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Papers by Bernhard Gebauer

Journal of Vascular and Interventional Radiology, Mar 1, 2016

Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: ... more Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on longterm follow up.

European Journal of Radiology, 2018

Background: Minimal invasive local therapies are alternative treatment options in patients with p... more Background: Minimal invasive local therapies are alternative treatment options in patients with primary and metastatic lung malignancies being not eligible for resection. However, thermal ablations are often limited by large tumour volumes. Purpose: To evaluate the efficacy and safety of CT-HDRBT in pulmonary tumours ≥4 cm compared to smaller tumours. Material and methods: In this retrospective study, 74 consecutive patients (mean age: 63 ± 12; m: 39, w: 35) with a total of 175 tumours treated in 132 interventions were enrolled between October 2003 and September 2016. Primary and assisted local tumour control (LTC), progression free survival (PFS) and overall survival (OS) after first CT-HDBRT were identified for two subgroups with tumours < 4 cm (A) as well as ≥4 cm (B) using the Kaplan-Meier-Method. Radiation parameters and side effects were recorded. Log-Rank-Test and Mann-Whitney-U-Test were performed for statistical analyses with p-values < 0.05 considered as significant. Results: There was no statistical difference in coverage with prescribed radiation dose (A:19.78 ± 8.62 mm (range 5-39 mm), 99.56 ± 0.99%; B:61.70 ± 21.09 mm (41-100 mm), 94.81 ± 7.19%, p = 0.263). LTC rates after 0.

JHEP Reports, 2020

SORAMIC DIAGNOSTIC TRIAL: HBP MRI VERSUS CT IN HCC Gadoxetic acid-enhanced HBP MRI provides more ... more SORAMIC DIAGNOSTIC TRIAL: HBP MRI VERSUS CT IN HCC Gadoxetic acid-enhanced HBP MRI provides more accurate treatment decisions than CT in HCC METHODS RESULTS CONCLUSION STUDY DESIGN • Multicentre, randomized, phase II • 538 patients IMAGING TECHNIQUES

Insights into Imaging

Background The purpose of this study is to evaluate uterine artery embolization (UAE) for the man... more Background The purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (< 10 cm) and large (≥ 10 cm) tumors based on the diameter of the dominant fibroid. Results A total of 245 patients were included into the final data analysis. The Kaplan–Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical impr...

Journal of Hepatology, 2021

European Radiology, 2020

Objectives To investigate the impact of the interventionalist’s experience and gender on radiatio... more Objectives To investigate the impact of the interventionalist’s experience and gender on radiation dose and procedural time in CT-guided interventions. Methods We retrospectively analyzed 4380 CT-guided interventions performed at our institution with the same CT scanner from 2009 until 2018, 1287 (29%) by female and 3093 (71%) by male interventionalists. Radiation dose, number of CT fluoroscopy images taken per intervention, total procedural time, type of intervention, and degree of difficulty were derived from the saved dose reports and images. All 16 interventionalists included in this analysis performed their first CT-guided interventions during the study period, and interventions performed by each interventionalist were counted to assess the level of experience for each intervention in terms of the number of prior interventions performed by her or him. The Mann-Whitney U test (MWU test), multivariate regression, and linear mixed model analysis were performed. Results Assessment ...

Acta Radiologica, 2019

Background Due to the broad variability of the prostatic artery (PA), its origin, small calibers,... more Background Due to the broad variability of the prostatic artery (PA), its origin, small calibers, and tortuous courses, prostatic arterial embolization (PAE) is challenging, time-consuming, and results in high radiation doses. Purpose To evaluate the accuracy of PA detection using cone-beam computed tomography (CBCT) performed from the aortic bifurcation in combination with a semi-automatic detection software in comparison to oblique view digital subtraction angiography (DSA) with internal iliac artery (IIA) injection. Material and Methods Twenty-two consecutive patients were included in this retrospective, IRB-approved study between July and December 2017. CBCT from the aorta and 30° oblique-view DSA from both IIAs were obtained for PA detection. Results of suggested PAs from the semi-automatic vessel detection software after CBCT and IIA DSA were compared. Moreover, dose area product (DAP) was recorded. Statistical analysis included Spearman’s correlation, Mann–Whitney U test, and...

