TREATMENT OF INOPERABLE HEPATOCELLULAR-CARCINOMA WITH INTRAHEPATIC ARTERIAL Y-90 MICROSPHERES - A PHASE-I AND PHASE-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 macroaggrega ted albumin (Tc-MAA) gamma scintigraphy. The treatment was given throu gh an arterial port placed during laparotomy. The radiation doses to t he liver and tumour were determined intraoperatively with a beta probe and liquid scintillation counting of multiple liver biopsies. The tre atment was well tolerated without major complications. In all patients the tumour marker fell to a level which ranged from 41% to 0.2% of th e pretreatment level. Tumour regression was found to be dose related. Progressive or static disease occurred in a higher proportion of patie nts whose rumours received < 120 Gy (P = 0.005). Survival was better i n 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 tumou r response is dose related. A tumour dose of > 120 Gy is recommended.