본문 바로가기
HOME> 논문 > 논문 검색상세

논문 상세정보

대한방사선종양학회지 = The Journal of the Korean soceity for therapeutic radiology and oncology v.25 no.4, 2007년, pp.219 - 226  
본 등재정보는 저널의 등재정보를 참고하여 보여주는 베타서비스로 정확한 논문의 등재여부는 등재기관에 확인하시기 바랍니다.

원발병소 불명암의 경부림프절 전이에서 방사선치료의 역할
Radiotherapy of Neck Node Metastases from an Unknown Primary Cancer

이정은   (경북대학교 의과대학 방사선종양학교실UU0000096  );
  • 초록

    목적: 원발병소 불명암의 경부림프절 전이 환자에서 방사선치료의 결과를 분석하고자 후향적 연구를 실시하였다. 대상 및 방법: 1986년 1월부터 2005년 12월까지 원발병소 불명암의 경부림프절 전이로 진단받고 근치적 목적으로 방사선치료 또는 수술 후 방사선치료를 실시한 환자 88명을 대상으로 본 연구를 시행하였다. 환자의 중앙연령은 59세( $35{\sim}74$ 세)이고 남자 74명, 여자 14명이었다. 조직학적으로 편평상피암이 72명, 미분화세포암이 6명, 선암이 1명이었고 조직학적으로 분류할 수 없었던 환자가 9명이었다. N 병기는 N1 병기가 4명, N2a 병기가 10명, N2b 병기 48명, N2c 병기가 8명, N3병기가 18명이었다. 방사선치료만 시행 받은 환자는 10명, 동시병용 방사선-항암화학요법을 받은 환자는 27명, 수술 및 수술 후 방사선치료는 35명, 수술 및 수술 후 동시병용 방사선-항암화학요법은 16명의 환자에서 시행되었다. 상부 경부림프절과 잠재적 원발병소인 인후두에 조사된 총 방사선량은 $50.4{\sim}79.6$ Gy (중앙값, 59.4Gy)였고, 하부 경부림프절에 조사된 총 방사선량은 $50{\sim}59.4$ Gy (중앙값 50Gy)였다. 추적관찰기간은 $1{\sim}154$ 개월(중앙값 32개월)이었다. 결과: 완전관해를 얻은 환자는 57명(70.4%)이었고 부분환해는 8명(9.9%)의 환자에서 관찰되었다. 전체 환자의 5년 생존율은 43.9%였으며, 5년 무병생존율은 41.7%였다. 경부절제술 여부와 원 발종양 발생 여부가 생존율에 영향을 미치는 예후인자이고, N 병기와 경부절제술 여부, 원발종양 발생여부가 무병생존율에 영향을 미치는 예후인자로 분석되었다. 결 론: 원발병소 불명암의 경부 림프절 전이 환자에서 근치적 수술과 방사선치료로 좋은 생존결과를 얻을 수 있으며, 양측 경부와 잠재적 원발병소를 포함한 광범위 방사선치료는 좋은 국소 제어율과 생존율을 기대할 수 있다. 그러나 광범위 방사선치료로 인한 부작용을 줄이기 위하여 방사선치료 범위에 대한 더 많은 연구가 필요하다.


    Purpose: The aim of this retrospective analysis was to analyze the results of radiotherapy administered to patients with neck node metastases from an unknown primary cancer, with or without neck dissection. Materials and Methods: From January 1986 to December 2005, 88 patients with neck node metastases from an unknown primary cancer were treated with curative intent. The age of the patients ranged from 35 to 74 years (median age, 59 years). There were 74 male and 14 female patients. Distribution of patients by N status was as follows: N1, 4 patients; N2a, 10 patients; N2b, 48 patients; N2c, 8 patients; N3, 18 patients. Fifty-one patients underwent neck dissection and 37 patients had only a biopsy (31 patients had fine-needle aspiration and 6 patients had an excisional biopsy). All patients received radiotherapy. The follow-up time ranged from 1 to 154 months, with a median time of 32 months. Results: The overall survival (OS) and disease-free survival (DFS) rate at 5 years were 43.9% and 41.7%, respectively. The factors associated with the OS rate were neck dissection, and a subsequent primary tumor. Factors associated with the DFS rate were N stage, neck dissection, and a subsequent primary tumor. Neck failure was noted in 15 patients, distant metastases in 18 patients, and a subsequent primary tumor in 8 patients. Conclusion: With comprehensive radiotherapy given to the bilateral neck and the potential mucosal sites, good survival rates can be obtained in patients with neck node metastases from an unknown primary cancer. However, considering the side effects, a randomized trial is required to determine the optimal radiotherapy volume.


  • 주제어

    경부림프절 전이 .   원발병소 불명암 .   방사선치료 .   생존율.  

