국소적으로 진행된 위암의 수술후 방사선 치료성적

이명자(Myung Za Lee0, 전하정(Ha Chung Chun),김인순(Insoon Kim),정태준(Tejune Chung) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2

목 적 : 국소적으로 진행된 위암치료는 수술이 주 치료로 5년 생존율은 그리높지 않아 좀더 완치율을 높이기 위하여 화학요법이나 화학요법과 병용하여 방사선치료 등이 시행되고 있다. 저자들은 위암환자에서 수술후 방사선치료를 받은 환자의 치료성적을 후향적으로 분석하였다 방 법 : 1985년 3월부터 1993년 6월까지 한양대학병원 치료방사선과에서 위절제수술후 방사선치료를 3500cGy 이상 받고 병기 3및 4기인 68명을 대상으로 후향적인 분석을 하였다. 연령분포는 28세부터 66세였고 중앙연령은 50세였다. 추적기간은 3개월에서 133개월(3명이 36개월 미만)로 중앙값은 50개월이었다. 조직병리상 37명이 non signet ring adenocarcinoma였고 29명이 signet r ing cell이었다. 병기로 ⅢA가 19명, ⅢB가 25명, Ⅳ가 24명이었다. 항암화학요법은 65명의 환자에게 투여되었으며 FAM계통의 치료가 28예 cisplatin, 5FU계통이 26예이었다. 결 과 : 5년생존율은 36.6% 5년무병생존율은 33.6%였다. 예후인자로 병소침입 임파선개수, 조직세포 종류 등이 생존율에 통계적으로 유의하게 영향을 주었고 잔존세포의 유무, 병기, 나이, 세포분화도 및, 방사선치료 총 기간 등도 생존율에 영향을 주었으나 통계적인 유의성은 없었고 항암화학제의 종류에따른 생존율의 차이는 없었다. 37명환자에서 재발이 있었고 위치로는 장망(omentum) 및 복막에 23.5%로 가장 재발율이 높았으며 남은 위나 봉합부위에 13.2%의 재발율을 보였다. 전체 국소재발은 20.7% 전체 원격전이는 39.7%였다. 방사선치료로 인한 부작용은 22.1%에서 grade 3의 백혈구감소가 있었고 1.5%에서 grade 4 부작용이 있었다. 치료중 10% 이상의 체중감소는 8.8%였다. 결 론 : 본 연구결과 수술후 화학요법과 방사선치료요법은 큰 부작용이 없었으며 실패양상은 주로 장망 및 복막이었고 치료부위내 국소재발율이 다음으로 많았다. 국소재발은 원격전이에 비해 많이 낮아지는 추세를 보였다. 방사선역할에 평가를 조금 더 명확하게 규명하기위해 향후 재발 위험이 큰 환자에서 수술후 화학요법만 한 군과 화학요법 및 방사선치료를 병용한 군과의 재발 양상 및 생존율 등의 전향적 비교 연구가 필요할 것으로 생각되며 더 나아가 수술후 항암화학요법 및 방사선 병용요법에 복강내 약물치료도 고려되어야 하겠다. Purpose : Radical gastrectomy is main treatment of gastric cancer. But the result is not satisfactory with surgery alone. Most of pattern of failure remain locoregional recurrence. To improve 5 year survival postoperative chemotherapy with or without radiotherapy has been used. We analyzed patients with stage Ⅲ and Ⅳ stomach cancer who had radical operation and received postoperative radiation therapy combined with or without chemotherapy retrospectively. Material and Method : From March 1985 to June 1993, 68 patients treated with curative resection and received postoperative adjuvant radiotherapy with 36Gy or more were evaluated. Median age was 60 years(range 28-66 yrs). Patients were followed from 3 to 133 months with median follow up of 48 months. Thirty seven patients had non signet ring adenocarcinoma, 29 signet ring cell, 2 other cell. Patients with stage ⅢA, ⅢB, Ⅳ disease were 19, 25 and 24 respectively. Chemotherapy was given to all patients except two. Results : Five-year overall survival and disease-free survival rate were 36.6% and 33.6%, respectively. Prognostic factor affecting survival were assessed. High ratio of involved/dissected lymph node, signet ring histology showed poor prognosis with statistical significance. Presence of residual tumor after surgery, stageⅣ, split course of radiation therapy, age, number of involved lymph node, number of lymph node dissection and grade of tumor affected survival without statistical significance. Type of chemotherapy did not affect survival. Recurrence was documented in 34 patients. High recurrence was seen in omentum and peritoneum with 23.5%, and remnant stomach, anastomosis site, A-loop and E- loop had also high recurrence with 13.2%. In field locoregional recurrence was 20.7% and total distant metastases were 39.7%. Total intraabdominal failure was 47.1% and extraabdominal failure was 13.2%. Treatment toxicity was considered to be acceptable. 22.1% of patients had grade 3 and only 1 patient had grade 4 leukopenia. Six patients(8.8%) had weigh loss more than 10%. Conclusion : Treatment toxicity was acceptable with combined treatment with chemotherapy and radiotherapy. Locoregional recurrence was relatively low compared to distant failure with addition of irradiation. Peritoneal and omental seeding was high. Five-year surival was increased with combined modality. Radiation may eradicate minimal residual disease and improve survival. To evaluate role of radiation prospective randomized study employing chemotherapy alone and chemotherapy plus radiation is necessary. Futhermore to reduce intraabdominal failure, role of intraabdominal chemotherapy in addition to combined chemotherapy plus radiation has to be explored.

