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Methods 55 (2011) 246–252

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Methods
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Iodine-131-Lipiodol therapy in hepatic tumours
Hojjat Ahmadzadehfar a,⇑, Amir Sabet a, Kai Wilhelm b, Hans Jürgen Biersack a, Jörn Risse c
a
Department of Nuclear Medicine, University Hospital Bonn, Germany
b
Department of Radiology, University Hospital Bonn, Germany
c
Radiology and Nuclear Medicine Institute, Bad Honnef, Germany

a r t i c l e i n f o a b s t r a c t

Article history: The incidence of hepatocellular carcinoma (HCC) is worldwide sharply on the rise and patients with
Available online 12 June 2011 advanced disease carry a poor prognosis. HCC is the sixth most common cancer and the third leading
cause of cancer associated deaths in the world. Intra-arterially administered 131I-Lipiodol is selectively
Keywords: retained by hepatocellular carcinomas, and has been used as a vehicle for delivery of therapeutic agents
Iodine-131 Lipiodol to these tumours. In this review we focus on the therapeutic indications, usefulness and methods of treat-
Liver cancer ment with 131-Iodine Lipiodol.
Transarterial interventions
The effectiveness of 131I-Lipiodol treatment is proven both in the treatment of HCC with portal throm-
Portal vein thrombosis
Hepatocellular carcinoma
bosis and also as an adjuvant to surgery after the resection of HCCs. It is at least as effective as chemo-
Cancer therapy embolization and is tolerated much better. Severe liver dysfunction represents theoretic contraindication
for radioembolization as well as for TACE. In such cases 131I-Lipiodol is an alternative therapy option
especially in tumours smaller than 6 cm.
Ó 2011 Elsevier Inc. All rights reserved.

1. Introduction 2. Treatment options of HCC

The incidence of hepatocellular carcinoma (HCC) is worldwide Despite a variety of treatment strategies for HCC patients, the
sharply on the rise and patients with advanced disease carry a poor only available curative options are liver transplantation, partial li-
prognosis. HCC is the sixth most common cancer and the third ver resection and locoregional ablative treatment, being feasible
leading cause of cancer associated deaths in the world [1]. In the only in a small minority of the patients. In general, the choice of
United States, the incidence of HCC is increasing faster than any treatment is dependent not only on the extent of the HCC but also
other malignancy [2,3]. on the severity of underlying hepatic dysfunction [10]. Surgery can
Chronic viral hepatitis B, C and D, alcohol, metabolic liver dis- be associated with substantial difficulty in patients with underly-
eases such as hemochromatosis and a-1-antitrypsin deficiency as ing cirrhosis and peri-operative mortality is as high as 30% to
well as non-alcoholic fatty liver disease may cause chronic liver in- 50% in patients with Child-Pugh class B or C. In the contrary, pa-
jury, regeneration, and cirrhosis [4]. Chronic hepatitis B (CHB) and tients with Child-Pugh class A show a surgical mortality of only
chronic hepatitis C (CHC) are recognised as the major risk factors of 5% to 10% [10,11].
HCC, with risk being greater in the presence of a co-infection [5,6]. For selected patients with HCC, confined to the liver but not
It is now widely accepted that a dysplastic nodule commonly amenable to resection or transplantation, both systemic and loco-
found in cirrhotic livers may slowly degenerate to low-grade HCC regional therapies can be considered. These include
[7,8]. Low-grade (well-differentiated) HCC tends to develop round,
well-defined, encapsulated masses. Over time, focal areas within a 1. Percutaneous interventions (ethanol injection, radiofrequency
low-grade HCC can degrade to poorly differentiated tumours infil- thermal ablation),
trating the liver and invading the venous or arterial network, 2. Transarterial interventions
which causes a more aggressive spread of the disease [9]. (a) Embolization (TAE), chemoperfusion (TAC), or chemoembo-
lization (TACE),
(b) Radioembolization (RE) or radioactive agent perfusion such
as 131Iodine-Lipiodol or 188RE-Lipiodol.
