유도항암화학요법이 국소진행된 자궁경부암의 근치적 방사선치료에 미치는 영향
The Effects of the Induction Chemotherapy on the Radical Radiotherapy in the Locally Advanced Cervical Cancer
대한암학회지 1998년 30권 4호 p.762 ~ 771
소속 상세정보
강기문/Ki Mun Kang
윤세철/장홍석/유미령/김연실/남궁성은/김승조/Sei Chul Yoon/Hong Seok Jang/Mi Ryeong Ryu/Yeon Shil Kim/Sung Eun Namkoong/Seung Jo Kim
KMID : 0360319980300040762
Abstract
서론
최근 암 예방을 위한 홍보 활동과 조기 진단에 대한 인식 향상으로 자궁경부암은 점차적
인 감소추세에 있으나 아직도 우리 나라 여성암 중 1위를 차지하고 있다. 자궁경부암의 치
료는 전통적으로 초기병기(FIGO 병기 I, IIA)에 있어서는 수술과 방사선치료가 주된 치료
방법이며 진행된 병기(FIGO 병기 IIB-IVA)에서는 방사선치료가 근간을 이루고 있다. 그중
국소진행된 자궁경부암에 있어서 전통적으로 방사선치료가 이용되어 왔으나 방사선 단독 치
료 시 실패율과 재발률을 피할 수 없고 무병생존율이 떨어지기에 병용치료방법의 필요성이
대두되게 되었다. 이러한 것을 극복하기 위하여 1980년 이후 국소진행된 자궁경부암의 치료
에 있어서 유도항암화학요법후 방사선병용치료를 시도함으로써 재발률을 낮추고 생존율을
증가시키려는 많은 연구가 진행되었다. 그러나 항암화학요법과 방사선 병용치료가 국소진행
된 자궁경부암의 치료에 미치는 영향에 대해서는 아직까지 논란의 대상이 되고 있는 실정이
다.
이에 본 연구에서는 항암화학요법치료후 근치적 방사선치료를 시행하였던 국소진행된 자
궁경부암 환자들을 대상으로 생존율, 무병생존율, 실패양상, 합병증을 살펴보고, 생존율에 영
향을 미치는 예후인자를 후향적으로 분석하여 유도항암화학요법치료의 효용성에 대해 알아
보고자 하였다.
Purpose: We evaluated the prognostic factors, survivals and patters of failure of the
patients with locally advanced cervical cancer who received radical radiotherapy alone
and induction chemotherapy followed by radiotherapy respectively.
Materials and Methods: Between May 1985 to December 1992, one hundred and sixty
three patients with locally advanced cervical cancer received curative radiotherapy.
Patients were divided into two groups: control group included 69 patients who received
curative radiotherapy and combined group included 94 patients who received induction
chemotherapy followed by curative radiotherapy. The curative radiotherapy consisted of
external pelvic radiotherapy and intracavitary brachytherapy. Induction chemotherapy was
delivered in VBP (vincristine, bleomycin, cisplatin) and FP (5-FU, cisplatin). Follow up
period ranged from 2 months to 99 months with median of 50 months.
Results: The overall response rate was 94.2% in the control group and 89.4% in the
combined group. The response rate by control group was 66.7% for CR (complete
response), 27.5% for PR (partial response), 5.8% for NR (no response). The response
rate by combined group of CR, PR, NR were 64.9%, 24.5%, 10.6%, respectively. There
was no difference in response for control group and combined group (p > 0.05). The
5-year overall survival had no significant difference in between control group and
combined group (54.6% vs. 57.3%). The 5-year disease free survival also had no
significant difference (52.9% vs. 55.0%). In the control group,23 patients (33.3%) had
treatment failure: twelve (17.4%) at a local recurrence, 9 (13.0%) as distant metastasis,
and 2 (2.9%) with both local recurrence and distant metastasis. In the combined group,
thirty patients(31.9%) failed therapy, with local recurrence in 21 patients (22.3%), distant
metastasis in 7 patients (7.5%), and both in 2 patients (2.1%). The difference between
the two groups was not significant in view of patterns of failure. The major toxicities
were nausea/vomiting, leukopenia, anemia, and diarrhea. The prognostic factors affecting
were hemoglobin level, KPS (karnofsky performance status), and treatment response in
both group by multivariate analysis.
Conclusion: This study did not prove the efficacy of induction chemotherapy followed
by radiotherapy in locally advanced cervical cancer.
키워드
Locally advanced cervical cancer; Induction chemotherapy; Radiotherapy;
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