Short-term efficacy of 125I seed implantation combined with transcatheter arterial chemoembolization in the treatment of advanced primary hepatocellular carcinoma

Abstract

Objective To evaluate the efficacy and safety of 125I seed implantation combined with transcatheter arterial chemoembolization (TACE) in the treatment of primary hepatocellular carcinoma (PHC). Methods 156 patients who had unresectable PHC seen from January 2012 to December 2015 in our unit were randomly assigned into the study group (76 patients) and the control group (80 patients). The study group of patients were treated with intra-hepatic implantation of 125I seed + TACE, and the control group of patients were treated with three dimensional conformal radiotherapy (3DCRT) + TACE. After radiotherapy the two groups of patients underwent 2 to 3 times TACE treatment. The biomarker levels were compared between the two groups before and after treatment, and the short-term efficacy, clinical safety and 1 year survival rates were assessed. Results The success rates of the treatment for the two groups were both 100%. Patients in the study group were implanted with 1 016 125I seeds, with an average of (13.7±2.5) seeds per patient. The two groups had no significant difference on short-term efficacy (P>0.05). The DCR, ORR and 1 year survival rates in the study group were 63.2%, 92.1%, 55.5%, and they were 61.3%, 90.0%, 58.1% in the control group, respectively. There were no significant differences between these 2 groups (P>0.05). At 1 month after treatment, the two groups had no significant differences on AFP, IGF-II and IGFBP-2 [(5.08±0.85) μg/L vs. (5.12±0.79) μg/L, (4.77±0.58) μg/L vs. (4.86±0.53) μg/L, (4.98±0.67) μg/L vs. (5.04±0.71) μg/L] (P>0.05). There were no significant differences on chemotherapy drug toxicities between the two groups (P>0.05). The incidence of radiation hepatitis in the study group was 1.3%, while the incidences of radiation dermatitis, hepatitis, gastric ulcer in the control group were 5.0%, 8.8%, 2.5%, respectively. The radiation dermatitis incidence in the study group was significantly lower than that of the control group (P<0.05). In the study group, 2 patients (2.6%) had their 125I seed slightly moved. Conclusion The short-term efficacy of 125I seed implantation plus TACE in the treatment of PHC is no less than the 3DCRT + TACE regimen, but with less radiation side effects. Key words: Primary hepatocellular carcinoma; Tumor thrombus; Transcatheter hepatic arterial chemoembolization; 125I seed implantation; Three dimensional conformal radiotherapy; Clinical efficacy