轉移性肝癌的放射線治療－個案報告及文獻溯閱

Palliative Radiotherapy for Liver Metastases Report of a Case and Literature Review

丁瑞山(R.S. Ding) ； 詹建勝(J. S. Jan)

《中華放射線醫學雜誌》 3卷4期 (1978/12) Pp. 303-311

摘要

榮民總醫院癌病治療中心於民國67年8月治療一名56歲男性病患為小細胞肺癌合併肝轉移。患者曾接受二治程的化學藥物治療以其效果不明顯故再以鈷六十放射線治療肝臟，每次腫瘤劑量150雷得，治療10次共1,500雷得，一次從前面照，另一次從後面照。緊接者用分程治療法照射肺部病灶共4,000雷得。肝臟照射後2天的核子醫學肝臟掃描攝影顯示肝內腫瘤顯著縮小，原已腫大的肝臟有顯著的縮小，1個半月後，肝內腫瘤在肝臟掃描圖像已無法辨認，2個半月後，肝臟掃描圖像已恢復正常。肝功能亦有改善，病人胃口及體重增加，肺內病灶也已控制，目前尚積極跟查中。根據文獻報告及此病例的經驗，放射線治療轉移性肝癌，可以推廣使用，它可縮小肝內轉移腫瘤，改善肝功能，或能減輕症狀如疼痛及黃疸，甚至延長生存期，最好3星期內腫瘤劑量小要超過3,000以免造成放射線肝炎。祇要劑量適合亦可合併化學藥物治療，此合併治療尚需進一步的研究。

並列摘要

A 56-year-old male patient was treated in Cancer Therapy Center, Veterans General Hospital in Aug. 1978 under the diagnosis of small cell carcinoma of lung, left lower lobe with liver metastases. He had initially received chemotherapy with Endoxan 1,127mg on day 1, methotrexate 3 mg on day 2 and oncovin 2.3mg on day 3 single intravenous injection, treatment repeated 4 days later with no apparent effect. Then he received Co^60 irradiation to the whole liver with 1,500 rads tumor dose in 10 fractions in 14 days from August 1,1978 to August 14,1978. Radiotherapy was given from anterior and posterior portals alternatively. The primary lung tumor had received Co^60 radiation of 4,000 rads tumor dose by split-course technique. (superscript 99m)Tc-S colloid liver scanning showed markedly regression of intrahepatic tumor masses two days after completion of liver irradiation. Another liver scanning revealed unrecognizable metastatic tumor and normal liver size one and half months later. Liver scintiphotogram remained to be normal two and half months later. Liver functions got improved. Body weight and appetite were increased. Primary lung lesion was under controlled. Reviewed the literature and the result of the our case indicated that palliative radiotherapy of liver metastases might be helpful. It could reduce metastatic tumors, improved liver functions, relieve symptoms such as pain, jaundice and liver size and even prolong the survival time. The optimal tumor dose should less than 3,000 rads tumor dose in 3 weeks in order to prevent radiation hepatitis. If radiotherapy combines with chemotherapy, the radiation dose should be compromised.