125I seed implantation for hepatocellular carcinoma with portal vein tumor thrombus: A systematic review and meta-analysis

PurposeAdvanced hepatocellular carcinoma often combined with portal vein tumor thrombus (PVTT), transcatheter arterial chemoembolization (TACE) is recommended as an effective treatment. Recent studies showed that TACE plus iodine-125 (¹²⁵I) seed for hepatocellular carcinoma with PVTT can improve the remission rate. This study aimed to systematically evaluate the efficacy and safety of ¹²⁵I seed implantation in patients with PVTT.Methods and MaterialsThe Embase, Medline/PubMed, Cochrane Library, and OVID databases were systematically searched from the earliest to October 2018. The references included in the literature were searched. The primary endpoints were remission rate and overall survival, and the secondary endpoints were portal venous pressure and adverse event. The odds ratio (OR) and hazard ratio (HR) were combined using either fixed or random effects model. Meta-analysis was performed using Stata 12.0 software.ResultsEight studies were included with 1098 patients, 591 patients received ¹²⁵I seed implantation, and 507 in the control group. Meta-analysis showed that ¹²⁵I seed implantation improved the remission rate in patients with PVTT (OR = 2.24, 95% confidence interval (CI) = 1.68–2.99, p = 0.000) and survival rate (HR = 0.27, 95% CI = 0.14–0.40, p = 0.000); it also reduced patient's mortality risk (HR = 0.46, 95% CI = 0.37–0.54, p = 0.000). Subgroup analysis suggested that the death risk of patients who responded to ¹²⁵I seed implantation declined 55% (HR = 0.45, 95% CI = 0.34–0.55, p = 0.000). ¹²⁵I seed implantation is more effective against PVTT delivered at a dose higher than 110 Gy. There was no difference in the occurrence adverse event between the two groups (OR = 1.07, 95% CI = 0.92–1.25, p = 0.262).ConclusionTACE plus ¹²⁵I seed implantation is more effective in treating PVTT. The use of ¹²⁵I seeds dose >110 Gy will show better results.     

肝癌 TACE术后残存病灶的判断方法及125I放射粒子治疗后疗效检测

目的：探讨肝癌TACE术后残存病灶的判断方法,125 I放射粒子治疗疗效及疗效检测方法。方法28例接受过1～5次TACE术治疗的肝癌患者共37个病灶,残存病灶确定方式为强化CT扫描10例,强化MRI 8例,PET‐CT 6例,肝动脉造影4例。根据治疗计划系统Brachy Interstitial‐Therapy Planning System （TPS）制订治疗计划,确定放射粒子数量及位置,肿瘤靶区超出肿瘤影像学边界0．5～1．0cm ,行C T引导下125 I放射粒子植入治疗残存病灶,定期检测血清AFP变化并与影像学结果做对比。结果强化CT、强化MRI 、PET‐CT、肝动脉造影均可确定肿瘤残存。28例患者37个病灶,均按计划完成治疗,分别于术后2、4、6、12月复查C T ,肿瘤局部控制有效率依次是：100％（37／37）、100％（37／37）、90．9％（36／37）、81．8％（34／37）,血清AFP变化并与影像学结果高度一致。结论强化CT和MRI检查是判定肝癌TACE术后残存的首选方法,125 I放射粒子治疗残存病灶是有效的,AFP检测是125 I放射粒子治疗后有效的疗效判断方法。     

