Survival after ¹³¹I-labeled lipiodol therapy for hepatocellular carcinoma

Summary

This study investigated the efficacy of ¹³¹iod- ine-labeled lipiodol (¹³¹1-lipiodol) as a palliative therapy, evaluated overall survival (OS) across Barcelona Clinic Liver Cancer (BCLC) stages, and determined the main prognostic factors influencing OS in patients with hepatocellular carcinoma (HCC). Patients, methods: We retrospectively analyzed 57 (44 men; mean age, 65.7 years; mean activity per session, 1.6 GBq; mean cumulative activity in patients with >1 sessions, 3.9 GBq) HCC patients who underwent ¹³¹1-lipiodol therapy. A majority of patients exhibited Child-Pugh class B (53.6%) disease and a good Eastern Cooperative Oncology Group performance status (0-1; 72%). Multinodular disease was observed in 87.7% patients, bilobar disease in 73%, and portal vein occlusion (PVO) in 54%. Furthermore, 21.1% patients were staged as BCLC B and 59.6 % as BCLC C. All patients were followed until death. Results: The median OS was 6.4 months, which varied significantly with disease stage (median OS for BCLC A, B, C, and D was 29.4, 12.0, 4.6, and 2.7 months, respectively; p = 0.009); Child-Pugh score and class; presence of ascites, PVO, or extrahepatic disease; largest lesion size; favourable treatment response; international normalized ratio, baseline albumin and alpha-fetopro- tein levels. Patients with a Child-Pugh A liver disease had a longer OS. Conclusion: Currently, different treatment modalities for HCC include radioembolization, transarterial chemoemboliz- ation, and systemic therapy with sorafenib; however, ¹³¹1-lipiodol therapy remains a feasible alternative for patients without a favourable response to other therapies, particularly for patients with Child-Pugh A liver cirrhosis.

Zusammenfassung

Diese Studie untersuchte die Wirksamkeit von Iod-131-markiertem Lipiodol (¹³¹I- Lipiodol) als palliative Therapie, bewertete das Gesamtüberleben (OS) in Barcelona Clinic Liver Cancer (BCLC) Stufen und behandelte die wichtigsten prognostischen Faktoren, die das OS bei Patienten mit hepatozellulärem Karzinom (HCC) beeinflussen. Patienten, Methoden: Wir analysierten retrospektiv 57 HCC-Patienten (44 Männer, Durchschnittsalter 65,7 Jahre; mittlere Aktivität pro Sitzung: 1,6 GBq, mittlere kumulative Aktivität bei Patienten mit >1 Therapie: 3,9 GBq ), die sich einer ¹³¹I- Lipiodol -Therapie unterzogen. Ein Großteil der Patienten konnte in Child- Pugh-Klasse B ( 53,6% ) eingeteilt werden und besaß einen guten Eastern Cooperative Oncology Group Performance-Status (0-1, 72%). Eine multinoduläre Erkrankung wurde bei 87,7% der Patienten, eine bilobäre Erkrankung bei 73% und ein Portalvenenverschluss (PVO) bei 54% der Patienten beobachtet. Darüber hinaus wurden 21,1% der Patienten als BCLC B eingestuft und 59,6% als BCLC C. Alle Patienten wurden bis zu ihrem Tode nachbeobachtet. Ergebnisse: Die mediane OS betrug 6,4 Monate und variierte deutlich mit dem Krankheitsstadium (mediane OS für BCLC A, B, C und D betrug 29,4, 12,0, 4,6 und 2,7 Monate, p = 0,009), dem Child-Pugh- Score und Klasse ; dem Vorhandensein von Aszites, PVO oder extrahepati- scher Metastasierung; dem max. Tumordurchmesser, einem guten Therapieansprechen; der international Normalized Ratio und den Albumin- und Alpha- Fetoprotein-Spiegeln. Patienten mit einer Child-Pugh A Erkrankung hatten eine längere Überlebenszeit. Schlussfolgerung: Die aktuellen Behandlungsmodalitäten für HCC umfassen Radioembolisation, transarterielle Chemoembolisation und systemische Therapien mit Sorafenib. Denndoch bleibt die ¹³¹I- Lipiodol-Therapie eine praktikable Alternative für Patienten ohne ausreichendes Ansprechen auf diese Therapien, besonders für Patienten mit Child-Pugh-A-Leberzirrhose.

Keywords

Liver cancer - hepatocellular carcinoma - radionuclide therapy - ¹³¹I-lipiodol - BCLC

Schlüsselwörter

Leberkrebs - hepatozelluläres Karzinom - Radionuklidtherapie - 131I-Lipiodol - BCLC

^* Hojjat Ahmadzadehfar and Elham Habibi contributed equally to this work.

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