TREATMENT OF HEPATOCELLULAR CARCINOMA BY INJECTION OF IODINE*131 LABELLED LIPIODOL INTO HEPATIC ARTERY.

Abstract

Purpose: To study therapeutic efficacy of iodine*131 labelled Lipiodol in the treatment of hepatocellular carcinoma (HCC). The results of the treatment were evaluated in 4 aspects, 1 size of the tumor, 2 serum alphafetoprotein level 3. the quality of patient's life, and 4 the survival rate.
Materials and methods. The hepatocellular carcinoma was diagnosed by evidence of mass in the liver by computed tomography or ultrasonography with tissue biopsy and/or high level of alphafetoprotein more than 500 U. 20 patients were ran- domized into 2 groups for comparison. The patients in group A were treated by intrahe- patic injection of iodine* 131 labeled Lipiodol 60 miliCuries (mCi). The patients in group B were treated by intrahepatic injection of mixture of Lipiodol and chemothe- rapeutic agents, mitomicin c 20 mg., and 5-fluouracil 500 mg. and followed by selective hepatic artery embolization of small pieces of gelatin sponge (gelfoam). Both groups were evaluated by computed tomography (CT) and possible repeating treatment protocol in 2 months.
Results. There was no serious side-effect or major complication in both groups of patients. The patients' conditions got worse by 40% in both groups. The tumors' sizes remained unchanged by 50% in both groups. The serum alphafetoprotein levels had increased by 40% in group A, and remained unchanged by 50% in group B.The survival rate at 1 and 2 years in group A were 20%, 20%, and in group B were 30%, 0%, respectively.
Conclusion Satisfactory results were obtained in the treatment of a small HCC, size less than 5 cm. with intrahepatic artery injection of iodine* 131 labeled Lipiodol. In the large HCC (>10cm) there was no response of the tumor in both groups. This was the first study performed in Thailand.
Introduction Hepatocellular carcinoma (HCC) is one of the most common malignant tumor in the Thai population, especially in the male patients. The incidence in Thailand are 36 cases/100,000/year in male, and 14 cases/100,000/year in the female population. There are several risk factors for the Thai people; hepatitis B and C, represented 10% of the population or around 6 millions people. Cirrhosis, food additives, toxins, parasitic infestation, etc. are included in the causative agents of the tumor. Today, HCC can be found in the younger age group, 20-40 years, who are active working - people. Furthermore, most of the patients came to see the doctor, when they had already been in advanced and late stages. This was because there were no symptoms yet when the sizes of the HCC in the liver were small. So the sizes of the HCC in the patients were often larger than 10 cm and/or there were vascular invasion, and they were unresectable. Although the tumor was small, surgical resection was often not indicated because the liver had already got advanced cirrhosis, multiple focalities, or vascular portal vein invasion.
For the treatment of the unresectable HCC, systemic chemotherapy, ligation of hepatic artery, and now-a-day, trans-catherized arterial oily chemoembolization (TOCE) were used. Nakakuma found that an oily contrast medium, Lipiodol used for contrast lymphagiograms injected through hepatic artery was selectively retained in HCC. The computed tomography (CT) performed after TOCE showed that the small droplets of lipiodol remained in the tumor vascular bed for months. Furthermore, Lipiodol has been used as a carrier for therapeutic agents in chemotherapy for HCC. Lipiodol is an ethyl ester of poppy seed oil fatty acid that contains 38% stable iodine 127 by weight. By exchange method, labeling of Lipiodol with radioactive iodine 131(I*131) can be achieved. Intrahepatic artery injection of Lipiodol-I*131 showed a high tumor to nontumor ratio and longer effective half life in the vascular HCC than the normal hepatic parenchyma. One reason is that HCC was mainly supplied by hepatic artery. There were many reports of therapeutic trial of internal radiation therapy for HCC with this Lipiodol- I*131.
The purpose of this study is to evaluate and compare the therapeutic efficicacy between Lipiodol-I*131 and TOCE, in the treatment of HCC in 4 aspects, 1. the size of the tumor, 2. serum alphafetoprotein level, 3. quality of life and 4. survival rate.
Our project study was approved by the ethical committee of Faculty of medicine, Siriraj hospital, Mahidol University and research fund from Faculty of Medicine Siriraj Hospital.