Feasibility study of radiophotoluminescent glass dosimeter for in vivo dosimetry in external photon beam radiotherapy

Shehzadi Nazia Neelam,Yi Chul-Young,Kim Ki-Hwan,Jang Jaeuk,Hwang Ui-Jung,Kim Yunho,Kim In Jung,Seong Young Min 한국물리학회 2021 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.78 No.6

The purpose of this study was to check the applicability of radiophotoluminescent glass dosimeter (RPLGD) for in vivo dosimetry in external photon beams radiotherapy. The entrance dose measurements were performed. The influence of beam set-up parameters on the entrance dose was investigated using the RPLGDs. In this study, the RPLGD and 6-MV photon beam produced by a linear accelerator were used. The entrance dose calibration factors of the RPLGDs and beam energy and geometry-dependent correction factors were measured using a water phantom. For a correction factor related to the irradiation set-up, Monte Carlo (MC) simulation was performed. The entrance dose verification was performed on an Alderson Rando phantom during 64 single beam irradiations using different beam set-up. One RPLGD was attached on surface during a single beam irradiation for delivery of clinically planned dose. Additionally, during 50 irradiations, one RPLGD was placed directly inside the Alderson Rando phantom at different points in the beam path to verify the dose delivery. The mean ratio of the measured entrance dose using RPLGD on the surface of the phantom to the expected dose which was calculated by treatment planning system was equal to 1.001 ± 0.030. The mean ratio of the dose measured using RPLGDs inside the Alderson Rando phantom to the expected dose was equal to 1.019 ± 0.019. This study concludes that the RPLGD is suitable for in vivo dosimetry in external photon beam radiotherapy for dose verification within ± 5% at the clinically acceptable level.

Treatment of Retinoblastoma: The Role of External Beam Radiotherapy

김주영,박영희 연세대학교의과대학 2015 Yonsei medical journal Vol.56 No.6

The risk of radiotherapy-related secondary cancers in children with constitutional retinoblastoma 1 (RB1) mutations has led to reduced use of external beam radiotherapy (EBRT) for RB. Presently, tumor reduction with chemotherapy with or without focal surgery (chemosurgery) is most commonly undertaken; EBRT is avoided as much as possible and is considered only as the last treatment option prior to enucleation. Nevertheless, approximately 80% of patients are diagnosed at a locally advanced stage, and only 20–25% of early stage RB patients can be cured with a chemosurgery strategy. As a whole, chemotherapy fails in more than two-thirds of eyes with advanced stage disease, requiring EBRT or enucleation. Radiotherapy is still considered necessary for patientswith large tumor(s) who are not candidates for chemosurgery but who have visual potential. When radiation therapy is indicated,the lowest possible radiation dose combined with systemic or local chemotherapy and focal surgery may yield the best clinical outcomes in terms of local control and treatment-related toxicity. Proton beam therapy is one EBRT method that can be used for treatment of RB and reduces the radiation dose delivered to the adjacent orbital bone while maintaining an adequate dose to the tumor. To maximize the therapeutic success of treatment of advanced RB, the possibility of integrating radiotherapy at early stages of treatment may need to be discussed by a multidisciplinary team, rather than considering EBRT as only a last treatmentoption.

Differences in radiotherapy application according to regional disease characteristics of hepatocellular carcinoma

( Chai Hong Rim ) 대한간암학회 2021 대한간암학회지 Vol.21 No.2

There are differences in opinion regarding the application of external beam radiotherapy in the treatment of hepatocellular carcinoma. Some major guidelines state that external beam radiotherapy is yet to attain a sufficient level of evidence. However, caution should be exercised when attempting to understand the clinical need for external beam radiotherapy solely based on the level of evidence. Previously, external beam radiotherapy had low applicability in the treatment of hepatocellular carcinoma before computed tomography-based planning was popularized. Modern external beam radiotherapy can selectively target tumor cells while sparing normal liver tissues. Recent technologies such as stereotactic body radiotherapy have enabled more precise treatment. The characteristics of hepatocellular carcinoma differ significantly according to the regional etiology. The main cause of hepatocellular carcinoma is the hepatitis B virus. It is commonly diagnosed as a locally advanced tumor but with relatively preserved hepatic function. The majority of these hepatocellular carcinoma cases are found in the East Asian population. Hepatocellular carcinoma caused by hepatitis C virus or other benign hepatitis tends to be diagnosed as a less locally aggressive tumor but with deteriorated liver function. The western world and Japan tend to have patients with such causes. External beam radiotherapy has been more commonly performed for the former, although the use of external beam radiotherapy in the latter might have more concerns with regard to hepatic toxicity. This review discusses the above subjects along with perspectives regarding external beam radiotherapy in recent guidelines. (J Liver Cancer 2021;21:113-123)

