비인강암의 방사선 치료 성적

이종영(Jong Young Lee)·노준규(John J.K. Loh)·서창옥(Chang Ok Suh)·이연구(Yonu Goo Lee)·홍원표(Won Pyo Hong) 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

This study is the retrospective evaluation of ninety-six patients with biopsy-proven carcinoma of nasopharynx treated with radiotherapy at Yonsei University, College of Medicine Radiation Oncology from January 1971 to December 1985. Patient's age ranged from 15 to 71 years with a median age of 49 years. Fifty-two point five percent of local control and 47.5% of actuarial 5 year survival were achieved with radical radiotherapy. Five year survival rate for Stage I & II, III and IV were 75.0%, 74.6% and 41.4%, respectively. Distant metastasis rate was related with N stage (N1 12.5%, N1 0%, N2 23.5%, N3 32.1%) and histologic type (lymphoepithelioma 41.7% squamous cell carcinoma 6.5%) but not with T stage. Thirty-one of sixty-seven patient covered adequate radiation field received induction chemotherapy. However induction chemotherapy does not appear to improve over all survival.

Effect of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

Chang Ok Suh(서창옥) , John J.K.Loh(노준규) , Jin Sil Seong(성진실) , Sun Rock Moon(문성록) Hyung Sik Lee(이형식) , Hyun Soo Shin(신현수) , Sung Sil Chu(추성실) , Gwi Eon Kim(김귀언) , Chan Il Park(박찬일) ,Eun Kyung Han(한은경) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8MHz 라디오파를 이용한 온열치료를 시행하였다. 42.5±0.5°C로 30분간 온열치료를 받은 군 (제1군, n=5), 45±0.5°C로 30분간 온열치료를 받은 군 (제2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견의 특이한 조직병리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제2군에서는 간 세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할 때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthemia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with 42.5±0.5°C for 30 minutes, and Group Ⅱ (N=5) was heated with 45±0.5°C for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and 7, 14, and 28 days after treatment. Blood samples were obtained before treatment and 1, 3, 5, 7, 14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group Ⅰ. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with 45°C for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liver damage dy heat of 42.5±0.5°C for 30 minutes is reversible, and liver damage by heat of 45±0.5°C for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in order to apply hyperthermic treatment on human liver tumor safely, close observation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.

비인강암의 방사선 치료 성적

이종영,노준규,서창옥,이연구,홍원표,Lee Jong Young,Loh John J.K.,Suh Chang Ok,Lee Youn Goo,Hong Won Pyo 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

This study is the retrospective evaluation of ninety-six patients with biopsy-proven carcinoma of nasopharynx treated with radiotherapy at Yonsei University, College of Medicine, Radiation Oncology from January 1971 to December 1985. Patient's age ranged from 15 to 71 years with a median age of 49 years. Fifty-two point five percent of local control and $47.5\%$ of actuarial 5 year survival were achieved with radical radiotherapy. Five year survival rate for Stage I&II, III and IV were $75.0\%,\;74.6\%\;and\;41.4\%$, respectively. Distant metastasis rate was related with N stage $(N1\;12.5\%,\;N1\;0\%,\;N2\;23.5\%,\;N3\;32.1\%$and histologic type (lymphoepithelioma $41.7\%$, squamous cell carcinoma $6.5\%$) but not with T stage. Thirty-one of sixty-seven patient covered adequate radiation field received induction chemotherapy. However induction chemotherapy does not appear to improve over all survival.

