동시 간 전이가 있는 직장암 환자에서 원발 부위에 대한 수술 후 보조 방사선 치료의 역할

표홍렬 (Hong Ryull Pyo),성진실 (Jin Sil Weong),신현수 (Hyun Soo Shin),이형식 (Hyung Sik Lee),김귀언 (Gwi Eon Kim),서창옥 (Chang Ok Suh),노준규 (Juhn Kyu Loh),김우철 (Woo Cheol Kim) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.1

Among the patients with rectal cancer who entered Yonsei University Hospital for management from Jan. 1980 to Dec. 1990, we selected 23 subjects who were received surgical resection of tumor in rectum, and who proved to have liver metastasis during the diagnostic work-up, at the time of the operation, of within 3 months after starting definitive treatment. With those subjects, we investigated the role of radiation therapy by comparison of the treatment results of the patients without radiation therapy (S group) with those of the patients with radiation therapy to the primary site (S+R group). The local control rates of S group and S+R group were 64% and 89%, and 2-year survival rates were 50% and 78%, respectively. Although there was not statistically meaningful difference, local control rate and 2-year survival rate were higher in the group with radiation therapy to primary site than that without radiation therapy. The 2-year survival rates of the case with resection of the liver and the case without it were 636% and 58.3% respectively, which was not statistically significant. Also, the 2-year survival rate of the case with sustained local control was higher than that of the case with local failure, which was statistically significant (76.5% and 16.7%, p<0.005). From the above results, it is thought that radiation therapy to the primary site might improve the local control rate even in the patients with liver metastasis, which seems to be correlated to the higher survival rate.

국한성 두경부 비호지킨스 림프종 환자에서의 다방면치료

표홍렬(Hong Ryull Pyo),서창옥(Chang Ok Suh),김귀언(Gwi Eon Kim),노재경(Jae Kyung Rho) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.2

Purpose : Traditionally the patients with early stage non-hodgkin's lymphoma of the head and neck was treated with radiotherapy. But the results were not satisfactory due to distant relapse. Although combined treatment with radiotherapy and chemotherapy was tried with some improved results and chemotherapy alone was also tried in recent years, the choice of treatment for the patients with early stage non-Hodgkin's lymphoma of the head and neck has not been defined. Therefore, in order to determine the optimum treatment method, we analysed retrospectively the outcomes of the patients with Ann Arbor stage Ⅰ and Ⅱ non-Hodgkin's lymphoma localized to the head and neck who were treated at Severance Hospital. Materials and Methods : 159 patients with stage Ⅰ and Ⅱ non-Hodgkin's lymphoma localized to the head and neck were treated at out hospital from January. 1979 to December. 1992. Of these patients, 114 patients whose primary sites were Waldeyer's ring or nodal region and received prescribed radiation dose and/or more than 2 cycles of chemotherapy were selected to analyze the outcomes according to the treatment methods (radiotherapy alone, chemotherapy alone, and combined treatment with radiotherapy and chemotherapy). Results : Five year overall actuarial survival of the patients whose primary site was Waldeyer's ring was 62.5% and that of the patients whose primary site was nodal region was 53.8%. There was no statistically significant difference between survivals of both groups. Initial response rate to radiotherapy, chemotherapy, and combined treatment was 92%, 83%, 94% respectively, and 5 year relapse free survival was 49.9%, 52.4%, 58.5% respectively (statistically not significant). In the patients with stage Ⅰ, 3 year relapse free survival of chemotherapy alone group was 75% and superior to other treatment groups. In the patients with stage Ⅱ, combined treatment group revealed the best result with 60.1% of 3 year relapse free survival. The effect of sequential schedule of each treatment method in the patients who were treated by combined modality was analyzed and the sequence of primary chmotherapy+radiotherapy+maintenance chemotherapy showed the best result (3 year relapse free survival was 79.1%). There was no significant survival difference between BACOP regimen and CHOP regimen. REsponse to treatment was only one significant (p<0.005) prognostic factor on univariate analysis and age and mass size was marginally significant (p<0.1). On multivariate analysis age (p=0.026) and mass size (p=0.013) were significant prognostic factor for the relapse free survival. Conclusion : In summary, the patients, who have non-Hodgkin's lymphoma fo the head and neck with stage Ⅰ and mass size smaller than 10cm, can be treated by chemotherapy alone, but remainder should be treated by combined treatment method and the best combination schedule was the sequence of initial chemotherapy followed by radiotherapy and maintenance chemotherapy.

