Vslue of Squamous Cell Carcinoma Associated Antigen fTA-41 in Patients Iurith Invasive Carcinoma of the Uterine Cervix

조문준,김재성,박승호,남상륜,Cho Moon-June,Kim Jae-Sung,Park Seoung-Ho,Nam Sang-Lyun The Korean Society for Radiation Oncology 1993 Radiation Oncology Journal Vol.11 No.2

We investigated the usefulness of tumor-associated antigen (TA-4) by a radioimmunoasay method in estimating the extent of disease and tracking the clinical course of disease in 58 patients with cervical cancer. According to our results and those of other authors, the normal range of serum TA-4 was arbitrarily taken to be less than 2 ng/ml. The proportion of the pretreatment positive serum TA-4 level of 48 squamous cell carcinoma patients was $60\%.$ And $40\%$ in 5 adenocarcinoma patients. Advanced disease group showed higher incidence of positive serum TA-4 level; $40\%,\;72\%,\;63\%,\;and\;100\%$ in stage I to IV, respectively. And the absolute values of TA-4 were higher in advanced disease. In patients treated with radiation, elevated serum TA-4 level usually declined after 3000 cGy and further dropped to normal range in $44\%$ after 5000 cGy. The positive rate in primary cervical cancer was $59\%,$ (32/54) and $100\%$ (4/4) in recurrent conical cancer. And 15 patients with recurrent or persistent disease during follow-up revealed $80\%$ positive serum TA-4 level. In conclusion, it would be suggested that serial serum TA-4 measurements may be helpful in tracking the clinical course during and after treatment. 자궁경부암 환자의 병변의 범위 및 임상 경과를 추정하는데 TA-4의 유용성을 검토하고자 충남대학교병원에서 자궁경부암으로 진단 받은 58명의 환자를 대상으로 혈청 TA-4치를 RIA 방법으로 측정하여 $\le2\;ng/ml$을 정상 범위로 정하여 다음과 같은 결과를 얻었다. 1) 치료전 평평상피암 환자의 TA-4의 양성율은 $60\%,$ 선암은 $40\%$였다. 2) 병기가 진행될수록TA-4의 양성율및 평균치가 높아서, 양성율 병기 I는 $40\%,$ II는 $72\%,$ III는 $63\%,$ IV는 $100\%$였으며 평균치는 병기 I에서 3.1, II는 6.6, III는 8, IV는17.7 ng/ml였다. 3) 방사선 치료후 혈청내 TA-4치는 감소하여 5000 cGy 조사후 치료전 양성을 보였던 환자의 $44\%$에서 TA-4치 가 정상으로 돌아왔다. 4) 원발성 자궁경부암 환자의 양성율은 $59\%$였으나 지속성 또는 재발성등 치료에 실패한 15명 환자의 양성율은 $80\%$였다. 이상으로 연속적 혈청내 TA-4치의 측정은 자궁경부암 환자의 방사선치료에 따른 임상 경과를 관찰하는데 도움이 될 것으로 사료된다.

The Result of Radiotherapy in Glottic Cancer

조문준(Moon June Cho),김일한(Il Han Kim),박찬일(Charn Il Park) 대한방사선종양학회 1985 Radiation Oncology Journal Vol.3 No.2

성문암은 술, 담배가 주 원인적 인자로 밝혀져 있다. 성문암은 쉰목소리 등으로 조기발견이 용이하며 대부분 분화도가 좋은 편평상피암이고 해부학적 위치상 조직생검 및 치료경과 관찰이 용이하며, 성운에는 임파절이 없으므로 전이가 적다. 국소 치료인 방사선치료와 수술이 치료의 주종을 이루며 방사선치료는 음성보전 측면에서 효과적이므로 초기병변에는 방사선치료를 진행된 병변의 경우 수술 혹은 수출 및 방사선 복합요법을 사용하고 있다. 저자들은 1979년 3월부터 1982년 9월까지 서울대학교병원 치료방사선과에서 성문암으로 치료받은 환자들을 추적 조사하여 다음과 같은 결과를 얻었다. 1. 방사선치료 후 3년 무병 생존율이 T1N0 : 78%T1N0 : 60%T3N0 : 50%, 2 구제적 수술후 3년 무병생존율이 T1N0 : 89%T2N0 : 80%T3N0 : 50% 3. 재발은 대개 3년 이내에 하였다. A retrospective analysis of 29 patients with glottic cancer, treated at the Department of Therapeutic Radiology, Seoul National University Hospital. 97% of the patients was male. Of the 29 patients, stage T1N0M0 comprised 31%, T2N0M0 52%, and stage T3N0M0 14%. Local control rate with radical readiotherapy was 78% for stage T1N0M0, 60%, for stage T2N0M0, and 50% for stage T3N0M0. 57% of the patients with the radiation failure was salvaged by surgery. The overall 3 year survival rate was 89% for the T1N0M0, 80% for stage T2N0M0, and 50% for stage T3N0M0. Among the survivors: 88% of T1N0M0 75% of T2N0M0, and 50% T3N0M0 had an intact larynx and natural voice. It is concluded that radiotherapy is a highly effective method as the primary treatment of the early glottic cancer, emphasized on preserving of the larynx and natural voice.

