Application and prospects of portal vein iodine-125 irradiation stents in hepatocellular carcinoma with portal vein tumor thrombus_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Xinchen ,  CHEN Li

Center of Interventional Radiology and Vascular Surgery, Department of Radiology, Zhongda Hospital; Medical School, Southeast University, Nanjing 210009, P. R. China;

Corresponding?author：

CHEN Li, Email: maple.cl@163.com

Keywords：

hepatocellular carcinoma; portal vein tumor thrombus; iodine-125 irradiation stent; radiotherapy

DOI：

10.7507/1007-9424.202510081

Video：

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Abstract Full text Figures/Tables Video References Cited by

Objective To summarize recent advances, clinical applications, and future directions of the portal vein iodine-125 (¹²⁵I) irradiation stent in the treatment of hepatocellular carcinoma (HCC) with portal vein tumor thrombus (PVTT). Methods Literature published over the past 15 years concerning ¹²⁵I irradiation stents for HCC with PVTT treatment was retrieved. Studies focusing on stent design, radiation dosimetry, combination treatment strategies, and prognostic outcomes were systematically reviewed and analyzed. Results The portal vein ¹²⁵I irradiation stent provides dual therapeutic benefits: mechanical recanalization of the obstructed portal vein and continuous intraluminal low-dose γ-radiation, achieving high-dose, long-duration localized irradiation. Clinical evidences indicate superior outcomes in maintaining portal vein patency, controlling tumor thrombus progression, and improving overall survival as compared with transcatheter arterial chemoembolization (TACE) or systemic therapy alone. Moreover, combination approaches with TACE or targeted or immunotherapy further enhance tumor control and survival benefits, making it an integral part of multidisciplinary HCC management. Conclusions As an innovative integration of interventional and brachytherapy techniques, the portal vein ¹²⁵I irradiation stent shows promising efficacy and safety in treating HCC with PVTT. Future developments should emphasize biomaterial optimization, image-guided precision implantation, and individualized dosimetry, supported by multicenter randomized controlled trials to establish standardized therapeutic protocols and advance precision oncology.

Citation： WANG Xinchen, CHEN Li. Application and prospects of portal vein iodine-125 irradiation stents in hepatocellular carcinoma with portal vein tumor thrombus. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2025, 32(12): 1527-1533. doi: 10.7507/1007-9424.202510081 Copy

