CAJ | 학술논문

目的通过分析皮肤早期放射反应对皮肤晚期放射反应的影响,探讨皮肤的继发性晚期放射损伤.方法对门诊随访的放疗后生存5年以上的335例鼻咽癌患者进行调查研究,其中放疗时中位年龄41岁(12～67岁),240例伴颈部淋巴结转移.鼻咽原发灶首程放疗中位剂量为70 Gy(55～86 Gy),以面颈野为主野放疗71例,以耳前野为主野放疗264例.颈部根治性放疗中位剂量为64 Gy(46～72 Gy),预防照射中位剂量为55 Gy(21～67 Gy).48例合并化疗.根据1995年SOMA标准评价皮肤晚期放射反应.结果随访间隔中位时间为14年(5～38年).63例无皮肤晚期反应,1、2、3、4级皮肤晚期反应发生率分别为43.9%(147例)、20.9%(70例)、13.7%(46例)、2.7%(9例).44例放疗中出现湿性脱皮反应,其中1、2、3、4级皮肤晚期反应发生率分别为41%(18例)、23%(10例)、30%(13例)和5%(2例);无湿性脱皮患者的相应发生率分别为44.3%(129例)、20.6%(印例)、11.3%(33例)和2.4%(7例),两者差异有统计学意义(χ2=17.42,P=0.002).分层分析结果显示初诊时是否伴颈部淋巴结转移、放疗野及颈部淋巴结放疗剂量均对皮肤晚期反应发生有关,而性别、年龄及是否联合使用化疗与皮肤晚期反应的发生无关.结论严重的皮肤早期放射反应可能增加皮肤晚期放射反应,可能存在继发性皮肤晚期放射损伤.
목적 통과분석피부조기방사반응대피부만기방사반응적영향,탐토피부적계발성만기방사손상.방법 대문진수방적방료후생존5년이상적335례비인암환자진행조사연구,기중방료시중위년령41세(12～67세),240례반경부림파결전이.비인원발조수정방료중위제량위70 Gy(55～86 Gy),이면경야위주야방료71례,이이전야위주야방료264례.경부근치성방료중위제량위64 Gy(46～72 Gy),예방조사중위제량위55 Gy(21～67 Gy).48례합병화료.근거1995년SOMA표준평개피부만기방사반응.결과 수방간격중위시간위14년(5～38년).63례무피부만기반응,1、2、3、4급피부만기반응발생솔분별위43.9%(147례)、20.9%(70례)、13.7%(46례)、2.7%(9례).44례방료중출현습성탈피반응,기중1、2、3、4급피부만기반응발생솔분별위41%(18례)、23%(10례)、30%(13례)화5%(2례);무습성탈피환자적상응발생솔분별위44.3%(129례)、20.6%(인례)、11.3%(33례)화2.4%(7례),량자차이유통계학의의(χ2=17.42,P=0.002).분층분석결과 현시초진시시부반경부림파결전이、방료야급경부림파결방료제량균대피부만기반응발생유관,이성별、년령급시부연합사용화료여피부만기반응적발생무관.결론 엄중적피부조기방사반응가능증가피부만기방사반응,가능존재계발성피부만기방사손상.
Objective To evaluate the relationship between early and late radiation damage in skin.Methods 335 patients with nasopharyngeal earcinoma treated with radical radiotherapy were evaluated. 240patients had lymph nodes in the neck at initial diagnosis. The median doses were 70 Gy (55-86 Gy) to thenasopharyngeal region by external beam radiotherapy. The median doses were 64 Gy (46-72 Gy) to the neck with lymph node metastases, 55 Gy (21-67 Gy) to the node-negative neck. 71 patients were treated with facial-neckfields, while 264 patients were treated with pre-auricular fields. Chemotherapy was given in 48 patients. According to the 1995 SOMA scales late radiation damage in the skin was evaluated. Results The median time from the radiotherapy to follow up was 14 years (range, 5-38 years). 63 patients have grade 0 late radiation reactions in the neck skin, the grade 1,2,3,4 late radiation reactions in the neck skin were 43.9% (147patients),20.9%(70 patients), 13.7% (46 patients)and 2.7% (9 patients), respectively.44 patients had moist desquamation in the medical records. The grade 1,2,3,4 late radiation reactions in the neck skin were 41% ,23%, 30% and 5%, respectively in patients with moist desquamation, while in patients without moist desquamation, the corresponding rates were 44.3%, 20.6%, 11.3% and 2.4%, respectively. The difference were significant between these two groups by chi-square analysis(χ2=17.42, P=0.002). Furthermore, whether patients had positive lymph node in the neck or not, the size of facial-neck fields and higher doses to the neck had more severe late radiation reaction in the neck skin, while age, gender and chemotherapy failed to show any effects on the development of late radiation reactions in the neck skin. Conclusion The severe early radiation damage in the skin possibly increases the late radiation damage in the neck skin.