ESTRO consensus recommendations for high dose rate interstitial liver brachytherapy

High dose rate (HDR) interstitial liver brachytherapy has become one of the established local ablative treatment options for selected primary and secondary liver tumours that are unsuitable for surgical resection. With its steep dose gradient and high conformality, it enables precise dose delivery to the target while effectively sparing surrounding healthy liver tissue and adjacent organs at risk. These GEC-ESTRO consensus recommendations provide comprehensive, standardised guidance on the technique and workflow of interstitial HDR liver brachytherapy, including image-guided catheter implantation, implantation techniques, and treatment planning. The recommendations further summarise available evidence on oncological outcomes, toxicities and adverse event management, and outlines principles for post-treatment follow-up. The consensus recommendations were developed by an expert panel of the GEC-ESTRO Gastrointestinal Working Group based on published evidence and collective clinical experience. They aim to harmonise practice across centres, promote safe and effective treatment delivery, and facilitate future research and data comparison in this evolving field of liver-directed radiotherapy.