Safety and efficacy of endovascular implantation of a portal vein stent combined with iodine-125 seed-strips followed by transcatheter arterial chemoembolization with sorafenib for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis.

Abstract

OBJECTIVE:

To assess the safety and efficacy of endovascular implantation of a portal vein stent combined with iodine-125 seed-strips followed by transcatheter arterial chemoembolization with sorafenib (PVS-125I-TACE-S) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).

METHODS:

Between January 2015 and July 2017, 18 patients with PVTT caused by HCC that were treated with PVS-125I-TACE-S were reviewed. The technical success, complications, changes in liver function from baseline values due to subsequent endovascular implantation of a portal vein stent combined with iodine-125 seed-strips (PVS-125I), time-to-tumor progression (TTP) and overall survival (OS) were observed.

RESULTS:

The technical success rate was 100%. Adverse events (AEs) were managed successfully, with no occurrence of procedure-related deaths. Liver function test values after PVS-125I were not significantly different than baseline values (P＞0.05). The median TTP was 7.0 months (range: 4.2-9.9 months). In Vp3 PVTT, the TTP was 9.7 months (range: 8.8-10.5 months), and in Vp4 PVTT, the TTP was 4.2 months (range: 2.8-5.6 months). The median OS was 10.0 months (range: 7.0-13.1 months). In Vp3 PVTT, OS was 11.9 months (range: 9.2-14.5 months), and in Vp4 PVTT, OS was 7.2 months (range: 3.8-10.7 months).

CONCLUSIONS:

PVS-125I-TACE-S is safe for patients with HCC with PVTT and may extend the TTP and survival of patients with Vp4 PVTT.

ADVANCES IN KNOWLEDGE:

PVS implantation promptly restored flow in the obstructed portal vein, which can reduce the risk of hepatic failure and upper gastrointestinal bleeding. Implantation of iodine-125 seed-strips may directly expose the portal tumor thrombus to radiation and kill cancer cells. Their combined use with TACE-S has a strong scientific rationale.

• Authors: Shuangxi Li, Lei Li, Baohua Li, Wenhui Wang
• Journal: The British journal of radiology (Br J Radiol) Vol. 93 Issue 1112 Pg. 20190279 (Aug 2020) ISSN: 1748-880X [Electronic] England
• PMID: 32464068 (Publication Type: Journal Article)

Chemical References

• Antineoplastic Agents
• Iodine Radioisotopes
• Sorafenib

Topics

• Aged
• Antineoplastic Agents (administration & dosage, therapeutic use)
• Blood Vessel Prosthesis (adverse effects)
• Carcinoma, Hepatocellular (complications, mortality, therapy)
• Chemoembolization, Therapeutic (instrumentation, methods)
• Combined Modality Therapy
• Endovascular Procedures (instrumentation, methods)
• Female
• Humans
• Iodine Radioisotopes (administration & dosage, adverse effects, therapeutic use)
• Liver Neoplasms (complications, mortality, therapy)
• Male
• Middle Aged
• Portal Vein
• Sorafenib (administration & dosage, therapeutic use)
• Stents (adverse effects)
• Survival Analysis
• Thrombosis (etiology, therapy)
• Treatment Outcome