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Transarterial Injection of ¹³¹I-Lipiodol, Compared with Chemoembolization, in the Treatment of Unresectable Hepatocellular Cancer

¹ The Sheila Sherlock Hepatobiliary-Pancreatic and Liver Unit, Royal Free Hospital, London, United Kingdom; ² Department of Nuclear Medicine, Royal Free Hospital, London, United Kingdom; ³ Department of Radiology, Royal Free Hospital, London, United Kingdom; and ⁴ Department of Oncology, Royal Free Hospital, London, United Kingdom

Correspondence: For correspondence or reprints contact: Andrew K. Burroughs, Liver Transplantation and Hepatobiliary Medicine Unit, Royal Free Hospital, Pond St., NW3 2QG, London, U.K. E-mail: andrew.burroughs{at}royalfree.nhs.uk

Transarterial chemoembolization (TACE) improves survival in patients with hepatocellular carcinoma (HCC) in whom curative therapies are not suitable. The aim of this study was to assess survival differences in patients with hepatic cirrhosis and unresectable HCC treated by ¹³¹I-lipiodol versus TACE or transarterial embolization (TAE). Methods: A retrospective study was performed on a cohort of 124 patients undergoing treatment for unresectable HCC between 1997 and 2006. A total of 50 patients (44 men; mean age, 59 y) received ¹³¹I-lipiodol (mean sessions per patient, 1.7), and 74 patients (63 men; mean age, 61 y) received TACE/TAE (mean sessions per patient, 1.8). Although no significant difference between the 2 treatment groups with respect to HCC size and clinical staging was observed, a higher proportion of patients with portal vein thrombosis (PVT) was treated with ¹³¹I-lipiodol than with TACE/TAE (28% vs. 8%, P = 0.003). Results: Actuarial survival was not significantly different between patients treated with ¹³¹I-lipiodol and patients treated with TACE/TAE. Survival at 6 mo, 1 y, 2 y, and 3 y was 86%, 69%, 54%, and 45%, respectively, after ¹³¹I-lipiodol, compared with 77%, 62%, 47%, and 43%, respectively, after TACE/TAE. However, patients with PVT survived a mean of 454 d after ¹³¹I-lipiodol, compared with a mean of 171 d after TACE/TAE (P = 0.025). In addition, patients with more advanced disease (Barcelona Clinic Liver Cancer stage D) lived on average 363 d after ¹³¹I-lipiodol, compared with 36 d after TACE/TAE (P = 0.014). Conclusion: In patients with unresectable HCC, there was no difference in survival between ¹³¹I-lipiodol therapy and TACE/TAE treatment. However, in the patients with advanced clinical staging or PVT, there was a significant survival advantage for those treated with ¹³¹I-lipiodol.

Key Words: hepatocellular carcinoma • chemoembolization • embolization • ¹³¹I-lipiodol • portal vein thrombosis

COPYRIGHT © 2009 by the Society of Nuclear Medicine, Inc.

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