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CardioVascular and Interventional Radiology

, Volume 42, Issue 1, pp 121–129 | Cite as

Feasibility of Helical I-125 Seed Implant in the Portal Vein

  • Chen Wang
  • Wansheng Wang
  • Jian Shen
  • Baosheng Ren
  • Xiaoli ZhuEmail author
  • Caifang NiEmail author
Laboratory Investigation

Abstract

Purpose

To evaluate the feasibility of helical iodine-125 (I-125) seed portal vein implantation.

Materials and Methods

Helical I-125 seed implants were placed into the portal vein of healthy pigs through the transjugular (n = 3) or percutaneous transhepatic (n = 3) route. Six pigs received follow-up at 9 weeks after implantation. Blood tests were performed preimplantation, and at 1 and 9 weeks after implantation. Contrast-enhanced computed tomography (CT) and single-photon emission computed tomography combined with CT (SPECT-CT) were acquired after implantation. Post-implantation CT was imported to the treatment planning system (TPS) for dose verification. At 9 weeks after implantation, another CT was performed before histopathological examination.

Results

All implantations were successful, and the helical implants were fixed to the portal vein. CT showed no implant migration or portal vein thrombosis. The average dose to 90% of the target volume calculated from TPS was 68.4 Gy. SPECT-CT revealed an irregular isodose around the implant, in which the hottest spot was near the central portal vein lumen. All pigs were in good condition at the 9-week follow-up. Histopathology studies confirmed no portal vein thrombosis. Pigs showed no signs of bleeding, necrosis, or perforation of the peripheral tissue or organs. Intimal hyperplasia was observed at the two ends of the implant. A mild inflammatory response was detected in the bile duct and adjacent liver tissues, yet there was no apparent inflammation of the hepatic arteries.

Conclusion

The helical I-125 seed implants can be inserted into the portal veins of healthy pigs.

Keywords

Portal vein Tumor thrombus Endovascular brachytherapy Helical I-125 seed implants 

Abbreviations

I-125

Iodine-125

CT

Contrast-enhanced computed tomography

SPECT

Single-photon emission computed tomography

TPS

Treatment planning system

D90

Dose to 90% of the target volume

HCC

Hepatocellular carcinoma

PVTT

Portal vein tumor thrombus

MPVTT

Main portal vein tumor thrombus

TACE

Transarterial chemoembolization

EBRT

External beam radiotherapy

3D

Three-dimensional

OAR

Organs-at-risk

DVH

Dose volume histogram

ANOVA

Analysis of variance

PTV

Planning target volume

Notes

Funding

This study was supported by Jiangsu Provincial Medical Talent funding (Grant Number ZDRCA2016038).

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the Animal Ethics Committee of Suzhou University in China. The Experimental Animal Center of Suzhou University provided six pigs that were single-housed. Food intake was monitored, and the animals were housed according to the standard procedures. All procedures performed in studies involving animals were in accordance with the ethical standards of the institution or practice at which the studies were conducted.

