Epirubicin-lipiodol chemotherapy versus131iodine-lipiodol radiotherapy in the treatment of unresectable hepatocellular carcinoma

Abstract

Background. Arterially administered iodized oil (Lipiodol) is selectively retained by hepatocellular carcinomas (HCCs), and has been used as a vehicle for delivery of therapeutic agents to these tumors. This study compared the efficacy of Lipiodol‐targeted epirubicin chemotherapy with Lipiodol‐131I radiotherapy. Methods. Ninety‐five patients with unresectable HCC confined to the liver were administered either Lipiodol‐epirubicin emulsion (n=69; 61 cirrhotics; Okuda tumor Stage I, 14; II, 37; III, 18; epirubicin dose, 75 mg/m2) or Lipiodol‐131I (131I) (n=26; 18 cirrhotics; Okuda tumor Stage I, 6; II, 19; III, 1; dose 750–1050 MBq). The last 28 patients (17 epirubicin, 11131I) were treated within a prospective randomized trial. Bolus drug or isotope was injected into the hepatic artery by transfemoral cannulation. Lipiodol and 131I uptake were gauged by 10th day computed tomography and 48‐hour scintiscan. Treatments were repeated two‐monthly when indicated. Results. Tumor size at 2 months remained static or diminished partially in 21 of 38 epirubicin recipients (55%) and 15/22 131I recipients (68%). Actuarial survival at 6, 12, and 24 months was 40%, 25%, and 6% with epirubicin, and 58%, 25%, and 0% with 131I; 30‐day mortality was 11% and 15%, respectively. Comparison with historic controls indicated survival benefit in Stages I and II. Similar findings were recorded in the 28 patients in the randomized trial. Conclusions. Patients with unresectable HCC receiving Lipiodol‐epirubicin or Lipiodol‐131I show good tumor localization, acceptable toxicity, and comparable survival benefit at 6 and 12 months with either modality. Cancer 1995; 76:2202–10.

Therapy of Hepatocellular Carcinoma with Iodine-131-Lipidiol

“…131I-Lipiodol therapy in patients with cirrhosis and HCC has an efficacy similar to that of TACE/TAE therapy 28,32,42 . However 131I-Lipiodol appears to be of more benefit in patients with advanced disease, for example, in those with Okuda stage III disease or BCLC stage D as well as in patients with PVT 42 .…”

Systematic review of randomized trials for unresectable hepatocellular carcinoma: Chemoembolization improves survival

“…Assessment of high-quality [59][60][61][62] versus low-quality trials, 57,58,63 only double-blinded, placebo-controlled studies, 59,60,62 and including all patients randomized also including tamoxifen as an adjuvant treatment of HCC. [57][58][59][60][61][62][63] and some studies published at that time are missing 28,36,43,44,46,47,50,52 whereas quasi-RCTs are included. 84 Seven new RCTs assessing embolization have been published since the first review, [30][31][32][33][41][42][43] 4 of which include an untreated control arm.…”

“…Therefore, further studies should be published to ensure a solid assessment, mainly in reference to therapies with acceptable response rates, such as internal radiation [54][55][56] or arterial chemotherapy. [44][45][46][47][48][49][50] In summary, the present systematic review provides consistent evidence that arterial chemoembolization may benefit a subset of patients with unresectable HCC and thus proposes this therapy as the standard intervention in these cases. The data are relevant for the decision-making process of these patients, who at present do not have any option for cure.…”

Career lifetime advances in nuclear medicine

“…The combination of the liver work and the skills available in interventional radiology led us to the use of I-131-Lipiodol for hepatocellular carcinoma. 5 In turn, our therapy practice led us to be become further involved in the diagnosis and treatment of neuroendocrine tumours, which are best treated by multidisciplinary teams. 6,7 MRI came along, which was clearly going to end nuclear medicine.…”