^(32)磷核素内照射治疗晚期肝细胞癌

Hepatic arterial infusion of ^(32)P radionuclide microspheres for radiation therapy of hepatocellular carcinoma

目的 探讨经肝动脉灌注32 磷玻璃微球 ( 32 P GMS)核素内照射治疗手术不能切除的肝细胞癌的疗效。 方法 对 17例不能切除的肝细胞癌经皮下埋藏药盒行肝动脉99Tc MAA (macroaggre gatedalbumin)造影 ,测定肺肝分流比和肿瘤、非肿瘤肝脏放射强度比 (T/N) ,然后灌注 1 11～ 1 3 0GBq放射量的32 P GMS内放射治疗 ;以同期 2 0例的肝动脉化疗栓塞患者作对照。 结果 17例中无治疗死亡 ,11例患者治疗后AFP下降或肿瘤体积缩小 5 0 %以上 ,有效率 64 7% ;中位生存期 5 5个月 ,3、6、9、12个月生存率分别为 94 1%、4 4 1%、3 1 0 %、2 4 4 %。疗效比肝动脉化疗栓塞组好。T/N≥ 2的患者中位生存期明显比T/N <2者长。 结论 经肝动脉灌注32 P GMS的核素内照射治疗晚期肝细胞癌是一种安全、方便、有效的方法。

Objective To investigate the efficacy of internal radiation of 32 P glass microspheres( 32 P GMS) in unresected hepatocellular carcinoma(HCC) via subcutaneous arterial port.MethodsHepatic arterial 99 technetium macroaggregate albumin( 99 Tc MAA) scanning via subcutaneous arterial port was undertaken to measure lung/liver shunting ratio and tumor/liver ratio. Hepatic arterial infusion of 32 P GMS was performed in 17 cases of HCC with a dose from 1 11 to 1 30 GBq. Twenty cases of HCC undergoing hepatic arterial chemoembolization (HACE) in the same period served as controls group. Results There was no treatment related death in the 17 cases. In 7 of the 17 cases, AFP level and/or tumor size decreased by 50% after treatment, with a response rate of 64 7%. The median survival time was 5 5 months, and the 3 ,6 , 9 ,12 month survival rates were 94 1%,44 1%,31 0%,24 4%, respectively. The the rapeutic efficacy was better than that of HACE. The survival time was significantly longer in patients with T/N ratio≥2 than in those with T/N<2( P <0 05). Conclusions Hepatic arterial infusion of 32 P GMS is an alternative treatment for unresected HCC.