Radiation Oncology Journal

  • 제28권2호
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  • Pages.71-78
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  • 2010
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  • 2234-1900(pISSN)
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  • 2234-3156(eISSN)
대한방사선종양학회 (The Korean Society for Radiation Oncology)
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국소 진행성 유방암 환자에서 선행 항암화학요법의 치료결과

Result of Neoadjuvant Chemotherapy, Surgery and Radiation Therapy in Locally Advanced Breast Cancer

  • 배선현 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 박원 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 허승재 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 최두호 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 남희림 (성균관대학교 의과대학 삼성서울병원 방사선종양학교실) ;
  • 양정현 (성균관대학교 의과대학 삼성서울병원 외과학교실) ;
  • 남석진 (성균관대학교 의과대학 삼성서울병원 외과학교실) ;
  • 이정언 (성균관대학교 의과대학 삼성서울병원 외과학교실) ;
  • 임영혁 (성균관대학교 의과대학 삼성서울병원 혈액종양내과학교실) ;
  • 안진석 (성균관대학교 의과대학 삼성서울병원 혈액종양내과학교실) ;
  • 박연희 (성균관대학교 의과대학 삼성서울병원 혈액종양내과학교실)
  • Bae, Sun-Hyun (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Won (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Huh, Seung-Jae (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Choi, Doo-Ho (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Nam, Hee-Rim (Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang, Jung-Hyun (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Nam, Seok-Jin (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Lee, Jeong-Eon (Department of Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Im,, Young-Hyuck (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Ahn, Jin-Seok (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Park, Yeon-Hee (Division of Hematology-Oncology, Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • 투고 : 2010.03.30
  • 심사 : 2010.05.11
  • 발행 : 2010.06.30
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초록

목 적: 국소 진행성 유방암으로 선행 항암화학요법 후 수술과 방사선치료를 시행한 환자를 대상으로 치료 결과와 예후에 영향을 미치는 인자를 알아보고자 하였다. 대상 및 방법: 1995년 4월부터 2006년 11월까지 삼성서울병원에서 유방암으로 선행 항암화학요법을 받은 환자는 총 159명이었다. 이중에서 진단 당시 종양의 크기가 5.0 cm를 초과하거나 액와림프절 전이가 의심된 유방암 환자로 항암화학요법 후 근치적 수술을 시행하고 방사선치료가 시행된 105명을 대상으로 하였다. 선행 항암화학요법은 2명을 제외한 모든 환자에서 anthracycline을 기반으로 하는 복합항암요법을 사용하였다. 치료 전 임상적 병기는 T1 3명(3%), T2 26명(25%), T3 39명(37%), T4 37명(35%)이었고 액와림프절 전이가 의심되는 사람이 98명(93%)이었다. 선행 항암화학요법을 시작한 날을 기준으로 추적 조사하였고 중앙추적조사기간은 41개월(7~142개월)이었다. 결 과: 전체 환자의 5년 국소제어율은 82.1%, 원격전이제어율은 69.9%, 무병생존율은 66.1%, 전체생존율은 77.1%이었다. 무병생존율과 전체생존율에 영향을 미치는 인자를 알아보기 위해 단변량분석을 시행하였을 때 임상적 원발병소 병기, 병리학적 원발병소 병기, 병리학적 림프절 병기 그리고 병리학적 TNM 병기가 공통적으로 통계적으로 유의한 인자들이었다. 다변량 분석을 시행하였을 때 호르몬치료 유무만 생존율과 연관된 의미 있는 인자였다. 결 론: 본 연구를 통하여 삼성서울병원에서 국소 진행성 유방암으로 선행 항암화학요법이 시행된 환자의 치료 성적이 지금까지 보고된 다른 선행 항암화학요법 치료 결과와 비교할 때 비슷하거나 나은 결과를 보여주었다. 또한, 호르몬치료를 시행한 경우에만 생존율이 의미 있게 좋았고 임상적 병기나 병리학적 병기가 낮은 경우 생존율이 좋은 경향을 보였다.

Purpose: To evaluate the result of neoadjuvant chemotherapy, surgery, and radiation therapy in locally advanced breast cancer as well as analyze the prognostic factors affecting survival. Materials and Methods: One hundred fifty-nine patients with breast cancer were treated by neoadjuvant chemotherapy between April 1995 and November 2006 at the Samsung Medical Center. Among these patients, we retrospectively reviewed 105 patients treated with neoadjuvant chemotherapy followed by surgery and radiation therapy for a cure with an initial tumor size >5 cm or clinically positive lymph nodes. All patients received anthracycline based chemotherapy except for 2 patients. According to clinical tumor stage, 3 patients (3%) were cT1, 26 (25%) were cT2, 39 (37%) were T3 and 37 (35%) were T4. Initially, 98 patients (93%) showed axillary lymph node metastasis. The follow-up periods ranged from 7~142 months (median, 41 months) after the beginning of neoadjuvant chemotherapy. Results: Locoregional failure free survival rate and distant metastasis free survival rate at 5 years were 82.1% and 69.9%, respectively. Disease free survival rate and overall survival rate at 5 years were 66.1% and 77.1%, respectively. The results of a univariate analysis indicate that clinical tumor stage, pathologic tumor stage, pathologic nodal stage and pathologic TNM stage were statistically significant factors for disease free survival rate and overall survival rate. Whereas, a multivariate analysis indicated that only hormone therapy was a statistically significant factor for survival. Conclusion: The current study results were comparable to other published studies for neoadjuvant chemotherapy for breast cancer. Hormone therapy was a statistically significant prognostic factor. The patients with early clinical or pathologic stage had a tendency to improve their survival rate.

키워드

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