Cho Byoung Chul, Kim Eun Hee, Choi Hye Jin, Kim Joo Hang, Roh Jae Kyung, Chung Hyun Cheol, Ahn Joong Bae, Lee Jong Doo, Lee Jong Tae, Yoo Nae Choon, Sohn Joo Hyuk
Department of Yonsei Cancer Center and Internal Medicine, Yonsei University College of Medicine, 134 Seodaemun-gu, Shinchon-dong, Seoul 120-752, Korea.
Yonsei Med J. 2005 Dec 31;46(6):799-805. doi: 10.3349/ymj.2005.46.6.799.
Percutaneous approaches, such as percutaneous ethanol injection and radiofrequency ablation, have been most widely used for hepatocellular carcinoma patients who were not eligible for surgery. New technologies to improve the efficacy are currently needed. (166)Holmium is a neutron activated radionuclide, and has several beneficial radiophysical characteristics for internal radiation therapy. (166)Holmium-Chitosan complex, in which chitosan is chelated with (166)Holmium, was developed as a radiopharmaceutical for cancer therapy. We have conducted a pilot study to evaluate the clinical efficacy of transarterial administration of (166)Holmium-Chitosan complex in patients with a single and small (< 3 cm) hepatocellular carcinoma. (166)Holmium-Chitosan complex, at a dose of 20 mCi per cm of tumor mass-diameter, was administered through the artery that directly fed the tumor. Twelve patients were treated with a median follow-up duration of 26 (range: 12-61) months. The tumor diameter ranged between 1.5 and 2.5 cm. Ten patients (83%) had complete response and two (17%) had partial response. The median complete response duration was not reached. The median AFP level declined from 83.8 to 8.3 ng/mL within 2 months after treatment. No grade III/IV toxicity was observed. Grade I and II toxicities were observed in four patients (2 abdominal pain, 1 fever, and 1 AST/ALT elevation). No toxic death occurred. This preliminary study shows a promising and durable complete response rate with an acceptable safety profile. Further studies with greater accrual of patients are warranted.
经皮治疗方法，如经皮乙醇注射和射频消融，已最广泛地应用于不符合手术条件的肝细胞癌患者。目前需要提高疗效的新技术。（166）钬是一种中子活化放射性核素，对于内照射治疗具有若干有益的放射物理特性。（166）钬 - 壳聚糖复合物，其中壳聚糖与（166）钬螯合，被开发为一种用于癌症治疗的放射性药物。我们进行了一项初步研究，以评估经动脉给予（166）钬 - 壳聚糖复合物对单个小（<3 cm）肝细胞癌患者的临床疗效。（166）钬 - 壳聚糖复合物以每厘米肿瘤质量直径20毫居里的剂量通过直接供血给肿瘤的动脉给药。12例患者接受了治疗，中位随访时间为26（范围：12 - 61）个月。肿瘤直径在1.5至2.5 cm之间。10例患者（83%）完全缓解，2例（17%）部分缓解。中位完全缓解持续时间未达到。治疗后2个月内，甲胎蛋白（AFP）水平中位数从83.8降至8.3 ng/mL。未观察到III/IV级毒性。4例患者观察到I级和II级毒性（2例腹痛、1例发热和1例谷草转氨酶/谷丙转氨酶升高）。未发生毒性死亡。这项初步研究显示出有前景且持久的完全缓解率以及可接受的安全性。有必要进行更大规模患者的进一步研究。
