Patient-reported health-related quality of life for men treated with low-dose-rate prostate brachytherapy as monotherapy with 125-iodine, 103-palladium,or 131-cesium: Results of a prospective phase II study

PurposeTo compare quality of life (QoL) after brachytherapy with one of the three approved radioactive isotopes.Methods and MaterialsPatients with mostly favorable intermediate-risk prostate cancer were treated on this prospective phase II trial with brachytherapy as monotherapy, without hormonal therapy. QoL was recorded at baseline and each follow-up by using the Expanded Prostate Cancer Index Composite instrument. The minimal clinically important difference was defined as half the standard deviation of the baseline score for each domain. Mixed effect models were used to compare the different isotopes, and time-driven activity-based costing was used to compute costs.ResultsFrom 2006 to 2013, 300 patients were treated with iodine-125 (I-125, n = 98, prescribed dose [PD] = 145 Gy), palladium-103 (Pd-103, n = 102, PD = 125 Gy), or cesium-131 (Cs-131, n = 100, PD = 115 Gy). Median age was 64.9 years. Median follow-up time was 5.1 years for the entire cohort, and 7.1, 4.8 and 3.3 years for I-125, Pd-103, and Cs-131 groups, respectively. All three isotope groups showed an initial drop in QoL at first follow-up, which gradually improved over the first 2 years for urinary and bowel domains. QoL profiles were similar between I-125 and Pd-103, whereas Cs-131 showed a statistically significant decrease in QoL regarding bowel and sexual function at 12 months compared with Pd-103. However, these differences did not reach the minimal clinically important difference. Compared with I-125, the use of Pd-103 or Cs-131 resulted in cost increases of 18% and 34% respectively.ConclusionsThe three different isotopes produced a similar QoL profile. Statistically significant differences favored Pd-103/I-125 over Cs-131 for bowel and sexual QoL, but this did not reach clinical significance.     

Knife or needles? A cohort analysis of outcomes after radical prostatectomy or brachytherapy for men with low- or intermediate-risk adenocarcinoma of the prostate

PurposeThe purpose of this study was to evaluate long-term outcomes for men with early stage prostate cancer treated with radical prostatectomy (RP) or brachytherapy (BT) at a single tertiary care center.Methods and MaterialsWe retrospectively analyzed data from 371 men with clinical T1a–T2c disease with prostate-specific antigen level <20 ng/mL and Gleason score (GS) 6–7 who were treated with RP (n = 279) or BT (n = 92) at MD Anderson Cancer Center in 2000–2001. Biochemical recurrence–free survival (BRFS) and prostate cancer–specific survival rates were compared by treatment modality.ResultsThe median followup time was 7.2 and 7.6 years for patients treated with RP and BT, respectively. Disease was upgraded from GS 6 to 7 after central review of the biopsy specimen for 36 men treated with RP (12.9%) and 15 men treated with BT (16.3%). After RP, GS was upgraded in 121 men (43.4%) between the centrally reviewed biopsy and the RP specimen. After RP, 5-year BRFS rates were 96.1% and 90.6% for low- and intermediate-risk disease, respectively (p = 0.003). After BT, 5-year BRFS rates were 92.5% and 95.8% for low- and intermediate-risk disease, respectively (p = 0.017). After RP or BT, 5-year BRFS rates were not significantly different with GS upgraded. Five-year prostate cancer–specific survival rates for patients with upgraded GS were 100% for both RP and BT.ConclusionsExcellent disease control outcomes can be achieved after either RP or BT as monotherapy for men with early stage prostate cancer. Upgrading of GS from 6 to 7, either (3 + 4) or (4 + 3), did not predict for worse outcomes.     

