Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Significance of the Failure Patterns in Cervical Lymph Nodes Achieving a Complete Response to Radical Radiotherapy

근치적 방사선치료에 완전반응을 보인 경부 림프절에서의 재발 양상 및 그 의의

  • Nam, Ji-Ho (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Kim, Won-Taek (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Ki, Yong-Kan (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Kim, Dong-Hyun (Department of Radiation Oncology, Pusan National University School of Medicine) ;
  • Choi, Young-Jin (Department of Internal Medicine, Pusan National University School of Medicine) ;
  • Cho, Kyu-Sup (Department of Otolaryngology, Pusan National University School of Medicine) ;
  • Lee, Jin-Choon (Department of Otolaryngology, Pusan National University School of Medicine) ;
  • Lee, Byung-Joo (Department of Otolaryngology, Pusan National University School of Medicine) ;
  • Kim, Dong-Won (Department of Radiation Oncology, Pusan National University School of Medicine)
  • 남지호 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 김원택 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 기용간 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 김동현 (부산대학교 의학전문대학원 방사선종양학교실) ;
  • 최영진 (부산대학교 의학전문대학원 내과학교실) ;
  • 조규섭 (부산대학교 의학전문대학원 이비인후과교실) ;
  • 이진춘 (부산대학교 의학전문대학원 이비인후과교실) ;
  • 이병주 (부산대학교 의학전문대학원 이비인후과교실) ;
  • 김동원 (부산대학교 의학전문대학원 방사선종양학교실)
  • Received : 2009.11.20
  • Accepted : 2010.01.11
  • Published : 2010.08.31
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Abstract

Purpose: This study was performed to examine the neck failure patterns after a complete response (CR) to definitive radiotherapy for advanced head and neck cancer patients, as well as evaluate the clinical significance of the results of this study. Materials and Methods: Between 1987 and 2008, the clinical data of patients who had been treated with radical radiotherapy for primary squamous cell carcinomas and enlarged cervical lymph nodes was analyzed retrospectively. Ultimately, the cases that showed CR of the cervical lymph node lesions to full-dose radiotherapy were included in this study. The recurrent rate and sites in the cervical lymphatic area were evaluated periodically by radiologic imaging studies, along with some factors which might have affected the rate of recurrence. Results: A total of 73 patients who achieved CR in neck area after radiotherapy were included in this study. The rate of subsequent neck failure among those patients was 19.2%. There was only a 5.5% failure rate in the 55 patients who underwent radiotherapy in their primary site. Eighty percent of the recurrent cases were found within 3 years (median follow-up, 68 months). The majority of neck recurrent cases (47%) were accompanied with the failure of the primary lesions. The initial response of the primary site and the method of radiotherapy simulation were significant prognostic factors associated with the nodal recurrence rate. Conclusion: The recurrence rate of cervical nodes in patients with CR to radiotherapy in the primary site and neck area was about 5%. These patients could be followed up with close observation without a planned neck dissection.

목 적: 진행된 두경부암 환자들에서 근치적 방사선치료 후 완전반응을 보인 경부 림프절 병변에서의 재발 빈도와 양상을 확인하고, 이의 임상적 의미를 알아보고자 이 연구를 진행하였다. 대상 및 방법: 1987년부터 2008년까지 원발성 두경부 상피세포암종 및 경부 림프절 종대 병변에 대해 근치적 방사선치료를 받았던 환자들의 임상자료를 분석하였다. 이들 중 경부 림프절 병변에 충분한 방사선조사를 받은 후 완전 반응으로 평가된 환자들을 최종 연구대상으로 선정하였다. 대상 환자들의 주기적 영상자료를 바탕으로 경부 림프절에서의 재발 빈도와 양상을 확인하였다. 아울러 재발률과 관련된 예후인자들도 분석하였다. 결 과: 방사선치료 후 경부 림프절에서 완전반응으로 평가된 환자들은 73명이었다. 이들의 추적관찰 기간 동안의 재발률은 19.2%였다. 원발 병변에서도 완전반응을 보인 55명에서의 경부 재발률은 5.5%였다. 경부 재발의 80% 이상이 3년 이내에 확인되었으며, 47%에서 원발 병변의 재발이나 진행과 관련이 있었다. 치료 후 원발 병변의 반응 정도와 방사선 모의치료 방법이 경부 림프절 재발률과 관련 있었다. 결 론: 방사선치료 후 원발 병변 및 경부 림프절 병변에서 완전반응으로 평가된 환자들에서의 경부 림프절 재발률은 약 5%로, 이들에서는 계획된 림프절 절제술 없이 정기적인 추적관찰이 가능할 것으로 판단된다.

Keywords

References

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