Caudate Lobe Hepatocellular Carcinoma Treated with Sequential Transarterial Chemoembolization and Iodine 125 Seeds Implantation: A Single-Center Retrospective Study

Abstract

Resection of the hepatocellular carcinoma (HCC) in the caudate lobe (CL) is challenging even for accomplished surgeons. This retrospective study evaluated the safety and efficacy of transarterial chemoembolization (TACE) and iodine 125 seeds implantation (ISI) for unresectable or "ablation unsuitable" HCC-CL detected at the initial presentation in clinical practice. Patients and Methods: A total of 20 HCC-CL patients undergoing sequential TACE and ISI from January 2014 to October 2018 were enrolled in this study. The overall survival (OS), progression-free survival (PFS), tumor response rate, and complication rates were analyzed and compared to non-caudate lobe (NCL) HCC patients. Multivariate analyses for potential clinical and radiological factors were performed using the Cox proportional hazard model. Results: The technical success rate was 100%, as all the patients received 28 ISI treatments. The median OS was 35 months. The 1-, 3-, and 5-year OS rates were 100%, 63.2%, and 11.1%, respectively. The median PFS was 16 months. The objective response rate was 60.0%. The puncture tract bleeding (2/20) and pneumothorax (1/20) were the most common complications in operation, but no operation-related deaths occurred. One year after the surgery, biliary tract injury occurred in 1 patient, necessitating percutaneous biliary intervention. No statistical difference was observed between the CL and NCL groups. Multivariable analysis revealed that Barcelona Clinic Liver Cancer stage B and tumor size >3 cm were two significant factors associated with OS. Conclusion: Sequential TACE and ISI were associated with the survival benefits in HCC-CL and should be considered as a reliable therapy for surgeons and interventional radiologists.

Advances in the interventional therapy of hepatocellular carcinoma originating from the caudate lobe

“…Brachytherapy can be used for the treatment of residual caudate lobe tumors that cannot be completely ablated. In an existing study, 80 transarterial chemoembolization and I 125 seed implantation for caudate lobe HCC had an objective response rate of 60.0% and a median OS of 35 months, while biliary tract injury only occurred in about 5% of cases, suggesting that it could become a new treatment option.…”

Application of radioactive iodine-125 microparticles in hepatocellular carcinoma with portal vein embolus

“…In particular, when the tumor thrombus grows along the main portal vein, the prognosis of patients is worse, and the tumor may metastasize extensively from the liver[ 7 ]. It induces esophageal and gastric varices, resulting in rupture bleeding and other fatal consequences[ 8 - 10 ]. For PHC combined with PVTT, surgical procedures, portal stent implantation, radiotherapy, radiofrequency ablation, alcohol embolization, transhepatic arterial chemoembolization (TACE), and other methods have been applied, but a standardized treatment scheme has not been established in the clinic[ 11 ].…”

Acute myocardial infarction induced by migration of iodine-125 seeds

“…Permanent radioactive seed implantation is one of the wellacknowledged treatments for solid tumor [1]. According to recent studies, it is effective and safe in treating primary or metastatic cancers including lung and hepatic cancer [2][3][4]. However, seed migration may cause severe clinical conditions because of its special physical characteristics.…”