The Clinic Value Of Hepatocellular Carcinoma And Portal Vein Tumor Thrombus Treated By ¹²⁵I Combined With High Intensity Focused Ultrasound

Background &AimsHepatocellular carcinoma（HCC） is regarded as one of the most common cancers around the world. Portal vein tumor thrombus（PVTT） is one of the complication of HCC which has the high morbility rate about 62.2%-90.2% and median survival time which is about 3-4 months.At present, in the medical basic researches and clinical studies of combined therapy, surgical resection, interventional therapy, radiation treatment and radiofrequency ablation commonly used to treat HCC with PVTT. However, there are still lack of effective systemic therapies for those large size tumor thrombus with the encroachment on branch or trunk of portal vein.With the development of interventional therapy, implantation of ¹²⁵I brachytherapy seeds has become a promising treatment for tumors, due to the concentration to local tumor and the killing power of radionuclide. It was safe as well as effective for the treatment of HCC with PVTT. Although ¹²⁵I seeds has seen to be effective in the treatment of PVTT, its efficacy in combination with other established treatment such as high intensity focused ultrasound（HIFU） has seldom to be reported. It is an established fact that HIFU can improve the therapeutic effect, both in treatment of tumor thrombus and primary tumor. It is the synergy of ¹²⁵I seeds combined HIFU that may enhance the effect of treat HCC with PVTT. In this study, the safety, clinical efficacy and feasibility of ¹²⁵I seeds in combination with HIFU were evaluated in the patient of HCC with PVTT.MethodsNineteen patients（17 men and 2 women） with HCC and PVTT were enrolled in this study from March 2011 to October 2013. PVTT was distributed into three grades, depends on the extent of tumor thrombus, patient of grade Ⅰ to Ⅲ were 8, 7 and 4. All patient in our study underwent implantation of ¹²⁵I brachytherapy seeds and HIFU(The 18.5 MBq radioactivity per a ¹²⁵I seed,the matched peripheral dose（MPD） was 80 to approximately 120 Gy. HIFU parameters: ultrasound wave frequency, 0.85 m Hz; output power, 200³00 W; total treatment time, 33-70min). CT scan or MRI, clinical symptoms, blood cell counts, liver function were recorded before and after treatment. The Kaplan-Meier method was used to analyze the survival rates, all statistical analyses were carried out with SPSS software, version19.0（SPSS Inc.）. All reported p-values were two-sided, with p<0.05 considered statistically significant.ResultsThe treatments was successfully completed in all the patients. No serious complications such as postoperative bleeding, cancer embolus shedding or acute liver function failure occurred. The most frequent adverse event was the abdomen pain, of the 17（89.5%） patients in the group, 5（26.3%） had a fever at 37.9³9.4℃, usually occurred 2-12 h after treatment and lasts 2-10 days, and 5（26.3%） had nausea and vomiting.The change of blood cell and liver function before and one month after treatment were evaluated. Statistical analysis showed that the change of total bilirubin（P=0.015） was statistical significant. And those of leukocytes（P=0.817）, platelet（P=0.238）, albumin（P=0.241）, Aspartate Aminotransferase（P=0.640）, alanine aminotransferase（P=0.301） had no statistical significant. After 1 month review, the effective rates（CR+PR+SD） was 68.42%. The one-year and two-year survival rate was 47.4% and 7.9% respectively. The median postoperative survival time of patients with PVTT of gradeⅠ to grade Ⅲ was 13.5, 7 and 4 months, respectively. Three cases survived more than 20 months.ConclusionThe combination of implantation of ¹²⁵I brachytherapy seeds and HIFU are effective, both in the treatment of PVTT and HCC. And the ¹²⁵I seeds are well tolerated by those patients. The combination treatment may be a promising therapeutic modality for HCC with PVTT.