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Original Articles
Neutrophil-to-Lymphocyte Ratio and Extrahepatic Spread Predict Response and Survival in Unresectable Hepatocellular Carcinoma
Dong Yun Kim, Heechul Nam, Jun Yong Park, Sang Hoon Ahn, Sung Won Lee, Do Young Kim
Received May 8, 2026  Accepted July 3, 2026  Published online July 7, 2026  
DOI: https://doi.org/10.4143/crt.2026.0498    [Accepted]
AbstractAbstract PDF
Purpose
Identifying nonresponders to atezolizumab plus bevacizumab (AB) remains challenging in unresectable hepatocellular carcinoma (uHCC). We aimed to develop and externally validate a simple risk scoring system using baseline neutrophil-to-lymphocyte ratio (NLR) and extrahepatic spread (EHS) to predict treatment outcomes.
Materials and Methods
We included 304 patients with uHCC receiving first-line AB from multiple Korean centers (discovery, n = 220; validation, n = 84). Study outcomes included objective response rate (ORR) assessed by modified Response Evaluation Criteria in Solid Tumors, overall survival (OS), and progression-free survival (PFS). Multivariable analysis identified high NLR (>4.575) and EHS as independent predictors of nonresponse. The NLR-EHS score assigned 2 points for high NLR and 1 point for EHS (range, 0–3).
Results
In the discovery cohort, the score predicted nonresponse with an area under the receiver operating characteristic curve (AUC) of 0.749 (95% CI, 0.688–0.810); ORR fell across low- (0), moderate- (1–2), and high-risk (3) groups (67.3%, 47.7%, and 8.2%; p < 0.001). Validation confirmed comparable discrimination (AUC, 0.705; 95% CI, 0.603–0.806) and a consistent ORR gradient (77.8%, 54.2%, and 22.2%; p < 0.001). The score was prognostic for OS in discovery (HR, 1.28; p = 0.003) and validation cohorts (HR, 1.45; p = 0.007), remaining significant after adjustment (adjusted HR, 1.25 and 1.61, respectively). High-risk patients had inferior median OS (6.9 vs. 17.1 months in validation).
Conclusion
The NLR-EHS score is a practical tool for stratifying nonresponse risk and survival in uHCC patients receiving AB, facilitating early identification of high-risk patients who may benefit from alternative strategies.
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Pediatric cancer
Malignant Hepatocellular Neoplasm, Not Otherwise Specified, Displays Poorer Chemoresponsiveness and Postoperative Prognosis Than Hepatoblastoma
In Hye Song, Sujin Gang, Hee Mang Yoon, Pyeong Hwa Kim, Bokyung Ahn, Jihun Kim, Deok Hoon Kim, Jung-Man Namgoong, Kyung-Nam Koh
Cancer Res Treat. 2026;58(2):642-655.   Published online May 12, 2025
DOI: https://doi.org/10.4143/crt.2025.117
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Malignant hepatocellular neoplasm, not otherwise specified (HCN-NOS) is a provisional diagnostic entity, characterised by intermediate or a combination of hepatoblastoma and pediatric hepatocellular carcinoma (p-HCC) features. We compared the characteristics of HCN-NOS with hepatoblastoma and p-HCC.
Materials and Methods
The records of 148 pediatric patients diagnosed with hepatocellular malignancy after resection were retrieved from the institutional database. Clinical parameters and histopathology slides were reviewed to re-establish each patient’s diagnosis. Molecular analyses were conducted in 37 patients.
Results
Patients were profiled as 21 (14.2%) with HCN-NOS, 109 (73.6%) with hepatoblastoma, and 18 (12.2%) with p-HCC. The median age was 8.6 years in HCN-NOS, 1.2 years in hepatoblastoma, and 7.9 years in p-HCC. Background liver disease was frequently observed in p-HCC (11/18, 61%) but infrequent in HCN-NOS (4/21, 19%) and hepatoblastoma (4/109, 3.7%). HCN-NOS presented with a more advanced PRETEXT stage (p=0.012), metastasis (p < 0.001), and lymphovascular invasion (p < 0.001) than hepatoblastoma and p-HCC. Patients with HCN-NOS received longer cycles of preoperative chemotherapy; however, they reported a lower decrease in serum alpha-fetoprotein and tumor size than hepatoblastoma (p=0.043, p=0.004, and p=0.044, respectively). HCN-NOS was an independent poor prognostic factor for event-free survival (hazard ratio, 4.968; 95% confidence interval, 2.004 to 12.32; p < 0.001).
Conclusion
The possibility of HCN-NOS should be considered in pediatric patients with liver cancer, especially those ≥ 5 years old with no background liver disease. Because HCN-NOS exhibits poor chemoresponsiveness and unfavourable postoperative prognosis, liver transplantation should be strongly considered.

