Skip to main content
SpringerLink
Log in

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

  • Original Paper
  • Published:
Journal of Cancer Research and Clinical Oncology Aims and scope Submit manuscript

An Erratum to this article was published on 26 February 2014

Abstract

Purpose

There was no standard treatment for hepatocellular carcinoma with portal vein tumour thrombosis (PVTT). This prospective, randomised, two-arm clinical trial aims to investigate the feasibility, safety and effectiveness of transarterial chemoembolisation (TACE) combined with the endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus conventional TACE.

Patients and methods

Eighty-five patients who met the eligibility requirements were randomly assigned to receive the treatment of TACE combined with the endovascular implantation of an iodine-125 seed strand (43 cases) or conventional TACE (42 cases). The end points were survival time, complications related to the procedure and adverse events.

Results

No significant differences in baseline characteristics were observed between groups. The mean and median survival times were 221.7 ± 16.3 days [95 % confidence interval (CI) 189.8–253.6 days] and 210.0 ± 17.5 days (95 % CI 175.8–244.2 days) in group A and 155.1 ± 7.9 days (95 % CI 139.6–170.5 days) and 154.0 ± 11.2 days (95 % CI 133.2–176.0 days) in group B (P = 0.000). The 90-, 180- and 360-day cumulative survival rates were 97.6, 58.9 and 12.3 % in group A and 92.5, 30.7 and 0 % in group B (P = 0.000).

Conclusion

Transarterial chemoembolisation combined with the endovascular implantation of an iodine-125 seed strand is feasible, safe and effective in the treatment for hepatocellular carcinoma with PVTT.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6

Similar content being viewed by others

References

  • Boettcher HD, Schopohl B, Liermann D, Kollath J, Adamietz IA (1994) Endovascular irradiation—a new method to avoid recurrent stenosis after stent implantation in peripheral arteries: technique and preliminary results. Int J Radiat Oncol Biol Phys 29(1):183–186

    Article  Google Scholar 

  • Bruix J, Sherman M, American Association for the Study of Liver D (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022. doi:10.1002/hep.24199

    Article  Google Scholar 

  • Chen Y, Wang XL, Yan ZP, Wang JH, Cheng JM, Gong GQ, Luo JJ (2012) The use of (1)(2)(5)I seed strands for intraluminal brachytherapy of malignant obstructive jaundice. Cancer Biotherapy Radiopharm 27(5):317–323. doi:10.1089/cbr 2011.0999

    Article  Google Scholar 

  • Connolly GC, Chen R, Hyrien O, Mantry P, Bozorgzadeh A, Abt P, Khorana AA (2008) Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 122(3):299–306. doi:10.1016/j.thromres.2007.10.009

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  • Guo JH, Teng GJ, Zhu GY, He SC, Fang W, Deng G, Li GZ (2008) Self-expandable esophageal stent loaded with I-125 seeds: initial experience in patients with advanced esophageal cancer. Radiology 247(2):574–581. doi:10.1148/radiol.2472070999

    Article  PubMed  Google Scholar 

  • Higaki I, Hirohashi K, Kubo S, Tanaka H, Tsukamoto T, Omura T, Kinoshita H (2000) Portal vein stenting to treat portal vein tumour thrombus in hepatocellular carcinoma. Osaka City Med J 46(2):99–104

    CAS  PubMed  Google Scholar 

  • Ii N, Yamakado K, Shouji K, Nomoto Y, Nakatsuka A, Nomura M, Yamashita Y, Takaki H, Akeboshi M, Senga M, Shiraki K, Takeda K (2007) Multimodality therapy using brachytherapy for caval tumour of hepatocellular carcinoma. Hepatogastroenterology 54(77):1522–1525

    PubMed  Google Scholar 

  • Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90. doi:10.3322/caac.20107

    Article  PubMed  Google Scholar 

  • Kim DY, Park W, Lim DH, Lee JH, Yoo BC, Paik SW, Kho KC, Kim TH, Ahn YC, Huh SJ (2005) Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma. Cancer 103(11):2419–2426. doi:10.1002/cncr.21043

    Article  PubMed  Google Scholar 

  • Kulik LM, Carr BI, Mulcahy MF, Lewandowski RJ, Atassi B, Ryu RK, Sato KT, Benson A 3rd, Nemcek AA Jr, Gates VL, Abecassis M, Omary RA, Salem R (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47(1):71–81. doi:10.1002/hep.21980

    Article  PubMed  Google Scholar 

  • Lai YC, Shih CY, Jeng CM, Yang SS, Hu JT, Sung YC, Liu HT, Hou SM, Wu CH, Chen TK (2003) Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumour thrombosis. World J Gastroenterol WJG 9(12):2666–2670

    CAS  Google Scholar 

  • Lau WY, Ho S, Leung TWT, Chan M, Ho R, Johnson PJ, Li AKC (1998) Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of (90) yttrium microspheres. Int J Radiat Oncol Biol Phys 40(3):583–592. doi:10.1016/s0360-3016(97)00818-3

    Article  CAS  PubMed  Google Scholar 

  • Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30(1):52–60. doi:10.1055/s-0030-1247132

    Article  CAS  PubMed  Google Scholar 

  • Liu MT, Li SH, Chu TC, Hsieh CY, Wang AY, Chang TH, Pi CP, Huang CC, Lin JP (2004) Three-dimensional conformal radiation therapy for unresectable hepatocellular carcinoma patients who had failed with or were unsuited for transcatheter arterial chemoembolisation. Jpn J Clin Oncol 34(9):532–539. doi:10.1093/jjco/hyh089

