Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
권호 표지

Effects of Fractionated Stereotactic Radiotherapy for Primary Hepatocellular Carcinoma

원발성 간암의 분할 정위방사선치료 효과

  • Choi Byeong Ock (Department of Radiation Oncology, The Catholic University of Korea College of Medicine) ;
  • Kang Ki Mun (Department of Radiation Oncology, Gyengsang National University College of Medicine) ;
  • Jang Hong Seok (Department of Radiation Oncology, The Catholic University of Korea College of Medicine) ;
  • Lee Snag-wook (Department of Radiation Oncology, University of Ulsan) ;
  • Kang Young Nam (Department of Radiation Oncology, The Catholic University of Korea College of Medicine) ;
  • Chai Gyu Young (Gyeongsang Institute of Health Sciences) ;
  • Choi Ihl Bhong (Department of Radiation Oncology, The Catholic University of Korea College of Medicine)
  • 최병옥 (가톨릭대학교 의과대학 방사선종양학교실) ;
  • 강기문 (경상대학교 건강과학원) ;
  • 장홍석 (가톨릭대학교 의과대학 방사선종양학교실) ;
  • 이상욱 (울산대학교 의과대학 방사선종양학교실) ;
  • 강영남 (가톨릭대학교 의과대학 방사선종양학교실) ;
  • 채규영 (경상대학교 건강과학원) ;
  • 최일봉 (가톨릭대학교 의과대학 방사선종양학교실)
  • Published : 2005.06.01
Download PDF
⟨ Previous Next ⟩

Abstract

Purpose : Reports on the outcome of curative radiotherapy for the primary hepatocellular carcinoma (HCC) are rarely encountered in the literature. in this study, we report our experience of a clinical trial where fractionated stereotactic radiotherapy (SRT) was used in treating a primary HCC. Materials and Methods : A retrospective analysis was peformed on 20 patients who had been histologically diagnosed as HCC and treated by fractionated SRT. The long diameter of tumor measured by CT was $2\~6.5$ cm (average: 3.8 cm). A single dose of radiation used in fractionated SRT was S or 10 Gy: each dose was prescribed based on the planning target volume and normalized to $85\~99\%$ isocenter dose. Patients were treated $3\~5$ times per week for 2 weeks, with each receiving a total dose of 50 Gy (the median dose: 50 Gy). The follow up period was $\~55$ months (the median follow up period: 23 months). Results : The response rate was $50\%$ (12 patients), with 4 patients showing complete response ($20%$), 8 patients showing partial response ($40\%$), and 8 patients showing stable disease ($40\%$). The 1-year and 2-year survival rates were $70.0\%$ and $43.1\%$, respectively, and the median survival time was 20 months. The 1-year and 2-year disease free survival rates were $65\%$ and $32.5\%$, respectively, and the median disease-free survival rate was 19 months. Some acute complications of the treatment were noted as follows: dyspepsia in 12 patients ($60\%$), nausea/emesis in 8 patients ($40\%$), and transient liver function impairment in 6 patients ($30\%$). However, there was no treatment related death. Conclusion : The study indicates that fractionated SRT is a relatively safe and effective method for treating primary HCC. Thus, fractionated SRT may be suggested as a local treatment for HCC of small lesion and containing a single lesion, when the patients are inoperable or operation is refused by the patients. We thought that fractionated SRT is a challenging treatment modality for the HCC.

