Investigation into the efficiency and prognostic elements of CT-guided ¹²⁵I particle implantation for liver cancer.

PURPOSE

This study assessed the effectiveness and prognostic factors of CT-guided ¹²⁵I seed implantation for primary hepatocellular carcinoma (HCC).

METHODS

A retrospective analysis of 71 patients (57 males, 14 females, median age 64) treated at three Chinese hospitals from 2018 to 2024 was conducted. The main outcomes were local progression-free survival (LPFS) and overall survival (OS). Treatment involved a 16-slice Spiral CT and Radioactive Particle Treatment Planning System (TPS), with seeds of 18.5-29.6 MBq implanted via freehand puncture. Efficacy was evaluated using the modified Response Evaluation Criteria in Solid Tumors (mRECIST) at three months, with follow-ups every three months for three years, then biannually until December 2024. Data analysis utilized SPSS 22.0, Kaplan-Meier, and Cox models.

RESULTS

With a median follow-up of 37 months, the complete response (CR) rate was 57.7%, partial response (PR) 31.0%, stable disease (SD) 5.6%, and progressive disease (PD) 5.6%. Local control was 94.3%. LPFS rates at 1, 3, and 5 years were 74.6%, 29.5%, and 1.4% (median LPFS 22 months), while overall survival (OS) rates were 88.7%, 47.8%, and 12.6% (median OS 35 months). CR was a key protective factor for LPFS and OS. Significant factors included the Barcelona Clinic Liver Cancer (BCLC) stage C, intrahepatic progression, and extrahepatic metastasis. Postoperative complications occurred in 35.2% of patients, with no severe cases.

CONCLUSION

CT-guided ¹²⁵I seed implantation is effective and safe for primary HCC, with CR being crucial for survival. Large-scale studies are needed to confirm these results.