3. External radiation therapy and
4. Chemotherapy, including gene and immune therapy.
⇑ Corresponding author. Address: Department of Nuclear Medicine, University
Hospital Bonn, Sigmund-Freud-Str. 25, 53127 Bonn, Germany. Fax: +49 228 287
9019858. Until the recent approval of sorafenib (Nexavar, Bayer Health-
E-mail address: hojjat.ahmadzadehfar@ukb.uni-bonn.de (H. Ahmadzadehfar). Care Pharmaceuticals Inc,Wayne, NJ) by the US Food and Drug

1046-2023/$ - see front matter Ó 2011 Elsevier Inc. All rights reserved.
doi:10.1016/j.ymeth.2011.05.003

[19] showed an unspe. but post-resection recurrence [12. since than 75% of the 131I-Lipiodol stays following the arterial adminis. H. lid tumours. estimated at P70 Gy. be calculated for a given tumour mass according to its size. more than 50% of patients patients with HCC and portal vein thrombosis (PVT) [17]. Its rationale comes from the anatomical and physiologi. however.33. use. According to biodistribution data. [21]) whereas 74% of the HCCs larger than 10 cm itation of systemic treatments resulted in the utility of exhibit only a weak retention of less than 50% (of type 1 or 2 interventional radiology techniques in the treatment of HCC. whilst the effective half life within the HCC tis. of Lipiodol from the tumour lasts longer than from the normal liver they lead to tumour destruction whilst preserving nontumourous or from the lungs. Lipiodol alone does targeting. according to the criteria of Maki) [22. Other and potentially replace large parts of the liver volume. / Methods 55 (2011) 246–252 247 Administration (FDA) no systemic chemotherapeutics showed sig. There is for the normal liver. [24]. The retention of 131I-Lipiodol in HCC tu- mours after intra-arterial infusion is related not only to emboliza. more than 10% of the injected Lipiodol remains within the tumour [20]. Moreover. primary neoplasms are often multifocal and irregular in shape tration in the liver and the remainder reaches the lungs [18].04 days. revealed by quantifica. To achieve this from its concentration in cancer cell lines. [25. The dose required to destroy so- mains in these tumours for a longer period compared to normal li. also to a small extent by way of the faeces (<3% at day 5) [18]. 5. DoseðcGyÞ ¼ 73:8  E  Te  þ 0:0346  C  g  toxic effects against the cancer cell lines even in doses as small as a M M quarter of the radioactivity of the 131I alone [19].13]. Indeed. Additionally. Isotopic exchange is used to label iodine. possibly because of a lack of macrophagic cells in liver parenchyma and may serve as a bridge to a more definitive the tumour [17]. as Lipiodol is a naturally iodinated oil com- A0 A0 pound with an iodine content of 38–40%. the initial activity (lCi). Ahmadzadehfar et al. M is the mass (g). Ao is creases with time. the therapeutic radiopharmaceuticals such as 90Y not appear to have any cytotoxic effect against any of the studied microspheres or 131I-Lipiodol may be administered via the hepatic cell lines. 131I emits a 4.23]. where E is the average beta energy (MeV). including the thyroid gland. I-Lipiodol in humans [18. cytotoxic for the cancer cell lines. but also to the entry into the interstitium and the tumour cells themselves.15]. G is the specific gamma ray constant (cGy cm2/mCi hr). The Beta with I131-Lipiodol radiation of 131I is responsible for its therapeutic effects whilst gamma radiation makes the distribution of the radiopharmaceuti. Based on studies considering biodistribution of intraarterial 131 like non-malignant ones to expel Lipiodol. The required therapy activity for the intended tumour dose can fulness and methods of treatment with 131-Iodine Lipiodol (131I. nancies have demonstrated that metastatic hepatic tumours The radionuclide is supplied in 2 ml solution for injection and >3 mm derive in contrast to healthy hepatic cells 80–100% of their stored in a 4 ml cone shaped glass vial. Basic characteristics of I-Lipiodol the delivery of locally concentrated therapy due to the selective retention of the agent in the tumours for an extended period [10].61 MeV and 0. The conjunction of lipiodol with TACE.1 GBq/ml and its shelf life from this time is 3 days lation [16]. Observations on vascular supply to hepatic malig. Generally. radiation doses for every mCi tion methods using computer-assisted image analysis. 