¹²⁵Iodine seed implantation and gamma knife for the treatment of portal vein tumor thrombosis in hepatocellular carcinoma: comparison of therapeutic efficacy

Objective: To compare the therapeutic efficacy of ¹²⁵Iodine seed implantation and gamma knife in treating portal vein tumor thrombosis (PVTT) in hepatocellular carcinoma (HCC), and to discuss their clinical applications. Methods: Between January 2009 and May 2013, a total of 60 HCC patients associated with PVTT were encountered at authors' hospital. The patients were divided into gamma knife group (n = 30) and ¹²⁵Iodine seed group (n = 30). Gamma knife treatment was carried out for the patients of gamma knife group. A total of 3-10 target points were designed. Single dose of 3-6 Gy per fraction was used and 2-5 times radiotherapy every week were conducted. The total treatment dose was 30-50 Gy. In designing the therapeutic scheme, 50%-70% of iso-dose curve contained PTV. ¹²⁵Iodine seed implantation was performed for the patients of ¹²⁵Iodine seed group. After the treatment, the change of PVTT size was assessed. The clinical efficacy was evaluated. Results: Three months after the treatment, in gamma knife group complete remission (CR) was seen in 0 patient (0%), partial remission (PR) in 8 patient (26.6%), stable disease (SD) in 17 patients (56.7%) and progressive disease (PD) in 5 patients (16.7%). In ¹²⁵Iodine seed group, CR was obtained in 3 patients (10.0%), PR in 19 patients (63.4%), SD in 7 patients (23.3%) and PD in one patient (3.3%). Statistically significant differences in responding the therapy existed between the two groups (P < 0.05), although no significant difference in the improvement of ascites and hepatic function existed between the two groups (P < 0.05). Conclusion: For the treatment of portal vein tumor thrombosis of hepatocellular carcinoma, the short-term efficacy of ¹²⁵Iodine seed implantation is much better than that of gamma knife, although its long-term effect needs to be further studied. (authors)