Radiation Oncology Journal

  • 제20권4호
  • /
  • Pages.295-302
  • /
  • 2002
  • /
  • 2234-1900(pISSN)
  • /
  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
권호 표지

조기 성문암 환자에서의 방사선치료

Radiotherapy for Early Glottic Carinoma

  • 김원택 (부산대학교 의과대학 방사선종양학교실) ;
  • 남지호 (부산대학교 의과대학 방사선종양학교실) ;
  • 권병현 (부산대학교 의과대학 방사선종양학교실) ;
  • 왕수건 (부산대학교 의과대학 이비인후과학교실) ;
  • 김동원 (부산대학교 의과대학 방사선종양학교실)
  • Kim, Won-Taek (Departments of Radiation Oncology, Pusan National University) ;
  • Nam, Ji-Ho (Departments of Radiation Oncology, Pusan National University) ;
  • Kyuon, Byung-Hyun (Departments of Radiation Oncology, Pusan National University) ;
  • Wang, Su-Gun (Departments of Otolaryngology, College of Medicine, Pusan National University) ;
  • Kim, Dong-Won (Departments of Radiation Oncology, Pusan National University)
  • 발행 : 2002.12.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

목적 : 조기 성문암(T1-2N0M0) 환자들에 대한 일차적인 치료로서의 방사선치료의 역할과 치료결과에 영향을 미치는 예후인자들에 대한 분석을 통해 향후 치료방침을 세우는데 자료로 삼고자 연구를 시행하였다. 대상 및 방법 : 1987년 8월부터 1996년 12월까지 부산대학교병원 치료방사선과에서 조기 성문암으로 근치적 방사선 치료를 시행받은 환자 80명을 대상으로 후향적 분석을 시행하였다. T1 병기가 66명$(82.5\%)$, T2 병기가 14명$(17.5\%)$이였으며, 방사선치료는 6 MV X-선을 좌우 대칭조사야로 1일 1회 180 cGy 내지 2n cGy씩 주 5회 총 $ 6,000\~7,560\;cGy$ (중앙값 6,840 cGy)를 조사하였다. 치료기간은 40일에서 87일이었고 중앙값은 51일이었다. 모든 환자에서 최소 3년 이상 추적 조사하였다. 예후인자들에 대한 연구를 위해 T-병기, 종양의 위치, 총방사선량, 분할선량, 조사야의 크기 및 전체 방사선치료기간 등에 대한 단변량 및 다변량분석을 실시하였다. 결과 : 5년 생존율은 전체가 $89.2\%$였고 병기별로는 T1이 $90.2\%$, T2가 $82.5\%$였다. 국소제어율은 전체에서 $81.3\%$였고, T1 병기가 $83.3\%$, T2 병기가 $71.4\%$였으나 구제수술 후의 궁극적 국소제어율은 전체가 $91.3\%,\;T1\;94.5\%,\;T2\;79.4\%$로 $89.2\%$의 증가를 보였다. 음성보존율은 $89.2\%$로 T1과 T2에서 각각 $94.7\%$와 $81.3\%$로 유의한 차이를 보였다. 전체 환자 80명 중 15명에서 치료 후 재발을 보였고 이 중 국소재발(11/15, $73.3\%$)의 빈도가 가장 높았다. 예후 인자로 T-병기와 전체 치료기간이 단변량분석에서 통계적으로 의미를 주었으나 다변량분석에서는 전체 치료기간만이 유의한 인자였다. 결론 : 조기 성문암 환자의 치료에 근치적 방사선치료 및 구제수술의 조합은 높은 국소제어율과 함께 성문의 기능보존이라는 측면에서 효과적인 치료방법이라고 할 수 있으며, 치료결과에 영향을 줄 수 있는 예후인자들에 대해서는 추가적인 연구가 더 필요하겠으나 치료계획 단계에서부터 고려해야할 요소들로 생각된다.

