간세포암종의 방사선치료 시 발생하는 간독성에대한 위험인자의 재고찰

이익재 ( Ik Jae Lee ),성진실 ( Jinsil Seong ),심수정 ( Su Jung Shim ),한광협 ( Kwang Hyub Han ),전재윤 ( Chae Yoon Chon ) 대한간학회 2006 Clinical and Molecular Hepatology(대한간학회지) Vol.12 No.3

신문혈(神門穴) 침자극(鍼刺戟)이 심전도(心電圖) 변화(變化)에 미치는 영향(影響)

이익재 ( Ik Jae Lee ),김이화 ( Ee Hwa Kim ),김순중 ( Soon Joong Kim ) 대한경락경혈학회 2005 Korean Journal of Acupuncture Vol.22 No.3

Objectives: The aim of this study is to investigate the effect of Shinmun-acupuncture stimulation on the relationship of change in electrocardiopgraphy (ECG). Methods: For this purpose, 11 healthy volunteers were acupunctured at Shinmun acupoint using the reinforcing or reducing by inserting the needle in the same direction as the channel runs or in the opposite direction (迎隨補瀉). Then, we measured and observed the change of standard leads Ⅰ, Ⅱ and Ⅲ in ECG. Results: In lead Ⅰ, acupuncture treated groups were increased the activity of PR interval and PR segment compared to the control group. In lead Ⅱ, during the acupuncture treated group by inserting the needle in the opposite direction as the channel runs was increased the activity of T wave duration, and after the acupuncture group by inserting the needle in the same direction as the channel runs was increased the activity of PR interval. In lead Ⅲ, acupuncture treated groups were increased the activity of ST duration, PR interval and QT interval. Conclusions: These results suggested that Shinmun acupuncture stimulation plays an important role on the activities of ECG.

곡면의 특이적분을 위한 가상 매핑 방법

이익재(Ik-Jae Lee),권순홍(Sun-Hong Kwon) 한국해양공학회 2019 韓國海洋工學會誌 Vol.33 No.1

A numerical method is suggested for evaluating the singular integral of curved panels in the higher-order boundary element method. Two-step mapping procedures that are significantly related to the physical properties of singular behaviors were developed and illustrated. As a result, the singular behaviors were significantly alleviated, and the efficiency and robustness of the present method for tangentially and axially deformed elements were proven. However, inaccuracies and numerical instabilities of twisted elements were discovered as a result of nonlinearities.

간세포암종의 새로운 치료: Local therapy : 간암의 토모테라피 치료

이익재 ( Ik Jae Lee ),성진실 ( Jin Sil Seong ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.2(S)

직장암의 근치적 절제술 후 보조 화학요법과 보조 화학방사선 병용요법

이강규(Kang Kyoo Lee),박경란(Kyung Ran Park),이익재(Ik Jae Lee),김익용(Ik Yong Kim),심광용(Kwang Yong Sim),김대성(Dae Sung Kim),이종영(Jong Young Lee) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.4

