비인강암 환자의 고선량 강내 방사선 치료의 효과

The Role of High Dose Rate (HDR) Intracavitary Radiation Therapy for the Management of Nasopharyngeal Carcinoma

From September 1989 to June 1992, 22 patients with nasopharyngeal carcinoma were treated in Asan Medical Center with an external beam of 60 Gy followed by a boost dose of 15 Gy HDR brachytherapy. There were 5 females and 17 males with median age of 44 years (range: 20-69 years). All patients were histologically confirmed and staged by physical examination, CT scan and/or MRI. By the AJCC TNM staging system, there were 2 patients with stage II (T2NO), 4 with stage III (T3NO, T1-3N1), and 16 with stage IV (T4 or N2-3). Four patients received chemotherapy with 5-FU and cisplatin prior to radiotherapy. All patients were followed up periodically by a telescopic examination and radiologic imaging study of CT scan or MRI with a median follow-up thime of 13 months (range: 3-34 months). Twenty one patients showed a complete response one month after completing therapy and one patient showed a compete response after three months. At the time of this analysis, seventeen patients remain alive without evidence of disease, but four patients developed distant metastasis and one patient died a month after treatment. the local control rate was 100% in a median follow-up time of 13 months. The two year overall and disease free survival rates by the Kaplan-Meier method were 94% and 67%, respectively. Serious radiation sequelae have not been observed yet. Although longer follow-up in needed, this retrospective analysis suggests that HDR brachytherap. given as a boost therapy for nasoharyngeal carcinoma may improve the local control. To reduce the incidence of distant metastasis, we need to develop a more effective systemic chemotherapy.