转移性肝癌组织间置管后装放射治疗

High dose rate interstitial radiation of hepatic metastasis from colorectal carcinoma

目的 观察转移性肝癌组织间插植后装放射治疗的效果和毒副反应，探讨其应用于治疗结、直肠癌术后肝转移的可行性。方法 对２５ 例结、直肠癌术后确诊肝转移患者行组织间插植后装放射治疗。剖腹探查术中置管１８ 例， Ｂ 超引导经皮肝穿刺置管７ 例。放射源为高剂量率１ ９ ２ Ｉｒ ，每次照射８ ～１０ Ｇｙ ，总量３０ ～４０ Ｇｙ ，３ ～５ 次，１ ～２ 周内完成。结果 ２５ 例无明显毒副反应，１ ，３ ，５ 年生存率（ 按寿命表法） 分别为８１ ．８ ％ ，３４ ．５ ％ ，１０ ．２ ％ 。瘤胚抗原（ Ｃ Ｅ Ａ） 滴度变化可作为肿瘤控制与否及有无肝内、外隐匿病灶的重要指标。结论 术中、 Ｂ 超引导肝穿刺２ 种置管法安全、可靠；作为局部根治性治疗手段，对原发于结、直肠的肝转移癌的治疗是有效的。

Objective To evaluate the results, radiation toxicity and feasibility of high dose rate (HDR)interstitial brachytherapy for hepatic metastasis from colorectal carcinoma. Methods From November 1992 to May 1997, 25 patients with unresectable hepatic metastasis from colorectal carcinoma underwent HDR interstitial brachytherapy. In the 25 patients, the treatment was done by laparotomy in 18 and in the other 7 it was given with the guide of B ultrasound.The radiation source was high dose rate 192 Ir . All patients received 8～10?Gy/F, to a total dose of 30～40?Gy,3～5F,1～2 weeks. Results No acute or chronic radiation toxicity was observed in the follow up. The 1 ,3 and 5 year survival rates were 81.8%, 34.5% and 10.2%. CEA might be an important marker to detect metastasis inside or outside of the liver. Conclusions This innovative and radical approach to unresectable colorectal hepatic metastasis has proved its safety, reliability and effectiveness. Further study is needed to see if the HDR interstitial brachytherapy is as effective as surgical resection.