부비동과 비강암의 방사선 치료

허원주 대한두경부종양학회 1999 대한두경부종양학회 학술대회 논문집 Vol.1999 No.1

Comparative Analysis of Patterns of Care Study of Radiotherapy for Esophageal Cancer among Three Countries: South Korea, Japan and the United States

허원주,최영민,김정기,이형식,최석렬,김일한 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.2

Purpose: For the first time, a nationwide survey of the Patterns of Care Study (PCS) for the various radiotherapy treatments of esophageal cancer was carried out in South Korea. In order to observe the different parameters, as well as offer a solid cooperative system, we compared the Korean results with those observed in the United States (US) and Japan. Materials and Methods: Two hundreds forty-six esophageal cancer patients from 21 institutions were enrolled in the South Korean study. The patients received radiation theraphy (RT) from 1998 to 1999. In order to compare these results with those from the United States, a published study by Suntharalingam, which included 414 patients [treated by Radiotherapy (RT)] from 59 institutions between 1996 and 1999 was chosen. In order to compare the South Korean with the Japanese data, we choose two different studies. The results published by Gomi were selected as the surgery group, in which 220 esophageal cancer patients were analyzed from 76 facilities. The patients underwent surgery and received RT with or without chemotherapy between 1998 and 2001. The non-surgery group originated from a study by Murakami, in which 385 patients were treated either by RT alone or RT with chemotherapy, but no surgery, between 1999 and 2001. Results: The median age of enrolled patients was highest in the Japanese non-surgery group (71 years old). The gender ratio was approximately 9:1 (male:female) in both the Korean and Japanese studies, whereas females made up 23.1% of the study population in the US study. Adenocarcinoma outnumbered squamous cell carcinoma in the US study, whereas squamous cell carcinoma was more prevalent both the Korean and Japanese studies (Korea 96.3%, Japan 98%). An esophagogram, endoscopy, and chest CT scan were the main modalities of diagnostic evaluation used in all three countries. The US and Japan used the abdominal CT scan more frequently than the abdominal ultrasonography. Radiotherapy alone treatment was most rarely used in the US study (9.5%), compared to the Korean (23.2%) and Japanese (39%) studies. The combination of the three modalities (Surgery+RT+Chemotherapy) was performed least often in Korea (11.8%) compared to the Japanese (49.5%) and US (32.8%) studies. Chemotherapy (89%) and chemotherapy with concurrent chemoradiotherapy (97%) was most frequently used in the US study. Fluorouracil (5-FU) and Cisplatin were the most preferred drug treatments used in all three countries. The median radiation dose was 50.4 Gy in the US study, as compared to 55.8 Gy in the Korean study regardless of whether an operation was performed. However, in Japan, different median doses were delivered for the surgery (48 Gy) and non-surgery groups (60 Gy). Conclusion: Although some aspects of the evaluation of esophageal cancer and its various treatment modalities were heterogeneous among the three countries surveyed, we found no remarkable differences in the RT dose or technique, which includes the number of portals and energy beams.

방광암에 대한 바륨-공기 이중 방광 조영술과 3 분할 방광종영술의 방사선학적 고찰

허원주 대한영상의학회 1984 대한영상의학회지 Vol.20 No.4

Clinically bladder tumors can be easily diagnosed on cystoscopic examination and biopsy in the patients with silent hematuria, terminal dribbling and dysuria. But for the evaluation of the extent of tumor invasion. the author performed both barium-air double contrast and triple-fractionated cystography on 16 patients suspected to be bladder tumor on cystoscopic examination in the radiologic department of B.N.U.H. from September 1982 to August 1983. The obtained results were summarized as follows. 1. On barium-air double contrast cystography and triple-fractionated cystography, 13 cases were concluded as bladder tumor, and 3 cases were consistent with findings of chronic inflammation out of the total 16 cases. 2. After operation of 15 cases, 12 cases were confirmed pathologically as transitional cell carcinoma, 1 case as prostatic hypertrophy, and 2 cases as chronic inflammation. 3. Among 9 cases of transitional cell carcinoma having the evidence of muscle invasion on triple-fractionated cystography, 8 cases were confirmed as more than stage B1 on pathologic study, and the other as chronic inflammation. 4, In detecting multiplicity, presence of ulceration, and evaluation of nature of tumor surface, barium-air double contrast cystography was more excellent than cystoscopic results. 5. Cases presenting both ulceration and cauliflower appearance on barium-air double contrast cystography was more than grade 111 on microscopic evaluation. 6. In conclusion, the author considers the barium-air double contrast and triple- fractionated cystography are easy to perform, resonable in price and have relatively high accuracy in tumor detection, staging and grading.

