Efficacy and Safety of Endovascular Brachytherapy Combined with Transarterial Chemoembolization for the Treatment of Hepatocellular Carcinoma Patients with Type III-IV Portal Vein Tumor Thrombosis

Background: The purpose of this study was to evaluate the safety and efficacy of endovascular brachytherapy (EVBT) combined with transarterial chemoembolization (TACE) for the treatment of hepatocellular carcinoma (HCC) complicated with type III-IV portal vein tumor thrombosis (PVTT) and to further analyze the major independent risk predictor factors of prognosis.Methods: We retrospectively analyzed the medical records of 54 patients who were diagnosed with HCC complicated with type III or IV PVTT and who received EVBT combined with improved TACE treatment from January 2017 to June 2019. Adverse events, treatment response, overall survival (OS), progression-free survival (PFS), and stent patency were analyzed to evaluate the efficacy and safety of this treatment. Major independent risk predictors of OS were also analyzed by the regression model.Results: No severe adverse events associated with EVBT combined with TACE were observed. The objective response and disease control rates four weeks after the treatment were 42.6% and 96.3%, respectively. The median OS and PFS were 209±46.5 days and 138±29.4 days, respectively. The cumulative stent patency rate was 70.4% at the last follow-up. AFP≥400 ng/ml, ECOG PS>1, Child-Pugh grade B, and nonhemihepatic HCC were independent risk predictors of OS.Conclusions: EVBT combined with TACE was effective and safe for the treatment of HCC with type III-IV PVTT.