임산부의 전뇌 방사선 치료에 있어서의 태아의 방사선량 측정 및 차폐 구조의 설계

지의규,하성환,박양균,박석원,조웅,허순녕,박종민 대한방사선방어학회 2006 방사선방어학회지 Vol.31 No.4

췌장암의 방사선치료

지의규 대한소화기학회 2008 대한소화기학회지 Vol.51 No.2

Radiotherapy has been offered to patients with pancreatic cancer, either in the adjuvant or definitive setting. However, the role of radiotherapy in pancreatic cancer is increasingly doubted, especially after the introduction of gemcitabine to both domains. Although contradictory data exist, combined chemoradiotherapy improves both quantity and quality of life for patients with locally advanced tumors compared with radiotherapy alone or chemotherapy alone. Recently, induction chemotherapy strategy is being evaluated for better selection of patients for optimal benefit from consolidative chemoradiotherapy. Much controversy has been suggested concerning the role of adjuvant radiotherapy, but quality assurance for radiotherapy was not considered in the previously reported studies. Combined chemoradiotherapy in the adjuvant setting is still considered as a viable option. Current phase III randomized on-going studies will provide better answers on the role of radiotherapy in the treatment of pancreatic cancer. (Korean J Gastroenterol 2008;51:101-110)

In Vitro and In Vivo Radiosensitizing Effect of Valproic Acid on Fractionated Irradiation

지의규,신진희,김진호,김학재,김인아,김일한 대한암학회 2015 Cancer Research and Treatment Vol.47 No.3

Purpose This study was conducted in order to validate the radiosensitization effect of valproic acid, a biologically available histone deacetylase inhibitor, for fractionated radiation. Materials and Methods Radiosensitization effect of valproic acid was tested for the A549 cell line and U87MG cell line in vitro. Fractionated irradiation of 12 Gy in four fractions was administered on D2-5 with valproic acid, 150 mg/Kg, ip, bid for six consecutive days (D1-6) to A549 and U87MG tumors implanted in BALB/c-nude mice. A growth delay curve was formulated. Results Radiosensitization effect of valproic acid was found for both cell lines; A549 at 1.5 mM and 3.0 mM concentration and U87MG at 3.0 mM concentration. In growth delay analysis, a statistically significant radiosensitization effect was observed for both tumors (p < 0.001 for both tumors). Difference for change in slope for control and valproic acid versus radiotherapy and radiotherapy plus valproic acid showed borderline significance for the U87MG cell line (p=0.065), indicating beyond additive effect, whereas this difference was statistically insignificant for A549 tumor (p=0.951), indicating additive effect. Conclusion Results of this study indicate that a radiosensitizing effect for fractionated radiotherapy of valproic acid for A549 and U87MG tumors in vivo is evident and that it may be more than additive for U87MG tumors. Further exploitation of histone deacetylase inhibitors in clinical trials is warranted.

The Rise of Particle Beam Therapy: Are We Ready for The Potential Game-Changer?

지의규,안용찬 대한암학회 2021 Cancer Research and Treatment Vol.53 No.3

$^{188}He$을 이용한 혈관내 방사선 치료시 시술자의 방사선 피폭 수준

지의규,이명묵,우홍균,Chie, Eui-Kyu,Lee, Myung-Mook,Wu, Hong-Gyun 대한방사선방어학회 2000 방사선방어학회지 Vol.25 No.4