식도암 방사선 치료에 대한 Patterns of Care Study (1998∼1999)의 예비적 결과 분석

허원주(Won Joo Hur),최영민(Youngmin Choi),이형식(Hyung Sik Lee),김정기(Jeung Kee Kim),김일한(Il Han Kim),이호준(Ho Jun Lee),이규찬(Kyu Chan Lee),김정수(Jung Soo Kim),전미선(Mi Son Chun),김진희(Jin Hee Kim),안용찬(Yong Chan Ahn),김상기(S 대한방사선종양학회 2007 Radiation Oncology Journal Vol.25 No.2

Purpose: For the first time, a nationwide survey in the Republic of Korea was conducted to determine the basic parameters for the treatment of esophageal cancer and to offer a solid cooperative system for the Korean Pattern of Care Study database. Materials and Methods: During 1998∼1999, biopsy-confirmed 246 esophageal cancer patients that received radiotherapy were enrolled from 23 different institutions in South Korea. Random sampling was based on powerallocation method. Patient parameters and specific information regarding tumor characteristics and treatment methods were collected and registered through the web based PCS system. The data was analyzed by the use of the Chi-squared test. Results: The median age of the collected patients was 62 years. The male to female ratio was about 91 to 9 with an absolute male predominance. The performance status ranged from ECOG 0 to 1 in 82.5% of the patients. Diagnostic procedures included an esophagogram (228 patients, 92.7%), endoscopy (226 patients, 91.9%), and a chest CT scan (238 patients, 96.7%). Squamous cell carcinoma was diagnosed in 96.3% of the patients; mid-thoracic esophageal cancer was most prevalent (110 patients, 44.7%) and 135 patients presented with clinical stage III disease. Fifty seven patients received radiotherapy alone and 37 patients received surgery with adjuvant postoperative radiotherapy. Half of the patients (123 patients) received chemotherapy together with RT and 70 patients (56.9%) received it as concurrent chemoradiotherapy. The most frequently used chemotherapeutic agent was a combination of cisplatin and 5-FU. Most patients received radiotherapy either with 6 MV (116 patients, 47.2%) or with 10 MV photons (87 patients, 35.4%). Radiotherapy was delivered through a conventional AP-PA field for 206 patients (83.7%) without using a CT plan and the median delivered dose was 3,600 cGy. The median total dose of postoperative radiotherapy was 5,040 cGy while for the non-operative patients the median total dose was 5,970 cGy. Thirty-four patients received intraluminal brachytherapy with high dose rate Iridium-192. Brachytherapy was delivered with a median dose of 300 cGy in each fraction and was typically delivered 3∼4 times. The most frequently encountered complication during the radiotherapy treatment was esophagitis in 155 patients (63.0%). Conclusion: For the evaluation and treatment of esophageal cancer patients at radiation facilities in Korea, this study will provide guidelines and benchmark data for the solid cooperative systems of the Korean PCS. Although some differences were noted between institutions, there was no major difference in the treatment modalities and RT techniques. 