Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with portal vein tumor thrombus

Hepatocellular carcinoma (HCC) is one of the most common malignant tumors worldwide. Portal venous invasion is reported in 12.5–39.7% of patients with advanced HCC (1). When the main portal vein (MPV) was involved by tumor thrombus, the patient’s prognosis was extremely poor (2). For these patients, there is no effective treatment and the optimal treatment remains controversial. Most HCCs with portal vein tumor thrombus (PVTT) are technically unresectable and they are not suitable for curative therapies. As a palliative treatment, transcatheter arterial chemoembolization (TACE) treatment for HCC with PVTT is safe and effective when there is sufficient collateral circulation. However, PVTT limits the effect of TACE on HCC and has a strong negative impact on the therapeutic effect (3). Therefore, opening the occlusion of the portal vein caused by PVTT and reperfusing the portal vein could improve the success of TACE, and this could be achieved using portal vein stenting (PVS). PVS combined with TACE has been successfully used in the treatment of HCC with PVTT. However, PVS effectively removes the portal vein obstruction but do not treat the thrombus per se, and stent restenosis may happen. Radioactive seed implantation is used in a variety of solid tumors. Iodine-125 (125I) seed implantation was attempted to treat HCC with PVTT and achieved excellent therapeutic efficacy (4) with a good safety profile (Figure 1)