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Radiation Therapy for Bone Metastases from Hepatocellular Carcinoma: Effect of Radiation Dose Escalation

간세포암에 의한 뼈전이의 방사선치료: 고선량 방사선치료의 효과

  • Kim, Tae-Gyu (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Hee-Chul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lim, Do-Hoon (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim, Cheol-Jin (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Hye-Bin (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kwak, Keum-Yeon (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Moon-Seok (Department of Internal Medicin, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Joon-Hyoek (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Koh, Kwang-Cheol (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Paik, Seung-Woon (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yoo, Byung-Chul (Department of Internal Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 김태규 (성균관대학교 의과대학 삼성서울병원 방사선종앙학교실) ;
  • 박희철 (성균관대학교 의과대학 삼성서울병원 방사선종앙학교실) ;
  • 임도훈 (성균관대학교 의과대학 삼성서울병원 방사선종앙학교실) ;
  • 김철진 (성균관대학교 의과대학 삼성서울병원 방사선종앙학교실) ;
  • 이혜빈 (성균관대학교 의과대학 삼성서울병원 방사선종앙학교실) ;
  • 곽금연 (성균관대학교 의과대학 삼성서울병원 내과학교실) ;
  • 최문석 (성균관대학교 의과대학 삼성서울병원 내과학교실) ;
  • 이준혁 (성균관대학교 의과대학 삼성서울병원 내과학교실) ;
  • 고광철 (성균관대학교 의과대학 삼성서울병원 내과학교실) ;
  • 백승운 (성균관대학교 의과대학 삼성서울병원 내과학교실) ;
  • 유병철 (성균관대학교 의과대학 삼성서울병원 내과학교실)
  • Received : 2011.02.24
  • Accepted : 2011.03.25
  • Published : 2011.06.30

Abstract

Purpose: To evaluate the extent of pain response and objective response to palliative radiotherapy (RT) for bone metastases from hepatocellular carcinoma according to RT dose. Materials and Methods: From January 2007 to June 2010, palliative RT was conducted for 103 patients (223 sites) with bone metastases from hepatocellular carcinoma. Treatment sites were divided into the high RT dose and low RT dose groups by biologically effective dose (BED) of 39 $Gy_{10}$. Pain responses were evaluated using the numeric rating scale. Pain scores before and after RT were compared and categorized into 'Decreased', 'No change' and 'Increased'. Radiological objective responses were categorized into complete response, partial response, stable disease and progression using modified RECIST (Response Evaluation Criteria In Solid Tumors) criteria; the factors predicting patients' survival were analyzed. Results: The median follow-up period was 6 months (range, 0 to 46 months), and the radiologic responses existed in 67 RT sites (66.3%) and 44 sites (89.8%) in the high and low RT dose group, respectively. A dose-response relationship was found in relation to RT dose (p=0.02). Pain responses were 75% and 65% in the high and low RT dose groups, respectively. However, no statistical difference in pain response was found between the two groups (p=0.24). There were no differences in the toxicity profiles between the high and low RT dose groups. Median survival from the time of bone metastases diagnosis was 11 months (range, 0 to 46 months). The Child-Pugh classification at the time of palliative RT was the only significant predictive factor for patient survival after RT. Median survival time was 14 months under Child-Pugh A and 2 months under Child-Pugh B and C. Conclusion: The rate of radiologic objective response was higher in the high RT dose group. Palliative AT with a high dose would provide an improvement in patient quality of life through enhanced tumor response, especially in patients with proper liver function.

목 적: 간세포암에 의한 뼈전이 환자의 방사선 조사선량에 따른 통증 감소 정도 및 전이성 병소의 영상학적 치료반응을 분석하고 고선량 방사선치료가 도움이 될 수 있는지 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2010년 6월까지 병리 혹은 임상적으로 간세포암에 의한 뼈전이로 진단받고 증상 완화 목적의 방사선치료를 받은 103명에서 뼈전이 병소 2237개 부위를 대상으로 연구하였다. 조사받은 생물학적 유효선량이 39 $Gy_{10}$이하인 경우 저선량군, 39 $Gy_{10}$를 초과하는 경우 고선량군으로 대상환자를 구분하였다. 통증 감소 정도는 숫자통증등급(numeric rating scale)을 이용하였고 통증이 감소한 경우, 통증 정도에 변화가 없는 경우, 통증이 증가한 경우로 나누었다. 영상학적 반응은 modified Response Evaluation Criteria In Solid Tumors (RECIST) 기준을 이용하였으며 환자의 생존율에 영향을 미치는 인자를 분석하였다. 결 과: 중앙추적 관찰기간은 6개월이었다(범위, 0~46개월). 저선량군에서는 67개 병소(66.3%) 부위에서, 고선량군 에서는 44개 병소(89.8%) 부위에서 영상학적 반응이 있었다 저선량군과 고선량군 사이에 영상학적 치료 반응 정도는 유의하게 차이를 보였다(p=0.02). 저선량군과 고선량군은 각각 65%와 75%의 통증 감소를 보였으나 통계적으로 유의한 차이는 없었다(p=0.24). 저선량군과 고선량군 사이에 급성 및 만성 치료 독성은 통계적으로 유의한 차이가 없었다(p>0.05). 뼈전이 진단 시부터 사망까지 생존기간은 0~46개월(중앙값, 11개월) 범위였고 1년 생존율은 41.6%였다. 잔존 간 기능(Child-Pugh 점수)이 생존율에 유의한 영향을 미치는 인자였고 Child-Pugh 점수에 따른 중앙생존기간은 A 14개월, 8와 C는 2개월로 나타났다. 결 론: 간세포암에 의한 뼈전이는 고선량군에서 영상학적 반응 정도가 더 높았다. 잔존 간 기능이 좋은 환자에게 고선량의 방사선치료 시 높은 치료 반응을 얻음으로써 삶의 질의 향상에 도움을 줄 수 있음을 알 수 있었다.

Keywords

Acknowledgement

Supported by : 한국연구재단

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