영아 내사시의 임상양상과 수술결과

정은지,장윤희,장지호,한승한,이종복,Eun-Jee Chung,Yoon-Hee Chang,Ji-Ho Chang,Seung-Han Han,Jong-Bok Lee 대한안과학회 2005 대한안과학회지 Vol.46 No.5

Purpose: To study the clinical manifestations and surgical outcome of infantile esotropia. Methods: This review retrospectively examined 165 patients of infantile esotropia who had undergone recession of bilateral medial rectus muscles from April 1991 to September 2001 at our institute. We measured the binocular alignment and analyzed the long term surgical outcome. Results: The average angle of deviation of 165 patients was 45.9±13.99PD (25~90PD) and the average refractive error was +sph 1.18±2.25D (-sph 7.00~+sph 6.00D). Amblyopia was found in 48.4% of the patients, DVD in 12.7%, IOOA in 11.3%, and manifest latent nystagmus in 6.0%. A binocular alignment within 10 PD was achieved in 73.9% and 57.9% at the 2nd and 4th post-operative year respectively. Conclusions: The surgical outcome of bimedial rectus muscle recession in infantile esotropia was satisfactory in 74%, and 58% of the patients at the 2nd and 4th post-operative year respectively.

Distant Metastases of Nasopharyngeal Carcinoma after Definite Irradiation

정은지,이형식,문성록,김귀언,노준규,Chung Eun Ji,Lee Hyung Sik,Moon Sun Rock,Kim Gwi Eon,Loh John Juhn-Kyu The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

1977년 7월부터 1987년 6월까지 10년간 연세대학교 의과대학 치료방사선과에서 방사선 치료를 받았던 135명의 비인강암 환자 중 치료시작 당시 조직학적으로 늑진되지 않았던 환자, 원격전이를 동반하고 있었던 환자 및 방사선 치료를 완료하지 못한 환자 30명을 제외한 105명 환자를 대상으로 원격전이의 빈도, 양상 및 예후를 분석하였다. 원격전이 진단은 임상증상과 방사선 소견으로 하였으며, 대상환자 105명중 원격전이를 보인 환자는26명으로 원격전이율 $24.8\%$였으며, 원격전이의 장기는 이전의 다른보고들에서와 마찬가지로골전이 $(50.0\%)$가 가장 많았고, 다음이 폐 $(19.3\%)$, 간$(11.5\%)$, 뇌 $(7.7\%)$ 순서였다. 원격전이에 영향을 미치는 인자로 연령, 성별, AJC의 T병기, N병기, Ho의 T병기, N병기, 조직 세포유형 및 치료방법등을 분석해 보았으나 Ho의 N병기에서만 NO, N1, N2, N3로 감에따라 원격전이율이 증가하는 양상을 보였다(p<0.05) .원격 전이 발생시기는 환자의 $80.8\%$에서 방사선 치료시작부터 2년이내에 일어나는 것을보여 비교적 조기에 발생함을 알 수 있었다. 원격전이가 발생한 26명의 환자에 있어서, 원격전이후 생존율을 살펴보면 중앙 생존치가 9개월이었고 1년생존율 $60\%$, 2년 생존율 $20\%$를 보여 비인강암 환자에서 일단 원격전이가 발생하면 그 예후가 불량함을 알 수 있었다. One hundred and thirty five patients with carcinoma of the nasopharyx were treated by radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University between August 1977 and July 1987. Of the 30 patients omitted: 8 had distant metastases at initial diagnosis or during radiotherapy; 18 Patients refused or did not receive a full course of radiation therapy, and four had not been confirmed histologically. The remaining 105 patients were analysed to determine the incidence and pattern of distant metastases. Diagnosis of distant metastases was made based on clinical signs and radiography, even though histologic confirmation was not made. Twenty-six patients developed distant metastases after definite irradiation of nasopharyx and neck, an incidence rate of $24.8\%$ . The common sites of distant metastases were, in descending order, bone, lung, liver, and brain. There was a strong correlation between Ho's N stage and distant metastases rate. But sex, age, histologic subtype (squamous cell and undifferentiated cell), AJC T and N stage, treatment modalities (radiotherapy alone and radiotherapy combined with chemotherapy) were not significant. Of those patients who developed distant metastases, $80.8\%$ were discovered within 2 years of their radical radiotherapy. The prognosis for nasopharyngeal carcinoma patients developing distant metastases was poor: median survival was nine months and $80\%$ of those patients died within two years of the initial diagnosis of distant metastasis.

