Accelerated Fractionation In The Treatment of Brain Metastasis From Non-Small Cell Carcinoma of The Lung

• 발행기관: 대한방사선종양학회
• 저자명: 홍성언(Seong Eon Hong)
• 간행물 정보: 『대한방사선종양학회지』제12권 제2호, 165~173쪽, 전체 9쪽
• 주제분류: 의약학 > 종양학
• 파일형태: PDF
• 발행일자: 1994.08.30

국문 초록

목적 : 폐암한자에 있어서 뇌전이는 심각한 문제이며 또한 장기간 생존을 기대할 수가 없다. 종양억제효과를 증가시키는 동시에 만발 장애를 감소시켜 전체 치료기간을 가능한 단축시키기 위하여 비소세포성 폐암환자의 뇌전이에 대한 다분할 조사법인 급속분할조사법을 시행하였다. 재료 및 방법 : 1991년부터 1993년까지 비소세포성 폐암으로 확진되어 뇌전이가 발생한 24명의 환자에게 6시간 간격으로 2Gy씩 하루 2회로 총 48Gy를 전뇌에 조사하였다. 단일 병소는 전뇌에 40Gy 조사후 치료범위를 축소하여 8Gy를 추가하였다. 총 26예중 신경증상이 점사 진행되는 양상을 보인 2명은 방사선치료를 중단하였다. 결과 : 방사선치료 도중에 3명은 급성 방사선효과로 오심과 구토를 호소하였으나, 방사선량 증가로 인한 심각한 부작용은 없었다. 통상적인 치료방법인 2주에 30Gy를 조사한 경우(4.5개월)보다 48Gy의 급속분할조사에 의한 방사선치료법이 중간생존기간을 향상시켰으나(7개월)통계학적 의의는 없었다.(p>0.05). 뇌에 국한된 전이 환자와 활동수행 상태가 양호한 군이 다방성 전이나 활동수행상태가 불량한 군보다 중간생존기간과 반년생존율에 있어서 유의한 증가를 나타내었다(p<0.01). 결론 : 뇌전이 단독소견과 양호한 활동수행능력 상태등 양호한 예후인자를 가진 환자는 생존기간 향상이 기대된다. 본 연구결과로 환자의 quality of life를 고려하여 하후 1회 치료법과 2또 3회치료법을 비교하는 다자간의 전형적인 연구가 필요하리라 생각된다.

영문 초록

Purpose : Metastatic cancer to the brain is a major problem for the patients with bronchogenic carcinoma, and most of these patients have a limited survival expectancy. To increase tumor control and/or to decrease late morbidity with possible shortening in over-all treatment period multiple adily fraction technique for brain metastasis was performed. The author reperesented the results of accelerated fractionation radiotherapy in patients with brain metastases from non-small cell lung cancer. Materials and Methods : Twenty-six patients with brain metastasesfrom non-small cell lung cancer between 1991 and 1993 received brain radiotherapy with a total dose of 48 Gy at 2 Gy per fraction, twice a day with a interfractional period of 6 hours and delivered 5 days a week. the whole brain was treated to 40Gy and boost dose escalated to 8Gy for single metastatic lesion by reduced field. Twenty-four of the 26 patients completed the radiotherapy. Radiotherapy was interupted in two patients suggesting progressive intracerebral diseases. Results : This radiotherapy regimen appears to be comparable to the conventional scheme in relief from symptoms. Three of the 24 patients experienced nausea and or vomiting during the course of treatment because of acute irradiation toxicity. The author observed no excessive toxicity with escalating dose of irradiation. An increment in median survival, although not statistically significant(p>0.05) was noted with escalating doses(48Gy) of accelerated fractionation(7 months) compared to conventional treatment(4.5 months). Median survival also increased in patients with brain solitary metastasis (9 months) compared to multiple extrathoracic sites(4 months) and in patients with good performance status (9 months versus 3.5 months) they were statistically significant (p<0.01). Conclusion : The increment in survival in patients with good prognostic factors such as controlled primary lesion metastasis in brain only and good performance status appeared encouraging. Based on these results a multi-institutional prospective randomized trial should be initiated to compare the twice-a-day and once-a-day radiotherapy schemes on patients with brain metastasis with careful consideration for the patients quality of life.

키워드

Non-small cell lung carcinoma Brain metastasis Accelerated fractionation