항암제 부작용에 대한 적절한 대처법 = Optimal Management of Chemotherapy-related Adverse Events

국문 초록 (Abstract)

본고에서는 췌장암, 담낭 및 담도암에서 흔히 사용되는 항암치료와 관련된 골수기능억제, 오심 및 구토, 설사 및 신경병증에 대하여 설명하고 이에 대한 치료를 설명하였다. 골수기능억제는 질병의 정도, 저혈압의 발생 여부, 만성 폐쇄성 폐질환의 유무, 이전에 곰팡이 감염 유무, 정맥영양 필요 여부, 호중구 감소성 발열의 발생시점과 환자의 연령에 따라 예후가 많이 달라진다. 특히 호중구 감소성 발열에서는 G-CSF의 사용을 권하며, 호중구 감소만 있는 경우에는 G-CSF를 환자의 상태에 따라 사용해야 한다. 호중구 감소가 장기간 지속되는 경우에는 pegylated G-CSF가 도움이 된다. 오심 및 구토는 급성 구토(acute emesis), 지연 구토(delayed emesis), 예측 구토(anticipatory emesis)로 NK1R antagonists, serotonin (5-HT3) receptor antagonists, glucocorticoid, metoclopramide, olanzapine, benzodiazepine 등이 사용된다. 중등도 위험군과 고위험군 항암제를 사용한 경우의 구토 예방 및 치료에서는 많은 다양한 방법들이 사용되지만 대부분 5-HT3 receptor antatonist를 단독요법으로 우선 사용해보는 것이 좋겠다. 한편, 저위험군 항암 치료 후 발생하는 구토의 경우에는 우선 스테로이드 단독요법을 사용하고, 예방치료에도 불구하고 구토가 발생한 경우에는 다음 치료일부터 중등도 위험군에 준하여 5-HT3 receptor antatonist를 단독요법으로 시행해볼 수 있다. 합병증이 동반되지 않은 1-2등급의 경한 설사의 경우에는 입원 필요 없이 장에 부담이 적은 BRAT 식단, 충분한 수분 섭취와 loperamide를 사용하는 지사요법이 도움이 되며, 합병증이 동반된 설사의 경우에는 보다 적극적으로 설사를 조절해야 한다. 암 생존자가 많아지면서 말초신경병증은 삶의 질 측면에서 심각한 영향을 미치는 부작용으로 항경련제, 항우울제, amifostine, nimodipine, vitamins, minerals, 식이보충제 등을 사용하더라도 효과가 없고, 운동 요법은 예방에서 효과가 있고, 증상완화에도 도움이 되며 duloxetine은 통증이 심한 말초신경병증에서 효과적이다.

다국어 초록 (Multilingual Abstract)

This review article deals with the optimal management of chemotherapy-related adverse events which are the nausea, vomiting, diarrhea, neutropenia, peripheral polyneuropathy. Recent literatures are reviewed and pathogenetic mechanism and management of each of adverse events are summarized. It is not simple but complexed and wide. Most patients could be expected how much they feel the nausea before the chemotherapy. We could prescribe several types of antiemetic agent efficiently. When the patients suffered from the neutropenia after previous chemotherapy, we should closely monitor their blood cell count. And we could help them after giving the granulocyte colony stimulating factor. Diarrhea is one of big troublesome issue related with chemotherapy. We could control the diarrhea by reducing the dose of the chemotherapy and prescribing optimally loperamide. Cisplatin and oxaliplatin could make the patients feel paresthesia and numbness but it’s hard to reverse or prevent even though we use anticonvulsants (carbamazepine, oxcarbazepine), antidepressants (amitriptyline, venlafaxine), amifostine, nimodipine, vitamins and minerals.

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