Iodine-125 implantation with transjugular intrahepatic portosystemic shunt for main portal vein tumor thrombus
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摘要
BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma(HCC).Therefore, attention should be paid to the treatment of MPVTT and its complications.AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization(TACE/TAE)+~(125)I seeds implantation with transjugular intrahepatic portosystemic shunt(TIPS) in treating MPVTT and its complications.METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and ~(125)I implantation(TIPS-~(125)I group) or TACE/TAE + TIPS only(TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-~(125)I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-~(125)I group,whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively(P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%,respectively, in the TIPS-~(125)I group, whereas those in the TIPS only group were31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%,27.5%, and 42.5%, respectively, in the TIPS-~(125)I group, and 42.2%, 68.9%, and84.4%, respectively, in the TIPS only group(P < 0.05). TIPS-~(125)I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.CONCLUSION TACE/TAE+~(125)I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.
BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma(HCC).Therefore, attention should be paid to the treatment of MPVTT and its complications.AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization(TACE/TAE)+~(125)I seeds implantation with transjugular intrahepatic portosystemic shunt(TIPS) in treating MPVTT and its complications.METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and ~(125)I implantation(TIPS-~(125)I group) or TACE/TAE + TIPS only(TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-~(125)I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-~(125)I group,whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively(P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%,respectively, in the TIPS-~(125)I group, whereas those in the TIPS only group were31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%,27.5%, and 42.5%, respectively, in the TIPS-~(125)I group, and 42.2%, 68.9%, and84.4%, respectively, in the TIPS only group(P < 0.05). TIPS-~(125)I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.CONCLUSION TACE/TAE+~(125)I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.
BACKGROUND Main portal vein tumor thrombus(MPVTT), which has a high incidence, is the major complication of terminal liver cancer. The occurrence of MPVTT is always a negative prognostic factor for patients with hepatocellular carcinoma(HCC).Therefore, attention should be paid to the treatment of MPVTT and its complications.AIM To evaluate the efficacy of transarterial chemoembolization/transarterial embolization(TACE/TAE)+~(125)I seeds implantation with transjugular intrahepatic portosystemic shunt(TIPS) in treating MPVTT and its complications.METHODS From January 2007 to March 2015, 85 consecutive patients with MPVTT were nonrandomly assigned to undergo treatment with TACE/TAE + TIPS and ~(125)I implantation(TIPS-~(125)I group) or TACE/TAE + TIPS only(TIPS only group) in Beijing Shijitan Hospital, and all clinical data were collected. During 24 mo follow-up, the incidence of overall survival, stent stenosis and symptom recurrence was analyzed to evaluate the efficacy of TIPS-~(125)I.RESULTS During 24 mo follow-up of all patients, we collected data at 6, 12 and 24 mo. The rates of survival were 80%, 45%, and 20%, respectively, in the TIPS-~(125)I group,whereas those in the TIPS only group were 64.4%, 24.4%, and 4.4%, respectively(P < 0.05). The rates of symptom recurrence were 7.5%, 22.5%, and 35%,respectively, in the TIPS-~(125)I group, whereas those in the TIPS only group were31.1%, 62.2%, and 82.2%(P < 0.05). The rates of stent restenosis were 12.5%,27.5%, and 42.5%, respectively, in the TIPS-~(125)I group, and 42.2%, 68.9%, and84.4%, respectively, in the TIPS only group(P < 0.05). TIPS-~(125)I was found to be significantly favorable in treating MPVTT and its complications in patients with HCC.CONCLUSION TACE/TAE+~(125)I combined with TIPS is effective in treating MPVTT and its complications, improving quality of life of patients and reducing mortality.
