[논문]국소적으로 진행된 식도암에서 동시항암화학방사선치료의 결과

변상준; 김진희; 김옥배; 송홍석

doi:10.3857/jkstro.2011.29.1.20

국소적으로 진행된 식도암에서 동시항암화학방사선치료의 결과
Concurrent Chemoradiotherapy in Locally Advanced Esophageal Cancer 원문보기

대한방사선종양학회지 = The Journal of the Korean soceity for therapeutic radiology and oncology, v.29 no.1, 2011년, pp.20 - 27

변상준 (계명대학교 의과대학 동산의료원 방사선종양학교실) , 김진희 (계명대학교 의과대학 동산의료원 방사선종양학교실) , 김옥배 (계명대학교 의과대학 동산의료원 방사선종양학교실) , 송홍석 (계명대학교 의과대학 동산의료원 내과학교실)

초록
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목 적: 국소적으로 진행된 식도암에서 동시항암화학요법 후 국소제어, 생존율, 예후인자 및 실패양상에 대해 알아 보고자하였다. 대상 및 방법: 1999년 6월부터 2008년 8월까지 계명대학교 동산의료원에서 국소적으로 진행된 식도암으로 진단받은 후, 근치적 목적의 동시항암화학방사선치료를 시행 받은 50명 중 추적검사가 이루어지지 않은 2명과 적절한 추적검사가 이루어지지 않아 치료의 효과를 판정할 수 없는 5명은 제외한 43명을 대상으로 하였다. 성별 구성은 남성 39명, 여성 4명이었고 연령분포는 43세에서 78세(중앙값, 63세), TNM 병기는 IIA기 7명(16.3%), III기 36명(83.7%)이었다. 방사선치료는 1.8 Gy씩 1일 1회, 주 5회로 방사선을 46~63 Gy(평균, 54 Gy)의 외부방사선을 조사하였다. 선행 항암화학요법을 시행 받은 환자는 8명이었고 동시항암화학치료는 주로 5-fluorouracil, cisplatin을 3회 사용하였다. 추적관찰 기간은 2개월에서 82개월로 중앙값이 15.5개월이었다. 결 과: 전체환자 43명 중에서 완전 관해는 9명(20.9%), 부분 관해는 23명(53.5%), 무반응 9명(20.9%), 진행이 2명(4.7%)이었다. 전체 환자의 중앙생존기간은 15개월이었고, 2년 및 5년 전체생존율은 36.5%, 17.3%이었으며, 2년 및 5년 무병생존율은 각각 32.4%, 16%였다. 43영의 환자 중에서 22명 (51.2%)에서 치료 실패를 보였고, 치료 실패 양상으로는 국소 재발 및 진행이 18명(41.9%), 원격전이가 4명(9.3%)이었다. 전체생존율 및 무병생존율에 영향을 미치는 인자에 대한 단변량분석상 항암화학방사선치료 시의 혈색소 수치 (${\geq}$12 vs. <12, p=0.02/p=0.1)와 치료에 대한 반응 여부(완전관해 및 부분관해 vs. 무반응 및 병의 진행, p=0.002/p<0.0001)가 통계적으로 유의한 인자였다. 다변량분석에서는 치료에 대한 반응 여부만이 통계적으로 유의한 것으로 나타났다. 환자의 나이, 성별, 병기, 흡연의 과거력, 식도 내 종양의 위치 및 선행항암화학요법의 유무에 따른 유의한 차이는 관찰되지 않았다. 결 론: 국소적으로 진행된 식도암의 동시 항암화학방사선치료 후 생존율은 다른 연구들과 유사한 수준이며 주된 재발 양상은 국소 재발이었다. 그러므로. 국소제어율을 향상시키기 위한 추가적인 연구가 향후 필요할 것으로 생각된다.

Abstract ▼ AI-Helper

Purpose: This study was designed to evaluate the results of local control, survival rate, prognostic factors, and failure pattern in locally advanced esophageal cancer. Materials and Methods: We retrospectively studied 50 patients with locally advanced esophageal cancer treated with concurrent chemoradiotherapy at Keimyung University Dongsan Medical Center from June of 1999 to August of 2008. Seven patients with inappropriate data were excluded, and 43 patients were analyzed. There were 39 males and four female patients ranging in age from 43 to 78 years (median, 63 years). There were seven patients with stage IIA and 36 with stage III. Irradiation from 46 Gy to 63 Gy (median, 54 Gy) was carried out 5 days per week, 1.8 Gy once a day. There were eight patients with neo-adjuvant chemotherapy, and we mostly used 5-fluorouracil, cisplatin with 3 cycles for concurrent chemotherapy. The range of follow up periods was from 2 to 82 months (median, 15.5). Results: There were nine patients that exhibited a cornplete response, 23 that exhibited a partial response, 9 that exhibited no response, and 2 that exhibited disease progression. The median survival time was 15 months. Two-year and 5-year survival rates were 36.5% and 17.3%, respectively. Two-year and 5-year disease-free survival rates were 32.4% and 16%, respectively. Treatment failure occurred in 22 patients (51.2%). Patterns of failure were categorized as local failure in 18 patients and distant metastasis in four patients. In a univariate analysis for prognostic factors related to overall survival and disease-free survival, the hemoglobin levels during chemoradiotherapy (${\geq}$ 12 vs. <12, p=0.02(p=0.1) and the response to the treatments (CR/PR vs. NR/PD, p=0.002/p< 0.0001) were statistically significant. In a multivariate analysis, only response to the treatments was revealed to be statistically significant. There was no statistical significance associated with patient age, gender, disease stage, T-stage, smoking history, tumor location, or neo-adjuvant chemotherapy. Conclusion: Our survival rate was similar to those of other institutions. Local recurrence was the main reason for failure. It is suggested that further prospective studies should be performed to improve local control.