목적 : 본 연구는 AJCC 병기 Ⅱ기와 Ⅲ기의 국소진행성 직장암으로 근치적 절제술을 받은 환자들을 대상으로 각 병기에서 보조 화학요법 단독에 비해 화학방사선 병행요법이 생존율 및 무병생존율을 향상시키는지에 대하여 알아보고자 하였다. 대상 및 방법 : 1989년 1월부터 1999년 12월까지 AJCC 병기 Ⅱ기와 Ⅲ기의 직장암으로 근치적 절제술이 시행된 144명을 대상으로 하였다. 그 중 보조 치료방법에 따라 분류를 하면 화학요법 단독군이 72명이었고, 화학방사선 병행용법군은 72명이었다. 화학요법은 수술 후 UFT를 매일 경구복용하거나 (중앙값 12개월) 5-FU를 기초로 한 항암제를 4주 간격으로 정맥주사하였고, 투여기간은 1~18차례 (중앙값 6차례)이였다. 방사선치료는 직장과 골반 내 영역 림프절 영역에 4,500 cGy를 조사한 후 수술 부위에 540~1,440 cGy (중앙값 540 cGy) 추가조사를 시행하였다. 추적관찰 기간은 20~150개월로 중앙값은 44개월이었다. 결과 : 5년 생존율은 화학요법 단독군과 화학방사선 병행요법군에서 각각 60.9%와 68.9% (p=0.0915)였고, 5년 무병 생존율은 각각 56.1%와 63.8% (p=0.3510)로 두 군사이에 유의한 차이를 보이지 않았다. 병기별로 분석하였을 때 Ⅱ기에서의 5년 생존율은 화학요법 단독군이 71.1%, 화학방사선 병행요법군은 92.2%로 두 군간에 통계적으로 유의한 차이를 보였으나(p=0.0379), 5년 무병생존율에서는 화학요법 단독군이 57.3%, 화학방사선 병행요법군은 85.4%로 두 군간에 통계적으로 유의한 차이를 보이지 않았다(p=0.1482). Ⅲ기에서는 5년 생존율과 무병생존율이 화학요법 단독군에서는 52.0%와 47.8%였고, 화학방사선 병행요법군에서는 55.0%와 49.8%로 두 군 사이에는 유의한 차이를 보이지 않았다. (p=0.4280, p=0.7891). 국소재발율은 화학요법 단독군이 16.7%, 화학방사선 병행요법군은 12.5%였고, 원격 재발율은 화학요법 단독군이 25.0%, 화학방사선 병행요법군은 26.4%였다. 결론 : 본 연구에서는 Ⅱ기에서 보조 화학요법에 방사선치료를 병행함으로써 보조 화학요법 단독 치료시와 비교하여 생존율의 유의한 증가를 보였고, 비록 통계적으로 유의한 차이를 보이지는 못했지만 국소재발율의 감소를 보였다. Purpose : The aim of this study was to determine if postoperative adjuvant chemotherapy (CT) alone and concurrent chemoradiation (CCRT), following radical surgery, improved the disease free survival (DFS) and overall survival (OS) in rectal cancer AJCC stage Ⅱ and Ⅲ patients. Materials and Methods : A total of 144 patients with AJCC stage Ⅱ and Ⅲ rectal cancer who had had radical surgery between 1989 and 1999 were include in the study. Of these patients, 72 had been treated with postoperative CT, and the other 72 with postoperative CCRT. The chemotherapy regimen consisted of oral UFT on a daily basis for 1~12 months (median 12 months) or 5-FU (500 mg/㎡ for 5 days) intravenous (Ⅳ) chemotherapy with 4 week intervals for 1~18 cycles (median 6 cycles). Radiation of 4,500 cGy was delivered to the surgical bed and regional pelvic lymph nodes area, followed by 540~1,440 cGy (median 540 cGy) boost to the surgical bed. The follow-up period ranged from 20 to 150 months, with a median of 44 months. Results : The 5-year OS was 60.9% and 68.9% (p=0.0915), and the 5-year DFS was 56.1% and 63.8%(p=0.3510) for postoperative CT and postoperative CCRT, respectively. In the stage Ⅱ patients, the 5-year OS was 71.1% and 92.2%, and the 5-year DFS was 57.3% and 85.4% for postoperative CT and CCRT respectively. The OS was significantly improved (p=0.0379) but the DFS was not with postoperative CCRT compared to the postoperative CT (p=0.1482). In the stage Ⅲ patients, the 5-year OS was 52.0% and 55.0%, and the 5-year DFS was 47.8% and 49.8% for postoperative CT and postoperative CCRT. There were no statistically significant differences between postoperative CT and CCRT (p=0.4280 and p=0.7891) in OS and DFS. The locoregional relapses were 16.7 and 12.5% for postoperative CT and CCRT, respectively. The distant relapses were 25.0% and 26.4% for postoperative CT and CCRT, respectively. Conclusion : These results showed that postoperative CCRT compared with CT alone improved OS in stage Ⅱ patients. Although there was no statistical significance, the addition of postoperative RT to CT reduced locoregional relapses compared to CT alone

측정기에 따른 고에너지 X-선의 표면 선량 및 최대 선량 지점 고찰

이용하(Yong Ha Lee),박경란(Kyung Ran Park),이종영(Jong Young Lee),이익재(Ik Jae Lee),박영우(Young Woo Vahc),이강규(Kang Kyoo Lee) 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.4

