Thomas D S, Nauta R J, Rodgers J E, Popescu G F, Nguyen H, Lee T C, Petrucci P E, Harter K W, Holt R W, Dritschilo A
Department of Radiation Medicine, Georgetown University School of Medicine, Washington, DC 20007.
Cancer. 1993 Mar 15;71(6):1977-81. doi: 10.1002/1097-0142(19930315)71:6<1977::aid-cncr2820710609>3.0.co;2-d.
Resection of liver metastases from colorectal carcinoma can be curative. Unresectable but liver-confined metastases might be ablated by high-dose radiation with a similar curative result.
At Georgetown University Hospital, 22 patients with unresectable hepatic metastases from colorectal carcinoma underwent 24 interstitial irradiation procedures at laparotomy in a Phase I-II study. A single dose was administered with a high-dose rate iridium-192 afterloader. Dose to the tumor periphery was 20 Gy, 25 Gy, and 30 Gy in 13, 9, and 2 procedures, respectively.
No acute or chronic radiation toxicity has occurred at a median follow-up of 11 months. Median actuarial local control at irradiated sites was 8 months, with 26% actuarial local control at 26 months by computed tomography (CT) or magnetic resonance imaging (MRI) scanning. In the two patients undergoing two procedures each, a second biopsy of previously irradiated areas demonstrated tumor eradication.
This innovative, radical approach to unresectable colorectal hepatic metastases proved safe. Additional study is needed to determine whether interstitial irradiation is as effective as surgical resection, or whether it alters the natural history of the disease or longevity.
切除结直肠癌肝转移灶可能治愈疾病。不可切除但局限于肝脏的转移灶可通过高剂量放疗消融，疗效相似。
在乔治敦大学医院，一项I-II期研究中，22例结直肠癌不可切除肝转移患者在剖腹手术时接受了24次组织间照射。使用高剂量率铱-192后装治疗机给予单次剂量照射。肿瘤周边剂量分别在13例、9例和2例中为20 Gy、25 Gy和30 Gy。
中位随访11个月，未发生急性或慢性放射毒性。照射部位的中位精算局部控制时间为8个月，通过计算机断层扫描（CT）或磁共振成像（MRI）扫描，26个月时精算局部控制率为26%。在两名接受了两次治疗的患者中，对先前照射区域进行的第二次活检显示肿瘤已根除。
这种针对不可切除的结直肠癌肝转移的创新、根治性方法被证明是安全的。需要进一步研究以确定组织间照射是否与手术切除同样有效，或者它是否会改变疾病的自然病程或生存期。