방사선치료 조사영역 내에 발생한 설암 환자에서 입체조형방사선치료 경험

조문준(Moon June Cho),김기환(Ki Hwan Kim),김병국(Byung Kook Kim),송창준(Chang Joon Song),김준상(Jun Sang Kim),김재성(Jae Sung Kim),장지영(Ji Young Jang) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.1

Objectives: We report an interim result of conformal radiotherapy in a patient with early stage cancer at the base of the tongue, which developed in a previously irradiated area. Materials and Methods: A 64-year-old male patient was diagnosed with T4N0M0 supraglottic cancer. He received 72Gy of radiation therapy from 21 November 1988 to 24 February 1989. He had local failure and underwent a salvage total laryngectomy on 28 August 1989. Subsequently, he did well. In early 1999, he suffered from throat pain. He had a 2.5cm ulcerative mass at the base of his tongue, in the area that had been irradiated previously. Biopsy showed squamous cell carcinoma. After workup, he was diagnosed with base of tongue cancer with T2N0M0. Surgery was not feasible because the morbidity was not acceptable. Since it was difficult to re-irradiate the area with a curable dose using conventional 2D radiation therapy with an acceptable morbidity, we decided to try conformal radiotherapy. We used 7 static beam ports with field sizes from 7x6.4to8x8cm 2, using 6 and 10MV photons. The fractionation regimen was 1.8Gy, 5 times per week. He received 64.8Gy in 36 fractions from 9 April 1999 to 1 June 1999. Results: In the 21 months since radiotherapy, the patient has not experienced any acute or chronic complications, such as xerostomia. He experienced relief of pain shortly after the start of radiotherapy, showed a complete response, and is still doing well. Conclusion: Conformal radiotherapy can be used to treat cancer that develops within a previously irradiated field, with curative intent.

비인강암의 방사선치료 성적

조문준(Moon-June Cho),장지영(Ji-Young Jang),김준상(Jun-Sang Kim),김병국(Byung-Kook Kim),송창준(Chang-Joon Song),김재성(Jae-Sung Kim) 대한방사선종양학회 2001 Radiation Oncology Journal Vol.19 No.1

목 적 :비인강암 환자의 방사선치료 성적을 후향적으로 분석하여 방사선치료의 효과와 예후인자를 분석하고자 하였다. 대상 및 방법 : 1989년 9월부터 1996년 10월까지 비인강암으로 진단받고 방사선치료를 받은 19명을 대상으로 하였다. 병기별로 보면 I 병기가 2명, II 병기가 6명, III 병기가 2명, IV 병기가 9명이었다. 병리조직학적으로 편평세포암이 5명, 미분화세포암이 14명이었다. 14명은 방사선치료만을 받았다. 5명은 항암제치료를 받았다. 추적 기간은 5개월에서 115개월이였으며 중앙값은 33개월이었다. 모든 환자에게서 추적이 가능하였다. 결 과 :방사선치료 후 15명(79%)에서 완전관해를 보였고 2명(10.5%)에서 부분관해를 보였으며 2명(10.5%)에서는 무반응을 보였다. 치료실패 양상은 국소 실패가 6명이었으며 원격전이가 4명에서 나타났다. 원격전이는 뼈, 간, 폐 등에서 관찰되었다. 전체 환자의 5년 생존율은 47.4%이었고 5년 무병 생존율은 48.1%였다. 병기, T 병기, N 병기, 뇌신경침윤 여부, 병리학적 유형, 활동지수, 반응도, 방사선량, 항암제 치료여부 등에 의한 생존율의 의미 있는 통계적 차이는 없었다. 결 론 :전체 환자의 5년 생존율은 47.4%이었고 5년 무병 생존율은 48.1%이었다. 치료 효과를 증가시키기 위하여 방사선치료 방법의 개선 및 항암제치료 방법에 대한 연구가 필요할 것으로 사료된다. Purpose :This is a retrospective study to evaluate the results of radiation therapy in nasopharyngeal carcinoma. Materials and Methods : From September 1989 to October 1996, 19 patients with nasopharyngeal ca rcinoma completed planned radiation therapy course. Stages were I in 2 patients, II in 6, III in 2 IV in 9 patients, respectively. Pathology was squamous cell carcinoma in 5 patients, undifferentiated cell carcinoma in 14 patients. Fourteen patients were treated with radiation therapy only. Five patients received chemotherapy. The follow- up period ranged from 5 months to 115 months with a median of 33 months. Follow- up was possible in all patients. Results : Responses to radiation therapy were complete response in 15 patients, partial response in 2, and no response in 2, respectively. Patterns of failure were as follows : locoregional recurrence in 6 patients and distant metastasis in 4 patients. The sites of distant metastasis were bone, liver and lung. Five year survival rate was 47.8% and five year disease free survival rate was 48.1%. Stage, T- stage, Nstage, central nervous system involvement, pathology type, performance status, response, radiation dose, chemotherapy were not significant prognostic factors. Conclusion :5- year survival rate was 47.8% and 5-yea r disease free survival rate was 48.1%. The advances in radiation therapy techniques and chemotherapy are needed.

