조기유방암에서 보존적 수술후 근치적 방사선치료

서창옥 (사)한국여자의사회 1994 한국여자의사회지 Vol.19 No.-

고 강도 차폐벽돌을 이용한 방사선치료실의 차폐설계

서창옥,김귀언,추성실,Suh Chang Ok,Kim Gwi Eon,Chu Sung Sil 한국의학물리학회 2004 의학물리 Vol.15 No.4

신체 심부의 악성종양치료를 위한 6~15 MV의 강력한 에너지의 방사선과 종양만을 조사하기 위한 입체조형치료, 세기 조절방사선치료, 입체적 치료방법 등이 개발됨으로써 방사선의 사출구가 전체 공간으로 확대되고 출력선량도 환자당 5~10 Gy의 과다 선량을 방출하기 때문에 고밀도의 차폐벽이 요구된다. 저자들은 세기조절방사선치료(IMRT)용 고 에너지 선형가속기를 기존건물에 설치하기 위하여 일반 콘크리트와 철, 티타늄등 중금속을 혼합한 고 밀도 차폐벽돌을 제작하여 방어벽을 설계하고 건축된 차폐벽으로부터 투과 산란된 선량을 측정하여 상호 비교하였다. 고 밀도 차폐벽돌을 사용함으로서 기존의 콘크리트(3.5 g/cc)에 비하여 고 에너지의 차폐율 즉 반가층 두께를 약 1/2로 줄일 수 있었다. According to developing high energy linear accelerators and treatment methods, like (3 dimensional conformal radiotherapy (3D-CRT), intensity modulated radiotherapy (IMRT), many radiotherapy centers are replacing older linear accelerators with new higher technical machines. This often presents a shielding problem as the designed shield for the existing rooms is not adequate for the higher technical machines. Additional shielding in limited existing space becomes necessary. We are replacing older brachytherapy room with new higher technical linear accelerator for IMRT. This room is not adequate for the IMRT machine without additional shielding design. The logical development of optimum structural shielding designs with concrete and high density shielding blocks are presented. We obtained following results by comparison between the pre-calculating values and actual survey of completed LINAC installation. High density shielding blocks have more powerful radiation protection about 2 times.

Effects of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

서창옥,노준규,신현수,이형식,문성록,성진실,추성실,김귀언,한은경,박찬일,Suh Chang Ok,Loh. John J.K.,Shin Hyun Soo,Lee Hyung Sik,Moon Sun Rock,Seong Jin Sil,Chu Sung Sil,Kim Gwi Eon,Han Eun Kyung,Park Chan Il The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8 MHz 라디오파를 이용한 온열치료를 시 행하였다. $42\pm0.5^{\circ}C$로 30분간 온열치료를 받은 군(제 1 군, n=5), $45\pm0.5^{\circ}C$로 30분간 온열치료를 받은 군(제 2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견외 특이한 조직병 리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제 2군에서는 간세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthermia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with $42.5\pm0.5^{\circ}C$ 30 minutes, and Group II (N=5) was heated with $45\pm0.5^{\circ}C$ for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and T,14, and 28 days after treatment. Blood samples were obtained before treatment and W, 3,5, 7,14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group 1. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with $45^{\circ}C$ for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liverdamage dy heat of $42.5\pm0.5^{\circ}C$ for 30 minutes is reversible, and liver damage by heat of $45\pm0.5^{\circ}C$ for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in erder to apply hyperthermic treatment on human liver tumor safely, close obsewation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.

갑상선기능항진증을 동반한 악성 난소갑상선종 1예

서창옥 대한영상의학회 1979 대한영상의학회지 Vol.15 No.1

Struma Ovarii was rare and was defined as ovarian teratoma, composed solely or predominantly of thyroid tissue, or with definite evidence of functionning struma ovarii manifested as hyperthyroidism. Most cases of struma ovarii was diagnosed after operative resection, so radionuclide study was incomplete. This report concerns with 49 year old women who had malignant struma ovarii with clinical manifestation of hyperthyroidism. I131 thyroid function study confirmed it and could delineate the tumor in the pelvic cavity. Surgical resection was not possible. So we administered internally large dose of I131.

