Chemotherapy lipiodol

T. Konno and H. Maeda, Targeting chemotherapy of hepatocellular carcinoma Arterial administration of SMANCS/Lipiodol, in Neoplasm in the Liver (K. Okada and K. G. Ishak, eds.), Springer-Verlag, New York, 1987, p. 343. 

Lipiodol (= iodized ester of poppyseed oil) used as a contrast medium for lymphography accumulates selectively in the tumour over a longer period of time. As a result, local-interventional (oily) lipiodol chemotherapy (TOCE) was developed. Lipiodol acts as a carrier for the admixed cytostatic agents, so that the latter retain their effect in the tumour long-term in a high (systematically unacceptable) dose. Hereby, cisplatin or epidox-orubicin (101) is emulgated in lipiodol. It was possible to achieve 1-year survival rates of 36-55%. Other cytostatics did not prove to be any more effective. 

Koimo T, Maeda H. Targeting chemotherapy of hepatocellular carcinoma arterial administration of SMANCS/Lipiodol. In Okada K, Ishak KG, eds. Neoplasm in the Liver. New York Springer-Verlag, 1987 343. 

Konno, T. and Maeda, H. (1987) Targeting chemotherapy of hepatocellular carcinoma arterial administration of smancs/lipiodol. In Okuda, K. and Ishak, K.G. (eds). Neoplasms of the Liver, pp. 343-352, chap. 27. Sptinger-Verlag, New York. 

Chemoembolization Chemoembolization with the combination of Ivalon and FUDR (800 mg), mitomycin C (10 mg), or cisplatin (150 mg) for colorectal hepatic metastases led to no significant improvement in response or survival. Yamashita et al. (1993), who treated 68 patients with various hepatic metastases using iodized oil and chemotherapeutic agents,noted a response rate of 22% and a median survival of 10 months. A similar result was observed by Inoue et al. (1989), i.e., a partial response rate of 16% and a median survival period of 11 months. We currently do not perform chemoembolization in patients with metastatic colorectal carcinoma because the survival rates have not improved compared to the less aggressive approach of intraarterial chemotherapy. However, Lang and Brown (1993) and Pentecost et al. (1992) are encouraged by their results for chemoembolization of hepatic metastases from colorectal cancer and they believe that the technique can be recommended as palliative treatment. More recently, Pajkos et al. (1998) treated 41 patients with metastatic colorectal carcinoma to the liver with chemoembolization consisting of Adriamycin (50 mg), mitomycin C (8 mg), cisplatin (50 mg), or carboplatin (150 mg), Lipiodol (10 ml), and starch microspheres every 6 weeks, as well as systemic 5FU (425 mg/m ) and leucovorin 20 mg/m for 5 days every 28 days. The response rate was 68% with a median survival time of 15 months. 

Egawa H et al. (1990) Effects of intra-arterial chemotherapy with a new lipophilic anticancer agent estradiol-chlorambucil (KM2210) dissolved in lipiodol on experimental liver tumor in rats. J Surg Oncol 44 109-114 Feldman F et al. (1975) Selective intra-arterial embolization of bone tumors A useful adjunct in the management of selected lesions. Am J Roentgenol Radium Ther Nucl Med 123 130-139... 

Kemeny N et al. (1999) Hepatic arterial infusion of chemotherapy after resection of hepatic metastases from colorectal cancer. N Engl J Med 341 2039-2048 Kim YH et al. (1999) Selective hepatic arterial chemoembolization for liver metastases in patients with carcinoid tumor or islet cell carcinoma. Cancer Invest 17 474-478 Konno T (1990) Targeting cancer chemotherapeutic agents by use of lipiodol contrast medium. Cancer 66 1897-1903 Konya A,Szendroi M (1992) Aneurysmal bone cysts treated by superselective embolization. Skeletal Radiol 21 167-172 Kramer SC et al. (1999) Interventional treatment of hemorrhages in advanced cervical carcinoma. Radiologe 39 795-798... 

Tsuchikya, K., Uchida, T., Kobayashi, M., Maeda, H., Konno, T., and Yamanaka, H., 2000, Tumor-targeted chemotherapy with SMANCS in Lipiodol for renal cell carcinoma longer survival with larger size tumors. Urology 55 495-500. 

Konno, T., 1992, Targeting chemotherapy for hepatoma arterial administration of anticancer drugs dissolved in Lipiodol. Eur. J. Cancer 28 403-409. 

You and colleagues (2005) evaluated the combination of systemic chemotherapy and chemoembolization. Chemoembolization was performed using a mixture of 10 ml lipiodol, 1500 mg 5-FU and 15 mg leucovorin. Two weeks following chemoembolization, patients underwent systemic chemotherapy with 2600 mg/m 5-FU continuous infusion for 24 h and received 150 mg leucovorin (intravenous bolus). The course of chemotherapy was repeated weekly for 24 weeks. The median disease-free interval was 12 months and the median survival time was 16 months. In conclusion the authors suggested that the results of this study are of sufficient interest to justify future randomized trials (You et al. 2005). 

Lorenz M, Waldeyer M, Muller HH (1996) Comparison of lipiodol-assisted chemoembolization versus only conservative therapy in patients with nonresectable hepatocellular carcinomas. Z Gastroenterol 34 205-206 Lorenz M, Heinrich S, Staib-Sebler E et al (2000) Relevance of locoregional chemotherapy in patients with liver metastases from colorectal primaries. Swiss Surg 6 11-22 Lubienski A (2005) Radiofrequency ablation in metastatic disease. Recent Result Cancer Res 165 268-276 Maksan SM, LehnertT, Bastert G, Herfarth C (2000) Curative liver resection for metastatic breast cancer. Eur J Surg Oncol 26 209-212... 

Fig. 10.5. Axial, nonenhanced CT of a patient with HCC (same as in Figs. 10.1 and 10.4) obtained one day following TACE, shows the lesion retaining the radio-opaque Lipiodol (arrow) in its most vascular regions. The retention of Lipiodol - and consequently chemotherapy since the two are mixed - can persist for weeks after TACE and correlates with tumor necrosis...

Recently iodinated poppy-seed oil (IPSO, Lipiodol Ultra-Fluid Labora-toire Guerber, France), the ethyl ester of iodinated fatty acids obtained by hydrolysis of poppy-seed oil, has been used for injection chemotherapy (Miller, 1987). Initial application of IPSO was reported by Idezuki et al. (19 ). They used IPSO as a diagnostic material in injecting the oil into the portal vein. According to this report, a plain abdominal X-ray film was taken after the injection and revealed a negative shadow of HCC surrounded by thick staining of nontumorous Uver tissue. Afterward, it was revealed that IPSO selectively accumulates in HCC tissue when it is injected into the hepatic artery (Iwai, 1984 Kobayashi, 1992 Nakakuma, 1983 Tsai, 1986). 

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