Efficacy Of Radioactive I-125 Seed Implantation In Transarterial Chemoembolization(TACE)refractory Hepatocellular Carcinoma

ObjectiveTo evaluate the effeacy of radioactive I-125 seed implantation in Transarterial chemoembolization(TACE)refractory and to analyze the prognostic factors influencing the survival of patients with TACE refractory.Methods A total of 70 patients were diagnosed with HCC in our hospital with TACE treatment on July 1,2016-August 31,2019.29 patients were converted to radioactive I-125 seed implantation,while 41 patients were continued to receive TACE treatment.Imaging follow-up(CT/MR)was conducted every 4-6 weeks after treatment for the two groups of patients and were evaluated according to mRECIST standard.To compare the ORR and survival time without tumor progression and survival time of the two groups patients.The factors affecting the survival of patients were analyzed and summarized.Results(1)This study was followed up by January 2020,with a median follow-up time of 8.7 months.9 patients were lost to follow-up during the study period,44 patients died and 17 patients survived at the end of the study.There was no significant difference in demographic data or characteristics between two groups(P>0.05).(2)1 month after the diagnosis of TACE refractory,the ORR was 20.7% in the radioactive I-125 seed implantation treatment group.In the continue TACE treatment group,the ORR was 2.6%.There was a statistically significant difference in ORR between the two groups(P=0.000).3 months after the diagnosis of TACE refractory,the ORR was 40.7% in the radioactive I-125 seed implantation treatment group.In the continue TACE treatment group,the ORR was 3.3%.There was a statistically significant difference in ORR between the two groups(P=0.005).6 months after the diagnosis of TACE refractory,the ORR was 34.6% in the radioactive I-125 seed implantation treatment group.In the continue TACE treatment group,the ORR was 5.0%.There was a statistically significant difference in ORR between the two groups(P=0.04).(3)The PFS time was 7.6 months(95%CI 5.146-10.121)in the radioactive I-125 seed implantation group and 3.5 months(95%CI 2.542-4.391)in the continue TACE group.There was a statistically significant difference in PFS between the two groups(P=0.0042).The OS time of the radioactive I-125 seed implantation group was 21.1 months(95%CI 14.848-27.419),while the continue TACE group was 8.5 months(95%CI 4.898-12.035).There was a significant statistical difference in OS between the two groups(P=0.0003).(4)The differences in the OS of patients with different Child-pugh grades and different treatment strategies were statistically significant(P < 0.05),and the OS of patients with Child-pugh grade A and radioactive I-125 seed implantation group were longer.multivariate analysis showed that Child-pugh grade(HR=3.069,P=0.005)and different treatment strategies(HR=3.171,P=0.002)were independent risk factors.The results of multivariate analysis were basically consistent with univariate analysis.(5)There was no significant difference in the incidence of adverse reactions and complications between the two groups(P > 0.05).Conclusion(1)Radioactive I-125 seed implantation could effectively control the tumor lesion.(2)TACE refractory patients could benefit from radioactive I-125 seed implantation treatment and prolong survival time.The PFS and OS of patients with Child-pugh grades A and I-125 radioactive seed implantation regimens were longer,which were independent influencing factors of OS.(3)The I-125 seed implantation did not increase the risk of adverse reactions and complications,and the treatment of TACE refractory HCC was safe and effective.