현재 서울대학교병원에서 진행중인 연구의 일환으로 혈관 내 방사선치료 시 시술자의 방사선피폭 정도 및 위험성에 대해 알아보고자 연구를 시행하였다. 심장혈관 폐색으로 연구에 포함되어 방사선치료른 시행 받은 42명의 환자 중 측정이 완벽한 34명의 자료를 토대로 분석을 시행하였다. 혈관내 방사선치료는 관상동맥성형술 직후 풍선도자법을 이용하여 대상 동맥의 중막에 17 Gy를 조사하였다. 사용된 동위원소는 $^{188}Re$이었으며 GM측정기로 각기 다른 8점에서 피폭선량을 측정하였다. 환자의 심장부위에서 10cm, 40cm 떨어진 지점을 시술자의 최대피폭량, 전신피폭량의 기준으로 삼았다. 치료선량의 중앙값은 111.6 mCi이었고 중앙치료시간은 576초였다. 환자 심장부위에서 l0cm, 40cm 지점의 평균 피폭 선량율은 0.43 mSv/hr, 0.30 mSv/hr 이었고, 각 지점에서의 시술 당 평균 피폭 선량은 0.07 mSv, 0.05 mSv 이었다. 이 수치는 ICRP-60나 과학기술부 고시에서 권고하고 있는 한계 피폭선량보다 훨씬 적은 값으로 현재 저울대학교병원에서 시행하고 있는 혈관내 방사선 치료법은 방사선방어 면에서 매우 안전한 방법임을 확인할 수 있었다. This study was undertaken to estimate the exposed dose of the medical personnel during the intracoronary radiotherapy procedure as a part of ongoing SPARE (Seoul National University Hospital Post-Angioplasty Rhenium) trial. Data of thirty-four patients among forty-two irradiated patients participating in this trial due to coronary artery stenosis were retrospectively analyzed. Intracoronary radiotherapy was delivered to the patient immediately after angioplasty ballooning. Prescribed dose was 17 Gy to media of the diseased artery and was delivered with $^{188}Re$ filled balloon catheter. Dosimetry was carried out with GM counter at eight different points. Ten centimeter and forty centimeter from the patient's heart were selected to represent maximum and whole-body exposed dose of the operator, respectively. Median delivered dose was 111.6 mCi with average treatment time of 576 seconds. Average exposed dose rate at 10 cm and 40 cm from the patient's heart were 0.43 mSv/hr and 0.30 mSv/hr, respectively. Average exposed doses per treatment were 0.07 mSv and 0.05 mSv for 10 cm and 40 cm from the patient's heart, respectively. Exposed doses measured are much lower than recommended limit of 50 mSv for radiation workers or 1 mSv for general population in ICRP-60. This study proves that current method of intracoronary radiotherapy incorporated in this trial is very safe regarding radiation protection.

Barriers in Oligometastasis Care in Korea: Radiation Oncologists’ Perspectives

지의규,임채홍,조원경,안용찬 대한암학회 2023 Cancer Research and Treatment Vol.55 No.4

유방암에서 유방보존수술 및 수술 후 방사선치료의 결과

지의규(Eui Kyu Chie),김규보(Kyubo Kim),최진화(Jin-Hwa Choi),장나영(Na-Young Jang),한원식(Wonshik Han),노동영(Dong-Young Noh),임석아(Seock-Ah Im),김태유(Tae-You Kim),방영주(Yung-Jue Bang),하성환(Sung Whan Ha) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.3