Adenocarcinoma of the Uterine Cervix

정은지,신현수,이형식,김귀언,노준규,서창옥,Chung Eun Ji,Shin Hyun Soo,Lee Hyung Sik,Kim Gwi Eon,Loh John Juhn-Kyu,Suh Chang Ok The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

1981년 1월부터 1987년 12월까지 연세대학교 의과대학 치료방사선과에서 침윤성 자궁경부암으로 방사선치료를 받은 총 1850명의 환자들중 조직학적 분류상 선암인 환자 76명 ($4.1\%$)을 대상으로 후향적인 임상분석을 하였다. 대상환자의 연령분포는 27세에서 71세까지로 평균 49세였고, $50\~59$세가 가장 많았다. 환자들의 주소는 대부분 이상자궁출혈($76\%$)이었으며, 병기의 분포는 FIGO 병기 Ib, IIa, IIb, IIIa, IIIb 및 IVa가 각각 16, 8, 33, 14, 5명으로 병기 IIb가 $43.4\%$로 가장 많이 차지했다. 조직학적 아형은 크게 4종류로 나눌 수 있었는데, 순수선암이 48명으로 가장 많았고, 선암과 편평상피암이 섞여있는 아형이 20명이었다. 방사선 치료후 3개월에 분석한 골반내 완전 관해율은 병기 Ib, II, III에 대해 각각 $100\%,\;95.1\%,\;64.3\%$였다. 선암의 조직학적 아형과 분화도, 자궁경부 종양의 크기 및 모양, 병기, 임파절 전이 여부, 치료방법(방사선 단독 및 수술과 방사선 병합요법)등에 따라 생존율을 분석한 결과 병기와 종양의 크기만이 생존율에 영향을 미치는 유의한 예후인자로 밝혀졌다. 전체 환자군의 5년 생존율은 $68\%$였고 병기별로는 Ib기(N=16)가 $90\%$, II기(N=41)가 $66\%$, III기(N=14)가 $54\%$였으며 IVa기(N=5) 환자군에는 5년 생존자가 없었다. 직장 합병증은 $6.6\%$(5/76)로 이중 한명에서 수술요법을시행하였고 방광의 합병증은 2례로 $2.6\%$를 보였다. 이상의 결과로서, 자궁경부선암은 편평상피암에 비해 그 치료성적이 나쁘지 않으므로 치료요법을 결정함에 있어 수술 및 방사선치료등 자궁경부 편평상피암과 같은 치료원칙에 따른다면 좋은 치료결과를 보일 수 있으리라 생각한다. Survival data, prognostic factors, and patterns of failure were retrospectively analyzed for a total of 76 patients with adenocarcinoma of the uterine cervix treated between January 1981 and December 1987, which represents $4.1\%$ of all primary cervical carcinomas treated, at Department of Radiation Oncology, Yensei Cancer Center, Yonsei University College of Medicine. The mean age of the patients was 49 years (range, $27\~79$ years) and the peak incidence was in the group 50 to 59 years of age. More half of the patients were postmenopausal (46/76= $60.5\%$). Most patients ($76\%$) had abnormal vaginal bleeding either alone or in combination with other symptoms. The proportion of stage IIb was $43.4\%$. There were 4 major histologic subtypes: pure adenocarcinoma (48/76=$63.2\%$), adenosquamous carcinoma (20/76=$26.3\%$), papillary (5/76=$6.6\%$) and clear cell carcinoma (3/76=$3.9\%$). Of the many clinicopathologic variables evaluated for prognosis, the most significant prognostic factors were stage of disease and the size of tumor. The overall 5-year survival rate was $68\%$, and the 5-year survival rates for stage Ib, II and III were $90\%,\;66\%\;and\;54\%$, respectively. Control of pelvic tumors was achieved in $93.8\%,\;90.2\%\;and\;50.0\%$ of cases of stage Ib, II and III disease, respectively. In present study, treatment modalities (radiation therapy alone/combined operative and radiation therapy) did not affect the local control of tumor and the survival.