목 적: 전국 병원의 방사선종양학과에서 식도암으로 방사선 치료를 받은 환자들을 각 병원으로부터 입력 받아 세부 항목별로 분석하여 식도암 환자들의 구성과 특징을 파악하여 범국가적인 자료로 활용하는 한편 치료방침을 분석하 여 향후 적절한 치료를 위한 가이드라인으로 삼고자 하였다. 대상 및 방법: 전국 병원의 방사선종양학과에서 1998년과 1999년의 2년간에 걸쳐 식도암으로 확진된 246명을 대상으로 하였다. 연간 400명 미만의 방사선치료 신환자 발생병원들을 A군, 400명 이상 900명 미만의 병원들을 B군, 그리고 900명 이상 신환자가 발생하는 병원을 C군으로 분류하여 최종적으로 A군에서 12병원, B군에서 8개 병원,그리고 C군에서 3개의 병원이 연구에 참여하였다. 이미 개발된 Web-based Korean PCS system을 통해 각 병원으로부터 직접 자료를 입력 받아 이를 세부 항목별로 분석하였고 통계적 처리는 SPSS version 12.0.1을 사용하고 범주형 자료는 Chi-squared test를 사용하였고 연속변수는 ANOVA, Kruskal-Wallis test를 적용하였다. 결 과: 입력된 환자들의 성별 분포는 남자 224명(91.1%), 여자 22명(8.9%)이었고 연령별 중앙값은 62세 전후였다.진단 및 병기결정을 위한 검사로는 식도 촬영술(228명, 92.7%), 식도내시경(226명, 91.9%) 및 흉부 식도 CT 스캔 (238명, 96.7%)을 주로 시행하였다. 편평상피암이 대종을 이루어 237명(96.3%)의 환자에서 관찰되었고 중흉부식도(mid-thoracic esophagus)에서 발생한 식도암이 가장 많았다(110명, 44.7%). 임상 병기는 III기가 과반수 이상을 차지하였다(135명, 54.9%). 방사선 치료만 받은 경우는 57명(23.2%), 방사선 치료와 수술을 병용한 경우는 전체의 15%인 37명, 항암약물 치료와 방사선 치료를 병용한 경우는 123명(50%)이었다. 수술과 방사선 치료를 병행한 경우 전례에서 수술을 먼저 시행한 후 방사선 치료를 하였다. 항암치료를 방사선치료와 병행한 경우 반수 이상에서 (70명, 56.9%) 동시항암방사선 치료를 시행하였고 31명(25.2%)에서 항암치료 후 방사선치료를 또는 항암요법 단독치료 후 동시항암방사선치료를(13명, 10.6%) 시행하였다. 방사선 치료는 6 MV (116명, 47.2%)와 10 MV (87명,35.4%)의 X-ray가 대종을 이루었다. 방사선 치료 시 조사야는 longitudinal margin의 경우 중앙값은 7.0 cm이었지만 각 군별로 현저한 차이가 있었다(A군; 5.5 cm, B군; 8.0 cm, C군; 14.0 cm). 계획용 CT를 사용하지 않고 고식적인 AP/PA 조사야를 사용하여 치료한 경우가 대부분이었는데(206명, 83.7%) 이 때 방사선 조사량의 중앙값은 3,600 cGy이었다. 이후 추가 방사선 치료 시 계획용 CT를 사용하지 않고 2-oblique fields 사용하여 치료한 경우가 87명(35.4%)이었는데 방사선 조사량의 중앙값은 1,800 cGy이었다. 전 환자에서 1일 1회 180 cGy로 치료하였다. 전 환자에서 조사된 총 방사선량의 중앙값은 5,580 cGy이었다. 수술 후 방사선 치료를 시행한 경우 중앙값은 5,040 cGy이었고 수술을 받지 않은 환자 중앙값은 5,940 cGy이었다. 근접조사 방사선 치료는 총 34명(13.8%)에서 시행되었고, 전 환자에서 high dose rate Iridium-192를 사용하였다. 조사범위는 종양에서 longitudinal margin의 중앙값은 1 cm, prescribed isodose curve에서 axial length의 평균값은 8.25 cm, 폭은 2 cm, 그리고 전후 폭의 중앙값도 2 cm이었다. Fraction size의 중앙값은 300 cGy이었는데 B군의 경우는 500 cGy이었다. 총 분할 횟수는 3∼4회가 대부분이었다. 한편, 방사선 치료 중 발생한 급성 부작용은 식도염이 가장 많았는데 전체 246명 환자 중 155명(63.0%)에서 발생하였다. 결 론: 전국 23개 병원의 식도암 환자 치료 Data를 분석해 본 결과 대부분의 병원에서 환자의 특징과 진단 및 병기결정 방법, 치료의 유형 등에서 유사한 결과를 보였으며 신환 발생 수에 따른 병원 규모의 차이는 조사 결과에 큰 영향을 미치지 못하였다. 하지만 병원 규모가 클수록 10 MV 이상의 고에너지로 치료하는 경향이 많았으며 3D CTPlan도 병원 규모가 클수록 활용도가 높았다. 조사 야의 면적도 병원 군별로 차이를 보였다. 향후 더 많은 환자를 입력하여 생존율 분석까지 이루어지면 이 연구는 식도암 치료방침의 결정에 중요한 guideline을 제시해 줄 것으로 사료된다.