1.	Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2.	Zhang ZM, Lai EC, Zhang C, et al. The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus. Int J Surg, 2015, 20: 8-16.
3.	Vogel A, Meyer T, Sapisochin G, et al. Hepatocellular carcinoma. Lancet, 2022, 400(10360): 1345-1362.
4.	Kudo M, Izumi N, Kubo S, et al. Report of the 20th nationwide follow-up survey of primary liver cancer in Japan. Hepatol Res, 2020, 50(1): 15-46.
5.	Katagiri S, Yamamoto M. Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus. Surg Today, 2014, 44(2): 219-226.
6.	Kim TS, Yang K, Choi GH, et al. Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis. Ann Hepatobiliary Pancreat Surg, 2024, 28(2): 134-143.
7.	Xue TC, Xie XY, Zhang L, et al. Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol, 2013, 13: 60. doi: 10.1186/1471-230X-13-60.
8.	Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase Ⅲ randomised, double-blind, placebo-controlled trial. Lancet Oncol, 2009, 10(1): 25-34.
9.	Dawson LA, Ten Haken RK, Lawrence TS. Partial irradiation of the liver. Semin Radiat Oncol, 2001, 11(3): 240-246.
10.	Pan CC, Kavanagh BD, Dawson LA, et al. Radiation-associated liver injury. Int J Radiat Oncol Biol Phys, 2010, 76(3 Suppl): S94-S100. doi: 10.1016/j.ijrobp.2009.06.092.
11.	Luo J, Yan Z, Liu Q, et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. J Vasc Interv Radiol, 2011, 22(4): 479-489.
12.	Lu J, Guo JH, Zhu HD, et al. Safety and efficacy of irradiation stent placement for malignant portal vein thrombus combined with transarterial chemoembolization for hepatocellular carcinoma: a single-center experience. J Vasc Interv Radiol, 2017, 28(6): 786-794.
13.	Luo JJ, Zhang ZH, Liu QX, et al. Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus. Hepatol Int, 2016, 10(1): 185-195.
14.	Hasegawa T, Yamakado K, Takaki H, et al. Portal venous stent placement for malignant portal venous stenosis or occlusion: who benefits?. Cardiovasc Intervent Radiol, 2015, 38(6): 1515-1522.
15.	Sedelnikova OA, Rogakou EP, Panyutin IG, et al. Quantitative detection of ¹²⁵IdU-induced DNA double-strand breaks with gamma-H2AX antibody. Radiat Res, 2002, 158(4): 486-492.
16.	Guo S, Yao Y, Tang Y, et al. Radiation-induced tumor immune microenvironments and potential targets for combination therapy. Signal Transduct Target Ther, 2023, 8(1): 205. doi: 10.1038/s41392-023-01462-z.
17.	Xiao Y, Yuan J, Yang C, et al. ¹²⁵I radioactive particles drive protective autophagy in hepatocellular carcinoma by upregulating ATG9B. J Clin Transl Hepatol, 2023, 11(2): 360-368.
18.	Yang C, Xiao Y, Du Y, et al. Iodine-125 seeds inhibit carcinogenesis of hepatocellular carcinoma cells by suppressing epithelial-mesenchymal transition via TGF- β1/Smad signaling. Dis Markers, 2022, 2022: 9230647. doi: 10.1155/2022/9230647.
19.	Wheldon TE, O’Donoghue JA. The radiobiology of targeted radiotherapy. Int J Radiat Biol, 1990, 58(1): 1-21.
20.	中國醫師協會肝癌專業委員會. 中國肝細胞癌合并門靜脈癌栓診療指南(2021年版). 中華醫學雜志, 2022, 102(4): 243-254.
21.	中國醫師協會肝癌專業委員會. 肝細胞癌合并門靜脈癌栓多學科診治中國專家共識(2018年版). 臨床肝膽病雜志, 2019, 35(4): 737-743.
22.	Lu J, Zhang XP, Zhong BY, et al. Management of patients with hepatocellular carcinoma and portal vein tumour thrombosis: comparing east and west. Lancet Gastroenterol Hepatol, 2019, 4(9): 721-730.
