Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Preliminary Results of Phase I/II Study of Simultaneous Modulated Accelerated (SMART) for Nasopharyngeal Carcinoma

비인강암의 치료에서 동시차등조사가속치료를 적용한 제1상/2상 연구의 예비적 결과

  • Park Jin-Hong (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Back Geum-Mun (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Yi Byong-Yong (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Choi Eun-Kyung (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Ahn Seung-Do (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Shin Seong-Soo (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Kim Jung-Hun (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Kim Sang-Yoon (Department of Otolaryngology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Lee Bong-Jae (Department of Otolaryngology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Nam Soon-Yuhl (Department of Otolaryngology College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Choi Seung-Ho (Department of Otolaryngology College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Kim Seung-Bae (Department of Medical Oncology, College of Medicine, University of Ulsan, Asan Medical Center) ;
  • Lee Sang-Wook (Department of Radiation Oncology, College of Medicine, University of Ulsan, Asan Medical Center)
  • 박진홍 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 백금문 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 이병용 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 최은경 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 안승도 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 신성수 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 김정훈 (울산대학교 의과대학 서울아산병원 방사선종양학과) ;
  • 김상윤 (울산대학교 의과대학 서울아산병원 이비인후과) ;
  • 이봉재 (울산대학교 의과대학 서울아산병원 이비인후과) ;
  • 남순열 (울산대학교 의과대학 서울아산병원 이비인후과) ;
  • 최승호 (울산대학교 의과대학 서울아산병원 이비인후과) ;
  • 김성배 (울산대학교 의과대학 서울아산병원 종양학과) ;
  • 이상욱 (울산대학교 의과대학 서울아산병원 방사선종양학과)
  • Published : 2006.03.01
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Abstract

Puroose: To present preliminary results of intensity-modulated radiotherapy (IMRT) using the simultaneous modulated accelerated radiation therapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: Twenty patients who underwent IMRT for non-metastatic NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. IMRT was delivered using the 'step and shoot' SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume (GTV), 60 Gy (2 Gy/day) to the clinical target volume (CTV) and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received concurrent chemotherapy using cisplatin once per week. Results: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had RTOG grade 3 mucositis, whereas nine (45%) had grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no grade 3 or 4 chronic xerostomia. All patients showed complete response. Two patients had distant metastases and loco-regional recurrence, respectively. Conclusion: IMRT using the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and may also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.

목적: 비인강암 환자를 대상으로 시행한 동시차등조사가속치료(simultaneous modulated accelerated radiation therapy, SMART)를 이용한 세기조절방사선치료(Intensity modulated radiation therapy, IMRT)의 예비적 임상결과를 보고하고자 하였다. 대상 및 방법: 2001년 9월부터 2003년 12월까지 서울아산병원에서 근치적 목적의 동시차등조사가속치료를 시행 받은 20명의 비전이성 비인강암 환자를 대상으로 전향적 분석을 시행하였다. IMRT는 "step and shoot" SMART를 사용하여 시행되었으며, 각각 육안적종양체적(gross tumor volume, GTV)에 72 Gy (2.4 Gy/day), 비인강과 전이성 림프절부위(metastatic nodal station) 등을 포함하는 임상표적체적 1 (Clinical target volume 1, CTV1)에 60 Gy (2.0Gy/day), 그리고 임상적으로 전이가 없는 경부 부위림프절을 포함하는 임상표적체적 2 (clinical target volume 2, CTV2)에 46 Gy (2 Gy/day)를 조사하였다. 18명의 환자는 주당 1회의 isplatin 화학요법을 시행받았다. 결과: 연구대상에 포함된 환자의 추적관찰 기간의 중앙값은 27개월이었다. 19명의 환자는 치료 중단 없이 계획된 치료를 성공적으로 수행하였으나, 1명은 고도의 인두염과 영양불량으로 2주간 치료가 중단되었다. 치료 기간 중급성 독성은 RTOG 3도의 점막염과 인두염이 각각 5명(25%)과 9명(45%)에서 관찰되었다. 7명(35%)은 10% 이상의 체중 감소를 보였으며 11명(55%)은 정맥수액요법 혹은 경관영양요법을 필요로 하였다. 만성 독성에서 3급 이상의 구강건조증은 관찰되지 않았다 치료 반응은 모든 환자에서 완전관해를 보였고, 원격전이와 국소재발이 각각 2명과 1명에서 관찰되었다. 결론: SMART를 사용한 IMRT를 도입하여 임상적으로나 선량측정상 이하선의 기능 보존이 가능하였으며, 또한 생물학적으로 더욱 효과적일 것으로 생각되었다 향후 정확한 종양억제 효과와 만기 독성을 알기 위해서는 추가적인 연구대상과 추적관찰이 필요하다고 생각한다.

Keywords

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