목적 : 원발성 간암에서 근치적 목적의 방사선치료 결과엔 대한 문헌상 보고는 드물다. 이에 저자들이 경험한 원발성 간암의 분할 정위방사선치료에 대한 결과를 보고하고자 하였다. 대상 및 방법 : 1999년 7월부터 2002년 3월까지 원발성 간암으로 조직학적 진단을 받은 후 분할 정위방사선치료를 시행한 20명을 대상으로 후향적 분석을 하였다. 종양의 장경은 $2~6.5\;cm$ (평균: 3.8 cm)였다. 분할 정위방사선치료는 1회 조사량으로 5와 10 Gy였고 선량은 계획용 표적체적(planning target volume)에 맞추어 처방하였으며 회전중심점 선량의 $85\~90\%$등선량 곡선에 치료를 하였다. 주 $3\~5$회 치료하여 2주 동안 총 50 Gy를 조사하였다(중앙선량: 50 Gy). 추적관찰기간은 $3\~55$개월(중간 추적관찰기간: 23개월)이었다. 결과 : 전체 치료 반응률은 $60\%$이었으며 완전 반응 4명($20\%$), 부분 반응 8명($40\%$), 안정성 병변이 8명($40\%$)이었다. 전체 환자의 1년 및 2년 생존율은 각각 $70\%$, $43.1\%$이었으며 중앙 생존기간은 20개월이었다. 1년 및 2년 무병 생존율은 각각 $65\%$, $32.5\%$이었으며 중앙 무병생존기간은 19개월이었다. 치료 부작용으로 소화장애가 16명($60\%$), 오심/구토가 8명($40\%$), 간 기능 저하가 6명($30\%$)에서 발생하였으나 부작용에 의한 사망은 없었다. 결론 : 원발성 간암의 분할 정위방사선치료는 비교적 안전하고 효과적인 방법이었다. 따라서 단일 병변이면서 비교적 종양의 크기가 작은 간암에서 내과적으로 수술이 불가능하거나 수술을 거부하는 환자에서 국소 치료방법으로 고려할 수 있을 것으로 사료된다.