131 I is a beta emitting radionuclide with a physical half life of 8. minority of patients are optimal candidates for such therapies [31]. Absolute contraindications tion in the micro vessels of the tumour. LipiocisÒ is licensed in France for the treatment of ation at a mean radiation dose of 43 Gy. of radiation than neoplastic tissue. 88% of the HCCs smaller than III [25.192 MeV respectively. and g is the geometric sue is also longer than that in healthy tissues (almost 6 days versus factor (cm). For in- Lipiodol). more tion doses in cases with focal involvement [30]. 5 cm exhibit a high retention (of type 3 or 4 according to the crite- nificant increases in survival in patients with HCC [14. 131I-Lipiodol is highly and only selectively artery [32]. 2 – life expectancy less than can be assessed by tomodensitometric examination and inversely 1 month. selectively to the tumour without damaging adjacent normal tis- Lipiodol is a mixture of iodised esters of poppy seed oil fatty sue [27].26]. reaching 30–50% of the injected activity at day 8. ibration date is 1. receive very little radiation. (days). Normal hepatocytes have a lower tolerance to the effects acids used as a contrast medium for the detection of HCC which re. erance dose of 35 Gy when delivered to the whole liver in 1.34]. may further (37 MBq) of administered activity were estimated to be 31 cGy enhance the cytotoxic effect of 131I-Lipiodol in cancer cells. The liver has a dual blood supply: the hepatic artery and with a five-fold larger diameter requires hundredfold more activity the portal vein. has also been used allowing 131 3. . The specific activity at cal- blood supply from the arterial rather than the portal hepatic circu.8 Gy/d rich Lipiodol with I131 (LipiocisÒ. ria of Maki et al. Te is the effective half-life The tumour/ non tumour uptake ratio is about 15–20:1 and in. 3 – hepatic encephalopathy. 131I-Lipiodol shows cyto. Inability of tumourous cells un. In this review we focus only on the therapeutic indications. quires less than 3 MBq I-131 whilst the same dose in a tumour tic agent. and 239 cGy for a tumour no separation of the 131I from Lipiodol during the uptake process with a greatest diameter of 4 cm using the formula: by the cancer cells. stance producing 120 Gy in a tumour with a diameter of 1 cm re- cal aspects of HCC being exploited for the delivery of the therapeu. 4 days). The maximum and mean beta particle energies are 0. 131I-Lipiodol is eliminated mainly through the uri- therapy like liver transplantation or as a salvage treatment for nary tract. Internal radiation aims at improving the selectivity of the radiation cific uptake of Lipiodol in non-malignant endothelial cells apart by targeting the radioisotopes to the tumour cells. also called TOCA (tran- sarterial oily chemoembolization). An in vitro assessment by Al-Mutfi et al. CIS Bio International/ member fractions [28]. 22 cGy for the lungs. If the whole liver is exposed to external-beam radi- of IBA group). It was develop liver dysfunction [29]. only a small tissues. This lim. 4 – tumour Stage OKUDA relates to the tumour size. Conformal and stereotactic radia- developed in the 1990s and was the first radiolabelled vector to tion therapy techniques can be used to deliver much higher radia- be used in this setting. Basics of interventional nuclear medicine therapies of HCC principal gamma photon of 364 keV (81% abundance). This retention 1 – Pregnancy and breastfeeding.26]. Radiation is tumouricidal if sufficient doses can be delivered cal visible. the clearance Although nonresectional locoregional therapies are not curative. is far greater than the liver tol- ver or in other tissues. However.