자궁경부암의 수술 및 방사선치료 후 국소재발 판정에 대한 MR 및 CT 평가

전하정,이명자,김형석 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.2

The objectives of our study were to analyze the CT and MR findings of local tumor recurrence at vaginal stump in patients of cervical carcinoma treated with hysterectomy and radiotherapy, and to assess the diagnostic value of the MR study. We retrospectively analyzed the CT(n=17) and MR (n=10) findings in 19 patients, who had uterine cervical carcinoma after hysterectomy with radiation therapy (extended-field irradiation and/or brachytherapy). The CT findings of local tumor recurrence were localized mass like lesion(n=5), slightly enhanced infiltrating lesion (n=4) and enhancing mass with central necrosis (n=1). The MR findings wer local iso-signal intensity mass on T1-weighted image and irregular high-signal intensity mass on T2-weighted image. The false positive results were three (two on CT and one on MR), due to inflammation and local fibrosis. On the basis of our study, the CT was the proper screening method for follow up in patients with cervical carcinoma after treatment. But, if any suspicion of tumor recurrence, MR was the useful tool to exclude the local fibrosis and inflammation, and to decide the next studies such as biopsy or observation with MR follow up.

Radiation Therapy for Openable Breast Cancer after Conservative Surgery

Myung Za Lee(이명자),Ha Chung Chun(전하정) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.4