Interventionelle Radiologie Scan, 2015

Die Bedeutung der interventionellen Radiologie bei der Implantation und dem Management von Kompli... more Die Bedeutung der interventionellen Radiologie bei der Implantation und dem Management von Komplikationen von zentralvenosen Kathetern hat deutlich zugenommen. Da die Indikationen und Einsatzgebiete der Katheter sehr unterschiedlich sind, haben sich viele verschiedene Kathetertypen entwickelt, deren Implantationstechnik, Einsatzgebiet und Spektrum an moglichen Komplikationen sehr unterschiedlich sind. Die verschiedenen Katheter und deren Besonderheiten werden im Artikel vorgestellt. Beim Management von Katheterkomplikationen ist die interventionelle Radiologie durch ihre diagnostischen und interventionellen Methoden ein idealer Partner und kann bei langfristigen Kathetern dem Patienten viele Optionen bieten den Katheter zu bewahren. Diese werden diskutiert und erlautert.

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2012

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2020

Background Immunotherapy represents an effective therapeutic approach for many malignant diseases... more Background Immunotherapy represents an effective therapeutic approach for many malignant diseases that were previously difficult to treat. However, since immunotherapy can lead to atypical therapy response patterns in the form of pseudo-progression or mixed responses and comprise an altered spectrum of adverse reactions, they present a new challenge for oncologic imaging. Detailed knowledge in this area is essential for oncologic clinical radiologists, since the radiological report is a cornerstone of response assessment, and increasingly influences therapy regimens and coverage by health insurances. Method This white paper is based on an expert meeting in Frankfurt am Main and subsequent discussions between the authors. Based on the iRECIST criteria, it is intended to provide orientation for a response assessment of oncologic patients undergoing immunotherapy that can be applied in the clinical routine. Results Radiological therapy monitoring outside clinical studies is subject to ...

Current Oncology, 2022

Purpose: To report and compare the results of endovascular and open surgical treatment for erosio... more Purpose: To report and compare the results of endovascular and open surgical treatment for erosion bleeding of visceral arteries following pancreatitis and pancreatic surgery. Materials and Methods: This retrospective study included 65 consecutive patients (46 males, mean age 63 ± 14 years) presenting with visceral artery erosions between January 2011 and December 2020. Endpoints were technical success, freedom from reintervention, stent-graft-related complications, and 30-day and one-year mortality. Results: The causes of erosion bleeding included complications of surgical treatment for the pancreas and upper gastrointestinal tract (75%), pancreatitis (19%), and spontaneous bleeding (6%). Pancreatectomy was performed in 34 (52%) patients, representing 2% of all pancreatectomy procedures (n = 1645) performed in our hospital during the study period. A total of 37 (57%) patients underwent endovascular treatment (EVT), and 28 (43%) patients had open surgery (OS) as a primary treatment....

Cancers, 2021

Purpose: Treatment of patients with primary and secondary liver tumors remains challenging. This ... more Purpose: Treatment of patients with primary and secondary liver tumors remains challenging. This study analyzes the efficacy and safety of transarterial radioembolization (TARE) combined with CT-guided high-dose-rate interstitial brachytherapy (CT-HDRBT) for the treatment of primary and secondary liver tumors. Patients and Methods: A total of 77 patients (30 female) with various liver malignancies were treated. Primary endpoints were median overall survival (OS) and time to untreatable progression (TTUP). Additionally, subgroup analyses were performed in consideration of diagnosis and procedure sequence. Median OS and TTUP prediction were estimated using Kaplan–Meier analysis and hazard ratios (HR) were calculated using a multivariate Cox proportional hazard model. Results: A total of 115 CT-HDRBT and 96 TARE procedures were performed with no significant complications recorded. Median OS and TTUP were 29.8 (95% CI 18.1–41.4) and 23.8 (95% CI 9.6–37.9) months. Median OS for hepatocel...

