Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The Results of Postoperative Radiotherapy for Endometrial Carcinoma

자궁 내막암의 수술 후 방사선치료 결과

  • Noh, O-Kyu (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Wook (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Seung-Do (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Eun-Kyung (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong-Hyeok (Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Yong-Man (Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Nam, Joo-Hyun (Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Mok, Jung-Eun (Departments of Obstetrics and Gynecology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong-Hoon (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Shin, Seong-Soo (Departments of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • 노오규 (울산대학교 의과대학 방사선종양학교실) ;
  • 이상욱 (울산대학교 의과대학 방사선종양학교실) ;
  • 안승도 (울산대학교 의과대학 방사선종양학교실) ;
  • 최은경 (울산대학교 의과대학 방사선종양학교실) ;
  • 김종혁 (울산대학교 의과대학 산부인과학교실) ;
  • 김용만 (울산대학교 의과대학 산부인과학교실) ;
  • 남주현 (울산대학교 의과대학 산부인과학교실) ;
  • 목정은 (울산대학교 의과대학 산부인과학교실) ;
  • 김종훈 (울산대학교 의과대학 방사선종양학교실) ;
  • 신성수 (울산대학교 의과대학 방사선종양학교실)
  • Published : 2007.06.30
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Abstract

[ $\underline{Purpose}$ ]: To evaluate the outcome and prognostic factors of postoperative radiotherapy in endometrial carcinoma. $\underline{Materials\;and\;Methods}$: From September 1991 to August 2003, 76 patients with endometrial carcinoma received postoperative adjuvant radiotherapy after hysterectomy at Asan Medical Center. Stage was classified as FIGO I in 41 (53.9%), II in 12 (53.9%), and III in 23 (30.3%). Histologic grade 1, 2 and 3 were in 29 (38.2%), 20 (26.3%), and 27 (35.5%) respectively. Forty two patients received both external beam radiation therapy (EBRT) and intracavitary radiation (ICR), 34 patients were treated with EBRT or ICR alone. EBRT dose was 50.4 Gy, ICR was performed in $4{\sim}6$ fractions with $4{\sim}5\;Gy$ per fraction. Median follow-up period was 51 (range $5{\sim}121$) months. $\underline{Results}$: Five-year overall survival was 89.6%. In univariate analysis, statistically significant factors to overall survival were FIGO stage, lymph node metastasis and histologic grade. In disease free survival, FIGO stage, lymph node metastasis and lymphovascular invasion were significant prognostic factors. Recurrence was seen in 11 patients. Of these, systemic failure was in 10 patients. There were no moderate to severe complications after radiation therapy. $\underline{Conclusion}$: The outcome of postoperative adjuvant radiotherapy in endometrial carcinoma was good. Main pattern of failure after postoperative radiotherapy was distant metastasis. So, adjuvant chemotherapy may help in improving outcome. Further study on chemotherapy in combined with postoperative radiotherapy will be needed, especially for patients with high risk factors such as high FIGO stage, lymphovascular invasion, and high histologic grade.

목 적: 근치적 자궁절제술 후 보조적 방사선 치료를 시행 받은 자궁내막암 환자의 치료 성적 및 예후 인자를 알아보고자 하였다. 대상 및 방법: 1991년 9월부터 2003년 8월까지 서울아산병원에서 자궁내막암으로 자궁 절제술을 시행한 후 보조적 방사선치료를 받은 76명을 대상으로 하였다. FIGO 병기는 I, II, III기가 각각 41명(53.9%), 12명(15.8%), 23명(30.3%)이었다. 조직분화도는 1이 29명(38.2%), 2가 20명(26.3%), 3이 27명(35.5%)이었다. 방사선치료는 외부방사선 조사와 강내 조사를 함께 시행한 환자가 42명, 외부 방사선 조사만 시행한 환자가 33명, 강내 조사만 시행한 환자는 1명이었다. 외부 방사선 치료의 조사 선량은 50.4 Gy였으며, 강내 조사는 1회 분할 선량을 $4{\sim}5\;Gy$씩 $4{\sim}6$회 실시하였다. 생존환자의 추적기간은 5개월에서 121개월로서 중앙값은 51개월이었다. 결 과: 5년 전체 생존율은 89.6%이었으며, FIGO I기는 96.8%, II기는 91.7%, III기는 75.7%였다. 5년 무병 생존율은 83.7%이었고, FIGO 병기에 따라 I기는 94.8%, II기는 91.6%, III기는 59.8%이었다. 단변량 분석에서 전체 생존율에 유의한 영향을 미치는 인자에는 FIGO 병기, 림프절 양성 유무, 조직분화도였고, 무병 생존율에서는 관계되는 인자는 FIGO 병기, 림프절 양성 유무, 림프혈관침범 유무였다. 총 11명에서 재발하였고, 국소재발 1명, 원격전이가 10명이었다. 방사선 치료 후에 중등도 이상의 합병증을 보이는 경우는 없었다. 결 론: 자궁내막암의 수술 후 방사선 치료의 성적은 좋은 결과를 보였다. 그러나 주로 원격전이로 재발하는 양상으로 보이므로 항암치료가 도움이 되리라 생각된다. 따라서 FIGO 병기가 높거나, 림프절 양성이거나, 림프혈관침범이 있거나, 조직 분화도가 높은 고위험 군에서 항암제를 포함한 방사선치료 방법에 대한 연구가 필요할 것으로 판단된다.

Keywords

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