Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Accelerated Hyperfractionated Radiotherapy for Locally Advanced Uterine Cervix Cancers

국소진행된 자궁경부암에서의 가속과분할 방사선치료

  • Seo, Young-Seok (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Cho, Chul-Koo (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Yoo, Seong-Yul (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Kim, Mi-Sook (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Yang, Kang-Mo (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Yoo, Hyung-Jun (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Choi, Chul-Won (Departments of Radiation Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Lee, Kyung-Hee (Departments of Gynecologic Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Lee, Eui-Don (Departments of Gynecologic Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Rhu, Sang-Young (Departments of Gynecologic Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Choi, Suck-Chul (Departments of Gynecologic Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Kim, Moon-Hong (Departments of Gynecologic Oncology, Korea Institute of Radiological & Medical Sciences) ;
  • Kim, Beob-Jong (Departments of Gynecologic Oncology, Korea Institute of Radiological & Medical Sciences)
  • 서영석 (원자력병원 방사선종양학과) ;
  • 조철구 (원자력병원 방사선종양학과) ;
  • 류성렬 (원자력병원 방사선종양학과) ;
  • 김미숙 (원자력병원 방사선종양학과) ;
  • 양광모 (원자력병원 방사선종양학과) ;
  • 유형준 (원자력병원 방사선종양학과) ;
  • 최철원 (원자력병원 방사선종양학과) ;
  • 이경희 (원자력병원 산부인과) ;
  • 이의돈 (원자력병원 산부인과) ;
  • 유상영 (원자력병원 산부인과) ;
  • 최석철 (원자력병원 산부인과) ;
  • 김문홍 (원자력병원 산부인과) ;
  • 김법종 (원자력병원 산부인과)
  • Published : 2008.03.30
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Abstract

Purpose: To assess the efficacy of the use of accelerated hyperfractionated radiotherapy(AHRT) for locally advanced uterine cervix cancers. Materials and Methods: Between May 2000 and September 2002, 179 patients were identified with FIGO stage IIB, IIIB, and IVA cancers. Of the 179 patients, 45 patients were treated with AHRT(AHRT group) and 134 patients were treated with conventional radiotherapy(CRT group), respectively. Patients undergoing the AHRT regimen received a dose of 30 Gy in 20 fractions(1.5 $Gy{\times}2$ fractions/day) to the whole pelvis. Subsequently, with a midline block, we administered a parametrial boost with a dose of 20 Gy using 2 Gy fractions. Patients also received two courses of low-dose-rate brachytherapy, up to a total dose of 85{\sim}90 Gy to point A. In the CRT group of patients, the total dose to point A was $85{\sim}90$ Gy. The overall treatment duration was a median of 37 and 66 days for patients that received AHRT and CRT, respectively. Statistical analysis was calculated by use of the Kaplan-Meier method, the log-rank test, and Chi-squared test. Results: For patients that received cisplatin-based concurrent chemotherapy and radiotherapy, the local control rate at 5 years was 100% and 79.2% for the AHRT and CRT group of patients, respectively(p=0.028). The 5-year survival rate for patients with a stage IIB bulky tumor was 82.6% and 62.1% for the AHRT group and CRT group, respectively(p=0.040). There was no statistically significant difference for severe late toxicity between the two groups(p=0.561). Conclusion: In this study, we observed that treatment with AHRT with concurrent chemotherapy allows a significant advantage of local control and survival for locally advanced uterine cervix cancers.

목적: 이 연구의 목적은 국소진행된 자궁경부암에서의 가속과분할 방사선치료의 효용성을 평가하기 위함이다. 대상 및 방법: 2000년 5월부터 2002년 9월 사이에 자궁경부암 병기 IIB, IIIB, IVA로 가속과분할 방사선치료를 받은 환자 45명과 같은 기간 동안 고식적 방사선치료를 받은 병기 IIB, IIIB, IVA 환자 134명이 비교 분석되었다. 가속과분할 방사선치료는 전골반에 대하여 총 30 Gy의 방사선을 1.5 Gy씩 하루 2회, 총 10일에 나누어 조사하였다. 전골반 조사 후 중심 차폐하여 자궁주위 조직에 대하여 총 20 Gy의 방사선을 2 Gy씩 하루 1회, 총 10일에 나누어 조사하였다. 외부방사선치료가 끝난 후 Cs-137을 이용한 저선량 근접치료를 Point A 기준 $55{\sim}60$ Gy의 방사선치료를 2회 시행하여, Point A 기준 총 $85{\sim}90$ Gy의 방사선 선량이 주어지도록 치료하였다. 고식적 방사선치료 또한 Point A 기준 총 $85{\sim}90$ Gy의 방사선 선량이 주어지도록 치료하였다. 총 치료기간은 가속과분할 치료군의 경우 중앙값이 37일이었으며, 고식적 치료군은 중앙값 66일이었다. 통계적 분석은 Kaplan-Meyer 법, log-rank test, 그리고 Chi-square test를 통해 이루어졌다. 결과: 항암치료를 시행했던 환자군에서, 5년 국소제어율은 각각 100.0%와 79.2%로 가속과분할 치료군이 고식적 치료군에 비해 통계적으로 유의하게 우수한 성적을 보였고(p=0.028), 5년 생존율은 병기 IIB의 큰 종양군에서 가속과분할 치료군이 82.6%으로 고식적 치료군의 62.1%에 비해 통계적으로 유의하게 우수한 성적을 보였다(p=0.074). 두 군간에 있어서 방사선치료로 인한 후기 합병증의 차이는 없었다(p=0.561). 결론: 항암치료와 동반된 가속과분할 방사선치료는 국소진행된 자궁경부암에서 생존율 및 국소제어율을 높이는데 효과가 있을 것으로 판단된다.

Keywords

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