188Re-HDD/lipiodol therapy for hepatocellular carcinoma: an activity escalation study

  • Bieke Lambert
  • Klaus Bacher
  • Luc Defreyne
  • Hans Van Vlierberghe
  • Jae Min Jeong
  • Rong Fu Wang
  • Jan van Meerbeeck
  • Peter Smeets
  • Roberto Troisi
  • Hubert Thierens
  • Filip De Vos
  • Christophe Van de Wiele
Original Article

Abstract

Purpose

The aim of this study was to investigate the feasibility of administering increasing activities of 188Re-4-hexadecyl-1-2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol/lipiodol (188Re-HDD/lipiodol) for the treatment of hepatocellular carcinoma (HCC) in patients with well-compensated cirrhosis.

Methods

The activity levels were increased by 1.1 GBq/step after a 6-week interval without unacceptable adverse events in at least five consecutive patients. Absorbed doses to the various organs were calculated according to the MIRD formalism, based on three gamma-scintigraphic studies. Response was assessed by means of MRI and alpha-fetoprotein (AFP) monitoring.

Results

Thirty-five treatments were carried out in 28 patients. Activities from 4.8 to 7.0 GBq 188Re-HDD/lipiodol were administered via a transfemoral catheter. The mean absorbed dose to the liver (including tumour) was 7.6±2.2, 9.8±4.9 and 15.2±4.9 Gy for the 4.8-, 5.9- and 7.0-GBq groups, respectively. Treatment was well tolerated at all activity levels. Further escalation of the administered activity was not feasible owing to limitations related to the radiolabelling procedure. Response assessment on MRI showed partial response, stable disease and disease progression in 1, 28 and 2 assessable treatments, respectively. In 8 of 17 treatment sessions with an initially elevated AFP, a reduction ranging from 19% to 97% was observed 6 weeks later.

Conclusion

Following the intra-arterial administration of 4.8–7.0 GBq 188Re-HDD/lipiodol in patients with HCC and well-compensated liver cirrhosis, no severe adverse events occurred. Further escalation was not feasible owing to limitations in the radiolabelling procedure.

Keywords

Hepatocellular carcinoma Lipiodol Rhenium-188 Radionuclide therapy HDD 

Notes

Acknowledgements

The authors would like to thank the IRE (Institut des Radio-Eléments, Fleurus, Belgium) for their technical assistance. The work was supported by a grant of the Bijzonder Onderzoeksfonds (Ghent University, No 011D9501).

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Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • Bieke Lambert
    • 1
  • Klaus Bacher
    • 2
  • Luc Defreyne
    • 3
  • Hans Van Vlierberghe
    • 4
  • Jae Min Jeong
    • 5
  • Rong Fu Wang
    • 6
  • Jan van Meerbeeck
    • 7
  • Peter Smeets
    • 8
  • Roberto Troisi
    • 9
  • Hubert Thierens
    • 2
  • Filip De Vos
    • 1
  • Christophe Van de Wiele
    • 1
  1. 1.Nuclear Medicine DivisionGhent University HospitalGentBelgium
  2. 2.Department of Medical PhysicsGhent UniversityGentBelgium
  3. 3.Division of Interventional RadiologyGhent University HospitalGentBelgium
  4. 4.Division of GastroenterologyGhent University HospitalGentBelgium
  5. 5.Department of Nuclear Medicine, Cancer Research InstituteSeoul National University College of MedicineSeoulKorea
  6. 6.Department of Nuclear MedicineBeijing UniversityBeijingPR China
  7. 7.Department of Respiratory DiseasesGhent University HospitalGentBelgium
  8. 8.Department of RadiologyGhent University HospitalGentBelgium
  9. 9.Division of Abdominal Surgery and Liver TransplantationGhent University HospitalGentBelgium

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