다형성 세망증(Polymorphic Reticulosis)의 방사선 치료 성적

정은지 (Eun Ji Chung),김귀언 (Gwi Eon Kim),박영년 (Young Nyun Park) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.1

During the period form January, 1975, to June, 1989, one hundred patients with histropathologically proven polymorphic reticulosis in the upper respiratory tract were treated with radiation therapy and the analysis of treatment results was undertaken. One hundred patients (69 males, 31 females) with a mean age of 46 years (range 12-79 years) were presented. Nasal cavity was the most frequent site of involvement (56%), and 44 cases had multifocal sites of involvement. The incidence of cervical lymph node metastasis at initial diagnosis was 24%, Staging was determined by Ann-Arbor classification, retrospectively. The number of patients of stage IE, IIE, IIIE and IVE were 35, 60, 1, and 4, respectively. The overall 5 year actuarial survival rates were 38.4%. The difference in 5 year survival rates between patients with stage IE and IIE, with solitary and multiple, with CR and PR after irradiation were significant statistically. For the analysis of failure patterns, failure sites include the following local failure alone (30/55=54.6%) systemic failure alone (9/55=16.4%), both local and systemic failure (16/55=29.0%). Retrograde slide review was available in 29 cases of PMR with respect to histopathologic bases, and immunohistochemical studies were performed using MT1 and DACO-UCHL-1 as T-cell markers, MB2 as a B-cell marker and alpha-1-antichymotrypsin as a histiocytic markers. All that 29 cases showed characteristic histologic features similar to those of peripheral T-cell lymphoma and showed positive reactio to the T-cell marker. These findings suggest strongly that quite a significant portion of PMR may be in fact T-cell lymphoma.

자궁경부 소세포암종의 방사선치료

정은지(Eun Ji Chung),이용희(Yong Hee Lee),김귀언(Gwi Eon Kim),서창욱(Chang Ok Suh) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4

