Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy

국문 초록 (Abstract)

목 적: 국소적으로 진행된, 절제 불가능한 췌장암 치료에 있어 고식적 방사선 치료와 비교하여 CyberKnife
(CK)를 이용한 정위 방사선 치료의 생존율 및 급성 독성에 대해 분석하고자 하였다. 대상 및 방법: 2003년 4월부터 2004년 4월까지의, Eastern Cooperative Oncology Group (ECOG) 활동도 3 이하이며 CT 및 PET/CT로 평가하여 원격 전이 없는 국소 진행된 췌장암 환자 19명을 대상으로 하였다. 대상 환자는 점차 방사선량을 증가시키는 방법으로 33 Gy, 36 Gy, 39 Gy를 3분할로 각각 6명, 4명, 9명에서 CK를 이용한 정위 방사선 치료를 시행하였으며, 생존율 및 Radiation Therapeutic Oncology Group (RTOG) acute radiation morbidity criteria에 의한 위장관 독성을 분석하였다. 또한 나이, 성별, ECOG 수행 점수, 항암 치료,우회로 조성술(bypass surgery) 여부, 방사선량, CA19-9, 계획용 표적 체적(planning target volume, PTV), CT상 주위 장기 및 혈관 침범 여부 등을 Log Rank test를 이용하여 예후 인자를 평가하였다.결 과: 본 연구에서 중앙 생존 기간은 11개월, 1년 생존율은 36.8%였다. 추적 조사 기간 중(범위 3∼20개월,
중앙값 10개월) 유의한 위장관 급성 독성은 관찰되지 않았다. 단일 인자 분석에서 계획용 표적 체적만이 유의한 예후 인자로 80 cc 이하인 경우가 80 cc 이상인 경우보다 생존율이 높았으며(p-value＜0.05), 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술, CA19-9 수치, 주위 장기 및 혈관 침범 여부 등에서는 통계적으로 유의한 차이를 보이지 않았다. 다인자 분석에서는 65세 이하인 경우와 PTV 80 cc 이하인 경우에서 생존율이 높았다. 결 론: 고식적 방사선 치료, 고선량 입체조형 방사선 치료(high dose conformal radiation therapy), 수술 중 방사선 치료(intraoperative radiation therapy) 또는 세기 조절 방사선 치료(intensity modulated radiation therapy, IMRT)를 이용한 최근의 결과와 비교하여 CK를 이용한 정위 방사선 치료는 생존율 측면에서 비슷하거나 나은 결과를 보였다. 또한 심각한 부작용은 관찰되지 않았으며 짧은 기간의 치료로 환자에게 편의를 제공할수 있어 결과적으로 삶의 질을 향상시킬 수 있을 것이다. 따라서, 이 새로운 치료 방법은 국소 진행된, 절제불가능한 췌장암 환자에서 심각한 부작용 없는 효과적인 치료가 될 것으로 생각된다. 또한 계획용 표적 체적은 CK 치료의 유용한 예후 인자로 사용될 것이다.

다국어 초록 (Multilingual Abstract)

Purpose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could
improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ≤3 and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up
period (range 3∼20 months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade
3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery,
radiation dose, CA19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV＞80 cc (p-value＜0.05). In multivariate analysis, age younger than 65 years and PTV＞80 cc showed better survival rate.
Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be
superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high
dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity
was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience
and, finally, quality of life would be increased. Consequently, this could be regarded as an effective
novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

목차 (Table of Contents)

• Introduction
• Materials and Methods
• Results
• Discussion

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