Endovascular brachytherapy combined with portal vein stenting and transarterial chemoembolization improves overall survival of hepatocellular carcinoma patients with main portal vein tumor thrombus

Abstract

Hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus have a median survival time of only about 4 months. We therefore compared the safety and efficacy of endovascular brachytherapy (EVBT) and sequential three-dimensional conformal radiotherapy (3-DCRT). From a cohort of 176 patients, we treated 123 with EVBT using iodine-125 seed strands (group A) and the remaining 53 with sequential 3-DCRT (group B). Overall survival, progression free survival and stent patency characteristics were compared between the two groups. Our analysis demonstrated a median survival of 11.7 ± 1.2 months in group A versus 9.5 ± 1.8 months in group B (p = 0.002). The median progression free survival was 5.3 ± 0.7 months in groupA versus 4.4 ± 0.4 months in group B (p = 0.010). The median stent patency period was 10.3 ± 1.1 months in group A versus 8.7 ± 0.7 months in group B (p = 0.003). Therefore, as compared to sequential 3-DCRT, EVBT combined with portal vein stenting and TACE improved overall survival of HCC patients with main portal vein tumor thrombus.

Efficacy and Safety of Endovascular Brachytherapy Combined with Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma Patients with Type III-IV Portal Vein Tumor Thrombosis

“…Wang [31] reported that the e cacy of radiotherapy combined with TACE was better than that of TACE or TACE combined with sorafenib for HCC patients with type III PVTT. However, it was found that the MST of EVBT combined with TACE (11.7 months) was longer than that of radiotherapy combined with TACE (9.5 months) for the treatment of HCC with type III PVTT [20].…”

“…Studies have shown improved e cacy of EVBT combined with TACE versus TACE alone, TACE combined with portal vein stent implantation, and TACE combined with external radiotherapy [17][18][19][20] for the treatment of HCC complicated with type III PVTT. However, type IV PVTT and type III PVTT with invasion of all second intrahepatic portal vein branches were all excluded from these studies.…”

A novel 125I seeds fixed on gastric tube for treatment of inoperable esophageal carcinoma

“…Besides, this approach is particularly useful for treating patients with unresectable cancer. [ 1 , 2 ] In this study, we explored the treatment benefit of a novel 125I seeds gastric tube in three patients with early inoperable EC. Briefly, the 125I seeds were placed in the gastric tube using a three-dimensional treatment planning system (Fig.…”

Portal Vein Stenting Combined with 125I Particle Chain Implantation Followed by As2O3 in the Treatment of Hepatocellular Carcinoma with Portal Vein Tumour Thrombus

“…If effective treatment is not available, the median survival time of these patients is only 2.7-4.0 months [3]. In recent years, portal vein stenting (PVS) combined with 125 I implantation has achieved significant effects in treating main portal vein tumour thrombus [4][5][6][7]. Stent implantation in the main portal vein can effectively alleviate portal vein pressure, relieve clinical symptoms, and improve quality of life [8].…”