The Physical Penumbra of the 6MV X-ray

조문준(Moon-June Cho),강위생(Wee-Saing Kang) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.2

충남대학교병원 치료방사선과내 설치되어 있는 6MV 선형가속기를 이용하여 음영을 측정하여 다음과 같은 결과를 얻었다. 1) 조사면 크기가 커질수록 음영폭은 증가하였으며 10×10cm 이상의 조사면에서는 계산한 음영폭보다 측정치가 대개 크게 나타났다. 조사면이 커질수록 이 차이는 더욱 증가하였다. 2) 깊이가 증가하면 음영폭도 증가하였다. 3) 90%~20%의 음영폭이 80~20%의 음영폭보다 컸으며 조사면이 커지고, 깊이가 증가할 수록 이 차이는 더 커졌다. High energy photon beam has a sharp beam margin due to a less side scatter and the other things. But there still remains a penumbra where the dose changes rapidly in the region near the edge of a radiation beam, although it is short in sidth. It is suggested that the width of the penumbra depends on the source size, distance from source to diaphragm, source to skin distance, and depth in tissue. However, it is also supposed that the other factors influence the penumbra width In this paper, we investigate changes of the physical penumbra widths according to various field sizes and depths, by using the three dimensional dosimetry system. As a result, we found that as field size and depth increase, the physical penumbra width also increases.

두경부 악성 종양 조직내 간질액 압력

조문준(Moon June Cho),김재성(Jae Sung Kim),이인태(ln tae Lee),김준상(Jun Sang Kim),장지영(Ji Young Jang),김기환(Ki Hwan Kim) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.1

Objectives: To determine the tumor interstitial fluid pressure(TIFP) in patients with head and neck cancerand predict radiotherapy outcome. Materials and Methods: In 12 biopsy proven primary head and neck cancer patients with accessible by direct inspection and palpation, and of sufficient thickness(>1cm) to permit accurate needle placement, we measured TIFP at cervical lymph node before and during radiotherapy using a modified wick-in-needle technique. Tumor size was measured clinically and radiologically. Results: The mean preradiotherapy TIFP was 23.4mmHg. Preradiotherapy TIFP had significant relationship with tumor size(p=0.0009). Preradiotherapy TIFP was not different between complete response group and partial or less response group(p=0.114). Radiotherapy outcome was not different between group with above and group with below average TIFP(p=0.09). Conclusion: The mean TIFP was elevated with 23.4mmHg before radiation therapy. Preradiotherapy TIFP had significant relationship with tumor size. It is not definitive that TIFP could be prognostic indicator of radiation response.

방사선치료시 두경부 림파절 종양내 간질액 압력의 변화 양상

조문준(Moon-June Cho),김재성(Jae-Sung Kim),이인태(Intae Lee),김준상(Jun-Sang Kim),김기환(Ki-Hwan Kim),장지영(Ji-Young Jang) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.2