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  • Conversion Hepatectomy After New FP Therapy for Malignant Hepatocellular Neoplasm, Not Otherwise Specified: A Case Report
    Etsuko Moriyama, Hironori Koga, Takashi Niizeki, Hideki Iwamoto, Shigeo Shimose, Tomotake Shirono, Takahiko Tokushige, Masahito Nakano, Ryoko Kuromatsu, Toru Goto, Masaki Honda, Taizo Hibi, Yoshiki Mikami, Reiichiro Kondo, Jun Akiba, Takumi Kawaguchi
    Hepatology Research.2026; 56(6): 1047.     CrossRef
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Special Article
Trends in Cancer-Screening Rates in Korea: Findings from the National Cancer Screening Survey, 2004-2023
EunKyo Kang, Kui Son Choi, Jae Kwan Jun, Yeol Kim, Hyeon Ji Lee, Chang Kyun Choi, Tae Hee Kim, Sun Hwa Lee, Mina Suh
Cancer Res Treat. 2025;57(1):28-38.   Published online August 2, 2024
DOI: https://doi.org/10.4143/crt.2024.325
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study aimed to report the overall national trends in the rates of cancer screening based on recommendations and provide insights into the changing trends of these rates across different demographics.
Materials and Methods
This study used data from the Korean National Cancer Screening Survey (KNCSS), which surveys nationwide cancer-screening rates and includes 4,500 individuals meeting the Korean National Cancer Screening Program (NCSP) protocol age criteria. Cancer-screening rates were assessed using structured questionnaires; yearly trends were analyzed for both lifetime cancer-screening rates and rates of screening based on recommendations, and subgroup analyses were performed based on age and sex.
Results
The rates of cancer screening based on recommendations showed significant increments: the stomach cancer-screening rate increased from 39.2% in 2004 to 77.5% in 2023 (3.50% per year), the liver cancer-screening rate increased from 20.0% to 48.8% (4.30% per year), and the colorectal cancer, increased from 19.9% to 70.7% (5.15% per year). The breast cancer-screening rate increased from 33.2% to 72.7% (2.88% per year), and the cervical cancer, increased from 58.3% to 70.2% (1.08% per year). Despite some differences, particularly in relation to sociodemographic factors, screening rates increased significantly for all cancer types.
Conclusion
Cancer-screening rates in Korea increased consistently from 2004 to 2023, demonstrating the effectiveness of the national cancer-screening program. However, the increments in breast, cervical and lung cancer-screening rates were relatively lower, indicating the need for additional efforts and strategies.

