Staging in local endometrial carcinoma. Assessment of magnetic resonance and ultrasound examinations

Possible deep (more than an inner third of the uterine wall) myometrial invasion and cervical extension of endometrial carcinoma were evaluated prospectively using magnetic resonance (MR) and transabdominal real-time sonography (US) in 20 and 10 patients, respectively. The data obtained from these examinations were compared with hysterosalpingography (HSG) and clinical modalities including hysteroscopy, sounding and histopathologic findings after surgery. The concordance of outlining cervical extension was between MR and hysteroscopy 85 per cent, and between US and hysteroscopy 50 per cent. Deep myometrial tumor invasion was suggested in 4/10 patients by US and in 6/20 by MR, and was confirmed in all but one in each group at histologic examination of the resected uterus. There were no false negative US or MR examinations. Transabdominal US did not prove accurate in defining local endometrial carcinoma (distinguishing between stages I and II), but it may be used as an additional tool in revealing myometrial invasion. MR, however, seems to refine the delineation of uterine tumor growth.     

Report on treatment of cancer of the ovary.

A malignant ovarian tumour has been diagnosed in 373 patients referred to the R.R.T.I. from January 1966 to Jun 1972. Serious ovarian carcinoma was the commonest type and occurred in 254 patients. The results in these patients are studied in detail after staging according to F.I.G.O. recommendations. Following surgery and postoperative radiotherapy, chemotherapy was started immediately in all patients with progressive disease and after randomization also in 50 per cent of the others. The three-year survival rate in Stage II patients tended to be more favourable following irridation ofthe pelvis and lumboaortic nodes (55 per cent ) than following radiotherapy restricted to the pelvic area (40 per cent). The dose should be 5-6 krad. The five-year survival was 68 per cent for Stage I, 26 per cent for Stage II and nearly zero for Stages III and IV, as well as for patients referred for treatment of a recurrence. In spite of whole-abdomen irradiation 50 per cent of the patients in the latter three groups were deceased within eight months; therefore chemotherapy should be preferred. The main problem in ovarian cancer is late diagnosis. Evaluation of results is difficult because numerous variable factors concerning pathology and treatment make it necessary to sub-divide the patients into groups too small for statistically reliable conclusions. Each treatment factor should be studied by a group of hospitals.     

Intra-arterial high-dose chemotherapy with cisplatin as part of a palliative treatment concept in oral cancer

BACKGROUND AND PURPOSE: Patients with cancer of the oral cavity often present with advanced tumor stages, distant metastasis, or severe comorbidities, which render radical surgery unfeasible. The purpose of this study was to investigate the response rate, technical feasibility, and safety of intra-arterial (IA) chemotherapy as palliative treatment in this situation. METHODS: From November 1997 to December 2003, 64 patients with histologically proven oral squamous cell carcinoma, classified as inoperable, received IA high-dose chemotherapy with cisplatin as a palliative treatment at our institution. To minimize toxic side effects, sodium thiosulfate was given intravenously. Twenty-eight percent of the patients were female; average age was 61.5 years. Clinical staging of primary tumors was TNM (tumor, nodules, metastases) stage IV in 89%, stage III in 6.3% and stage II in 4.7%. After local chemotherapy, additional radiation of the tumor area or radiochemotherapy was performed in 33 patients. RESULTS: There were no major catheter-related complications or severe side effects of IA chemotherapy. After the first cycle, 10% percent of the patients had complete remission (CR), 35% had partial response (PR), and 43.3% presented with stable disease. Mean follow-up interval was 11 +/- 12.9 months. Forty-five patients died after a mean period of 7.6 +/- 7.0 months (median, 5.1 months). The overall 1- and 2-year survival rates were 29.5% and 18%, respectively. There was a trend toward longer survival in patients who received subsequent radiation or radiochemotherapy after IA chemotherapy. CONCLUSION: IA chemotherapy in patients with inoperable carcinoma of the oral cavity as palliative treatment was technically feasible and safe. The overall response rate after IA chemotherapy was 45% (CR 10%; PR 35%). Side effects could be minimized by neutralizing the cytotoxic agent by sodium thiosulfate.     

