Original Article J Korean Geriatr Soc 2013;17(2):79-85 http://dx.doi.org/10.4235/jkgs.2013.17.2.79 노인전립선암환자에서나선형토모테라피의적용 부산대학교의학전문대학원방사선종양학교실 1, 부산대학교병원방사선종양학과 2, 부산대학교병원의생명연구원 3, 양산부산대학교병원방사선종양학과 4 기용간 1,2,3 남지호 1,4 김원택 1,2,3 박달 2,3 김동현 2,3 이주혜 2,3 전호상 4 김동원 1,2,3 Helical Tomotherapy in Elderly Prostate Cancer Patients Yong Kan Ki, MD 1,2, Ji Ho Nam, MD 1,3, Won Taek Kim, MD 1,2, Dahl Park, PhD 2, Dong Hyun Kim, MD 2, Ju Hye Lee, MD 2, Ho Sang Jeon, PhD 3, Dong Won Kim, MD 1,2 1 Department of Radiation Oncology, Pusan National University School of Medicine, Busan, 2 Department of Radiation Oncology, Biomedical Research Institute, Pusan National University Hospital, Busan, 3 Department of Radiation Oncology, Pusan National University Yangsan Hospital, Yangsan, Korea Background: Helical tomotherapy is a new form of image-guided intensity modulated radiation therapy that may improve local control and decrease radiation toxicity. The aim of this study was to evaluate if high-dose helical tomotherapy is tolerated by patients aged 75 years or older and if the side effects are comparable with those experienced by younger patients. Methods: Between January 2011 and August 2012, patients with prostate cancer who underwent helical tomotherapy without elective pelvic irradiation as definitive aim were reviewed and divided into two age groups: 75 years and <75 years. Acute genitourinary (GU) and lower gastrointestinal (GI) toxicities between the two groups were compared. Results: Twenty patients aged 75 years or older and 23 patients younger than 75 years were evaluated. Radiotherapy was administered to a total dose of 76 78 Gy in 38 39 fractions or 70 Gy in 28 fractions. There was no grade 3 or 4 acute toxicity and no grade 2 acute lower GI symptom, but the patients complained of grade 2 acute GU toxicity, 25.0% for the older group and 13.0% for the younger group. There was no significant difference in the rate of acute toxicity between the age groups. Hypofractionation showed a significant association with higher grade 2 acute GU toxicity (p=0.024) with the grade 2 acute GU toxicity having no significant correlation with T-stage, Gleason score, prostate specific antigen level, androgen deprivation therapy, and comorbidities. Conclusion: High-dose helical tomotherapy to the prostate without pelvic irradiation was well tolerated by elderly prostate cancer patients 75 years and older. Key Words: Helical tomotherapy, Prostate cancer, Elderly 서 론 Received: February 5, 2013 Revised: March 24, 2013 Accepted: March 26, 2013 Address for correspondence: Ji Ho Nam, MD Department of Radiation Oncology, Pusan National University Yangsan Hospital, 20 Geumo-ro, Yangsan 626-787, Korea Tel: +82-55-360-3453, Fax: +82-55-360-3449 E-mail: jihonam@hanmail.net 기대수명의연장과전립선특이항원 (prostate specific antigen, PSA) 선별검사의도입으로인해 1) 해마다전립선암으로진단받는노인환자의수는증가하고있다. 2010년국가암등록통계발표자료에의하면전립선암은조발생률이 10만명당 31.4 명으로남성전체암중다섯번째로흔한종양이며, 65세이상인경우 10만명당 274.1명으로폐암, 위암, 대장암에이어네번째로높은발생률을보인다고한다. 전립선암의치료방법으로는수술, 방사선치료, 남성호르몬차단요법 (androgen deprivation therapy), 대기요법 (watchful waiting) 등이있으며, 이중수술과방사선치료가근치적치료에속한다. Copyright 2013 Korean Geriatric Society This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/).
