放射性微球治疗晚期肝癌内照射剂量与疗效关系的探讨

The relationship between effects and radiation doses of intraarterial phosphorus32 glass microspheres for patients with advanced hepatocellular carcinomas (HCC)

目的探讨核素微球治疗晚期肝癌的量效关系。材料与方法３２磷一玻璃微球（Ｐｈｏｓｐｈｏｒｕｓ－３２ｇｌａｓｓｍｉｃｒｏｓｐｈｅｒｅｓ，３２Ｐ－ＧＭＳ）肝动脉灌注治疗２８例晚期肝癌患者，动脉血酮体比率（Ａｒｔｅｒｙｋｅｔｏｎｅｂｏｄｙｒａｔｉｏ，ＡＫＢＲ）等监测术后肝脏能量代谢变化，ＣＴ、ＥＣＴ、Ｂ超、ＡＦＰ等观察疗效，平均随访２８个月。结果６１μ的３２Ｐ－ＧＭＳ是治疗晚期肝癌安全有效的放射性栓塞材料，当靶肝组织吸收放射剂量＞５０Ｇｙ及微球量＞３ｇ时近期疗效满意，但有严重消化道反应和明显肝代谢功能损害，而２８～３７Ｇｙ组术后肝功能恢复良好，各种术后并发症明显减少，远期疗效较好。结论放疗性栓塞治疗肝硬变肝癌患者的合理靶肝吸收剂量应在３０Ｇｙ左右。

Purpose To evaluate the relationship between effects and internal radiation doses of phosphorus32 glass microspheres for liver cancer.Materials and Methods From March ,1994 to Feb. 1996,28 patients with unresectable hepatocellular carcinomas received intraarterial radioembolization using 32PGMS. Postoperative energy change level in the liver was tested by blood ketone body ratio(AKBR).Results Hepatic arterial perfusion of 32PGMS(61μ) appeared to be safe and effective for HCC. The tumor shrinking rate and AFP decreasing rate in the radiation dose>50Gy or microspheres >3g group was higher than the 28～37Gy group, but the AKBR significantly dropped and serious gastrointestinal tract reaction occurred in almost all patients in the former group,while mild postoperative complications and long term survival were observed in the latter group.Conclusion The reasonable hepatic absorbed radiation doses for HCC may be about 30Gy for HCC.