Conservative Surgery and Primary Radiotherapy for Early Bresst Cancer: Yonsei Cancer Center Experience

서창옥,이희대,이경식,정우희,오기근,김귀언,Suh Chang Ok,Lee Hy De,Lee Kyung Sik,Jung Woo Hee,Oh Ki Keun,Kim Gwi Eon The Korean Society for Radiation Oncology 1994 Radiation Oncology Journal Vol.12 No.3

병기 1기, 2기 유방암에서 유방보존적 수술 후 방사선치료는 기존의 유방전적출술을 대치할 수 있는 치료법으로 정립되었다. 연세암센터에서는 1991년 부터 유방보존술을 적극적으로 시행하였고 첫 3년동안 140예를 치료하였다. 목적 : 연세암센터에서 시행하고 있는 유방보존술의 적응증, 치료방침과 방사선치료 방법을 소개하고 결과 및 방사선치료의 부작용을 보고하고자 한다. 방법 : 1991년 1월부터 1992년 12월까지 연세암센터 치료방사선과에서 유방보존적수술 후 근치적 방사선치료를 받았던 64명의 조기 유방암 환자를 대상으로 하였다. 모든 환자들은 종괴 또는 병변을 포함한 부분유방절제술과 액와임파절 곽청술을 시행받은 후 방사선치료를 받았다. 방사선치료는 수술후 3-18주에 시행되었는데 선형가속기 4MV X-ray를 사용하여서 침범된 유방 전체에 4500-5040 cGy를 5-6주에 걸쳐서 조사하였고 원발 병소 주변에 전자선을 사용하여서 1-2주에 걸쳐서 1000-2000 cGy를 추가 조사하였다. 치료를 받았던 환자들의 임상적 특성과 치료방법, 방사선치료에 따르는 부작용, 재발 여부 등을 분석하였다. 결과 : 대상환자들의 연령은 23세에서 59세로 중앙값이 40세 였다. 총 64명중 T1은 27명, T2는34명 이었으며 3명은 비침윤성 암이었다. 또한 전체의 $42.2\%$인 27명은 액와임파절 침윤이 있었다. 추적 기간(6-30개월, 중앙값 14개월) 동안 1예의 유방내 재발과 2예의 원격 전이가 관찰되었는데 유방내 재발은 원발병소와 다른 사분원에 위치하여서 처음 진단에서 발견하지 못했던 유방조영술상의 미세석회화음영에서 종괴가 자랐던 예로 다시 유방전적출술을 받은 후 무병생존 중이다. 방사선치료 중 또는 추적 기간 동안 치료를 요하는 부작용으로는 1예에서만 방사선 폐렴이 있었으나 대증요법 으로 완쾌되었다. 결론 : 추적 기간이 짧기 때문에 국소재발율, 생존율, 미용효과 등의 치료 결과를 평가하기는 이르지만 조기 유방암에서 유방보존적 수술과 근치적 방사선치료는 심한 급성 또는 아급성 부작용이 없는 안전하고 편안한 치료법임을 확인할 수 있었다. 또한 국소재발율을 낮추기 위해서는 유방보존술에 적합한 환자들을 선택하기 위한 철저한 평가가 필수적임을 알 수 있었다. Breast conserving surgery and irradiation is now accepted as preferable treatment method for the patients with stage I and II breast cancer. Our institution activated team approach for breast conservation in 1991 and treated one hundred and fourty patients during the next three years. Purpose : To present our early experience with eligibility criteria, treatment techniques, and the morbidities of primary radiotherapy. Materials and Methods: Sixty four patients with early stage breast cancer who received breast conserving treatment between January 1991 and December 1992 were evaluated. All patients received partial mastectomy(wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Total dose of 4500-5040 cGy in 5-5 1/2 weeks was given to entire involved breast and boost dose of 1000-2000 cGy in 1-2 weeks was given to the primary tumor site. Linac 4 MV X-ray was used for breast irradiation and electron beam was used for boost. Thirty five Patients received chemotherapy before or after radiotherapy. Patients characteristics, treatment techniques, and treatment related morbidities were analyzed. Results : Age distribution was ranged from 23 to 59 year old with median age of 40. Twenty-seven patients had T1 lesions and 34 patients had T2 lesions. In three patients, pathologic diagnosis was ductal carcinoma in situ. Thirty-seven Patients were N0 and 27 patients were Nl. There were three recurrences, one in the breast and two distant metastases during follow-up period(6-30 months, median 14 months). Only one breast recurrence occured at undetected separate lesion with microcalcifications on initial mammogram. There was no serious side reaction which interrupted treatment courses or severe late complication. Only one symptomatic radiation pneumonitis and one asymptomatic radiation pneumonitis were noted. Conclusions: Conservative surgery and primary radiotherapy for early breast cancer is Proven to be safe and comfortable treatment method without any major complication. Long-term follow up is needed to evaluate our treatment results in terms of loco-regional control rate, survival rate, and cosmetic effect.