하인두암의 방사선치료 성적

이창걸,노준규,류삼열,박경란,서창옥,김귀언,홍원표,김병수,Lee Chang Gul,Loh John J.K.,Ryu Sam Youl,Park Kyung Ran,Suh Chang Ok,Kim Gew Earn,Hong Won Pyo,Kim Byung Soo 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

A rerospective review of fifty patients with carcinoma of hypopharynx treated with $RT{\pm}surgery$ was studied for eleven-year period from 1974 to 1984. Of the 50 patients,46 were pyriform sinus in origin, 4 were posterior pharyngeal wall. Eighty-eight percent of patients were locoregionally advanced(stage III, IV) and 78% of patients presented conical lymphadenopathy. 5-year disease-free survival rate of the pyriform sinus ca. was $25.4\%$ in RT alone group, $80\%$ in combined modality group and $30.6\%$ in overall. Local control rate with RT alone in early stage (II) was excellent $(100\%)$, however combined modality appears to be better for local control$(80\%)$ in advanced stage (III, IV) as compared with that of RT alone group $(32\%).$ On basis of this study, RT alone is effective in terms of local control and functional preservation in treatment of early stage of pyriform sinus ca. while surgery can be reserved for salvage purpose when RT fails and combined modality is recommended in patients with locally advanced stage for better local control and survival.

Effects of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

서창옥,노준규,신현수,이형식,문성록,성진실,추성실,김귀언,한은경,박찬일,Suh Chang Ok,Loh. John J.K.,Shin Hyun Soo,Lee Hyung Sik,Moon Sun Rock,Seong Jin Sil,Chu Sung Sil,Kim Gwi Eon,Han Eun Kyung,Park Chan Il The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8 MHz 라디오파를 이용한 온열치료를 시 행하였다. $42\pm0.5^{\circ}C$로 30분간 온열치료를 받은 군(제 1 군, n=5), $45\pm0.5^{\circ}C$로 30분간 온열치료를 받은 군(제 2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견외 특이한 조직병 리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제 2군에서는 간세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthermia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with $42.5\pm0.5^{\circ}C$ 30 minutes, and Group II (N=5) was heated with $45\pm0.5^{\circ}C$ for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and T,14, and 28 days after treatment. Blood samples were obtained before treatment and W, 3,5, 7,14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group 1. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with $45^{\circ}C$ for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liverdamage dy heat of $42.5\pm0.5^{\circ}C$ for 30 minutes is reversible, and liver damage by heat of $45\pm0.5^{\circ}C$ for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in erder to apply hyperthermic treatment on human liver tumor safely, close obsewation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.

Photon Energy Dependence of the Sensitivity of LiF TLDs Loaded with Thin Material

민병민,김수길,노준규,조영갑,Min Byongim J,Kim Sookil,Loh John J.K,Cho Young Kap The Korean Society for Radiation Oncology 1999 Radiation Oncology Journal Vol.17 No.3