引文
1 Cabibbo G,Enea M,Attanasio M,Bruix J,CraxìA,CammàC.A meta-analysis of survival rates of untreated patients in randomized clinical trials of hepatocellular carcinoma.Hepatology 2010;51:1274-1283[PMID:20112254 DOI:10.1002/hep.23485]
2 Huang M,Lin Q,Wang H,Chen J,Bai M,Wang L,Zhu K,Jiang Z,Guan S,Li Z,Qian J,Li M,Pang P,Shan H.Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT:a retrospective matched cohort study.Eur Radiol 2016;26:3428-3436[PMID:26792430 DOI:10.1007/s00330-015-4198-x]
3 Villa E,Moles A,Ferretti I,Buttafoco P,Grottola A,Del Buono M,De Santis M,Manenti F.Natural history of inoperable hepatocellular carcinoma:estrogen receptors'status in the tumor is the strongest prognostic factor for survival.Hepatology 2000;32:233-238[PMID:10915729 DOI:10.1053/jhep.2000.9603]
4 Izumi R,Shimizu K,Ii T,Yagi M,Matsui O,Nonomura A,Miyazaki I.Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection.Gastroenterology 1994;106:720-727[PMID:8119543 DOI:10.1016/0016-5085(94)90707-2]
5 Katagiri S,Yamamoto M.Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus.Surg Today 2014;44:219-226[PMID:23591833 DOI:10.1007/s00595-013-0585-6]
6 Yamamoto Y,Ikoma H,Morimura R,Shoda K,Konishi H,Murayama Y,Komatsu S,Shiozaki A,Kuriu Y,Kubota T,Nakanishi M,Ichikawa D,Fujiwara H,Okamoto K,Sakakura C,Ochiai T,Otsuji E.Posthepatectomy survival in advanced hepatocellular carcinoma with portal vein tumor thrombosis.World JGastroenterol 2015;21:246-253[PMID:25574098 DOI:10.3748/wjg.v21.i1.246]
7 Samuel D,Colombo M,El-Serag H,Sobesky R,Heaton N.Toward optimizing the indications for orthotopic liver transplantation in hepatocellular carcinoma.Liver Transpl 2011;17 Suppl 2:S6-13[PMID:21858912 DOI:10.1002/lt.22423]
8 Luo JJ,Zhang ZH,Liu QX,Zhang W,Wang JH,Yan ZP.Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus.Hepatol Int 2016;10:185-195[PMID:26341514 DOI:10.1007/s12072-015-9663-8]
9 Zhang YW,Naren TG,Gao F.Color Doppler guided percutaneous oily chemoembolization for the treatment of portal vein tumor thrombus in HCC patients.Zhongguo Jieru Yingxiang Yu Zhiliaoxue Zazhi2009;2[DOI:10.13929/j.1672-8475.2009.02.020]
10 Peng B,Liang L,He Q,Zhou F,Luo S.Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus.Hepatogastroenterology 2006;53:415-419[PMID:16795984 DOI:10.1136/gut.2005.089136]
11 Liu L,Zhao Y,Qi X,Cai G,He C,Guo W,Yin Z,Chen H,Chen X,Fan D,Han G.Transjugular intrahepatic portosystemic shunt for symptomatic portal hypertension in hepatocellular carcinoma with portal vein tumor thrombosis.Hepatol Res 2014;44:621-630[PMID:23679937 DOI:10.1111/hepr.12162]
12 Qiu B,Li K,Dong X,Liu FQ.Transjugular Intrahepatic Portosystemic Shunt for Portal Hypertension in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus.Cardiovasc Intervent Radiol 2017;40:1372-1382[PMID:28488102 DOI:10.1007/s00270-017-1655-8]
13 Yang M,Fang Z,Yan Z,Luo J,Liu L,Zhang W,Wu L,Ma J,Yang Q,Liu Q.Transarterial chemoembolisation(TACE)combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone:a two-arm,randomised clinical trial.J Cancer Res Clin Oncol 2014;140:211-219[PMID:24374800 DOI:10.1007/s00432-013-1568-0]
14 Bruix J,Sherman M;American Association for the Study of Liver Diseases.Management of hepatocellular carcinoma:an update.Hepatology 2011;53:1020-1022[PMID:21374666 DOI:10.1002/hep.24199]
15 Tarantino L,Francica G,Sordelli I,Esposito F,Giorgio A,Sorrentino P,de Stefano G,Di Sarno A,Ferraioli G,Sperlongano P.Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma:color Doppler US,contrast-enhanced US,and fine-needle biopsy.Abdom Imaging 2006;31:537-544[PMID:16865315 DOI:10.1007/s00261-005-0150-x]
