Tumor Regression Patterns Based on Follow-up Duration in Patients With Head and Neck Squamous Cell Carcinoma Treated With Radiotherapy or Chemoradiotherapy

공문규,홍성언 대한이비인후과학회 2015 Clinical and Experimental Otorhinolaryngology Vol.8 No.4

Objectives. We describe patterns of tumor regression based on follow-up duration after radiotherapy (RT) or chemo-RT in patients with head and neck squamous cell carcinoma. Methods. Thirty-one patients with head and neck squamous cell carcinoma were included in this study and received definitive RT or chemo-RT. The pattern of primary tumor regression after treatment was evaluated every 1 to 2 months. Predictive factors for the length of time to full regression were also analyzed. Results. Among all patients, 27 patients showed regression of the primary tumor, 24 patients showed >50% regression, and 15 patients showed total regression. The primary tumor gradually regressed during the course of follow-up. The median time to full regression was 5.2 months (range, 1.3 to 17.9 months). In the 24 patients who showed >50% regression, the rate of >50% regression increased over time as follows: 25.0% at 1 month, 62.5% at 2 months, 75.0% at 3 months, 91.7% at 4 months, and 95.8% at 5 months. Higher total RT dose and shorter RT duration were associated with longer time to full regression. Conclusion. A substantial number of patients showed continuous regression of the primary tumor for more than 2 months after treatment. The timing for evaluation of tumor regression must be greater than 2 months from the completion of RT or chemo-RT in patients with head and neck squamous cell carcinoma.

Which Patients Might Benefit from Postmastectomy Radiotherapy in Breast Cancer Patients with T1-2 Tumor and 1-3 Axillary Lymph Nodes Metastasis?

공문규,홍성언 대한암학회 2013 Cancer Research and Treatment Vol.45 No.2

Purpose This study compared the clinical outcomes of T1-2N1 breast cancer patients with and without postmastectomy radiotherapy (PMRT). Risk factors for loco-regional recurrence (LRR) were identified in order to define a subgroup of patients who might benefit from PMRT. Materials and Methods Of 110 T1-2N1 breast cancer patients who underwent mastectomy from January 1994 through December 2009, 32 patients underwent PMRT and 78 patients did not. Treatment outcomes and risk factors for LRR were analyzed. Results The 5- and 10-year LRR rates were both 6.2% in the PMRT group, and 10.4% and 14.6% in the no-PMRT group (p=0.336). In addition, no significant differences in distant metastasis-free survival (DMFS) or overall survival (OS) were observed between patients receiving and not receiving PMRT. In multivariate analysis, factors associated with higher LRR rates included grade 3 disease, extracapsular extension (ECE), and triple negative subtype. Patients who had one or more risk factors for LRR were defined as a high-risk patient group. In the high-risk group, both 5- and 10-year LRR rates for patients who underwent PMRT was 18.2%, and LRR rates of 21.4% at five years and 36.6% at 10 years were observed for patients who did not undergo PMRT (p=0.069). Conclusion PMRT in T1-2N1 breast cancer patients should be considered according to several prognostic factors in addition to T and N stage. Findings of our study indicated that PMRT did not improve LRR, DMFS, or OS in T1-2N1 breast cancer patients. However,in a subgroup of patients with grade 3 disease, ECE, or triple negative subtype, PMRT might be beneficial.

A Long Term Results of External Beam Radiation Therapy in Hemophilic Arthropathy of the Ankle in Children

공문규,강진오,최진현,박서현 대한의학회 2010 Journal of Korean medical science Vol.25 No.12

Bleeding into joint space is critical to develop hemophilic arthropathy. To reduce the frequency of bleeding in the ankle joint of children with hemophilic arthropathy, low dose external beam irradiation was performed for 37 patients. Among them, 35 patients followed-up for longer than 1 yr (median 87 months) were enrolled for analysis. The average number of bleedings per month was 3.6 during one year prior to radiation therapy. After radiation therapy, it was decreased to 2.1 during the first year, after then it was maintained in the range of 1.0 to 1.5 until the tenth year. The bleeding frequency was reduced to 42% at the first year and it was maintained in the range of 58% to 73% from the second to the tenth year. Especially the patients who had 3 or more bleedings per month, and who had MRI score more than 3 showed significant decreases. During the follow-up period, growth disturbances and secondary malignancies were not found. External beam radiotherapy can be considered for the hemophilic patients with surgical or isotope therapies are not amenable.

