EPIRUBICIN-LIPIODOL CHEMOTHERAPY VERSUS (131)IODINE-LIPIODOL RADIOTHERAPY IN THE TREATMENT OF UNRESECTABLE HEPATOCELLULAR-CARCINOMA

Background. Arterially administered iodized oil (Lipiodol) is selectiv ely retained by hepatocellular carcinomas (HCCs), and has been used as a vehicle for delivery of therapeutic agents to these tumors. This st udy compared the efficacy of Lipiodol-targeted epirubicin chemotherapy with Lipiodol-I-131 radiotherapy. Methods. Ninety-five patients with unresectable HCC confined to the liver were administered either Lipiod ol-epirubicin emulsion (n = 69; 61 cirrhotics; Okuda tumor Stage I, 14 ; II, 37; III, 18; epirubicin dose, 75 mg/m(2)) or Lipiodol-I-131 (I-1 31) (n = 26; 18 cirrhotics; Okuda tumor Stage I, 6; II, 19; III, 1; do se 750-1050 MBq). The last 28 patients (17 epirubicin, 11 I-131) were treated within a prospective randomized trial. Bolus drug or isotope w as injected into the hepatic artery by transfemoral cannulation, Lipio dol and I-131 uptake were gauged by 10th day computed tomography and 4 8-hour scintiscan, Treatments were repeated two-monthly when indicated . Results. Tumor size at 2 months remained static or diminished partia lly in 21 of 38 epirubicin recipients (55%) and 15/22 I-131 recipients (68%). Actuarial survival at 6, 12, and 24 months was 40%, 25%, and 6 % with epirubicin, and 58%, 25%, and 0% with I-131; 30-day mortality w as 11% and 15%, respectively, Comparison with historic controls indica ted survival benefit in Stages I and II. Similar findings were recorde d in the 28 patients in the randomized trial. Conclusions, Patients wi th unresectable HCC receiving Lipiodol-epirubicin or Lipiodol-I-131 sh ow good tumor localization, acceptable toxicity, and comparable surviv al benefit at 6 and 12 months with either modality.