Coronary imaging after bioabsorbable vascular scaffold: A case report

서창옥,박정랑,강민규 대한내과학회 2021 대한내과학회 추계학술대회 Vol.2021 No.1

Korean Association of Medical Journal Editors at the Forefront of Improving the Quality and Indexing Chances of its Member Journals

서창옥,오세정,홍성태 대한의학회 2013 Journal of Korean medical science Vol.28 No.5

The article overviews some achievements and problems of Korean medical journals published in the highly competitive journal environment. Activities of Korean Association of Medical Journal Editors (KAMJE) are viewed as instrumental for improving the quality of Korean articles, indexing large number of local journals in prestigious bibliographic databases and launching new abstract and citation tracking databases or platforms (eg KoreaMed, KoreaMed Synapse, the Western Pacific Regional Index Medicus [WPRIM]). KAMJE encourages its member journals to upgrade science editing standards and to legitimately increase citation rates, primarily by publishing more great articles with global influence. Experience gained by KAMJE and problems faced by Korean editors may have global implications.

The Roles of Radiotherapy and Chemotherapy in the Era of Multimodal Treatment for Early-Stage Nasal-Type Extranodal Natural Killer/T-Cell Lymphoma

서창옥,김태형,김진석,서양건,조재호,양우익 연세대학교의과대학 2016 Yonsei medical journal Vol.57 No.4

Purpose: To evaluate radiotherapy (RT) and chemotherapy (CT) treatments of early-stage extranodal natural killer/T-cell lymphoma(ENKTL). Materials and Methods: Fifty-five patients with stage I or II ENKTL [n=39 (71%) and 16 (29%) patients, respectively] who were treated with RT between 1999 and 2013 were analyzed retrospectively. The median age was 54 years (range, 24–81). Patients were grouped by treatment modality as RT alone [n=19 (35%)], upfront CT plus RT [CT+RT, n=16 (29%)], and concurrent chemoradiotherapy[CCRT, n=20 (36%)]. The median RT dose was 48 Gy. Patient characteristics between each treatment group were well balanced. Patterns of failure and survival were analyzed. Results: The overall response rate after RT was 94.6%. Ten patients experienced distant failure, and seven experienced local failurecomprising five in-field and two out-field failures. The local and distant failure rates in the RT-alone group were the same (16%). In the CT+RT group, the most common failure sites were local (19%). In the CCRT group, the most common failures were distant (25%). At a median follow-up of 56 months (range, 1–178 months), the 5-year overall survival (OS) and progression-free survival rates were 66% and 54%, respectively. The 5-year OS rate for the RT-alone and CT+RT groups were 76% and 69%, respectively,and the 2-year OS rate for the CCRT group was 62% (p=0.388). Conclusion: In the era of multimodal treatment for ENKTL, RT alone using advanced techniques should be considered for local disease control, whereas maintenance CT regimens should be considered for distant disease control.

Treatment of Carcinoma of the Uterine Cervix with High-Dose-Rate Intracavitary Irradiation using Ralstron

서창옥,김귀언,노준규,Suh Chang Ok,Kim Gwi Eon,Loh John J.K. The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.2

