The Clinical Usefulness of 18F-Fluorodeoxyglucose Positron Emission Tomography (PET) to Predict Oncologic Outcomes and PET-Based Radiotherapeutic Considerations in Locally Advanced Nasopharyngeal Carcinoma

윤홍인,김경환,이정심,노윤호,윤미진,조병철,이창걸,금기창 대한암학회 2016 Cancer Research and Treatment Vol.48 No.3

Purpose We investigated 18F-fluorodeoxyglucose positron emission tomography (PET)-derived parameters as prognostic indices for disease progression and survival in locally advanced nasopharyngeal carcinoma (NPC) and the effect of high-dose radiotherapy for a subpopulation with PET-based poor prognoses. Materials and Methods Ninety-seven stage III and Iva-b NPC patients who underwent definitive treatment and PET were reviewed. For each primary, nodal, and whole tumor, maximum standardized uptake value, metabolic tumor volume, and total lesion glycolysis (TLG) were evaluated. Results Based on the C-index (0.666) and incremental area under the curve (0.669), the whole tumor TLG was the most useful predictor for progression-free survival (PFS); the whole tumor TLG cut-off value showing the best predictive performance was 322.7. In multivariate analysis, whole tumor TLG was a significant prognostic factor for PFS (hazard ratio [HR], 0.3; 95% confidence interval [CI], 0.14 to 0.65; p=0.002) and OS (HR, 0.29; 95% CI, 0.11 to 0.79; p=0.02). Patients with low whole tumor TLG showed the higher 5-year PFS in the subgroup for only patients receiving intensity modulated radiotherapy (77.4% vs. 53.0%, p=0.01). In the subgroup of patients with high whole tumor TLG, patients receiving an EQD2 ! 70 Gy showed significantly greater complete remission rates (71.4% vs. 33.3%, p=0.03) and higher 5-year OS (74.7% vs. 19.6%, p=0.02). Conclusion Our findings demonstrated that whole tumor TLG could be an independent prognostic factor and high-dose radiotherapy could improve outcomes for NPC showing high whole tumor TLG.

High Radiation Dose to the Fornix Causes Symptomatic Radiation Necrosis in Patients with Anaplastic Oligodendroglioma

윤홍인,장종희,김태형,조재호,강석구,문주형,서창옥,박예원 연세대학교의과대학 2024 Yonsei medical journal Vol.65 No.1

Purpose: Surgery, radiotherapy (RT), and chemotherapy have prolonged the survival of patients with anaplastic oligodendroglio ma. However, whether RT induces long-term toxicity remains unknown. We analyzed the relationship between the RT dose to the fornix and symptomatic radiation necrosis (SRN). Materials and Methods: A total of 67 patients treated between 2009 and 2019 were analyzed. SRN was defined according to the following three criteria: 1) radiographic findings, 2) symptoms attributable to the lesion, and 3) treatment resulting in symptom improvement. Various contours, including the fornix, were delineated. Univariate and multivariate analyses of the relationship between RT dose and SRN, as well as receiver operating characteristic curve analysis for cut-off values, were performed. Results: The most common location was the frontal lobe (n=40, 60%). Gross total resection was performed in 38 patients (57%), and 42 patients (63%) received procarbazine, lomustine, and vincristine chemotherapy. With a median follow-up of 42 months, the me dian overall and progression-free survival was 74 months. Sixteen patients (24%) developed SRN. In multivariate analysis, age and maximum dose to the fornix were associated with the development of SRN. The cut-off values for the maximum dose to the fornix and age were 59 Gy (equivalent dose delivered in 2 Gy fractions) and 46 years, respectively. The rate of SRN was higher in patients whose maximum dose to the fornix was >59 Gy (13% vs. 43%, p=0.005). Conclusion: The maximum dose to the fornix was a significant factor for SRN development. While fornix sparing may help main tain neurocognitive function, additional studies are needed.