The Measurements of Plasma Cytokines in Radiation-induced Pneumonitis in Lung Cancer Patients

허원주(Won Joo Hur),윤선민(Seon Min Youn),이형식(Hyung Sik Lee),양광모(Kwang Mo Yang),신건호(Geun Ho Sin),손춘희(Choon Hee Son),한진영(Jin Yeong Han),이기남(Ki Nam Lee),정민호(Min Ho Jeong) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.4

목 적 :폐암으로 확진되어 근치적 방사선 치료를 받은 환자에서 방사선폐렴이 발생할 수 있는 위험군을 사전에 예측해 보고자 혈장내 TGF-β1, TNF-α, IL-6의 농도를 측정하여 폐렴 발생과의 상관관계를 분석하고자 하였다. 재료 및 방법: 1998년 5월부터 1999년 7월까지 폐암으로 확진되어 근치적 방사선 치료를 받은 17명의 환자(비소세포암 11명, 소세포암 6명)을 대상으로 하였다. 방사선 치료는 주 5회 매일 1.8 Gy씩 실시하였고 비소세포암과 소세포암에서 각각 평균 60 Gy와 54 Gy를 조사하였다. 모든 환자에서 방사선치료 전, 방사선치료 중 주 1회, 치료 후 추적관찰로 내원시마다 혈액을 채취하여 혈장 TGF-β1, TNF-α 및 IL-6의 양을 ELISA법으로 측정하였다. 모든 환자에서 단순흉부촬영(치료중 주1회, 치료 후 추적관찰 시마다 촬영) 및 방사선 폐렴과 연관된 증세를 관찰하여 방사선 폐렴의 징후가 발견되면 즉시 고해상도 컴퓨터 단층 촬영(HRCT)를 촬영하여 방사선 폐렴 발생여부를 확진하고자 하였다. 결 과: 17명의 환자 중 13명에서 방사선 폐렴과 연관된 증세가 발현되었고 단순 흉부 촬영과 고해상도 컴퓨터 단층 촬영에서 이를 확인할 수 있었다. 방사선 폐렴이 발생한 환자에서 측정한 TGF-β1의 경우 특징적인 수치 변화를 보여 치료 전 평균값은 38.45 ng/ml로 방사선 폐렴이 발생하지 않은 군에 비해 상승되어 나타났고(22.77 ng/ml) 방사선치료 중 13.66 ng/ml의 평균값을 보인 후 다시 점진적으로 상승하여 치료 2∼4주 후까지 평균 60.63 ng/ml로 상승되어 유지되었고 이 수치는 폐렴이 발생하지 않은 군과 비교할 때(12.77 ng/ml) 통계적으로 의미가 있었다(p Purpose :To investigate whether changes in plasma concentrations of transforming growth factor- β1 (TGF-β1), tumor necrosis factor- alpha (TNF-α) and interleukin- 6 (IL- 6) could be used to identify the development of radiation- induced pneumonitis in the lung cancer patients. Methods and Materials : Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation- induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-β1, TNF-α and IL- 6 were obtained in all patients before, weekly during radiotherapy and at each follow- up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow- up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. Results :Thirteen patients eventually developed signs and symptoms of clinical pneumonitis while four patients did not. TGF-β1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2- 4 weeks after completion of radiotherapy). The levels of TNF-α and IL- 6 were also elevated in the group of patients who developed pneumonitis but the pattern was not characteristic. Conclusions :Changes in plasma TGFβ- 1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF- α and IL- 6 shows no meaningful changes in association with radiation pneumonitis.

