바로가기  >

이달의 연구자 바로가기 Click!

Abstract
Objective: To assess the effect of local ablative therapy (LAT) on overall survival in patients with lung metastases from colorectal cancer (CRC) compared with patients treated with systemic therapy.

Summary background data: CRC affects approximately 1.4 million individuals worldwide every year. The lungs are commonly affected by CRC, and there is no treatment standard for a secondary lung metastasis from CRC.

Methods: This longitudinal, retrospective cohort study (2010-2018) quantified the pulmonary and extrapulmonary tumor burden of 1143 patients by retrospectively reviewing computed tomography images captured at diagnosis. A comprehensive multidisciplinary approach informed how and when surgery and/or stereotactic body radiotherapy was administered.

Results: Among 1143 patients, 473 patients (41%) received LAT, with surgery first (n = 421) or stereotactic ablative radiation therapy first (n = 52) either at the time of diagnosis (n = 288), within 1 year (n = 132), or after 1 year (n = 53). LAT was repeated in 158 patients (33.4%, 384 total sessions) when new lung metastases were detected. The 5- and 10-year survival rates for patients treated with LAT (71.2% and 64.0%, respectively) were significantly higher than those of patients treated with systemic therapy alone (14.2% and 10.0%, respectively; P <0.001). The overall survival of patients who received LAT intervention increased as the total tumor burden decreased.

Conclusions: A high long-term survival rate was achievable in a significant portion of patients with lung metastasis from CRC by the timely administrations of LAT to standard systemic therapy. The tumor burden and LAT feasibility should be included in a discussion during the follow-up period.

1143명의 환자에서 폐 전이 진단 당시 Chest CT를 통해 폐 전이의 개수를 정량화하였고, 추가적인 영상 검사를 통해 폐 이외의 전신 부위에서의 종양 부하량도 정량화하였다. 종양 부하량이 증가할수록 생존율이 비례하여 감소하는 경향을 보였다. 이 결과는 3개 또는 5개 이하의 전이암으로 정의되는 기존의 'oligometastasis'라는 개념이 단순히 이분법적인 개념이 아니라 질병의 스펙트럼을 나타낸다는 것을 시사하였다.

질병 부하량에 따른 국소 치료 효과를 분석한 서브그룹 결과: 폐 이외의 전신 부위에 전이암이 없는 경우, 폐 전이의 개수가 6개 이상이더라도 국소 치료가 효과적일 수 있다는 것을 시사하였다.

좌: 수술을 받는 것이 방사선 치료를 받는 것보다 생존율이 높게 나타났지만, 이는 주로 전이 개수가 적거나 폐 이외의 전신 부위에 전이암이 없는 경우에 수술을 우선적으로 시행하는 환자의 특성을 반영한다고 볼 수 있다.

우: 국소 치료 후 폐 전이가 재발하더라도 여러 번의 국소 치료를 재시행한 환자들은 국소 치료 한 번만 시행한 후 재발이 없이 추적 관찰된 환자와 비교하여 마찬가지로 좋은 생존율을 보였다.

Affiliations

Byung Min Lee 1 2, Jee Suk Chang 1, Woong Sub Koom 1, Hwa Kyung Byun 1, Han Sang Kim 3, Seung-Hoon Beom 3, Caleb Oh 1, Young Joo Suh 4, Joong Bae Ahn 3, Sang Joon Shin 3, Byung Jo Park 5, Seong Yong Park 5 6
1Department of Radiation Oncology, Yonsei University College of Medicine, Seoul, Republic of Korea.
2Department of Radiation Oncology, Uijeongbu St. Mary's Hospital, The Catholic University of Korea, Uijeongbu, Gyeonggi-do, Republic of Korea.
3Division of Medical Oncology, Department of Internal Medicine, Yonsei University College of Medicine, Seoul, Republic of Korea.
4Department of Radiology, Yonsei University College of Medicine, Seoul, Republic of Korea.
5Department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Republic of Korea.
6Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea.