Biological efficacy of simulated radiolabeled Lipiodol® ultra-fluid and microspheres for various beta emitters: study based on VX2 tumors

BACKGROUND: Radioembolization is one therapeutic option for the treatment of locally early-stage hepatocellular carcinoma. The aim of this study was to evaluate the distribution of Lipiodol® ultra-fluid and microspheres and to simulate their effectiveness with different beta emitters ((90)Y, (188)Re, (32)P, (166)Ho, (131)I, and (177)Lu) on VX2 tumors implanted in the liver of 30 New Zealand rabbits. RESULTS: Twenty-three out of 30 rabbits had exploitable data: 14 in the group that received Lipiodol® ultra-fluid (group L), 6 in the group that received microspheres (group M), and 3 in the control group (group C). The histologic analysis showed that the Lipiodol® ultra-fluid distributes homogeneously in the tumor up to 12 days after injection. The X-ray μCT images showed that Lipiodol® ultra-fluid has a more distal penetration in the tumor than microspheres. The entropy (disorder of the system) in the L group was significantly higher than in the M group (4.06 vs 2.67, p = 0.01). Equivalent uniform biological effective doses (EUBED) for a tumor-absorbed dose of 100 Gy were greater in the L group but without statistical significance except for (177)Lu (p = 0.03). The radionuclides ranking by EUBED (from high to low) was (90)Y, (188)Re, (32)P, (166)Ho, (131)I, and (177)Lu. CONCLUSIONS: This study showed a higher ability of Lipiodol® ultra-fluid to penetrate the tumor that translated into a higher EUBED. This study confirms (90)Y as a good candidate for radioembolization, although (32)P, (166)Ho, and (188)Re can achieve similar results. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s13550-023-01051-9.