Indication of Radiation Therapy in Hepatocellular Carcinoma Treatment

Kang Mo Kim(김강모) 한국간담췌외과학회 2014 한국간담췌외과학회 학술대회지 Vol.2014 No.4

Because of the technical improvement of radiation therapy (RT) for hepatocellular carcinoma (HCC), experiences of RT in the treatment of HCC are rapidly increasing. RT has a potential role particularly for locally confined viable HCC unsuitable for, or refractory to, other locoregional therapies. However, RT is generally not considered as a standard option in HCC consensus national guidelines, because of the lack of level 1 evidence. In daily practice of Korea where HCC is quite prevelant, external beam RT has been widely performed as a combination treatment with other locoregional or systemic treatment and the tentative indication is 1) HCC with gross vascular invasion, 2) salvage treatment for intrahepatic HCC, 3) curativeintent treatment in metastatic HCC, and 4) palliative treatment for symptomatic metastasis. In the near future, the role of RT in the treatment of HCC will be more and more important and RT needs to be considered as a treatment option in patients unsuitable for other local therapies in the daily practice. Future prospective studies and close collaboration of radiation oncologist and hepatologist is warranted for the refinement of adequate indication, potential benefit compared with other treatment and optimal combination strategy with RT.

비알코올 지방간질환의 약물치료 업데이트

김강모 ( Kang Mo Kim ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Clinical significance of nonalcoholic fatty liver disease (NAFLD) in Korea will be increasing in the near future according to the improvement of nutrition and changing dietary habits. According to 2018 practice guideline for NAFLD recently introduced by AASLD, lifestyle intervention including diet control and exercise is a mainstay of treatment for NAFLD. Although drug development for NAFLD has been delayed compared with other liver disease area, a few positive advances are being achieved in NASH patients. Pioglitazone or high dose vitamin E supplement could be used in NASH patients, but long-term safety of these medications has to be confirmed in further studies. Metformin, UDCA and omega-3 fatty acid are not recommended as a treatment of NASH, but metformin and omega-3 fatty acid could be considered as a treatment of combined diabetes or dyslipidemia in NASH patients. Recently liraglutide (GLP-1R agonist), obeticholic acid (FXR agonist), elafibranor (PPARα/δ agonist), cenicriviroc (Dual CCR2/CCR5 antagonist) and selonsertib (ASK1 inhibitor) are showing relatively promising data in clinical trials and could be good candidate for NASH treatment in the future. Bariatric surgery could be considered in NASH patients with morbid obesity or medical treatment failure, but the long-term safety and efficacy is not fully confirmed especially in cirrhotic patients.

비알코올 지방간질환의 현재 치료법과 개발 중인 치료법들

김강모 ( Kang Mo Kim ) 대한간학회 2015 Postgraduate Courses (PG) Vol.2015 No.1

Clinical significance of nonalcoholic fatty liver disease (NAFLD) in Korea will be increasing in the near future according to the improvement of nutrition and changing dietary habits. According to the practice guideline for NAFLD recently introduced by KASL, lifestyle modification including diet control and exercise is a mainstay of treatment for NAFLD. Although drug development for NAFLD has been delayed compared with other liver disease area, a few positive advances are being achieved in NASH patients. Pioglitazone or high dose vitamin E supplement could be used in NASH patients, but long term safety of these medications has to be confirmed in further studies. Metformin, statins and omega-3 are not recommended as a treatment of NASH, but it could be considered as a treatment of combined diabetes or dyslipidemiain NASH patients. Recently obeticholic acid (FXR agonist) and liraglutide (GLP-1R agonist) are showing relatively promising data in clinical trials and could be good candidate for NASH treatment in the future. Bariatric surgery could be considered in NASH patients with morbid obesity or medical treatment failure, but the long term safety and efficacy is not fully confirmed especially in cirrhotic patients.

PARALLEL SYMPOSIUM 3 : Acute on Chronic Liver Failure: Natural History and Prognosis

