비인강암의 방사선 치료

고경환,박우윤,조철구,류성렬,심윤상,오경균,Koh Kyoung Hwan,Park Woo Yoon,Cho Chul Koo,Yoo Seong Yul,Shim Youn Sang,Oh Kyung Kyoon The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.1

Total of 154 patients of pathologically proven and previously untreated nasopharyngeal carcinoma who were treated in the Department of Therapeutic Radiology, Korea Cancer Center Hospital during the period from 1964 to 1984 were analyzed. Minimal follow-up period of survivors was 3 years. Thirteen percent of the patients had $T_4$ primary lesions and $65\%$ had stage IV disease. Total radiation dose to the primary site was $1550\~1750$ ret in 82 and above 1750 ret in 72 patients. Local control was obtained in $79\%$ of patients. Significant prognostic factors for the survival were tumor dose (above vs. below 1750 ret), age (below vs. above 30 years), stage (AJCC I-III vs. IV), T stage ($T_1\;vs.\;T_2-4$), and N stage (NO vs. $N^+$). 1964년부터 1984년까지 원자력병원 치료방사선과에서 비인강암으로 근치적 목적의 방사선치료를 받은 154명의 환자에 대한 임상적 특성과 치료결과를 분석하였다. 생존자의 최소추적기간은 3년이었다. 환자의 $13\%$가 $T_4$의 원발병소를 가졌고, $65\%$가 AJCC병기 제 4 기였다. 병소부위의 총방사선량은 82명에서 $1550\~1750$ret였고, 72명에서 1750ret이상이었다. 국소적 완전관해율은 $79\%$이었다. 유의한 예후인자로는 방사선량(1750ret이상 또는 이하), 나이 (30세이하 또는 이상), 병기 (AJCC 제 $1\~3$기 또는 제 4기), 원발병 소정도 ($T_1$ 또는 $T_2\~T_4$병기), 경부임파절유무 (NO 또는 $N^+$)이었다.

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.

915 MHz 극초단파 자입온열시 온도분포 적정화에 관한 연구 -조직등가물 및 가묘대뇌를 대상으로-

고경환,조철구,박영환,류성렬,김종현,이승훈,Kyoung Hwan Koh,Cho Chul Koo,Park Young Hwan,Yoo Seong Yul,Kim Jong Hyun,Lee Seung Hoon The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.1

원자력병원 치료방사선과에서는 자입온열치료 등을 위한 역동적 조직 등가물을 자체 고안하여 제작된 역동적 조직등가물에서 얻은 결과와 실제 가묘 대뇌실질에 자입온열치료를 시행해서 얻은 결과에서 다음과 같은 결론에 도달하여 향후 인위적으로 유발시킨 가묘 대뇌실질 내 악성종양에 대한 실험적 연구의 기초가 되고 암치료율 향상을 위한 시발로 삼으려 한다. 1, 915MHz 극초단파를 이용한 자입온열기 단말의 치료가능 용적은 $50\%$ S.A.R. (specific absorption rate)에 의하면 $2\;cm\times\;cm\times6\;cm$이었다. 2, 순환이 되지 않는 정적 조직등가물에서는 공기 중 압력분포와 같았고 자입온열치료기 가동후 $5\~10$분 내에 극초단파에 의해 간섭받지 않는 Ga-As fiberoptic thermistor로 측정되지 않는 $55^{\circ}C$ 이상의 온도 이상으로 상승됨이 관찰되었다. 3, 생리식염수를 순환시킨 역동적 조직등가물에서 자입온열치료기 가동 후 5분 이내의 경과기(transit period)를 거쳐 45분 이상의 안정기 (steady peroid)를 얻을 수 있었다. 4, 역동적 조직등가물에서 순환을 차단하면 정적 등가물과 같은 온도 상승이 관촬되었다. 5, 가묘 대뇌실질에 대한 자입온열치료를 5 Watts이하의 출력으로 사용하는 경우 비교적 안정되게 시행 가능했고 순환차단에 의한 급격한 온도상승이 관찰되었고 최고 $55^{\circ}C$ 이상까지 걸리는 시간이 출력 5, 10 및 15 Watts에서 각각 15.2 (SE 0.4), 9.7 (SE 0.3) 그리고 6.3 (SE 0.4)분 이었다. 본 연구는 기초 생물학적 실험이지만, 그 결과는 임상 암치료 방법에 직접 이용되는 것이며 또한 치료수행을 위해 반드시 필요한 과정이다. 따라서 치료방법의 결정, 성적분석, 치료 부작용의 예측 및 대책확립 등에 적용될 뿐만 아니라, 외국의 치료결과와 비교시 본원 온열치료의 특성제시에 활용될 수 있다. The ultimate objective of our experiment is to obtain the precise distribution of temperature in malignant tumors occurring in cerebral parenchyme of human beings when we will carry out interstitial hyperthermia in the near future. To achieve this purpose, first of all, it is necessary to make an attempt at performing interstitial hyperthermia in vivo under the similar condition of human beings. Therefore, we chose cats as materials much alike tissue characteristics of human beings. Moreover, it is also necessary to get the basic data from dynamic phantom in order to standardize and compare results obtained from interstitial hyperthermia carried out in cats. By having performed these experiments we got the following results. 1) On doing interstitial hyperthermia with 915 MHz microwave, the possible treated volume was 2 cm by 2 cm by 6 cm according to $50\%$ specific absorption rate (SAR). 2) The distribution of temperature within non-circulated static phantom was much the same as power density in air, but we observed that the temperature, within $5\~10$ minutes, rose to more higher than $55^{\circ}C$ not measured with Ga-As fiberoptic thermistor which was not impeded by microwave after performing interstitial hyperthermia. 3) Within dynamic phantom in which normal saline was circulating, temperature reached steady state which was maintained for more than 45 minutes through transit period in 5 minutes after starting interstitial hyperthermia. 4) When we interrupted circulation in the dynamic phantom, we observed that temperature rose to the same level as in the static phantom. 5) We could carry out interstitial hyperthermia safely when we used the generating power below 5 watts. Abrupt interruption of circulation caused a rapid increase in temperature. Times taking to rise to maximum $55^{\circ}C$ were 15.2 minutes (SE 0.4),9.7 minutes (SE 0.3), and 6.3 min-utes (SE 0.4) respectively with generating powers of 5,10, and 15 watts.