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문제 정의

This study was designed to retrospectively evaluate the local control, survival rate, prognostic factors and failure patterns in locally-advanced esophageal cancer treated with concurrent chemoradiotherapy in our institution.

제안 방법

1999 to August of 2008. Patients underwent physical examination, complete blood cell count, chest X-ray, chest high resolution computed tomography, positron emission tomography computed tomography (PET-CT), and endoscopic biopsies to confirm the presence of disease and evaluate the clinical stage. PET-CT scan was performed since March of 2007 in our institution and only eight patients underwent PET-CT for clinical staging.

대상 데이터

There were eight patients who underwent concurrent chemoradiotherapy 4 weeks after completion of neo-adjuvant chemotherapy. Six patients were treated with 5-FU/cisplatin and two patients were given paclitaxel/cisplatin before concurrent chemoradiotherapy.

데이터처리

(DFS). Univariate analysis evaluating factors asscxiiated with OS was performed by a log-rank test. Factors found to influence survival on univariate analysis were then analyzed by Cox proportional hazard regression analysis.

이론/모형

Univariate analysis evaluating factors asscxiiated with OS was performed by a log-rank test. Factors found to influence survival on univariate analysis were then analyzed by Cox proportional hazard regression analysis. Statistical analyses were performed with SPSS ver.
The Kaplan-Meier method was used to estimate overall survival rates (OS) and disease-free survival rate (DFS). Univariate analysis evaluating factors asscxiiated with OS was performed by a log-rank test.
PET-CT scan was performed since March of 2007 in our institution and only eight patients underwent PET-CT for clinical staging. The patients were grouped according to the AJCC TNM 6th edition staging method. The eligibility criteria for locally-advanced disease were stage T1N1M0 or T2-4, any N, M0.

성능/효과

As shown in Table 4, on univariate analysis for identifying potential prognostic factors related to overall survival, hemoglobin level at the time of chemoradiotherapy ( 12, p=0.02) and response to treatments (CR/PR vs. NR/PD, p=0.002) were statistically significant (Fig. 3, 4) and the total dose of radiation therapy (54 Gy, p=0.06) was marginally significant.
In conclusion, the survival rates of patients with locally-ad-vanced esophageal cancer treated with concurrent chemoradiotherapy in our study were similar to those of other institutions. Local recurrence was a main cause of treatment failure.
24) reported a 6% rate of ulceration and 21% rate of esophageal stricture among 68 patients with esophageal cancer after concunent chemoradiotherapy. Our results showed 11.6% of esophagitis with 2.3% of ulceration and 27.9% of esophageal stricture and obstruction. In our sludy, small number of patients and irregular follow-up periods might effect on the difference in the results compared with other trials.
They also found improved overall survival in patients with locally-advanced esophageal cancer compared to those who received radiation therapy alone. Two-year and 5-year overall survival rates were 27% and 9%, respectively, in chemoradiotherapy group, and 12% and 7%, respectively, in the group that only received radiation.

후속연구

Local recurrence was a main cause of treatment failure. It is suggested that further prospective studies need to be performed to improve local control.
However, the distribution of patients according to disease stage was relatively uneven, seven patients were stage IIA and 36 were stage Ⅲ. More reliable results would be obtained if the study had been conducted with a more uniform patients group.

참고문헌 (24)

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국소적으로 진행된 식도암에서 동시항암화학방사선치료의 결과
Concurrent Chemoradiotherapy in Locally Advanced Esophageal Cancer 원문보기

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국소적으로 진행된 식도암에서 동시항암화학방사선치료의 결과 Concurrent Chemoradiotherapy in Locally Advanced Esophageal Cancer 원문보기

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국소적으로 진행된 식도암에서 동시항암화학방사선치료의 결과
Concurrent Chemoradiotherapy in Locally Advanced Esophageal Cancer 원문보기

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