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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)
만성 C형간염 환자에서 인터페론 알파와 리바비린 병합요법의 치료 효과와 합병증
황상연 ( Sang Youn Hwang ),이혜정 ( Hae Jung Lee ),박기태 ( Kee Tae Park ),김경엽 ( Kyung Yup Kim ),이선미 ( Sun Mi Lee ),박찬원 ( Chan Won Park ),김태오 ( Tae Oh Kim ),김광하 ( Gwang Ha Kim ),허정 ( Jeong Heo ),강대환 ( Dae Hwan 대한소화기학회 2007 대한소화기학회지 Vol.49 No.3
목적: 만성 C형간염 환자의 인터페론 혹은 페그인터페론과 리바비린 병합요법의 치료 효과는 잘 알려져 있다. 그러나 치료에 따른 합병증을 중점으로 다룬 연구는 많지 않다. 이번 연구는 다양한 범주의 만성 C형간염 환자를 대상으로 인터페론과 리바비린 병합요법의 효용성과 합병증을 연구하고자 하였다. 대상 및 방법: 2001년 1월부터 2005년 1월까지 부산대학교병원에서 인터페론과 리바비린을 투여 받은 240명의 만성 C형간염 환자를 대상으로 치료 합병증을 평가하였고, 그중 치료를 종결한 154명의 환자를 대상으로 이들의 치료종결반응(end of treatment resoponse, ETR)과 지속바이러스반응(sustained virologic response, SVR)을 후향으로 평가하였다. 투여기간은 유전자 1형은 12개월, 비 1형은 6개월로 하였고, 인터페론 알파 300만 단위를 주 3회 피하주사로, 리바비린 800-1,200 mg을 매일 경구로 투여하였다. 결과: 총 240명의 환자의 남녀비는 143:97였고, 유전자 1형은 111명, 비 1형은 106명, 검사하지 않았거나 분석할 수 없었던 경우가 23명이었다. 치료를 완료한 154명의 ETR, SVR은 각각 79.2%, 61.0%였고, ETR을 보인 환자 중 SVR에 관한 추적관찰을 하지 못한 13명을 제외하였을 때 SVR은 66.7%였다. 치료를 조기에 중단한 환자는 35.8%로 순수 치료 부작용으로 인한 경우가 15.4%, 추적방문 실패로 인한 경우가 7.9%, 치료 경과 중 바이러스 음전실패 및 돌파현상으로 인한 경우가 11.3%, 그 외 원발 복막염, 간세포암종, 심근경색의 경우가 1.2%였다. 부작용으로 치료를 중단했던 경우는 간기능 악화가 8명, 우울증과 관련된 증상이 10명 (식욕부진 5명, 무력감 및 피곤함 2명, 자살충동 2명, 불면증 1명), 체질증상이 7명, 탈모 4명, 피부발진 2명, 혈소판 감소 2명, 그 외 피부 소양증, 설사, 흉통, 체중 감소가 각각 1명이었다. 빈혈로 인해 리바비린을 감량한 경우는 37명(15.4%), 백혈구 감소와 혈소판 감소로 인터페론을 감량한 경우는 각각 21명(8.8%)과 11명(4.6%)이었다. 결론: 치료를 완료한 환자들의 SVR은 61.0%였고, 환자의 약 3분의 1이 치료반응 부족, 부작용 및 순응도 부족으로 치료를 조기 중단하였다. Background/Aims: The effectiveness of combination therapy with conventional or pegylated interferon alpha and ribavirin in patients with chronic hepatitis C is well understood. However, the profound investigation about complications of the treatment has been rarely reported in Korea, where patients have broader spectrum of disease manifestations. The aim of this study was to evaluate the effectiveness and complications of the combination therapy of interferon alpha and ribavirin in patients with chronic hepatitis C. Methods: Two hundred and forty patients with chronic hepatitis C were included. All patients were treated with interferon alpha (3 million units thrice a week) in combination with ribavirin (800-1,200 mg, depending on body weight). Patients were treated for 6 or 12 months according to the genotypes (genotype 1; 12 months, non-1; 6 months). We retrospectively evaluated ETR (end of treatment response) and SVR (sustained virologic response) on the basis of intent-to-treat in patients completing the therapy. Results: In 154 patients who had completed the therapy, ETR was 79.2% and SVR was 61.0%. Multivariate analysis showed that genotype and early virologic response at 3 months of treatment were indepedent predictive factors of SVR. Due to insufficient response, 11.3% of the patients discontinued the therapy. In addition, 24.5% of the patients prematurely discontinued the therapy due to adverse events including aggravated liver function (15.4%), failure to return (7.9%), and others (1.2%). Dose modifications of interferon alpha or ribavirin were required due to anemia (15.4%), neutropenia (8.8%), or thrombocytopenia (4.6%). Conclusions: The overall SVR of patients who had completed the combination therapy with interferon alpha and ribavirin was 61.0%. However, about one third of the patients discontinued the therapy prematurely due to insufficient response, adverse events and/or noncompliance. (Korean J Gastroenterol 2007;49:166-172)
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.
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)
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)
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)