암 이야기 : 담낭암의 치료 예후

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암 이야기 : 담낭암의 치료 예후

작성자 닥터코리아 조회수 2608

담낭암 치료방법 개요 1, 2

 

 


1. 국한성 담낭암의 치료

localized gallbladder cancer treatment

 

당낭과 담낭주변의 인접 조직 절제 수술

간의 일부 근처의 림프절 절제

 

수술요법+방사선치료

수술요법+방사선치료+화학요법

 

방사선치료

방사선치료+화학요법

 

surgery to remove the gallbladder and some of the tissue around it.

part of the liver and nearby lymph nodes may also be removed.

radiation therapy with or without chemotherapy may follow surgery.
radiation therapy with or without chemotherapy.
a clinical trial of radiation therapy with radiosensitizers.


  

담낭암이 전에 발견된 적이 없었고 병리학적 검사상 담낭의 점막층에만 있는 경우 80%이상 완치된다.

when gallbladder cancer is previously unsuspected and is discovered in the mucosa of the gallbladder at pathologic examination, it is curable in more than 80% of cases.

 

하지만 담낭암의 증상이 의심되어 수술시 근육층이나 장막층을 관통하는 병변이 발견되면  완치율이 5% 이하이다.

gallbladder cancer suspected before surgery because of symptoms, however, usually penetrates the muscularis and serosa and is curable in fewer than 5% of patients.

 

수술방법으로 담낭의 제거,  간의 쇄기형 절제, 간외부의 담도절제, 국소작인 림프절 절제를 사용하였을경우 5년 생존율은 임프절에 종양세포가 없는 경우 42.5%, 림프절에 종양잔이의 증거가 있ㅇ는 경우 31% 정도 였다.

 

the standard surgical procedure was removal of the gallbladder, a wedge resection of the liver, resection of the extrahepatic bile duct, and resection of the regional (n1 and n2) lymph nodes. kaplan-meier estimates of the 5-year survival for node negative tumors pathologically staged as t2 to t4 were 42.5% ± 6.5% and for similar node positive tumors, 31% ± 6.2%.

 

 

standard treatment options

 

1.surgery

 

전에 암이 없었던 환자의 경우 일반적인 담낭수술에서 점막층에 도는 근육층에만 병이 국한 되어있는 경우 대부분의 환자는 완치되고 더이상의 수술을 받을 필요가 없다.

in previously unsuspected gallbladder cancer, discovered in the surgical specimen following a routine gallbladder operation and confined to mucosa or muscle layer (t1), the majority of patients are cured and require no further surgical intervention.

 

당남 주변의 간조직을 잘라내고 n1 n2 림프절을 포함하는 림프절절제나 고식적인 혹은 확장된 간절제술을 시행하여 간세포를 추적하는 치료를 시행하면 1기 2기 담낭암의 환자에게서 재발이 지연되며 생존기간이 연장된다.

 

re-exploration to resect liver tissue near the gallbladder bed or extended or formal hepatectomy and lymphadenectomy including n1 and n2 lymph node basins may be associated with delayed recurrences or extended survival in patients with stage i or ii gallbladder cancer.

 

간과 간-십이지장을 연결하는 인대의 림프절과 림프조직을 을 쇄기모양으로 절제하는 방법은 장기간의 무병기간을 보장하는 수술방법이다.

apparently localized cancers that are suspected before or during the operation can be surgically removed with a wedge of liver and lymph nodes and lymphatic tissue in the hepatoduodenal ligament. long-term disease-free survival will occasionally be achieved.

 

3기 4기의 황달이 있는 환자는 담도폐쇄의 고통을 해결하기 위하여 경피적으로 간을 경위하여 담낭액을 배액시키는 치료를 수술전에 시행한다. 복강경 시술을 통하여 시술 통로 조직에 간암세포를 이식하는 부작용이 일어날 수 있다. 그러므로 1기 환자에게서도 통로 조직을 완전히게 절제해야 한다.

in jaundiced patients (stage iii or stage iv), there should be consideration of preoperative percutaneous transhepatic biliary drainage for relief of biliary obstruction. implantation of the carcinoma at all port sites (including the camera site) after laparoscopic removal of an unsuspected cancer is a problem. even for stage i cancers, the port sites must be excised completely.

