HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Abstract Full Text Full Text (PDF) Submit a response Alert me when this article is cited Alert me when eLetters are posted Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kumar, A. Articles by Bandopadhyaya, G. P. Search for Related Content PubMed PubMed Citation Articles by Kumar, A. Articles by Bandopadhyaya, G. P.

Inoperable Hepatocellular Carcinoma: Transarterial ¹⁸⁸Re HDD–Labeled Iodized Oil for Treatment—Prospective Multicenter Clinical Trial¹

¹ From the Departments of Nuclear Medicine (A.K., C.B., G.S.P., G.P.B.), Radiology (D.N.S., S.T., S.S.), and Biostatistics (P.C.), All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India 110029; and Departments of Nuclear Medicine (T.T.M.C., N.V.H., L.H.T., T.Q.X., N.X.C.), Radiology (H.D.L.), and Surgery (L.T.C.), Cho Ray Hospital, Ho Chi Minh City, Vietnam. Received July 25, 2005; revision requested September 28; revision received December 20; accepted January 20, 2006; final version accepted, September 14. Supported in part by the International Atomic Energy Agency. Address correspondence to D.N.S. (e-mail: drdeepsrivastava{at}rediffmail.com).

View larger version (168K): [in this window] [in a new window] [Download PPT slide]   Figure 1a: Images in 69-year-old man with two HCC lesions involving both lobes of the liver. Both lesions were completely ablated after two doses of 188Re HDD iodized oil at three monthly intervals. At the time of this writing, the patient was alive and ambulatory with normal serum AFP levels and no evidence of a mass at 3-year follow-up CT. (a) Pretherapy transverse CT scan shows two lesions (arrows): One each in segments IV (subdiaphragmatic) and VIII. (b) Angiogram shows increased vascularity in both lesions (arrows). (c) Posttreatment 188Re whole-body scan shows radiotracer accumulation in the tumors (arrows), with faint visualization of lungs and no radiotracer uptake in the thyroid, gastrointestinal tract, or anywhere else. (d) Repeat transverse CT scan obtained 3 months after the second dose shows complete disappearance of both lesions (arrows). Small radioopaque area in segment IV lesion (appearing to be enhancing HCC mass in larger arterial phase image) is actually a small amount of iodized oil, which was seen in all CT scanning phases (noncontrast, arterial, portal venous, and delayed). (e) Positron emission tomography/CT scan obtained 2 years after treatment also shows no evidence of residual or recurrent disease (arrows). Inset images show segment IV lesion.

View larger version (123K): [in this window] [in a new window] [Download PPT slide]   Figure 1b: Images in 69-year-old man with two HCC lesions involving both lobes of the liver. Both lesions were completely ablated after two doses of 188Re HDD iodized oil at three monthly intervals. At the time of this writing, the patient was alive and ambulatory with normal serum AFP levels and no evidence of a mass at 3-year follow-up CT. (a) Pretherapy transverse CT scan shows two lesions (arrows): One each in segments IV (subdiaphragmatic) and VIII. (b) Angiogram shows increased vascularity in both lesions (arrows). (c) Posttreatment 188Re whole-body scan shows radiotracer accumulation in the tumors (arrows), with faint visualization of lungs and no radiotracer uptake in the thyroid, gastrointestinal tract, or anywhere else. (d) Repeat transverse CT scan obtained 3 months after the second dose shows complete disappearance of both lesions (arrows). Small radioopaque area in segment IV lesion (appearing to be enhancing HCC mass in larger arterial phase image) is actually a small amount of iodized oil, which was seen in all CT scanning phases (noncontrast, arterial, portal venous, and delayed). (e) Positron emission tomography/CT scan obtained 2 years after treatment also shows no evidence of residual or recurrent disease (arrows). Inset images show segment IV lesion.

