Radionuclide therapy for hepatocellular carcinoma: indication, cost and efficacy

Area of Science:

• Nuclear Medicine
• Oncology
• Radiotherapy

Background:

• Hepatocellular carcinoma (HCC) often presents as large, inoperable tumors, precluding standard treatments like percutaneous ablation or chemoembolization, especially with portal vein thrombosis.
• Patients with inaccessible, subcapsular, or subdiaphragmatic tumors also face limitations with percutaneous therapies.

Purpose of the Study:

• To evaluate internal radioisotope therapy as an effective treatment for patients with inoperable hepatocellular carcinoma (HCC).
• To explore the potential of radioisotope therapy to prolong survival and enhance the quality of life for HCC patients unsuitable for other treatments.

Main Methods:

• Direct intra-tumoral implantation of radioisotopes.
• Parenteral injection of radiolabeled antibodies specific to HCC antigens (radioimmunotherapy).
• Trans-arterial radioisotope therapy (TART) via hepatic artery injection.

Main Results:

• Radioisotope therapy is a reasonable and effective alternative for large, inoperable HCC, particularly those with portal vein thrombosis.
• It serves as a valuable neoadjuvant or adjuvant therapy to reduce recurrence risk before or after liver transplantation/resection.
• Generator-produced Rhenium-188 (Re-188) shows comparable or superior efficacy and cost-effectiveness, with convenient availability.

Conclusions:

• Internal radioisotope therapy provides a crucial treatment option for a significant patient group with advanced HCC.
• Rhenium-188 (Re-188) offers a particularly convenient and cost-effective radioisotope choice, especially for remote areas and developing nations.
• This therapeutic modality enhances treatment accessibility and efficacy for challenging HCC cases.