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국소적으로 진행된, 절제 불가능한 췌장암에서 정위 방사선 치료
Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy

최철원    (원자력병원 방사선종양학과   ); 김미숙    (원자력병원 방사선종양학과   ); 조철구    (원자력병원 방사선종양학과   ); 류성렬    (원자력병원 방사선종양학과   ); 양광모    (원자력병원 방사선종양학과   ); 유형준    (원자력병원 방사선종양학과   ); 이동한    (원자력병원 방사선종양학과   ); 지영훈    (원자력병원 방사선종양학과   ); 한철주    (원자력병원 내과   ); 김진    (원자력병원 내과   ); 김영한    (원자력병원 방사선과  );
  • 초록

    목적: 국소적으로 진행된, 절제 불가능한 췌장암 치료에 있어 고식적 방사선 치료와 비교하여 Cyberknife(CK)를 이용한 정위 방사선 치료의 생존율 및 급성 독성에 대해 분석하고자 하였다. 대상 및 방법: 2003년 4월부터 2004년 4월까지의, Eastern Cooperative Oncology Group (ECOG) 활동도 3 이하이며 CT 및 PET/CT로 평가하여 원격 전이 없는 국소 진행된 췌장암 환자 19명을 대상으로 하였다 대상 환자는 점차 방사선량을 증가시키는 방법으로 33 Gy, 36 Gy, 39 Gy를 3분할로 각각 6명, 4명, 9명에서 CK를 이용한 정위 방사선 치료를 시행하였으며, 생존율 및 Radiation Therapeutic Oncology Group (RTOG) acute radiation morbidity criteria에 의한 위장관 독성을 분석하였다 또한 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술(bypass surgery) 여부, 방사선량, CAl9-9, 계획용 표적 체적(planning target volume, PTV), CT상 주위 장기 및 혈관 침범 여부 등을 Log Rank test를 이용하여 예후 인자를 평가하였다. 결과: 본 연구에서 중앙 생존 기간은 11개월, 1년 생존율은 36.8%였다. 추적 조사 기간 중(범위 $3{\sim}20$ 개월, 중앙값 10개월) 유의한 위장관 급성 독성은 관찰되지 않았다 단일 인자 분석에서 계획용 표적 체적만이 유의한 예후 인자로 80cc 이하인 경우가 80cc 이상인 경우보다 생존율이 높았으며(p-value


    Puroose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ${\leq}3$ and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range $3{\sim}20$ months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA 19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV>80 cc (p-value 80 cc showed better survival rate. Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.


  • 주제어

    췌장암 .   정위 방사선 치료.  

  • 참고문헌 (34)