23.	Nakai H, Shimizu H, Taniguchi T, et al. Long-term efficacy and risk factors for stent occlusion in portal vein stent placement: a multi-institutional retrospective study. CVIR Endovasc, 2022, 5(1): 27. doi: 10.1186/s42155-022-00307-0.
24.	Vibert E, Azoulay D, Cunha AS, et al. Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients. J Surg Oncol, 2013, 107(7): 696-701.
25.	Guo L, Sun J, Wang C, et al. Epirubicin enhances the anti-cancer effects of radioactive ¹²⁵I seeds in hepatocellular carcinoma via downregulation of the JAK/STAT1 pathway. Front Oncol, 2022, 12: 854023. doi: 10.3389/fonc.2022.854023.
26.	Liu S, Wang W, Hu S, et al. Radiotherapy remodels the tumor microenvironment for enhancing immunotherapeutic sensitivity. Cell Death Dis, 2023, 14(10): 679. doi: 10.1038/s41419-023-06211-2.
27.	Sun JH, Zhou T, Zhu T, et al. Portal vein stenting combined with iodine-125 seeds endovascular implantation followed by transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma patients with portal vein tumor thrombus. Biomed Res Int, 2016, 2016: 3048261. doi: 10.1155/2016/3048261.
28.	Li S, Guo JH, Lu J, et al. I¹²⁵ irradiation stent for treatment of hepatocellular carcinoma with portal vein thrombosis: a meta-analysis. Cancer Radiother, 2021, 25(4): 340-349.
29.	Lu J, Guo JH, Ji JS, et al. Irradiation stent with ¹²⁵I plus TACE versus sorafenib plus TACE for hepatocellular carcinoma with major portal vein tumor thrombosis: a multicenter randomized trial. Int J Surg, 2023, 109(5): 1188-1198.
30.	Li L, Cheng N, Huang X, et al. Efficacy and safety of endovascular brachytherapy combined with transarterial chemoembolization for the treatment of hepatocellular carcinoma patients with type Ⅲ or Ⅳ portal vein tumor thrombosis. World J Surg Oncol, 2022, 20(1): 30. doi: 10.1186/s12957-022-02495-4.
31.	Choi Y, Jung K. Normalization of the tumor microenvironment by harnessing vascular and immune modulation to achieve enhanced cancer therapy. Exp Mol Med, 2023, 55(11): 2308-2319.
32.	Zhang ZH, Liu QX, Zhang W, et al. Combined endovascular brachytherapy, sorafenib, and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus. World J Gastroenterol, 2017, 23(43): 7735-7745.
33.	Cheng SQ, Wu MC, Chen Han, et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein. Hepatogastroenterology, 2007, 54(74): 499-502.
34.	Li S, Li B, Li L, et al. A combination of portal vein stent insertion and endovascular iodine-125 seed-strip implantation, followed by transcatheter arterial chemoembolization with sorafenib for treatment of hepatocellular carcinoma-associated portal vein tumor thrombus. J Contemp Brachytherapy, 2021, 13(6): 670-679.
35.	Zhang ZH, Zhang W, Liu QX, et al. Combined treatment with iodine-125 (¹²⁵I) seed strand and transarterial chemoembolization (TACE) plus lenvatinib with anti-PD-1 antibodies in patients with unresectable hepatocellular carcinoma (uHCC) and portal vein tumor thrombus (PVTT): real-world experience in China. J Clin Oncol, 2021, 39(15_suppl): e16152. doi: 10.1200/JCO.2021.39.15_suppl.e16152.
