국소적으로 진행된 자궁경부암에서 동시 항암화학방사선 치료의 독성 비교 = Comparison of Concurrent Chemoradiotherapy Regimen Toxicities in the Treatment of Loco-Regionally Advanced Cervical Cancer

다국어 초록 (Multilingual Abstract)

Objective : Concurrent chemoradiotherapy is the idea where the chemotherapeutic agent acts as a radiosensitizer thus producing a synergistic effect between radiotherapy and chemotherapy. We evaluated the efficacy and toxicity of concurrent chemoradiotherapy (CCRT) in loco-regionally advanced cervical cancer patients. Methods : The medical records were retrospectively reviewed for 24 patients who underwent CCRT (cisplatin 70 mg/m^2 on day 1, 29; 5-FU: 100 mg/m^2 on day 2-5 and 30-33×4 cycles), 26 patients who underwent weekly CCRT (cisplatin: 40 mg/m^2 ×6 weeks) and 62 patients who had underwent radiation therapy alone for loco-regionally advanced cervical cancer at Ajou University Hospital. Toxicity was assessed according to the Gynecologic Oncology Group toxicity criteria. Statistical analysis was performed with chi-squre test. Results : 2 year overall survival rate of patients only treated with RT was 75.0％ (39/52). When this was compaired to CCRT, 83.3％ (20/24) with monthly CCRT and 88.5％ (23/26) with weekly CCRT of 2 year overall survival rates were attained. Recurrence rates were measured 2 years after each therapy done, they were 30.8％ (16/52) with RT, 25.0％ (6/24) with weekly CCRT, and 23.1％ (6/26) monthly CCRT. During CCRT, grade 3 and 4 acute complication rates of nausea/vomiting (20.8％ vs. 3.8％) and leukocytopenia (29.1％ vs. 15.4％) was significantly higher in monthly group compared to weekly group (p<0.05). Weekly group had more patients who completed planned therapy group compared to weekly group (p<0.05). Weekly group had more patients who completed planned therapy compaired to monthly group (70.9％ vs. 84.6％). Conclusion : CCRT improved overall survival rates and disease-free survival rate, but in some cases increased acute toxicity, and it is suggested that CCRT may be advantageous compared to radiation therapy for loco-regionally advanced cervical cancer. Weekly CCRT does not seem to afford distinct advantages in terms of acute toxicities over monthly CCRT, except for possible better patient compliance. Due to small size sample and short duration of follow up, further study of a large group of patients and the long survival rate is necessary.

참고문헌 (Reference)

1 "자궁경부암의 동시 항암화학방사선치료" 32-36,

2 "자궁경부암 환자 1058예의 임상적 분석" 44 : 101-113, 2001

3 "보건복지부: 한국 중앙 암 등록 사업 연례보고서" 한국 중앙 암 등록 본부 2002

4 "a Cisplatin, radiation, and adjuvant hysterectomy for bulky stage IB cervical carcinoma" 340 : 1154-1161, 1999

5 "Weekly paclitaxel/cisplatin with concurrent radiotherapy in patients with locally advanced non-small cell lung cancer: a phase I study" 24 : 113-116, 1997

6 "The influence of sample takers on cellular composition of cervical smears" 30 : 251-257, 1985

7 "Schedule-dependent therapeutic gain from the combination of fractionated irradiation plus c-DDP and 5-FU or plus c-DDP and cyclophosphamide in C3H/Km mouse model systems" 20 : 227-232, 1991

8 "Radiotherapy with of without misonidazole for patients with stage IIIB or IIA squamous cell carcinoma of the uterine cervix preliminary report of a Radiation Therapy Oncology Group randomized trial" 13 : 541-549, 1987

9 "Quality-assurance study of simultaneously sampled, non- correlating cervical cytology and biopsies" 9 (9): 138-144, 1993

10 "Presentation of cervical cancer" 42 : 48-53, 1991

11 "Preoperative prognostic variables and the impact of postoperative adjuvant therapy on the outcomes of stage IB or II cervical carcinoma patients with or with-out pelvic lymph node metastasis:an analysis of 891 cases" 85 : 1537-1546, 1999

12 "Phase I-II trial of preoperative chemoradiation in locally advanced cervical carcinoma" 78 : 324-328, 2000

13 "Pelvic radiation with concurrent chemotherapy compared with pelvic and para-aortic radiation for high-risk cervical cancer" 340 : 1137-1143, 1999

14 "Mechanisms of action and modulation of fluorouracil" 7 : 249-259, 1997

15 "Locally advanced cervical carcinoma:The role of chemoradiation" 21 : 47-53, 1994

16 "Impact of Increasing Papanicolaou Test Sensitivity and Compliance: A Modeled Cost and Outcomes Analysis" 97 (97): 781-788, 2001

17 "Hydroxyurea and radiation therapy in advanced cervical cancer" 120 : 407-412, 1974

18 "False-negative results in cervical cytologic studies" 29 : 1043-1046, 1985

19 "Effect of cis-dichlorodiammine platinum II and X rays on mammalian cell survival" 7 : 929-933, 1981

20 "Concurrent chemotherapy and pelvic radiation therapy compared with pelvic radiation therapy alone as adjuvant therapy after radical surgery in high-risk early-stage cancer of the cervix" 18 : 1606-1613, 2000

21 "Clinical Gynecology Oncology" St. Louis, Mosby 68-72, 2000

22 "Cisplatin in advanced cancer of the cervix. An update" 18 : 11-24, 1991

23 "Chemoradiation for carcinoma of the cervix: Advances and opportunities" 154 : 229-236, 2000

24 "Carboplatin as a radiation sensitizer in locally advanced cervical cancer:a pilot study" 65 : 336-342, 1997

25 "Cancer in developing countries" 44 : 81-90, 1994

26 "Biological basis for the interaction of chemotherapeutic agents and radiation therapy" 55 : 2123-2130, 1985

27 "Analysis of the severe complications of irradiation of carconoma of the cervix:whole pelvis irradiation and intracavitary radium" 9 : 367-371, 1983

28 "A randomized comparison of fluorouracil plus cisplatin versus hydroxyurea as an adjunct to radiation therapy in stages IIB-IIA carcinoma of the cervix with negative para-aortic lymph nodes" 17 : 1339-1348, 1999

29 "A concurrent cisplatin based chemotherapy and radiotherapy for locally advanced cervical cancer" 340 : 1144-1153, 1999