Caudate Lobe Hepatocellular Carcinoma Treated with Sequential Transarterial Chemoembolization and Iodine 125 Seeds Implantation: A Single-Center Retrospective Study

Abstract

Purpose

Resection of the hepatocellular carcinoma (HCC) in the caudate lobe (CL) is challenging even for accomplished surgeons. This retrospective study evaluated the safety and efficacy of transarterial chemoembolization (TACE) and iodine 125 seeds implantation (ISI) for unresectable or “ablation unsuitable” HCC-CL detected at the initial presentation in clinical practice.

Patients and Methods

A total of 20 HCC-CL patients undergoing sequential TACE and ISI from January 2014 to October 2018 were enrolled in this study. The overall survival (OS), progression-free survival (PFS), tumor response rate, and complication rates were analyzed and compared to non-caudate lobe (NCL) HCC patients. Multivariate analyses for potential clinical and radiological factors were performed using the Cox proportional hazard model.

Results

The technical success rate was 100%, as all the patients received 28 ISI treatments. The median OS was 35 months. The 1-, 3-, and 5-year OS rates were 100%, 63.2%, and 11.1%, respectively. The median PFS was 16 months. The objective response rate was 60.0%. The puncture tract bleeding (2/20) and pneumothorax (1/20) were the most common complications in operation, but no operation-related deaths occurred. One year after the surgery, biliary tract injury occurred in 1 patient, necessitating percutaneous biliary intervention. No statistical difference was observed between the CL and NCL groups. Multivariable analysis revealed that Barcelona Clinic Liver Cancer stage B and tumor size >3 cm were two significant factors associated with OS.

Conclusion

Sequential TACE and ISI were associated with the survival benefits in HCC-CL and should be considered as a reliable therapy for surgeons and interventional radiologists.

Keywords:

• transarterial chemoembolization
• iodine 125 seeds implantation
• hepatocellular carcinoma
• caudate lobe
• survival

Acknowledgments

This work was supported by grants from the National Nature Science Foundation of China (81873919 and 81701800).

Abbreviations

HCC, hepatocellular carcinoma; CL, caudate lobe; PVTT, portal vein tumor thrombus; RFA, radiofrequency ablation; BCLC, Barcelona clinic liver cancer; TACE, transarterial chemoembolization; ECOG, Eastern Cooperative Oncology Group; mRECIST, modified response evaluation criteria in solid tumors; CR, complete response; PR, partial response; SD, stable disease; PD, progressive disease; ORR, objective response rate; OS, overall survival; PFS, progression-free survival; CTCAE, common terminology criteria for adverse events; CT, computed tomography; MR, magnetic resonance; AFP, alpha-fetoprotein; SD, standard deviation; CI, confidence intervals; HR, hazard ratio; TPS, treatment-planning system; EASL, European Association for the study of the liver; DSA, digital subtraction angiography; HBV, hepatitis B virus; LTP, local tumor progression; DR, distant recurrence.

Ethics Approval and Informed Consent

This was a retrospective study and performed according to the guidelines of the Helsinki Declaration. This study was approved by the ethics committee of Union Hospital, Tongji Medical College, Huazhong University of Science and Technology (UHCT-IEC-SOP-016-03-01). The need for informed consent was waived by this institution.

Author Contributions

All authors made substantial contributions to conception and design, acquisition of data, or analysis and interpretation of data; took part in drafting the article or revising it critically for important intellectual content; agreed to submit to the current journal; gave final approval for the version to be published; and agreed to be accountable for all aspects of the work.

Disclosure

All authors declare that they have no conflicts of interest.