진행된 비인강암의 화학요법 및 방사선 치료

Sequential Chemotherapy and Radiation Therapy for Advanced Nasopharyngeal Carcinoma

1985년 1월부터 1992년 7월까지 경북대학교병원 치료방사선과에서 화학요법후 방사선치료를 받은 국소진행된 비인강암 환자 52명을 대상으로 화학요법의 효과를 판정하기 위하여 후향적 조사를 실시하였다. 남녀성비는 3.3:1이었고 중앙연령은 41세였다. 병리조직학소견은 40예에서 편평세포암이었고, 나머지 12예에서는 미분화세포암이었다. AJC병기에 따른 분류는 III기가 7예였고, 나머지 45예는 IV기였다. 모든환자는 2회의 화학요법후 방사선치료를 받았으며 사용된 화학요법 제재는 CVB (cyclo-phosphamide+vincristine+ bleomycin)이나 CF (cicplantin+5-FU)였다. 방사선조사량은 원발병소에 6000~7500 cGy, 임파절은 병의 정도에 따라 최대 7000 cGy까지 조사하였다. 국소관해율, 생존율 및 무병생존율을 분석하였다. 화학요법에 대한 완전관해율은 $15\%,$ 부분관해율은 $46\%$였으며 방사선치료후 완전관해율은 $87\%$였다. 중앙추적기간은 51개월 이었으며 3년 생존율 및 무병생존율은 각각 $54\%$와 $49\%$였다. 중앙재발기간은 15개월이었으며 완전관해 후 재발의 양상은 국소재발단독이 12예, 원격전이단독이 11예, 국소재발 및 원격 전이가 2예였다. Cox's multivariate regression model에 따르면 임파절전이 유무가 무병생존율에 영향을 미치는 가장 중요한 예후인자이었다(p=0.001). 다른 보고에서의 방사선 단독치료의 결과와 비교하여 볼 때 화학요법에 대한 종양의 반응율은 높으나 화학요법 및 방사선치료가 국소관해율 및 생존율의 향상으로는 연결되지는 않았다. 결론적으로 진행된 비인강암에서의 화학요법은 좀더많은 비교대조군 연구(controlled clinical trial)를 통해서만 역 할을 이야기할 수 있을 것으로 사료된다.

Between January 1985 and July 1992, 52 patients with locally advanced nasopharyngeal carcinoma were studied retrospectively for the effectiveness of sequential chemotherapy and radiation therapy. The male to female ratio was 3.3:1 with a median age of 41 years. Forty patients had squamous cell carcinoma and the remaining 12 had undifferentiated carcinoma. Seven patients had stage III disease and the remainder had stage IV disease at time of presentation. All patients were treated two courses of chemotherapy followed by radiation therapy. Chemotherapy consisted of either CVB (cisplatin, vincristine and bleomycin) or CF (cisplatin and 5-FU). Total radiation dose to the primary site ranged from 6000 cGy to 7500 cGy. Neck nodes were given booster treatment to maximum of 7000 cGy, depending on the extent of disease. Local control, overall survival and disease-free survival rates were analyzed. The complete response (CR) rate to chemotherapy was $15\%$ and the partial response (PR) rate was $46\%,$ for overall major response rate of $61\%.$ The CR rate was $87\%$ after radiation therapy. Median follow-up time was 51 months. The overall survival and disease-free survival rates at 36 months were $54\%\;and\;49\%,$ respectively. Median time to relapse was 15 months. The patterns of initial relapse in CR patients was as follows: locoregional failure only, 12 patients; distant metastasis only,11: both,2. Cox's multivariate regression model revealed that nodal status was the single most important independant prognostic factor influencing disease-free survival (p=0.001). Comparision of these results with other published reports with radiation therapy alone showed that a high rate of initial response to chemotherapy did not translate into local control or survival. At present time radiation therapy alone remains the standard treatment for locoregional cancer of the nasopharyngeal cancer. More controlled clinical trials must be completed before acceptance of chemotherapy as a part of treatment of advanced nasopharyngeal carcinoma.