Radiation-induced Pulmonary Toxicity following Adjuvant Radiotherapy for Breast Cancer

국문 초록 (Abstract)

목 적: 유방암 환자에서 보조적 방사선치료 후 호흡기 증상을 동반한 방사선 폐렴(SRP) 및 방사선학적 폐 독성
(RPT)의 빈도 및 이에 영향을 미치는 예측인자를 알아보고자 하였다. 특히 3차원 방사선계획에서 얻은 선량체적히
스토그람(DVH) 인자와 RTP의 상관관계를 중심으로 분석해보고자 하였다. 대상 및 방법: 2003년 9월부터 2006년 2월까지 171명의 환자가 유방암으로 수술 후 방사선치료를 받았다. 2개의 tangential photon 조사야가 통상적으로 사용되었고, 액와부 림프절 전이 정도에 따라 anterior oblique photon 조사야를 추가하였다. 유방 보존술 후 보조적 방사선치료를 받은 침윤성 유방암 환자에는 전자선을 이용한 boost가 적용되었다. 방사선 치료 후의 정기추적 흉부 단순촬영소견을 흉부방사선전문의와 함께 검토, 분석하였다. RTOG 특성기준 및 modified WHO grading system을 적용하였다. 조사받은 방사선량에 따라 V15, V20, V30 및 mean lung dose (MLD)를 구하되, 동측 폐를 tangential 및 SCL 영역으로 구분하여, 각각의 DVH parameters 즉 V15 TNGT, V20 TNGT, V30 TNGT, MLD TNGT 및 V15 SCL, V20 SCL, V30 SCL, MLD SCL을 구하여 RPT와의 상관관계를 분석하였다. 결 과: 호흡기 증상을 동반한 방사선 폐렴(SRP)이 4예(2.1%)에서 발생하였다(RTOG grade 3가 3예 grade 1이 1예). 나이 흡연여부, 기존폐질환유무, 항암요법, 호르몬치료, regional RT 여부 등은 SRP와 무관하였다. 3-RTP가 시행된 137예 중 13.9%에서 tangential 영역에 RPT가 발생하였다. Regional RT를 받은 59 중 49.2%에서 SCL 영역에 RPT가 발생하였다. Regional RT 유무(p＜0.001), 환자의 나이(p=0.039), V15 TNGT를 제외한 모든 DVH
parameter들이 RPT와 유의한 상관관계를 나타내었다. MLD TNGT는 TNGT 영역의 RPT를, V15 SCL는 SCL 영역의 RPT
를 예측하기에 적합한 것으로 분석되었다. 결 론: 본 연구에서 SRP의 빈도는 매우 낮았다. Regional RT 여부와 환자의 나이, DVH parameter들이 RPT와 유의한 상관관계를 나타내었으며, MLD TNGT는 TNGT 영역에서, V15 SCL는 SCL 영역에서 RPT의 유의한 예측인자였다.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the incidences and potential predictive factors for symptomatic radiation pneumonitis
(SRP) and radiographic pulmonary toxicity (RPT) following adjuvant radiotherapy (RT) for patients with breast
cancer. A particular focus was made to correlate RPT with the dose volume histogram (DVH) parameters
based on three-dimensional RT planning (3D-RTP) data. Materials and Methods: From September 2003 through February 2006, 171 patients with breast cancer were treated with adjuvant RT following breast surgery. A radiation dose of 50.4 Gy was delivered with tangential photon fields on the whole breast or chest wall. A single anterior oblique photon field for supraclavicular (SCL) nodes was added if indicated. Serial follow-up chest radiographs were reviewed by a chest radiologist. Radiation Therapy Oncology Group (RTOG) toxicity criteria were used for grading SRP and a modified World Health Organization (WHO) grading system was used to evaluate RPT. The overall percentage of the ipsilateral lung volume that received ≥15 Gy (V15), 20 Gy (V20), and 30 Gy (V30) and the mean lung dose (MLD) were calculated. We divided the ipsilateral lung into two territories, and defined separate DVH parameters, i.e., V15 TNGT, V20 TNGT, V30 TNGT, MLD TNGT, and V15 SCL, V20 SCL, V 30SCL, MLD SCL to assess the relationship between these parameters and RPT. Results: Four patients (2.1%) developed SRP (three with grade 3 and one with grade 2, respectively). There was no significant association of SRP with clinical parameters such as, age, pre-existing lung disease, smoking, chemotherapy, hormonal therapy and regional RT. When 137 patients treated with 3D-RTP were evaluated, 13.9% developed RPT in the tangent (TNGT) territory and 49.2% of 59 patients with regional RT developed RPT in the SCL territory. Regional RT (p＜0.001) and age (p=0.039) was significantly correlated with RPT. All DVH parameters except for V15 TNGT showed a significant correlation with RPT (p＜0.05). MLDTNGT was a better predictor for RPT for the TNGT territory than V15 SCL for the SCL territory. Conclusion: The incidence of SRP was acceptable with the RT technique that was used. Age and regional RT were significant factors to predict RPT. The DVH parameter was good predictor for RPT for the SCL territory while MLD TNGT was a better predictor for RPT for the TNGT territory.

목차 (Table of Contents)

• Introduction
• Materials and Methods
• Results
• Discussion

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