Combined endovascular brachytherapy, sorafenib, and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus

Zhang, Zi-Han; Liu, Qingxin; Zhang, Wen; Ma, Jingqin; Wang, Jianhua; Luo, Jianjun; Liu, Lingxiao; Yan, Zhenlin

doi:10.3748/wjg.v23.i43.7735

Cited by 27 publications

(33 citation statements)

References 32 publications

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“…More cases are needed to reach more reliable results. All these patients were in the BCLC-C stage, and treatment with targeted drugs such as sorafenib may have yielded better results [18]. However, due to economic constraints or concerns about the side effects of targeted drugs, these patients were not able to combine targeted drugs at the same time.…”

Section: Discussionmentioning

confidence: 99%

Evaluation of D-TACE combined with endovascular brachytherapy for HCC with MPVTT

Wu¹,

Gong²,

Huang³

et al. 2020

Preprint

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BackgroundThe goal of this study was to compare the clinical results of conventional transcatheter arterial chemoembolization (C-TACE) and doxorubicin-eluting bead transcatheter arterial chemoembolization (D-TACE) combined with endovascular stent implantation with an iodine-125 seed strand in hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT).MethodsThis study was a prospective controlled study with follow-up dates spanning from Mar 2015 to Feb 2020. Patients with both HCC and MPVTT were randomly divided into two groups. Portal vein stents with iodine-125 seed strands were implanted first; then, C-TACE or D-TACE was administered to all patients. Objective response rates were assessed. The time to disease progression and survival rate were compared between the two groups.ResultsA total of 26 patients were enrolled, with 13 in each group. During follow-up, the portal stent patency times were 112.3 ± 98.2 days in the C-TACE group and 101.7 ± 90.4 days in the D-TACE group. The time to disease progression was 42 days in the C-TACE group and 120 days in the D-TACE group (p = 0.03). The overall survival time from the first intervention procedure was 216 days in the C-TACE group and 239 days in the D-TACE group (p = 0.047). The D-TACE group was superior to the C-TACE group in terms of progression-free survival (PFS) and overall survival (OS) times.ConclusionEndovascular implantation of a stent with an iodine-125 seed strand combined with TACE is safe and effective in HCC patients with MPVTT. Compared to C-TACE, D-TACE achieves more benefits regarding PFS and OS.Trial registrationThis study was a cohort study, no health-related interventions to evaluate the effects on health outcomes. This study wasn’t a clinical trial.

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Section: Discussionmentioning

confidence: 99%

Evaluation of D-TACE combined with endovascular brachytherapy for HCC with MPVTT

Wu¹,

Gong²,

Huang³

et al. 2020

Preprint

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“…In the present study, a signi cant survival bene t in patients in group A relative to those in group B (342.0 vs 231.0 days). This may be because patients treated with the combination of PVS and endovascular 125 I seed-strip implantation prior to TACE-S achieved better liver function, suggesting that restoring portal vein through and reduction of tumor thrombus burden is associated with improved OS [12,13]. With respect to safety, the most frequent AEs following the combination of PVS and 125 I seed-strip implantation was a transient decrease in liver functionality, likely as a result of injury to the bile duct upon puncture of the portal vein [28].…”

Section: Discussionmentioning

confidence: 99%

“…There has been some research regarding the use of TACE-sorafenib (TACE-S) owing to observations that it exhibits therapeutic synergy when employed to treat HCC patients with PVTT provided there is good patency for the main portal vein or su cient collateral circulation [6,10,11]. This combination is associated with some increase in patient survival, but overall the e cacy of this approach is limited, and a superior combination strategy is thus needed [12].…”

