간문맥종양혈전증을 동반한 간세포암종에서 반복적인 간동맥 내 항암약물주입요법의 효과
Efficacy of Repeated Hepatic Arterial Infusion Chemotherapy in Advanced Hepatocellular Carcinoma with Portal Vein Tumor Thrombosis
1
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
목적: 간문맥혈전증을 동반한 간세포암종은 그 예후가 매우 나쁘며, 치료하지 않는 경우 평균 생존기간은 2개월 정도이다. 이러한 경우 반복적인 간동맥 내 항암약물주입요법이 시도되고 있으나, 그 약제나 방법에 대해 아직 확립된 바가 없다. 본 저자 등은 간동맥혈전증을 동반한 간세포암종에서 반복적으로 간동맥 내 주입한 항암제와 각 군의 생존율을 비교하였다. 대상과 방법: 1999년 1월부터 2003년 12월까지 간문맥혈전증을 동반한 간세포암종으로 진단받은 103명의 환자를 대상으로 다음과 같이 2군으로 나누어 분석하였다. 즉, 제 1군(67명)은 CDDP (80 mg/m2, 2시간 1일 간)만을, 제 2군(36명)은 CDDP (60 mg/m2, 2시간 1일 간)과 5- FU (500 mg/m2, 5시간 3일 간)을 1개월마다 간동맥 내로 투여하였다. 치료 3개월에 치료 반응을 평가하고 각 군의 생존기간을 비교하였다. 결과: 초치료 3개월째에 반응을 평가할 수 있었던 66명(64.1%)의 환자에서 종양의 크기 또는 혈청 AFP의 감소에 따른 치료 반응을 종합하여 볼 때 완전관해는 2명(3.0%), 부분관해는 11명(16.7%), 안정병변은 18명(27.3%), 진행병변은 35명(53.0%)이었다. 치료군의 생존중앙값은 6개월이었으며 제1군은 5개월, 제2군은 8.5개월이었다(P>0.05). 치료의 부작용은 보존적 치료로 대부분 조절되었고, 간기능의 악화는 Ⅰ군에서 Ⅱ군보다 더 많았다(P<0.05). 결론: 간문맥혈전증을 동반한 간세포암종에서 CDDP을 포함한 반복적인 간동맥 내 항암약물주입요법은 일부에서 치료 효과가 있으며, 5-FU와의 병합요법을 시행할 경우 치료 효과를 높일 수 있을 것으로 기대된다.
Abstract
Background/Aims: The aim of this study is to elucidate the efficacy of repeated hepatic arterial infusion chemotherapy (HAIC) and different chemotherapeutic regimens for treating patients having advanced hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT). Methods: From Jan. 1999 and Dec. 2003, a total of 103 patients diagnosed as having HCC with PVTT, but without extrahepatic spreading, were enrolled in this study. They were stratified into two groups. Group I (67 patients) received intraarterial cisplatin (CDDP, 80 mg/m2 for 2 hours on Day 1), Group Ⅱ (36 patients) received intraarterial CDDP (60 mg/m2 for 2 hours on Day 2) and 5-fluorouracil (5-FU, 500 mg/m2 for 5 hours on Day 1-3). They were scheduled to receive at least three consecutive courses of the HAIC at 1 month intervals. Results: Among the 66 patients who completed the protocol, one (2.5%) and seven (17.5%) patients of group Ⅰ, and one (3.8%) and four (15.4%) of group Ⅱ, exhibited complete and partial responses, respectively. The median survival period of all the patients was 6 months. Group Ⅱ showed a tendency to improve the median survival compared to group Ⅰ (8.5 vs 5.0 months, respectively, P=0.45). The most common adverse reaction was nausea (58.2%). However, an elevation of the total bilirubin level was more frequent in Group Ⅰ than in Group Ⅱ (61.3% vs 20.7%, respectively, P<0.05). Conclusions: Repeated HAIC using CDDP achieved favorable results in a few patients with HCC with PVTT, and additional 5-FU may be useful.
참고문헌 (18)
- "Natural history of untreated nonsurgical hepatocellular carcinoma:rationale for the design and evaluation of therapeutic trials", 29, pp.62~67 (1999)
- "Treatment of non-resectable hepatocellular carcinoma", 17, pp.424~427 (2002)
- "Therapy for unresectable hepatocellular carcinoma review of the randomized clinical trials-I hepatic arterial embolization and embolization- based therapies in unresectable hepatocellular carcinoma", 15, pp.427~437 (2004)
- "Hepatic arterial infusion chemotherapy for hepatocellular carcinoma with portal vein tumor thrombosis", 9, pp.2666~2670 (2003)
- "Hepatic arterial infusion chemotherapy for advanced hepatocellular carcinoma with portal vein tumor thrombosis:analysis of 48 cases", 95, pp.588~595 (2002)
- "Hepatic arterial infusion of 5-fluorouracil and cisplatin for unresectable or recurrent hepatocellular carcinoma with tumor thrombus of the portal vein", 80, pp.143~148 (2002)
- "A novel chemotherapy for advanced hepatocellular carcinoma with tumor thrombosis of the main trunk of the portal vein", 79, pp.1890~1896 (1997)
- "Intra-arterial infusion chemotherapy in patients with advanced hepatocellular carcinoma with portal vein thrombosis", 67, pp.40~48 (2004)
- "Therapy for unresectable hepatocellular carcinoma review of the randomized clinical trials-II systemic and local non-embolization-based therapies in unresectable and advanced hepatocellular carcinoma", 15, pp.439~452 (2004)
- "Treatment outcome of transcatheter arterial chemoinfusion according to anticancer agents and prognostic factors in patients with advanced hepatocellular carcinoma", 45(5), pp.847~858 (2004)
- "Efficacy of repeated intra-arterial infusion chemotherapy via chemoport system in advanced hepatocellular carcinoma", pp.63~73S (2002)
- "Concurrent chemo- radiation therapy for advanced hepatocellular carcinoma with portal vein thrombosis", 8, pp.71~79 (2002)
- "Efficacy of repeated arterial infusion of cisplatin and 5-fluorouracil via a percutaneously implantable port system in advanced hepatocellular carcinoma", 7, pp.61~67 (2001)
- "Practice guideline for diagnosis and treatment of hepatocellular carcinoma", 10, pp.88~98 (2004)
- "Assessment of tumor response after non-surgical treatment for hepatocellular carcinoma The general rules for the study of primary liver cancer June 2004", pp.4~48 (2004)
- "The efficacy of the combination therapy of 5-fluorouracil,cisplatin and leucovorin for hepatocellular carcinoma and its predictable factors", 53, pp.296~304 (2004)
- "Regional intra-arterial infusion of cisplatin in primary hepatocellular carcinoma", 58, pp.2386~2388 (1986)
- "Combined therapy consisting of intraarterial cisplatin infusion and systemic interferon-alpha for hepatocellular carcinoma patients with major portal vein thrombosis or distant metastasis", 88, pp.1986~1991 (2000)