Anticancer Research, 2019

Background/Aim: Treatment of patients with large hepatocellular carcinoma (HCC) remains challengi... more Background/Aim: Treatment of patients with large hepatocellular carcinoma (HCC) remains challenging and survival in advanced tumor stages is limited. This study was conducted to investigate the efficacy of embolization followed by computed tomography (CT)-guided interstitial high-dose-rate brachytherapy (CT-HDRBT) in patients with unresectable HCC. Patients and Methods: A total of 47 patients undergoing CT-HDRBT were divided into 2 groups: i) patients previously treated with transarterial chemoembolization (TACE) and ii) patients treated with bland transarterial embolization (TAE). The primary endpoint was overall survival (OS), while secondary endpoints were the time to progression (TTP) and the local progression rate. Results: A total of 78 lesions were treated. The mean size of the main tumors was 58.3 mm. The median OS in TACE and TAE groups was 28.9 months and 32.3 months, respectively (p=NS). The median OS of patients classified as BCLC stage A using the Barcelona Clinic Liver Cancer classification system (BCLC) was 32.3 months, while the median OS of patients in BCLC stage B and C was 36.9 and 17.7 months, respectively. The local progression rate was 7.7% (6/78), with no statistically significant difference between TACE and TAE. The median TTP was significantly longer in the TACE group compared to the TAE group (11.7 months and 10.3 months, respectively). Conclusion: Treatment with transarterial embolization and subsequent CT-HDRBT leads to a very promising survival rate for patients with unresectable HCC.

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, 2018

Zusammenfassung Zielsetzung Nach ersten Auswertungen des ALPPS-Registers mit insbesondere für zen... more Zusammenfassung Zielsetzung Nach ersten Auswertungen des ALPPS-Registers mit insbesondere für zentrale Gallengangkarzinome ernüchternden, perioperativen Ergebnissen wich die anfängliche Euphorie für dieses Verfahren. Es ist somit angezeigt, das Konzept dahingehend zu modifizieren, die Invasivität und hohe Komplikationsrate des Verfahrens zu reduzieren. Indikationen Wir berichten nachfolgend über eine 72-jährige Patientin mit einem in die Segmente 4 b und 5 infiltrierend-wachsenden und metastasierenden Gallenblasenkarzinom. Bei zu kleinem zukünftigen Restlebervolumen vor erweiterter Hemihepatektomie rechts planten wir zur Hypertrophieinduktion eine laparoskopische partielle PVE-ALPPS. Methode Nach unauffälliger Staging-Laparoskopie erfolgte in einem ersten Schritt die oberflächliche Parenchymdissektion entlang des Lig. falciforme mittels Ultraschallschere. Kreuzende tiefere Strukturen zu Segment 4 wurden mittels CUSA dargestellt und zwischen Clips durchtrennt. Eine Parenchymbrücke vo...

Anticancer Research, 2018

Background/Aim: Thermal-ablative therapies are limited to tumors of 3-4 cm diameter. The purpose ... more Background/Aim: Thermal-ablative therapies are limited to tumors of 3-4 cm diameter. The purpose of this study was to evaluate the local tumor control (LTC) of CT-guided High-Dose-Rate-Brachytherapy (CT-HDRBT) for ablation of cholangiocarcinomas (CCA) ≥4 cm compared to smaller tumors. Patients and Methods: Sixty-one patients (tumors: 142, interventions: 91) were treated from March 2008 to January 2017. LTC, progression-free survival (PFS) and overall survival (OS) after first CT-HDRBT were identified for two subgroups (A:<4 cm, B:≥4 cm) and the influence of coverage and target-dose were evaluated. Log-Rank-and Mann-Whitney-U-Tests were performed for statistical analyses with p-values <0.05 considered as significant. Results: Better coverage was achieved for smaller tumors (

Hepatobiliary & Pancreatic Diseases International, 2015

CT-guided high-dose-rate brachytherapy (CT-HDRBT) is an interventional radiologic technique for l... more CT-guided high-dose-rate brachytherapy (CT-HDRBT) is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer. Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation (15-20 Gy) using a 192Ir-source. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall survival. The mean tumor diameter was 29 mm (range 10-73). The mean irradiation time was 20 minutes (range 7-42). The mean coverage of the clinical target volume was 98% (range 88%-100%). The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis (20%) and overall 15%. The mean follow-up time was 13.7 months (range 1.4-55.0). The median progression-free survival was 4.9 months (range 1.4-42.9, mean 9.4). Local recurrence occurred in 5 (10%) of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months (range 1.5-55.3). Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months (mean 12.9). Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months (mean 5.0). The rate of local tumor control was 91% in both groups after 12 months. CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.

Anticancer research, 2015

Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previ... more Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previous resection is rising. The purpose of this study was to determine survival of patients undergoing computed tomography-guided brachytherapy (CT-HDRBT). Altogether 19 patients with unresectable HCC recurrence were treated with CT-HDRBT at our Institution. Patients underwent single-fraction high-dose irradiation by an iridium-192 source after CT fluoroscopy-guided catheter placement. The median tumor-enclosing target dose was 20 Gy. The median follow-up was 33 months. According to the Kaplan-Meier method, median overall survival after CT-HDRBT was 50 months, and median survival after first hepatic resection was 87 months. The median duration of local tumor control was 32 months and time to disease progression was 20 months. There were no serious complications after CT-HDRBT and no treatment-related deaths. CT-HDRBT is a safe, potentially life prolonging technique in patients with recurren...