Early changes in [18F]FLT uptake after chemotherapy: an experimental study

This study evaluated the use of 3'-deoxy-3'-[(18)F]fluorothymidine ([(18)F]FLT) for monitoring of the early effects of anticancer chemotherapy on tumour cell proliferation. Cells derived from human oesophageal squamous cell carcinoma (OSC-1) were grown for 2 days and incubated with cisplatin (CDDP), 5-fluorouracil (5-FU), methotrexate (MTX) or gemcitabine (GEM) for 4 h. Cultures were incubated with drug doses (CDDP: 0.67, 6.7, 67 micro M; 5-FU 15.4, 154, 1,540 micro M; MTX: 4.4, 44, 440 micro M; GEM: 0.0067, 0.067, 0.67 micro M) corresponding to approximately 10%-95% proliferation inhibition (MTX: 10%-75%). Treatment was stopped and cells were allowed to recover for 4, 24 or 72 h. [(18)F]FLT was added for 10-180 min. Control cultures were incubated with [(18)F]fluorodeoxyglucose (FDG). Cell counts, viability, clonogenic activity and cell cycle distribution estimated by flow cytometry were used to evaluate the cytotoxic effects of chemotherapy. Strikingly, FLT uptake per 10(5) viable cells was increased seven- to tenfold 24 h after treatment with 5-FU or MTX irrespective of dose. Thus, total FLT uptake per tissue culture exceeded that of controls despite a considerable decrease in overall cell counts due to cytostasis up to 72 h after treatment. 5-FU-treated cells showed accumulation in early S phase (overall S phase: 88% vs 42%). GEM treatment resulted in a more moderate increase in total FLT accumulation, to a maximum of fivefold at the dose close to the IC(50). In contrast, FLT accumulation was significantly reduced at cytostatic concentrations of CDDP and was still decreasing in a dose-related manner at 72 h despite considerable S phase arrest. With 5-FU or CDDP, the uptake of FDG did not differ significantly from control values 24 h after treatment. These findings demonstrate that tumour cell uptake of FLT - in contrast to that of FDG - reveals specific changes depending on the cytostatic drug used for treatment. The antimetabolites 5-FU and MTX massively increase FLT accumulation per cell independent of dose, i.e. cytotoxicity. Early after treatment, this increase is not predictive of proliferation inhibition but reflects activated salvage pathway of DNA synthesis. By contrast, CDDP results in an early decline in FLT but not in FDG uptake. This drug-specific modulation of FLT uptake has to be taken into account in positron emission tomography studies using FLT for treatment monitoring.     

双路动脉化疗治疗头颈部鳞状细胞癌

目的总结动脉直接灌注大剂量化疗药物顺铂,同时静脉注射硫代硫酸钠进行中和的双路动脉化疗治疗头颈部鳞状细胞癌的临床经验。方法头颈部鳞状细胞癌患者16例,采用股动脉径路进入病变的供血动脉,以供血动脉的血流速度为灌注速度,按150mg/m2的顺铂每周进行1次动脉灌注,4～6次为一疗程。静脉同时予以注射硫代硫酸钠进行解毒。结果头颈部鳞状细胞癌常有明确的血供,表现为病变局部的异常血管团着色。该组晚期头颈部鳞状细胞癌患者中,动脉化疗近期有效率100%,表现为肿瘤在化疗后当日或第2日疼痛和肿胀感缓解,口、鼻腔内出现分泌物或坏死组织脱落。在可随访的病例中,CR4例,PR8例,NR1例。结论双路动脉化疗是治疗头颈部鳞状细胞癌的有效手段之一,可以作为手术治疗的重要补充。     

Complications of arterial infusion of CDDP in the treatment of malignant neoplasms]