7. Occasionally. diagnostic average dose between 140 and 443 lSv at the level of the fingers angiography of the liver vessels should be performed with special and about 17 lSv at the thorax. radiation exposure to their environment becomes low enough to ciplinary management including the patient selection and care. 1) per- tients should receive both written and verbal information about formed one week later is recommended to confirm the distribution the procedure and the palliative nature of the treatment [26]. Injecion should time points required for technical success are not well established take at least some minutes to ensure good tolerance by the patient. adequate follow-up of the patient as well as the prove the therapy effectiveness [41]. and at the thorax respectively. In patients with ‘‘normal’’ hepatic arte. Relative contraindications 1 – High extrahepatic tumour burden. For the evaluation of response. the average attention to collateral arteries to other organs. management of possible complications. portal vein patency. after each therapy [26]. 3 phase CT. 50 mg pethidine immediately before application of the radiophar. 11C-/18F-Cholin or 11C-/18F-Acetate PET/CT. / Methods 55 (2011) 246–252 6. and post treatment follow-up schedules vary depending on the The procedure and special radiation protection measures have treatment plan of each patient. CT of the liver could be used for dosimetry. tively large tumour several injections in 2–3 months interval may rone during the whole procedure and intraarterial injection of be necessary to obtain an effective response. Fig. 3 – The presence of contraindications for hepatic artery catheterisation [25. partly with the injection of small amounts of istration of high therapeutic activities of 131I-Lipiodol can be car- ‘‘cold’’ Lipiodol (GuerbetÒ). nuclear medicine specialist receives an maceutical. 1. multiple nodules or variable arterial blood supply. stated. Although FDG-PET is suitable for tumours showing high glu- cose metabolism such as colorectal carcinoma. After the proce. head and neck. 2 – acute or severe chronic pulmonary disease. Dexamethasone and tamoxifen could increase the tumoural up- tional treatment including timing and selection of systemic treat. and breast cancers. should be given a peri-interventional drug regimen with slow For certain patients. it adds valuable prognostic information (meta- bolic grading) as patients with a negative FDG-PET show a better prognosis than those with high FDG uptake. dialysis has to dosimetry could be achieved by performing a hybrid SPECT/CT of be planned and timed before and after the intervention. melanoma. take of Lipiodol and could be combined with 131I-Lipiodol to im- ment. Intervention technique Treatment with 131I-Lipiodol serves as an example for multidis. ried out with a dose much lower than the European regulatory rial anatomy the catheter can be positioned in the main hepatic ar.and post-treatment evaluation in this group of patients. Choline PET/CT may also play a role in imaging of specific types of HCC in the near fu- ture [35–38]. Follow-up 131 I-Lipiodol (2. considering the visibility of Lipiodol in CT as a contrast agent. of 131I-Lipiodol [26]. 2). Patients the liver (Fig. As Garin et al.22 GBq in 2 ml/ampulla) should be prepared in an appropriately ventilated cabinet in the department of Nuclear Definitions of the appropriate length of the follow-up and the Medicine to avoid radioiodine aerosol inhalation. Haemodialysis adays a better quantification of the radioactive distribution and patients may be treated with 131I-Lipiodol. in Germany <1 mSv/year) [40]. 9. except for their aggressive types show no or a very low-grade FDG uptake[35].248 H. ranging between 50% and 70% makes it an unsatisfactory imaging choice for the pre. in particular those presenting with a rela- intravenous infusion of 24 mg dexamethasone and 8 mg ondanset. and the extent of extra-hepatic dis- ease. The authors showed that the admin- ter could be added. Quantitative whole body scintigraphy obtained 7 days post therapeutic in a 52-year-old man showing significant activity in the HCCs and only a faint lung uptake. 