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High dose versus standard dose radiation therapy with concurrent chemotherapy in esophageal cancer

Other Titles
 식도암에 대한 동시병용 방사선-항암화학요법에서 고선량 방사선 치료와 표준선량 방사선치료의 비교 
Issue Date
Dept. of Medicine/석사
[한글]목적: 식도암 환자에 대한 동시병용 방사선-항암화학요법에서 고선량 방사선 치료의 효과를 알아보고자 하였다. 재료 및 방법: 1996년부터 2007년까지 식도암으로 동시병용 방사선-항암화학요법을 받은 207명의 환자를 대상으로 분석하였다. 207명중 65명은 54 Gy 이하의 방사선을 조사받았으며 (표준선량군), 142 명은 59.4 Gy 이상의 방사선을 조사받았다 (고선량군). 표준선량군과 고선량군의 중앙 방사선 선량은 각각 54 Gy (범위, 45 - 54 Gy) 와 63 Gy (범위, 59.4 -70 Gy) 였다. 5-fluorouracil (5-FU)와 cisplatin이 전체환자의 85%에서 처방되었으며 그 외의 환자에서는 5-FU 단독 항암화학치료가 시행되었다. 국소재발은 다음의 3가지로 분류하였으며, 최종 방사선 조사야 내의 재발은 중심부위 재발 (central recurrence), 최종 방사선 조사야 바깥이지만 초기 방사선 조사야 내의 재발은 경계부위 재발 (marginal recurrence), 그리고 초기 방사선 조사야 외의 재발은 조사야 외 재발 (out-field recurrence)로 정의하였다. 결과: 표준선량군과 고선량군 간에 환자의 나이, 성별, 병리학적 특성에 통계적으로 유의한 차이는 없었다. 그러나 1-2 기의 환자는 표준선량군에서 많은 빈도를 보였다 (41% versus 9%). 모든 환자의 무병 생존율, 생존율은 각각 중앙값 13 개월, 24 개월이었으며 두 군간에 통계적으로 유의한 차이는 관찰되지 않았다. 국소 조절율은 고선량군에서 더 높았다 (75% vs. 64%, p=0.05). 국소 재발의 패턴은 유사하였으며 (central, 44% versus 27%; marginal, 0% versus 6%; outfield 11% versus 8%) 원발병소의 완전 관해율은 고선량군이 더 높았다 (68% versus 33%, p=0.04). 치료와 연관된 만성 합병증은 두 군에서 모두 관찰되지 않았다. 결론: 본 연구에서 고선량군이 향상된 생존율은 보이지 못했지만, 진행된 병기의 환자들이 고선량군에 많았음에도 불구하고 좋은 생존율과 표준선량군보다 더 높은 국소 조절율과 완전 관해율을 보였다. 따라서 본 연구는 향후의 전향적 무작위 임상연구에 지침을 제공할 수 있을 것이다.
[영문]Purpose: Esophageal cancer shows a poor prognosis. In operable patients, esophagectomy or neoadjuvant concurrent chemoradiation therapy (CCRT) followed by surgery is generally accepted. In other patients without distant metastasis, CCRT is the standard treatment. But the optimum radiation dose in the setting of CCRT is controversial. In this study, we investigated the efficacy of higher dose radiotherapy with concurrent chemotherapy for patients with esophageal cancer. Methods and Materials: From January 1996 to July 2007, a total of 207 patients treated with CCRT were analyzed. Of the 207 patients, 65 had received ≤54 Gy (standard dose group) and 142 had received ≥59.4 Gy Gy (high dose group). The median doses in the standard and high dose groups were 54 Gy (range, 45 - 54 Gy) and 63 Gy (range, 59.4 - 70 Gy), respectively. A cone-down technique was used in all patients. The initial field was designed as 5 cm of longitudinal margin from the gross tumor; the boost field was 2 cm of longitudinal margin from the gross tumor. The median dose to the initial field was 36 Gy (range, 30.6 - 41.4 Gy). There was no difference between the two groups. Cisplatin and 5-fluorouracil were administered to 85% of the patients, and the other patients received 5-fluorouracil mono-chemotherapy. Local recurrences within boost field were considered central; those within or outside the initial field were considered marginal or out-field, respectively. Results: There were no significant differences in patients' age, sex, pathology, and histologic grade between the two groups. But Stage I-II patients were higher in the standard group (41% versus 19%). The median disease progression free survival, and overall survival in all patients were 13 months, and 24 months, and no significant differences were found between the two groups. But the 2-year local control rate is significantly higher in the high-dose group (68% vs. 38%, p=0.05). The high-dose group and the standard-dose group showed similar patterns of failure (central, 44% versus 27%; marginal, 0% versus 6%; outfield 11% versus 8%). But complete responses were higher in the high-dose group (68% versus 33%, p=0.04). No significant treatment- related late toxicities were observed. Conclusion: Our data did not show improved survivals in the high-dose group. Despite that, advanced stage patients were higher in the high-dose group, higher dose radiotherapy showed comparable survivals and higher local control rate, and a higher complete response rate. Our results deserve further well-designed investigation into a radiation dose escalation study for esophageal cancer in the setting of CCRT.
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1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 2. Thesis
Yonsei Authors
Suh, Yang Gun(서양권)
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