Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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The Preliminary Results of Intensity-Modulated Radiotherapy for Tonsillar Cancer

편도암에 대한 세기조절방사선치료의 예비적 결과

  • Park, Geum-Ju (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Sang-Wook (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Choi, Eun-Kyung (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Jong-Hoon (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Song, Si-Yeol (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Youn, Sang-Min (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Sung-Ho (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Dong-Wook (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Ahn, Seung-Do (Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine)
  • 박금주 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 이상욱 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 최은경 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 김종훈 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 송시열 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 윤상민 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 박성호 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 박동욱 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 안승도 (울산대학교 의과대학 서울아산병원 방사선종양학교실)
  • Received : 2009.06.05
  • Accepted : 2009.08.14
  • Published : 2009.09.30
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Abstract

Purpose: We wanted to present the preliminary results of intensity-modulated radiotherapy (IMRT) for the treatment of tonsillar cancer. Materials and Methods: We retrospectively analyzed 12 patients who underwent IMRT for tonsillar cancer at Asan Medical Center between November 2002 and February 2007. Seven patients (58%) received definitive treatment, and five (42%) were treated in the postoperative setting. Among the definitively treated patients, 6 patients received cisplatin-based chemotherapy regimens. Simultaneous modulated accelerated radiation therapy (SMART) was used in nine patients. The prescribed dose was 72 Gy at 2.4 Gy/fraction for the definitively treated cases and 61.6 Gy at 2.2 Gy/fraction for the postoperative cases. The median follow-up period was 34 months. Results: All twelve patients completed treatment without interruption, and eleven showed a complete response. One patient had persistent loco-regional disease after treatment. The three-year estimates of loco-regional control, disease-free survival and overall survival were 91.7%, 91.7%, and 100%. The worst acute mucositis was Grade 1 in four patients, Grade 2 in five patients, Grade 3 in two patients and Grade 4 in one patient. Grade 3 xerostomia was observed in six patients. Conclusion: Intensity-modulated radiotherapy was shown to be a safe and effective treatment modality for tonsillar cancer. Further studies with a larger number of patients and a longer follow-up period are needed to evaluate the ultimate tumor control and late toxicity of IMRT for treating tonsillar cancer.

목 적: 편도암 환자를 대상으로 시행한 세기조절방사선치료의 예비적 임상결과를 보고하고자 하였다. 대상 및 방법: 2002년 11월부터 2007년 2월까지 서울아산병원에서 세기조절방사선치료를 시행 받은 12명의 편도암 환자를 대상으로 후향적 분석을 시행하였다. 수술 후 방사선치료는 5명, 근치적방사선치료는 7명에서 시행되었고, 이중 6명의 환자가 cisplatin을 기본으로 하는 항암화학요법과 병용으로 치료를 받았다. 세기조절방사선치료는 9명의 환자에서 동시차등조사가속치료(simultaneous modulated accelerated radiation therapy)가 이용되었다. 근치적치료의 경우 일회선량 2.4 Gy 씩 총 72 Gy, 그리고 수술 후 치료의 경우 일회선량 2.2 Gy 씩 총 61.6 Gy의 방사선량이 조사되도록 하였다. 전체 환자의 추적 관찰 기간은 24~80개월(중앙값 34개월)이었다. 결 과: 전체 대상 환자 12명 모두 치료 중단 없이 계획된 치료를 수행 받았다. 방사선치료 종료 후 11명의 환자에서 완전반응을 보였고 한 명의 환자에서 잔존림프절종양이 발견되어 구제 경부곽청술을 시행하였으나 3개월 후 국소림프절종양이 재발하였다. 완전 반응을 보인 11명의 환자는 마지막 추적 관찰 시점까지 국소림프절 재발 및 원격전이는 관찰되지 않았다. 치료 기간 중 급성 합병증은 Radiation Therapy Oncology Group 3도 이상의 구강 점막염, 인두염과 구강건조증이 각각 3명, 3명, 6명에서 관찰되었다. 결 론: 세기조절방사선치료는 편도암의 치료에 있어서 초기 종양반응과 국소제어면에서 임상적으로 적용 가능한 치료법임을 확인 할 수 있었다. 향후 궁극적인 종양반응과 만성 합병증을 알기 위해서는 추가적인 연구대상과 추적 관찰이 필요하겠다.

Keywords

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