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Radioembolization in Hepatocellular Carcinoma
Ho Jong Chun(천호종) 한국간담췌외과학회 2014 한국간담췌외과학회 학술대회지 Vol.2014 No.4
Radioembolization is an emerging treatment modality in patients with hepatocellular carcinoma (HCC) and is a form of brachytherapy in which intra-arterially injected Ytrrium-90 microspheres are used for internal radiation purpose. Ytrrium-90 is a high energy beta particle-emitting radioisotope. Ytrrium-90 microspheres administered via arterial route direct the highly concentrated radiation to the tumor while normal liver parenchyma is relatively spared due to its preferential blood supply from portal venous blood. Main complications do not result from the microembolic effect, even in patients with portal vein thrombosis, but rather from an excessive irradiation to the non-target tissues including the liver. All the evidence that support the use of radioembolization in HCC is based on retrospective series or non-controlled prospective studies. However, reliable data can be obtained from the literature, particularly since the recent publication of large series. When compared to the standard of treatment for the intermediate and advanced stages (TACE and sorafenib), radioembolization consistently provides similar survival rates. Many randomized controlled trials using radioembolization are underway and will provide optimal evidences as standard treatment for unresectable HCC.
천호종 ( Ho Jong Chun ) 대한간암학회 2014 대한간암학회지 Vol.14 No.1
Radioembolization is an emerging treatment modality in patients with hepatocellular carcinoma (HCC) and is a form of brachytherapy in which intra-arterially injected Ytrrium-90 microspheres are used for internal radiation purpose. Ytrrium-90 is a high energy beta particle-emitting radioisotope. Ytrrium-90 microspheres administered via arterial route direct the highly concentrated radiation to the tumor while normal liver parenchyma is relatively spared due to its preferential blood supply from portal venous blood. Main complications do not result from the microembolic effect, even in patients with portal vein thrombosis, but rather from an excessive irradiation to the non-target tissues including the liver. All the evidence that support the use of radioembolization in HCC is based on retrospective series or non-controlled prospective studies. However, reliable data can be obtained from the literature, particularly since the recent publication of large series. When compared to the standard of treatment for the intermediate and advanced stages (TACE and sorafenib), radioembolization consistently provides similar survival rates. Many randomized controlled trials using radioembolization are underway and will provide optimal evidences as standard treatment for unresectable HCC.
오정석 ( Jung Suk Oh ),천호종 ( Ho Jong Chun ) 대한간암학회 2012 대한간암학회지 Vol.12 No.2
Early stage hepatocellular carcinoma (HCC) based on BCLC staging system can be curatively treated by liver transplantation, surgical resection or percutaneous ablation. However, transarterial approaches, including transarterial chemoembolization (TACE) or transarterial radioembolization (TARE), are standard of care for intermediate stage HCC and can be an alternative treatment in the patients with early stage HCC which are unresectable, unsuitable for percutaneous ablation, or not eligible for liver transplantation. Many previous TACE studies in early stage HCC revealed that the overall survival rate was competitive with those of curative therapies considering their operation risks, but recurrence-free survival rate was significantly lower than curative therapies. Moreover, the histopathologic reports about TACE in early stage HCC demonstrated that only 38% of the HCC nodules were completely necrotic after TACE and only 81% of the nodules with complete response by EASL criteria showed complete necrosis. Although there is no long-term survival data about TARE in early stage HCC, a histopathologic report about TARE showed that 73% of the HCC nodules were completely necrotic after TARE and 100% of the nodules with complete response by EASL criteria showed complete necrosis. In conclusion, TACE is now limited to be categorized into a curative therapy in early stage HCC, according to the previous data about TACE. However, new recent technologies including C-arm CT, superselective embolization technique, drug-eluting bead (DEB) may sufficiently improve the survival data of TACE to prove its curative role. Considering its RFA-comparable histopathologic tumor response, TARE may prove to be a potential curative therapeutic for early stage HCC.
