Abstract
BackgroundThe purpose of this study was to evaluate the efficacy and safety of endovascular brachytherapy (EVBT) combined with transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) complicated with type III OR IV portal vein tumor thrombosis (PVTT) and to further analyze the prognostic predictors for the patients with HCC and PVTT.MethodsWe retrospectively analyzed the medical records of 54 patients who were diagnosed with HCC complicated with type III or IV PVTT and received EVBT combined with modified TACE treatment from January 2017 to June 2019. Adverse events, treatment response, overall survival (OS), progression-free survival (PFS), and stent patency were analysed to evaluate the efficacy and safety of this treatment. The independent prognostic predictors of OS were also statistically analyzed by the cox regression model.ResultsNo adverse events occurred in the enrolled patients receiving EVBT combined with TACE treatment. The objective response and disease control rates were 42.6% and 96.3% respectively within 4 weeks after the treatment. The median OS and PFS were 209 days and 138 days, respectively. Cumulative stent patency rate was 70.4% at the last follow-up. AFP ≥ 400 ng/ml, ECOG PS > 1, Child Pugh grade B, and non-hemihepatic HCC were independent risk predictors to evaluate the OS of HCC patient with type III or IV PVTT.ConclusionsEVBT combined with TACE was a relatively effective and safe strategy to treat HCC patients with type III or IV PVTT.
Highlights
The purpose of this study was to evaluate the efficacy and safety of endovascular brachytherapy (EVBT) combined with transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) complicated with type III OR IV portal vein tumor thrombosis (PVTT) and to further analyze the prognostic predictors for the patients with HCC and PVTT
The medical records of patients who were diagnosed with HCC complicated with type III or IV PVTT and who received EVBT combined with TACE treatment from January 2017 to June 2019 were retrospectively analyzed
The exclusion criteria were as follows: (1) Child-Pugh grade C patients; (2) ECOG Eastern Cooperative Oncology Group performance status (PS) of 3-4 points; (3) patients had suffered from other malignant tumors; (4) patients had severe heart, lung, or kidney function insufficiency; and (5) prior to TACE, surgery, ablation treatment, intrahepatic tumor Iodine 125 (125I) seed implantation, or other treatments received within 1 month before EVBT combined with TACE treatment (Fig. 1)
Summary
The purpose of this study was to evaluate the efficacy and safety of endovascular brachytherapy (EVBT) combined with transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) complicated with type III OR IV portal vein tumor thrombosis (PVTT) and to further analyze the prognostic predictors for the patients with HCC and PVTT. Transarterial chemoembolization (TACE), targeted drugs, or yttrium-90 resin microspheres for correctional selective internal radiation therapy were applied to treat the patients who cannot receive surgical resection. Among these therapeutic approaches, TACE exerts its anti-tumor effects by injecting chemotherapeutic agents into the hepatic artery, and causes the selective obstruction of the tumorfeeding arteries. Target drugs (such as sorafenib or Lenvatinib), on the other hand, suppress HCC growth, metastasis, and angiogenesis by inhibiting the activity of tyrosine kinase All these approaches only showed limited clinical efficacy in the treatment of HCC complicated with type III PVTT [10,11,12,13,14,15]
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