Adjuvant intra-arterial lipiodol-iodine-131 for resectable hepatocellular carcinoma: a prospective randomised trial

W Y Lau, T W T Leung, S K W Ho, M Chan, D Machin, J Lau etc

Summary

Background Resection of hepatocellular carcinoma is potentially curative, but local recurrence is common. In this prospective randomised trial, we aimed to find out if one dose of postoperative adjuvant intra-arterial iodine131-labelled lipiodol could reduce the rate of local recurrence and increase disease-free and overall survival.

Methods Patients who underwent curative resection for hepatocellular carcinoma and recovered within 6 weeks were randomly assigned one 1850 MBq dose of 131 I-lipiodol or no further treatment (controls). We compared rates of recurrence and disease-free and overall survival (the primary endpoints) between the two groups by intention to treat. We planned an interim analysis when 30 patients (both groups together) had been followed up for a median of 2 years, with the intention of stopping early if the between-group difference in disease-free survival was significant (p=0·029) .

Findings Between April, 1992, and August, 1997, we recruited 43 patients: 21 received intra-arterial 131I-lipiodol and 22 received no adjuvant treatment. During a median follow-up of 34·6 (range 14·1–69·7) months, there were six (28·5%) recurrences among the 21 patients in the adjuvant treatment, compared with 13 (59%) in the controls (p=0·04) . Median disease-free survival in the treatment and control groups was 57·2 (0·4–69·7) and 13·6 (2·1–68·3) months, respectively (p=0·037). 3-year overall survival in the treatment and control groups was 86·4% and 46·3%, respectively (p=0·039). The interim analysis showed a significant increase in disease-free survival in the treatment group compared with the controls (p=0·01), so we closed the trial early. 131I-lipiodol had no significant toxic effects.

Interpretation In patients with hepatocellular carcinoma, one 1850 MBq dose of intra-arterial 131I-lipiodol given after curative resection significantly decreases the rate of recurrence and increases disease-free and overall survival.

Abstract: http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(98)06475-7/abstract