만삭 임신과 동반된 역형성 성상세포종 1예

신수경 ( Su Kyong Shin ),서연림 ( Yeon Lim Suh ),최원준 ( Won Jun Choi ),이순애 ( Soon Ae Lee ),이종학 ( Jong Hak Lee ),백원영 ( Won Young Paik ) 대한주산의학회 2002 大韓周産醫學會雜誌 Vol.13 No.3

일반적으로 성상세포종은 주로 20~40대에 나타나는 종양으로 두개강내 종양의 약 12%를 차지하나 악성이며 예후가 불량한 역형성 성상세포종은 흔하지 않다. 임신과 동반되는 성상세포종은 매우 드문 것으로 알려져 있어 국내외적으로 보고된 예가 매우 드물다. 저자들은 임신 34주 4일의 산모에서 좌측 전두엽 역형성 성상세포종을 진단하였으며 임신 38주 1일에 제왕절개 분만을 하였고 분만 후 2개월째에 부분 종양절제술을 시행하고 방사선 치료와 항암 치료를 시행한 1예를 경험하였기에 보고하는 바이다. Intracranial astrocytoma is often discovered in third-fifth decade and occupies about 12% of the intracranial tumor patients. The concurrence of tumors of the brain and pregnancy is uncommon, moreover, astrocytoma of the brain in term pregnancy is very rare. Generally, astrocytoma is divided into six subgroups. Among them anaplastic astrocytoma is thought to be a malignant brain tumor. In the management of patients with brain tumor complicating pregnancy, judgments with regard to the optimal time for neurologic studies and operation and the mode of delivery are frequently difficult and occasionally controversial. We experienced a case of anaplastic astrocytoma of left frontal lobe, which was diagnosed by MR imaging at the third trimester of pregnancy. We report the case with a brief review of literature.

악성 성상세포종 및 교모세포종의 적정 방사선 조사 영역에 대한 고찰

조흥래(Heunglae Cho),최영민(Youngmin Choi) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.3

목적 : 본 연구의 목적은 악성 성상세포종 및 교모세포종 환자들의 방사선 치료 시 가장 적절한 조사 영역을 알아 보고자 시행하였다. 대상 및 방법 : 1994년 1월부터 2000년 3월까지 악성 성상세포종 및 교모세포종으로 진단되어 수술 및 방사선 치료를 받은 후 MRI로 추적관찰이 시행된 환자 중 재발이 확인된 21 명을 대상으로 분석하였다. 원발 병소 바깥 경계에서부터 처음 재발이 확인된 병소까지의 거리를 측정하였다. 그 외에 종양의 크기, 부종의 정도, 수술 절제의 범위, 감마나이프를 이용한 정위방사선수술, 다발성 병변 등이 재발 양상에 미치는 영향에 대하여 분석을 하였다. 결과 : 총 21명 중 18명(86%)이 2 cm 이내에서 재발을 하였다. 이들 중 1 cm 이내가 12명, 1 ~ 2 cm 사이의 재발이 6명이었다. 나머지 3명의 재발은 3 cm, 4 cm, 5 cm, 떨어져서 각각 재발을 하였다. 2 cm 이상 떨어져 재발한 3명은 모두 다발성 병변이 있는 환자였다. 종양의 크기, 부종의 범위, 수술 절제의 범위, 감마나이프 시행 유무에 따른 재발의 양상에 차이가 없었다. 다만 다발성 병변일 경우 더 멀리서 재발하는 경향을 보였다. 결론 : 악성 성상세포종 및 교모세포종에서 재발 양상은 원발 병소 준위의 2 cm 이내 재발이 주 재발 양상이었다. 방사선 조사영역의 넓이는 부종의 범위나, 병소의 크기, 감마 나이프 수술 등에 따라 더 넓힐 필요는 없는 것으로 판단된다. 그러나 다발성 병변의 경우에는 단일 병소보다 더 넓은 조사 범위가 필요할 것으로 생각된다. Purpose : This study was peformed to determine the optimal radiation therapy field for the treatment of malignant astrocytoma and glioblastoma multiforme. Materials and Methods : From Jan. 1994 to Mar. 2000, 21 patients with malignant astrocytoma and glioblastoma multiforme, confirmed as recurrent by follow up MRI after surgery and radiation therapy, were analyzed. The distance from the margin of the primary lesion to the recurrent lesion was measured. The following factors were analyzed to Investigate the influence of these factors to recurrence pattern tumor size, degree of edema, surgical extent, gamma knife radiosurgery and multiple lesions. Results : Among the 21 patients, 18 (86%) were recurred within 2 cm from the primary lesion site. 12 within 1 cm, 6 between 1 and 2 cm. The other 3 patients all with multiple lesions, were recurred at 3, 4, 5 cm, from the primary lesion site. The recurrence pattern was not influenced by the factors of tumor size, extent of edema, surgical extent, or gamma knife radiosurgery. However, patients with multiple lesions showed a tendency of recurrence at sites further from the primary lesion. Conclusions : Most (86%) of the recurrences of malignant astrocytoma and glioblastoma multiforme occurred within 2 cm from the primary lesion site. The width of treatment field does not need to be changed according to tumor size, degree of edema, surgical extent, or gamma knife radiosurgery. However, the treatment field for multiple lesions appears to be wider than that for a single lesion.