Current Oncology, 2022

The value of gadoxetic acid in the diagnosis of hepatocellular carcinoma (HCC), based on perfusio... more The value of gadoxetic acid in the diagnosis of hepatocellular carcinoma (HCC), based on perfusion criteria, is under dispute. This post-hoc analysis of the prospective, phase II, randomized, controlled SORAMIC study compared the accuracy of gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI) (arterial, portovenous, and venous phase only) versus contrast-enhanced computed tomography (CT) for stratifying patients with HCC to curative ablation or palliative treatment. Two reader groups (radiologists, R1 and R2) performed blind reads of CT and gadoxetic acid-enhanced MRI (contrast dynamics only). A truth panel, with access to clinical and imaging follow-up data, served as reference. Primary endpoint was non-inferiority (margin: 5% points) of MRI vs. CT (lower 95% confidence interval [CI] > 0.75) in a first step and superiority (complete 95% CI > 1) in a second step. The intent-to-treat population comprised 538 patients. Accuracy of treatment decisions was 73.4% and 7...

Cancer Imaging, 2017

LI-RADS (Liver Imaging Reporting and Data System) is a comprehensive system for standardise inter... more LI-RADS (Liver Imaging Reporting and Data System) is a comprehensive system for standardise interpretation and reporting of CT, MR and US examinations performed on patients at risk for hepatocellular carcinoma (HCC). LI-RADS was developed by a large committee with international and multidisciplinary input and is supported by the American College of Radiology (ACR). The aims of LI-RADS are to: • Establish minimum technical parameters for CT, MR, and US HCC surveillance • Standardise: terminology, interpretation, reporting and imaging management • Enhance communication among radiologists, hepatologists, surgeons and pathologists LI-RADS (version2017) was released at the end of June 2017. Different from the previous versions, which were PowerPoint based, the new version is a downloadable pdf. New content in v.2017 includes modules on ultrasound surveillance, contrast enhanced ultrasound (CEUS), reporting, management and tumour response. In addition, the CT/MR algorithm has been modified. The details of these changes will be discussed.

Skeletal radiology, 2015

To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drillin... more To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drilling, in radiofrequency ablation of osteoid osteoma as an alternative to conventional orthopedic drills. Between 2009 and 2013, altogether 33 patients underwent CT-guided radiofrequency ablation of an osteoid osteoma at our institution. To access the nidus of the clinically and radiologically suspected osteoid osteoma, a channel was drilled using the OnControl Bone Marrow Biopsy System (OBM, Arrow OnControl, Teleflex, Shavano Park, TX, USA) and a biopsy was taken. Procedure time (i.e., drilling including local anesthesia), amount of scans (i.e., single-shot fluoroscopy), radiation exposure, and the results of biopsy were investigated and compared retrospectively to a classical approach using either a manual bone biopsy system or a conventional orthopedic drill (n = 10) after ethical review board approval. Drilling the tract into the nidus was performed without problems in 22 of the 23 OBM c...

Journal of Vascular and Interventional Radiology, Mar 1, 2016

Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: ... more Percutaneous radiofrequency ablation as first-line treatment for small hepatocellular carcinoma: results and prognostic factors on longterm follow up.

European Journal of Radiology, 2018

Background: Minimal invasive local therapies are alternative treatment options in patients with p... more Background: Minimal invasive local therapies are alternative treatment options in patients with primary and metastatic lung malignancies being not eligible for resection. However, thermal ablations are often limited by large tumour volumes. Purpose: To evaluate the efficacy and safety of CT-HDRBT in pulmonary tumours ≥4 cm compared to smaller tumours. Material and methods: In this retrospective study, 74 consecutive patients (mean age: 63 ± 12; m: 39, w: 35) with a total of 175 tumours treated in 132 interventions were enrolled between October 2003 and September 2016. Primary and assisted local tumour control (LTC), progression free survival (PFS) and overall survival (OS) after first CT-HDBRT were identified for two subgroups with tumours < 4 cm (A) as well as ≥4 cm (B) using the Kaplan-Meier-Method. Radiation parameters and side effects were recorded. Log-Rank-Test and Mann-Whitney-U-Test were performed for statistical analyses with p-values < 0.05 considered as significant. Results: There was no statistical difference in coverage with prescribed radiation dose (A:19.78 ± 8.62 mm (range 5-39 mm), 99.56 ± 0.99%; B:61.70 ± 21.09 mm (41-100 mm), 94.81 ± 7.19%, p = 0.263). LTC rates after 0.

