28	Mean	12.93 Gy
10 February	5.81	3.28	2.44	24.5	21.29	V15Gy	30.27%
14 May	11.71	5.17	3.68	4.25	3.78	V20Gy	26.12%
20 May	9.43	4.99	3.68	84.28	57.29	V30Gy	16.36%
2 September	21.67	12.29	10.21	3.13	3.13	V40Gy	7.57%
9 September	12.73	7.43	5.725	49.46	34.19
17 September	15.2	8.76	6.576	22.1	16.57

EBRT: External beam radiotherapy.