목 적: 전이성 뇌종양 환자에서 전뇌조사를 시행받은 160명의 환자를 대상으로 원발 종양 가중치에 따른 생존율을 후향적으로 분석해보고자 하였다. 대상 및 방법: 2002년부터 2008년 사이에 인하대병원에서 전이성 뇌종양으로 진단받은 암환자들 중 전뇌 조사 방사선 치료 30 Gy를 받은 160명의 환자를 대상으로 후향적으로 분석하였다. 원발성 종양이 유방암인 경우는 20명, 폐암인 경우는 103명이었다. 160명의 환자 중 척수 연수막 전이(leptomeningeal seeding) 환자를 제외한, 142명의 환자를 대상으로 예후 인자 및 Recursive Partitioning Aanalysis (RPA) 분류에 따른 생존율, 중앙생존기간과, RPA 분류에 원발 종양의 종류에 따라 가중치를 둔 새로운 Weighted Partitioning Analysis (WPA) 분류에 따른 생존율과 중앙생존기간을 분석하였고 RPA분류와 비교 분석하였다. 결 과: RPA분류에 의한 중앙생존기간은 분류 I (8명), 분류 II (76명), 분류 III (58명)가 각각 20.0개월, 10.0개월, 3.0개월이었으며(p=0.003), WPA 분류의 경우에는 분류 I (3명), 분류 II (9명), 분류 III (70명), 분류 IV (60명)가 각각 36개월, 23.7개월, 10.9개월, 8.6개월로(p=0.001) RPA 분류보다 더 우위성을 보였다. 결 론: 새로운 예후 지표인 WPA 분류가 기존의 RPA 분류보다 전이성 뇌종양 환자에서 치료 방침을 결정함에 있어 도움을 줄 것으로 생각된다.
Purpose: This study was performed to retrospectively analyze patient survival by weighting according to the primary tumor oncotype in 160 patients with brain metastasis and who underwent whole brain radiotherapy. Materials and Methods: A total of 160 metastatic brain cancer patients who were treated with whole brain radiotherapy of 30 Gy between 2002 and 2008 were retrospectively analyzed. The primary tumor oncotype of 20 patients was breast cancer, and that of 103 patients was lung cancer. Except for 18 patients with leptomeningeal seeding, a total of 142 patients were analyzed according to the prognostic factors and the Recursive Partitioning Analysis (RPA) class. Weighted Partitioning Analysis (WPA), with the weighting being done according to the primary tumor oncotype, was performed and the results were correlated with survival and then compared with the RPA Class. Results: The median survival of the patients in RPA Class I (8 patients) was 20.0 months, that for Class II (76 patients) was 10.0 months and that for Class III (58 patients) was 3.0 months (p<0.003). The median survival of patients in WPA Class I (3 patients) was 36 months, that for the patients in Class II (9 patients) was 23.7 months, that for the patients in Class III (70 patients) was 10.9 months and that for the patients in Class IV (60 patients) was 8.6 months (p<0.001). The WPA Class might have more accuracy in assessing survival, and it may be superior to the RPA Class for assessing survival. Conclusion: A new prognostic index, the WPA Class, has more prognostic value than the RPA Class for the treatment of patients with metastatic brain cancer. This WPA Class may be useful to guide the appropriate treatment of metastatic brain lesions.