Arterial infusion of cis-diamminedichloroplatinum (CDDP) is an effective therapy for malignant neoplasms. Severe complications after this therapy in 298 patients with malignant tumors were reviewed in our institute from March 1982 to August 1989. Arteries infused with CDDP and the number of infusions were as follows: bronchial artery (a.) 277, hepatic a. 153, internal iliac a. 51, femoral or popliteal a. 15, lumbar a. 6, pulmonary a. 5, esophageal a. 3 and intercostal a. 3. Eight cases of severe complications were encountered: 3 of esophageal ulcer, 3 of spinal paralysis, and one each of mediastinitis and toe necrosis. The arteries responsible for complications were the bronchial a. in 3 cases of esophageal ulcer and 2 of spinal paralysis, intercostal a. in one of spinal paralysis, esophageal a. in one of mediastinitis and popliteal a. in toe necrosis. Complication rates were 2.7% (8/298 cases) and 1.5% (8/518 infusions). Angiotensin II was infused in 6 of 8 of the cases with complications. The complication rate was 2.9% (6/209 infusions) in the group with CDDP and angiotensin II and 0.6% (2/309 infusions) in the group with CDDP only. Arterial infusion of CDDP, especially combined with angiotensin II, should be done in consideration of the arteries responsible for such complications.     

An organ-preserving selective arterial chemotherapy strategy for head and neck cancer.

PURPOSESquamous cancer of the upper aerodigestive tract is a disheartening disease. Despite our best efforts, the long-term survival rate remains only 15% to 40%, and surgical cures often decrease the quality of life owing to the loss of swallowing and speech organs. A better understanding of tumor dynamics and the discovery that thiosulfate can neutralize cisplatin led us to develop a treatment plan that combines a rapid superselective high-dose intraarterial delivery of cisplatin (CDDP), simultaneous intravenous infusion of its antagonist, thiosulfate, and radiation therapy.METHODSPatients with advanced head and neck squamous cancer were entered into the protocol after a multidisciplinary evaluation that included CT or MR imaging. Forty-two patients constituted the first cohort. After baseline angiography, an arterial acceptance test determined the maximum infusion rate that the tumor''s nutrient artery would accept. CDDP was then infused at that rate, usually within 3 to 5 minutes, while the antagonist thiosulfate was given intravenously. In the second cohort of 85 patients with stage 3 or 4 previously untreated and unresectable disease, local radiation was added to the treatment plan. The radiation dose (180-200 cGy/d x 35) was delivered regionally on the basis of the known radiosensitizing effect of CDDP.RESULTSCohort 1 allowed us to develop the infusion technique and to establish a dose quantity and delivery frequency. When 150 mg/m2 was administered weekly for 4 weeks, no severe toxicity was found. In cohort 2, 72 (92%) of the remaining 78 patients had complete disappearance of their tumor. Seventeen severe toxic events were associated with 323 femoral catheterizations. One patient died of pulmonary embolus, precluding follow-up evaluation. Six patients had neurologic sequelae, three with transient and three with permanent strokes.CONCLUSIONRapid superselective chemotherapy with CDDP combined with a circulatory systemic antagonist allowed delivery of an antitumoral drug directly into the lesion while protecting the kidneys and bone marrow from the agent''s systemic effects. Use of a dose regimen of 150 mg CDDP/m2 per week for 4 weeks resulted in the disappearance of a large percentage of advanced squamous cancers.     

Transarterial internal radiation therapy with I-131 lipiodol for multifoca hepatocellular carcinoma: Immediate and long-term results

Transarterial internal radiation with I-131 Lipiodol (TAIR) was performed in 21 patients with multifocal hepatic carcinoma. Eight patients were treated by TAIR alone and 13 by combination of TAIR and intraarterial infusion ofcis-diamminedichloroplatinum (CDDP) and/or adriamycin mitomycin C oil suspension (ADMOS). TAIR was found effective immediately and long-term. Serum α-fetoprotein (AFP) levels dropped to 50% or less in 7 of 14 patients. Eleven of 21 patients (52%) showed 50% or greater decrease in tumor size. The overall 1-year survival rate was 43% and 67% in patients who received 50 Gy or greater tumor dose. Lipiodol distribution pattern of the tumor indicated some difference in the prognosis between the scattered pattern and solid pattern. The solid pattern showed a statistically significant better survival rate. Patients treated with TAIR alone versus those treated with TAIR and chemotherapy showed no difference in their survival rate.     