Section: Introductionmentioning

confidence: 99%

Treatment of Hepatocellular Carcinoma-associated Portal Vein Tumor Thrombus Using Combination of Portal Vein Stent Insertion and Endovascular Lodine-125 Seed-strip Implantation Followed by Transcatheter Arterial Chemoembolization- Sorafenib

et al. 2020

Preprint

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BackgroundTo evaluate the efficacy of portal vein stent (PVS) insertion and endovascular iodine-125 (125I) seed-strip implantation followed by transcatheter arterial chemoembolization (TACE)-sorafenib (PVS-125I-TACE-S) in patients with hepatocellular carcinoma (HCC)-associated portal vein tumor thrombus (PVTT).MethodsThis retrospective analysis was performed on 53 consecutive HCC patients with PVTT between May 2014 and July 2018. Twenty-eight patients were treated via PVS-125I-TACE-S, and 25 patients were treated by TACE-S. Hepatic function, disease control, and overall survival (OS) in both groups were analyzed. The Albumin-Bilirubin (ALBI) score approach was used as a means of evaluating liver function, and a Cox regression analysis was utilized to determine which factors were linked to treatment outcomes.ResultsNo preoperative differences in ALBI scores between groups (P=0.724), nor did these scores at 1-month postoperative (P=0.666). However, these scores were significantly different at 3 (P=0.007) and 6 (P=0.044) months postoperatively. PVS-125I-TACE-S exhibiting higher rates of disease control (71.4% vs. 44.0%, P=0.043) after 6 months of treatment and extended OS duration (342.0 vs 231.0 days, P=0.007). A stratified analysis revealed OS in patients with type II PVTT did not differ significantly (313.0 vs. 321.0 days, P=0.689), but OS with type III did (344.0 vs. 226.0 days, P=0.002). A multivariate analysis revealed that tumor size > 10 cm was independently predictive of poor prognosis (P=0.002), whereas PVS-125I-TACE-S was a predictor of a favorable patient prognosis (P=0.040).ConclusionPVS-125I-TACE-S represents a potentially viable strategy for improving hepatic functionality, disease control, and OS in HCC with type III PVTT.

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“…Endoluminal brachytherapy is infrequently used for cancer treatment. Only a handful of reports describe the utility of intra-venous stent and 125 I seed implantation in patients with cancer-associated portal vein or peripheral vein tumor occlusion [7,8].…”

Section: Discussionmentioning

confidence: 99%

Endovascular brachytherapy for extensive right-heart and pulmonary artery sarcoma – a case report

Aviel

Meirovitz

Planer

et al. 2019

jcb

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Primary sarcoma of the heart is a rare but devastating tumor. Median survival with conventional treatment is 8-12 months. When resection is not feasible, patients often succumb to heart failure secondary to obstruction of blood flow, valve dysfunction, chamber compression or conduction abnormalities. Palliative treatment options include systemic chemotherapy and external beam irradiation. We herein describe a novel technique using endovascular brachytherapy, aiming at reducing tumor mass, alleviating right ventricular pressure overload and at the same time keeping the option of R0 resection viable. Material and methods: A 35-year-old man was diagnosed with a non-resectable high-grade intimal sarcoma of the right ventricle (RV), main pulmonary artery (PA) and right PA. After three cycles of doxorubicin and ifosfamide, the patient's symptoms of right heart failure worsened. Imaging documented tumor progression and supra-systemic pulmonary artery pressure. Through a trans-femoral venous access, a brachytherapy sleeve was placed in the RV and main and right PA. A dose of 20 Gy was delivered over a period of ten minutes. Results: The patient had an uneventful course and was discharged home 24 hours after the procedure. Ten months after brachytherapy, repeat imaging demonstrated a significant reduction in tumor volume and an increase in pulmonary artery cross-sectional area with a marked reduction of pulmonary artery pressure, leading to a complete resolution of heart failure symptoms. Conclusions: Endovascular brachytherapy is a novel, safe and effective therapeutic modality for non-resectable primary cardiac sarcomas either for palliation of obstruction, or tumor mass reduction to allow complete resection.

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Combined endovascular brachytherapy, sorafenib, and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus

Cited by 27 publications

References 32 publications

Evaluation of D-TACE combined with endovascular brachytherapy for HCC with MPVTT

Evaluation of D-TACE combined with endovascular brachytherapy for HCC with MPVTT

Treatment of Hepatocellular Carcinoma-associated Portal Vein Tumor Thrombus Using Combination of Portal Vein Stent Insertion and Endovascular Lodine-125 Seed-strip Implantation Followed by Transcatheter Arterial Chemoembolization- Sorafenib

Endovascular brachytherapy for extensive right-heart and pulmonary artery sarcoma – a case report

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