성문암(聲門癌) 방사선치료(放射線治療) 20년(年) 성적(成績)

조철구,고경환,유성열,Cho Chul-Koo,Koh Kyoung-Hwan,Yoo Seong-Yul 대한두경부종양학회 1988 대한두경부 종양학회지 Vol.4 No.1

To evaluate the result of radiation therapy for twenty years experience, a total of 115 cases of pathologically proven glottic carcinoma had been analyzed according tot survival respectively. All the patients had been treated with radiation therapy in curative intent using Co-60 teletherapy machine. The results are as follows: 1) Accoridng to sex, 5YSR & 10YSR were 58.7% and 50.4% in male patients, and 80.0% & 72.0% in female. 2) According to T staging, 5YSR & 10YSR were 83.4% & 83.4% in T1, 69.2% & 60.0% in T2, 34.3% & 21.8% in T3, 32.0% & 0% in T4. 3) According to N staging, 5YSR & 10YSR were 63.8% & 59.2% in node-negative groups, and 30.7% & 15.4% in node-positive groups. 4) According to the histologic grade, 5YSR & 10YSR were 66.8% & 57.6% in G1, 61.3% 54.3% in G2, and 35.0% 35.0% in G3. 5) According to AJC staging, 5YSR & 10YSR were 83.4%% 83.4% in stage I, 72.0% & 62.7% in stage II, 36.8% & 28.3% in stage III, and 14.3% & 7.1% in stage IV. 6) In summary, 5YSR & 10YSR wre 60.4% & 52.8% in glottic carcinoma.

방사선 조사에 의한 DNA Double Strand Breaks의 생성 및 회복에 미치는 인삼 알칼로이드 분획의 효과

조철구,김태환,류성렬,고경환,김미숙,김정희,김성호,윤형근,지영훈,Cho Chul Koo,Kim Tae Hwan,Yoo Seong Yul,Koh Kyoung Hwan,Kim Mi Sook,Kim Jeong Hee,Kim Seong Ho,Yoon Hyung Keun,Ji Young Hoon 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.2

Purpose : To investigate the effect of alkaloid fraction from Korean ginseng on radiation-induced DNA double strand breaks (dsb) formation and repair in murine lymphocytes Materials and Methods : We used the neutral filter elution technique to assay $^{60}Co\;{\gamma}$ ray-induced DNA double strand breaks formation and repair in C57BL/6 mouse spleen lymphocytes for evaluating the dose-response relationship in the presence of alkaloid fraction as a radioprotective agent. The lymphocytes were stimulated with Phytohemagglutinin (PHA, 2 u g/ml) to label $^3[H]-thymidine.$ Isotope-labelled lymphocytes in suspension were exposed to 100 Gy at $0^{\cdot}C$ in the alkaloid fraction-treated group and elution procedure was performed at PH 9.6. The extents of formation of radiation-induced DNA double strand breaks and repair were compared respectively via strand scission factor (SSF) and relative strand scission factor (RSSF). Results: Alkaloid fraction reduced the formation of double strand breaks with dose modification factor of 2 15, compared to control group Rejoining of DNA dsb appeared to take place via two components. The first fast component was completed within 20.4 minutes, but the second slow component was not completed until 220.2 minutes after irradiation. About $30\%$ of dsb formed by irradiation was ultimately unrejoined despite the administration of alkaloid fraction. The administration of alkaloid fraction had a great effect on the second slow component of repair; the half-time of fast component repair was not changed, but that of slow component was 621.8 minutes. Conclusion: Neutral filter elution assay Proved to be a very effective method to quantitate the extents of DNA dsb formation and its repair. By using this technique, we were able to evaluate the efficiency of alkaloid fraction from Korean ginseng as a valuable radioprotector. Alkaloid fraction can be used prophylactically to prevent or ameliorate the severe radiation damages in workers and neighbors around the atomic power plants. For more refined study, however, more advanced purification of alkaloid fraction wil be needed in the near future.

