The Result of Radiotherapy in Esophageal Cancer

박찬일,최은경,정웅기,방영주,김노경,Park, Charn-Il,Choi, Eun-Kyung,Chung, Woong-Ki,Bang, Yung-Jue,Kim, Noe-Kyeong The Korean Society for Radiation Oncology 1988 Radiation Oncology Journal Vol.6 No.2

1979년 3월부터 1986년 8월까지 식도의 편평상피암으로 진단되어 서울대학교병원 치료방사선과에서 방사선치료를 받은 177명중 근치적 방사선 치료를 시행한 152명을 대상으로 후향성 분석을 시행하여 다음과 같은 결과를 얻었다. $80\%$이상의 환자에서 관해를 보였으며, 이중 완전관해는 $22\%$, 부분 관해는 $63\%$이었다. 전체 환자의 2년, 5년 생존율은 각각 $22.9\%,\; 13.3\%$이었으며 식도암의 위치, 크기, 병기 그리고 관해 정도에 따라 생존율에 차이가 있었다. 식도 촬영상 5cm 이하$(17\%)$ 또는 식도의 상부 1/3에 종양이 있는 경우$(25.6\%)$에 가장 좋은 5년 생존율을 보였다. 관해 정도에 따른 생존율은 완전관해를 보인 경우의 5년 생존율이 $34.3\%$인 반면 반응이 없던 경우는 $0\%$이었다 During the period between March 1979 and August 1986, 177 patients with carcinoma of the esophagus were treated with radiotherapy in the Department of Therapeutic Radiology, SNUH. Among these, 25 patients who had incomplete treatment were excluded. So a retrospective analysis was undertaken of 152 patients who were treated by curative radiotherapy. More than $80\%$ showed response: Complete remission $(22\%)$, partial remission $(63\%)$ and no response $(15\%)$. The overall two-year and five-year actuarial survival rate were $22.9\%\;and\;13.3\%$ respectively. Prognostic factor was analyzed by its site, size, T stage, and tumor response. Patients with the best five-year survival rate were those who had the tumor no more than 5cm in length $(17\%)$ or confined to the upper third of the esophagus $(20.6\%)$. Complete responders had $34.3\%$ of 5-year actuarial survival, but no responders had $0\%$ of survival.

Squamous Cell Carcinoma of the Supraglottic Larynx Treated with Radiation Therapy

박찬일,김광현,Park, Charn-Il,Kim, Kwang-Hyun The Korean Society for Radiation Oncology 1989 Radiation Oncology Journal Vol.7 No.1

1979년 3월부터 1984년 2월까지 성문상부의 편평상피암으로 진단되어 근치적 방사선치료를 시행한 66명을 대상으로 치료성적을 분석하였다. 전체 환자군의 최소 추적기간은 4년이었다. 진단당시 전체 환자군의 $78\%$가 T3 T4 병변이었고 임파절 전이율은 $58\%$이었으며, 전체 환자군의 5년 생존율은 $31.3\%$, 병기에 따른 생존율은 병기 II, III, IV에서 각각 $60.7\%,\;46.7\%\;및\;13.5\%$이었다. 3명의 환자$(5\%)$에서 원격전이가 관찰되었으며 수술을 요하는 주부작용률은 $11\%$이었다. 방사선치료 후 잔유병변 또는 재발에 대한 구제수술 성공률은 $57\%$이었다. 병기 I, II및 병기 III 초기의 성문상부암은 방사선 단독 치료만으로도 높은 근치율과 생존자의 성대기능 보존이 가능 하나, 병기 III과 IV의 성문상부암 환자 중 경부에 전이된 임파절의 절제가 가능한 환자는 수술과 방사선치료의 병용이 권장된다. Sixty-six patients with squamous cell carcinoma of the supraglottic larynx received irradiation with curative intent between 1979 and 1985 were retrospectively analysed. All patients had a minimum follow-up of 4 years. Of the entire group consisting of $73\%$T3 and T4 lesions and $58\%$ lymph node metastases, a 5-year acturial survival rate was $31.3\%$. A 5-year acturial survival rates for stage II, III and IV were $60.7\%,\;45.7\%\;and\;13.5\%$ respectively (p<0.05). Patients without lymphnode metastases had better survival rate than those with postive lymphnode metastases $(54.8\%\;vs\;12.2\%)$ (p<0.005). Surgical salvage rate w8s 4/7 $(57\%)$. Three patients developed distant metastases. Major complications requiring surgery were seen in $11\%$, Radiation therapy alone with surgical salvage was an effective, voice preserving treatment for stage I, II and selected III carcinoma of the supraglottic carcinoma, however planned combined treatment with surgery and radiation therapy is advised for stage III and IV carcinoma of the supraglottic larynx with resectable neck disease.

