Rhenium-188 (~188Re) is a high energy beta-emitter with a physical half life of 17 hours. Various ~188Re based radiopharmaceuticals were developed to treat liver malignancies. The vast majority of studies focus on patients suffering from hepatocellular carcinoma (HCC). Most radiopharmaceuticals are based on Lipiodol as a vehicle for the rhenium-188. The radiopharmaceutical that was tested clinically in detail is the ~~188Re-HDD/Lipiodol, developed by the Seoul University. Clinical data derived from several phase I and II studies using ~188Re-HDD/Lipiodol suggest an excellent tolerance in patients with Child-Pugh A cirrhosis. A shortcoming in some trials was the occasional low labelling efficiency of ~188Re-HDD/Lipiodol. Some newer ~188Re based radiopharmaceuticals claim to have consistent high labelling efficiencies, however clinical data for these compounds are scarce or lacking at this moment. Hopefully, phase I clinical data will become available for promising radiopharmaceuticals such as ~188Re-SSS-Lipiodol, developed by the group of Rennes, in the upcoming years. In Dresden a very different approach is used. They labelled human serum albumin microspheres with high activities of ~188Re. In a small group of patients with liver metastasis and a few HCC patients, treatment proved safe. In the present clinical field, ~188Re-based radiopharmaceuticals will have to proof firmly their strength and reliability in large patient groups if they want to compete with the commercially available yttrium-90 microspheres.
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