125I seed implantation for hepatocellular carcinoma with portal vein tumor thrombus: A systematic review and meta-analysis

PURPOSE: Advanced hepatocellular carcinoma often combined with portal vein tumor thrombus (PVTT), transcatheter arterial chemoembolization (TACE) is recommended as an effective treatment. Recent studies showed that TACE plus iodine-125 (I-125) seed for hepatocellular carcinoma with PVTT' can improve the remission rate. This study aimed to systematically evaluate the efficacy and safety of I-125 seed implantation in patients with PVTT. METHODS AND MATERIALS: The Embase, Medline/PubMed, Cochrane Library, and OVID databases were systematically searched from the earliest to October 2018. The references included in the literature were searched. The primary endpoints were remission rate and overall survival, and the secondary endpoints were portal venous pressure and adverse event. The odds ratio (OR) and hazard ratio (HR) were combined using either fixed or random effects model. Meta-analysis was performed using Stata 12.0 software. RESULTS: Eight studies were included with 1098 patients, 591 patients received I-125 seed implantation, and 507 in the control group. Meta-analysis showed that I-125 seed implantation improved the remission rate in patients with PVTT (OR = 2.24, 95% confidence interval (CI) = 1.68-2.99, p = 0.000) and survival rate (HR = 0.27, 95% CI = 0.14-0.40, p = 0.000); it also reduced patient's mortality risk (HR = 0.46, 95% CI = 0.37-0.54, p = 0.000). Subgroup analysis suggested that the death risk of patients who responded to I-125 seed implantation declined 55% (HR = 0.45, 95% CI = 0.34-0.55, p = 0.000). I-125 seed implantation is more effective against PVTT delivered at a dose higher than 110 Gy. There was no difference in the occurrence adverse event between the two groups (OR = 1.07, 95% CI = 0.92-1.25, p = 0.262). CONCLUSION: TACE plus I-125 seed implantation is more effective in treating PVTT. The use of I-125 seeds dose >110 Gy will show better results. (C) 2019 The Authors. Published by Elsevier Inc. on behalf of American Brachytherapy Society.