View larger version (183K): [in this window] [in a new window] [Download PPT slide]   Figure 1c: Images in 69-year-old man with two HCC lesions involving both lobes of the liver. Both lesions were completely ablated after two doses of 188Re HDD iodized oil at three monthly intervals. At the time of this writing, the patient was alive and ambulatory with normal serum AFP levels and no evidence of a mass at 3-year follow-up CT. (a) Pretherapy transverse CT scan shows two lesions (arrows): One each in segments IV (subdiaphragmatic) and VIII. (b) Angiogram shows increased vascularity in both lesions (arrows). (c) Posttreatment 188Re whole-body scan shows radiotracer accumulation in the tumors (arrows), with faint visualization of lungs and no radiotracer uptake in the thyroid, gastrointestinal tract, or anywhere else. (d) Repeat transverse CT scan obtained 3 months after the second dose shows complete disappearance of both lesions (arrows). Small radioopaque area in segment IV lesion (appearing to be enhancing HCC mass in larger arterial phase image) is actually a small amount of iodized oil, which was seen in all CT scanning phases (noncontrast, arterial, portal venous, and delayed). (e) Positron emission tomography/CT scan obtained 2 years after treatment also shows no evidence of residual or recurrent disease (arrows). Inset images show segment IV lesion.

View larger version (168K): [in this window] [in a new window] [Download PPT slide]   Figure 1d: Images in 69-year-old man with two HCC lesions involving both lobes of the liver. Both lesions were completely ablated after two doses of 188Re HDD iodized oil at three monthly intervals. At the time of this writing, the patient was alive and ambulatory with normal serum AFP levels and no evidence of a mass at 3-year follow-up CT. (a) Pretherapy transverse CT scan shows two lesions (arrows): One each in segments IV (subdiaphragmatic) and VIII. (b) Angiogram shows increased vascularity in both lesions (arrows). (c) Posttreatment 188Re whole-body scan shows radiotracer accumulation in the tumors (arrows), with faint visualization of lungs and no radiotracer uptake in the thyroid, gastrointestinal tract, or anywhere else. (d) Repeat transverse CT scan obtained 3 months after the second dose shows complete disappearance of both lesions (arrows). Small radioopaque area in segment IV lesion (appearing to be enhancing HCC mass in larger arterial phase image) is actually a small amount of iodized oil, which was seen in all CT scanning phases (noncontrast, arterial, portal venous, and delayed). (e) Positron emission tomography/CT scan obtained 2 years after treatment also shows no evidence of residual or recurrent disease (arrows). Inset images show segment IV lesion.

View larger version (124K): [in this window] [in a new window] [Download PPT slide]   Figure 1e: Images in 69-year-old man with two HCC lesions involving both lobes of the liver. Both lesions were completely ablated after two doses of 188Re HDD iodized oil at three monthly intervals. At the time of this writing, the patient was alive and ambulatory with normal serum AFP levels and no evidence of a mass at 3-year follow-up CT. (a) Pretherapy transverse CT scan shows two lesions (arrows): One each in segments IV (subdiaphragmatic) and VIII. (b) Angiogram shows increased vascularity in both lesions (arrows). (c) Posttreatment 188Re whole-body scan shows radiotracer accumulation in the tumors (arrows), with faint visualization of lungs and no radiotracer uptake in the thyroid, gastrointestinal tract, or anywhere else. (d) Repeat transverse CT scan obtained 3 months after the second dose shows complete disappearance of both lesions (arrows). Small radioopaque area in segment IV lesion (appearing to be enhancing HCC mass in larger arterial phase image) is actually a small amount of iodized oil, which was seen in all CT scanning phases (noncontrast, arterial, portal venous, and delayed). (e) Positron emission tomography/CT scan obtained 2 years after treatment also shows no evidence of residual or recurrent disease (arrows). Inset images show segment IV lesion.

