[논문]비인강암에서 저용량 시스플라틴<tex>$\\pm$</tex>경구용 UFT를 이용한 동시항암방사선치료의 효과

안진희; 장혜숙; 이상욱; 박진홍; 김상윤; 남순열; 조경자; 김우건; 이정신; 김성배

비인강암에서 저용량 시스플라틴$\\pm$경구용 UFT를 이용한 동시항암방사선치료의 효과
Concurrent Chemoradiotherapy Using Weekly Cisplatin with or without Daily Oral UFT in Nasopharyngeal Cancer 원문보기

대한 두경부 종양 학회지 = Korean journal of head & neck oncology, v.18 no.2, 2002년, pp.184 - 191

초록
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연구방법 : 근치적 목적의 동시항암방사선치료를 시행받은 비인강암 환자들을 대상으로하여 치료 효과와 독성에 대한 후향적 분석을 시행하였다. 환자 및 방법 : 1993년 8월부터 1999년 3월까지 원격전이가 없는 50명의 비인강암 환자들이 방사선 치료기간 중 주 1회의 시스플라틴 $20mg/m^2$을 투여받았고, 1999년 4월부터 2000년 4월까지 20명의 환자가 상기 용량의 시스플라틴에 더하여 경구용 UFT300mg을 추가적으로 투여받았다. 총 70명 환자들의 임상기록과 병리 기록지를 검토하였다. 결 과: 연령의 중앙값은 47세 (범위 $18{\sim}76$)였고, 남자와 여자가 각각 53명과 17명 이었으며, 병기 II, III, IVA, IVB가 각각 23명, 14명, 15명, 18명이었다. 치료에 대한 반응율은 92.8%(95% C.I. $42{\sim}143%$)였고(완전반응 57명, 부분반응 8명), 총 34개월의 추적 관찰 기간 동안에 완전반응을 보인 57명 중 21명에서 재발(국소재발 5, 원격전이 11, 복합전이 5)을 하였다. 3년 무진행 생존율은 51.5%였으며 5년 생존율은 60.3%였다. 경구용 UFT의 추가적 사용은 주 1회 시스플라틴 항암치료에 비하여 반응율과 생존율 및 독성에 유의한 영향을 미치지 않았다. 결 론: 주 1회 저용량 시스플라틴$\pm$경구용 UFT를 이용한 동시항암방사선요법은 비인강암 환자의 치료에 있어서 비교적 적은 독성으로 높은 반응율을 나타내었으나, 향후 재발율을 감소시키기 위한 연구가 지속되어야 할 것으로 사료된다.

주제어

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제안 방법

electrocardiogram. All patients underwent biopsy of the nasopharynx with direct nasopharyngoscopy, and a computed tomography (CT) scan or MRI of the head and neck for staging of the primary disease. Metastatic workup included a chest x-ray, a liver ultrasound, and a bone scan in all patients.
Treatment response was evaluated according to the WHO response criteria」。Acute and late toxicities were evaluated according to the Radiation Therapy Oncology Group (RTOG) criteria. Hematologic assessment with a complete blood count was performed once a week during the course of CRT. We underwent direct nasopharyngoscopy and imaging study once in every 3 months during the first 2 years, once in every 6 months after 2 years, and followed them yearly after the fifth years.
The initial examination prior to the treatment included a medical history, a physical examination, a complete blood count, a biochemical analysis, and an electrocardiogram. All patients underwent biopsy of the nasopharynx with direct nasopharyngoscopy, and a computed tomography (CT) scan or MRI of the head and neck for staging of the primary disease.

대상 데이터

Between August 1993 and May 2000, a total of 70 patients with histologically confirmed NPC were included in this study ; 50 patients received weekly cisplatin and 20 patients received weekly cisplatin plus daily oral UFT during RT. The patient characteristics are listed in Table 1.
Sixty-four patients had a palpable neck lymph node, the most common sign at the time of the diagnosis. Cranial nerve palsy was observed from 10 patients. All patients completed the planned dose of RT during a median period of 9 weeks.
The patient characteristics are listed in Table 1. Fifty-three patients were male and 17 were female. The median age was 47 years old, with a range of 18 to 76 years.

이론/모형

Overall survival (OS) and progression-free survival (PFS) were determined from the first date of starting RT by the Kaplan-Meier method. Locoregional PFS (LRPFS) and distant met-astasis-fre6 survival (DMFS) rates in patients who developed either type of failure were calculated.

성능/효과

5%. The 5-year DMFS rate in stages Ⅱ, Ⅲ, IVA and IVB were 82.0%, 76.6%, 60.6%, and 36.5%, respectively (Fig. 2). Sal.
-quent cause of failure as evaluated in previously reported studies. The 5-year DMFS rate was 64.5%, and there was a significant difference in DMFS between stages (stage Ⅱ, 82.0% ; stage Ⅲ, 76.6% ; stage IVA, 60.6% ; stage Ⅳ.B, 36.5%). Also, the 5 patients who did not respond until the end of RT showed distant metastasis, irrespective of locoregional response.
This study has a unique aspect in that the efficacies and toxicities of concurrent CRT using weekly cisplatin with or without UFT were observed in a homogenous population of NPC. The overall 5-year survival rate has been around 50% for patients treated by RT alone and has improved very little in the last 20 years.

후속연구

We plan to do further study using a moderately intensified dose of weekly cisplatin and oral UFT with RT, especially in patients with more advanced NPC due to its high incidence of distant metastasis.

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