국소 진행된 간암의 방사선 온열치료성적

The Clinical Results of Thermo-Irradiation on the Locally Advanced Hepatoma with or without Hepatic Arterial Chemo-Embolization

Purpose : The aim of this study is to analyze the clinical results of thermo-irradiation treatment for surgically unreserctable advanced hepatoma with or without hepatic arterial chemo-embolization (HACE), chemotherapy (CT) and interferon (IFN) therapy. Materials and Methods : Between February 1990 and December 1992. 45 patients with surgically unresectable advanced hepatomas were treated by thermo-irradiation with or without hepatic arterial chemo-embolization and other treatment modalities. Among them, We analyzed retrospectively 24 patients who received more than three times of hyperthermias. Mean age was 50 years (range : 18-71 years) and male to female ratio was 20:5. In the study, treatment was administered as follows : 3patients received radiation therapy(RT) and hyperthermia (HT). 3 received RT+HT+CT. 3received RT+HT+HACE. 1received RT+HT+CT+HACE. 2 received RT+HT+CT+IFN. 10 received RT+HT+HACE+IFN. 3 received RT+HT+CT+HACE+IFN. Radiation therapy was done by a 6 MV linear accelerator. Patients were treated with daily fractions of 180 cGy to doses of 11gy-50Gy (median 30Gy). Local hyperthermia was done by HEH-500C(Omron Co.Japan), 30-45 min/session, 2 sessions/wk and the number of HT sessions ranged from 3 to 17 (median 7 times). 15 patients of 25 were followed by abdominal CT scan or abdominal ultra-sonogram. The following factors were analyzed : Age, histologic grade, sex, number of hyperthermia, total RT dose, hepatic arterial chemo-embolization. Results : Of 25 patients, there were observed tumor regression (partial response and minimal response) in 6(24%), no response in 8(32%), progression in 1(4%) and not evaluable ones in 10(40%) radiographically. The over all 1-year survival was 25%, with a mean survival of 33 weeks. The treatment modes of partial and minimal responsive patients (PR+MR) were as follow : Two were treated with RT+HT+HACE 2 were done with RT+HT+HACE+IFN Remaining 2 were treated with RT+HT+CT+HACE+IFN. The significant factor affecting the survival rate were RT dose (more than 25 Gy), HACE, number of HT(above 6 times), responsiveness after treatment (PR+MR). Age, sex, histologic differentiation, chemotherapy, interferon therapy were not statistically significant factors affecting the survival rate. Conclusion : Although follow-up duration was short, the thermo-irradiation with/without hepatic arterial chemo-embolization was well tolerated and there were no serious complications. In future, it is considered the longer follow up and prospective, well controlled trials should be followed to evaluate the efficacies of survival advantage.