nach oben

Journal of Cancer Research and Clinical Oncology

Erschienen in:

01.02.2014 | Original Paper

Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial

verfasst von: MinJie Yang, ZhuTing Fang, ZhiPing Yan, JianJun Luo, LingXiao Liu, Wen Zhang, LinLin Wu, JingQin Ma, QingHui Yang, QingXin Liu

Erschienen in: Journal of Cancer Research and Clinical Oncology | Ausgabe 2/2014

Einloggen, um Zugang zu erhalten

Abstract

Purpose

There was no standard treatment for hepatocellular carcinoma with portal vein tumour thrombosis (PVTT). This prospective, randomised, two-arm clinical trial aims to investigate the feasibility, safety and effectiveness of transarterial chemoembolisation (TACE) combined with the endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus conventional TACE.

Patients and methods

Eighty-five patients who met the eligibility requirements were randomly assigned to receive the treatment of TACE combined with the endovascular implantation of an iodine-125 seed strand (43 cases) or conventional TACE (42 cases). The end points were survival time, complications related to the procedure and adverse events.

Results

No significant differences in baseline characteristics were observed between groups. The mean and median survival times were 221.7 ± 16.3 days [95 % confidence interval (CI) 189.8–253.6 days] and 210.0 ± 17.5 days (95 % CI 175.8–244.2 days) in group A and 155.1 ± 7.9 days (95 % CI 139.6–170.5 days) and 154.0 ± 11.2 days (95 % CI 133.2–176.0 days) in group B (P = 0.000). The 90-, 180- and 360-day cumulative survival rates were 97.6, 58.9 and 12.3 % in group A and 92.5, 30.7 and 0 % in group B (P = 0.000).

Conclusion

Transarterial chemoembolisation combined with the endovascular implantation of an iodine-125 seed strand is feasible, safe and effective in the treatment for hepatocellular carcinoma with PVTT.

Boettcher HD, Schopohl B, Liermann D, Kollath J, Adamietz IA (1994) Endovascular irradiation—a new method to avoid recurrent stenosis after stent implantation in peripheral arteries: technique and preliminary results. Int J Radiat Oncol Biol Phys 29(1):183–186CrossRef

Bruix J, Sherman M, American Association for the Study of Liver D (2011) Management of hepatocellular carcinoma: an update. Hepatology 53(3):1020–1022. doi:10.1002/hep.24199 CrossRef

Chen Y, Wang XL, Yan ZP, Wang JH, Cheng JM, Gong GQ, Luo JJ (2012) The use of (1)(2)(5)I seed strands for intraluminal brachytherapy of malignant obstructive jaundice. Cancer Biotherapy Radiopharm 27(5):317–323. doi:10.1089/cbr 2011.0999CrossRef

Connolly GC, Chen R, Hyrien O, Mantry P, Bozorgzadeh A, Abt P, Khorana AA (2008) Incidence, risk factors and consequences of portal vein and systemic thromboses in hepatocellular carcinoma. Thromb Res 122(3):299–306. doi:10.1016/j.thromres.2007.10.009 PubMedCentralPubMedCrossRef

Guo JH, Teng GJ, Zhu GY, He SC, Fang W, Deng G, Li GZ (2008) Self-expandable esophageal stent loaded with I-125 seeds: initial experience in patients with advanced esophageal cancer. Radiology 247(2):574–581. doi:10.1148/radiol.2472070999 PubMedCrossRef

Higaki I, Hirohashi K, Kubo S, Tanaka H, Tsukamoto T, Omura T, Kinoshita H (2000) Portal vein stenting to treat portal vein tumour thrombus in hepatocellular carcinoma. Osaka City Med J 46(2):99–104PubMed

Ii N, Yamakado K, Shouji K, Nomoto Y, Nakatsuka A, Nomura M, Yamashita Y, Takaki H, Akeboshi M, Senga M, Shiraki K, Takeda K (2007) Multimodality therapy using brachytherapy for caval tumour of hepatocellular carcinoma. Hepatogastroenterology 54(77):1522–1525PubMed