Overexpression of SOX2 Is Associated with Better Overall Survival in Squamous Cell Lung Cancer Patients Treated with Adjuvant Radiotherapy

윤홍인,박규현,이은정,금기창,이창걸,김철훈,김용배 대한암학회 2016 Cancer Research and Treatment Vol.48 No.2

Purpose The purpose of this study is to investigate the prognostic significance of SOX2 gene amplification and expression in patients with American Joint Committee on Cancer stage III lung squamous cell carcinoma (SCC) who underwent surgery followed by adjuvant radiotherapy. Materials and Methods Pathological specimens were obtained from 33 patients with stage III lung SCC treated with surgery followed by adjuvant radiotherapy between 1996 and 2008. SOX2 gene amplification and protein expression were analyzed using fluorescent in situ hybridization and immunohistochemistry, respectively. Patients were divided into two groups according to their SOX2 gene amplification and protein expression status. Kaplan-Meier estimates and a Cox proportional hazards model were used to identify the prognostic factors affecting patient survival. Results The median follow-up period for surviving patients was 58 months (range, 5 to 102 months). SOX2 gene amplification was observed in 22 patients and protein overexpression in 26 patients. SOX2 overexpression showed significant association with SOX2 gene amplification (p=0.002). In multivariate analysis, SOX2 overexpression was a significant prognostic factor for overall survival (OS) (hazard ratios [HR], 0.1; 95% confidence interval [CI], 0.002 to 0.5; p=0.005) and disease-free survival (DFS) (HR, 0.15; 95% CI, 0.04 to 0.65; p=0.01). Age (HR, 0.33; 95% CI, 0.11 to 0.98; p=0.046) and total radiation dose (HR, 0.13; 95% CI, 0.02 to 0.7; p=0.02) were the independent prognostic factors for OS and DFS. Patients with SOX2 amplification did not show a longer OS (p=0.95) and DFS (p=0.48). Conclusion Our data suggested that SOX2 overexpression could be used as a positive prognostic factor in patients with stage III lung SCC receiving adjuvant radiotherapy.

포스터전시 : 간세포암종에서 방사선치료로 인한 간독성 예측인자로서 ICG-R15 검사의 임상적 유용성 (초)

윤홍인,금웅섭,이익재,김자경,한광협,성진실 대한간학회 2010 Clinical and Molecular Hepatology(대한간학회지) Vol.16 No.3(S)

Clinical Benefit of Hepatic Arterial Infusion Concurrent Chemoradiotherapy in Locally Advanced Hepatocellular Carcinoma: A Propensity Score Matching Analysis

윤홍인,송기준,이익재,김도영,한광협,성진실 대한암학회 2016 Cancer Research and Treatment Vol.48 No.1

Purpose The aim of this study was to evaluate whether hepatic arterial infusion concurrent chemora- diotherapy (CCRT) could improve overall survival (OS) in patients with locally advanced hepatocellular carcinoma (LAHCC). Materials and Methods Two databases were reviewed from Yonsei Cancer Center (YCC) and Korean Liver Cancer Study Group (KLCSG) nationwide multi-center hepatocellular carcinoma (HCC) cohort. The CCRT group included 106 patients, with stage III-IV, Child-Pugh classification A, Eastern Cooperative Oncology Group performance status 0 or 1, who underwent definitive CCRT as the initial treatment at YCC. We used propensity score matching to adjust for seven clinical factors, including age, tumor size, TNM stage by the Liver Cancer Study Group of Japan, T stage, Barcelona Clinic Liver Cancer (BCLC) staging system, etiology of HCC, and portal vein invasion, which all differed significantly in the two databases. From the KLCSG cohort enrolled at 32 institutions, 106 patients for the non-CCRT group were defined. Results After propensity score matching, all patient characteristics were balanced between the two groups. The CCRT group had better OS (median, 11.4) than the non-CCRT group (6.6 months, p=0.02). In multivariate analyses for all patients, CCRT (hazard ratio [HR], 1.48; 95% confidence interval [CI], 1.11 to 1.97; p=0.007), tumor size (HR, 1.08; 95% CI, 1.04 to 1.12; p < 0.001), and BCLC stage (HR, 0.54; 95% CI, 0.36 to 0.8; p=0.003) were inde- pendent prognostic factors for OS. Conclusion CCRT showed better OS for LAHCC patients. In LAHCC patients with a good performance and normal liver function, CCRT could be a feasible treatment option. All of these findings need to be validated in prospective clinical trials.

