Clinical value of 125I seeds implantation combined with high intensity focused ultrasound for the treatment of portal vein tumor thrombus from hepatocellular carcinoma

Objective To investigate the clinical efficacy and feasibility of 125I seeds implantation combined with high intensity focused ultrasound (HIFU) for portal vein tumor thrombus (PVTT) from HCC. Methods Nineteen cases of PVTT from HCC (17 males, 2 females; average age: 50 years, stage: Ⅰ-Ⅲ) undergoing 125I seeds implantation combined with HIFU from March 2011 to October 2013 were retrospectively studied. The radioactivity of each 125I seed was 18.5 MBq and the matched peripheral dose was 90-120 Gy. HIFU parameters were set as follows: ultrasound wave frequency, 0.85 mHz; output power, 300-400 W; total treatment duration, 33-70 min. During the follow-up of 3-24 months, the change of PVTT size, postoperative complications and survival rate were recorded. Kaplan-Meier method was used to analyze the survival rate. Results The treatment was successfully completed in all patients and no serious complications were observed. After 1 month of follow-up, the tumor thrombi shrank in all patients. Among 19 patients, 9 achieved PR, 4 SD, 6 PD. The one-year and two-year survival rates were 47.4% and 7.9%, respectively. The mean survival was 11.6±3.0 months (range: 3-24 months). The median postoperative survival for stagesⅠ, Ⅱ, Ⅲ was 13.5, 7.0, 4.0 months, respectively. Conclusion 125I seeds implantation combined with HIFU could be a safe and effective therapy for PVTT from HCC. Key words: Liver neoplasms; Thrombosis; Portal vein; Brachytherapy; Iodine radioisotopes; Ultrasound, high intensity focused