| Background: Primary Hepatic Carcinoma( HCC) is one of the common gastrointestinal malignant tumors in China which has high case fatality rate. Either stages of liver cancer could invade the portal vein extremely easily, thus form the portal vein tumor thrombus(portal vein tumor thrombus, PVTT). The incidence of PVTT is 62.2%- 90.2%, and its prognosis is extremely poor, can lead to serious complications such as portal hypertension, ascites, collateral veins rupture hemorrhage etc. The natural death period of the patients whose main portal vein was invaded by PVTT is only 2.7 4 months. Though many traditional therapies were applied in the treatment of PVTT such as surgery, interventional therapy, radiotherapy, local damage therapy and targeted therapy, the therapeutic effects is always not satisfactory. The comprehensive therapy concentrated on surgery could excise tumor and tumor thrombus effectively, improve liver function, elevate the quality of living and lengthen the time period of survival,however the risk of surgery is high,and could lead to big trauma. The comprehensive concentrated in non-surgical treatment has little trauma, less risk, and can improve the control of local tumor thrombus, but the low efficiency and short alleviate period could no lead to radical cure of PVTT. High intensity focused ultra sound(High intensity focused ultra sound, HIFU) could focus the energy of ultra sound, thus lead to the treatment of solid tumors non-invasively. HIFU is more safe and non-invasive in the treatment of PVTT than traditional therapies. HIFU combined 125 I implantation therapy provide a new effective therapeutic method for PVTT. Though HIFU combined 125 I implantation therapy is already applied in the treatment of PVTT, few researches were designed to study the safety and efficacy of this therapy. Ablation rate established by WHO were conventionally used to evaluate the clinical effects for the treatment of PVTT,however,there is no study was performed to study the distance of retrograde invasion of PVTT in portal vein.Purpose: To study the clinical application of HIFU combined 125 I implantation therapy in the treatment of primary hepatic carcinoma(HCC) complicated with PVTT and discuss the safety and efficacy.Method : Thirty three patients with primary hepatic carcinoma complicated PVTT hospitalized during March 2011 to December 2015 were included to retrospectively analyzed. All patients received ultrasound guided 125 I implantation in tumor thrombus before received HIFU for the treatment of lesions in the liver and tumor thrombus in 7 days according to the conditions of patients, all operation were accomplished by same group of doctor. The distance of retrograde invasion of PVTT in portal vein in 3 month after the operation was measured to evaluate the ablation rate of HIFU combined 125 I implantation therapy in PVTT. Clinical characteristics such as liver function, coagulation and alpha fetoprotein(alpha fetoprotein, AFP) were compared before and after operation. All cases were followed and the survival period was analyzed to assess the influence of different types of tumor thrombus in the prognosis of PVTT.Results: All of 33 patients successfully accomplished the treatment. No patient occurred any of the severe operation complications such as bleeding, skin burns, defulvium of tumor thrombus and hepatic failure in or 3 days after operation. Epigastria enhanced MRI or CT took in 3 month follow up after operation showed that, the average invasion distance of PVTT in portal vein is 5.94 mm, median invasion distance is 0mm, and the percent of patients with 0 mm invasion distance is 69.7%. The average survival period was 18.9±3.6 months, the median survival period as 14.8 months. The survival rate of 6 month, 9 months, 1 year and 2 year was 89.1%, 71.1%, 64.6% and 24.1%, respectively.Conclusion: HIFU combined 125 I implantation therapy is a safe, mini-invasive and effective for the treatment of PVTT. |
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