목 적: 고에너지 X-선의 표면선량과 선량보강(build-up) 영역에서의 선량분포는 일반적으로 방사선 계측에 사용되는 전리함 측정기로는 정확한 선량분포를 얻기가 매우 어렵다. 본 연구는 고에너지 X-선 선량계측에 보편적으로 사용되고 있는 여러 측정기를 이용하여 팬톰 표면에서의 흡수선량과 최대 선량 지점(dmax)을 측정하여 측정기 사이의 정확성을 비교 분석하고, 각 치료기관에서 보편적으로 사용되는 측정기 중 표면 선량 측정에 적절한 측정장치를 제안하고 그 유용성을 제시하고자 한다. 대상 및 방법 : 본 실험에서는 6 MV와 15 MV X-선에 대해 조사면이 10×10 cm 2,SSD=100cm에서 TLD, 팀블형 전리함(thimble type ion chamber), 다이오드 검출기, 다이아몬드 검출기와 Markus 평행판 전리함 등을 이용하여 심부선량백분율(percent depth dose: PDD)을 측정하여, 표면 선량(surface dose)과 최대 선량 지점(dmax)을 비교 분석하고,또한 TLD 측정 시와 동일 조건으로 Monte Carlo 계산을 실행하여 TLD의 측정 결과와 비교하였다. 결 과: 6 MV와 15 MV X-선에 대해 Markus 평행판 전리함을 이용하여 측 정 한 표 면 선 량 은 각각 29.31%와 23.36%으로 측정되었으며, TLD는 37.17%와 24.01%, 다이아몬드 검출기는 34.78%와 24.06%, 다이오드 검출기는 38.18%와 27.8%, 팀블형 전리함은 47.92%와 36.01% 였으며, Monte Carlo 계산에 의한 표면 선량 값은 6 MV X-선에 대해 TLD 측정 시와 동일한 조건으로 팬톰 내에 가상적인 TLD를 삽입한 경우 36.22%로 실제 측정값 37.17%와 유사하였다. 최대 선량지점의 깊 이는 모든 측정기에서 6 MV X-선에 대하여 14˜16mm, 15 MV X-선에서는 27˜29mm 사이의 측정기에 따라 작은 차이를 보였다. 결 론: 표면 선량의 경우에는 측정기에 따라 현저한 차이를 보였으며 Markus 평행판 전리함이 사용된 측정기 중 가장 정확한 결과를 보였고, 팀블형 전리함의 경우 다른 측정기에 비해 약 10% 이상 높은 선량을 보여 피부 표면에 가까이 위치한 종양에 대한 방사선 치료계획시에는 임상에서 가장 보편적으로 사용되고 있는 팀블형 전리함의 선량 값을 그대로 사용하기에는 많은 오류가 발생하므로 가능한 표면 선량 측정에 적절한 측정기를 선택하여 사용하거나 측정기 특성을 고려한 보정이 필요할 것으로 생각된다. 최대 선량 지점(dmax)의 결과는 모든 측정기에서 비슷한 결과를 나타내고 있어 본 실험에서 사용한 모든 측정기는 그 특성에 상관없이 최대 선량 지점 측정에 사용이 가능함을 알 수 있었다. Purpose It is difficult to exactly determine the surface dose and the dose distribution in buildup region of hi gh energy X-rays by using the conventional ion chamber. The aim of this study is to evaluate the accuracy of widely used dosimetry systems to measure the surface dose and the depth of maximum dose (d max). Materials and Methods: We measured the percent depth dose (PDD) from the surface to the dmax in either a water phantom or in a solid water phantom using TLD-100 chips, thimble type ion chamber, d i o de detector, diamond detector and Markus parallel plate ion chamber for 6 MV and 15 MV X-rays, 10 × 10 cm 2, at SSD=100cm. We analysed the surface dose and the dmax. In order to verify the accuracy of the TLD data, we executed the Monte Carlo simulation for 6 MV X-ray beams. Results The surface doses in 6 MV and 15 MV X-rays were 29.31% and 23.36% for Markus parallel plate ion chamber, 37.17% and 24.01% for TLD, 34.87% and 24.06% for diamond detector, 38.13% and 27.8% f or diode detector, and 47.92% and 36.01% for thimble type ion chamber, respectively. In Monte Carlo simulation for 6 MV X-rays, the surface dose was 36.22%, which is similar to the 37.17% of the TLD measurement data. The dmax in 6 MV and 15 MV X-rays was 14 16 mm and 27 29 mm, respectively. There was no significant difference in the dmax among the detectors. Conclusion There was are markable difference in the surface dose among the detectors. The Markus parallel plate chamber showed the most accurate result. The surface dose of the thimble i on chamber was 10% higher than that of other detectors. We suggest that the correction should be made when the surface dose of the thimble ion chamber is used for the treatment planning for the superficial tumors. All the detectors used in our study showed no difference in the dmax.