1979년 5월부터 1981년 12월까지 총 524명의 자궁경부암 환자가 근치적 목적하에 방사선 치료를 받았다. 524명의 환자중, 356명이 코발트 선원을 사용한 원격 조정 아프터로딩 고선량률 강내조사 시스템 (Ralstron)으로써 치료받았으며 168명의 환자는 라듐 선원을 사용한 저선량률 강내 조사를 받았다. 외부조사는 골반부 전체에 총 40-50 Gy가 주어졌으며, 이어서 A지점에 10-13번에 걸쳐 30-39 Gy의 강내 조사를 시행하는 치료지침이 사용되었다. 강내조사는 3 Gy씩, 일주일에 세번 주어졌다. 고선량률 강내조사를 받은 군에서의 5년 실제생존률은 IB기 (N=20)가 $77.6{\%}$, II기 (N=182)가 $68.2{\%}$ 그리고 III기 (N=148)가 $50.9{\%}$였다. 저산량률 강내조사군에서의 5년 생존률은 IB기 (N=22)가 $87.5{\%}$, II기 (N=91)가 $66.3{\%}$, 그리고 III기 (N=52)가 $55.4{\%}$였다. 생존률은 병기에 따라서는 통계학적으로 유의한 차이를 보였지만, 두 강내조사군 간에는 유의한 차이가 없었다. 방사선치료후 내장의 후기 합병증은 고선량률 강내조사 군에서 $3.7{\%}$, 저산량률 강내조사군은 $8.4{\%}$에서 관찰되었다. 그러나 외과적 치료가 필요할 만큼 심한 합병증은 없었다. 방광에서 발생한 합병증의 빈도는 고선량률 강내조사군이 $1.4{\%}$, 저선량률 강내조사군은 $2.4{\%}$였다. 고선량률 강내조사의 시술은 외래 환자에 시행하기에 기술적으로 간단하고 쉬우며 마취가 필요없고, 환자가 매우 잘 견딘다. 담당자에 대한 방사선 피폭도 저선량률 강내조사에 비해 사실상 거의 없다. 고선량률 강내조사의 경우 치료시간이 짧기 때문에 주어진 시간내에 더 많은 환자를 치료할 수 있다. 따라서 많은 환자를 치료해야 되는 암센터의 경우, 고선량률 강내조사 시스템이 훨씬 더 권장되어 진다. 그러나 더욱 향상된 결과를 얻기 위하여, 다른 치료 방식으로 광범위한 연구를 통해, 고선량률 강내조사의 적절한 선량-분할조사 계획과 외부조사와 강내조사의 적절한 배합이 이루어져야 할 것이다. From May 1979 through December 1981 a total of 524 patients with carcinoma of the uterine cervix were treated by radiation therapy with curative intent. Among the 524 patients, 350 were treated with a high-dose-rate (HDR), remote-controlled, afterloading intracavitary irradiation (ICR) system using a cobalt source (Ralstron), and 168 patients received a low-dose-rate (LDR) ICR using a radium source. External beam irradiation with a total dose of 40-50 Gy to the whole pelvis followed by intracavitary irradiation with a total dose of 30-39 Gy in 10-13 fractions to point A was the treatment protocol. ICR was given three times a week with a dose of 3 Gy per fraction. Five-year actuarial survival rates in the HDR-ICR group were $77.6{\%}$ in stage IB (N=20), $68.2{\%}$ in stage II (N=182), and $50.9{\%}$ in stage III (N=148). In LDR-ICR group, 5-year survival rates were $87.5{\%}$ in stage IB (N=22), $66.3{\%}$ in stage II (N=91), and $55.4{\%}$ in stage III (N=52). Survival rates showed a statistically significant difference by stage, but there was no significant difference between the two ICR groups. Late bowel complications after radiotherapy were noted in $3.7{\%}$ of the HDR-ICR group and $8.4{\%}$ of the LDR-ICR group. There was no severe complication requiring surgical management. The incidence of bladder complications was $1.4{\%}$ in the HDR-ICR group and $2.4{\%}$ in the LDR-ICR group. The application of HDR-ICR was technically simple and easily performed on an outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually nil in contrast to that of LDR-ICR. Within a given period of time, more patients can be treated with HDR-ICR because of the short treatment time. Therefore, the HDR-ICR system is highly recommended for a cancer center, particularly one with a large number of patients to be treated. In order to achieve an improved outcome, however, the optimum dose-fractionation schedule of HDR-ICR and optimum combination of intracavitary irradiation with external beam irradiation should be determined through an extensive protocol.

송과체부위종양 및 중추신경계 배아세포종양의 치료 : 치료방법의 변천에 따른 치료성적 Evolution of Treatment Policy and Result

서창옥,김귀언,이규성,최중언,정상섭,이규창,노준규 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.6

A retrospective analysis has been made of 40 patients with pineal region tumors and CNS germ cell tumors who were treated at Yonsei University Hospital, Department of Radiation Oncology between 1971 and 1985. A tissue diagnosis was obtained before radiotherapy in 19 patients and 21 patients were irradiated without histological diagnosis. Among 19 biospyproven cases, 14 were germinomas, 2 were teratomas, and the others were two pineocytomas and one pineoblastoma. In the earlier period, every attempt was made to obtain a tissue pathology by either stereotaxic biopsy or open craniotomy before irradiation. However, in recent years, wityh the advent of CT scan, a trial radiotherapy with a modest dose of 20 ㏉m 2 weeks was attempted in cases of highly suspected germinomas by CT scan findings. Further management after trial radiation depended on the radiation response shown on the follow up CT scan and tumor marker study. Radiation fields varied from a small local field to whole brain or entire neuroaxis irradiation. Most patients received 40-50 ㏉ to the primary tumor site and 20-30 ㏉ to the neuroaxis. Twenty-nine of the total 40 patients are alive without of disease 22-144 months after treatment and the overall 5-year recurrence-free survival rate was 74.4%, Univariate analysis of prognostic factors at presentation showed that tumor type was highly correlated with outcome. Two of fourteen biopsy-proven germinomas and none of nine presumed germinomas by trial radiation recurred. On the other hand, five of six patients who showed poor response to trial radiation died of uncontrolled disease and only one patient with elevated AFP in serum and CSF was salvaged by chemotherapy. On the basis of the results of this study, application of trial radiation therapy without tissue biopsy is well justified as a treatment modality in a suspected germinoma by CT scan finding. Aggressive combined modality approaches with surgery, radiotherapy and chemotherapy need to be investigated to improve results in radioresistant tumors.