국한성 두경부 혈관 중심위 림프종에서 화학방사선 병용치료법과 방사선치료 단독요법의 비교

Combined Chemotherapy and Radiotherapy versus Radiotherapy alone in the Management of Localized Angiocentric Lymphoma of the Head and Neck

목적: 국한성 두경부 혈관 중심위 림프종에서 화학방사선 병용치료법과 방사선치료 단독용법의 치료성적을 비교하여 화학방사선 병용치료법의 임상적 유용성 여부를 알아보고자 하였다. 대상 및 방법: 1976년부터 1995년까지 연세암센터에서 병기 Ⅰ,Ⅱ기의 두경부 혈관 중심위 림프종으로 치료받은 143예를 대상으로 하였다. 방사선치료단독(104예)의 경우 20~70 Gy(중앙갑 50.4 Gy)를 병소 부위에 국소적으로 조사하였고 화학방사선 병용치료(39예)의 경우에는 1~6회(중앙값 3회)의 화학요법을 시행한 후 병소 부위에 국소적으로 방사선치료를 시행하였다. 치료방법에 따른 반응율, 치료실패양상, 후유증, 생존율 등을 비교하여 보았다. 결과: 치료에 대한 높은 반응율에도 불구하고 국소치료실패가 치료실패양상의 가장 흔한 원인이었고 화학요법의 시행에 따른 치료실패양상의 변화는 없었다. 치료방법에 따른 환자들의 순응도에는 차이가 없었으나 혈구포식세포증후군(hemophagocytic syndrome), 폐혈증, 난치성 출혈(intractable bleeding), 2차 암(new primary cancer) 등의 발생빈도는 화학방사선 병용치료법을 시행한 경우에 방사선치료 단독용법을 시행한 경우보다 높은 경향을 나타냈다. 방사선 단독으로 치료한 경우의 5년 생존율과 무병 생존율은 각각 38%와 32%로 저조하였고 화학요법의 병용 여부는 생존율에 영향을 미치지 못했다. 결론: 국한성 두경부 혈관 중심위 림프종의 치료에서 화학방사선 병용치료법이 방사선치료 단독요법보다 유용하다는 사실이 입증되지 못하였다.

Purpose: To Clarify the clinical benefit derived from the combined modality therapy (CMT) consisting of chemotherapy (CT) and involved field radiotherapy (RT) for stage Ⅰ and Ⅱ angiocentric lymphomas of the head and neck. Materials and Methods: Of 143 patients with angiocentric lymphoma of the head and neck treated at our hospital between 1976 and 1995, 104 patients (RT group) received involved field RT alone with a median dose of 50.4 Gy(range: 20~70 Gy), while 39 Patients (CMT group) received a median 3cycles(range: 1~6 cycles) of CT before involved field RT. The response rate, patterns of failure. complications, and survival data of the RT group were compared with those of the CMT group. Results: Despite a higher response rate, local failure was the most common pattern of failure in patients of both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination CT. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignencies were more frequently observed in patients of the CMT group. The prognosis of patients in the RT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic CT. Achieving complete remission was the most important prognostic factor by univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival. conclusions: Involved field RT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the addition of CT to involved field RT failed to demonstrate any therapeutic advantage over involved over involved field RT alone.