Lau W Y, Leung W T, Ho S, Leung N W, Chan M, Lin J, Metreweli C, Johnson P, Li A K
Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories.
Br J Cancer. 1994 Nov;70(5):994-9. doi: 10.1038/bjc.1994.436.
Eighteen patients with inoperable hepatocellular carcinoma (HCC) were treated with intrahepatic arterial yttrium-90 microspheres. All these patients showed a lung shunting below 15% and a tumour-to-normal ratio higher than 2 as determined by diagnostic technetium-99m macroaggregated albumin (Tc-MAA) gamma scintigraphy. The treatment was given through an arterial port placed during laparotomy. The radiation doses to the liver and tumour were determined intraoperatively with a beta probe and liquid scintillation counting of multiple liver biopsies. The treatment was well tolerated without major complications. In all patients the tumour marker fell to a level which ranged from 41% to 0.2% of the pretreatment level. Tumour regression was found to be dose related. Progressive or static disease occurred in a higher proportion of patients whose tumours received < 120 Gy (P = 0.005). Survival was better in those whose tumours received > 120 Gy (median survival = 55.9 weeks) than those whose tumours received lower doses (median survival = 26.2 weeks). This difference is statistically significant with P = 0.005. We conclude that yttrium-90 microsphere therapy is safe and that tumour response is dose related. A tumour dose of > 120 Gy is recommended.
18例无法手术切除的肝细胞癌（HCC）患者接受了肝内动脉钇-90微球治疗。通过诊断性锝-99m大颗粒白蛋白（Tc-MAA）γ闪烁扫描确定，所有这些患者的肺分流率均低于15%，肿瘤与正常组织的比值高于2。治疗通过剖腹手术期间放置的动脉端口进行。术中使用β探头和对多次肝活检进行液体闪烁计数来确定肝脏和肿瘤的辐射剂量。治疗耐受性良好，无重大并发症。所有患者的肿瘤标志物均降至治疗前水平的41%至0.2%。发现肿瘤消退与剂量相关。肿瘤接受<120 Gy的患者中，疾病进展或稳定的比例更高（P = 0.005）。肿瘤接受>120 Gy的患者（中位生存期 = 55.9周）的生存期优于肿瘤接受较低剂量的患者（中位生存期 = 26.2周）。这种差异具有统计学意义，P = 0.005。我们得出结论，钇-90微球治疗是安全的，且肿瘤反应与剂量相关。建议肿瘤剂量>120 Gy。
