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남택근,나병식,오윤경 조선대학교 부설 의학연구소 2002 The Medical Journal of Chosun University Vol.27 No.2
Background and Objectives: To evaluate the role of brachytherapy following external radiotherapy by retrospective analysis in view of survival and prognostic factors in esophageal carcinoma. Materials and Methods: From Apr. 1999 to Dec. 2000, a total of 28 patients, who were diagnosed as esophageal carcinoma, were treated by curative external radiotherapy followed by brachytherapy with or without chemotherapy. Eligible primary tumors were located in the thoracic esophagus and lymphatic metastases were restricted to supraclavicular or mediastinal nodes. External radiotherapy was performed by 6 MV or 10 MV X-ray and the range of doses was 50.0 Gy - 59.4 Gy (median; 54.9) to primary tumors. One week later, the intraluminal brachtherapy (IB) was performed by high-dose rate remote controlled afterloader with radioisotope of ^192Ir. Fraction size of IB was 2~5 Gy, twice a week and delivered up to total doses of 3 Gy~ 20 Gy (median; 12). Twenty-one patients were treated by concurrent chemotherapy with the agents of cisplatin and 5-FU. Cisplatin, 75 ㎎/㎡, was given on the first day of weeks 1, 5, 8, 11 and 5-FU, 1,000 ㎎/㎡, was administered as a continuous infusion for the first 4 days of each course. Results: The estimated median survival time was 15 months and 1, 2, 3-year survival rates were 60.7%, 27.5%, 9.2%, respectively. The median survival time (MST) of the patients with stage II (n=9), III (n=17), IVA (n=2) were 20, 15, 5 months, respectively (p=0.68). The MST of the patients with complete response vs partial response were 21 vs 14 months, respectively (p=0.12). The MST of patients younger than 60 years vs older were 22 vs 12 months, respectively (p=0.07). The MST of patients with ECOG performance index 1 vs 2 were 16 vs 10 months, respectively (P=0.06) Tile Mn of patients treated by concurrent chemotherapy vs untreated were 20 vs 12 months, respectively (p=0.07). Four patients (14.3%) suffered massive hematemesis after brachytherapy and one patient with local recurrence salvaged by esophagectomy had mediastinal abscess. Of 21 patients treated by concurrent chemoradiothetapy, one patient had pancytopenia and other two patients had severe leukopenia. Conclusion: This study showed no better outcomes of brachytherapy boost after external radiotherapy than historical results of external radiotherapy alone. Concurrent chemotherapy might have more significant therapeutic role rather than brachytherapy boost and the employment of brachythelapy should be considered with great caution in the treatment of esophageal carcinoma.
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나병식(Byung Sik Nah),남택근(Taek Keun Nam),안성자(Sung Ja Ahn),정웅기(Woong Ki Chung) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2
목 적 : 근치적 목적으로 통상적인 방사선 단독치료 또는 유도화학 방사선 병용요법을 받은 편도암 환자들을 대상으로 생존율과 예후인자를 후향적으로 분석하여 이들 치료방법의 역할을 평가하고자 하였다. 대상 및 방법 : 1985년 11월부터 1993년 12월까지 근치적 목적의 통상적 방사선 치료를 받은 총 34명의 편도암 환자 중 16명은 방사선 단독치료를, 다른 18명은 유도화학 방사선 병용요법으로 치료하였고 유도화학 약제는 cisplatin과 5-fluorouracil 또는 pepleomycin으로 1회에서 3회까지 시행하였다. 방사선 치료는 6MV-X선으로 하루 1.8Gy씩 주 5회 시행하여 원발병소에는 55.0- 86.4Gy(중앙값; 66.6), 경부 임파절 병소에는 55.8-90Gy(중앙값; 69.7)까지 시행하였다. 결 과 : 추적기간은 4-118개월(중앙값; 13.5)이었고 남녀비는 31:3이었고 연령분포는 33-79세(중앙값; 56.5)였다. 전체 환자의 5년 생존율은 32%였다. 병기 Ⅰ+Ⅱ(n=8), Ⅱ(n=13), Ⅲ(n=13)기의 5년 생존율은 각각 47%, 29%, 25%였다(p=0.33). 병기 T2(n=13), T3(n=10), T4(n=7)의 5년 생존율은 각각 38%, 27%, 0%였고, T1환자 4명 중 3명은 25, 45, 53개월 현재 재발 또는 원격전이없이 생존중이며 전체 T병기에서의 생존율의 경향은 유의한 차이가 있었다(p=0.01). 경부 임파절의 전이군(n=20, 59%)과 비전이군(n=14)의 5년 생존율은 각각 32%, 31%였다(p=0.85). 방사선 단독치료군(n=16)과 유도화학 병용요법군(n=18)의 중앙 생존기간은 각각 9.5개월, 24개월이었고 5년 생존율은 각각 22%, 38%였으나 통계적인 유의한 차이는 없었다(p=0.24). 원발암의 주위 조직으로의 침습여부에 따라 침습군(n=21)과 비침습군(n=13)의 5년 생존율은 각각 28%, 38%였다(p=0.62). 방사선 치료기간에 따라 60일 이하군(n=10)과 61일 이상군(n=24)의 5년 생존율은 60%, 18%였다(p=0.027). 