방사선종양학

본문글자크기
  • [Yonsei Med J.] Optimal Timing of Radiotherapy after Incomplete Transarterial Chemoembolization for Barcelona Clinic Liver Cancer Stage B Hepatocellular Carcinoma

    연세의대 / 변화경, 성진실*

  • 출처
    Yonsei Med J.
  • 등재일
    2021 May
  • 저널이슈번호
    62(5):409-416. doi: 10.3349/ymj.2021.62.5.409.
  • 내용

    바로가기  >

    Abstract
    Purpose: The optimal timing for radiotherapy (RT) after incomplete transarterial chemoembolization (TACE) remains unclear. This study investigated the optimal timing to initiate RT after incomplete TACE in patients with Barcelona Clinic Liver Cancer stage B hepatocellular carcinoma.

    Materials and methods: This study included 116 lesions in 104 patients who were treated with RT after TACE between 2001 and 2016. The time interval between the last TACE session and RT initiation was retrospectively analyzed. The optimal cut-off time interval that maximized the difference in local failure-free rates (LFFRs) was determined using maximally selected rank statistics.

    Results: The median time interval was 26 days (range: 2-165 days). At a median follow-up of 18 months (range: 3-160 months), the median overall survival was 18 months. The optimal cut-off time interval appeared to be 5 weeks; using this cut-off, 65 and 39 patients were classified into early and late RT groups, respectively. Early RT group had a significantly poorer Child-Pugh class and higher alpha-fetoprotein levels compared to late RT group. Other characteristics, including tumor size (7 cm vs. 6 cm; p=0.144), were not significantly different between the groups. The 1-year LFFR was significantly higher in the early RT group than in the late RT group (94.6% vs. 70.8%; p=0.005). On multivariate analysis, early RT was identified as an independent predictor of favorable local failure-free survival (hazard ratio: 3.30, 95% confidence interval: 1.50-7.29; p=0.003).

    Conclusion: The optimal timing for administering RT after incomplete TACE is within 5 weeks. Early administration of RT is associated with better local control.

     

     

     

    Affiliations

    Hwa Kyung Byun  1 , Nalee Kim  2 , Jinsil Seong  3
    1 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.
    2 Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.
    3 Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea. jsseong@yuhs.ac.

  • 키워드
    Carcinoma, hepatocellular; chemoembolization, therapeutic; radiotherapy.
  • 편집위원

    간암에서 TACE 후 RT까지의 시기를 5주를 기준으로 분석하였을 때, 5주 이내에 RT가 시작되는 것이 국소재발이 낮음을 보여줌

    2021-06-30 16:04:40

  • 편집위원2

    간세포암종에서 TACE 후 반응이 불충분한 경우 방사선치료를 추가할 때 적절한 시기가 확립되어 있지 않은데, 상기 연구는 TACE 후 2-3주 내로 빠르게 시행시 종양 주위 lipiodol uptake에 의한 이미지 영향 및 TACE에 의한 일시적 간기능 저하가 동반되고, 성적에 차이가 없으므로 TACE 후 3-5주 사이 시행하는 것을 추천합니다. 비록 적은 수의 후향적 연구이지만 간세포암종에 대해 경험이 많지 않은 경우 임상진료시 도움이 되는 연구로 생각됩니다.

    2021-06-30 16:05:46

  • 덧글달기
    덧글달기
       IP : 44.200.32.31

    등록