HMA 세포내 산도증가가 온열과 항암화학 치료의 세포독성에 미치는 효과

허원주(Won Joo Hur),송창원(Chang Won Song) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.2

Purpose : The enhanced cytotoxic effect of combined treatment of hyperthermia and chemotherapy by increasing intracellular acidity with HMA was investigated. Materials and Methods : FSall tumor cells were injected on the hindlegs of female C₃H mice. When the tumor volume reached about 200mm³, experiments were performed on the groups classified as follows : Group Ⅰ : Control. Group Ⅱ : Melphalan alone (2.5mg/kg, 5mg/kg, 10mg/kg, 15mg/kg). Group Ⅲ : Heat alone (42.5°C for 1 hour). Group Ⅳ : Mephalan + Heat (42.5°C for 1 hour). Group Ⅴ : HMA(10mg/kg) + Melphalan(5.0mg/kg) + Heat(42.5°C for 1 hour). Each group included 8-12 mice on each experiment. HMA (3-amino-6-chloro-5-(1-homopiperidyl)-N-(diaminomethylene)-c-pyrazinecarboxamide). an analog of amiloride which increases intracellular pH(pHi) was dissolved in dimethyl sulfoide (DMS) and injected tnto the tumor-bearing mice through the tail vein. 10mg/kg of HMA and each dose of mephalan were injected into peritoneum of the tumor-bearing mice 30 minutes before heating. Tumor growth delay was calculated when the tumor volme reached at 1500mm³. Excision assay was performed on each group and repeated 2-4 times. Results : Tumor growth delay of each experimental group at 1500mm³ were 9, 10, 13 and 19 days respectively. In vivo-in vitro excision assay using FSall tumor cells, the mytotoxicity of each experimental groups was 1.2X10⁷, 1X10⁷, 6X10⁶, 1.7X10⁶ and 1X10⁵ clonogenic cells/gm respectively. When HMA was added to the combined treatment of heat and chemotherapy, the tumor growth was delayed more than combined treatment without HMA i.e., 6 days tumor growth delay at 1500mm³ of tumor volume. conclusion : The combined effect of cytotoxicity by heat and chemotherapy can be much more enhanced by HMA.

국소적으로 진행된 비소세포 폐암에 대한 과분할 방사선 치료의 성적

허원주(Won Joo Hur),이형식(Hyung Sik Lee),김정기(Jeong Ki Kim),최영민(Young Min Choi),이호준(Ho Jun Lee),윤선민(Seon Min Youn),김재석(Jae seok Kim),김효진(Hyo Jin Kim),우종수(Jong Soo Woo),최필조(Pill Jo Choi),이기남(Ki Nam Lee) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.3

