목 적: 본 연구는 미분화 갑상선암 환자에서 방사선치료에 대한 치료순응도와 치료 성적을 분석하고자 하였다. 대상 및 방법: 1993년부터 2002년까지 미분화 갑상선암으로 외부방사선치료를 시행받았던 17명을 대상으로 후향적으로 분석하였다. 외부방사선치료는 14명에서 수술 후에 시행하였고, 3명에서 조직검사 후에 시행하였다. 수술이 시행되었던 14명의 수술 방법은 9명은 근치적절제술 5명은 고식적절제술이었다. 고분화 갑상선암이 6명에서 동반되어 있었고, 진단 당시 암의 크기가 5 cm보다 컸던 경우는 14명이었다. 총방사선량은 $6{\sim}70\;Gy$ (중앙선량, 37.5 Gy)이었고, 11명은 예정된 방사선치료를 끝낼 수 있었고, 6명에서는 방사선치료가 중단되었다. 추적기간은 $1{\sim}104$개월로 중앙값이 5개월, 평균값이 20개월이었다. 결 과: 5명에서는 방사선치료를 시작할 당시에 육안적 종양이 없었으며, 5명 모두 종양의 재성장 없이 방사선치료를 잘 끝낼 수 있었다 나머지 12명에서는 방사선치료를 시작할 당시 육안적 종양이 있었는데, 이 중 4명은 근치적절제술 후에 바로 암이 자란 경우였고, 5명은 고식적절제술, 3명은 조직검사만을 받은 상태였다. 육안적 종양이 있었던 12명 중 6명 만이 예정된 방사선치료를 끝낼 수 있었는데, 2명에서는 방사선치료로 종양의 크기가 현저히 감소하였고, 2명은 약간 감소, 2명은 무반응이었다. 전체 환자의 생존기간은 $1{\sim}104$개월의 범위로 중앙 생존기간은 5개월이었고, 평균 생존기간은 21개월이었다. 1년 2년, 5년 생존율은 41%, 24%, 12%이었다. 원발암수, 종양크기, 수술, 방사선치료 완료가 의미있는 예후인자였다. 장기 생존자는 단기 생존자에 비해 진단 당시와 방사선치료 시작 당시에 암의 크기가 작은 경향이 있었다. 결 론: 진단 당시 암의 크기가 5 cm 이하, 방사선치료 전에 수술 시행(근치적 또는 고식적), 수술 부위에 종양의 빠른 재성장이 없는 환자들이 수술후 방사선치료의 좋은 지원자가 될 수 있음을 시사하며, 그와 반대인 경우는 방사선치료가 중단되기 쉽고 생존기간이 짧았기 때문에 방사선치료의 역할이 매우 부족하여 방사선치료를 시행하지 않을 수도 있겠다.
목 적: 본 연구는 미분화 갑상선암 환자에서 방사선치료에 대한 치료순응도와 치료 성적을 분석하고자 하였다. 대상 및 방법: 1993년부터 2002년까지 미분화 갑상선암으로 외부방사선치료를 시행받았던 17명을 대상으로 후향적으로 분석하였다. 외부방사선치료는 14명에서 수술 후에 시행하였고, 3명에서 조직검사 후에 시행하였다. 수술이 시행되었던 14명의 수술 방법은 9명은 근치적절제술 5명은 고식적절제술이었다. 고분화 갑상선암이 6명에서 동반되어 있었고, 진단 당시 암의 크기가 5 cm보다 컸던 경우는 14명이었다. 총방사선량은 $6{\sim}70\;Gy$ (중앙선량, 37.5 Gy)이었고, 11명은 예정된 방사선치료를 끝낼 수 있었고, 6명에서는 방사선치료가 중단되었다. 추적기간은 $1{\sim}104$개월로 중앙값이 5개월, 평균값이 20개월이었다. 결 과: 5명에서는 방사선치료를 시작할 당시에 육안적 종양이 없었으며, 5명 모두 종양의 재성장 없이 방사선치료를 잘 끝낼 수 있었다 나머지 12명에서는 방사선치료를 시작할 당시 육안적 종양이 있었는데, 이 중 4명은 근치적절제술 후에 바로 암이 자란 경우였고, 5명은 고식적절제술, 3명은 조직검사만을 받은 상태였다. 육안적 종양이 있었던 12명 중 6명 만이 예정된 방사선치료를 끝낼 수 있었는데, 2명에서는 방사선치료로 종양의 크기가 현저히 감소하였고, 2명은 약간 감소, 2명은 무반응이었다. 전체 환자의 생존기간은 $1{\sim}104$개월의 범위로 중앙 생존기간은 5개월이었고, 평균 생존기간은 21개월이었다. 1년 2년, 5년 생존율은 41%, 24%, 12%이었다. 원발암수, 종양크기, 수술, 방사선치료 완료가 의미있는 예후인자였다. 장기 생존자는 단기 생존자에 비해 진단 당시와 방사선치료 시작 당시에 암의 크기가 작은 경향이 있었다. 결 론: 진단 당시 암의 크기가 5 cm 이하, 방사선치료 전에 수술 시행(근치적 또는 고식적), 수술 부위에 종양의 빠른 재성장이 없는 환자들이 수술후 방사선치료의 좋은 지원자가 될 수 있음을 시사하며, 그와 반대인 경우는 방사선치료가 중단되기 쉽고 생존기간이 짧았기 때문에 방사선치료의 역할이 매우 부족하여 방사선치료를 시행하지 않을 수도 있겠다.
Purpose: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. Materials and Methods: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT...
Purpose: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. Materials and Methods: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from $6{\sim}70\;Gy$ (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from $1{\sim}104$ months (median, 5 months; mean, 20 months). Results: Five patients started the ERT without the presence of a gross mass and all of the patients competed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, $1{\sim}104$ months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. Conclusion: This study suggests that patients with a small initial tumor (${\leq}5\;cm$), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.
