Radioimmunotherapy in the multimodality treatment of hepatocellular carcinoma with reference to second‐look resection

Experimental study using nude mice human hepatocellular carcinoma (HCC) xenograft indicated that the combination treatment with iodine 131 (¹³¹I)‐anti‐human HCC isoferritin (¹³¹I‐isoFtAb), cisplatin, and mixed bacterial vaccine (MBV) yielded better inhibition rate as compared with double combination or ¹³¹I‐isoFtAb alone. Based on these findings, 25 patients with surgically proven nonresectable and pathologically proven HCC have been treated by radioimmunotherapy using ¹³¹I‐isoFtAb intrahepatic arterial infusion as a part of multimodality treatment. Of the 25 patients, seven (28.0%) received second‐look resection after marked shrinkage of tumor. The 1‐year survival was 52.5% (12/23) and 2‐year survival 27.7% (five of 18) in the entire series. Of the five patients with 2‐year survival, four were in the second‐look resection group. Patients with tumor ≦ 8 cm showed higher second‐look resection rate (62.5% versus 11.8%) and 1‐year survival (85.7% versus 37.5%) as compared with tumor > 8 cm. Mixed bacterial vaccine as adjuvant immunotherapy seemed effective to prolong survival. The 2‐year survival was higher in patients with second‐look resection as compared with those without (75.0% versus 14.3%). Thus, radioimmuno‐therapy using ¹³¹I‐isoFtAb might be one of the modalities of choice, particularly in the conversion of nonresectable to resectable HCC in a well‐designed multimodality treatment regimen.