Preoperative Concurrent Chemoradiotherapy for Locally Advanced Rectal Cancer: Treatment Outcomes and Analysis of Prognostic Factors

공문규,홍성언,최우석,김시영,최진현 대한암학회 2012 Cancer Research and Treatment Vol.44 No.2

Purpose This study was designed to investigate the long-term oncologic outcomes for locally advanced rectal cancer patients after treatment with preoperative concurrent chemoradiotherapy followed by total mesorectal excision, and to identify prognostic factors that affect survival and pathologic response. Materials and Methods From June 1996 to June 2009, 135 patients with locally advanced rectal cancer were treated with preoperative concurrent chemoradiotherapy followed by total mesorectal excision at Kyung Hee University Hospital. Patient data was retrospectively collected and analyzed in order to determine the treatment outcomes and identify prognostic factors for survival. Results The median follow-up time was 50 months (range, 4.5 to 157.8 months). After preoperative chemoradiotherapy, sphincter preservation surgery was accomplished in 67.4% of whole patients. A complete pathologic response was achieved in 16% of patients. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for all patients was 82.7% and 75.7%, 76.8% and 71.9%, 67.9% and 63.3%, respectively. The estimated 5- and 8-year overall survival, loco-regional recurrence-free survival, and distant metastasis-free survival rate for pathologic complete responders was 100% and 100%, 100% and 88.9%,95.5% and 95.5%, respectively. In the multivariate analysis, pathologic complete response was significantly associated with overall survival. The predictive factor for pathologic complete response was pretreatment clinical stage. Conclusion Preoperative chemoradiotherapy for locally advanced rectal cancer resulted in a high rate of overall survival, sphincter preservation, down-staging, and pathologic complete response. The patients achieving pathologic complete response had very favorable outcomes. Pathologic complete response was a significant prognostic factor for overall survival and the significant predictive factor for a pathologic complete response was pretreatment clinical stage.

Comparison of survival rates between patients treated with conventional radiotherapy and helical tomotherapy for head and neck cancer

공문규,홍성언,최진현,김영경 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.1

Purpose: Compared to conventional radiotherapy (RT), intensity-modulated radiotherapy (IMRT) significantly reduces the rate of treatment-induced late toxicities in head and neck cancer. However, a clear survival benefit of IMRT over conventional RT has not yet been shown. This study is among the first comparative study to compare the survival rates between conventional RT and helical tomotherapy in head and neck cancer. Materials and Methods: From January 2008 to November 2011, 37 patients received conventional RT and 30 patients received helical tomotherapy for management of head and neck cancer. We retrospectively compared the survival rates between patients treated with conventional RT and helical tomotherapy, and analyzed the prognostic factors for survival. Results: The 1- and 2-year locoregional recurrence-free survival rates were 61.2% and 58.1% for the conventional RT group, 89.3% and 80.3% for the helical tomotherapy group, respectively. The locoregional recurrence-free survival rates of the helical tomotherapy group were significantly higher than conventional RT group (p = 0.029). There were no significant differences in the overall and distant metastasis-free survival between the two groups. RT technique, tumor stage, and RT duration were significant prognostic factors for locoregional recurrence-free survival. Conclusion: This study showed the locoregional recurrence-free survival benefits of helical tomotherapy in the treatment of head and neck cancers.

Three Cases of Radiation-Induced Hepatitis B Virus Reactivation after Hepatic Tomotherapy

공문규(Moonkyoo Kong),홍성언(Seong Eon Hong),김병호(Byung-Ho Kim),최진현(Jinhyun Choi) 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.1

방사선간염은 대개 황달을 동반하지 않은 알칼리인산 분해효소(alkaline phophatase)의 상승을 특징으로 보인다. 하지만, 방사선간염 환자의 일부에서는 아미노전달효소(transaminase)의 상승을 특징적인 소견으로 보이고, 이러한 소견은 특히 간암 환자의 70∼90%가 B형 간염 바이러스 보균자인 아시아 지역에서 흔하게 관찰된다. 또한 B형 간염 바이러스 보균자인 간암 환자를 방사선으로 치료했을 때 방사선간염이 더 흔하게 발생한다. 이런 사실들은 B형 간염 바이러스 보균자에서 방사선간염의 발생 기전이 비보균자에서의 그것과 다를 수 있다는 것을 시사하고, B형 간염 바이러스 보균자에서 발생하는 방사선간염의 발생기전은 B형 간염 바이러스의 재활성화와 연관이 있을 것으로 추측된다. 하지만, 현재 간암의 방사선치료 후 B형 간염 바이러스의 재활성화에 대한 연구는 미미한 수준이다. 이에 저자들은 간암 환자의 토모테라피 후 발생한 B형 간염 바이러스 재활성화 3예를 보고하고자 한다. Radiation-induced liver disease (RILD) has been characterized as a veno-occlusive disease with anicteric elevation of alkaline phosphatase (ALP). However, some RILD patients present with elevated transaminase levels rather than with anicteric elevation of ALP, and these findings are common in the Asia-Pacific region where hepatitis B virus (HBV) infection is associated with 70∼90% of hepatocelluar carcinoma (HCC) cases. In addition, the development of RILD is more common in patients with hepatitis B virus-related HCC. These findings indicate that susceptibility to RILD might be different in HBV carriers and non-carriers, and moreover, RILD in patients with HBV-related HCC might be associated with another unique pathogenesis such as HBV reactivation. However, HBV reactivation after hepatic irradiation has been reported in only a few studies. This study reports three cases of HBV reactivation after hepatic tomotherapy for management of HCC.

