Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus

Propose To evaluate the safety and efficacy of endovascular brachytherapy (EVBT) with iodine-125 (125 I) seed strand implantation combined with stent placement and transarterial chemoembolization (TACE) to treat hepatocellular carcinoma (HCC) with main portal vein tumor thrombus (MPVTT). Methods Data of 276 consecutive HCC patients with MPVTT treated by stent placement and TACE were analyzed retrospectively. 125 I seed strands were implanted in 182 patients (group A). The remaining 94 patients, who did not receive EVBT, served as control (group B). The overall survival, free of disease progression survival, stent patency period and procedure-related complications were compared between the two groups. Results During a mean 9.9 +/- 9.7 month (range 1.3-62.2 months) follow-up, the median survival time was 9.3 +/- 0.9 months (95 % CI 7.6-11.0 months) in group A compared to 4.9 +/- 0.5 months (95 % CI 4.0-5.8 months) in group B (p < 0.001). Median free of disease progression survival time in group A and B was 1.8 +/- 0.1 months (95 % CI 1.6-2.0 months) and 1.5 +/- 0.1 months (95 % CI 1.3-1.7 months), respectively (p < 0.001). Median stent patency period was 9.2 +/- 1.1 months (95 % CI 7.0-11.4 months) in group A and 4.8 +/- 0.5 months (95 % CI 3.9-5.7 months) in group B, respectively (p < 0.001). Conclusion These findings suggested that EVBT combined with stent placement and TACE might be a safe and effective palliative treatment option for HCC with main portal vein tumor thrombus.