Li Jie, Zhang Lijuan, Xie Qigen, Wang Weiguo, Hua Yanyan, Zhou Leyuan, Sun Zongqiong
Department of Interventional Radiology, The Affiliated Hospital of Jiangnan University, Wuxi 4th People's Hospital, Jiangsu Province, Wuxi, China.
Department of Radiology, Wuxi People's Hospital, Nanjing Medical University, Wuxi, China.
Brachytherapy. 2019 May-Jun;18(3):420-425. doi: 10.1016/j.brachy.2018.12.008. Epub 2019 Feb 7.
The effect of I seed implantation for the treatment of local residual tumor of hepatocellular carcinoma located beneath the diaphragm (HCC-LBD) after transcatheter arterial chemoembolization (TACE) has not yet been reported. This retrospective study was performed to evaluate the safety and efficacy of I seeds implantation (ISI) for the treatment of residual HCC-LBD after TACE.
A total of 18 patients treated with ISI between August 2012 and March 2018 for residual HCC-LBD after single or multiple TACE were enrolled. Local control, survival, and postoperative complications were analyzed retrospectively. Overall followup time was displayed by survival curves.
The 18 patients received a total of 20 ISI treatments. The total number of seeds implanted was 650, with a mean of 36 ± 13 seeds per patients (range, 20-70). Mean D90 was 123 Gy. Complete response + partial response (CR + PR) was documented in 14, 16, and 16 of patients at 3, 6, and 12 months after implantation, respectively. In four patients, seeds implantation was performed through the diaphragm; two of these patients developed small pneumothoraces. Pulmonary compression of pneumothorax is less than 30% combined with a little blood in sputum, no chest tightness, shortness of breath, all symptoms subsided without interventions, and the patients were discharged after observation for 2 days. After the procedure, routine blood examination and liver and kidney function were normal.
The combination of TACE with ISI appears to be a safe and efficient treatment for residual HCC-BLD.
This study evaluated the feasibility, safety, and short-term efficacy of ISI for local residual tumor of hepatocellular carcinoma located beneath the diaphragm (HCC-LBD) after TACE. Results suggest that residual tumor of HCC after TACE located in the posterosuperior part of the liver (segments seven and eight), laparoscopic liver resection, and alblation is difficult to perform and that as a supplement treatment, I seeds implantation is safe and easy accessible. TACE combined with I seeds has excellent local control effectiveness, and long-term efficacy and survival benefit still need to be more comprehensively evaluated.
经导管动脉化疗栓塞术（TACE）后，碘种子植入治疗位于膈肌下方的肝细胞癌局部残留肿瘤（HCC-LBD）的效果尚未见报道。本回顾性研究旨在评估碘种子植入术（ISI）治疗TACE后残留HCC-LBD的安全性和有效性。
纳入2012年8月至2018年3月期间接受ISI治疗的18例单或多次TACE后残留HCC-LBD患者。回顾性分析局部控制、生存情况及术后并发症。通过生存曲线展示总体随访时间。
18例患者共接受20次ISI治疗。植入种子总数为650枚，平均每位患者36±13枚（范围20 - 70枚）。平均D90为123 Gy。植入后3、6和12个月时，分别有14、16和16例患者达到完全缓解+部分缓解（CR + PR）。4例患者经膈肌进行种子植入；其中2例出现小气胸。气胸肺压缩小于30%，伴有少量痰中带血，无胸闷、气短，所有症状未经干预自行消退，观察2天后患者出院。术后血常规及肝肾功能正常。
TACE联合ISI似乎是治疗残留HCC-BLD的一种安全有效的方法。
本研究评估了ISI治疗TACE后位于膈肌下方的肝细胞癌局部残留肿瘤（HCC-LBD）的可行性、安全性和短期疗效。结果表明，TACE后位于肝脏后上部（肝段七和八）的HCC残留肿瘤，腹腔镜肝切除和消融难以实施，作为补充治疗，碘种子植入安全且易于操作。TACE联合碘种子具有良好的局部控制效果，长期疗效和生存获益仍需更全面评估。