915 MHz 극초단파 및 초음파를 이용한 온열치료와 방사선치료 병합치료에 의한 두경부암의 치료성적

고경환(Kyoung Hwan Koh),박영환(Young Hwan Park),조철구(Chul Koo Cho),류성렬(Seong Yul Yoo) 대한두경부종양학회 1990 대한두경부 종양학회지 Vol.6 No.1

Thirty five lesions of 35 patients with locally advanced malignant tumors of head and neck were received thermoradiotherapy with ultrasound and/or 915 MHz microwave. 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 a fraction size of 2 Gy up to total 30 to 60 Gy. Conclusions are as follows; 1) Total response rate (CR+PR) of thermoradiotherapy with microwave and ultrasound was 80%. 2) Tumor depth, minimum temperature of tumor center, number of heat fraction and irradiation dose were statistically significant factors affecting response. 3) Hyperthermia with microwave and ultrasound can be used efficiently to control locally advanced malignant tumors in head and neck whether previously received near tolerance dose of radiotherapy or not.

이 연구에 적절한 통계를 적용했는가?

Kyoung Hwan Koh(고경환) 대한견주관절의학회 2015 대한견주관절학회 학술대회논문집 Vol.2015 No.4

오구쇄골 인대 재건술을 위한 골터널의 해부학적 위치: 카데바 연구

고경환(Koh Kyoung-Hwan),손민수(Shon Min-Soo),Tae-Kang Lim 대한견주관절의학회 2016 대한견주관절학회 학술대회논문집 Vol.2016 No.7

조기 유방암에서 보존적 수술후 방사선치료성적

고경환(Kyoung Hwan Koh),김미숙(Mi Sook Kim),류성렬(Seong Yul Yoo),조철구(Chul Koo Cho),김재영(Jae Young Kim),김용규(Yong Kyu Kim),문난모(Nan Mo Moon),백남선(Nam Sum Paik),이종인(Jong Inn Lee),최동욱(Dong Wook Choi) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.2