碘125粒子联合肝动脉化疗栓塞术治疗原发性肝癌合并门脉分支癌栓疗效分析

目的探讨碘125(~(125)I)粒子联合TACE治疗原发性肝癌合并门脉分支癌栓患者的临床疗效和安全性。方法收集中国医科大学附属第一医院自2013年1月至2015年12月经病理检查或影像学证实的诊断为原发性肝癌伴门脉分支癌栓的患者89例,分为治疗组(n=47)和对照组(n=41)。治疗组患者给予患者超声引导下行门脉癌栓125I粒子植入术及TACE治疗;对照组患者进行传统的TACE治疗。末次随访时间为2016年1月31日。主要研究终点是总体生存期(OS),次要终点包括:术后1个月的疗效评价及不良反应的评价。同时,对影响OS的因素进行分析。结果治疗组与对照组的OS分别为17.8个月和8.4个月(P<0.05)。通过COX模型分析发现,肝内病灶最大径是否>5 cm是影响OS的主要因素(P<0.01)。治疗组与对照组疾病有效率(RR)分别为89.5%、41.5%(P<0.05),疾病控制率(DCR)分别为94.7%、56.8%(P<0.05);两组患者主要不良反应为发热、恶心呕吐、肝区疼痛、转氨酶升高及白蛋白减低等,但不良反应发生率方面差异均无统计学意义(P>0.05)。结论125I粒子联合TACE在肝癌合并门脉分支癌栓患者的治疗中可以有效延长患者的生存期,值得进一步研究。     

Predictive factors of benefit from iodine-125 brachytherapy for hepatocellular carcinoma with portal vein tumor thrombosis

Purpose

The aims of this study were to evaluate treatment responses and predictive factors for overall survival (OS) in hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) treated with iodine-125 (¹²⁵I) brachytherapy.

CT引导下125I放射性粒子治疗肝癌源性肺转移癌

目的 评价CT引导下125I放射性粒子植入治疗肝癌源性肺转移癌的临床价值.方法 38例肝癌肺转移患者共60个病灶,在CT引导下植入125I放射性粒子,病灶平均最大径（2.8±1.5）cm.结果 术后平均随访时间（17±7.2）月.完全缓解7个,部分缓解31个,稳定17个,进展5个,总有效率为63.33％（38/60）.肺转移癌最大径较术前缩小（P＜0.05）.结论 CT引导下125 I放射性粒子植入是治疗肝癌源性肺转移癌的有效手段.     

血清nm23-H1水平对肝细胞肝癌TACE治疗预后的影响

目的 探讨肝细胞肝癌患者血清nm23-H1基因水平及其对TACE治疗预后的影响.方法 收集60例行TACE治疗的肝细胞肝癌患者血清,采用ELISA检测血清nm23-H1水平,并与12例正常对照组进行比较.回顾性分析所有患者的临床病理资料,对患者血清nm23-H1水平与临床资料进行相关性分析,用Kaplan-Meier生存曲线分析患者生存率,并用log等级检验比较.多因素分析方法评估血清nm23-H1水平及相关因素对预后的意义.结果 肝细胞肝癌患者血清nm23-H1平均水平为(126.4 ± 51.3)ng/ml,明显低于正常对照组的(228.3 ± 38. 9)ng/ml(P < 0. 01).患者血清nm23-H1水平与白蛋白水平呈负相关(r ＝ -0.256, P ＝ 0.048),而与患者年龄及血清AFP、ALT、AST、GGT、胆红素水平均无相关性.随访1周～ 83个月,中位随访时间为17.5个月.单因素分析显示肝外转移、门静脉瘤栓、动静脉瘘和血清AFP升高是预后不良的因素.多因素COX模型分析显示血清nm23-H1水平是影响生存的因素之一.结论 血清nm23-H1水平有可能作为肝细胞肝癌患者TACE治疗疗效观察及预后判断的有用指标.     

125I粒子组织间植入治疗局部晚期胰腺癌进展

早在20世纪初人们就开始将放射性粒子用于胰腺癌治疗,但由于使用的放射性粒子如226Ra针、198Au、192Ir和222Rn等放射生物学或放射物理学方面的局限性,植入技术和植入计划系统的不健全,使得粒子植入治疗胰腺癌发展缓慢。20世纪60年代末期随着125I粒子临床应用,放射性核素放射生物学及放射物理学特性的深入研究,三维治疗计划系统的飞速发展,术中超声技术的使用,使得粒子植入治疗胰腺癌再度回归。     

CT-guided radiofrequency ablation after with transarterial chemoembolization in treating unresectable hepatocellular carcinoma with long overall survival improvement

Purpose

To assess the time to disease progression (TTP), long-term survival benefit and safety of patients with unresectable hepatocellular carcinoma (HCC) treated with computed tomography (CT)-guided radiofrequency ablation (RFA) with transarterial chemoembolization chemoembolization (TACE).