Postoperative Radiation Therapy in Non-Small-Cell Lung Cancer

박찬일,김종훈,김주현,Park, Charn-Il,Kim, Jong-Hoon,Kim, Joo-Hyun The Korean Society for Radiation Oncology 1988 Radiation Oncology Journal Vol.6 No.2

Sixty patients with proven lung cancer were retrospectively studied to determine whether postoperative radiation therapy improves survival. Patterns of treatment failure and 5 year survival were assessed according to extent of tumor spread, histology, type of operation, positive resection margin and radiation dose. Of the 60 patients, excluding S patients who received incomplete treatment or poor pulmonary function,55 patients received postoperative radiation therapy following curative resection. The overall survival at 5 years was $39\%$. The hilar and mediastinal lymph node involvement had an influence on survival. The authors recommend that patients with resection. lung cancer involving the hilar and mediastinal lymph nodes may require postoperative radiotherapy to reduce the local recurrence and improve survival. 최근 폐암의 발생빈도는 높아지고 있으나, 아직까지 만족할 만한 치료 성적은 제시되시 많고 있으며, 현재로서는 가능한 한 초기에 발견하여 수술을 시행후 국소재발 위험군의 경우 방사선 치료를 시행하는 것이 최선의 방법으로 알려져있다. 이에 저자들은 1979년 3월부터 1986년 2월까지 서울대학교 병원에서 비소세포성 폐암 진단하에 근치적 절제수술 시행후 방사선 치료를 받은 60명의 환자를 대상으로 수술후 방사선 치료의 효과 및 예후인자에 대한 분석을 시행하여 다음과 같은 결과를 얻었다. 전체 환자 60명중 방사선 치료를 불완전하게 시행한 5명을 제외한 55명을 분석한 결과 전체 환자의 5년 생존율은 $39\%$였으며 무병생존율은 $29\%$였다. 환자의 예후를 결정하는 주요인자로서는 병기 및 국소 임파절 전이 여부였고, 1병기와 병리조직학적 분류 및 나이, 성별, 방사선 조사선량과 수술시 절제면의 종양 침범 여부는 예후에 큰 영향을 미치지 못하였다. 수술 시행후 방사선 치료를 받은 환자 군의 생존율은, 문헌상에 나타난 수술 단독 시행 환자군의 생존율과 비교해 볼 때 국소 임파절 전이가 있는 환자군에서 더 높은 결과를 보였으며, 임파절 전이가 없는 환자군에서는 큰 차이를 발견할 수 없었다. 국소 재발율도 임파절 전이가 있는 환자군에서는 수술 단독 시행 환자군보다 현저히 낮은 결과를 보여 수술후 방사선 치료가 임파절 전이가 있는 환자에게는 생존율의 증가 및 국소재발 억제의 효과를 나타냄을 관찰할 수 있었다.

超音波를 利用한 溫熱療法時 溫度分布에 關한 硏究

朴贊一(Charn Il Park),高京煥(Kyeong Whan Koh),河星煥(Sung Whan Ha) 대한방사선종양학회 1984 Radiation Oncology Journal Vol.2 No.1

Temperature homogeniety and stationary temperature is the most important thermometric considerations for the clinical use of hyperthermia. A thermal mapping was done in a phantom with thermocouple during hyperthermia which was induced by 1.0 MHz, 0.7~0.8 watts/㎠ ultrasound and unfocused 2.5 cm-diameter transducer. The results were as follows 1. Effective heating range(42.5℃±0.5℃) were obtained 3 cm in width and 4 cm in depth from surface of phantom and temperature distribution was relatively uniform. 2. There was little heating effect more than 2 cm away from transducer axis and more than 5cm in depth. 3. There was hot spots(more than 43℃) in 2.0±0.5 cm depth from transducer along transducer axis.

