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Title: Intra-Arterial Rhenium-188 Lipiodol in the Treatment of Inoperable Hepatocellular Carcinoma: Results of an IAEA-Sponsored Multination Study
Authors: Patricia Bernal
Jean Luc Raoul
Gaj Vidmar
Erdenechimeg Sereegotov
Felix X. Sundram
Ajay Kumar
Jae Min Jeong
Pawana Pusuwan
Chaitanya Divgi
Pat Zanzonico
Janez Stare
John Buscombe
Chau Trinh Thi Minh
Maung Maung Saw
Shaoliang Chen
Ruben Ogbac
Ajit K. Padhy
Fundacion Santa Fe de Bogota
Centre Eugene Marquis Rennes
University of Ljubljana Faculty of Medicine
Mongolian National University of Medical Sciences
Singapore General Hospital
All India Institute of Medical Sciences, New Delhi
Seoul National University Hospital
Mahidol University
Memorial Sloan-Kettering Cancer Center
University of Pennsylvania
Cho Ray Hospital
Fudan University
St. Luke’s Medical Center
International Atomic Energy Agency, Vienna
Keywords: Biochemistry, Genetics and Molecular Biology;Medicine;Physics and Astronomy
Issue Date: 1-Dec-2007
Citation: International Journal of Radiation Oncology Biology Physics. Vol.69, No.5 (2007), 1448-1455
Abstract: Purpose: Intra-arterial injections (IAI) of 131I-lipiodol is effective in treating hepatocellular carcinoma patients, but is expensive and requires a 7-day hospitalization in a radioprotection room. 188Re is inexpensive, requires no patient isolation, and can be used with lipiodol. Methods and Materials: This International Atomic Energy Agency-sponsored phase II trial aimed to assess the safety and the efficacy of a radioconjugate 188Re + lipiodol (188Re-Lip) in a large cohort of hepatocellular carcinoma patients from developing countries. A scout dose is used to determine the maximal tolerated dose (lungs <12 Gy, normal liver <30 Gy, bone marrow <1.5 Gy) and then the delivery of the calculated activity. Efficacy was assessed using response evaluation criteria in solid tumor (RECIST) and alpha-feto-protein (αFP) levels and severe adverse events were graded using the Common Toxicity Criteria of the National Cancer Institute scale v2.0. Results: The trial included 185 patients from eight countries. The procedure was feasible in all participating centers. One treatment was given to 134 patients; 42, 8, and 1 received two, three, and four injections, respectively. The injected activity during the first treatment was 100 mCi. Tolerance was excellent. We observed three complete responses and 19 partial responses (22% of evaluable patients, 95% confidence interval 16-35%); 1- and 2-year survivals were 46% and 23%. Some factors affected survival: country of origin, existence of a cirrhosis, Cancer of the Liver Italian Program score, tumor dose, absence of progression, and posttreatment decrease in αFP level. Conclusions: IAI of 188Re-Lip in developing countries is feasible, safe, cost-effective, and deserves a phase III trial. © 2007 Elsevier Inc. All rights reserved.
ISSN: 03603016
Appears in Collections:Scopus 2006-2010

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