Yong Kan Ki, et al: Tomotherapy in Elderly Prostate Cancer Patients 전립선암은비교적진행이느리기때문에보존요법만을시행하더라도전립선암으로인한사망률은 10년이경과한후에야급증한다고보고되고있고 2), 수술이나방사선치료에의한합병증의위험때문에노인전립선암환자에서는치료방법을결정할때병기, PSA 수치, Gleason 점수외에도나이를매우중요한인자로고려하고있다 3). 일반적으로근치적인치료는기대수명이 10년이상인경우에적용되며, 고령이나다른동반질환으로인해 10년이상의생존을기대하기어려운경우에는남성호르몬차단요법이나대기요법과같은소극적인치료를하게되고 4), 75세이상의환자중 60% 정도에서소극적치료가일차적으로시행되는것으로보고되고있다 5). 노인환자의경우진단당시적극적인치료가필요한고위험군 (high-risk group) 의비율이젊은환자에비해많지만 6), 많은경우에소극적인치료만을시행하게되어전립선암으로인한사망률이상대적으로높게보고되고있다 7). 소극적인치료중대기요법은환자에게암이진행할수있다는지속적인불안감을줄수있고, 적극적인치료와적절하게비교된연구가없어근거가부족하다는주장이있고 8), 남성호르몬차단요법은당뇨병, 이상지질혈증, 심혈관질환, 우울증의이환율이증가한다는보고가있을뿐아니라 9-11) 장기간지속시 3년이내에호르몬불응성으로진행하게된다고한다 12). 이런이유로노인전립선암환자에서도삶의질향상과생존율향상을위해서적극적인치료의필요성이제기되고있다. 방사선치료는수술에비해상대적으로급성합병증의가능성이낮기때문에동반질환이나신체상태로인해수술이힘들거나진행된병기등으로완전절제가힘든경우, 또는환자가원하는경우에근치적치료로시행된다. 일반적으로노인전립선암환자에서는수술보다급성부작용의위험이적은방사선치료가권장되고있지만, 노인환자에서방사선부작용의빈도와정도가상대적으로더높은것으로보고되고있어 13) 적극적으로고선량의방사선치료를권장하기에는어려움이있었다. 최근방사선치료기술의발전으로나선형토모테라피 (helical tomotherapy) 와같이영상유도세기변조방사선치료 (image-guided intensity modulated radiation therapy) 가가능한장비들이국내에도입되면서기존방사선치료의부작용을최소화하고치료효과는최대화할수있게되었다. 더구나매회치료때마다컴퓨터단층영상을얻어치료부위를확인하고방사선을조사할수있어기존의방사선치료보다더욱정밀한치료가가능해졌다. 토모테라피를이용하여고선량의방사선치료를노인전립선암환자에게적용했을때방사선에의한급성부작용의빈도와 정도가심하지않다면노인전립선암환자에서도고선량의방사선치료를안전하게시행할수있을것이다. 대상및방법 1. 대상 2011년 1월부터 2012년 8월까지조직검사결과전립선암으로진단받고, 근치적목적으로나선형토모테라피치료를시행받은환자를대상으로하였다. 대상환자중방사선치료전컴퓨터단층영상이나자기공명영상에서림프절전이가확인된경우와뼈스캔영상에서뼈전이가확인된경우는제외하였다. 방사선치료전전립선비대증이나전립선암으로절제술을받은환자는제외하였고, 남성호르몬차단요법을받았거나받고있는환자는대상에포함시켰다. 대상환자를 75세를기준으로 75세이상과 75세미만, 두군으로나누어비교분석하였다. 본연구는부산대학교병원기관생명윤리위원회승인을거처진행하였다. 2. 방사선치료 모든환자는촬영 1시간전에관장을하여방광과직장을비우고 500 ml의물을마셔서방광을채운뒤모의치료 (simulation) 를진행하였다. 전신진공쿠션 (whole body vacuum cushion) 을사용하여환자를고정하고, 2 mm 간격의전산화단층촬영 (computed tomography, CT) 을시행하여계획용영상을얻었다. 이과정은방사선치료중에도똑같이시행한후진행하였고, 매회치료전마다고에너지전산화단층촬영 (mega-voltage CT) 을실시하여계획용영상과비교, 확인한후치료를진행하였다. 고에너지전산화단층촬영영상에서직장내가스가있는경우환자스스로배출하게한뒤재확인하여진행하였고, 방광도같은방법으로조절하여진행하였다. 방사선치료는토모테라피 (TomoTherapy Hi-Art Treatment System, TomoTherapy Inc., Madison, WI, USA) 를이용하여시행하였다. 치료부위는 T1 T2 환자들은전립선만을 T3 이상의환자들은전립선과정낭을임상표적체적 (clinical target volume) 으로정하였다. 임상표적체적에서후방으로 3 5 mm의여유 (margin) 을두고나머지방향으로는 5 7mm의여유를두어계획용표적체적 (planning target volume) 을얻었 80 J Korean Geriatr Soc 17(2) June 2013
