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뇌 성상세포종 환자의 외부 방사선치료

External Beam Radiotherapy in the Management of Low Grade Astrocytoma of the Brain

  • 전하정 (한양대학교 의과대학 치료방사선학교실)
  • Chun, Ha-Chung (Department of Therapeutic Radiology, College of Medicine Hanyang University)
  • 발행 : 2009.03.30

초록

목적: 뇌 성상세포종 환자에서 수술 후 외부 방사선치료의 효과를 평가하고 최적의 방사선 치료 방법 및 예후 인자를 알아보고자 하였다. 대상 및 방법: 1989년 10월부터 2006년 9월까지 본원에서 수술 후 방사선치료를 받은 69명의 뇌 성상세포종 환자를 후향적으로 분석하였다. 환자 나이의 중앙값은 36세이었다. 41명은 40세 이하이었으며 28명은 41세 이상이었다. 14명의 환자는 조직 검사만을 시행하였고 55명의 환자는 아절제술을 시행하였다. 카르노프스키 수행 점수는 39명은 80%미만 이었고 30명은 80%이상 이었다. 2명의 환자는 뇌전체를 조사받은 후 축소 조사야로 치료받았고 67명의 환자는 적당한 여유를 두고 부분조사를 시행하였다. 대부분의 환자는 5,000 내지 5,500 cGy를 조사받았다. 결과: 전체 환자의 5년 및 7년 생존율은 40% 및 45%이었다. 5년 및 7년의 무병 생존율은 각각 45%와 40%이었다. 아절제술을 시행 받은 환자에서 조직검사만을 시행 받은 환자보다 보다 나은 생존율을 나타내었다. 아절제술을 시행 받은 환자와 조직 검사만을 시행 받은 환자의 5년 생존율은 각각 57% 및 38%이었다. 40세 이하 41명의 환자에서 41세 이상 28명의 환자보다 높은 5년 생존율을 보였다(56% vs 40%). 그러나 카르노프스키 수행 점수 80% 이상 환자와 80% 이하 환자의 5년 생존율은 통계적으로 유의한 차이를 나타내지 않았다(51% vs 47%). 비록 환자 한 명이 방사선 치료 중 치료를 중단 하였으나 유의한 방사선 치료에 의한 합병증은 관찰되지 않았다. 결론: 뇌 성상세포종의 수술 후 외부 방사선 치료는 안전하고 효과적인 치료요법이었다. 수술의 정도 및 나이가 유의한 예후 인자임을 알 수 있었다. 그러나 성상세포종 환자의 장기 생존율을 높이기 위한 보다 효과적인 치료법이 향후 필요할 것으로 사료된다.

Purpose: This study was designed to evaluate the effectiveness of postoperative radiotherapy for patients with low-grade astrocytomas and to define an optimal radiotherapeutic regimen and prognostic factors. Materials and Methods: A total of 69 patients with low-grade astrocytomas underwent surgery and postoperative radiotherapy immediately following surgery at our institution between October 1989 and September 2006. The median patient age was 36 years. Forty-one patients were 40 years or younger and 28 patients were 41 years or older. Fourteen patients underwent a biopsy alone and the remaining 55 patients underwent a subtotal resection. Thirty-nine patients had a Karnofsky performance status of less than 80% and 30 patients had a Karnofsky performance status greater than 80%. Two patients were treated with whole brain irradiation followed by a coned down boost field to the localized area. The remaining 67 patients were treated with a localized field with an appropriate margin. Most of the patients received a dose of $50\sim55$ Gy and majority of the patients were treated with a dose of 54 Gy. Results: The overall 5-year and 7-year survival rates for all of the 69 patients were 49% and 44%, respectively. Corresponding disease free survival rates were 45% and 40%, respectively. Patients who underwent a subtotal resection showed better survival than patients who underwent a biopsy alone. The overall 5-year survival rates for patients who underwent a subtotal resection and patients who underwent a biopsy alone were 57% and 38%, respectively (p<0.05). Forty-one patients who were 40 years or younger showed a better overall 5-year survival rate as compared with 28 patients who were 41 years or older (56% versus 40%, p<0.05). The overall 5-year survival rates for 30 patients with a Karnofsky performance status greater than 80% and 39 patients with a Karnofsky performance status less than 80% were 51% and 47%, respectively. This finding was not statistically significant. Although one patient was not able to complete the treatment because of neurological deterioration, there were no significant treatment related toxicities. Conclusion: Postoperative radiotherapy following surgery is a safe and effective treatment for patients with low-grade astrocytomas. The extent of surgery and age were noted as significant prognostic factors in this study. However, further effective treatment might be necessary in the future to improve long-term survival rates.

키워드

참고문헌

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