External Beam Radiotherapy for Primary Spinal cord Tumors

1969년부터 1983년까지 버지니아 의대부속 병원에서 방사선 치료를 받은 34예의 원발성 척수암중, 조직검사 또는 아절제술을 시행한후 수술후 방사선 요법으로 치료 받은 32예(Astrocytoma 16, ependymoma 16)에 대한 치료실적을 보고하고자 한다. 29예에서는 45~55Gy를 5내지 6주간에 조사받았으며 나머지 3예에서는 40Gy 이하의 선량을 조사받았다. 50Gy 이상 조사된 6예는 모두 척수가 조사야에 포함되었다.. 본 연구의 최저 추적 기간은 5년이었다. 방사선 치료 실패후 재수술로 치료된 3예를 포함하여, 모든 예에서 생존율은 5년과 10년에서 각각 73%와 50%이었다. 각각의 투병생존율은 60%와 32%이었다. 45Gy 이상의 선량을 받은 29예에서는 5년 무병생존이 63%이었다. 13예에서 치료실패를 경험했으며 치료실패는 조사야에서만 관찰되었다. Ependymoma가 Astrocytoma보다 통계적으로 유의하게 무병생존율이 높았다. (45% : 89%(p<0.05)), 원발부위에 있어 경추가 포함된 예에서 그렇지 않은 예보다 생존율이 저하되었다. 원발부위의 cauda equina 포함여부는 예후에 영향이 없었다. 최고 20년간 추적결과 방사선 치료에 의한 신경성 합병증은 관찰되지 않았다. 본 연구는 원발성 척수암의 치료에 있어서 방사선 치료가 안전하고 효과적임을 확인하였다.

Of 34 evaluated patients with primary spinal cord tumors, 32 were irradiated at our institution between 1969 and 1983. The results are reported of 32 patients, 16 with ependymoma and 16 with astrocytoma, who were treated with post-operative external beam radiotherapy following biopsy or subtotal resection. Twenty-nina patients received 45~55 Gy megavoltage beam irradiation in 5~6 weeks and the remaining three patients received less then 40 Gy. Spinal cord was in the irradiated field for six patients who received more than 50 Gy. The minimum follow-up was five years. Five and ten year acturaial survival rates for entire group of patients were 73% (22/30) and 50% (8/16), including three patients who were salvaged by surgery after radiation failures. Corresponding five and ten year relapse free survival rates were 60% (18/30) and 32% (6/19), respectively. Of the 29 patients who recived more than 45 Gy, relapse free survival at five years was 63% (17/27). Treatment failed in 13 patients and all of those failures were in the irradiated portal. Patients with ependymomas have significantly better relapse free survival than those with astrocytomas, 80% vs. 4O% (p<0.05). There was significant difference in survival between patients with tumors involving the cervical spine and those with tumors in the other loactions, 45% vs. 89% (p<0.05). There was no significant difference in survival between patients with cauda equina tumors and those with tumors at spinal cord. 100% vs. 68% (p>0.05). No radiotherapy related neurological deficit was noted with a maximum 20 year follow-up. This study confirms that external beam radiotherapy is a safe and effective treatment modality for primary spinal cord tumors.