The Role of Radiation Therapy in Management of Wilms' Tumor

1979년부터 1988년까지 서울대학교병원 치료방사선과에서 방사선 치료를 받았던 Wilms씨 종양환자 28명의 치료성적을 분석하였다. 평균 추적관찰기간은 40개월이었다. 3년 국소 치유율 및 생존율은 각각 78.1%와 67.4%이었다. 연령에 따른 국소치유율이 차이는 없었다. Favorable histology와 Unfavorable histology 유형의 국소치유율은 각각 83.3%와 62.5%이었다. Favorable histology 유형의 Ⅱ기와 Ⅲ기 종양의 국소치유율 간에는 차이가 없었다(83.3% vs 100.0%). Unfavorable histology 유형의 Ⅰ/Ⅱ기와 Ⅲ기 종양의 국소치유율 간에는 유의한 차이가 있었다(83.3% vs 0%). 임파절 침윤이 확인된 경우에서의 국소치유율은 불량하였다(50.0% vs 87.5%). 방사선치료를 수술후 10일 이후에 개시한 경우에서의 국소치유율과 수술 후 9일 이내에 개시한 경우에서의 국소치유율간에는 유의한 차이가 있었다(p<0.05). 따라서 방사선치료는 국소치유율을 향상시키는데 유용하였으나 수술적 절제가 불가능한 종양에 대하여는 치료방법의 강화가 필요하다고 판단된다.

Treatment results of 28 patients with Wilms' tumor who received radiation therapy at the Department of Therapeutic Radiology, Seoul National University Hospital from 1979 to 1988 were analyzed. The median follow-up period for the survivors was 40 months. The local control and overall survival rate at 3 years were 78.1% and 67.4%, respectively. The local control was not affected by age. The local control rates for favorable histology (FH) and unfavorable histology (UH) were 83.3% and 62.5%, respectively. In FH, the local control rates of stage Ⅱ and Ⅲ were not different (83.3% vs 100.0%). In UH, the control rates of stage Ⅰ/Ⅱ and stage Ⅲ were 83.3% and 0%, respectively. Poor local control was correlated with involvement of lymph node (50.0% vs 87.5%). Radiotherapy delayed 10 or more days after operation resulted in poorer local control than that without delay (p<0.05). Thus radiotherapy contributed to reduction of local recurrence in patients with high risk factor without increased severe complication. It is suggested that vulky unresectable mass might need a more intensified treatment.