36.	Jin Q, Lin C, Zhu X, et al. ¹²⁵I seeds irradiation inhibits tumor growth and induces apoptosis by Ki-67, P21, survivin, livin and caspase-9 expression in lung carcinoma xenografts. Radiat Oncol, 2020, 15(1): 238. doi: 10.1186/s13014-020-01682-5.
37.	Mori Y, Sato H, Kumazawa T, et al. Analysis of radiotherapy-induced alteration of CD8⁺ T cells and PD-L1 expression in patients with uterine cervical squamous cell carcinoma. Oncol Lett, 2021, 21(6): 446. doi: 10.3892/ol.2021.12707.
38.	曹熠熠, 李文波, 翁宇, 等. ¹²⁵I粒子植入聯合抗PD-1治療對小鼠Lewis肺癌的抑制作用研究. 中國腫瘤臨床, 2021, 48(5): 225-229.
39.	Lu M, Zhang X, Gao X, et al. Lenvatinib enhances T cell immunity and the efficacy of adoptive chimeric antigen receptor-modified T cells by decreasing myeloid-derived suppressor cells in cancer. Pharmacol Res, 2021, 174: 105829. doi: 10.1016/j.phrs.2021.105829.
40.	Chen Y, Dai S, Cheng CS, et al. Lenvatinib and immune-checkpoint inhibitors in hepatocellular carcinoma: mechanistic insights, clinical efficacy, and future perspectives. J Hematol Oncol, 2024, 17(1): 130. doi: 10.1186/s13045-024-01647-1.
41.	Yao LH, Su L, Liu L, et al. Stenting of the portal vein combined with different numbers of iodine-125 seed strands: dosimetric analyses. Chin Med J (Engl), 2017, 130(18): 2183-2189.
42.	Tan Z, Wu D, Guo J, et al. Endovascular brachytherapy with iodine-125 seed strand for extensive portal vein tumor thrombus in patients with hepatocellular carcinoma. Front Oncol, 2023, 13: 1201381. doi: 10.3389/fonc.2023.1201381.
43.	Jung S, Shen S, Ye SJ. Dose perturbation and inhomogeneity of multi-arrays of ¹²⁵I seed-loaded stent for treatment of portal vein tumor thrombosis. Phys Med, 2019, 66: 1-7.
44.	Wu YF, Wang T, Yue ZD, et al. Stents combined with iodine-125 implantation to treat main portal vein tumor thrombus. World J Gastrointest Oncol, 2018, 10(12): 496-504.
45.	Yang J, Qin Y, Lv Z, et al. Hepatic infarction occurred after ¹²⁵I particle stent treatment for hepatocellular carcinoma with portal vein tumor thrombus: a case report. J Cancer Res Clin Oncol, 2024, 150(6): 308. doi: 10.1007/s00432-024-05826-y.
46.	Zong J, He Q, Liu Y, et al. Advances in the development of biodegradable coronary stents: a translational perspective. Mater Today Bio, 2022, 16: 100368. doi: 10.1016/j.mtbio.2022.100368.
47.	Li Y, Shi Y, Lu Y, et al. Additive manufacturing of vascular stents. Acta Biomater, 2023, 167: 16-37.
48.	Jin Z, Al Amili M, Guo S. Tumor microenvironment-responsive drug delivery based on polymeric micelles for precision cancer therapy: strategies and prospects. Biomedicines, 2024, 12(2): 417. doi: 10.3390/biomedicines12020417.
49.	May BJ, Charalel RA. Cone beam computed tomography for the interventional oncologist: a practical approach. Semin Intervent Radiol, 2024, 41(3): 252-257.
50.	Adhikari T, Montenegro T, Jung JW, et al. The use of Monte Carlo simulation techniques in brachytherapy: a comprehensive literature review. Brachytherapy, 2025, 24(4): 564-621.
51.	Liu B, Xiong T, Lu J, et al. Technical note: a fast and accurate analytical dose calculation algorithm for ¹²⁵I seed-loaded stent applications. Med Phys, 2021, 48(11): 7493-7503.
52.	European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol, 2025, 82(2): 315-374.

