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

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European Journal of Nuclear Medicine and Molecular Imaging Aims and scope Submit manuscript

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.

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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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Authors and Affiliations

  1. Nuclear Medicine Division, Ghent University Hospital, De Pintelaan 185, 9000, Gent, Belgium

    Bieke Lambert, Filip De Vos & Christophe Van de Wiele

  2. Department of Medical Physics, Ghent University, Gent, Belgium

    Klaus Bacher & Hubert Thierens

  3. Division of Interventional Radiology, Ghent University Hospital, Gent, Belgium

    Luc Defreyne

  4. Division of Gastroenterology, Ghent University Hospital, Gent, Belgium

    Hans Van Vlierberghe

  5. Department of Nuclear Medicine, Cancer Research Institute, Seoul National University College of Medicine, Seoul, Korea

    Jae Min Jeong

  6. Department of Nuclear Medicine, Beijing University, Beijing, PR China

    Rong Fu Wang

  7. Department of Respiratory Diseases, Ghent University Hospital, Gent, Belgium

    Jan van Meerbeeck

  8. Department of Radiology, Ghent University Hospital, Gent, Belgium

    Peter Smeets

  9. Division of Abdominal Surgery and Liver Transplantation, Ghent University Hospital, Gent, Belgium

    Roberto Troisi

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  1. Bieke Lambert
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  2. Klaus Bacher
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Correspondence to Bieke Lambert.

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Lambert, B., Bacher, K., Defreyne, L. et al. 188Re-HDD/lipiodol therapy for hepatocellular carcinoma: an activity escalation study. Eur J Nucl Med Mol Imaging 33, 344–352 (2006). https://doi.org/10.1007/s00259-005-1954-1

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  • DOI: https://doi.org/10.1007/s00259-005-1954-1

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