김강모 ( Kang Mo Kim ) 대한간학회 2013 춘·추계 학술대회 (KASL) Vol.2013 No.1

Session 2: 위장관 바이러스성 질환의 국내 역학 및 특성 : 급성 바이러스성 간염의 개괄

김강모 ( Kang Mo Kim ) 대한인수공통전염병학회 2013 창립총회 및 학술대회 초록집 Vol.2013 No.1

급성 바이러스성 간염은 간을 주로 침범하는 전신성 바이러스 감염 질환으로 실지 임상에서는독성 간염, 알코올성 간질환, 자가면역 간염, 허혈성 간염, Budd-Chiari 증후군, 류마치스성 질환의간침범 등 여러 질환과의 감별이 필요하다. 급성 바이러스성 간염을 일으키는 바이러스로는hepatitis A virus (HAV), hepatitis B virus (HBV), hepatitis C virus (HCV), hepatitis D virus (HDV),hepatitis E virus (HEV), Ebstein Barr virus (EBV), herpes simplex virus (HSV), cytomegalovirus(CMV) 등이 있으며 드물게는 coxsachievirus, echovirus, yellow fever virus 등도 급성 간염을 일으키는 것으로 알려져 있으나 실지 임상에서 접하는 바이러스성 간염의 대부분은 HAV, HBV, HCV,HEV에 의한 간염이다. 10여 년 전에는 급성 B형 간염의 빈도가 전체 급성 바이러스성 간염의 약40%에 까지 이르렀으나 최근에는 HBV 백신 접종에 의해 5% 미만으로 감소했으며 최근에는 급성A형 간염이 가장 흔하게 접하게 되는 바이러스성 간염이다. 급성 A형 간염과 급성 B형 간염은 대표적인 경구 전파 바이러스성 간염이며 급성기가 지나면 만성화되지 않고 대부분 완치가 되나 일부에서는 전격성 간염으로 진행하여 치명적일 수도 있다. 급성 B형 간염 및 급성 C형 간염은 그빈도가 높지는 않으나 적지 않은 수에서 만성화하여 간경변 및 간암으로 진행되기도 한다. 급성바이러스성 간염의 예방을 위해서는 손씻기 등의 위생이 중요하며, A, B형 간염의 경우에는 예방접종을 실시해야 한다. 본 강의에서는 임상에서 흔히 접하게 되는 급성 바이러스성 간염을 그 원인에 따라 임상의의 측면에서 개괄하여 이에 대한 이해를 높이고자 하였다.

임상의가 놓치기 쉬운 간질환 : 원발담즙간경변증

김강모 ( Kang Mo Kim ) 대한간학회 2009 Clinical and Molecular Hepatology(대한간학회지) Vol.15 No.2(S)

Primary biliary cirrhosis (PBC) is a slowly progressive chronic cholestatic liver disease of autoimmune etiology, characterized histologically by portal inflammation and necrosis of the interlobular and septal bile ducts. Patients affected by PBC are often asymptomatic middle-aged women who are commonly diagnosed after evaluation for abnormal serum liver function tests. Fatigue, pruritus, and/or unexplained hyperlipidemia may also be found at initial presentation. Anti-mitochondrial antibody (AMA) positivity is nearly diagnostic of PBC when present. The identification of PBC is important, as effective medical therapy with ursodeoxycholic acid (UDCA) has been demonstrated to slow disease progression and improve survival independent of liver transplantation. However, therapeutic options for the medical complications of PBC, such as fatigue and metabolic bone disease, are currently limited. Mathematical models have been developed which accurately characterize and predict the natural history of PBC.

2008년 미국간학회 하이라이트 : C형간염 관련 분야(바이러스학 및 병인)

김강모 ( Kang Mo Kim ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.4

DNA 시퀀스 데이터베이스를 위한 저장-효율적인 Trie 인덱싱 기법

김강모(Kang-Mo Kim),서남호(Nam-Ho Seo),원정임(Jung-Im Won),윤지희(Jee-Hee Yoon),박상현(Sang-Hyun Park),김상욱(Sang-Wook Kim) 한국정보과학회 2004 한국정보과학회 학술발표논문집 Vol.31 No.1B

대규모 DNA 시퀀스를 대상으로 하여 서브시퀀스를 고속으로 검색하기 위한 인덱싱 방법으로서 접미어 트리가 유용하다. 그러나 접미어 트리는 데이터 크기의 약 100배에 해당하는 방대한 저장 공간을 필요로 한다. 본 논문에서는 기존 접미어 트리의 검색 성능을 유지하며, 저장 공간을 획기적으로 감소시킬 수 있는 새로운 인덱스 구조를 제안한다. 제안된 인덱싱 방안에서는 DNA 시퀀스 내의 모든 염기 위치에 고정 길이의 슬라이딩 윈도우를 위치시켜, 윈도우 크기에 해당하는 연속된 서브시퀀스를 추출한 후, 이들을 대상으로 트라이를 구성한다. 트라이는 저장 공간 감소를 위하여 각 문자를 최소 비트 정보로 표현하며, 저장 구조로서 포인터를 사용하지 않는 디스크 기반의 이진 트라이 구조를 사용한다. DNA 서브시퀀스 검색을 효율적으로 처리하기 위한 인덱스 기반의 질의 처리 알고리즘을 제안하고 실험을 통하여 그 유용성을 보인다. 제안된 인덱스는 접미어 트리의 약 10분의 1의 저장 공간을 필요로 하며, 데이터 크기 증가에 거의 영향을 받지 않는 안정된 고속 검색 성능을 지원한다.