1. Bray F, Laversanne M, Sung H, et al. Global cancer statistics 2022: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin, 2024, 74(3): 229-263.
2. Zhang ZM, Lai EC, Zhang C, et al. The strategies for treating primary hepatocellular carcinoma with portal vein tumor thrombus. Int J Surg, 2015, 20: 8-16.
3. Vogel A, Meyer T, Sapisochin G, et al. Hepatocellular carcinoma. Lancet, 2022, 400(10360): 1345-1362.
4. Kudo M, Izumi N, Kubo S, et al. Report of the 20th nationwide follow-up survey of primary liver cancer in Japan. Hepatol Res, 2020, 50(1): 15-46.
5. Katagiri S, Yamamoto M. Multidisciplinary treatments for hepatocellular carcinoma with major portal vein tumor thrombus. Surg Today, 2014, 44(2): 219-226.
6. Kim TS, Yang K, Choi GH, et al. Surgical outcome and risk scoring to predict survival after hepatic resection for hepatocellular carcinoma with portal vein tumor thrombosis. Ann Hepatobiliary Pancreat Surg, 2024, 28(2): 134-143.
7. Xue TC, Xie XY, Zhang L, et al. Transarterial chemoembolization for hepatocellular carcinoma with portal vein tumor thrombus: a meta-analysis. BMC Gastroenterol, 2013, 13: 60. doi: 10.1186/1471-230X-13-60.
8. Cheng AL, Kang YK, Chen Z, et al. Efficacy and safety of sorafenib in patients in the Asia-Pacific region with advanced hepatocellular carcinoma: a phase Ⅲ randomised, double-blind, placebo-controlled trial. Lancet Oncol, 2009, 10(1): 25-34.
9. Dawson LA, Ten Haken RK, Lawrence TS. Partial irradiation of the liver. Semin Radiat Oncol, 2001, 11(3): 240-246.
10. Pan CC, Kavanagh BD, Dawson LA, et al. Radiation-associated liver injury. Int J Radiat Oncol Biol Phys, 2010, 76(3 Suppl): S94-S100. doi: 10.1016/j.ijrobp.2009.06.092.
11. Luo J, Yan Z, Liu Q, et al. Endovascular placement of iodine-125 seed strand and stent combined with chemoembolization for treatment of hepatocellular carcinoma with tumor thrombus in main portal vein. J Vasc Interv Radiol, 2011, 22(4): 479-489.
12. Lu J, Guo JH, Zhu HD, et al. Safety and efficacy of irradiation stent placement for malignant portal vein thrombus combined with transarterial chemoembolization for hepatocellular carcinoma: a single-center experience. J Vasc Interv Radiol, 2017, 28(6): 786-794.
13. Luo JJ, Zhang ZH, Liu QX, et al. Endovascular brachytherapy combined with stent placement and TACE for treatment of HCC with main portal vein tumor thrombus. Hepatol Int, 2016, 10(1): 185-195.
14. Hasegawa T, Yamakado K, Takaki H, et al. Portal venous stent placement for malignant portal venous stenosis or occlusion: who benefits?. Cardiovasc Intervent Radiol, 2015, 38(6): 1515-1522.
15. Sedelnikova OA, Rogakou EP, Panyutin IG, et al. Quantitative detection of ¹²⁵IdU-induced DNA double-strand breaks with gamma-H2AX antibody. Radiat Res, 2002, 158(4): 486-492.
16. Guo S, Yao Y, Tang Y, et al. Radiation-induced tumor immune microenvironments and potential targets for combination therapy. Signal Transduct Target Ther, 2023, 8(1): 205. doi: 10.1038/s41392-023-01462-z.
17. Xiao Y, Yuan J, Yang C, et al. ¹²⁵I radioactive particles drive protective autophagy in hepatocellular carcinoma by upregulating ATG9B. J Clin Transl Hepatol, 2023, 11(2): 360-368.
18. Yang C, Xiao Y, Du Y, et al. Iodine-125 seeds inhibit carcinogenesis of hepatocellular carcinoma cells by suppressing epithelial-mesenchymal transition via TGF- β1/Smad signaling. Dis Markers, 2022, 2022: 9230647. doi: 10.1155/2022/9230647.
19. Wheldon TE, O’Donoghue JA. The radiobiology of targeted radiotherapy. Int J Radiat Biol, 1990, 58(1): 1-21.
