자궁경부암 환자의 근치적 방사선치료성적
Treatment Results of Radical Radiotherapy in Uterine Cervix Cancer
소속 상세정보
허승재/Seung Jae Huh
김보경/임도훈/신성수/이정은/강민규/안용찬/Bo Kyong Kim/Do Hoon Lim/Seong Soo Shin/Jeong Eun Lee/Min Kyu Kang/Yong Chan Ahn
KMID : 0859320020200030237
Abstract
목적: 삼성서울병원 치료방사선과에서 근치적 목적으로 외부조사와 고선량율 강내치료를 이용하여 치료한 자궁경부암 환자의 치료 성적을 분석하고자 하였다.
대상 및 방법: 1994년 9월부터 1998년 7월까지 근치적 목적으로 방사선치료를 시행한 106명의 환자를 대상으로 분석하였으며, 환자의 연령분포는 22∼89세(중앙값, 61세)이었다. 98명의 환자에서 편평상피암이었다. 환자의 FIGO 병기는 CIS 4명, ⅠA 4명,
ⅠB
17명,
ⅡA 15명, ⅡB 33명, ⅢA 2명, ⅢB 27명, ⅣA가 4명이었다. ECOG 활동도는 88명에서 1이하였다. 11명의 환자에서 전보조화학요법이 시행되었다. 방사선치료는 상피내암인 4명을 제외한 102명에서 30.6- 50.4 ㏉를 외부 조사하였으며 고선량율 강내치료를 모든
환자에서 A점
기준으로 24 ㏉/6회 시행하였다. 치료 예후 인자는 연령(≤60세 vs >60세), 병리조직학적 소견(편평상피암 vs 기타 병리), FIGO 병기(ⅡA 이하 vs ⅡB vs ⅢA 이상), ECOG 활동도(ECOG 0, 1 vs 2), 항암화학요법의 시행여부, 그리고 방사선치료 후
반응정도(완전관해
vs
부분관해), 방사선치료기간(≤55일 vs >55일)에 따라 비교하였다. 환자의 추적관찰기간은 6∼66개월(중앙값, 28개월)이었다.
결과: 전체 3년 및 5년 생존율은 각각 82%, 73%이었으며, 무병생존율은 각각 72%, 69%이었다. FIGO 병기별 생존율은 병기 ⅠB, ⅡA, ⅡB, 그리고 Ⅲ에서 3년 생존율이 각각 100%, 83%, 87%, 62%이었고 5년 생존율은 ⅠB 100%, ⅡA 69%, ⅡB 80%, Ⅲ에서는
62%이었다. 단변량분석에 따른 예후인자를 살펴보면 전체생존율에서는 FIGO 병기와 방사선치료의 반응이 무병생존율과 골반부 조절율에는 나이와 병기, 방사선치료의 반응, 방사선치료기간이 의미 있는 인자로 확인되었다. 방사선치료 부작용으로 직장 출혈은 모두
14명(13%)의 환자에서 나타났다.
결론: 자궁경부암 환자의 고선량율 강내치료와 외부 방사선치료는 효과적인 치료방법임을 확인하였으며, 치료기간의 단축이 중요한 예후 결정 요인임을 확인할 수 있었다.
Purpose: This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim.
Materials and Methods: Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radiotherapy were analyzed. The median age
was 61
years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range 30.6∼50.4 ㏉ to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of 24∼28 ㏉
with
6∼7 fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy.
Results: Early responses of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The
overall
survival (OS) rate of all patients was 82%, and 73%, and the disease free survival (DFS) rate was 72%, and 69%, at 3, and 5 years, respectively. The pelvic control rate (PCR) was 79% at both 3 and 5 years. According to the FIGO stage, 3 and 5
year
OS
were 100% and 50% in CIS/ⅠA, 100% and 100% in ⅠB, 83% and 69% in ⅡA, 87% and 80% in ⅡB, and 62% and 62% in Ⅲ, respectively. The 3 year OS in 4 patients with stage ⅣA was 100%. Three-year DFS were 80% in CIS/ⅠA, 88% in ⅠB, 100% in ⅡA, 64%
in
ⅡB, 58% in Ⅲ, and 75% in ⅣA. Three-year PCR were 100% in CIS/ⅠA, 94% in ⅠB, 100% in ⅡA, 84% in ⅡB, 69% in Ⅲ, and 50% in ⅣA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant
factors
for
DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate, treatment response and OTT were significant factors. By multivariate analysis, FIGO stage had a borderline significance for OS (p=0.0825) and
treatment response had a borderline significance for DFS (p=0.0872). A total of 14 patients (13%) experienced rectal bleeding, which occurred from 3 to 44 months (median, 13 months) after the completion of radiotherapy.
Conclusion: HDR brachytherapy protocol of Samsung Medical Center combined with properly optimal external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer. The authors found that OTT of less
than 55
days had a positive impact on pelvic control and survival rate.
키워드
방사선치료; 자궁경부암; 고선량율; 강내치료; Cervix cancer; Radiotherapy; High dose rate brachytherapy;
원문 및 링크아웃 정보
등재저널 정보