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. 2023 Feb 14:10:231-240.
doi: 10.2147/JHC.S392293. eCollection 2023.

Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus

Xiao-Hui Zhao  1 , Hai-Liang Li  1 , Chen-Yang Guo  1 , Quan-Jun Yao  1 , Wei-Li Xia  1 , Hong-Tao Hu  1
Affiliations

Downstaging and Conversation Strategy for Advanced Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus: TACE, 125I Seed Implantation, and RFA for Hepatocellular Carcinoma with Portal Vein Branch Tumor Thrombus

Xiao-Hui Zhao et al. J Hepatocell Carcinoma. .

Abstract

Background and objectives: Trans-arterial chemoembolization (TACE) combined with 125I seed implantation is an effective treatment modality for hepatocellular carcinoma (HCC) with a portal vein tumor thrombus (PVTT). However, there are no reports on the effectiveness of radiofrequency ablation (RFA) after downstaging in such patients. This study aimed to investigate the efficacy and safety of TACE in combination with 125I seed implantation and RFA for the treatment of HCC complicated by PVTT.

Methods: 49 patients diagnosed with HCC with PVTT between February 2015 and December 2016 were included. All patients were clinically or pathologically diagnosed with advanced HCC, intrahepatic lesions ≤3, and a single tumor diameter ≤70 mm, total diameter ≤100 mm. PVTT was limited to the unilateral portal vein branches. All the patients were treated with TACE combined with PVTT 125I seed implantation. The size and activity of intrahepatic lesions and PVTT were evaluated using enhanced magnetic resonance imaging 3 months after treatment, and other indicators were combined to determine the success of downstaging.

Results: A total of 31 patients were successfully downstaged, while 18 patients did not achieve downstaging owing to the progression of intrahepatic lesions or PVTT activity/progression, the success rate of the downstaging was 63.27%. All 31 patients with successful downstaging underwent RFA for intrahepatic lesions. The 1-, 2-, and 3-year survival rates were 90.3%, 80.6%, and 48.4%, respectively. The median overall survival was 36 months (95% CI: 24.7-47.3).

Conclusion: 125I seed implantation in combination with TACE can effectively inactivate PVTT and achieve downstaging. Furthermore, the addition of RFA can significantly improve patient survival.

Keywords: 125I seed; downstaging treatment; hepatocellular carcinoma; portal vein tumor thrombus; transcatheter arterial chemoembolization.

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Conflict of interest statement

The authors have no conflict of interest related to this publication.

Figures

Figure 1
Figure 1
Patient selection flowchart.
Figure 2
Figure 2
Images representing case patients.
Figure 3
Figure 3
Kaplan-Meier curves for OS (A) and RFS (B) in patients with successful downstaging. Kaplan-Meier curves for OS (C) in patients with complete ablation and incomplete ablation.
See this image and copyright information in PMC

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