국소 진행된 두경부암 환자의 방사선치료 후 갑상샘기능저하증 = Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer

다국어 초록 (Multilingual Abstract)

Purpose: The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection.
Materials and Methods: From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months.
Results: The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis.
Conclusion: Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patientsespecially with the risk factor of neck node dissection.

국문 초록 (Abstract)

목 적: 국소 진행된 두경부암 환자에서 방사선치료를 포함한 근치적 치료 후 갑상샘기능저하증의 발생률을 분석하고자 후향적 연구를 실시하였다.
대상 및 방법: 2000년 1월부터 2005년 12월까지 본원에서 국소 진행된 두경부암으로 진단받고 근치적 목적으로 방사선치료 단독 또는 수술 후 방사선치료를 받은 환자 중 수술로 갑상샘을 절제하지 않았고, 방사선치료 전 갑상샘 기능이 정상이며, 하부 경부림프절이 방사선치료 범위에 포함된 115명의 환자를 대상으로 본 연구를 시행하였다. 환자의 중앙연령은 59세(28∼85세)이고 남자 73명, 여자 42명이었다. 원발병소의 위치는 구강, 구인두, 하인두, 후두, 그 외가 각각 18, 40, 28, 22, 7명이었으며, 편측 경부절제술을 받은 환자가 19명(16.5%), 양측 경부절제술을 받은 환자가 18명(15.7%), 방사선치료만을 시행한 환자가 78명(67.8%)이었다. 방사선치료는 6-MV X-ray를 사용하였으며, 통상 분할 조사법에 의해 하루 1.8∼2 Gy 씩, 주 5회 조사하였다. 원발병소에 조사된 방사선량은 중앙값 70.2 Gy (59.4∼79.4 Gy)이었으며, 하부 경부림프절에 조사된 방사선량은 중앙값 50.0 Gy (44.0∼66.0 Gy)이었다. 추적관찰기간은 2∼91개월이었으며, 중앙값은 29개월이었다.
결 과: 전체 115명 환자 중에서 38명(33.0%)의 환자에서 갑상샘기능저하증이 관찰되었다. 전체 환자의 1년, 3년의 갑상샘기능저하증 발생률은 각각 28.7% (33명), 33.0% (38명)이었으며, 갑상샘기능저하증 발생시기의 중앙값은 8.5개월(0∼36개월)이다. 갑상샘기능저하증 발생에 영향을 주는 인자로 단변량분석결과 경부절제술 여부가 위험인자로 분석되었으나, 다변량분석에서는 통계적으로 유의한 관련 인자는 없었다.
결 론: 두경부 종양환자의 방사선치료를 포함한 근치적 치료 후 갑상샘기능저하증이 발생할 수 있으며, 대부분이 1년 이내 발생하므로 치료 후 갑상샘기능검사를 정기적으로 실시할 필요가 있다. 특히 경부 림프절제술 후 방사선치료를 시행하는 경우 더욱 주의하여 갑상샘기능저하증의 발생을 확인해야 한다.

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