JHEP Reports, 2020

SORAMIC DIAGNOSTIC TRIAL: HBP MRI VERSUS CT IN HCC Gadoxetic acid-enhanced HBP MRI provides more ... more SORAMIC DIAGNOSTIC TRIAL: HBP MRI VERSUS CT IN HCC Gadoxetic acid-enhanced HBP MRI provides more accurate treatment decisions than CT in HCC METHODS RESULTS CONCLUSION STUDY DESIGN • Multicentre, randomized, phase II • 538 patients IMAGING TECHNIQUES

Insights into Imaging

Background The purpose of this study is to evaluate uterine artery embolization (UAE) for the man... more Background The purpose of this study is to evaluate uterine artery embolization (UAE) for the management of symptomatic uterine leiomyomas regarding changes in quality of life after treatment in a large patient collective. This study retrospectively analyzed prospectively acquired standardized questionnaires of patients treated with UAE. Clinical success was evaluated before and after embolization. Patients were stratified into short- (≤ 7 months) and long-term (> 7 months) follow-up groups depending on the time of completion of the post-interventional questionnaire. Uterine leiomyomas were furthermore divided into small (< 10 cm) and large (≥ 10 cm) tumors based on the diameter of the dominant fibroid. Results A total of 245 patients were included into the final data analysis. The Kaplan–Meier analysis showed a cumulative clinical success rate of 75.8% after 70 months until the end of follow-up (9.9 years). All questionnaire subscales showed a highly significant clinical impr...

Journal of Hepatology, 2021

European Radiology, 2020

Objectives To investigate the impact of the interventionalist’s experience and gender on radiatio... more Objectives To investigate the impact of the interventionalist’s experience and gender on radiation dose and procedural time in CT-guided interventions. Methods We retrospectively analyzed 4380 CT-guided interventions performed at our institution with the same CT scanner from 2009 until 2018, 1287 (29%) by female and 3093 (71%) by male interventionalists. Radiation dose, number of CT fluoroscopy images taken per intervention, total procedural time, type of intervention, and degree of difficulty were derived from the saved dose reports and images. All 16 interventionalists included in this analysis performed their first CT-guided interventions during the study period, and interventions performed by each interventionalist were counted to assess the level of experience for each intervention in terms of the number of prior interventions performed by her or him. The Mann-Whitney U test (MWU test), multivariate regression, and linear mixed model analysis were performed. Results Assessment ...

Acta Radiologica, 2019

Background Due to the broad variability of the prostatic artery (PA), its origin, small calibers,... more Background Due to the broad variability of the prostatic artery (PA), its origin, small calibers, and tortuous courses, prostatic arterial embolization (PAE) is challenging, time-consuming, and results in high radiation doses. Purpose To evaluate the accuracy of PA detection using cone-beam computed tomography (CBCT) performed from the aortic bifurcation in combination with a semi-automatic detection software in comparison to oblique view digital subtraction angiography (DSA) with internal iliac artery (IIA) injection. Material and Methods Twenty-two consecutive patients were included in this retrospective, IRB-approved study between July and December 2017. CBCT from the aorta and 30° oblique-view DSA from both IIAs were obtained for PA detection. Results of suggested PAs from the semi-automatic vessel detection software after CBCT and IIA DSA were compared. Moreover, dose area product (DAP) was recorded. Statistical analysis included Spearman’s correlation, Mann–Whitney U test, and...

Interventionelle Radiologie Scan, 2015

Die Bedeutung der interventionellen Radiologie bei der Implantation und dem Management von Kompli... more Die Bedeutung der interventionellen Radiologie bei der Implantation und dem Management von Komplikationen von zentralvenosen Kathetern hat deutlich zugenommen. Da die Indikationen und Einsatzgebiete der Katheter sehr unterschiedlich sind, haben sich viele verschiedene Kathetertypen entwickelt, deren Implantationstechnik, Einsatzgebiet und Spektrum an moglichen Komplikationen sehr unterschiedlich sind. Die verschiedenen Katheter und deren Besonderheiten werden im Artikel vorgestellt. Beim Management von Katheterkomplikationen ist die interventionelle Radiologie durch ihre diagnostischen und interventionellen Methoden ein idealer Partner und kann bei langfristigen Kathetern dem Patienten viele Optionen bieten den Katheter zu bewahren. Diese werden diskutiert und erlautert.