목 적: 조기유방암의 치료에 있어 과거에는 유방 전적출술이 주된 치료였으나 현재는 유방보존술이 표준 치료방법 으로 정립되었다. 저자들은 서울대학교병원에서 유방보존수술 및 방사선치료를 받은 환자의 임상적 특성을 조사 하고 치료결과 및 예후인자를 분석하고자 하였다. 대상 및 방법: 1992년 2월부터 2002년 1월까지 침윤성 유방암으로 유방보존수술 및 수술 후 방사선치료를 받은 424명을 대상으로 후향적으로 분석하였다. 대부분의 환자는 사분절제술 및 액와림프절 청소술을 시행 받았다(396명, 93.4%). 302명이 T1이었고 122명은 T2 병기였으며, 림프절 전이는 107명에서 확인되었다. 방사선치료는 전체 유방에 28회에 걸쳐 50.4 Gy를 조사한 후 종양이 있었던 부위에 10 Gy의 추가조사를 실시하였다. 영역림프절 조사는 57명에서 시행되었다. 항암화학요법은 231명에서 시행되었으며, 그 중 170명이 cyclophosphamide, methotrexate 및 5-fluorouracil을 투여 받았다. 중앙추적기간은 64개월이었다. 결 과: 전체 환자의 5년 국소제어율은 95.6%이었다. 추적관찰 중 15명의 환자에서 국소재발이 확인되었다. 5년 생존율은 93.1%이었고, 병기에 따른 5년 생존율은 I기 94.8%, IIA기 95.0%, IIB기 91.1%, IIIA기 75.9%, IIIC기 57.1% 이었다. 5년 무병생존율은 88.7%이었고, 병기별로는 I기 93.1%, IIA기 89.4%, IIB기 82.8%, IIIA기 62.0%, IIIC기 28.6%이었다. 예후인자 분석에서는 N 병기(p=0.0483)가 생존율에, 연령(p=0.0284)과 N 병기(p=0.0001)가 무병생존율에 각각 유의한 영향을 보였다. 결 론: 조기유방암에서 유방보존수술 및 수술 후 방사선치료는 우수한 국소제어율 및 생존율을 기대할 수 있는 치료법임을 확인할 수 있었다. Purpose: We analyzed the treatment outcomes and prognostic factors of breast conserving surgery, followed by postoperative radiotherapy. Materials and Methods: A total of 424 breast cancer patients treated with breast conserving surgery and postoperative radiotherapy between February 1992 and January 2001 were retrospectively analyzed. A quadrantectomy and axillary lymph node dissection was performed in 396 patients. A total of 302 patients had T1 disease, and 122 patients had T2 disease. Lymph node involvement was confirmed in 107 patients. Whole breast irradiation was administered at up to 50.4 Gy in 28 fractions, followed by a 10 Gy boost in 5 fractions to the tumor bed. In addition, 57 patients underwent regional lymph node irradiation. Moreover, chemotherapy was administered in 231 patients. A regimen consisting of cyclophosphamide, methotrexate, and 5-fluorouracil was most frequently used with 170 patients. The median follow-up time was 64 months. Results: The 5-year local control rate was 95.6%. During the follow-up period, local tumor recurrence was observed in 15 patients. The 5-year overall and disease-free survival rates were 93.1% and 88.7%, respectively. The 5-year overall survival rates, by stage, were 94.8% for stage I, 95.0% for stage IIA, 91.1% for stage IIB, 75.9% for stage IIIA, and 57.1% for stage IIIC. As for disease-free survival, the corresponding figures, by stage (in the same order), were 93.1%, 89.4%, 82.8%, 62.0%, and 28.6%, respectively. The advanced N stage (p=0.0483) was found to be a significant prognostic factor in predicting poor overall survival, while the N stage (p=0.0284) and age at diagnosis (p=0.0001) were associated with disease-free survival. Conclusion: This study has shown that breast conserving surgery and postoperative radiotherapy for early breast cancer results was excellent for local control and survival.

항문암의 치료성적

지의규(Eui Kyu Chie),하성환(Sung Whan Ha),박재갑(Jae-Gahb Park),방영주(Yung-Jue Bang),허대석(Dae Seog Heo),김노경(Noe Kyeong Kim) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.1

