Twenty four patients with hepatocellular carcinoma who refused surgery or had unresectable tumor ranging 2.5 to 8.0 cm in size were treated with intrahepatic arterial injection of iodine-131-labeled iodized oil (I-131 Lipodol) in an attempt to achieve internal radiation of tumor. 555-2,220 MBq in 3-8 ml of I-131 Lipiodol was injected into the hepatic artery or proximal to the tumor feeding vessel depending on the tumor size. Tumor size reduction was observed in 88.9% of tumor smaller than 4.0 cm in diameter, 65.5% between 4.1 to 6.0 cm, and 25.0% of larger than 6.1cm, respectively. The tumor size reduction was corresponded to the gradual drop of serum AFP levels, decreased uptake on gallium-67 scintigraphy, and devascularization on follow-up angiography. Tumors having significant A-V shunts revealed further tumor growth. Adverse reactions from the treatment include fever, mild abdominal pain, nausea and elevation of transaminases. These have been mild and well-tolerated by the patients. This method was able to provide long term local control without complications related to thyroid, lung, GI tract and bone marrow.
Adult ; Aged ; Angiography ; Carcinoma, Hepatocellular/radionuclide imaging/*therapy ; Follow-Up Studies ; Humans ; Infusions, Intra-Arterial ; Iodine Radioisotopes/therapeutic use ; Iodized Oil/adverse effects/*therapeutic use ; Liver Neoplasms/radionuclide imaging/*therapy ; Male ; Middle Aged

OBJECTIVE: We wanted to investigate the feasibility of using FDG-PET for evaluating the antitumor effect of intraarterial administration of a hexokinase II inhibitor, 3-bromopyruvate (3-BrPA), in a rabbit VX2 liver tumor model. MATERIALS AND METHODS: VX2 carcinoma was grown in the livers of ten rabbits. Two weeks later, liver CT was performed to confirm appropriate tumor growth for the experiment. After tumor volume-matched grouping of the rabbits, transcatheter intraarterial administration of 3-BrPA was performed (1 mM and 5 mM in five animals each, respectively). FDG-PET scan was performed the day before, immediately after and a week after 3-BrPA administration. FDG uptake was semiquantified by measuring the standardized uptake value (SUV). A week after treatment, the experimental animals were sacrificed and the necrosis rates of the tumors were calculated based on the histopathology. RESULTS: The SUV of the VX2 tumors before treatment (3.87+/-1.51[mean+/-SD]) was significantly higher than that of nontumorous liver parenchyma (1.72+/-0.34) (p < 0.0001, Mann-Whitney U test). The SUV was significantly decreased immediately after 3-BrPA administration (2.05+/-1.21) (p = 0.002, Wilcoxon signed rank test). On the one-week follow up PET scan, the FDG uptake remained significantly lower (SUV 1.41+/-0.73) than that before treatment (p = 0.002), although three out of ten animals showed a slightly increasing tendency for the FDG uptake. The tumor necrosis rate ranged from 50.00% to 99.90% (85.48%+/-15.87). There was no significant correlation between the SUV or the SUV decrease rate and the tumor necrosis rate in that range. CONCLUSION: Even though FDG-PET cannot exactly reflect the tumor necrosis rate, FDG-PET is a useful modality for the early assessment of the antitumor effect of intraarterial administration of 3-BrPA in VX2 liver tumor.
Animals ; Disease Models, Animal ; Enzyme Inhibitors/*pharmacology ; Feasibility Studies ; Fluorodeoxyglucose F18 ; Infusions, Intra-Arterial ; Injections, Intra-Arterial ; Liver Neoplasms, Experimental/*drug therapy/pathology/*radionuclide imaging ; Necrosis ; *Positron-Emission Tomography ; Pyruvate Dehydrogenase Complex/antagonists & inhibitors ; Pyruvates/*pharmacology ; Rabbits ; Radiopharmaceuticals

Bone is a common site of metastasis in patients with hepatocellular carcinoma (HCC). We report a rare case of rib metastasis from HCC treated by transcatheter arterial chemoembolization (TACE). A 55-year-old man with liver cirrhosis presented with right lower chest pain. The diagnosis was an HCC with a bone metastasis in the right eighth rib. Intra-arterial injections of doxorubicin mixed with Lipiodol and Gelfoam particles were instituted through the right eighth intercostal artery. Computed tomography and a Tc99-labeled scan performed 2 months after the third TACE revealed no viable HCC in the right eighth rib.
Bone Neoplasms/radiography/secondary/*therapy ; Carcinoma, Hepatocellular/diagnosis/secondary/*therapy ; *Chemoembolization, Therapeutic ; Doxorubicin/administration & dosage ; Gelatin Sponge, Absorbable/administration & dosage ; Hepatic Artery/pathology ; Humans ; Injections, Intra-Arterial ; Iodized Oil/administration & dosage ; Liver Cirrhosis/diagnosis/pathology ; Liver Neoplasms/diagnosis/pathology/*therapy ; Male ; Middle Aged ; *Ribs/radiography/radionuclide imaging ; Tomography, X-Ray Computed