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노금엽 ( Geum Youb Noh ), 한철주 ( Chul Ju Han ), 김연주 ( Youn Joo Kim ), 양기영 ( Ki Young Yang ), 박수철 ( Su Cheol Park ), 김진 ( Jin Kim ), 김유철 ( Yu Cheol Kim ), 김미숙 ( Mi Sook Kim ) 대한간암연구학회(구 대한간암연구회) 2011 대한간암학회지 Vol.11 No.2
Radiation therapy (RT) is one of the managements for unresectable hepatocellular carcinoma (HCC). Traditionally, RT has played only a limited role in HCC treatment because of its low efficacy and the low tolerance of the liver for this modality. However, as the technology of RT grows rapidly in recent years, indication of RT for HCC has been extended remarkably. Stereotactic body radiation therapy (SBRT) is a technique that allows precise delivery of a large ablative radiation dose to the tumor while sparing normal surrounding tissue in 1 to 5 fractions. As RT becomes useful therapeutic strategy, the important problem is that there could be serious complication after RT. Here we present a case of 54 years old male with advanced stage of HCC, who underwent a serious neurologic complication of paraplegia following Cyberknife (CK) treatment. He had a huge HCC in right lobe of the liver, and initially transarterial chemoembolization (TACE) was performed with an unsatisfactory response. Therefore, CK was performed, and another TACE was done for a new lesion, which was followed by remarkable complete remission of the tumor. However, paraplegia developed in both of his lower extremities a year after CK. Investigation has shown radiation myelitis as the cause of paralysis. Three and a half years have passed since CK treatment, and HCC is still in complete remission state, however, paraplegia is persistent now. Radiation myelitis should be considered as a complication, when CK is applied to treatment of HCC.
송도선 ( Do Seon Song ), 송명준 ( Myeong Jun Song ), 배시현 ( Si Hyun Bae ), 최종영 ( Jong Young Choi ), 윤승규 ( Seung Kew Yoon ), 천호종 ( Ho Jong Chun ), 김동구 ( Dong Goo Kim ) 대한간암연구학회(구 대한간암연구회) 2012 대한간암학회지 Vol.12 No.1
Hepatocellular carcinoma (HCC) is the third most common malignancy in Korea where chronic hepatitis B virus is prevalent. More than 60-70% of HCC cases are diagnosed at an advanced stage that are not eligible for curative therapy such as surgical resection, liver transplantation, radiofrequency ablation, and percutaneous ethanol injection. According to Barcellona Clinic Liver Cancer (BCLC) staging and treatment, standard treatment of advanced HCC is sorafenib. And there are some reports that hepatic arterial infusion chemotherapy (HAIC) could be a beneficial therapeutic option for patients with advanced HCC. We report a case of advanced HCC with portal vein thrombosis that received liver transplantation after combination treatment of HAIC and sorafenib.
Hepatocellular carcinoma (HCC) is the third most common cause of cancer death in the world. There has been many advances in diagnosis of HCC during the last ten-year period, especially imaging techniques. The Korean Liver cancer study group (KLCSG), European Association for the Study of the Liver (EASL), American Association for the Study of Liver disease (AASLD) and Asian-Pacific Association for the Study of Liver (APASL) have made and changed HCC guidelines with advances of imaging technique and results of research on HCC. We reviewed the changes of imaging guidelines in HCC diagnosis according to the advances of imaging. In addition, further studies will be needed to solve the controversies in diagnosis of HCC smaller than 1 cm in size.
Toll-like receptors are a family of pattern recognition receptors that allow the immune system to sense molecules that are present in most classes of pathogens such as bacteria and viruses, but not the host, and to coordinate defense mechanisms against these pathogens. Emerging evidence also suggests that TLRs have an important role in maintaining tissue homeostasis by regulating the inflammatory and tissue repair responses to injury. Due to the important role in inflammation, tissue regeneration and fibrogenesis, TLRs are potential candidates to mediate effects of the innate immune system on carcinogenesis. Although the role of TLRs in carcinogenesis is far from being completely understood, current data suggest a dual role of TLRs in carcinogenesis: anti-tumor effects versus tumor-promoting effects. Here we discuss how TLRs function in the context of carcinogenesis.
