Therapy of hepatocellular carcinoma with ¹³¹I-lipiodol: patient dosimetry

Summary

Aim: Dosimetry in ¹³¹I-lipiodol therapy for hepatocellular carcinoma (HCC) in the hitherto largest existing patient cohort. Patients, methods: 38 courses of intra-arterial ¹³¹I-lipiodol therapy with a total activity up to 6.7 GBq were performed in 18 patients with HCC. Liver and tumour volume were measured by computed tomography (CT) and ¹³¹I activity by scintigraphy on day 3, 6, 14, 28 and 42 after injection. Lipiodol deposition in tumour nodules as shown by CT rendered definite attachment to scintigraphic data possible. The radiation dose in tumour nodules, liver and lungs was calculated according to the MIRD concept and the tumour dose related to pre-therapeutic tumour volume, response and survival. Results: Mean tumour dose was 23.6 ± 3.6 Gy (14.2 ± 2.1 mGy/MBq) with maximal 162 Gy (90.1 mGy/MBq) after one and 274 Gy after three courses. The dose to nontumourous liver was 1.9 ± 0.2 Gy (1.2 ± 0.1 mGy/MBq) and the mean dose ratio of tumour / nontumourous liver 11.1 ± 1.7 (max. 82). The pulmonary dose was 25.9 ± 1.8 mGy (16.3 ± 1.2 μGy/MBq) and therefore much lower. There was a reciprocal relation between tumour dose and pretherapeutic tumour volume. Tumour dose had no effect on response or survival. Conclusion: High radiation doses are particularly in small tumour nodes achievable but not necessarily related to tumour response. The dose of non-tumourous liver and lungs is much lower.

Zusammenfassung

Ziel: Dosimetrie bei Iod-131-Lipiodol-Therapie beim hepatozellulären Karzinom (HCC) am bisher größten Patientenkollektiv. Patienten, Methoden: 38 intraarterielle Therapien mit ¹³¹I-Lipiodol mit Summenaktivitäten von bis zu 6,7 GBq wurden bei 18 HCC-Patienten durchgeführt. Leber- und Tumorvolumina wurden computertomographisch, die ¹³¹I-Aktivitätsverteilung szintigrafisch an Tag 3, 6, 14, 28 und 42 nach Injektion gemessen. Die computertomografisch nachweisbare Speicherung des Lipiodols im Tumor ermöglichte die eindeutige Zuordnung der szintigrafischen Daten. Herddosen für Tumorknoten und Organdosen für Leber und Lunge wurden mit dem MIRD-Konzept ermittelt und die Tumordosis auf initiales Tumorvolumen, Response und Uberleben bezogen. Ergebnisse: Die Tumorherddosis betrug im Mittel 23,6 ± 3,6 Gy (14,2 ± 2,1 mGy/MBq) bei maximal 162 Gy (90,1 mGy/MBq) nach einer und 274 Gy nach drei Therapien. Die Organdosis im nichttumorösen Leberparenchym lag bei 1,9 ± 0,2 Gy (1,2 ± 0,1 mGy/ MBq) und der mittlere Dosisquotient aus Tumorgewebe / nicht tumorösem Leberparenchym bei 11,1 ± 1,7 (max. 82). Die Organdosis der Lunge lag mit 25,9 ± 1,8 mGy (16,3 ± 1,2 μGy/MBq) deutlich niedriger. Zwischen Tumorherddosis und Ausgangsvolumen fand sich eine reziproke Beziehung. Die Tumordosis hatte aber keinen Einfluss auf Response oder Überleben. Schlussfolgerung: Hohe Herddosen sind besonders bei kleinen Tumoren erzielbar, müssen aber nicht mit Response einhergehen. Die Organdosen für das umgebende Leberparenchym und die Lunge liegen deutlich niedriger.

Keywords

Hepatocellular carcinoma - iodine-131-lipiodol - dosimetry - liver - lung - computed tomography

Schlüsselwörter

Hepatozelluläres Karzinom - Iod-131-Lipiodol - Dosimetrie - Leber - Lunge - Computertomographie

^* Dres. Risse and Pauleit equally contributed to this manuscript.

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