경부 유건종(Desmoid Tumor)의 방사선치료

표홍렬(Hong Ryull Pyo),신현수(Hyun Soo Shin),김귀언(Gwi Eon Kim),박정수(Cheong Soo Park) 대한두경부종양학회 1991 대한두경부 종양학회지 Vol.7 No.1

A 66 years old female who had a huge desmoid tumor on her left neck was treated by partial excision and postoperative irradiation. Detailed summary of this rare tumor are included with a review of the literature about treatment modality including irradiation. We suggest that local irradiation is one of the effective treatment tools in the management of desmoid tumor, especially, in the case of unresectable or postoperative residual tumors on the neck.

마우스 종양에서 저선량 방사선이 Apoptosis의 유도에 미치는 영향

성진실(Jinsil Seong),표홍렬(Hong Ryull Pyo),정은지(Eun Ji Chung),김성희(Sung Hee Kim),서창옥(Chang Ok Suh) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.4

목 적 : 방사선에 의한 apoptosis 유도에 저선량 방사선이 미치는 영향을 관찰하여 adaptive response 현상이 관계되는지를 마우스 종양에서 분석하고 관련되는 기전에 관하여 연구하고자 하였다. 대상 및 방법 : 마우스 동종암인 HCa-I, OCa-I에서 저선량 (0.05 Gy) 방사선 조사 후 고선량 (25 Gy)을 조사하여 이로부터 일정시간 후 종양에서 유도된 apoptosis 수준을 비교분석하였다. 또한, apoptosis의 조절 물질인 p53, Bcl-2, Bax, Bcl-X 등의 발현을 Western blotting으로 분석하여 관련된 기전을 연구하였다. 결 과 : OCa-I에서 0.05 Gy 를 전처치 후에 25 Gy 를 조사한 군에서 apoptosis의 유도 수준은 세포 1000개당 229로서 예상되는 값인 324 에 비하면 약 30%정도 감소된 결과로 나타나서( p<0.05) 저선량의 방사선에 의하여 apoptosis의 유도 수준이 감소한 것으로 나타났다. 반면 HCa-I에서는 예상된 apoptosis수준과 실제 관찰치간에 변화가 없었다. 유전물질의 발현에서 p53은 두 종양 공히 0.05 Gy 조사군, 25 Gy 조사군 및 0.05+25 Gy 조사군에서 발현이 증가되었다. Bcl-2와 Bax는 두 종양 모두 발현 수준의 등락이 현저하지는 않았으나 OCa-I의 0.05+25 Gy 조사군에서 Bcl-2의 발현이 Bax 를 상회하는 결과를 보였다. Bcl-X는 HCa-I에서 0.05 Gy 정도의 저선량에서부터 높은 상승을 보인 반면, OCa-I에서는 전혀 발현되지 않았다. 결 론 : 마우스 종양의 일부에서 0.05 Gy 의 저선량이 고선량 방사선에 의한 apoptosis 유도에 대하여 adaptive response를 보이는 것으로 나타났다. 이는 Bcl-2, Bax의 발현 수준과 Bcl-X 등이 관련되는 것으로 보였다. 본 연구는 방사선에 의한 apoptosis에서 adaptive response의 관련성이 일정치 않다는 것을 마우스 종양에서 보여주었다. Purpose : To investigate the presence of adaptive response by low dose radiation in murine tumors in relation to radiation induced apoptosis as well as related mechanism. Materials and Methods : Syngeneic murine tumors, OCa -I and HCa-I, were given 0.05 Gy pretreatment followed by therapeutic dose of 25 Gy radiation. Induction of apoptosis was analyzed for each treatment group. Regulating molecules of apoptosis, p53, Bcl-2, Bax, Bcl-X, were also analyzed by Western blotting. Results : In 0.05 Gy pretreatment group of OCa -I, 25 Gy -induced apoptosis per 1000 cells was 229, which was estimated at 30% lower level than the expected ( p<0.05). In contrast, this reduction in radiation induced apoptosis was not seen in HCa-I. In the expression of apoptosis regulating molecules, p53 increased in both tumors in response to radiation. Bcl-2 and Bax did not show significant change in both tumors however, the expression of Bcl-2 surpassed that of Bax in 0.05 Gy pretreatment group of OCa -I. Bcl - X was not expressed in OCa -I. In HCa -I, Bcl-X showed increased expression even with 0.05 Gy. Conclusion : Adaptive response by low dose radiation is shown in one murine tumor, OCa -I, in relation to radiation induced apoptosis. Apoptosis regulating molecules including Bcl -2/Bax and Bcl-X, appear to related. This study shows an evidence that adaptive response is present, but not a generalized phenomenon in vivo.

