Treatment of hepatocellular carcinoma by transcatheter hepatic arterial injection of radioactive iodized oil solution

Abstract

After 12 days of culture, VX2 carcinoma cells were inoculated into the liver of 16 rabbits; 14 days later, 131I-labeled iodized oil ([131I]-Lp) suspended in lipiodol was injected into the hepatic artery. Selective accumulation of the contrast material in the tumor for an extended time was evident on X-rays and hepatic scintiphotographs. The antitumor effect was remarkable. [131I]-Lp agents warrant further examination for their clinical usefulness. Internal radiation therapy by transcatheter hepatic arterial injection of [131I]-Lp (group A) was evaluated in 9 patients with hepatocellular carcinoma (HCC, tumor stage III or IV) associated with liver cirrhosis (LC) and compared with combination therapy of Lp-TAE (group B) in 18 patients with HCC (tumor stage III or IV) associated with LC. In group A, serum AFP levels dropped rapidly in eight of the nine patients who had an elevated initial level of more than 500 ng/ml. The average reduction in tumor size was 50% in eight cases as determined by computed tomography. Histological examination of one resected liver specimen at 3 months after the third injection of [131I]-Lp revealed microscopic features highly suggestive of a radiation effect in the [131I]-Lp-containing area. The 1-year survival value for patients with HCC was estimated at 49.0% using the Kaplan-Meier method. The survival of patients treated with internal radiation therapy tended to be better than that of those treated with Lp-TAE (P = 0.119).

Meta‐analysis of interstitial pneumonia in studies evaluating iodine‐131‐labeled lipiodol for hepatocellular carcinoma using exact likelihood approach

“…The 36 studies that were analyzed (5 randomized control trials, 2 non‐comparative phase II trials, one phase I trial, and 28 cohorts) included 911 patients. Table displays their characteristics.…”

Optimization of Hepatocarcinoma Uptake with Radiolabeled Lipiodol: Development of New Lipiodol Formulations with Increased Viscosity

“…Results are in accordance with data on Lipiodol biodistribution, since it is known that Lipiodol redistribution in lungs increases with time. [17][18][19] However, this ratio increases less for the 0.8% formulation, and even decreases at 72 hours for the 1.3% formulation. This probably reflects a decrease of the secondary Lipiodol release from liver to lungs because of the inability of these new formulations to go through arterioveinous shunts due to their high viscosity.…”

Therapeutic Strategies in HCC: Radiation Modalities

“…According to different studies, the administered activity generally ranges from 0.74 to 4.40 GBq for 131 I Lipiodol and from 2.0 to 3.0 GBq for 90 Y microspheres, respectively [ 70 ]. Therapeutic activities have also been settled on the basis of dosimetry and alternatively computed taking into account the dose delivered to the target or to the critical organs [ 71 , 72 ]. On the other hand, the super-selective approach excludes the prophylactic irradiation of the healthy parenchyma that has been established effectively in reducing relapse or recurrence.…”