    1. Koong AC, Le QT, Ho A, et al. Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2004;58:1017-1021 
    2. Kim JG, Lee DH, Kim MS, et al. A study of the reduction of organ motion from respiration. Korea J Medi Phy 2004;15:179-186 
    3. Mortel GG, Frytak S, Hahn RG, et al. Therapy of locally unresectable pancreatic carcinoma: a randomized comparison of high dose (6,000 rads) radiation alone, moderate dose radiation (4,000 rads+5-fluorourcil), and high dose radiation + 5-fluorouracil. The Gastrointestinal Tumor Study Group. Cancer 1981;48:1705-1710 
    4. Treurniet-Donker AD, Van Mielro MJM, Van Putten WLJ, et al. Localized unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 1990;18:560-562 
    5. Morganti AG, Valentini V, Macchia G, et al. 5-fluorouracil-based chemoradiation in unresectable pancreatic carcinoma: phase I-II dose-escalation study. Int J Radiat Oncol Biol Phys 2004;59: 1454-1460 
    6. Nishimura Y, Hosotani R, Shibamoto Y, et al. External and intraoperative radiotherapy for respectable and unresectable pancreatic cancer: analysis of survival rates and complications. Int J Radiat Oncol Biol Phys 1997;39:39-49 
    7. Gastrointestinal Tumor Study Group. Treatment of locally unresectable carcinoma of the pancreas: comparison of combined modality therapy(chemotherapy plus radiotherapy) to chemotherapy alone. J Natl Cancer Inst 1988;80:751-755 
    8. Ishii H, Okada S, Tokuuye. et al. Protracted 5-fluorouracil infusion with concurrent radiotherapy as a treatment for locally advanced pancreatic carcinoma. Cancer 1997;79:1516-1520 
    9. Okusaka T, Okada S, Tokuuye K, et al. Lack of effectiveness of radiotherapy combined with cisplatin in patients with locally advanced pancreatic carcinoma. Cancer 2001;91:1384-1389 
    10. Wanebo HJ, Glicksman AS, Vezeridis MP, et al. Preoperative chemotherapy, radiotherapy and surgical resection of locally advanced pancreatic cancer. Arch Surg 2000;35:81-87 
    11. Talamonti MS, Catalano PJ. Vaughn DJ, et al. Eastern Cooperative Oncology Group Phase I trial of protracted venous infusion fluorouracil plus weekly gemcitabine with concurrent radiation therapy in patients with locally advanced pancreas cancer: A regimen with unexpected early toxicity. J Clin Oncol 2000;135:81-87 
    12. Whang YW, Chang HJ, Lee JK, et al. Survival and recurrence pattern after curative resection of pancreatic cancer. Korean J Gastoenterol 2001 ;38:276-283 
    13. Shankar A, Russell RC. Recent advances in the surgical treatment of pancreatic cancer. World J Gastroenterol 2001; 7:622-626 
    14. Ben-Josef E, Shields AF, Vaishampayan U, et al. Intensity-modulated radiotherapy (1MRT) and concurrent capecitabine for pancreatic cancer. Int J Radiat Oncol Biol Phys 2004;59:454-459 
    15. Schetter TE, Cardenes HR, Kavanagh BD. Stereotactic body radiation therapy for liver tumors. In: Kavanagh BD, Timmerman RD, eds. Stereotactic body radiation therapy. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2005;115-124 
    16. Andre T, Balosso J, Louvet C, et al. Combined radiotherapy and chemotherapy (cisplatin and 5-fluorouracil) as palliative treatment for localized unresectable or adjuvant treatment for resected pancreatic adenocarcinoma: results of a feasibility study. Int J Radiat Oncol Biol Phys 2000;46: 903-911 
    17. Li CP, Chao Y, Chi KH, et al. Concurrent chemoradiotherapy treatment of locally advanced pancreatic cancer: gemcitabine versus 5-fluorouracil, a randomized controlled study. Int J Radiat Oncol Biol Phys 2003;54:137-141 
    18. Bai YR. Wu GH, Guo WJ, et al. Intensity modulated radiation therapy and chemotherapy for locally adcanced pancreatic cancer: results of feasibility study. World J Gastreenterol 2003;9:2561-2564 
    19. Kornek GV, Potter R, Selzer E, et al. Combined radiochemotherapy of locally advanced unresectable pancreatic adenocarcinoma with mitomycin C plus 24-hour continuous infusional gemcitabine. Int J Radiat Oncol Biol Phys 2001; 49:291-295 
    20. Whittington R, Neuberg D, Tester WJ, et al. Protracted intravenous flourouracil infusion with radiotherapy in the management of localized pancreaticobiliary carcinoma: 1 phase Eastern Cooperative Oncology Group trial. J Clin Oncol 1995;13:227-232 
    21. Kim YB, Seong JS, Song SY, et al. Concurrent chemoradiotherapy for unresectable pancreatic cancer. J Korean Soc Ther Radiol Oncol 2002;20:328-333     
    22. Crane CH, Janjan NA, Evans DB, et al. Toxicity and efficacy of concurrent gemcitabine and radiotherapy for locally advanced pancreatic cancer. Int J Pancreatol 2001;29:9-18 
    23. Martin JL. Harvey HA. Lipton A, et al. Combined chemoradiotherapy for unresectable pancreatic cancer. Am J Clin Oncol 1999;22:309-314 
    24. Safran H, Moore T, lannitti D, et al. Paclitaxel and concurrent radiation for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 2001;49:1275-1279 
    25. Song DY. Blomgren H. Stereotactic body radiation therapy for lung tumors. In: Kavanagh BD, Timmerman RD, eds. Stereotactic body radiation therapy. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2005:99-107 
    26. Kamthan AG, Morris JC, Dalton J, et al. Combined modality therapy for stage II and stage III pancreatic carcinoma. J Clin Oncol 1997;15:2920-2927 
    27. Fowler JF, Tome WA, Welsh JS. Estimation of required doses in stereotactic body radiation therapy. In: Kavanagh BD, Timmerman RD, eds. Stereotactic Body Radiation Therapy. 1st ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2005:7-14 
    28. Ghaneh P, Slavin J, Sutton R, et al. Adjuvant therapy in pancreatic cancer. World J Gastroenterol 2001;7:482-489 
    29. Fisher BJ, Perera FE, Kocha W, et al. Analysis of the clinical benefit of 5-fluorouracil and radiation treatment in locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 1999;45:291-295 
    30. Klaassen DJ, Maclntyre JM, Catton GE, et al. Treatment of locally unresectable cancer of the stomach and pancreas: a randomized comparison of 5-fluorouracil alone with radiation plus concurrent and maintenance 5-fluorouracil: an Eastern Cooperative Oncology Group Study. J Clin Oncol 1985;3:373-378 
    31. Gastrointestinal Tumor Study Group. A multi-institutional comparative trial of radiation therapy alone and in combination with 5-Fluorouracil for locally unresectable pancreatic carcinoma. Ann Surgery 1979;189-205 
    32. Central Cancer Registry Center Ministry of Health and Welfare, Korea. Annual report of the central cancer registry in Korea 2002 
    33. Lee SJ. Clinical study on pancreatic cancer and its prognostic factors. Korean J Gastoenterol 1994;26: 1010-1020 
    34. Shinchi H, Takao S, Noma H, et al. Length and quality of survival after external-beam radiotherapy with concurrent continuous 5-fluorouracil infusion for locally unresectable pancreatic cancer. Int J Radiat Oncol Biol Phys 2002;53: 146-150 
  • 이 논문을 인용한 문헌 (1)

    1. Ryu, Mi-Ryeong ; Yoon, Sei-Chul ; Kim, Yeon-Sil ; Chung, Su-Mi 2006. "The Results of Palliative Radiation Therapy in Patients with Unresectable Advanced Pancreatic Cancer" 대한방사선종양학회지 = The Journal of the Korean soceity for therapeutic radiology and oncology, 24(4): 243~247     

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