목적 : 얇은 박막을 위에 얹은 TLD 선량계의 반응 값에 영향을 미치는 인자를 조사하였고, 특히, 금속박막을 얹은 TLD 선량계의 광자에너지와 표면 흡수선량에 대한 의존성을 조사하였다. 방법 및 재료 : 본 연구에서는 TLD-100과 TLD-100 위에 얹은 Slt은 물질로는 주석, 금, 그리고 TE 플라스틱 판을 사용하였다. 각 금속 박막의 두께는 0.1 mm, TE 플라스틱 판의 두께는 1 mm였고 각 박막의 면적은 TLD-100의 면적과 같이 하였다. 방사선치료에 많이 산이는 6 MV에서 15 MV사이의 광자에너지에 대한 TLD-100의 반응감도와 금박막을 얹은 TLD-100의 반응감도, 그리고 주석 박막을 얹은 TLD-100의 반응감도를 비교해 보았다. 결과 : 금속 박막을 얹은 TLD의 경우 표면 흡수선량의 증가가 명백히 나타나고, 금 박막을 얹은 TLD의 경우 10MV에서 정상 TLD보다 약 1.83배 정도 과잉 반응하는 것으로 관측되었으며, 흡수선량에 따른 반응감도의 변화는 주석을 얹은 TLD의 경우가 가장 작았다 금속 박막을 얹은 TLD의 일반 TLD에 대한 상대 반응감도는 에너지에 대한 의존성을 거의 나타내지 않았다. 그리고 311은 박막의 조직에 대한 등가 두께에 따라 반응감도가 증가하였다. 결론 : 금속박막을 얹은 TLD 선량계의 반응값이 고 에너지(6-15 MV)에 대한 의존성을 거의 나타내지 않았으며, 흡수선량에 대한 선형성도 뛰어난 것으로 관측되었다. 따라서 금속박막을 얹은 TLD 선량계는 매우 작은 크기의 광자빔과 표면흡수선량의 측정에 매우 적합한 것으로 사료된다. Purpose : An investigation has been carried out on the factors which affect the response reading of thermoluminescent dosimeters (TLD-100) loaded with thin material in high energy Photon. The aim of the study was to assess the energy response of TLD-100 to the therapeutic ranges of photon beam. Materials and Methods : In this technique, TLD-100 (abbreviated as TLD) chips and three different thin material (Tin, Gold, and Tissue equivalent plastic plate) which mounted on the TLD chip were used in the clinical photon beam. The thickness of each metal plates was 0.1 mm and TE plastic plate was 1 mm thick. These compared with the photon energy dependence of the sensitivities of TLD (normal chip), TLD loaded with Tin or Gold plate, for the photon energy range 6 MV to 15 MV, which was of interest in radiotherapy. Results : The enhancement of surface dose in the TLD with metal plate was clearly detected. The TLD chips with a Gold plate was found to larger response by a factor of 1.83 in 10 MV photon beam with respect to normal chip. The sensitivity of TLD loaded with Tin was less than that for normal TLD and TLD loaded with Gold. The relative sensitivity of TLD loaded with metal has little energy dependence. Conclusion : The good stability and linearity with respect to monitor units of TLD loaded with metal were demonstrated by relative measurements in high energy Photon ($6\~15$ MV) beams. The TLD laminated with metals embedded system in solid water phantom is a suitable detector for relative dose measurements in a small beam size and surface dose.

Treatment of Carcinoma of the Uterine Cervix with High-Dose-Rate Intracavitary Irradiation using Ralstron

서창옥,김귀언,노준규,Suh Chang Ok,Kim Gwi Eon,Loh John J.K. The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.2

