Adjuvant Intrahepatic Injection Iodine-131-Lipiodol Improves Prognosis of Patients with Hepatocellular Carcinoma After Resection: a Meta-Analysis

Abstract

High incidence of intrahepatic recurrence is a major surgical limitation following hepatectomy of hepatocellular carcinoma (HCC). This study was intended to investigate the effects of adjuvant intrahepatic injection of iodine-131-lipiodol on disease recurrence and survival in patients with HCC who underwent resection. A computerized literature search was performed to identify relevant articles. Data synthesis was performed using Review Manager 5.0 software, and results are presented as odds ratio (OR) with 95 % confidence intervals. Two randomized controlled trials and three case-control studies with a total of 334 participants were analyzed. Iodine-131-lipiodol treatment achieved significantly lower rates of intrahepatic recurrence (OR=0.48, 95 % confidence interval (95 % CI)=0.30-0.74; P=0.001) and early recurrence (<2 year) (OR=0.45, 95 % CI=0.23-0.89; P=0.02). Likewise, iodine-131-lipiodol treatment improved both the 5-year disease-free survival and overall survival significantly (OR=1.85, 95 % CI=1.13-3.03; P=0.01; OR=2.00, 95 % CI=0.99-4.04; P=0.05, respectively). Adjuvant intrahepatic injection of iodine-131-lipiodol resulted in a preventive effect on recurrence and improved survival after resection of HCC. Further larger, multi-centred, randomized prospective trial is warranted.

Prognostic value of preoperative alpha-fetoprotein (AFP) level in patients receiving curative hepatectomy- an analysis of 1,182 patients in Hong Kong

“…Another topic which is worth further study is adjuvant therapy. It was shown in several studies (19,20) that there might be potential benefit by adjuvant therapy, such as transcatheter arterial chemoembolization, in a selected group of patients who received curative resection. In a randomized controlled trial by Zhong et al (21), it was shown that hepatectomy with adjuvant TACE was able to improve both the OS when compared with hepatectomy alone in patients with Stage IIIA disease (UICC 6 th edition).…”

2018 Korean Liver Cancer Association–National Cancer Center Korea Practice Guidelines for the Management of Hepatocellular Carcinoma

“…As the 5-year recurrence rate even after curative resection for HCC is very high at 50% to 70% (154531532), an effective adjuvant therapy is urgently required. Although many studies for adjuvant therapy after curative therapy in HCC through TACE (533), 131 I infusion via the hepatic artery (534), vitamin K 2 (535), and vitamin A analogue (536) have been performed, there is still no proven clinical significance (77). Cytotoxic systemic chemotherapy (537) and sorafenib (538) also have no clinical evidence for adjuvant therapy.…”

Hepatocellular Carcinoma: Diagnosis and Operative Management

“…A total of 334 patients were included. This study detected a statistical benefit for patients receiving I-131 lipiodol over the control group 15 . However, this drug is not approved by the FDA and is not available for use in the US and most countries.…”

“…A recent meta-analysis evaluated the results of two randomized clinical trials and three case-control studies evaluating the effects of the use of I-131 lipiodol transarterial (via hepatic artery) for tumor chemoembolization (TACE) 15 . A total of 334 patients were included.…”