Intra-Arterial Iodine-131-Lipiodol for Unresectable Hepatocellular Carcinoma

BACKGROUND: Hepatic artery administration of iodine-131-Lipiodol serves as a modality that delivers targeted radiation therapy to hepatocellular carcinoma. Its efficacy has been promising according to trials conducted in the adjuvant setting after hepatic resection. Further investigation of its role in the palliative setting is warranted. METHODS: A retrospective review of 72 patients with unresectable hepatocellular carcinoma treated with iodine-131-Lipiodol and followed up by the St. George Hospital Sydney's hepatobiliary service was conducted. Efficacy of treatment was determined based on progression-free and overall survival as the endpoints using the Kaplan-Meier method. RESULTS: Sixty men and 12 women with a mean age of 65 years (standard deviation = 11) underwent iodine-131-Lipiodol treatment. Chronic viral hepatitis was present in 29 (41%) patients. Fifty (69%) patients were Child-Pugh class A. Median progression-free survival was 6 months, and overall survival was 14 months; the 1-, 2-, and 3-year survival rates were 52%, 33% and 20%, respectively. Factors associated with survival include the American Joint Committee on Cancer stage (P=.03), Barcelona Clinic Liver Cancer stage (P=.05), Cancer of the Liver Italian Program score (P=.008), tumor size (P=.01), extrahepatic disease (P<.001), previous surgery (P=.02), and response to treatment (P<.001). The response to treatment was identified through a multivariate analysis as the single independent predictor for survival (hazard ratio, 3.5; 95% confidence interval, 2.2-5.4; P<.001). CONCLUSIONS: Encouraging survival outcomes may be derived through administration of iodine-131-Lipiodol in patients with unresectable hepatocellular carcinoma. The overall success of treatment may be determined by the response to treatment. Cancer 2010;116:4069-77. (C) 2010 American Cancer Society.