처방선량 및 치료기법별 치료성적 분석 결과에 기반한 자궁경부암 환자의 최적 방사선치료 스케쥴

조재호(Jae Ho Cho),김현창(Hyun Chang Kim),서창옥(Chang Ok Suh),이창걸(Chang Geol Lee),금기창(Ki Chang Keum),조남훈(Nam Hoon Cho),이익재(Ik Jae Lee),심수정(Su Jung Shim),서양권(Yang Kwon Suh),성진실(Jinsil Seong),김귀언(Gwi Eon Kim) 대한방사선종양학회 2005 Radiation Oncology Journal Vol.23 No.3

목 적: 고선량률 강내근접치료와 외부방사선의 병합치료는 자궁경부암의 표준치료법이지만, 최적의 병합 방식 및 선량 분할 스케쥴은 아직 정해지지 않고 있다. 부분적으로는 이에 영향을 미치는 인자들의 다양성 및 기존의 문헌 들의 방사선 선량에 관한 자세한 정보 부족을 그 이유로 들 수 있다. 이에 본 연구는 고선량률 강내근접치료에 대 한 풍부한 경험을 바탕으로 단일기관에서 비교적 균일한 치료를 받은 많은 수의 환자 모집단을 대상으로 이들 다 양한 인자들 및 방사선치료에 대한 자세한 분석을 통해서 최적의 방사선치료를 위한 지침을 얻고자 하였다. 대상 및 방법: 1990년부터 1996년까지 연세암센터에서 고선량률 강내근접치료 및 외부방사선치료로 자궁경부암 에 대한 근치적 치료를 받은 743명의 환자들을 대상으로 하였으며, 중앙추적관찰 기간은 52개월이었다. FIGO 병기 분포는 IB 198명, IIA 77명, IIB 364명, IIIA 7명, IIIB 89명, IVA 8명이었다. 전골반방사선 선량은 23.4∼59.4 Gy (중앙값 45 Gy)의 분포를 보였으며, 진단 시 종양의 크기 및 외부방사선치료에 대한 종양의 반응에 따라서 그 시기를 조절 하는 중앙차폐는 495예에서 시행되었으며, 그 시기는 14.4∼43.2 Gy (중앙값 36.0 Gy)로 비교적 광범위하고 다양한 분포를 보였다. 강내근접치료와 외부방사선치료의 분할 선량 차이를 극복하기 위해 생물학적 유효선량(Biologically Effective Dose, BED) 개념을 적용하였으며, 종양 및 정상 조직에 대한 α/β비는 각각 10 및 3으로 하였다. 모든 개 별 환자의 직장 전벽 및 방광 흡수선량을 분석하였고, 합병증 및 골반제어율과의 상관 관계를 규명하고자 하였다. 이외에도 방사선치료 스케쥴에 영향을 미칠 수 있는 인자들인 총 치료기간, 강내근접치료의 분할 선량 크기, 주치 의의 선호도에 따른 치료 스케쥴 차이 등도 함께 고려하여 분석하였다. 결 과: 전체 환자에서 RTOG Grade 1-4 독성 발생률은 33.1%였다. 전체 환자의 5년 골반제어율은 83%로 분석되었다. 중앙차폐이전 외부방사선선량과 강내근접치료의 합산 BED값(=MD-BED Gyα/β은 α/β=10인 경우 62.0∼121.9 Gy10 (중앙값= 93.0 Gy10)의 분포를, α/β=3인 경우 93.6∼187.3 Gy3 (중앙값=137.6 Gy3)의 분포를 보였다. MD-BED Gy3는 직장합병증 발생과의 관계는 통계적으로 유의하였고, 방광합병증과는 유의하지 않았다. 직장합병증과의 연관성은 MD-BED Gy3보다 개별 환자의 직장전벽 총 선량 BED값인 R-BED Gy3가 훨씬 더 높았다. 요도카테터 풍선의 후방지점이 대변하는 방광의 총 선량 BED값인 V-BED Gy3도 방광합병증과 경향성 테스트에서 통계적 유의성을 보였다. 하지만, 어떠한 방사선선량도 골반제어율과 의미 있는 상관관계를 보이지 않았다. 본 기관에서 주치의의 선호도에 따라 강내근접치료가 외부방사선치료의 중간에 시행되는 형태인 샌드위치기법과 외부방사선치료 후반부에 시행되는 순차적 기법으로 구분하였을 때, 두 방식간 치료성적 및 합병증의 차이는 없었다. 총 치료기간에 대한 분석에서는 치료기간이 길어질수록 재발 위험이 커지는 경향을 보였으나, 나이 및 병기, 종양의 크 기, MD-BED Gy10 등의 예후 인자를 보정한 다변량분석에서는 치료기간이 100일 이상인 경우에만 통계적으로 유의하게 증가하였다. 