Adjuvant intraarterial injection of 131I-labeled lipiodol after resection of hepatocellular carcinoma: Progress report of a case-control study with a 5-year minimal follow-up

Abstract

Recurrences after resection of hepatocellular carcinoma are frequent. A single postoperative injection of 131I-labeled lipiodol in the hepatic artery was shown in 1999 by Lau and colleagues to be an effective adjuvant treatment, and those results were strengthened by our experience with a case-control study, reported in 2003. The goal of this paper is to update the 2003 results for a minimal follow-up of 5 y. Methods: Between January 1999 and September 2001, 38 patients were given an adjuvant postoperative intraarterial injection of 131I-lipiodol and were matched (for Okuda group and tumor size) with 38 patients who had undergone resection between January 1997 and January 1999 without postoperative treatment. The 2 groups were similar. Results: There were 28 recurrences in the control group and 22 in the 131I-lipiodol group (not statistically significant), and the mean time of recurrence was 21 and 26.5 mo, respectively, after surgery (statistically significant). The number of recurrences was lower in the first 2 y in the 131I-lipiodol group (statistically significant). Disease-free survival was better (P < 0.03) in the 131I-lipiodol group than in the control group (2-, 3-, and 5-y rates [±95% confidence interval] of 77% ± 7%, 63% ± 8%, and 42% ± 8.5%, respectively, for the 131I-lipiodol group vs. 47% ± 8%, 34% ± 8%, and 27% ± 8%, respectively, for the control group). Overall survival did not differ between the 2 groups (P = 0.09), even though there was a trend toward better survival in the 131I-lipiodol group (2-, 3-, and 5-y rates of 76% ± 7%, 68% ± 7.5%, and 51% ± 9%, respectively, vs. 68% ± 7.5%, 53% ± 8%, and 39% ± 8%, respectively, in the control group). Conclusion: With a longer follow-up, the results of this retrospective case-control study still favor a single postoperative injection of 131I-lipiodol. These retrospective findings point out the need for a large-scale, prospective, randomized study. Copyright © 2008 by the Society of Nuclear Medicine, Inc.