Purpose: To investigate the efficacy and safety of transcatheter arterial chemoembolization (TACE) combined with iodine-125 (125I) seed implantation and three-dimensional conformal radiotherapy (3DCRT) in treating primary hepatocellular carcinoma (HCC) in the advanced stage.
Methods: A total of 110 primary HCC patients in the advanced stage without operative indications admitted to and treated in our hospital from March 2014 to March 2016 were selected and divided into two groups using randomized single-blind method to receive TACE and 125I seed implantation combined with 3DCRT (TACE + 125I + 3DCRT group, n=55) as well as TACE combined with 3DCRT (TACE + 3DCRT group, n=55) separately. The short-term clinical efficacy, changes in the levels of alpha fetoprotein (AFP), insulin-like growth factor-II (IGF-II) and insulin-like growth factor binding protein-2 (IGFBP-2) in the serum before and after treatment, adverse reactions and long-term survival of the patients were observed and recorded.
Results: TACE + 125I + 3DCRT group had significantly higher objective response rate (ORR) and disease control rate (DCR) than TACE + 3DCRT group [83.6% (46/55) vs. 63.6% (35/55), 96.4% (53/55) vs. 83.6% (46/55)] (p=0.029, p=0.043). The levels of serum AFP, IGF-II and IGFBP-2 declined markedly after treatment in both groups compared with those before treatment (p<0.001), while they were evidently lower in TACE + 125I + 3DCRT group than TACE + 3DCRT group (p=0.008, p=0.004, p=0.018). The major adverse reactions in the patients after treatment included bone marrow suppression, fever, gastrointestinal reaction, transaminase elevation, radiodermatitis, radiation-induced hepatitis and radiation-induced gastric ulcer, most of which were in I-II grade. There was no statistically significant difference in the incidence rate of adverse reactions between the two groups of patients after chemoradiotherapy (p>0.05). The results of follow-up indicated that TACE + 125I + 3DCRT group had notably longer overall survival (OS) and progression-free survival (PFS) than TACE + 3DCRT group (p=0.030, p=0.016).
Conclusion: The treatment scheme of TACE and 125I seed implantation combined with 3DCRT have exact efficacy in advanced primary HCC, which can distinctly increase the ORR and DCR, prominently reduce the levels of serum AFP, IGF-II and IGFBP-2 and prolong the survival time of the patients without increasing adverse reactions compared with TACE + 3DCRT, so it is worthy of clinical popularization and application.