Intra-arterial radionuclide therapy for liver tumours: effect of selectivity of catheterization and 131I-Lipiodol delivery on tumour uptake and response.
Several authors have demonstrated the good tolerance of hepatic intra-arterial 131I-Lipiodol therapy and report survival rates of 21-25% after 1 year in inoperable patients. This study explored the possibility that more selective hepatic arterial instillation could be a strategy for increasing tumoural uptake and response of 131I-Lipiodol. Between June 1999 and September 2001 we selected 24 patients: 14 received a selective instillation of 131I-Lipiodol to the proper hepatic artery (SEL group); and 10 received a hyperselective instillation in the right or left hepatic artery (HYP-SEL group). The individual 131I-Lipiodol activity as a per cent of the injected activity per millilitre of tumour (%IA/ml tumour) was correlated with the selectivity of instillation in 28 tumours and with tumour response in 24 tumours. Differences in tumour response or tumour uptake between the SEL and HYP-SEL groups were not significant. In general, we observed a %IA/ml tumour of 0.05-2.6% for the uptake of 131I-Lipiodol. The uptake was significantly higher in responsive disease than in stable or progressive disease (P=0.002). A large tumour volume was invariably related to low uptake of 131I-Lipiodol and progressive disease (P=0.008). In conclusion, our study does not support the general use of hyper-selective or super-selective intra-arterial administration of 131I-Lipiodol. This result may be extrapolated to similar types of intra-arterial, loco-regional hepatic radionuclide therapy.
Brans
B
B
Department of Nuclear Medicine, Ghent University Hospital, Belgium. b.brans@atriummc.nl
Bacher
K
K
Vandevyver
V
V
Vanlangenhove
P
P
Smeets
P
P
Thierens
H
H
Dierckx
R A
RA
Defreyne
L
L
D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000378:metabolism* / Q000532:radiotherapy* / Q000601:surgery; D002406:Catheterization, Peripheral / Q000379:methods*; D005260:Female; D006801:Humans; D007269:Injections, Intra-Arterial / Q000379:methods*; D007457:Iodine Radioisotopes; D007459:Iodized Oil / Q000008:administration & dosage* / Q000493:pharmacokinetics*; D008113:Liver Neoplasms / Q000098:blood supply / Q000378:metabolism* / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011874:Radiometry; D019275:Radiopharmaceuticals / Q000493:pharmacokinetics / Q000627:therapeutic use; D011879:Radiotherapy Dosage; D014018:Tissue Distribution; D016896:Treatment Outcome
D007457:Iodine Radioisotopes; D019275:Radiopharmaceuticals; D007459:Iodized Oil