목 적 : 자궁경부 소세포암종으로 진단되어 방사선치료를 받은 환자에서 조직병리학적인 재검사를 시행하여 조직병리학적 특성을 알아보고, 환자 및 종양의 특징, 방사선치료 후의 치료 성적 등을 조직병리학적 유형에 따라 후향적으로 비교 분석해 보았다. 대상 및 방법 : 1981년 10월부터 1995년 4월까지 연세의대 연세암센터 치료방사선과에서 자궁경부암으로 방사선치료를 받은 환자 총 2890명 중 조직학적 유형이 소세포암종이었던 환자는 60명으로 2.08%였다. 타병원에서 조직검사 및 병기 결정 후 방사선치료 만을 위해 전과되었던 36예에서는 자궁경부 생검 조직을 확보할 수 없었고, 이들을 제외한 24명에서 조직에 대한 병리학적 재검사가 가능하여 H & E 염색 및 신경내분비 표지인 neuron-specific enolase(NSE), chromogranin, synaptophysin, Grimelius 면역조직화학 염색을 시행하였다. 이들 24예의 환자 및 종양의 특성, 방사선치료에 대한 반응, 치료 실패 양상, 5년 생존율 및 5년 무병 생존율 등을 후향적으로 분석하였다. 결 과 : H & E 염색 및 4가지 neuroendocrine marker 검사 후 13예는 신경내분비암종으로 진단되었고 11예는 소세포 유형의 편평상피암종으로 진단되어 병리학적으로 크게 2가지 군으로 분류하였다. 신경내분비암종으로 분류된 13예 중 5예는 중등도 이상으로 분화가 좋은 편이었으나 8예는 분화가 나쁘거나 미분화되었다. 전체 24예 대상 환자들의 연령은 23-79세로 중앙 연령치 54세였으며 FIGO 병기 분포는 Ib 8예(33.3%), IIa 1예(4.2%), IIb 11예(45.8%), IIIa 2예(8.3%), IIIb 1예(4.2%), IV 1예(4.2%)로 병기 I- II가 20예로 대다수를 차지하였다. 골반 림프절에 전이가 있었던 환자가 5예(20.8%) 있었는데 이 중 3예는 수술후 조직학적으로 확인되었고(2예는 근치적 수술, 1예는 골반 림프절 생검) 다른 2예는 전산화 단층 촬영상 골반 림프절이 커져 있어 전이로 판단되었다. 이들 2가지 병리학적 분류군에 따라 환자 및 종양의 특성을 비교해 보았는데 특별한 차이는 발견할 수 없었으며, 방사선치료에 대한 반응, 치료 실패 양상, 5년 생존율 및 5년 무병 생존율 등의 치료 결과를 비교해 보았을 때 치료 실패 양상에 있어서 소세포형의 편평상피암종에서는 원격 전이가 2예(18.2%)인데 반해 신경내분비암종에서는 6예(46.2%)로 신경내분비암종(neuroendocrine carcinoma)에서 원격 전이율이 높았으나 환자 수가 적어 통계학적인 유의성은 없었다(P>0.05). 결 론 : 병리조직학적 재검사가 가능하였던 24예의 자궁경부 소세포암종 환자 중 13예가 신경내분비암종으로 진단되었으며 나머지 11예는 소세포형의 편평상피암종으로 분류되었는데 환자 및 종양의 특징, 방사선치료 성적을 비교해 볼 때 신경내분비암종에서 원격 전이가 호발하였으나(46.2% vs. 18.2%), 5년 생존율과 5년 무병 생존율의 차이는 없었다. 이런 결과로 자궁경부에서 발생한 소세포암종 중 신경내분비암종의 경우는 원격 전이가 많으므로 방사선치료, 수술 등의 국 소 치료와 더불어 적절한 항암화학요법을 추가하여 치료 결과를 증진시킬 수 있으리라 생각한다. Purpose : This study was performed to identify the histopathologic feature by the reevaluation of the pathologic specimen of the cervical tumors and to evaluate the clinical findings and the treatment results of the patients with small cell carcinoma of the cervix treated by radiotherapy. Materials and Methods : 2890 patients with cervical carcinoma received radiotherapy at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine between October 1981 and April 1995. Of the 2890 patients in this data base, sixty were found to have small cell carcinomas (2.08%). Among them thirty six patients were transferred from other hospitals, the biopsy specimens of those patients were not available. So we could review the slides of the other twenty four patients who were diagnosed at our hospital. Twenty four patients with small cell carcinoma of the cervix were analyzed retrospectively based on the assessment of H & E staining and other four immunohistochemical stains for neuroendocrine differentiation (neuron specific enolase, chromogranin, synaptophysin and Grimelius stain). And we also evaluate the patients and tumor characteristics, response to radiation, patterns of failures, 5 year overall and disease free survival rates. Results : Thirteen tumors were neuroendocrine carcinomas (13/24=54.2%) and eleven tumors were squamous carcinomas, small cell type (11/24= 47.8%) based on the assessment of H & E staining and other four neuroendocrine marker studies. So we classified the patients two groups as neuroendocrine carcinoma and small cell type of squamous carcinoma. Among the 13 neuroendocrine carcinomas, five were well to moderately differentiated tumors and the other eight were poorly differentiated or undifferentiated ones. The median age was 54 years old (range 23-79 years). Eight patients had FIGO stage IB disease, 12 had stage II, 3 had stage III and one had stage IV disease. Pelvic lymph node metastases were found in five patients (20.8%), three of them were diagnosed by surgical histologic examination and the other two were diagnosed by CT scan. There was no difference between two histopathologic groups in terms of patients and tumor characteristics, response to radiation, 5 year overall and disease free survival rates. However the distant metastases rate was higher in neuroendocrine carcinoma patients (6/13:46.2%) than in small cell type of squamous carcinoma patients (2/11:18.2%), but there was no statistically significant difference because of the small number of patients (P>0.05). Conclusion : More than half of the small cell carcinoma of the cervix patients were neuroendocrine carcinoma (13/24 : 54.1%) by reevaluation of the biopsy specimen of the cervical tumors. The tendency of distant metastases of the neuroendocrine carcinoma was greater than those of the small cell type of squamous carcinoma (46.2% vs. 18.2%). But there were no differences in the patients and tumor characteristics and other clinical treatment results in both groups. These data suggest that radical local treatment such as radiotherapy or radical surgery combined with combination systemic cytotoxic chemotherapy might provide these patients with the best chance for cure.