Dosimetry for 131Cs and 125I seeds in solid water phantom using radiochromic EBT film

PurposeTo measure the 2D dose distributions with submillimeter resolution for ¹³¹Cs (model CS-1 Rev2) and ¹²⁵I (model 6711) seeds in a Solid Water phantom using radiochromic EBT film for radial distances from 0.06 cm to 5 cm. To determine the TG-43 dosimetry parameters in water by applying Solid Water to liquid water correction factors generated from Monte Carlo simulations.MethodsEach film piece was positioned horizontally above and in close contact with a ¹³¹Cs or ¹²⁵I seed oriented horizontally in a machined groove at the center of a Solid Water phantom, one film at a time. A total of 74 and 50 films were exposed to the ¹³¹Cs and ¹²⁵I seeds, respectively. Different film sizes were utilized to gather data in different distance ranges. The exposure time varied according to the seed air-kerma strength and film size in order to deliver doses in the range covered by the film calibration curve. Small films were exposed for shorter times to assess the near field, while larger films were exposed for longer times in order to assess the far field. For calibration, films were exposed to either 40 kV (M40) or 50 kV (M50) x-rays in air at 100.0 cm SSD with doses ranging from 0.2 Gy to 40 Gy. All experimental, calibration and background films were scanned at a 0.02 cm pixel resolution using a CCD camera-based microdensitometer with a green light source. Data acquisition and scanner uniformity correction were achieved with Microd3 software. Data analysis was performed using ImageJ, FV, IDL and Excel software packages. 2D dose distributions were based on the calibration curve established for 50 kV x-rays. The Solid Water to liquid water medium correction was calculated using the MCNP5 Monte Carlo code. Subsequently, the TG-43 dosimetry parameters in liquid water medium were determined.ResultsValues for the dose-rate constants using EBT film were 1.069±0.036 and 0.923±0.031 cGy U⁻¹ h⁻¹ for ¹³¹Cs and ¹²⁵I seed, respectively. The corresponding values determined using the Monte Carlo method were 1.053±0.014 and 0.924±0.016 cGy U⁻¹ h⁻¹ for ¹³¹Cs and ¹²⁵I seed, respectively. The radial dose functions obtained with EBT film measurements and Monte Carlo simulations were plotted for radial distances up to 5 cm, and agreed within the uncertainty of the two methods. The 2D anisotropy functions obtained with both methods also agreed within their uncertainties.ConclusionEBT film dosimetry in a Solid Water phantom is a viable method for measuring ¹³¹Cs (model CS-1 Rev2) and ¹²⁵I (model 6711) brachytherapy seed dose distributions with submillimeter resolution. With the Solid Water to liquid water correction factors generated from Monte Carlo simulations, the measured TG-43 dosimetry parameters in liquid water for these two seed models were found to be in good agreement with those in the literature.     

Lung-conserving treatment of a pulmonary oligometastasis with a wedge resection and 131Cs brachytherapy

PurposeSoft-tissue sarcomas most frequently metastasize to the lung. Surgical resection of pulmonary metastases is the primary treatment modality. Although lobectomy is widely acknowledged as the standard procedure to treat primary pulmonary tumors, the standard for pulmonary metastases is not well defined; furthermore, compromised lung function may tip the scales in favor of a less invasive approach. Here, we report the results of a patient treated with wedge resection and intraoperative cesium-131 (¹³¹Cs).Methods and MaterialsA 58-year-old African American female was diagnosed with the American Joint Committee on Cancer Stage IIA mixed uterine leiomyosarcoma and underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy followed by adjuvant external beam radiotherapy to a total dose of 45 Gy and vaginal brachytherapy to a total dose of 20 Gy. At 2 years, a routine CT scan of the chest revealed metastasis to right upper lobe of the lung. The patient's poor pulmonary function, related to a 45 pack-year smoking history and chronic emphysema, precluded a lobectomy.ResultsAfter the patient underwent a lung-sparing wedge resection of the pulmonary right upper lobe metastasis and intraoperative brachytherapy with ¹³¹Cs seeds to a total dose of 80 Gy, she remained disease free in the implanted area. At a 2-year followup, imaging continued to reveal 100% local control of the area treated with wedge resection and intraoperative ¹³¹Cs brachytherapy. The patient had no complications from this treatment.ConclusionsSuch treatment approach may become an attractive option in patients with oligometastatic disease and compromised pulmonary function.     

