Radiation Oncology Journal

The Korean Society for Radiation Oncology (대한방사선종양학회)
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Treatment Outcome of Metastatic Carcinoma of Cervical Lymph Node from an Unknown Primary

원발병소 블명의 경부림프절 전이의 치료결과

  • Kim Kyubo (Departments of Radiation Oncology, Seoul National University College of Medicine) ;
  • Chie EuiKyu (Departments of Radiation Oncology, Seoul National University College of Medicine) ;
  • Wu Hong-Gyun (Departments of Radiation Oncology, Institute on Radiation Medicine, Medical Research Center, Seoul National University College of Medicine) ;
  • Kim Kwang Hyun (Departments of Otorhinolarynogology and Head & Neck Surgery Seoul National University College of Medicine) ;
  • Sung Myung-Whun (Departments of Otorhinolarynogology and Head & Neck Surgery Seoul National University College of Medicine) ;
  • Heo Dae Seog (Departments of Internal Medicine, Seoul National University College of Medicine) ;
  • Park Charn Il (Departments of Radiation Oncology, Institute on Radiation Medicine, Medical Research Center, Seoul National University College of Medicine)
  • 김규보 (서울대학교 의과대학 방사선종양학교실) ;
  • 지의규 (서울대학교 의과대학 방사선종양학교실) ;
  • 우홍균 (서울대학교 의과대학 방사선종양학교실, 의학연구원 방사선의학연구소) ;
  • 김광현 (서울대학교 의과대학 이비인후과학교실) ;
  • 성명훈 (서울대학교 의과대학 이비인후과학교실) ;
  • 허대석 (서울대학교 의과대학 내과학교실) ;
  • 박찬일 (서울대학교 의과대학 방사선종양학교실, 의학연구원 방사선의학연구소)
  • Published : 2005.09.01
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Abstract

Purpose: To analyze the outcome of radiation therapy for patients with a metastatic carcinoma of cervical lymph nodes from an unknown primary (MUO), and identify the prognostic factors for these patients. Materials and Methods: Between July 1981 and June 1999, 39 patients with MUO underwent radiation therapy with curative intent. Twelve patients were treated with radiation therapy alone (Group 1), 8 with neoadjuvant chemotherapy followed by radiation therapy (Group 2), and 19 with either an excision or neck dissection and postoperative radiation therapy (Group 3). There were 31 males and 8 females, with a median age of 55 years, ranging from 25 to 77 ears. The median duration of follow-up was 38 months, ranging from 3 to 249 months. Results: The 5-year overall survival rate was $55\%$. According to the treatment modality, the 5-year disease-free survival rates of Groups 1, 2 and 3 were 48, 19 and $75\%$, respectively (p=0.0324). In addition to the treatment modality, the appearance of the primary site was a significant prognostic factor for disease-free survival (p=0.0085). Conclusion: Surgical resection and radiation therapy achieves a superior disease-free survival compared to radiation therapy alone, either with or without chemotherapy Further investigation Is needed to evaluate the role of chemotherapy in the treatment of MUO.

목적: 원발병소 불명의 경부림프절 전이의 치료는 각 기관들의 치료원칙에 따라 경부림프절청소술, 림프절 절제술, 방사선치료 및 항암화학치료 등 다양한 조합의 치료가 적용되고 있다. 저자들은 서울대학교병원에서 원발병소 불명의 경부림프절 전이의 치료성적을 분석하고자 하였다. 대상 및 방법: 1981년 7월부터 1999년 6월까지 서울대학교병원 방사선종양학과에서 근치적 또는 수술 후 방사선치료를 받은 39명의 환자들을 대상으로 후향적으로 분석하였다. 방사선치료가 12명에서, 선행항암화학요법 및 방사선치료가 8명에서, 수술 및 수술 후 방사선치료가 18명에서 시행되었고, 1명은 선행항암화학요법, 경부림프절청소청술 및 수술 후 방사선치료를 받았다. 성별은 남자가 31명, 여자가 8명이었고, 연령의 중앙값은 55세였다. 결과: 전체 환자의 5년 생존율은 $55\%$였다. 치료방법에 따라 분석해보았을 때, 수술+방사선치료가 방사선 치료 단독 혹은 항암화학요법+방사선치료에 비해 우월한 5년 무병생존율을 보고하였다 ($78\%\;vs.\;48\%\;vs.\;19\%$). 그 외에 원발병소 발현여부가 무병생존율에 유의한 영향을 주는 것으로 나타났다. 결론: 원발병소 불명의 경부림프절 전이의 치료에 있어서 수술적 절제술 및 방사선치료의 병용요법이 방사선치료$\pm$항암화학요법에 비해 우월한 무병생존율을 보여주었다. 항암화학요법의 효과에 대해서는 추가 연구가 요망된다.

Keywords

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