유방 관상피내암의 유방 보존술 후 방사선 치료의 성적과 예후 인자 분석 = Treatment Outcome and Analysis of the Prognostic Factors of Ductal Carcinoma in situ Treated with Breast Conserving Surgery and Radiotherapy

국문 초록 (Abstract)

목적: 유방 관상피내암 환자들의 유방 보존술 및 방사선 치료 후 생존율과 국소 재발률, 재발 양상 및 국소 재발에 영향을 준 인자들을 분석하고, 적절한 치료법을 결정하고자 하였다.
대상 및 방법: 1995년 6월부터 2001년 12월까지 유방 관상피내암으로 유방 보존술 후 방사선 치료를 받았던 96명의 환자를 대상으로 후향적 분석을 시행하였다. 수술은 국소 절제 또는 광범위 절제가 시행되었고, 일부에서 액와림프절 곽청술이 시행되었다. 방사선 치료는 전 유방에서 50.4 Gy/ 28회를 조사하였고, 절단면에 종양이 있거나 절단면에서 종양이 가까웠을 경우 (≤2mm) 일부에서 종양이 있었던 부위에 10~14 Gy를 추가 조사하였다. 전체 환자의 중앙 추적 관찰기간은 43개월(12~102개월)이었다.
결과: 5년 국소 무병생존율 생존율은 각각 91%, 100%였다. 국소 재발은 6명(6.3%)에서 발생하였고, 이 중 침윤성 유방암으로 재발한 환자는 1명이었다. 수술에서 재발까지의 기간은 1명을 제외하고는 모두 2년 이상이었다. 주위림프절 재발이나 원격전이는 없었다. 재발한 환자 중 5명은 유방전절제술 후 무병생존 중이고, 1명은 구제 치료예정이다. 국소 재발에 영향을 준 인자들에 대해 문석했을 때 , 연령, 절단면 상태, comedo type, 핵분화도 모두 국소 재발에 영향을 주지 않는 것으로 나타났다. 수술 범위에 따라서도 국소 재발에 차이를 보이지 않았고(p=0.30), 절단면이 종양에서 가까웠던 경우 초기 종양 부위에 추가 조사도 국소 재발에 영향을 주지 않았다.(p=1.0)
결론: 유방 관상피내암의 치료로 유방 보존술 및 방사선 치료 시행 후 높은 국소 제어율과 생존율을 얻을 수 있었다. 종양이 절단면을 침범하지 않는 한 절단면과 종양과의 거리와 추가 방사선 조사는 국소 재발에 영향을 주지 않는 것으로 나타났으나 향후 더 많은 환자로 장기적인 추적관찰이 필요할 것으로 생각된다.

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the survival rate, local failure rate and patterns of failure, and analyze the prognostic factors affecting local relapse of ductal carcinoma in situ treated with breast conserving surgery and radiotherapy
Materials and Methods: From June 1995 to December 2001, 96 patients with ductal arcinoma in situ treated with breast conserving surgery and radiotherapy were etrospectively analyzed. The operations were either local or wide excision in all patients, with an axillary lymph node dissection performed in some patients. Radiation dose to the whole breast was 50.4 Gy, over 5 weeks, with 1.8 Gy daily fractions, with additional doses (10 14 Gy) administered to the primary tumor bed in some patients with close ( 2 mm) or positive resection margin. The median follow-up period was 43 months (range 12 102 months).
Results: The 5-year local relapse free survival and overall survival rates were 91 and 100% respectively. Local relapse occurred in 6 patients (6.3%). Of the 6 recurrences, one was invasive ductal cell carcinoma. With the exception of one, all patients recurred 2 years after surgery. There was no regional recurrence or distant metastasis. Five patients with local recurrence were salvaged with total mastectomy, and are alive with no evidence of disease. One patient with recurrent invasive ductal cell carcinoma will receive salvage treatment.
On analysis of the prognostic factors affecting local relapse, none of the factors among the age, status of resection margin, comedo type and nuclear grade affected local relapse. Operation extent also did not affect local control (p=0.30). In the patients with close resection margin, boost irradiation to the primary tumor bed did not affect local control (p=1.0).
Conclusions: The survival rate and local control of the patients with ductal carcinoma in situ treated with breast conserving surgery and radiotherapy were excellent. Close resection margin and boost irradiation to the primary tumor bed did not affect local relapse, but further follow-up with much more patients is needed.

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