Treatment of unresectable hepatocellular carcinoma with radiolabelled lipiodol

Background: Hepatocellular carcinoma (HCC) is one of the most common solid organ tumours, with approximately 500 000 new cases being reported each year. It has a very high prevalence in Asia, and almost two-thirds of all cases occur in this region. The incidence of this tumour in Australia has nearly doubled in the past decade. Surgical resection is the mainstay of treatment, but only 10-30% of HCC are amenable to surgical resection at the time of diagnosis. The prognosis for patients with unresectable HCC remains dismal. Internal radiotherapy with radiolabelled lipiodol has been used with some success in treatment of HCC. Several studies have validated its usefulness in an adjuvant setting, but it also appears to have a role in treating unresectable tumours. Methods: Twenty-two patients with proven HCC, not amenable to or having failed surgical treatment, were evaluated for radiolabelled lipiodol treatment. Of these, 10 patients were excluded after initial evaluation and 12 patients underwent treatment. Patients were followed up every 3 months with physical examination, computed tomography scan and alpha-fetoprotein levels. Overall survival, change in tumour size and alpha-fetoprotein levels were used to evaluate the efficacy of treatment. Results: The median overall survival in patients undergoing lipiodol therapy was 15 months. Tumour size was stabilized in most patients and very few side-effects of the treatment were observed. Conclusion: This study has shown that radiolabelled lipiodol is an effective method for the treatment of unresectable locally advanced HCC.