SELECTIVE INTERNAL RADIATION-THERAPY WITH INTRAARTERIAL IODINE-131-LIPIODOL IN INOPERABLE HEPATOCELLULAR-CARCINOMA

From August 1990 to June 1993, 26 patients with inoperable hepatocellu lar carcinoma were treated with intra-arterial iodine-131-Lipiodol (I- 131-L). Methods: lodine-131-Lipiodol was given through either an impla ntable arterial port (9 patients) or during hepatic angiography (17 pa tients). All 26 patients had multiple lesions, 3 had involved resectio n margin after surgical resection and 1 had diffuse infiltrative lesio ns. The median size of the largest tumor among 22 patients with a meas urable lesion was 4.5 cm (2-9.5 cm). The end points are tumor response in terms of tumor size, change in serum alpha-fetoprotein level, toxi city of treatment and overall survival. Results: Twenty-three patients received a single treatment of 1.11-2.22 GBq (30-60 mCi)I-131-L. Thre e patients received 2.22-4.44 GBq (60-120 mCi)I-131-L in three fractio ns. Considering both radiological regression and reduction in serum al pha-fetoprotein level as objective response criteria, the overall resp onse rate was 52% (13 out of 25 patients with evaluable disease). Ten out of 15 patients who had raised alpha-fetoprotein levels had more th an 50% reduction and 8 patients had more than 90% reduction in alphafe toprotein level. Since analysis, 19 patients have died and 7 remain al ive, giving a minimum median survival of 6 mo (range 1.2-16.6 mo), wit h 4 surviving more than 1 yr calculated from the day of treatment. The re was only one patient who had late deterioration of liver function c ompatible with radiation hepatitis. There was no bone marrow toxicity documented in any patients. Conclusion: Treatment with intra-arterial I-131-L was well tolerated in patients with inoperable hepatocellular carcinoma and produced an objective response of 52% with median surviv al of 6 mo. A fractionated dose of I-131-L was feasible and the radiat ion dose could be escalated safely.