8. Now- trast agents during the pre-therapeutic angiogram. The applied activity should abdominal imaging should be performed 4 weeks and 2–3 months be determined as the difference between activity in the last recep. the be discharged (e. . and the catheter-system after flushing with saline.g. In cases with nel [42]. For the radiologists. The renal functional status should be adequate for the use of con. 18F-FDG. the post-interven. however. the liver lobe containing the largest tumour mass is treated in the first session and the remaining masses in the following ones. however. The suboptimal sensitivity of FDG-PET for the detection of HCC. malignancies such as HCC or neuro- endocrine tumours. Appropriate imaging The work-up includes a three-phase contrast computed tomog- raphy (CT) and gadolinium-enhanced magnetic resonance imaging (MRI) of the liver for the assessment of tumour and non-tumour volume. Post therapeutic quantitative whole body imaging (Fig. Ahmadzadehfar et al. detailed anatomical study and dose calculation. AFP should dure the patients are transferred to the station and isolated until be tested for patients with initially increased AFP. limit of 500 mSv at the level of the fingers for the exposed person- tery for nonselective injection of 131I-Lipiodol. pa. doses received are 215 lSv and 15 lSv at the level of the fingers puted tomography with arterioportography (CT-AP) via the cathe. After blocking the thyroid with perchlorate. been readily published in detail [39]. Follow-up should be performed with the tacle before injection and the remaining activity of last receptacle same modality used pre-therapeutic such as MRI. com. Prior to the therapy.26].

ted with 131I-Lipiodol. two early studies with seven and nine patients showed activity of 2.5 cases per 1000 treated patients with a median respiratory 152 ± 122 Gy for the second treatment. a fixed injected tients. dide premedication can significantly decrease thyroid iodide tered activity at the first treatment. symptoms delay of 30 days [49]. Therapeutic indications for 131 I-Lipiodol no one appeared to respond at lower absorbed doses [43]. Ahmadzadehfar et al. Intersti- activity of 2220 MBq. 10.48]. moderate and temporary disturbances of the biological liver test Becker et al. compared with 15. 280 Gy was found to represent an effective threshold absorbed dose. calculated in tomo. and pointed out a correla. Its main limitation is its ineffective- 131 11. Dosimetry fairly frequently consist of moderate and temporary fever (29%). The treatment is more effective for small. However.2 GBq is proposed as a good compromise to achieve response in all tumours [44. They found a mean tumoural absorbed dose tial pneumonia has been reported in an estimated prevalence of of 248 ± 176 Gy for the first treatment. it must be considered that a reduction An improved survival rate is readily documented for those trea- in tumour mass does not necessarily correlate with improved sur. Using potassium io- alone. transarterial therapy with 131 I-Lipiodol is superior to systemic therapy in tumours up to 5 cm A phase I study [47] and a multi centric phase II trial [46] could in diameter [53]. Tumour response adversely correlates with tumour size. not demonstrate any specific toxic effects of 131I-Lipiodol. tion between the tumoural absorbed dose. performed a dosimetric evaluation using SPECT/CT (20%) and hepatic pain on injection (12. However. A tumoural absorbed dose of uptake and consequently probability of hypothyroidism [51]. Undesirable effects observed creases to about 30% [54]. Palliative treatment of inoperable primary hepatocellular rates have been found in tumour nodes with diameters below carcinoma 6 cm in which an absorbed dose of up to 288 Gy has been calcu- lated [44–46]. 12. whilst 84% of the patients above this value were responders. and morphological response to first treatment ism despite the very low thyroid uptake [50]. Safety of I-Lipiodol therapy ness in large (>5 cm) tumours. In larger studies classifying ther- the desired efficacy whilst reducing the hospital stay to 1 week. Consequently. These results pleaded in favour of increasing the adminis. / Methods 55 (2011) 246–252 249 Fig. comparing to those receiving only medical vival [20]. apy success according to the WHO criteria. support [52].1. SPECT/CT of the liver could be used for a better quantification of the radioactive distribution as well as dosimetry simultaneously.26.47]. Some authors have expressed their concern about hypothyroid- graphic mode. solitary and well encapsulated tumours and the response rate decreases with increasing tumour size. applied to a series of 41 patients who received one or more Moderate and reversible leukopenia (7%) and serious interstitial injections of 131I-Lipiodol for treatment of HCC using a standard pneumopathies (2%) are observed more rarely [25. Note the distribution of 131I-Lipiodol in the HCCs showed with arrows. A de- main limiting factor was the long patient isolation required for crease in tumour size has been reported in about 50% to 60% of pa- the purpose of radioprotection. The The data on therapy efficacy have remained non-uniform. the response rate de- Serious adverse effects are very rare. 2. [43]. This is in agreement with our own .5%). High response 12. H.

