Transarterial chemoembolization combined with computed tomography-guided 125iodine implantation enhances survival in hepatocellular carcinoma patients with portal vein tumor thrombus

// Hong Tao Hu 1 , Jun Peng Luo 1 , Hai-Liang Li 1 , Chen Yang Guo 1 , Quan Jun Yao 1 , Xiang Geng 1 , Li Jiang 1 1 Department of Radiology and Research Institute of Radiology, The Affiliated Cancer Hospital of Zhengzhou University, Henan Cancer Hospital, Zhengzhou, Henan Province 450003, P. R. China Correspondence to: Hai-Liang Li, email: irlihailiang@163.com Keywords: hepatocellular carcinoma, portal vein tumor thrombus, transarterial chemoembolization, 125 iodine implantation, computed tomography-guided Received: October 11, 2016 Accepted: February 14, 2017 Published: March 23, 2017 ABSTRACT We conducted a retrospective study to evaluate the safety and efficacy of transarterial chemoembolization (TACE) combined with computed tomography-guided 125 iodine implantation (TACE- 125 iodine) in hepatocellular carcinoma (HCC) patients with type B portal vein tumor thrombus (PVTT). From medical records, we determined that 50 patients who received 125 iodine implantation 4-7 days after the first TACE session showed better survival than 50 patients who received only TACE (median survival, 13.1 vs. 6.0 months; P <0.01). Moreover, the PVTT control rate was higher in the TACE- 125 iodine than TACE alone group (78% vs. 18%; P <0.01). Multivariate analysis demonstrated that the TACE- 125 iodine procedure was an independent prognostic factor for overall survival. We also observed that bilirubin levels were increased at 4 weeks, indicating that 125 iodine seeding in the PVTT beneficially impacted the small bile duct, which is proximal to the portal vein. No severe adverse events were observed in patients that received 125 iodine seed implantation, and the mild adverse events were successfully treated. This study shows that TACE- 125 iodine therapy enhances patient survival with minimal adverse events. It is also more affordable than sorafenib, which is currently the recommended therapy for advanced HCC patients with PVTT.