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1254 KISEP Head and Neck Korean J Otolaryngol 2005; 48: 1254-60 비인강암의 치료 성적과 예후인자 치료 실패의 분석 연세대학교 의과대학 이비인후과학교실, 1 치료방사선과학교실, 2 건국대학교 의과대학 이비인후-두경부외과학교실 3 백승재 1 ·이세영 1 ·임영창 3 ·구본석 1 ·이진석 1 ·이창걸 2 ·김귀언 2 ·이원상 1 ·최은창 1 TreatmentOutcome,PrognosticFactorsandPatternsofFailure ofNasopharyngealCarcinoma SeungJaeBaek,MD 1 ,SeiYoungLee,MD 1 ,YoungChangLim,MD 3 , BonSeokKoo,MD 1 ,JinseokLee,MD 1 ,ChangGeulLee,MD 2 , KyuUnKim,MD 2 ,WonSangLee,MD 1 andEunChangChoi,MD 1 1 Department of Otorhinolaryngology and 2 Radiation Oncology, Yonsei University College of Medicine, Seoul ; and 3 Department of Otolaryngology-Head and Neck Surgery, Konkuk University College of Medicine, Seoul, Korea ABSTRACT PurposeThe first treatment of choice for nasopharyngeal carcinoma (NPC) is radiotherapy as NPC is more responsive to radiotherapy than any other head and neck cancer. We analyzed the clinical characteristics and prognostic factors of NPC patients treated at the Severance Hospital. Subjects and MethodCharts of 123 patients diagnosed with NPC at the Severance Hospital from 1995 to 2002 were reviewed and retrospectively analyzed. They were staged according to the 1997 AJCC criteria. According to the WHO classification, the type I included 14 cases, type II 44 cases, and type III 65 cases. Sixty-five cases were treated with radiotherapy only and 58 cases were treated with a combined modality of chemotherapy and radiotherapy. ResultsThe factors for a poor prognosis were age over 47 years’ old, histologic findings of WHO type I and advanced T, N stage. The overall 5 year survival rate was 66.22%. According to treatment modality, only the radiotherapy group was 68.6%, while the chemoradiothe- rapy group was 63.6%. There was no difference in survival (p>0.05). In chemoradiotherapy group, the survival of induction chemoradiotherapy group was 82.1% and the concurrent chemoradiotherapy group was 36.8%. There was significant difference in survival. ConclusionsThere was no significant difference in the 5 year survival rate between the patients who were treated with radiotherapy only and those who were treated with both radiotherapy and chemotherapy. (KoreanJOtolaryngol2005; 48:1254-60) KEYWORDSNasopharyngeal carcinoma·Treatment outcome·Radiotherapy·Chemotherapy·Prognostic factor. 비인강암은 다른 두경부 영역의 암과는 치료 법, 성장 식, 병기의 설정 및 Epstein-Barr virus와의 연관성 여 부 등에서 차이를 보이는 질병이다. 1) 중국 광동지 , 타이 완, 필리핀 등지에서 빈도가 높은 것으로 알려져 있으며, 우리나라에서는 아직까지 전국적인 역학 조사가 이루어 진 것이 없다. 다만 기관에 따라 전체 두경부 악성 종양 환자 의 7.2~23.1%의 유병율을 보고 하고 있다. 2)3) 이러한 비 인강암은 발생부위의 해부학적 특징 때문에 조기 발견이 어 렵고, 두개저와 인접하여 수술적 접근이 곤란하고, 다른 두 경부 암들보다 사선 치료에 더 잘 반응하기 때문에 일차 적인 선택으로 사선 치료가 많이 시도되고 있다. 사선 치료에 따른 5년 생존율은 보고자에 따라서 45.6~53.6% 가 보고되고 있지만, 국내에는 예후 인자 및 치료 실패의 유 형에 대한 문헌이 많지 않다. 4)5) 이에 저자들은 1995년부 터 2002년까지 세브란스병원에서 치료 받은 비인강암 환 자에 대한 임상적 특징과 예후인자 및 치료 실패의 유형을 후향적으로 알아보고, 향후 치료 법의 결정에 도움을 얻 고자 본 연구를 시행하였다. 논문접수일:2005년 3월 30일 / 심사완료일:2005년 6월 14일 교신저자:최은창, 120-752 서울 서대문구 신촌동 134번지 연세대학교 의과대학 이비인후과학교실 전화:(02) 2228-3608·전송:(02) 393-0580 E-mail:[email protected]

