title: 188Re-HDD/lipiodol for treatment of hepatocellular carcinoma: a feasibility study in patients with advanced cirrhosis.
abstract: This study aimed to investigate the feasibility of the intraarterial administration of 3.7 GBq (188)Re-4-hexadecyl-1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol/lipiodol ((188)Re-HDD/lipiodol) for treatment of hepatocellular carcinoma (HCC) in patients with moderately advanced cirrhosis.
  
  
  METHODS
  Patients with HCC and underlying cirrhosis classified as Child-Pugh B in terms of severity were eligible. Whole-body scintigraphies were performed at 4 time points after injection. Absorbed doses to the various organs were calculated according to the MIRD formalism. Urine was collected for 52 h after injection. Toxicity was assessed until 6 wk after administration by means of the Common Toxicity Criteria for Adverse Events (version 3.0) scale. Responses were evaluated on MRI and by alpha-fetoprotein (AFP) monitoring.
  
  
  RESULTS
  A mean activity +/- SD of 3.7 +/- 0.2 GBq (188)Re-HDD/lipiodol was administered in the hepatic artery to 12 patients; 36.2% +/- 5.7% of the activity was excreted in the urine 52 h after injection. The absorbed dose to the liver, lungs, kidney, and thyroid was 7.6 +/- 2.9, 4.8 +/- 2.6, 0.8 +/- 0.7, and 0.2 +/- 0.1 Gy (mean +/- SD), respectively. Two weeks after administration, 6 of 12 patients had adverse events consisting of aggravations of preexisting laboratory changes (3 patients), fatigue (2 patients), vomiting (1 patient), fever (1 patient), encephalopathy (1 patient), and ascites (1 patient). Toxicity assessment at week 6 revealed single cases of the worsening of hyperbilirubinemia, pleural effusion, thrombocytopenia, and dyspnea. Three patients dropped out of the study because of deterioration of their general condition. The response was assessable by MRI in 8 patients: 1 patient with a partial response and 7 patients with stable disease were reported. Nine patients with an initially elevated AFP were evaluated. Stable AFP was recorded in 1 patient and 3 showed a reduction, whereas a considerable increase was observed in 5 patients.
  
  
  CONCLUSIONS
  After the administration of 3.7 GBq (188)Re-HDD/lipiodol, half of the Child-Pugh B patients in the present study had a worsening of their general condition or aggravation of preexisting symptoms. This was associated with a rise in AFP in a considerable number of patients. In the future, administration of the radiopharmaceutical as close to the tumor feeding arteries as possible might avoid further deterioration of the liver function and show enhanced antitumoral activity.
authors.affiliation: Nuclear Medicine Division, Ghent University Hospital, Belgium. bieke.lambert@ugent.be
authors.forename: Bieke
authors.initials: B
authors.lastname: Lambert
authors.forename: Klaus
authors.initials: K
authors.lastname: Bacher
authors.forename: Katrien
authors.initials: K
authors.lastname: De Keukeleire
authors.forename: Peter
authors.initials: P
authors.lastname: Smeets
authors.forename: Isabelle
authors.initials: I
authors.lastname: Colle
authors.forename: Jae Min
authors.initials: JM
authors.lastname: Jeong
authors.forename: Hubert
authors.initials: H
authors.lastname: Thierens
authors.forename: Roberto
authors.initials: R
authors.lastname: Troisi
authors.forename: Filip
authors.initials: F
authors.lastname: De Vos
authors.forename: Christophe
authors.initials: C
authors.lastname: Van de Wiele
mesh_terms: D000328:Adult; D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000150:complications* / Q000532:radiotherapy*; D005240:Feasibility Studies; D005260:Female; D006801:Humans; D007459:Iodized Oil / Q000009:adverse effects* / Q000627:therapeutic use*; D008103:Liver Cirrhosis / Q000209:etiology* / Q000517:prevention & control*; D008875:Middle Aged; D009942:Organometallic Compounds / Q000009:adverse effects* / Q000627:therapeutic use*; D010865:Pilot Projects; D011832:Radiation Injuries / Q000209:etiology*; D019275:Radiopharmaceuticals / Q000009:adverse effects / Q000627:therapeutic use; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: C498051:188Re-4-hexadecyl-1,2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol lipiodol conjugate; D009942:Organometallic Compounds; D019275:Radiopharmaceuticals; D007459:Iodized Oil