78 [P < 0. Tumour volume (AR = [CR + PR + SD]) for a total of 325 patients with HCC. approved by the Food and Drug Administration for patients with In a published study from our group 38 courses of intra-arterial primary and metastatic liver cancer [35]. PVT patients HCC and PVT [65]. However. 131I-Lipiodol is much vival rates at 3. although apy (SIRT).2. and 6% respectively. frequently due to microscopic 131 Efficacy of I-Lipiodol therapy in patients with unresectable HCC. A multicentre randomised trial by Raoul et al. small microscopic daughter tumours can be stimulated De Baere [54] 23 0 3 – 12 8 – to grow. treatment with resin microspheres was peated therapy frequently resulted in further tumour reduction. associated with a significantly higher proportion of AR than with Partial response was seen in 11 nodules whilst four nodules glass microsphere (0. A single dose of Borbath [61] 19 1 0 – 7 11 2/24 1. 131I-Lipiodol as an adjuvant therapy Bhattacharya 22 0 7 – 8 7 2/22 It has been thought that when the postsurgical liver starts to [59] Raoul [56] 25 1 15 4 3 2 20/40 regenerate. 24 and 36 months was TACE. Ahmadzadehfar et al. The median survival in patients with unresectable HCC under.6 cm). recent studies describe vs 3–4). Although resin microspheres could pose the patient at risk for sig- going 131I-Lipiodol therapy has been reported between 7 and nificant liver dysfunction based on the embolic treatment effect. admin- istering 2. care. extrahepatic disease. The most important side effect was a pancreatitis-like a poor insurance system. cost up to 10 times more than therapy with 131I-Lipiodol [67]. In their recent published paper the response (tumour reduction between 25 and 50%. [68]. its embolic nature makes severe liver with pre-therapeutic nodule volume up to 150 ml (diameter of dysfunction a theoretic contraindication for this technique. metachronous multicentric Reference Number of evaluable CR PR MR SD PD AFP carcinoma within the liver remnant not detected before or during patients decrease resection by conventional imaging [68] and has led to attempts at Yoo [57] 24 0 3 5 8 8 13/16 adjuvant or neoadjuvant therapies. Matched-pairs anal. 12.1. reported the factors associated with therasphere has been shown to be safe even when the portal vein survival in a newly published study including the AJCC stage (1–2 has been invaded by tumour [27].1. In addition. only reports with more than ten patients. for example. 131I-Lipiodol-therapy versus TAC and TACE 131 favourable response in this study [64]. PVT is not an absolute contraindication for RE any more. If these were pre-cleared the chances of a recurrence Risse [55] 13 0 2 3 4 4 – would be lowered. Accord- decreased in 20/32 index nodules (63%) after the first course. 27 months [61–64]. and 10%. 48%. showed almost 80% any response formed in 18 patients with HCC (6 with PVT) [40].67]. 6. and 9 mo was 71%. [56] showed that 131I-Lipiodol 12. are considered. Survival rate after 3. 50%. and 7% for the treated better tolerated than chemoembolization. Barcelona Clinic Liver Cancer stage (A–B vs C). 0% and 0% for the group receiving only supportive cally expressed side effects and arteriographic findings [56]. both in terms of clini- group. techniques using 90Y-labelled products tend to 78%. Performing 131I-Lipiodol as an adjuvant or neo-adjuvant therapy Early intrahepatic recurrence is common after curative resec- Table 1 tion of hepatocellular carcinoma. Re.89 vs 0. showed a minor response. and survival. in those with Okuda stage III disease has proved to be an effective therapy option in patients with or BCLC stage D as well as in patients with PVT [67]. ysis of survival revealed 131I-Lipiodol to be superior to medical affecting the therapeutic approach especially in the countries with treatment. 