Implanting Iodine-125 Seed Strand Inside the Portal Vein Stent: An Improved Approach to Endovascular Brachytherapy for Treatment of Patients with Hepatocellular Carcinoma and Main Portal Vein Tumor Thrombus

Abstract

Liang Zhang,1,* Jun Wang,1,* Yang Li,2 Leina Hou,3 Jianguo Xia,4,* Jialin Shen1,* 1Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 2Department of Radiology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China; 3Department of Anesthesiology, Shaanxi Provincial Cancer Hospital, Xi’an, Shaanxi, People’s Republic of China; 4Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, People’s Republic of China*These authors contributed equally to this workCorrespondence: Jianguo Xia, Department of Ultrasound, Renji Hospital, Shanghai Jiao Tong University School of Medicine, NO. 160 Pujian Road, Shanghai, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected] Jialin Shen, Department of Interventional Oncology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, NO. 160 Pujian Road, Shanghai, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: To investigate the feasibility and efficacy of implanting an iodine-125 (125I) seed strand inside a portal vein stent (PVS) in the treatment of patients with hepatocellular carcinoma (HCC) and main portal vein tumor thrombus (mPVTT).Patients and Methods: Twenty-three patients who diagnosed with HCC and mPVTT and underwent endovascular implantation 125I seed strands and portal vein stenting were included in this study. Patients were divided into two groups. For patients in group A (n = 12), the 125I seed strand was placed outside the PVS, and for those in group B (n = 11), the strand was placed inside the PVS. Technical success, pain intensity during the procedure (numeric rating scale), procedure-related complications, changes in liver function, stent patency, and survival rates were recorded and analyzed.Results: The procedures were successful in all patients, and no serious procedure-related complications occurred in either group. Pain intensity during the procedure was significantly lower in group B than in group A (2.64 ± 1.50 vs 4.08 ± 1.78, p = 0.048), and there were no significant differences between pre- and post-procedure liver function in either group. The median duration of stent patency was 9 months (95% CI 2.21– 15.79 months) in group A and 12 months (95% CI 3.63– 18.37 months) in group B (p = 0.670). Median survival was 12 months (95% CI 10.30– 13.70 months) in group A and 13 months (95% CI 10.03– 15.97 months) in group B (p = 0.822). The cumulative stent patency and survival rates at 3, 6, and 12 months were 75%, 50%, and 41.7%, and 83.3%, 75%, and 50% in group A and 72.7%, 62.3%, and 31.2%, and 90.9%, 80.8%, and 50.5%, respectively.Conclusion: Implantation of 125I seed strand inside the PVS is effective and feasible for treating patients with HCC and mPVTT.Keywords: portal vein tumor thrombus, 125I seed, portal vein stent, endovascular brachytherapy, hepatocellular carcinoma

Keywords

• portal vein tumor thrombus
• 125i seed
• portal vein stent
• endovascular brachytherapy
• hepatocellular carcinoma