Treatment Result in Advanced T3 and T4 Glottic Carcinoma: YUMC Experience

T3, T4병기 성문암의 치료성적

Between January 1980 and September 1988,08 patients with advanced T3 & T4 glottic carcinoma were treated with RT and surgery/RT in the Department of Radiation Oncology, Yonsei Cancer Center and ENT, Yonsei University College of Medicine. The mean age was 60 years old (range 33 to 79 years old). The 34 patients were treated with irradiation alone, and the remaining 34 patients with surgery and irradiation. Initial nodal presentation was $37\% (25/68);\;31\%$ (l1/34) in RT alone group and $41\%$ (14/34) in combined treatment group. The minimum follow-up was 2 years. The local control rate after treatment was $47\%$ in RT alone group and $65\%$ in combined treatment group; $57\%$ for node negative and $27\%$ for node positive patients treated with RT alone; $65\%$ for node negative and $54\%$ for node positive patients treated with combined treatment. The treatment failure was observed in 30 patients; 14 patients for primary local failure, 6 patients for regional nodal failure,5 patients for local and regional failure, 26 patients for primary failure and/or distant metastasis, and 2 patient for regional failure and/or distant metastasis. The overall 5-year suwival rate was $57\%;\;37\%$ in RT alone group and $70\%$ in combined treatment group; $55\%$ for node negative and $20\%$ for node positive patients treated with RT alone; $73\%$ for node negative and $77\%$ for node positive patients treated with combined treatment. In conclusion, the combined treatment groups in the treatment of advanced 73 and 74 glottic cancer showed the better results in local control rates and S-year actuarial survival rates than RT alone group. We suggest that total laryngectomy and postoperative RT in the most patients of advanced glottic cancer were performed. However, in cases of node negative patints, RT alone is prefer as a treatment modality over combined surgery and RT since the treatment results were comparable and furthermore functional preservation could be achieved.

1980년 1월부터 1988년 9월사이에 연세대학병원, 연세암센터 치료방사선과 및 이비인후과에서 치료받았던 68예의 T3, T4병기의 성문암 환자를 대상으로 후향적분석을 하였다. 이 중 34명은 방사선 치료 단독으로 치료하였고 34명은 성문절제술후 방사선치료를 하였으며 이들 환자의 최소 추적기간은 2년이었고 54명 $(79\%)$에서 5년 추적조사가 가능하였다. 치료후 국소관해율은 방사선치료 단독군에서는 $51\%$, 수술 및 수술후 방사선치료군에서는 $79\%$이었고 임파절 음성군에서는$72\%,\;76\%$였으며 임파절 양성군에서는$31\%,\;81\%$이었다. 이들의 치료실패요인은 대부분 국소 국한적 이었고 30명 $(44\%)$에서 관찰되었다. 치료에 따른 5년 생존율은 방사선치료 단독군에서는 $37\%$, 수술 및 수술후 방사선치료군에서는 $76\%$로서 T3, T5병기의 성문암환자에 있어서 수술시 행후 방사선치료를 병용하는 복합요법 이 더 좋은 치료결과를 얻을 수 있음을 알았다. 그러나 임파절 음성군에서는 방사선치료 단독군과 수술 및 수술 후 방사선치료군을 비교해 본 결과 5년 생존율이 $55\%$와 $73\%$로 통계학적으로 유의한 차이를 보이지는 않았다. 따라서 본 저자들은 T3, T4병기의 성문암치료시 수술 및 방사선치료 병용요법이 더 좋은 치료결과 를 얻을 수 있지만 임파절 음성군에서는 기능적인 보존측면에서 방사선치료가 일차적 차료방법으로서 효과적이리라 사료된다.