유방암에서 근치적 수술 후 흉골 주위 재발
Parasternal Recurrence after Curative Resection of Breast Cancer
대한암학회지 1998년 30권 2호 p.253 ~ 261
소속 상세정보
정은지/Eun Ji Chung
서창목/박원/이희대/이경식/김귀언/Chang Ok Suh/Won Park/Hy De Lee/Kyung Sik Lee/Gwi Eon Kim
KMID : 0360319980300020253
Abstract
서론
유방암으로 근치적 유방절제술을 받은 후 흉벽이나 국소 림프절에 국한되어 발생하는 국
소 재발은 약 10∼37% 의 발생률이 보고되고 있다. 이런 국소 재발 중에서 흉골 및 내유방
림프절 전이를 포함하는 흉골 주위 재발(parasternal recurrence)은 정확한 빈도가 보고되지
않았으나 대개 매우 낮은 것으로 알려져 있고, 그 임상적 특성이나 치료에 대한 보고가 별
로 얼다. 본 연구에서는 흉골 주위 재발(parastemal recurrence)을 흉골 자체에서 재발하였
거나, 내유방 림프절 또는 내측 흉벽에서 재발하여 흉골이나 그 주변에 종양의 침범을 보이
는 경우로 정의하여 연구 대상에 포함시켰다. 유방암에 대한 일차적 치료 후 발생하는 국소
재발 중 가장 흔한 것은 흉벽 재발(chest wall recurrence) 로 전체 국소 재발의 20∼70%를
차지하는데(2,5∼13), 내측 흉벽(medial chest wall)에서 재발할 경우 흉골까지 침범하는 경
우가 많게는 43∼58% 점도로 보고되었다. 또한 원격 전이 중 골 전이는 유방암에서 매우
호발하며 대개 다발성으로 나타나는데 흉골 전이의 경우는 다발성 골 전이중의 하나로 나타
나기보다는 단독 전이로 나타나는 경우가 상당수 있으며 부검 시 흉골 전이 발견율이 약
30% 정도로 보고되고 있다. 흉골 주위 재발에 포함되는 또 한가지 부류는 내유방 림프절
(internal mammary lymph node or parasternal lymph node)에서의 재발로 내유방 림프절
단독 재발은 1∼3%로 매우 드물고, 흉벽이나 다른 주변 림프절 재발과 함께 다발성으로 재
발하는 것을 포함하면 대개 8∼11%의 재발률이 보고되고 있다. 이에 본 연구자들은 유방암
에서 근치적 절제술 후 나타나는 흉골 주위 재발(parasternal recurrence)에서 초기 수술 당
시의 환자 및 종양의 임상적 특징과 재발 양상의 특성을 조사하였고, 재발의 임상 양상에
따라 3군으로 분류하여 보았으며, 흉골 주위 재발암에 대한 방사선치료의 성적을 평가해 보
고자 본 연구를 시행하였다.
Purpose : We tried to find the patients' characteristics of parasternal recurrence, to
classify the parasternal recurrence according to the radiological and clinical features, and
to evaluate the efficacy of local radiotherapy.
Materials and Methods : Between August 1987 and April 1997, twenty one patients
with parasternal recurrence of breast cancer after surgery with or without adjuvant
chemotherapy were treated with radiotherapy, Age distribution at initial operation was
ranged from 31 to 79 years(median 48 years). Sixteen(76.2%) cancers were in the right
breast and five(23.8%) were in the left. The pathologic types were infiltrative ductal
carcinoma in 18 patients and medullary carcinoma in 3 patients. Eight patients had stage
Ⅰ, three had stage Ⅱa, six had stage Ⅱb, one had stage Ⅲa diseases and we had no
information about the initial stage of the other 3 patients. Parasternal recurrence were
diagnosed by biopsy in 7 patients, and the other 14 recurrences were diagnosed by
clinical and radiologic findings such as chest CT, whole body bone scan. All the
patients were treated with radiation for the parasternal recurrent tumors. In addition,
five patients also received chemotherapy(FAC or Taxol based protocol) and one patient
also received partial resection before radiotherapy. Radiotherapy was delivered with
Co-60 γ-ray or 4∼6 MV X-ray or electron beam to both supraclavicular lymph nodes
and parasternal areas with total doses of 3000∼6480 cGy(median 6100 cGy).
Results : The range of interval between curative resection and parasternal recurrence
were 4∼110 months(median 34 months). The main symptoms of the parasternal
recurrence were a painless mass(n= 10). The duration of symptom before diagnosis
ranged from one to 36 months(median 7 months). Among 21, five patients(23.8%)
presented distant metastses at the diagnosis of parasternal recurrences. The parasternal
recurrences we're classified into three groups according to radiologic and clinical
findings ; the recurrent tumors originated from sternum and invaded into adjacent
tissues(Group 1, n=5), tumors originated from internal mammary lymph nodes and
invaded into sternum or parasternal tissues(Group 2, n=6), tumors originated from medial
chest wall and invaded into sternum or parasternal tissues(Group 3, n= 10). In nineteen
patients(19/21 ; 90.5%) there was complete response of parasternal recurrence following
radiotherapy. Although the follow up period was relatively short(3 ∼78 months, median
14 months), there were no local recurrence in radiation field in 19 patients with complete
response. Among the 16 patients without distant metastases at diagnosis of parasternal
recurrence, nine patients were alive without any evidence of disease.
Conclusion : Chest CT scan is necessary and effective in patients with parasternal
discomfort, pain, swelling or palpable mass after mastectomy. And we found that
radiotherapy was very effective for the local treatment of parasternal recurrence in
terms of symptom palliation and local control of tumor. Although we classified the
parasternal recurrence into three groups, we could not reach any conclusive results
because of short follow up duration and insufficient patients number.
키워드
Parasternal recurrence; Breast cancer; Radiotherapy;
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