자궁경부암의 치료에 있어서 항암화학요법의 역할

Abstract

[한글]

자궁경부암의 치료에 있어 항암화학요법은 수술이나 방사선 치료에 부적합한 재발암이나 진행된 암에 국한되어 고식적으로 사용되어왔으나, 최근에는 치료실패율이 높은 예후 인자를 가졌거나 행된 암에서 치료실패율을 감소시키고 무병생존율을 증가시키기위하여

수술이나 방사선치료와 함께 병행요법으로 이용되고 있다.

본 연구는 1977년 6월부터 약 8년간 연세의대 부속 세브란스 병원 산부인과에서 자궁경부암으로 항암화학요법을 단독 또는 방사선치료나 근치건 수술 등과 병행하여 시행했던 총 66예 (재발암17예, Ⅱ기암17예, Ⅲ기암23예, Ⅳ기암6예, I^^B 기암 3예 )를 대상으로

하여 그 치료효과 및 독성을 조사하여 다음과 같은 결과를 얻었다.

1. 항암화학요법을 시행하여 치료반응을 판정할 수 있었던 62예중 완전반응 6예(9.6%), 부분반응 36예(58.1%)로 67.7%에서 치료효과를 보였다.

2. 기왕 방사선치료 및 수술을 받았던 재발암과 이전에 치료를 받은 적이없는 일차암에서 항암화학요법의 효과를 비교해 보면 재발암에서 43.7%의 반응율을 보인반면 일차암에서는 76.1%의 높은 치료반응율을 보였다.

3. 기왕치료력이 없는 Ⅱ기 또는 Ⅲ기암의 일차치료로서 항암화학요법을 받았던 21예에서 3-15개월 추적관찰중 전 예에서 완전 관해를 보였는데 암 파급정도(stage), 병소의 크기, 연령이 동일한 방사선 치료만을 시행했던 대조군 21예에서는 16예(76.1%)만 완전관해

, 부분관해 3예(14.3%), 고정성 질환 1예 (4.8%) 및 진행성 질환 1예 (4.8%)였고, 완전관해를 보였던 16예중 1예는 7개월만에 재발하였다.

4. 병소의 크기가 클수록 항암화학요법의 치료효과는 낮아지는 경향을 보였으며 병소의 크기가 5.0㎝ 이상인 술통형의 병소에서 치료전 항암화학요법을 먼저 시행했을 경우 완전반응율100%로 방사선 치료만 시행한 경우의 55.6%에 비해 치료효과가 좋았다.

5. 자궁경암 근치술후 보조적 항암화학요법을 시행했던 I^^B기암 3예에서 6-16개월 추적관찰중 재발은 없었다.

6. DDP-5FU복합제의 주된 독성으로 오심 및 구토, 탈모증, 과립백혈구 감소등의 골수기능 저하, 신독성 및 간독성 등이 있었으며 이독정 때문에 항암제의 투여가 중단 또는 지연된 경우가 18예 (32.7%)있었지만 대개 임상 증상없이 비정상적인 검사소견을 보였었으

며 치료후 곧 정상으로 회복되었다. 또 항암화학방사선요법을 시행했던 26예중 6예 (23.1%)는 방사선치료도중 백혈구수가 감소하였으나 임상증상은 없었으며 치료를 중단할 정도로 심하지는 않았다.

THE ROLE OF CHEMOTHERAPY IN MANAGEMENT OF CARCINOMA OF THE CERVIX

Dong Hee Choi, M.D.

Department of Medical Science The Graduate School, Yonsei University

(Directed by Professor Tchan Kyu Park, M.D.)

In management of the carcinoma of cervix, the chemotherapy had been used

palliatively for the recurrent and the far advanced cancers that were net amenable

to radiotherapy or surgery.

Recently, in order to prevent or to lewer the treatment failures (recurrent or

persistent cancers) and to improve the disease free survivals of the patients, the

chemotherapy had been tried in combination with radiotherapy or/and surgery as

primary treatment in cases with poor prognostic factors showing high treatment

failure rates and in advanced cancers.

In this study 66 patients with cervical cancer including 17 cases with recurrent

cancers, 3 cases with stage IB, 17 cases with stave Ⅱ, 23 cases with stage Ⅲ and

6 cases with stage Ⅳ, treated with chemotherapy, alone or in combination with

surgery or/and radiotherapy at the Department of Obstetrics and Gynecology, YUMC,

were selected, and the response rates and toxicities were evaluated according to

the therapy.

The results of this study were as follows;

1. In 62 cases the response rates to chemotherapy were evaluated; complete

response was seen in 6 cases (9.6%), and partial response in 30 cases (58.1%), so

the total response rate to the chemotherapy was 67.7%.

2. The response rates to chemotherapy were compared between the previously

irradiated recurrent cancers and the previously untreated primary cancers (stage

Ⅱ, Ⅲ, Ⅳ). The response rate was 43.7% with recurrent cancers, which was lower

than 76.1% of primary cancers.