목적: 항문암의 치료에 있어 고전적으로는 복회음부절제술이 주된 치료였으나 현재는 화학방사선병용요법이 주된 치료방법으로 정립되었다. 저자들은 서울대학교병원에서 항문암으로 치료 받은 환자의 임상적 특성을 조사하고, 치료방법에 따른 치료성적과 예후인자를 분석하고자 하였다. 대상 및 방법: 1979년 8월부터 1998년 7월까지 서울대학교병원 치료방사선과에서 근치적 또는 수술 후 방사선 치료를 받은 42명의 환자를 대상으로 후향적으로 분석하였다. 표피양암종이 38명으로 방사선치료가 4명에서, 복회음부절제술 및 수술 후 방사선치료±화학요법이 19명에서, 화학방사선요법이 15명에서 시행되었다. 화학방사선요법은 복합화학요법(5-FU 1,000 ㎎/㎡ D1~5, cisplatin 60 ㎎/㎡ D1)을 3회 시행 후 원발병소 및 영역림프절에 50.4 Gy를 조사하였고, 양측 서혜림프절에도 동일양을 조사하였다. 잔존암이 있는 경우 복합화학요법을 3회 추가 실시하였다. 중앙추적기간은 85개월이었다. 결과: 전체 항문암 환자의 5년 생존율은 80.3%이었다. 치료방법에 따른 5년 생존율은 복회음부절제술 및 수술 후 방사선치료±화학요법군, 화학방사선요법군에서 각각 88.9%, 79.4%이었으며 두군간의 생존율의 차이의 통계적인 의미는 없었다(p=0.4923). 화학방사선요법을 시행 받은 환자군에서의 항문보존율은 86.7%였다. 예후인자 중 단변량분석에서는 연령(p=0.0164)과 수행능력(p=0.0007)이 유의성을 보였으며, 다변량분석에서는 연령(p=0.0426)과 수행능령 (p=0.0068) 및 서혜림프절 전이여부(p=0.0093)가 통계학적으로 유의하였다. 결론: 항문암의 치료에 있어서 화학방사선요법을 시행할 경우 기존에 알려진 바와 같이 복회음부절제술과 유사한 생존율을 보이며, 항문기능을 보존할 수 있는 치료 방법임을 확인할 수 있었다. 나아가 병행화학요법이 아닌 선행화학요법을 시행하여 수반되는 합병증을 줄일 수 있는 가능성을 확인하였다. Purpose: This study was undertaken to analyze the efficacy and sphincter preservation rate of platinum based neoadjuvant chemotherapy plus radiotherapy versus abdominoperineal resection and postoperative radiotherapy for anal cancer. Materials and Methods: Data of forty-two patients with anal cancer were retrospectively analyzed. A,mong thirty-eight patients with epidermoid histology, four patients received radiotherapy, and nineteen patients received abdominoperineal resection and adjuvant radiotherapy with or without chemotherapy (APR+RT±CT), and fifteen patients received neoagjuvant chemotherapy and radiotherapy (CRT). The CRT regimen was composed of three cycles of 5-fluorouracil (1,000 ㎎/㎡ bolus on D1~5) and cisplaltin (60 ㎎/㎡ bolus on D1) followed by 50.4 Gy to the tumor bed and regional lymphatics over 5.5 weeks. Both inguinal lymphatics were treated with an identical dose schedule. Residual disease was treated with an additional three cycles of identical adjuvant chemotherapy/ An identical dose schedule was used for post-operative radiotherapy. Median follow-up period was eighty-five months Results: Overall five-year survival rates were 80.3%, 88.9 and 79.4% for entire patients, APR+RT±CT group, and the CRT group, respectively. No significant difference was found between the two groups (p=0.49). Anus preservation rate for the CRT group was 86.7%. Age (p=0.0164) and performance status (p=0.0007) were found to be significant prognostic factors by univariate analysis. Age (p=0.0426), performance status (p=0.0068), and inguinal lymph node metastasis (p=0.0093) were statistically significant prognostic factors by multivariate analysis. No case of RTOG grade 3 complication or higher was reported. Conclusion: This and other recent studies have shown that combined chemotherapy plus radiotherapy for anal cancer results in a high rate of anal sphincter preservation as well as local control and survival. Furthermore, neoadjuvant use of chemotherapy with a cisplatin based regimen rather than a concurrent regimen may lead to a decrease in complications.

기획종설 : 췌장암 ; 췌장암의 방사선치료

지의규 ( Eui Kyu Chie ) 대한소화기학회 2007 대한소화기학회지 Vol.51 No.2

Radiotherapy has been offered to patients with pancreatic cancer, either in the adjuvant or definitive setting. However, the role of radiotherapy in pancreatic cancer is increasingly doubted, especially after the introduction of gemcitabine to both domains. Although contradictory data exist, combined chemoradiotherapy improves both quantity and quality of life for patients with locally advanced tumors compared with radiotherapy alone or chemotherapy alone. Recently, induction chemotherapy strategy is being evaluated for better selection of patients for optimal benefit from consolidative chemoradiotherapy. Much controversy has been suggested concerning the role of adjuvant radiotherapy, but quality assurance for radiotherapy was not considered in the previously reported studies. Combined chemoradiotherapy in the adjuvant setting is still considered as a viable option. Current phase III randomized on-going studies will provide better answers on the role of radiotherapy in the treatment of pancreatic cancer. (Korean J Gastroenterol 2008;51:101-110)

간세포암종의 새로운 치료: Local therapy : 선형가속기를 이용한 간세포암의 방사선치료

지의규 ( Eui Kyu Chie ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.2(S)