Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The Role of Radiotherapy in the Treatment of Portal Vein Thrombosis from Advanced Hepatocellular Carcinoma

진행된 간세포암에서의 간문맥 혈전증에 대한 방사선치료 효과

  • 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)
  • 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)
  • Published : 2007.09.30
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Abstract

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.

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.

Keywords

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