3. In cases with stage Ⅱ & Ⅲ cancers, the response rate to chemoradiotherapy

was compared to radiotherapy alone (control group). During the 3-L5 months follow

up all of 21 cases who had received chemoradiotherapy showed complete response,

while in the control group, complete responses were seen in 16 cases (76.1%) only,

3 cases (14.3%) of partial response, 1 case (4.8%) of stable disease and 1 case

(7.8%) of progressive disease. In radiotherapy alone group, 1 case showing the

complete response had recurrence of the cancer 7 months after the therapy.

4. In primary cancers, the response rates to chemotherapy seemed to decrease with

increasing size of the lesion, and especially in cases with barrel shaped lesion

with the size of 5.0cm or more complete response was better (100%) in the

chromotherapy prior to radiotherapy than in the radiotherapy alone (55.6%).

5. In 3 cases with stage IB showing poor prognostic histopathologic factors of

high treatment failures, who had adjuvant chemotherapy following curative surgery

(radical abdominal hysterectomy with bilateral pelvic lymph node dissection), no

recurrence was seen during the 6-16 months follow up period.

6. The toxicities of combination chemotherapy of DDP-5 FU in치uded nausea &

vomiting (100%), alopecia (100%), bone marrow depression such as leukopenia

(65.4%), granulocytopenia (63.6%), anemia (45.4%), and thrombocytopenia (5.5%),

renal toxicity (10.9%), hepatotoxicity (38.2%), and hypomagnesemia (20%), therefore

the delay or discontinuation of further chemotherapy was ensued in 18 cases

(32.7%). Mostly they showed abnormal laboratory findings without clinical symptoms

but they fully recovered after the discontinuation or completion of the

chemotherapy. In 26 cases treated with chemoradiotherapy, asymptomatic leukopenia (

< 2000/㎣) was seen in 6 cases (23.1%) during the radiotherapy, but it was not so

severe enough to discontinue the radiotherapy.

[영문]

In management of the carcinoma of cervix, the chemotherapy had been used palliatively for the recurrent and the far advanced cancers that were net amenable to radiotherapy or surgery.

Recently, in order to prevent or to lewer the treatment failures (recurrent or persistent cancers) and to improve the disease free survivals of the patients, the chemotherapy had been tried in combination with radiotherapy or/and surgery as primary treatment in cases with poor prognostic factors showing high treatment failure rates and in advanced cancers.

In this study 66 patients with cervical cancer including 17 cases with recurrent cancers, 3 cases with stage IB, 17 cases with stave Ⅱ, 23 cases with stage Ⅲ and 6 cases with stage Ⅳ, treated with chemotherapy, alone or in combination with

surgery or/and radiotherapy at the Department of Obstetrics and Gynecology, YUMC, were selected, and the response rates and toxicities were evaluated according to the therapy.

The results of this study were as follows;

1. In 62 cases the response rates to chemotherapy were evaluated; complete response was seen in 6 cases (9.6%), and partial response in 30 cases (58.1%), so the total response rate to the chemotherapy was 67.7%.

2. The response rates to chemotherapy were compared between the previously irradiated recurrent cancers and the previously untreated primary cancers (stage Ⅱ, Ⅲ, Ⅳ). The response rate was 43.7% with recurrent cancers, which was lower than 76.1% of primary cancers.

3. In cases with stage Ⅱ & Ⅲ cancers, the response rate to chemoradiotherapy was compared to radiotherapy alone (control group). During the 3-L5 months follow up all of 21 cases who had received chemoradiotherapy showedcomplete response, while in the control group, complete responses were seen in 16 cases (76.1%) only, 3 cases (14.3%) of partial response, 1 case (4.8%) of stable disease and 1 case (7.8%) of progressive disease. In radiotherapy alone group, 1 case showing the complete response had recurrence of the cancer 7 months after the therapy.

4. In primary cancers, the response rates to chemotherapy seemed to decrease with increasing size of the lesion, and especially in cases with barrel shaped lesion with the size of 5.0cm or more complete response was better (100%) in the

chromotherapy prior to radiotherapy than in the radiotherapy alone (55.6%).

5. In 3 cases with stage IB showing poor prognostic histopathologic factors of high treatment failures, who had adjuvant chemotherapy following curative surgery (radical abdominal hysterectomy with bilateral pelvic lymph node dissection), no recurrence was seen during the 6-16 months follow up period.

6. The toxicities of combination chemotherapy of DDP-5 FU in치uded nausea & vomiting (100%), alopecia (100%), bone marrow depression such as leukopenia (65.4%), granulocytopenia (63.6%), anemia (45.4%), and thrombocytopenia (5.5%), renal toxicity (10.9%), hepatotoxicity (38.2%), and hypomagnesemia (20%), therefore the delay or discontinuation of further chemotherapy was ensued in 18 cases (32.7%). Mostly they showed abnormal laboratory findings without clinical symptoms but they fully recovered after the discontinuation or completion of the

chemotherapy. In 26 cases treated with chemoradiotherapy, asymptomatic leukopenia ( < 2000/㎣) was seen in 6 cases (23.1%) during the radiotherapy, but it was not so severe enough to discontinue the radiotherapy.