¼¼±âÁ¶Àý¹æ»ç¼±Ä¡·á(IMRT)·Î Ä¡·áÇÑ
Incidence and Prognostic Factors of Radiation Pneumonitis
±è¸í¼¼,
¼Ò¼Ó »ó¼¼Á¤º¸
±è¸í¼¼ ( Kim Myung-Se )
¿µ³²´ëÇб³ ÀÇ°ú´ëÇÐ ¹æ»ç¼±Á¾¾çÇб³½Ç
KMID : 0859320080260010035
Abstract
¸ñÀû: ¼¼±âÁ¶Àý¹æ»ç¼±Ä¡·á·Î Ä¡·áÇÑ ºñ¼Ò¼¼Æ÷Æó¾Ï ȯÀÚ¿¡¼ ¹æ»ç¼± Æó·ÅÀÇ ¹ß»ý·ü°ú ¿µÇâÀ» ¹ÌÄ¡´Â ¿äÀÎÀ» ºÐ¼® ÇÏ°íÀÚ ÇÏ¿´´Ù.
´ë»ó ¹× ¹æ¹ý: 2004³â 8¿ù 1ÀϺÎÅÍ 2006³â 11¿ù 30ÀϱîÁö ºñ¼Ò¼¼Æ÷Æó¾ÏÀ¸·Î È®ÁøµÇ°í ¼¼±âÁ¶Àý¹æ»ç¼±Ä¡·á·Î Ä¡·áÇÑ È¯ÀÚ 105¸íÀ» ´ë»óÀ¸·Î ÇÏ¿´´Ù. Æò±Õ¿¬·ÉÀº 62.9¼¼¿´°í ÆíÆò»óÇǾÏÀÌ 81¸í(77%)À̾ú°í, III±â ȯÀÚ°¡ 66¸íÀ¸·Î(62.9%) °¡Àå ¸¹¾ÒÀ¸¸ç ¿ìÃø Æó¿¡ º´¼Ò¸¦ °¡Áø ȯÀÚ´Â 59¸í, ÁÂÃø Æó´Â 46¸íÀ̾ú´Ù. ¼ö¼ú Àü ¹æ»ç¼± Ä¡·á·Î 3,060 cGy¸¦ Á¶»ç¹ÞÀº ȯÀÚ´Â 27¸í, ¼ö¼ú ÈÄ ¹æ»ç¼±Ä¡·á·Î 5,040 cGy¸¦ Á¶»ç¹ÞÀº ȯÀÚ´Â10¸íÀ̾ú°í 7,020 cGyÀÇ ±ÙÄ¡Àû ¹æ»ç¼±Ä¡·á¸¦ ¹ÞÀº ȯÀÚ´Â 68¸íÀ̾ú´Ù. Ä¡·á°èȹÀº CORVUS ½Ã½ºÅÛÀÌ 68¸í, ECLIPSE ½Ã½ºÅÛÀÌ 37¸íÀ̾ú´Ù.
°á°ú: ¹æ»ç¼± Æó·Å ȤÀº ¹æ»ç¼± Ä¡·á¿Í °ü·ÃµÈ º´¸®ÇÐÀû ÀÌ»ó ¼Ò°ßÀ¸·Î º»¿ø ¿µ»óÀÇÇаú¿¡¼ Áø´ÜµÈ ȯÀÚ´Â 21¸í(20%)À̾úÀ¸³ª, Áõ»óÀÌ ÀÖ¾î Ä¡·á¸¦ ¹ÞÀº »ç¶÷Àº 7¸í(6.7%)À̾ú´Ù. Ä¡·á¹ÞÀº ȯÀÚ´Â ±â°ü½Äµµ´©°ø(1¸í), Àç¹ß(2¸í), ³úÀüÀÌ(1¸í), ¹Ý´ë Ãø ÆóÀüÀÌ(2¸í)¸¦ µ¿¹ÝÇÑ È¯ÀÚ¿´°í, Ç×¾ÏÁ¦ Ä¡·áÁß ¿øÀÎ ºÒ¸íÀ¸·Î ÈÀå½Ç¿¡¼ »ç¸ÁÇÑ 1¸íÀ» Æ÷ÇÔ 7¸í ¸ðµÎ°¡ »ç¸ÁÇÏ¿´À¸³ª ¹æ»ç¼± Æó·Å¸¸ÀÌ »ç¸Á ¿øÀÎÀ̶ó°í ´ÜÁ¤Çϱâ´Â ¾î·Á¿ü´Ù. ¿µ»óÀÇÇаú¿¡¼ Áø´ÜµÈ 21¸íÁß CORVUS ½Ã½ºÅÛÀ¸·Î Ä¡·á °èȹÇÑ È¯ÀÚ°¡ 16¸í(23.5%), ECLIPSE·Î °èȹÇÑ È¯ÀÚ´Â 5¸í(13.5%)ÀÌ¾î¼ CORVUS·Î Ä¡·áÇÑ È¯ÀÚ ±º¿¡¼ Æó·ÅÀÇ ¹ß»ýÀÌ À¯ÀÇÇÏ°Ô ³ô¾Ò´Ù. ¼ö¼ú Àü ¹æ»ç¼± Ä¡·áȯÀÚ 27¸íÁß 5¸íÀÌ, ¼ö¼ú ÈÄ ¹æ»ç¼±Ä¡·á¸¦ ¹ÞÀº ȯÀÚ 10¸íÁß 3¸íÀÌ ¹æ»ç¼±Æó·ÅÀ» º¸¿© ¼ö¼úÀÌ ½ÃÇàµÈ ±ºÀÌ ¼ö¼úÀÌ ½ÃÇàµÇÁö ¾ÊÀº ±º¿¡ ºñÇØ »ó´ëÀûÀ¸·Î Àú ¼±·®ÀÓ¿¡µµ ºÒ±¸ÇÏ°í Æó·Å ¹ß»ý·üÀÌ ³ô¾Ò´Ù. V20Àº ¿ìÃø¿¡¼ 10% ÀÌ»óÀΠȯÀÚ, V10Àº ¿ìÃø¿¡¼ 20% ÀÌ»óÀΠȯÀÚ¿¡¼ Åë°èÇÐÀûÀÎ À¯ÀǼºÀ» º¸¿´´Ù.