Selective Inhibition of PI3K Isoforms in Brain Tumors Suppresses Tumor Growth by Increasing Radiosensitivity

윤홍인,설미연,최서희,이익재,박형순,김혜련,김상겸 연세대학교의과대학 2023 Yonsei medical journal Vol.64 No.2

Purpose: Glioblastoma (GBM) is a malignant brain tumor with poor prognosis. Radioresistance is a major challenge in the treat ment of brain tumors. The development of several types of tumors, including GBM, involves the phosphoinositide 3-kinase (PI3K)/protein kinase B (AKT) signaling pathway. Upon activation, this pathway induces radioresistance. In this study, we investigated whether additional use of selective inhibitors of PI3K isoforms would enhance radiosensitivity in GBM. Materials and Methods: We evaluated whether radiation combined with PI3K isoform selective inhibitors can suppress radiore sistance in GBM. Glioma 261 expressing luciferase (GL261-luc) and LN229 were used to confirm the effect of combination of radi ation and PI3K isoform inhibitors in vitro. Cell viability was confirmed by clonogenic assay, and inhibition of PI3K/AKT signaling activation was observed by Western blot. To confirm radiosensitivity, the expression of phospho-γ-H2AX was observed by immu nofluorescence. In addition, to identify the effect of a combination of radiation and PI3K-α isoform inhibitor in vivo, an intracranial mouse model was established by implanting GL261-luc. Tumor growth was observed by IVIS imaging, and survival was analyzed using Kaplan–Meier survival curves. Results: Suppression of the PI3K/AKT signaling pathway increased radiosensitivity, and PI3K-α inhibition had similar effects on PI3K-pan inhibition in vitro. The combination of radiotherapy and PI3K-α isoform inhibitor suppressed tumor growth and ex tended survival in vivo. Conclusion: This study verified that PI3K-α isoform inhibition improves radiosensitivity, resulting in tumor growth suppression and extended survival in GBM mice.

랜덤 ECU ID 기반 블록체인 활용한 차량용 네트워크 보안성 강화 방안

윤홍 한국정보처리학회 2022 정보처리학회지 Vol.29 No.4

직장암 환자의 골반 방사선치료에서 벨리보드 하위 경계 위치 변화의 영향

윤홍인(Hong In Yoon),정윤선(Yoonsun Chung),김주호(Joo Ho Kim),박효국(Hyo Kuk Park),이상규(Sang Kyu Lee),김영석(Young Suk Kim),최윤선(Yunseon Choi),김미선(Misun Kim),이하윤(Hayoon Lee),장지석(Jeesuk Chang),차혜정(Hyejung Cha),성진실(Jins 대한방사선종양학회 2010 Radiation Oncology Journal Vol.28 No.4

