• Radiation Oncology Journal
• /
• 제19권2호
• /
• pp.118-126
• /
• 2001

목적 : 본 연구에서는 원발성 간암의 국소 방사선치료 시 조사선량을 높여준 것이 종양의 반응의 향상을 유도하였는지 분석하고자 하였다. 또한, 저선량을 조사하였던 환자들과 고선량을 조사하였던 환자들의 종양의 반응 및 부작용과 이에 영향을 미치는 인자들을 분석함으로써 향후 적절한 조사선량 범위를 결정하는데 유용한 기준을 제시하고자 하였다. 대상 및 방법 : 대상 환자의 선정 기준은 방사선치료의 과거력이 없는 경우, 간외전이가 없는 경우, 간경변증의 정도가 Child's class A 또는 B군인 경우, 종양이 전체 간 용적의 2/3를 넘지 않는 경우, 전신수행도가 ECOG 3기 이상으로 악화되지 않은 경우로 하였다. 1992년 1월부터 2000년 3월까지 원발성 간암에 국소 방사선치료를 시행 받은 환자들 중 158명이 연구 대상에 포함되었다. 조사영역은 종양과 주변 부위 $2\~3\;cm$를 포함하였고 일일 1.8 Gy씩 주 5회 조사되었다. 방사선치료 전과 종료 후 $4\~6$주째의 컴퓨터 단층 촬영 영상 및 자기 공명 영상, 간동맥 혈관 촬영 영상 등을 이용하여 조사영역 내의 종양의 반응을 평가하였다. 주 1회 혈액 검사를 시행하여 말초 혈액 혈구수 및 간기능을 관찰하였다. 치료의 종료 후 체중 증가, 복수, 간종대 등의 소견을 관찰하였고 4주와 8주에 간기능 검사를 시행하였다. 위장관계의 부작용은 상부위장관 내시경을 시행하여 확인하였다. 종양의 관해 정도에 따라 반응군과 비반응군으로 구분한 후 조사선량의 분포를 통계적으로 분석하였다. 또한, 연구대상을 조사선량에 따라 세 군으로 분류하고 종양의 반응과 임상적 특성을 분석하였다. 결과 : 종양의 반응은 106명이 부분 관해를 보여서 반응군의 비율은 $67.1\%$이었다. 완전 관해는 없었다. 종양이 $50\%$ 이하로 감소된 경우가 41명$(25.9\%)$, 종양의 진행을 보인 경우가 11명$(7\%)$이었다. 반응군의 평균 조사선량은 $50.1{\pm}6.6\;Gy$이었고 비반응군의 평균 조사선량은 $44.3{\pm}9.0\;Gy$로 통계적으로 의미 있는 차이를 보였다. 다변량 분석에서도 조사선량이 p-value 0.001로 유일하게 의미 있는 인자로 나타났다. 종양의 반응률은 조사선량이 40 Gy 미만인 군에서 $29.2\%$, 40 Gy에서 50 Gy사이인 군에서 $68.6\%$, 50 Gy를 넘는 환자 군에서 $77.1\%$로 나타났다. 종양의 크기는 40 Gy 미만인 군에서 $9.8{\pm}2.6\;cm$, 40 Gy에서 50 Gy사이인 군에서 $9.8{\pm}2.6\;cm$, 50 Gy를 넘는 환자 군에서 $8.3{\pm}3.2\;cm$로 고선량을 조사한 군에서 작았다. 간문맥 혈전증은 각각 $66.7\%,\;64.7\%,\;37.3\%$에서 양성으로 50 Gy를 넘는 선량이 조사된 군에서 상대적으로 간문맥 혈전증의 양성률이 낮았다. 방사선 간염, 십이지장의 궤양은 조사선량을 증가시킬수록 증가하는 경향을 나타내었다. 경미한 정도의 복수가 발생하거나 전형적인 방사선 간염의 발생, 위장관계의 염증 등이 치료 전 간경변증이 심할수록 현저히 많이 발생하는 경향을 보였다. 결론 : 원발성 간암에서 국소 방사선치료를 시행하는 경우 고선량이 조사될수록 반응군의 비율이 증가하는 선량반응 관계가 성립함을 확인할 수 있었다. 고선량이 조사될수록 대상 환자의 종양의 크기가 작았고 간문맥 혈전증의 비율도 적었는데 이는 병기가 낮은 경우 완치를 목표로 오히려 고선량을 투여하는 경향 때문으로 생각되었다. 조사선량이 50 Gy를 넘는 경우 조사선량의 증가에 따른 반응률의 향상이 현저하지 않은 반면 방사선 간염의 발생은 간경변증의 정도에 크게 영향을 받는다는 점을 고려할 때, 조사선량의 증가는 반드시 치료를 받는 대상 환자의 간기능과 간경변증의 정도 등을 고려하여 조심스럽게 진행되어야 할 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제15권9호
• /
• pp.3915-3920
• /
• 2014