강내근접치료 분할선량 크기인 3 Gy와 5 Gy 사이에 골반제어율 및 합병증의 차이는 없었다.결 론: 자궁경부암의 최적방사선치료 스케쥴에 대한 지침을 세우기 어렵게 만드는 가장 중요한 이유는 강내근접치료가 갖는 선량분포 특성에서 기인하는 방사선선량-골반제어율 상관 관계의 부재 및 개별 종양의 방사선에 대한 반응 속도가 환자마다 크게 다를 수 있다는 점이다. 따라서 전체적인 원칙과 함께 개인화된 맞춤치료가 필요하다. 치료 지침에 영향을 미칠 수 있는 요소들의 복합적인 고려도 중요하다고 할 수 있겠다. 합병증 발생이 우려되는 경우 생물학적 유효선량을 낮추기 위해 적절한 조기 중앙차폐 및 강내근접치료의 분할선량 크기 감소를 고려해볼 수 있다. Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of 23.4∼59.4 Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-ICBT) was also performed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of 14.4∼43.2 Gy (Median 36.0) of EBRT in 495 patients, while in the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor (α/β=10) and late-responding tissues (α/β=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED Gy3 and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED Gy3 and rectal complications and between V-BED Gy3 and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED Gy10, and the treatment duration. Results: The overall complication rate for RTOG Grades 1∼4 toxicities was 33.1%. The 5-year actuarial pelvic control rate for all 743 patients was 83%. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 Gy10 (median 93.0) for tumors and from 93.6 to 187.3 Gy3 (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED Gy3) and bladder point BED (V-BED Gy3) were 118.7 Gy3 (range 48.8∼265.2) and 126.1 Gy3 (range: 54.9∼267.5), respectively. MD-BED Gy3 showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED Gy3 had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED Gy3. B-BED Gy3 also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences in tumor responses to radiation therapy and the complexity of affecting factors.

Variable Axis Baseplate를 이용한 Non-coplanar 토모테라피의 유용성

하진숙,정윤선,이익재,신동봉,김종대,김세준,전미진,조윤진,김기광,이슬비,Ha, Jin-Sook,Chung, Yoon-Sun,Lee, Ik-Jae,Shin, Dong-Bong,Kim, Jong-Dae,Kim, Sei-Joon,Jeon, Mi-Jin,Cho, Yoon-Jin,Kim, Ki-Kwang,Lee, Seul-Bee 대한방사선치료학회 2011 대한방사선치료학회지 Vol.23 No.1