목적 : 조기 유방암에서 보존적 수술후 방사선치료는 외국에서 과거 20여면 동안 근치적 수술과 비슷한 생존율을 보였다. 그러나 아직 우리 나라에서는 보편화되지는 못한 실정이다. 이 논문은 원자력병원에서 시행한 조기 유방암환자에서 보존적 수술의 성적 및 부작용의 결과를 알기 위함이다. 방법 : 1987년 1월부터 1989년 12월까지 원자력 병원 치료방사선과에서 보존적 수술후 방사선치료를 받은 조기 유방암 환자 45명에 대해 후향적 연구를 시행하였다. 추적 관찰기간은 4-82개월이었고 중앙값은 54개월이었다. 수술은 조직 생검만 시행한 경우 및 Tumorectomy 또는 Quadrantectomy를 시행한 경우가 있었다. 28예에서 액와림프절 박리를 시행하였다. 방사선치료는 전유방에 Tangential field로 하루 1.8-2 Gy씩 총 50 또는 50.4 Gy를 조사하였다. 항암요법은 30예의 환자에서 시행되었고 호르몬 치료는 11예에서 시행되었다. 결과 : 5년 생존율, 5년 무병생존율 및 5년 국소제어율은 각각 87.2%, 86.5%, 97.6%였다. 전신 요법을 시행하는 군이 시행하지 않은 군에 비하여 5년 생존율에서 좋은 성적을 보였으나 통계학적인 의미는 없었다 (0.05<p<01). 심각한 후유증은 8.9%였다. 결론 : 조기 유방암에서 보존적 수술후 방사선 치료는 근치적 수술과 비교하여 생존율 및 국소제어율에 차이가 없음을 알 수 있었다. 향후 많은 환자 수와 오랜 추적기간을 통하여 국소제어율과 미용 효과에 영향을 미치는 예후인자를 찾아 환자선택과 치료에 응용함으로 더 높은 국소제어율과 미용 효과의 증대를 꾀할 수 있으리라 사료된다. Purpose : Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy during the past 2 decades. In this country, however, the practice of conservatinve therapy for early invasive breast cancer has not been generalized yet. The purpose of this report was to evaluate the results and complications of breast conservation therapy in Korean Cancer Center Hospital(KCCH). Materials and Methods : From January 1987 to December 1989. 45 patients with early breast cancer treated with conservative treatment in KCCH were studied retrospectively. Median follow up was 54 months(range, 4 to 82 months). All patients received partial mastectomy (biopsy, tumorectomy, or quadrantectomy) and radiation therapy. Twenty eight patients received axillary dissection. The breast was treated with two opposing tangential fields (total 50 Gy or 50.4 Gy in 5 weeks with daily target dose of 2 Gy or .8 Gy). Thirty patients received chemotherapy before and after radiotherapy. Eleven patients received hormonal therapy. Results : Five-year survival rate, 5-year disease free survival rate and 5-year local control rate were 87.2%, 86.5% and 97.6%, respectively. Administration of systemic Therapy (chemotherapy or hormonal therapy) correlated with good prognosis but statistically not significant (0.05<p<01). The severe late complication rate was 8.9%. Conclusion : Primary radiation therapy following breast-conserving surgery for early breast cancer is an alternative treatment comparing to radical treatment. Long term follow-up and more patients collection os needed to evaluate the prognostic factor and cosmetic outcome.

인체 상피암 세포주에서 방사선감수성과 손상회복의 상관관계에 관한 연구

고경환 (Kyoung Hwan Koh),하성환 (Sung Whan Ha),박찬일 (Charn Il Park) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.1

To investigate the relationship between radiosensitivity and postirradiation recovery in human cancer cells, a study was performed using human cancer cell lines-A549, CaSki, SNU-C5 and PCI-13. For the study of radiosensitivity, single doses of 2, 4, 6, 8, 10, 12, and 14 Gy were given and for postirradiation recovery, two fractions of 4 Gy were separated with a time interval of 0, 0.5, 1, 1.5, 2, 2.5, 3, 4, 5, or 6 hours. surviving fraction was estimated using colony forming ablility. Surviving fractions at 2 Gy (SF2) were 0.496 (0.570-0.412) for A549, 0.496 (0.660-0.332) for CaSki, 0.386 (0.576-0.276) for SNU-C5, and 0.185 (0.247-0.123) for PCI-13. By statistical analysis the SF2 of PCI-13 was lower signigicantly than those of others (p<0.05). This difference was also observed at 4, 6 and 8 Gy dose levels. At 6 and 8 Gy the surviving fractions of SNU-C5 were also lower significantly than A549, CaSki (p<0.005). By the analysis with linear quadratic model, the values of ⍺ for A549, CaSki, SNU-C5 and PCI-13 were 0.3016, 0.3212, 0.4327 and 0.8423, respectively, and those of β were 0.02429, 0.02009, 0.03349 and 0.00059, respectively. So, the value of ⍺ showed increasing tendency with decreasing SF2. By the multitarget single hit model the values of Do for A549, CaSki, Sun-C5 and PCI-13 were 1.97, 1.97, 1.46 and 0.81, respectively, and those of n were 1.53, 1.50, 1.56 and 2.28, respectively. So, the value of Do decreased with decreasing SF2. Post-irradiation recovery reached plateau at around 2 hours. Recovery ratio at plateau phase ranged from 1.2 to 4.2; the value were 1.2 for PCI-13, 3.2 for CaSki, 3.3 for SNU-C5, and 4.2 for A549. Recovery rate well correlated with SF2, and increased with increasing Do and decreasing ⍺. According to above results, the intrinsic radiosenstibity was quite different among the tested cell lines; PCI-13 was the most sensitive and A549 and CaSki was similar. This difference of radiosensitivity is thought to be partly due to the difference in amount of postirradiation recovery. By linear quadratic model the difference of ⍺ values was very high, and by multitarget single hit model the difference of Do value was significantly high among four cell lines.

