Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus
Menée à partir de données portant sur 276 patients atteints d'un carcinome hépatocellulaire, cette étude évalue l'efficacité, du point de vue de la survie sans progression et de la survie globale, et la sécurité d'un traitement combinant une curiethérapie endovasculaire avec implants de grains d'iode 125, une chimio-embolisation transartérielle et la pose d'une endoprothèse
Propose : To evaluate the safety and efficacy of endovascular brachytherapy (EVBT) with iodine-125 (125I) 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. 125I 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.
http://link.springer.com/article/10.1007%2Fs12072-015-9663-8