External Beam Radiotherapy Alone in Advanced Esophageal Cancer

안성자(Sung Ja Ahn),정웅기(Woong Ki Chung),나병식(Byung Sik Nah),남택근(Taek Keun Nam) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.1

Purpose :We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. Me thods and Mate rials :One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow- up was completed in 100 patients (94%) and ranged from 1 month to 92 months (median; 6 months). Results :The median age was 62 years old and male to female ratio was 104 : 2. Fifty- three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55∼70.8 Gy) and median duration of the radiation therapy was 53 days. The median survival of all patients was 6 months and 1-year and 2- year overall survival rate was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except for 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2- year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2- year survival rate of the patients who could tolerate regular diet was 9 months and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less tumor length and those with more than 5 cm tumor length was marginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, thestatistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). Conclusion :The survival outcome for advanced esophageal cancer patients treated by external beam radiotherapy alone was very poor. In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome 목 적 : 진행된 식도암 환자에서 외부 방사선 단독치료를 받았던 환자의 치료성적에 대하여 후향적 분석을 시행하였다. 재료 및 방법 : 흉곽내에 위치한 편평상피세포암의 식도암으로 1990년 7월부터 1996년 12월까지 전남대학교병원 치료방사선과에서 외부 방사선 단독 치료를 받은 106명을 대상으로 후향적 분석을 시행하였다. 근치 목적의 방사선은 6 MV 혹은 10 MV X선으로 55 Gy에서 70.8 Gy 의 선량으로 통상적인 분할치료를 시행하였다. 추적이 가능한 환자는 100명(94%) 으로 추적기간은 1개월에서 92개월(중앙값; 6개월)이었다. 결 과 : 전체환자의 중앙연령은 62세였으며, 남녀 비율은 104 :2였다. 가장 흔한 병변부위는 중앙 부위로 54%를 차지하였다. 83%의 환자가 근치목적의 방사선치료를 받았고 이들의 평균 방사선 선량은 58.6 Gy였으며(55∼70.8 Gy) 평균 치료소요기간은 53일이었다. 전체환자의 중앙생존기간은 6개월이었고, 1, 2년 생존율은 각각 27, 12%였다. 연하곤란으로 위루술을 시행한 7명을 제외하고 대부분의 환자에서 증상의 완화를 보였다. 치료 직후 완전 관해율은 32% (34/106)였고 이들 환자의 중앙생존기간(14개월)과 2년 생존율(30%)은 다른 환자의 중앙생존기간(4개월)과 2년 생존율(0%)에 비해 좋았다(p= 0.000). 진단시 연하곤란의 정도에 따른 중앙생존기간과 2년 생존율을 비교해보면, 정상적인 음식물 섭취가 가능한 경우는 9개월과 16%인 반면, 전혀 음식물을 삼킬 수 없었던 환자의 경우는 3개월과 0%였다(p=0.004). 그러나 식도주변조직의 침범이나 주변 임파절 침범 유무에 따른 두 군간의 성적의 차이는 보이지 않았다. 다요인 분석에서는 방사선치료 직후 종양의 완해 여부가 가장 중요하였고 그외 원발 병소의 길이, 진단 당시 연하곤란의 정도 순으로 생존율에 통계적으로 유의한 영향을 주는 인자였다. 치료로 인한 부작용은 10명의 환자에서 관찰되었다(9%). 결 론 : 진행된 식도암 환자의 외부방사선 단독 치료는 좋지 않은 결과를 보여 주었다. 이에 진행된 병기의 식도암환자의 치료 선택에 있어서 반드시 근접치료나 항암화학요법의 병행을 고려해야 하겠다.