한국인 간세포암 환자에서 경피적 에탄올 주입술의 치료 효과

강현우 ( Kang Hyeon U ),김윤준 ( Kim Yun Jun ),김강모 ( Kim Gang Mo ),강정묵 ( Kang Jeong Mug ),김수환 ( Kim Su Hwan ),김진현 ( Kim Jin Hyeon ),윤원재 ( Yun Won Jae ),윤정환 ( Yun Jeong Hwan ),윤용범 ( Yun Yong Beom ),이효석 ( Lee 대한소화기학회 2003 대한소화기학회지 Vol.42 No.6

Background/Aims: Percutaneous ethanol injection therapy (PEIT) is widely used for the treatment of hepatocellular carcinoma (HCC). However, its long-term therapeutic efficacy is not verified in Korea, one of hepatitis B virus (HBV) endemic areas. Thus, this study was to assess its efficacy and prognostic factors affecting tumor-free survival following PEIT in Korean HCC patients. Methods: From 1997 to 1999, 100 consecutive patients who had 1 to 3 HCC nodules of maximum diameter less than 3 cm and underwent PEIT were enrolled. Therapeutic efficacy, overall and tumor-free survival rates were assessed during follow-up periods. Results: In 83 patients, HCC nodules were completely ablated by PEIT. The cumulative 1, 2, and 3 year overall survival rates were 98%, 96%, and 88%, respectively. The cumulative 1, 2, and 3 year tumor-free survival rates were 73%, 50%, and 37%, respectively. Larger tumors (=2 cm) were associated with a higher local recurrence rate. Conclusions: These results demonstrate that PEIT is therapeutically useful in patients with HCC less than 4 in number and less than 3 cm in diameter. However, since multiple or large tumors are associated with low tumor-free survival or high local recurrence rates, PEIT for these tumors and the subsequent post-treatment follow-up should be performed carefully. (Korean J Gastroenterol 2003;42:502-509)

진행된 간세포암에서의 간문맥 혈전증에 대한 방사선치료 효과

김정훈(Jung Hoon Kim),최은경(Eun Kyung Choi),안승도(Seung Do Ahn),이상욱(Sang-wook Lee),신성수(Seong Soo Shin),최원식(Wonsik Cho),임영석(Young-suk Lim),김강모(Kang Mo Kim),서동진(Dong Jin Suh),정영화(Young Wha Chung),이영상(Young San 대한방사선종양학회 2007 Radiation Oncology Journal Vol.25 No.3

목 적: 치료방법이 정립되지 않은 진행된 간세포암에서의 간문맥 혈전증에 대한 방사선치료의 효과와 간독성을 측 정함으로써 향후 방사선치료의 효용성에 대하여 알아보고자 한다. 대상 및 방법: 2000년 5월부터 2005년 12월까지 서울아산병원에서 원발성 간세포암으로 진단받은 환자 중 간문맥혈전증이 동반된 70명의 환자를 대상으로 후향적 분석을 하였다. 대상 환자들의 나이는 24∼74세(중앙값 51세)였으며, 대부분이 Child-Pugh’s class A, B였고 Eastern Cooperative Oncology Group (ECOG) 2 이하였다. 방사선치료는 3차원입체조형치료를 시행하였으며, 1회 선량은 2∼4 Gy로 총방사선량은 40∼60 Gy (중앙값 48 Gy)였으며, 생물학적 유효선량(biologic effective dose)은 31.3∼78.0 Gy10 (중앙값 61.6 Gy10)였다. 결 과: 치료 반응평가는 치료 전과 치료 종료 후 최소 1개월 이상 경과 후 컴퓨터 단층촬영(CT)을 시행하여 평가하였으며, 대상 환자들의 추적관찰기간은 2∼24개월(중앙값 9개월)이었다. 방사선치료 후 완전반응인 경우가 2명(2.9%), 부분반응 31명(44.3%), 무반응 35명(50.0%), 진행병변 2명(2.9%)이었다. 1년 무진행 생존율(progression-free survival)은 60%였으며, 중앙 무진행 생존기간은 17개월이었다. 전체 환자의 중앙 생존기간(overall survival)은 11개월이었으며, 치료반응 유무에 따라 부분 반응 이상을 보인 환자군의 중앙 생존기간은 15개월, 무반 응이거나 진행병변을 보인 환자군은 8개월로 통계학적 차이를 보였다(p=0.032). 치료 중 일시적인 간기능 저하가 4명(5.7%), 방사선 간염은 1명(1.4%)에서 발생하였다. 결 론: 진행된 간세포암에서의 간문맥 혈전에 대해 방사선치료를 시행한 경우 비교적 유용하며 안전한 치료법이며,앞으로의 연구에서는 방사선치료가 생존율을 향상시킬 수 있는지 여부와 적절한 방사선량을 결정하기 위한 연구가 필요할 것으로 생각된다. 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.