Radiolabeled lipiodol therapy for hepatocellular carcinoma in patients awaiting liver transplantation: pathology of the explant livers and clinical outcome.
BACKGROUND
Liver transplantation has become an important curative treatment option for hepatocellular carcinoma (HCC). Criteria for transplantation are strict and, therefore, it is crucial that patients awaiting transplantation do not suffer disease progression. One of the therapeutic options to achieve disease stabilization is neoadjuvant radiolabeled lipiodol treatment. This study aimed to document the dropout rate on the waiting list, the pathological findings on the explant livers, and the long-term outcome of patients treated with radionuclide therapy while awaiting transplantation.


METHODS
Patients eligible for transplantation were treated with 2.1 GBq (131)I-lipiodol or 4.1 GBq (188)Re-HDD/lipiodol by transfemoral catheterization of the hepatic arteries. Tumor necrosis was assessed in the explant livers and follow-up data, such as dropout from the waiting list, recurrence, and survival following transplantation were retrospectively documented.


RESULTS
In 5 of 22 explants, necrosis exceeded 90%. Two patients died while on the waiting list (10%) and 4 of 20 transplanted patients (20%) suffered recurrent disease. The overall recurrence-free survival was 19.7 months (range, 1.75-56), with a mean follow-up of 20.1 months.


CONCLUSIONS
Our data support the evaluation on larger patient numbers to confirm the benefit of radiolabeled lipiodol in candidates for liver transplantation who are suffering from HCC.
Lambert
Bieke
B
Division of Nuclear Medicine, Ghent University Hospital, B-9000 Ghent, Belgium. Bieke.Lambert@Ugent.be
Praet
Marleen
M
Vanlangenhove
Peter
P
Troisi
Roberto
R
de Hemptinne
Bernard
B
Gemmel
Filip
F
Van Vlierberghe
Hans
H
Van de Wiele
Christophe
C
D006528:Carcinoma, Hepatocellular / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D003287:Contrast Media / Q000627:therapeutic use*; D018450:Disease Progression; D018572:Disease-Free Survival; D005500:Follow-Up Studies; D006801:Humans; D007459:Iodized Oil / Q000627:therapeutic use*; D008113:Liver Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000628:therapy*; D016031:Liver Transplantation / Q000379:methods*; D009336:Necrosis; D011868:Radioisotopes / Q000627:therapeutic use; D013997:Time Factors; D016896:Treatment Outcome
D003287:Contrast Media; D011868:Radioisotopes; D007459:Iodized Oil