악성 타액선 종양의 방사선 치료 성적에 대하여 -원자력 병원의 10년 경험 ($1975.1{\sim}1984.12$)-

조철구,고경환,류성렬,박영환,박우윤,심윤상,오경균,Cho Chul Koo,Koh Kyoung Hwan,Yoo Seong Yul,Park Young Hwan,Park Woo Yoon,Shim Young Sang,Oh Kyung Kyoon The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.1

1975년 1월부터 1984년 12월까지 원자력병원 치료 방사선과에서 악성 타액선 종양으로 방사선 치료를 받은 58명의 환자를 대상으로 하여 이들의 생존율을 후향적으로 분석하였다. 이들은 수술후 재발했거나, 수술이 불가능한 환자들이었다. 58명의 환자중 mucoepidermoid carcinoma를 가진 환자가 $43.1\%$, adenoid cystic carcinoma를 가진 환자는 $41.3\%$였다. 주 타액선 종양의 5년 보험생존율은 $68.2\%$, 10년 생존율은 $31.8\%$였으나, 무병생존율은 각각 $43.2\%\;13.0\%$로써 치료 후 재발된 상태에서도 비교적 오래 산다는 것을 알 수 있었다. TNM staging에 의한 생존율도 $T_1$의 5년 생존율이 $86.5\%,\;T_2+T_3$가 $40.0\%,\;T_4$가 $0\%$로, T stage가 높아지면 질수록 생존율도 현저히 감소하였다. 병리조직학적 관점에서 볼 때, adenoid cystic carcinoma의 5년 무병생존율은 $40.1\%$로써, mucoepidermoid ca.의 $49.8\%$보다 낮았으나, 전체적인 생존율은 $77.3\%$로써, mucoepidermoid ca.의 $51.5\%$보다 현저히 높았다. 따라서, adenoid cystic carcinoma는 치료실패후 병을 가진 상태에서도 상당 기간 생존할 수 있다는 것을 알았으며, 평균 생존기간은 2년 이었다. 또한 mucoepidermoid ca.인 경우에는 세포의 분화정도에 따라 생존율이 달라졌는데, 저등도 분화세포의 5년 생존율이 $78.8\%$로 고등도 분화세포의 $38.2\%$보다 거의 2배나 높았다. 암의 위치와 성별에 따른 생존율의 차이는 없었다. Minor salivary gland tumor는 6명으로 5년 보험생존률은 $32.3\%$였다. 따라서 주 타액선 종양의 생존율에 영향을 끼칠 수 있는 예후 인자는 1) 병리조직학적 세포종류, 2) T와 N stages (AJCC), 3) mucoepidermoid carcinoma에 있어서 분화 정도 였다. Retrospective analysis of survival rates was undertaken in the patients of 58 cases treated with conventional radiation therapy for malignant salivary gland tumors between January 1975 and December 1984 in Korea Cancer Center Hospital (KCCH). They were patients whose long-term follow-up was possible and who had refused surgery or had had recurrences postoperatively. Out of 58 patients, 25 patients ($43.1\%$) had mucoepidermoid carcinomas and 24 patients ($41.3\%$) adenoid cystic carcinoma. Total actuarial survival rates at 5 years and 10 years were $68.2\%\;and\;31.8\%$ respectively, but disease-free survival rates, $43.2\%\;and\;13.0\%$, respectively. According to TNM stage, the survival rates at 5 years were $86.5\%$ in $T_1,\;40.0\%\;in\;T_2+T_3,\;and\;0\%\;in\;T_4$. In terms of histologic types, 5 years disease-free survival rate of adenoid cystic carcinomas ($40.1\%$) was lower than that of mucoepidermoid carcinomas ($49.8\%$) but overall survival rate ($77.3\%$) was much higher than that of mucoepidermoid carcinomas ($51.5\%$). There-fore, we concluded that the patients, who had had disease after failure of treatment, could survive during a certain period of time and their alive times were 2 years on the average. There was a difference in survival rates in the mucoepidermoid carcinomas in terms of histological grade of differentiation and it was a arbiter in prognosis: 5 YSR of low-grade was $78.8\%$ and higher 2 times than that of high-grade. There was no difference in survival rates according to location and sex. The number of patients having minor salivary gland tumors was 6 cases and their actuarial 5 YSR was $32.3\%$. Consequently, prognostic factors which influence the survival rates of patients with malignant salivary gland tumors are thought to be 1) histological subtypes 2) T and N staging (AJCC) 3) histological grade, especially in mucoepidermoids.