목적 : 유방암 환자에서 국소적 절제 수술 후 방사선 치료 후 재발 양상, 생존율 및 예후 인자를 평가하기 위해 후향적으로 분석을 하였다. 대상 및 방법 : 1985년 1월부터 1996년 12월까지 한양대학교 병원 치료방사선과에서 유방보존수술 후 방사선치료를 위해 의뢰된 유방암 1기, 2기 및 3기 53명을 대상으로 후향적 분석을 하였다. 추적기간은 평균 84개월이었고 최소 5년이었다. 연령분포는 24세부터 72세였고 중앙연령을 43세였다. 2명을 제외한 51명이 액과 림프절 곽청술을 받았고 조직병리상 42명이 침윤성 선암이었고 2명이 소엽 세포암 2명은 선관내 선암이었고 7명은 그 외 병리소견을 가졌다. 병기로 T0 2명 T1 30명, T2 21명이었고, 53명 중 15명이 액와 림프절 침윤이 있었다. 원발 종양위치로 내측이 13명, 외측이 38명 유두 하 부위가 2명이었다, 방사선 조사는 전체유방에 46~50 Gy와 원발 종양 주위에 14~18 Gy 추가조사를 시행하였다. 결과 : 5년 생존율은 94.3% 5년 무병생존율은 92.4%였다. 10년 생존율은 91.2% 10년 무병생존율은 81%였다. 병기 별로 I 100%, IIa는 100%, IIB 및 IIIa는 66.7%의 5년 생존율을 보였다. 4명(7.5%)에서 국소 재발이 있었고 3명(5.7%)에서 원격전이가 있었다. 원발 병소 내 국소 재발은 2년 이내였고 원발 병소 밖의 국소 재발은 8년 후에 보였다. 원격전이는 2년에서 6년 사이였다. 35세 이하의 환자에서 국소 및 원격전이가 높아 12예 중 5예의 재발율을 보였고 (국소재발 2명, 원격전이 3명) 종양크기가 2cm 이상인 환자 21예 중 5예(국소재발 2명, 원격전이 3명)에서 재발율을 보였다. 액과 림프절 침윤이 있는 15명 중 4명(26.6%)에서 원격전이가 있었다. 종양의 크기 2cm 이상인 환자에서 임파선 전이율이 38.1%였고 35세 이하의 젊은 연령에서 임파선 전이율이 58.3%였다. 예후 인자로는 연령과 액와 림프절 침윤과 종양이 클수록 생존율이 유의하게 낮았다. 결론 : 유방 보존 수술 후 방사선 치료를 받은 조기 유방암환자의 치료결과는 양호함을 알 수 있었다. 국소 재발율은 추적기간이 길수록 증가함으로 보다 더 장기적인 추적이 필요하고 젊은 연령층의 치료 결과를 향상시키기 위해 보다 효과적인 치료법의 개발이 필요하리라 생각된다. Purpose : To evaluate the result of conservative management on recurrence, survival and prognostic fac-tors of patient with operable breast cancer. Materials and Methods : Fifty three patients, treated for localized breast cancer by lumpectomy or quad-rantectomy followed by radiotherapy between January 1985 and December 1996, were retrospectively studied. All patients followed up for at least five years. Their median age was 43 years (range 24~72). The tumor stages were as follows : T1 in 30 patients, T2 in 21, Tis in 2 Thirty-eight patients had nega-tive and 15 had positive axillary nodes. The histological types were 42 infiltrating ductal, 2 infiltrating lobu-lar, and 2 intraductal carcinomas with 7 other histologies. The tumor locations were outer quadrant in 38 breasts, the inner quadrant in 13 and central in 2. Radiation doses of 46~50 Gy were given to the entire breast areas with additional doses of 14-18 Gy delivered to the tumor bed areas. Results : The overall five and 10 year actuarial and disease free survivals were 94.3% and 92.4%, 91.2 and 81%, respectively. The overall five year survivals were 100% in stage I and IIa, and 66.7% in stage IIb and IIIa tumors. Seven patientes failed either locally or distantly. Incidence of local failure and distant metastasis for the first failure were 7.5% and 5.7%, respectively. Local recurrence appeared within 2 years of treatment at the primary site and after more than 8 years outside of primary lesion, whereas distant metastasis appeared between 2 and 6 years following treatment. The overall recurrences were high at a young age (< or = 35 years), with 5 out of 12 (2 local, 3 distant), and in T2 lesions with 5 out of 21 (1 local, 3 distant, and 1 in both). Distant metastasis was high in the positive axillary lymph node group with 4 out of 15 (26.6%). A high incidence in the axillary node was noted at a young age with 7 out of 12 (58.3%) and in T2 lesions with 8 out of 21 (38.4%). A young age, positive axillary node and large tumor size were all related with poor survival. Conclusion : Based on this study, lumpectomy or quadrantectomy, followed by radiation appears to be an adequate therapeutic method in operable breast cancer. A long term follow-up is necessary because a recurrence of breast can occur long time after treatment. The poor prognostic group, especially young patients with an aggressive biological behavior needs more effective treatment modalities to improve their survival

Clinical Application of the Dual Energy Photon Beam Using 6 MV and 10 MV X-ray

Myung Za Lee(이명자),Hye Gyeong Han(한혜경) 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

