Multimodality therapy using brachytherapy for caval tumor of hepatocellular carcinoma.
OBJECTIVE
Hepatocellular carcinoma (HCC) invading the inferior vena cava will expose patients to a risk of sudden death. Effective therapeutic approaches have not been established for caval tumor. This pilot study was conducted to evaluate the feasibility, safety, and clinical efficacy of multimodality therapy using endovascular brachytherapy with iridium-192 for caval tumor.


METHODS
Six consecutive patients underwent endovascular high-dose-rate brachytherapy. An iridium-192 source was placed adjacent to the caval tumor through a vascular sheath introduced via the femoral vein. The total dose of brachytherapy ranged from 10 to 14Gy (5-7Gy per fraction). Hepatic arterial infusion chemotherapy was used in combination in all patients and external-beam radiotherapy was performed in 5 patients.


RESULTS
Endovascular brachytherapy was technically successful in all patients. There were no complications related to brachytherapy. The median period of follow-up was 14.5 months (range, 3-29 months). Complete response and partial response were achieved in 2 (33%) and 4 (67%) patients, respectively. The 1- and 2-year survival rates were 50% and 17%, respectively, with a median survival of 14 months.


CONCLUSIONS
Multimodality therapy using endovascular brachytherapy was a feasible, safe, and effective treatment for patients with advanced HCC invading the inferior vena cava.
Ii
Noriko
N
Department of Radiology, Faculty of Medicine, Mie University, Mie, Japan. ii-n@clin.medic.mie-u.ac.jp
Yamakado
Koichiro
K
Shouji
Kazufusa
K
Nomoto
Yoshihito
Y
Nakatsuka
Atsuhiro
A
Nomura
Miwako
M
Yamashita
Yasufumi
Y
Takaki
Haruyuki
H
Akeboshi
Masao
M
Senga
Masayo
M
Shiraki
Katsuya
K
Takeda
Kan
K
D000368:Aged; D000369:Aged, 80 and over; D001918:Brachytherapy; D006528:Carcinoma, Hepatocellular / Q000556:secondary* / Q000628:therapy*; D003131:Combined Modality Therapy; D005240:Feasibility Studies; D006801:Humans; D008113:Liver Neoplasms / Q000473:pathology* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009360:Neoplastic Cells, Circulating; D014682:Vena Cava, Inferior