성문상부암의 방사선치료

남택근(Taek-Keun Nam),정웅기(Woong-Ki Chung),조재식(Jae-Shik Cho),안성자(Sung-Ja Ahn),나병식,(Byung-Sik Nah) 오윤경(Yoon-Kyeong Oh) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.2

Purpose : A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. Materials and Methods : From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2∼79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0∼93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage Ⅰ and ⅣB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0∼68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0∼59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (±lymph node dissection), three had a supraglottic horizontal laryngectomy (±lymph node dissection), and one had a primary excision alone. Results : The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage Ⅰ+Ⅱ, Ⅲ+Ⅳ were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+RT) vs radiotherapy alone (RT) in stage Ⅱ, Ⅲ, ⅣA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (p<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+RT vs RT in stage Ⅱ, Ⅲ, ⅣA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (p<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (p<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. Conclusion : In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted. 목 적 : 성문상부암에서 방사선 단독치료 또는 수술 후 방사선치료를 받은 환자를 대상으로 방사선치료의 역할을 국소종양제어율과 생존율을 중심으로 후향적으로 분석하고자 하였다. 대상 및 방법 : 1986년 1월부터 1996년 10월까지 134명이 성문상부암으로 진단되어 방사선단독 또는 수술 후 방사선치료가 시행되었고 이 중 계획된 방사선량을 조사 받은 117명의 환자를 대상으로 하였다. 1997년의 AJCC 병기분류체계에 의하여 재분류하였고 병기 Ⅰ, Ⅱ, Ⅲ,ⅣA, ⅣB의 환자 수는 각각 6 (5%), 16 (14%), 53 (45%), 32 (27%), 10 (9%)이었다. 전체 환자 중 80명은 근치적 목적의 방사선치료로 원발병소에 61.2∼79.2 Gy (평균 : 69.2 Gy), 경부림프절에 45.0∼93.6 Gy (평균 : 54.0 Gy)를 조사하였다. 전체 환자 중 병기 Ⅰ과 ⅣB 환자는 모두 방사선 단독치료를 시행하였다. 37명의 환자에서 수술 후 방사선치료를 받았고 원발병소 절제부위에 45.0∼68.4 Gy (평균 : 56.1 Gy), 경부 림프절에 45.0∼59.4 Gy (평균 : 47.2 Gy)를 조사하였다. 수술방법으로서 33명은 전후두적출술(±경부림프절 청소술), 3명은 부분후두적출술(±경부림프절 청소술), 나머지 1명은 원발병소만의 절제술이었다. 결 과 : 전체환자의 5년 생존율은 43%이었다. 병기 Ⅰ+Ⅱ와 Ⅲ+Ⅳ의 5년 생존율은 49.9%, 41.2%이었으나(p=0.27), 병기 I (n=6) 환자의 종양특성생존율은 100%이었다. 수술 후 방사선치료군(S+RT)과 방사선단독 치료군(RT)의 5년 생존율은 병기 Ⅱ에서 100% 대 43%, 병기 Ⅲ에서 62% 대 52%이었으나 유의한 차이는 없었고(p=0.17, p=0.32), 병기 ⅣA에서 58% 대 6%로 S+RT군의 생존율이 유의한 차이로 양호하였다(p<0.001). 전체 환자의 국소종양 제어율은 57%이었다. 병기별 국소종양제어율은 병기 Ⅰ, Ⅱ, Ⅲ, ⅣA, ⅣB에서 각각 100, 74, 60, 44, 30%이었다(p=0.008). S+RT군과 RT군의 국소종양제어율은 병기 Ⅱ에서 100% 대 68%, 병기 Ⅲ에서 67% 대 55%로 유의한 차이는 없었으나(p=0.29, p=0.23), 병기 ⅣA에서는 81% 대 20%로 유의한 차이가 있었다(p<0.001). 방사선 단독치료를 받은 80명의 환자 중 방사선치료반응에 따른 국소종양제어율은 완전관해, 부분관해, 부분관해미만 군에서 각각 76, 20, 0%이었다(p<0.001). 전체환자에서 생존율에 영향을 미치는 예후인자는 다변량 분석을 시행한 결과 N 병기, 수술 여부, 나이였고 국소종양 제어율에 영향을 미치는 유의한 인자는 N 병기, 수술 여부, ECOG 활동도였다. 방사선 단독치료군에서 다변량 분석결과 생존율과 국소종양제어율 모두에 유의한 인자는 방사선치료 후 종양반응과 N 병기였다. 결 론 : 조기 병기의 성문상부암에서는 통상적인 방사선단독치료로 후두기능을 보존하면서 수술군과 대등한 종양제어율을 보여주었다. 그러나 진행된 병기의 경우에는 수술과 방사선치료의 병용요법 또는 후두기능의 보존적 측면에서의 동시적 항암화학방사선요법이 고려되어야 할 것으로 생각된다. 특히 진행된 림프절 병소에 대해서는 가능한 한 방사선치료 전 또는 유도화학요법 후 계획된 경부림프절 청소술을 고려해야 할 것으로 생각된다.