20. 中國醫師協會肝癌專業委員會. 中國肝細胞癌合并門靜脈癌栓診療指南(2021年版). 中華醫學雜志, 2022, 102(4): 243-254.
21. 中國醫師協會肝癌專業委員會. 肝細胞癌合并門靜脈癌栓多學科診治中國專家共識(2018年版). 臨床肝膽病雜志, 2019, 35(4): 737-743.
22. Lu J, Zhang XP, Zhong BY, et al. Management of patients with hepatocellular carcinoma and portal vein tumour thrombosis: comparing east and west. Lancet Gastroenterol Hepatol, 2019, 4(9): 721-730.
23. Nakai H, Shimizu H, Taniguchi T, et al. Long-term efficacy and risk factors for stent occlusion in portal vein stent placement: a multi-institutional retrospective study. CVIR Endovasc, 2022, 5(1): 27. doi: 10.1186/s42155-022-00307-0.
24. Vibert E, Azoulay D, Cunha AS, et al. Portal stenting for hepatocellular carcinoma extending into the portal vein in cirrhotic patients. J Surg Oncol, 2013, 107(7): 696-701.
25. Guo L, Sun J, Wang C, et al. Epirubicin enhances the anti-cancer effects of radioactive ¹²⁵I seeds in hepatocellular carcinoma via downregulation of the JAK/STAT1 pathway. Front Oncol, 2022, 12: 854023. doi: 10.3389/fonc.2022.854023.
26. Liu S, Wang W, Hu S, et al. Radiotherapy remodels the tumor microenvironment for enhancing immunotherapeutic sensitivity. Cell Death Dis, 2023, 14(10): 679. doi: 10.1038/s41419-023-06211-2.
27. Sun JH, Zhou T, Zhu T, et al. Portal vein stenting combined with iodine-125 seeds endovascular implantation followed by transcatheter arterial chemoembolization for treatment of hepatocellular carcinoma patients with portal vein tumor thrombus. Biomed Res Int, 2016, 2016: 3048261. doi: 10.1155/2016/3048261.
28. Li S, Guo JH, Lu J, et al. I¹²⁵ irradiation stent for treatment of hepatocellular carcinoma with portal vein thrombosis: a meta-analysis. Cancer Radiother, 2021, 25(4): 340-349.
29. Lu J, Guo JH, Ji JS, et al. Irradiation stent with ¹²⁵I plus TACE versus sorafenib plus TACE for hepatocellular carcinoma with major portal vein tumor thrombosis: a multicenter randomized trial. Int J Surg, 2023, 109(5): 1188-1198.
30. Li L, Cheng N, Huang X, et al. Efficacy and safety of endovascular brachytherapy combined with transarterial chemoembolization for the treatment of hepatocellular carcinoma patients with type Ⅲ or Ⅳ portal vein tumor thrombosis. World J Surg Oncol, 2022, 20(1): 30. doi: 10.1186/s12957-022-02495-4.
31. Choi Y, Jung K. Normalization of the tumor microenvironment by harnessing vascular and immune modulation to achieve enhanced cancer therapy. Exp Mol Med, 2023, 55(11): 2308-2319.
32. Zhang ZH, Liu QX, Zhang W, et al. Combined endovascular brachytherapy, sorafenib, and transarterial chemobolization therapy for hepatocellular carcinoma patients with portal vein tumor thrombus. World J Gastroenterol, 2017, 23(43): 7735-7745.
33. Cheng SQ, Wu MC, Chen Han, et al. Tumor thrombus types influence the prognosis of hepatocellular carcinoma with the tumor thrombi in the portal vein. Hepatogastroenterology, 2007, 54(74): 499-502.
34. Li S, Li B, Li L, et al. A combination of portal vein stent insertion and endovascular iodine-125 seed-strip implantation, followed by transcatheter arterial chemoembolization with sorafenib for treatment of hepatocellular carcinoma-associated portal vein tumor thrombus. J Contemp Brachytherapy, 2021, 13(6): 670-679.
35. Zhang ZH, Zhang W, Liu QX, et al. Combined treatment with iodine-125 (¹²⁵I) seed strand and transarterial chemoembolization (TACE) plus lenvatinib with anti-PD-1 antibodies in patients with unresectable hepatocellular carcinoma (uHCC) and portal vein tumor thrombus (PVTT): real-world experience in China. J Clin Oncol, 2021, 39(15_suppl): e16152. doi: 10.1200/JCO.2021.39.15_suppl.e16152.
