Treatment of liver cancer with Rhenium-188 Lipiodol: Colombian experience

Aim:Trans-arterial Radio-conjugate therapy plays an important role in the palliative treatment of inoperable liver cancer. It also helps in reduction of the tumor to an operable state from an inoperable one. As a part of an IAEA sponsored coordinated research project, a new radiopharmaceutical, Rhenium-188 Lipiodol has been developed. The aim of this study was to establish the safety of the radiopharmaceutical and to find out the efficacy of treatment. Materials and Methods: Eight patients suffering from various forms of liver cancer (Hepatocellular carcinoma-4, Metastases from carcinoma of colon-3 and Carcinoid- 1) were treated with Rhenium -188 Lipiodol. Seven out of the eight patients were classified as ECOG- 1 and one as ECOG- 3. Labelling of Rhenium-188 with Lipiodol was carried out according to a protocol developed under the CRP and standardized in our service. Rhenium-188 Lipiodol was administered through the trans-arterial route by either selective (75%) or ultra selective (25%) hepatic arteriography. Administered therapeutic doses ranged between 170 MBq and 4181 MBq. Dosimetric evaluations were made using the IAEA developed dosimetry spreadsheet. All patients were followed up (1-5 months, average = 2 months) after treatment by clinical examination, liver function tests, haematological examinations and CT scans of liver to determine the size of hepatic tumor. Results: Rhenium-188 Lipiodol treatment was well tolerated by all patients. No immediate systemic complications were noted in any of the patients within 72 hrs. following therapy. Only two patients had mild rise in temperature in the immediate post-therapy period, which subsided subsequently. One patient who was classified as Child B and ECOG 3, developed encephalopathy on the seventh day after treatment. He died of hepatic failure. Another one present depressive syndrome, didn't accept food and died Follow-up CT scans in all the surviving (6/8) patients revealed significant reduction of the tumours, varying from 30-75% within this short follow-up period. Best results were seen in patients with hepatocellular carcinomas, which also demonstrated excellent tumoral concentration of Re-188 Lipiodol. Differential distribution of Re-188 Lipiodol was encountered in the normal liver tissue, depending on selected arterial route of administration; selective or ultra-selective. All patients are being followed up and Results will be discussed. Conclusions: Rhenium-188 Lipiodol appears to be a promising and safe radiopharmaceutical for the treatment of liver cancer. Further studies on a large number of patients are necessary before any conclusion can be made about its efficacy