Citations

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  • Optimal interval of screening endoscopy for reducing gastric cancer mortality: a nationwide cohort study
    Soo-Yoon Sung, Hyun Ho Choi, Seung Ho Sin, Hyung-Keun Kim, Sang Woo Kim, Sung Soo Kim
    Gastrointestinal Endoscopy.2026; 103(4): 725.     CrossRef
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    Yosep Chong, Ran Hong, Hyeong Ju Kwon, Haeryoung Kim, Lucia Kim, Soon Jae Kim, Yoon Jung Choi
    Diagnostic Cytopathology.2026; 54(2): 146.     CrossRef
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    Hye-Sun Lee, Gyeong-U Hong, Wonjeong Jeong, Kyounghee Oh, Jae Kwan Jun
    Health Communication.2026; 41(10): 1708.     CrossRef
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    International Journal of Epidemiology.2026;[Epub]     CrossRef
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    Wen‐Feng Hsu, Masau Sekiguchi, Jeongkuk Seo, Hyun‐Soo Kim, Takahisa Matsuda, Han‐Mo Chiu
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    Jaewoo Cha, Minku Kang
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    Alejandro J. Zárate, Suraj Samtani, Roberto Salas, Camila Leiva
    Revista Médica Clínica Las Condes.2026; 37(2): 147.     CrossRef
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    Yafen Wang, Enhui Zhou, Zhengyu Shi, Weijun Huang, Tianjiao Zhou, Chen Xu, Jinxiu Yao, Jing Wang, Siqiong Jiang, Fang Fang, Wen Lu, Hongliang Yi
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    Hyun Jin Kim, Hyeon Ji Lee, Hye Young Shin, Hye-Sun Lee, Jae Kwan Jun, Kui Son Choi, Mina Suh, Fatemeh Zarei
    PLOS One.2026; 21(7): e0353242.     CrossRef
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    Da Hea Seo, Kyoung Hwa Ha, Dae Jung Kim
    Endocrinology and Metabolism.2026; 41(4): 558.     CrossRef
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    Cancer Epidemiology.2026; 104: 103209.     CrossRef
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    Seong-Uk Baek, Jin-Ha Yoon
    Cancers.2025; 17(6): 956.     CrossRef
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    Lisa Jungblut
    European Radiology.2025; 35(12): 8162.     CrossRef
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    Kyeongmin Lee, Mina Suh, Kui Son Choi
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    Hee-Yeon Kang, Eunjung Park, Thi Tra Bui, Byungmi Kim, Jin-Kyoung Oh
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    Cancer Prevention Research.2025; 18(11): 681.     CrossRef
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Original Articles
Gastrointestinal Cancer
Fasting Blood Glucose, Cholesterol, and Risk of Primary Liver Cancer: The Kailuan Study
Xiangming Ma, Haozhe Cui, Miaomiao Sun, Qian Liu, Xining Liu, Guangjian Li, Yaochen Wei, Qingjiang Fu, Siqing Liu, Liying Cao
Cancer Res Treat. 2021;53(4):1113-1122.   Published online January 19, 2021
DOI: https://doi.org/10.4143/crt.2020.817
AbstractAbstract PDFPubReaderePub
Purpose
The influence of fasting blood glucose (FBG) and cholesterolemia primary liver cancer (PLC) in china was analyzed via a large prospective cohort study based on a community population, and the combined effects between them were investigated.
Materials and Methods
Overall, 98,936 staff from the Kailuan Group who participated in and finished physical examinations between 2006 and 2007 were included in the cohort study. Their medical information was collected and they were followed up after examination. The correlations of serum FBG or TC with PLC were analyzed. Then, we categorized all staff into four groups: normal FBG/ non-hypocholesterolemia, normal FBG/hypocholesterolemia, elevated FBG/non-hypocholesterolemia, elevated FBG/hypocholesterolemia and normal FBG/ non-hypocholesterolemia was used as a control group. The combined effects of elevated FBG and hypocholesterolemia with PLC were analyzed using the Age-scale Cox proportional hazard regression model.
Results
During 1,134,843.68 person*years follow up, a total of 388 PLC cases occured. We found the elevated FBG and hypocholesterolemia increases the risk for PLC, respectively. Compared with the non-hypocholesterolemia/normal FBG group, the risk of PLC was significantly increased in the non-hypocholesterolemia/elevated FBG group (HR=1.19,95%CI 0.88–1.62) and hypocholesterolemia/normal FBG group (HR=1.53,95%CI 1.19–1.97), and in the hypocholesterolemia/elevated FBG group (HR=3.16 95%CI2.13-4.69). And, a significant interaction effect was found of FBG and TC on PLC. All results were independent from the influence of liver disease.
Conclusion
Elevated serum FBG and hypocholesterolemia are risk factors for PLC, especially when combined. Thus, for the prevention and treatment of PLC, serum FBG and TC levels should be investigated.