전립샘암 환자의 방사선 치료 중 전립샘 특이 항원의 변화 양상과 예후의 상관관계

공문규 ( Moon Kyoo Kong ),강진오 ( Jin Oh Kang ),최진현 ( Jin Hyun Choi ) 경희대학교 경희의료원 2010 慶熙醫學 Vol.26 No.1

Purpose: To evaluate the relationship between PSA change during curative radiotherapy and prognosis in prostate cancer. Methods: A total of 37 patients among 73 patients treated with curative radiotherapy from July 2002 to January 2008 in Kyung Hee university medical center were enrolled. According to pre-RT PSA values, patients were classified into two groups, group 1 (pre-RT PSA value≥12 ng/mL) and group 2 (pre-RT PSA value≥12 ng/mL). Group 1 was classified into two groups according to median PSAV(iRT) resulting group1 fast (PSAV(iRt)≤-1.35%/day) and group1 slow (PSAV(iRT)>-1.35%/day). Group 2 was classified into two groups according to the median PSAV(iRT) resulting group2 fast (PSAV(iRT)≤1 .05%/day) and group2 slow (PSA(iRt)>-1.05%/day). The stage, radiation dose, age, Gleason score and the rate of biochemical failure (BF) of these groups were analyzed. Results: Patient`s age, stage and radiation dose were not significantly different among groups. Among the group1 fast (n=10), 2 patients developed biochemical failure, while among group1 slow (n10), 6 patients developed (P=0.068). The median biochemical failure free survival of group1 fast and group1 slow was 24.9 and 10.7 months, respectively. Among the group2 fast (n=9) there was no biochemical failure, while among the group2 slow (n=8), 1 patient developed (P=0.331). Conclusion: Among the patients with high pre-RT PSA values, slower PSAV(iRt) showed a tendency of more biochemical failure, but there were no statistical significance. To identify more definitely the relationship between PSAV(iRT) and development of biochemical, further studies with larger sample are necessary.

Different Expressions of HIF-1α, Bcl-2 and Baxin DU145 Prostate Cancer Cells Transplanted in Nude Mouse between X-Ray and Neutron Irradiation

Moonkyoo Kong(공문규),Jin Oh Kang(강진오),Sang Ki Kim(김상기),Dong Oh Shin(신동오),Seo Hyun Park(박서현),Chang Ju Kim(김창주),Hyun Kyung Chang(장현경) 대한방사선종양학회 2009 Radiation Oncology Journal Vol.27 No.4

Purpose: To investigate the radiobiologic effects of neutron and X-ray irradiation on DU-145 prostate carcinoma cells by identifying the differences of HIF-1α expression and apoptosis. Materials and Methods: Nude mice were injected with the human prostate cancer cell line, DU-145, and then irradiated with 2 Gy and 10 Gy X-rays, or 0.6 Gy and 3.3 Gy neutrons, respectively. The mice were sacrificed at 24 hours and 120 hours after irradiation. The expression levels of HIF-1α, Bcl-2 and Bax were compared with immunohistochemical staining and western blotting. The apoptotic indexes were compared with the Terminal deoxynucleotidyl biotin-dUTP nick and labeling (TUNEL) assay. Results: At day 1, HIF-1α and Bcl-2 expression decreased, while Bax expression and the number of TUNEL positive cells increased in neutron irradiated groups for the control and X-ray irradiated groups. The Bcl-2/Bax ratio was significantly lower in the neutron irradiated groups regardless of dose (p=0.001). The same pattern of the differences in the expressions of the HIF-1α, Bcl-2, Bax, Bcl-2/Bax ratio, and apoptotic indexes were indentified at day 5. HIF-1α expression was related with Bcl-2 (p=0.031), Bax (p=0.037) expressions and the apoptotic indexes (p=0.016) at day 5. Conclusion: Neutron irradiation showed a decrease in HIF-1α, Bcl-2 expression, and Bcl-2/Bax ratio, but increased Bax expression regardless of dose. This study suggests that the differences radiobiological responses between photon and neutron irradiation may be related to different HIF-1α expression and subsequent apoptotic protein expressions. 목 적: 전립샘암 세포주 DU 145에서 엑스선과 중성자선에 의한 HIF-1α와 아포프토시스 발현의 차이를 비교함으로써 엑스선과 중성자선의 방사선생물학적 차이의 기전을 알아보고자 한다. 대상 및 방법: 누드 마우스에 DU 145 전립샘암 세포주를 주입한 후 2 Gy 엑스선, 10 Gy 엑스선, 0.6 Gy 중성자선, 3.3 Gy 중성자선을 각각 조사했다. 엑스선을 조사한 군과 중성자선을 조사한 군에서 HIF-1α, Bcl-2, Bax, 아포프토시스 발현 정도를 면역조직화학 염색과 western blotting을 이용하여 비교하였다. 아포토시스의 정도는 terminal deoxynucleotidyl biotin-dUTP nick end labeling (TUNEL) 염색을 이용하여 비교하였다. 결 과: 방사선 조사 1일째, X선을 조사한 군과 비교했을 때, 중성자선을 조사한 군에서 HIF-1α와 Bcl-2의 발현은 감소하였고, Bax와 아포프토시스 세포의 수는 증가하였다. Bcl-2/Bax 비는 중성자선을 조사한 군에서 의미 있게 감소하였다. 이러한 HIF-1α, Bcl-2, Bax, Bcl-2/Bax 비, 아포프토시스 발현의 차이는 방사선 조사 5일째에도 동일하게 유지되어 나타났다. 또한, HIF-1α 발현은 방사선 조사 5일째 Bcl-2 (p=0.031), Bax (p=0.037), TUNEL (p=0.016) 발현과 연관성을 보였다. 결 론: 중성자선 조사한 경우 엑스선에 비해 HIF-1α와 Bcl-2 발현, Bcl-2/Bax 비가 감소하고, Bax 발현은 증가하였다. 중성자선 치료의 광자선과 다른 방사선생물학적인 반응은 HIF-1α와 그로 인한 아포프토시스 관련 단백질 발현의 차이와 연관성이 있을 것으로 생각한다.

