| Objective To evaluate the efficacy of transcatheter arterial chemoembolization embolism(TACE)combined with iodine 125(iodine 125,125I)seed implantation or radiofrequency ablation in the treatment of hepatocellular carcinoma(HCC).Materials and methods From January 2010 to January 2016,158 patients with primary hepatocellular carcinoma were treated with TACE in our hospital,then the residual surviving tumor were treated with iodine 125 seed implantation or radiofrequency ablation.The clinical data were analyzed retrospectively.According to the different treatment methods,they were divided into group A and group B.The former was TACE combined with 125I(A group),and the latter was TACE combined with RFA(B group).There was no significant difference in baseline characteristics between the two groups.After TACE treatment,there were 170 residual survival lesions in the two groups.There were 82 cases with 88 lesions in group A and 76 cases with 82 lesions in group B.The difference of local curative effect,survival time,survival rate and survival time without disease progression were compared between the two groups.Results In the Group A,58 patients with AFP positive all decreased 1 month after operation,with an average decrease of 51.49%.Of which,24 cases(41.38%)were reduced to normal levels.After 3 months,the overall AFP level decreased by 64.77% on average compared with that before operation.38 cases(65.52%)were reduced to normal.After 6 months,3 cases(5.17%)increased significantly,and increased by 79.31%,which exceeded the preoperative AFP level,and showed recurrence of liver cancer on imaging.14 cases(24.14%)decreased by 78.74%.41 cases(70.69%)decreased to normal.In group B,55 patients with AFP positive all decreased 1 month after operation,with an average decrease of 43.86%.21 cases(38.18%)AFP decreased to normal.After 3 months,the AFP level of 55 cases decreased by 59.74%.35 cases(63.64%)were reduced to normal.After 6 months,the AFP of 7 cases(12.73%)increased significantly(increased by 57.81%),which exceeded the preoperative value.Imaging examination showed that the tumor progressed.In 14 cases(25.45%),the average decrease was 56.62%.34 cases(61.82%)decreased to normal.P value was 0.021,0.015,0.017 and 0.031,0.017,0.023 respectively.The difference was statistically significant.The levels of AFP were compared between the two groups at 6 months after operation(t = 3.1925,P = 0.012),there was significant difference between the two groups.According to postoperative CT monitoring,in reference to m RECIST criteria,there were 88 lesions in group A.All lesions were reduced 1 month after operation and 35 lesions(39.77%)were completely relieved.There were 52 cases(59.09%)with partial remission,with an average reduction of 47.23% and there was 1(1.14%)with stable lesions.After 3 months,34 lesions(38.64%)were completely relieved,50(56.82%)lesions were partially relieved,with an average reduction of 71.21% and 4(4.55%)lesions were stable and no progression was observed.6 months later,31 of the 88 lesions were still completely relieved,and good results were obtained.There are 48 cases(54.55%)with partial remission.There was 7(7.95%)with stable lesions.2 cases(2.27%)had progression of lesions.The complete remission rate of 27 lesions(diameter ? 5cm)was 88.89%(24/ 27).The complete remission rate of 38 lesions(41.18%)with 5cm~10cm diameter was 73.68%(28/38).The complete remission rate of 23 lesions with diameter ? 10 cm was 13.04%(3/23).In group B,82 lesions were all reduced 1 month after operation.There are 25 cases(30.49%)with partial remission.55(67.07%)lesions were partial remission,with an average reduction of 63.61%.There was 2(2.44%)with stable lesions.After 3 months,24 lesions(29.27%)were completely relieved,44 lesions(53.66%)were partially relieved and 14 lesions(17.07%)were stable.Six months later,21(25.61%)lesions were completely relieved,31(37.80%)lesions were partially alleviated,23(28.05%)lesions were stable,7(8.54%)lesions progressed.The complete remission rate of 24 lesions with tumor diameter ? 5cm was 79.17%(19/24).The complete remission rate of 39 lesions with diameter 5cm~10cm was 2.56%(1/39).None of 19 lesions with diameter ? 10 cm had complete remission.The effective rate at 3 months and 6 months after operation was compared with that in group B.The X2 and P value were 8.28?9.19 and 0.023?0.017 respectively,which were significantly higher than those in B group.Group A(n = 82),among them,6 cases had low fever after operation and disappeared after symptomatic treatment.No other serious complications were found.In group B,76 cases of RFA had epigastric discomfort,even severe pain,sweating dripping and so on,especially the lesions located under the hepatic capsule,which caused severe pain.Fever occurred in 21 cases(27.63%)and they remained normal after symptomatic treatment.2 cases had severe complications such as hemorrhage.CT scanning immediately after RFA showed a small amount of perihepatic hemorrhage in the puncture area which was related to more times of puncture and incomplete cauterization of needle.Bleeding stopped after conservative treatment,such as intravenous infusion of deaminopressin and local compression.Half an hour later,CT findings showed that there was no significant increase in perihepatic blood volume,and the vital signs were stable.There was a report of 10 case of gall heart reflex without other serious complications.Statistics of 158 patients with quality of life index,The frequency and degree of pain in group A were significantly less than those in group B.Six months later,according to the physical status(ECOG)score,in group B,4 cases were bedridden while in group A patients were able to take care of themselves.The survival rates of group A in one,two,three year were 85.37%,78.94% and 45.21% respectively.Median survival time was 28.55 months(6.20 ~ 72.10 months).The survival rates of group B were 76.83%,65.85%,33.78% respectively in one,two,three year.The median survival time was 26.25 months(6.07 ~ 92.83 months).The one year,two years and three years survival rates in group A were significantly higher than those in group B(P < 0.05).The survival time of disease free progression in group A and B was 4.50 ~ 52.17 months,with an average of 27.76 ±10.82 months and 4.23 ~ 41.10 months,with an average of 18.93 ±12.57 months respectively,which was significantly better than that of group B(P < 0.05).Conclusion TACE combined with 125 I seed in the treatment of liver cancer has better short-term efficacy than TACE combined with RFA.It can effectively kill tumor cells with less damage and less systemic reaction.It is worthy of clinical application. |
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