 

2.external-beam radiation therapy (ebrt)

단기 조절용 치료로서 다음과 같은 치료가 일부 시행된다.

ebrt

ebrt+화학요법

방사선 치료

방사선 치료+화학요법

 

 

 

the use of ebrt with or without chemotherapy as a primary treatment has been reported in small groups of patients to produce short-term control. similar benefits have been reported for radiation therapy with or without chemotherapy administered following resection.


treatment options under clinical evaluation

방사선감작 약물을 이용하는 방사선치료가 시행되고 있다.

clinical trials are exploring ways of improving local control with radiation therapy combined with radiosensitizer drugs. when possible, such patients are appropriately considered candidates for these studies.

 

 

 

 

2. 절제 불가능한, 재발한, 전이한 담낭암의 치료

unresectable, recurrent, or metastatic gallbladder cancer treatment

 

경피적으로 접근하여 간을 통과하여 담낭의 저류액을 배액하는 시술

담도 폐쇄에 의한 증상을 완화하기 위한 스텐츠 장치

방사선치료나 보완적 완화 치료 추가 가능함

 

담도 폐쇄 증상을 완화하기 위한 수술

 

화학요법

 

새로운 방식의 치료법의 임상적인 시도 가능함

radiation therapy + hyperthermia therapy, radiosensitizers, or chemotherapy.

 

여러가지 약제의 임상적 치료 시도 가능함

 

percutaneous transhepatic biliary drainage or the placement of stents to relieve symptoms caused by blocked bile ducts. this may be followed by radiation therapy as palliative treatment.


surgery as palliative treatment to relieve symptoms caused by blocked bile ducts.


chemotherapy.


a clinical trial of new ways to give palliative radiation therapy, such as giving it together with hyperthermia therapy, radiosensitizers, or chemotherapy.


a clinical trial of new drugs and drug combinations.

 

 

 


 


완치되기 함들다

담도폐쇄를 완화시켜서 고통을 덜어줄 수 있다.

매우 천천히 성장하는 종류의 암환자는 수년간 생존한다.

임상적인 여러가지 치료를 시험해 볼 수는 있다.


these patients are not curable. significant symptomatic benefit can often be achieved with relief of biliary obstruction. a few patients have very slow-growing tumors and may live several years. patients with unresectable, recurrent, or metastatic gallbladder cancer should be considered for inclusion in clinical trials whenever possible.

 

 

treatment options

 

1암에 의하여 소양증이 생기거나 간기능 부전이 생기면 담도페쇄를 해결하는 치료를 시행한다. 경피적으로 간을 통과하는 배액법을 시행하거나 내시경적으로 스텐츠를 장치하는 방법이 시행된다. 수술적으로 통로를 만들어 주는 방법은 상기 두 방법이 불가능 할 때 사용한다. 배액술 후 증상 완화용으로 방사선 치료를 시행하면 여러가지 잇점이 있다. 방사선 감작물질(hyperthermia, radiosensitizer drugs, or cytotoxic chemotherapeutic agents)을 이용하여 하는 치료의 효과를 증진시키기 위하여 시험적으로 자진 참여자에개 치료를 시행하기도 한다.

 

1.relief of biliary obstruction is warranted when symptoms such as pruritus and hepatic dysfunction outweigh other symptoms from the cancer. the preferred approach is percutaneous transhepatic drainage or endoscopically placed stents; surgical bypass may be appropriate when these approaches are infeasible. palliative radiation therapy after biliary drainage may be beneficial, and patients may be candidates for inclusion in clinical trials that explore ways to improve the effects of radiation therapy with various radiation sensitizers such as hyperthermia, radiosensitizer drugs, or cytotoxic chemotherapeutic agents.


2.전신적인 화학요법(fluoropyrimidines, gemcitabine, platinum agents, and docetaxel )은 소수에게 유용하다.

 

2.systemic chemotherapy is appropriate for selected patients with adequate performance status and intact organ function. fluoropyrimidines, gemcitabine, platinum agents, and docetaxel have been reported to produce transient partial remissions in a minority of patients.

  

a randomized phase iii study of up to 6 months of gemcitabine versus gemcitabine and cisplatin in 410 patients with unresectable, recurrent or metastatic gallbladder cancer demonstrated an improvement in median overall survival (os) among patients treated with combination therapy (11.7 months vs. 8.1 months, hr, 0.64 (95% confidence interval, 0.52–0.80), p < .001).

 

a similar median os benefit was demonstrated in all subgroups, including 149 patients with gallbladder cancer. grade 3 and 4 toxicities occurred with similar frequency in both study arms, with the exception of increased hematologic toxicity in patients randomly assigned to gemcitabine-cisplatin and increased hepatotoxicity in patients randomly assigned to single-agent gemcitabine.


other drugs and drug combinations await evaluation in randomized trials.