Reuters Health Information (2005-10-12): Iodine-131 lipiodol offers palliation in hepatocellular carcinoma
Iodine-131 lipiodol offers palliation in hepatocellular carcinoma
Last Updated: 2005-10-12 14:43:06 -0400 (Reuters Health)
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
"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
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
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.