Epirubicin-lipiodol chemotherapy versus131iodine-lipiodol radiotherapy in the treatment of unresectable hepatocellular carcinoma

Abstract

Background. Arterially administered iodized oil (Lipiodol) is selectively retained by hepatocellular carcinomas (HCCs), and has been used as a vehicle for delivery of therapeutic agents to these tumors. This study compared the efficacy of Lipiodol‐targeted epirubicin chemotherapy with Lipiodol‐¹³¹I radiotherapy. Methods. Ninety‐five patients with unresectable HCC confined to the liver were administered either Lipiodol‐epirubicin emulsion (n=69; 61 cirrhotics; Okuda tumor Stage I, 14; II, 37; III, 18; epirubicin dose, 75 mg/m²) or Lipiodol‐¹³¹I (¹³¹I) (n=26; 18 cirrhotics; Okuda tumor Stage I, 6; II, 19; III, 1; dose 750–1050 MBq). The last 28 patients (17 epirubicin, 11¹³¹I) were treated within a prospective randomized trial. Bolus drug or isotope was injected into the hepatic artery by transfemoral cannulation. Lipiodol and ¹³¹I uptake were gauged by 10th day computed tomography and 48‐hour scintiscan. Treatments were repeated two‐monthly when indicated. Results. Tumor size at 2 months remained static or diminished partially in 21 of 38 epirubicin recipients (55%) and 15/22 ¹³¹I recipients (68%). Actuarial survival at 6, 12, and 24 months was 40%, 25%, and 6% with epirubicin, and 58%, 25%, and 0% with ¹³¹I; 30‐day mortality was 11% and 15%, respectively. Comparison with historic controls indicated survival benefit in Stages I and II. Similar findings were recorded in the 28 patients in the randomized trial. Conclusions. Patients with unresectable HCC receiving Lipiodol‐epirubicin or Lipiodol‐¹³¹I show good tumor localization, acceptable toxicity, and comparable survival benefit at 6 and 12 months with either modality. Cancer 1995; 76:2202–10.