Distant Metastases of Nasopharyngeal Carcinoma after Definite Irradiation

Eun Ji Chung(정은지) , Hyung Sik Lee(이형식) , Sun Rock Moon(문성록) , Gwi Eon Kim(김귀언) John Juhn-Kyu Loh(노준규). 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

1977년 7월부터 1987년 6월까지 10년간 연세대학교 의과대학 치료방사선과에서 방사선 치료를 받았던 135명의 비인강암 환자 중 치료시작 당시 조직학적으로 확진되지 않았던 환자, 원격전이를 동반하고 있었던 환자 및 방사선 치료를 완료하지 못한 환자 30명을 제외한 105명 환자를 대상으로 원격전이의 빈도, 양상 및 예후를 분석하였다. 원격전이 진단은 임상증상과 방사선 소견으로 하였으며, 대상환자 105명중 원격전이를 보인 환자는 26명으로 원격전이율 24.8%였으며, 원격전이의 장기는 이전의 다른 보고들에서와 마찬가지로 골전이(50.0%)가 가장 많았고, 다음이 폐(19.3%), 간(11.5%), 뇌(7.7%) 순서였다. 원격전이에 영향을 미치는 인자로 연령, 성별, AJC의 T병기, N병기, Ho의 T병기, N병기, 조직세포유형 및 치료방법등을 분석해 보았으나 Ho의 N병기에서만 N0, N1, N2, N3로 감에따라 원격전이율이 증가하는 양상을 보였다 (p One hundred and thirty five patients with carcinoma of the nasopharyx were treated by radiation therapy in the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University between August 1977 and July 1987. Of the 30 patients ommitted : 8 had distant metastases at initial diagnosis or during radiotherapy; 18 patients refused or did not receive a full course of radiation therapy, and four had not been confirmed histologically. The remaining 105 patients were analysed to determine the incidence and pattern of distant metastases. Diagnosis of distant metastases was made based on clinical signs and radiography. even though histologic confirmation was not made. Twenty-six patients developed distant metastases after definite irradiation of nasopharyx and neck, an incidence rate of 24.8%. The common sites of distant metastases were, in descending order, bone, lung, liver, and brain. There was a strong correlation between Ho's N stage and distant metastases rate. But sex, age, histologic subtype(squamous cell and undifferentiated cell), AJC T and N stage, treatment modalities (radiotherapy alone and radiothergrapy combined with chemotherapy) were not significant. Of those patients who develop distant metastases, 80.8% were discovered within 2 years of their radical radiotherapy. The prognosis for nasopharyngeal carcinoma patients developing distant metastases was poor : median survival was nine months and 80% of those patients died whthin two years of the initial diagnosis of distant metastasis.

소아암의 방사선 치료후 발생한 이차 악성 고형 종양

정은지(Eun Ji Chung),서창옥(Chang Ok Suh),김귀언(Gwi Eon Kim),유철주(Chuhl Joo Lyu),김병수(Byung Soo Kim) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.3

Radiotherapy and chemotherapy can effectively control cancer but can also cause new second cancers to develop as long-term complications especially in childhood cancer. We experienced two patients with second malignant solid neoplasm who had been treated with radiation and chemotherapy for childhood cancers. One female patient with rhabdomyosarcoma of the right popliteal fossa was treated with radiotherapy at total dose of 54Gy. Three years and seven months later, osteosarcoma developed in the field of the small bowel was treated with radiotherapy and leiomyosarcoma developed in the field of radiotherapy 18 years later. We reviewed the literature of the second malignant neoplasm in children in respect of risk factors. The risk for a second primary cancer following radiotherapy or chemotherapy emphasizes the need for life long follow-up of patients receiving such treatments, particularly patients treated for childhood cancers. 방사선치료와 항암화학요법 등 암의 치료법이 점차 발전해감에 따라 치료후 장기간 생존하는 환자들이 많아지고 특히 소아암 치료후 장기 생존자가 증가하면서 여러가지 치료로 인한 합병증 및 문제점들이 발생하고 있다. 그중 중요한 하나가 이차암의 발생인데 본과에서 이차 악성 고형 종양 발생 환자 2예를 경험하였이게 보고하고자 한다. 한 예는 우측 슬와부에 발생한 rhabdomyosarcoma group Ⅱ로 수술후 방사선치료 및 항암화학요법을 시행받았는데 3년 7개월 후 방사선치료부위에서 osteosarcoma가 발생하였고 또 다른 한 예는 우측 하복부에 소장 악성 림프종이 발생하여 방사선치료 및 항암화학요법을 시행받았고 18년후에 방사선치료부위에 leimyosarcoma가 발생하였다. 문헌 고찰을 통해 소아암 치료후 이차암 발생의 위험 요인들을 고찰하였고 이차암에 대한 인식 및 세밀한 추적 조사가 필요함을 확인하였다.