목 적 : 국소적으로 진행된 병기 IIIA, IIIB 비소세포 폐암에서 과분할 방사선 치료의 효과를 알아보고자 하였다. 방 법 : 1992년 10월부터 1995년 10월까지 병기결정과 병리조직 검사상 절제 불가능한 비소세포 폐암으로 확진된 환자 중 전신상태가 양호한 (ECOG score 2 이하) 61명을 대상으로 분석하였다. 방사선치료는 확진 후 2주내 시행하였으며 15 MV x-ray를 이용하여 일일 2회 (매 치료당 120cGy) 주 5회 치료하였으며 방사선 총량은 6400-7080 cGy (중앙값 6934 cGy)가 되도록 조사하였다. 결 과 : 치료후 종양의 완전관해 (CR)는 전체 61명 중 22명이었고 부분관해 (PR)가 32명에서 관찰되었으며 무반응 (NR)의 경우도 7명에서 관찰되었다. 완전관해의 경우 중앙 생존기간이 19.5개월로 부분관해의 11.7개월, 무반응의 6.3개월에 비해 높아 통계적 유의성이 있었으며 (p=0.0003), 1년 및 2년 생존율도 완전 관해군에서 70.0%, 22.7%로 부분관해의 46.8% 및 3.3%보다 높았다. 전체 61명 환자 중 IIIA군이 29명 IIIB군이 32명이었고 완전 관해는 IIIA군에서 11명, IIIB군에서도 11명이었다. 각 병기에 따른 1년 및 2년 생존율은 IIIA군이 각각 63.3%, 16.8%이고 IIIB군이 43.3%, 3.6% 로 통계적 유의성이 있었고 (p=0.043), 중앙 생존기간은 IIIA가 16.7개월, IIIB가 11.4개월이었다. 국소 치료 실패율은 양군에서 유사한 정도로 관찰되었으나 (IIIA 74.4%, IIIB 75%), 원격전이는 IIIB 환자가 높게 나타났다 (IIIA 24.1%, IIIB 43.8%). 조직학적으로도 편평상피암과 선암의 경우 국소치료 실패율은 비슷하였으나 (편평상 피암 74.5%, 선암 71.4%), 원격전이는 선암이 많았다 (편평상피암 29.8%, 선암 50.0%). 과분할 방사선 치료에 대한 합병증은 전체 61명 환자 중 43명에서 Grade I- II의 방사선 식도염이 관찰되었고 치료 종결 후 2개월 내에 2명의 환자에서 급성 방사선 폐렴이 나타났고, 만성 방사선 폐렴은 1명에서 나타났으며 13개월만에 만성 방사선 폐렴에서 폐 섬유화가 진행되어 사망하였다. 결 론 : 국소적으로 진행되어 수술 불가능한 비소세포성 폐암중 특히 IIIA의 경우 치료에 대한 독성을 감안하더라도 과분할 방사선 치료를 시도하여 완전 관해율을 향상시킴으로써 생존율 향상에 많은 도움을 줄 수 있을 것으로 사료된다. Purpose:The effect of hyperfractionated radiotherapy on locally advanced non-small lung cancer was studied by a retrospective analysis. Materials & Methods:We analyzed sixty one patients of biopsy -confirmed, IIIA and IIIB non-small cell lung cancer. Using the ECOG performance scale, all the patients were scored less than 2. They were treated by curative hyperfractionated radiotherapy alone from Oct. 1992 to Oct. 1995 at the Department of Radiation Oncology. All the patients received 120cGy b.i.d with more than 6 hours interval between each fraction. The total dose of radiation was reached up to 6400-7080 cGy with a mean dose of 6934 cGy. The results were analyzed retrospectively. Results:The overall survival rate was 53.1% in 1 year, 9.9% in 2 years with a median survival time (MST) of 13.9 months. The progression free survival (PFS) rate was 37.0% in 1 year, 8.9% in 2 years. Twenty two patients were classified as complete responders to this treatment and their MST was 19.5 months. When this was compared with that of partial responders (MST: 11.7months), it was statistically significant (p=0.0003). Twenty nine patients of stage IIIA showed a better overall survival rate (1yr 63.3%, 2yr 16.8%) than IIIB patients (1yr 43.3%, 2yr 3.6%), which was also statistically signifcant (p=0.003). Patients with adenocarcinoma showed a better survival rate (1yr 64.3%, 2yr 21.4%) than that of squamous cell counterpart (1yr 49.4%, 2yr 7.4%), although this was not significant statistically (p=0.61). Two patients developed fatal radiation-induced pneumonia right after the completion of the treatment which progressed rapidly and they all died within 2 months. One patient developed radiation- induced fibrosis after 13 months. He refused further treatment and died soon after the development of fibrosis. Conclusion : Among locally advanced NSCLC, hyperfractionated radiotherapy was effective on stage IIIA patients by increasing MST with acceptable toxicities. Acute radiation-induced pneumonia should be carefully monitored and must be avoided during or after this treatment.

Comparative Analysis of Patterns of Care Study of Radiotherapy for Esophageal Cancer among Three Countries

Won Joo Hur(허원주),Youngmin Choi(최영민),Jeung Kee Kim(김정기),Hyung Sik Lee(이형식),Seok Reyol Choi(최석렬),Il Han Kim(김일한) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.2