최근에 선형가속기에 대한 제작기술의 발달로 하나의 기계에서 두가지 X-선이 생성된다. 이러한 기계적 특성을 충분히 이용할 수 있도록 임상적으로 어떠한 장점이 있는지 아는 것은 매우 중요하다. 특히 SAD 방법으로 치료시 다른 에너지를 사용하여야 될 경우 환자를 다른에너지가 있는 치료실로 이동시키지 않아도 되는 장점이 있다. 저자는 직장암 환자 15예를 중심으로 6MV와 10MV X-선의 에너지를 복합적으로 사용하여 치료를 하였을 때 단일에너지 6MV 혹은 10MV X-선을 이용했을 때와 등량곡선의 분포도 및 선량률의 차이를 비교하였다. 선량 계산은 치료계획용 Mevaplan콤퓨터를 이용하였다. 정상조직에 들어가는 방사선량의 차이를 계산하기위해 방광 및 우측 대퇴부를 임의의 점으로 잡아 콤퓨터에 입력시켜 그 부위의 최대선량 최소선량 및 평균선량을 구하였다. 6MV 및 10MV의 이중에서지 X-선을 이용하였을 때 6MV 단일 에너지 X-선으로 치료시 보다 방광의 평균 방사선량은 8.1% 감소하였고 방광 전벽 방사선량 즉 소장과 근접해 있는 부위는 7.4%의 감소를 보였다. 최대선량치 Dmax는 1.25% 감소하였다. 대퇴부위의 평균 방사선량은 2% 감소하였다. 이중에너지 X-선 치료는 10 MV 단일에너지와 비교하여 방광의 평균 방사선량은 8.5% 감소하였고, 소장근접 부위는 11.8% 감소하였다. 최대선량치 Dmax는 0.8%의 증가로 거의 차이가 없었다. 대퇴부위 방사선량은 0.8% 증가로 비슷하였다. 그외 회음부 및 전골전방 부위는 전방조사야에 10MV 대신 6MV를 씀으로써 피부 sparing 효과를 줄여주어 충분한 방사선량을 줄 수 있었다. 위의 결과로 이중에너지 X-선 치료는 정상조직의 손상은 같게주며 종양부위의 방사선량을 7~12%정도 올려줄 수 있는 장점이 있음을 알 수 있었다. Some modern accerelators provide a dual energy for photon beam treatment. The main advantages of dual energy in the treatment of rectosigmoid or rectal cancer are as follows. 1. Dose in the critical organ such as small intestine, bladder and genital organ are reduced. 2. Presacral and perineal area is fully covered. Dose distribution analysis such as calculation of dose in a target volume, isocenter. Dmax and dose spectrum in any region of interest are possible. Examples of plan are given and results are discussed.

Ewing씨 육종의 치료성적

이명자(Myung Za Lee) 대한방사선종양학회 1984 Radiation Oncology Journal Vol.2 No.1

Vanadate 처리가 종양세포의 방사선 감수성에 미치는 영향

이명자(Myung Za Lee),이원영(Won Young Lee) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.2

Intracellular ions which have a major role in cellular function have been reported to affect repair of radiation damage. Recently it has been reported that ouabain sensitizes A549 tumor cells but not CCL-120 normal cells to radiation. Ouabain inhibits the Na⁺-K⁺-ATPase inhibitors. This study was performed to see any change in radiosensitivity of tumor cell by vanadate and any role of NA⁺-K⁺ATPase in radiosensitization. Experiments have been carried out by pretreatment with vanadate in human cell line(A549, JMG) and mouse cell line(L1210, spleen). For the cell survival MTT assay was performed for A549 and JMG cells and trypan blue dye exclusion test for L120 and spleen cells. Measurements of Na⁺-K⁺-ATPase activity in control, vanadate treated cell, radiation treated cell (9 Gy for A549 and JMG, 2 Gy for L1201, spleen), and combined 10⁻⁶M vanadate and radiation treated cells were done. The results were summerized as follows, 1. L1210 cell was most radiosensitive and spleen cell and JMG cell were intermediate and A549 cell was least radiosensitive. 2. Mininum or no cytotoxicity was seen with vanadate below concentration of 10⁻⁶M. 3. In A549 cells there was a little change in radiosensitivity with treatment of vanadate. However radiation sensitization was shown in low dose level of radiation i.e. 2-Gy. In JMG cells no change in radiosensitivity was noted. Both L1210 and spleen cell had radiosensitization but change was greater in tumor cell. 4. NA⁺-K⁺-ATPase activity was inhibited significantly in tumor cell by treatment of vanadate. 5. Radiation itself inhibited Na⁺-K⁺-ATPase activity of tumor cell with high Na⁺-K⁺-ATPase concention. Increase in radiosensitivity by vanadate was closely associated with orginal Na⁺-K⁺-ATPase contents. From the above results vanadate had little cytotoxicity and it sensitized tumor cells to radiation. Inhibitory effect of vanadate on Na⁺K⁺-ATPase activity might be one of the contributing factors for radiosensitization to tumor cells which has greater enzyme activity than that of normal cell. It was suggested vanadate could be used as a potential radiosensitizer for tumor cells.