Methods

This study was approved by the institutional review board. We reviewed the records of patients with intermediate and advanced HCC treated with CT-guided RFA with TACE between January 2000 and December 2009. Median TTP, overall survival (OS) and hepatic function were analyzed with the Kaplan–Meier method and log-rank tests.

Results

One hundred and twenty-two patients (112 men and 10 women, mean age 53 years, range 18–86 years) were included in the study. The median follow-up time was 42 months (range 6–89 months), TTP was 6.8 months, the median OS was 31 months, and the 1-, 3-, and 5-year OS were 88.5%, 41.0%, and 10.7%. The results of the univariate analysis revealed that intrahepatic lesion, AJCC stage, and Child-Pugh stage were predictors of OS (P < 0.01). In the multivariate analysis, the AJCC stage system showed a statistically significant difference for prognosis. Procedure-related death was 0.21% (1/470) within 1 month, and a statistical difference was found between the TACE and RFA of liver decompensation and Child-Pugh stage (P < 0.05).

Conclusions

The survival probabilities of OS increased with CT-guided RFA with TACE, as observed in randomized studies from Europe and Asia. The longest TTP was observed for the intermediate stage HCC. The procedures were well tolerated with acceptable minor and major complications in unresectable HCC patients.     

CT引导下125I放射性粒子植入治疗肝癌门静脉癌栓的疗效评价

目的探讨CT引导下^125I放射性粒子植入联合肝动脉化疗栓塞术（TACE）治疗肝癌合并门静脉癌栓（PVTT）的疗效。方法回顾性分析原发性肝癌合并PVTT患者58例,A组（26例）行TACE结合CT引导下^125I放射性粒子植入局部放射治疗;B组（32例）单纯行TACE。对比两组疗效。结果 A组1、2年生存率分别为42.3%、23.0%,平均生存期15.5个月,完全缓解（CR）3例,部分缓解（PR）9例,总有效率（CR＋PR）为46.2%（12/26）。B组1、2年生存率分别为21.9%、6.3%,平均生存期7.5个月CR2例,PR6例,CR＋PR为25.0%（8/32）。A组的生存率及总有效率显著高于B组（P〈0.05）。结论 TACE联合CT引导下^125I放射性粒子植入治疗肝癌门脉癌栓能明显提高其疗效,并具有创伤少,并发症少等优点。     

复合125I粒子植入技术联合TACE治疗肝癌合并门静脉癌栓

【摘要】 目的 评估复合125I粒子植入技术（125I粒子螺旋系统序贯肿瘤同侧分支癌栓粒子植入术）联合TACE治疗肝细胞癌（HCC）合并程氏Ⅲ型门静脉癌栓（PVTT）的安全性及有效性。方法 对24例HCC合并Ⅲ型PVTT患者行门静脉主干内125I粒子螺旋系统植入术,随后同期行TACE治疗;7～10 d后继行肿瘤同侧分支癌栓内125I粒子植入术。每6～8周行CT增强随访,并按需行再次TACE治疗。统计分析患者并发症、治疗反应率及总生存期。 结果 所有患者均未发生3级以上严重并发症。门静脉主干癌栓（MPVTT）的客观反应率（ORR）与疾病控制率（DCR）分别为54.2%及87.5%;肝内病变的ORR及DCR分别为29.2%及37.5%。患者中位生存期为（9.5±1.4）（95%CI,6.7～12.3）个月。结论 复合125I粒子植入技术联合TACE治疗HCC合并Ⅲ型PVTT是安全可行的,该模式有望进一步改善此类患者预后。     