18-FDG PET/CT在肝癌治疗后AFP升高患者中的应用

目的 探讨18F-脱氧葡萄糖(FDG)PET/CT检测肝癌治疗后甲胎蛋白(AFP)升高患者肿瘤复发和(或)转移病灶的价值.方法 原发性肝细胞癌治疗后血清AFP升高患者123例,皆行全身18F-FDG PET/CT显像.所有图像经图像融合后,进行PET/CT融合图像、PET图像和CT图像帧对帧对比分析.肿瘤复发和(或)转移病灶根据病理检查结果、多种影像学诊断及临床随访而确诊.随访时间均>6个月.采用SPSS 11.5软件进行统计学处理,进行X2检验.结果 123例患者中,明确诊断肿瘤复发和(或)转移者111例.18F-FDG PET显像诊断肿瘤复发和(或)转移78例,其灵敏度为70.3%(78/111);18F.FDG PET/CT显像诊断肿瘤复发和(或)转移97例,灵敏度提高至87.4%(97/111,χ2=9.744,P=0.002).18F.FDG PET/CT诊断肝癌复发和转移的特异性、准确性、阳性预测值和阴性预测值分别为83.3%(10/12)、87.0%(107/123)、98.0%(97/99)和41.7%(10/24).9例高分化肝细胞癌患者均确诊为肿瘤复发和(或)转移,18F-FDG PET/CT显像诊断其肿瘤复发和(或)转移5例,灵敏度(5/9)明显低于总体灵敏度(87.4%;χ2=6.616,P=0.01).结论 18F-FDG PET/CT显像在检测原发性肝癌治疗后AFP升高患者肿瘤复发和(或)转移病灶中有较好的应用价值,但高分化肝细胞癌可能出现假阴性.     

Transcatheter arterial chemotherapy using doxorubicin, iodized oil and Gelfoam embolization in hepatocellular carcinoma

Computed tomography (CT) was performed in 54 patients with hepatocellular carcinoma three weeks after transcatheter arterial chemotherapy using iodized oil and doxorubicin with or without gelfoam embolization. Patients with iodized oil retention in the tumor greater than 50 per cent of tumor size survived longer than patients with retention of less than 50 per cent. Differences were also found within Okuda stages I and II, but they were significant only in Okuda stage I (p less than 0.0001). These results suggest a possible relationship between iodized oil retention and survival. In addition to Okuda stage, several factors affected iodized oil retention: tumor vascularity, tumor size, portal thrombosis and Gelfoam embolization. These factors may thus influence the prognosis after transcatheter arterial chemotherapy.     

Long-term prognosis of patients undergoing transcatheter arterial chemoembolization for unresectable hepatocellular carcinoma: comparison of cisplatin lipiodol suspension and doxorubicin hydrochloride emulsion.

PURPOSE: To evaluate long-term prognosis of transcatheter arterial chemoembolization (TACE) with use of cisplatin (CDDP) lipiodol (LPD) suspension (CDDP/LPD) compared with that with use of doxorubicin hydrochloride (ADM) LPD emulsion (ADM/LPD) in patients with unresectable hepatocellular carcinoma (HCC). MATERIALS AND METHODS: One hundred eight patients were treated with use of CDDP/LPD and 26 were treated with use of ADM/LPD. Survival rates and frequency of side effects and complications in the CDDP/LPD group were compared with those in the ADM/LPD group. RESULTS: CDDP/LPD was given at a dose of 15-70 mg (mean dose, 41 mg), whereas ADM/LPD was given at a dose of 20-100 mg (mean dose, 57 mg) throughout the study period. The survival rates in the CDDP/LPD group were 81% at 1 year, 41% at 3 years, 19% at 5 years, and 13% at 7 years, whereas those in the ADM/LPD group were 67% at 1 year, 18% at 3 years, and 0% at 5 years. The CDDP/LPD group showed significantly better survival than the ADM/LPD group (P <.05). In the CDDP/LPD group, there was a significant prolongation of survival in patients with monofocal HCC (P <.05) and patients with HCC assessed as an almost complete LPD accumulation (P <.05). There were no significant differences in survival rates in the ADM/LPD group according to tumor size and number of tumors. Hepatic failure was observed in 8% of all procedures and was not different between the two therapeutic groups. Renal dysfunction was observed in 2% of all treatments involving CDDP/LPD, and it resolved spontaneously with appropriate medications. CONCLUSIONS: TACE with use of low-dose CDDP was efficacious for unresectable HCC and had few complications. TACE with use of CDDP may contribute to prolongation of the life span of patients with HCC versus TACE with use of ADM.     

