Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Probabilities of Pulmonary and Cardiac Complications and Radiographic Parameters in Breast Cancer Radiotherapy

유방암의 방사선치료에서 방사선학적 지표에 따른 폐 및 심장의 부작용 확률

  • Noh, O-Kyu (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) ;
  • Ahn, Seung-Do (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) ;
  • Lee, Sang-Wook (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) ;
  • Yoon, Sang-Min (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)
  • 노오규 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 박성호 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 안승도 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 최은경 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 이상욱 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 송시열 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 윤상민 (울산대학교 의과대학 서울아산병원 방사선종양학교실) ;
  • 김종훈 (울산대학교 의과대학 서울아산병원 방사선종양학교실)
  • Received : 2009.09.03
  • Accepted : 2010.02.10
  • Published : 2010.08.31
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Abstract

Purpose: To evaluate the relationship between the normal tissue complication probability (NTCP) of 3-dimensional (3-D) radiotherapy and the radiographic parameters of 2-dimensional (2-D) radiotherapy such as central lung distance (CLD) and maximal heart distance (MHD). Materials and Methods: We analyzed 110 patients who were treated with postoperative radiotherapy for breast cancer. A two-field tangential technique, a three-field technique, and the reverse hockey stick method were used. The radiation dose administered to whole breast or the chest wall was 50.4 Gy, whereas a 45 Gy was administered to the supraclavicular field. The NTCPs of the heart and lung were calculated by the modified Lyman model and the relative seriality model. Results: For all patients, the NTCPs of radiation-induced pneumonitis and cardiac mortality were 0.5% and 0.7%, respectively. The NTCP of radiation-induced pneumonitis was higher in patients treated with the reverse hockey stick method than in those treated by other two techniques (0.0%, 0.0%, 3.1%, p<0.001). The NTCP of radiation-induced pneumonitis increased with CLD. The NTCP of cardiac mortality increased with MHD ($R^2=0.808$). Conclusion: We found a close correlation between the NTCP of 3-D radiotherapy and 2-D radiographic parameters. Our results are useful to reanalyze the previous 2-D based clinical reports about breast radiation therapy complications as a viewpoint of NTCP.

목 적: 정상 장기의 부작용 확률(normal tissue complication probability, NTCP) 모델을 이용하여, 중심폐거리(central lung distance, CLD)와 최대심장거리(maximal heart distance)와 같은 이차원 방사선치료의 방사선학적 지표들과 삼차원 입체조형방사선치료의 부작용확률 사이의 관계를 평가해 보고자 하였다. 대상 및 방법: 2006년 11월부터 2007년 8월까지 서울아산병원에서 유방암으로 진단받고 수술 후 방사선치료를 시행 받은 110명을 무작위로 추출하여 분석하였다. 방사선치료는 2문 빗면 조사법, 3문 조사법, Reverse Hockey Stick법을 사용하였고, 유방 및 흉벽에는 5,040 cGy/28회, 쇄골 상부에는 4,500 cGy/25회로 조사하였고, 유방보존술을 시행한 경우에는 원발 병소에 1,000 cGy/4회의 추가치료를 하였다. 모든 환자에서 전산화단층촬영모의치료를 시행하였고, Eclipse Planning System을 사용하여 선량 계산을 시행 후 폐와 심장의 선량 부피 곡선(dose volume histogram, DVH)을 추출하였다. 추출된 DVH를 사용하여 modified Lymam model과 relative seriality model을 통해 NTCP를 계산하고 분석하였다. 결 과: 전체 환자의 방사선 폐렴과 심장 사망의 NTCP 값은 각각 0.5%, 0.7%로 낮은 수치를 보였다. 방사선 폐렴의 NTCP는 2문 조사법과 3문 조사법에 비해 Reverse Hockey Stick 법에서 높았다(0%, 0%, 3.1%, p<0.001). 방사선 폐렴의 NTCP 값은 중심폐거리가 커질수록 증가하였고, 심장 사망의 NTCP는 최대심장거리가 커질수록 증가하였다($R^2=0.808$). 결 론: 이차원 방사선치료의 방사선학적 지표들과 삼차원 입체조형방사선치료의 NTCP 값 사이에는 밀접한 관계가 있다. 이러한 연관성을 통해 과거의 부작용학률에 대한 자료들을 이차원 방사선치료의 방사선학적 지표들을 이용하여 NTCP 모델의 관점에서 재분석하는데 유용할 것으로 생각된다.

Keywords

References

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