  • 참고문헌 (40)

    1. Million RR, Nicholas JC, Mancuso AA. The unknown primary. In: Million RR, Cassisi NT, eds. Management of Head and Neck Cancer: a Multidisciplinary Approach, 2nd ed. Philadelphia, PA: Lippincott Co. 1994:311-320 
    2. Grau C, Johansen LV, Jakobsen J, Geertsen P, Andersen E, Jensen BB. Cervical lymph node metastases from unknown primary tumours. Results from a national survey by the Danish Society for Head and Neck Oncology. Radiother Oncol 2000;55:121-129 
    3. Iganej S, Kagan R, Anderson P, et al. Metastatic squamous cell carcinoma of the neck from an unknown primary: management options and patterns of relapse. Head Neck 2002;24:236-246 
    4. Glynne-Jones RG, Anand AK, Young TE, Berry RJ. Metastatic carcinoma in the cervical lymph nodes from an occult primary: a conservative approach to the role of radiotherapy. Int J Radiat Oncol Biol Phys 1990;18:289-294 
    5. Abbruzzese JL, Abbruzzese MC, Hess KR, Raber MN, Lenzi R, Frost P. Unknown primary carcinoma: natural history and prognostic factors in 657 consecutive patients. J Clin Oncol 1994;12:1272-1280 
    6. Mendenhall WM, Million RR, Cassisi NJ. Squamous cell carcinoma of the head and neck treated with radiation therapy: the role of neck dissection for clinically positive neck nodes. Int J Radiat Oncol Biol Phys 1986;12:733-740 
    7. Christiansen H, Hermann RM, Martin A, Nitsche M, Schmidberger H, Pradier O. Neck lymph node metastases from an unknown primary tumor retrospective study and review of literature. Strahlenther Onkol 2005;181:355-362 
    8. Strojan P, Anicin A. Combined surgery and postoperative radiotherapy for cervical lymph node metastases from an unknown primary tumour. Radiother Oncol 1998;49:33-40 
    9. Nguyen C, Shenouda G, Black MJ, Vuong T, Donath D, Yassa M. Metastatic squamous cell carcinoma to cervical lymph nodes from unknown primary mucosal sites. Head Neck 1994;16:58-63 
    10. Harper CS, Mendenhall WM, Parsons JT, Stringer SP, Cassisi NJ, Million RR. Cancer in neck nodes with unknown primary site: role of mucosal radiotherapy. Head Neck 1990;12:463-469 
    11. Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. MACH-NC Collaborative Group. Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 2000; 355:949-955 
    12. Hathaway B, Johnson JT, Piccirillo JF, et al. Chemoradiation for metastatic SCCA: role of comorbidity. Laryngoscope 2001;111:1893-1895 
    13. Mendenhall WM, Mancuso AA, Parsons JT, Stringer SP, Cassisi NJ. Diagnostic evaluation of squamous cell carcinoma metastatic to cervical lymph nodes from an unknown head and neck primary site. Head Neck 1998;20: 739-744 
    14. Friesland S, Lind MG, Lundgren J, Munck-Wikland E, Fernberg JO. Outcome of ipsilateral treatment for patients with metastases to neck nodes of unknown origin. Acta Oncol 2001;40:24-28 
    15. De Braud F, al-Sarraf M. Diagnosis and management of squamous cell carcinoma of unknown primary tumor site of the neck. Semin Oncol 1993;20:273?278 
    16. Wang RC, Goepfert H, Barber AE, Wolf P. Unknown primary squamous cell carcinoma metastatic to the neck. Arch Otolaryngol Head Neck Surg 1990;116:1388-1393 
    17. Nordstrom DG, Tewfik HH, Latourette HB. Cervical lymph node metastases from an unknown primary. Int J Radiat Oncol Biol Phys 1979;5:73-76 
    18. Lapeyre M, Malissard L, Peiffert D, et al. Cervical lymph node metastasis from an unknown primary: is a tonsillectomy necessary? Int J Radiat Oncol Biol Phys 1997;39:291-296 
    19. Erkal HS, Mendenhall WM, Amdur RJ, Villaret DB, Stringer SP. Squamous cell carcinomas metastatic to cervical lymph nodes from an unknown head-and-neck mucosal site treated with radiation therapy alone or in combination with neck dissection. Int J Radiat Oncol Biol Phys 2001;50:55-63 
    20. Park IK, Yun SM, Kim JC. Radiotherapy of metastatic neck nodes from an unknown primary site. The J Kor Soc Thera Raiol Oncol 1997;15:105-111 
    21. Sinnathamby K, Peters LJ, Laidlaw C, Hughes PG. The occult head and neck primary: to treat or not to treat? Clin Oncol (R Coll Radiol) 1997;9:322-329 
    22. Weir L, Keane T, Cummings B, et al. Radiation treatment of cervical lymph node metastases from an unknown primary: an analysis of outcome by treatment volume and other prognostic factors. Radiother Oncol 1995;35:206-211 
