The Study Of Metallic Stent Implantation Combined By External Radiation Therapy In HCC Patients With Portal Vein Tumor Thrombus

Part One: The Experimental Study of the Effect on Liver Function and Portal Vein of Domestic Pigs by Stent in Portal Vein Combined by External RadiationObjective: To evaluate the effect on liver function and portal vein by stent in portal vein combined by external radiation.Materials and Methods: Ten domestic pigs were divided into A and B groups. There were five in A group. They were treated by stent in portal vein combined by external radiation, namely experimental group. The control group labeled by B was only treated by external radiation simply. Group A was installed the metal internal stent in portal vein and then after one week radiated externally to the region of portal vein. The two groups were both radiated once a week,5 Gy per time, three times continuously. Four weeks after the third time external radiation, the pigs were put to death and taken out of the liver tissue samples of radiating and non-radiating region and portal vein sample . The pathological changes of portal vein were observed by macrography, light microscope and electron microscope. The pathological changes of liver tissue samples in radiating region and non-radiating region were observed by macrography and light microscope. Before placing the stents and executing the pigs in group A, or before external radiation and executing the pigs in group B, the vein blood was drawn respectively to investigate serum total bilirubin, direct bilirubin and glutamate-pyruvate transaminase.Results: There was no obvious difference between experimental group and control group pigs about the pathological changes of portal vein and the radiating regional liver tissue. There was also no difference in the liver function between two groups.Conclusion: The injury to liver and portal vein from portal vein stent combining with external radiation was no bigger than that from external radiation simply. There was important referential clinical effect on the therapy of hepatocellular carcinoma patients with portal vein tumor thrombus who could be treated by placing stent accompanied by radiotherapy. Part Two: The Clinical Study of the Portal Venous Pressure Change due to Metallic Stents Implanted into Portal Veins in HCC PatientsObjective: To research the change of the portal venous pressure after the stents were implanted into portal vein in HCC patients.Materials and Methods: 15 HCC patients who were suffering from portal venous stem embolization were included in this study. The portal venous pressures were recorded before varices embolized (P1), after embolized (p2) and after stents implanted (p3), respectively. The pressures included portal vein stem (PV), portal vein branch without tumor invaded (PVB), splenic vein (SV) and superior mesenteric vein (SMV).Results: In PV group, P1 was 45.13±7.17 cmH₂O, and P2 was 48.27±6.63 cmH₂O, P=0.00 < 0.05, P3 was 39.47±7.63 cmH₂O, thus P=0.00 < 0.05 compared with P2. In PVB group, P1 was 38.07±9.25 cmH₂O, and P2 was 38.67±9.24 cmH₂O, P=0.47 > 0.05, P3 was 37.33±7.51 cmH₂O, compared with P2, P=0.30 > 0.05. In SV group, P1 was 44.53±6.65 cmH₂O, and P2 was 48.13±7.14 cmH₂O, P=0.001 <0.05, P3 was 41.53±6.88 cmH₂O, compared with P2, P=0.001 <0.05. In SMV group, P1 was 45.20±6.97 cmH₂O, P2 was 48.33±6.90 cmH₂O, P=0.000<0.05, P3 was 41.20±7.13 cmH₂O, compared with P2, P=0.000 <0.05.Conclusions: In portal vein stem embolization patients, portal venous pressure are higher after varices embolized than before, and they are lower after stents implanted into portal veins.Part Three: The preliminary study of metallic stent implantation combined by three-dimensional conformal radiation therapy in HCC Patients with Portal Vein Tumor ThrombusObjective: To study the clinical efficiency of metallic stent implantation combined by three-dimensional conformal radiation therapy in HCC Patients with Portal Vein Tumor Thrombus.Materials and Methods: Two groups of HCC patient with portal vein tumor thrombus were retrospectively analyzed. There are 10 cases in group A, which were treated by stent implantation and TACE and 3DCRT. There were 12 cases in group B, which were treated by stent implantation and TACE. The rate of success, stenosis re-open, complications after interventional therapy, radiotherapy reaction, stent pantency period and survival period were recorded.Results: (1)The portal vein catheterization was successful in all patients in the two groups(The successful rate was 100%). The stent implantations catheterized through transhepatic approach were successful in all patients in the two groups. The rate of stent-implanted success was 100%. (2)24 stents were implanted in 22 cases. The rate of stenosis re-open was 100%. (3)There was no abdominal hemorrhage in all patients. Because of PTVE and TACE performed synchronously, all patients had the symptoms of abdominalgia, abdominal distension, nausea and vomiting in different degree, which were relieved in one week. (4)A11 patients in group A completed the treatment. I II degree gastrointestinal tract reaction occurred in 3 cases, and were completely relieved after expectant treatment. I～II degree myelosuppression occurred in 2 cases, and completely recovered after treated by G-CSF and IN-11. (5)The stent patency rate of 4, 6 and 12 months in group A was 90%,70%, 30%. In group B it was 50%,25%,16.7%. Diagnosis analysis was assessed by the Long-Rank test. As a result there was significant difference between the patency of the two groups(P<0.05). (6) The survival rate of 3, 6 and 12 months in group A was 100%, 80%, 30%. In group B, it was 91.7%,41.7%,16.7%. Diagnosis analysis was assessed by the Long-Rank test. As a result there was significant difference between the survival curves of the two groups(P<0.05).Conclusions: Survival rate of 3, 6, 12 months in the HCC patients with portal vein tumor thrombus, who were treated by stent implantation and TACE and 3DCRT, was 100%, 80%, 30%, the median survival time was 10 months. (2) Stent implantation combined with three-dimensional conformal radiation therapy has a better therapeutic effect on hepatocellular carcinoma with portal vein tumor thrombus. (3) Stent implantation combined with three-dimensional conformal radiation therapy causes less damage to liver.