16 Bruix J,Qin S,Merle P,Granito A,Huang YH,Bodoky G,Pracht M,Yokosuka O,Rosmorduc O,Breder V,Gerolami R,Masi G,Ross PJ,Song T,Bronowicki JP,Ollivier-Hourmand I,Kudo M,Cheng AL,Llovet JM,Finn RS,LeBerre MA,Baumhauer A,Meinhardt G,Han G;RESORCE Investigators.Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment(RESORCE):a randomised,double-blind,placebo-controlled,phase 3 trial.Lancet 2017;389:56-66[PMID:27932229 DOI:10.1016/S0140-6736(16)32453-9]
17 Sun JH,Zhou T,Zhu T,Zhang Y,Nie C,Ai J,Zhou G,Zhang A,Dong MJ,Wang WL,Zheng SS.Portal Vein Stenting Combined with Iodine-125 Seeds Endovascular Implantation Followed by Transcatheter Arterial Chemoembolization for Treatment of Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus.Biomed Res Int 2016;2016:3048261[PMID:27999793 DOI:10.1155/2016/3048261]
18 Lin J,Jiang H,Yang W,Jiang N,Zheng Q,Huang N,Wang X,Li A,Huang J.Predictive factors of benefit from iodine-125 brachytherapy for hepatocellular carcinoma with portal vein tumor thrombosis.Brachytherapy 2018;pii:S1538-4721(18)30424-0[PMID:30467014 DOI:10.1016/j.brachy.2018.10.002]
19 Han G,Qi X,He C,Yin Z,Wang J,Xia J,Yang Z,Bai M,Meng X,Niu J,Wu K,Fan D.Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis.J Hepatol 2011;54:78-88[PMID:20932597 DOI:10.1016/j.jhep.2010.06.029]
20 Boyer TD,Haskal ZJ.American Association for the Study of Liver Diseases Practice Guidelines:the role of transjugular intrahepatic portosystemic shunt creation in the management of portal hypertension.J Vasc Interv Radiol 2005;16:615-629[PMID:15872315 DOI:10.1097/01.RVI.0000157297.91510.21]
21 Bettinger D,Knüppel E,Euringer W,Spangenberg HC,R?ssle M,Thimme R,Schulthei?M.Efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPSS)in 40 patients with hepatocellular carcinoma.Aliment Pharmacol Ther 2015;41:126-136[PMID:25329493 DOI:10.1111/apt.12994]
22 Zhang ZH,Liu QX,Zhang W,Ma JQ,Wang JH,Luo JJ,Liu LX,Yan ZP.Combined endovascular brachytherapy,sorafenib,and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus.World J Gastroenterol 2017;23:7735-7745[PMID:29209114 DOI:10.3748/wjg.v23.i43.7735]
23 Wu YF,Wang T,Yue ZD,Zhao HW,Wang L,Fan ZH,He FL,Liu FQ.Stents combined with iodine-125implantation to treat main portal vein tumor thrombus.World J Gastrointest Oncol 2018;10:496-504[PMID:30595803 DOI:10.4251/wjgo.v10.i12.496]
24 Zhang ZH,Zhang W,Gu JY,Liu QX,Ma JQ,Liu LX,Wang JH,Luo JJ,Yan ZP.Treatment of Hepatocellular Carcinoma with Tumor Thrombus with the Use of Iodine-125 Seed Strand Implantation and Transarterial Chemoembolization:A Propensity-Score Analysis.J Vasc Interv Radiol 2018;29:1085-1093[PMID:29754851 DOI:10.1016/j.jvir.2018.02.013]
25 Li XL,Guo WX,Hong XD,Yang L,Wang K,Shi J,Li N,Wu MC,Cheng SQ.Efficacy of the treatment of transarterial chemoembolization combined with radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus:A propensity score analysis.Hepatol Res 2016;46:1088-1098[PMID:26783741DOI:10.1111/hepr.12657]
26 Im JH,Yoon SM,Park HC,Kim JH,Yu JI,Kim TH,Kim JW,Nam TK,Kim K,Jang HS,Kim JH,Kim MS,Yoon WS,Jung I,Seong J.Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area.Liver Int 2017;37:90-100[PMID:27317941 DOI:10.1111/liv.13191]
27 Chuan-Xing L,Xu H,Bao-Shan H,Yong L,Pei-Jian S,Xian-Yi Y,Xiao-Ning L,Li-Gong L.Efficacy of therapy for hepatocellular carcinoma with portal vein tumor thrombus:chemoembolization and stent combined with iodine-125 seed.Cancer Biol Ther 2011;12:865-871[PMID:22037354 DOI:10.4161/cbt.12.10.17676]