The Results of Radiation Treatment in Carcinoma of the Uterine Cervix

이명자(Myung Za Lee),김정진(Jung Jin Kim) 대한방사선종양학회 1985 Radiation Oncology Journal Vol.3 No.2

1979년 7월부터 1985년 3철까지 한양대학병원에서 자궁경암의 표준화된 방사선치료기준, 즉 전 골반의 외부방사선조사와 강내조사의 병용요법으로 112명의 환자를 치료하였다. 전원이 추적 가능하였고 6 ~ 75개월의 추적기간에 평균은 31개월이었다. 2명이 선암이고 110명은 펀평상피 세포암이었고 I_b병기 9명(8%), II_a병기 14명(12.5%), II_b 병기 50명(44.6%), III병기 33명 (29.5%), 그리고 IV병기는 6명 (5.4%)이었다. 연령분포는 30대 10명(8.9%), 40대, 50대가 다같이 41명(36.6%)씩으로 73.2%이고 60대 이상이 19명 (17%)이며 특수하게 20세미만이 1예 있었다. 방사선치료는 전 골반에 평행대항 조사야로 180 ~ 200rad를 주 5회 4,000 ~ 4,200rad 조사하였고 중앙부 4cm를 차폐하고 600 ~ l,000rad를 자궁방결합조직에 추가 조사하였다. 강내조사는 Cs-137 소선원(20mg 라디움당량)을 자궁강내 2 ~ 3개 질강내 2개를 TAO Applicator로 삽입하였고 7 ~ 12일 간격으로 2회 시행하였다. 치료기간은 평균 52일간이고 40 ~ 65일에 걸쳐서 시행되었다. A점에 조사한 방사선량은 6,820 ~ 10,500rad로 평균 8,388rad이고 B점에는 4,850 ~ 6,899rad로 평균 5,898rad이었다. 생명표 5년 생존율(actuarial 5year survival rate)은 전체로 61.8%이고, I_b병기에서 84.6%, II_a병기는 77.8%, II_b병기는 56.7%, III병기는 60.6%, 그리고 IV 병기는 33.3%이었다. A점의 방사선량이 8,000rad 이상일 때는 7/18(38.9%)의 실패율이었고 이에 비해서 8,000rad이상일 때는 25/94(26.5%)의 실패율이었다. 또 B점 선량으로 보면 6,000rad이하에서 20/63(34.9%)의 실패율에 비하여 6,000rad이상일 때는 10/49(20.4%)의 실패율이었다. 연령 벨로는 40 ~ 49세에서 실패율(14/41 24.1%)이 많았다. 본 성적으로 보아서 생존율은 여러 저자들과 큰 차이가 없음을 알 수 있었고 A점 선량은 8,000rad 이상, B점은 6,000rad이상이 조사되어야 적정선량이 됨을 시사해 주고 있다. From July 1979 through March 1985,112 patients with carcinoma of the uterine cervix were treated by whole pelvis irradiation and intracavitary radiation with Cs-137. The treatment consisted of 3600rad-5200rad to the whole pelvis by parallel opposing portals, 5 days per week, 180-200rad per day. Parametrial boost with 400-800rad was given in 60 patients. 2 intracavitary Cs-137 radiation using TAO applicator were done with 7-10 days interval. Total treatment times were 40-65 days with average 52 days. Total dose of radiation to point A varied from 6820 to 10500rad with average 8388rad and to point B from 4850 to 6899ra0 with average 5898rad. All patients had follow up from 6 months to 75 months and median follow up of 31 months. 9(8%) had stage 14(12.5%) had stage IIa, 50(44.6%) had stage IIb, 33(29.5%) had stage III, 6(5.4%) had stage IV. 110 patients had squamous cell carcinoma and 2 patients had adenocarcinoma. 5 year actuarial survival rates were 61.8% for the entire group, 84.6% for stage Ib, 77.8% for stage IIa, 56.7% for stage IIb, 60% for stage III, 33.3% for stage IV. RT dose to medial parametrium (point A) below 8000rad resulted in 7/18(38.9%) failure (=death) in contrast to 25/94 (26.5%) failure with dose over 8000rad. RT dose to lateral parametrium (point B) below 6000ra0 yielded 20/63 (34.9%) failure compared to 10/49(20.4%) failure with dose over 6000rad. Poor survival group of age were between 40-49 years with failure of 14/41(34.1%). There was no increased failure rate below age of 40 with failure of 2111(13.9%). The results suggest that survival is as good as other published data, and that higher doses over 8000rad to point A and 6000rad to point B should be delivered.