Thermography of the female breast: a five-year study in relation to the detection and prognosis of cancer.

More than 12,000 women have been examined thermographically in the Breast Unit of the Royal Marsden Hospital, London. Of these women 1,464 had biopsy and histology; 363(25 per cent) were found to have carcinoma and of these 68 per cent had abnormal thermograms, 13 per cent has some thermal asymmetry of doubtful significance and 19 per cent had normal thermal patterns. Fifty-seven per cent and 62 per cent of patients with Stage I and Stage II cancer, respectively, had abnormal thermograms whereas 83 per cent of patients with Stage III cancer had abnormal thermograms. Of 1,101 women who had benign lesions, 63 per cent had normal thermal patterns, 15 per cent had thermal asymmetry of doubtful significance and 22 per cent had abnormal thermograms. The subsequent histories of 172 cancer patients examined thermographically have been analysed and three-year survival rates have been correlated with thermography report, the clinical stage of the disease and the histotogical grade (Bloom, 1950) of the excised tumour. The mean three-year survival rates for patients with Stage II or Stage III cancer are 84 per cent for those with normal and 61 per cent for those with abnormal thermograms.     

Concurrent chemoradiotherapy using protracted infusion of low-dose CDDP and 5-FU and radiotherapy for esophageal cancer]

PURPOSE: We evaluated the effects and safety of concurrent chemoradiotherapy for patients with esophageal cancer. MATERIALS AND METHODS: Between March 1994 and April 1998, concurrent chemoradiotherapy using protracted infusion of low-dose cisplatin (CDDP: 3-6 mg/m2/24h), 5-fluorouracil (5-FU: 200 mg/m2/24h) and radiotherapy was given to 26 patients. The median age was 70 yr, with a range from 58 to 86 yr. With regard to TNM classification (1987), six patients were stage II, five stage III, and 15 stage IV. Radiotherapy was performed by external irradiation alone in 23 patients and external irradiation plus brachytherapy in three patients. One patient underwent surgery after a dose of 40 Gy owing to the possibility of idiopathic bleeding from the stomach. RESULTS: Locally, primary effects resulted in complete response in 11 patients (42.3%) and partial response in 15 (57.7%). Acute toxicity was primarily hematologic. Leukopenia and thrombocytopenia of grade 3 or 4 occurred in eight (30.7%) and six (23.0%) of 26 patients, respectively. In patients administered CDDP at more than 5 mg/m2/day, hemotoxicity was severe because in five of the 10 patients administered 5 mg/m2 CDDP and one of the two patients administered 6 mg/m2 CDDP, thrombocytopenia of grade 3 or 4 occurred. CONCLUSION: Protracted infusion of low-dose CDDP and 5-FU with concomitant radiation therapy is effective, but from the point of acute toxicity, the optimal dose of CDDP and 5-FU needs further investigation.     

Efficiency of postoperative radiation in carcinoma of the breast. A comparison between two methods.

