The anti-tumoral activity of neoadjuvant intra-arterial I-131-lipiodol treatment for hepatocellular carcinoma: A pilot study

Background: The high recurrence rate after curative resection has stimulate d the development of adjuvant treatment modalities, such as local embolizat ion. This study was set up to investigate the anti-tumoral potential of neo -adjuvant I-131-lipiodol administration before liver transplantation. Methods: In this preliminary, prospective study we treated 10 consecutive H CC patients by intra-arterial injection of I-131-lipiodol into the hepatic artery followed by liver transplantation within 1-9 months (mean 3.4). Afte r hepatic catheterization, 1332-2146 MBq (mean 1887 MBq) or 36-58 mCi (mean 51 mCi) was instilled as selective as possible, depending on the distribut ion of the tumors: non-selectively in the hepatic artery propria (n = 4), s electively in the right and/or left hepatic artery (n = 3) or superselectiv ely in segmental arteries (n = 3). Results: Anti-tumoral activity was regarded as obvious vith 1) a strong dec rease of alfa-fetoprotein (AFP), comparing the highest recorded value befor e and after I-131-lipiodol and/or 2) a downstaging in TNM classification on the posttherapy MRI as compared to the pre-therapy MRI and/or 3) tumors wi th > 50% necrosis on histo-pathology of the explanted liver, without previo us chemoembolization. Either of these criteria were met by 5/10 (50%) of pa tients. A 4) downstaging in pTNM classification on histopathology compared to the TNM classification of the MRI and/or a 5) tumor necrosis of only 10- 50% were regarded as possibly tumor-related but were not accepted as a sing le criteria of anti-tumoral activity. This was seen in 3/10 (30%) of patien ts. Clinical side-effects of the I-131-lipiodol therapy were generally mild with a temperature rise in two cases, nausea without vomiting in another t wo and upper back pain in one patient. In one patient progressive liver fai lure developed one week after I-131-lipiodol therapy, necessitating prematu re liver transplantation after 4 weeks. Conclusion: With the use of stringent anti-tumoral criteria, this study sho ws evidence of an anti-tumoral effect in 50% of patients. Our data support the evaluation on larger patient numbers to confirm the promising anti-tumo ral activity of I-131-lipiodol in HCC patients candidated for liver transpl antation.