메트로놈 항암요법을 통하여 완전관해를 경험한 진행성 간세포암 2예
전연주 ( Yeon Joo Chun ),배시현 ( Si Hyun Bae ),정문경 ( Mun Kyoung Chung ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),천호종 ( Ho Jong Chun ),최병길 ( Byung Gil Choi ) 대한내과학회 2010 대한내과학회지 Vol.78 No.6
Advanced hepatocellular carcinoma (HCC) has a poor prognosis and few effective therapies. Recently, low-dose antiangiogenic (also called metronomic) chemotherapy has been tested in patients with advanced HCC. Here, we report two patients with advanced HCC who showed a good response after metronomic chemotherapy. The first was a 54-year-old man who was diagnosed with advanced HCC with lung metastasis. After three cycles of metronomic chemotherapy, the size of tumor and pulmonary metastatic lesions had decreased markedly on follow-up computed tomography. The second was a 54-year-old woman who was diagnosed with HCC with portal vein thrombosis. Metronomic therapy was performed. After 9 months, tumor enhancement in the arterial phase had disappeared completely, and the portal vein thrombus was decreased slightly. Metronomic therapy is an interesting treatment option for patients with advanced HCC. More clinical data and studies are needed to confirm this result. (Korean J Med 78:741-746, 2010)
괴상형 간세포암 간문맥 침범을 보인 괴상형 간세포암의 치료
권정현 ( Jung Hyun Kwon ),최종영 ( Jong Young Choi ),김진동 ( Jin Dong Kim ),우현영 ( Hyun Young Woo ),배시현 ( Si Hyun Bae ),윤승규 ( Seung Kew Yoon ),이영준 ( Young Jun Lee ),천호종 ( Ho Jong Chun ) 대한간암학회 2009 대한간암학회지 Vol.9 No.-
A 52 year-old-man patient was admitted for evaluation of hepatic mass which was detected on screening ultrasonography. His abdominal CT showed a massive infiltrating mass in left hepatic lobe and another 2.4 cm nodule in S6 of Rt. Hepatic lobe with arterial enhancement and rapid wash out underlying liver cirrhosis. Also, low density tumor thrombus are filled in Lt. portal vein and extended into main portal vein. He was finally diagnosed HCC (UICC stage IVa) with liver cirrhosis (Child-Pugh class A) and hepatitis B. With the four times of trasnarterial chemo-lipiodolization and seven times of intraarterial infusion chemotherapy for huge mass and one time Radiofrequency ablation (RFA) for daughter nodule, his HCC showed no stain in hepatic angiogram at nine month from initial diagnosis. After additional eight times of intra-arterial infusion chemotherapy, new small nodule developed in S6 and was ablated with RFA. At eighteen months after initial diagnosis, he shows no viable lesion on the imaging study and tumor markers are normalized.
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)
간문맥혈전을 동반한 거대 간세포암종 환자에서 간동맥항암 단독요법과 동시 방사선-간동맥항암 병합요법의 효과 비교
유찬란 ( Chan Ran You ),장정원 ( Jeong Won Jang ),강석휘 ( Seok Hui Kang ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),최일봉 ( Ihl Bhong Choi ),이동훈 ( Dong Hoon Lee ),천호종 ( Ho Jong Chun ),최 대한간학회 2007 Clinical and Molecular Hepatology(대한간학회지) Vol.13 No.3
김진동 ( Jin Dong Kim ),권정현 ( Jung Hyun Kwon ),배시현 ( Si Hyun Bae ),최종영 ( Jong Young Choi ),윤승규 ( Seung Kew Yoon ),이영준 ( Young Jun Lee ),나성은 ( Sung Eun Rha ),천호종 ( Ho Jong Chun ),최병길 ( Byung Gil Choi ),이해 대한간암연구회 2009 대한간암학회지 Vol.9 No.-
Radiofrequency ablation (RFA) is the preferred method of local ablation for patients with small (<3 cm sized) hepatocellular carcinoma (HCC) when surgical resection cannot be applied. If RFA procedure is sufficiently completed, it provides lower local tumor recurrence, and longer overall as well as disease-free survival. We experienced a case of early stage HCC which recurred at 2 months after successful RFA procedure, and rapidly metastasized to lung and brain.