기용간외 : 노인전립선암환자에서토모테라피의적용 다. 계획용표적체적의 100% 체적에처방선량의 95% 이상이조사되게계획하였다. 주위정상조직인직장은일회조사량 2Gy를기준으로하여 70 Gy, 60 Gy, 50 Gy, 40 Gy 이상조사되는체적이각각 10%, 20%, 30%, 40% 이내가되도록계획하였고, 방광은 70 Gy, 60 Gy, 50 Gy 이상조사되는체적이각각 20%, 30%, 50% 이하가되게하였는데, 정낭이임상표적체적에포함된경우에는 5% 씩확장하여계획하였다. 치료완료일로부터기간을계산하였다. 4. 통계 두군사이의방사선항목별변수의비교는 chi-square test 또는 Fisher exact test를이용하였고, 연속형변수는 Mann- Whitney U test 를통하여비교하였다. 2등급이상의방사선부작용발생시기는 Kaplan-Meier method를이용하여분석하였고, 단변량과다변량분석은각각 log-rank test 와 Cox 회귀분 Fig. 1. Incidence rates of (A) acute genitourinary (GU) and (B) gastrointestinal (GI) toxicity after beginning of radiotherapy. 3. 방사선부작용 방사선치료부작용은방사선치료중일주일에 1 2회시행된진료기록과치료완료후 1 3개월마다시행된추적관찰기록을근거로하여 Radiation Therapy Oncology Group acute radiation morbidity scoring criteria 14) 을기준으로후향적분석하였다. 급성부작용은방사선치료완료후 2개월까지를기준으로하였다. 비뇨기부작용은빈뇨, 절박뇨, 배뇨통, 혈뇨를분석하였고, 하부위장관부작용은배변습관변화, 복통, 설사, 혈변을분석하였다. 방사선부작용의발생시점은방사선치료시작일을기준으로하였고, 회복기간은방사선 Table 1. Patients and treatment characteristics according to age group Characteristic Age 75 yr Age<75 yr p-value * No. of patients 20 (46.5) 23 (53.5) ECOG performance status 0 1 2 15 (75.0) 3(15.0) 2(10.0) 16 (69.6) 6(26.1) 1 (4.3) 0.592 T stage 0.346 T1 T2 T3 T4 Gleason score 5 6 7 8 9 Pretreatment PSA level (ng/ml) <10 10 19.99 20 0 (0.0) 8(40.0) 9(45.0) 3(15.0) 4(16.7) 6(25.0) 14 (58.3) 8(40.0) 6(30.0) 6(30.0) Androgen deprivation therapy Yes 16 (80.0) No 4(20.0) Benign prostatic hyperplasia medication Yes No Fractionation Conventional Hypofractionated 14 (70.0) 6(30.0) 15 (75.0) 5(25.0) 3(13.0) 9(39.1) 10 (43.5) 1 (4.3) 5(26.3) 5(26.3) 9(47.4) 10 (43.5) 9(39.1) 4(17.4) 16 (69.6) 7(30.4) 18 (78.3) 5(21.7) 19 (82.6) 4(17.4) 0.781 0.676 0.501 0.728 0.711 Values are presented as number (%). ECOG, Eastern Cooperative Oncology Group; PSA, prostate specific antigen. * p-value obtained by Fisher exact test. J Korean Geriatr Soc 17(2) June 2013 81
Yong Kan Ki, et al: Tomotherapy in Elderly Prostate Cancer Patients Table 2. Concomitant disease according to age group Concomitant disease Age 75 yr Age<75 yr p-value * Hypertension Coronary artery disease Diabetes mellitus Chronic kidney disease Cerebrovascular accident 9(45.0) 2(10.0) 2(10.0) 1 (5.0) 1 (5.0) *p-value obtained by Fisher exact test. 11 (47.8) 0(0) 2(8.7) 1(4.3) 2(8.7) 0.853 0.120 0.883 0.919 0.635 석을통하여유의성을검정하였다. 