The prevalence of hypoglycemia in hepatocellular carcinoma (HCC) ranged from 4 to 27%. The causes of hypoglycemia in HCC are two type. Type A is a poorly differentiated tumor with mild to moderate severity of hypoglycemia that occurs in the late stage of the disease. The less common type B tumor is a well-differentiated slow growing tumor in which severe hypoglycemia occurs in early stages of the disease. We reported a case of improvement of hypoglycemia due to HCC by sorafenib.
이지은 ( Ji Eun Lee ), 장재영 ( Jae Young Jang ), 정승원 ( Soung Won Jeong ), 이세환 ( Sae Hwan Lee ), 김상균 ( Sang Gyune Kim ), 김영석 ( Young Seok Kim ), 조영덕 ( Young Deok Cho ), 김홍수 ( Hong Soo Kim ), 김부성 ( Boo Sung Kim ) 대한간암연구학회(구 대한간암연구회) 2011 대한간암학회지 Vol.11 No.2
Radiofrequency ablation (RFA) inducing of coagulation necrosis by using thermal energy via electrodes placed within the tissue effectively controls hepatocellular carcinoma (HCC). RFA has been commonly applied as an alternative curative therapy to surgical resection for small HCC due to effective local tumor control. Although the technique is considered relatively safe, several major complications requiring hospitalization for treatment have been reported such as vascular thrombosis, pneumothorax, pleural effusion, skin burn, hematoma, liver abscess and colon perforation. Most complications occur due to thermal injuries to adjacent structures by RFA. The risk of bowel perforation has been observed only when the target lesion is adjacent to a gastrointestinal lumen, but, mechanical obstruction is extremely rare. Therefore, we report a case of mechanical obstruction after transaction of ileum secondary to RFA of HCC.
노금엽 ( Geum Youb Noh ), 한철주 ( Chul Ju Han ), 김연주 ( Youn Joo Kim ), 양기영 ( Ki Young Yang ), 박수철 ( Su Cheol Park ), 김진 ( Jin Kim ), 김유철 ( Yu Cheol Kim ), 최윤희 ( Yoon Hee Choi ), 이효락 ( Hyo Rak Lee ) 대한간암연구학회(구 대한간암연구회) 2011 대한간암학회지 Vol.11 No.1
Surgical resection for hepatocellular carcinoma (HCC) is one of the managements, showing improved long term survival. Nowadays, it is being accepted as the main curative treatment. However, the biggest problem we used to face is that surgery cannot be applied at the point of presentation in many patients due to advanced stage. Here we present a case of 54 years old female, who had transarterial chemoembolization (TACE) and sorafenib due to advanced stage of HCC, and later underwent curative surgery due to remarkable response. She had a CT scan of abdomen, which showed multiple huge masses. HCC was confirmed by ultrasonography-guided liver biopsy. TACE was performed once. After TACE, the size of masses increased. Therefore, sorafenib was administered and then continued for 9 months. As partial response was obtained at that time, surgical resection was successfully done. In the pathological report of removed tumor, we could confirm total necrosis of tumor. Now, it`s been 6 months and she is followed up without any recurrence.
Hepatocellular carcinoma (HCC) develops on chronic liver disease and often accompanies portal hyperternsion. Portal hypertension induces hypersplenism with splenomegaly. Because hypersplenism results in pancytopenia, especially thrombocytopenia, it is not easy to decide the hepatic resection for many surgeons in patients with HCC and hypersplenism. Although liver transplantation is the most ideal treatment for HCC and hypersplenism, liver resection has been performed commonly because of donor shortage. Splenectomy has performed to control intractable varices as a Hassab`s operation (=decongestion of upper gastric marginal veins and splenectomy). Recently, as a development of surgical techniques and equipments, especially laparoscopic surgery, splenectomy has been performed safely and easily. Some studies reported that splenectomy improved the liver function. Splenectomy in patients with HCC expanded the indication of liver resection and increased disease free survival (DFS). However, portal vein thrombosis (PVT) is a one of well-recognized complications of splenectomy and recent prospective study reported the 50% rate of PVT in non-cirrhotic splenectomized patients. Some studies reported that splenectomy with simultaneously or staged liver resection was performed safely without a significant complication and operative mortality. We experienced a case that underwent simultaneously liver resection and splenectomy and then recovered without complication. The further study may be needed to evaluate the role of splenectomy in patients with HCC and hypersplenism.