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  • 1254

    KISEP Head and Neck Korean J Otolaryngol 2005;;;;48::::1254-60

    ,1 ,2 -3

    113112211

    Treatment Outcome, Prognostic Factors and Patterns of Failure

    of Nasopharyngeal Carcinoma

    Seung Jae Baek, MD1, Sei Young Lee, MD1, Young Chang Lim, MD3,

    Bon Seok Koo, MD1, Jinseok Lee, MD1, Chang Geul Lee, MD2,

    Kyu Un Kim, MD2, Won Sang Lee, MD1 and Eun Chang Choi, MD1 1Department of Otorhinolaryngology and 2Radiation Oncology, Yonsei University College of Medicine, Seoul; and 3Department of Otolaryngology-Head and Neck Surgery, Konkuk University College of Medicine, Seoul, Korea ABSTRACT

    PurposeThe first treatment of choice for nasopharyngeal carcinoma (NPC) is radiotherapy as NPC is more responsive to radiotherapy than any other head and neck cancer. We analyzed the clinical characteristics and prognostic factors of NPC patients treated at the Severance Hospital. Subjects and MethodCharts of 123 patients diagnosed with NPC at the Severance Hospital from 1995 to 2002 were reviewed and retrospectively analyzed. They were staged according to the 1997 AJCC criteria. According to the WHO classification, the type I included 14 cases, type II 44 cases, and type III 65 cases. Sixty-five cases were treated with radiotherapy only and 58 cases were treated with a combined modality of chemotherapy and radiotherapy. ResultsThe factors for a poor prognosis were age over 47 years old, histologic findings of WHO type I and advanced T, N stage. The overall 5 year survival rate was 66.22%. According to treatment modality, only the radiotherapy group was 68.6%, while the chemoradiothe-rapy group was 63.6%. There was no difference in survival (p>0.05). In chemoradiotherapy group, the survival of induction chemoradiotherapy group was 82.1% and the concurrent chemoradiotherapy group was 36.8%. There was significant difference in survival. ConclusionsThere was no significant difference in the 5 year survival rate between the patients who were treated with radiotherapy only and those who were treated with both radiotherapy and chemotherapy. (Korean J Otolaryngol 2005; 48:1254-60) KEY WORDSNasopharyngeal carcinomaTreatment outcomeRadiotherapyChemotherapyPrognostic factor.

    , , Epstein-Barr virus .1) , , , .

    7.2~23.1% .2)3) , , . 5 45.6~53.6% , .4)5) 1995 2002 , .

    2005 3 30 / 2005 6 14 , 120-752 134 (02) 2228-3608(02) 393-0580 [email protected]

  • 1255

    1995 1 2002 3 226 , , , 138 123 . , , , , , . . 5 108, 51. (complete remission) , 4 , (treatment failure) (re-currence) 6 , . . , (CT) (MRI) , . 1997 5 AJCC (The 5th Edition of the American Joint Committee on Cancer Staging System, Table 1) .6) T1 24(20%), T2 60(49%), T3 5(4%), T4 34(27%) , N0 22(18%), N1 28(22%), N2 45(36%), N3a 13(11%), N3b 15(12%) . level 71.5%, level , (Table 2). (paraph-aryngeal extension) T2a T2b , (retropharyngeal lymphadenopa-

    thy) (pharyngobasilar fascia) T2a T2b (Table 3). SPSS for Windows(Release 11.0.1) . , , Kaplan-Meier

    Table 1. The 5th Edition of the AJCC* staging system of Na-sopharynx

    T1 Tumor confined to the nasopharynx T2

    Tumor extends to soft tissue of oropharynx and/ornasal fossa

    T2a Without parapharyngeal extension

    T2b With parapharyngeal extension T3

    Tumor invades bony structures and/or paranasal sinuses

    T4

    Tumor with intracranial extension and/or involvement of cranial nerves, infratemporal fossa, hypopharynx,or orbit

    Nx Regional lymph node cannot be assessed

    N0 No regional lymph node metastasis

    N1 Unilateral metastasis in lymph node (s) measuring6 cm in greatest dimension above supraclavicularfossa

    N2

    Bilateral metastasis in lymph node (s) measuring 6cm in greatest dimension above the supraclavicularfossa

    N3 Metastasis in a lymph node (s)