肝动脉栓塞化疗联合CT导向射频消融术治疗中、晚期肝癌的评价

目的 探讨肝动脉栓塞化疗联合CT导向下的射频消融治疗中、晚期原发性肝癌的疗效。方法 85例中、晚期原发性肝癌患者按单双日法分组原则分为A、B2组。A组：经导管肝动脉栓塞化疗组(TACE组)，共43例；B组：肝动脉栓塞化疗联合CT导向下的射频消融治疗组(联合治疗组)，共42例。结果 TACE组的完全坏死率、初次复发率及1年存活率分别20．93％、39．53％和79．07％；而联合治疗组分别为92．86％、9．53％和97．62％。两组间完全坏死率、初次复发率及1年生存率的差异皆有显著性意义(其相应P值分别为0．001，0．004，0．009)。结论 肝动脉栓塞化疗联合CT导向下的射频消融治疗效果明显优于单纯栓塞化疗。     

125I粒子近距离照射在肿瘤治疗中的应用

125I的生物物理学特性适合近距离照射治疗,125I作为粒子源植入体内,目前在国外广泛用于各种恶性肿瘤的治疗,尤其是用于前列腺癌的治疗已相当成熟,取得了良好的疗效,但在治疗中还存在一定的问题.     

Role of diffusion-weighted magnetic resonance imaging in the evaluation of hepatocellular carcinoma response to transcatheter arterial chemoembolization using drug eluting beads; correlation with dynamic MRI

Aim

To evaluate accuracy of DWI in evaluating HCC response to DEB TACE and compare the results with DCE MRI.

125I粒子植入联合肝动脉栓塞化疗治疗肝癌

目的 探讨125I粒子植入联合经肝动脉栓塞化疗治疗肝癌的短期疗效和安全性.方法 60例经病理检查确诊的肝癌患者,按照入院时间的单、双日,随机分为观察组和对照组,观察组28例,对照组32例.观察组患者确诊后行肝动脉栓塞化疗,2周后用放射性粒子计算机治疗计划系统制定治疗方案,在CT或B超导向下经皮穿刺,将125I粒子植入肝脏瘤体内,平均植入粒子数25粒/例(15-4JD粒/例).粒子植入术后定期行肝动脉栓塞化疗.粒子植入治疗前、后进行血常规、肝功能等检测,并进行重复测量方差分析.每2个月复查1次X线平片及腹部CT.对照组患者行单纯经肝动脉栓塞化疗.2组患者一般临床资料及生存率、有效率的比较采用X2检验.结果 观察组28例放射性粒子按术前计划植入到位,植入过程中无粒子丢失及移位;粒子植入后1周内丙氨酸转氨酶(ALT)、天冬氨酸转氨酶(AST)有一过性升高,2周后基本恢复正常;WBC、Hb、IgA、IgG手术前后无明显变化;术后未见严重并发症发生.治疗后4个月观察组有效率为75.0%(21/28),对照组为37.5%(12/32),2组差异有统计学意义(X2=8.485,P=0.004).观察组和对照组6个月生存率分别为92.9%(26/28)和75.0%(24/32),2组差异无统计学意义(X2=2.263,P=0.132);1年生存率分别为72.0%(18/25)和43.3%(13/30),2组间差别有统计学意义(X2=4.556,P=0.033).结论 125I粒子植入联合肝动脉栓塞化疗治疗肝癌方法简单易行、安全、近期疗效确切.     

经皮穿刺植入125I粒子治疗恶性肿瘤的临床应用

目的根据内放射源125I粒子的物理特性探讨其治疗原理、治疗计划系统(TPS)的意义、治疗方式及临床疗效.方法18例晚期肿瘤患者采取经皮穿刺植入125I粒子行组织间放疗.结果18例肿瘤患者均未出现任何严重的并发症,生存质量明显提高.2个月后经胸片、CT复查18例患者肿瘤均有不同程度缩小,12例明显缩小,其中5例肿瘤基本消失.结论短期疗效证明,125I粒子组织间放疗对晚期肿瘤效果显著,不良反应小.     

