肝臟腫瘤體積於釔90治療中所扮演的角色

The Volumetry Planning of Liver Tumor in Yttrium-90 Treatment

陳暘升(Yang-Sheng Chen) ； 黃姍姒(Shan-Su Huang) ； 張建法(Chien-Fa Chang) ； 李潤川(Rheun-Chuan Lee)

《北市醫放雜誌》 7卷1期 (2017/12) Pp. 7-14

https://doi.org/10.6663/TPART.201712_7(1).0002

摘要

對於無法控制之原發性肝癌或其他癌症(如大腸直腸癌)轉移至肝臟患者，由於腫瘤體積較大、或腫瘤瀰漫性散布於全肝，病人無法以開刀、介入性栓塞、化學治療方式來做治療，經過評估並且考量病人體能，利用血管攝影結合電腦斷層技術，以股動脈經導管方式將釔90 微球體注入肝臟血管裡，再藉由近距離、高能量、短射程的貝他射線將腫瘤殺死，已是近年來新興治療肝癌的趨勢。然而術前治療計畫需要經過非常精確的評估、舉凡血管供應腫瘤狀況、肝臟、肺臟血液分流、腸胃系統血管供應、肝臟、腫瘤體積大小等，會因為患者本身的身體構造、病症，遭遇不同程度的困難，這些皆需要非常有經驗之工作團隊一起合作。本篇將列出一些在執行釔90 治療計畫時，計算肝臟及腫瘤體積所面臨到的病症、困難和經驗，逐一分享。

關鍵字

釔90微球體 ； 大腸直腸癌 ； 肝癌 ； Angio-CT系統

並列摘要

Patients with Hepatocellular carcinoma or other metastatic cancers (ex.: metastatic colorectal cancer), tumors are usually bulky and spread in the whole liver. Surgery, chemotherapy, and radiotherapy has limitation owing to these patients usually with poor physical status and tumor involving major vessels. Radiologists injecting Yttrium-90 microspheres, a high energy beta ray, through intra-arterial catheter combing both angiography and CT scan into the liver and kill tumors has being the new treatment technique in recent years. However the pre-treatment volumetry planning, the total liver volume, both lobes, tumor size, needs to be very cautious. It’s difficult to achieve precise volumes because of patient’s liver anatomy variation, tumor size, tumor invasion vessels severity. In this article demonstrate and share the experience in 3D liver volumetry planning in Yttrium-90 cases.

並列關鍵字

Yttrium-90 ； Colorectal Cancer ； Hepatocellular Carcinoma ； Angio-CT