Iodine-125 seed implantation for residual hepatocellular carcinoma or cholangiocellular carcinoma in challenging locations after transcatheter arterial chemoembolization. Initial experience and findings

Abstract

Purpose To evaluate the clinical efficacy and safety of computed tomography (CT)-guided iodine-125 ( 125 I) seed implantation (ISI) for hepatocellular carcinoma (HCC) or cholangiocellular carcinoma (CCC) lesions in challenging locations after transcatheter arterial chemoembolization (TACE). Material and methods A retrospective single-center review of 24 patients with HCC or CCC tumors in challenging locations (hepatic dome or close to the heart/diaphragm/hepatic hilum) was conducted. Patients who underwent CT-guided 125 I implantation from May 2014 to January 2019 were recruited. Patients’ demographics and details including technical success, treatment response, patient survival, and complication rate were also evaluated. Results Treated tumors were located in the hepatic dome ( n = 10; 41.7%), subcapsularly ( n = 6; 25%), close to the heart ( n = 3; 12.5%), and in the liver hilum ( n = 5; 20.8%). The mean maximum diameter of tumors in challenging locations was 40.08 ±11.34 mm (range, 25-68 mm). TACE (2 ±1, 1-4 times) was applied before ISI. There were 27 ISI treatments administered (3 patients also received supplemental ISI). The total number of implanted seeds was 1,160, with mean 48 ±16 seed per patient (range, 30-90 seeds). The mean D 90 value for ISI was 125 Gy. Technical success rate was 100%, while a complete response + partial response (CR + PR) was documented in 70.83%, 79.17%, 83.33%, and 79.17% of patients at 3, 6, 12, and 24 months post-ISI, respectively. There were no major complications, although 2 cases experienced 125 I seed transfer to the diaphragm, and 1 case experienced transfer to the heart cavity. Conclusions CT-guided ISI for HCC or CCC lesions in challenging locations after TACE is both highly effective and safe.

Transarterial chemoembolization with insertion of radioactive seeds for hepatocellular carcinoma.

“…Hence, 125 I seeds may facilitate superior therapeutic efficacy for TACE treatment. RSI can also efficiently treat residual HCC tumor cells following TACE [ 10 , 11 ].…”

“…For one, tumor embolization can restrict the tumor blood flow [ 21 ]. In addition, TACE can generate high levels of ischemia and inflammatory edema in the peritumoral regions, contributing to greater brachytherapeutic benefits upon 125 I seed insertion [ 10 , 11 ]. The 125 I seeds were also able to destroy hypovascular HCC tumor regions refractory to precision TACE treatment [ 10 , 11 ].…”

“…In individuals exhibiting tumors proximal to the liver surface, diaphragm, gallbladder, or major vessels, however, PA is not an appropriate approach [ 9 ]. In these patients, some studies have employed radioactive seed insertion (RSI) as an alternative therapeutic strategy [ 10 , 11 ]. To date there have only been a relatively small number of studies focused on the combination of TACE and RSI as a means of treating HCC.…”

Long-term outcome of percutaneous radiofrequency ablation for periportal hepatocellular carcinoma: tumor recurrence or progression, survival and clinical significance

“…Immediate imaging assessment after ablation and closer follow-up monitoring are necessary for patients with periportal HCC to prevent rapid tumor progression due to residual tumor or tumor recurrence. In addition, non-RFA-related technologies could provide an alternative option for periportal HCC to prevent or minimize newly recognized RFA-related tumor recurrence [ 20 ], such as microwave ablation [ 25 ], cryoablation [ 26 ] and irreversible electroporation [ 27 ], and iodine-125 seed implantation [ 28 ].…”

A combination of portal vein stent insertion and endovascular iodine-125 seed-strip implantation, followed by transcatheter arterial chemoembolization with sorafenib for treatment of hepatocellular carcinoma-associated portal vein tumor thrombus

“…However, some reports suggested that sorafenib was less effective in those with Vp3/4 PVTT (< 10% of response rate) [ 6 , 9 ]. In contrast, 125 I seed implantation in the portal vein allowed for effective PVTT control owing to sustained low-dose X- and γ-ray release throughout the tumor area, damaging tumor cell DNA and disrupting proliferation [ 11 , 29 , 30 ].…”