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원발성 간암 환자에서 간동맥내 cisplatin 주입요법의 치료 효과

Other Titles
 Therapeutic effect of hepatic arterial infusion of cisplatin in patients with primary hepatocellular carcinoma 
Issue Date
1993
Description
의학과/석사
Abstract
[한글] 원발성 간암은 우리나라와 일본 등에서 흔한 악성종양의 하나로서, 치료를 받지 않는 경우 중앙 생존기간이 약 1-4 개월 정도로 대단히 예후가 불량하다. 치료방법으로는 근치적 절제술이 가장 좋은 방법이나 근치적 수술을 시행하기 어려운 경우가 많아 국소적인 치료방법으로 간동맥 색전요법, 간동맥내 항암제 주입요법이 시도되어 일부 환자에서 효과를 보고 있다. 간동맥내 항암제 색전요법 중 doxorubicin(Adriamycin**(R))은 널리 연구 사용되고 있으나 그 관해율은 평균 20%에 불과하다. 한편 cisplatin은 여러 고형종양 에서 탁월한 항암효과를 나타내는 약제로서 원발성 간암에서도 간동맥내로 단독주입 혹은 색전법과 병용하여 치료효과를 기대해 볼 수 있다. 저자는 원발성 간암환자에서 간동맥내 cisplatin 주입요법의 치료효과와 부작용을 평가하고자 본 임상연구를 시행하여 다음 과 같은 결과를 얻었다. 1. 대상 환자는 1991년 4월 부터 1992년 9월 까지 연세대학교 의과대학 부속 세브란스병원에 입원한 원발성 간암환자 21예이며, 중앙 연령은 54세(38-72세)였으며 남자가 18명, 여자가 3명(남녀비 6:1)이었다. 운동수행능력은 ECOG 기준 0-1이 18예, 2가 3예 였다. 간경변을 동반한 14예중 Child 분류 A가 12예. B가 2예로 대부분 A에 속하였고, HBsAg이 양성인 경우가 11예, 항 HCV항체가 양성인 경우가 3예 였다. 2. 치료는 간동맥 혈관조형술을 시행하여 종양의 크기와 범위를 확인후 초선택적으로 종양 영양공급혈관에 카테터 삽입후 시행하였는데, cisplatin(80-120mg/m**2 )을 단독으로 주입한 경우가 7예. cisplatin과 Lipiodol(5-20cc) 혹은 cisplatin, Lipiodol과 AdriamyCin(40mg/m**2)을 병용하여 주입한 경우가 14예였다. 3. 치료반응은 치료일로 부터 4-6주 후 시행한 복부 전산화단층촬영, 혹은 간동맥조영술 소견을 바탕으로 종양의 최대 직경변화를 측정하여 WHO기준에 따라 분류하였는데 총 21예 중 완전관해는 없었으며, 부분관해 4예 19%. 안정병변 11예 52%, 진행병 변 6예 29%로 관해율은 19%였다. cisplatin을 단독주입한 Ⅰ군과, Lipiodol 혹은 Lipiodol과 Adriamycin을 병용 주입한 Ⅱ군의 관해율을 각각 14%, 21%로 2군에서 높은 경향을 보였으나 통계학적인 의의는 없었다. 4. 대상환자 총 21예의 6개월 및 1년 생존율은 각각 71%, 33%였으며, cisplatin을 단독 주입한 Ⅰ군과, Lipiodel 혹은 Lipiodol과 Adriamycin을 병용 주입한 Ⅱ군의 중앙 생존기 간은 각각 8개월, 8.3개월로 양 군간에 유의한 차이는 없었다. 5. 부작용으로는 ECOG toxicity grade 2이하의 오심과 구토 증상이 정도의 차이는 있었지만 대부분의 환자(90%)에서 관찰되었고 혈액학적인 부작용으로는 ECOG toxicity grade 2의 백혈구의 감소와 혈소판수의 감소가 2예(7%)에서 관찰되었다. 간독성은 7예(25%)에서 관찰되었으며, 이중 2예에서는 ECOG toxicity grade 3 이었다. 그외 발열, 복부 동통 등이 관찰되었으나 부작용은 대부분 가역적이었고 치료와 관련된 사망은 없었다. 결론적으로 원발성 간암에서 간동맥내 cisplatin을 단독주입 혹은 Lipiodol과 Adriamycin을 병용 주입하여 치료란 본 연구에서 관혜율 19%와 1년 생존율 33%의 결과를 나타내어 다른 항암제를 이용한 간동맥 항암제색전 치료효과와 유사하였으나, 부작용은 수용할만하여 향후 좀 더 많은 환자를 대상으로 시도해 볼 필요가 있다고 생각된다. Therapeutic effect of hepatic arterial infusion of cisplatin in patients with primary hepatocellular carcinoma Jae Yong Cho Department of Medical Science The graduate ScHool, Yonsei University (Directed by Associated Professor Jae Kyung Roh) Hepatocellular carcinoma is one of the most common malignant neoplasms in Korea and its prognosis with conventional treatment is dismal with a median survival of 1-4 months. Even for small tumors, surgical resection is not often indicated because of coexisting advanced cirrhosis. multifocality, or anatomical site. Recently, hepatic intraarterial chemoembolization with doxorubicin(Adriamycin), mitomycin C. and various other agents have been tried for the treatment of unresectab1e advanced hepatocellular carcinoma. This study was undertaken to assess the therapeutic efficacy of hepatic intraarterial infusion of cisplatin. The response rate, survival rate, and side effects were analyzed according to the therapeutic modalities. 1) From April 1991 to September 1992, 21 patients with hepatocellular carcinoma were given either an hepatic arterial infusion of cisplatin alone (Group Ⅰ, n=7). or infusion of cisplatin combined with Lipiodol of Lipiodol and Adriamycin (Group Ⅱ, n=11). There was no significant difference in sex, age. biochemical tests, and chiId's classification between the two groups. 