유아의 결합조직형성 대뇌 성상세포종

김경범,허재택,송영진,허해경,나서희,정진숙,최순섭 대한신경외과학회 1998 Journal of Korean neurosurgical society Vol.27 No.12

Radiotherapy for the Low-grade Astrocytomas

김대용(Dae Yong Kim),김일한(Il Han Kim),지제근(Je Geun Chi) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.1

목적 : 양성 성상세포종에 대한 방사선치료의 효과를 평가하고 방사선치료 결과에 지대한 영향을 미치는 인자를 규명한다. 방법 : 1979년 부터 1990년 까지 서울대학교병원에서 개두술(36예) 또는 조직생검(10예) 등을 통하여 양성 성상세포종임을 확인한 후 방사선치료를 시행한 46명의 치료성적을 분석하였다. 20명의 세계보건기구에서 설정한 조직 문화도 Ⅰ등급이었고 26명은 Ⅱ등급이었다. 방사선치료는 통상적 분할치료법에 따랐으며 총방사선량은 45 내지 60Gy(중앙값 54Gy)이었다. 추적관찰기간의 중앙값은 60개월이었다. 결과 : 전체환자 46명의 2년 및 5년 생존율은 80% 및 72% 이었고, 2년 및 5년 무진행 생존율은 75% 및 63%이었다. 조직학적 분화도가 유의성이 가장 큰 예후 인자임을 확인되었으며 조직학적 유형과 운동수행능력 또한 생존율에 영향을 미침을 확인하였다. 방사선 치료에 따른 중증의 합병증은 발생하지 않았다. 결론 : 생존율은 양호하였으나 치료 실패의 주요소는 국소적 종야치유 실패였다. 확인된 3종의 양호한 예후인자와 아울러 연령 및 수술적 절제범위 등도 향후 치료방침 결정시 고려되어야 할 것이다. Purpose : To evaluate the efficacy of radiotherapy for the low-grade astrocytomas and confirm the variables influencing treatment results. Materials and Methods : Forty-six patients with low-grade astrocytoma received radiotherapy after surgical removal (36 patients) or biopsy (10 patients) from 1979 to 1980. Twenty patients had grade Ⅰ Histology and 26 had grade Ⅱ. External radiotherapy was done by conventional schedule with the total dose of 45 to 60 Gy(median : 54Gy). The median follow-up period was 5 years. Results : The 2-and 5-year survival rates were 80% and 72%, respectively and the 2-and 5-year progression-free survival was 75% and 63% respectively. The survival was influenced significantly by the histologic grade, the histologic type and performance status. Major complication was not found. Conclusion : In spite of good survival, the local failure was still the major problem. Age and the extent of surgery as well as three favorable factors should be considered in the future treatments.

External Beam Radiotherapy in the Management of Low Grade Astrocytoma of the Brain

전하정 대한방사선종양학회 2009 Radiation Oncology Journal Vol.27 No.1

Purpose: This study was designed to evaluate the effectiveness of postoperative radiotherapy for patients with low-grade astrocytomas and to define an optimal radiotherapeutic regimen and prognostic factors. Materials and Methods: A total of 69 patients with low-grade astrocytomas underwent surgery and postoperative radiotherapy immediately following surgery at our institution between October 1989 and September 2006. The median patient age was 36 years. Forty-one patients were 40 years or younger and 28 patients were 41 years or older. Fourteen patients underwent a biopsy alone and the remaining 55 patients underwent a subtotal resection. Thirty-nine patients had a Karnofsky performance status of less than 80% and 30 patients had a Karnofsky performance status greater than 80%. Two patients were treated with whole brain irradiation followed by a coned down boost field to the localized area. The remaining 67 patients were treated with a localized field with an appropriate margin. Most of the patients received a dose of 50∼55 Gy and majority of the patients were treated with a dose of 54 Gy. Results: The overall 5-year and 7-year survival rates for all of the 69 patients were 49% and 44%, respectively. Corresponding disease free survival rates were 45% and 40%, respectively. Patients who underwent a subtotal resection showed better survival than patients who underwent a biopsy alone. The overall 5-year survival rates for patients who underwent a subtotal resection and patients who underwent a biopsy alone were 57% and 38%, respectively (p<0.05). Forty-one patients who were 40 years or younger showed a better overall 5-year survival rate as compared with 28 patients who were 41 years or older (56% versus 40%, p<0.05). The overall 5-year survival rates for 30 patients with a Karnofsky performance status greater than 80% and 39 patients with a Karnofsky performance status less than 80% were 51% and 47%, respectively. This finding was not statistically significant. Although one patient was not able to complete the treatment because of neurological deterioration, there were no significant treatment related toxicities. Conclusion: Postoperative radiotherapy following surgery is a safe and effective treatment for patients with low-grade astrocytomas. The extent of surgery and age were noted as significant prognostic factors in this study. However, further effective treatment might be necessary in the future to improve long-term survival rates.