Evaluation Of Iodine-125 Seed Implantation Combined With TACE In The Treatment Of Portal Vein Tumor Thrombus

Objective To assess the clinical values and prognosis of CT-guided iodine-(125)~ seed implantation as a novel therapeutic modality for portal vein thrombus (PVTT) due to hepatocellular carcinoma (HCC).Methods Sixty-four HCC patients with PVTT from December 2008 to December 2010 were enrolled in this study. According to the treatment planning system (TPS), CT-guided iodine-(125)~ seed therapy was performed with the prescription dose of 100～120 Gy after transcatheter arterial chemoembolization (TACE). Clinical characteristics were noted, including serum alpha fetoprotein (AFP), alanine aminotransferase (ALT), aspartate aminotransferase (AST), total bilirubin (TBIL), white blood cell (WBC), platelets (PLT) and sizes of thrombus of the PVTT patients before and after this therapeutic modality. Furthermore, the treatment efficiency, median survival time and one or two-year survival rate were assessed. Finally, all patients were evaluated for prognostic factors, such as age, location and size of thrombus, and levels of liver function.Results The one-year and two-year survival rates were 44.3%±7.5% and 28.5%±10.0% respectively with CT-guided iodine-(125)~ seed implantation therapy. The general survival period was 14.88±1.64 month. Complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD) were observed in 5, 33, 20 and 6 patients respectively. The response rate (CR+PR) and disease control rate (CR+PR+SD) were 59.37% and 90.62%. The alpha fetoprotein (AFP) levels and PVTT sizes decreased significantly (P=0.001) after treatment. The levels of liver function markedly affect the prognosis of patients, while age (>60 vs.≤60), PVTT location (main trunk vs. left/right branches) and PVTT size (>3cm vs.≤3cm) were not significant factors for survival (P>0.05).Conclusion CT-guided iodine-(125)~ seed implantation can markedly improve the therapeutic effect with the advantages of minimally invasion, rapid recovery and limited complication. It might be a promising and effective strategy for PVTT associated with advanced HCC. Furthermore, it was found that the levels of liver function of patients act as one of prognosis factors.