1979년 5월부터 1981년 12월까지 총 524명의 자궁경부암 환자가 근치적 목적하에 방사선 치료를 받았다. 524명의 환자중, 356명이 코발트 선원을 사용한 원격 조정 아프터로딩 고선량률 강내조사 시스템 (Ralstron)으로써 치료받았으며 168명의 환자는 라듐 선원을 사용한 저선량률 강내 조사를 받았다. 외부조사는 골반부 전체에 총 40-50 Gy가 주어졌으며, 이어서 A지점에 10-13번에 걸쳐 30-39 Gy의 강내 조사를 시행하는 치료지침이 사용되었다. 강내조사는 3 Gy씩, 일주일에 세번 주어졌다. 고선량률 강내조사를 받은 군에서의 5년 실제생존률은 IB기 (N=20)가 $77.6{\%}$, II기 (N=182)가 $68.2{\%}$ 그리고 III기 (N=148)가 $50.9{\%}$였다. 저산량률 강내조사군에서의 5년 생존률은 IB기 (N=22)가 $87.5{\%}$, II기 (N=91)가 $66.3{\%}$, 그리고 III기 (N=52)가 $55.4{\%}$였다. 생존률은 병기에 따라서는 통계학적으로 유의한 차이를 보였지만, 두 강내조사군 간에는 유의한 차이가 없었다. 방사선치료후 내장의 후기 합병증은 고선량률 강내조사 군에서 $3.7{\%}$, 저산량률 강내조사군은 $8.4{\%}$에서 관찰되었다. 그러나 외과적 치료가 필요할 만큼 심한 합병증은 없었다. 방광에서 발생한 합병증의 빈도는 고선량률 강내조사군이 $1.4{\%}$, 저선량률 강내조사군은 $2.4{\%}$였다. 고선량률 강내조사의 시술은 외래 환자에 시행하기에 기술적으로 간단하고 쉬우며 마취가 필요없고, 환자가 매우 잘 견딘다. 담당자에 대한 방사선 피폭도 저선량률 강내조사에 비해 사실상 거의 없다. 고선량률 강내조사의 경우 치료시간이 짧기 때문에 주어진 시간내에 더 많은 환자를 치료할 수 있다. 따라서 많은 환자를 치료해야 되는 암센터의 경우, 고선량률 강내조사 시스템이 훨씬 더 권장되어 진다. 그러나 더욱 향상된 결과를 얻기 위하여, 다른 치료 방식으로 광범위한 연구를 통해, 고선량률 강내조사의 적절한 선량-분할조사 계획과 외부조사와 강내조사의 적절한 배합이 이루어져야 할 것이다. From May 1979 through December 1981 a total of 524 patients with carcinoma of the uterine cervix were treated by radiation therapy with curative intent. Among the 524 patients, 350 were treated with a high-dose-rate (HDR), remote-controlled, afterloading intracavitary irradiation (ICR) system using a cobalt source (Ralstron), and 168 patients received a low-dose-rate (LDR) ICR using a radium source. External beam irradiation with a total dose of 40-50 Gy to the whole pelvis followed by intracavitary irradiation with a total dose of 30-39 Gy in 10-13 fractions to point A was the treatment protocol. ICR was given three times a week with a dose of 3 Gy per fraction. Five-year actuarial survival rates in the HDR-ICR group were $77.6{\%}$ in stage IB (N=20), $68.2{\%}$ in stage II (N=182), and $50.9{\%}$ in stage III (N=148). In LDR-ICR group, 5-year survival rates were $87.5{\%}$ in stage IB (N=22), $66.3{\%}$ in stage II (N=91), and $55.4{\%}$ in stage III (N=52). Survival rates showed a statistically significant difference by stage, but there was no significant difference between the two ICR groups. Late bowel complications after radiotherapy were noted in $3.7{\%}$ of the HDR-ICR group and $8.4{\%}$ of the LDR-ICR group. There was no severe complication requiring surgical management. The incidence of bladder complications was $1.4{\%}$ in the HDR-ICR group and $2.4{\%}$ in the LDR-ICR group. The application of HDR-ICR was technically simple and easily performed on an outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually nil in contrast to that of LDR-ICR. Within a given period of time, more patients can be treated with HDR-ICR because of the short treatment time. Therefore, the HDR-ICR system is highly recommended for a cancer center, particularly one with a large number of patients to be treated. In order to achieve an improved outcome, however, the optimum dose-fractionation schedule of HDR-ICR and optimum combination of intracavitary irradiation with external beam irradiation should be determined through an extensive protocol.

대장직장암에서 임상조직학적 소견과 DNA ploidy와의 상관관계

이석호,김헌정,김우철,조영갑,노준규,우제홍,황태숙,Lee Suk Ho,Kim Hun Jung,Kim Woo Chul,Cho Young Kap,Loh John J K,Woo Ze Hong,Hwamg Tae Sook 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.3