식도의 편평상피세포암 환자에서 외부방사선치료의 결과

장지영(Ji Young Jang) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.1

목 적: 최근 진행된 식도암의 치료는 병행항암방사선요법 후 수술을 시행하는 것이 가장 성적이 좋은 것으로 보고되고 있다. 그러나 병행치료의 발전에도 불구하고 여전히 많은 식도암 환자에서 병행치료가 어려워 방사선치료 단독으로 치료받게 된다. 이에 저자는 통상적인 외부방사선치료를 받은 식도암 환자의 치료성적과 예후인자를 알아보고자 하였다. 대상 및 방법: 1998년 1월부터 2005년 12월까지 식도의 편평상피세포암으로 진단받고 40 Gy 이상 외부방사선조사를 받은 30명의 환자를 대상으로 분석하였다. 총방사선량은 44∼60 Gy (중간선량 57.2 Gy)이었으며 방사선치료기간은 36∼115일(중간방사선치료기간 45일)이었다. 13명(43.3%)의 환자는 당뇨, 고혈압, 결핵 등의 과거력이 있었으며 그중 4명의 환자에서 식도암 진단 전 3명이 위암, 1명이 하인두암으로 진단받고 치료받은 적이 있었다. 원발병소부위는 중흉부식도에 위치한 예가 19명(63.3%)으로 가장 많았고 상흉부식도 4명(13.3%), 하흉부식도 7명(23.3%)이었다. 원발병소의 길이는 2∼11 cm이었고, 중간 길이는 6 cm이었다. 진단당시 병기는 AJCC 병기로 병기 I이 2명(6.7%), 병기 II 4명(13.3%), 병기 III 19명(63.3%), 병기 IV 5명(16.7%)이었다. 결 과: 전체 환자의 중간 생존기간은 8.3개월이었고 1년 생존율 33.3%, 2년 생존율 18.7%이었다. 치료종료 1∼3개월째 치료결과를 판정하여 완전관해를 보인 환자가 6명(20%), 부분관해 21명(70%)이었다. 치료종료 1∼3개월 후에 평가한 연하곤란증상은 29명(96.7%)의 환자에서 호전되었다. 치료성적에 영향을 미치는 예후인자에 대한 단변량 분석결과 연령, 종양의 길이, 병기, 치료 전 식사, 치료 목적, 치료에 따른 반응정도가 통계적인 유의성을 보였다. 다변량분석에서는 종양의 길이, 치료 목적, 치료에 따른 반응정도가 생존율에 영향을 미치는 인자로 확인되었다. 치료실패는 국소 실패가 28명, 전이가 4명이었다. 추적조사기간동안 2명의 환자에서 이차적인 암이 발생하여 과거력상 식도이외의 암이 있었던 환자를 포함하면 6명(20%)에서 다발성 암으로 진단받았다. 치료로 인한 부작용 중 식도협착이 발생한 예가 3명(10%), 방사선폐렴이 발생한 예가 2명(6.7%)이었다. 결 론: 식도암에서 단독 방사선치료 결과는 병행치료에 비해 만족스럽지 못하지만 부작용이 많지 않아 연하곤란증상을 완화시키기 위한 목적으로 여전히 이용되고 있다. 진행된 식도암에서 항암제 혹은 항암제 이외의 적절한 병행치료를 시행하여 완전관해율을 높인다면 생존율의 향상을 얻을 수 있으리라 기대해 본다. Purpose: The best treatment for advanced esophageal cancer is chemoradiotherapy followed by surgery. In spite of the advance of multimodality therapy, most patients with esophageal cancer are treated with radiation therapy alone. This study reports the outcome of the use of conventional external beam radiotherapy alone for the treatment of esophageal cancer. Materials and Methods: Between January 1998 and December 2005, 30 patients with squamous cell carcinoma of the esophagus were treated with external beam radiotherapy using a total dose exceeding 40 Gy. Radiotherapy was delivered with a total dose of 44-60 Gy (median dose, 57.2 Gy) over 36∼115 days (median time, 45 days). Thirteen patients (43.3%) had a history of disorders such as diabetes, pertension, tuberculosis, lye stricture, asthma, cerebral infarct, and cancers. Four patients metachronously had double primary cancers. The most common location of a tumor was the mid-thoracic portion of the esophagus (56.7%). Tumor lengths ranged from 2 cm to 11 cm, with a median length of 6 cm. For AJCC staging, stage III was the most common (63.3%). Five patients had metastases at diagnosis. Results: The median overall survival was 8.3 months. The survival rates at 1-year and 2-years were 33.3% and 18.7%, respectively. The complete response rate 1∼3 months after radiotherapy was 20% (6/30) and the partial response rate was 70% (21/30). Sixteen patients (53.3%) had an improved symptom of dysphagia. Significant prognostic factors were age, tumor length, stage, degree of dysphagia at the time of diagnosis and tumor response. Cox regression analysis revealed the aim of treatment, clinical tumor response and tumor length as independent prognostic factors for overall survival. Twenty-eight patients had local failure and another four patients had metastases. Three patients were detected with double primary cancers in this analysis. A complication of esophageal stricture was observed in three patients (10%), and radiation pneumonitis occurred in two patients (6.7%). Conclusion: The prognosis of esophageal cancer remains poor, in spite of advances in radiotherapy techniques. Radiotherapy is one of the main treatment modalities for the relief of dysphagia and treatment related complications are minimal. It is expected that the addition of chemotherapy or another systemic modality to radiotherapy will improve tumor control and increase the survival rate in advanced esophageal cancer.