모든분석은 IBM SPSS ver. 19.0 (IBM Co., Armonk, NY, USA) 을이용하였다. 결 과 1. 환자특성및동반질환 총 67명의전립선환자가나선형토모테라피를시행받았고, 이전에수술을받은적이있거나골반부방사선치료를받은경우를제외한환자는총 44명이었다. 이중방사선치료완료후추적관찰이되지않은환자 1명을제외하고총 43명을대상으로분석하였다. 중앙추적관찰기간은 11개월 (5 23 개월 ) 이었고, 전체환자의중앙나이는 74세 (56 85 세 ) 였다. 이중 75세이상은 20명, 75세미만은 23명이었고, 각군나이의중앙값은각각 78세와 66세였다. T병기는 75세이상에서는 T2가 8명, T3가 9명이었고, 75세미만에서는 T2와 T3가각각 9명과 10명이었다. 방사선치료는 34명 (79.1%) 의환자에서통상분할조사 (conventional fractionation) 로 2Gy씩 36 38회, 총 76 78 Gy가조사되었고, 거주지또는재정과관련된환자사정에의해장기간의방사선치료가힘든 9명 (20.9%) 에서는일회조사량을증가시켜서 2.5 Gy씩 28회, 총 70 Gy 의소분할조사 (hypofractionation) 가시행되었다 (Table 1). 모든환자는외래로통원치료를받았고, 중단없이계획된치료를완료하였다. 동반질환으로는고혈압, 당뇨병, 만성신장병, 관상동맥질환, 뇌졸중등이있었고고혈압이총 20명 (46.5%) 으로가장많은비중을차지하였다. 두군사이에동반질환의차이는없었으며, 자세한내용은 Table 2에정리하였다. 2. 급성방사선부작용 전체환자중 34 명 (79.1%) 의환자에서 1 등급이상의부작 Table 3. Acute radiation toxicity according to age group Acute genitourinary toxicity Grade 0 Grade 1 Grade 2 Day of onset Acute gastrointestinal toxicity Grade 0 Grade 1 Grade 2 Day of onset Age 75 yr Age<75 yr p-value * 3(15.0) 12 (60.0) 5(25.0) 23 (12 43) 16 (80.0) 4(20.0) 0(0) 33 (28 42) 6 (26.1) 14 (60.9) 3 (13.0) 22 (14 33) 19 (82.6) 4 (17.4) 0(0) 32 (25 37) 0.484 0.522 0.826 0.773 * p-value obtained by Fisher exact test and Mann-Whitney U test 용을호소하였고, 이중 2등급이상의부작용을호소하는환자는 8명 (18.6%) 이었다. 비뇨기부작용이방사선치료시작후평균 23일 (12 43일) 에나타나기시작했고일부환자에서는평균 41일 (29 57일 ) 에 2등급부작용으로진행하였다. 하부위장관부작용은비뇨기부작용보다평균 10일정도늦게나타났고, 치료시작 33일경 (25 42일) 에호소하기시작하였다 (Fig. 1). 전체부작용중빈뇨가 24명 (55.8%) 로가장많았고, 다음으로배뇨통 13명 (30.2%), 절박뇨 10명 (23.3%) 순이었다. 2등급의부작용은비뇨기부작용에서만나타났는데, 빈뇨가 5명 (11.6%), 배뇨통이 3명 (7.0%) 이었다. 하부위장관부작용은각각 4명 (9.3%) 의환자에서 1등급의하복부통증과배변양상의변화를호소한것외에설사, 혈변등의부작용을호소하는환자는없었다. 75세를기준으로한두군사이에비뇨기와하부위장관부작용모두에서빈도와발생일의차이를찾을수없었고 (Table 3), 대부분의부작용은방사선치료완료후 27 83일 ( 중앙값, 33 일 ) 이내에치료전상태로회복되었다. 2등급이상의비뇨기부작용은 75세이상에서 5명, 75 세미만에서 3명이호소하였고, 발생률은두군사이에차이를찾을수없었다 (p=0.329). 소분할조사를시행한 9명의환자중 4명에서 2등급급성비뇨기부작용이나타났는데 (p=0.024), 그중 3명이배뇨통을호소하였다. 소분할조사는다변량분석에서도의미있는위험인자로분석되었다 (p=0.041). 이외에활력징후와질병상태, 남성호르몬차단요법, 전립선비대증약물치료등에서는의미있는상관관계를찾을수없었다. 다른동반질환으로치료를받고있는환자 30명중 6명에서 2등급비뇨기부작용을호소하였는데, 고혈압 3명, 당뇨병 2명, 심혈관질환이 1명이었다. 하지만, 동반질환과의분석에 82 J Korean Geriatr Soc 17(2) June 2013