Background: Hepatocellular carcinoma (HCC) is a dismal tumor with a high incidence, prevalence and poor prognosis and survival. Management of HCC necessitates multidisciplinary clinics due to the wide heterogeneity in its presentation, different therapeutic options, variable biologic behavior and background presence of chronic liver disease. We studied the different prognostic factors that affected survival of our patients to improve future HCC management and patient survival. Materials and Methods: This study is performed in a specialized multidisciplinary clinic for HCC in Kasr El Eini Hospital, Cairo University, Egypt. We retrospectively analyzed the different patient and tumor characteristics and the primary mode of management applied to our patients. Further analysis was performed using univariate and multivariate statistics. Results: During the period February 2009 till February 2013, 290 HCC patients presented to our multidisciplinary clinic. They were predominantly males and the mean age was $56.5{\pm}7.7years$. All cases developed HCC on top of cirrhosis that was mainly due to HCV (71%). Most of our patients were Child-Pugh A (50%) or B (36.9%) and commonly presented with small single lesions. Transarterial chemoembolization was the most common line of treatment used (32.4%). The overall survival was 79.9% at 6 months, 54.5% at 1 year and 22.4% at 2 years. Serum bilirubin, site of the tumor and type of treatment were the significant independent prognostic factors for survival. Conclusions: Our main prognostic variables are the bilirubin level, the bilobar hepatic affection and the application of specific treatment (either curative or palliative). Multidisciplinary clinics enhance better HCC management.

• Korean Journal of Radiology
• /
• 제23권11호
• /
• pp.1067-1077
• /
• 2022

Objective: To determine whether Sonazoid-enhanced ultrasound (SZUS) was noninferior to SonoVue-enhanced ultrasound (SVUS) in diagnosing hepatocellular carcinoma (HCC) using the same diagnostic criteria. Materials and Methods: This prospective, single-center, noninferiority study (NCT04847726) enrolled 105 at-risk participants (71 male; mean age ± standard deviation, 63 ± 11 years; range, 26-86 years) with treatment-naïve solid hepatic nodules (≥ 1 cm). All participants underwent same-day SZUS (experimental method) and SVUS (control method) for one representative nodule per participant. Images were interpreted by three readers (the operator and two independent readers). All malignancies were diagnosed histopathologically, while the benignity of other lesions was confirmed by follow-up stability or pathology. The primary endpoint was per-lesion diagnostic accuracy for HCC pooled across three readers using the conventional contrast-enhanced ultrasound diagnostic criteria, including arterial phase hyperenhancement followed by mild (assessed within 2 minutes after contrast injection) and late (≥ 60 seconds with a delay of 5 minutes) washout. The noninferiority delta was -10%p. Furthermore, different time delays were compared as washout criteria in SZUS, including delays of 2, 5, and > 10 minutes. Results: A total of 105 lesions (HCCs [n = 61], non-HCC malignancies [n = 19], and benign [n = 25]) were evaluated. Using the 5-minutes washout criterion, per-lesion accuracy of SZUS pooled across the three readers (72.4%; 95% confidence interval [CI], 64.1%-79.3%) was noninferior to that of SVUS (71.4%; 95% CI, 63.1%-78.6%), meeting the statistical criterion for non-inferiority (difference of 0.95%p; 95% CI, -3.8%p-5.7%p). The arterial phase hyperenhancement combined with the 5-minutes washout criterion showed the same sensitivity as that of the > 10-minutes criterion (59.0% vs. 59.0%, p = 0.989), and the specificities were not significantly different (90.9% vs. 86.4%, p = 0.072). Conclusion: SZUS was noninferior to SVUS for diagnosing HCC in at-risk patients using the same diagnostic criteria. No significant improvement in HCC diagnosis was observed by extending the washout time delay from 5 to 10 minutes.