Clinical significance of radiotherapy in patients with primary uterine carcinosarcoma: a multicenter retrospective study (KROG 13-08)

차지혜,김영석,박원,김학재,김주영,김진희,김주리,윤원섭,김준원,김용배 대한부인종양학회 2016 Journal of Gynecologic Oncology Vol.27 No.6

Objective: To investigate the role of radiotherapy (RT) in patients who underwenthysterectomy for uterine carcinosarcoma (UCS). Methods: Patients with the International Federation of Gynecology and Obstetrics stage I–IVa UCS who were treated between 1990 and 2012 were identified retrospectively in a multiinstitutionaldatabase. Of 235 identified patients, 97 (41.3%) received adjuvant RT. Twentytwopatients with a history of previous pelvic RT were analyzed separately. Survival outcomeswere assessed using the Kaplan-Meier method and Cox proportional hazards model. Results: Patients with a previous history of pelvic RT had poor survival outcomes, and 72.6%of these patients experienced locoregional recurrence; however, none received RT after adiagnosis of UCS. Univariate analyses revealed that pelvic lymphadenectomy (PLND) andpara-aortic lymph node sampling were significant factors for locoregional recurrence-freesurvival (LRRFS) and disease-free survival (DFS). Among patients without previous pelvicRT, the percentage of locoregional failure was lower for those who received adjuvant RT thanfor those who did not (28.5% vs. 17.5%, p=0.107). Multivariate analysis revealed significantcorrelations between PLND and LRRFS, distant metastasis-free survival, and DFS. Insubgroup analyses, RT significantly improved the 5-year LRRFS rate of patients who did notundergo PLND (52.7% vs. 18.7% for non-RT, p<0.001). J Gynecol Oncol. 2016 Nov;27(6):e58https://doi.org/10.3802/jgo.2016.27.e58pISSN 2005-0380·eISSN 2005-0399Original ArticleReceived: Feb 4, 2016Revised: Jun 23, 2016Accepted: Jun 27, 2016Correspondence toYong Bae KimDepartment of Radiation Oncology, YonseiCancer Center, Yonsei University College ofMedicine, 50-1 Yonsei-ro, Seodaemun-gu,Seoul 03722, Korea. E-mail: ybkim3@yuhs.acCopyright © 2016. Asian Society ofGynecologic Oncology, Korean Society ofGynecologic OncologyThis is an Open Access article distributedunder the terms of the Creative CommonsAttribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/)which permits unrestricted non-commercialuse, distribution, and reproduction in anymedium, provided the original work is properlycited. ORCIDJihye Chahttp://orcid.org/0000-0001-5926-5685Hak Jae Kimhttp://orcid.org/0000-0003-3602-2263Juree Kimhttp://orcid.org/0000-0002-3724-5293Won Sup Yoonhttp://orcid.org/0000-0002-6098-1993Jun Won Kimhttp://orcid.org/0000-0003-1358-364XYong Bae Kimhttp://orcid.org/0000-0003-4884-2330Conflict of InterestNo potential conflict of interest relevant to thisarticle was reported. Jihye Cha,1 Young Seok Kim,2 Won Park,3 Hak Jae Kim,4 Joo-Young Kim,5 Jin HeeKim,6 Juree Kim,7 Won Sup Yoon,8 Jun Won Kim,9 Yong Bae Kim101Department of Radiation Oncology, Yonsei University Wonju College of Medicine, Wonju, Korea2Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul,Korea3Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School ofMedicine, Seoul, Korea4Department of Radiation Oncology, Seoul National University Hospital, Seoul National University Collegeof Medicine, Seoul, Korea5Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea6Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung UniversitySchool of Medicine, Daegu, Korea7Department of Radiation Oncology, Cheil General Hospital & Women's Healthcare Center, DankookUniversity College of Medicine, Seoul, Korea8Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine,Ansan, Korea9Department of Radiation Oncology, Gangnam Severance Hospital, Yonsei University College of Medicine,Seoul, Korea10Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul,KoreaClinical significance of radiotherapyin patients with primary uterinecarcinosarcoma: a multicenterretrospective study (KROG 13-08)Concl...

Oncologic Safety of Immediate Breast Reconstruction for Invasive Breast Cancer Patients: A Matched Case Control Study

박신후,한원식,YOO TAE KYUNG R,이한별,진웅식,장학,민경원,노동영 한국유방암학회 2016 Journal of breast cancer Vol.19 No.1

