I(125) irradiation stent for treatment of hepatocellular carcinoma with portal vein thrombosis: A meta-analysis.

A meta-analysis aimed to systematically evaluate the safety and efficiency of I125 irradiation stent placement for patients with hepatocellular carcinoma (HCC) combined with portal vein tumor thrombosis (PVTT). The Cochrane library, PubMed/Medline, EMBASE, CNKI, Wanfang Data and CQVIP were systematically screened out from the earliest to December 2019. The qualities of all included studies were assessed. The primary endpoints were the 6-month, 12-month stent cumulative patency rate and 6-month, 12-month, 24-month overall survival rate while the secondary endpoints were the objective response rate of PVTT, main portal venous pressure changes and treatment-related adverse events. Our meta-analysis was conducted using Stata 12.0 software. Totally seven studies with 1018 patients were included in the final analysis, in which 602 patients received TACE and I125 irradiation stent placement, and 416 patients in control group underwent TACE and stent placement without endovascular brachytherapy (EVBT). Meta-analysis showed that the I125 irradiation stent improved the cumulative stent patency rates in 6months [OR=1.65, 95% CI (1.32-2.05), P<0.001] and 12months [OR=2.55, 95% CI (1.90-3.42), P<0.001] and the survival rates in 6months [OR=1.77, 95% CI (1.41-2.22), P<0.001], 12months [OR=3.14, 95% CI (2.24-4.40), P<0.001] and 24months [OR=7.39, 95% CI (3.55-15.41), P<0.001]. However, there was no difference in the objective response rate of PVTT [OR=1.13, 95% CI (0.87-1.48), P=0.365], main portal venous pressure and the occurrence adverse event [OR=0.88, CI=0.72-1.08, P=0.212] between two groups. I125 irradiation stent seems to be more effective in treating hepatocellular carcinoma with portal vein tumor thrombosis. The usage of portal vein stent combined endovascular brachytherapy has the potential to act as an alternative therapy for HCC with PVTT. On account of the limitation of studies included, more studies with high-level evidence, such as RCTs, are requisite to support the above promising results.

Li S ，Guo JH ，Lu J ，Wang C ，Wu H ，Wang H ，Zha J ，Fan R ... -  《-》

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

Luo JJ ，Zhang ZH ，Liu QX ，Zhang W ，Wang JH ，Yan ZP ... -  《-》

(125)I seed implantation for hepatocellular carcinoma with portal vein tumor thrombus: A systematic review and meta-analysis.

Advanced hepatocellular carcinoma often combined with portal vein tumor thrombus (PVTT), transcatheter arterial chemoembolization (TACE) is recommended as an effective treatment. Recent studies showed that TACE plus iodine-125 (125I) seed for hepatocellular carcinoma with PVTT can improve the remission rate. This study aimed to systematically evaluate the efficacy and safety of 125I seed implantation in patients with PVTT. The Embase, Medline/PubMed, Cochrane Library, and OVID databases were systematically searched from the earliest to October 2018. The references included in the literature were searched. The primary endpoints were remission rate and overall survival, and the secondary endpoints were portal venous pressure and adverse event. The odds ratio (OR) and hazard ratio (HR) were combined using either fixed or random effects model. Meta-analysis was performed using Stata 12.0 software. Eight studies were included with 1098 patients, 591 patients received 125I seed implantation, and 507 in the control group. Meta-analysis showed that 125I seed implantation improved the remission rate in patients with PVTT (OR = 2.24, 95% confidence interval (CI) = 1.68-2.99, p = 0.000) and survival rate (HR = 0.27, 95% CI = 0.14-0.40, p = 0.000); it also reduced patient's mortality risk (HR = 0.46, 95% CI = 0.37-0.54, p = 0.000). Subgroup analysis suggested that the death risk of patients who responded to 125I seed implantation declined 55% (HR = 0.45, 95% CI = 0.34-0.55, p = 0.000). 125I seed implantation is more effective against PVTT delivered at a dose higher than 110 Gy. There was no difference in the occurrence adverse event between the two groups (OR = 1.07, 95% CI = 0.92-1.25, p = 0.262). TACE plus 125I seed implantation is more effective in treating PVTT. The use of 125I seeds dose >110 Gy will show better results.

Yuan D ，Gao Z ，Zhao J ，Zhang H ，Wang J ... -  《-》

Combined endovascular brachytherapy, sorafenib, and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus.

Zhang ZH ，Liu QX ，Zhang W ，Ma JQ ，Wang JH ，Luo JJ ，Liu LX ，Yan ZP ... -  《-》

Safety and Efficacy of Irradiation Stent Placement for Malignant Portal Vein Thrombus Combined with Transarterial Chemoembolization for Hepatocellular Carcinoma: A Single-Center Experience.

To assess feasibility, safety, and preliminary efficacy of an irradiation portal vein stent for portal vein tumor thrombosis (PVTT) in patients with hepatocellular carcinoma (HCC). Between October 2012 and September 2015, 25 of 40 patients (mean age of 55.5 y) with PVTT caused by HCC were recruited for treatment with an irradiation portal vein stent (self-expandable stent loaded with iodine-125 seeds) at a single hospital. Liver function was classified as Child-Pugh class A in 15 patients (60%) and class B in 10 patients (40%). The Eastern Cooperative Oncology Group performance status score was 0 in 3 patients (12%), 1 in 13 patients (52%), and 2 in 9 patients (36%). Transarterial chemoembolization was performed after stent placement. Outcomes were measured in terms of technical success, complications, stent patency, and overall survival. The technical success rate was 92.0% (23/25). No complications grade 3 or higher according to Common Terminology Criteria for Adverse Events were observed. Median stent patency period was 8.0 months (range, 0.6-30.0 months). Between 7 and 955 days after stent placement, 65 cycles of transarterial chemoembolization were performed with a mean of 2.8 cycles per patient. Median survival was 12.5 months (range, 0.6-35.7 months). Placement of an irradiation portal vein stent appears feasible and safe and may prolong the patency of the portal vein. It is a promising technique for combining recanalization of an occluded portal vein and brachytherapy.

Lu J ，Guo JH ，Zhu HD ，Zhu GY ，Chen L ，Teng GJ ... -  《-》