치료방사선과 의료서비스에 대한 원가산정

신경환(Kyung Hwan Shin),신현수(Hyun Soo Shin),표홍렬(Hong Ryull Pyo),이규찬(Kyu Chan Lee),이윤래(Yoon Tae Lee),명희봉(Hee Bong Myoung),염용권(Yong Kwon Yeom) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2

목 적 : 치료방사선과 의료서비스에 투입된 자원을 토대로 의료서비스별 원가를 산정하여 적절한 수가수준을 알아보고자 본 연구를 시행하였다. 대상 및 방법 : 현행 ‘의료보험요양급여기준 및 진료수가기준(95년 12월판)’을 검토후 적절치 못한 수가항목을 재조정하고 이를 토대로 원가조사표를 개발한 후 40개병원을 대상으로 조사를 실시하여 의뢰하여 적절한 자료가 수집된 24개 병원의 자료를 분석하였다. 원가자료는 1995년도 1년간 발생한 비용자료로서 의료서비스별 원가를 산출후 의료장비의 가동률에 근거한 조정원가를 계산하였다. 현행 보험수가와의 비교를 위하여 3차병원 가산율 30%를 적용한 후 이를 본연구 결과로 산출된 조정원가와 비교하였다. 결 과 : 의료서비스별 추정원가 및 조정원가를 산출한 후 이를 현행 보험수가와 비교한 결과 방사선치료계획의 경우 5.05배-6.58배, 차폐물제작은 2.22배, 체외조사는 1.57배-2.86배, 강내치료 및 조직내치료는 3.82배-5.01배, 전신조사는 1.12배-2.55배씩 조정원가에 비하여 현행 보험수가가 낮은 가격을 보이는 것으로 나타났다. 또한 현행 진료수가기준의 진료행위 분류체계는 각진료행위의 원가를 적절히 반영하기에는 부적절하다고 판단되며 전신조사의 경우 적절한 재분류시 약 5배의 수가 차이를 보이는 것으로 생각된다. 결 론 : 치료방사선과의 현행 의료보험수가제도에서의 문제점은 보험수가의 수준이 낮다는 점과 진료행위 분류체계가 부적절하게 되어있다는 점이다. 향후 수가 책정시 이러한 문제점이 적절히 반영, 해결되도록 하여야 할 것으로 판단된다. Purpose : The main purpose of this study is to develop new payment rates for services of Radiation Oncology, considering costs of treating patients. Material and Methods : A survey of forty hospitals has been conducted in order to analyze the costs of treating patients. Before conducting the survey, we evaluated and reclassified the individual service items currently using as payments units on the fee-for-service reimbursement system. This study embodies the analysis of replies received from the twenty four hospitals. The survey contains informations about the hospitals' costs of 1995 for the reclassified service items on Radiation Oncology. After we adjust the hospital costs by the operating rate of medical equipment, we compare the adjusted costs with the current payment rates of individual services. Results : The current payment rates were 5.05-6.58 times lower than the adjusted costs in treatment planning services, 2.22 times lower in block making service, 1.57-2.86 times lower in external beam irradiation services, 3.82-5.01 times lower in intracavitary and interstitial irradiation and 1.12- 2.55 times lower in total body irradiation. Conclusion : We could conclude that the current payment system on Radiation Oncology does not only reflect the costs of treating patients appropriately but also classify the service items correctly. For an example, when the appropriate costs and classification are applied to TBI, the payment rates of TBI should be increased five times more than current level.