Purpose: Helical Tomotherapy allows only coplanar beam delivery because it does not allow couch rotation. We investigated a method to introduce non-coplanar beam by tilting a patient's head for Tomotherapy. The aim of this study was to compare intrafractional movement during Tomotherapy between coplanar and non-coplanar patient's setup. Materials and Methods: Helical Tomotherapy was used for treating eight patients with intracranial tumor. The subjects were divided into three groups: one group (coplanar) of 2 patients who lay on S-plate with supine position and wore thermoplastic mask for immobilizing the head, second group (non-coplanar) of 3 patients who lay on S-plate with supine position and whose head was tilted with Variable Axis Baseplate and wore thermoplastic mask, and third group (non-coplanar plus mouthpiece) of 3 patients whose head was tilted and wore a mouthpiece immobilization device and thermoplastic mask. The patients were treated with Tomotherapy after treatment planning with Tomotherapy Planning System. Megavoltage computed tomography (MVCT) was performed before and after treatment, and the intrafractional error was measured with lateral(X), longitudinal(Y), vertical(Z) direction movements and vector ($\sqrt{x^2+y^2+z^2}$) value for assessing overall movement. Results: Intrafractional error was compared among three groups by taking the error of MVCT taken after the treatment. As the correction values (X, Y, Z) between MVCT image taken after treatment and CT-simulation image are close to zero, the patient movement is small. When the mean values of movement of each direction for non-coplanar setup were compared with coplanar setup group, X-axis movement was decreased by 13%, but Y-axis and Z-axis movement were increased by 109% and 88%, respectively. Movements of Y-axis and Z-axis with non-coplanar setup were relatively greater than that of X-axis since a tilted head tended to slip down. The mean of X-axis movement of the group who used a mouthpiece was greater by 9.4% than the group who did not use, but the mean of Y-axis movement was lower by at least 64%, and the mean of Z-axis was lower by at least 67%, and the mean of Z-axis was lower by at least 67%, and the vector was lower by at least 59% with the use of a mouthpiece. Among these 8 patients, one patient whose tumor was located on left frontal lobe and left basal ganglia received reduced radiation dose of 38% in right eye, 23% in left eye, 30% in optic chiasm, 27% in brain stem, and 8% in normal brain with non-coplanar method. Conclusion: Tomotherapy only allows coplanar delivery of IMRT treatment. To complement this shortcoming, Tomotherapy can be used with non-coplanar method by artificially tilting the patient's head and using an oral immobilization instrument to minimize the movement of patient, when intracranial tumor locates near critical organs or has to be treated with high dose radiation.

간 종양의 방사선치료에서 위내용적과 종양 위치 간의 관계

전미진,이창걸,이익재,최원훈,최윤선,신동봉,김종대,김세준,하진숙,조윤진,Jeon, Mi-Jin,Lee, Chang-Geol,Lee, Ik-Jae,Choi, Won-Hoon,Choi, Yun-Sun,Shin, Dong-Bong,Kim, Jong-Dae,Kim, Sei-Joon,Ha, Jin-Suk,Cho, Yoon-Jin 대한방사선치료학회 2010 대한방사선치료학회지 Vol.22 No.2

Purpose: It aims to evaluate the location change and tendency of hepatic and intrahepatic tumors according to gastric volume and change of location. Materials and Methods: It studied 9 patients with hepatic tumors who visited Gangnam Severance Hospital from March 2009 to April 2010 and who underwent CT or PET (Positron Emission Tomography) within 2 weeks before CT-simulation. The patients fasted for 6 hours before CT-simulation and drank 240~250 cc of water just before CT or PET for image fusion. Those two types of images were fused to RTP (Radiation Treatment Planning, Pinnacle 8.0h) focusing on bone structure of individual patients. Results: They drank 240~260 cc of water but their stomach volume after drinking water varied from 259.3 cc to 495.4 cc. Even though individual differences existed in the change of stomach volume before and after drinking water, the volume was increased by 130 cc (174%) on average. The change in absolute distance between the centers of tumors ranged from 0.52 cm to 3.04 cm (1.52 cm on average); from 0.1 cm to 1.35 cm (0.44 cm on average) in cranial-caudal direction; from 0.05 cm to 2.75 cm (1.22 cm on average) in left-right direction; and from 0.05 cm to 1.85 cm (0.33 cm on average) in ventral-dorsal direction. Conclusion: It is hard to predict the movement of tumors by observing stomach movement, due to great individual differences; however, it was observed that the location of hepatic tumors was right-sided as the stomach was filled with water. Thus, it is recommended to maintain the fastened state to secure the accuracy of hepatic tumor treatment. If it cannot maintain the fastened state, it is recommended to measure stomach volumes and movement in the patient to consider the movement of hepatic tumors before radiation treatment.