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2012

RöFo - Fortschritte auf dem Gebiet der Röntgenstrahlen und der bildgebenden Verfahren, 2020

Background Immunotherapy represents an effective therapeutic approach for many malignant diseases... more Background Immunotherapy represents an effective therapeutic approach for many malignant diseases that were previously difficult to treat. However, since immunotherapy can lead to atypical therapy response patterns in the form of pseudo-progression or mixed responses and comprise an altered spectrum of adverse reactions, they present a new challenge for oncologic imaging. Detailed knowledge in this area is essential for oncologic clinical radiologists, since the radiological report is a cornerstone of response assessment, and increasingly influences therapy regimens and coverage by health insurances. Method This white paper is based on an expert meeting in Frankfurt am Main and subsequent discussions between the authors. Based on the iRECIST criteria, it is intended to provide orientation for a response assessment of oncologic patients undergoing immunotherapy that can be applied in the clinical routine. Results Radiological therapy monitoring outside clinical studies is subject to ...

Current Oncology, 2022

Purpose: To report and compare the results of endovascular and open surgical treatment for erosio... more Purpose: To report and compare the results of endovascular and open surgical treatment for erosion bleeding of visceral arteries following pancreatitis and pancreatic surgery. Materials and Methods: This retrospective study included 65 consecutive patients (46 males, mean age 63 ± 14 years) presenting with visceral artery erosions between January 2011 and December 2020. Endpoints were technical success, freedom from reintervention, stent-graft-related complications, and 30-day and one-year mortality. Results: The causes of erosion bleeding included complications of surgical treatment for the pancreas and upper gastrointestinal tract (75%), pancreatitis (19%), and spontaneous bleeding (6%). Pancreatectomy was performed in 34 (52%) patients, representing 2% of all pancreatectomy procedures (n = 1645) performed in our hospital during the study period. A total of 37 (57%) patients underwent endovascular treatment (EVT), and 28 (43%) patients had open surgery (OS) as a primary treatment....

Cancers, 2021

Purpose: Treatment of patients with primary and secondary liver tumors remains challenging. This ... more Purpose: Treatment of patients with primary and secondary liver tumors remains challenging. This study analyzes the efficacy and safety of transarterial radioembolization (TARE) combined with CT-guided high-dose-rate interstitial brachytherapy (CT-HDRBT) for the treatment of primary and secondary liver tumors. Patients and Methods: A total of 77 patients (30 female) with various liver malignancies were treated. Primary endpoints were median overall survival (OS) and time to untreatable progression (TTUP). Additionally, subgroup analyses were performed in consideration of diagnosis and procedure sequence. Median OS and TTUP prediction were estimated using Kaplan–Meier analysis and hazard ratios (HR) were calculated using a multivariate Cox proportional hazard model. Results: A total of 115 CT-HDRBT and 96 TARE procedures were performed with no significant complications recorded. Median OS and TTUP were 29.8 (95% CI 18.1–41.4) and 23.8 (95% CI 9.6–37.9) months. Median OS for hepatocel...

Anticancer Research, 2019

Background/Aim: Treatment of patients with large hepatocellular carcinoma (HCC) remains challengi... more Background/Aim: Treatment of patients with large hepatocellular carcinoma (HCC) remains challenging and survival in advanced tumor stages is limited. This study was conducted to investigate the efficacy of embolization followed by computed tomography (CT)-guided interstitial high-dose-rate brachytherapy (CT-HDRBT) in patients with unresectable HCC. Patients and Methods: A total of 47 patients undergoing CT-HDRBT were divided into 2 groups: i) patients previously treated with transarterial chemoembolization (TACE) and ii) patients treated with bland transarterial embolization (TAE). The primary endpoint was overall survival (OS), while secondary endpoints were the time to progression (TTP) and the local progression rate. Results: A total of 78 lesions were treated. The mean size of the main tumors was 58.3 mm. The median OS in TACE and TAE groups was 28.9 months and 32.3 months, respectively (p=NS). The median OS of patients classified as BCLC stage A using the Barcelona Clinic Liver Cancer classification system (BCLC) was 32.3 months, while the median OS of patients in BCLC stage B and C was 36.9 and 17.7 months, respectively. The local progression rate was 7.7% (6/78), with no statistically significant difference between TACE and TAE. The median TTP was significantly longer in the TACE group compared to the TAE group (11.7 months and 10.3 months, respectively). Conclusion: Treatment with transarterial embolization and subsequent CT-HDRBT leads to a very promising survival rate for patients with unresectable HCC.