목적 : 여러 종양에 있어 DNA ploidy 양상은 여러 임상조직학적인 소견과의 연관성을 보여주어 왔다. 이에 본 연구에서는 대장직장암에 있어서의 이러한 연관성에 대해 알아보고 직장 5상 결장암에 있어서 치료 실패율과의 연관성에 대해 알아 보고자 하였다. 대상 및 방법 : 본 연구에서는 대장 직장암으로 진단 후, 근치적 절제술을 시행받은 환자 117명을 대상으로 하였고 Medley method에 따라 파라핀에 고정 후 flow cytometry를 사용하여 DNA ploldy와 여러 임상조직학적인 소견들과의 연관성을 밝히고자 하였다. 이 중 Duke 병기 B, C 직장 5상 결장암 환자 75명을 대상으로 하여 치료실패 양상과 DNA ploidy 간의 상관관계를 알아 보았다. 결과 : 종양분석 결과 40예(34.2%)에서 aneupioldy histogram을 얻을 수 있었다. DNA aneuploidy와 나이, 성별, 침범 깊이, 위치 그리고 Dukes' 병기와는 유의한 상관관계를 보이지 않았다. 그러나 Dukes 병기 B 직장암에 있어서는 치료 실패율과 DNA ploidy 사이에 유의한 상관관계를 보였다(p=0.048). 결론 : 대장 직장암에서 DNA ploi텀는 다른 임상조직학적 소견들과 관련이 없었고 직장 5상 결장암 병기 B에서는 치료 실패율과 연관성을 보였으나 보다 많은 수의 환자를 대상으로한 검증이 필요하다고 생각된다. Purpose : DNA ploidy pattern was shown to correlate with several clinicohistologic findings in several tumors. Aim of this study was to evaluate the correlation of the clinicohistologic findings in colorectal cancer and the failure pattern in rectosigmoid cancer with DNA ploidy. Materials and Methods DNA flow cytometry using the Hedley methods on paraffin embedded specimen from 117 patients with colorectal cancers after curative resection was peformed. We tried to find the correlation between DNA ploidy and various clinicohistologic findings. And then the correlation DNA ploidy and the failure pattern in 75 patients of rectosigmoid cancer was analized. Results : Forty samples (34.2%) from tumors gave aneuploidy histogram. There was no significant difference in the frequency of DNA aneuploidy in terms of age, sex, depth of invasion, location and Dukes stage. But there was a significant correlation between DNA ploidy and the failure rates in Dukes stage B rectosigmoid cancer (P=0.048). Conclusions : These findings suggest that DNA ploidy pattern shows the correlation with the treatment failure rates in Dukes stage B rectosigmoid, but not with many other clinicohistologic findings. However,more patients will be needed to disclose these findings.

Clinical and Therapeutic Aspects of Squamous Cell Carcinoma of Oral Tongue

류삼열,이창걸,박인규,서창옥,김귀언,노준규,Ryu Samuel,Lee Chang Gul,Park In Kyu,Suh Chang Ok,Kim Gwi Eon,Loh John J.K. The Korean Society for Radiation Oncology 1987 Radiation Oncology Journal Vol.5 No.2

구강 내 설암은 설의 전방 삼분의 이에서 발생하는 것으로 근치적 요법으로는 수술과 방사선 치료가 그 근간을 이루어 왔으며, 같은 병기에서 두 요법간의 완치율은 거의 동일한 것으로 보고되고 있다. 특히 조기병소(T1, T2)에서는 이 두 요법간에 비슷한 국소 퇴치율을 보이므로 치료법의 선택에는 그 치료로 인해 발생하는 기능적 손상 및 미용적 결손을 최소화하는데 역점을 두어야 할 것이다. 그러므로 큰 기능적 손상 없이 용이하게 절제할 수 있는 첨단부 및 배부의 작은 병소를 제외하고 대부분의 조기병소는 방사선 요법으로 정상적인 발성 및 연하작용을 유지하며 치료할 수 있다. 그러나 비교적 진행된 병소(late T2, T3) 중 하부 침윤이 심하지 않으면 방사선 치료만으로 완치될 수 있으며 수술은 방사선 치료 후 재발암의 구원요법으로 유보해 두는 것이 바람직할 것이다. 방사선 치료의 방법으로는 외부 조사법 외에 자입요법 등이 있으나 최대의 국소 퇴치를 위해서는 자입요법이 필수적인 것으로 나타났다. 이러한 자입요법으로 치료기간을 단축할 수 있음은 말할 것도 없고 투여되는 선량을 증가시킴으로서 국소 퇴치율의 향상을 기대하고 나아가 생존율을 높일 수 가 있을 것이다. Fourty nine patients with squamous cell carcinoma of oral tongue were reviewed retrospectively for the evaluation of clinical manifestation and for the comparison between therapeutic modalites. The gross shape of the tumor was infiltrative in 22, ulcerative in 12, ad ulcer-oinfiltrative type in 10 patients. Direct extension of the tumor was most commonly to the floor of the mouth. The incidence of nodal metastasis generally increased with tumor stage. $55\%$ of the patients showed neck nodal metastasis at the time of diagnosis. Ipsilateral subdigastric node were most commonly involved, followed by submandibular nodes. The 5-year survival rate of patients treated with surgery and radiotherapy was $58.7\%$ in contrast to $21.6\%$ in radiation alone group. Overall 5-year survival rate was $31\%$ In radiation alone group, half of the patients in stage I, II were locally controlled. But the local control In stage III, IV was much inferior to early lesions. Especially, of 4 patients combined with implantation technique, 3 were completely controlled. 5-year survival rate of these implanted patients was $50\%,\;49.4\%$ of patients treated over 7,000cGy survived 5 years. This was significant in contrast to $6.4\%$ of the group treated below 7,000cGy. The most common sites of failures were primary sites. In early lesions primary radiotherapy with implantation would be an appropriate treatment in cancer of oral tongue, operation reserved for radiation failure. Operation and adjuvant radiotherapy is recommended in cases of advanced disease.

