Zhu Wenliang, Zhong Zhihui, Yan Huzheng, Guo Huanqing, Xiao Meigui, He Xu, Gao Fei, Zhang Fujun
Department of Minimally Invasive and Interventional Radiology, State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-Sen University Cancer Center, 651 Dongfeng Road, East, Guangzhou, 510060, People's Republic of China.
Department of Interventional Radiology, The Third Affiliated Hospital, Sun Yat-Sen University, No. 600, Tianhe Road, Tianhe District, Guangzhou, 510630, People's Republic of China.
Insights Imaging. 2022 Dec 6;13(1):185. doi: 10.1186/s13244-022-01327-z.
Treatment methods of local residual or recurrent hepatocellular carcinoma (HCC) after thermal ablation are limited. Therefore, our study aimed to explore the efficacy and prognostic factors of I brachytherapy for local residual or recurrent lesion after thermal ablation.
A total of 114 patients with 212 local residual or recurrent HCC tumors after thermal ablation underwent I brachytherapy. Local progression-free survival (LPFS) and prognostic factors were analyzed by Kaplan-Meier curves and the Cox model.
After a 6-month follow-up, the percentage of patients who achieved complete response (CR), partial response (PR), and stable disease (SD) was 57%, 13.2%, and 5.2%, respectively. The 1-, 2-, and 3-year LPFS rates were 58.7%, 50.0%, and 41.2%, respectively. Portal vein tumor thrombus (PVTT) (p = 0.03), the number of intrahepatic tumors (p = 0.01), and AFP level (p = 0.02) were independent risk factors for local tumor progression (LTP). The median LPFS in patients without PVTT (22 months) was much longer compared to those with PVTT (10 months). The median LPFS in patients with less than three intrahepatic lesions improved from 17 to 24 months. The median LPFS was only 5 months in the high AFP group, but was prolonged with a decrease in AFP level (24 months). No severe complications were recorded. All complications were controllable and treatable.
CT-guided I brachytherapy was a safe and effective treatment for patients with local residual or recurrent HCC after thermal ablation to improve local control rate.
热消融术后局部残留或复发性肝细胞癌（HCC）的治疗方法有限。因此，我们的研究旨在探讨碘粒子近距离治疗热消融术后局部残留或复发病变的疗效及预后因素。
114例热消融术后有212个局部残留或复发性HCC肿瘤的患者接受了碘粒子近距离治疗。采用Kaplan-Meier曲线和Cox模型分析局部无进展生存期（LPFS）及预后因素。
随访6个月后，达到完全缓解（CR）、部分缓解（PR）和疾病稳定（SD）的患者百分比分别为57%、13.2%和5.2%。1年、2年和3年的LPFS率分别为58.7%、50.0%和41.2%。门静脉癌栓（PVTT）（p = 0.03）、肝内肿瘤数量（p = 0.01）和甲胎蛋白水平（p = 0.02）是局部肿瘤进展（LTP）的独立危险因素。无PVTT患者的中位LPFS（22个月）比有PVTT患者（约10个月）长得多。肝内病变少于3个的患者中位LPFS从17个月提高到24个月。甲胎蛋白水平高的组中位LPFS仅5个月，但随着甲胎蛋白水平降低而延长（24个月）。未记录到严重并发症。所有并发症均可控制和治疗。
CT引导下碘粒子近距离治疗是热消融术后局部残留或复发性HCC患者提高局部控制率的一种安全有效的治疗方法。