Purpose: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. Materials and Methods: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from $6{\sim}70\;Gy$ (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from $1{\sim}104$ months (median, 5 months; mean, 20 months). Results: Five patients started the ERT without the presence of a gross mass and all of the patients competed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, $1{\sim}104$ months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. Conclusion: This study suggests that patients with a small initial tumor (${\leq}5\;cm$), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.
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제안 방법
The treatment results were analyzed as the mean survival, the median survival, 1-year survival, 2-year survival and 5-year survival. Local control of a tumor mass was described as marked regression and slight regression instead of complete remission and partial remission, as in some patients the precise measurement of tumor size was impossible due to a diffuse infiltration in the neck.
대상 데이터
reviewed. Seventeen patients were treated with ERT during this period (Table 1). The median patient age was 66 years (age range, 47~81 years).
데이터처리
The follow-up period ranged from 1 ~104 months (median, 5 months; mean, 20 months). Overall survival was calculated using the Kaplan-Meier method and the log rank test was used for comparing differences between two groups.Multivariate analysis using Cox regression analysis was also performed for various prognostic factors.
성능/효과
The prognostic variables evaluated for univariate analysis included age (<60 years or 260 years), gender (male, female), coexistence of a welbdifferentiated thyroid carcinoma (yes or no), a first malignancy (yes or no), the number of primary tumors (one or two), tumor size (5 cm), surgery (yes or no), resection extent (curative resection, palliative resection, biopsy only), the presence of a gross mass at the start of ERT (yes or no), completion of ERT (yes or no) and ERT intent (curative or palliative).
참고문헌 (13)
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Chang HS, Yoon JH, Chung WY, Park CS. Treatment of anaplastic thyroid carcinoma: a therapeutic dilemma. J Kor Surg Soc 2004;66:14-19
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Nel CJC, Heerden JA, Goellner JR, et al. Anaplastic carcinoma of the thyroid: a clinicopathologic study of 82 cases. Mayo Clin Proc 1985;60:51-58
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Haigh PI, Ituarte PHG, Wu HS, et al. Completely resected anaplastic thyroid carcinoma combined with adjuvant chemotherapy and irradiation is associated with prolonged survival. Cancer 2001;91:2335-2342
Sugitani I, Kasai N, Fugimoto Y, Yanagisawa A. Prognostic factor and therapeutic strategy for anaplastic carcinoma of the thyroid. World J Surg 2001;25:617-622
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