Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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High-Dose-Rate Intraluminal Brachytherapy for Biliary Obstruction by Secondary Malignant Biliary Tumors

속발성 담도부 종양에 의한 담도 폐쇄에서 고선량률 관내 근접치료

  • Yoon Won-Sup (Department of Radiation Oncology, College of Medicine, Korea University) ;
  • Kim Tae-Hyun (Department of Radiation Oncology, College of Medicine, Korea University) ;
  • Yang Dae-Sik (Department of Radiation Oncology, College of Medicine, Korea University) ;
  • Choi Myung-Sun (Department of Radiation Oncology, College of Medicine, Korea University) ;
  • Kim Chul-Yong (Department of Radiation Oncology, College of Medicine, Korea University)
  • 윤원섭 (고려대학교 의과대학 방사선종양학교실) ;
  • 김태현 (고려대학교 의과대학 방사선종양학교실) ;
  • 양대식 (고려대학교 의과대학 방사선종양학교실) ;
  • 최명선 (고려대학교 의과대학 방사선종양학교실) ;
  • 김철용 (고려대학교 의과대학 방사선종양학교실)
  • Published : 2003.03.01
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Abstract

Purpose :To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic billary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor Methods and Materials : A retrospective study was performed on 24 patients having undergone HDR-ILB, with PTBD catheter Insertion, be)ween December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-lLB, while slx were treated with HDR-lLB only. The 4otal external beam, and brachytherapy radiations dose were 30$\~$61.2 and 9$\~$30 Gy, with median doses of 50 and 15 Gy, respectively. Results : Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8$\%$ (5 patients), respectively. The median survivals for stomach and gailbladder cancers were 7.8 and 10.2 months, respectively, According to the unlvariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (o=0.0200), with all )he patients surviving more than one year had been Irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangltis due to the radiation therapy Conclusion :An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of 4hose patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-lLB, which is a prognostic factor In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and It could be regarded as a safe treatment.

목적 : 속발성 담도부 종양에 의한 담도 페쇄로 방사선치료를 시행한 환자 중 고선량률 관내 근접치료를 시행한 환자를 대상으로 생존기간, 고식적 치료 효과, 예후인자, 치료에 수반된 부작용을 조사하여 방사선치료의 유용성에 대해 분석하고자 하였다. 대상 및 방법 : 1992년 12월부터 20이년 8월까지 속발성 담도부 종양에 의한 담도 폐쇄가 발생한 24명의 환자를 대상으로 후향적인 연구를 하였다. 환자의 연령은 35세부터 82세(중앙 연령 58.5세)였다. 대상 환자를 원발 종양 부위에 따라 분류해 보면 위암이 12명, 담낭암이 6명, 간암이 3명, 췌장암이 2명, 대장암이 1명이었다. 환자의 중앙 추적조사기간은 7.2개월(3$\~$76개월)이었다. 외부방사선치료는 24명 중 18명에서 시행하였으며 매일 1.8$\~$2.5 Gy씩 주 5회 분할치료를 하였고 30$\~$61.2 Gy (중앙값 50 Gy)의 방사선량이 조사되었다. 고선량률 관내 근접치료는 주당 2회에서 3회를 치료하였고 16명의 환자는 일일분할선량을 3 Gy로, 8명의 환자에서는 분할선량을 2.5 Gy로 하루 2회 시행하는 방법으로 치료하였다. 고선량률 관내 근접치료의 총조사선량은 9$\~$30 Gy (중앙값 15 Gy)이었다. 결과 : 대상 환자 24명 중 22명은 추적기간 중 사망하였다. 환자의 중앙 생존 기간은 7.3개월이었고 6개월 이상 생존한 환자는 13명(54.2$\%$), 1년 이상 생존한 환자는 5명(20.8$\%$)이었다. 단일변량분석에서 1년 이상 생존에 영향을 준 유의한 인자는 총 방사선량50 Gy 이상)(p=0.0200)이었고 다변량분석에서도 총 방사선량(50 ey 이상)(p=0.0337)이 유의성을 보였다. 추적조사 기간 동안 5명의 환자에서 방사선치료로 인한 담도염이 의심되었다. 1명의 환자에서 치료후 7개월에 혈액담즙증(hemobllla)이 발생하였으나 이는 방사선치료에 의한 후기 합병증보다는 종양의 국소적인 진행에 의한 천공으로 생각되었다 결론 : 담도의 배액술을 시행한 후 고선량률 관내 근접치료를 시행할 경우 기존의 배액술만 시행한 환자에 비해생존기간의 연장이 기대되었고 고선량률 관내 근접치료를 외부방사선치료에 추가할 경우 추가 방사선량은 효과적으로 조사할 수 있었고 예후인자인 총 방사선량을 늘릴 수 있었다. 외부방사선치료 및 고선량률 관내 근접치료에 따른 부작용은 대증 요법에 의해 효과적으로 조절되어 안전한 치료였다

Keywords

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