Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Evaluation of the Treatment Response after Hypofractionated Radiotherapy in Patients with Advanced Head and Neck Cancers

진행성 두경부 상피세포암 환자에서 소분할 방사선조사 후의 치료반응 평가

  • Kim, Won-Taek (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Ki, Yong-Kan (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Nam, Ji-Ho (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Kim, Dong-Hyun (Departments of Radiation Oncology, Pusan National University School of Medicine) ;
  • Cho, Kyu-Sup (Departments of Otolaryngology, Pusan National University School of Medicine) ;
  • Lee, Jin-Choon (Departments of Otolaryngology, Pusan National University School of Medicine) ;
  • Lee, Byung-Joo (Departments of Otolaryngology, Pusan National University School of Medicine) ;
  • Kim, Dong-Won (Departments of Radiation Oncology, Pusan National University School of Medicine)
  • 김원택 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 기용간 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 남지호 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 김동현 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 조규섭 (부산대학교 의학전문대학원 이비인후과학교실) ;
  • 이진춘 (부산대학교 의학전문대학원 이비인후과학교실) ;
  • 이병주 (부산대학교 의학전문대학원 이비인후과학교실) ;
  • 김동원 (부산대학교 의학전문대학원 방사선종양학교실)
  • Received : 2009.04.20
  • Accepted : 2009.05.26
  • Published : 2009.06.30
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Abstract

Purpose: This study was performed to objectively evaluate the rate of tumor response to hypofractionated radiotherapy for advanced squamous cell carcinomas of the head and neck. Materials and Methods: Thirty-one patients with advanced squamous cell carcinoma of the head and neck, who were treated by hypofractionated radiotherapy with 3 Gy per fraction for palliative purpose between 1998 and 2008, were reviewed retrospectively. Every tumor-volume was measured and evaluated from CT (computed tomography) images obtained before and 2~3 months after radiotherapy. The radiation toxicity was assessed during and after radiotherapy. A statistical analysis was performed to investigate overall survival, progressionfree survival, and the prognostic factors for survival and response. Results: The median age of the study patients was 70 years. In addition, 85% of the patients were in stage 4 cancer and 66.7% had an ECOG performance status of 1~2. The mean tumor-volume was 128.4 cc. Radiotherapy was administered with a total dose of 24~45 Gy (median: 36 Gy) over 10~25 days. Twenty-nine patients were treated with 30 Gy or more. The observed complete response rate was 12.9% and the partial response rate was 61.3%. Median survival time was 8.9 months and the 1-year progression-free survival rate was 12.9%. The treatment response rate was confirmed as a prognostic factor in the rate of survival. The primary site, stage, tumor-volume, radiotherapy field and overall radiation-dose showed a significant relationship with survival and treatment response. No grade 4 toxicity was observed during and after radiotherapy. Conclusion: There was an objective tumor-regression in about 74% of patients treated by hypofractionated radiotherapy. Further evaluation is needed to select the appropriate fraction-size and patient who may require the additional radiotherapy.

목 적: 근치적 치료가 힘든 두경부 진행암 환자들을 대상으로 시행된 소분할 방사선조사의 치료반응 정도를 객관적으로 평가해 보고, 이런 환자들에 대한 적절한 방사선치료 방법을 알아보고자 이 연구를 진행하였다. 대상 및 방법: 두경부에서 발생한 상피세포암종으로 진단되어 1998년부터 2008년까지 원발 병변 또는 림프절 병변에 대해 3 Gy 분할선량으로 고식적 소분할 방사선치료를 받았던 환자 31명을 대상으로 후향적 분석을 하였다. 대상 환자들의 방사선치료 전 컴퓨터단층촬영 영상자료를 통해 종양의 용적을 측정하였고, 이를 방사선치료 종료 후 2~3개월째의 컴퓨터단층촬영 자료와 비교하여 치료반응을 평가하였다. 아울러 소분할 방사선치료로 인한 치료독성의 빈도와 정도를 확인하였고, 전체 생존율 및 무진행 생존율, 그리고 생존율이나 치료반응과 관련된 예후인자들 알아보고자 통계 분석 작업을 하였다. 결 과: 대상 환자들의 평균 연령은 70세였으며, 85%의 경우가 stage 4였다. 종양의 용적은 평균 128.4 cc였고, ECOG 활동점수 상 1점과 2점이 67.7%였다. 총방사선량은 24~45 Gy (중간값 36 Gy)로 2명을 제외한 대부분의 환자가 30 Gy 이상 조사받았으며, 치료기간은 10~25일이었다. 완전반응을 보인 경우가 4명(12.9%)이었고, 19명(61.3%)의 환자에서 부분반응을 보였다. 중간 생존기간은 8.9개월이었으며, 1년 무진행생존율은 12.9%였다. 치료반응 정도에 따른 생존율의 차이를 발견할 수 있었으며, 원발 부위, 병기, 종양의 용적, 방사선치료 범위, 총방사선량 등이 생존율이나 치료반응 정도와 유의한 관련이 있었다. 치료 기간 및 치료 종결 후 grade 4 이상의 치료독성은 없었다. 결 론: 소분할 방사선치료 결과 약 74%의 환자들에서 종양이 줄어드는 것을 객관적으로 확인할 수 있었다. 적절한 분할선량 및 추가 방사선치료가 필요한 환자들의 선별에 있어서는 추가적인 연구가 필요하겠다.

Keywords

References

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