Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Incidence and Prognostic Factors of Radiation Pneumonitis in NSCLC Treated with Intensity Modulated Radiation Therapy(IMRT)

세기조절방사선치료(IMRT)로 치료한 비소세포폐암 환자에서의 방사선 폐렴

  • Kim, Myung-Se (Department of Radiation Oncology, Yeungnam University College of Medicine)
  • 김명세 (영남대학교 의과대학 방사선종양학교실)
  • Published : 2008.03.30
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Abstract

Purpose: To evaluate the incidence and prognostic factors of treatment-related pneumonitis in non-small-cell lung cancer(NSCLC) patients treated with intensity modulated radiation therapy(IMRT). Materials and Methods: One-hundred-five patients with NSCLC treated with IMRT between 1 August 2004 and 30 November 2006 were analyzed retrospectively. The mean age of patients was 62.9 years, and squamous carcinomas were confirmed in 81 patients(77%). Sixty-six patients(62.9%) were classified as stage III, and 59 patients had lesions in the right lung. Twenty-seven patients were treated with a dose of 3,060 cGy preoperatively, and 10 patients were given a dose of 5,040 cGy postoperatively. Sixty-eight patients received a dose of 7,020 cGy for curative intent. Sixty-eight patients were treated with the use of the CORVUS planning system and 37 patients were treated with the use of the ECLIPSE planning system. Results: Of 105 patients, 21 patients(20%) had abnormal radiological findings, but only seven patients(6.7%) required treatment for radiation pneumonitis. Six of the seven patients had other serious lesions, including a bronchioesophageal fistula(one patient), recurrence in the treatment field(two patients), brain metastasis(one patient) and lung-to-lung metastasis(two patients); all of these patients died within 19 months after radiation treatment. Sixteen patients(23.5%) that received planning with the CORVUS system had abnormal lung findings. Five patients(13.5%) had abnormal lung findings with the use of the ECLIPSE planning system. Other prognostic factors such as perioperative radiation therapy, a volume over 10% of the V20 volume in the right lung, were also statistically significant. Conclusion: This retrospective analysis suggests that IMRT could be a beneficial treatment modality for the reduction of radiation pneumonitis in NSCLC patients. However, the higher incidence of abnormal radiological findings in perioperative patients treated with relatively lower doses($3,060{\sim}5,040$ cGy) suggest the need for judicious treatment planning in preoperative or postoperative treatment.

목적: 세기조절방사선치료로 치료한 비소세포폐암 환자에서 방사선 폐렴의 발생률과 영향을 미치는 요인을 분석하고자 하였다. 대상 및 방법: 2004년 8월 1일부터 2006년 11월 30일까지 비소세포폐암으로 확진되고 세기조절방사선치료로 치료한 환자 105명을 대상으로 하였다. 평균연령은 62.9세였고 편평상피암이 81명(77%)이었고, III기 환자가 66명으로(62.9%) 가장 많았으며 우측 폐에 병소를 가진 환자는 59명, 좌측 폐는 46명이었다. 수술 전 방사선 치료로 3,060 cGy를 조사받은 환자는 27명, 수술 후 방사선치료로 5,040 cGy를 조사받은 환자는10명이었고 7,020 cGy의 근치적 방사선치료를 받은 환자는 68명이었다. 치료계획은 CORVUS 시스템이 68명, ECLIPSE 시스템이 37명이었다. 결과: 방사선 폐렴 혹은 방사선 치료와 관련된 병리학적 이상 소견으로 본원 영상의학과에서 진단된 환자는 21명(20%)이었으나, 증상이 있어 치료를 받은 사람은 7명(6.7%)이었다. 치료받은 환자는 기관식도누공(1명), 재발(2명), 뇌전이(1명), 반대 측 폐전이(2명)를 동반한 환자였고, 항암제 치료중 원인 불명으로 화장실에서 사망한 1명을 포함 7명 모두가 사망하였으나 방사선 폐렴만이 사망 원인이라고 단정하기는 어려웠다. 영상의학과에서 진단된 21명중 CORVUS 시스템으로 치료 계획한 환자가 16명(23.5%), ECLIPSE로 계획한 환자는 5명(13.5%)이어서 CORVUS로 치료한 환자 군에서 폐렴의 발생이 유의하게 높았다. 수술 전 방사선 치료환자 27명중 5명이, 수술 후 방사선치료를 받은 환자 10명중 3명이 방사선폐렴을 보여 수술이 시행된 군이 수술이 시행되지 않은 군에 비해 상대적으로 저 선량임에도 불구하고 폐렴 발생률이 높았다. $V_{20}$은 우측에서 10% 이상인 환자, $V_{10}$은 우측에서 20% 이상인 환자에서 통계학적인 유의성을 보였다. 결론: 영상의학과에서 폐렴으로 진단된 환자는 21명이었으나 증상이 있어 치료를 받은 환자는 7명(6.7%)으로 세기조절 방사선치료가 정상조직의 손상을 줄여 합병증을 줄이는 데 기여하였다고 생각된다. 통계학적으로 유의한 예후인자로는 치료 전후의 수술, CORVUS 시스템으로의 치료계획, 우측, $V_{20}$이 10% 이상, $V_{20}$이 20% 이상인 경우 였고, 비교적 적은 방사선량을 조사받은 수술 전, 수술 후 방사선치료 환자에서 높은 비율의 증상을 동반한 폐렴을 보인 것은 향후 세심한 치료계획이 필요함을 나타내었다.

Keywords

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