Transarterial radionuclide therapy with Re-188-HDD-lipiodol in case of unresectable hepatocellular carcinoma with extensive portal vein thrombosis

We tried to evaluate the role of dosimetry-guided transarterial radionuclide therapy with rhenium (Re)-188 labeled lipiodol in a patient with unresectable hepatocellular carcinoma and extensive portal vein thrombosis. Dosimetry revealed that the normal liver parenchyma, lungs, bone marrow and the tumor would have received 0.276, 0.141, 0.0006 and 2.95 cGy of radiation absorbed dose per MBq of injected activity. “Maximum tolerated activity” of Re-188, which could have been safely injected to this patient, was calculated to be 8511 MBq with lungs being the dose limiting organ. The dosimetry helped to deliver the maximum possible activity of Re-188, thus radiation absorbed dose into the tumor without jeopardizing healthy liver tissue or other organs. There was no procedure related complication and the patient tolerated therapy well with no adverse effects. His 6.8 cm × 5.7 cm × 5.3 cm tumor, involving segment V-VIII with tumor thrombus in right branch and main portal vein, disappeared completely after two doses (4293 and 4170 MBq, respectively). The treatment appears to be safe, effective and promising as demonstrated by the complete disappearance of tumor along with portal vein thrombus.