Jemal A, Bray F, Center MM, Ferlay J, Ward E, Forman D (2011) Global cancer statistics. CA Cancer J Clin 61(2):69–90. doi:10.3322/caac.20107 PubMedCrossRef

Kim DY, Park W, Lim DH, Lee JH, Yoo BC, Paik SW, Kho KC, Kim TH, Ahn YC, Huh SJ (2005) Three-dimensional conformal radiotherapy for portal vein thrombosis of hepatocellular carcinoma. Cancer 103(11):2419–2426. doi:10.1002/cncr.21043 PubMedCrossRef

Kulik LM, Carr BI, Mulcahy MF, Lewandowski RJ, Atassi B, Ryu RK, Sato KT, Benson A 3rd, Nemcek AA Jr, Gates VL, Abecassis M, Omary RA, Salem R (2008) Safety and efficacy of 90Y radiotherapy for hepatocellular carcinoma with and without portal vein thrombosis. Hepatology 47(1):71–81. doi:10.1002/hep.21980 PubMedCrossRef

Lai YC, Shih CY, Jeng CM, Yang SS, Hu JT, Sung YC, Liu HT, Hou SM, Wu CH, Chen TK (2003) Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumour thrombosis. World J Gastroenterol WJG 9(12):2666–2670

Lau WY, Ho S, Leung TWT, Chan M, Ho R, Johnson PJ, Li AKC (1998) Selective internal radiation therapy for nonresectable hepatocellular carcinoma with intraarterial infusion of (90) yttrium microspheres. Int J Radiat Oncol Biol Phys 40(3):583–592. doi:10.1016/s0360-3016(97)00818-3 PubMedCrossRef

Lencioni R, Llovet JM (2010) Modified RECIST (mRECIST) assessment for hepatocellular carcinoma. Semin Liver Dis 30(1):52–60. doi:10.1055/s-0030-1247132 PubMedCrossRef

Liu MT, Li SH, Chu TC, Hsieh CY, Wang AY, Chang TH, Pi CP, Huang CC, Lin JP (2004) Three-dimensional conformal radiation therapy for unresectable hepatocellular carcinoma patients who had failed with or were unsuited for transcatheter arterial chemoembolisation. Jpn J Clin Oncol 34(9):532–539. doi:10.1093/jjco/hyh089 PubMedCrossRef

Llado L, Virgili J, Figueras J, Valls C, Dominguez J, Rafecas A, Torras J, Fabregat J, Guardiola J, Jaurrieta E (2000) A prognostic index of the survival of patients with unresectable hepatocellular carcinoma after transcatheter arterial chemoembolisation. Cancer 88(1):50–57PubMedCrossRef

Llovet JM, Ricci S, Mazzaferro V, Hilgard P, Gane E, Blanc JF, de Oliveira AC, Santoro A, Raoul JL, Forner A, Schwartz M, Porta C, Zeuzem S, Bolondi L, Greten TF, Galle PR, Seitz JF, Borbath I, Haussinger D, Giannaris T, Shan M, Moscovici M, Voliotis D, Bruix J, Group SIS (2008) Sorafenib in advanced hepatocellular carcinoma. N Engl J Med 359(4):378–390. doi:10.1056/NEJMoa0708857 CrossRef

Llovet JM, Bustamante J, Castells A, Vilana R, Ayuso Mdel C, Sala M, Bru C, Rodes J, Bruix J (1999) Natural history of untreated nonsurgical hepatocellular carcinoma: rationale for the design and evaluation of therapeutic trials. Hepatology 29(1):62–67. doi:10.1002/hep.510290145 PubMedCrossRef

Luo J, Yan Z, Liu Q, Qu X, Wang J (2011) Endovascular placement of iodine-125 seed strand and stent combined with chemoembolisation for treatment of hepatocellular carcinoma with tumour thrombus in main portal vein. J Vasc Interv Radiol 22(4):479–489. doi:10.1016/j.jvir.2010.11.029 PubMedCrossRef

