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  • [Radiat Oncol.] 기도를 침범한 T4b 식도암에서의 방사선치료

    [Radiat Oncol.] 기도를 침범한 T4b 식도암에서의 방사선치료 Clinical outcomes of radiation therapy for clinical T4b oesophageal cancer with airway invasion.

    성균관의대 / 김하경, 오동렬*

  • 출처
    Radiat Oncol.
  • 등재일
    2018 Dec 14
  • 저널이슈번호
    13(1):245. doi: 10.1186/s13014-018-1196-6.
  • 내용

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    Abstract
    BACKGROUND:
    Oesophageal cancer with airway invasion presents a challenge for therapy and often has serious complications. We analysed the clinical outcomes of radiation therapy (RT) in patients with clinical T4b oesophageal cancer with airway invasion.

    METHODS:
    We retrospectively reviewed the medical records of 73 patients with oesophageal cancer who had clinical T4 disease and who received RT between January 1994 and June 2017. Among them, 47 patients with clinical T4b disease with airway invasion were included in this study; 31 had gross invasion on bronchoscopy and 16 had extrinsic compression with mucosal change. We investigated the survival outcomes, clinical courses, and toxicities.

    RESULTS:
    The median survival (MS) time was 9 months. The 1- and 2-year overall survival (OS) rates were 41.4 and 27.4%, respectively. The MS times for patients treated with curative or palliative aims were 15 and 4 months, respectively (p = 0.001). Seven patients (14.9%) had fistulae at diagnosis; after RT, three had no change in size, three closed, and one had increased. Newly developed oesophageal fistulae after treatment were observed in 13 patients (27.7%). The median time to a newly developed fistula was 3 months (range, 1-15). Among them, a fistula was closed in only one patient. Death from aspiration pneumonia occurred in one patient who had a fistula at diagnosis and in nine patients who newly developed fistulae after treatment. Severe oesophageal bleeding causing death occurred in two patients. Patients with gross invasion on bronchoscopy had a higher risk of developing a fistula than did patients with mucosal change (37.5% vs. 25.0%, respectively).

    CONCLUSIONS:
    Even for clinical T4b disease with airway invasion, RT with a curative aim showed acceptable survival outcomes in patients with good performance status and no distant metastasis at initial diagnosis. However, the risk of fistula development associated with fatal events remains high. Further study is warranted to decrease the risks of treatment and improve clinical outcomes.

    TRIAL REGISTRATION:
    Retrospectively registered.

     


    Author information

    Kim H1, Oh D2, Ahn YC1, Park K3, Ahn MJ3, Lee SH3,4, Sun JM3, Shim YM5, Zo JI5, Choi YS5, Kim HK5, Cho JH5.
    1
    Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    2
    Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea. dongryul.oh@samsung.com.
    3
    Department of Medicine (Hemato-oncology), Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.
    4
    Department of Health Sciences and Technology, Samsung Advanced Institute of Health Science and Technology, Sungkyunkwan University, Seoul, Republic of Korea.
    5
    Department of Thoracic Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Republic of Korea.

  • 키워드
    Oesophageal fistula; Radiation therapy; T4b oesophageal cancer
  • 연구소개
    기도 침범이 있는 식도암은 방사선치료 중이나 후에 식도-기도 루(fistula), 혹은 출혈 등의 심각한 부작용이 발생할 수 있어 매우 주의가 필요한 임상 상황이다. 하지만 이러한 환자에서 방사선치료 후 임상 경과 및 치료 성적에 대한 보고들은 드물다. 본 연구는 기도 침범이 있는 식도암 환자에서 방사선치료 후 임상 경과 및 치료 성적을 분석하여, 임상 의사가 환자와 상담하고 방사선치료를 결정할 때 중요한 정보를 제공하는 것에 의미가 있다.
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