극초단파와 초음파온열치료에 의한 각종암의 임상치료

고경환,박영환,조철구,류성열,Koh Kyoung Hwan,Park Young Hwan,Cho Chul Koo,Yoo Seong Yul 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

Twenty seven lesions of 25 patients with locally advanced malignant tumors were treated with combined hyperthermia introduced by microwave and ultrasound and radiotherapy. Most of all patients were failed with previous conventional therapeutic trial. Hyperthermia had been done immediately after radiotherapy, twice a week, $43^{\circ}C$ for one hour and radiotherapy had been done 5 fractions per week with fraction size of 2Gy upto 30 to 60Gy. Conclusions are as follows. 1. Total response rate (PR+PR) to thermoradiotherapy with microwave and ultrasound was $81\%$. 2. Tumor depth, minimum temperature of tumor center, number of heat fraction and radiation dose were statistically significant factors affecting response. 3. Hyperthermia with microwave and ultrasound can be used efficiently to control locally advanced malignant disease whether previously received near tolerance dose of radiotherapy or not.

Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy

Chul-Won Choi(최철원),Mi-Sook Kim(김미숙),Chul-Koo Cho(조철구),Seong-Yul Yoo(류성열),Kwang-Mo Yang(양광모),Hyung-Jun Yoo(유형준),Dong-Han Lee(이동한),Young-Hoon Ji(지영훈),Chul-Ju Han(한철주),Jin Kim(김진),Young-Han Kim(김영한) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.1

목 적: 국소적으로 진행된, 절제 불가능한 췌장암 치료에 있어 고식적 방사선 치료와 비교하여 CyberKnife (CK)를 이용한 정위 방사선 치료의 생존율 및 급성 독성에 대해 분석하고자 하였다. 대상 및 방법: 2003년 4월부터 2004년 4월까지의, Eastern Cooperative Oncology Group (ECOG) 활동도 3 이하이며 CT 및 PET/CT로 평가하여 원격 전이 없는 국소 진행된 췌장암 환자 19명을 대상으로 하였다. 대상 환자는 점차 방사선량을 증가시키는 방법으로 33 Gy, 36 Gy, 39 Gy를 3분할로 각각 6명, 4명, 9명에서 CK를 이용한 정위 방사선 치료를 시행하였으며, 생존율 및 Radiation Therapeutic Oncology Group (RTOG) acute radiation morbidity criteria에 의한 위장관 독성을 분석하였다. 또한 나이, 성별, ECOG 수행 점수, 항암 치료,우회로 조성술(bypass surgery) 여부, 방사선량, CA19-9, 계획용 표적 체적(planning target volume, PTV), CT상 주위 장기 및 혈관 침범 여부 등을 Log Rank test를 이용하여 예후 인자를 평가하였다.결 과: 본 연구에서 중앙 생존 기간은 11개월, 1년 생존율은 36.8%였다. 추적 조사 기간 중(범위 3∼20개월, 중앙값 10개월) 유의한 위장관 급성 독성은 관찰되지 않았다. 단일 인자 분석에서 계획용 표적 체적만이 유의한 예후 인자로 80 cc 이하인 경우가 80 cc 이상인 경우보다 생존율이 높았으며(p-value<0.05), 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술, CA19-9 수치, 주위 장기 및 혈관 침범 여부 등에서는 통계적으로 유의한 차이를 보이지 않았다. 다인자 분석에서는 65세 이하인 경우와 PTV 80 cc 이하인 경우에서 생존율이 높았다. 결 론: 고식적 방사선 치료, 고선량 입체조형 방사선 치료(high dose conformal radiation therapy), 수술 중 방사선 치료(intraoperative radiation therapy) 또는 세기 조절 방사선 치료(intensity modulated radiation therapy, IMRT)를 이용한 최근의 결과와 비교하여 CK를 이용한 정위 방사선 치료는 생존율 측면에서 비슷하거나 나은 결과를 보였다. 또한 심각한 부작용은 관찰되지 않았으며 짧은 기간의 치료로 환자에게 편의를 제공할수 있어 결과적으로 삶의 질을 향상시킬 수 있을 것이다. 따라서, 이 새로운 치료 방법은 국소 진행된, 절제불가능한 췌장암 환자에서 심각한 부작용 없는 효과적인 치료가 될 것으로 생각된다. 또한 계획용 표적 체적은 CK 치료의 유용한 예후 인자로 사용될 것이다. Purpose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ≤3 and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range 3∼20 months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV>80 cc (p-value<0.05). In multivariate analysis, age younger than 65 years and PTV>80 cc showed better survival rate. Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

극초단파와 초음파온열치료에 의한 각종암의 임상치료

고경환(Kyoung Hwan Koh)·박영환(Young Hwan Park)·조철구(Chul Koo Cho)·류성열(Seong Yul Yoo) 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

Twenty seven lesions of 25 patients with locally advanced malignant tumors were treated with combined hyperthermia introduced by microwave and ultrasound and radiotherapy. Most of all patients were failed with previous conventional therapeutic trial. Hyperthermia had been done immediately after radiotherapy, twice a week. 43℃ for one hour and radiotherapy had been done 5 fractions per week with fraction size of 2 Gy upto 30 to 60 Gy. Conclusions are as follows. 1. Total response rate (PR+PR) to thermoradiotherapy with microwave and ultrasound was 81%. 2. Tumor depth, minimum temperature of tumor center, number of heat fraction and radiation dose were statistically significant factors affecting response. 3. Hyperthermia wiht microwave and ultrasound can be used efficiently to control locally advanced malignant disease whether previously received near tolerance dose of radiotherapy or not.