Zentralblatt für Chirurgie - Zeitschrift für Allgemeine, Viszeral-, Thorax- und Gefäßchirurgie, 2018

Zusammenfassung Zielsetzung Nach ersten Auswertungen des ALPPS-Registers mit insbesondere für zen... more Zusammenfassung Zielsetzung Nach ersten Auswertungen des ALPPS-Registers mit insbesondere für zentrale Gallengangkarzinome ernüchternden, perioperativen Ergebnissen wich die anfängliche Euphorie für dieses Verfahren. Es ist somit angezeigt, das Konzept dahingehend zu modifizieren, die Invasivität und hohe Komplikationsrate des Verfahrens zu reduzieren. Indikationen Wir berichten nachfolgend über eine 72-jährige Patientin mit einem in die Segmente 4 b und 5 infiltrierend-wachsenden und metastasierenden Gallenblasenkarzinom. Bei zu kleinem zukünftigen Restlebervolumen vor erweiterter Hemihepatektomie rechts planten wir zur Hypertrophieinduktion eine laparoskopische partielle PVE-ALPPS. Methode Nach unauffälliger Staging-Laparoskopie erfolgte in einem ersten Schritt die oberflächliche Parenchymdissektion entlang des Lig. falciforme mittels Ultraschallschere. Kreuzende tiefere Strukturen zu Segment 4 wurden mittels CUSA dargestellt und zwischen Clips durchtrennt. Eine Parenchymbrücke vo...

Anticancer Research, 2018

Background/Aim: Thermal-ablative therapies are limited to tumors of 3-4 cm diameter. The purpose ... more Background/Aim: Thermal-ablative therapies are limited to tumors of 3-4 cm diameter. The purpose of this study was to evaluate the local tumor control (LTC) of CT-guided High-Dose-Rate-Brachytherapy (CT-HDRBT) for ablation of cholangiocarcinomas (CCA) ≥4 cm compared to smaller tumors. Patients and Methods: Sixty-one patients (tumors: 142, interventions: 91) were treated from March 2008 to January 2017. LTC, progression-free survival (PFS) and overall survival (OS) after first CT-HDRBT were identified for two subgroups (A:<4 cm, B:≥4 cm) and the influence of coverage and target-dose were evaluated. Log-Rank-and Mann-Whitney-U-Tests were performed for statistical analyses with p-values <0.05 considered as significant. Results: Better coverage was achieved for smaller tumors (

Hepatobiliary & Pancreatic Diseases International, 2015

CT-guided high-dose-rate brachytherapy (CT-HDRBT) is an interventional radiologic technique for l... more CT-guided high-dose-rate brachytherapy (CT-HDRBT) is an interventional radiologic technique for local ablation of primary and secondary malignomas applying a radiation source through a brachycatheter percutaneously into the targeted lesion. The aim of this study was to assess local tumor control, safety and efficacy of CT-HDRBT in the treatment of liver metastases of pancreatic cancer. Twenty consecutive patients with 49 unresectable liver metastases of pancreatic cancer were included in this retrospective trial and treated with CT-HDRBT, applied as a single fraction high-dose irradiation (15-20 Gy) using a 192Ir-source. Primary endpoint was local tumor control and secondary endpoints were complications, progression-free survival and overall survival. The mean tumor diameter was 29 mm (range 10-73). The mean irradiation time was 20 minutes (range 7-42). The mean coverage of the clinical target volume was 98% (range 88%-100%). The mean D100 was 18.1 Gy and the median D100 was 19.78 Gy. Three major complications occurred with post-interventional abscesses, three of which were seen in 15 patients with biliodigestive anastomosis (20%) and overall 15%. The mean follow-up time was 13.7 months (range 1.4-55.0). The median progression-free survival was 4.9 months (range 1.4-42.9, mean 9.4). Local recurrence occurred in 5 (10%) of 49 metastases treated. The median overall survival after CT-HDRBT was 8.6 months (range 1.5-55.3). Eleven patients received chemotherapy after ablation with a median progression-free survival of 4.9 months (mean 12.9). Nine patients did not receive chemotherapy after intervention with a median progression-free survival of 3.2 months (mean 5.0). The rate of local tumor control was 91% in both groups after 12 months. CT-HDRBT was safe and effective for the treatment of liver metastases of pancreatic cancer.