    23. Marcial-Vega VA, Cardenes H, Perez CA, et al. Cervical metastases from unknown primaries: radiotherapeutic management and appearance of subsequent primaries. Int J Radiat Oncol Biol Phys 1990;19:919-928 
    24. Mintzer DM, Warhol M, Martin AM, Greene G. Cancer of unknown primary: changing approaches. A multidisciplinary case presentation from the Joan Karnell Cancer Center of Pennsylvania hospital. Oncologist 2004;9:330-338 
    25. Kim K, Chie EK, Wu HG, et al. Treatment outcome of metastatic carcinoma of cervical lymph node from an unknown primary. J Korean Soc Ther Oncol 2005;23:137-142     
    26. Coster JR, Foote RL, Olsen KD, Jack SM, Schaid DJ, DeSanto LW. Cervical nodal metastasis of squamous cell carcinoma of unknown origin: indications for withholding radiation therapy. Int J Radiat Oncol Biol Phys 1992;23:743- 749 
    27. Kaplan EL, Meier P. Non-parametric estimations from incomplete observations. J Am Stat Assoc 1958;53:457-481 
    28. Fogarty GB, Peters LJ, Stewart J, Scott C, Rischin D, Hicks RJ. The usefulness of fluorine 18-labelled deoxyglucose positron emission tomography in the investigation of patients with cervical lymphadenopathy from an unknown primary tumor. Head Neck 2003;25:138-145 
    29. Nieder C, Gregoire V, Ang KK. Cervical lymph node metastases from occult squamous cell carcinoma: cut down a tree to get an apple? Int J Radiat Oncol Biol Phys 2001;50:727-733 
    30. Jereczek-Fossa BA, Jassem J, Orecchia R. Cervical lymph node metastases of squamous cell carcinoma from an unknown primary. Cancer Treat Rev 2004;30:153-164 
    31. Califano J, Leong PL, Koch WM, Eisenberger CF, Sidransky D, Westra WH. Second esophageal tumors in patients with head and neck squamous cell carcinoma: an assessment of clonal relationships. Clin Cancer Res 1999; 5:1862-1867 
    32. Aslani M, Sultanem K, Voung T, Hier M, Niazi T, Shenouda G. Metastatic carcinoma to the cervical nodes from an unknown head and neck primary site: Is there a need for neck dissection? Head Neck 2007;29:585-590 
    33. Greco FA, Hainsworth JD. Cancer of unknown primary site. In: Devia VT Jr, Hellman S, Rosenberg SA, eds. Principles and Practice of Oncology. 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins. 2005:2213-2236 
    34. Johnson JT, Wagner RL, Myers EN. A long-term assessment of adjuvant chemotherapy on outcome of patients with extracapsular spread of cervical metastases from squamous carcinoma of the head and neck. Cancer 1996;77:181- 185 
    35. Fernandez JA, Suarez C, Martinez JA, Llorente JL, Rodrigo JP, Alvarez JC. Metastatic squamous cell carcinoma in cervical lymph nodes from an unknown primary tumour: prognostic factors. Clin Otolaryngol Allied Sci 1998; 23:158-163 
    36. Colletier PJ, Garden AS, Morrison WH, Goepfert H, Geara F, Ang KK. Postoperative radiation for squamous cell carcinoma metastatic to cervical lymph nodes from an unknown primary site: outcomes and patterns of failure. Head Neck 1998;20:674-681 
    37. Maulard C, Housset M, Brunel P, et al. Postoperative radiation therapy for cervical lymph node metastases from an occult squamous cell carcinoma. Laryngoscope 1992;102:884- 890 
    38. Reddy SP, Marks JE. Metastatic carcinoma in the cervical lymph nodes from an unknown primary site: results of bilateral neck plus mucosal irradiation vs. ipsilateral neck irradiation. Int J Radiat Oncol Biol Phys 1997;37:797-802 
    39. Green FL, Page DL, Fleming ID, et al. AJCC cancer staging manual. 6th ed. New York, Springer. 2002 
    40. Browman GP, Hodson DI, Mackenzie RJ, Bestic N, Zuraw L; Cancer Care Ontario Practice Guideline Initiative Head and Neck Cancer Disease Site Group. Choosing a concomitant chemotherapy and radiotherapy regimen for squamous cell head and neck cancer: a systematic review of the published literature with subgroup analysis. Head Neck 2001;23:579-589 

 활용도 분석

  • 상세보기

    amChart 영역
  • 원문보기

    amChart 영역

원문보기

무료다운로드
  • NDSL :
  • 대한방사선종양학회 : 저널
유료다운로드
  • 원문이 없습니다.

유료 다운로드의 경우 해당 사이트의 정책에 따라 신규 회원가입, 로그인, 유료 구매 등이 필요할 수 있습니다. 해당 사이트에서 발생하는 귀하의 모든 정보활동은 NDSL의 서비스 정책과 무관합니다.

원문복사신청을 하시면, 일부 해외 인쇄학술지의 경우 외국학술지지원센터(FRIC)에서
무료 원문복사 서비스를 제공합니다.

NDSL에서는 해당 원문을 복사서비스하고 있습니다. 위의 원문복사신청 또는 장바구니 담기를 통하여 원문복사서비스 이용이 가능합니다.

이 논문과 함께 출판된 논문 + 더보기