Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus
Xiao-Hui Zhao, Hai-Liang Li, Chen-Yang Guo, Quan-Jun Yao, Wei-Li Xia, Hong-Tao Hu Department of Minimally-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, People’s Republic of ChinaCorrespondence: Hong-Tao Hu, Department of Mi...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2023-02-01
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| Series: | Journal of Hepatocellular Carcinoma |
| Subjects: | |
| Online Access: | https://www.dovepress.com/downstaging-and-conversation-strategy-for-advanced-hepatocellular-carc-peer-reviewed-fulltext-article-JHC |
| _version_ | 1811165009038802944 |
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| author | Zhao XH Li HL Guo CY Yao QJ Xia WL Hu HT |
| author_facet | Zhao XH Li HL Guo CY Yao QJ Xia WL Hu HT |
| author_sort | Zhao XH |
| collection | DOAJ |
| description | Xiao-Hui Zhao, Hai-Liang Li, Chen-Yang Guo, Quan-Jun Yao, Wei-Li Xia, Hong-Tao Hu Department of Minimally-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, People’s Republic of ChinaCorrespondence: Hong-Tao Hu, Department of Minimally-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan Province, 450008, People’s Republic of China, Tel +86-135-9264-6376, Email huhongtaogy@163.comBackground and Objectives: Trans-arterial chemoembolization (TACE) combined with 125I seed implantation is an effective treatment modality for hepatocellular carcinoma (HCC) with a portal vein tumor thrombus (PVTT). However, there are no reports on the effectiveness of radiofrequency ablation (RFA) after downstaging in such patients. This study aimed to investigate the efficacy and safety of TACE in combination with 125I seed implantation and RFA for the treatment of HCC complicated by PVTT.Methods: 49 patients diagnosed with HCC with PVTT between February 2015 and December 2016 were included. All patients were clinically or pathologically diagnosed with advanced HCC, intrahepatic lesions ≤ 3, and a single tumor diameter ≤ 70 mm, total diameter ≤ 100 mm. PVTT was limited to the unilateral portal vein branches. All the patients were treated with TACE combined with PVTT 125I seed implantation. The size and activity of intrahepatic lesions and PVTT were evaluated using enhanced magnetic resonance imaging 3 months after treatment, and other indicators were combined to determine the success of downstaging.Results: A total of 31 patients were successfully downstaged, while 18 patients did not achieve downstaging owing to the progression of intrahepatic lesions or PVTT activity/progression, the success rate of the downstaging was 63.27%. All 31 patients with successful downstaging underwent RFA for intrahepatic lesions. The 1-, 2-, and 3-year survival rates were 90.3%, 80.6%, and 48.4%, respectively. The median overall survival was 36 months (95% CI: 24.7– 47.3).Conclusion: 125I seed implantation in combination with TACE can effectively inactivate PVTT and achieve downstaging. Furthermore, the addition of RFA can significantly improve patient survival.Keywords: hepatocellular carcinoma, portal vein tumor thrombus, 125I seed, transcatheter arterial chemoembolization, downstaging treatment |
| first_indexed | 2024-04-10T15:31:41Z |
| format | Article |
| id | doaj.art-d188da8ee8464723823057c7d3ef6010 |
| institution | Directory Open Access Journal |
| issn | 2253-5969 |
| language | English |
| last_indexed | 2024-04-10T15:31:41Z |
| publishDate | 2023-02-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Journal of Hepatocellular Carcinoma |
| spelling | doaj.art-d188da8ee8464723823057c7d3ef60102023-02-13T17:59:03ZengDove Medical PressJournal of Hepatocellular Carcinoma2253-59692023-02-01Volume 1023124081620Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor ThrombusZhao XHLi HLGuo CYYao QJXia WLHu HTXiao-Hui Zhao, Hai-Liang Li, Chen-Yang Guo, Quan-Jun Yao, Wei-Li Xia, Hong-Tao Hu Department of Minimally-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou City, People’s Republic of ChinaCorrespondence: Hong-Tao Hu, Department of Minimally-Invasive Intervention, The Affiliated Cancer Hospital of Zhengzhou University & Henan Cancer Hospital, Zhengzhou, Henan Province, 450008, People’s Republic of China, Tel +86-135-9264-6376, Email huhongtaogy@163.comBackground and Objectives: Trans-arterial chemoembolization (TACE) combined with 125I seed implantation is an effective treatment modality for hepatocellular carcinoma (HCC) with a portal vein tumor thrombus (PVTT). However, there are no reports on the effectiveness of radiofrequency ablation (RFA) after downstaging in such patients. This study aimed to investigate the efficacy and safety of TACE in combination with 125I seed implantation and RFA for the treatment of HCC complicated by PVTT.Methods: 49 patients diagnosed with HCC with PVTT between February 2015 and December 2016 were included. All patients were clinically or pathologically diagnosed with advanced HCC, intrahepatic lesions ≤ 3, and a single tumor diameter ≤ 70 mm, total diameter ≤ 100 mm. PVTT was limited to the unilateral portal vein branches. All the patients were treated with TACE combined with PVTT 125I seed implantation. The size and activity of intrahepatic lesions and PVTT were evaluated using enhanced magnetic resonance imaging 3 months after treatment, and other indicators were combined to determine the success of downstaging.Results: A total of 31 patients were successfully downstaged, while 18 patients did not achieve downstaging owing to the progression of intrahepatic lesions or PVTT activity/progression, the success rate of the downstaging was 63.27%. All 31 patients with successful downstaging underwent RFA for intrahepatic lesions. The 1-, 2-, and 3-year survival rates were 90.3%, 80.6%, and 48.4%, respectively. The median overall survival was 36 months (95% CI: 24.7– 47.3).Conclusion: 125I seed implantation in combination with TACE can effectively inactivate PVTT and achieve downstaging. Furthermore, the addition of RFA can significantly improve patient survival.Keywords: hepatocellular carcinoma, portal vein tumor thrombus, 125I seed, transcatheter arterial chemoembolization, downstaging treatmenthttps://www.dovepress.com/downstaging-and-conversation-strategy-for-advanced-hepatocellular-carc-peer-reviewed-fulltext-article-JHChepatocellular carcinomaportal vein tumor thrombus125i seedtranscatheter arterial chemoembolizationdownstaging treatment |
| spellingShingle | Zhao XH Li HL Guo CY Yao QJ Xia WL Hu HT Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus Journal of Hepatocellular Carcinoma hepatocellular carcinoma portal vein tumor thrombus 125i seed transcatheter arterial chemoembolization downstaging treatment |
| title | Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus |
| title_full | Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus |
| title_fullStr | Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus |
| title_full_unstemmed | Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus |
| title_short | Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus |
| title_sort | downstaging and conversation strategy for advanced hepatocellular carcinoma with portal vein branch tumor thrombus tace 125i seed implantation and rfa for hepatocellular carcinoma with portal vein branch tumor thrombus |
| topic | hepatocellular carcinoma portal vein tumor thrombus 125i seed transcatheter arterial chemoembolization downstaging treatment |
| url | https://www.dovepress.com/downstaging-and-conversation-strategy-for-advanced-hepatocellular-carc-peer-reviewed-fulltext-article-JHC |
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