Intensity-Modulated Radiation Therapy (IMRT) for Uterine Cervical Cancer to Reduce Toxicity and Enhance Efficacy - an Option or a Must?: A Narrative Review

이세원,김애란,이성종,김성환,이종훈 대한암학회 2024 Cancer Research and Treatment Vol.56 No.1

Radiotherapy (RT) is a fundamental modality in treatment of cervical cancer. With advancement of technology, conventional RT used for external beam radiotherapy (EBRT) for over half a century has been rapidly replaced with intensity-modulated radiation therapy (IMRT) especially during the last decade. This newer technique is able to differentiate the intensity of radiation within the same field, thus reduces the inevitable exposure of radiation to normal organs and enables better dose delivery to tumors. Recently, the American Society for Radiation Oncology has released a guideline for RT in cervical cancer. Although a section of the guideline recommends IMRT for the purpose of toxicity reduction, a thorough review of the literature is necessary to understand the current status of IMRT in cervical cancer. This narrative review updates the recent high-level evidences regarding the efficacy and toxicity of IMRT and provides a better understanding of the most innovative techniques currently available for EBRT enabled by IMRT.

Long Term Follow-up Results of External Beam Radiotherapy as Primary Treatment for Retinoblastoma

최상열,김미숙,유성열,조철구,지영훈,김금배,서영석,박경덕,이준아,이태원 대한의학회 2010 Journal of Korean medical science Vol.25 No.4

The authors reviewed their experiences of external beam radiotherapy (EBR) as an initial treatment in retinoblastoma patients to determine its long-term effect on subsequent tumor control and complications. A total of 32 eyes in 25 patients that underwent EBR for retinoblastoma were reviewed retrospectively. The patients consisted of 21 boys and 4 girls of median age at treatment of 7.1 months. Radiation doses ranged from 35 to 59.4 Gy. The 10-yr ocular and patient survivals were 75.4%and 92.3%, respectively. Nine of the 32 eyes progressed; 7 of these were enucleated and 2 were salvaged by focal treatment. According to the Reese-Ellsworth classification,4 of 5 eyes of Group II, 13 of 16 Group III eyes, 2 of 4 Group IV eyes, and 5 of 7 Group V eyes were retained, and of the 32 eyes, 13 had visual acuity better than 20/200. Eleven patients experienced a radiation-induced complication. No patient developed a second malignancy during follow-up. Despite the limited number of patients enrolled, EBR may provide a mean of preserving eyeball and vision for some advanced lesions.

Long Term Follow-up Results of External Beam Radiotherapy as Primary Treatment for Retinoblastoma

Choi, Sang Yul,Kim, Mi-Sook,Yoo, SungYul,Cho, ChulKoo,Ji, YoungHoon,Kim, KumBae,Seo, YoungSeok,Park, Kyung Duk,Lee, JunAh,Lee, Tai-Won The Korean Academy of Medical Sciences 2010 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.25 No.4

<P>The authors reviewed their experiences of external beam radiotherapy (EBR) as an initial treatment in retinoblastoma patients to determine its long-term effect on subsequent tumor control and complications. A total of 32 eyes in 25 patients that underwent EBR for retinoblastoma were reviewed retrospectively. The patients consisted of 21 boys and 4 girls of median age at treatment of 7.1 months. Radiation doses ranged from 35 to 59.4 Gy. The 10-yr ocular and patient survivals were 75.4% and 92.3%, respectively. Nine of the 32 eyes progressed; 7 of these were enucleated and 2 were salvaged by focal treatment. According to the Reese-Ellsworth classification, 4 of 5 eyes of Group II, 13 of 16 Group III eyes, 2 of 4 Group IV eyes, and 5 of 7 Group V eyes were retained, and of the 32 eyes, 13 had visual acuity better than 20/200. Eleven patients experienced a radiation-induced complication. No patient developed a second malignancy during follow-up. Despite the limited number of patients enrolled, EBR may provide a mean of preserving eyeball and vision for some advanced lesions.</P>