The results of simple mastectomy and postoperative irradiation of the chest wall and the regional lymph nodes in a series of 256 patients with primary carcinoma of the breast (between 1970 and 1972) were compared with those in a series of 155 patients (from 1963 to 1965) treated with radical mastectomy and postoperative irradiation of the regional lymph nodes. A statistically significant difference (p less than 0.01) was found between the chest wall recurrences in the group of patients with irradiation of the chest wall and the group without. No evidence indicates that routine postoperative irradiation should be harmful. Distant metastases in the 1970--1972 group were less frequent (13%) than in the 1963--1965 group (29%)9 The age-corrected 4-year survival rates for stages I and II were 83 per cent for the 1970--1972 group and 78 for the 1963--1965 group. The age-corrected 10-year survival rates for states I and II were 60 per cent.     

The influence of pelvic lymph node disease on survival for stage I and II carcinoma of the cervix

Two hundred and eighteen patients were referred to the Oxford Radiotherapy Department in the 5 years 1973-77 with stages I and II tumours of the uterine cervix. One hundred and eighty-one underwent pre-operative intracavitary radiotherapy followed by Wertheim hysterectomy and pelvic lymphadenectomy. Twenty-three per cent of these patients had metastatic disease in pelvic lymph nodes. Fifty-five per cent of patients with positive pelvic nodes died of carcinoma of the cervix compared with 9% of negative node cases. Prognostic factors are discussed and management of carcinoma of the cervix reviewed.     

Chemoembolization of hepatocellular carcinoma with cisplatin, doxorubicin, mitomycin-C, ethiodol, and polyvinyl alcohol: prospective evaluation of response and survival in a U.S. population.

PURPOSE: To evaluate response and survival after hepatic chemoembolization with cisplatin, doxorubicin, mitomycin-C, Ethiodol, and polyvinyl alcohol in a U.S. population of patients with hepatocellular carcinoma. MATERIALS AND METHODS: Thirty-eight consecutive patients were treated: 35% stage I, 62% stage II, 3% stage III. Fifty-one percent had cirrhosis. Chemoembolization was performed at approximately monthly intervals for one to seven sessions (mean, 2.2). Pretreatment and posttreatment cross-sectional imaging and alpha-fetoprotein (AFP) levels were obtained prospectively 1 month after treatment and then every 3 months. Thirty-day response was calculated by means of the the World Health Organization/Eastern Cooperative Oncology Group criteria. RESULTS: One patient was lost to follow-up. In seven patients, lesions became resectable after chemoembolization. Among 13 evaluable patients with initially elevated AFP level, 70% had a partial biologic response (>50% decrease in AFP), 15% had a minor response (25-50% decrease), and the remaining 15% remained stable. Among 25 patients evaluable for morphologic response, 36% had a partial response, 32% had a minor response, and 32% remained stable. No patients had progression of disease while receiving therapy. The cumulative survival was 60% at 1 year, 41% at 2 years, and 16% at 3 years. Two patients developed progressive hepatic failure. Thirty-day mortality was 3% (one patient). CONCLUSION: These results compare favorably to published response and survival data for chemoembolization of advanced hepatocellular carcinoma from Asia and Europe.     

Lymphography in carcinoma of the uterine cervix.

Lymphography was carried out in a series of 158 patients with carcinoma of the uterine cervix. The diagnostic accuracy rate of 85 per cent compares favourably with the results of a similar investigation made ten years ago. Positive lymphography does not alter the survival rate in clinical stages I and II, probably due to the more accurate and selective therapeutic approach induced by lymphography. In stage III the 2-year survival rate of patients with negative findings is 58 per cent compared to only 17 per cent in case of positive lymphographic findings.     

Intraarterial chemotherapy for uterine cervical adenocarcinoma: evaluation of its efficacy as neoadjuvant therapy

We performed preoperative intraarterial chemotherapy in twenty cases of uterine cervical adenocarcinoma (stage Ib: 2, II: 15, III: 3) and evaluated the efficacy of this therapy. The dosages used were 75-120 mg of CDDP, 10-20 mg of MMC and 30-60 mg of EPIR. These drugs were administered by intraarterial one-shot infusion twice every three weeks. In five cases, complete response (CR) of the primary lesion was confirmed by histologic examination. There were no cases of CR inpatients with well differentiated adenocarcinoma. Stage reduction was achieved in all cases except three. In all but one case, more than 50% volume reduction was recognized on MR images. These results were not significantly different from those in cases of uterine cervical squamous cell carcinoma in which we performed this therapy. Therefore, we concluded that intraarterial chemotherapy is highly effective and should be carried out as neoadjuvant therapy for advanced uterine cervical adenocarcinoma.     

