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주문맥혈전증을 동반한 거대 간세포암 환자에서 정위 체부 방사선치료와 sorafenib 병합으로 종양의 완전관해 유도 후 위궤양천공이 발생한 1예
황상연 ( Sang Youn Hwang ),이선미 ( Seon Mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),최철원 ( Chul Won Choi ),양광모 ( Gwang Mo Yang ) 대한간암학회 2014 대한간암학회지 Vol.14 No.1
Hepatocellular carcinoma (HCC) patients with main portal vein invasion have a poor prognosis associated with a median survival time of 2.7 months. Though many guidelines recommended sorafenib in HCC patients with macrovascular invasion (MVI), many clinicians or centers still select locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib because the survival improvement by sorafenib only is expected to be shorter than that without MVI. However this multidisciplinary approach may increase treatment related toxicity such as liver failure etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (3-5 fractions) of large fraction size and is expected to new effective modality for HCC with MVI. Based on above suggestions, we herein offer our experience of a patient with perforation of radiation induced gastric ulcer after complete remission of tumor and main portal vein thrombosis by combination therapy of SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with main portal vein invasion.
주문맥침범과 임파절 전이를 동반한 Child 등급 B인 간세포암 환자에서 방사선치료와 sorafenib 병합으로 종양의 부분관해를 경험한
황상연 ( Sang Youn Hwang ),이선미 ( Seon Mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),강현철 ( Hyun Cheol Kang ),최철원 ( Cheol Won Choi ),양광모 ( Gwang Mo Yang ) 대한간암학회 2014 대한간암학회지 Vol.14 No.2
Reserved liver function is one of the most important determinants of survivial in advanced hepatocellular carcinoma (HCC). Especially in cirrhotic patient with decompensated liver function, sorafenib for HCC with main portal vein invasion have limited efficacy and survival benefit. Therefore many clinicians or centers still try locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib in this situation. However this multidisciplinary approach may increase treatment related toxicity such as liver failure, etc. Recently, studies for combination of RT and sorafenib for HCC with portal vein invasion have been tried and reported not only bettertherapeutic efficacy, but also more hepatic toxicity.Based on above suggestions, we herein offer our experience of a patient that although achieved survival gain via partial remission of intrahepatic tumor and main portal vein thrombosis and metastatic lymph node by combination therapy of RT and sorafenib, finally expired due to hepatictoxicity. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage decompenstated cirrhotic patients with HCC with main portal vein invasion. (J Liver Cancer 2014;14:120-126)
다발성 전이를 동반한 고령의 간세포암 환자에서 경동맥방사선색전술과 반복적 경동맥화학색전술로 간내암과 다발성 전이의 부분관해를 이룬 증례
황상연 ( Sang Youn Hwang ),이선미 ( Seon-mi Lee ),임정우 ( Jung Woo Im ),전기정 ( Ki Jeong Jeon ),안상부 ( Sang Bu Ahn ),박진영 ( Jin-young Park ) 대한간암학회 2018 대한간암학회지 Vol.18 No.2
The number of older adults with hepatocelluar carcinoma (HCC) has been increasing with longer life expectancy and earlier diagnosis and treatment. However, older patients have lesser function reserve of multiple organ systems, more disability rate. Therefore, the treatment of elderly HCC patients remains a challenge worldwide. Recently, studies suggests that the survival outcome of older patients may be comparable to that of younger patients and active treatment may achieve promising rates of local and systemic control in selected patients. Based on above suggestions, we herein offer our experience of a case achieved partial remission by sequential therapy of transarterial chemoembolization after transarterial radioemoblization in elderly HCC patient with multiple metastasis. Further study, maybe regarding a combination of locoregional and systemic treatment, is necessary on how to manage HCC in elderly patients. (J Liver Cancer 2018;18:151-156)
부신, 폐전이를 동반한 거대 간세포암 환자에서 경동맥 화학색전술, 방사선 치료, sorafenib을 병합하여 간내암과 부신전이의 완전관해를 경험한 1예
황상연 ( Sang Youn Hwang ),이선미 ( Seon-mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn,),지은경 ( Eun Kyeong Ji ),최철원 ( Chul Won Choi ),양광모 ( Gwang-mo Yang ) 대한간암학회 2013 대한간암학회지 Vol.13 No.1
Extrahepatic metastasis (EHM) associated with hepatocellular carcinoma (HCC) has been increasing due to prolonged survival with recent advances in therapeutic approaches including locoregional therapy such as transarterial chemoemoblization (TACE), radiofrequency ablation and radiation therapy (RT). Though many guidelines recommended systemic therapy such as sorafenib in this situation, some clinicians or centers still select locoregional therapy because the survival improvement of 2 or 3 months by sorafenib is far from optimal. Moreover, some studies showed that complete and partial response of intrahepatic tumors can result in significant improvement of patient survival even in situation of EHM. Based on above suggestions, we herein offer our experience of a patient with complete remission of intrahepatic tumor and adrenal gland metastasis treated with combination therapy of TACE and RT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy (so called multidisciplinary approach), is necessary on how to manage HCC patients with EHM.
