Stereotactic Body Radiation Therapy in Hepatocellular Carcinoma

Transarterial Radioembolization (TARE) with 131 Iodine-Lipiodol for Unresectable Primary Hepatocellular Carcinoma: Experience from a Tertiary Care Center in India

Purpose This article presents our experience regarding survival benefits in inoperable intermediate stage hepatocellular carcinoma (HCC) and advanced stage HCC treated with ¹³¹ I-lipiodol.

Materials and Methods This is a retrospective study of intermediate stage HCC (Barcelona Clinic Liver Cancer [BCLC] stage B) not responding to prior treatment and/or advanced stage HCC (BCLC stage C) treated with ¹³¹ I-lipiodol. ¹³¹ I-lipiodol was injected into the hepatic artery through transfemoral route. Postprocedure, the patient was isolated for 5 to 7 days. All patients underwent tumor response evaluation after 4 weeks. Survival of patients was calculated up to either death or conclusion of the study.

Results A total of 55 patients (52 males [94.5%], 3 females [5.4%]) were given intra-arterial ¹³¹ I-lipiodol therapy. The median overall survival after transarterial radioembolization (TARE) was 172 ± 47 days (95% confidence limit, 79–264 days). The overall survival at 3, 6, 9, and 12 months was 69, 47, 32, and 29%, respectively. A multivariate Cox regression analysis showed the presence of treatment prior to TARE to most significantly influence survival ( B = 2.161, p ≤ 0.001). This was followed by size of the lesion which was second in line ( B = 0.536, p = 0.034). Among 45 patients, 14 patients (31.1%) showed a partial response, 11 patients (24.4%) showed stable disease, and 20 patients (44.4%) showed progressive diseases.

Conclusion TARE with ¹³¹ I-lipiodol can be a safe and effective palliative treatment in advanced stage HCC and in patients with poor response to prior treatments like transarterial chemoembolization.