Preliminary Research Of TACE Combined With¹²⁵I Radioactive Seeds Implantation In Treatment Of Intractable Hepatic Carcinoma

Objective:To investigate the clinical value of ultrasound-guided125I radioactive seeds implantation for the treatment of intractable hepatic carcinoma lesions.Materials and Methods:A total of18patients with hepatic carcinoma which had been diagnosed by pathology or clinical evidence were studied. The patients were all the inpatients of the2nd Affiliated Hospital of Zhejiang University School of Medicine between May2010and June2013. The25target lesions from18patients were examined by CT and MR imaging before interventional procedure and in6and12months respectively after interventional procedure.Tl-weighted imaging(TlWI),T2-weighted imaging(T2WI), dynamic contrast-enhanced MR imaging and diffusion-weighted imaging (DWI) were performed in MR examination. The localization of125I radioactive seeds was observed by CT. mRECIST standard,EASL standard,the volume of viable tumor standard, T2WI and DWI on MRI and ADC values were used to evaluate the curative effect of125I radioactive seeds implantation on intractable hepatic carcinoma lesions in6and12 months respectively, we also compared the preoperative and postoperative AFP values.Results:Among25lesions from18patients,13lesions from10patinets were hypervascular lesions and12lesions form8patients were hypo vascular lesions. All the patients had been followed up for12months. CR,PR,SD and PD of13hypervascular lesions were10,0,3and0respectively in postoperative6months and12,1,0and0in postoperative12months according to the mRECIST and EASL standard. Effective rates of125I seeds radioactive implantation in the postoperative6and12months were76.92%and100.00%according to the mRECIST and EASL standard.12hypovascular lesions from8patients were not be evaluated, because mRECIST and EASL standard were not suitable to assess the curative effect of hypovascular lesions. CR,PR,SD and PD of25lesions were17,4,4and0respectively in postoperative6months and23,1,1and0respectively in postoperative12months according to the volume of viable tumor standard. Effective rates of125I radioactive seeds implantation in the postoperative6and12months were84.00%and96.00%according to the volume of viable tumor standard. CR,PR,SD and PD of13hypervascular lesions were10,1,2and0respectively in postoperative6month and12,1,0and0in postoperative12months according to the volume of viable tumor standard. Effective rates of125I radioactive seeds implantation in the postoperative6and12months were84.62%and100.00%according to the volume of viable tumor standard. CR,PR,SD and PD of12hypovascular lesions were7,3,2and0respectively in postoperative6month and11,0,1and0in postoperative12months according to the volume of viable tumor standard. Effective rates of125I radioactive seeds implantation in the postoperative6and12months were83.33%and91.67%according to the volume of viable tumor standard. After125I radioactive seeds treatment T2WI, DWI in tumors showed reduced signal, suggesting a favorable outcome. The mean ADC values of target lesions were1.37±0.45mm2/s,1.83±0.35mm2/s respectively in preoperative and postoperative6months,1.37±0.45mm2/s,1.98±0.58mm2/s in preoperative and postoperative12months. The mean ADC values before and after the interventional procedure in two periods showed statistical significance (Z=-4.287, P=0.000; Z=-4.258,P=0.000). In the8patients who had high level of AFP value before125I radioactive seeds therapy, the AFP values were decreased in3patients in postoperative6months and4patients in postoperative12months. Implantation metastasis in one patient and2seeds translocation in2patients occurred.Conclusions:125I radioactive seeds implantation offers significant therapeutic benefit in treating intractable hepatic carcinoma lesions. mRECIST standard、EASL standard and the volume of viable tumor standard may all be used to evaluate the treatment effect of125I radioactive seeds implantation, whereas the volume of viable tumor standard has been proved to be a more scientific and more accurate method comparing with mRECIST standard、EASL standard. T2WI, DWI derived from MRI offer main evidence to assess the curative effect for hypovascular lesions due to their high accuracy and high credibility.