頭頸部惡性腫瘍의 放射線治療計劃에 있어서 電算化斷層撮影의 利用에 關한 硏究

趙徹九(Chul Koo Cho) 대한방사선종양학회 1984 Radiation Oncology Journal Vol.2 No.1

Management of cancer pain : Management of Cancer pain using Radiation Therapy

조철구 ( Chul Koo Cho ) 대한임상종양학회 2005 대한임상종양연구 심포지엄 Vol.4 No.-

頭頸部惡性腫瘍의 放射線治療計劃에 있어서 電算化斷層撮影의 利用에 關한 硏究

趙徹九(Chul Koo Cho) 대한방사선종양학회 1983 Radiation Oncology Journal Vol.1 No.1

聲門癌 放射線治療 20年 成績

Chul Koo Cho(趙澈九),Kyoung Hwan Koh(高京煥),Seang Yul Yoo(柳星烈) 대한두경부종양학회 1988 대한두경부 종양학회지 Vol.4 No.1

To evaluate the result of radiation therapy for twenty years experience, a total of 115 cases of pathologically proven glottic carcinoma had been analyzed according tot survival respectively. All the patients had been treated with radiation therapy in curative intent using Co-60 teletherapy machine. The results are as follows : 1) Accoridng to sex, 5YSR & lOYSR were 58.7% and 50.4% in male patients, and 80.0% & 72.0% in female. 2) According to T staging, 5YSR & 10YSR were 83.4% & 83.4% in Tl, 69.2% & 60.0 % in T2, 34.3% & 21.8% in T3, 32.0% & 0% in T4. 3) According to N staging, 5YSR & 10YSR were 63.8% & 59.2% in node-negative groups, and 30.7% & 15.4% in node-positive groups. 4) According to the histologic grade, 5YSR & 10YSR were 66.8% & 57.6% in Gl, 61.3% 54.3% in G2, and 35.0% 35.0% in G3. 5) According to AJC staging, 5YSR & 10YSR were 83.4% % 83.4% in stage I, 72.0% & 62.7% in stage II, 36.8% & 28.3% in stage III, and 14.3% & 7.1% in stage IV. 6) In summary, 5YSR & 10YSR wre 60.4% & 52.8% in glottic carcinoma.

Gingko Biloba Extract가 C3H 마우스 섬유육종의 저산소세포 분획에 미치는 영향

조철구(Chul Koo Cho),이춘자(Chun Ja Yi),하성환(Sung Whan Ha),박찬일(Charn Il Park) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.3

목적 : C3H 마우스의 섬유육종에 있어서 저산소 분획 및 대사상태에 미치는 Ginkgo biloba extraact (GBE)의 영향을 알아보기 위해 본 실험을 시행하였다. 방법 : C3H 마우스의 우측 대퇴부에 이식한 섬유육종이 6mm가 되었을때 TCD50를 이용하여 저산소 세포 분획을 계산하였다. 방사선은 GBE(100mg/kg) 1회 투여시는 1시간 후에, 2회 투여시는 24시간 간격으로 2회 투여후 1시간 경과후 방사선을 조사하였으며, 산소공급이 충분한 상태와 결찰에 의한 저산소 상태에서 각각 조사하였다. 종양의 대사 상태 변화르를 알아보기 위해 GBE 투여 전과 투여 후 1시간에 각각 31P핵자기 공명 분광분석법을 시행하였다. 결과 : 종양 치료방사선량은 결찰에 의한 저산소 상태시 81.7(77.7-86.0)Gy, 정상 혈류상태시는 69.6(66.8-72.5)Gy 였으며, GBE 1회 투여한 경우에는 67.5(64.1-71.1)Gy, GBE 2회 투여시는 62.2(59.1-65.5) Gy로서, 2회 투여시 현저히 감소하였다. 이로부터 계산한 저산소 세포 분획은 정상 혈류 상태에서는 10.6%, GBE 1회 투여시는 7.2%로 다소 감소하였고, GBE 2회 투여시는 2.7%로 현저히 감소하였다. 31P 핵자기공명분광분석결과 PCr/Pi 비는 대조군 0.27±0.04, GBE 1회 투여시는 0.40±0.04, 2회 투여시는 0.71±0.04로 GBE 2회 투여시 종양의 대사상태가 현저히 호전되었다. 결론 : 이상의 결과를 종합해 볼 때, GBE의 투여에 의해 혈류량과 산소 및 영양분의 공급이 증가함에 따라, 저산소세포분획이 감소하였고, 종양의 대사 상태가 호전되어, 종양의 방사선에 대한 감수성이 높아졌다고 판단되었다. Purpose : To investigate the effect of Ginkgo biloba extract (GBE) on hypoxic cell fraction and metabolic status in fibrosarcoma (FSa Ⅱ) of C3H mouse. Materials and Methods : Fibrosarcoma (FSa Ⅱ), 6mm in diameter, growing in the right hindleg muscle of C3H mouse was used for estimation of hypoxic cell fraction using comparison of TCD50. Radiation was given one hour after administration of GBE (100 mg/Kg, i.p.) with or without priming dose of GBE (100mg/Kg, i.p.) given 24hours earlier. Radiation was also given under air breathing condition or clamp hypoxia without GBE as controls. 31P NMR spectroscopy was performed before and one hour after administration of GBE with or without priming dose of GBE. Results : TCD50/120's were 81.7 (77.7-86.0) Gy when irradiated under clamped hypoxia. 69.6 (66.8-72.5) Gy under air breathing condition, 67.5 (64.1-71.1) Gy with a single dose of GBE (100mg/kg) given one hour before irradiation, and 62.2(59.1-65.5) Gy with two doses of GBE given at 24 hours and one hour before irradiation. The hypoxic cell fractions, estimated from TCD50/120's, were 10.6% under air breathing condition, 7.2% after a single dose of GBE, and 2.7% after two doses of GBE. The results af 31P NMR spectroscopy were as follows. PCr/Pi ratio was 0.27±0.04, respectively, with priming dose (p<0.01). These findings indicate that the metabolic status is slightly improved after a single dose and markedly after repeated administrations. Conclusion : GBE decreases the hypoxic cell fraction and improves the metabolic status of tumor, probably by increasing the blood flow and delivery of oxygen and nutrients, resulting in increased radiosensitivity of tumor.

Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy

Chul-Won Choi(최철원),Mi-Sook Kim(김미숙),Chul-Koo Cho(조철구),Seong-Yul Yoo(류성열),Kwang-Mo Yang(양광모),Hyung-Jun Yoo(유형준),Dong-Han Lee(이동한),Young-Hoon Ji(지영훈),Chul-Ju Han(한철주),Jin Kim(김진),Young-Han Kim(김영한) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.1

목 적: 국소적으로 진행된, 절제 불가능한 췌장암 치료에 있어 고식적 방사선 치료와 비교하여 CyberKnife (CK)를 이용한 정위 방사선 치료의 생존율 및 급성 독성에 대해 분석하고자 하였다. 대상 및 방법: 2003년 4월부터 2004년 4월까지의, Eastern Cooperative Oncology Group (ECOG) 활동도 3 이하이며 CT 및 PET/CT로 평가하여 원격 전이 없는 국소 진행된 췌장암 환자 19명을 대상으로 하였다. 대상 환자는 점차 방사선량을 증가시키는 방법으로 33 Gy, 36 Gy, 39 Gy를 3분할로 각각 6명, 4명, 9명에서 CK를 이용한 정위 방사선 치료를 시행하였으며, 생존율 및 Radiation Therapeutic Oncology Group (RTOG) acute radiation morbidity criteria에 의한 위장관 독성을 분석하였다. 또한 나이, 성별, ECOG 수행 점수, 항암 치료,우회로 조성술(bypass surgery) 여부, 방사선량, CA19-9, 계획용 표적 체적(planning target volume, PTV), CT상 주위 장기 및 혈관 침범 여부 등을 Log Rank test를 이용하여 예후 인자를 평가하였다.결 과: 본 연구에서 중앙 생존 기간은 11개월, 1년 생존율은 36.8%였다. 추적 조사 기간 중(범위 3∼20개월, 중앙값 10개월) 유의한 위장관 급성 독성은 관찰되지 않았다. 단일 인자 분석에서 계획용 표적 체적만이 유의한 예후 인자로 80 cc 이하인 경우가 80 cc 이상인 경우보다 생존율이 높았으며(p-value<0.05), 나이, 성별, ECOG 수행 점수, 항암 치료, 우회로 조성술, CA19-9 수치, 주위 장기 및 혈관 침범 여부 등에서는 통계적으로 유의한 차이를 보이지 않았다. 다인자 분석에서는 65세 이하인 경우와 PTV 80 cc 이하인 경우에서 생존율이 높았다. 결 론: 고식적 방사선 치료, 고선량 입체조형 방사선 치료(high dose conformal radiation therapy), 수술 중 방사선 치료(intraoperative radiation therapy) 또는 세기 조절 방사선 치료(intensity modulated radiation therapy, IMRT)를 이용한 최근의 결과와 비교하여 CK를 이용한 정위 방사선 치료는 생존율 측면에서 비슷하거나 나은 결과를 보였다. 또한 심각한 부작용은 관찰되지 않았으며 짧은 기간의 치료로 환자에게 편의를 제공할수 있어 결과적으로 삶의 질을 향상시킬 수 있을 것이다. 따라서, 이 새로운 치료 방법은 국소 진행된, 절제불가능한 췌장암 환자에서 심각한 부작용 없는 효과적인 치료가 될 것으로 생각된다. 또한 계획용 표적 체적은 CK 치료의 유용한 예후 인자로 사용될 것이다. Purpose: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. Materials and Methods: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status ≤3 and locally advanced pancreas cancer without distant metastasis, evaluated by CT or PET/CT, were included. We administered stereotactic RT consisting of either 33 Gy, 36 Gy or 39 Gy in 3 fractions to 6, 4 and 9 patients, respectively, in an effort to increase the radiation dose step by step, and analyzed the survival rate and gastrointestinal toxicities by the acute radiation morbidity criteria of Radiation Therapeutic Oncology Group (RTOG). Prognostic factors of age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA19-9, planning target volume (PTV), and adjacent organ and vessel invasion on CT scan were evaluated by Log Rank test. Results: The median survival time was 11 months with 1-year survival rate of 36.8%. During follow-up period (range 3∼20 months, median 10 months), no significant gastrointestinal acute toxicity (RTOG grade 3) was observed. In univariate analysis, age, sex, ECOG performance score, chemotherapy, bypass surgery, radiation dose, CA19-9 level, and adjacent organ and vessel invasion did not show any significant changes of survival rate, however, patients with PTV (80 cc showed more favorable survival rate than those with PTV>80 cc (p-value<0.05). In multivariate analysis, age younger than 65 years and PTV>80 cc showed better survival rate. Conclusion: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