    N3a 6 cm in greatest dimension

    N3b Extension to the supraclavicular fossa

    MX Distant metastasis cannot be assessed

    M0 No distant metastasis

    M1 Distant metastasis *AJCCAmerican Joint Committee on Cancer Supraclavicular zone or fossa is relevant to the staging of na-sopharyngeal carcinoma and is the triangular region originally described by Ho. It is defined by three points(1) the superior margin of the sternal end of the clavicle, (2) the superior margin of the lateral end of the clavicle, (3) the point where the neck meets the shoulder. Note that this would include caudal por-tions of Levels IV and V. All cases with lymph nodes (whole or part) in the fossa are considered N3b. Table 2. Neck node presentation of nasopharyngeal carci-noma (n=123)

    Level of neck node Number of patients (%)

    I 05 (04.0)

    II 88 (71.5)

    III 50 (40.6)

    IV 18 (14.6)

    V 31 (25.2)

    None 22 (17.9)

  • Korean J Otolaryngol 2005;48:1254-60 1256

    , log-rank test .7)

    123 102(83%) 21(17%). 12 75 46.8. WHO 1( , Keratinizing squamous cell carcinoma) 14(11%), 2( , Non-keratinizing squamous cell carcinoma) 44(36%), 3(, Undifferentiated carcinoma) 65(53%). 78(63.4%), 39(31.7%), 34(27.6%), 20(16.3%), 17(13.8%), 16(13.0%), 16(13.0%), 8(6.5%). 2 48 , 5.6. 20 5, 6 11 9 . 80(65.0%), (excisional biopsy) 32(26.0%), 10(8.0%) 3 1(1.0%). 65(53.0%) 3 . 58(47.0%) . 7020cGy, (N0) 5040 cGy, (N+) 7020cGy

    (target dose) , 1 (residual mass) (booster radiotherapy) . 6620cGy 8100cGy( 6878cGy) 4500 cGy 7800cGy( 5408cGy) 6120cGy 9700cGy( 6757cGy), 4500cGy 8000cGy( 5896cGy) . () (induction chemotherapy) 22, (CCRTConcurrent Chemo-Radio Therapy, ) 36 . , (pre-radiotherapy dental care) 1 , 2 . 5-FU 1, 5-FU+platinum 49, 5-FU+platinum+Taxotere 3, 5-FU+platinum+Vinblastine 3, 5-FU+Vinblastine 1, oral UFT granule (5-FU ) 1(Table 4). 1 4, 2 8, 3 9, 4 4, 5 2, 6 27 4.

    Table 3. TNM staging of nasopharyngeal cancer (n=123)

    T1 T2 T3 T4 Total

    N0 3 7 2 10 022 (018%)

    N1 7 14 1 6 028 (022%)

    N2 7 25 1 12 045 (036%)

    N3a 5 6 0 2 013 (011%)

    N3b 2 8 1 4 015 (012%)

    Total 24 (19%) 60 (49%) 5 (4%) 34 (27%) 123 (100%)

    Table 4. Treatment modalities of nasopharyngeal carcinoma (N=123)

    Treatment modality Number (%)

    Radiotherapy only 65 (53.0) Surgery+radiotherapy 03

    Chemo-radiotherapy 58 (47.0) Induction chemotherapy 22

    5-FU 01 5-FU+DDP 17 5-FU+DDP+Taxotere 01 5-FU+DDP+Vinblastine 03

    Concurrent chemotherapy 36 5-FU+DDP 32 5-FU+DDP+Taxotere 02 5-FU+Vinblastine 01 Oral UFT 01

  • 1257

    6 cm (central necrosis) (pe-ripheral rim enhancement) 3 , 2 , 1 . Kaplan-Meier 5

    66.22%(Fig. 1). 5 61.8%, 84.8% (p>0.05). 47 5 47 48.9%, 47 86.1% (Fig. 2). 5 WHO 1 40.1%, 2 61.4%, 3 76.4% (Fig. 3). 5 48.4% 70.0% (p0.05). 5 82.1% 36.8% (Fig. 6). 123 22(18%) , 21(17%). 15 , 54 .

    Fig. 1. Overall cumulative survival rate of 123 patients with na-sopharyngeal carcinoma.

    1.0

    0.8

    0.6

    0.4

    0.2

    0.0

    0.00 20.00 40.00 60.00 80.00 100.00 120.00

    Time (Months)

    Ove

    rall s

    urvi

    val

    Fig. 2. Overall survival rate of nasopharyngeal carcinoma byage group.

