CIO 2022-9 Evaluation of Transarterial Radioembolization With Iodine-131 Lipiodol for Hepatic Metastases

Purpose: To analyze the response and survival benefits of transarterial radioembolization (TARE) with iodine-131 Lipiodol for hepatic metastases.

Materials and Methods: This is a prospective study of 600 patients between May 2015 and December 2021 with pathologically proven hepatic metastases referred for palliative therapy with TARE. At baseline (the day of the first session of intraarterial treatment), standard laboratory data, including tumor marker levels, imaging characteristics of the liver and hepatic lesions from cross-sectional imaging (computed tomography [CT] or magnetic resonance imaging), and prior treatment history, were recorded. After the procedure, the patients were reviewed after 1 month with a follow-up positron emission tomography/CT and tumor marker levels to evaluate response of treatment.

Results: By the end of follow-up period, 84 patients died. The mean overall survival period after TARE was 34.415 ± 3.0 months. The mean durations of survival were found to be 38.88 ± 5 months in patients with neuroendocrine tumors (NETs), 35.118 ± 3.95 months in patients with gastrointestinal (GI) malignancies, 27.21 ± 8.3 months for patients with pancreaticobiliary malignancies, and 20.685 ± 5.2 months for patients with other malignancies (P = 0.17). Overall survival after 45 months was 70%. Forty-five-month survival rates in patients with NETs were 76% and 75% in GI malignancies, 57% in those with pancreaticobiliary malignancies, and 50% in those with other malignancies. Response evaluation could not be done in 27 patients because they did not undergo follow-up imaging. In the rest of the 489 patients, 266 patients showed partial responses, 155 patients showed stable disease, and 66 patients showed progressive diseases. In 222 patients with NETs, 169 patients showed partial responses, 30 patients showed stable disease, and 23 patients showed progressive diseases. In 133 patients with GI malignancies, 95 patients showed partial responses, 25 patients showed stable disease, and 13 patients showed progressive diseases. In 88 patients with pancreaticobiliary malignancies, 61 patients showed partial responses, 18 patients showed stable disease, and 9 patients showed progressive diseases. All 46 patients with other malignancies showed stable disease.

Conclusions: TARE with iodine-131 Lipiodol is highly effective in patients with hepatic metastases, especially in those with poor response to other treatments, and has shown significant survival benefit and better quality of life.