병기 T1 성문암의 방사선치료

정은지(Eun Ji Chung),이상욱(Sang Wook Lee),이창걸(Chang Geol Lee),김귀언(Gwi Eon Kim),김광문(Kwang Moon Kim),홍원표(Won Pyo Hong) 대한두경부종양학회 1996 대한두경부 종양학회지 Vol.12 No.1

Radiation therapy in T1 glottic cancer offers an excellent cure rate with preservation of voice. From 1983 to 1992 eighty nine patients with TNM staged T1N0M0 invasive squamous cell carcinoma of the glottis were treated at the Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University. There were 84 men and 5 women with median age of 59 years. All patients were treated either with Co-60 teletherapy unit or 4MV linear accelerator with an median dose of 6400 cGy(6000-7000 cGy), 200 cGy per day, 5 days in a week. Fourteen local failures have been observed and the median time to local recurrence was 17 months. There were no nodal failure without local recurrence or distant metastases. The 5 year local control rate was 84.3%. The 5 year actuarial surivival rate and the 5 year disease free survival rate were 89.2%, 87.5%, respectively. The 5 year actuarial survival rate and the 5 year disease free survival rate of the nineteen patients with anterior commissure involvement were 77.8% and 74.5% which were lower than those of seventy patients without anterior commissure involvement(91.6%, 90.6%)(p < 0.05). Among the several influencing factors, anterior commissure involvement was the significant prognostic factor. Final local control rate, taking into account the salvage surgery, was 89.9% at 5 years.

Late Rectal Complication in Patients Treated with High Dose Rate Brachytherapy for Stage IIB Carcinoma of the Cervix

정은지(Eun Ji Chung),김귀언(Gwi Eon Kim),서창옥(Chang Ok Suh),금기창(Ki Chang Keum),김우철(Woo Cheol Kim) 대한방사선종양학회 1996 Radiation Oncology Journal Vol.14 No.1

