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The Role of Radiotherapy in the Treatment of Portal Vein Thrombosis from Advanced Hepatocelluar Carcinoma
±èÁ¤ÈÆ, ¾È½Âµµ, ÀÌ¿µ»ó, ÀÓ¿µ¼®, ÃÖÀº°æ, ÀÌ»ó¿í, ½Å¼º¼ö, ÃÖ¿ø½Ä, ±è°¸ð, ¼µ¿Áø, Á¤¿µÈ, ¿øÇüÁø, ±èÁ¾ÈÆ,
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±èÁ¤ÈÆ ( Kim Jung-Hoon )
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ÀÌ¿µ»ó ( Lee Yung-Sang )
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ÀÓ¿µ¼® ( Lim Young-Suk )
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ÃÖÀº°æ ( Choi Eun-Kyung )
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ÀÌ»ó¿í ( Lee Sang-Wook )
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½Å¼º¼ö ( Shin Seong-Soo )
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ÃÖ¿ø½Ä ( Choi Won-Sik )
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±è°¸ð ( Kim Kang-Mo )
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¼µ¿Áø ( Suh Dong-Jin )
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Á¤¿µÈ ( Chung Young-Hwa )
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¿øÇüÁø ( Won Hyung-Jin )
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±èÁ¾ÈÆ ( Kim Jong-Hoon )
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KMID : 0859320070250030170
Abstract
¸ñ Àû: Ä¡·á¹æ¹ýÀÌ Á¤¸³µÇÁö ¾ÊÀº ÁøÇàµÈ °£¼¼Æ÷¾Ï¿¡¼ÀÇ °£¹®¸Æ Ç÷ÀüÁõ¿¡ ´ëÇÑ ¹æ»ç¼±Ä¡·áÀÇ È¿°ú¿Í °£µ¶¼ºÀ» ÃøÁ¤ÇÔÀ¸·Î½á ÇâÈÄ ¹æ»ç¼±Ä¡·áÀÇ È¿¿ë¼º¿¡ ´ëÇÏ¿© ¾Ë¾Æº¸°íÀÚ ÇÑ´Ù.
´ë»ó ¹× ¹æ¹ý: 2000³â 5¿ùºÎÅÍ 2005³â 12¿ù±îÁö ¼¿ï¾Æ»êº´¿ø¿¡¼ ¿ø¹ß¼º °£¼¼Æ÷¾ÏÀ¸·Î Áø´Ü¹ÞÀº ȯÀÚ Áß °£¹®¸Æ Ç÷ÀüÁõÀÌ µ¿¹ÝµÈ 70¸íÀÇ È¯ÀÚ¸¦ ´ë»óÀ¸·Î ÈÄÇâÀû ºÐ¼®À» ÇÏ¿´´Ù. ´ë»ó ȯÀÚµéÀÇ ³ªÀÌ´Â 24¡74¼¼(Áß¾Ó°ª 51¼¼)¿´À¸¸ç, ´ëºÎºÐÀÌ Child-Pugh¡¯s class A, B¿´°í Eastern Cooperative Oncology Group (ECOG) 2 ÀÌÇÏ¿´´Ù. ¹æ»ç¼±Ä¡·á´Â 3Â÷¿øÀÔüÁ¶ÇüÄ¡·á¸¦ ½ÃÇàÇÏ¿´À¸¸ç, 1ȸ ¼±·®Àº 2¡4 Gy·Î Ãѹæ»ç¼±·®Àº 40¡60 Gy (Áß¾Ó°ª 48 Gy)¿´À¸¸ç, »ý¹°ÇÐÀû À¯È¿¼±·®(biologic effective dose)Àº 31.3¡78.0 Gy10 (Áß¾Ó°ª 61.6 Gy10)¿´´Ù.
°á °ú: Ä¡·á ¹ÝÀÀÆò°¡´Â Ä¡·á Àü°ú Ä¡·á Á¾·á ÈÄ ÃÖ¼Ò 1°³¿ù ÀÌ»ó °æ°ú ÈÄ ÄÄÇ»ÅÍ ´ÜÃþÃÔ¿µ(CT)À» ½ÃÇàÇÏ¿© Æò°¡ÇÏ¿´À¸¸ç, ´ë»ó ȯÀÚµéÀÇ ÃßÀû°üÂû±â°£Àº 2¡24°³¿ù(Áß¾Ó°ª 9°³¿ù)À̾ú´Ù. ¹æ»ç¼±Ä¡·á ÈÄ ¿ÏÀü¹ÝÀÀÀÎ °æ¿ì°¡ 2¸í(2.9%), ºÎºÐ¹ÝÀÀ 31¸í(44.3%), ¹«¹ÝÀÀ 35¸í(50.0%), ÁøÇິº¯ 2¸í(2.9%)À̾ú´Ù. 1³â ¹«ÁøÇà »ýÁ¸À²(progression-free survival)Àº 60%¿´À¸¸ç, Áß¾Ó ¹«ÁøÇà »ýÁ¸±â°£Àº 17°³¿ùÀ̾ú´Ù. Àüü ȯÀÚÀÇ Áß¾Ó »ýÁ¸±â°£(overall survival)Àº 11°³¿ùÀ̾úÀ¸¸ç, Ä¡·á¹ÝÀÀ À¯¹«¿¡ µû¶ó ºÎºÐ ¹ÝÀÀ ÀÌ»óÀ» º¸ÀΠȯÀÚ±ºÀÇ Áß¾Ó »ýÁ¸±â°£Àº 15°³¿ù, ¹«¹ÝÀÀÀ̰ųª ÁøÇິº¯À» º¸ÀΠȯÀÚ±ºÀº 8°³¿ù·Î Åë°èÇÐÀû Â÷À̸¦ º¸¿´´Ù(p=0.032). Ä¡·á Áß ÀϽÃÀûÀÎ °£±â´É ÀúÇÏ°¡ 4¸í(5.7%), ¹æ»ç¼± °£¿°Àº 1¸í(1.4%)¿¡¼ ¹ß»ýÇÏ¿´´Ù.
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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 Gy10 (median dose: 61.6 Gy10). 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.
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Portal vein thrombosis;Hepatocelluar carcinoma;Three-dimensional conformal radiotherapy
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