Addition of intracavitary brachytherapy to external beam radiation therapy for T1–T2 nasopharyngeal carcinoma

PurposeWe compared efficacy and toxicity outcomes of patients with T1–T2 nasopharyngeal carcinoma (NPC) treated with external beam radiation therapy (EBRT) in combination with intracavitary brachytherapy (BT) vs. a historical cohort treated with EBRT alone.Methods and MaterialsOf the 348 NPC patients diagnosed with T1–2N0–3M0 disease, 175 received EBRT + BT and 173 received EBRT alone. For the EBRT + BT group, median dose of EBRT was 58 Gy and median dose of BT was 20 Gy; for the EBRT group, median dose was 72 Gy (range, 60–82.4 Gy). Measured outcomes included 5- and 10-year local control (LC), regional failure–free survival, distant metastasis–free survival, disease-free survival, overall survival (OS), and late toxicity.ResultsMedian followup duration was 120 months (range, 5–190). Ten-year OS and LC rates for the EBRT + BT and EBRT-alone groups were 71.7% vs. 49.9% and 94.0% vs. 85.2%, respectively (χ² = 21.273, p = 0.000 for OS and χ² = 4.684, p = 0.030 for LC). Late complication rates for EBRT + BT were generally lower compared with the EBRT-alone group except for nasopharyngeal ulceration or necrosis, where the rate was higher but not statistically significant. Both stage of disease at diagnosis and treatment techniques (i.e., the use of BT) were significant predictive factors for OS and LC.ConclusionIntracavitary BT in combination with EBRT may improve the therapeutic ratio for T1–T2 NPC.     

Cesium-131 prostate brachytherapy: A single institutional long-term experience

AimsTo report on the PSA outcomes in men undergoing prostate seed implant (PSI) with Cesium-131 at a single institution.Materials and MethodsAll patients who underwent prostate brachytherapy with Cesium-131 (¹³¹Cs) at our institution and had the potential for at least 24 months of follow up were included in this study. Results are reported for the by NCCN risk group (low, low/high-intermediate, and high), as well as by treatment received (monotherapy, combination external beam radiation + PSI, or trimodal therapy with androgen deprivation). The Phoenix definition (absolute nadir plus 2 ng/mL) was used to define biochemical freedom from disease (BFD).ResultsEight hundred and six men have undergone prostate brachytherapy with Cesium-131 at our institution, and 669 men were included in analysis. Median follow up was 60.0 months (range: 0–144 months). According to NCCN risk categories, 29.9% were low-, 55.6% intermediate-, and 14.5% high-risk. Using the Phoenix criteria, 5/10-year BFD was 97.1/95.3% for patients in the low-risk category, 94.0/90.1% for patients in the intermediate-risk category, and 86.2/56.6% for patients in the high-risk category. PSA ≤0.2 ng/dL at 4 years was predictive of 10 year biochemical control: 96.3% vs 70.4%, p < 0.001.ConclusionsThe present study demonstrates that prostate brachytherapy with ¹³¹Cs achieves excellent long-term biochemical control.     

Toward four-dimensional image-guided adaptive brachytherapy in locally recurrent endometrial cancer

PurposeTo evaluate clinical outcome and feasibility of a four-dimensional image-guided adaptive brachytherapy concept in patients with locally recurrent endometrial cancer.Methods and MaterialsForty-three patients with locally recurrent endometrial cancer were included. Treatment consisted of conformal external beam radiotherapy followed by a boost using pulsed-dose-rate brachytherapy (BT). Large tumors were treated with MRI-guided interstitial BT. Small tumors were treated with CT-guided intracavitary BT. The planning aim (total external beam radiotherapy and BT) for high-risk clinical target volume was D₉₀ > 80 Gy, whereas constraints for organs at risk were D_2cc ≤ 90 Gy for bladder and D_2cc ≤ 70 Gy for rectum, sigmoid, and bowel in terms of equivalent dose in 2 Gy fractions.ResultsMedian high-risk clinical target volume was 18 cm³ (range, 0–91). D₉₀ was 82 Gy (range, 77–88). D_2cc to bladder, rectum, and sigmoid were 67 Gy (range, 50–81), 67 Gy (range, 51–77), and 55 Gy (range, 44–68), respectively. Median followup was 30 months (6–88). Two-year local control rate was 92% (standard error [SE], 5). Disease-free survival rate and overall survival rate was 59% (SE, 8) and 78% (SE, 7), respectively. Patients with low- to intermediate-risk for recurrence had a 2-year disease-free survival rate of 72% (SE, 9) compared with 42% (SE, 12) in patients with high risk for recurrence (p = 0.04). Late morbidity Grade 3 was recorded in 5 (12%) patients.ConclusionsFour-dimensional image-guided adaptive brachytherapy is feasible in locally recurrent endometrial cancer. Local control rate is good. Systemic control remains a problem in patients with high risk for recurrence.     