• Journal of Yeungnam Medical Science
• /
• 제33권1호
• /
• pp.72-75
• /
• 2016

Pulmonary epithelioid hemangioendothelioma (PEH) is a rare, low-to-intermediate malignant tumor of endothelial origin. Computed tomography (CT) findings of PEH demonstrate multiple small bilateral nodules; however, to the best of our knowledge, there were no reports on PEH coexisting with other malignancies. Here, we reported on a case involving PEH in a patient with colon cancer and breast cancer which was misconceived as pulmonary meta- stasis. A 63-year-old woman who suffered from constipation for 2 weeks visited our hospital. Colonoscopy showed a large mass with obstruction on hepatic flexure. The histological diagnosis was adenocarcinoma of the ascending colon. Multiple nodules in both lungs and breast were observed on a chest CT scan. A core biopsy of a breast nodule was performed and a diagnosis of invasive ductal carcinoma of the left breast was made. Pulmonary nodules observed on the chest CT scan was considered as pulmonary metastasis from colon or breast cancer. Laparoscopic right hemicolectomy was performed. At the same time, wedge resection of the lung was performed and pathological diagnosis was PEH. Radiologic features of PEH were difficult to distinguish from lung metastasis. Therefore the author reported a rare case involving PEH in a patient with primary malignancy of colon and breast.

• 한국수의병리학회지
• /
• 제2권2호
• /
• pp.95-106
• /
• 1998

The prevalence of primary liver carcinoma (PLC) is relatively high in Clonorchis sinensis (CS) endemic areas in Korea. PLC is a malignant tumor which can be subclassified into hepatocellular carcinoma and cholangiocarcinoma(CC). CC has been associated with clonorchiasis, but it is unclear whether clonorchiasis is associated with hepatocarcinogenesis. This experiment was designed to investigate relationships between clonorchiasis and early changes of hepatocarcinogenesis. Sixteen Sprague-Dawley rats weighing 150g were divided into two groups of 8 rats in each. All rats were fed choline-devoid(CD) diet for 4 weeks. Group 1 was given 0.015-0.020% diethylnitrosamine(DEN) as drinking water for 1 week. After one week, the rats were treated orally with 1% N-acetylaminofluorene(AAF) (5 times per week for 2 weeks). Group 2 was treated equally to group 1 except for CS infection during AAF treatment. Two rats in each group were sacrificed at 4th, 5th, 6th and 7th week of the experiment. Livers were stained with OV -6, proliferating cell nuclear antigen(PCNA) and GST-p. Results were as follows: Group 2 livers showed more oval cell proliferation in parenchyma and portal areas at the 4th, 5th, 6th and 7th weeks than did livers of group 1 (p＜0.01). PCNA was mostly localized in oval cell populations, rather than hepatocytes and biliary cells. The ratio of oval cells to hepatocytes was much higher in group 2 than in group l(p＜0.01 The ratio of hepatocytes to biliary cells is higher in group 2 than in group 1 (p＜0.05), More group 2 acidophilic foci reacted to GST-p monoclonal antibody than in the noninfected group. It appeared that CS infection promoted potentially precancerous acidophilic foci and oval cell proliferation.