현재 생존하고 있는 11명의 환자들은 모두 구강 건조, 발치, 충치, 연하 장애 그리고 하악골 괴사 1례 등 만기 후유증을 호소하였다. 5년생존율에 영향을 미치는 예후인자로서 단일변량 분석으로는 방사선 치료기간의 장단과 원발암의 병기였고, 다변량 분석에서는 방사선 치료기간만이 가장 유의한 인자였다. 전체 환자 중 2명은 진단 당시 동시적 이중 원발암으로서 각각 구개수암, 구강저암이 있었고 다른 3명은 추적기간 17, 33, 36개월째에 이차성 원발암으로서 각각 식도암, 설암, 폐암이 진단되었다. 결 론 : 유도화학방사선 병용요법 또는 통상적인 방사선 단독치료는 일부 소수 초기 병변에서 그 치료적 효과를 볼 수 있었으나 대부분의 진행된 병기에서는 저조한 효과를 보였고 생존자 전원은 심각한 만기 후유증을 호소하여, 결국 국소제어율의 상승과 함께 더 작은 일회 조사량으로 만기 후유증을 최소화하려는 생물학적인 측면을 고려하여 가급적 치료기간을 줄일 수 있는 다분할조사가 시행되어야 할 것이고 이에 대한 전향적인 연구가 필요하다고 생각된다. Purpose : To evaluate the roles of conventional radiotherapy alone or with neoadjuvant chemotherapy for tonsillar carcinomas and any prognostic factors affecting survivals by retrospective analysis. Materials and Methods : Thirty four patients received radical radiotherapy for tonsillar carcinomas from Nov. 1985 to Dec. 1993. Of them, 16 patients were treated by conventional radiotherapy alone and the other 18 patients were received radiotherapy with 1 to 3 cycles of neoadjuvant chemotherapy of cisplatin and 5-fluorouracil or pepleomycin. Radiotherapy was performed by 6MV X-ray with daily fraction of 1.8Gy and the range of primary tumor doses was 55.0-86.4Gy(median 66.6Gy), and that of clinically positive nodal doses was 55.8-90Gy(median 69.7Gy). Results : Overall 5-year actuarial survival rate (5YSR) was 32%. The 5YSRs in stage Ⅰ+Ⅱ (n=8), Ⅲ(n=13) and Ⅳ(n=13) were 47%, 29% and 25%, respectively(p=0.33). The 5YSRs in T2(n=13), T3(n=10) and T4 (n=7) were 38%, 27% and 0%, respectively and 3 of 4 patients of T1 are alive with NED at 25, 45, 53 months respectively with statistical significance of the trend in survivals among the four T-stages(p=0.01), and those of node negative(n=14) vs node positive patients(n=20) were 31% vs 32%, respectively(p=0.85). There was no significant survival difference between radiotherapy alone group and with neoadjuvant chemotherapy group(22% vs. 38%, p=0.24). The 5YSRs of 21 patients of primary tumor extension to adjacent sites and the other 13 patients of tonsillar proper site were 28% and 38%, respectively but the difference was not significant statistically(p=0.62). There was a statistically significant difference in 5YSRs between the groups of the patients who received radiotherapy in less than 61days vs more than 60days(60% vs. 18%, p=0.027). All living patients without any tumor progression(n=11) had suffered from serious late sequelae such as xerostomia, edentia, dental caries and one patient had the osteoradionecrosis of mandible. On univariate analysis, the duration of radiotherapy and T-stage were the significant prognostic factors affecting 5YSR. On multivariate analysis, also the duration of radiotherapy was the only significant prognostic factor(p=0.01). Conclusion : There was no survival difference between the radiotherapy alone and with neoadjuvant chemotherapy groups. Although it was a retrospective study, the role of conventional radiotherapy alone could be effective as the local treatment modality only for the early stage of tonsillar carcinomas. But for the purpose of more improved survivals and better quality of lives of living patients, other altered fractionation such as hyperfractionated radiotherapy with shorter treatment time and smaller fraction size rather than conventional radiotherapy might be beneficial and these prospective studies are needed.
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Nam, Taek-Keun,Nah, Byung-Sik,Choi, Ho-Sun,Chung, Woong-Ki,Ahn, Sung-Ja,Kim, Seok-Mo,Song, Ju-Young,Yoon, Mi-Seon The Korean Cancer Association 2005 Cancer Research and Treatment Vol.37 No.3
<P>To assess tumor regression, as determined by pelvic magnetic resonance imaging (MRI), and evaluate the efficacies and toxicities of the interim brachytherapy (BT) modification method, according to tumor regression during multi-fractionated high-dose-rate (HDR) BT for uterine cervical cancer.</P>
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