목 적 : 외부 방사선 치료(External Radiation Therapy) 및 Gamma-med (Iridium-192) 고선량 강내 방사선 치료를 받은 자궁 경부암 FIGO stage IIB 환자에서 직장 합병증 발생률 및 이와 관계있는 인자를 후향적으로 분석해 보았다. 대상 및 방법 : 1989년 11월부터 1992년 12월까지 연세암센터 치료방사선과에서 근치적 목적의 외부 및 강내 방사선치료를 받은 FIGO 병기 IIB 자궁경부암 환자 88명을 대상으로 방사선치료후 발생한 직장 합병증 및 이와 연관된 인자들을 분석하여 보았다. 환자들의 연령은 29-83세로 평균치, 중앙치 모두 57세였고 병리조직 분류상 편평상피세포암이 84예 선암이 4예였다. 방사선치료는 외부방사선을 골반 부위에 5-6주 동안 4500-5400cGy 치료하였으며 환자별로 중간 차폐를 시행하였고 고선량 Gamma-med ICR은 A점에 1회당 500cGy씩 1주 2회로 총 3000cGy 조사하였다. 외부 방사선치료시 중앙 차폐까지의 외부 조사량, ICR rectal dose(r) 및 total rectal dose(R), ICRU 38에 따른 ICR rectal dose(Dr)와 total Dr dose(DR), ICR reference volume, TDF, BED(Biologically Effective Dose)를 계산하고 분석해 합병증과의 연관성을 찾아보았다. 대상 환자 88명중 87명(98.9%)에서 최저 24개월 이상 추적 관찰이 가능하였으며 중앙치는 40개월(20-66개월)이었다. 결 과 : 직장 합병증은 27예에서 발생하였는데(30.7%) grade 1이 12예(13.6%), 2가 12예(13.6%), 3이 3(3.4%)예였고 합병증이 발생하는 시기는 방사선치료후 4-43개월(중앙치 16개월, 평균 17.3개월)이었다. 직장 합병증이 발생하지 않은 환자군의 total rectal dose(R)는 6772.67±884.02로 grade 2-3 합병증이 발생한 15명의 R=7163.0±838.49와 유의한 차이를 보였으며 total Dr dose (DR)도 두 군간에 차이를 보였다 또 grade 2-3인 직장 합병증 발생률은 중앙 차폐시 까지의 외부 방사선량과 관계가 있었는데 36Gy이하에서는 10%, 36-40Gy는 21.4%, 40Gy 이상에서는 29.3%의 직장 합병증이 발생하여 중앙 차폐까지 조사된 외부 방사선량이 증가할수록 직장 합병증이 증가함을 알 수 있었다. 직장에 조사된 총직장 조사량(R)에 따라 grade 2-3 합병증 발생률이 증가하였는데 65Gy 이하에서는 10.5%, 65-75Gy는 17.2%, 75Gy이상 조사된 환자군에서는 28.5%로 조사량이 증가할수록 직장 합병증이 증가하는 양상이었으며 ICRU 38 에 따른 total rectal dose (DR)에 대해서도 비슷한 양상이었다. ICR rectal dose(r, Dr)만 따로 분석해 보았는데 방사선량과 직장 합병증간에는 차이가 없었다. 그 외의 인자로 분석한 TDF 와 BED도 grade 2-3의 경우에는 그 값이 증가할수록 증가하는 양상을 보였으나 통계적인 유의성은 없었고 Gamma Dot 에서 계산되는 ICR reference volume도 분석해 보았으나 합병증과의 연관성을 발견할 수 없었다. 결 론 : 병기 IIB 자궁경부암 환자에서 외부 방사선치료 및 고선량 강내 방사선치료후 직장 합병증 발생률은 30.7%(grade 2-3: 15예 17%)였다. 직장 합병증 발생에 영향을 미치는 중요한 인자는 직장에 조사된 전골반 방사선량(중앙 차폐까지의 방사선량) 및 고선량 강내 방사선 치료와 합한 총직장 방사선량(r, Dr)으로 나타났으며 이들이 증가할수록 합병증 발생률이 증가하였다. Purpose : This paper reports a dosimetric study of 88 patients treated with a combination of external radiotherapy and high dose rate ICR for FIGO stage IIB carcinoma of the cervix. The purpose is to investigate the correlation between the radiation doses to the rectum, external radiation dose to the whole pelvis. ICR reference volume. TDF, BED and the incidence of late rectal complications, retrospectively. Materials and Methods : From November 1989 through December 1992, 88 patients with stage IIB cervical carcinoma received radical radiotherapy at Department of Radiation Oncology in Yonsei University Hospital. Radiotherapy consisted of 44-54 Gy(median 49 Gy) external beam irradiation plus high dose rate intracavitary brachytherapy with 5 Gy per fraction twice a week to a total dose of 30 Gy on point A. The maximum dose to the rectum by contrast(r, R) and reference rectal dose by ICRU 38(dr, DR) were calculated. The ICR reference volume was calculated by Gamma Dot 3.11 HDR planning system, retrospectively. The time-dose factor(TDF) and the biologically effective dose (BED) were calculated. Results : Twenty seven(30.7%) of the 88 patients developed late rectal complications:12 patients(13.6%) for grade 1, 12 patients(13.6%) for grade 2 and 3 patients(3.4%) for grade 3. We found a significant correlation between the external whole pelvis irradiation dose and grade 2, 3 rectal complication. The mean dose to the whole pelvis for the group of patients with grade 2, 3 complication was higher, 4093.3±453.1 cGy, than that for the patients without complication, 3873.8±415.6 (0.05<p<0.1). The gradual increase in the frequency of grade 2, 3 rectal complication increased as a function in the dose of external beam therapy to the whole pelvis(midline shielding start dose) and total rectal dose. The mean total rectal dose by rectal barium(R) for the group of patients with grade 2, 3 rectal complication was higher. 7163.0±838.5 cGy, than that for the Patients without rectal complication, 6772.7±884.0 (p<0.05). There was no correlation of the rate of grade 2, 3 rectal complication with the ICR rectal doses(r, dr), ICR reference volume, TDF and BED. Conclusion : This investigation has revealed a significant correlation between the dose calculated at the rectal dose by ICRU 38(DR) or the most anterior rectal dose by contrast(R), dose to the whole pelvis and the incidence of grade 2, 3 late rectal complications in patients with stage IIB cervical cancer undergoing external beam radiotherapy and HOR ICR. Thus these rectal reference points doses and whole pelvis dose appear to be useful Prognostic indicators of late rectal complication in high dose rate ICR treatment in cervical carcinoma.

자폐성장애아동의 문제행동 중재프로그램 동향연구

정은지 ( Chung Eun Ji ) 대구대학교 한국특수교육문제연구소 2016 한국특수교육문제연구소 학술대회발표자료집 Vol.2016 No.-