국소 진행된 비인강암의 방사선-항암제 병용요법
Radiation Therapy Combined with Cisplatin Based Chemotherapy for the Patients with Locally Advanced Nasopharyngeal Cancer
손석현, 김지윤, 김연실, 김성환, 문성권, 조승호, 박영학, 홍영선,
소속 상세정보
손석현 ( Son Seok-Hyun )
가톨릭대학교 의과대학 방사선종양학교실
김지윤 ( Kim Ji-Yoon )
가톨릭대학교 의과대학 방사선종양학교실
김연실 ( Kim Yeon-Sil )
가톨릭대학교 강남성모병원 방사선종양학과
김성환 ( Kim Sung-Hwan )
가톨릭대학교 의과대학 방사선종양학교실
문성권 ( Mun Seong-Kwon )
가톨릭대학교 의과대학 방사선종양학교실
조승호 ( Cho Seung-Ho )
가톨릭대학교 의과대학 이비인후과학교실
박영학 ( Park Young-Hak )
가톨릭대학교 의과대학 이비인후과학교실
홍영선 ( Hong Young-Seon )
가톨릭대학교 의과대학 내과학교실
KMID : 0356820060220020123
Abstract
Objective : This retrospective study was designed to evaluate the anti-tumor efficacy and toxicities of the radiation therapy(RT) combined with cisplatin-based chemotherapy in locally advanced nasopharyngeal cancer(NPC).
Materials & Methods : Fifty three patients with locally advanced NPCs(AJCC stage II, III, IV) received curative RT and cisplatin-based chemotherapy. Duration of follow-up ranged from 5.5 to 201 months(median 50.8 months). Nineteen patients(35.8%) were treated with induction chemotherapy including cisplatin $100mg/m^2$ for 1 day and 5-fluorouracil $1g/m^2$ for 5 days followed by RT(Induction CTx-RT). Another 34 patients (64.2%) were treated with concurrent chemoradiation(CCRT) using cisplatin $100mg/m^2$(D1, 22, 43).
Results : Thirty-six(67.9%) and 11(20.8%) patients achieved clinical complete response and partial response, respectively. The pattern of failure was as follows：14 locoregional recurrence(26.4%) and 7 distant metastasis(13.2%). Among them, two patients(3.8%) had both locoregional and distant failure. Median overall survival(OS) and progression-free survival(PFS) were 85.5 months and 87.5 months, respectively. Five-year OS rate was 57.1%. The stage(AJCC), tumor response to chemoradiation and T stage were significant prognostic factors for OS(p=0.0113, p=0.0362 and p=0.0469). The stage(AJCC), tumor response to chemoradiation were also significant prognostic factors for PFS(p=0.0329, p=0.0424). Compared to each treatment group(Induction CTx-RT vs. CCRT), there were no significant differences in OS and PFS(p=0.7000, p=0.8261). Grade 3-4 mucositis, nausea/vomiting and hematological toxicities were noticed in 35.8%, 11.3% and 13.2%, respectively. Delayed RT over 2 weeks was inevitable in 26.5%. Seventeen patients(50%) successfully completed planned 3 courses of cisplatin in CCRT group.
Conclusion : RT combined with cisplatin-based chemotherapy in locally advanced NPC showed high response rate, good locoregional control, and survival rate. As expected, frequency of acute toxicities increased, and the patient’s compliance to treatment was need to be improved. Although our data could not show additional survival benefit of CCRT compare to that of induction chemotherapy followed by RT, patients’ accrual and further follow-up are required due to limitation of retrospective study.
키워드
비인강암;방사선-항암제 병용요법;시스플라틴
Nasopharyngeal cancer;Chemoirradiation;Cisplatin;Radiation
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