肝细胞癌的放射性核素治疗

Radionuclide therapy of hepatocellular carcinoma.

作者信息

Keng G H, Sundram F X

机构信息

Department of Nuclear Medicine, Singapore General Hospital, Outram Road, Singapore 169608.

出版信息

Ann Acad Med Singap. 2003 Jul;32(4):518-24.

PMID:12968558

Abstract

INTRODUCTION

Hepatocellular carcinoma (HCC) is a common malignancy worldwide. Surgical resection is generally accepted as the first choice treatment of HCC. Many non-surgical techniques have been developed and used for the treatment of inoperable HCC, with limited efficacy. This paper studies the role of radionuclide therapy in the treatment of inoperable HCC and in an adjuvant setting following curative resection of HCC.

MATERIALS AND METHODS

Relevant articles published between 1980 and 2002 were reviewed. Articles were identified through a Medline search using the key words hepatocellular carcinoma, iodine-131 (I-131), lipiodol, yttrium-90 (Y-90), rhenium-188 (Re-188), monoclonal antibodies and anti-ferritin.

RESULTS

The objective response rate of patients with HCC treated with intra-arterial I-131 lipiodol was 40% to 70% and the median survival was between 6 and 9 months. The efficacy of I-131 lipiodol was similar to transarterial chemo-embolisation, but appears to be better tolerated by patients. A median survival of 9.4 months to 54 weeks was achieved using intra-arterial Y-90 microspheres for the treatment of HCC. Tumours in 4 patients became resectable after treatment. Re-188 lipiodol is a relatively new radiopharmaceutical used for the treatment of HCC. The results of a pilot study have shown Re-188 lipiodol to be a safe and cost-effective radiopharmaceutical for the treatment of HCC via the intra-arterial route. Its efficacy should be subjected to further evaluation. The use of radio-labelled monoclonal antibodies, such as anticarcinoembryonic antigen and antiferritin, for the treatment of HCC has yielded encouraging results but these forms of treatment are largely experimental and limited to a few centres. Intra-arterial treatment using I-131 lipiodol in an adjuvant setting for patients following curative resection of HCC has resulted in improved disease-free and overall survival. The 3-year survival for the treatment and control groups were 86.4% and 46.3%, respectively.

CONCLUSION

Radionuclide therapy presents another interesting option for the treatment of HCC amidst the wide array of non-surgical modalities available.

摘要

引言

肝细胞癌（HCC）是全球常见的恶性肿瘤。手术切除通常被认为是HCC的首选治疗方法。已经开发了许多非手术技术并用于治疗无法手术切除的HCC，但疗效有限。本文研究放射性核素治疗在无法手术切除的HCC治疗以及HCC根治性切除后的辅助治疗中的作用。

材料与方法

回顾了1980年至2002年间发表的相关文章。通过使用关键词肝细胞癌、碘-131（I-131）、碘油、钇-90（Y-90）、铼-188（Re-188）、单克隆抗体和抗铁蛋白进行Medline检索来识别文章。

结果

动脉内注射I-131碘油治疗的HCC患者的客观缓解率为40%至70%，中位生存期为6至9个月。I-131碘油的疗效与经动脉化疗栓塞相似，但患者的耐受性似乎更好。使用动脉内Y-90微球治疗HCC的中位生存期为9.4个月至54周。4例患者的肿瘤在治疗后变得可切除。Re-188碘油是一种相对较新的用于治疗HCC的放射性药物。一项初步研究的结果表明，Re-188碘油是一种通过动脉内途径治疗HCC的安全且具有成本效益的放射性药物。其疗效应进一步评估。使用放射性标记的单克隆抗体，如抗癌胚抗原和抗铁蛋白，治疗HCC已取得令人鼓舞的结果，但这些治疗形式大多处于实验阶段，且仅限于少数几个中心。在HCC根治性切除后的患者中，在辅助治疗中使用动脉内I-131碘油可改善无病生存期和总生存期。治疗组和对照组的3年生存率分别为86.4%和46.3%。