Abstract:
Objective
To compare the therapeutic effect of TACE combined with or without endovascular implantation of iodine-125 seeds strand for hepatocellular carcinoma（HCC）with extensive portal vein tumor thrombus（PVTT）with randomized design.
Methods
From May-2011 to Dec 2012，62 patients of HCC with extensive PVTT who received TACE were randomized divided into group A（conbined with，30 cases）and group B（without，32 cases）endovascular implantation of iodine-125 seeds strand were analyzed retrospectively.TACE was performed after the iodine-125 seed strand implanted in the target segment of PVTT.Adverse events，laboratory tests and abdominal constrast CT results between two groups were compared.Kaplan-Meier method was used for analyzing for survival rate.
Results
The objective remission rate of lesions was 10.0%（CR in 1 and PR in 6）in group A and 28.1%（CR in 2，PR in 7）in group B（χ2=3.259，P=0.071）.The mean number of iodine-125 seed was 20.4±4.4（14—32）for every patient.The recanalization rate of portal vein was 28.1%in group B higher than 0 in group A（χ2=7.734，P=0.005）.Technical success rate was 100.0%for implantation of iodine-125 seeds strand in the target segment of PVTT.No serious procedure related complications occurred in two group.The mean and median survival time was（153.8±9.9）d（95%CI：134.5—173.1）and（150.0±10.9）d（95%CI：128.6—171.4）in Group A and（221.5±19.2）d 95%CI：183.8—259.1）and（190.0±24.7）d 95%CI：141.6—238.4）in Group B，respectively（χ2=10.973，P=0.001）（HR（A：B）=2.577，95%CI：1.437—4.623，P=0.001）.The 90，180，360 d cumulative survival rates were 89.7%，28.7%and 0 in group A and 96.8%，56.0%and 15.2%in group B，respectively.In group with recanalization of portal vein（group Bl，9 cases），the mean and median survival time were（306.9±45.6）d（95%CI：217.5—396.2）and（264.0±41.7）d（95%CI：182.3—345.7），respectively and the 90，180，360 d cumulative survival rates were 100.0%，87.5%and 40.0%respectively.While in group without recanalization of portal vein（group B2，23 cases）the mean and median survival time were（189.5±16.5）d（95%CI：157.2—221.9）and（175.0±20.4）d（95%CI：134.9—215.1），respectively and the 90，180，360 d cumulative survival rates were 95.5%，43.2%and 6.4%，respectively.There was statistically significant difference between two groups（χ2=5.105，P=0.024）（HR（B2∶B1）=2.960，95%CI：1.100—7.969，P=0.032）.
Conclusion
TACE combined with endovascular implantation of iodine-125 seeds strand is an effective treatment for HCC with extensive PVTT.
Key words:
Carcinoma,hepatocellular,
Iodine-125 seed,
TACE,
Portal vein,
Tumor thrombus
Zhu-ting FANG, Zhi-ping YAN, Jian-jun LUO, Qing-xin LIU, Xu-dong QU, Wen ZHANG, Ling-xiao LIU, Lin-lin WU, Min-Jie YANG, Jian-hua WANG. Radomized comparative study of hepatocellular carcinoma with extensive portal vein tumor thrombus treated by TACE combined with or without endovascular implantation of iodine-125 seeds strand[J]. Chinese Journal of Interventional Radiology(Electronic Edition), 2013, 01(01): 8-12.