36. Jin Q, Lin C, Zhu X, et al. ¹²⁵I seeds irradiation inhibits tumor growth and induces apoptosis by Ki-67, P21, survivin, livin and caspase-9 expression in lung carcinoma xenografts. Radiat Oncol, 2020, 15(1): 238. doi: 10.1186/s13014-020-01682-5.
37. Mori Y, Sato H, Kumazawa T, et al. Analysis of radiotherapy-induced alteration of CD8⁺ T cells and PD-L1 expression in patients with uterine cervical squamous cell carcinoma. Oncol Lett, 2021, 21(6): 446. doi: 10.3892/ol.2021.12707.
38. 曹熠熠, 李文波, 翁宇, 等. ¹²⁵I粒子植入聯合抗PD-1治療對小鼠Lewis肺癌的抑制作用研究. 中國腫瘤臨床, 2021, 48(5): 225-229.
39. Lu M, Zhang X, Gao X, et al. Lenvatinib enhances T cell immunity and the efficacy of adoptive chimeric antigen receptor-modified T cells by decreasing myeloid-derived suppressor cells in cancer. Pharmacol Res, 2021, 174: 105829. doi: 10.1016/j.phrs.2021.105829.
40. Chen Y, Dai S, Cheng CS, et al. Lenvatinib and immune-checkpoint inhibitors in hepatocellular carcinoma: mechanistic insights, clinical efficacy, and future perspectives. J Hematol Oncol, 2024, 17(1): 130. doi: 10.1186/s13045-024-01647-1.
41. Yao LH, Su L, Liu L, et al. Stenting of the portal vein combined with different numbers of iodine-125 seed strands: dosimetric analyses. Chin Med J (Engl), 2017, 130(18): 2183-2189.
42. Tan Z, Wu D, Guo J, et al. Endovascular brachytherapy with iodine-125 seed strand for extensive portal vein tumor thrombus in patients with hepatocellular carcinoma. Front Oncol, 2023, 13: 1201381. doi: 10.3389/fonc.2023.1201381.
43. Jung S, Shen S, Ye SJ. Dose perturbation and inhomogeneity of multi-arrays of ¹²⁵I seed-loaded stent for treatment of portal vein tumor thrombosis. Phys Med, 2019, 66: 1-7.
44. Wu YF, Wang T, Yue ZD, et al. Stents combined with iodine-125 implantation to treat main portal vein tumor thrombus. World J Gastrointest Oncol, 2018, 10(12): 496-504.
45. Yang J, Qin Y, Lv Z, et al. Hepatic infarction occurred after ¹²⁵I particle stent treatment for hepatocellular carcinoma with portal vein tumor thrombus: a case report. J Cancer Res Clin Oncol, 2024, 150(6): 308. doi: 10.1007/s00432-024-05826-y.
46. Zong J, He Q, Liu Y, et al. Advances in the development of biodegradable coronary stents: a translational perspective. Mater Today Bio, 2022, 16: 100368. doi: 10.1016/j.mtbio.2022.100368.
47. Li Y, Shi Y, Lu Y, et al. Additive manufacturing of vascular stents. Acta Biomater, 2023, 167: 16-37.
48. Jin Z, Al Amili M, Guo S. Tumor microenvironment-responsive drug delivery based on polymeric micelles for precision cancer therapy: strategies and prospects. Biomedicines, 2024, 12(2): 417. doi: 10.3390/biomedicines12020417.
49. May BJ, Charalel RA. Cone beam computed tomography for the interventional oncologist: a practical approach. Semin Intervent Radiol, 2024, 41(3): 252-257.
50. Adhikari T, Montenegro T, Jung JW, et al. The use of Monte Carlo simulation techniques in brachytherapy: a comprehensive literature review. Brachytherapy, 2025, 24(4): 564-621.
51. Liu B, Xiong T, Lu J, et al. Technical note: a fast and accurate analytical dose calculation algorithm for ¹²⁵I seed-loaded stent applications. Med Phys, 2021, 48(11): 7493-7503.
52. European Association for the Study of the Liver. EASL Clinical Practice Guidelines on the management of hepatocellular carcinoma. J Hepatol, 2025, 82(2): 315-374.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Application and prospects of portal vein iodine-125 irradiation stents in hepatocellular carcinoma with portal vein tumor thrombus

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