Purpose :To determine if the tumor intersitial fluid pressure (TIFP) and/or its change in patients with metastatic lymph node in head and neck area can predict radiotherapy outcome. Materials and Methods : In 26 biopsy proven metastatic lymph node patients in head and neck area with accessible by direct inspection and palpation, and of sufficient thickness (> 1 cm) to permit accurate needle placement, we measured TIFP at cervical lymph node before and during radiotherapy. Tumor size was measured clinically and radiologically. Results :The mean preradiotherapy TIFP was 24.7 mmHg. Preradiotherapy TIFP had marginally significant relationship with tumor size (p=0.06). Preradiotherapy TIFP significantly decreased when tumor size decreased (p=0.009). Preradiotherapy TIFP was not different between complete response group and group with partial or less respone (p=0.75). Radiotherapy outcome was not different between group with above and group with below than average TIFP (p=0.229). TIFP decreased 36 mmHg in complete response group and 29.7 mmHg in group with partial or less respone. Conclusion :The mean TIFP was elevated with 24.7 mmHg. Preradiotherapy TIFP had marginally significant relationship with tumor size (p=0.06). TIFP decreased 36 mmHg in complete response group and 29.7 mmHg in group with partial or less respone but there was no statistically significant relationship in two groups. 목 적 : 두경부 악성 림파절 환자에서 방사선치료중 종양내 간질액 압력을 측정하여 종양내 간질액 압력 및 이의 변화가 갖는 임상적 의의를 밝히고자 하였다. 방 법 : 조직학적으로 확진된 26명의 전이성 두경부 악성 림파절 환자를 대상으로 육안적으로 확인 가능하며 접근이 가능한 부위에 위치하고 주사침 끝이 적절히 위치할 수 있도록 적어도 1 cm 이상의 충분한 두께를 갖는 경부 림프절에서 방사선치료 직전 및 방사선치료 중에 종양내 간질액 압력을 측정하였다. 종양의 크기는 촉지하여 임상적으로 측정하고 방사선과적 검사로 측정을 확인하였다. 결 과 : 방사선치료 전 TIFP는 25명에서 측정이 가능하였으며 평균치는 24.7 mmHg였다. 방사선치료 전종양의 크기가 클수록 치료 전 TIFP가 높았으며 통계적으로 marginal한 상관관계를 보였고(p=0.06), 치료 전 종양 크기가 크면 치료 후 TIFP의 감소가 큰 경향을 보였으나 통계적인 유의성은 없었다(p=0.43). 방사선치료 중 9명에서 TIFP의 측정이 가능하였으며, 이들의 방사선치료 전과 치료 후 TIFP변화는 평균 12.5 mmHg로 감소하였으며 통계적으로 유의한 결과를 보였다(p=0.009). 치료 전 TIFP가 평균치 이상인 환자군과 이하인 환자군 사이에 방사선치료 결과의 차이가 관찰되지 않았다(p=0.229). 방사선 치료 후 완전 관해를 보인 환자군과 부분관해 이하의 치료 결과를 보인 군 사이에 치료 전 TIFP의 차 이는 관찰되지 않았다(p=0.75). 방사선치료 후 완전 관해를 보인 환자군의 TIFP의 치료 전과 치료 중 비교시 평균 36 mmHg 감소하였으며 부분관해 이하의 치료 결과를 보인 군은 29.7 mmHg 감소하여 현재까지는 두 환자군 사이에 유의한 차이는 관찰되지 않았다(p=0.75) 결 론 : 방사선치료 전 TIFP의 평균치는 24.7 mmHg였으며 종양의 크기가 클수록 치료 전 TIFP가 높았으며 통계적으로 marginal하게 유의하였다(p=0.06). 방사선치료 후 부분 관해 이하의 치료 결과를 보인 환자군의 치료 전과 치료 중 TIFP를 비교시 평균 29.7 mmHg로 감소하였으나 완전관해를 보인 군은 36mmHg의 더 큰 감소를 보였으나 현재까지는 두 군간의 차이는 유의하지는 않았다(p=0.75).

공동에 의한 6MV X 선의 재선량증가 현상에 관한 연구

조문준(Moon June Cho),최은경(Eun Kyung Choi),정웅기(Woong Ki Chung),강위생(Wee Saing Kang),박찬일(Charn Il Park) 대한방사선종양학회 1989 Radiation Oncology Journal Vol.7 No.1

The inclusion of air filled cavities in treatment fields creates a potential dosimetric problem due to the rebuildup phenomenon near the air-tissue interface using a simulated phantom, such as air gap, air cylinder, and air cavity, the amount of rebuldup along the various field sizes and air cavity dimensions was measured. The results are as follows. 1. As the field size becomes larger in comparison with the cavity size, or as the cavity size gets bigger when the field size is equal to the cavity size, rebuildup decreases. 2. When the distance between the phantom surface and the air cavity is less than 1.5cm, there is prominent rebuildup. And when the distance is more than 1.5cm, rebuildup is relatively constant. 3. The change according to the depth of the cavity is affected by the field size and the cavity size, rebuildup usually increases when the depth of the cavity increases. 4. It is suggested that tissue equivalent material should be applied on the skin to make tissue thickness over the air cavity more than 1.5 ㎝ and that the field size should include the air cavity with at least 1cm margin.