131I-Lipiodol versus radioembolization with 90Y-microspheres therapy (n = 73) was associated with a better patient tolerance 90Y radioembolization (RE). NG . compared 131I-Lipiodol therapy receiving 131I-Lipiodol lived on average almost a year longer than and best supportive care in patients with HCC and PVT. However it should be noted that radioembolization (RE) changes in tumour size and follow-up studies of at least one with 90Y-Microspheres has proved to be a feasible alternative month. Chua et al. I-Lipiodol) in patients with PVT in HCC considering response sponse to treatment (favourable vs unfavourable) [64]. In a meta-analysis of 14 131 I-Lipiodol therapy with a total activity up to 6. Reported response rates in different studies are summa. I-Lipiodol therapy in patients with cirrhosis and HCC has an efficacy similar to that of TACE/TAE therapy [56.3. PD: progressive disease same authors confirmed their results after a longer follow up (tumour increase >25%). maximum tumour is no prospective study which compares these two methods (RE vs 131 size (<4 vs >4 cm). Considering rate. time-to-progression. However 131 12. PR: partial response (tumour reduction >50%). those treated with TACE or TAE. metastatic disease or less commonly. therapy procedures for palliative treatment of HCC.02]) [66]. Significant response was associated compared to 131I-Lipiodol. 131I-Lipiodol vanced disease. as in 6. 17%. syndrome whilst overall tolerance was very acceptable. MR: minimal in a study by Lau et al. Cancer of safe performance of RE with resin microspheres even in PVT. or selective internal radiation ther- and fewer vascular complications than TACE (n = 69).2. AFP alpha-fetoprotein. published articles Venti et al.7 GBq were per. Palliative treatment of HCC with Portal vein thrombosis (PVT) I-Lipiodol appears to be of more benefit in patients with ad- Although the PVT prohibits any attempt of TACE.59.4 GBq 131I-Lipiodol 8–12 weeks after surgery [71]. palliative treatment of HCC in the presence of portal vein thrombo- rised in Table 1. Moreover. SD: stable disease (tumour size change between 25% and +25%). Stable disease was found in 12 patients Although RE is currently the preferred method for treating HCC and progressive disease in 5. The authors concluded that 131I-Lipiodol is a safe and effective 12. treatment for HCC patients with PVT as discussed in following 131 I-Lipiodol is also comparatively favourable to other regional section. ing to this meta-analysis. Raoul [46] 30 0 18 4 6 2 22/29 Leung [58] 22 1 3 – 12 6 13/25 12.250 H. Raoul et al. response rate. [70]. 39%. is a promising catheter-based liver-directed modality no survival advantage was demonstrated [56].131I-Lipiodol has been used in an adjuvant Rindani [60] 12 0 6 – 5 1 5/7 setting after curative surgical resection [69]. / Methods 55 (2011) 246–252 data [55]. previous surgery and re. These findings were also confirmed by Boucher et al. AJCC stage 1–2 and Cancer of the Liver Italian Pro- gramme score <2 were found to be independent predictors for a 12. 6. Thus.1. The sur. 61%. There the Liver Italian Programme score (<2 vs >2). data on sis [52].1.85 GBq 131I-Lipiodol administered 6 weeks after curative resec- Risse [40] 17 0 4 1 7 5 – Boucher [62] 40 1 18 – 19 2 tion of hepatocellular carcinoma could significantly decrease the rate of recurrence and increased disease-free and overall survival CR: complete response.1.2. 9.

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