Radiation Oncology Journal

  • 제25권3호
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  • Pages.170-176
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  • 2007
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  • 2234-1900(pISSN)
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  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지

진행된 간세포암에서의 간문맥 혈전증에 대한 방사선치료 효과

The Role of Radiotherapy in the Treatment of Portal Vein Thrombosis from Advanced Hepatocellular Carcinoma

  • 김정훈 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 최은경 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 안승도 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 이상욱 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 신성수 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 최원식 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 임영석 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 김강모 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 서동진 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 정영화 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 이영상 (울산대학교 의과대학 서울아산병원 소화기내과학교실) ;
  • 원형진 (울산대학교 의과대학 서울아산병원 영상의학과학교실) ;
  • 김종훈 (울산대학교 의과대학 서울아산병원 방사선종양학교실)
  • Kim, Jung-Hoon (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Eun-Kyung (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Seung-Do (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Wook (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Seong-Soo (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Won-Sik (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lim, Young-Suk (Departments of Gasteroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Kang-Mo (Departments of Gasteroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Suh, Dong-Jin (Departments of Gasteroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Young-Wha (Departments of Gasteroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Young-Sang (Departments of Gasteroenterology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Won, Hyung-Jin (Departments of Radiology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong-Hoon (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • 발행 : 2007.09.30
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초록

목적: 치료방법이 정립되지 않은 진행된 간세포암에서의 간문맥 혈전증에 대한 방사선치료의 효과와 간독성을 측정함으로써 향후 방사선치료의 효용성에 대하여 알아보고자 한다. 대상 및 방법: 2000년 5월부터 2005년 12월까지 서울아산병원에서 원발성 간세포암으로 진단받은 환자 중 간문맥 혈전증이 동반된 70명의 환자를 대상으로 후향적 분석을 하였다. 대상 환자들의 나이는 $24{\sim}74$세(중앙값 51세)였으며, 대부분이 Child-Pugh's class A, B였고 Eastern Cooperative Oncology Group (ECOG) 2 이하였다. 방사선치료는 3차원입체조형치료를 시행하였으며, 1회 선량은 $2{\sim}4$ Gy로 총방사선량은 $40{\sim}60$ Gy (중앙값 48 Gy)였으며, 생물학적 유효선량(biologic effective dose)은 $31.3{\sim}78.0\;Gy_{10}$ (중앙값 61.6 $Gy_{10}$)였다. 결과: 치료 반응평가는 치료 전과 치료 종료 후 최소 1개월 이상 경과 후 컴퓨터 단층촬영(CT)을 시행하여 평가하였으며, 대상 환자들의 추적관찰기간은 $2{\sim}24$개월(중앙값 9개월)이었다. 방사선치료 후 완전반응인 경우가 2명(2.9%), 부분반응 31명(44.3%), 무반응 35명(50.0%), 진행병변 2명(2.9%)이었다. 1년 무진행 생존율(progression-free survival)은 60%였으며, 중앙 무진행 생존기간은 17개월이었다. 전체 환자의 중앙 생존기간(overall survival)은 11개월이었으며, 치료반응 유무에 따라 부분 반응 이상을 보인 환자군의 중앙 생존기간은 15개월, 무반응이거나 진행병변을 보인 환자군은 8개월로 통계학적 차이를 보였다(p=0.032). 치료 중 일시적인 간기능 저하가 4명(5.7%), 방사선 간염은 1명(1.4%)에서 발생하였다. 결론: 진행된 간세포암에서의 간문맥 혈전에 대해 방사선치료를 시행한 경우 비교적 유용하며 안전한 치료법이며, 앞으로의 연구에서는 방사선치료가 생존율을 향상시킬 수 있는지 여부와 적절한 방사선량을 결정하기 위한 연구가 필요할 것으로 생각된다.

Purpose: To determine the role of radiotherapy for the treatment of portal vein thrombosis (PVT) from hepatocellular carcinoma (HCC). Material and Methods: A retrospective analysis was performed on 70 patients that had been diagnosed with HCC and were treated with three-dimensional conformal radiotherapy (3D-CRT) for the PVT. The radiation dose ranged from 40 Gy to 60 Gy (median dose: 48 Gy) and the biological effective dose (BED) ranged from 31.3 Gy to 78.0 $Gy_{10}$ (median dose: 61.6 $Gy_{10}$). Response was determined by measuring the extent of the PVT on a CT image at 0, 1 and 3 months after completion of the radiotherapy. The median follow-up period was 9 months. Results: The response rate was 47.1% (33 patients), with two patients (2.9%) showing a complete response, 31 patients (44.3%) showing a partial response, and 35 patients (50%) showing stable disease or no response. The 1-year progression-free survival rate was 60%, and the median progression-free survival time was 17 months. The median overall survival time was 11 months, the median survival time in the responders was 15 months and in the nonresponders was 8 months (p=0.032). Four patients (5.7%) had transient liver function impairment during treatment. Radiation induced liver disease (RILD) was observed in only one patient (1.4%). Conclusion: Three-dimensional conformal radiotherapy for the treatment of PVT from advanced HCC was a relatively effective and safe method.

키워드

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