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재발성 또는 지속성 상피성 난소암에서의 Docetaxel 요법의 효용성 및 독성
주다혜 ( Da Hye Ju ),김용만 ( Yong Man Kim ),김민균 ( Min Gyun Kim ),김유진 ( Eu Gene Kim ),김대연 ( Dae Yeon Kim ),서대식 ( Dae Sik Seo ),김종혁 ( Jong Hyeok Kim ),김영탁 ( Young Tak Kim ),남주현 ( Joo Hyun Nam ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11
목적: Paclitaxle-platinum 병합요법 치료 후, 재발하거나 반응이 없는 상피성 난소암에서 docetaxel 단독 및 병합 요법의 치료에 대한 효과 및 독성을 알아보고자 하였다. 연구 방법: 1989년 5월부터 2006년 12월까지 서울아산병원에서 재발성 혹은 지속성 상피성 난소암 환자 중 docetaxel 단독 요법 및 다른 항암제와의 병합 요법을 받은 40명의 환자를 대상으로 하였다. Docetaxel 요법은 docetaxel 75 mg/m2 단독 요법이나 docetaxel과 platinum (carboplatin AUC5 또는 cisplatin 75 mg/m2)을 1 일째 투여하는 병합 요법으로 하여 3~4주 간격으로 시행하였다. 치료 효과는 RECIST criteria와 CA-125 response criteria 정의에 따라 평가하였다. 약제 독성은 NCI Common Toxicity Criteria에 따라 평가하였다. 결과: 20명은 RECIST criteria를 기준으로, 20명은 CA-125 response criteria의 정의에 따라 평가하였다. 전체 반응률은 35% (14/40)이었고, 완전 반응은 11명 (27.5%)이었으며, 부분 반응은 3명 (7.5%)이었다. 40명의 재발성 난소암의 환자들의 평균 치료 반응 기간은 11.29개월 (4~20.7개월), 평균 병의 진행 기간은 6.91개월 (1~23개월)이었다. Platinum sensitivity에서 반응군에서는 38.7%, 저항군에서는 22.2%의 반응률을 보여 통계적으로 유의하지 않았으나 (p=0.776) 반응군에서 더 높은 반응률을 보였다. 한편 이전 3회 이상의 치료를 받은 군에서 그렇지 않은 군보다 통계적으로 유의하게 낮은 반응률을 보였다 (p=0.022). 가장 흔한 약제 독성은 탈모와 위장관계 독성이었으며, 가장 심각한 약제 독성은 골수 억제 반응이었다. 결론: 초회 치료로 paclitaxel-platinum 병용 요법을 사용 한 재발성 또는 지속성 상피성 난소암 환자에서 docetaxel은 효과와 독성 면에서 2차 치료약제로 고려할 만한 약제이다. Objective: The aim of this study is to determine the efficacy and toxicity of docetaxel in patients with recurrent or persistent epithelial ovarian cancer, previously treated with paclitaxel and platinum combination chemotherapy. Methods: Forty patients with recurrent or persistent epithelial ovarian cancer, had been treated with docetaxel combination chemotherapy at Asan Medical Center from May 1989 to December 2006. They received docetaxel (75 mg/m2) only or docetaxel (75 mg/m2) and platinum (carboplatin AUC5 or cisplatin 75 mg/m2) on day 1. The administration was repeated every 3 or 4 weeks. The response of patients was evaluated with CA-125 response criteria and RECIST criteria. The toxicities were defined according to the NCI common toxicity criteria. Results: Twenty patients had been evaluated by RECIST criteria and twenty patients had been evaluated by CA-125 response criteria. The overall response rate was 35% (14/40). Eleven patients were belonged to complete response (CR), and three patients were belonged to partial response (PR). The mean response duration (RD) was 11.29 months (4 to 20.7 months) and the mean time to progression (TTP) was 6.91 months (1 to 23 months). The response rate in the platinum-sensitive patients was 38.7% but in the platinum-resistant patients was 22.2%. The platinum-sensitive patients showed more favorable response rate, but that was not significant statistically. Heavily treated group, more than three prior regimens were used, had poor outcome. The common toxicities were alopecia and gastrointestinal toxicities (anorexia and nausea). Bone marrow suppression was the most serious drug toxicity, however, it was tolerable. Conclusion: The docetaxel is a considerable 2nd line chemotherapy with acceptable efficacy and toxicity in patients with recurrent or persistent epithelial ovarian cancer previously treated with paclitaxel and platinum combination chemotherapy.
김민균 ( Min Gyun Kim ),김정훈 ( Chung Hoon Kim ),이사라 ( Sa Ra Lee ),주다혜 ( Da Hye Ju ),김성훈 ( Sung Hoon Kim ),채희동 ( Hee Dong Chae ),강병문 ( Byung Moon Kang ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.11
Endometriosis is a relatively common gynecologic disease. However thoracic endometriosis syndrome is exceedingly rare among various types of external endometriosis. We experienced a case of 35-year-old woman who presented with recurrent episodes of spontaneous right-sided pneumothorax that occurred during her menstrual periods. After the localization of the disease site by means of chest radiography and computed tomography of the thorax, a chest tube was inserted after which bullectomy and pleurodesis using doxycycline were performed. A hormonal treatment with gonadotropin-releasing hormone (GnRH) agonist for 12-months was also conducted. However, right-sided pneumothorax recurred two times after these procedures. Subsequently, surgical excision of diaphragmatic lesion along with pleurodesis was underwent. To prevent recurrence, we maintained long-term GnRH agonist administration with add back therapy using low dose estrogen-progesterone. Menstruation stopped, and the chest pain disappeared. During a 19-months follow-up period, pneumothorax did not recur. We report this case with a brief review of the concerned literatures.