聲門上部癌의 治療成績

朴贊一(Charn Il Park),金光顯(Kwang Hyun Kim) 대한방사선종양학회 1984 Radiation Oncology Journal Vol.2 No.1

From March of 1979 through December of 1982, 84 patients with supraglottic carcinoma were seen and evaluated in the Department of Therapeutic Radiology, Seoul National University Hospital. Of these, 58 patients were treated with a curative intent by employing either radiotherapy alone or a combined approach of radiotherapy plus surgery. Sixteen patients refused to complete the treatment program. Seventy-three per cent of patients had T3 and T4 lesions and 63% of patients had lymph node metastasis at the time of diagnosis. Actuarial recurrence-free survival at 3 year was : Stage Ⅰ~Ⅱ 62%, Stage Ⅲ 54%, Stage Ⅳ 18%. For T1-2, T3 and T4 lesions, the actuarial recurrence free survival at 3 years were 50%, 34% and 9% respectively. Of 39 patients with treatment failure, 29 patients (78%) had uncontrol or ultimate recurrence at the primary site while 9 patients having lymph node recurrence, 14 patients(21%) had lymph node recurrence, and 5 patients had distant metastasis. It is suggested that planned combined radiotherapy is indicated for advanced but resectable supraglottic carcinoma.

Nasopharyngeal Carcinoma

박찬일(Charn Il Park),박우윤(Woo Yoon Park),김종선(Jong Sun Kim) 대한방사선종양학회 1989 Radiation Oncology Journal Vol.7 No.1

1979년부터 1985년까지 서울대학교병원 치료방사선과에서 비인강암으로 확진되어 방사선치료를 시행한 총 환자는 110명이었다. 이중 진단시 원격전이된 5명과, 근치 방사선량을 받지 못한 16명을 제외한 89명의 치료성적을 분석하였다. 생존 환자의 최소 추적기간은 36개월이었다. 전체 환자의 43%가 T4병변, 72%가 제 4병기이었으며, 편평상피암이 40%, 미분화암이 47%이었고 임파상피암은 5%이었다. T1, T2의 초기병변과 경부 임피절 전이는 6,500cGy의 선량으로 대부분이 근치되었다. 추적기간 중 재발된 환자는 42명,(47%)으로, 이중 16명(38%)은 국소재발, 24명(57%)은 원격전이를 일으켰다. 국소재발된 예중 9명에게 재치료를 시행하여 이중 2명에서 장기 생존이 관찰되고 있다. 전체 환자의 5년 생존율 42%, 무병생존율은 38%이었다. T-병기와 조직학적 아형은 생존율에 무관하나, N-병기는 생존율에 유의한 상관관계가 있음이 증명되었다. One hundred and ten patients with carcinoma of the nasopharynx were treated by radiation therapy in Department of Therapeutic Radiology, Seoul National University Hospital between 1979 and 1985. Among these, one hundred and five patients were treated with curative intent and 5 patients with palliative aim. Excluding 16 patients who did not receive a full course of radiation therapy, the remaining 89 patients were reviewed for this analysis. Minimum follow-up period of survivors was 36 months. Forty-three percent of the patients had T4 primary lesions and 72% had stage IV disease. The histology was squamous cell carcinoma in 46% of the patients. undifferentiated carcinoma in 49%, and lymphoepithelioma in 5%. Total radiation dose to the primary site averaged 6,500cCY for T1, T2 lesions and 7500cCY for T3, T4 lesions. Neck node were given boost treatment to a maximum 7,500cCY depending on the extent of disease. Early primary lesion(T1, T2) and neck nodes were successfully controlled in most cases when dose of greater than 6,500cCY was delievered. Forty two patients(47%) had recurred, 16 of whom(38%) received at the primary site and 24(57%) developed distant metastases. Of these. 9 patients received re-irradiation with or without chemotherapy and local control was obtained in 2 patients(22%). Actuarial overall survival and disease-free survival rate was 42% and 38% at 5 years. T-stage and histologic subtype were not correlated with survival. However, N-stage was related to survival significantly(p=0.043).

