자궁경부암의 방사선치료성적

• 영문명: Results of Radiotherapy for the Uterine Cervical Cancer
• 발행기관: 대한방사선종양학회
• 저자명: 김철용(Chul Yong Kim)·최명선(Myung Sun Choi)·서원혁(Won Hyuck Suh)
• 간행물 정보: 『대한방사선종양학회지』제6권 제1호, 63~73쪽, 전체 11쪽
• 주제분류: 의약학 > 종양학
• 파일형태: PDF
• 발행일자: 1988.06.30

영문 초록

One hundred fifty-four patients with the carcinoma of the uterine cervix were studied retrospectively to assess the result and impact of treatment at Department of Radiation Oncology, Korea University, Hae-Wha Hospital from Feb 1981 through Dec. 1986. Prior to radiotherapy, the patients were evaluated and staged by recommendation of FIGO including physical examination, pelvic examination, cystoscopy, rectosigmoidoscopy, chest X-ray, IVP, Ba enema. Also an additional pelvic CT scan was obtained for some of the patients. The patients were treated by radiotherapy alone or adjuvant postoperative irradiation; In case of radiation therapy only, whole pelvic irradiation was given with Co-60 teletherapy unit via AP and PA parallel opposing fields or 4-oblique fields, 180 cGy per day, 5 days per week and intracavitary insertion was performed. In satges Ia, Ib, and IIa with small primary lesion, external irradiation was initially given to pelvis up to 2,000~3,000 cGy/2½-3½ weeks and then intracavitary insertion was performed using Fletcher-Mini-Declos Applicator with cesium-137 cources and followed by external irradiation of 1,000~2,000 cGY/1½-2½ weeks via AP and PA parallel opposing fields with midline shield to spare of bladder and rectum. However, if the primary lesion is large, external irradiation was given without midline shield. More than stages IIb, the patients were treated by external beam irradiation up to 5,400 cGy/30f fot 6 weeks via 4-oblique portals and at the dose of 5,040 cGy/28f the field was cut 5 cm from the top margin for spare of small bowel, and followed by intracavitary irradiation. If there was residual tumor, an additional dose of 900~1,200 cGy/5~7f was given to parametrium and/or residual tumor area. Total dose of radiation to A and B-point were as follows; A-point : B-point In early stages, Ia, Ib, IIa : 8,000~9,000 5,000~6,000 cGy In advanced stages IIb, IIIa, IIIb : 9,000~10,000 6,000~7,000 cGy The results were obtained and as follows; 1. The Patients distribution according to FIGO staging system were stage Ia 6, Ib27, IIa 28, IIb 54, IIIa 12, IIIb 18, and stage lVa 9. 2. Value of CT scan were demonstration of cervix tumor mass, parametrial and pelvic side wall tumor spread, pelvic and inguinal lymph nodes metastases, and hydronephrosis. Three dimensional quantitative demonstration of tumor volume is also important in planning radiation therapy. Another advantage of CT scan was detection of recurrent tumor after radiation or surgery. 3. Local control rate of tumor according to the size was 91.3% for less than 5cm in size and 44.6% in tumor over 5cm (p<0.0068) 4. Thirty out of 50 recurrent sites has locoregional failures and 17 cases has distant metastases. And the para-aortic lymph nodes were the most common site for distant metastases. 5. The most common complication was temporal rectal bleeding which was controlled most by conservative management. However, 4 patients required for endoscopic cauterization. 6. The 5-year survival rates showed; stage la and Ib 95%, stage IIa 81% stage IIb 67%, stage IIIa 37.7%, stage IIIb 23%, and 3-year survival rate of stage IVa showed 11.6%, retrospectively.