위암의 보조항암화학요법
Adjuvant Chemotherapy in Gastric Cancer
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초록
위암 환자들의 수술 후 치료성적을 향상시키는 고무적인 연구결과들이 최근 발표되고 있다. 그 중에는 국내 위암 환자들에게 적용할 수 있는 결과들도 있는 반면에, 질병의 임상양상이나 치료 행태가 상이하여 적용하기 곤란한 결과들도 있다. 하지만 최근에 발표된 중요한 연구결과들 중에는 국내에서 시행된 것들이 있어 우리 현실에 바로 적용시킬 수 있어서 매우 고무적이다. 위암의 완치를 기대할 수 있는 유일한 방법은 위암이 위와 위 주변부 림프절에 국한되어 있는 경우 근치적 완전절제술을 시행하는 것이나, 비록 수술이 성공적으로 행해진다 하여도 여전히 상당수의 환자는 재발을 경험하고 있다. 2000년 대 이후 발표된 비교임상시험 결과들을 바탕으로 근치적 절제술이 시행된 경우 치료성적을 향상시키기 위해 수술 후 보조요법을 추가하는 것이 이미 표준 치료로 널리 받아들여지고 있다. 그러나 국소 치료로서 D2 절제술을 적절히 시행하지 않은 환자를 대상으로 시행된 연구 결과를 우리나라 환자에게 적용하는 것은 적절하지 않겠다. 현재 국내에서는 ACTS-GC 연구와 CLASSIC 연구 결과에 근거하여 S-1 또는 XELOX 항암화학요법이 병기 II-III기의 위암에서 수술 후 표준 보조항암화학요법으로 인정되고 있다. 향후, 병기에 따라 어떤 보조항암화학요법을 적용할 것인가와 보조항암화학요법의 사용 기간, 방사선 치료 또는 표적치료제의 병용 가능성, 수술 전 선행화학 요법과의 연계 가능성에 대해서는 지속적으로 연구가 시행되어야 할 것이다.
Abstract
Gastric cancer remains the second most common malignancy worldwide. Surgical resection with D2 lymph node dissection is the standard of care in localized gastric cancer. However about 40% of patients in East Asia and 70% of patients in Western countries experience recurrence after curative surgical resection of localized gastric cancer. Once recurrence occurs, the prognosis of patients is usually dismal, especially in case of distant metastases. Although many clinical trials of adjuvant treatment were conducted to reduce recurrence of gastric cancer after surgical resection, it was controversial until early 2000s whether adjuvant treatment could improve recurrence-free survival or overall survival in gastric cancer. In early 2000s, adjuvant chemoradiation became the standard of care in the US based on the results of SWOG 9008/INT 0116 trial, where only minor portion of patients underwent D2 lymph node dissection. However, adjuvant chemoradiation was considered not applicable to patients with gastric cancer in East Asia where D2 lymph node dissection is the standard surgical method. Recently, large scale phase III studies including ACTS-GC and CLASSIC trial were conducted in the East Asia. Based on those studies, adjuvant chemotherapy is currently accepted as standard treatment in gastric cancer in the East Asia. (Korean J Med 2012;83:291-296)
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