Citations

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    Cardiovascular Diabetology.2022;[Epub]     CrossRef
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General
Trends in Cancer Screening Rates among Korean Men and Women: Results of the Korean National Cancer Screening Survey, 2004–2018
Seri Hong, Yun Yeong Lee, Jaeho Lee, Yeol Kim, Kui Son Choi, Jae Kwan Jun, Mina Suh
Cancer Res Treat. 2021;53(2):330-338.   Published online October 20, 2020
DOI: https://doi.org/10.4143/crt.2020.263
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The Korean National Cancer Screening Survey (KNCSS) is a nationwide annual cross-sectional survey conducted for the past 15 years. This study aimed to report trends in the overall screening rates of both organized and opportunistic cancer screening programs from 2004–2018.
Materials and Methods
KNCSS data were collected using a structured questionnaire. For five major cancers (i.e., stomach, liver, colorectal, breast, and cervical cancer), we evaluated both the lifetime screening rate and the screening rate with recommendations. The study population included men aged 40–74 years and women aged 20–74 years with no cancer histories.
Results
Screening rate with recommendations increased from 2004 annually by 4.4% and 1.5% until 2013 for stomach and liver cancers, respectively, by 4.0% until 2012 for breast cancer, and by 3.6% and 1.2% until 2014 for colorectal and cervical cancers, respectively, followed by nonsignificant trends thereafter. In 2018, screening rates with recommendations for these cancers were 72.8%, 26.2%, 63.1%, 58.4%, and 55.6%, respectively.
Conclusion
Screening rates for the five types of cancer demonstrated a marked increase between 2004 and 2018. However, many recent screening rates have been flattened with nonsignificant trends, and there are lower rates for cervical cancer screening among young age groups. Steady efforts are needed to achieve higher screening participation rates overall, especially for the cervical cancer screening of young women in their 20s.

Citations

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Preclinical Efficacy Testing for Stomach and Liver Cancers
Jun Won Park, Nam Suk Baek, Seok Cheol Lee, Su Jin Oh, Seok Hoon Jang, In Hoo Kim, Dae Yong Kim, Hark Kyun Kim
Cancer Res Treat. 2014;46(2):186-193.   Published online April 15, 2014
DOI: https://doi.org/10.4143/crt.2014.46.2.186
AbstractAbstract PDFPubReaderePub
Purpose

Hollow fiber assays offer an early in vivo method of anticancer drug screening. The assays have been optimized for human cancers originating from the lung, breast, colon, ovary, and brain, but not from the stomach and liver. The current study focused on optimization of hollow fiber assays for gastric and hepatocellular carcinoma cell lines.

Materials and Methods

Gastric (SNU-16, SNU-484, SNU-668) and hepatocellular (HepG2, SK-Hep-1, Hep3B) carcinoma cell lines in hollow fibers were transplanted subcutaneously and intraperitoneally into mice, which were subsequently treated with a standard anticancer agent, paclitaxel. The hollow fiber activity of paclitaxel in each cell line was compared with the xenograft activity.

Results

Using optimized inoculation densities and schedules, treatment with paclitaxel was effective in gastric carcinoma cell lines, SNU-16 and SNU-484, but not in SNU-668. In the hollow fiber assays, paclitaxel was effective in hepatocellular carcinoma cell lines, HepG2 and SK-Hep-1, but not in Hep3B. Consistent with the results of the hollow fiber assay, SNU-16 and SNU-484, but not SNU-668, showed tumor regression, and HepG2 and SK-Hep-1, but not Hep3B, showed effective tumor responses following treatment with paclitaxel in xenograft models. When EW7197, a novel compound, and flavopiridol were tested in SNU-16 cells under optimized conditions, the hollow fiber activity showed good correlation with the xenograft activity of each compound.

