Therapy of hepatocellular carcinoma with iodine-131-lipiodol

Summary

Aim: To evaluate the efficacy and tolerance of iodine- 131-lipiodol (¹³¹I-lipiodol) for hepatocellular carcinoma (HCC) in German long term patients and comparison with medically treated controls. Patients, Methods: 38 courses of intra-arterial ¹³¹I-lipiodol therapy with a total activity up to 6.7 GBq were performed in 18 patients with HCC (6 with portal vein thrombosis). Liver and tumour volume and lipiodol deposition were measured by computed tomography and ¹³¹I activity by scintigraphy. Therapeutic efficacy was determined by tumour volume change and matched-pairs analysis in comparison to medically (i.e. tamoxifen or medical support) treated patients. Results: Tumour volume decreased in 20/32 index nodules (63%) after the first course. Repeated therapy frequently resulted in further tumour reduction. Overall response to treatment was partial in 11 nodules, minor response in 4 nodules, and disease was stable in 12 and progressive in 5. Significant response was associated with pretherapeutic nodule volume up to 150 ml (diameter of 6.6 cm). Survival rate after 3, 6, 9, 12, 24 and 36 months was 78, 61, 50, 39, 17, and 6%. Matched-pairs analysis of survival revealed ¹³¹I-lipiodol to be superior to medical treatment. The most important side effect was a pancreatitis-like syndrome whereas overall tolerance was good. Conclusion: The long term results confirm that HCC therapy with ¹³¹I-lipiodol is effective and probably superior to medical treatment. Tumour nodules of up to 6 cm diameter are well suited for this therapy even in the presence of portal vein thrombosis.

Zusammenfassung

Ziel: Überprüfung der Wirksamkeit und Verträglichkeit der Iod-131-Lipiodol-Therapie beim hepatozellulären Karzinom (HCC) an einem deutschen Kollektiv und der Vergleich mit einem medikamentös behandelten Kontrollkollektiv. Patienten, Methoden: 38 intraarterielle Therapien mit Iod-131-Lipiodol mit Summenaktivitäten von bis zu 6,7 GBq wurden bei 18 HCC-Patienten (davon 6 mit Pfortaderthrombose) durchgeführt. Leber- und Tumorvolumina sowie die Speicherung des Lipiodols wurden computertomographisch, die ¹³¹I-Aktivitätsverteilung szintigraphisch ermittelt. Der Therapieerfolg wurde anhand der Volumenänderung der Tumore bestimmt und die Überlebenszeit mittels Matched-pairs-Analyse mit medikamentös (Tamoxifen oder supportiv) behandelten Patienten verglichen. Ergebnisse: Eine initiale Größenabnahme zeigte sich bei 20/32 Tumorknoten (63%). Wiederholte Therapie führte häufig zu einer weiteren Größenabnahme. Insgesamt ergab sich bei 11 Knoten eine partielle Remission, 4 Knoten „minor response“, 12 waren unverändert und 5 progredient. Eine Größenabnahme trat nur bei Tumorvolumina bis etwa 150 ml (6,6 cm Durchmesser) auf. Die Überlebensrate nach 3, 6, 9, 12, 24 und 36 Monaten betrug 78, 61, 50, 39, 17 und 6%. Die Matched-pairs-Analyse der Überlebenszeit erbrachte einen signifikanten Vorteil für ¹³¹I-Lipiodol gegenüber der medikamentösen Therapie. Bei insgesamt guter Verträglichkeit war die wesentlichste Nebenwirkung ein Pankreatitis-ähnliches Krankheitsbild. Schlussfolgerung: Die Langzeitdaten belegen, dass die ¹³¹I-Lipiodol-Therapie bei HCC wirksam und wahrscheinlich auch in Bezug auf das Überleben einer supportiven Therapie überlegen ist. Indiziert ist die Therapie insbesondere bei Tumorknoten bis 6 cm Durchmesser, auch bei Pfortaderthrombose.

Keywords

Hepatocellular carcinoma - cancer therapy - iodine-131-lipiodol - portal vein thrombosis - long term analysis

Schlüsselwörter

Hepatozelluläres Karzinom - Tumortherapie - Iod-131-Lipiodol - Pfortaderthrombose - Langzeitanalyse

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