Treatment Result of Postoperative Radiotherapy of Carcinoma of the Uterine Cervix

박찬일(Charn Il Park),김정수(Jun Soo Kim),김일한(Il Han Kim),하성환(Sung Whan Ha),이효표(Hyo Pyo Lee),신면우(Myon Woo Shin) 대한방사선종양학회 1985 Radiation Oncology Journal Vol.3 No.2

조기자궁경부암의 치료에는 환자 개개의 특성에 따라 근치적수술 또는 근치적방사선치료가 행해지고 있으며, 그 치료성적은 비슷한 것으로 보고되고 있다. 그러나 근치적 수술후 병리조직 소견에 따라 원발병소가 크거나, 임파절전이, 혈관 또는 임파관의 종양 침윤이 있으면 이들 소견이 없던 경우에 비해 재발이 현저히 높고, 생존율이 반으로 줄게 되므로, 이를 극복하기 위해 수출후 방사선 치료가 시행되고 있으나 생존율에 대한 기여에는 아직 논란이 많다. 이에 1979년 2월부터 1982년 9월까지 서울대학교병원 치료방사선과에서 자궁경부암으로 수술 후 방사선 치료를 받았던 203예에 대한 치료성적을 분석하여 얻은 결과는 다음과 같다. 모든 환자에 있어 actuarial 3년 생존율은 83.4%이었으며 3년 무병 생존율은 73.4%이었다. 병기에 따른 actuarial 3년 생존율은 I_B, II_A, II_B, 각각 90.7%, 69.6%, 85.2%이었다. 병기별 3년 무병 생존율은 I_B, II_A, II_B 각각 79.8%, 67.8%, 68.3%이었다. 재발은 총 203예중 51예 (25.1%)에서 관찰되었으며 이중 국소재발이 8.4%, 원격전이가 14.3%이었고, 국소재발과 원격전이가 함께 있던 경우가 2.4%이었다. 병기별 재발율은 I_B, II_A, II_B에서 각각 19.8%(18/91예), 29.1%(16/55예), 29.8%(17/57예)이어다. 합병증중 급성으로 나타난 것이 57.6%이었으나 7.4%만이 심한 증상을 보였고, 만성 합병증은 7.9%에서 관찰되었으며, 장폐색, 비뇨기계증상의 악화, 방사선 방광염등의 순이었다. The early carcinoma of the uterine cervix may be treated by either radical surgery or radical radiotherapy according to the patient's characteristics, and the survival is high with either treatment. But, because of the size of the lesion, metastasis to lymph nodes, and vascular space invasion by tumor have all been shown to influence recurrence and survival, postoperative radiotherapy may be considered as their histopathologic finding after radical surgery. However, there are still debates on the increasing survival rates with postoperative radiotherapy. Two hundreds and three patients with carcinoma of the uterine cervix who were treated with postoperative radiotherapy from February 1979 to September 1982 in the Department of Therapeutic Radiology, Seoul National University were analyzed and following results were obtained. 3-year actuarial survival rate and 3-year disease free sruvival rate were 83.4% and 73.4% respectively and 3-year actuarial survival rates by stages were 90.7% for IB, 69.6% for IIA, and 85.2% for IIB. 3-year disease free survival rates by stage IB, IIA, IIB were 79.8%, 07.8%, 68.3% respectively. The overall failure rate was 25.1% (51/203); local recurrence rate was 8.4%, distant metastasis rate was 14.3% and simultaneous local recurrence and distant metastasis was 2.4%. Failure rates by stages were 19.8% (18/19) for IB, 29.1% (16/55) for IIA and 29.8% (17/57) for IIB. The overall acute complication rate was 57.6%; tolerable cases was 50.2% and severe cases was 7.4%. Late complication rate was 7.9% and the major late complication were intestinal obstruction. aggravated urinary symptom, radiation cystitis in order of frequency.