Prostate-specific antigen spikes with 131Cs brachytherapy. Is there a difference with other radioisotopes?

PurposeThere is a suggestion that a dose-rate effect exists for the prostate-specific antigen (PSA) spike after brachytherapy. ¹³¹Cs is a newer radioisotope with a half-life of 9.7 days that is being used for prostate brachytherapy. There is no published data on the PSA spike with this radioisotope and the goal of this study was to quantify PSA spikes with ¹³¹Cs and compare it with published data for other isotopes.Methods and MaterialsWe have been maintaining a prospective database for all patients treated with ¹³¹Cs prostate brachytherapy at our institution. We selected patients for whom followup PSA was available for at least 24 months. The PSA spike was defined as an increase of 0.2 ng/mL, followed by a decline to prespike level.ResultsOne hundred twenty-three patients had monotherapy, whereas 32 had external beam radiation therapy followed by a brachytherapy boost. Median followup was 36 months and mean numbers of PSAs obtained were 7. Forty-six (29.7%) patients had a PSA spike. The mean time and duration for the PSA spike were 12.5 and 8.8 months, respectively. The mean magnitude of increase and mean PSA value at increase were 0.63 and 1.56 ng/mL, respectively.ConclusionsThe incidence of a PSA spike in our series is consistent with reported numbers for other radioisotopes. The occurrence of the spike at 12.5 months appears to be at the early end of the spectrum reported for ¹²⁵I, but the duration and magnitude are similar to other radioisotopes.     

Is stereotactic CyberKnife radiotherapy or multicatheter HDR brachytherapy the better option dosimetrically for accelerated partial breast irradiation?

ObjectiveTo compare dosimetrically the stereotactic CyberKnife (CK) therapy and multicatheter high-dose-rate (HDR) brachytherapy (BT) for accelerated partial breast irradiation (APBI).MethodsTreatment plans of 25 patients treated with CK were selected, and additional plans using multicatheter HDR BT were created on the same CT images. The prescribed dose was 6.25/25 Gy in both plans to the target volume (PTV). The dose-volume parameters were calculated for both techniques and compared.ResultsThe D90 total dose of the PTV was significantly lower with CK than with HDR BT, D90 was 25.7 Gy, and 27.0 Gy (p < 0.001). However, CK plans were more conformal than BT, COIN was 0.87, and 0.81 (p = 0.0030). The V50 of the non-target breast was higher with CK than with BT: 10.5% and 3.3% (p = 0.0010), while there was no difference in the dose of the contralateral breast and contralateral lung. Dose to skin, ipsilateral lung, and ribs were higher with CK than with BT: D₁ was 20.6 Gy vs. 11.5 Gy (p = 0.0018) to skin, 11.4 Gy vs. 9.6 Gy (p = 0.0272) to ipsilateral lung and 18.5 Gy vs. 12.3 Gy (p = 0.0013) to ribs, while D_0.1 to heart was lower, 3.0 Gy vs. 3.2 Gy (p = 0.0476), respectively.ConclusionsMulticatheter HDR BT yields more advantageous plans than stereotactic CyberKnife treatment in accelerated partial breast irradiation, except in terms of dose conformality and the dose to the heart. There was no difference in the dose of the contralateral breast and lung.     

