CT-guided 125I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study

Zixiong Chen; Xiaobo Fu; Zhenkang Qiu; Maoyuan Mu; Weiwei Jiang; Guisong Wang; Zhihui Zhong; Han Qi; Fei Gao

doi:10.2478/raon-2023-0012

CT-guided ¹²⁵I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study

Radiol Oncol. 2023 Mar 22;57(1):127-139. doi: 10.2478/raon-2023-0012. eCollection 2023 Mar 1.

Authors

Zixiong Chen¹, Xiaobo Fu¹, Zhenkang Qiu², Maoyuan Mu¹, Weiwei Jiang¹, Guisong Wang¹, Zhihui Zhong¹, Han Qi¹, Fei Gao¹

Affiliations

¹ Department of Minimally Invasive & Interventional Radiology, Sun Yat-sen University Cancer Center and Sun Yat-sen University State Key Laboratory of Oncology in South China, and Collaborative Innovation Center for Cancer Medicine, Guangzhou, Guangdong, China.
² Interventional Medical Center, Affiliated Hospital of Qingdao University, Qingdao, Shandong, China.

Abstract

Background: This study aimed to evaluate the safety and efficacy of ¹²⁵I brachytherapy combined with transarterial chemoembolization (TACE) and microwave ablation (MWA) for unresectable hepatocellular carcinoma (HCC) in high-risk locations.

Patients and methods: After 1:2 propensity score matching (PSM), this retrospectively study analyzed 49 patients who underwent TACE +MWA+¹²⁵I brachytherapy (group A) and 98 patients who only received TACE +MWA (group B). The evaluated outcomes were progression-free survival (PFS), overall survival (OS), and treatment complications. Cox proportional hazards regression analysis survival was used to compare the two groups.

Results: The patients in group A showed a longer PFS than group B (7.9 vs. 3.3 months, P = 0.007). No significant differences were observed in median OS between the two groups (P = 0.928). The objective response rate (ORR), disease control rate of tumors in high-risk locations, and the ORR of intrahepatic tumors were 67.3%, 93.9%, and 51.0%, respectively, in group A, and 38.8%, 79.6% and 29.6%, respectively, in group B (P < 0.001, P = 0.025 and P = 0.011, respectively). TACE-MWA-¹²⁵I (HR = 0.479, P < 0.001) was a significant favorable prognostic factor that affected PFS. The present of portal vein tumor thrombosis was an independent prognostic factor for PFS (HR = 1.625, P = 0.040). The Barcelona clinic liver cancer (BCLC) stage (BCLC C vs. B) was an independent factor affecting OS (HR = 1.941, P = 0.038). The incidence of complications was similar between the two groups, except that the incidence of abdominal pain was reduced in the group A (P = 0.007).

Conclusions: TACE-MWA-¹²⁵I resulted in longer PFS and better tumor control than did TACE-MWA in patients with unresectable hepatocellular carcinoma in high-risk locations.

Keywords: 125I brachytherapy; hepatocellular carcinoma; high-risk location; microwave ablation; transarterial chemoembolization.

MeSH terms

Brachytherapy*
Carcinoma, Hepatocellular* / pathology
Chemoembolization, Therapeutic* / adverse effects
Chemoembolization, Therapeutic* / methods
Humans
Liver Neoplasms* / surgery
Microwaves / therapeutic use
Propensity Score
Retrospective Studies
Tomography, X-Ray Computed
Treatment Outcome

Substances

Iodine-125