Anticancer research, 2015

Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previ... more Prevalence of patients with unresectable recurrence of hepatocellular carcinoma (HCC) after previous resection is rising. The purpose of this study was to determine survival of patients undergoing computed tomography-guided brachytherapy (CT-HDRBT). Altogether 19 patients with unresectable HCC recurrence were treated with CT-HDRBT at our Institution. Patients underwent single-fraction high-dose irradiation by an iridium-192 source after CT fluoroscopy-guided catheter placement. The median tumor-enclosing target dose was 20 Gy. The median follow-up was 33 months. According to the Kaplan-Meier method, median overall survival after CT-HDRBT was 50 months, and median survival after first hepatic resection was 87 months. The median duration of local tumor control was 32 months and time to disease progression was 20 months. There were no serious complications after CT-HDRBT and no treatment-related deaths. CT-HDRBT is a safe, potentially life prolonging technique in patients with recurren...

Current Oncology, 2022

The value of gadoxetic acid in the diagnosis of hepatocellular carcinoma (HCC), based on perfusio... more The value of gadoxetic acid in the diagnosis of hepatocellular carcinoma (HCC), based on perfusion criteria, is under dispute. This post-hoc analysis of the prospective, phase II, randomized, controlled SORAMIC study compared the accuracy of gadoxetic acid-enhanced dynamic magnetic resonance imaging (MRI) (arterial, portovenous, and venous phase only) versus contrast-enhanced computed tomography (CT) for stratifying patients with HCC to curative ablation or palliative treatment. Two reader groups (radiologists, R1 and R2) performed blind reads of CT and gadoxetic acid-enhanced MRI (contrast dynamics only). A truth panel, with access to clinical and imaging follow-up data, served as reference. Primary endpoint was non-inferiority (margin: 5% points) of MRI vs. CT (lower 95% confidence interval [CI] > 0.75) in a first step and superiority (complete 95% CI > 1) in a second step. The intent-to-treat population comprised 538 patients. Accuracy of treatment decisions was 73.4% and 7...

Cancer Imaging, 2017

LI-RADS (Liver Imaging Reporting and Data System) is a comprehensive system for standardise inter... more LI-RADS (Liver Imaging Reporting and Data System) is a comprehensive system for standardise interpretation and reporting of CT, MR and US examinations performed on patients at risk for hepatocellular carcinoma (HCC). LI-RADS was developed by a large committee with international and multidisciplinary input and is supported by the American College of Radiology (ACR). The aims of LI-RADS are to: • Establish minimum technical parameters for CT, MR, and US HCC surveillance • Standardise: terminology, interpretation, reporting and imaging management • Enhance communication among radiologists, hepatologists, surgeons and pathologists LI-RADS (version2017) was released at the end of June 2017. Different from the previous versions, which were PowerPoint based, the new version is a downloadable pdf. New content in v.2017 includes modules on ultrasound surveillance, contrast enhanced ultrasound (CEUS), reporting, management and tumour response. In addition, the CT/MR algorithm has been modified. The details of these changes will be discussed.

Skeletal radiology, 2015

To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drillin... more To evaluate the use of a novel battery-powered drill, enabling specimen requirement while drilling, in radiofrequency ablation of osteoid osteoma as an alternative to conventional orthopedic drills. Between 2009 and 2013, altogether 33 patients underwent CT-guided radiofrequency ablation of an osteoid osteoma at our institution. To access the nidus of the clinically and radiologically suspected osteoid osteoma, a channel was drilled using the OnControl Bone Marrow Biopsy System (OBM, Arrow OnControl, Teleflex, Shavano Park, TX, USA) and a biopsy was taken. Procedure time (i.e., drilling including local anesthesia), amount of scans (i.e., single-shot fluoroscopy), radiation exposure, and the results of biopsy were investigated and compared retrospectively to a classical approach using either a manual bone biopsy system or a conventional orthopedic drill (n = 10) after ethical review board approval. Drilling the tract into the nidus was performed without problems in 22 of the 23 OBM c...