목 적: 방광압박도구(bladder compression device) 추가에 따른 벨리보드(belly board) 하위 경계의 위치 변화에 따라 조사체적(irradiated volume) 내의 각 장기의 체적 차이 및 선량체적히스토그람을 분석하여 벨리보드의 하위 경계의 위치가 미치는 영향에 대해 알아보고자 하였다. 대상 및 방법: 2010년 5월부터 2010년 9월까지 직장암으로 수술 전이나 후에 방사선치료를 위해 벨리보드만 사용하여 전산화 단층촬영을 시행한 경우와 방광압박도구를 추가하여 전산화 단층촬영을 재 시행한 10명을 대상으로 후향적으로 분석하였다. 환자의 중앙나이는 64세(범위, 45∼75세)로 조직학적으로 선암 진단을 받고, 수술 전 혹은 후에 동시항암화학방사선요법을 시행받았다. 방광압박도구 사용 전후 각 체적과 조사체적비의 평균비교 및 복강과 골반강의 조사체적의 합과 소장의 체적비와 방광의 체적비 간의 상관관계를 분석하였다. 결 과: 방광압박도구 추가 후 벨리보드 하위 경계는 치골결합 부위에서 허리엉치관절 부위 상방으로 올라갔다. 방광압박도구 사용 후 소장의 조사체적은 174.3±89.5 mL로 사용 전 조사체적 373.3±145.0 mL보다 유의하게 감소하였고 (p=0.001), 복부골반강(abdominopelvic cavity)의 조사체적도 사용 전보다 유의하게 감소하였다(1,282.6±218.7 mL vs. 1,571.9±158 mL, p<0.001). 방광압박도구 사용 전과 후의 치료체적 안의 방광 체적은 사용 후가 전보다 유의하게 증가하였다(222.9±117.9 mL vs. 153.7±95.5 mL, p<0.001). 방광압박도구 사용 후 복부골반강 대 방광의 조사체적비는 33.5±14.7%로 사용 전 조사체적비인 27.5±13.1%보다 유의하게 증가하였고(<0.001),복부골반강 대 소장의 조사체적비는 방광압박도구 사용 후 유의하게 감소하였다(13.9±7.6% vs. 24.2±10.2%, p<0.001). 결 론: 방광압박도구를 추가함으로 인해 벨리보드의 하위 경계를 허리엉치관절 부위 상방으로 올리는 것이 복부골반강 내 방광의 체적을 증가시켜 소장의 조사체적을 감소시킬 수 있음을 확인할 수 있었다. Purpose: We investigated the effect of location changes in the inferior border of the belly board (BB) aperture by adding a bladder compression device (BCD). Materials and Methods: We respectively reviewed data from 10 rectal cancer patients with a median age 64 years (range, 45∼75) and who underwent computed tomography (CT) simulation with the use of BB to receive pelvic radiotherapy between May and September 2010. A CT simulation was again performed with the addition of BCD since small bowel (SB) within the irradiated volume limited boost irradiation of 5.4 Gy using the cone down technique after 45 Gy. The addition of BCD made the inferior border of BB move from symphysis pubis to the lumbosacral junction (LSJ). Results: Following the addition of BCD, the irradiated volumes of SB and the abdominopelvic cavity (APC) significantly decreased (174.3±89.5 mL vs. 373.3±145.0 mL, p=0.001, 1282.6±218.7 mL vs. 1571.9±158 mL, p<0.001, respectively). Bladder volume within the treated volume increased with BCD (222.9±117.9 mL vs. 153.7±95.5 mL, p<0.001). The ratio of irradiated bladder volume to APC volume with BCD (33.5±14.7%) increased considerably compared to patients without a BCD (27.5±13.1%) (p<0.001), and the ratio of irradiated SB to APC volume decreased significantly with BCD (13.9±7.6% vs. 24.2±10.2%, p<0.001). The ratios of the irradiated SB volumeand irradiated bladder volume to APC volume negatively correlated (p=0.001). Conclusion: This study demonstrated that the addition of BCD, which made the inferior border of BB move up to the LSJ, increased the ratio of the bladder to APC volume and as a result, decreased the irradiated volume of SB.

비소세포성 폐암으로 수술 후 방사선치료가 시행된 N2병기 환자들에서 다발 부위 종격동 림프절 전이 여부에 따른 N2병기 구분의 임상적 의미

윤홍인(Hong In Yoon),김용배(Yong Bae Kim),이창걸(Chang Geol Lee),이익재(Ik Jae Lee),김송이(Songyih Kim),김준원(Jun Won Kim),김주항(Joo Hang Kim),조병철(Byung Chul Cho),이진구(Jin Gu Lee),정경영(Kyung Young Chung) 대한방사선종양학회 2009 Radiation Oncology Journal Vol.27 No.3

