고위험 유방암 환자의 수술 후 방사선치료

Postoperative Radiation Therapy in High-risk Breast Cancer

목적: 고위험 유방암 환자의 수술 후 방사선치료 후 국소 재발율, 생존율 및 예후인자를 후향적 분석하여 방사선 치료의 역할을 규명하고자 하였다. 대상 및 방법: 1984년부터 1995년까지 유방암으로 변형 근치적 유방절제술 후 종야의 크기가 4cm 이상이거나, 4cm미만이나 액와 림프절의 전이가 있는 환자 중 방사선치료를 완료한 48명을 대상으로 하였다. 중앙 연령은 47세 (31~79세)이었으며, 종양의 크기가 2cm미만 1명, 2~5cm 15명, 5cm이상이 32명이었다. 액와림프절에 전이된 환자는 32명이었다. 흉벽과 국소림프절에 방사선치료를 받은 환자는 42명, 흉벽만 받은 환자는 6명이었으며 방사선량은 1일 1회(1.8Gy)로 총 선량은 50.4Gy이었다. 48명중 18명(38%)은 50FU를 기본으로 하는 항암화학요법을 방사선치료 전 혹은 후에 투여하였다. 중앙 추적기간은 61개월이었다. 결과: 국소 재발율은 8%, 원격전이율은 14%이었다. 전체환자의 5년 생존율은 63%, 무병생존율은 62%이었으며 중앙생존기간은 67개월이었다. 병기에 따른 5년 생존율은 IIB는 70%, IIIA는 58%이었으며, 생존율에 미치는 예후인자는 병기이었다(p=0.0076). 결론: 고 위험군의 유방암 환자의 수술 후 방사선치료는 국소재발율은 감소시키고 생존율을 향상시킬 수 있으며, 생존율에 영향을 주는 인자는 병기이었다.

Purpose: To assess the locoregional recurrence rate, survival rate and prognostic factors after modified radical mastectomy and postoperative adjuvant radiation therapy with or with chemotherapy in high-risk breast cancer patients. Method: Between 1984~1995, 48 patients underwent postoperative irradiation to the regional lymphatics and chest wall due to large tumor size (≥5 cm) or small tumor size (<5 cm) with axillary lymph node involvement after modified radical mastectomy. The median age of the patients was 47 years (range, 31~79 years). The clinical tumor size was <2cm in 1 patient, 2~5 cm in 15 patients, and >5 cm in 32 patients. Thirty two patients had positive axillary lymhp nodes. Forty two patients were irradiated to the chest wall and regional lymph node and 6 patients were irradiated in the chest wall only. Radiation dose to the chest wall and regional lymph node was 5040 cGy/28 fraction. The median follow-up time was 61months. Results: Locoregional recurrence rate was 8% and distant metastatic rate was 14%. The actuarial overall survival rate and disease-free survival rate was 63% and 62% at 5 years, respectively. The median survival time was 67 months. Five-year overall survival rate by the stage in 70% in IIB and 58% in IIIA. The significant prognostic factor for survival on multivariate analysis was the stage. Conclusion: Postoperative adjuvant radiation therapy in high-risk breast cancer can reduce the locoregional recurrence rate and increase the survival time by combined chemotherapy. The significant prognostic factor for survival rate was the stage.