T2NOMO 비소세포성 폐암의 근치적 방사선치료

Curative Radiation Therapy for T2N0M0 Non-Small Cell Lung Cancer

Purpose : Surgery is the treatment of choice for resectable non-small cell lung cancer. For patients who are medically unable to tolerate a surgical resection or who refuse surgery, radiation therapy is an acceptable alternative. A retrospective analysis of patients with stage Ⅰ non-small cell lung cancer treated with curative radiation therapy was performed to determine the results of curative radiation therapy and pattern of failure, and to identify factors that may influence survival. Materials and Methods : From 1986 through 1993, 39 patients with T2N0M0 non-small cell lung cancer were treated with curative radiation therapy at department of radiation oncology. Kyungpook national university hospital. All patients were not candidates for surgical resection because of either patient refusal (16 patients) poor pulmonary function (12 patients) old age (7 patients) poor performance (2 patients) or coexisting medical disease (2 patients). Median age of patients was 67 years. Histologic cell type was squamous cell carcinoma in 36, adenocarcinoma in 1, large cell carcinoma in 1 and mucoepidermoid carcinoma in 1. All patients were treated with megavoltage irradiaton and radiation dose ranged from 5000cGy to 6150cGy with a median dose of 6000cGy. The median follow-up was 17 months with a range of 4 to 82 months. Survival was measured from the date therapy initiated. Results : The overall survival rate for entire patients was 40.6% at 2 years and 27.7% at 3 years with a median survival time of 21 months. The disease-free survival at 2 and 3years was 51.7% and 25.8% respectively. Of evaluable 20 patients with complete response. 15 patients were considered to have failed. Of these. 13 patients showed local failure and 2 patients failed distantly. Response to treatment (p=0.0001), tumor size (p=0.0019) and age (p=0.0247) were favorably associated with overall survival. Only age was predictive for disease-free survival (p=0.0452). Conclusion : Radiation therapy is an effective treatment for small (less than 3cm) tumors, and should be offered as an alternative to surgery in elderly or infirm patients. Since local failure is the prominent patterns of relapse, potential methods to improve local control with radiation therapy are discussed.