Treatment of inoperable hepatocellular carcinoma with intrahepatic arterial yttrium-90 microspheres: a phase I and II study.
Eighteen patients with inoperable hepatocellular carcinoma (HCC) were treated with intrahepatic arterial yttrium-90 microspheres. All these patients showed a lung shunting below 15% and a tumour-to-normal ratio higher than 2 as determined by diagnostic technetium-99m macroaggregated albumin (Tc-MAA) gamma scintigraphy. The treatment was given through an arterial port placed during laparotomy. The radiation doses to the liver and tumour were determined intraoperatively with a beta probe and liquid scintillation counting of multiple liver biopsies. The treatment was well tolerated without major complications. In all patients the tumour marker fell to a level which ranged from 41% to 0.2% of the pretreatment level. Tumour regression was found to be dose related. Progressive or static disease occurred in a higher proportion of patients whose tumours received < 120 Gy (P = 0.005). Survival was better in those whose tumours received > 120 Gy (median survival = 55.9 weeks) than those whose tumours received lower doses (median survival = 26.2 weeks). This difference is statistically significant with P = 0.005. We conclude that yttrium-90 microsphere therapy is safe and that tumour response is dose related. A tumour dose of > 120 Gy is recommended.
Lau
W Y
WY
Chinese University of Hong Kong, Prince of Wales Hospital, Shatin, New Territories.
Leung
W T
WT
Ho
S
S
Leung
N W
NW
Chan
M
M
Lin
J
J
Metreweli
C
C
Johnson
P
P
Li
A K
AK
D000293:Adolescent; D000328:Adult; D000368:Aged; D014408:Biomarkers, Tumor / Q000097:blood; D006528:Carcinoma, Hepatocellular / Q000532:radiotherapy* / Q000601:surgery; D004305:Dose-Response Relationship, Drug; D005260:Female; D006499:Hepatic Artery; D006801:Humans; D007269:Injections, Intra-Arterial; D008113:Liver Neoplasms / Q000098:blood supply / Q000532:radiotherapy* / Q000601:surgery; D008297:Male; D008863:Microspheres; D008875:Middle Aged; D015021:Yttrium Radioisotopes / Q000008:administration & dosage* / Q000009:adverse effects
D014408:Biomarkers, Tumor; D015021:Yttrium Radioisotopes