Prospective randomized trial of chemoembolization versus intra-arterial injection of131I-labeled-iodized oil in the treatment of hepatocellular carcinoma

Raoul, Jean-Luc; Guyader, Dominique; Bretagne, J.; Heautot, Jean François; Duvauferrier, R; Bourguet, P.; Bekhechi, D; Deugnier, Yves; Gosselin, Michel

doi:10.1002/hep.510260511

Cited by 119 publications

(55 citation statements)

References 5 publications

(6 reference statements)

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“…We also have used 131 I-Lip injections for palliative purposes for several years and have gained considerable experience in implementing this protocol and in recognizing potential adverse effects. 9,10 Considering the results obtained by Lau et al, 8 our unit's Multidisciplinary Concentration Committee for Primary Liver Cancer decided to propose postoperative 131 I-Lip adjuvant therapy as our new standard protocol for patients undergoing surgical resection of HCC. We examined the validity of this choice by analyzing 2 retrospective series of matched patients treated in our unit before and after addition of 131 I-Lip injection to our standard surgical strategy.…”

mentioning

confidence: 99%

Adjuvant intra-arterial injection of iodine-131–labeled lipiodol after resection of hepatocellular carcinoma

Boucher¹,

Corbinais²,

Rolland³

et al. 2003

Hepatology

100

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The high rate of recurrence after surgical resection of hepatocellular carcinoma (HCC) is a major therapeutic challenge. Postoperative injection of 131-iodine-labeled lipiodol ( 131 ILip) into the hepatic artery has been proposed as adjuvant treatment (Lau et al.). We analyzed 2 retrospective series of matched patients treated in our unit before and after addition of 131 I-Lip adjuvant therapy to our standard surgical strategy. Thirty-eight patients who had undergone surgical resection of HCC after January 1999 were given adjuvant intra-arterial injection of 131 I-Lip after surgery. These patients were matched with 38 other patients who had undergone surgical resection only between January 1997 and January 1999. The frequency of recurrences, disease-free rates, and overall survival rates were compared. The 2 groups were similar for clinical, biologic, or histologic parameters studied and Cancer Liver Italian Program scores. There were 15 recurrences in the group without adjuvant treatment and 9 in the group with 131 I-Lip adjuvant treatment. The 1-, 2-, and 3-year disease-free survival rates (؎95% confidence interval) were different (P < .02): 94.7% ؎ 3.6%, 83.7% ؎ 6.1%, and 68.4% ؎ 9.7%, respectively, in the 131 I-Lip group versus 73.7% ؎ 7.1%, 54.3% ؎ 8.2%, and 41.5% ؎ 10.5% in the surgery group. The 1-, 2-, and 3-year survival rates (؎95% confidence interval) also were different (P < .02): 94.7% ؎ 3.6%, 91.7% ؎ 4.6%, and 91.7% ؎ 4.6%, respectively, in the 131 I-Lip group versus 94.7% ؎ 3.6%, 71.3% ؎ 7.8%, and 49.9% ؎ 10% in the surgery group. In conclusion, this retrospective analysis supports the promising contribution of postoperative injection of 131 I-Lip after resection of HCC. A randomized study including more patients would be necessary to confirm its contribution to therapeutic management. (HEPATOLOGY 2003;38:1237-1241

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mentioning

confidence: 99%

Adjuvant intra-arterial injection of iodine-131–labeled lipiodol after resection of hepatocellular carcinoma

Boucher¹,

Corbinais²,

Rolland³

et al. 2003

Hepatology

100

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“…One RCT comparing selective iodine 131 radiation versus chemoembolization failed to show a difference in survival between the 2 groups. 13 Chemotherapy HCC is relatively resistant to antineoplastic agents. Several RCTs have assessed the role of systemic or intraarterial chemotherapy using several agents (doxorubicin, cisplatin, mitomycin, fluorouracil, and others) either alone or in combination on tumor progression and survival.…”

Section: Internal Radiation Therapymentioning

confidence: 99%

Nonsurgical treatment of hepatocellular carcinoma

2000

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“…35 The intraarterial injec-17. Shiina S, Tagawa liminary results, 36 but it requires more intensive study. …”

Section: Percutaneous Ethanol Injectionmentioning

confidence: 99%

Treatment of hepatocellular carcinoma

Bruix¹

1997

Hepatology

120

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early disease recurrence were common events. However, Treatment of Hepatocellular with newer imaging techniques (spiral computed tomography, magnetic resonance), the additional tumor nests are Carcinoma more easily identified preoperatively, and thus, a large HCC classified as solitary may indeed be solitary, and may still be suitable for successful surgery despite its size. Liver JORDI BRUIX function should be preserved, and this cannot be assessed merely by the preoperative Child-Pugh classification. Despite selecting only Child's A patients for surgery, more than half of them will develop hepatic decompensation (namely ascites) after resection, and if this does not resolve Hepatocellular carcinoma (HCC) is one of the most common within 3 months, it constitutes an indicator of poor prognomalignancies worldwide.1 In most of the cases, HCC develops sis. 7 We have recently shown that the presence of signifiin the setting of cirrhosis. Thus, cirrhotic patients constitute cant portal hypertension (hepatic venous pressure gradient the population at risk, their 5-year probability of developing ¢10 mm Hg) is the best predictor of unresolved postoperaan HCC being around 20%. [1][2][3][4] This has prompted the screen-tive hepatic decompensation, being more accurate than any ing of cirrhotic patients for HCC, which is usually performed other parameter including the indocyanine green metaboby regular ultrasound examination and a-fetoprotein deter-lism.7 Accordingly, surgical resection should be proposed mination. This policy has facilitated the detection of HCC at only in patients with extremely well-preserved liver funcan early and/or asymptomatic phase when potentially effec-tion (serum bilirubin should be normal because increased tive treatments are available. However, the lack of controlled values are associated with decompensation and poorer outtrials for most therapeutic options precludes knowing if their come) and no portal hypertension. These patients will not antitumoral effect is associated with an improved survival. present relevant functional impairment, and thus, their Frequently, the reported benefit is estimated by comparison medium and long-term survival will not be impaired by with the outcome of historical cases thought to share the surgery. Using these selection criteria, the 5-year survival same baseline status. However, it must be stressed that the exceeds 50%, there being no differences between Western prognosis of HCC patients is determined not only by the HCC and Japanese studies. [6][7][8][9] The main drawback of tumor restage, but also by the functional status of the underlying section is the high recurrence rate, which may exceed 50% liver.5 Thus, prospective trials or retrospective analysis after 5 years of follow-up. 6-9 New HCC foci may be the result should be designed to avoid a bias caused by an incomplete of dissemination from the primary tumor or may be a metabaseline evaluation, which should include prognostic vari-chronous HCC in a predisposed cirrhotic liver. Pathological ables relate...

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Prospective randomized trial of chemoembolization versus intra-arterial injection of131I-labeled-iodized oil in the treatment of hepatocellular carcinoma

Cited by 119 publications

References 5 publications

Adjuvant intra-arterial injection of iodine-131–labeled lipiodol after resection of hepatocellular carcinoma

Adjuvant intra-arterial injection of iodine-131–labeled lipiodol after resection of hepatocellular carcinoma

Nonsurgical treatment of hepatocellular carcinoma

Treatment of hepatocellular carcinoma

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