시험관내의 인체폐암 세포 A549의 방사선 및 5-Fluorouracil 에 대한 효과

이명자(Myung Za Lee),전하정(Ha Chong Chun),이원영(Won Young Lee) 대한방사선종양학회 1989 Radiation Oncology Journal Vol.7 No.1

Effects of ionizing radiation alone and combined with chemotherapy on tumor growth and it’s clonal specificity monitored by changes in distribution of chromosome number were studies in A549 cell line originated from human adenocarcinoma of the lung. Radiation (300 rad, 600 rad and 900 rad) were delivered with or without 5-FU. Forty eight hours later, 57.5% of growth inhibition of cell was Seen in cells treated with 5-FU concentration of 0.47μg/ml for 24 hr exposure. Cell survival carves after radiation with and without 5-FU were made. Chromosomal analysis of cells in metaphase in control, and in cells treated with 300 rad of radiation, or 0.47μg/ml of 5-FU treatment, and combined treatment of both were to examine the changes in ploidy and number of chromosome. Radiation combined with 5-FU enhanced growth inhibition of A549 cells. However, no evidence of synergegic effects in growth inhibition was observed in the cells treated with the combination therapy. Pattern of chromosomal distribution of survived cells were shifted from hyperploidy to hypoploidy by single dose of radiation(300 rad). As radiation dose increased a large number of hypoploidy cells were observed. Following treatment of cells with 5-FU, chomosomal distribution of survived cells were also shifted to hypodiploidy, which were seen in cells treated with radiation. The cell treated with 5-FU and followed by radiation within 24 hrs had cell with increased number of hypodiploidy cells. Almost same type of chromosomal changes were reproduced in cells treated with combined treatment with radiation and 5-FU. Minor differences were that cells with fewer number of chromosome were more frequent in cells treated with combined therapy. Further increase in cells of hypoploidy(93%) having 1∼10 chromosome were induced by additional radiation. Therefore, the enhanced therapeutic effect of 5-FU combined with radiation of A549 cells appeared to be additive rather than synergistic.

비인강암의 방사선치료 성적

이명자(Myung Za Lee),전하정(Ha Chung Chun) 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.4

