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괴상형 간세포암 간동맥화학색전술에 반응을 보이지 않은 거대 간세포암종을 간절제술로 치료한
김정한 ( Jeong Han Kim ),임형준 ( Hyung Joon Yim ),김승영 ( Seung Young Kim ),안재홍 ( Jae Hong Ahn ),김지훈 ( Ji Hoon Kim ),서연석 ( Yeon Seok Seo ),이승화 ( Seung Hwa Lee ),정환훈 ( Hwan Hoon Chung ),송태진 ( Tae Jin Song ),이 대한간암학회 2009 대한간암학회지 Vol.9 No.-
Surgical resection is the treatment of choice for hepatocellular carcinoma (HCC) in non-cirrhotic patients. The optimal indication for resection is a single tumor in a suitable location for resection. However, limit of the tumor size is not clear. We report a case of successful hepatic resection in patients with massive HCC sized more than 15 cm that did not respond to transarterial chemoembolization (TACE). A 49-year-old male patient had received TACE two times for massive HCC. However, the tumor size increased. Right hemihepatectomy was performed despite the extensive tumor size and underlying liver cirrhosis. Ascites and wound infection were developed after resection, but the patient`s general condition got recovered soon. Until 6 months after surgery, recurrence has not been detected. However, distant metastasis was noted at 7th month. Although recurrence with distant metastasis was noted, we think aggressive surgical approach prolonged this patient`s survival.
고빌리루빈혈증과 담도 침범을 동반한 간세포암에 대한 경동맥화학 리피오돌색전술의 안전성과 예후 인자
양경모 ( Keungmo Yang ),성필수 ( Pil Soo Sung ),오정석 ( Jung Suk Oh ),천호종 ( Ho Jong Chun ),장정원 ( Jeong Won Jang ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ) 대한간암학회 2018 대한간암학회지 Vol.18 No.2
Background/Aims: The treatments and outcomes of hepatocellular carcinoma (HCC) with bile duct invasion are not well known. We aimed to confirm the safety of transarterial chemolipiodolization (TACL) and identify prognostic factors for patients with bile duct invasion treated with TACL. Methods: Fifty patients with central bile duct invasion treated with TACL between 2005 and 2017 were enrolled. Patients were divided into three groups: hyperbilirubinemia (total bilirubin ≥2.5 mg/dL) with pre-TACL biliary drainage, hyperbilirubinemia without biliary drainage, and without hyperbilirubinemia. Tumor response to TACL, survival outcomes, length of hospitalization, adverse events using Common Terminology Criteria for Adverse Events (CTCAE), and factors affecting overall survival were compared. Results: TACL-induced changes of mean CTCAE grades for albumin, alanine aminotransferase, creatinine, prothrombin time, and platelet were not significantly different among patients with or without initial hyperbilirubinemia. Serum bilirubin level was not significantly changed after TACL in all the three groups. Overall survival was not significantly different among the three groups (P=0.097). On multivariate analysis, alpha-fetoprotein <400 ng/dL (hazard ratio [HR]=0.477, P=0.048) and highest total bilirubin level of <2.5 mg/dL within one month after TACL (HR=0.335, P=0.004) were significantly associated with longer survival. Conclusions: TACL was a safe treatment for HCC patients with central bile duct invasion, irrespective of the presence of initial hyperbilirubinemia. (J Liver Cancer 2018;18:121-129)
Liver transplantation for hepatocellular carcinoma with portal vein tu-mor thrombosis
( Sang Jin Kim ),( Jong Man Kim ) 대한간암학회 2021 대한간암학회지 Vol.21 No.2
Traditionally, liver transplantation for hepatocellular carcinoma with portal vein tumor thrombosis is not recommended. However, with recent developments in locoregional therapies for hepatocellular carcinoma, more aggressive treatments have been attempted for advanced hepatocellular carcinoma. Recently, various studies on locoregional therapies for downstaging followed by living donor liver transplantation reported inspiring overall survival and recurrence-free survival of patients. These downstaging procedures included threedimensional conformal radiation therapy, trans-arterial chemoembolization, stereotactic body radiation therapy, trans-arterial radioembolization, hepatic arterial infusion chemotherapy and combinations of these therapies. Selection of the optimal downstaging protocol should depend on tumor location, biology and background liver status. The risk factors affecting outcome include pre-downstaging alpha-fetoprotein values, delta alpha-fetoprotein values, disappearance of portal vein tumor thrombosis on imaging and meeting the Milan criteria or not after downstaging. For hepatocellular carcinoma with portal vein tumor thrombosis, downstaging procedure with liver transplantation in mind would be helpful. If the reaction of the downstaged tumor is good, liver transplantation may be performed. (J Liver Cancer 2021;21:105-112)
Sung Hoon Chang,김태석,전용환,정누리현,최대희 대한간암학회 2022 대한간암학회지 Vol.22 No.2
In recent years, radiotherapy (RT) has been used to treat hepatocellular carcinoma (HCC) at each stage. This clinical trend has developed with the increasing improvement of RT techniques, which show clinical results comparable to those of other treatment modalities. Intensity- modulated radiotherapy uses a high radiation dose to improve treatment effectiveness. However, the associated radiation toxicity can damage adjacent organs. Radiation-induced gastric damage with gastric ulcers is a complication of RT. This report presents a novel management strategy for preventing post-RT gastric ulcers. We present the case of a 53-year- old male patient diagnosed with HCC, who experienced gastric ulcer after RT. Before the second round of RT, the patient was administered a gas-foaming agent, which was effective in preventing RT complications.