CT-guided 125I brachytherapy for hepatocellular carcinoma in high-risk locations after transarterial chemoembolization combined with microwave ablation: a propensity score-matched study

CT-guided 125I brachytherapy for HCC in high-risk locations after TACE combined with MWA: a propensity score-matched study

Abstract

Objectives: This study aimed to evaluate the safety and efficacy of ¹²⁵I brachytherapy combined with transarterial chemoembolization (TACE) and microwave ablation (MWA) for unresectable hepatocellular carcinoma (HCC) in high-risk locations.

Methods: After 1:2 propensity score matching (PSM), this retrospectively study analyzed 49 patients who underwent TACE +MWA+¹²⁵I brachytherapy (group A) and 98 patients who only received TACE +MWA (group B). The evaluated outcomes were progression-free survival (PFS), overall survival (OS), and treatment complications. Cox proportional hazards regression analysis survival was used to compare the two groups.

Results: The patients in group A showed a longer PFS than group B (7.9 vs 3.3 months, P=0.007). No significant differences were observed in median OS between the two groups (P=0.928). The objective response rate (ORR), disease control rate of tumors in high-risk locations, and the ORR of intrahepatic tumors were 67.3%, 93.9%, and 51.0%, respectively, in group A, and 38.8%, 79.6% and 29.6%, respectively, in group B (P<0.001, P=0.025 and P=0.011, respectively). TACE-MWA-¹²⁵I (HR=0.479, P<0.001) was a significant favorable prognostic factor that affected PFS. The present of portal vein tumor thrombosis was an independent prognostic factor for PFS (HR=1.625, P=0.040). The BCLC stage (BCLC C vs B) was an independent factor affecting OS (HR=1.941, P=0.038). The incidence of complications was similar between the two groups, except that the incidence of abdominal pain was reduced in the group A (P=0.007).

Conclusions: TACE-MWA-¹²⁵I resulted in longer PFS and better tumor control than did TACE-MWA in patients with unresectable hepatocellular carcinoma in high-risk locations.