대동맥주위 림프절 전이를 동반한 자궁경부암에 대한 동시병용 방사선 및 항암화학 요법에 대한 연구 = Concurrent chemoradiation in cervical cancer with para-aortic lymph node involvement

다국어 초록 (Multilingual Abstract)

Objectives This study was undertaken to evaluate the therapeutic results and complications after concurrent chemoradiation treatment of and to investigate the prognostic factors for cervical cancer with para-aortic lymph node involvement. Methods From May 1999 to August 2005, thirty eight patients with cervical cancer, treated by combined platinum base chemotherapy and extended field radiation treatment in tertiary medical center. All patients were diagnosed para-aortic lymphnode involvement with imaging studies. The radiation dose of external beam was 34.2-64.4 Gy to whole pelvis and 32.4-59.4 Gy to para-aortic area. And cisplatin based chemotherapy was done simultaneously. We evaluate the prognostic factors such as stage, inguinal and supraclavicular lymphnode status, and radiation doses. Results Median follow-up period is 34 months(7-85 months). The 3 year overall and disease free survival rates were 63.6% and 56.4%, respectively. There was no case of recurrence after 3 years of treatment. Two patients were omitted the treatment because of Grade III or IV gastroenteral complications; abdominal pain and diarrhea. Grade III or IV hematologic complications were occurred in fifteen patients, but all patients were recovered without serious complications including sepsis. We could not find any significant prognostic factors in this study. Conclusions Concurrent chemoradiation treatment of cervical cancer with para-aortic lymph node involvement is well tolerable and effective treatment for cure.

국문 초록 (Abstract)

목적: 대동맥주위 림프절 전이가 영상 진단에서 확인된 자궁경부암 환자에게 확대조사면 (extended field) 방사
선과 항암화학요법을 동시병용 치료한 의무기록을 참고로, 치료 성적 및 부작용을 알아보고자 하였다.
연구 방법: 1999년 5월부터 2005년 8월까지 대동맥주위 림프절 전이가 동반된 자궁경부암으로 진단받고 확대조
사면 방사선치료와 항암화학 요법을 동시에 시행 받은 환자들 가운데 원격전이가 있는 환자는 제외하고, 쇄골상
부 림프절 및 서혜부 림프절 전이만 있는 경우는 포함하여 38명을 대상으로 하였다. 방사선치료는 외부조사로
골반부에 34.2 ~ 64.4 Gy (중앙값 55.8 Gy), 대동맥 주위에 32.4 ~ 59.4 Gy (중앙값 55.8 Gy)를 시행하고, 고선
량율 강내조사는 6회에 걸쳐 24 Gy를 시행하였다. 항암화학요법은 방사선 치료 기간 동안 Cisplatin을 근간으
로 매주 단독 또는 3 주 간격으로 5-FU와 복합하여 투여하였다. 중앙 추적관찰 기간은 34개월 (7 ~ 85개월)이었
다.
결과: 대상환자의 연령분포는32 ~ 74세 (중앙값 50세)이었고, 진단시 FIGO 병기는 각각 IB 2 명, IIA 5 명,
IIB 23 명, IIIB 6 명, IVA 2명이었다.두 명의 환자에서Grade III 이상의 복통 및 설사가 발생하여 방사선치료
가 중지되었다. 혈액학적 급성합병증으로 Grade III 이상의 빈혈이 2명, 백혈구 감소증이 13 명에서 발생하였
다. 만성합병증은 소장천공 1명, 방광-결장루 1명이 각각 발생하여 개복수술을 시행하였다. 전체 환자의 3년 생
존율은 63.6%이었고, 3년 무병 생존율은 56.4%이었다. 3년 이후에 재발을 보인 경우는 없었다.
결론: 대동맥주위 림프절 전이를 동반한 자궁경부암 환자에서 동시병용 방사선 및 항암화학 요법은 수용할 만
한 합병증과 함께 비교적 우수한 치료성적을 보였다. 대상 환자 수가 적고 추적기간이 짧아 결론을 내리기는 어
렵지만, 대동맥주위 림프절 전이가 있는 경우 근치목적의 동시병용 방사선 및 항암화학 치료를 시행하는 것이
당위성을 가지며, 또한 치료성적 향상을 위한 연구가 필요하다고 사료된다.

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