References

  1. 1.
    Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65(2):87–108.  https://doi.org/10.3322/caac.21262.CrossRefPubMedGoogle Scholar
  2. 2.
    Minagawa M, Makuuchi M. Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus. World J Gastroenterol. 2006;12(47):7561–7.CrossRefGoogle Scholar
  3. 3.
    Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, et al. Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology (Baltimore, Md). 1999;29(1):62–7.  https://doi.org/10.1002/hep.510290145.CrossRefGoogle Scholar
  4. 4.
    Villa E, Moles A, Ferretti I, Buttafoco P, Grottola A, Del Buono M, et al. Natural history of inoperable hepatocellular carcinoma: estrogen receptors’ status in the tumor is the strongest prognostic factor for survival. Hepatology (Baltimore, Md). 2000;32(2):233–8.  https://doi.org/10.1053/jhep.2000.9603.CrossRefGoogle Scholar
  5. 5.
    Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, et al. Sorafenib in advanced hepatocellular carcinoma. The New England journal of medicine. 2008;359(4):378–90.  https://doi.org/10.1056/NEJMoa0708857.CrossRefPubMedGoogle Scholar
  6. 6.
    Cheng AL, Kang YK, Chen Z, Tsao CJ, Qin S, Kim JS, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase III randomised, double-blind, placebo-controlled trial. Lancet Oncol. 2009;10(1):25–34.  https://doi.org/10.1016/s1470-2045(08)70285-7.CrossRefPubMedGoogle Scholar
  7. 7.
    Geschwind JF, Kudo M, Marrero JA, Venook AP, Chen XP, Bronowicki JP, et al. TACE Treatment in Patients with Sorafenib-treated Unresectable Hepatocellular Carcinoma in Clinical Practice: Final Analysis of GIDEON. Radiology. 2016;279(2):630–40.  https://doi.org/10.1148/radiol.2015150667.CrossRefPubMedGoogle Scholar
  8. 8.
    Chao Y, Chung YH, Han G, Yoon JH, Yang J, Wang J, et al. The combination of transcatheter arterial chemoembolization and sorafenib is well tolerated and effective in Asian patients with hepatocellular carcinoma: final results of the START trial. Int J Cancer. 2015;136(6):1458–67.  https://doi.org/10.1002/ijc.29126.CrossRefPubMedGoogle Scholar
  9. 9.
    Yu JI, Park HC. Radiotherapy as valid modality for hepatocellular carcinoma with portal vein tumor thrombosis. World J Gastroenterol. 2016;22(30):6851–63.  https://doi.org/10.3748/wjg.v22.i30.6851.CrossRefPubMedPubMedCentralGoogle Scholar
  10. 10.
    Huang M, Lin Q, Wang H, Chen J, Bai M, Wang L, et al. Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT: a retrospective matched cohort study. Eur Radiol. 2016;26(10):3428–36.  https://doi.org/10.1007/s00330-015-4198-x.CrossRefPubMedPubMedCentralGoogle Scholar
  11. 11.
    Luo JJ, Zhang ZH, Liu QX, Zhang W, Wang JH, Yan ZP. Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus. Hep Intl. 2016;10(1):185–95.  https://doi.org/10.1007/s12072-015-9663-8.CrossRefGoogle Scholar
  12. 12.
    Lu J, Guo JH, Zhu HD, Zhu GY, Chen L, Teng GJ. Safety and efficacy of irradiation stent placement for malignant portal vein thrombus combined with transarterial chemoembolization for hepatocellular carcinoma: a single-center experience. JVIR. 2017;28(6):786–94.e3.  https://doi.org/10.1016/j.jvir.2017.02.014.CrossRefPubMedGoogle Scholar
  13. 13.
    Zhang FJ, Li CX, Jiao DC, Zhang NH, Wu PH, Duan GF, et al. CT guided 125iodine seed implantation for portal vein tumor thrombus in primary hepatocellular carcinoma. Chin Med J. 2008;121(23):2410–4.PubMedGoogle Scholar
  14. 14.
    Luo J, Yan Z, Liu Q, Qu X, Wang J. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. Journal of vascular and interventional radiology: JVIR. 2011;22(4):479–89.  https://doi.org/10.1016/j.jvir.2010.11.029.CrossRefPubMedGoogle Scholar
  15. 15.
    Yang M, Fang Z, Yan Z, Luo J, Liu L, Zhang W, et al. Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial. J Cancer Res Clin Oncol. 2014;140(2):211–9.  https://doi.org/10.1007/s00432-013-1568-0.CrossRefPubMedGoogle Scholar
  16. 16.
    Yu TZ, Zhang W, Liu QX, Li WH, Ma JQ, Zhang ZH, et al. Endovascular brachytherapy combined with portal vein stenting and transarterial chemoembolization improves overall survival of hepatocellular carcinoma patients with main portal vein tumor thrombus. Oncotarget. 2017;8(7):12108–19.  https://doi.org/10.18632/oncotarget.14520.CrossRefPubMedPubMedCentralGoogle Scholar
  17. 17.
    Zhu HD, Guo JH, Mao AW, et al. Conventional stents versus stents loaded with (125)iodine seeds for the treatment of unresectable oesophageal cancer: a multicentre, randomised phase 3 trial. Lancet Oncol. 2014;15:612–9.CrossRefGoogle Scholar
  18. 18.
    Zhu HD, Guo JH, Zhu GY, et al. A novel biliary stent loaded with (125)I seeds in patients with malignant biliary obstruction: preliminary results versus a conventional biliary stent. J Hepatol. 2012;56:1104–11.CrossRefGoogle Scholar
  19. 19.
    Yao LH, Su L, Liu L, Sun HT, Wang JJ. Stenting of the Portal Vein Combined with Different Numbers of Iodine-125 Seed Strands: Dosimetric Analyses. Chin Med J. 2017;130(18):2183–9.  https://doi.org/10.4103/0366-6999.213974.CrossRefPubMedPubMedCentralGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and the Cardiovascular and Interventional Radiological Society of Europe (CIRSE) 2018

Authors and Affiliations

  1. 1.Department of Interventional Radiology, First Affiliated HospitalSoochow UniversitySuzhouChina
  2. 2.Department of Vascular and Interventional Radiology, Third Affiliated HospitalShihezi UniversityShiheziChina
  3. 3.Department of Interventional RadiologyThe Affiliated Changzhou NO.2 People’s Hospital of Nanjing Medical UniversityChangzhouChina

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