기용간외 : 노인전립선암환자에서토모테라피의적용 Table 4. Factors associated with acute urinary toxicity grade 2 Factor Hazard ratio (95% CI) * p-value Age ( 75 yr) ECOG performance status T-stage Gleason score Pretreatment PSA level Androgen deprivation therapy Benign prostatic hyperplasia medication Hypofractionation Concomitant diseases 2.012 (0.481 8.423) 1.067 (0.352 3.240) 1.261 (0.556 2.858) 1.521 (0.768 3.011) 1.018 (0.990 1.047) 0.531 (0.127 2.224) 0.298 (0.074 1.198) 4.259 (1.063 17.061) 1.420 (0.339 5.941) 0.329 0.729 0.846 0.250 0.207 0.368 0.004 0.024 0.630 CI, confidence interval; ECOG, Eastern Cooperative Oncology Group; PSA, prostate specific antigen. * Hazard ratio obtained by Cox regression. p-value obtained by Kaplan-Meier for univariate analysis. Concomitant diseases included hypertension, coronary artery disease, diabetes mellitus, chronic kidney disease, and cerebrovascular accident. 서도의미있는상관관계를찾지는못하였다 (Table 4). 고찰 75세이상의노인환자에서나선형토모테라피를이용하여전립선또는정낭부위에만 76 78 Gy의고선량국소방사선치료를시행했을때심각한급성부작용없이치료를완료할수있었다. 한연구에의하면전립선암의방사선치료결과급성방사선부작용이 70세이상의노인환자에서 1 2주더빨리나타나고, 특히 2등급이상의급성비뇨기부작용이더흔하게나타난다고보고하였다 13). 하지만, 골반부조사를제외하고전립선과정낭부위에만 70 Gy 까지삼차원입체조형방사선치료를시행한다른연구에서는이번연구결과와같이 75세이상과미만환자군사이에급성부작용의차이가없었고, 오히려노인환자에서더우수한생화학적무병생존율을보여국소방사선치료가노인에서안전하고효과적임을보고하였다 15). 남성호르몬차단요법은근치적인치료가어려운경우또는노인환자에서흔히이용되는치료법으로 75세이상의전립선암환자 40% 이상에서남성호르몬차단요법이일차적으로적용되고있다고한다 16). 하지만, 남성호르몬차단요법은체지방량을증가시키고인슐린감수성을떨어뜨려서 9) 당뇨병 1.44 배, 심혈관질환 1.16배, 돌연심장사를 1.16배증가시킨다고보고되고있고 10), 남성호르몬차단요법을받는환자중 12.8% Fig. 2. Comparison of isodose curves for (A) helical tomotherapy and (B) 3 dimentional-conformal radiotherapy. 에서우울증이나타난다는보고되고있어 11) 부작용에대한주의가필요하다. 이러한부작용등으로인해일차적남성호르몬차단요법은최근감소하는추세를보이고있으며 16), 국소적전립선암에서는적용하지않는것을권장하고있다 17). 방사선치료기술의발전으로나선형토모테라피외에도원뿔형빔전산화단층촬영 (cone beam CT) 를이용한영상유도세기변조방사선치료, 입체적세기변조회전방사선치료 (volumetric modulated arc therapy) 등과같은첨단방사선치료기법들이도입되면서전립선암환자에서기존의이차원또는삼차원방사선치료에비해방광이나직장과같은주위정상조직의방사선노출을최소화하고, 전립선에만고선량의방사선을조사할수있게되었다 (Fig. 2). 78 Gy 전후의고선량방사선치료는기존의 70 Gy 정도의통상적인방사선치료에비해생화학적재발률 (biochemical recurrence rate) 을의미있게낮출수있다고알려져있고 18), 특히 T1 T2의국소전립선암환자에서는고선량의방사선치료가전립선절제술과비슷한생화학적제어율 (biochemical control rate) 을보이는것으로보고되고있어전립선암의방사선치료에서세기변조방사선치료를이용한고선량방사선조사가주요치료법으로자리잡게되었다 19). 고위험군환자에서림프절전이의예방목적으로골반부 J Korean Geriatr Soc 17(2) June 2013 83