목 적: 비인강암 환자에서 방사선 치료 후 재발 양상, 생존율 및 생존율에 미치는 예후인자를 분석 평가하기 위해 후향적으로 분석을 하였다. 대상 및 방법 :1984년 1월부터 2000년 6월까지 한양대학병원 치료방사선과에서 방사선치료를 위해 의뢰된 비인강암 49명을 대상으로 후향적 분석을 하였다. 추적기간은 평균 76개월이었고 최소 2년 6개월이었다. 연령분포는 17세부터 78세였고 중앙연령은 52세였다. 조직병리상 편평상피세포암이 21예, 미분화암이 25예,샘모양낭암 종이 3예였다. 미국암합동위원회의 1997년 개정판으로 재분류한 병기로 T1 14예, T2 24예, T3 3예, T4 8예였다. N0 17예, N1 15예, N2 4예, N3 13예였다. 병기군별은 stage I,IIa, IIb, III, IVa IVb가 각각 4예, 7예, 12예, 5예, 8예, 13예였다.방사선은 원발병소나 임파선전이부위에 58˜ 70 Gy를 조사 시행하였다. 결 과: 5년 생존율 및 10년 생존율은 각각 54.5% 및 47%였다. 5년 무병 생존율 및 10년 무병생존율은 가각 55.7% 및 45.3%였다. 병기별로 100%,IIa 80%, IIb 59.5%,III 40%, IV 42.2%의 5년 생존율을 보였다.총 23예의 재발을 보였고 10예(20.4%)에서 국소 재발, 4예(8.2%)에서 임파선 재발, 10예(20.4%)에서 원격전이가 있었다.병기에 따른 국소 재발률은 T1 2예(4.3%), T2 3예(12.5%), T4 5예(62.6%)로 T병기가 높을수록 재발률이 높았다. 원격전이는 N2-3환자에서 많았다(41.2%). 국소 재발시기는 50%가 2년 이내였고 원격 전이시기는 70%에서 2년 이내였다.예후로는 여성, 젊은 연령,조기T병기 및 조기 전체적인 병기 및 미분화 세포가 생존율이 높았으며 그 중 조기 T병기 및 전체적인 병기가 통계적인 유의성이 있었다. 결 론: 비인강암의 방사선치료결과는 국소 재발률은 T4 병기에 높고 원격전이는 2˜3병기에 현저히 높음을 알 수 있었다. 국소재발을 낮추기 위 해 특히 T4에서 좀더 많은 양의 방사선이 요구 되며 방사선량을 높이기 위해 삼차원적인 치료계획을 이용한 입체조형 방사선 치료나 세기조절 방사선 치료 등이 필요하리라 생각되며 임파선전이 환자에서 보다 효과적인 항암제와 방사선의 병용요법의 개발이 필요하리라 생각된다. Purpose: To evaluate the results of radiation management on recurrence, survival and prognostic factors of patients with nasopharyngeal cancer. Materials and Methods: Forty-nine patients, treated for nasopharyngeal cancer by radiotherapy between January 1984 and June 2000, were retrospectively studied. All patients were followed up for at least 2.5 years. Their median age was 52 years (range 17 78). The histological types were 21 squamous cell carcinoma, 25 undifferentiated carcinoma, and 3 adenoid cystic carcinoma. The tumor stages were as follows: T1 in 14 patients, T2 in 24, T3 in 3, and T4 in 8, and N0 in 1 7 patients, N1 in 15, N2 in 4 and N3 in 13. Stages I, IIa, IIb ,III, IV and IVb were 4, 7, 12, 5, 8, and 13 patients respectively. Radiation doses of 58 70 Gy (median 68.7 Gy) were given to the nasopahryngeal and involved lymphatic areas and of 46 50 Gy to the uninvolved neck areas. Results: The overall 5 and 10-year actuarial and disease free survival rates were 54.53% and 47%, and 55.7% and 45.3%, respectively. The overall five-year survival rates were 100% in stage I, 80% in stage IIa, 59.5% in stage IIIb, 40% in stage III, and 42.2% in stage IV tumors. Twenty-three patients failed either loco-regionally or distantly. Incidences of local failure, regional failure and distant metastasis for the first failure were 20.4%, 8.2% and 20.4%, respectively. Local recurrences were 4.3% in T1, 12. 5% in T2, 0% in T3, and 62.5% in T4 lesions. Distant metastasis was seen in 41.2% of N2-3 lesions. Fifty percent o f local recurrence appeared within 2 years of treatment at the primary lesion, whereas 70% of distant metastasis appeared within 2 years following treatment. Young age, female, early T stage, N0 stage, and poorly differentiated carcinoma were all related with good survival. However only stage showed statistically significance. Conclusion: Based on the results of this study, radiation therapy to nasopharyngeal cancer showed high local recurrence in T4 and increased metastasis in N2-3 lesions. To improve local failure, further radiation doses,such as stereotactic radiation or IMRT radiation, are necessary especially in T4 lesions. The high incidence of distant metastasis in positive lymph node patients, indicates that combined radiation and effective chemotherapeutic agents with appropriated schedule are necessary.

소아의 후두와 수아종에 대한 임상적 고찰

박철완,김광명,오석전,김남규,정환영,이항,이승노,이명자 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.4

The author analyzed 15 children with medulloblastoma confirmed histopathologically at the Department of Neurosurgery of the Hanyang University Hospital from Jan. 1981 to Jan. 1989. The results were as followings : 1) The mean age of incidence was 9.3 years and male to female ratio was 2 : 1. 2) The most common symptoms were those of increased intracranial pressure noted in all cases(100.0%), cerebellar symptoms and signs in 7 cases(46.7%) and the brain stem symptoms and signs in 2 cases(13.3%). The symptom duration varied from 7 to 180 days with a mean of 60 days. 3) In the majority of patients(12 cases, 80.0%), tumor was located in the midline on the computed tomographic scanning of the brain and as less typical features of the medulloblastoma, calcification and cystic or necrotic zone within the tumor mass occurred in 5 cases(33.3%) and in 6 cases(40.0%) respectively, suggesting higher frequency than observed in other articles. 4) The tumors with calcification within tumor mass were larger in size and presented with longer symptom duration than those without calcification. And tumors with cystic or necrotic zone within tumor mass were larger in size and presented with shorter symptom duration than those without such lesions. 5) Among 8 cases managed with various degree of surgical resections and full doses of postoperative radiotherapy, spinal metastasis occurred in 1 case(12.5%) at 26 months after the operation. 6) In conclusion, aggressive therapeutic approach with combined modalities, utilizing radical resection of the tumor, scheduled postoperative radiotherapy and chemotherapy, seemed to exert benificial influence on the outcome, with no evidence of disease in 4 out of 6 cases during the follow up period of 8 to 27 months.