Echocardiogram의 임상적 응용

박찬일 ( Park Charn Il ) 국군의무사령부 1976 대한군진의학학술지 Vol.7 No.1

子宮頸部癌의 放射線治療成績

朴贊一(Charn Il Park) 대한방사선종양학회 1984 Radiation Oncology Journal Vol.2 No.1

A Study on Recovery from Potentially Lethal Damage Induced by γ-Irradiation in Plateau-phase vero Cells in vitro

Il Han Kim(김일한),Eun Kyung Choi(최은경),Sung Whan Ha(하성환),Charn Il Park(박찬일),Chang Yong Cha(차창룡) 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

방사선 조사후 발생한 잠재치사손상의 회복(PLDR)에 있어 조사선량 및 시간에 따른 환경변화가 회복의 동적양상에 미치는 영향을 Vero 세포계를 이용하여 실험하였다. 배양액을 교환시키지 않고 배양하여 평형기에 도달한 세포에 동물실험용 세시움 조사기로 1Gy~9Gy의 감마선을 조사하고 각 조사조건에서 0~6 및 24 시간동안 정치지킨 후 Agarose가 포함된 새로운 배양액에서 배양하였다. 16Gy를 조사한 동종의 세포를 feeder 세포로 첨가하여 배양액내의 전체세포수를 일정하게 한 조건에서 형성된 세포집락수에 따라 세포의 생존을 정하였다. 잠재치사손상의 회복은 2~4시간 정치후에 포화수준에 도달한 빠른 회복이었다. 방사선량이 증가함에 따라 회복속도는 증가하였고, 포화수준의 회복량도 증가하였다. Linear-quadratic model에 의한 ‘방사선량-생존분획’ 분석결과 잠채치사손상이 회복됨에 따라 일차 비활성계수 α는 급속히 감소하여 0에 접근하였고 이차 비활성계수 ß는 미미하게 증가하여 PLDR은 α로 표시되는 손상에 주로 영향을 주었다. Multitarget model에 따라 분석한 결과 Do는 변화가 없고 Dq가 증가하였다. 세포 생존분획이 높은 3 Gy 이하의 저선량 영역에서 dose modifying factor가 높아 잠재치사손상의 회복에 의한 영향이 저선량 영역에서 상대적으로 크게 나타났다. Recovery from potentially lethal damage (PLDR) after irradiation was studied in plateau-phase culture of Vero cells in vitro. Unfed plateau-phase cells were irradiated wth dose of 1 to 9 Gy using Cs-137 irradiator. Cells then were incubated again and left in situ for 0,1,2,3,4,5,6, and 24 hours and then were trypsinized, explanted, and subcultured in fresh RPMI-1640 media containing 0.33% agar. Cell survival was measured by colony forming ability. An adequate number of heavily irradiated Vero cells were added as feeder cells to make the total cell number constant in every culture dish. As the postirradiation in situ incubation time increased, surviving fraction increased by PLDR. The rate of PLDR was so rapid that increased surviving fraction reached saturation level at 2 to 4 hours after in situ incubation. As the radiation dose increased, the rate of PLDR fastened and the magnitude of increased surviving fraction at saturation level by PLDR also increased. In analysis of cell survival curve fitted to the linear-quadratic model, the linear inactivation coefficient (α) decreased largely and reached nearly to zero but the quadratic inactivation coefficient (ß) increased minimally by increment of postirradiation in situ incubation time. So PLDR mainly affected the damage expressed as α. In the multitarget model, significant change was not obtained in Do but in Dq Therefore, shoulder region in cell survival curve was mainly affected by PLDR and terminal slope was not influenced at all. And dose-modifying factor by PLDR was relatively higher in shoulder region, that is, in low dose area below 3 Gy.