방사선종양학

  • [J Gynecol Oncol.] Definitive treatment of primary vaginal cancer with radiotherapy: multi-institutional retrospective study of the Korean Radiation Oncology Group (KROG 12-09).

    [J Gynecol Oncol.] Definitive treatment of primary vaginal cancer with radiotherapy: multi-institutional retrospective study of the Korean Radiation Oncology Group (KROG 12-09).

    서울의대/ 장지현, 김학재*

  • 출처
    J Gynecol Oncol.
  • 등재일
    2016 Mar
  • 저널이슈번호
    27(2):e17.
  • 내용

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    Abstract

    OBJECTIVE:

    To assess the outcome of the treatment of primary vaginal cancer using definitive radiotherapy (RT) and to evaluate the prognostic factors of survival.

     

    METHODS:

    The medical records of nine institutions were retrospectively reviewed to find the patients with vaginal cancer treated with definitive RT with or without chemotherapy. A total of 138 patients met the inclusion criteria. None had undergone curative excision.

     

    RESULTS:

    The median follow-up time of the survivors was 77.6 months and the median survival time was 46.9 months. The 5-year overall survival, cancer-specific survival (CSS), and progression-free survival (PFS) rates were 68%, 80%, and 68.7%, respectively. In the survival analysis, the multivariate analysis showed that a lower the International Federation of Gynecology and Obstetrics (FIGO) stage and prior hysterectomy were favorable prognostic factors of CSS, and a lower FIGO stage and diagnosed prior to year 2000 were favorable prognostic factors of PFS. In the subgroup analysis of the patients with available human papillomavirus (HPV) results (n=27), no statistically significant relationship between the HPV status and recurrence or survival was found. Grade 3 or 4 acute and late toxicity were present in 16 and 9 patients, respectively. The FIGO stage and the tumor size were predictors of severe late toxicity.

     

    CONCLUSION:

    The data clearly showed that a higher FIGO stage was correlated with a worse survival outcome and higher severe late toxicity. Therefore, precise RT and careful observation are crucial in advanced vaginal cancer. In this study, the HPV status was not related to the survival outcome, but its further investigation is needed. 

     

     

    Author information

    Chang JH1, Jang WI2, Kim YB3, Kim JH4, Kim YS5, Kim YS1, Park W6, Kim J7, Yoon WS8, Kim JY9, Kim HJ10.

    1Department of Radiation Oncology, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.

    2Department of Radiation Oncology, Korea Institute of Radiological & Medical Science, Seoul, Korea.

    3Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, Korea.

    4Department of Radiation Oncology, Keimyung University Dongsan Medical Center, Keimyung University School of Medicine, Daegu, Korea.

    5Department of Radiation Oncology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

    6Department of Radiation Oncology, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, Korea.

    7Department of Radiation Oncology, Cheil General Hospital & Women's Healthcare Center, Dankook University College of Medicine, Seoul, Korea.

    8Department of Radiation Oncology, Korea University Ansan Hospital, Korea University College of Medicine, Ansan, Korea.

    9Center for Uterine Cancer, Research Institute and Hospital, National Cancer Center, Goyang, Korea.

    10Department of Radiation Oncology, Seoul National University College of Medicine, Seoul, Korea. khjae@snu.ac.kr. 

  • 키워드
    Radiotherapy; Stage; Vaginal Neoplasms
  • 연구소개
    본 연구는 매우 드문 종양인 질암의 근치적 목적의 방사선치료의 성적 및 예후인자를 평가하기 위하여, 한국의 9개의 병원에서 치료받은 138 명의 환자의 기록을 바탕으로 대한방사선종양학회 부인암분과에서 시행한 후향적 연구입니다. 대한민국 5년동안 등록된 질암 환자의 수가 240 명 정도이며 수술적 절제도 상당수 이루어지는 것을 감안하면 적지 않은 수의 환자에 대한 결과라고 볼 수 있겠습니다. 환자의 전체 5년생존률 (overall survival)은 68% 이었으나, 암과관련된 5년 생존률 (cancer specific survival) 은 80% 임을 감안하면 방사선치료를 시행하였을때 높은 수준의 질암과 관련한 생존률을 기대할 수 있다고 할 수 있겠습니다. 다만 병기가 높거나 크기가 큰 종양을 가진 환자분들의 경우에는 생존률이 낮아짐은 물론이고, 치료로 인한 부작용도 빈도가 높게 나타나, 세기조절방사선치료 (IMRT) 등의 적극적인 도입이 필요할 것으로 생각됩니다.
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