Combined fractionated isotopic and external irradiation of the liver in Hodgkin's disease.A study of 21 patients

Of 21 Hodgkin's disease patients with laparotomy-documented splenic and/or hepatic involvement (Stages IIIs and IVH) treated with total lymphoid and combined external and internal (198Au) whole liver irradiation, nine patients remain disease-free for 17 to 34 months. All but two of the relapses occurred in patients previously treated to local fields only. One death is directly attributable to the isotope. Another death at 34 months was due to intercurrent disease. About half of the combined whole liver dose of 2,500 rads is delivered by external megavoltage x-ray therapy and half by radioactive colloidal gold (198Au). The usual isotopic dose is 25–30 mCi administered intravenously at a maximum rate of 10 mCi every 2 weeks. Tumoricidal doses can thus be delivered to the critical periportal areas within the liver, whereas dose to the central vein region of the lobule remains within the normal liver tissue tolerance level, thus avoiding the immediate reaction of radiation hepatitis and the remote development of cirrhosis. Thrombocytopenia, the most serious complication, may be prevented or lessened by adjusting the fractionated and total dose of the isotope.