Internal Mammary Lymph Node Irradiation after Breast Conservation Surgery : Radiation Pneumonitis versus Dose­Volume Histogram Parameters

Joo Young Kim(김주영),Ik Jae Lee(이익재),Ki Chang Keum(금기창),Yong Bae Kim(김용배),Su Jung Shim(심수정),Kyoungkeun Jeong(정경근),Jong Dae Kim(김종대),Chang Ok Suh(서창옥) 대한방사선종양학회 2007 Radiation Oncology Journal Vol.25 No.4

목 적: 방사선 폐렴과 체적­선량 히스토그램(dose­volume histogram, DVH) 변수들 사이의 연관성을 평가하고, 내유림 프절이 포함된 유방암의 방사선치료에서 방사선 폐렴을 방지할 수 있는 실제적인 지침을 제공하고자 한다. 대상 및 방법: 부분유방절제술을 받은 초기 유방암 환자 20명이 본 연구에 포함되었다. 전체 유방, 상부쇄골림프절,내유림프절에 총 28회 50.4 Gy가 조사되었다. 방사선 폐렴은 방사선 영상에서의 폐 변화(radiological pulmonary change; RPC)와 증상이 있는 방사선 폐렴(symptomatic radiation pneumonitis)에 의해 평가되었다. DVH 변수들은 grade<2 RPC와 grade≥2 RPC로 나누어 비교되었다. 이 때, DVH 변수들은 평균 폐 선량(mean lung dose), V10 (10 Gy 이상 받는 폐의 백분율 부피), V20, V30, V40, 그리고 정상 조직 합병증 확률(normal tissue complication probability, NTCP)이다. 결 과: 20명의 환자 중 9명(45%)에서 grade 2 RPC가 발생하였고, 11명(55%)에서는 발생하지 않았다. 1명의 환자에서 grade 1의 증상이 있는 방사선 폐렴이 발생하였다. 단변량 분석에서 DVH 변수 중, NTCP가 두 RPC grade 군 간에 유의한 차이를 보여주고 있다 (p<0.05). Fisher의 정확한 검증(exact test)은 NTCP값 45%가 RPC의 threshold level로서 적합함을 보여준다. 결 론: 본 연구는 NTCP가 유방암의 내유림프절 방사선치료 후 RPC 예측인자 중 한가지로 쓰일 수 있음을 보여준다. 임상적으로 이는 NTCP 45% 이상에서 RPC가 발생하기 용이함을 의미한다. Purpose: To evaluate the association between radiation pneumonitis and dose-volume histogram parameters and to provide practical guidelines to prevent radiation pneumonitis following radiotherapy administered for breast cancer including internal mammary lymph nodes. Materials and Methods: Twenty patients with early breast cancer who underwent a partial mastectomy were involved in this study. The entire breast, supraclavicular lymph nodes, and internal mammary lymph nodes were irradiated with a dose of 50.4 Gy in 28 fractions. Radiation pneumonitis was assessed by both radiological pulmonary change (RPC) and by evaluation of symptomatic radiation pneumonitis. Dose-volume histogram parameters were compared between patients with grade <2 RPC and those with grade ≥2 RPC. The parameters were the mean lung dose, V10 (percent lung volume receiving equal to and more than 10 Gy), V20, V30, V40, and normal tissue complication probability (NTCP). Results: Of the 20 patients, 9 (45%) developed grade 2 RPC and 11 (55%) did not develop RPC (grade 0). Only one patient developed grade 1 symptomatic radiation pneumonitis. Univariate analysis showed that among the dose-volume histogram parameters, NTCP was significantly different between the two RPC grade groups (p<0.05). Fisher’s exact test indicated that an NTCP value of 45% was appropriate as an RPC threshold level. Conclusion: This study shows that NTCP can be used as a predictor of RPC after radiotherapy of the internal mammary lymph nodes in breast cancer. Clinically, it indicates that an RPC is likely to develop when the NTCP is greater than 45%.