Clinical

Iodine-131 lipiodol offers palliation in hepatocellular carcinoma

Last Updated: 2005-10-12 14:43:06 -0400 (Reuters Health)

By Will Boggs, MD

NEW YORK (Reuters Health) - Metabolic radiotherapy with I-131-lipiodol (Lipiocis) provides meaningful survival in some patients with advanced hepatocellular carcinoma (HCC), researchers in Belgium report.

"Patients with well preserved liver function, advanced HCC, and portal vein thrombosis could benefit from Lipiocis as no embolization is performed," Dr. Yves Horsmans from Universite Catholique de Louvain, Brussels, told Reuters Health.

Dr. Horsmans and associates investigated the feasibility, tolerance, and efficacy of I-131-lipiodol in 29 patients with advanced multifocal tumors not amenable to surgery, transplantation, percutaneous treatments, or chemo-embolization.

Nine patients had two courses of I-131-lipiodol, and one patient had three courses, according to the report, published in the September European Journal of Gastroenterology and Hepatology.

The median survival was 203 days, the authors report. Patients with Cancer of the Liver Italian Program (CLIP) scores of 2 or less had significantly longer median survival (453 days) than did patients with CLIP scores above 2 (60 days).

Patients without portal vein thrombosis had higher 6-month survival (75%) than did patients with portal vein thrombosis (25%), the results indicate.

Tumor response as assessed by MRI in 19 patients revealed a partial response in 1 patient, stable disease in 10 patients, and progressive disease in 8 patients.

Alpha-fetoprotein and Child-Pugh scores did not differ meaningfully after treatment, the researchers note.

The patients tolerated treatment well, the investigators report, with all but one patient experiencing only moderate fever and mild asthenia. Severe complications included two cases of interstitial pneumonia and one upper digestive hemorrhage as a result of bleeding esophageal varices.

Two patients died, one with interstitial pneumonia and one with acute liver failure, for a treatment-related mortality of 6.9%.

"In our series, I-131-lipiodol seemed to give the same survival rates as those observed in the published data for portal vein thrombosis-negative patients or those known for patients with similar CLIP scores," the authors explain.

"The CLIP score should be used to select patients who could benefit from I-131-lipiodol, and have a better survival," the investigators conclude. "There is no benefit in subjecting patients with a CLIP score greater than 2 to I-131-lipiodol therapy."

"Otherwise, at this stage, our data do not support the use of Lipiocis instead of chemo-embolization in Child-Pugh A or B patients," Dr. Horsmans added.

Eur J Gastroenterol Hepatol 2005;17:905-910.