门静脉支架联合碘-125粒子条血管内植入术继以索拉非尼经动脉化疗栓塞术治疗伴门静脉癌栓肝细胞癌的安全性和疗效
Safety and efficacy of endovascular implantation of a portal vein stent combined with iodine-125 seed-strips followed by transcatheter arterial chemoembolization with sorafenib for the treatment of hepatocellular carcinoma with portal vein tumor thrombosis.
作者信息
Li Shuangxi, Li Lei, Li Baohua, Wang Wenhui
机构信息
Interventional Department, The First Hospital of Lanzhou University, Lanzhou, Gansu, China.
出版信息
Br J Radiol. 2020 Aug;93(1112):20190279. doi: 10.1259/bjr.20190279. Epub 2020 Jun 3.
OBJECTIVE
To assess the safety and efficacy of endovascular implantation of a portal vein stent combined with iodine- seed-strips followed by transcatheter arterial chemoembolization with sorafenib (PVS-I-TACE-S) for the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT).
METHODS
Between January 2015 and July 2017, 18 patients with PVTT caused by HCC that were treated with PVS-I-TACE-S were reviewed. The technical success, complications, changes in liver function from baseline values due to subsequent endovascular implantation of a portal vein stent combined with iodine- seed-strips (PVS-I), time-to-tumor progression (TTP) and overall survival (OS) were observed.
RESULTS
The technical success rate was 100%. Adverse events (AEs) were managed successfully, with no occurrence of procedure-related deaths. Liver function test values after PVS-I were not significantly different than baseline values (P＞0.05). The median TTP was 7.0 months (range: 4.2-9.9 months). In Vp3 PVTT, the TTP was 9.7 months (range: 8.8-10.5 months), and in Vp4 PVTT, the TTP was 4.2 months (range: 2.8-5.6 months). The median OS was 10.0 months (range: 7.0-13.1 months). In Vp3 PVTT, OS was 11.9 months (range: 9.2-14.5 months), and in Vp4 PVTT, OS was 7.2 months (range: 3.8-10.7 months).
CONCLUSIONS
PVS-I-TACE-S is safe for patients with HCC with PVTT and may extend the TTP and survival of patients with Vp4 PVTT.
ADVANCES IN KNOWLEDGE
PVS implantation promptly restored flow in the obstructed portal vein, which can reduce the risk of hepatic failure and upper gastrointestinal bleeding. Implantation of iodine- seed-strips may directly expose the portal tumor thrombus to radiation and kill cancer cells. Their combined use with TACE-S has a strong scientific rationale.
目的
评估门静脉支架联合碘粒子条带血管内植入，随后用索拉非尼进行经动脉化疗栓塞（PVS-I-TACE-S）治疗伴有门静脉癌栓（PVTT）的肝细胞癌（HCC）的安全性和有效性。
方法
回顾性分析2015年1月至2017年7月间18例因HCC导致PVTT并接受PVS-I-TACE-S治疗的患者。观察技术成功率、并发症、门静脉支架联合碘粒子条带（PVS-I）血管内植入后肝功能相对于基线值的变化、肿瘤进展时间（TTP）和总生存期（OS）。
结果
技术成功率为100%。不良事件（AE）得到成功处理，未发生与手术相关的死亡。PVS-I术后肝功能测试值与基线值无显著差异（P＞0.05）。中位TTP为7.0个月（范围：4.2 - 9.9个月）。在Vp3 PVTT中，TTP为9.7个月（范围：8.8 - 10.5个月），在Vp4 PVTT中，TTP为4.2个月（范围：2.8 - 5.6个月）。中位OS为10.0个月（范围：7.0 - 13.1个月）。在Vp3 PVTT中，OS为11.9个月（范围：9.2 - 14.5个月），在Vp4 PVTT中，OS为7.2个月（范围：3.8 - 10.7个月）。
结论
PVS-I-TACE-S对伴有PVTT的HCC患者是安全的，并且可能延长Vp4 PVTT患者的TTP和生存期。
知识进展
PVS植入可迅速恢复受阻门静脉的血流，从而降低肝衰竭和上消化道出血的风险。碘粒子条带植入可使门静脉肿瘤血栓直接接受辐射并杀死癌细胞。它们与TACE-S联合使用具有充分的科学依据。
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