위말트림프종에서 방사선 치료의 역할
The Role of Radiotherapy for the Treatment of Gastric MALT Lymphoma
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초록
위말트림프종은 우리나라에서 전체 악성림프종의 9%의빈도로 호발하며, 이는 서구나 다른 아시아 지역과 비교했을때 높은 빈도를 보이고 있다[1,4]. 대부분의 위말트림프종은점막이나 점막하 조직에 국한되어 있으며, 림프절 침범이 관찰되는 경우에도 대부분 상복부 림프절에 국한되어 임상병기 I 단계 혹은 IIE1 단계로 진단되므로, 위나 위 주위 림프절을 포함한 방사선 치료로 100%에 가까운 치료율에 도달할수 있다[11,23]. 이 뿐만 아니라, 방사선 치료 후 5년 및 10년장기 추적검사상에서도 생존율이 90% 가까이 관찰되고 있어서 국소형 위말트림프종에서는 H. pylori 제균 요법에 반응이 없거나 H. pylori 음성인 경우에는 방사선 치료가 좋은치료 방법이 될 수 있다[14]. 방사선 치료의 부작용은 급성기에는 조절이 가능한 경미한 부작용이 대부분이다. 대표적인지연성 부작용으로는 이차 종양의 위험성이 증가될 수 있다는 일부 보고가 있지만, 이를 방사선 치료가 직접적으로 원인으로 볼 수 있다는 근거는 아직 없다. 국소형 위말트림프종의 치료로 항암치료와 방사선 치료를 비교한 연구는 많지않으며, 어떠한 치료가 우월성을 지니는가 결론을 내리기 위해서는 많은 환자를 대상으로 하는 장기 추적관찰 연구가필요한 상태이다.
Abstract
Gastric mucosa-associated lymphoid tissue (MALT) lymphoma represents approximately 9% of all malignant lymphoma in Korean, and its incidence is higher than that of western and other Asian countries. Helicobacter pylori eradication is the first line treatment in limited stage gastric MALT lymphoma. There is no consensus about initial treatment with chemotherapy or radiotherapy for the patient with insufficient response to H. pylori eradication or H. pylori negative. Radiotherapy is a conventional therapeutic modality and showed the excellent long term results. The radiotherapy for limited gastric MALT lymphoma shows that the 4-5-year disease free survival rate is 85-100% and acute toxicities is reasonable. However, only non-randomized studies support a role of local radiotherapy in gastric MALT lymphoma. (Korean J Med 2012;83:712-717)
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