2 Huang M,Lin Q,Wang H,Chen J,Bai M,Wang L,Zhu K,Jiang Z,Guan S,Li Z,Qian J,Li M,Pang P,Shan H.Survival benefit of chemoembolization plus Iodine125 seed implantation in unresectable hepatitis B-related hepatocellular carcinoma with PVTT:a retrospective matched cohort study.Eur Radiol 2016;26:3428-3436[PMID:26792430 DOI:10.1007/s00330-015-4198-x]
3 Villa E,Moles A,Ferretti I,Buttafoco P,Grottola A,Del Buono M,De Santis M,Manenti F.Natural history of inoperable hepatocellular carcinoma:estrogen receptors'status in the tumor is the strongest prognostic factor for survival.Hepatology 2000;32:233-238[PMID:10915729 DOI:10.1053/jhep.2000.9603]
4 Izumi R,Shimizu K,Ii T,Yagi M,Matsui O,Nonomura A,Miyazaki I.Prognostic factors of hepatocellular carcinoma in patients undergoing hepatic resection.Gastroenterology 1994;106:720-727[PMID:8119543 DOI:10.1016/0016-5085(94)90707-2]
5 Katagiri S,Yamamoto M.Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus.Surg Today 2014;44:219-226[PMID:23591833 DOI:10.1007/s00595-013-0585-6]
6 Yamamoto Y,Ikoma H,Morimura R,Shoda K,Konishi H,Murayama Y,Komatsu S,Shiozaki A,Kuriu Y,Kubota T,Nakanishi M,Ichikawa D,Fujiwara H,Okamoto K,Sakakura C,Ochiai T,Otsuji E.Posthepatectomy survival in advanced hepatocellular carcinoma with portal vein tumor thrombosis.World JGastroenterol 2015;21:246-253[PMID:25574098 DOI:10.3748/wjg.v21.i1.246]
7 Samuel D,Colombo M,El-Serag H,Sobesky R,Heaton N.Toward optimizing the indications for orthotopic liver transplantation in hepatocellular carcinoma.Liver Transpl 2011;17 Suppl 2:S6-13[PMID:21858912 DOI:10.1002/lt.22423]
8 Luo JJ,Zhang ZH,Liu QX,Zhang W,Wang JH,Yan ZP.Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus.Hepatol Int 2016;10:185-195[PMID:26341514 DOI:10.1007/s12072-015-9663-8]
9 Zhang YW,Naren TG,Gao F.Color Doppler guided percutaneous oily chemoembolization for the treatment of portal vein tumor thrombus in HCC patients.Zhongguo Jieru Yingxiang Yu Zhiliaoxue Zazhi2009;2[DOI:10.13929/j.1672-8475.2009.02.020]
10 Peng B,Liang L,He Q,Zhou F,Luo S.Surgical treatment for hepatocellular carcinoma with portal vein tumor thrombus.Hepatogastroenterology 2006;53:415-419[PMID:16795984 DOI:10.1136/gut.2005.089136]
11 Liu L,Zhao Y,Qi X,Cai G,He C,Guo W,Yin Z,Chen H,Chen X,Fan D,Han G.Transjugular intrahepatic portosystemic shunt for symptomatic portal hypertension in hepatocellular carcinoma with portal vein tumor thrombosis.Hepatol Res 2014;44:621-630[PMID:23679937 DOI:10.1111/hepr.12162]
12 Qiu B,Li K,Dong X,Liu FQ.Transjugular Intrahepatic Portosystemic Shunt for Portal Hypertension in Hepatocellular Carcinoma with Portal Vein Tumor Thrombus.Cardiovasc Intervent Radiol 2017;40:1372-1382[PMID:28488102 DOI:10.1007/s00270-017-1655-8]
13 Yang M,Fang Z,Yan Z,Luo J,Liu L,Zhang W,Wu L,Ma J,Yang Q,Liu Q.Transarterial chemoembolisation(TACE)combined with endovascular implantation of an iodine-125 seed strand for the treatment of hepatocellular carcinoma with portal vein tumour thrombosis versus TACE alone:a two-arm,randomised clinical trial.J Cancer Res Clin Oncol 2014;140:211-219[PMID:24374800 DOI:10.1007/s00432-013-1568-0]
14 Bruix J,Sherman M;American Association for the Study of Liver Diseases.Management of hepatocellular carcinoma:an update.Hepatology 2011;53:1020-1022[PMID:21374666 DOI:10.1002/hep.24199]
15 Tarantino L,Francica G,Sordelli I,Esposito F,Giorgio A,Sorrentino P,de Stefano G,Di Sarno A,Ferraioli G,Sperlongano P.Diagnosis of benign and malignant portal vein thrombosis in cirrhotic patients with hepatocellular carcinoma:color Doppler US,contrast-enhanced US,and fine-needle biopsy.Abdom Imaging 2006;31:537-544[PMID:16865315 DOI:10.1007/s00261-005-0150-x]