Quantitative Analysis of DNA Single-strand Breaks in EL 4 cells and Mouse Spleen Lymphocytes after Irradiation

류성렬,조철구,고경환,박우윤,박영환,김성호,김태환,정인용,Yoo Seong Yul,Cho Chul Koo,Koh Kyung Hwan,Park Woo Yoon,Park Young Hwan,Kim Sung Ho,Kim Tae Hwan,Chung In Yong The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.2

Filter elution 방법으로 EL 4백서 백혈병 세포 및 C57BL/6백서 유래의 비장 임파구에 대한 Co-60 $\gamma$ 선의 DNA single-strand breaks (SSB) 효과를 정량적으로 측정하였다. 임파구는 [${^3}H$]thymidine을 표지하기 위하여lipopolysaccharide (LPS, 20 $\mug/ml$)를 첨가하여 자극하고 부유 상태의 EL 4 세포 및 임파구를 $0^{\circ}C$에서 0 Gy, 1 Gy, 5 Gy, 10 Gy 또는 15 Gy조사하였으며, elution용액의 pH는 12.1로 하였다. $\gamma$ 선 조사에 따른 single-strand breaks의 수는 방사선 조사량에 따라 증가 하였으며 21 ml elution 양을 기준으로 한 strand scission factor (SSF)는 EL 4 세포에서 $0.01301\pm0.00096\;Gy^{-1}(n=5)$이었고, 임파구는 $0.01097\pm0.00091\;Gy^{-1}(n=5)$를 나타내므로 본 실험에서는 EL 4 세포가 정상 임파구에 비하여 방사선에 의한 DNA SSB가 민감함을 알 수 있었다(p<0.005). 본 연구 결과 DNA strand breaks의 측정법을 이용하여 방사선의 특성 및 생물학적 효과의 파악은 물론 나아가 기존의 방호제 및 새로운 약제의 DNA에 대한 효과를 판별할 수 있을 것이다. The filter elution technique was used to assay Co-60 $\gamma$ ray-induced DNA single-strand breaks(SSB) in EL 4 mouse leukemia cell and mouse spleen lymphocyte. The lymphocytes were stimulated with lipopolysaccharide (LPS, 20 $\mug/ml$) to label [${^3}H$] thymidine. EL 4 cells and lymphocytes in suspension were exposed at $0^{\circ}C$ to 0 Gy, 1 Gy, 5 Gy,10 Gy of Co-60 radiation and elution procedure was performed at PH 12.1. The number of DNA single-strand breaks increased with increasing doses of $\gamma$ rays. The strand scission factor (SSF) was estimated in each experiment (eluted volume 21 ml). The slope for EL 4 cells was $0.01301\pm0.00096\;Gy^{-1}(n=5)$ and the slope for lymphocytes was $0.01097\pm0.00091\;Gy^{-1}(n=5)$. The slopes were significantly different (P<0.005). Thus EL 4 cells were more sensitive to induction of DNA SSB by ionizing radiation than lymphocytes.