Conclusion

Our protocols may be useful for screening candidate small molecules that may exhibit activity against stomach and liver cancers, both of which are common in Korea.

Citations

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  • Synopsis on the Linkage of Alzheimer's and Parkinson's Disease with Chronic Diseases
    Nasimudeen R. Jabir, Chelapram K. Firoz, Saleh S. Baeesa, Ghulam Md Ashraf, Suhail Akhtar, Warda Kamal, Mohammad A. Kamal, Shams Tabrez
    CNS Neuroscience & Therapeutics.2015; 21(1): 1.     CrossRef
  • The Effect of Disintegrin–Metalloproteinase ADAM9 in Gastric Cancer Progression
    Jeong Min Kim, Hei-Cheul Jeung, Sun Young Rha, Eun Jeong Yu, Tae Soo Kim, You Keun Shin, Xianglan Zhang, Kyu Hyun Park, Seung Woo Park, Hyun Cheol Chung, Garth Powis
    Molecular Cancer Therapeutics.2014; 13(12): 3074.     CrossRef
  • 15,239 View
  • 136 Download
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Geographical Variation of Liver Cancer Mortality in Korea (1992-1998)
Duk Hee Lee, Jin Ha Kim, Byung Hun Han, Sang Ook Lee, Hai Rim Shin, In Chul Jung
Cancer Res Treat. 2001;33(5):420-426.   Published online October 31, 2001
DOI: https://doi.org/10.4143/crt.2001.33.5.420
AbstractAbstract PDF
PURPOSE
The death rate of liver cancer in Korea has been reported as one of the highest in the world. This study was conducted to investigate geographical variations of liver cancer mortality in Korea in order to obtain insight into possible environmental factors related to liver cancer.
MATERIALS AND METHODS
The sex-specific standardized mortality ratios (SMRs) of liver cancer were calculated for 168 basic administrative units in Korea based upon the vital statistics for the seven years 1992 to 1998, as well as the sex- and age-specific population of each area for 1995. The SMRs were classified into six categories and depicted on a map for each sex.
RESULTS
The southern provinces showed clearly higher mortality rates as compared to the rest of the country in both males and females. Looking at the maps in detail, there was a geographical variation even within the southern provinces. The areas around large rivers, some costal areas, and costal islands showed a high mortality rate. Even in the middle and northern provinces, the eastern costal areas showed relatively higher mortality rates as compared to inland areas. Conversely, some southern areas known for low levels of pollution showed relatively lower mortality rates.
CONCLUSION
This finding suggests a possible relationship between liver cancer and water-related foods from polluted rivers or seas. Further studies should be performed in order to clarify which factors cause this geographical variation.