Radiographic diagnosis of bile duct cysts. Retrospective analysis of thirteen cases

Twelve patients and a foetus with congenital bile duct cysts suggested in the majority of cases at routine upper abdominal sonography were examined by two or more of the following investigations: ultrasonography (10 patients), computed tomography (5 patients), CT-cholangiography (2 patients), oral cholecystography (7 patients), intravenous cholangiography (4 patients), endoscopic retrograde cholangiopancreatography (ERCP) (6 patients) and cholescintigraphy (2 patients). The sensitivity of each investigation for the diagnosis of bile duct cysts was: ultrasound 40 per cent, computed tomography 20 per cent, CT-cholangiography 100 per cent, oral cholecystography 17 per cent, intravenous cholangiography 75 per cent, ERCP 83 per cent and cholescintigraphy 50 per cent. When a bile duct cyst has been suggested by ultrasonography or other examinations, without a conclusive diagnosis being made, CT-cholangiography is recommended as the next examination. In patients with impaired biliary excretion of contrast medium, ERCP may be required to achieve the diagnosis.     

Inoperable hepatocellular carcinoma: transarterial 188Re HDD-labeled iodized oil for treatment--prospective multicenter clinical trial

PURPOSE: To prospectively evaluate, in a multicenter clinical trial, dosimetry-guided transarterial radionuclide therapy (TART) with rhenium 188 ((188)Re) 4-hexadecyl 1,2,9,9-tetramethyl-4,7-diaza-1,10-decanethiol (HDD)-labeled iodized oil in inoperable hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Ninety-three patients were recruited from 2000 to 2005 for this ethics committee-approved study. Informed written consent was obtained. After complete clinical evaluation (including assessment of liver status, serum alpha-fetoprotein [AFP] level, tumor size, portal vein status, Child-Pugh classification, Okuda staging), radiation absorbed dose (RAD) to various organs, including tumor, was calculated after injecting 185 MBq of (188)Re HDD iodized oil via the hepatic artery. From this value, the maximum tolerable activity of (188)Re, defined as the amount of radioactivity delivering no more than 12 Gy of RAD to lungs, 30 Gy to normal liver, or 1.5 Gy to bone marrow, was calculated and injected. RESULTS: Mean patient age was 53 years (80 men and 13 women). Sixty-eight percent of patients had serologic evidence of hepatitis B and/or C; 40% had clinicoradiologic evidence of cirrhosis. Mean tumor diameter was 10.3 cm +/- 4.4, with 40% of patients having more than three lesions; in 50% of patients, tumor was either unilateral, occupying 50% or more of the liver, or bilateral. AFP was elevated in 68% of patients and was elevated to more than 300 ng/mL in 44% of patients. There was portal vein thrombosis in 38% of patients, Child-Pugh status B disease in 37% of patients, and Okuda stage II or III disease in 50% of patients. Mean first administered activity was 5.3 GBq +/- 1.6, which delivered 88 Gy of RAD to the tumor. Treatment was tolerated well. Of 66 patients in whom complete tumor response occurred, five (8%) had complete tumor mass ablation, 17 (26%) had a partial response (>50% tumor reduction), and 23 (35%) had stable disease. Only RAD to the tumors was found to be significantly (P = .001) associated with tumor and/or AFP response. Survival rates at 6, 9, 12, 24, and 36 months among patients with objective tumor response were 100%, 95%, 90%, 58%, and 30%, respectively, with a median survival of 980 days. CONCLUSION: TART appears to be a safe, effective, and promising therapeutic option in patients with inoperable HCC.