Portal vein stenting combined 125I particle implanted followed by transarterial chemoembolization in the treatment of hepatocellular carcinoma with portal vein tumor thrombus

Abstract

Objective To assess the clinical value of portal vein stenting (PVS) combined 125I particle implanted followed by transcatheter arterial chemoembolization (TACE) in the treatment of hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT).Methods The clinical data of 26 patients with HCC accompanied with MPVTT were retrospectively analyzed.All the patients received PVS combined 125I particle implanted first and TACE treatment later.The patients were followed-up and the cumulative survival rate was calculated.Results There were 25 male,one female and the median age was 49 years.Sixteen cases had multiple lesions in the liver and 10 cases had single lesion.Among those,the lesion of eight cases was in right lobe and two in left lobe.A total of six patients with right portal vein tumor thrombus,three with left portal vein tumor thrombus,13 with main and right portal vein tumor thrombus and four with main and left portal vein tumor tbrombus.The liver function grading of 20 patients was Child-Pugh A and six was Child-Pugh B.All the patients received PVS combined 125I particle implanted followed by TACE treatment successfully,the success rate of operation was 100％.A total of 26 stents and 28 125I particle chains (520 125I particles) were implanted and 55 TACE were operated.In all the patients,no severe complications,such as puncture bleeding,bile leak complicated by infection,liver abscess,abdominal bleeding,tumor rupture bleeding and gastrointestinal bleeding occurred.After operation,patients were followed-up for 6 to 15 months.The survival rates at 3th,6th,9th,12thand 15thmonth were 100.0％ (26/26),61.5％ (16/26),53.8％ (14/26),30.8％ (8/26) and 15.4％ (4/26),respectively.The stent patency rates were 96.2％ (25/26),76.9％ (20/26),57.7％ (15/26),23.1％ (7/26) and 7.7％ (2/26),respectively.Among 16 dead patients,two died of lung metastasis,five died of gastrointestinal bleeding,six died of liver failure,and one died of brain metastases,one died of vertebral metastases,one died of heart failure for tumor invasion in atrial.Conclusion Treated by PVS combined 125I particle implanted followed by TACE,HCC patients with MPVTT complication may obtain a long stent patency and survival time. Key words: Carcinoma, hepatocellular;  Portal vein;  Neoplasm circulating cells;  Stents;  Iodine radioisotopes;  Chemoembolization, therapeutic