Fig. 1

A 60-year old man with metastatic leiomyosarcoma presenting with multiple lung metastasis. He had undergone multiple microwave ablations for other lung tumors. A malignant left sub-hilar lymph node continued to grow despite treatment with multiple cycles of doxorubicin and olaratumab. This tumor was treated with CT-guided interstitial HDR brachyablation. A Placement of co-axial needle under CT-guidance during brachytherapy catheter implantation. A co-axial needle was advanced percutaneously and placed directly into the ultra-central tumor abutting the heart. B Axial C Sagittal and D Coronal views of resultant treatment isodose distribution