核素^(125)I-碘油内辐射联合外照射治疗肝癌

Experimental and Clinical Study on Nuclide ^(125)I-labeled Lipiodol Internal Radiation Combined with External Radiation for Liver Cancer

[目的]观察经肝动脉介入核素125I-碘油内辐射、肝动脉化疗栓塞（TACE）联合外照射治疗肝癌患者的体内代谢和疗效。[方法]采用125I标记超液化碘油（125I-LUF）治疗中晚期肝癌共3组病例:A组（125I-LUF+放疗,19例）用125I-LUF作内辐射加TACE治疗后进行肿瘤局部外放疗,B组（125I-LUF,21例）125I-LUF内辐射联合TACE,C组（单TACE,20例）仅肝动脉化疗栓塞。A、B、C组3组病例TACE平均治疗分别为2.56、2.48和2.6例次;A组和B组病人注入125I-LUF放射剂量均值（x±s）分别为（303.77±120.99）MBq/例和（350.02±163.91）MBq/例。A组在瘤区加体外局部放疗,放射剂量均值（x±s）为（52.11±10.30）Gy。3组TACE用的化疗药物相同。[结果]体内代谢和SPECT结果显示125I-LUF给药后核素125I长期特异滞留在瘤内。A、B、C3组治后肿瘤缩小率（CR+PR+MR）分别为68.42％（13/19）、47.6％（10/21）和25％（5/20）,P<0.05;AFP下降率分别为84.6％（11/13）、85.7％（12/14）、60.0％（9/15）,P>0.05;治后1、2、3、4年累计生存率分别为94.74％、80.64％、69.12％和69.12％;58.38％、58.38％、43.79％和29.19％;32.73％、26.18％、26.18％和0;A、B与C组比,x2=13.98,P<0.0009;A、B、C组治后中位生存期（月）分别为40.96（95％CI=33.

[Purpose]To observe the biodistribution and therapeutic effects of nuclide 125I-labeled lipiodol ultra-fluide (LUF)in the treatment for patients with primary liver cancer (PLC). [Methods]125I-LUF was prepared by the isotopic exchange reaction. Sixty patients were enrolled in the study. They were divided into three groups : group A, 19 patients treated with I251-LUF plus external radiation;group B,21 patients with 125 I -LUF; group C, 20 patients with transcatheter arterial chemoembolization (TACE) . The average number of times in A , B and C group treated with TACE were 2.56, 2.48 and 2.60 , respectively.The median values of the radiation dose( MBq/ case) of A, B group were 303.77±120.99 and 350.02 ± 163.91, respectively. [Results] The result of biodistribution study and SPECT showed that 125I was retained within the tumor for a long time. The response rate (CR + PR + MR) ofA,B and C groups was 68.42% (13/19), 47.6% (10/21) and 25% (5/20), respectively (P<0.05),and decrease level of AFP were 84.6% (11/13), 85.7% (12/14) and 60.0% (9/15) , respectively(P > 0.05) .The 1, 2, 3, 4years cumulative survival rates were 94.74%, 80.64%, 69.12% and 69.12% in group A; 58.38%, 58.38%, 43.79% and 29.19% in group B; 32.73% ,26.18% ,26.18% and 0 in group C, respectively(P < 0.0009). The median survival months of A,B,C groups was 40.96(95%CI = 33.30%-48.62%), 30.83(95%CI = 22.29% - 39.37%) and 17.04(95%CI= 11.72% - 22.37%), respectively. [Conclusion] ① 125I-LUF can retain within the tumor for a long time .②Marked effect with 125 I-LUF might be due to the synergistic effects of internal radiotherapy and external radiation combination enhancing the killing effect to tumor cell. ③125I-LUF internal radiation combined with external radiation therapy may be considered as a safe and effective method for PLC with portal vein thrombosis.