목 적: 식도암의 방사선 치료에 대해 최초로 시행한 한국의 PCS의 결과를 토대로 미국, 일본에서 시행한 결과와 비교 분석하여 식도암 환자들의 특징, 진단 및 치료방침의 차이를 파악해 향후 범 국가적으로 활용할 시스템의 구축에 응용 하고자 하였다. 대상 및 방법: 국내의 21개 병원의 방사선 종양학과에서 1998-1999년 동안 식도암으로 확진 된 후 방사선 치료를 받은 총 246명을 대상으로 하였다. 이 결과를 미국 59개 병원에서 식도암 환자 414명을 연구한 PCS 결과 (Suntharalingam)와 비교 하였다. 또 일본의 76개 병원에서 수술과 방사선치료를 받았거나 수술, 방사선 치료, 항암제 치료를 함께 받은 수술 군 환자 220명(Gomi), 수술을 받지 않고 방사선 치료만 시행하였거나 방사선 치료와 항암제치 료를 함께 시행한 비 수술 군 환자 385명(Murakami)을 대상으로 시행한 PCS 결과와 비교 분석하였다. 결 과: 환자들의 평균 연령은 일본의 비 수술 군이 가장 높았다(71세). 한국과 일본은 남성의 발생 빈도가 월등히 높았지만(9:1) 미국은 여성의 발생률이 23.1%였다. 한국과 일본은 편평상피세포암이 압도적으로 많았지만(한국 96.3%,일본 98%) 미국은 선암이 더 많은 양상을 보였다(49.6%). 병기결정을 위한 검사는 식도 내시경, 흉부 컴퓨터 단층촬영, 식도조영술을 가장 많이 사용하였고 미국과 일본은 복부 컴퓨터단층촬영을 복부 초음파보다 더 자주 시행하였다. 치료방침을 분석한 결과 방사선 단독치료의 비율은 한국이 23.2%, 일본이 39%인데 반해 미국은 9.5%에 불과하였다. 수술과 방사선 및 항암치료를 병용한 빈도는 미국(32.8%)과 일본 (49.5%)이 한국(11.8%)보다 높았다. 식도암 치료에 있어서 항암제 치료는 미국이 가장 높은 빈도로 사용되어졌고(89%) 동시항암방사선 치료도의 빈도도 미국이 가장 높았다(97%). 항암치료제는 3개국 모두에서 cisplatin과 5-FU를 가장 선호하였다. 방사선 조사량은 한국 55.8 Gy, 미국 50.4 Gy였고 일본은 수술 군(48 Gy)과 비 수술 군(60 Gy)이 현격한 차이를 보였다. 결 론: 한국, 미국, 일본에서 시행된 식도암 환자의 PCS 결과를 분석하여 환자 및 종양의 특징, 진단 및 치료 방침에 다소간의 상이점을 발견하였다. 그러나 방사선 조사량과 조사야 수, 방사선치료 에너지의 종류 등 방사선 기술적인 부분은 3개국 모두에서 큰 차이를 보이지 않았다. Purpose: For the first time, a nationwide survey of the Patterns of Care Study (PCS) for the various radiotherapy treatments of esophageal cancer was carried out in South Korea. In order to observe the different parameters, as well as offer a solid cooperative system, we compared the Korean results with those observed in the United States (US) and Japan. Materials and Methods: Two hundreds forty-six esophageal cancer patients from 21 institutions were enrolled in the South Korean study. The patients received radiation theraphy (RT) from 1998 to 1999. In order to compare these results with those from the United States, a published study by Suntharalingam, which included 414 patients [treated by Radiotherapy (RT)] from 59 institutions between 1996 and 1999 was chosen. In order to compare the South Korean with the Japanese data, we choose two different studies. The results published by Gomi were selected as the surgery group, in which 220 esophageal cancer patients were analyzed from 76 facilities. The patients underwent surgery and received RT with or without chemotherapy between 1998 and 2001. The non-surgery group originated from a study by Murakami, in which 385 patients were treated either by RT alone or RT with chemotherapy, but no surgery, between 1999 and 2001. Results: The median age of enrolled patients was highest in the Japanese non-surgery group (71 years old). The gender ratio was approximately 9:1 (male:female) in both the Korean and Japanese studies, whereas females made up 23.1% of the study population in the US study. Adenocarcinoma outnumbered squamous cell carcinoma in the US study, whereas squamous cell carcinoma was more prevalent both the Korean and Japanese studies (Korea 96.3%, Japan 98%). An esophagogram, endoscopy, and chest CT scan were the main modalities of diagnostic evaluation used in all three countries. The US and Japan used the abdominal CT scan more frequently than the abdominal ultrasonography. Radiotherapy alone treatment was most rarely used in the US study (9.5%), compared to the Korean (23.2%) and Japanese (39%) studies. The combination of the three modalities (Surgery+RT+Chemotherapy) was performed least often in Korea (11.8%) compared to the Japanese (49.5%) and US (32.8%) studies. Chemotherapy (89%) and chemotherapy with concurrent chemoradiotherapy (97%) was most frequently used in the US study. Fluorouracil (5-FU) and Cisplatin were the most preferred drug treatments used in all three countries. The median radiation dose was 50.4 Gy in the US study, as compared to 55.8 Gy in the Korean study regardless of whether an operation was performed. However, in Japan, different median doses were delivered for the surgery (48 Gy) and non-surgery groups (60 Gy). Conclusion: Although some aspects of the evaluation of esophageal cancer and its various treatment modalities were heterogeneous among the three countries surveyed, we found no remarkable differences in the RT dose or technique, which includes the number of portals and energy beams.

