131I-Labelled-iodized oil for palliative treatment of hepatocellular carcinoma

The incidence of hepatocellular carcinoma (HCC) is growing in western countries. Poor liver status and tumour size make curative options scarce. Palliative treatments such as chemo-embolization are improving survival in selected patients, but side-effects are frequent. There is a need for the validation of alternative treatments. Metabolic radiotherapy using lipiodol labelled with 131I-iodine (I-131-lipiodol) is one of these treatments.

To analyse the effect of I-131-lipiodol in a population of advanced HCC patients and to define the potential prognostic factors in this setting.

A retrospective analysis of the effect of I-131-lipiodol on 29 patients bearing multifocal tumours was performed. An analysis of two subgroups, defined by a Cancer of the Liver Italian Program (CLIP) score of 2 or less (n=20) or greater than 2 (n=9) was performed to assess the prognostic significance of the score in this setting.

Overall median survival in the entire study population was 203 days (95% confidence interval 83-322 days). Median survival was significantly better in the group with CLIP scores of 2 or less than in the group with CLIP scores greater than 2 (453 versus 60 days, P< or =0.001). Treatment-related mortality was 6.9% (one interstitial pneumonia and one acute liver failure).

The survival of patients treated with I-131-lipiodol in this series compared favourably with published data. Stratification according to the CLIP score was useful to predict survival. In particular, patients with portal vein thrombosis should only be considered for I-131-lipiodol if the CLIP score is lower than 2.