TACE联合^(125)I放射性粒子植入治疗肝细胞癌门静脉癌栓

Transarterial chemoembolization combined with CT-guided ^(125)I seed implantation for the treatment of hepatocellular carcinoma associated with portal vein tumor thrombus

目的探讨TACE联合125I放射性粒子植入治疗肝细胞癌(HCC)门静脉癌栓(PVTT)的方法及疗效。方法纳入TACE联合CT引导下植入125I放射性粒子治疗的HCC合并PVTT患者48例。根据PVTT部位,分为门静脉主干癌栓(A型)、门静脉一级分支癌栓(B型)和门静脉二级及以下分支癌栓(C型)。根据粒子是否植入到PVTT内,分为癌栓内直接植入法(癌栓内部植入组)和癌栓周围植入法(其粒子植入到癌栓周围1.7 cm内的肝实质或肿瘤内,癌栓周围植入组)。比较不同类型PVTT及不同植入方法的癌栓控制率(DCR)、癌栓进展时间(TTP)及患者总生存率(OS)。结果 48例患者均成功进行TACE及粒子植入治疗。A、B、C型PVTT患者,中位OS(m OS)分别为8、11.5和15个月,组间差异有统计学意义(P=0.003);癌栓DCR分别为61.5%、70.8%和72.7%(P=0.548),肝内肿瘤DCR分别为69.2%、75.0%和81.8%(P=0.483);癌栓中位TTP分别为4.5、8和11个月(P=0.030),肝内肿瘤中位TTP分别为5、9和9.5个月。癌栓内部植入组和癌栓周围植入组的m OS分别为10和11.5个月(P=0.239);癌栓DCR分别为69.2%、68.2%(P=0.591),肝内肿瘤DCR分别为73.1%和77.3%(P=0.502);癌栓中位TTP分别为7和10个月(P=0.276),肝内肿瘤中位TTP分别为8和9.5个月(P=0.089)。结论 TACE联合125I放射性粒子植入治疗HCC伴PVTT,可有效控制PVTT和肝内肿瘤进展,延长患者生存期;癌栓内直接植入法和癌栓周围植入法,对PVTT的疗效无影响。

Objective To evaluate the therapeutic effect of transarterial chemoembolization（TACE）combined with CT-guided125 I seed implantation in treating hepatocellular carcinoma（HCC） complicated by portal vein tumor thrombus（PVTT）, and to discuss the technical points. Methods A total of 48 HCC patients with PVTT were enrolled in this study. TACE combined with CT-guided125 I seed implantation was carried out in all 48 patients. Based on the sites of PVTT, the lesions were classified into type A（PVTT within main portal vein）, type B（PVTT within level-1 portal branch） and type C（PVTT within level-2 or more distal portal branch）. According to whether the125 I seeds were directly implanted into the PVTT or not, the patients were divided into direct in-tumor thrombus implantation group（group A） and around tumor thrombus implantation group（group B; the125 I seeds were implanted in the liver parenchyma or in tumor tissue around the tumor thrombus within 1.7 cm region）. The tumor thrombus control rate（TTCR）, the disease control rate（DCR）,the time to progress（TTP） and the overall survival rate of patients（OS） were determined, and the results were compared among different types and groups. Results TACE combined with CT-guided125 I seed implantationwas successfully accomplished in all 48 patients. The median OS of type A, B and C was 8, 11.5 and 15 months respectively（P=0.003）; the TTCR of type A, B and C was 61.5%, 70.8% and 72.7% respectively（P=0.548）; the DCR of type A, B and C was 69.2%, 75% and 81.8% respectively（P=0.483）; the median TTP of type A, B and C was 4.5, 8 and 11 months respectively（P=0.030）; the median TTP of intra-hepatic tumor of type A, B and C was 5, 9 and 9.5 months respectively（P=0.012）. The median OS in group A and group B was 10 and 11.5 months respectively（P=0.239）; the TTCR in group A and group B was 69.2% and 68.2%respectively（P =0.591）; the DCR of intra-hepatic tumor in group A and group B was 73.1% and 77.3%respectively（P =0.502）; the median TTP of tumor thrombus in group A and group B was 7 and 10 months respectively（P=0.276）; and the median TTP of intra-hepatic tumor in group A and group B was 8 and 9.5months respectively（P =0.089）. Conclusion For the treatment of hepatocellular carcinoma complicated by portal vein tumor thrombus, TACE combined with CT-guided125 I seed implantation can effectively control the progress of both the tumor thrombus and the intra-hepatic tumor and prolong patient＇s survival time.Implantation of125 I seeds into the portal vein tumor thrombus and implantation of125 I seeds into the liver parenchyma around the tumor thrombus have the same therapeutic results.