Predictive Factors for Radiation Pneumonitis in Lung Cancer Treated with Helical Tomotherapy

김영경,홍성언,공문규,최진현 대한암학회 2013 Cancer Research and Treatment Vol.45 No.4

Purpose Predictive factors for radiation pneumonitis (RP) after helical tomotherapy (HT) may differ from those after linac-based radiotherapy. In this study, we identified predictive factors for RP in patients with lung cancer treated with HT. Materials and Methods We retrospectively analyzed clinical, treatment-related and dosimetric factors from 31 patients with lung cancer treated with HT. RP was graded according to Common Terminology Criteria for Adverse Events version 4.0 and grade ≥2 RP was defined as a RP event. We used Kaplan-Meier methods to compute the actuarial incidence of RP. For univariate and multivariate analysis, the log-rank test and the Cox proportional regression hazard model were used. We generated receiver-operating characteristics (ROC) curves to define the cutoff values for significant parameters. Results The median follow-up duration was 6.6 months (range, 1.6 to 38.5 months). The 2-,4-, and 6-month actuarial RP event rates were 13.2%, 58.5%, and 67.0%,respectively. There was no grade 4 or more RP. Ipsilateral V5, V10, V15, and contralateral V5 were related with RP event on univariate analysis. By multivariate analysis, ipsilateral V10 was factor most strongly associated with RP event. On the ROC curve, the cutoff values of ipsilateral V5, V10, V15, and contralateral V5 were 67.5%, 58.5%, 50.0%, and 55.5%, respectively. Conclusion In our study, ipsilateral V5, V10, V15, and contralateral V5 were significant predictive factors for RP after HT.

Dosimetric Comparisons of Intensity-Modulated Radiotherapy, Volumetric Modulated Arc Therapy, Tomotherapy, Stereotactic Radiosurgery, and Proton Therapy for Treatment of Patients with a Vestibular Schwannoma

오윤진,신동오,공문규,신동호,정원규,김동욱 한국물리학회 2019 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.74 No.4

This study compares the dosimetric characteristics of radiotherapy treatment methods for patients with a vestibular schwannoma. We generated and compared intensity-modulated radiotherapy (IMRT), volumetric modulated arc therapy (VMAT), tomotherapy (TOMO), and proton therapy (Proton) treatment plans among eight patients with a vestibular schwannoma who received stereotactic radiosurgery based on M3 (M3-SRS) treatment. The dose comparison of the planning target volume (PTV) was performed by calculating the homogeneity index (HI), conformity index (CI), coverage index (CVI), and equivalent uniform dose (EUD). A dose comparison for adjacent normal organs was performed by calculating the EUD and the normal tissue complication probability (NTCP). The PTV coverage showed excellent dose homogeneity and conformity on the target volume for M3-SRS treatment. The sparing of the organs at risk (OARs) was excellent in terms of dose delivery to most normal organs away from the target for Proton; however, the other modalities were also within the tolerance dose limit for the OARs. This study further conrmed the possibility of using radiotherapy, along with the use of other treatment methods, for patients with a vestibular schwannoma.