    Article  PubMed  Google Scholar 

  • Llado L, Virgili J, Figueras J, Valls C, Dominguez J, Rafecas A, Torras J, Fabregat J, Guardiola J, Jaurrieta E (2000) A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolisation. Cancer 88(1):50–57

    Article  CAS  PubMed  Google Scholar 

  • Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Haussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J, Group SIS (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390. doi:10.1056/NEJMoa0708857

    Article  Google Scholar 

  • Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, Bru C, Rodes J, Bruix J (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29(1):62–67. doi:10.1002/hep.510290145

    Article  CAS  PubMed  Google Scholar 

  • Luo J, Yan Z, Liu Q, Qu X, Wang J (2011) Endovascular placement of iodine-125 seed strand and stent combined with chemoembolisation for treatment of hepatocellular carcinoma with tumour thrombus in main portal vein. J Vasc Interv Radiol 22(4):479–489. doi:10.1016/j.jvir.2010.11.029

    Article  PubMed  Google Scholar 

  • Morris WJ, Keyes M, Palma D, Spadinger I, McKenzie MR, Agranovich A, Pickles T, Liu M, Kwan W, Wu J, Berthelet E, Pai H (2009) Population-based study of biochemical and survival outcomes after permanent I-125 brachytherapy for low- and intermediate-risk prostate cancer. Urology 73(4):860–865. doi:10.1016/j.urology.2008.07.064

    Article  CAS  PubMed  Google Scholar 

  • National Cancer Institution (2009) Common terminology criteria for adverse events (CTCAE) vesion 4.0

  • Pleguezuelo M, Marelli L, Misseri M, Germani G, Calvaruso V, Xiruochakis E, Pinelopi M, Burroughs AK (2008) TACE versus TAE as therapy for hepatocellular carcinoma. Expert Rev Anticancer Ther 8(10):1623–1641. doi:10.1586/14737140.8.10.1623

    Article  CAS  PubMed  Google Scholar 

  • Salem R, Lewandowski R, Roberts C, Goin J, Thurston K, Abouljoud M, Courtney A (2004) Use of Yttrium-90 glass microspheres (TheraSphere) for the treatment of unresectable hepatocellular carcinoma in patients with portal vein thrombosis. J Vasc Interv Radiol 15(4):335–345

    Article  PubMed  Google Scholar 

  • Yamada K, Izaki K, Sugimoto K, Mayahara H, Morita Y, Yoden E, Matsumoto S, Soejima T, Sugimura K (2003) Prospective trial of combined transcatheter arterial chemoembolisation and three-dimensional conformal radiotherapy for portal vein tumour thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 57(1):113–119

    Article  PubMed  Google Scholar 

  • Yamakado K, Tanaka N, Nakatsuka A, Matsumura K, Takase K, Takeda K (1999) Clinical efficacy of portal vein stent placement in patients with hepatocellular carcinoma invading the main portal vein. J Hepatol 30(4):660–668. doi:10.1016/s0168-8278(99)80197-4

    Article  CAS  PubMed  Google Scholar 

  • Zhang XB, Wang JH, Yan ZP, Qian S, Du SS, Zeng ZC (2009) Hepatocellular carcinoma with main portal vein tumour thrombus: treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolisation. Cancer 115(6):1245–1252. doi:10.1002/cncr.24139

    Article  PubMed  Google Scholar 

  • Zhang W, Yan ZP, Luo JJ, Fang ZT, Wu LL, Liu QX, Qu XD, Liu LX, Wang JH (2013) Iodine-125 Seeds strand for treatment of tumour thrombus in inferior vena cava: an experimental study in a rabbit model. Cardiovasc Intervent Radiol 36(5):1371–1382. doi:10.1007/s00270-013-0628-9

    Article  PubMed  Google Scholar 

  • Zhu HD, Guo JH, Zhu GY, He SC, Fang W, Deng G, Qin YL, Li GZ, Coldwell DM, Teng GJ (2012) A novel biliary stent loaded with I-125 seeds in patients with malignant biliary obstruction: preliminary results versus a conventional biliary stent. J Hepatol 56(5):1104–1111

    Article  CAS  PubMed  Google Scholar 

Download references

Conflict of interest

None.

Author information

Authors and Affiliations

  1. Department of Interventional Radiology, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, 200032, China

    MinJie Yang, ZhuTing Fang, ZhiPing Yan, JianJun Luo, LingXiao Liu, Wen Zhang, LinLin Wu, JingQin Ma, QingHui Yang & QingXin Liu

  2. Department of Interventional Radiology, Provincial Hospital of Fujian Province, Teaching Hospital of Fujian Medical University, Fuzhou, China

    ZhuTing Fang

Authors
  1. MinJie Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. ZhuTing Fang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. ZhiPing Yan
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. JianJun Luo
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. LingXiao Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Wen Zhang
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. LinLin Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. JingQin Ma
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. QingHui Yang
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. QingXin Liu
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to QingXin Liu.

Additional information

MinJie Yang and ZhuTing Fang have contributed equally to this work.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Yang, M., Fang, Z., Yan, Z. 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 140, 211–219 (2014). https://doi.org/10.1007/s00432-013-1568-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00432-013-1568-0

Keywords

Search

Navigation