[논문]T2N0 병기 성문암의 방사선치료

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[국내논문] T2N0 병기 성문암의 방사선치료
Radiation Therapy for T2N0 Glottic Cancer 원문보기

대한방사선종양학회지 = The Journal of the Korean soceity for therapeutic radiology and oncology, v.24 no.4, 2006년, pp.217 - 222

초록
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목 적: T2N0 병기 성문암 환자에서 방사선치료의 결과 및 무병생존율에 영향을 미치는 예후인자를 알아보고자 하였다. 대상 및 방법: 1986년 9월부터 2004년 6월까지 본원에서 방사선치료를 받은 30예의 T2N0 병기 성문암 환자를 후향적으로 분석하였다. 대상 환자 모두 남자였으며 연령 범위는 39세에서 79세였다(중간값 62세). 조직학적 유형은 30예 모두 편평상피세포암이었다. 방사선치료는 6 MV 선형가속기를 이용하였고, 후두에 조사된 총방사선량은 $66{\sim}70\;Gy$의 범위였다(중간값 66 Gy). 추적기간의 중간값은 63개월이었다. 결 과: 대상 환자 전체의 5년 무병생존율은 79%였다. 성문하 침범이 있는 환자에서는 5년 무병생존율이 감소하는 양상을 보였다(p<0.05). 전연합 침범, 성문상 침범, 성문 운동성 감소 등은 5년 무병생존율의 감소와 무관하였다. 동시 화학요법 추가 또한 통계적 의의가 없었다. 원발병소 재발 3예 및 경부림프절 재발 2예는 근치적 수술로 구제되었으나, 원발병소 및 림프절 동시재발 2예는 근치적 수술로 구제되지 못하였다. 최종 국소제어율은 86%였고, 성대 보존율은 83%였다. 결 론: T2N0 성문암에서 근치적 방사선치료 시 성문하 침범이 무병생존율에 영향을 줄 수 있는 인자로 분석되었다.

Abstract ▼ AI-Helper

$\underline{Purpose}$: This study evaluated the results of definitive radiation therapy and the prognostic factors that affect survival rates for T2N0 glottic cancer patients. $\underline{Materials\;and\;Methods}$: Thirty patients with T2N0 glottic cancer who were treated with definitive radiation therapy at our institution between September 1986 and June 2004 were retrospectively reviewed. All patients were pathologically confirmed as having squamous cell carcinoma and were staged as AJCC T2N0. The age of the patients ranged from 39 to 79 (median 62) years and all were male. A total dose of $66{\sim}70\;Gy$ (median 66 Gy) was delivered with a 6-MV linear accelerator in $6.5{\sim}7$ weeks. The median follow-up period was 63 months. $\underline{Results}$: The actuarial disease-free survival rate for the entire group of the patients was 79% at 5 years. The five-year disease-free survival rates for patients without and with subglottic extension were 90% and 56%, respectively (p=0.03). However, anterior commissure involvement, supraglottic extension, and impaired cord mobility were not statistically significant prognostic factors. The five-year disease-free survival rates for patients with and without concurrent chemotherapy were 86% and 69%, respectively (p=0.47). $\underline{Conclusion}$: Subglottic extension can be considered a poor prognostic factor for T2N0 glottic cancer.

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문제 정의

rate. The purpose of this study was to evaluate the result of definitive radiation therapy and the prognostic factors to affect survival rates in T2N0 glottic cancer patients.

제안 방법

In this analysis, we retrospectively evaluated the clinical records of patients with T2N0 glottic cancer who were treated by radiation therapy at our institution, where the use of CCRT for T2N0 glottic cancer was started in 1997 to improve the control rate. The purpose of this study was to evaluate the result of definitive radiation therapy and the prognostic factors to affect survival rates in T2N0 glottic cancer patients.
All patients were pathologically confirmed as squamous cell carcinoma and were staged as T2N0 according to the 2002 AJCC criteria. Clinical diagnostic staging work-up included medical history, physical examination, indirect and direct laryngoscopy, CBC, chest X-rays, and laryngeal CT. The locations of the lesion varied.
Radiation therapy was delivered with a 6-MV linear accelerator. Treatment was given once a day, five times a week. Patients received a dose of 66 ~70 Gy (median 66 Gy) in 6.
to the RTOG/EORTC toxicity criteria. Various prognostic factors such as tumor location, anterior commissure involvement, subglottic extension, supraglottic extension, cord mobility, and CCRT were evaluated. Survival time was counted from the end of radiation treatment.

데이터처리

Survival time was counted from the end of radiation treatment. Kaplan-Meier method was used to calculate survival, and evaluation of the prognostic factors was performed with log rank test. Multivariate analysis was perfonned using a Cox regression analysis in a forward stepwise manner.

성능/효과

However, anterior commissure involvement, impaired cord mobility, and supraglottic extension were not statistically significant prognostic factors. Five-year disease-free survival rates for patients with and without concurrent chemotherapy were 86% and 69%, respectively (p=0.47). Multivariate analysis, however, showed no significant prognostic factors (Table 2).
In this study, there were approximately 13% nodal failures (2 regional + 2 locoregional), which might be attributed to misdiagnosis of supraglittic cancers with glottic extension as glottic cancers. Three of 4 patients with nodal failures had initial supraglottic lesions, and the location of failures was level Ⅱ.
In conclusion, considering the high percentage of voice preservation with initial radiotherapy, radiotherapy should be the first choice treatment of T2N0 glottic cancer. However, more effective treatment modalities need to be developed for T2N0 glottic cancer with subglottic extension.

참고문헌 (24)

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