Objective: To analyze the clinical efficacy and safety of (125)I radioactive seed implantation in the treatment of sub-capsular hepatocellular carcinoma (sub-HCC) with sequential radiofrequency ablation and transcatheter arterial chemoembolization (TACE). Methods: The clinical data of 76 cases with advanced HCC with sub-capsular nodules including 68 males and 8 females, with an average age of (58±9) years, ranging from 33 to 78 years, enrolled in Lishui Central Hospital from January 2010 to December 2016 were collected.The average maximum diameter of tumor is (5.7±2.3) cm, ranging from 3.1 cm to 12.0 cm.The patients were divided into TACE+ RFA group and (125)I + TACE+ RFA group with 38 cases in each group.The overall survival (OS) and progression free survival(PFS) were calculated.The clinical efficiency and adverse events were evaluated. Results: The disease control rate were 84.2%(32/38) in (125)I + TACE+ RFA group and 63.2% (24/38) in TACE+ RFA group, χ(2)=4.34, P= 0.04.The median PFS were 18 months in (125)I + TACE+ RFA group and 11 months in TACE+ RFA group, χ(2)=4.84, P=0.03.The FPS cumulative rate in (125)I + TACE+ RFA group were higher than that in TACE+ RFA group at 6 months (94.7%±3.6% vs 81.3%±6.4%, Z=24.1>2.58, P=0.00), 1 year (89.2%±5.1% vs 40.7%±8.3%, Z=13.3>2.58, P=0.00) and 2 year (55.9%±8.6% vs 29.6%±8.2%, Z=7.2>2.58, P=0.00). The median OS were 42 months in (125)I + TACE+ RFA group and 30 months in TACE+ RFA group, χ(2)=4.76, P=0.029.The survival cumulative rate in (125)I+ TACE+ RFA group were higher than that in TACE+ RFA group at 1 year (92.1%±4.4% vs 83.8%±6.1%, Z=23.5>2.58, P=0.00), 2 year (75.8%±7.0% vs 59.8%±8.4%, Z=12.43>2.58, P=0.00), 3 year (59.0%±8.2% vs 41.7%±8.9%, Z=8.3>2.58, P=0.00), 5 year (34.2%±8.2% vs 18.2%±8.1%, Z=5.5>2.58, P=0.00). In addition, there was no statistical difference in liver function and complications between TACE+ RFA group and (125)I+ TACE+ RFA group. Conclusion: (125)I radioactive seed implantation plus TACE combined with RFA treatment is an effective and safe treatment for sub-capsular hepatocellular carcinoma.
目的： 分析(125)I放射性粒子植入联合肝动脉化疗栓塞(TACE)序贯射频消融(RFA)方案治疗包膜下肝癌结节的临床疗效及安全性。 方法： 回顾分析2010年1月至2016年12月丽水市中心医院76例包膜下(肝包膜下<1 cm)中晚期肝癌患者资料。男68例、女8例，年龄33～78(58±9)岁，肿瘤最大径3.1～12.0(5.7±2.3) cm，Child-Pugh A级28例，Child-Pugh B级48例，BCLC B期29例，C期47例。按照治疗方式分为两组，其中38例(TACE＋RFA组)行TACE序贯RFA治疗，38例((125)I＋TACE＋RFA组)在TACE序贯RFA治疗后，行(125)I放射性粒子植入术。分别计算中位生存时间及肿瘤无进展时间，评价两组患者的肿瘤控制有效率及不良反应。 结果： TACE＋RFA组和(125)I＋TACE＋RFA组患者肿瘤有效控制率分别为63.2%(24/38)和84.2%(32/38)，(χ(2)＝4.34, P＝ 0.04)；肿瘤无进展时间中位值为11和18个月(χ(2)＝4.84，P＝0.03)，(125)I＋TACE＋RFA组在6个月(94.7%±3.6%比81.3%±6.4%，Z＝24.1>2.58，P＝0.00)、1年(89.2%±5.1%比40.7%±8.3%，Z＝13.3>2.58，P＝0.00)、2年(55.9%±8.6%比29.6%±8.2%，Z＝7.2>2.58，P＝0.00)的累计肿瘤无进展率高于TACE＋RFA组。(125)I＋TACE＋RFA组和TACE＋RFA组的生存时间中位值为42和30个月(χ(2)＝4.76，P＝0.029)。(125)I＋TACE＋RFA组在1年(92.1%±4.4%比83.8%±6.1%，Z＝23.5>2.58，P＝0.00)、2年(75.8%±7.0%比59.8%±8.4%，Z＝12.43>2.58，P＝0.00)、3年(59.0%±8.2%比41.7%±8.9%，Z＝8.3>2.58，P＝0.00)、5年(34.2%±8.2%比18.2%±8.1%，Z＝5.5>2.58，P＝0.00)的累计生存率高于TACE＋RFA组。TACE＋RFA组和(125)I＋TACE＋RFA组术后肝功能、并发症差异无统计学意义。 结论： (125)I放射性粒子植入能够提高TACE序贯RFA治疗中晚期包膜下肝癌的疗效，是一种有效的、安全的中晚期肝癌治疗方法。.
Keywords: Drug therapy, combination; Iodine isotopes; Liver neoplasms.