Evaluation of DNA Double Strand Breaks in Human and Mouse Lymphocyte Following γ-Irradiation

김태환(Tae Hwan Kim),김성호(Sung Ho Kim),정인용(In Yong Chung),조철구(Chul Koo Cho),고경환(Kyung Hwan Koh),류성열(Seong Yul Yoo) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.2

각 방사선량의 조사에 따른 사람 정상임파구, 마우스 정상임파구, 그리고 EL-4마우스 백혈병 세포의 DNA double strand breaks 발생율에 대하여 비교분석 하였던 바 다음과 같은 결과를 얻었다. LPS와 PHA를 첨가하여 각각 배양한 마우스 정상임파구의 DNA double strand breaks의발생율을 strand scission factor의 기울기로 비교평가해 본 바 LPS를 첨가배양한 군이 DNA DSB가 더 많이 형성되었다(P<0.005). 이것으로 볼 때 DNA double strand breaks발생에 있어서는 B cells이 T cells보다 더 민감하였다. 또한 EL-4 백혈병 세포는 정상 임파구보다 유의하게 DNA DSB가 더 많이 형성된 것이 관찰되었다(p<0.005). 한편 사람 정상임파구와 마우스 정상임파구 사이의 intrinsic radiosensitivity는 시험관내 실험에서 비교적 유사한 kinetics를 나타냈으나, 마우스 정상임파구가 사람 정상임파구보다 DNA DSB수율이 더 낮았다. 그래서 방사선을 조사하고 3.5시간이 지난후에 10% DNA DSB발생에 필요한 선량을 두 군간에 비교평가해 본 바 마우스 정상임파구의 선량이 더 높게 나타났다. 이상의 실험결과를 정확하게 설명하기는 어렵지만 아마도 환경적인 요인과 유전적인 요인 때문인 것으로 사료되었다. 그리고 본 연구결과는 방사선조사에 따른 임상반응의 이해와 cytometric assessment의 방사선 생물학적 parameter로 이용될 수 있을 것으로 판단되었다. The evaluation of radiation-induced DNA double strand breaks (DSB) was made following irradiation of human lymphocytes, murine lymphocytes and EL-4 leukemia cells over a wide dose range of 60Co gamma-rays. In lipopolysaccharide (LPS) or phytohemagglutinin (PHA)-stimulated murine lymphocytes, the slopes of the stand scission factor (SSF) revealed that lymphocytes with LPS increased DNA DSB formation by a factor of 1.432 (p<0.005). Furthermore, strand break production was relatively inefficient in the T lymphocytes compared to the B lymuhocytes. And EL-4 leukemia cells were found to form significantly more DNA DSB to a greater extent than normal lymphocytes (p<0.005). The in vitro studies of the intrinsic radiosensitivity between human lymphocytes and murine lymphocytes showed similar phasic kinetics. However, murine lymphocytes were lower in DNA DSB formation and higher in the relative radiation dose of 10 percent DNA strand breaks at 3.5 hours following gamma-irradiation than human lymphocytes. Though it is difficult to interpret these results, these differences may be result from environmental and genetic factors. From our data, if complementary explanations for this difference will be proposed, the differences in the dose-effect relationship for the induction of DSB between humans and mice must be related to interspecies variations in the physiological condition of the peripheral blood in vitro and not to differences in the intrinsic radiation sensitivity of the lymphocytes. These results can be estimated on the basis of dose-effect correlation enabling the interpretation of clinical response and the radiobiological parameters of cytometrical assessment.

뇌종양에서 이리디움(Iridium-192)을 이용한 뇌정위외과적 자입근접치료법에 대한 초기 임상보고

김종현,류성열 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.5

Five patients with brain tumors have been treated with an afterloaded removable Indium 192 interstitial brachytherapy using Brown-Roberts-Wells stereotactic system. There were two cases of glioblastoma multiforme, one case of recurrent glioblastoma multiforme, one case of recurrent metastatic brain tumor and one case of recurrent astrocytoma grade Ⅱ. The patients were treated by combination of surgery or stereotactic biopsy and external radiation previously. Tumor doses ranging from 4100 to 8600 c㏉ were delivered to these patients. There was no death and 4 patients showed definite tumor regression 3 months following interstitial brachytherapy. The method was safe and appeared to be effective modality to achieve local control of brain tumors.