Image-based three-dimensional conformal brachytherapy for medically inoperable endometrial carcinoma

PurposeDefinitive radiotherapy is a viable option for medically inoperable patients with early stage endometrial cancer. We present our experience using image-based brachytherapy (BT).Methods and MaterialsPatients with medically inoperable clinical Stage I endometrial adenocarcinoma received definitive BT with or without external beam radiotherapy. High-dose-rate BT was delivered using MRI- or CT-based planning for each fraction. For patients with an MRI, gross tumor volume (GTV) was contoured although dose was still prescribed to the clinical treatment volume (CTV), including the entire uterus, cervix, and upper 1–2 cm of vagina. Equivalent 2 Gy doses (EQD₂) were calculated.ResultsThirty-eight patients were treated from 2007 to 2013, 20 receiving BT alone with a median dose of 37.5 Gy in five to six fractions. For combined therapy, median external beam and BT doses were 45 and 25 Gy in four to five fractions. With 15-month median followup, the 2-year actuarial local control and overall survival were 90.6% and 94.4%. No Grade 2–5 late toxicities were observed. Mean CTV D₉₀ EQD₂ for BT alone and combined therapy was 48.6 ± 5.6 and 72.4 ± 6.0 Gy, whereas mean GTV D₉₀ EQD₂ was 172.3 ± 59.6 and 138.0 ± 64.6 Gy.ConclusionsImage-based BT is feasible for medically inoperable early stage endometrial cancer with excellent early results. Despite low CTV doses, high doses delivered to GTV with BT likely accounts for high local control. Endometrial cancer guidelines for image-based planning are needed to define target volumes based on risk with differential dose delivery.     

Dosimetric influence of seed spacers and end-weld thickness for permanent prostate brachytherapy

PurposeThe aim of this study was to analyze the dosimetric influence of conventional spacers and a cobalt chloride complex contrast (C4) agent, a novel marker for MRI that can also serve as a seed spacer, adjacent to ¹⁰³Pd, ¹²⁵I, and ¹³¹Cs sources for permanent prostate brachytherapy.Methods and MaterialsMonte Carlo methods for radiation transport were used to estimate the dosimetric influence of brachytherapy end-weld thicknesses and spacers near the three sources. Single-source assessments and volumetric conditions simulating prior patient treatments were computed. Volume–dose distributions were imported to a treatment planning system for dose–volume histogram analyses.ResultsSingle-source assessment revealed that brachytherapy spacers primarily attenuated the dose distribution along the source long axis. The magnitude of the attenuation at 1 cm on the long axis ranged from −10% to −5% for conventional spacers and approximately −2% for C4 spacers, with the largest attenuation for ¹⁰³Pd. Spacer perturbation of dose distributions was less than manufacturing tolerances for brachytherapy sources as gleaned by an analysis of end-weld thicknesses. Volumetric Monte Carlo assessment demonstrated that TG-43 techniques overestimated calculated doses by approximately 2%. Specific dose–volume histogram metrics for prostate implants were not perturbed by inclusion of conventional or C4 spacers in clinical models.ConclusionsDosimetric perturbations of single-seed dose distributions by brachytherapy spacers exceeded 10% along the source long axes adjacent to the spacers. However, no dosimetric impact on volumetric parameters was noted for brachytherapy spacers adjacent to ¹⁰³Pd, ¹²⁵I, or ¹³¹Cs sources in the context of permanent prostate brachytherapy implants.     

Physical derivation of nomograms in permanent prostate brachytherapy

PurposeTo demonstrate the physical origin of nomograms in permanent prostate brachytherapy, by using the correlation between fractional integral target dose (FITD) and target volume.Methods and MaterialsThe integral dose (ID) E delivered by unit activity is given by the integration of 4πr²D(r)/r²dr × 1.44T_1/2 using the point source model from AAPM TG43. If A is the total activity implanted, then total ID will be A × E. Integral target dose are obtained by multiplying the prostate volume V with mean dose D_mean by definition, assuming prostate gland has a unity density. The FITD the target receives is defined as FITD = D_meanV/AE by energy conservation in the target volume. From this equation, the total activity needed to achieve given dose for a target of volume V is obtained. Results are compared with existing nomograms for ¹²⁵I and ¹⁰³Pd, and available clinical data for ¹³¹Cs.ResultsAgreement within 10.0% for ¹²⁵I and ¹⁰³Pd compared with existing nomograms for gland sizes from 18 to 80 cc is observed. For ¹³¹Cs, the agreement is within 8.0% compared with available clinical data.ConclusionsIt is shown that the correlation between the FITD and target volume can be used to obtain the total activity needed to achieve prescribed dose. This correlation is inherent rather than empirical. It suggests that the correlation between fraction of energy deposition in target and target volume is the underlying physical origin for nomograms used in permanent prostate brachytherapy.     