肝动脉化疗栓塞联合射频消融或放射性粒子组织间放疗对原发性肝癌的疗效比较研究

目的 评价比较肝动脉化疗栓塞(TACE)联合射频消融(RFA),以及TACE联合放射性粒子组织间放疗治疗原发性肝癌的效果.方法 50例患者接受TACE联合RFA,34例患者接受TACE联合125I组织问放疗.术后4周复查动态增强CT或MR,对病灶碘油聚集不良者,再次行TACE,术后定期复查,观察疗效.结果 TACE联合RFA或125I放疗后1个月.肿瘤局部控制率分别为98.0%和97.1%,两组间差异无统计学意义.结论 TACE联合RFA和125I植入放疗是肝细胞性肝癌的有效的治疗方法,是单纯TACE疗效不佳者的理想选择.     

C臂CT引导经皮乙醇消融术在巨块型肝癌经肝动脉化疗栓塞后的近期疗效

目的 评价C臂CT引导经皮无水乙醇消融术(PEI)在巨块型肝癌经肝动脉化疗栓塞术(TACE)后的可行性及近期疗效.方法 回顾分析巨块型肝癌患者95例,其中40例行单纯TACE治疗(对照组),55例行TACE联合PEI治疗(联合组).对照组1个月后重复TACE治疗1次.联合组TACE1周后行PEI.术前经C臂CT扫描评估碘油沉积情况,定位穿刺路径及注入部位.2周后对碘油沉积缺损部分追加PEI.3个月后两组复查CT,对碘油沉积分布情况进行统计学分析.结果 联合组初次PEI术后显示碘油沉积为Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型病灶分别为41.8％ (23/55)、49.1％(27/55)、7.3％ (4/55)和1.8％(1/55);2周后分别为25.4％ (14/55)、50.9％(28/55)、16.4％(9/55)和7.3％(4/55).再次对除Ⅰ型病灶外的41例患者行PEI.3个月后复查CT,对照组碘油沉积Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型病灶分别为7.5％ (3/40)、30％(12/40)、42.5％(17/40)、20％(8/40);联合组碘油沉积Ⅰ型、Ⅱ型、Ⅲ型及Ⅳ型病灶分别为30.9％(17/55)、40％ (22/55)、23.6％(13/55)、5.5％(3/55).两组差异有统计学意义.结论 C臂CT成像技术在TACE术后联合PEI治疗巨块型肝癌的指导和评估中具有重要价值,保证了手术的安全性、准确性和有效性.     

Dosimetry,efficacy, and safety of three-dimensional printing noncoplanar template-assisted and CT-guided 125I seed implantation for recurrent retroperitoneal lymphatic metastasis after external beam radiotherapy

ObjectivesTo evaluate the dosimetry, efficacy, and safety of radioactive ¹²⁵I seed implantation (RISI) assisted by three-dimensional printing noncoplanar template (3D-PNCT) and CT for recurrent retroperitoneal lymphatic metastasis (RRLM) after previous external beam radiotherapy.Methods and MaterialsFrom June 2016 to August 2018, 32 patients with RRLM successfully underwent 3D-PNCT–assisted and CT-guided RISI. The dosimetry, pain relief rate, performance improvement rate, overall response rate, disease control rate, local control time (LCT), overall survival (OS), and safety profiles were evaluated.ResultsDosimetric results showed that the D90, D100, V100, V150, V200, and homogeneity index were consistent in preoperation and postoperation (p > 0.05), except for the external index and conformal index (p = 0.048, p = 0.034). After RISI, 81.3% of the patients achieved pain relief, and 71.9% achieved an improvement of performance. The overall response rate and disease control rate were 85.3% and 94.1%, respectively. The LCT rates reached 66.2% and 43.2% in 1 year and two years, respectively, with a median LCT of 15.8 months. The OS rates were 74.1% and 28.1% in 1 year and two year, respectively, with a median OS reaching 17.6 months. Univariate analysis showed that when D90 > 130 Gy or D100 > 63 Gy or tumor size ≤49.8 cm³, LCT was extended significantly, but not for OS. Except for two patients developing Grade 1 retroperitoneal hematomas, no other severe adverse events were observed.Conclusions3D-PNCT and CT guidance provide excellent accuracy for RISI, which can be an effective and safe alternative for RRLM after external beam radiotherapy. Radiation dose and tumor size seem to significantly influence the local control.     

