초기 자궁경부암 수술 후 재발 고위험 군에서 보조적동시 항암화학방사선치료의 적정성 및 효용성 평가
Propriety and Efficacy of Postoperative Adjuvant ConcurrentChemoradiotherapy for High Risk Group Early Stage Cervical CcancerPatients Following Radical Hysterectomy and Pelvic Lymph Node Dissection
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목적 : 초기 자궁경부암 (병기 IA, IB, IIA) 환자에서 근치적자궁적출술과 골반림프절절제술 후에 치료실패율이 높은 고위험군에게 보조적 동시 항암화학방사선치료 (GOG #109 protocol)에 따른 치료의 효용성 및 적정성을 알아보고자 하였다. 연구 방법 : 1994년 7월부터 2001년 6월까지 아주대학교 병원에서 초기 자궁경부암 (병기 IA2, IB, IIA)으로 진단 받고, 근치적 자궁적출술과 부대동맥 및 골반림프절절제술을 시행한 환자 151명 중에서 부대동맥림프절 전이가 있거나 선행화학요법 혹은 방사선치료를 시행한 환자들을 제외한 144명을 대상으로 연구를 시행하였다. 이들 중에서 암세포의 골반림프절 전이, 절단면 침윤 혹은 자궁방 침윤을 보인 30명을 치료군으로 하여 보조적 동시 항암화학방사선요법 (adjuvant concurrent chemoradiotherapy)을 시행하고 치료 효과와 부작용을 후향적으로 임상 분석하였다. 보조적 치료는 수술 후 2-3주 이내에 항암화학치료를 시작하였고, 매 4주마다 총 4주기를 시행하였고, 제 1일에 cisplatin 70 mg/m2, 2일에서 5일까지 5-FU (1000 mg/m2)를 주사하였다. 2주기에서 3주기에 방사선치료는 5주간 병용되었다. 결과 : 수술적 치료를 받은 144명의 환자 중에서 9명 (6.3%)이 재발하였고, 치료군에서 3명 (10%), 대조군에서 6명 (5.3%) 이었다. 5년 생존율은 치료군이 100%, 대조군이 96.8%로 통계적인 차이는 없었고, 5년 재발률 (9.5% vs 6.3%)과 5년 무병생존율 (90.5% vs 93.7%)에서도 치료군과 대조군의 유의한 차이는 보이지 않았다. (p>0.05) 결론 : 본 연구로 근치적자궁적출술 및 림프절절제술 후 치료 실패 고위험 인자를 가진 초기 자궁경부암 환자에서 보조적 동시 항암화학방사선치료를 함으로써 5년 재발률 및 5년 무병생존율을 위험인자가 없는 대조군 수준으로 향상시킬 수 있음을 확인하였다.
Abstract
Objective : This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high risk early cervical cancer (stage IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. Methods : From July 1994 to June 2003, we reviewed the chart of 146 patients who underwent radical abdominal hysterectomy and pelvic lymphadenectomy at Ajou University Hospital for early cervical cancer (stage IA2, IB, IIA). CCRT was performed in 30 patients with high risk factors such as positive pelvic lymph node, positive parametrial involvement, or positive surgical margins. Chemotherapy consisted of cisplatin (70 mg/m2 on day 1) and 5-FU (1000 mg/m2 on day 2-5) for 4 cycles every 4 weeks beginning 2-3 weeks after operation. Pelvic radiotherapy were started with 2nd and 3rd cycle of chemotherapy concurrently. We compared the recurrence rate and survival rate with 114 patients who received no adjuvant therapy after operation. The mean follow up period was 49 months (24-94 months). Results : Disease recurred in 9 of 144 patients treated with surgery (6.3%). There were recurrences in 3 patients after CCRT (10.0%), and in 6 patients in the control group (5.3%) respectively. The actuarial 5-year overall survival rates for patients with adjuvant CCRT, and with no adjuvant treatment were 100%vs. 96.8% (p>0.05). The recurrence and progression-free survival rates were 9.5% vs 6.3%, 90.5% vs. 93.7% (p>0.05). Conclusion : This study shows good local control and 5 years overall and progression free survival rates in the high-risk cervical cancer patients after CCRT which is similar results seen in control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stage IA2-IIA cervical cancer patients with high risk.
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