Purpose : The Purpose of this study was to establish general guidelines for the treatment of patients with early glottic carcinoma (T1-2N0M0), by assessing the role of primary radiotherapy and by analyzing the tumor-related and treatment-related factors that have an influence on the treatment results. Materials and Methods : This retrospective study was composed of 80 patients who suffered from early glottic carcinoma and were treated by primary radiotherapy at Pusan National University Hospital, between August 1987 and December 1996. The distribution of patients according to T-stage was 66 for stage T1 and 14 for stage T2. All of the patients were treated with conventional radical radiotherapy using a 6MV photon beams, a total tumor dose of $60\~75.6\;Gy$ (median 68.4 Gy), administered in 5 weekly fractions of $1.8\~2.0\;Gy$. The overall radiation treatment time was from 40 to 87 days, median 51 days. All patients were followed up for at least 3 years. Univariate and multivariate analysis was done to identify the prognostic factors affecting the treatment results. Results : The five-years survival rate was $89.2\%$ for all patients, $90.2\%$ for T1 and $82.5\%$ for T2. The local control rate was $81.3\%$ for all patients, $83.3\%$ for T1 and $71.4\%$ for T2. However, when salvage operations were taken into account, the ultimate local control rate was $91.3\%,\;T1\;94.5\%,\;T2\;79.4\%$, reprosenting an increase of $8\~12\%$ in the local control rate. The voice preservation rate was $89.2\%,\;T1\;94.7\%,\;T2\;81.3\%$. Fifteen patients suffered a relapse after radiotherapy, among whom 12 patients underwent salvage surgery. We included T-stage, tumor location, total radiation dose, fraction size, field size and overall radiation treatment time as potential prognostic factors. T-stage and overall treatment time were found to be statistically significant in the univariate analysis, but in the multivariate analysis, only the over-all treatment time was found to be significant. Conclusion : The high cure and voice preservation rates obtained when using a procedure, comprising a combination of radical radiotherapy and salvage surgery, may make this the treatment of choice for patients with early glottic carcinoma. However, the prognostic factors affecting the treatment results must be kept in mind, and more accurate treatment planning and further optimization of the radiation dose are necessary.

