Background. Arterially administered iodized oil (Lipiodol) is selectively retained by hepatocellular carcinomas (HCCs), and has been used as a vehicle for delivery of therapeutic agents to these tumors. This study compared the efficacy of Lipiodol-targeted epirubicin chemotherapy with Lipi~dol-'~lI radiotherapy.
Methods. Ninety-five patients with unresectable HCC confined to the liver were administered either Lipiodolepirubicin emulsion (n = 69; 61 cirrhotics; Okuda tumor Stage I, 14; 11, 37; 111, 18; epirubicin dose, 75 mg/m') or Lipiodol-13'I (T) (n = 26; 18 cirrhotics; Okuda tumor Stage I, 6; 11, 19; 111, 1; dose 750-1050 MBq). The last 28 patients (17 epirubicin, 11 "'I) were treated within a prospective randomized trial. Bolus drug or isotope was injected into the hepatic artery by transfemoral cannulation. Lipiodol and 13' 1 uptake were gauged by 10th day computed tomography and 48-hour scintiscan. Treatments were repeated two-monthly when indicated.
Results. Tumor size at 2 months remained static or diminished partially in 21 of 38 epirubicin recipients (55%) and 15/22 131L recipients (68%). Actuarial survival at 6,12, and 24 months was 40%, 25%, and 6% with epirubicin, and 58%, 25%, and 0% with 1311; 30-day mortality was 11% and 15%, respectively. Comparison with historic controls indicated survival benefit in Stages I and 11.