Tace Combined With Iodine-125Seeds Implantation For The Treatment Of Primary Hepatocellular Carcinoma With Portal Vein Tumor Thrombus

Background and PurposePrimary hepatocellular carcinoma (PHC) is the second most commonmalignacies in our country, Primary hepatocellular carcinoma patients oftencombined with portal vein tumor thrombosis, the rate was62.2%~90.2%, portalvein tumor thrombus formation is an important factor of tumor recurrence, metastasis,and blood-borne transmission, especially when the portal vein tumor thrombusgrowth along in main thoroughfare,which indicated a worse prognosis,the portal veintumor thrombus could lead to widespread metastatic tumors in the liver, inducedesophageal and gastric vein variceal bleeding or liver failure, the natural course ofonly2.7to4months.Hepatocellular carcinoma with portal vein tumor thrombus was once a restrictedarea of treatment, with the development of medical technology and more in-depthknowledge of the disease, there are a variety of treatments, including surgicalresection, transcatheter arterial chemoembolization(TACE),portal vein stentimplantation,external radiation therapy, percutaneous ethanol injection (PEI), a localradio frequency ablation, etc, but not yet established a standardized and uniformtreatment. Theoretically, surgical resection can be cured PVTT the most thorough, themost efficient method, but the indications for surgery has a low recurrence rate、highrisk of surgical、 more expensive,these important factors are restricted thedevelopment of surgery, TACE is a most common treatment for the primaryhepatocellular carcinoma, also effective for the pvtt which supplied with arterial, theliver toleranced to radiation is very poor, and the portal thrombosis is deeply inliver,the deep position of portal vein tumor thrombus limited the therapeutic effect ofexternal radiotherapy, portal vein stent in the treatment of portal vein tumor thrombushas disadvantages of high recurrence rate and stent restenosis more invasive, efficacy,side effects, broad indications of treatment worthy of further discussion and research.From October2010to May2013,the patients treated in our hospital withprimary hepatocellular carcinoma with portal vein tumor thrombus as the object ofstudy, first used transcatheter arterial chemoembolization (TACE) treatment ofintrahepatic primary tumor, and then under CT guidance in portal vein thrombosis(PVTT) within125I seed implantation, investigate the clinical efficacy of125I seedscombined with transcatheter arterial chemoembolization (TACE) treatment ofprimary hepatocellular carcinoma with portal vein tumor thrombus, analysisthrombus location, type, patients liver function, the relationship between age andtumor markers (AFP) and other factors associated with survival. Evaluation of125Iseeds combined with transcatheter arterial chemoembolization (TACE) forhepatocellular carcinoma (primary hepatocellular carcinoma, PHC with portal veinthrombosis portal vein tumor thrombus(PVTT) clinical value.Materials and MethodsA retrospective analysis on32cases of patients with primary hepatocellularcarcinoma with portal vein tumor thrombus, which all patients were treatedintrahepatic primary tumor by TACE first. Then underwent CT-guided percutaneousimplanted radioactive Iodine-125seeds in the portal vein tumor thrombus.Observingthe change of tumor thrombus after treatment and analysing the treatment efficiency,disease control rate, median survival,1-year and2-year survival rate in order to explore the efficacy.ResultsAfter treatment, CR in1.PR in15.SD in9,PD in7. Total effective ratewas59.38%of all patients and the disease control rate was87.50%, with an averagesurvival period of15.89months.1year and2-year survival rates were49.6%±10.2%and25.5%±10.2%.Conclusion1．Local efficacy TACE combined with125I radioactive seeds implantation could controlthe portal vein thrombosis effectively, some patients may achieved recanalization, this group ofpatients in the treatment of thrombosis disease control rate (DCR) was68.8%, efficiency (CR+PR)was65.6%2．Portal vein diameter Before treatment was13.85±3.18mm, after2months reviewwas1.18±2.11mm,(P <0.01)3．Survival1-year survival was49.6%%;2-year survival rate was25.5%; median survivaltime was15.89months; Child-pugh A-level median survival was18.92months,1-year survivalrate was59.9%%. Child-pugh B grade median survival was11.14months,1-year survival ratewas34.6%4．Prognostic factor arteriovenous fistula (P <0.004) extrahepatic metastasis (P <0.008)tumor type (P <0.009) tumor thrombus type*(P <0.001)...