HDR brachytherapy boost using MR-only workflow for intermediate- and high-risk prostate cancer: 8-year results of a pilot study

PurposeTo report 8-year clinical outcome with high-dose-rate brachytherapy (HDRBT) boost using MRI-only workflow for intermediate (IR) and high-risk (HR) prostate cancer (PC) patients.Methods and MaterialsFifty-two patients were treated with 46–60 Gy of 3D conformal radiotherapy preceded and/or followed by a single dose of 8–10 Gy MRI-guided HDRBT. Interventions were performed in a 0.35 T MRI scanner. Trajectory planning, navigation, contouring, catheter reconstruction, and dose calculation were exclusively based on MRI images. Biochemical relapse-free- (BRFS), local relapse-free- (LRFS), distant metastasis-free- (DMFS), cancer-specific-(CCS) and overall survival (OS) were analyzed. Late morbidity was scored using the Common Terminology Criteria for Adverse Events (CTCAE 4.0) combined with RTOG (Radiation Therapy Oncology Group) scale for urinary toxicity and rectal urgency (RU) determined by Yeoh.ResultsMedian follow-up time was 107 (range: 19–143) months. The 8-year actuarial rates of BRFS, LRFS, DMFS, CSS and OS were 85.7%, 97%, 97.6%, and 77.6%, respectively. There were no Gr.3 GI side effects. The 8-year actuarial rate of Gr.2 proctitis was 4%. The 8-year cumulative incidence of Gr.3 GU side effects was 8%, including two urinary stenoses (5%) and one cystitis (3%). EPIC urinary and bowel scores did not change significantly over time.ConclusionsMRI-only HDR-BT boost with moderate dose escalation provides excellent 8-year disease control with a favorable toxicity profile for IRPC and HRPC patients. Our results support the clinical importance of MRI across the BT workflow.     

Fukushima radionuclides in Vilnius/Lithuania aerosols: Modelling of aerosol transport

Measurements of activity concentrations of ¹³¹I; ^129mTe, ¹³²Te, ¹³⁴Cs and; ¹³⁶Cs, ¹³⁷Cs in aerosol were carried out in daily samples after the Fukushima accident during the period of March–April, 2011 in Vilnius. The maximum activity concentrations of ¹³¹I and ¹³⁷Cs were found to be 3700 μBq m⁻³ and 1040 μBq m⁻³, respectively. Variations in activity ratios of ¹³²Te/^129mTe and ¹³⁷Cs/¹³⁶Cs observed after the accident were explained by the decay of the short-lived isotopes, while those in ¹³⁴Cs/¹³⁷Cs by the dilution effect of the Chernobyl-derived ¹³⁷Cs. It was found that different behaviours of highly volatile ¹³¹I and ¹³⁷Cs resulted in enrichment of ground level aerosol particles by ¹³¹I with respect to ¹³⁷Cs. Simulated activity concentrations of ¹³⁷Cs attached to aerosol particles for the Vilnius site reasonably agreed with measured activities in aerosol samples during the Fukushima accident.     

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

PurposeAdvanced 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 (¹²⁵I) seed for hepatocellular carcinoma with PVTT can improve the remission rate. This study aimed to systematically evaluate the efficacy and safety of ¹²⁵I seed implantation in patients with PVTT.Methods and MaterialsThe 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.ResultsEight studies were included with 1098 patients, 591 patients received ¹²⁵I seed implantation, and 507 in the control group. Meta-analysis showed that ¹²⁵I 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 ¹²⁵I seed implantation declined 55% (HR = 0.45, 95% CI = 0.34–0.55, p = 0.000). ¹²⁵I 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).ConclusionTACE plus ¹²⁵I seed implantation is more effective in treating PVTT. The use of ¹²⁵I seeds dose >110 Gy will show better results.