국소 진행된 분화 갑상선 유두암에서의 외부 방사선 치료의 역할

김주희,김광민,박준범,배금석,강성준,Joo Hee Kim,Kwang Min Kim,Joon Beom Park,Keum Seok Bae and Seong Joon Kang 대한갑상선-내분비외과학회 2012 The Koreran journal of Endocrine Surgery Vol.12 No.2

Carcinoma of the Uterine Cervix Treated with External Baem Irradiation Alone

김미숙(Mi Sook Kim),하성환(Sung Whan Ha) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.2

자궁경부암의 방사선 치료중 외부방사선조사로만 치료한 환자에서 생존율, 합병증, 예후인자를 알아보기 위하여 본 연구를 시행하였다. 1979년 3월부터 1988년 12월까지 서울대학교병원 치료방사선과에서 근치적 방사선 치료를 시행받은 총 650명의 자궁경부암 환자 중 외부방사선 조사만 시행한 42명을 대상으로 후향적 분석을 실시하였다. 방사선치료는 45 Gy내지 50 Gy의 전골반 조사후 3 내지 2 조사야를 사용한 축소야로 12 Gy에서 22 Gy의 추가조사를 시행하였다. 외부방사선조사만 시행한 이유는 심한 종양괴사로 인한 경우 25예, vaginal vault가 좁은 경우 5예, 외부방사선 치료 중 자궁강의 파열 1예등 강내조사용기구삽입이 불가능한 경우(poor geometry) 31명, 내과적 문제 5명, 고령 2명, 환자의 거부 2명, 장관 유착과 골반질환이 각각 1명이었다. FIGO병기 IB, IIA, IIB, IIIA, IIIB, IVA의 환자수는 각각 1명, 3명, 12명, 1명, 20명, 5명이었다. 병기 IIA, IIB, IIIB, IVA에 따른 5년 국소치유율은 각각 66.7%, 38.9%, 27.0%, 20.0%이었고 5년 생존률은 각각 66.7%, 36.4%, 32.8%, 25.0%으며 1명씩의 IB와 IIIA의 환자는 무병생존했다. 방사선 치료가 끝난 후 치료반응 판정에서 완전관해와 부분관해를 보인 환자군이 그렇지 않은 환자군보다 5년 국소치유율은 의미있게 높았으나 (45.3% vs 17.8% p=0.04) 5년 생존률의 의미있는 차이는 없었다(43.5% vs 23.1% p=0.17). 방사선 치료후 1개월에서 완전관해와 부분관해를 보인 환자군은 그렇지 않은 환자군보다 5년 국소치유율 (53.8% vs 0% p=0.0002)과 5년 생존률(51.3% vs 1.0% p=0.001)이 의미있게 높았다. Grade 2와 Grade 3의 합병증은 각각 12%와 10%였다. 진행된 경우일수록 합병증의 빈도가 증가하는 경향이었다. 따라서 자궁경부암 환자의 방사선 치료에 가장 적합한 방법은 외부조사와 강내 치료를 병행하는 것이나 강내 치료가 불가능한 환자군에 대해서는 적극적 수술방법의 도입을 고려해야하겠다. A retrospective analysis was peformed on 42 patients with carcinoma of the uterine cervix who were treated with external beam (EB) radiation therapy alone at the Department of Therapeutic Radiology, Seoul National University Hospital from March 1979 to December 1988. After whole pelvic field irradiation of 50Gy, all the patients received additional booster dose of 12-22Gy to the primary tumor Thirty one received EB radiotherapy alone because of poor geometry for intracavitary application,5 because of medical problems and 6 because of other reasons. Five year locoregional control rate and five year survival rate were 34.5%;and;35.4%, respectively. Five year survivals were 66.7%, 36.4%, 32.8% and 25.0% for stage IIA, IIB, IIIB and IVA, respectively. The response one month after treatment well correlated with prognosis. The incidence of grade 2 and 3 complication was 12% and 10%, respectively. There was tendency of increased complication with advanced stage.