Yong Kan Ki, et al: Tomotherapy in Elderly Prostate Cancer Patients 방사선치료 (elective pelvic radiotherapy) 가시행되기도하는데, 소장의방사선노출이많아설사와복통, 오심, 구토등의급성위장관부작용의주요원인중하나로알려져있다 20). 최근에는예방적골반부조사가국소재발, 원격전이, 생화학적재발등의무진행생존율 (progresson-free survival) 에영향을주지못한다는연구결과들로인해그중요성이줄어들고있는경향이있지만 21), 고위험군에서는여전히논란이남아있는상태이다. 이번연구에서는전립선과정낭주위에국소방사선치료를받은환자들만을분석하였고, 2등급이상의위장관부작용을호소하는환자는전체환자에서한명도없었다. 고위험군만을대상으로한연구결과가나와야하겠지만, 뚜렷한이득이증명되지않는다면림프절전이가없는노인환자에서급성방사선부작용의중요원인중하나인예방적골반부조사 20) 를제외하고국소조사만시행하는것도치료순응도를높이는방법이될수있을것이라생각된다. 이번연구에서 2등급의급성방사선부작용은 8명 (18.6%) 의환자에서비뇨기에서만나타났고, 나이에따른발생이나정도의차이는없었다. 다만소분할조사의시행여부가 2등급의급성비뇨기부작용과의미있는상관관계를보였는데, 소분할조사는일회조사량을증가시켜서치료기간과총조사량을줄이는방사선치료법이다. α/β 비가정상조직보다낮은전립선암의조직특성때문에통상분할조사보다는소분할조사가전립선암에서효과적일것으로예상되었고, 이와관련된많은연구결과들이보고되고있다. 여러연구에서소분할조사가통상분할조사와방사선부작용이비슷하거나더적을뿐아니라생화학적제어율이더우수하다는결과들을보고하고있어 22,23) 현재진행되고있는무작위대조군연구들의결과에따라전립선암방사선치료의기본치료법이될수도있을것이다. 하지만, 소분할조사는일회조사량이크기때문에이번연구결과에서처럼방사선부작용의빈도가증가한다는보고도있어 24), 안정성과치료이득이확실히증명될때까지는신중해야한다는주장도제기되고있다 25). 중앙추적기간이 11개월로짧아만성부작용을분석하지는못했지만, 만성부작용의가장중요한예측인자가 2등급이상의급성부작용유무인점을고려한다면 15) 만성부작용의빈도나정도도급성부작용과비슷한결과를얻을것으로추측된다. 전체추적기간중생화학적재발을보인환자는없었지만, 방사선치료이후에도남성호르몬차단요법을받고있는환자가 17명 (39.5%) 이포함되어있어방사선치료의치료효과를분석하기위해서는장기적인추적관찰이필요할것이다. 나선형토모테라피를통해직장과방광의방사선노출을최소화할수있었고, 예방적골반부조사를제외한국소방사선치료를통하여소장의방사선노출을차단할수있었다. 좀더많은환자를대상으로하여장기적인추적관찰이필요하겠지만, 75세이상의노인전립선암환자에서도나선형토모테라피와같은영상유도세기변조방사선치료를이용한다면심각한부작용없이고선량의방사선치료를안전하게시행할수있을것으로생각된다. 요약 연구배경 : 나선형토모테라피는국소제어를향상시키고방사선부작용을줄일수있는영상유도세기변조방사선치료법이다. 나선형토모테라피를이용한고선량방사선조사가 75세이상의노인환자에서심각한부작용없이안전하게시행할수있는지확인하고, 75 세미만의환자와부작용정도를비교하고자한다. 방법 : 2011년 1월부터 2012년 8월까지나선형토모테라피를이용하여근치적목적의국소방사선치료를받은전립선암환자를대상으로하여 75세이상과 75세미만의두군으로나누어급성비뇨기부작용과하부위장관부작용을비교하였다. 결과 : 전체환자중 75세이상은 20명, 75 세미만은 23명이었다. 방사선치료는 34명의환자에서 2Gy씩총 76 78 Gy가조사되었고, 9명의환자에서 2.5 Gy 씩총 70 Gy 가조사되었다. 두군모두에서 3등급이상의급성부작용은없었다. 2등급이상의부작용은비뇨기에서만나타났고, 75세이상과미만에서각각 5명 (25.0%) 과 3명 (13.0%) 에서나타났다. 두군사이의급성부작용발생률은차이가없었다 (genitourinary, p=0.0.484; gastrointestinal, p=0.826). 소분할조사만 2등급급성비뇨기부작용과의미있는상관관계를보였고 (p=0.024), 이외에 T 병기, Gleason 점수, prostate specific antigen 수치, 동반질환, 남성호르몬차단요법등에서는유의한관계를찾을수없었다. 결론 : 75세이상의노인전립선암환자에서나선형토모테라피와같은영상유도세기변조방사선치료를이용하여심각한부작용없이고선량의방사선치료를안전하게시행할수있었다. REFERENCES 1. Kwak YS, Jeon HS, Lim YA. Appropriate use of prostate-spe- 84 J Korean Geriatr Soc 17(2) June 2013
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