Morris WJ, Keyes M, Palma D, Spadinger I, McKenzie MR, Agranovich A, Pickles T, Liu M, Kwan W, Wu J, Berthelet E, Pai H (2009) Population-based study of biochemical and survival outcomes after permanent I-125 brachytherapy for low- and intermediate-risk prostate cancer. Urology 73(4):860–865. doi:10.1016/j.urology.2008.07.064 PubMedCrossRef

National Cancer Institution (2009) Common terminology criteria for adverse events (CTCAE) vesion 4.0

Pleguezuelo M, Marelli L, Misseri M, Germani G, Calvaruso V, Xiruochakis E, Pinelopi M, Burroughs AK (2008) TACE versus TAE as therapy for hepatocellular carcinoma. Expert Rev Anticancer Ther 8(10):1623–1641. doi:10.1586/14737140.8.10.1623 PubMedCrossRef

Salem R, Lewandowski R, Roberts C, Goin J, Thurston K, Abouljoud M, Courtney A (2004) Use of Yttrium-90 glass microspheres (TheraSphere) for the treatment of unresectable hepatocellular carcinoma in patients with portal vein thrombosis. J Vasc Interv Radiol 15(4):335–345PubMedCrossRef

Yamada K, Izaki K, Sugimoto K, Mayahara H, Morita Y, Yoden E, Matsumoto S, Soejima T, Sugimura K (2003) Prospective trial of combined transcatheter arterial chemoembolisation and three-dimensional conformal radiotherapy for portal vein tumour thrombus in patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 57(1):113–119PubMedCrossRef

Yamakado K, Tanaka N, Nakatsuka A, Matsumura K, Takase K, Takeda K (1999) Clinical efficacy of portal vein stent placement in patients with hepatocellular carcinoma invading the main portal vein. J Hepatol 30(4):660–668. doi:10.1016/s0168-8278(99)80197-4 PubMedCrossRef

Zhang XB, Wang JH, Yan ZP, Qian S, Du SS, Zeng ZC (2009) Hepatocellular carcinoma with main portal vein tumour thrombus: treatment with 3-dimensional conformal radiotherapy after portal vein stenting and transarterial chemoembolisation. Cancer 115(6):1245–1252. doi:10.1002/cncr.24139 PubMedCrossRef

Zhang W, Yan ZP, Luo JJ, Fang ZT, Wu LL, Liu QX, Qu XD, Liu LX, Wang JH (2013) Iodine-125 Seeds strand for treatment of tumour thrombus in inferior vena cava: an experimental study in a rabbit model. Cardiovasc Intervent Radiol 36(5):1371–1382. doi:10.1007/s00270-013-0628-9 PubMedCrossRef

Zhu HD, Guo JH, Zhu GY, He SC, Fang W, Deng G, Qin YL, Li GZ, Coldwell DM, Teng GJ (2012) A novel biliary stent loaded with I-125 seeds in patients with malignant biliary obstruction: preliminary results versus a conventional biliary stent. J Hepatol 56(5):1104–1111PubMedCrossRef

Titel: Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial
verfasst von: MinJie Yang
ZhuTing Fang
ZhiPing Yan
JianJun Luo
LingXiao Liu
Wen Zhang
LinLin Wu
JingQin Ma
QingHui Yang
QingXin Liu
Publikationsdatum: 01.02.2014
Verlag: Springer Berlin Heidelberg
Erschienen in: Journal of Cancer Research and Clinical Oncology / Ausgabe 2/2014
Print ISSN: 0171-5216
Elektronische ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-013-1568-0

Update Onkologie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen

Live-Webinar "Urologie und Sexualmedizin in der Praxis"

Springer Medizin

Transarterial chemoembolisation (TACE) combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone: a two-arm, randomised clinical trial