목 적: 비소세포성 폐암 림프절 병기 N2 환자에서 수술 후 방사선치료의 결과와 예후에 영향을 주는 인자에 대해 알아보고자 하였다. 대상 및 방법: 1999년부터 2008년 2월까지 비소세포성 폐암으로 진단받고 수술 후 병기 N2로 방사선치료를 시행받은 112명의 환자를 대상으로 하였다. 폐구간절제술(segmentectomy) 및 폐엽절제술(lobectomy)를 시행받은 환자는 75명(67%), 전폐절제술(pneumonectomy)을 시행 받은 환자는 37명(33%)였다. 절제연 음성인 환자는 94명 (83.9%)이었고, 근접절제연 및 절제연 양성인 환자는 모두 18명(16.1%)이었다. 수술 후 보조적 요법으로 103명(92%)의 환자에서 항암치료가 시행되었다. 방사선치료의 분할선량은 1.8에서 2 Gy로 총선량은 45에서 66 Gy가(중앙값, 54 Gy) 시행되었다. 결 과: 전체환자의 2년 생존율과 무병생존율은 각각 60.2%와 44.7%였다. 예후 인자에 대한 단변량 분석을 하였을때 종격동 림프절 부위(nodal station)의 전이가 단일 부위(single-station)인 환자에 비해 다발 부위(multiple-station) 일 때 생존율과 무병생존율이 통계학적으로 의미 있게 감소하였다(p=0.047, p=0.007). T병기가 3기 이상일 때 생존율과 무병생존율이 의미 있게 감소하였다(p<0.001, p=0.025). 종양크기가 5 cm 이상이거나 림프혈관침윤이 양성인 경우 의미 있는 생존율의 감소를 보였고(p=0.035, p=0.034), 무병생존율은 통계학적으로 의미 있는 차이가 없었다. Cox-regression을 이용한 다변량 분석상 전이된 종격동 림프절 부위의 다발 부위 여부와 T병기가(<T3 vs.≥T3) 생존율(p=0.046, p<0.001)과 무병생존율(p=0.005, p=0.033)에 통계학적으로 의미 있는 인자들이었다. 치료후 재발한 환자는 71명(63.4%)이었고, 국소재발은 23명(20.5%), 원격전이는 62명(55.4%), 그리고 국소재발과 원격전이가 동시에 진단된 환자는 14명(12.5%)이었다. 결 론: 수술 후 방사선치료를 시행받은 절제된 N2 병기 비소세포성 폐암에서 전이된 종격동 림프절 부위의 수가 다발 부위인 경우는 중요한 예후 인자로 향후 N2 병기와 관련된 하위 분류 연구와 그에 적절한 보조 요법에 대한 임상 연구가 필요할 것으로 생각한다. Purpose: We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy. Materials and Methods: We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103 (92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8∼2 Gy. Results: The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage (≥T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size (≥5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage (≥T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients. Conclusion: Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.

스테레오 카메라를 이용한 측두하악관절 교정장치(NO SICK)의 성능 평가

윤홍일(Yun, Hong-Ii),박준수(Park, Joon-Su),정구영(Chung, Koo-Yeong),신기영(Shin, Ki-Young),박준기(Park, Joon-Ki) 한국정보전자통신기술학회 2015 한국정보전자통신기술학회논문지 Vol.8 No.5

카이로프래틱 치료에서 측두하악관절(TMJ)는 인체의 균형을 유지하는데 중요한 역할을 하는 관절로서 구강내 교정장치를 통해 인체의 균형을 교정할 수 있게 된다. 현재 이러한 구강내 교정장치의 효과를 스테레오비전을 이용하여 정량적으로 평가할 수 있는 측정 장치가 없었기 때문에 본 연구에서는 이를 측정 할 수 있는 시스템을 개발하였다. 이 시스템은 스테레오 비전과 적외선 조명, 적외선 통과 필터 등으로 구성되어 있으며, 광학식 마커를 피험자의 주요 부위에 부착하여야 한다. 마커의 부착위치는 얼굴의 주요 랜드 마커 중 구강내 교정장치의 착용으로 인해 변화가 나타날 수 있는 8개의 부위를 선택하였다. 개발된 시스템을 이용하여 11명의 피험자를 대상으로 교정장치 착용 전/후 마커의 변화량을 측정하였을 때, 피험자의 얼굴에 부착된 마커의 위치 변화가 정량적으로 측정되었다. TMJ(TemporoMandibular Joint) is considered as the most important articulation in human body for maintaining the balance. Thus it is one of the main treatment areas in Chiropractic. Instead of Chiropractic treatment, NOSICK, a TMJ balancing device, can be used. As there is no such device to quantify the effect of NOSICK, a system was developed to measure the effect of NOSICK. This system is composed of stereo vision, infrared lights, and infrared through filter, etc. It requires optical markers for the measurement. 8 land markers were selected from the face which will show different displacement as NOSICK is applied. 11 test subjects were measured with the system developed with and without NOSICK applied. Quantifiable displacement of markers before and after applying NOSICK was successfully measured with the system developed.