국한성 두경부 혈관 중심위 림프종에서 화학방사선 병용치료법과 방사선치료 단독요법의 비교

장세경(Sei Kyung Chang),김귀언(Gwi Eon Kim),이상욱(Sang-wook Lee),박희철(Hee Chul Park),표홍렬(Hong Ryull Pyo),김주항(Joo Hang Kim),문성록(Sun rock Moon),이형식(Hyeong Sik Lee),최은창(Eun Chang Choi),김광문(Kwang Moon Kim) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.1

목적: 국한성 두경부 혈관 중심위 림프종에서 화학방사선 병용치료법과 방사선치료 단독용법의 치료성적을 비교하여 화학방사선 병용치료법의 임상적 유용성 여부를 알아보고자 하였다. 대상 및 방법: 1976년부터 1995년까지 연세암센터에서 병기 Ⅰ,Ⅱ기의 두경부 혈관 중심위 림프종으로 치료받은 143예를 대상으로 하였다. 방사선치료단독(104예)의 경우 20~70 Gy(중앙갑 50.4 Gy)를 병소 부위에 국소적으로 조사하였고 화학방사선 병용치료(39예)의 경우에는 1~6회(중앙값 3회)의 화학요법을 시행한 후 병소 부위에 국소적으로 방사선치료를 시행하였다. 치료방법에 따른 반응율, 치료실패양상, 후유증, 생존율 등을 비교하여 보았다. 결과: 치료에 대한 높은 반응율에도 불구하고 국소치료실패가 치료실패양상의 가장 흔한 원인이었고 화학요법의 시행에 따른 치료실패양상의 변화는 없었다. 치료방법에 따른 환자들의 순응도에는 차이가 없었으나 혈구포식세포증후군(hemophagocytic syndrome), 폐혈증, 난치성 출혈(intractable bleeding), 2차 암(new primary cancer) 등의 발생빈도는 화학방사선 병용치료법을 시행한 경우에 방사선치료 단독용법을 시행한 경우보다 높은 경향을 나타냈다. 방사선 단독으로 치료한 경우의 5년 생존율과 무병 생존율은 각각 38%와 32%로 저조하였고 화학요법의 병용 여부는 생존율에 영향을 미치지 못했다. 결론: 국한성 두경부 혈관 중심위 림프종의 치료에서 화학방사선 병용치료법이 방사선치료 단독요법보다 유용하다는 사실이 입증되지 못하였다. Purpose: To Clarify the clinical benefit derived from the combined modality therapy (CMT) consisting of chemotherapy (CT) and involved field radiotherapy (RT) for stage Ⅰ and Ⅱ angiocentric lymphomas of the head and neck. Materials and Methods: Of 143 patients with angiocentric lymphoma of the head and neck treated at our hospital between 1976 and 1995, 104 patients (RT group) received involved field RT alone with a median dose of 50.4 Gy(range: 20~70 Gy), while 39 Patients (CMT group) received a median 3cycles(range: 1~6 cycles) of CT before involved field RT. The response rate, patterns of failure. complications, and survival data of the RT group were compared with those of the CMT group. Results: Despite a higher response rate, local failure was the most common pattern of failure in patients of both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination CT. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignencies were more frequently observed in patients of the CMT group. The prognosis of patients in the RT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic CT. Achieving complete remission was the most important prognostic factor by univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival. conclusions: Involved field RT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the addition of CT to involved field RT failed to demonstrate any therapeutic advantage over involved over involved field RT alone.

직장에 발생한 위장관 간질종양 7예

백승혁(Seung Hyuk Baik),김남규(Nam Kyu Kim),이중호(Chung Ho Lee),이강영(Kang Young Lee),손승국(Seung Kook Sohn),조장환(Chang Hwan Cho),김호근(Ho Geun Kim),표홍렬(Hong Ryull Pyo),라선영(Sun Young Rha),정현철(Hyun Chul Chung) 대한외과학회 2005 Annals of Surgical Treatment and Research(ASRT) Vol.68 No.2