ULTRASOUND-GUIDED INTERNAL RADIOTHERAPY USING YTTRIUM-90-GLASS MICROSPHERES FOR LIVER MALIGNANCIES

Treatment of liver malignancies, in particular hepatocellular carcinom a, remains a serious problem because of the difficulty of delivering a dequate therapeutic agents to the lesions while sparing the surroundin g normal tissue. In an attempt to overcome this obstacle, intratumoral injection of Y-90, a beta-emitter, was performed. Methods: Twenty-sev en hepatocellular carcinoma's and six liver metastases were studied, m ost of which had failed other therapeutic modalities. Guided by ultras ound, Y-90-glass microspheres (GMS) were carefully injected into prede termined tumor sites. The procedure was repeated at 3-4-wk intervals w here indicated. Echographic, clinical and laboratory follow-up was con ducted at regular intervals. Results: Twelve to 32 mo after treatment, 27 patients were still alive, with dramatic improvement of their clin ical condition: 90.6% of the tumor fool became smaller, with echogenic or blood flow changes on liver sonograms. Serum titers of alpha-FP in 10 of 13 patients returned to normal levels. Repeat biopsy in nine pa tients showed complete tumor destruction in eight. Six patients died o f either end-stage disease or wide dispersion of the tumor, Conclusion : The intratumoral administration of Y-90-GMS under ultrasound guidanc e yielded a higher cure rate for liver malignancy with no severe side effects. The higher radiation dosage delivered by injected Y-90 to the periphery of the lesions (up to 28,215-75,720 cGy) was thought to acc ount for the successful outcome. These results show that intratumoral radionuclide injection is feasible for treatment of malignant lesions inside the body.