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¹⁸⁸Re-HDD/Lipiodol for Treatment of Hepatocellular Carcinoma: A Feasibility Study in Patients with Advanced Cirrhosis

¹ Nuclear Medicine Division, Ghent University Hospital, Gent, Belgium
² Department of Medical Physics, Ghent University, Gent, Belgium
³ Department of Vascular and Interventional Radiology, Ghent University Hospital, Gent, Belgium
⁴ Department of Radiology, Ghent University Hospital, Gent, Belgium
⁵ Division of Gastroenterology, Ghent University Hospital, Gent, Belgium
⁶ Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea
⁷ Division of Abdominal Surgery, Ghent University Hospital, Gent, Belgium

This study aimed to investigate the feasibility of the intraarterial administration of 3.7 GBq ¹⁸⁸Re-4-hexadecyl-1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol/lipiodol (¹⁸⁸Re-HDD/lipiodol) for treatment of hepatocellular carcinoma (HCC) in patients with moderately advanced cirrhosis. Methods: Patients with HCC and underlying cirrhosis classified as Child–Pugh B in terms of severity were eligible. Whole-body scintigraphies were performed at 4 time points after injection. Absorbed doses to the various organs were calculated according to the MIRD formalism. Urine was collected for 52 h after injection. Toxicity was assessed until 6 wk after administration by means of the Common Toxicity Criteria for Adverse Events (version 3.0) scale. Responses were evaluated on MRI and by -fetoprotein (AFP) monitoring. Results: A mean activity ± SD of 3.7 ± 0.2 GBq ¹⁸⁸Re-HDD/lipiodol was administered in the hepatic artery to 12 patients; 36.2% ± 5.7% of the activity was excreted in the urine 52 h after injection. The absorbed dose to the liver, lungs, kidney, and thyroid was 7.6 ± 2.9, 4.8 ± 2.6, 0.8 ± 0.7, and 0.2 ± 0.1 Gy (mean ± SD), respectively. Two weeks after administration, 6 of 12 patients had adverse events consisting of aggravations of preexisting laboratory changes (3 patients), fatigue (2 patients), vomiting (1 patient), fever (1 patient), encephalopathy (1 patient), and ascites (1 patient). Toxicity assessment at week 6 revealed single cases of the worsening of hyperbilirubinemia, pleural effusion, thrombocytopenia, and dyspnea. Three patients dropped out of the study because of deterioration of their general condition. The response was assessable by MRI in 8 patients: 1 patient with a partial response and 7 patients with stable disease were reported. Nine patients with an initially elevated AFP were evaluated. Stable AFP was recorded in 1 patient and 3 showed a reduction, whereas a considerable increase was observed in 5 patients. Conclusion: After the administration of 3.7 GBq ¹⁸⁸Re-HDD/lipiodol, half of the Child–Pugh B patients in the present study had a worsening of their general condition or aggravation of preexisting symptoms. This was associated with a rise in AFP in a considerable number of patients. In the future, administration of the radiopharmaceutical as close to the tumor feeding arteries as possible might avoid further deterioration of the liver function and show enhanced antitumoral activity.

Key Words: hepatocellular carcinoma • radionuclide therapy • ¹⁸⁸Re • 4-hexadecyl-1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol • lipiodol

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JNM 2005 46: 8a-9a. [Full Text]