Retrospective Study
Copyright ©The Author(s) 2018. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Oncol. Dec 15, 2018; 10(12): 496-504
Published online Dec 15, 2018. doi: 10.4251/wjgo.v10.i12.496
Stents combined with iodine-125 implantation to treat main portal vein tumor thrombus
Yi-Fan Wu, Tao Wang, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Fu-Quan Liu
Yi-Fan Wu, Zhen-Dong Yue, Hong-Wei Zhao, Lei Wang, Zhen-Hua Fan, Fu-Liang He, Fu-Quan Liu, Department of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, Beijing 100038, China
Tao Wang, Department of Interventional Therapy, The Affiliated Yantai Yuhuangding Hospital of Qingdao University, Yantai 264000, Shandong Province, China
Author contributions: Wu YF, Wang T, Yue ZD, Zhao HW, Wang L, Fan ZH, He FL and Liu FQ designed the research; Zhao HW, Wang L, Fan ZH and He FL performed the research; Wu YF, Wang T, Yue ZD and Liu FQ analyzed the data; Wu YF wrote the paper.
Supported by the Beijing Municipal Science and Technology Commission project, the Capital of the Public Health Cultivation - Transcatheter active particles implantation combined with TACE/TAE in the treatment of portal vein tumor thrombus in clinical research, No. Z171100000417031.
Institutional review board statement: This study was reviewed and approved by the Ethics Committee for Scientific Research of Beijing Shijitan Hospital Affiliated to Capital Medical University.
Informed consent statement: The patients provided written informed consent.
Conflict-of-interest statement: The authors declare that they have no conflicts of interest.
Data sharing statement: Dataset available from the corresponding author at the provided email address. Participants gave informed consent for data sharing.
Open-Access: This is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author to: Fu-Quan Liu, MD, Professor, De¬partment of Interventional Therapy, Beijing Shijitan Hospital, Capital Medical University, No. 10, Tie Yi Road, Haidian District, Beijing 100038, China. liufq_sjt@163.com
Telephone: +86-10-63926272 Fax: +86-10-63925588
Received: August 7, 2018
Peer-review started: August 8, 2018
First decision: October 4, 2018
Revised: October 19, 2018
Accepted: November 23, 2018
Article in press: November 24, 2018
Published online: December 15, 2018
ARTICLE HIGHLIGHTS
Research background

Tumor thrombus in the main portal vein indicates late-stage disease. Treatment for portal vein tumor thrombus includes surgery, chemotherapy, radiotherapy, targeted therapy, and proton beam radiation. In recent years, radioactive iodine-125 (125I) particles have been used to treat portal vein tumor thrombus. However, seed implantation in recent studies had some disadvantages. We carried out the present study to explore a new method of seed implantation.

Research motivation

Previously, 125I was implanted in the form of particle strands. This limits the number of 125I particles implanted, and their position cannot be adjusted. In this study, we performed 125I seed implantation combined with stent implantation, placing the particles between the stent and tumor thrombus. The stent could hold the 125I particles, and the method can be widely used in clinical application.

Research objectives

125I has been shown to be effective in treating portal vein thrombosis. The main objective of this study was to determine the efficacy of stents combined with 125I implantation in the treatment of liver cancer accompanied by main portal vein tumor thrombus, as well as the technical feasibility of this method of seed implantation.

Research methods

Patients were non-randomly assigned to undergo treatment with transarterial chemoembolization (TACE)/transarterial embolization (TAE) + portal vein stents combined with 125I implantation (Group A) or TACE/TAE + portal vein stents only (Group B). It could show differences in treatment and outcomes between the two groups. After operation, scheduled follow-up was performed at 6, 12 and 24 mo. Follow-up included postoperative and preoperative portosystemic pressure gradient, postoperative stenting stenosis rate, and survival rate. Time-to-event outcomes were evaluated with Kaplan–Meier curves and log-rank test. Cox regression model was used to identify independent predictors. Kaplan–Meier curves and log-rank test clearly demonstrated the differences in survival rate and restenosis rate between the two groups, as well as the efficacy of 125I in the treatment of main portal vein tumor thrombus. Cox analysis could take various factors into account to make the results more convincing.

Research results

Compared with stents alone, stents combined with 125I implantation had a good therapeutic effect in liver cancer with main portal vein tumor thrombus. This method reduced the restenosis rate and improved survival rate. Stents combined with 125I implantation were safe and reliable in clinical application. In this study, the 125I was placed between the stent and tumor thrombus and the stent could hold the particles. Using this method of 125I implantation, the number and position of the particles could be adjusted, which is more flexible in clinical application. However, as the size of the liver cancer shrinks, the particles may drift to other parts of the body via blood flow, and this needs further study.

Research conclusions

Stents combined with 125I implantation have a good therapeutic effect in the treatment of liver cancer with main portal vein tumor thrombus. The 125I was placed between the stent and the tumor thrombus, and the stent could hold the particles. The new method can avoid the drawbacks of particle strands and can be widely used in the clinic. Stents combined with 125I implantation have a good therapeutic effect in the treatment of liver cancer with main portal vein tumor thrombus. The method is technically safe and reliable. Tumor thrombus in the main portal vein indicates late-stage disease. 125I is an effective treatment for main portal vein thrombosis. Compared with stents alone, stents combined with 125I implantation can reduce restenosis rates and improve survival rate. It is technically safe and reliable. 125I has made great achievements in the treatment of main portal vein tumor thrombus, but there are drawbacks in the method of 125I implantation, and new methods should be explored.

Research perspectives

Liver cancer with portal vein thrombosis seriously affects patient quality of life and should be treated in a timely manner. Stents combined with 125I implantation have a good therapeutic effect in liver cancer with main portal vein tumor thrombus. Appropriate patients were selected for seed implantation treatment according to the inclusion criteria. The particle drift rate of the patients was followed up at 6, 12 and 24 mo after the operation.