Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Treatment Outcome of Thymic Epithelial Tumor: Prognostic Factors and Optimal Postoperative Radiation Therapy

흉선상피종의 치료 성적: 예후 인자 및 방사선치료 방법에 대한 연구

  • Oh Dong Ryul (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn Yong Chan (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim Kwan Min (Department of Rhoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kim Jhingook (Department of Rhoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Shim Young Mog (Department of Rhoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Han Jung Ho (Department of Pathology, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 오동렬 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 안용찬 (성균관대학교 의과대학 삼성서울병원 방사선종양학과) ;
  • 김관민 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 김진국 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 심영목 (성균관대학교 의과대학 삼성서울병원 흉부외과) ;
  • 한정호 (성균관대학교 의과대학 삼성서울병원 병리과)
  • Published : 2005.06.01
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Abstract

Purpose : This study was conducted to analyze treatment outcome and prognostic significance of World Health Organization (WHO)-defined thymic epithelial tumor (TET) subtype and to assess optimal radiation target volume in patients receiving surgery and adjuvant radiation therapy with TET. Materials and Methods: The record of 160 patients with TET, who received surgical resection at the Samsung medical Center, from December 1994 to June 2004, were reviewed. 99 patients were treated with postoperative radiation therapy (PORT). PORT was recommended when patients had more than one findings among suspicious Incomplete resection or positive resection margin or Wasaoka stage $II\~IV$ or WHO type $B2\~C$. PORT peformed to primary tumor bed only with a mean dose of 54 Gy. The prognostic factor and pattern of failure were analyzed retrospectively. Results : The overall survival rate at 5 years was $87.3\%$. Age (more than 60 years $77.8\%$, less than 60 years $91.1\%$; p=0.03), Wasaoka stage (I $92.2\%$, II $95.4\%$, III $82.1\%$, IV $57.5\%$; p=0.001), WHO tumor type (A-Bl $96.0\%$, B2-C $82.3\%$; p=0.001), Extent of resection (R0 resection $92.3\%$, R1 or 2 resection $72.6\%$, p=0.001) were the prognostic factors according to univariate analysis. But WHO tumor type was the only significant prognostic factor according to multivariate analysis. Recurrence was observed in 5 patients of 71 Masoka stage I-III patients who received grossly complete tumor removal (R0, R1 resection) and PORT to primary tumor bed. Mediastinal recurrence was observed In only one patients. There were no recurrence within irradiation field. Conclusion : WHO tumor type was the important prognostic factor to predict survival of patients with TET. This study suggest that PORT to only primary tumor bed was optimal. To avoid pleura- or pericardium-based recurrence, further study of effective chemotherapy should be investigated.

목적 : 본 연구는 흉선상피종의 수술 및 수술 후 방사선치료의 치료 성적과 예후 인자로서 WHO세포형의 중요성에 대하여 알아보고, 방사선 조사 범위를 종양이 있던 부위로 국한하였을 때 재발 양상을 분석하여 조사 범위의 적절성을 평가하였다. 대상 및 방법 : 1994년 12월부터 2004년 6월까지 흉선상피종으로 진단 받고 수술을 시행 받은 160명을 대상으로 하였다. 수술 및 병리조직 소견 상 (1) 종양의 완전 절제가 의심되는 경우, (2) 병리 검사결과 절제연이 양성인 경우, (3) 조직병리가 WHO 세포형 B2이상인 경우, (4) Masaoka 병기 2기 이상인 경우에 수술 후 방사선치료를 추가하도록 권유하였으며, 실제 99명이 수술 후 방사선치료를 시행받았다. 방사선치료의 표적 용적은 종양 원발 부위에서 $1.5\~2$ cm 여유를 두고 결정하였으며, 매일 1.8 Gy또는 2 Gy씩, 주 5회 조사하는 통상분할조사법으로 목표선량은 54 Gy였다. 결과 : 전체 환자의 5년 생존율은 $87.3\%$였다. 단변량 분석결과 5년 생존율에 유의한 영향을 미치는 인자는 연령(60세 이상 $77.8\%$, 60세 미만 $91.3\%$: p=0.03), Masaoka 병기(1기 $92.2\%$, 2기 $95.4\%$, 3기 $82.1\%$, 4기 $67.5\%$: p=0.001), WHO세포형(A-B1 $96.0\%$, B2-C $82.4\%$: p=0.001), 절제 정도(완전절제 $92.3\%$, 부분절제 및 조직검사 $72.3\%$: p=0.001)였다. 다변량 분석 결과는 WHO 세포형만이 유의한 차이(p=0.03)를 보였다. 육안적 완전 절제(R0-1 절제) 후 보조적 방사선 치료를 종양 원발 부위에만 시행 받았던 Masaoka 병기 1-3기 환자 71명 중 총 5명에서 재발이 확인되었고, 재발 부위는 늑막강 파종이 2명, 심장막강 파종 및 폐 전이 1명, 폐 전이 1명이었고, 단 1명만이 종격동 림프절 재발이었다. 모든 환자에서 방사선 조사범위 안에서 재발은 없었다. 결론 : WHO 세포형은 Masaoka 병기, 완전 절제 여부, 연령과 함께 흉선상피종 환자의 생존율에 영향을 미치는 중요한 예후인자로 확인되었다. 또한 수술 후 보조적 방사선치료는 조사범위를 종양 원발 부위에 국한하여 시행하는 것이 재발 양상 및 부작용을 고려할 때 안전하고 유효한 방법으로 판단되며, 늑막강 및 심장막강 파종에 의한 재발을 막기 위해서는 효과적인 보조적 항암화학요법에 대한 연구가 진행되어야 할 것이다.

Keywords

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