In vivo proton magnetic resonance spectroscopy of large focal hepatic lesions and metabolite change of hepatocellular carcinoma before and after transcatheter arterial chemoembolization using 3.0-T MR scanner

PURPOSE: To investigate the value of in vivo proton magnetic resonance spectroscopy (MRS) in the assessment of large focal hepatic lesions and to measure the metabolite change of hepatocellular carcinoma (HCC) after transcatheter arterial chemoembolization (TACE) using 3.0-T scanner. MATERIALS AND METHODS: In this prospective study, 43 consecutive patients with large (not less than 3 cm in diameter) hepatic tumors and eight normal volunteer were included. MRS of the lesions in addition to uninvolved liver parenchyma was carried out using a whole-body 3.0-T scanner. Among the patients with proven HCC, eight lesions were evaluated before and two to five days after TACE. The choline-to-lipid (cho/lipid) ratio was measured by dividing the peak area of choline at 3.2 ppm by the peak area of lipid at 1.3 ppm. The sensitivity and specificity profiles of MRS in the diagnosis of malignant hepatic tumors were determined by plotting empirical receiver operating characteristic (ROC) curve. The mean cho/lipid ratios in different groups before and after TACE were also measured. RESULTS: The technical success rate for MRS was 90% (53/59). The ROC curve showed proton MRS has moderate discriminating ability in diagnosing malignant hepatic tumors, although the sensitivity was less than 50% while 1-specificity was less than 20%. The area under the curve was 0.71 (P < 0.05). The mean +/- 1 standard error (SE) of cho/lipid ratios for uninvolved liver (N = 8), benign tumor (N = 8), and malignant tumor (N = 21; 19 HCC, one angiosarcoma, and one lymphoma) were 0.06 +/- 0.02, 0.02 +/- 0.02, and 0.17 +/- 0.05, respectively. A significantly statistical difference (ANOVA planned contrast test, P = 0.01 and Games-Howell procedure, P = 0.03) was achieved in the mean cho/lipid ratio between malignant and benign tumors. The mean cho/lipid ratios were significantly decreased from 0.23 +/- 0.11 before TACE to 0.01 +/- 0.00 after the treatment (t = 2.01, P < 0.05, one-tail paired t-test; z = -2.37, P < 0.05, Wilcoxon Signed Ranks Test). CONCLUSION: In vivo proton MRS is technically feasible for the evaluation of focal hepatic lesions. The technique has potential in the detection of early metabolite change in malignant liver tumors after TACE but limitation still exists in clear differentiation between normal liver and benign and malignant tumor.     

肝动脉化疗加栓塞结合中草药治疗70例中晚期肝癌的疗效观察

目的 评价肝动脉化疗栓塞术（TACE）结合中草药治疗中晚期肝癌的临床疗效。方法 对70例经临床综合检查确诊为中晚期肝癌患者进行了肝动脉化疗加栓塞，术后服用中草药。所有患者栓塞术后随访1～5a。结果 70例患者临床症状大多改善，综合治疗后1a，2a，3a，4a，5a的生存率分别为67.1%，52.8%，41.4%，21.4%，8.5%。结论 肝动脉化疗加栓塞结合中草药是治疗中晚期肝癌的有效方法之一，此法操作较简便安全，效果可靠，并发症少痛苦小，值得临床推广应用。