Feasibility of 125I brachytherapy combined with sorafenib treatment in patients with multiple lung metastases after liver transplantation for hepatocellular carcinoma

To evaluate I-125 seed brachytherapy combined with sorafenib in the treatment of patients with multiple lung metastases after orthotopic liver transplantation (OLT) for hepatocellular carcinoma (HCC). From July 2006 to December 2009, eight patients with multiple lung metastases after OLT for HCC underwent I-125 brachytherapy combined with sorafenib, and laboratory and radiologic examinations were performed before and after the treatment. Changes in symptoms and survival time were noted at follow-up. The follow-up time ranged from 14 to 37 months. The local control rates of multiple lung metastases after OLT for HCC after 4, 6, 12, 18 and 24 months were 92.2, 82.4, 76.2, 73.3 and 72.2%, respectively. Four patients died (survival time 14, 15, 25 and 37 months, respectively), and four patients are alive at the time of this writing (follow-up time 18, 21, 26 and 30 months, respectively). The overall 1-, 2- and 3-year survival rates were 100, 50 and 12.5%, respectively. The median survival time was 21 months. Procedure-related complications were minimal. I-125 brachytherapy combined with sorafenib is safe, feasible and promising approach in the treatment of patients with multiple lung metastases after OLT for HCC, but large-scale randomized clinical trials are necessary for confirmation.