소라페닙 치료 실패 후 소라페닙과 Tegafur 병용요법을 통해 간세포암의 완전관해를 유도한 증례 1예
황상연 ( Sang Youn Hwang ),이선미 ( Seon-mi Lee ),임정우 ( Jung Woo Im ),전기정 ( Ki Jeong Jeon ),안상부 ( Sang Bu Ahn ),박진영 ( Jin-young Park ),최철원 ( Cheol-won Choi ),양광모 ( Kwang-mo Yang ) 대한간암학회 2017 대한간암학회지 Vol.17 No.1
Sorafenib is the only approved targeted agent as the first line systemic therapy for treatment of advanced hepatocellular carcinoma (HCC). However, the improvement of survival duration under 3 months is far from clinical satisfactory and most patients experience disease progression within 6 months after sorafenib therapy. Unfortunately, second line systemic therapy after treatment failure of sorafenib was not established and there were no clear guidelines for salvage treatment modalities. Recently, studies suggests that combination of sorafenib and single cytotoxic agent can be relatively effective and safe strategy that achieves promising rates of local and systemic control in advanced HCC patients. Based on above suggestions, we herein offer our experience of a case achieved complete remission by combination therapy of sorafenib and tegafur in the patient with progressed disease after sorafenib therapy. (J Liver Cancer 2017;17:88-93)
반복적인 경동맥 화학색전술 후 대혈관 침범으로 재발한 간세포암에 대해 정위체부방사선치료로 완전관해를 경험한 1예
황상연 ( Sang Youn Hwang ),이선미 ( Seon-mi Lee ),임정우 ( Jong Woo Im ),전기정 ( Ki Jeong Jeon ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),박진영 ( Jin-young Park ),최철원 ( Cheol-won Choi ),양광모 ( Gwang-mo Yang ) 대한간암학회 2016 대한간암학회지 Vol.16 No.2
Transarterial chemoembolization (TACE) is the worldwide procedure performed for patients with various stage hepatoceullar carcinoma (HCC), but is not yet considered as curative treatment because of relatively high local recurrence rate. Moreover, many clinicians frequently experience treatment failure (incomplete necrosis or stage progression etc.) after repeated TACE, but no clear guidelines have been recommended about salvage treatment modalities for this situation. Recently, studies for combination of radiation therapy and TACE for HCC with TACE refractoriness have been tried and reported better therapeutic efficacy. Based on above suggestions, we herein offer our experience of a patient with macrovascular invasion developed after repeated TACE that achieve complete remission by stereotactic body radiation therapy. Further study, maybe regarding a combination of locoregional and systemic therapy, is necessary on how to manage HCC patients with TACE refractoriness. (J Liver Cancer 2016;16:123-128)
황상연 ( Sang Youn Hwang ),김령고 ( Ryoung-go Kim ),최철원 ( Cheol-won Choi ),안상부 ( Sang Bu Ahn ) 대한간암학회 2016 대한간암학회지 Vol.16 No.2
Hepatocellular carcinoma (HCC) patients with portal vein tumor thrombosis (PVTT) have a extremely poor prognosis. According to the Barcelona Clinic Liver Cancer guideline, sorafenib is a standard therapy in this situation, but many clinicians still select locoregional therapy (LRT) such as transarterial therapy, external beam radiation therapy (EBRT), even surgical resection (SR) or combination of LRTs because the survival improvement by sorafenib is unsatisfactory. Based on recent meta-analysis and prospective study, transarterial chemoembolization (TACE) and transarterial radioembolization seem to be effective and safe therapeutic option that have comparable outcome to sorafenib. Recently