Keywords

References

  1. Okuda K, Ohtsuki T, Obata H, et al. Natural histology of hepatocellular carcinoma and prognosis in relation to treatment. study of 850 patients. Cancer 1985;56:918-928 https://doi.org/10.1002/1097-0142(19850815)56:4<918::AID-CNCR2820560437>3.0.CO;2-E
  2. Bruix J. Treatment of hepatocellular carcinoma. Hepatology 1997;25:259-262 https://doi.org/10.1002/hep.510250201
  3. The liver cancer study group of Japan. Primary liver cancer in Japan: clinicopathologic features and results of surgical treatment. An Surg 1990;211:277-287
  4. Yamanaka N, Okamoto E, Toyosaka A, et al. Prognostic factors after hepatectomy for hepatocellular carcinomas. Cancer 1990;65:1104-1110 https://doi.org/10.1002/1097-0142(19900301)65:5<1104::AID-CNCR2820650511>3.0.CO;2-G
  5. Bismuth H, Chiche L, Adam R, Castaing D, Diamond T, Dennison A. Liver resection versus transplantation for hepatocellular carcinoma in cirrhotic patients. Ann Surg 1993;218:145-151 https://doi.org/10.1097/00000658-199308000-00005
  6. Matsui O, Kadoya M, Yoshikawa J, et al. Small hepatocellular carcinoma: treatment with subsegmental transcatheter arterial embolization. Radiology 1993;188:79-83 https://doi.org/10.1148/radiology.188.1.8390073
  7. Orlando A, Cottone M, Virdone R, et al. Treatment of small hepatocellular carcinoma associated with cirrhosis by percutaneous ethanol injection: a trial with a comparison group. Scan J Gastroenterol 1997;32:595-603 https://doi.org/10.3109/00365529709025106
  8. Horigome H, Nomura T, Nakao H, et al. Percutaneous radiofreqeuncy ablation therapy using a clustered electrode for malignant liver tumors. J Clin Gastroenterol 2001;32:418-422 https://doi.org/10.1097/00004836-200105000-00012
  9. Cheng JC, Chuang VP, Cheng SH, et al. Local radiotherapy with or without transcatheter arterial chemoembolization for patients with unresectable hepatocellular carcinoma. Int J Radiat Oncol Biol Phys 2000;47:435-442 https://doi.org/10.1016/S0360-3016(00)00462-4
  10. Seong J, Park HC, Han KH, et al. Clinical results of 3-dimensional conformal radiotherapy combined with transarterial chemoembolization for hepatocellular carcinoma in the cirrhotic patients. Hepatol Res 2003;27:30-35 https://doi.org/10.1016/S1386-6346(03)00162-1
  11. Wada H, Takai Y, Nemoto K, Yamada S. Univariated analysis of factors correlated with tumor control probability of three dimensional conformal hypofractionated high dose radiotherapy for small pulmonary or hepatic tumors. Int J Radiat Oncol Biol Phys 2004;58:1114-1120 https://doi.org/10.1016/j.ijrobp.2003.08.012
  12. Keum KC, Park HC, Seong JS, et al. Preliminary results of 3 dimensional conformal radiotherapy for primary unresectable hepatocellular carcinoma. J Korean Soc Ther Radiol Oncol 2002;20:123-129
  13. Sato M, Uematsu M, Yamamoto F, et al. Feasibility of frameless stereotactic high dose radiation therapy for primary or metastatic liver cancer. J Radiosurg 1998;1:233-238 https://doi.org/10.1023/B:JORA.0000015199.41948.7c
  14. Herfarth KK, Debus J, Lohr F, et al. Stereotactic single dose radiation therapy of liver tumors: results of a phase I/II trial. J Clin Oncol 2001;19:164-170 https://doi.org/10.1200/JCO.2001.19.1.164
  15. Kang KM, Choi IB, Kim IA, et al. Preliminary result in patients with primary hepatoma treated with stereotactic radiotherapy. J Korean Soc Ther Radiol Oncol 2001;19:34-39
  16. Bush DA, Hillebrand DJ, Slater JM, Slater JD. High dose proton beam radiotherapy of hepatocellular carcinoma: preliminary results of a phase II trial. Gastroenterol 2004;127:S189-S193 https://doi.org/10.1053/j.gastro.2004.09.033
  17. Leksell L. The stereotaxic method and radiosurgery of the brain. Acta Chir Scand 1951;102:316-319
  18. Lax I, Blomgren H, Naslund I, Svanstrom R. Stereotactic radiotherapy of malignancies in the abdomen. Methodological aspects. Acta Oncol 1994;33:677-683 https://doi.org/10.3109/02841869409121782
  19. Lee SW, Choi EK, Park HJ, et al. Stereotactic body frame based fractionated radiosurgery on consecutive days for primary or metastatic tumors in the lung. Lung Cancer 2003;40:309-315 https://doi.org/10.1016/S0169-5002(03)00040-0
  20. Umatsu M, Shioda A, Tahara K, et al. Focal, high dose, and fractionated modified stereotactic radiation therapy for lung carcinoma patients. Cancer 1998;82:1062-1070 https://doi.org/10.1002/(SICI)1097-0142(19980315)82:6<1062::AID-CNCR8>3.0.CO;2-G
  21. Jones D, Christopherson DA, Washington JT, et al. A frameless method for stereotactic radiotherapy. Br J Radiol 1993;66:1142-1150 https://doi.org/10.1259/0007-1285-66-792-1142
  22. Murphy MJ, Marthin D, Whyte R, Hai J, Ozhasoglu C, Le QT. The effectiveness of breath holding to stabilize lung and pancreas tumors during radiotherapy. Int J Radiat Oncol Biol Phys 2002;53:475-482 https://doi.org/10.1016/S0360-3016(01)02822-X
  23. Nagata Y, Negoro Y, Aoli Y, et al. Clinical outcomes of 3D conformal hypofractionated single high dose radiotherapy for one or two lung tumors using a stereotactic body frame. Int J Radiat Oncol Biol Phys 2002;52:1041-1046 https://doi.org/10.1016/S0360-3016(01)02731-6
  24. Koong AC, Le QT, Ho A, et al. Phase I study stereotactic radiosurgery in a patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2004;58:1017-1021 https://doi.org/10.1016/j.ijrobp.2003.11.004
  25. Sims E, Doughty D, Macaulay E, et al. Stereotactically delivered cranial radiation therapy: a ten-year experience of linacbased radiosurgery in the UK. Clin Oncol 1999;11:303-320 https://doi.org/10.1053/clon.1999.9073
  26. Ulm AJ, Friedman WA, Bova FJ, Bradshaw P, Amdur RJ, Mendenhall WM. Linear accelerator radiosurgery in the treatment of brain metastases. Neurosurgery 2004;55:1076-1085 https://doi.org/10.1227/01.NEU.0000141084.28973.76
  27. Lax I, Blomgren H, Larson D, Naslund I. Extracranial stereotactic radiosurgery of licalized targets. J Radiosurg 1998;66:1142-1150
  28. Blomgren H, Lax I, Naslund I, Svanstrom R. Stereotactic high dose fraction radiation therapy of extracranial tumors using an accelerator. Acta Oncol 1995;34:861-870 https://doi.org/10.3109/02841869509127197