수술이 불가능한 췌장암에 대한 고강도집속초음파 응고술(하이프) = High-intensity Focused Ultrasound Treatment (HIFU) for the Advanced Pancreatic Cancer

다국어 초록 (Multilingual Abstract)

Purpose: We wanted to evaluate the levels of effect and safety of high-intensity focused ultrasound ablation (HIFU) for treating patients with advanced pancreatic cancer.
Materials and Methods: Nineteen sessions of HIFU, with the patients under general anesthesia, were performed in 18 patients with advanced pancreatic cancer. The change of the gray-scale of the target lesion was analyzed during HIFU, and MRI was performed before and after HIFU. We assessed the extent of coagulative necrosis, the change of pain and the complications after HIFU. The change of tumor size and the survival of patients were also evaluated.
Results: The average size of tumor was 4 cm in diameter. Eighty nine percent of the target tumors showed increased echogenicity. On MRI, necrosis of the entire target tumor occurred in 79% of the patients. After treatment, effective pain relief was noted in 89% of the patients. There were no major complications. No size increase of the treated tumor was noted during 24 weeks of follow-up for 10 patients. Six patients among 12 patients who were available for follow-up are still alive and they are receiving chemotherapy. Six patients expired due to other disease or progression of metastasis.
Conclusion: HIFU is a safe method without any major complications, and it is effective for inducing tumor necrosis and achieving pain control for patients with advanced pancreatic cancer.

국문 초록 (Abstract)

목적: 수술이 불가능한 췌장암에서 고강도집속초음파응고술(high-intensity focused ultrasound system, HIFU, 하이프)의 효과와 안전성을 알아보고자 한다.
대상과 방법: 수술이 불가능한 췌장암으로 진단받은 18명의 환자에서 전신 마취하에 19번의 하이프 시술을 하였다. 치료 중 초음파로 치료 구역의 회색도 변화를 분석하였다. 시술 전후에 MRI를 시행하여 응고괴사범위를 치료계획 범위와 비교하였다. 시술 전후 췌장암으로 인한 통증의 변화를 분석하였고, 합병증의 유무를 확인하였으며 추적 검사를 통해 췌장암 종괴의 크기변화와 환자의 생존 여부를 알아보았다.
결과: 종괴의 시술 전 크기는 최대 지름이 평균 4 cm이었다. 치료 중 초음파에서 치료 구역의 고에코의 회색도 변화는 89%에서 나타났다. 2주 후 추적 MRI 영상에서 79%에서 치료계획 범위 전체가 응고괴사되었다. 89%에서는 시술 후 통증이 경감하거나 소실되었다. 시술 후 경미한 합병증은 있었으나, 중대한 합병증은 없었다. 두 번 이상 영상 추적검사를 시행한 10명의 환자에서 추적 검사기간은 평균 24주였고, 치료한 종양의 크기 증가는 뚜렷하지 않았다. 추적검사가 가능했던 12명의 환자에서 현재 6명의 환자가 항암치료를 받으며 생존해 있다. 하이프치료 후 사망한 6명은 다른 질환이나, 전이암이 진행되어 사망하였다.
결론: 수술이 불가능한 췌장암에서 하이프 시술은 종양의 응고 괴사와 통증 조절에 효과적이며, 중대한 합병증이 없는 안전한 방법이다.

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