Radiation Therapy Results of the Non-Hodgkin's Lymphoma of the Sinonasal Cavity

김수곤,박경란,이창걸,서창옥,김귀언,노준규,홍원표,김병수,류삼열,Kim Soo Kon,Park Kyung Ran,Lee Chang Gul,Suh Chang Ok,Kim Gwi Eon,Loh John J.K.,Hong Won Pyo,Kim Byung Soo,Ryu Samuel The Korean Society for Radiation Oncology 1987 Radiation Oncology Journal Vol.5 No.2

1970년부터 1980년까지 연세대학교 치료방사선과에서 방사선치료 받은 비강 및 부비동에 발생한 NHL환자 15예를 대상으로 후향성 분석을 하여 다음과 같은 결과를 얻었다. 1. 병기분포는 13예가 IE 2예가 IIE였고 TNM병기에 따르면 7예가 국소병변이 진행된 T3, T4 환자였다. 2. Overall 5년 생존율을 $25\%$, IE는 $28\%$, IIE는 $0\%$였다. 3. 병기별 치료실패율은 T1, T2는 $33\%(2/6),\; T3,\;T_4는\;86\%(6/7),\;IIE$에서는 $100\%(2/2)$였다. 4. 방사선 조사량이 55Gy 이상인 경우 $100\%$의 완전 관해율을 보였으며 55Gy이하인 경우 $73\%$의 완전 관해율을 보였다. 5. 비강 및 부비동의 NHL의 Ann Arbor병기 분류와 함께 TNM 병기도 예후에 중요한 요인이 될 것 같다. 6. 국소병변이 진행된 병기 T3, T4와 IIE 환자에서는 화학요법제의 병용치료가 필요할 것 같다. From January 1970 through December 1984, 15 patients with sinonasal Non-Hodgkin's lymphoma combined to the head and neck were treated by external irradiation.13 patients were stage It and 2 were stage IIE by Ann Arbor Classification. However, when using TNM system, 7 were locally advanced T3, T4 lesions. All patients had follow up from 3.7 to 16 years with the median follow-up of 8.5 years. The overall actuarial 5-year survival rates were $25\%,\;28\%$ for IE and $0\%$ for IIE. Total tumor dose varied from 40 to 68 Gy. $100\%$ complete response with a total tumor dose of more than 55 Gy and $73\%$ complete response with less than 55Gy. When the disease was staged using the TNM (AJC) system, the five-year disease free survival for T1 and T2 patients was $50\%$ as compared with $14\%$ for T3 and T4. Failure rate by stage was $33\%(2/6)$ for T1 and T2, $86\%(6/7)$ for T3 and T4, and $100\%$(2/2) for IIE. The results suggest that 1. Higher CR could be obtained with a total tuner dose of more than 55 Gy. 2. Use of TNM staging system is as important as Ann arbor in management of sinonasal NHL. 3. The addition of combination chemotherapy should be considered for T3, T4 and IIE the sinonasal Non-Hodgkin's lymphoma although the disease is limited to head and neck.