large nationwide studies demonstrated that SR can be a potentially curative treatment in selected patients. Hepatic arterial infusion chemotherapy (HAIC) can be also good option, especially in Child class B patients based on small volume prospective studies. Moreover, multidisciplinary strategies based on the combination of LRTs (SR plus TACE, TACE + EBRT, TACE + Sorafenib, HAIC + EBRT etc.) may improve survival of HCC patients with PVTT. Finally we discuss individualized and tailored treatment strategies for different clinical situations. (J Liver Cancer 2016;16:69-81)
담관 침범을 동반한 저혈관성 간세포암종에서 경동맥화학색전술, 정위 체부 방사선 치료, sorafenib을 병합하여 부분관해를 경험한 1예
황상연 ( Sang Youn Hwang ),이선미 ( Seon Mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),최철원 ( Chul Won Choi ),양광모 ( Gwang Mo Yang ) 대한간암학회 2013 대한간암학회지 Vol.13 No.2
Hepatocellular carcinoma (HCC) patients with bile duct invasion have a poor prognosis because many do not receive effective treatment. Surgical resection is thought to be only option of curative treatment, increasing chance of survival, but it is possible to minor group of patients because of poor reserved liver function associated with underlying liver disease and obstructive jaundice. Therefore many clinicians or centers still select locoregional therapy such as transarterial chemoembolization (TACE), radiation therapy (RT) etc. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose for a small numbers (1-5 fractions) of large fraction size and is expected to salvage modality for HCC showed incomplete response of TACE due to vascularity or accessibility of feeding artery. Based on above suggestions, we herein offer our experience of a patient with partial remission of tumor by combination therapy of TACE, SBRT and sorafenib. Further study, maybe regarding a combination of locoregional and systemic therapy (so called multidisciplinary approach), is necessary on how to manage HCC patients with bile duct invasion or sparse vascularity.
동정맥 단락을 동반한 4.8 cm의 침윤성 간세포암에서 정위체부방사선치료와 경동맥화학색전술로 종양의 완전관해를 경험한 1예
황상연 ( Sang Youn Hwang ),이선미 ( Seon Mi Lee ),임정우 ( Jung Woo Im ),김준석 ( Joon Suk Kim ),전기정 ( Ki Jeong Jeon ),안상부 ( Sang Bu Ahn ),지은경 ( Eun Kyeong Ji ),강현철 ( Hyun Cheol Kang ),최철원 ( Cheol Won Choi ),양광모 대한간암학회 2015 대한간암학회지 Vol.15 No.1
Infiltrative hepatocellular carcinoma (HCC) patients have a poor prognosis because most patients present with advanced disease. Although tumor size is small, ablation therapy is difficult because it is difficult to delineate tumor boundary and tumor often combined vascular invasion. Therefore many clinicians still try locoregional therapy (LRT) such as transarterial chemoembolization (TACE), radiation therapy (RT), or combination with LRT and sorafenib in this situation. Stereotactic body radiation therapy (SBRT) is new technology providing very highly conformal ablative radiation dose and is expected to salvage modality for HCC showed incomplete response of TACE due to combined arteriovenous (AV) shunts. Based on above suggestions, we herein offer our experience of a complete remission of tumor by combination of SBRT and TACE in a patient with infiltrative HCC. Further study, maybe regarding a combination of locoregional and systemic therapy is necessary on how to manage infiltrative HCC with AV shunts. (Journal of Liver Cancer 2015;15:64-69)