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.

쇄골 간부 분쇄골절에서 골편간 나사고정과 금속판을 이용한 치료 결과

고경환 ( Kyoung Hwan Koh ),손민수 ( Min Soo Shon ),이승원 ( Seung Won Lee ),김종호 ( Jong Ho Kim ),유재철 ( Jae Chul Yoo ) 대한골절학회 2012 대한골절학회지 Vol.25 No.4

목 적: 전위된 골절편을 동반한 쇄골 간부 골절 환자에서 모든 골절편을 해부학적으로 정복한 후 골절편간 나사못을 이용하여 고정하고 추가적으로 금속판을 이용하여 고정하여 치료한 결과를 보고하고자 한다. 대상 및 방법: 2005년 6월부터 2011년 8월까지 Edinburgh 분류상 IIB2에 해당하는 전위된 골절편을 가진 쇄골 간부 분쇄 골절로, 수술적 치료를 시행한 연속적인 13예에 대하여 후향적 연구를 시행하였다. 모든 골절편을 해부학적으로 정복하였으며 이에 대한 골편간나사고정을 먼저 시행한 후 금속판을 적용하였다. 골절편의 수, 골절의 전위 정도와 쇄골의 단축 정도를 평가하였다. 유합의 여부와 유합까지 걸린 기간, 그리고 합병증의 유무에 대하여 조사하였다. 결 과: 골절편은 7예에서 2개, 5예에서 3개, 그리고 1예에서 5개였다. 쇄골의 평균 단축은 1.1 cm였고 주요 골편간 전이는 평균2.6 cm였다. 모든 환자에서 방사선학적 유합을 관찰할 수 있었으며 평균 유합기간은 10.8주(8∼14주)였다. 불유합과 감염을 포함한 합병증은 발생하지 않았다. 결 론: 모든 골절편을 해부학적으로 정복하고 골절편간 나사못으로 고정한 후 금속판 고정을 시행하여 여러 개의 골절편을 동반한 전위된 쇄골 간부 골절에서 좋은 결과를 보여주었다. Purpose: To report the treatment results of anatomical reduction of all fracture fragments and internal fixation using an inter-fragmentary screw and plate in displaced mid-shaft clavicle fracture with comminution. Materials and Methods: Between June 2005 and August 2011, 13 consecutive displaced clavicle fractures with comminution (Edinburgh classification IIB2) treated by anatomic reduction and internal fixation using inter-fragmentary screw and plate were retrospectively evaluated. There were 11 male and 2 female patients with a mean age of 37.4 years (15∼55 years). The right clavicle was injured in 4 patients and the dominant arm was involved in 46%. The mean duration from trauma to surgery was 7.0 days. The cause of injury was a traffic accident in three, a fall in two, and sports activity or direct injury in eight patients. All of the fracture pieces were anatomically reduced and fixed with inter-fragmentary screws. An additional plate was applied to maintain and reinforce the reduction of the fracture. Radiographic assessments for the numbers of fragments and the amount of shortening and displacement were performed. To verify the fracture healing and determine the time from fracture surgery to union and complications, all of the radiographs taken after surgery were evaluated. Results: The number of fragments was 2 in 7 cases, 3 in 5 cases, and 6 in one case. The mean shortening of the clavicle was 1.1 cm (0.3∼2.1 cm) and mean displacement between the main fragments was 2.6 cm (1.3∼4.5 cm). The mean duration of follow-up was 16.5 months (8∼26 months). Radiographic union was achieved in all patients with a mean time to union of 10.8 weeks (8∼14 weeks). There were no complications including metal failure, nonunion, or infection. Conclusion: Anatomical reduction of all the fracture fragments and fixation using inter-fragmentary screws in addition to the usual plate fixation showed good fracture healing in displaced clavicle fracture with comminution.