Published online Jan 27, 2023. doi: 10.4240/wjgs.v15.i1.105
Peer-review started: November 1, 2022
First decision: November 21, 2022
Revised: November 30, 2022
Accepted: December 21, 2022
Article in press: December 21, 2022
Published online: January 27, 2023
Primary hepatocellular carcinoma (PHC) is a malignant tumor with a high incidence in the Chinese population. Transarterial chemoembolization (TACE) is an effective treatment for PHC. Radioactive iodine (125I) therapy has been used in the treatment of advanced PHC, especially in patients with portal vein tumor thrombosis.
Due to insidious onset and atypical early symptoms of PHC, more than 80% of hepatocellular carcinoma patients are diagnosed with metastasis and are ineligible for surgical treatment. Therefore, it is crucial to develop effective treatment methods, such as TACE and 125I therapy. However, the data on the therapeutic effect of TACE combined with 125I therapy in PHC is scarce.
To investigate the short-term efficacy of TACE combined with 125I in patients with PHC.
Ninety-eight patients with PHC were recruited and randomly divided into the study group (n = 49, treatment with TACE and 125I therapy) and the control group (n = 49, treatment with TACE alone). The tumor length, alpha-fetoprotein (AFP) level, and computed tomography (CT) perfusion were recorded. Complete remission, partial remission (PR), stable disease and progressive disease were evaluated for all patients. Then, the efficacy was compared between the control group and the study group.
The tumor length and serum AFP level were lower in the study group compared to those in the control group after 1 mo and 3 mo of therapy. After 3 mo of treatment, the complete and PR rate in the study group was higher than in the control group (93.88% vs 77.55%, P < 0.05). Furthermore, CT perfusion parameters, including blood volume, permeability surface, blood flow, hepatic artery flow, and mean transit time, were all lower in the study group than in the control group (P < 0.05). The survival time of patients in the study group was 22 mo, which was significantly longer than 18 mo in the control group [log rank (Mantel-Cox) = 4.318, P = 0.038].
For advanced PHC patients, TACE combined with 125I implantation better inhibits the formation of blood vessels in tumor tissues and further reduces the perfusion level of tumor lesions compared to TACE alone. The combination of TACE and 125I therapy improves clinical efficacy and plays a synergistic role in prolonging the survival time of patients.
TACE combined with 125I implantation or other therapeutic methods, such as radiofrequency ablation, programmed cell death ligand 1 therapy, and immune therapy, should be investigated in advanced PHC patients in the future.