국한성 소세포 폐암의 방사선 및 항암제 병용요법

Abstract

[한글]

폐암의 20-25%를 차지하는 소세포 폐암(small cell lung cancer)은 진단당시 미세전이를 잘하여 항암제요법 및 방사선치료에 민감한 암에도 불구하고 생존율은 극히 저조한 것으로 보고된, 최근 항암제요법 및 방사선치료의 발달로 생존율이 점차 향상되고 있다. 저자는 1975년 1월부터 1986년 12월까지 12년간 연세의대 치료방사선과에 내원하여 시대별로 치료경향에 따라 다양하게 치료하였던 국한성 병기(limited stage) 소세포 폐암 환자

72명을 후향적 분석을 통해 다음과 같은 결과를 얻었다.

1. 연령별 분포는 40세에서 71세로 정중앙 연령(median age)은 55세, 50대 60대가 전체의 86.1%였고, 남녀비는 5:1이었다.

2. 치료군별에 따른 완전관해율은 CV+RT 33.3%, CAV+RT 43.5%, MOCA+RT 28.6%, 그리고 CAV+VP+RT군이 62.5%로 가장 높았고 MOCA+RT군에 비행 통계학적으로 유의한 차이를 보였으나(P=0.02), CV+RT 혹은 CAV+RT군과는 차이가 없었다(P>0.1).

3. 치료군별에 따른 정중앙 생존기간과 5년 생존율은 CV+RT 15.3개월, 16.2%; CAV+RT 14개월, 16.3%: MOCA+RT 7개월, 0% 그리고 CAV+VP+RT 24개월, 30.7%로 CAV+VR+RT군에서 가장 높았고 MOCA+RT군에 비해 통계학적으로 유의한 차이를 보였으나 MOCA+RT군에 비해 통계학적으로 유의한 차이를 보였으나(P<0.05), CV+RT 혹은 CAV+RT군과는 차이가 없었다(P=0.08).

4. 치료에 완전관해를 얻은 환자들의 재발양상은 국소재발 24%, 원격전이 52%, 국소 및 원격 동시재발이 24%였다.

5. 완전관해군에서 방사선량에 따른 국소제어율은 4500-4900cGy의 선량에서 50%, 5000cGy에서 43%인데 비해 5100-7000cGy에서는 100%였다.

6. 예방적전뇌조사의 효과는 시행하지 않았던 군에서 32%의 뇌전이를 보인 반면, 시행군에서는 20%로 상대적으로 낮았으나 유의성은 없었다(p=0.32).

7. 통계학적으로 유의한 예후인자로는 전신적수행도(Performance), TNM병기, 상대정맥 증후군 및 흉막삼출액의 유무, 종양의 위치, 치료에 대한 반응정도 그리고 지속적 화학요법(maintenance chemotherapy)의 시행유무등이었다.

The Treatment Results of Combination of Radiotherapy and Chemothereapy in Limited

Stage Small Cell Lung Cancer

Chang Geol Lee, M.D.

Department of Medical Science, The Graduate School, Yonsei University

(Directed by Professor John Juhn Kyu Loh, M.D.)

A total of 72 patients with limited stage small cell lung cancer treated with

combination of chemotherapy and radiotherapy at department of Radiation Oncology,

Yonsei University College of Medicine between Jan. 1975 and Dec. 1986 were

retrospectively analysed.

1. Age distribution of patients was between forty and seventy-one with median age

fifty-five and male to female ratio was 5:1.

2. Complete response rate by treatment modality was as follows; CV+RT was 33.3%;

CAV+RT, 43.5%; MOCA+RT, 28.6% and CAV+VP+RT was 62.5%. CAV+VP+RT group showed best

result and this was statistically significant to MOCA+RT group (P=0.02) but

insignificant to CV+RT or CAV+RT group(P>0.1).

3. Median survival and 5 year actuarial survival rate by treatment modality were

as follows; CV+RT was 15.3months and 16.2%; CAV+RT, 14months and 16.3%; MOCA+RT,

7month and 0% and CAV+VP+RT was 24month and 30.7% respectively. CAV+VP+RT group

showed the best results and these were statistically significant to MOCA+RT

group(P<0.05) but insignificant to CV+RT group(P>0.05).

4. Patterns of failure in complete response group were as follows; local failure

was 24%; distant failure, 52% and local and distant failure was 24%.

5. Local control rate by radiation dosage in complete response group was as

follows; when total dose of 4500-4900cGy was given, local control rate was 50%;

5000cGy, 43% however when total dose was given between 5100-7000cGy, local control

rate was significantly improved to 100%.

6. The incidences of brain metastsis in PCI(Prophylactin Cradinal Irradiation)

group and control group were 20% and 32% respectively, although this was

statistically insignificant(P=0.32).

7. Statistically significant factors affecting prognosis were performance status,

TNM stage, initial status of presentation of superior vena cava syndrome and

pleural effusion, location of tumor, response status to treatment and whether or

not maintenance chemothereapy is added.

[영문]

A total of 72 patients with limited stage small cell lung cancer treated with combination of chemotherapy and radiotherapy at department of Radiation Oncology, Yonsei University College of Medicine between Jan. 1975 and Dec. 1986 were retrospectively analysed.

1. Age distribution of patients was between forty and seventy-one with median age fifty-five and male to female ratio was 5:1.

2. Complete response rate by treatment modality was as follows; CV+RT was 33.3%; CAV+RT, 43.5%; MOCA+RT, 28.6% and CAV+VP+RT was 62.5%. CAV+VP+RT group showed best result and this was statistically significant to MOCA+RT group (P=0.02) but insignificant to CV+RT or CAV+RT group(P>0.1).

3. Median survival and 5 year actuarial survival rate by treatment modality were as follows; CV+RT was 15.3months and 16.2%; CAV+RT, 14months and 16.3%; MOCA+RT, 7month and 0% and CAV+VP+RT was 24month and 30.7% respectively. CAV+VP+RT group

showed the best results and these were statistically significant to MOCA+RT group(P<0.05) but insignificant to CV+RT group(P>0.05).

4. Patterns of failure in complete response group were as follows; local failure was 24%; distant failure, 52% and local and distant failure was 24%.

5. Local control rate by radiation dosage in complete response group was as follows; when total dose of 4500-4900cGy was given, local control rate was 50%; 5000cGy, 43% however when total dose was given between 5100-7000cGy, local control rate was significantly improved to 100%.

6. The incidences of brain metastsis in PCI(Prophylactin Cradinal Irradiation) group and control group were 20% and 32% respectively, although this was statistically insignificant(P=0.32).

7. Statistically significant factors affecting prognosis were performance status, TNM stage, initial status of presentation of superior vena cava syndrome and pleural effusion, location of tumor, response status to treatment and whether or not maintenance chemothereapy is added.