CT-Guided 125I Brachytherapy in the Treatment of Hepatocellular Carcinoma Refractory to Conventional Transarterial Chemoembolization: A Pilot Study

Abstract

Purpose To investigate the efficacy and safety of CT-guided 125 I brachytherapy in the treatment of hepatocellular carcinoma (HCC) refractory to conventional transarterial chemoembolization (TACE). Methods Nineteen patients with TACE-refractory HCC treated with CT-guided 125 I brachytherapy between June 2017 and June 2020 at Jiangyin People’s Hospital were enrolled in this study. In addition, we used the modified Response Evaluation Criteria in Solid Tumors (mRECIST) criteria to evaluate the treatment response after 125 I brachytherapy. Results Twenty-one tumours were treated with CT-guided 125 I brachytherapy in nineteen patients. Twelve tumours (57.1%) showed a complete response, and a partial response was observed in seven tumours (33.3%). The six-month objective response rate was 90.5% (19/21). The adverse effects of CT-guided 125 I brachytherapy were tolerable. Conclusion Our preliminary clinical experience demonstrated that CT-guided 125 I brachytherapy was effective and well tolerated for the treatment of TACE-refractory HCC, suggesting that CT-guided 125 I brachytherapy has the potential to become an effective alternative treatment for TACE-refractory HCC.

Embedding expertise knowledge into inverse treatment planning for low‐dose‐rate brachytherapy of hepatic malignancies

“…Computed tomography (CT)‐guided low‐dose‐rate (LDR) permanent seed brachytherapy is a safe and effective treatment for patients with large hepatic malignancies (>3 cm in diameter), lesions unsuitable for radiofrequency ablation, hepatocellular carcinoma (HCC) refractory to conventional transarterial chemoembolization, 1 or HCC combined with portal vein tumor thrombus 2 . Sealed radioactive seeds, such as iodine‐125 seed ( 125 I), can be implanted within or close to the tumor permanently after a percutaneous puncture operation 1–3 . In contrast to external radiation therapy, brachytherapy delivers a highly concentrated dose of radiation in tumors while sparing the surrounding healthy tissue 4 .…”

“…In the reported studies 1–3,7,8 on 125 I seed implantation for liver tumors, the TPS has been used to generate implantation plans, including Panther TPS (Prowess, Concord, USA), Beihang implantation TPS (BUAA, Beijing, China), and BT‐RSI model TPS (Yuanbo, Beijing, China). The gross tumor volume (GTV), which can generate planning target volume (PTV) of each HCC lesion and OAR, was manually delineated layer by layer on CT images.…”

“…2 Sealed radioactive seeds, such as iodine-125 seed ( 125 I), can be implanted within or close to the tumor permanently after a percutaneous puncture operation. [1][2][3] In contrast to external radiation therapy, brachytherapy delivers a highly concentrated dose of radiation in tumors while sparing the surrounding healthy tissue. 4 Therefore, designing the pose of the seeds based on the shape of the tumor and generating a conformal dose map is vital in the brachytherapy treatment planning system (TPS).…”

“…5 Meanwhile, the selection of the corresponding puncture pathway should be considered in the design of seed distribution where the puncture needle should avoid bones and other organs at risk (OAR). 6 In the reported studies [1][2][3]7,8 on 125 I seed implantation for liver tumors, the TPS has been used to generate implantation plans, including Panther TPS (Prowess, Concord, USA), Beihang implantation TPS (BUAA, Beijing, China), and BT-RSI model TPS (Yuanbo, Beijing, China). The gross tumor volume (GTV), which can generate planning target volume (PTV) of each HCC lesion and OAR, was manually delineated layer by layer on CT images.…”

Subsequent Treatment after Transarterial Chemoembolization Failure/Refractoriness: A Review Based on Published Evidence

“…At the first follow-up, tumor response was achieved in all 60 patients, among whom 45 (75%) had complete responses and 15 (25%) had partial responses. Xu et al20 reported computed tomography-guided Iodine-125 ( 125 I) seed implantation for the treatment of HCC after TACE failure/refractoriness. All 21 patients in their cohort had solitary HCC nodules with a mean diameter of 4.3 cm.…”