키워드

참고문헌

  1. MendenhaII WM, Parsons JT, Stringer SP, et aI. T1-T2 vocal cord carcinoma : A basis for conparing the resuIts of radiotherapy and surgery. Head Neck Surg 1988;10:373-377 https://doi.org/10.1002/hed.2890100603
  2. MendenhaII WM, et aI. Larynx. In Principles and Practice of Radiation Oncology, 2nd ed, Perez CA, Brady LW, Philadelphia, JB Lippincott, 1992, pp740-759
  3. Sessions RB, Harrison LB, Hong WK. Cancer of the Head and Neck. In Cancer : Principles and Practice of Oncology, 4th ed, DeVita VT, Hellman S, Rosenberg SA, Philadelphia, JB Lippincott, 1993, pp631-647
  4. American Joint Committee on Cancer. Manual for staging of cancer. 5th ed. Philadelphia, New York; Lippincott Co, 1997;41-46
  5. Wang CC. Carcinoma of the larynx. In : Wang CC. eds. Radiation Therapy for Head and Neck Neoplasms : Indications, Techniques, and Results. 2nd ed. Chicago, IL : Year Book Medical Publishers, 1990:223-260
  6. MendenhaII WM, Parsons JT, MiIIion RR, et aI. T1-T2 squamous cell carcinoma of the glottic larynx treated with radiation therapy: relationship of dose- fractionation factors to local control and compIicationa. Int J Radiat Oncol Biol Phys 1988;15:1267-1273 https://doi.org/10.1016/0360-3016(88)90220-9
  7. MiIIon RR, Cassis NJ. Management of head and neck cancer; A multidisciplinary approach. 2nd ed. Philadelphial, New York; Lippincontt Co, 1994:461
  8. Marshak GM, Brenner B, Shvero J, et aI. Prognostic factors for local control of early glottic cancer; The Rabin Medical Center retrospective study on 207 patients. Int J Radiat Oncol Biol Phys 1999;43:1009-1013
  9. Kwon BH, Kim DW. Local control after radiation therapy for T1-T2 glottic cacinoma. J Korean Soc Ther Radial Oncol 1994;12:331-336
  10. Kim YH, Chai GY. Radiotherapy of early stage glottic cancer. J Korean Soc Ther Radiol Oncol 1997;15:315-319
  11. Park CI, Shin KH, Park SW, et aI. Prognostic factors for local control and survivial in T1-T2 glottic cancer. J Korean Cancer Assoc 1997;29(6):984-991
  12. Pene F, FIetcher GH. Results in irradiation on the in situ carcinomas of the vocal cords. Cancer 1976;37:2586-2590 https://doi.org/10.1002/1097-0142(197606)37:6<2586::AID-CNCR2820370604>3.0.CO;2-X
  13. Burke LS, Greven KM, McGuirt WT, et aI. Definitive radiotherapy for early glottic carcinoma : prognostic factors and implications for treatment. Int J Radiat Oncol Biol Phys 1997;38:1001-1006 https://doi.org/10.1016/S0360-3016(97)00150-8
  14. Wiernik G, AIcock CJ, FowIer JF, et aI. The predictive value of tumor classification compared with results of the Britiah Institute of Radiology fractionation trial in treatment of laryngopharyngeal carcinoma. Laryngoscope 1990;100:863-872
  15. Ang KK and Peters LJ. Vocal cord cancer : 2B worse than not 2B? Radiother Oncol 1990;18:365-366
  16. Karim AB, KraIendonk JH, Yap LY, et aI. Heterogeneity of stage II glottic carinoma and its therapeutic implicatiocs. Int J Radiat Oncol Biol Phys 1987;13:313-317 https://doi.org/10.1016/0360-3016(87)90004-6
  17. Garden AS, Morrison WH, Ang KK, Peters LJ. Hyperfractionated radiation in the treatment of squamous cell carcinomas of the head and neck : A comparison of two fractionation schedules. Int J Radiat Oncol Biol Phys 1995;31:493-502 https://doi.org/10.1016/0360-3016(94)00334-H
  18. Fein DA, MendenhaII WM, Parsons JT, MiIIon RR. T1-T2 squamous cell carcinoma of the glottic larynx treated with radiotherapy : A muItivariate analysis of variables potentially influencing local control. Int J Radiat Oncol Biol Phys 1993;25:605-611 https://doi.org/10.1016/0360-3016(93)90005-G
  19. Benninger MS, GiIIen J, Thieme P, et aI. Factors associated with recurrence and voice quality following radiation therapy for T1 and T2 glottic carcinoma. Laryngoscope 1994;104:294-298
  20. Shvero J, Hadar T, SegaI K, et aI. T1 glottic carcinoma involving the anterior commissure. Eur J Surg Oncol 1994;20:557-560
  21. Zohar Y, Rahima M, ShviIi Y, et aI. The controversial treatment of anterior commissure carcinoma of the larynx. Laryngoscope 1992;102:69-72
  22. Hirota S, Soejima T, Obayashi K, et aI. Radiotherapy of TI and T2 glottic cancer. Analysis of anterior commissure involvement. Radiat Med 1996;14:297-302
