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Integrated I-125 Seed Implantation Combined with Transarterial Chemoembolization for Treatment of Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombus

  • Clinical Investigation
  • INTERVENTIONAL ONCOLOGY
  • Published:
CardioVascular and Interventional Radiology Aims and scope Submit manuscript

Abstract

Purpose

To compare the safety and efficacy of integrated iodine-125 (I-125) seed implantation (sequential implantation of helical I-125 seed implant into the main portal vein and of I-125 seeds into the branch tumor thrombus directly forming main portal vein tumor thrombus (MPVTT)) combined with transarterial chemoembolization (TACE) versus TACE alone for hepatocellular carcinoma (HCC) with MPVTT.

Materials and Methods

From December 2016 to January 2020, 46 HCC patients with MPVTT were analyzed. In the combination group, 21 patients received helical I-125 seed implantation in the main portal vein through a patent small portal vein branch and TACE in a single session. After 7–10 days, I-125 seeds were implanted percutaneously into the branch tumor thrombus directly forming MPVTT. In the TACE group, 25 patients received TACE alone. Thereafter, TACE was repeated as needed in both groups. Adverse events, tumor response, and overall survival (OS) of the two groups were compared.

Results

No adverse events grade ≥ 3 were observed in either group. The optimal objective response rate and disease control rate for MPVTT in the combination group and TACE group were 52.4% versus 4.0% (P < 0.001) and 85.7% versus 32.0% (P < 0.001), respectively. Median OS in the combination group (9.8 months) was longer than in the TACE group (5.2 months) (P = 0.024). Multivariate analysis revealed that, compared with the TACE group, the mortality risk in the combination group significantly decreased (hazard ratio: 0.444; P = 0.020).

Conclusion

Integrated I-125 seed implantation combined with TACE is a safe and effective treatment for HCC with MPVTT.

Level of Evidence

Level 3, Non-randomized controlled cohort/follow-up study.

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Acknowledgements

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Funding

This study was supported by the Suzhou Science and Technology Bureau Project (No.SYS2019036), Suzhou People’s Livelihood Science and Technology Project (No. SS202059), Jiangsu Provincial Medical Talent funding (No.ZDRCA2016038), and the National Natural Science Foundation of China (No.81771945).

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Author notes

  1. Wansheng Wang, Chen Wang, Jian Shen and Baosheng Ren these authors contributed equally to this work.

Authors and Affiliations

  1. Department of Interventional Radiology, First Affiliated Hospital, Soochow University, No. 188 Shizi Road, Suzhou, 215006, China

    Wansheng Wang, Chen Wang, Jian Shen, Baosheng Ren, Yu Yin, Jun Yang, Haohuan Tang, Xiaoli Zhu & Caifang Ni

  2. Department of Vascular and Interventional Radiology, Third Affiliated Hospital, Shihezi University, Shihezi, 832000, China

    Chen Wang

  3. Department of Interventional Radiology, The Affiliated Changzhou NO.2 People’s Hospital of Nanjing Medical University, Changzhou, 213000, China

    Baosheng Ren

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  1. Wansheng Wang
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  2. Chen Wang
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  3. Jian Shen
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  4. Baosheng Ren
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  5. Yu Yin
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  8. Xiaoli Zhu
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  9. Caifang Ni
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Corresponding authors

Correspondence to Xiaoli Zhu or Caifang Ni.

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This retrospective study was approved by the local ethics committee. For this type of study, formal consent is not required.

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Wang, W., Wang, C., Shen, J. et al. Integrated I-125 Seed Implantation Combined with Transarterial Chemoembolization for Treatment of Hepatocellular Carcinoma with Main Portal Vein Tumor Thrombus. Cardiovasc Intervent Radiol 44, 1570–1578 (2021). https://doi.org/10.1007/s00270-021-02887-1

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  • DOI: https://doi.org/10.1007/s00270-021-02887-1

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