The Clinical Application Of CT Guided1251Seeds And Fluorouracil Implants Combined With Transcatheter Arterial Chemoembolization For Hepatocellular Carcinoma Patients With Portal Vein Tumor Thrombosis

Objective:To explore the feasibility, safety and efficacy of CT guided1251seeds and fluorouracil implants combined with Hepatic artery chemoembolization for liver cancer patients with Portal vein tumor thrombosis (PVTT).Methods:From February2006to May2013,51liver cancer with Portal vein tumor thrombosis(PVTT) underwent Hepatic artery chemoembolization and lodine-125seeds implantation in45patients (35male and10female; age35-75years, mean58.9years), all patients with pathologically diagnosed as primary hepatocellular carcinoma (HCC).7patients had the left Portal vein tumor thrombosis,9patients had the right Portal vein tumor thrombosis, both the main portal vein and the left portal vein were affected in11patients, both the main portal vein and the right portal vein were affected in12patients,6patients had the PVTT in Portal venous trunk and branch of portal vein.25cases of liver function were Child-Pugh A,20cases were Child-Pugh B.16cases were AJCC stage IⅡb,29cases were Ⅲa, TACE was first performed in the patients, lodine-125seeds and fluorouracil implants were implanted rightly in the PVTT by the CT guided after24-48h,The radioactivity of lodine-125seed is0.8-1.0mci The follow-up was1-6months, Local curative effect was analyzed according to the RECIST criteria, The patients’ physiclal status evaluated by the Karnofsky performance score(KPS), the1month,3months,6months,12months survival was evaluated by Kaplan-Meier survival analysis.Results: Overall the51experiences performed successfully, without serious complication, and observed for more than12months.(1)After1,2,4and6months, the effective rate of local tumor [CR+PR] were31.37%(16/51),47.06%(24/51)、78.43%(40/51),80.39%(41/51);(2) The improvement of the patients’physiclal status:the KPS exceed80before and after the operation were12,16,22,23,20.(3)There were no significant differences in peripheral blood cells, liver functions, renal functions and clotting mechanism.(4)The tumor markers degraded obviously,the effction rate were93.3%、86.7%respectively after three and six months. Celiac lymph nodes and retroperitonel lymph nodes metastasis were found in3patients,1patient suffered brain metastases. Hepatic subcapsular hemorrhage and local pain were seen in (6.67%)(3/45) and15.56%(7/45) respectively.After six months,1251seeds were found partial lost in two patients.Conclusion:CT-guided percutaneous implantation of1251seeds and fluorouracil implants combined with Hepatic artery chemoembolization for liver cancer patients with Portal vein tumor thrombosis (PVTT) is effective and safe, which has the advantage of the high local control rate and low complication.