Huang Wei, Gong Ju, Wang Qingbing, Wang Ziyin, Liu Qin, Liu Jingjing, Gu Junwei, Ding Xiaoyi, Wu Zhiyuan
Department of Interventional Radiology, Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Department of Interventional Radiology, Ruijin Hospital Luwan Branch, Shanghai Jiao Tong University School of Medicine, Shanghai, China.
Front Oncol. 2022 Aug 18;12:973357. doi: 10.3389/fonc.2022.973357. eCollection 2022.
Hepatocellular carcinoma (HCC) patients with main portal vein tumor thrombus (MPVTT) may be able to have TACE through stent implantation into the portal vein with thrombosis to recover portal blood flow.
The goal of this study was to compare clinical results of conventional transcatheter arterial chemoembolization (C-TACE) and doxorubicin-eluting bead transcatheter arterial chemoembolization (D-TACE) combined with endovascular brachytherapy in HCC patients with MPVTT.
This study was a retrospective controlled study with follow-up dates spanning from Mar 2015 to Feb 2020. Patients with both HCC and MPVTT were divided into two groups. Portal vein stents with iodine-125 seed strands were implanted first; then, C-TACE or D-TACE was administered to all patients. Objective response rates were assessed.
A total of 26 patients were enrolled, with 13 in each group. During follow-up, the portal stent patency times were 112.3 ± 98.2 days in the C-TACE group and 101.7 ± 90.4 days in the D-TACE group. The time to disease progression was 42 days in the C-TACE group and 120 days in the D-TACE group (p=0.03). The overall survival time from the first intervention procedure was 216 days in the C-TACE group and 239 days in the D-TACE group (p=0.047). The D-TACE group was superior to the C-TACE group in terms of progression-free survival (PFS) and overall survival (OS) times.
Endovascular implantation of brachytherapy combined with TACE is safe and effective in HCC patients with MPVTT. This combination therapy may be helpful for survival benefits to patients with stage BCLC-C HCC.
伴有主门静脉肿瘤血栓（MPVTT）的肝细胞癌（HCC）患者或许能够通过将支架植入有血栓形成的门静脉来恢复门静脉血流，从而进行经动脉化疗栓塞术（TACE）。
本研究旨在比较传统经导管动脉化疗栓塞术（C-TACE）与载药微球经导管动脉化疗栓塞术（D-TACE）联合血管内近距离放疗在伴有MPVTT的HCC患者中的临床效果。
本研究为回顾性对照研究，随访时间跨度为2015年3月至2020年2月。将同时患有HCC和MPVTT的患者分为两组。首先植入带有碘-125籽源链的门静脉支架；然后，对所有患者实施C-TACE或D-TACE。评估客观缓解率。
共纳入26例患者，每组13例。随访期间，C-TACE组门静脉支架通畅时间为112.3±98.2天，D-TACE组为101.7±90.4天。C-TACE组疾病进展时间为42天，D-TACE组为120天（p=0.03）。首次干预手术后的总生存时间，C-TACE组为216天，D-TACE组为239天（p=0.047）。D-TACE组在无进展生存期（PFS）和总生存期（OS）方面优于C-TACE组。
血管内近距离放疗联合TACE植入术在伴有MPVTT的HCC患者中安全有效。这种联合治疗可能有助于改善BCLC-C期HCC患者的生存获益。