View larger version (117K): [in this window] [in a new window] [Download PPT slide]   Figure 2a: Images in 55-year-old man with large biopsy-proved inoperable HCC in right lobe of liver. There was an approximately 85% reduction in tumor size with necrosis and fibrosis after one dose of 188Re HDD iodized oil. The serum AFP level also decreased to 249 from 55 582 ng/mL. At the time of this writing, the patient was alive and fully ambulatory. (a) Transverse CT scan shows large mass in right lobe of liver. (b) Angiogram in same patient. (c) Posttreatment 188Re whole-body scan shows good radiotracer accumulation in tumor, with faint visualization of lungs and liver. (d) Transverse CT scan obtained 6 months after treatment shows approximately 85% reduction in tumor size with necrosis and fibrosis. Also seen is iodized oil in the shrunken lesion.

View larger version (169K): [in this window] [in a new window] [Download PPT slide]   Figure 2b: Images in 55-year-old man with large biopsy-proved inoperable HCC in right lobe of liver. There was an approximately 85% reduction in tumor size with necrosis and fibrosis after one dose of 188Re HDD iodized oil. The serum AFP level also decreased to 249 from 55 582 ng/mL. At the time of this writing, the patient was alive and fully ambulatory. (a) Transverse CT scan shows large mass in right lobe of liver. (b) Angiogram in same patient. (c) Posttreatment 188Re whole-body scan shows good radiotracer accumulation in tumor, with faint visualization of lungs and liver. (d) Transverse CT scan obtained 6 months after treatment shows approximately 85% reduction in tumor size with necrosis and fibrosis. Also seen is iodized oil in the shrunken lesion.

View larger version (148K): [in this window] [in a new window] [Download PPT slide]   Figure 2c: Images in 55-year-old man with large biopsy-proved inoperable HCC in right lobe of liver. There was an approximately 85% reduction in tumor size with necrosis and fibrosis after one dose of 188Re HDD iodized oil. The serum AFP level also decreased to 249 from 55 582 ng/mL. At the time of this writing, the patient was alive and fully ambulatory. (a) Transverse CT scan shows large mass in right lobe of liver. (b) Angiogram in same patient. (c) Posttreatment 188Re whole-body scan shows good radiotracer accumulation in tumor, with faint visualization of lungs and liver. (d) Transverse CT scan obtained 6 months after treatment shows approximately 85% reduction in tumor size with necrosis and fibrosis. Also seen is iodized oil in the shrunken lesion.

View larger version (111K): [in this window] [in a new window] [Download PPT slide]   Figure 2d: Images in 55-year-old man with large biopsy-proved inoperable HCC in right lobe of liver. There was an approximately 85% reduction in tumor size with necrosis and fibrosis after one dose of 188Re HDD iodized oil. The serum AFP level also decreased to 249 from 55 582 ng/mL. At the time of this writing, the patient was alive and fully ambulatory. (a) Transverse CT scan shows large mass in right lobe of liver. (b) Angiogram in same patient. (c) Posttreatment 188Re whole-body scan shows good radiotracer accumulation in tumor, with faint visualization of lungs and liver. (d) Transverse CT scan obtained 6 months after treatment shows approximately 85% reduction in tumor size with necrosis and fibrosis. Also seen is iodized oil in the shrunken lesion.

View larger version (12K): [in this window] [in a new window] [Download PPT slide]   Figure 3: Kaplan-Meier survival curve (with log-rank test) shows significant difference in survival among different categories of tumor response (median survival for patients with objective response, stable disease, and progression, respectively, was 980 days [solid line], 356 days [dotted line], and 116 days [dashed line]).

View larger version (11K): [in this window] [in a new window] [Download PPT slide]   Figure 4: Kaplan-Meier survival curve (with log-rank test) shows significant difference in survival among different categories of AFP response (median survival for patients with objective response, stable disease, and progression, respectively, was 980 days [solid line], 336 days [dotted line], and 118 days [dashed line]).

View larger version (9K): [in this window] [in a new window] [Download PPT slide]   Figure 5: Kaplan-Meier survival curve shows overall survival in all patients (median survival, 356 days).

View larger version (14K): [in this window] [in a new window] [Download PPT slide]   Figure 6: Graph shows relationship between RAD to tumor and survival time.