Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Effects of Concurrent Chemotherapy and Postoperative Prophylactic Paraaortic Irradiation for Cervical Cancer with Common Iliac Node Involvement

자궁경부암의 근치적 절제술 후 총장골동맥림프절 침범 시 동시항암화학치료와 예방적 대동맥주위림프절 방사선조사의 효과

  • Han, Tae-Jin (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Wu, Hong-Gyun (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Kim, Hak-Jae (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Ha, Sung-Whan (Department of Radiation Oncology, Seoul National University College of Medicine) ;
  • Kang, Soon-Beom (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Song, Yong-Sang (Department of Obstetrics and Gynecology, Seoul National University College of Medicine) ;
  • Park, Noh-Hyun (Department of Obstetrics and Gynecology, Seoul National University College of Medicine)
  • 한태진 (서울대학교 의과대학 방사선종양학교실) ;
  • 우홍균 (서울대학교 의과대학 방사선종양학교실) ;
  • 김학재 (서울대학교 의과대학 방사선종양학교실) ;
  • 하성환 (서울대학교 의과대학 방사선종양학교실) ;
  • 강순범 (서울대학교 의과대학 산부인과학교실) ;
  • 송용상 (서울대학교 의과대학 산부인과학교실) ;
  • 박노현 (서울대학교 의과대학 산부인과학교실)
  • Received : 2010.07.02
  • Accepted : 2010.08.16
  • Published : 2010.09.30
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Abstract

Purpose: To retrospectively assess the advantages and side effects of prophylactic Paraaortic irradiation in cervical cancer patients with common iliac nodal involvement, the results for survival, patterns of failure, and treatment-related toxicity. Materials and Methods: From May 1985 to October 2004, 909 patients with cervical carcinoma received postoperative radiotherapy at the Seoul National University Hospital. Among them, 54 patients with positive common iliac nodes on pathology and negative Paraaortic node were included in the study. In addition, 44 patients received standard pelvic irradiation delivered 50.4 Gy per 28 fractions (standard irradiation group), and chemotherapy was combined in 16 of them. The other 10 patients received pelvic irradiation at a dose of 50.4 Gy per 28 fractions in addition to Paraaortic irradiation at 45 Gy per 25 fractions (extended irradiation group). In addition, all of them received chemotherapy in combination with radiation. Follow-up times for pelvic and Paraaortic irradiation ranged from 6 to 201 months (median follow-up time, 58 months) and 21 to 58 months (median follow-up time, 47 months), respectively. Results: The 4-year overall survival, disease free survival, and distant metastasis free survival in the standard irradiation group and extended irradiation group were 67.2% vs. 90.0% (p=0.291), 59.0% vs. 70.0% (p=0.568) and 67.5% vs. 90.0% (p=0.196), respectively. The most common site of first failure for the standard irradiation group was the paraaortic lymph node, while no paraaortic failure was observed in the extended irradiation group. Relatively, hematologic toxicity grade 3 or greater was common in the extended irradiation group (2/10 extended vs. 2/44 standard), while gastrointestinal toxicity of grade 3 or greater was lower (2/10 extended vs. 6/44 standard), and urologic toxicity of grade 3 or greater was observed in the standard irradition group only (0/10 vs. 3/44). Conclusion: Concurrent chemotherapy and prophylactic Paraaortic irradiation in patients with common iliac nodal involvement showed slightly improved clinical outcomes aside from increased hematologic toxicity, which was statistically insignificant. Considering the relatively small number of patients and short follow-up times, additional studies are needed to obtain more conclusive outcomes.

목 적: 자궁경부암에서 근치적 절제술 후 림프절 침범은 중요한 예후인자 중 하나이다. 본 연구에서는 총장골동맥림프절 침범 시 대동맥주위림프절에 대한 예방적 방사선조사의 효과를 알아보고자 하였다. 대상 및 방법: 1985년 5월부터 2004년 10월까지 총 909명의 환자가 서울대병원에서 자궁경부암으로 근치적 절제술 후 방사선치료를 시행받았다. 골반 내 림프절 침범이 있는 환자는 375명이었고 총장골동맥림프절 침범이 있는 환자는 69명이었다. 이 중 총장골동맥림프절 침범이 있으면서 대동맥주위림프절 침범은 없었던 54명의 환자를 대상으로 후향적 분석을 시행하였다. 대상환자의 FIGO 병기는 IB, IIA, IIB가 각각 22명, 21명, 11명이었다. 이 중 10명은 전골반과 대동맥주위림프절을 포함하는 확장조사야로 방사선치료를 받았고 모두 항암화학치료를 병용하였으며, 나머지 44명은 전골반 만을 포함하는 표준조사야로 방사선치료를 받았고 이 중 16명이 항암화학치료를 병용하였다. 확장조사군과 표준조사군의 추적관찰기간은 각각 21~58개월(중간값, 47개월)과 6~201개월(중간값, 58개월)이었다. 결 과: 전체 환자의 4년 생존율, 4년 무병생존율, 4년 무전이생존율은 각각 70.0%, 61.1%, 71.7%였다. 단변량 분석 시 절제연 침범(p<0.001), 림프관내 종양 침범(p=0.041)이 있는 경우 유의하게 생존율이 낮았고, 양측 림프절침범(p=0.001), 5개 이상의 림프절 전이(p=0.006)가 있는 경우 유의하게 낮은 무병생존율을 보여주었다. 낮은 무전이생존율과 관련 있는 인자는 양측 림프절 침범(p=0.009), 5개 이상의 림프절 전이(p=0.003), 자궁경부 전층 침범(p=0.013), 절제연 침범(p=0.014), 림프관내 종양 침범(p=0.041)이었다. 확장조사군과 표준조사군의 4년 생존율은 90.0%와 67.2% (p=0291), 4년 무병생존율은 70.0%와 59.0% (p=0.568), 4년 무전이생존율은 90.0%와 67.5% (p=0.196), 4년 대동맥주위림프절 전이율은 0%와 14.3% (p=0.249)로 통계적으로 유의한 차이가 없었다. 3등급 이상의 중등도 급성합병증은 확장조사군 10명 중 4명(40%; 조혈계 2명, 위장관계 2명)에서 발생하였고, 표준조사군 44명 중에서는 11명(25%; 조혈계 2명, 위장관계 6명, 비뇨생식계 3명)에서 발생하였다. 결론: 자궁경부암의 근치적 절제술 후 총장골동맥림프절 침범이 있는 경우 예방적 대동맥주위림프절 방사선조사의 생존율에 대한 통계적 유용성은 확인할 수 없었다. 그러나 확장조사야로 치료받은 환자수가 적고 추적관찰기관이 짧았던 점을 고려하면 추가적인 추적관찰이 필요할 것으로 생각한다.

Keywords

References

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