  23. Mentravadi RV, Liebner EJ, Haas RE, et aI. Cancer of the glottis: Prognostic factors in radiation therapy. Raadiology 1983;149:311-314
  24. Sessions DG, Ogura JH, Fried MP. The anterior commissure in glottic carcinoma. Laryngoscope 1975;85:1642-1632
  25. Burke LS, Greven KM, McGuirt WT, et aI. Definitive radiotherapy for early glottic carcinoma : Prognostic factors and implications for treatment. Int J Radiat Oncol Biol Phys 1997;38:37-42 https://doi.org/10.1016/S0360-3016(96)00613-X
  26. Yu E, Shenouda G, Beaudet MP, BIack MJ. Impact of radiation therapy fraction size on local control of early gIottic carcinoma. Int J Radiat Oncol Biol Phys 1997;37:587-691 https://doi.org/10.1016/S0360-3016(96)00578-0
  27. RudoItz MS, Benanunar A, Mohiuddin M. Prognostio factors for local control and survival in T1 squamous cell carcinoma of the glottis. Int J Radiat Oncol Biol Phys 1993;26:767-772 https://doi.org/10.1016/0360-3016(93)90490-M
  28. Wang CC, Efird JT. Does prolonged treatment course adversly affect local control of carcinoma of the larynx? Int J Radiat Oncol Biol Phys 1994;29:657-660
  29. Teshima T, Chatani M, Inoue T. Radiation therapy for early glottic cancer (T1N0M0) : Prospective randomized study concerning radiation field. Int J Radiat Oncol Biol Phys 1990;18:119-123 https://doi.org/10.1016/0360-3016(90)90275-O
  30. Dinshaw KA, Sharma V, AgarwaI JP, Ghosh S, HavaIdar R. Radiation therapy in T1-T2 glottic carcinoma : influence of various treatment parameters on local on local control/complications. Int J Radiat Oncol Biol Phys 2000;48:723-735 https://doi.org/10.1016/S0360-3016(00)00635-0
  31. Fein DA, Lee WR, HanIon AL, Ridge JA, Curran WJ, Coia LR. Do overall treatment time, field size, and treatment energy influence local control of T1-T2 squamous cell carcinomas of the glottic larynx? Int J Radiat Oncol Biol Phys 1996;34:823-31
  32. Parsons JT, Greens BD, SpeerTW, Kirkpatrik SA, Barhorst DB, Yanckowitz T. Treatment of early and moderately advanced vocal cord carcinoma with 6-MV X-rays. Int J Radiat Oncol Biol Phys 2001;50:953-9 https://doi.org/10.1016/S0360-3016(01)01472-9
  33. Lee JH, Machtay M, McKenna MG, et aI. Radiotherapy with 6-megavoltage photons for early glottic carcinoma : potential impact of extension to the posterior vocal cord. Am J Otolaryngol 2001;22:43-54 https://doi.org/10.1053/ajot.2001.20679
  34. SkIadowski K, Tarnawski R, Maciejewski B, Wygoda A, SIosarek K. CIinical radiobiology of glottic T1 squamous cell carcicoma. Int J Radiat Oncol Biol Phys 1999;41:101
  35. Warde P, O'SuIIivan B, Bristow RG, et aI. T1/T2 glottic carcinoma managed by external beam radiotherapy : the influcarcinoma managed by external beam radiotherapy : the influence of pretreatment hemoglobin on local control. Int J Radiat Oncol Biol Phys 1998;41:347
  36. Luscher MS, Pedersen U, Johansen LV. Treatment outcome after laser excision of early glottic squamous cell carcinoma--a Iiterature survey. Acta Oncol 2001;40:796-800 https://doi.org/10.1080/02841860152703409
  37. de Gier HH, Knegt PP, de Boer MF, Meeuwis CA, van der VeIden LA, Kerrebijn JD. CO2-laser treatment ot recurrent glottic carcinoma. Head Neck 2001;23:177-180 https://doi.org/10.1002/1097-0347(200103)23:3<177::AID-HED1015>3.0.CO;2-8
  38. Hinerman RW, MendenhaII WM, Amdur RJ, ViIIaret DB, Robbins KT. Early Iaryngeal cancer. Curr Treat Options Oncol 2002;3:3-9 https://doi.org/10.1007/s11864-002-0036-x
  39. Spector JG, Sessions DG, Chao KS, Hanson JM, Simpson JR, Perez CA. Management of stage ll (T2N0M0) glottic carcinoma by radiotherapy and conservation surgery. Head Neck 1999;21:116-123 https://doi.org/10.1002/(SICI)1097-0347(199903)21:2<116::AID-HED4>3.0.CO;2-8
  40. Bron LP, SoIdati D, Zouhair A, et aI. Treatment of early stage squamous cell carcinoma of the glottic larynx : endoscopic surgery or cricohyoidoepigloffopexy versus radiotherapy. Head Neck 2001;23:823-829 https://doi.org/10.1002/hed.1120
  41. Haugen H, Johansson KA, Mercke C. Hyperfractionatedaccelerated or conventionally fractionated radiotherapy for early glottic cancer. Int J Radiat Oncol Biol Phys 2002;52:109-119 https://doi.org/10.1016/S0360-3016(01)01812-0