Ultrasound and CT-guided 125I implantation combined with TACE therapy in the treatment of recurrent HCC after RFA.

[PURPOSE] This study aimed to evaluate the efficacy and safety of combining transarterial chemoembolization (TACE) with 125Iodine (125I) seed implantation for the treatment of recurrent hepatocellular carcinoma (HCC) following radiofrequency ablation (RFA).

[METHOD] A retrospective analysis was conducted on 221 HCC patients treated between January 2016 and January 2025, divided into two groups: TACE monotherapy (n = 132) and TACE combined with 125I seed implantation (TACE-125I, n = 89). Treatment outcomes, including overall survival (OS), progression-free survival (PFS), and recurrence patterns, were assessed. Complications were evaluated using the Common Terminology Criteria for Adverse Events (CTCAE v5.0).

[RESULTS] The TACE-125I group demonstrated significantly improved survival outcomes compared to the TACE group, with a median OS of 38 months (95% CI: 34.6-41.4) versus 21 months (95% CI: 14.6-27.4) (p < 0.001) and a median PFS of 19 months (95% CI: 13.7-24.3) versus 10 months (95% CI: 7.8-12.2) (p < 0.001). Local recurrence rates were lower in the TACE-125I group (10 cases vs. 20 cases). The safety profile was favorable, with no severe complications or procedure-related fatalities. Multivariate analysis identified the neutrophil-to-lymphocyte ratio (NLR) as an independent prognostic factor for both OS and PFS.

[CONCLUSIONS] The combination of TACE and 125I seed implantation significantly improves survival and local tumor control in recurrent HCC after RFA, offering a promising therapeutic option for patients with limited treatment alternatives. Further prospective studies are needed to validate these findings and optimize patient selection criteria.