TACE Combined With CT-guided ¹²⁵I Radioactive Seed Implantation For Primary Hepatic Carcinoma Adjacent To The Hepatic Hilum

ObjectiveTo discuss the safety and feasibility of transarterial chemoembolization（TACE）combined with CT-guided ¹²⁵I radioactive seed implantation in treating primary hepatic carcinoma adjacent to the hepatic hilum.Materials and MethodsRetrospectively collected the clinical data of the Second Affiliated Hospital of Guangzhou Medical University interventional radiology department in July 2016 to February 2018,finally a total of 24 cases were diagnosed by clinical or pathological in patients with primary hepatic carcinoma adjacent to the hepatic hilum,and patients with initial and postoperative recurrence were included in the study.20 cases of male and 4 cases of female,age 28⁷5,average（51.6±12.8）,including 21 cases of hepatocellular carcinoma and 3 cases of cholangiocarcinoma.TACE combined with CT-guided ¹²⁵I radioactive seed implantation was carried out in all 24patients.We collected baseline characteristics included age（<50/50 or higher）,portal vein tumor thrombus（PVTT）（with/without）,cirrhosis（with/without）,hepatitis B（with/without）,extrahepatic metastasis（with/without）,Child-Pugh grade of liver function（grade A/B）,tumor source（cholangiocarcinoma/hepatocellular carcinoma）,the lesion size（<5 cm/5 cm or higher）,etc.Before surgery,all patients were preoperatively performed a CT or MRI dynamic enhancement scanning to exclude the surgical contraindications.Transarterial chemoembolization was first performed in patients,then a CT scan was performed on the 3rd day after surgery,and combined with preoperative enhanced image data to verify the size and location of the tumor and its adjoining relationship with the surrounding organs,and the postoperative situation of TACE.A treatment plan was made for each patient by using a computerized treatment plan system（TPS）based on the patient’s imaging data.With CT guidance,¹²⁵I radioactive seeds were placed into the tumor which adjacent to the hepatic hilum based on the TPS.Both TACE and ¹²⁵I radioactive seed implantation were performed with local anesthesia.The patients were checked on the blood,coagulation function and liver function in 3 days after seed implantation.A CT or MRI dynamic enhancement scanning was performed every 4 to 6 weeks during the follow-up.The modified response evaluation criteria in solid tumors（mRECIST）was used to evaluate the short-term efficacy.The disease control rate（DCR）was defined as the total percentages of patients who were evaluated as CR,PR or SD according to the above criteria after combined treatment,and the percentage of patients who lasted for at least 4 weeks,namely the DCR=（CR+PR+SD）x100%.Kaplan-Meier method is used to evaluate the median overall survival time（mOS）,and analyze the factors influencing survival time and survival outcome by multivariate Cox regression model based on the patient’s baseline characteristics and follow-up time and ending.Results1、All operations succeeded.More than 70 cases of TACE were performed,about 3cases per person.56 cases of ¹²⁵I seed implantation were performed,about 2.33 cases per capita.About 12 to 50 seeds were implanted per case,and the total number of particles was 1838,and the average number of particles of each patient was 76.6.A CT or MR reexamination was porformed two months after operation and fined out 2cases of CR（8.3%）;8 cases of PR（33.3%）;SD 8 cases（33.3%）,the response rate（RR）was 41.7%（CR 2,PR 8）,and the disease control rate（DCR）was 75%.The predicted median overall survival（mOS）was 10 months respectively（95%CI:6.712¹3.288 months）,the median time to tumor progression（mTTP）was 6 months（in range of 1 to 11 months）.The follow-up time of 24 patients was up to February 2018,and the median follow-up time was 6 months（in range of 2 to 18 months）.During the follow-up,10 patients died,including 7 cases of tumor progression and 3 cases of liver failure.Fourteen patients survived the follow-up period.2、In multivariate analysis,combined portal vein tumor thrombus was an independent prognostic factor of the survival time of patients underwent TACE and ¹²⁵I radioactive seed implantation（RR=0.079,95%CI:0.009⁰.661,P=0.019）,The mortality risk of patients with portal vein tumor thrombus was 12.648 times that of patients without combined portal vein tumor thrombus（95%CI:1.513¹05.727）.3、The surgical complications included 5 cases with abdominal distension and pain（20.8%）,3 cases of Nausea and vomiting（12.5%）,jaundice in 2 cases（8.3%）,blood oxygen decreased in 2 cases（8.3%）,fever in 1 case（4.2%）,and pneumothorax in 1case（4.2%）,all can be alleviated after giving symptomatic treatment.2 cases of seed migration（8.3%）,and 1 case of hepatic subcapsular fluid（4.2%）,which did not require special treatment.There were no serious complications such as bone marrow suppression,hemorrhage,bile leakage,etc.Conclusion1、TACE combined with ¹²⁵I radioactive seed implantation in the treatment of primary hepatic carcinoma adjacent to the hepatic hilum had a good recent clinical effect.2、The combination of portal vein tumor thrombus independently affected of the survival time of patients underwent TACE and ¹²⁵I radioactive seed implantation.3、TACE combined with 125I radioactive seed implantation in the treatment of primary hepatic carcinoma adjacent to the hepatic hilum was relatively safe,with no serious complications.