진행된 후두암 환자에서 수술 후 방사선 병합치료군과 방사선 후 구제수술군의 치료성적 비교

Abstract

Background and Objectives：Patients with early squamous cell carcinoma of the head and neck are successfully treated with radiation or surgery. But in advanced laryngeal squamous cell carcinoma, combined therapy with irradiation and surgery appears to provide better local control and survival rates than either form of treatment alone. The purpose of this article is to compare the treatment results and survival rates of treatment modality in patients with advanced (stage III, IV) laryngeal carcinoma. Materials and Methods：We analyzed 47 advanced laryngeal carcinoma patients who underwent preoperative radiotherapy and salvage operation due to recurred cancer versus operation with post-operative radiotherapy during the period of 18 years from January 1989 to December 2006. TNM staging of the disease was done by the AJCC staging system issued in 2011. The 5-year survival rate was calculated by Kaplan-Meier method. Results：The overall 5 year survival rate was 48.9%. The 5 year survival rate according to staging showed 78.6%, 36.4% in stage III, IV respectively. The 5 year survival rate according to treatment modality showed 47.1%, 50.0% in pre-operative radiotherapy and salvage operation, post-operative radiotherapy respectively. In the site of treatment failure, 17 had local/regional failure and 6 had distant metastasis. Twelve patients who were treated with functional orgal preservation surgery and post-operative radiotherapy could preserve voice. Conclusions：Although treatment of laryngeal carcinoma could be individualized, surgery and postoperative irradiation can be considered as a option with larynx preservation for advanced laryngeal cancer. (J Clinical Otolaryngol 2014;25:49-55)

진행성 후두암의 치료법은 다양하지만 수술과 방사선치료의 병합요법이 선호된다. 수술과 방사선치료 중 어느 것을 먼저 시행하느냐에 대해서는 아직 많은 의견들이 있다. 후두암의 5년 생존율은 병기와 관련성이 있었으나 원발 병소와 치료방법에 따라서는 통계적 유의성이 없었다. 그러나 수술을 우선한 환자에서 보존적 수술의 적응이 많았던 점으로 미루어 수술을 거부하고 방사선치료나 약물치료에만 의존하는 것보다 적절한 시기에 수술 을 시행하는 것이 중요하다. 진행성 후두암의 여러 가지 치료 중 수술과 비수술적 치료의 선택은 환자의 희망과 삶의 질 목표에 따라 진행 하되, 술 전 정확한 병기확인 및 평가로 수술과 방사선 치료를 병행한다면 후두의 기능보존과 함께 좋은 성적을 얻을 수 있을 것이라 기대한다.