16 Bruix J,Qin S,Merle P,Granito A,Huang YH,Bodoky G,Pracht M,Yokosuka O,Rosmorduc O,Breder V,Gerolami R,Masi G,Ross PJ,Song T,Bronowicki JP,Ollivier-Hourmand I,Kudo M,Cheng AL,Llovet JM,Finn RS,LeBerre MA,Baumhauer A,Meinhardt G,Han G;RESORCE Investigators.Regorafenib for patients with hepatocellular carcinoma who progressed on sorafenib treatment(RESORCE):a randomised,double-blind,placebo-controlled,phase 3 trial.Lancet 2017;389:56-66[PMID:27932229 DOI:10.1016/S0140-6736(16)32453-9]
17 Sun JH,Zhou T,Zhu T,Zhang Y,Nie C,Ai J,Zhou G,Zhang A,Dong MJ,Wang WL,Zheng SS.Portal Vein Stenting Combined with Iodine-125 Seeds Endovascular Implantation Followed by Transcatheter Arterial Chemoembolization for Treatment of Hepatocellular Carcinoma Patients with Portal Vein Tumor Thrombus.Biomed Res Int 2016;2016:3048261[PMID:27999793 DOI:10.1155/2016/3048261]
18 Lin J,Jiang H,Yang W,Jiang N,Zheng Q,Huang N,Wang X,Li A,Huang J.Predictive factors of benefit from iodine-125 brachytherapy for hepatocellular carcinoma with portal vein tumor thrombosis.Brachytherapy 2018;pii:S1538-4721(18)30424-0[PMID:30467014 DOI:10.1016/j.brachy.2018.10.002]
19 Han G,Qi X,He C,Yin Z,Wang J,Xia J,Yang Z,Bai M,Meng X,Niu J,Wu K,Fan D.Transjugular intrahepatic portosystemic shunt for portal vein thrombosis with symptomatic portal hypertension in liver cirrhosis.J Hepatol 2011;54:78-88[PMID:20932597 DOI:10.1016/j.jhep.2010.06.029]
20 Boyer TD,Haskal ZJ.American Association for the Study of Liver Diseases Practice Guidelines:the role of transjugular intrahepatic portosystemic shunt creation in the management of portal hypertension.J Vasc Interv Radiol 2005;16:615-629[PMID:15872315 DOI:10.1097/01.RVI.0000157297.91510.21]
21 Bettinger D,Knüppel E,Euringer W,Spangenberg HC,R?ssle M,Thimme R,Schulthei?M.Efficacy and safety of transjugular intrahepatic portosystemic shunt(TIPSS)in 40 patients with hepatocellular carcinoma.Aliment Pharmacol Ther 2015;41:126-136[PMID:25329493 DOI:10.1111/apt.12994]
22 Zhang ZH,Liu QX,Zhang W,Ma JQ,Wang JH,Luo JJ,Liu LX,Yan ZP.Combined endovascular brachytherapy,sorafenib,and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus.World J Gastroenterol 2017;23:7735-7745[PMID:29209114 DOI:10.3748/wjg.v23.i43.7735]
23 Wu YF,Wang T,Yue ZD,Zhao HW,Wang L,Fan ZH,He FL,Liu FQ.Stents combined with iodine-125implantation to treat main portal vein tumor thrombus.World J Gastrointest Oncol 2018;10:496-504[PMID:30595803 DOI:10.4251/wjgo.v10.i12.496]
24 Zhang ZH,Zhang W,Gu JY,Liu QX,Ma JQ,Liu LX,Wang JH,Luo JJ,Yan ZP.Treatment of Hepatocellular Carcinoma with Tumor Thrombus with the Use of Iodine-125 Seed Strand Implantation and Transarterial Chemoembolization:A Propensity-Score Analysis.J Vasc Interv Radiol 2018;29:1085-1093[PMID:29754851 DOI:10.1016/j.jvir.2018.02.013]
25 Li XL,Guo WX,Hong XD,Yang L,Wang K,Shi J,Li N,Wu MC,Cheng SQ.Efficacy of the treatment of transarterial chemoembolization combined with radiotherapy for hepatocellular carcinoma with portal vein tumor thrombus:A propensity score analysis.Hepatol Res 2016;46:1088-1098[PMID:26783741DOI:10.1111/hepr.12657]
26 Im JH,Yoon SM,Park HC,Kim JH,Yu JI,Kim TH,Kim JW,Nam TK,Kim K,Jang HS,Kim JH,Kim MS,Yoon WS,Jung I,Seong J.Radiotherapeutic strategies for hepatocellular carcinoma with portal vein tumour thrombosis in a hepatitis B endemic area.Liver Int 2017;37:90-100[PMID:27317941 DOI:10.1111/liv.13191]
27 Chuan-Xing L,Xu H,Bao-Shan H,Yong L,Pei-Jian S,Xian-Yi Y,Xiao-Ning L,Li-Gong L.Efficacy of therapy for hepatocellular carcinoma with portal vein tumor thrombus:chemoembolization and stent combined with iodine-125 seed.Cancer Biol Ther 2011;12:865-871[PMID:22037354 DOI:10.4161/cbt.12.10.17676]