Purpose: The purpose of this study was to compare locoregional recurrence-free survival (LRFS) and disease-free survival (DFS) between patients undergoing mastectomy and immediate breast reconstruction (IBR) and those undergoing mastectomy alone. Methods: A retrospective review of patients who underwent mastectomy and immediate breast reconstruction for resectable invasive breast cancer between 2002 and 2010 at a single center was conducted. These cases were matched to patients who underwent mastectomy alone in the same time period, performed by 1:2 matching. Matching control variables included age, tumor size, axillary lymph node metastasis, and estrogen receptor status. Overall, 189 patients were identified in the IBR group, and 362 patients were matched to this group. Results: In the IBR group, 75 patients (39.7%) underwent conventional total mastectomy, 78 (41.3%) underwent skin-sparing mastectomy (SSM), and 36 (19.0%) underwent nipple-sparing mastectomy (NSM). The IBR group was significantly younger than the control group (41.9 and 45.1 years, respectively) (p=0.032), in spite of matching between three age groups. The DFS rates were similar between the IBR group and mastectomy alone group, at 92.0% and 89.9%, respectively, at 5-year follow-up (log-rank test, p=0.496). The 5-year LRFS was 96.2% in the IBR group and 96.4% in the mastectomy alone group (log-rank test, p=0.704), similar to data from previous reports. Subgroup analyses for SSM or NSM patients showed no differences in LRFS and DFS between the two groups. Additionally, in stage III patients, IBR did not cause an increase in recurrence. Conclusion: IBR after mastectomy, including both SSM and NSM, had no negative impact on recurrence or patient survival, even in patients with advanced disease.

비인강암의 방사선치료성적

신세원,김성규,김명세 영남대학교 의과대학 1992 Yeungnam University Journal of Medicine Vol.9 No.2

1986년 4월부터 1992년 3월까지 6년간 영남대학교 의과대학 부속병원 치료방사선과에 내원하여 근치적인 방사선치료를 시행한 후 6개월 이상 추적조사가 가능하였던 31명의 치료성적은 다음과 같다. 대상환자 31명중 남자가 22명으로 여자보다 2.4배 많았으며 30세미만 3명을 제외하면 30대에서 60대까지 고른 분포를 보였다. 병리조직학적 분류상 편평세포암이 13명, 미분화세포암이 18명이었다. 임상적병기는 Ⅰ기 1명, Ⅱ기 2명, Ⅲ기 6명, Ⅳ기 22명이었다. 31명중 방사언치료만 시행된 경우가 11명, 항암제등과 병합치료를 시행한 경우가 20명이었다. 편평세포암 환자 11명중 6명에서 방사선치료만을 시행하였고 5명에서 병합치료를 시행하였으나, 미분화세포암에서는 18명중 5명은 방사선치료만을 시행하였고 13명은 병합치료를 실시하였다. 치료에 대한 반응은 치료방법에 따른 차이가 없었으나, 방사선치료만 시행한 경우에 편평세포암 6명중 3명이 완전관해를 보인 반면에, 미분화세포암 5명 모두 완전관해를 보여 큰 차이를 보였으나 병합치료에서는 세포형태에 따른 차이가 소실되었다. 치료 후 1년 생존율은 치료방법에 따른 차이가 없었다. 완전관해를 보인 환자 22명중에서 방사선치료만 시행한 8명중 6명에서 재발을 보였으며 그중 3명은 원격전이를 동반하였으나, 병합치료를 시행한 14명중에서 3명만이 재발을 보였으며 그중2명은 원격전이를 보였다. 이상의 결과에서 치료방법에 따른 관해율은 비슷하였으나 치료 후 추적과정에서 발생하는 재발은 방사선치료만 시행한 경우보다 병합치료를 실시한 경우에 현저히 줄어듬을 보여주어 비인강암에 대한 병합치료가 국소재발의 감소 및 원격전이의 감소를 통하여 생존율의 향상에도 기여하리라 사료된다. Radiotherapeutically, nasopharyngeal cancer is an important disease in korea. Because of its blind anatomic location, early detection is relatively uncommon. Clinically, most of cases are locally advanced and nodal involvement are common. Recently better understanding of nature of the disease and improvement of radio- therapy technique permit better treatment results, including locoregional control and survival rate, and minimal normal tissue damages comparing with previously published data. We analyzed 31 patients of pathologically proven and previously untreated naso- pharyngeal carcinoma with different treatment techniques, retrospectively. Minimal and maximal follow up period of the survuor is 6 months and 68 months, respectively. Thirteen patients with squamous cell carcinoma are included in this analysis. The median age is 49 years (range from 20 to 64 years). Twenty two patients are stage Ⅲ. Eleven patients are treated with radiotherapy alone and 20 are treated with comblined modalities treatment. The degree of responses after radiotherapy are categorized by 3-classes, i.e. complete response, partial response. In spite of simioarities of complete response rate and 1-year survival rate between two different treatment techniques, those patients with undifferentiated carcinoma appear to benefit from the adjuvant chemotherapy. In addition, systemic failure is more prominant in radiotherapy alone group than in combined modalities treatment group. These results suggest that adjuvant therapy in the radiotherapeutic management of nasopharyngeal cancers needs additional reserch according to histologic types and future extensive clinical trials.

국소 진행된 분화 갑상선 유두암에서의 외부 방사선 치료의 역할

김주희,김광민,박준범,배금석,강성준,Joo Hee Kim,Kwang Min Kim,Joon Beom Park,Keum Seok Bae and Seong Joon Kang 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.2