Efficacy and safety of computed tomography-guided 125I brachytherapy for lymph node metastatic from hepatocellular carcinoma

Purpose: A survival benefit may be associated with the positive control of extrahepatic lymph node metastasis (LNM) of hepatocellular carcinoma (HCC). However, no standard treatment exists. The aim of this study was to evaluate the safety and efficacy of iodine-125 (125I) brachytherapy (BT) of LNM of HCC, especially in patients with multiple lymph nodules or repeated lymph node recurrence. Materials and Methods: From June 2007 to July 2016, clinical and imaging data of 22 patients were collected at our center. According to the treatment planning system, 37 BT targets were treated by seed implantation with computed tomography (CT)-guidance. The radioactive treatment-related adverse events and surgical complications were recorded. The BT target therapeutic response was evaluated by the RECIST. The median survival time and rates were evaluated by the Kaplan-Meier method. Results: Twenty-two patients were enrolled (median age: 48 years; 90.9% males), and 58 lymph node areas were diagnosed as metastatic. The incidence of LNM was high in porta hepatis (33.9%) and right para-aortic nodes (14.2%), and lower incidence rates were observed in other areas. The median imaging follow-up time was 12 months (inter-quartile range 5.5-20.5), the complete response was 29, the partial response was 5, the stable disease was 2, the progressive disease was 1, and the local response rate was 91.8%. The median survival time from the beginning of BT was 25 months. The 1, 2, and 3-year overall survival rates were 64.3%, 43.4%, and 27.1%, respectively, and the 5-year overall survival rate from the time of HCC diagnosis was 31.1%. No BT-induced acute morbidity according to the Radiation Therapy Oncology Group criteria was reported. After 5.5 months, one patient diagnosed with a duodenal ulcer underwent gastroduodenoscopy. The surgical complications included mild pancreatitis in 3 patients and stomach bleeding and pneumothorax in 1 patient. Conclusion: CT-guided 125I BT treatment of LNM of HCC presented good local control rates and controllable complications. It is a safe and effective palliative treatment for patients with LNM of HCC. Further study is needed to evaluate its long-term safety and efficacy.