- 期刊
Management of Bilateral Adrenal Metastases from Hepatocellular Carcinoma: A Case Report
兩側腎上腺肝癌轉移之治療經驗－病例報告
摘要
腎上腺是肝癌肝外轉移在臨床上比較少見受侵犯之器官，由於腎上腺之肝癌轉移瘤有破裂出血之危機，因此在治療上需採取積極之治療。目前在腎上腺肝癌轉移之治療經驗仍很缺乏，本病例報告提供一位有兩側腎上腺肝癌轉移之病患，經放射治療及經導管動脈化學栓塞治療之經驗，患者左側腎上腺肝癌轉移瘤因經導管動脈化學栓塞治療失敗，故採取3D-conformal放射治療，治療後腫瘤縮小，且於追蹤期間無復發之證據，其右側腎上腺肝癌轉移瘤接受兩次經導管動脈化學栓塞治療，但腫瘤在治療後並無明顯縮小，反而逐漸變大，故又接受3D-conformal放射治療（共5,400cGy），腫瘤於治療後一個月縮小l公分，患者之肝功能維持在Child A等級、腎功能於追蹤期間均維持正常，患者也無出現明顯可查覺之放射治療副作用，我們之經驗可提供往後處理類似患者之參考。
並列摘要
The adrenal glands rarely are an extrahepatic site for metastasis from hepatocellular carcinoma (HCC). Once identified, adrenal metastasis requires aggressive management, due to the risk of rupture and internal hemorrhaging. Disease management of adrenal metastasis from HCC is limited, given the relative lack of available knowledge, and the present report details our efforts in managing bilateral adrenal metastases from HCC. For this patient, we used radiation therapy and transcatheter arterial chemoembolization (TACE). The left adrenal tumor was treated by 3D conformal radiation therapy, following the failure of TACE. The size of the left adrenal tumor decreased and no evidence of recurrence after management was noted. One right adrenal tumor was treated using two sessions of TACE, and the size of the tumor did not decrease. We later observed that the right tumor actually progressively increased in size. The tumor was then treated by 3D conformal radiation therapy (total 5,400 cGy), and the size decreased by 10mm, 1 month after treatment. The patient's condition was stable and liver function was maintained at early stage liver cirrhosis (Child A). Renal function was maintained within normal ranges after diagnosis of HCC and throughout the entire follow-up period, and no complications secondary to radiation therapy were noted. Our experience may provide useful information in disease management for these patients.
延伸閱讀
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