| Background and purposeHepatocellular carcinoma(HCC)is one of the most common malignancies with high death rates.Treatment of HCC primary lesions have been clearly defined in multiple guide.The survival of patients will prolong,as well as the incidence of extrahepatic metast asis will increase,with the increasing local control rate of liver lesions.The most common extrahepatic metastatic sites include lungs,lymph nodes,bone and adrenal glands.Survival benefits may be associated with positive control of extrahepatic lymph node metastasis(LNM)from Hepatocellular carcinoma(HCC),but there is no standard treatment for LNM now.In this study,radioactive I-125 seeds were used to treat LNM from HCC,its safety and efficacy will be discussed too.At the same time,the puncture techniques of abdominal lymph node metastases will be summarized aimed to improving the accuracy and reducing the complications.As the method of radioactive I-125 seeds implantation belongs to brachytherapy,the efficacy and complications are closely related to radiation dose.Better puncture techniques are technical support in the treatment of HCC lymph node metastasis,with better dose distribution of treatment target and organs at risk(OAR)Materials and MethodsThis retrospective study was approved by the institutional ethics committee,and all patients provided written informed consent.From June 2007 to July 2016,22 cases clinic and imaging data were collected in our center.According to the Treatment Planning System(TPS),37 BT targets were treated by seeds implantation with CT guided.The Radioactive adverse event and surgical complications were recorded.The BT targets therapeutic response was evaluated by RECIST.The median survival time and rates of survival analysis was evaluated by Kaplan–Meier method.The puncture techniques of HCC lymph node metastasis and abdomen LNM in our Center were summarized at the same time.Result22 patients(Median age 48 years,90.9% males),58 lymph node areas were diagnosed metastasis.The incidence of LNM is high in porta hepatic(33.9%)and Right paraaortic nodes(14.2%),The lower incidence in other LNM areas.The brachytherapy targets was 37.The median imaging follow-up time was 12 months(Inter-Quartile Range,IQR 5.5-20.5),The Complete Response(CR)was 29,Partial Response(PR)was 5,Stable Disease(SD)was 2,Progressive Disease(PD)was 1,Local response rate(LRR)was 91.8%.The median survival time from the beginning of BT was 25 months,The 1-year,2-year and 3-year overall survival rates were 64.3%,43.4%,27.1%,and the 5-year overall survival rate from the time of HCC diagnosis was 31.1%.The Median Prescription dose was 100Gy(IQR 90-100),The radioactivity of seeds was 0.8m Gi,Planning pre-operation: Gross Tumour Volume(GTV)was 24.1cc(IQR 12.3-50.9),D90(Dose 90,90% of the tumor volume get prescription dose was 105.5 ± 10.8Gy.The number of seeds was 21(IQR 14-40.5).Verification post-operation: GTV was 26.4cc(IQR 14-55.6),D90 was 87.6±20.4Gy,The number of seeds was 26(IQR 15-43).There was a statistically significant difference in GTV,D90 and the sum of seeds between pre-operation and post-operation(P<0.05).No BT-induced acute morbidity of RTOG criteria.After 5.5 months,one case could be diagnosed as duodenal ulcer underwent gastroduodenoscopy.The surgical complications include mild pancreatitis in 3 cases,Stomach bleeding and pneumothorax in 1 case respectively.Single needle,Parallel needles,By the organ,Widened the path,Coaxial needle,Rely on the vessel wall were the most commonly used method of puncture.ConclusionsCT-guided I-125 BT with LNM from HCC presented with good local control rates,and controllable complications.It is a safe and effective palliative treatment for LNM of HCC.Effectively combination in various puncture techniques make accurately reaching to targets,leads to better distribution of I-125 seeds,improving local control rates of HCC lymph nodes,and reducing puncture surgery complications. |
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