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

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:

• hepatocellular carcinoma
• portal vein tumor thrombus
• ¹²⁵I seed
• transcatheter arterial chemoembolization
• downstaging treatment

Data Sharing Statement

The Excel format data used to support the findings of this study are available from the corresponding author at [[email protected]] upon request.

Ethical Statement

This retrospective study was approved by the Research Ethics Committee of the Cancer Hospital affiliated with Zhengzhou University and complied with the ethical guidelines of the World Medical Association Declaration of Helsinki.

Acknowledgments

We thank all our authors listed in this manuscript, and also thank all the patients participated in the study.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

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

Additional information

Funding

Henan Province Natural Science Foundation (212300410403). Medical Education Research Project of Henan Province (Wjlx2021334). Technology Major Project of the Ministry of Science and Technology of China (2018ZX10303502).