Citations

Citations to this article as recorded by  
  • Regional Factors Affecting Liver Cancer Mortality Using GWR
    Jin Hyun Son, Wooseok Ryu
    Journal of Health Informatics and Statistics.2024; 49(4): 404.     CrossRef
  • Prevalence and Related Factors of Clonorchiasis among Five Major Riverside Residents in South Korea
    Chunmi Kim, Kyung Ja June, Shin Hyeong Cho, Kyung Soon Park, Hung Sa Lee, Ji Yeon Park
    Journal of Korean Academy of Community Health Nursing.2016; 27(4): 346.     CrossRef
  • The knowledge and attitudes towards hepatitis B among paramedic students
    Bo-Ram Choi, Dong-Ok Kim, Gyung-Hun Min
    The Korean Journal of Emergency Medical Services.2016; 20(3): 57.     CrossRef
  • Viral Hepatitis and Liver Cancer in Korea: an Epidemiological Perspective
    Yohwan Yeo, Jin Gwack, Seokin Kang, Boyeon Koo, Sun Jae Jung, Prakash Dhamala, Kwang-Pil Ko, Young-Khi Lim, Keun-Young Yoo
    Asian Pacific Journal of Cancer Prevention.2013; 14(11): 6227.     CrossRef
  • A Study on the Prevalence of Clonorchis Sinensis and the Effects of Educational Program among Residents in the Basin of the Youngsan River, Korea
    Chunmi Kim, Aeyoung So, Kyung-Ja June, Hee Young Jung
    Journal of Korean Academy of Community Health Nursing.2011; 22(1): 56.     CrossRef
  • Hepatitis B and C virus prevalence in a rural area of South Korea: the role of acupuncture
    H R Shin, J Y Kim, J I Kim, D H Lee, K Y Yoo, D S Lee, S Franceschi
    British Journal of Cancer.2002; 87(3): 314.     CrossRef
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Intrahepatic Recurrence after Transhepatic Arterial Chemoembolization in Hepatocellular Carcinoma
Tae Yong Moon, Byung Soo Kim, Suck Hong Lee, Hak Jin Kim, Sung Yup Lim, Bong Sig Koo
J Korean Cancer Assoc. 1995;27(6):924-929.
AbstractAbstract PDF
Purpose
We have investigated the annual frequency of recurrent intrahepatic tumors and the doubling time of regrowing tumors after transhepatic arterial chemoembolization (TAE) to know the proper time for subsequent TAE. Materials and Methods: Among cases in which a previous TAE was performed, 28 cases showed definite intrahepatic recurrence and 7 cases showed a regrowing tumor in the follow-up liver CT scan and/or hepatic angiography. Resnlts: The annual frequency of intrahepatic recurrence in the 28 tumors was 71.4% (20/28) within one year and 100% within 6 years. The mean doubling time of 7 regrowing tumors was 68.3 days. Conclusion: We concluded that periodically repeated TAE is needed for further treatment of the recurrent and regrowing tumors.
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Dose-Response Relationship of Radiotherapy for Locally Advanced Hepatocellular Carcinoma
Dae Yong Kim, Joon Hyoek Lee, Kwang Cheol Koh, Seung Woon Paik, Yong Chan Ahn, Seung Jae Huh, Inhwan J Yeo, Suk Won Park, Seung Hee Chang
J Korean Cancer Assoc. 2000;32(5):918-924.
AbstractAbstract PDF
PURPOSE
Recently radiotherapy is applied alone or in conjunction with transcatheter arterial chemoembolizaion (TACE) or percutaneous ethanol injection therapy (PEIT) for locally advanced hepatocellular carcinoma (HCC). The purpose of this study was to evaluate dose-response relationship of radiotherapy for local control and toxicity in inoperable HCC.
MATERIALS AND METHODS
Twenty-eight patients who were not eligible for TACE and PEIT or had showed no response to these treatment were treated with a total dose of 40 Gy with 2 Gy per fraction or 30 Gy with 3 Gy per fraction (low dose group, 18 patients) or 45 Gy with 3 Gy per fraction (high dose group, 10 patients).
RESULTS
The median survival duration was 8 months and 1-year survival rate was 37%. The treatment results were as follows; partial response in 11% and 70% (p=0.001), stable disease in 56% and 30%, and progressive disease in 33% and 0% in low dose group and high dose group, respectively. The incidence of gastrointestinal (G-I) toxicity by the criteria of Southwest Oncology Group was as follows; grade 1 in 22% and 40%, grade 2 in 17% and 10%, respectively (p=0.56). There was no patient with severe G-I toxicity above grade 3. The incidence of G-I toxicity by site was as follows; grade 1 in 24% and 29%, and grade 2 in 0% and 57% in patients with right lobe and left lobe lesion, respectively (p=0.001).
CONCLUSION
This study indicates that there is clear dose-response relationship in local control. The G-I toxicity does not increase significantly with increment of radiation dose within the dose range tested in this study. And careful attention should be paid for G-I toxicity when the tumor is located in left lobe.
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Radioresponse of Hepatdegrees Celluar Carcinoma Treatment of Lymph Node Metastasis
Jong Hoon Kim, Eun Kyung Choi, Young Wha Chung, Young Sang Lee, Dong Jin Seo
J Korean Cancer Assoc. 2000;32(3):571-577.
AbstractAbstract PDF
No abstract available.
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  • 19 Download
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