세기조절방사선치료(IMRT)로 치료한 비소세포폐암 환자에서의 방사선 폐렴 = Incidence and Prognostic Factors of Radiatio Pneumonitis in NSCLC Treated with Intensity Modulated Radiation Therapy (IMRT)

다국어 초록 (Multilingual Abstract)

Purpose: To evaluate the incidence and prognostic factors of treatment-related pneumonitis in non-small-cell
lung cancer (NSCLC) patients treated with intensity modulated radiation therapy (IMRT).
Materials and Methods: One-hundred-five patients with NSCLC treated with IMRT between 1 August 2004 and
30 November 2006 were analyzed retrospectively. The mean age of patients was 62.9 years, and squamous
carcinomas were confirmed in 81 patients (77%). Sixty-six patients (62.9%) were classified as stage III, and 59
patients had lesions in the right lung. Twenty-seven patients were treated with a dose of 3,060 cGy
preoperatively, and 10 patients were given a dose of 5,040 cGy postoperatively. Sixty-eight patients received a
dose of 7,020 cGy for curative intent. Sixty-eight patients were treated with the use of the CORVUS planning
system and 37 patients were treated with the use of the ECLIPSE planning system.
Results: Of 105 patients, 21 patients (20%) had abnormal radiological findings, but only seven patients (6.7%)
required treatment for radiation pneumonitis. Six of the seven patients had other serious lesions, including a
bronchioesophageal fistula (one patient), recurrence in the treatment field (two patients), brain metastasis (one
patient) and lung-to-lung metastasis (two patients); all of these patients died within 19 months after radiation
treatment. Sixteen patients (23.5%) that received planning with the CORVUS system had abnormal lung findings.
Five patients (13.5%) had abnormal lung findings with the use of the ECLIPSE planning system. Other prognostic
factors such as perioperative radiation therapy, a volume over 10% of the V20 volume in the right lung, were also
statistically significant.
Conclusion: This retrospective analysis suggests that IMRT could be a beneficial treatment modality for the
reduction of radiation pneumonitis in NSCLC patients. However, the higher incidence of abnormal radiological
findings in perioperative patients treated with relatively lower doses (3,060∼5,040 cGy) suggest the need for
judicious treatment planning in preoperative or postoperative treatment.

국문 초록 (Abstract)

목 적: 세기조절방사선치료로 치료한 비소세포폐암 환자에서 방사선 폐렴의 발생률과 영향을 미치는 요인을 분석
하고자 하였다.
대상 및 방법: 2004년 8월 1일부터 2006년 11월 30일까지 비소세포폐암으로 확진되고 세기조절방사선치료로 치
료한 환자 105명을 대상으로 하였다. 평균연령은 62.9세였고 편평상피암이 81명(77%)이었고, III기 환자가 66명으
로(62.9%) 가장 많았으며 우측 폐에 병소를 가진 환자는 59명, 좌측 폐는 46명이었다. 수술 전 방사선 치료로
3,060 cGy를 조사받은 환자는 27명, 수술 후 방사선치료로 5,040 cGy를 조사받은 환자는10명이었고 7,020 cGy의
근치적 방사선치료를 받은 환자는 68명이었다. 치료계획은 CORVUS 시스템이 68명, ECLIPSE 시스템이 37명이었
다.
결 과: 방사선 폐렴 혹은 방사선 치료와 관련된 병리학적 이상 소견으로 본원 영상의학과에서 진단된 환자는 21명
(20%)이었으나, 증상이 있어 치료를 받은 사람은 7명(6.7%)이었다. 치료받은 환자는 기관식도누공(1명), 재발(2
명), 뇌전이(1명), 반대 측 폐전이(2명)를 동반한 환자였고, 항암제 치료중 원인 불명으로 화장실에서 사망한 1명을
포함 7명 모두가 사망하였으나 방사선 폐렴만이 사망 원인이라고 단정하기는 어려웠다. 영상의학과에서 진단된 21
명중 CORVUS 시스템으로 치료 계획한 환자가 16명(23.5%), ECLIPSE로 계획한 환자는 5명(13.5%)이어서
CORVUS로 치료한 환자 군에서 폐렴의 발생이 유의하게 높았다. 수술 전 방사선 치료환자 27명중 5명이, 수술 후
방사선치료를 받은 환자 10명중 3명이 방사선폐렴을 보여 수술이 시행된 군이 수술이 시행되지 않은 군에 비해 상
대적으로 저 선량임에도 불구하고 폐렴 발생률이 높았다. V20은 우측에서 10% 이상인 환자, V10은 우측에서 20%
이상인 환자에서 통계학적인 유의성을 보였다.
결 론: 영상의학과에서 폐렴으로 진단된 환자는 21명이었으나 증상이 있어 치료를 받은 환자는 7명(6.7%)으로 세
기조절 방사선치료가 정상조직의 손상을 줄여 합병증을 줄이는 데 기여하였다고 생각된다. 통계학적으로 유의한
예후인자로는 치료 전후의 수술, CORVUS 시스템으로의 치료계획, 우측, V20이 10% 이상, V10이 20% 이상인 경우
였고, 비교적 적은 방사선량을 조사받은 수술 전, 수술 후 방사선치료 환자에서 높은 비율의 증상을 동반한 폐렴을
보인 것은 향후 세심한 치료계획이 필요함을 나타내었다.

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