°á·Ð: ¿µ»óÀÇÇаú¿¡¼ Æó·ÅÀ¸·Î Áø´ÜµÈ ȯÀÚ´Â 21¸íÀ̾úÀ¸³ª Áõ»óÀÌ ÀÖ¾î Ä¡·á¸¦ ¹ÞÀº ȯÀÚ´Â 7¸í(6.7%)À¸·Î ¼¼±âÁ¶Àý ¹æ»ç¼±Ä¡·á°¡ Á¤»óÁ¶Á÷ÀÇ ¼Õ»óÀ» ÁÙ¿© ÇÕº´ÁõÀ» ÁÙÀÌ´Â µ¥ ±â¿©ÇÏ¿´´Ù°í »ý°¢µÈ´Ù. Åë°èÇÐÀûÀ¸·Î À¯ÀÇÇÑ ¿¹ÈÄÀÎÀڷδ ġ·á ÀüÈÄÀÇ ¼ö¼ú, CORVUS ½Ã½ºÅÛÀ¸·ÎÀÇ Ä¡·á°èȹ, ¿ìÃø, V20ÀÌ 10% ÀÌ»ó, V10ÀÌ 20% ÀÌ»óÀÎ °æ¿ì ¿´°í, ºñ±³Àû ÀûÀº ¹æ»ç¼±·®À» Á¶»ç¹ÞÀº ¼ö¼ú Àü, ¼ö¼ú ÈÄ ¹æ»ç¼±Ä¡·á ȯÀÚ¿¡¼ ³ôÀº ºñÀ²ÀÇ Áõ»óÀ» µ¿¹ÝÇÑ Æó·ÅÀ» º¸ÀÎ °ÍÀº ÇâÈÄ ¼¼½ÉÇÑ Ä¡·á°èȹÀÌ ÇÊ¿äÇÔÀ» ³ªÅ¸³»¾ú´Ù.
Purpose: To evaluate the incidence and prognostic factors of treatment-related pneumonitis in non-small-cell lung cancer (NSCLC) patients treated with intensity modulated radiation therapy (IMRT).
Materials and Methods: One-hundred-five patients with NSCLC treated with IMRT between 1 August 2004 and 30 November 2006 were analyzed retrospectively. The mean age of patients was 62.9 years, and squamous carcinomas were confirmed in 81 patients (77%). Sixty-six patients (62.9%) were classified as stage III, and 59 patients had lesions in the right lung. Twenty-seven patients were treated with a dose of 3,060 cGy preoperatively, and 10 patients were given a dose of 5,040 cGy postoperatively. Sixty-eight patients received a dose of 7,020 cGy for curative intent. Sixty-eight patients were treated with the use of the CORVUS planning system and 37 patients were treated with the use of the ECLIPSE planning system.
Results: Of 105 patients, 21 patients (20%) had abnormal radiological findings, but only seven patients (6.7%) required treatment for radiation pneumonitis. Six of the seven patients had other serious lesions, including a bronchioesophageal fistula (one patient), recurrence in the treatment field (two patients), brain metastasis (one patient) and lung-to-lung metastasis (two patients); all of these patients died within 19 months after radiation treatment. Sixteen patients (23.5%) that received planning with the CORVUS system had abnormal lung findings. Five patients (13.5%) had abnormal lung findings with the use of the ECLIPSE planning system. Other prognostic factors such as perioperative radiation therapy, a volume over 10% of the V20 volume in the right lung, were also statistically significant.
Conclusion: This retrospective analysis suggests that IMRT could be a beneficial treatment modality for the
reduction of radiation pneumonitis in NSCLC patients. However, the higher incidence of abnormal radiological findings in perioperative patients treated with relatively lower doses (3,060¡5,040 cGy) suggest the need for judicious treatment planning in preoperative or postoperative treatment.
Å°¿öµå
¼¼±âÁ¶Àý¹æ»ç¼±Ä¡·á;ºñ¼Ò¼¼Æ÷Æó¾Ï;¹æ»ç¼±Æó·Å;¹ß»ý·ü;¿¹ÈÄÀÎÀÚ
Intensitymodulatedradiationtherapy(IMRT);Non-small-celllungcancer(NSCLC);Radiationpneumonitis;Incidencerate;Prognosticfactors
¿ø¹® ¹× ¸µÅ©¾Æ¿ô Á¤º¸
µîÀçÀú³Î Á¤º¸