title: The anti-tumoral activity of neoadjuvant intra-arterial 131I-lipiodol treatment for hepatocellular carcinoma: a pilot study.
abstract: BACKGROUND
  The high recurrence rate after curative resection has stimulated the development of adjuvant treatment modalities, such as local embolization. This study was set up to investigate the anti-tumoral potential of neo-adjuvant 131I-lipiodol administration before liver transplantation.
  
  
  METHODS
  In this preliminary, prospective study we treated 10 consecutive HCC patients by intra-arterial injection of 131I-lipiodol into the hepatic artery followed by liver transplantation within 1-9 months (mean 3.4). After hepatic catheterization, 1332-2146 MBq (mean 1887 MBq) or 36-58 mCi (mean 51 mCi) was instilled as selective as possible, depending on the distribution of the tumors: non-selectively in the hepatic artery propria (n = 4), selectively in the right and/or left hepatic artery (n = 3) or super-selectively in segmental arteries (n = 3).
  
  
  RESULTS
  Anti-tumoral activity was regarded as obvious with 1) a strong decrease of alfa-fetoprotein (AFP), comparing the highest recorded value before and after 131I-lipiodol and/or 2) a downstaging in TNM classification on the posttherapy MRI as compared to the pre-therapy MRI and/or 3) tumors with > 50% necrosis on histo-pathology of the explanted liver, without previous chemoembolization. Either of these criteria were met by 5/10 (50%) of patients. 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 single criteria of anti-tumoral activity. This was seen in 3/10 (30%) of patients. Clinical side-effects of the 131I-lipiodol therapy were generally mild with a temperature rise in two cases, nausea without vomiting in another two and upper back pain in one patient. In one patient progressive liver failure developed one week after 131I-lipiodol therapy necessitating premature liver transplantation after 4 weeks.
  
  
  CONCLUSIONS
  With the use of stringent anti-tumoral criteria, this study shows evidence of an anti-tumoral effect in 50% of patients. Our data support the evaluation on larger patient numbers to confirm the promising anti-tumoral activity of 131I-lipiodol in HCC patients candidated for liver transplantation.
authors.affiliation: Division of Nuclear Medicine, Ghent University Hospital, De Pintelaan 185, B-9000 Ghent, Belgium. boudewijn.brans@rug.ac.be
authors.forename: B
authors.initials: B
authors.lastname: Brans
authors.forename: F
authors.initials: F
authors.lastname: De Winter
authors.forename: L
authors.initials: L
authors.lastname: Defreyne
authors.forename: R
authors.initials: R
authors.lastname: Troisi
authors.forename: P
authors.initials: P
authors.lastname: Vanlangenhove
authors.forename: H
authors.initials: H
authors.lastname: Van Vlierberghe
authors.forename: B
authors.initials: B
authors.lastname: Lambert
authors.forename: M
authors.initials: M
authors.lastname: Praet
authors.forename: B
authors.initials: B
authors.lastname: de Hemptinne
authors.forename: R A
authors.initials: RA
authors.lastname: Dierckx
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy* / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial; D007457:Iodine Radioisotopes / Q000627:therapeutic use*; D007459:Iodized Oil / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D009364:Neoplasm Recurrence, Local; D010865:Pilot Projects; D011446:Prospective Studies; D018714:Radiotherapy, Adjuvant
chemical_list: D007457:Iodine Radioisotopes; D007459:Iodized Oil