여러 가지 계면활성제를 이용한 유기-무기 혼성 중간세공 분자체의 합성과 세공크기 조절

허한창,박성수,천종현,방원주,박동호 인제대학교기초과학연구소 2001 자연과학 Vol.5 No.-

세공의 크기가 다른 유기-무기 혼성 중간세공 분자체를 함성하기 위해, 알킬 사슬의 길이가 다른 3가지 종류의 계면활성제(DDTABr, CTABr 그리고 ODTABr)를 주형으로 사용하였다. 유기-무기잔구체로는 1,2-bis(triethoxysilyl)ethane(BTSE)또는 1,2-bis(triethoxysilyl)ethane(BTME)를 이용하였다. 각각의 세 가지 반응혼합물 1.00 DDTABr:3.38 BTSE: 6.42 NaOH: 1215-1620 H_2O,1.00 CTABr: 3.38 BTSE: 1.32 H_2SO_4: 6.42 NaOH: 1215-1620 H_2O그리고 0.12 ODTABr: 1.00 BTSE: 1.00 NaOH: 231 H_2O를 실온에서 24시간, 48시간, 그리고 72시간 동안 숙성하여 세공의 크기가 다른 유기-무기 혼성 중간세공 분자체를 합성하였다. 시료의 결정성, 새공크기, 새공분포 그리고 표면적은 X-선 회절패턴, 투과전자 현미경(TEM) 그리고 질소 등온 흡-탈착 곡선으로 확인하였다. 시료의 입자모양은 주사 전자현미경(SEM)을 이용하여 관찰하였다. 주형으로 DDTABr, CTABr 그리고 ODTABr을 사용하여 합성한 중간 세공의 크기는 각각 15.9Å,24.2Å 그리고 29.2Å이었다. BET 표면적은 각각 1101.9㎡/g, 918.5㎡/g 그리고 661.3㎡/g이였다. The organic-inorganic hybrid mesoporous molecular with various pore diameters were synthesized using surfactants (DDTABr, CTABr, and ODTABr)with various alkyl chain lengths as template agent. 1,2-bis(triethoxysilyl)ethane(BTSE)and 1,2-bis(triethoxysilyl)ethane(BTME)were used as organic-inorganic hybrid precursors. The organic-inorganic hybrid mesoporous molecular sieves with various pore diameters were synthesized from reaction gel mixture with molar ratios of 1.00 DDTABr:3.38 BTSE: 6.42 NaOH: 1215-1620 H_2O,1.00 CTABr: 3.38 BTSE: 1.32 H_2SO_4: 6.42 NaOH: 1215-1620 H_2O and 0.12 ODTABr: 1.00 BTSE: 1.00 NaOH: 231 H_2O with aging at room temperature for 24 h, 48 h, and 72 h, respectively. Crystallinity, porediameter, pore size distribution, and surface area of samples were investigated by X-ray diffraction pattern, transmittance electron microscope, and N_2 adsorption-desorption isotherm. Morphology of sample was observed using scanning electron microscope. Pore diameters of organic-inorganic hybrid mesoporous molecular sieves with DDTABr, CTABr, and ODTABr as template agent were 15.9Å,24.2Å and 29.2Å, respectively. BET surface areas were 1101.9㎡/g, 918.5㎡/g and 661.3㎡/g, respectively.

서울시 도시재생 통한 선형공원 조성사업 효과 진단과 정책 과제

김원주(Won-Ju Kim),허자연(Jayun Heo),강원삼(Won-Sam Kang),윤희연(Heeyeon Yoon) 서울연구원 2020 서울연구원 정책과제연구보고서 Vol.- No.-