무기폐를 동반한 폐암의 방사선 치료

Effect of Radiation Therapy on Atelectasis from Lung Cancer

1981년부터 1989년까지 경희대학 부속병원 치료방사선과에서 무기폐를 동반한 폐암으로 방사선 치료를 받은 환자중, 과거력상 폐절제술, 항암요법, 방사선치료등의 기왕력이 있는 환자를 제외한 42명을 대상으로 치료성적을 분석하였다. 1. 비소세포성 폐암은 $62\%$ (21/34), 소세포성 폐암은 $75\%$ (6/8)에서 각각 무기폐가 방사선 치료 후 재팽창 되었으며, 전체 환자의 $64\%$ (27/42)에서 부분 또는 완전반응(reexpansion)을 나타내었다. 2. 방사선 총선량이 40 Gy (1297 ret) 이하와 40 Gy (1337 ret) 이상인 군에서 반응은 각각 $50\%$ (6/12)와 $70\%$ (21/30)이 었으며, 총선량과 무기폐 반응사이에는 유의한 관계가 있었다(p<0.01). 3. 분할조사선량에 따른 반응율은 소선량($180\~200$ cGy)에서는 $53\%$ (14/22), 대선량(300 cGy)에서는 $65\%$ (13/20)이었다. 4. 이상의 성적으로 보아 무기폐를 동반한 폐암 환자중에서, 특히 수술과 항암요법으로 치료가 곤란하고 조속한 처치를 요하는 비소세포성 폐암에서 방사선 치료의 중요한 역할이 확인되었다.

From January 1981 to December 1989, total 42 patients with atelectasis from lung cancer were treated with radiation therapy at the Department of Therapeutic Radiology in Kyung Hee University Hospital. The reexpansion of atelectasis after radiotherapy of the lung was evaluated retrospectively, utillzing treatment records and follow-up chest radiographs. Of the patients with non-small cell carcinoma of the lung, the response rate was $62\%$ (21/34). Patient with small cell carcinoma showed a $75\%$ (6/8) response rate. There appears to be some evidence of a relationship of total tumor dose versus response of atelectasis; radiation dose over 40 Gy (1337 ret), had a favorable effect on the rate of response compared with that below 40 Gy (1297 ret), $70\%$(21/30) and $50\%$ (6/12), respectively (p<0.01). Total response rate (partial and complete responses) of all patients was $64\%$ (27/42). Franction size was not contributed to the difference of response rates between small fraction ($180\~200$ cGy) and large fraction (300 cGy), $53\%$ (14/22) and $65\%$ (13/20), respectively. The results of this study suggest that radiation therapy has a definite positive role in management of atelectasis caused by lung cancer, especially in inoperable non-small cell carcinoma.