2) The response rates of group Ⅰ and Ⅱ there 14% and 21% respectively, and there lass no significant difference between therapeutic groups. 3) The survival rate at 6 months, 1 year for all 21 patients was 71% and 33% respectively and there was no significant difference according to therapeutic modalities. 4) Adverse reactions related to treatment included nausea, vomiting, fever, abdominal pain and elevation of transaminases. All the treatment related toxicities were acceptable and reversible, and there was no treatiment related death. In conclusion, these results lese not blotter than those of other chemoembolization studies with various chemotherapeutic agents, and the side effects were acceptable and reversible. Further study is warranted to verify the efficacy of hepatic intraarterial infusion of cisplatin in more patients with advanced primary hepatocellular carcinoma.
[영문] Hepatocellular carcinoma is one of the most common malignant neoplasms in Korea and its prognosis with conventional treatment is dismal with a median survival of 1-4 months. Even for small tumors, surgical resection is not often indicated because of coexisting advanced cirrhosis. multifocality, or anatomical site. Recently, hepatic intraarterial chemoembolization with doxorubicin(Adriamycin), mitomycin C. and various other agents have been tried for the treatment of unresectab1e advanced hepatocellular carcinoma. This study was undertaken to assess the therapeutic efficacy of hepatic intraarterial infusion of cisplatin. The response rate, survival rate, and side effects were analyzed according to the therapeutic modalities. 1) From April 1991 to September 1992, 21 patients with hepatocellular carcinoma were given either an hepatic arterial infusion of cisplatin alone (Group Ⅰ, n=7). or infusion of cisplatin combined with Lipiodol of Lipiodol and Adriamycin (Group Ⅱ, n=11). There was no significant difference in sex, age. biochemical tests, and chiId's classification between the two groups. 2) The response rates of group Ⅰ and Ⅱ there 14% and 21% respectively, and there lass no significant difference between therapeutic groups. 3) The survival rate at 6 months, 1 year for all 21 patients was 71% and 33% respectively and there was no significant difference according to therapeutic modalities. 4) Adverse reactions related to treatment included nausea, vomiting, fever, abdominal pain and elevation of transaminases. All the treatment related toxicities were acceptable and reversible, and there was no treatiment related death. In conclusion, these results lese not blotter than those of other chemoembolization studies with various chemotherapeutic agents, and the side effects were acceptable and reversible. Further study is warranted to verify the efficacy of hepatic intraarterial infusion of cisplatin in more patients with advanced primary hepatocellular carcinoma.
URI
http://ir.ymlib.yonsei.ac.kr/handle/22282913/117060
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2. 학위논문 > 1. College of Medicine (의과대학) > 석사
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