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Treatment of hepatocellular carcinoma with intra-arterial injection of radionuclides

Nature Reviews Gastroenterology & Hepatology volume 7, pages 41–49 (2010)Cite this article

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Abstract

Hepatocellular carcinoma (HCC) is becoming an important public health concern. Current therapeutic options are limited and new treatments are therefore being developed. The intra-arterial treatment chemoembolization has limited efficacy and few prospects for further progress. One particularly promising, though little used, alternative to chemoembolization is radioembolization with iodine-131 (131I) or rhenium-188 labeled lipiodol or yttrium-90 labeled microspheres (glass or resin beads). Three randomized studies have proven the effectiveness of 131I-lipiodol in patients with HCC—as adjuvant therapy after surgery, compared with chemoembolization, and also in patients who have portal vein thrombosis. Microspheres enable the delivery of high-dose radiation (>200 Gy) to the tumor while sparing the neighboring hepatic tissue from overexposure. Overall, the efficacy of radioembolization has been good and toxic effects have been low. These results are comparable to those obtained with chemoembolization but further improvement can be expected by combining radioembolization with standard chemotherapy or with targeted therapies, such as anti-angiogenic drugs.

Key Points

  • Hepatocellular carcinomas (HCC) are highly hypervascularized via the hepatic artery and remain as localized disease for a long time, consequently intra-arterially delivered treatment is frequently used as a palliative treatment

  • Radioembolization, with iodine-131 (131I) or rhenium-118 labeled lipiodol or yttrium-90 (90Y) microspheres, is a promising option

  • In phase III trials 131I -lipiodol has been shown to be effective in patients with HCC and portal vein thrombosis (PVT) and in prevention of postresection recurrence

  • In a phase III trial 131I -lipiodol was shown to be equivalent to chemoembolization in patients with HCC without PVT

  • 90Y -microspheres deliver homogeneous irradiation to large tumors and preliminary results as a bridge to transplantation, for downstaging of the tumor before curative treatment, and as a palliative treatment, are impressive

  • The efficacy of radioembolization might be improved by combination with systemic chemotherapy and targeted therapy, such as anti-angiogenic drugs

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Figure 1: Schematic representation of the mechanism of action of microspheres and radiolabeled lipiodol in a liver with tumor nodules.
Figure 2: A multinodular hepatocellular carcinoma with many small lesions (arrows) 15 days after intra-arterial injection of iodine-131 (131I)-lipiodol.
Figure 3: A large hepatocellular carcinoma during the arterial phase of a CT scan before treatment.

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Authors and Affiliations

  1. European University in Brittany, 12 Avenue Janvier, 35000, Rennes, France

    Jean-Luc Raoul & Etienne Garin

  2. Department of Medical Oncology, Comprehensive Cancer Center,

    Eveline Boucher

  3. Department of Medical Imaging, Center E Marquis, 35042, Rennes Cedex, France

    Yan Rolland

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  1. Jean-Luc Raoul
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Correspondence to Jean-Luc Raoul.

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Competing interests

J.-L. Raoul declares associations with Bayer (consultant) and Bristol-Myers Squibb (on the speaker's bureau). E. Boucher, Y. Rolland and E. Garin declare no competing interests.

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Raoul, JL., Boucher, E., Rolland, Y. et al. Treatment of hepatocellular carcinoma with intra-arterial injection of radionuclides. Nat Rev Gastroenterol Hepatol 7, 41–49 (2010). https://doi.org/10.1038/nrgastro.2009.202

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