    1.0

    0.8

    0.6

    0.4

    0.2

    0.0

    0.00 20.00 40.00 60.00 80.00 100.00 120.00

    Time (Months)

    Cum

    ulat

    ive

    surv

    ival

    rate

    p=47 years

    Age

  • Korean J Otolaryngol 2005;48:1254-60 1258

    10(16%),

    5(8%) 5(8%) . 1, 2 . , 15. 3(2.4%) 2(3%), 1(2%) . 1 2

    13 . 6 9(7%) 5(8%), 4(7%) . 4, 3, 2. 1 , 2 , 1 5 . , 15 . 10(8%), 8(13%), 2(3%). 6, C (type C infratemporal fossa approach) 2, 1, 1 . 4, 3 (NEDNo evidence of disease) . 4(3%) 3 , 1 3 . 7(5%) , 1 7 .

    1.0

    0.8

    0.6

    0.4

    0.2

    0.0

    0.00 20.00 40.00 60.00 80.00 100.00 120.00

    Time (Months)

    Cum

    ulat

    ive

    surv

    ival

    rate

    p=0.0305

    T1 T3

    T2

    T4

    Fig. 4. Survival rate of nasopharyngeal carcinoma by T-stage.

    Fig. 5. Survival rate of nasopharyngeal carcinoma by N-stage.

    1.0

    0.8

    0.6

    0.4

    0.2

    0.0

    0.00 20.00 40.00 60.00 80.00 100.00 120.00

    Time (Months)

    Cum

    ulat

    ive

    surv

    ival

    rate

    p=0.031

    N1

    N0 N2a

    N2b

    N3

    Fig. 6. Overall survival rate of induction chemoradiotherapy and concurrent chemoradiotherapy.

    1.0

    0.8

    0.6

    0.4

    0.2

    0.0

    0.00 20.00 40.00 60.00 80.00 100.00

    Time (Months)

    Cum

    ulat

    ive

    surv

    ival

    rate

    p=0.0004

    Induction chemoradiotherapy

    Concurrent chemoradiotherapy

  • 1259

    . . - , . . 16 3, 4 . 30~40 , .8) 5 47 . WHO 3 WHO 1 . (53%) (36%), (11%) . 1 . 1 5 (40.1%), (p= 0.0017). 1 . T T . T3 5 , p- 0.03 .

    . ,9) . T2b . . 5 N3b . .10) 3, 4 5-FU+platinum 3 platinum 3 5 30% .11) 5 , . . . , .

    9

  • Korean J Otolaryngol 2005;48:1254-60 1260

    5 66.22%, , , T-, N-, . . .

    REFERENCES

    1) Teo P, Shiu W, Leung SF, Lee WY. Prognostic factors in nasoph-aryngeal carcinoma investigated by computer tomography - an an-alysis of 659 patients. Radiother Oncol 1992;23:79-93.

    2) Shin YS, Kim JH, Kim KR, Park CW, Lee HS, Ahn KS. Clinical study of Malignant Tumors of the Nasopharynx. Korean J Otolaryngol-Head Neck Surg 1989;32:879-87.

    3) Kim HK, Park SK. The clinical and statistical study of the head and neck tumors. Korean J Otolaryngol-Head Neck Surg 1978;21:535-41.

    4) Kim HS, Lee BJ, Kim SY. Clinical Characteristics and Treatment

    Results of Nasopharyngeal Cancer. Korean J Otolaryngol-Head Neck Surg 1998;41: 251-6.

    5) Lee WJ, Shim YS, Oh KK, Lee YS, Park CK. Nasopharyngeal carci-noma: A clinical study and analysis of prognostic factors. Korean J Otolaryngol-Head Neck Surg 1996;39:1455-63.

    6) American Joint Committee on Cancer. Manual for staging of cancer. 5th ed Philadelphia: JB Lippincott;1997.

    7) Kaplan E, Meier P. Monparametric estimation from incomplete observations. J Am Stat Assoc 1958;53:457-81.

    8) Lee AW, Poon YF, Foo W, Law SC, Cheung FK, Chan DK, et al. Retrospective analysis of 5037 patients with nasopharyngeal carci-noma treated during 1976-1985: Overall survival and patterns of failure. Int J Radiat Oncol Biol Phys 1992;23:261-70.

    9) McLaughlin MP, Mendenhall WM, Mancuso AA, Parsons JT, Mc-Carty PJ, Cassisi NJ, et al. Retropharyngeal adenopathy as a predictor of outcome in squamous cell carcinoma of the head and neck. Head Neck 1995;17:190-8.

    10) Chua DT, Sham JS, Kwong DL, Choy DT, Au GK, Wu PM. Prog-nostic value of paranasopharyngeal extension of nasopharyngeal carcinoma. A significant factor in local control and distant meta-stasis. Cancer 1996;78:202-10.

    11) Al-Sarraf M. Treatment of locally advanced head and neck cancer: Historical and critical review. Cancer Control 2002; 9:387-99.