Result of Postoperative Radiotherapy of the Rectal Cancer

조문준(Moon June Cho),하성환(Sung Whan Ha),박찬일(Charn Il Park),최국진(Kuk Jin Choe),김진복(Jin Pok Kim) 대한방사선종양학회 1986 Radiation Oncology Journal Vol.4 No.2

직장암은 한국인에서 발생하는 악성종양 중 7번째로 빈번한 종양이며, 그 해부학적 구조상 근치적 절제술이 비교적 어려운 것으로 되어 있어 수술 후 상당수에서 국소적인 재발이 발생한다. 수술후 방사선치료를 병용하여 국소재발율이 현저히 저하되는 것으로 알려겼으며 나아가서 생존률의 향상을 기대하고 있다. 저자들은 1979년 3월부터 1984년 4월까지 서울대학병원 치료방사선과에서 직장암으로 근치적 수술후 방사선치료를 받은 133명의 환자들을 대상으로 다음과 같은 성적을 얻었다. 1) 국소재발율은 B_2+B_3 가 10%, C_1이 6%, C_2+C_3가 25%였다. 2) 3년 무병 생존율은 B_2+B_3가 68%, C_1이 51%, C_2+C_3가 25%였다. 3) Life-table방식에 의한 3년 생존을은 B_3+B_3가 78%, C_1이 47%, C_2+C_3가 39%였다. 4) 133명중 7명에서 수술이 필요한 정도의 장폐쇄 증상이 있었다. To assess the effect of postoperative radiotherapy on tumor recurrence and patient survival, 133 patients who received adjuvant postoperative radiotherapy for adenocarcinoma of the rectum were retrospectively analyzed. Sixty-one percent of the patients were in stage C_2 by Astler-Coller staging system. A significant statistical difference was noticed in failure rates for lymph node negative vs lymph node positive patients; 26%(9/35) vs 50% (49/98). The incidence of local failure was found to be strongly dependent on the pathologic stages; with 9%(3/35) of recurrence in stage B and 21%(21/98) in stage C. Distant metastasis has occurred in 29%(38/133) of the patients; 2%(7/35) in stage B and 32%(31/98) in stage C. The actuarial survival at 3 years for patients in stage B_2, stage C_1, and stage C_2were 78%, 47%, and 38%, respectively. In conclusion, the postoperative adjuvant radiotherapy for rectal carcinoma appears to reduce local recurrence significantly.

Enhancement of in vivo Radiosensitization by Combination with Pentoxifylline and Nicotinamide

Intae Lee(이인태) , Moon-June Cho(조문준) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

Pentoxifylline (PENTO)는 적혈구의 유동성을 증가시켜 모세혈관의 적혈구 흐름을 증가시킨다. 또한 적혈구내 2.3-DPG를 증가시켜서 산소 친화력을 감소시켜 산소의 해리를 촉진시킨다. Nico-tinamide (NA)는 종양내 혈류를 일시적으로 증가시켜서 종양내 급성 저산소 세포의 수를 감소시킨다. PENTO와 NA의 병용이 저산소 세포의 산소화에 의해서 방사선 감수성을 증가시킬 수 있는지를 확인하기 위하여 FSaⅡ 생쥐의 섬유육종을 이용하여 실험을 시행하였다. 방사선에 의한 성장 장애가 유의하게 증가하였으며, 증가율은 2.5~2.8이었다. TCD₅₀가 대조 종양군에서는 57Gy였으나 PENTO+NA 투여 종양군에서는 32Gy로 1.8배의 TCD₅₀의 감소를 보였다. 정상피부의 방사선 감수성에는 영향이 없었다. PENTO+NA의 방사선 감수성의 증가를 규명하기 위하여 종양내 혈류의 변화, 종양내 산소농도를 laser Doppler flowmetry와 산소 미소전극 방법으로 측정하였다. PENTO+NA 투여후 10분 경과하여 혈류가 유의하게 증가하였으며 종양내 산소 분압도 8mmHg에서 19mmHg로 유의하게 증가함을 관찰하였다. 라서 PENTO 또는 NA 단독보다 PENTO+NA 병용이 더욱 효과적이라 사료되며 생체내 종양의 방사선 감수성의 증가는 종양내 산소의 증가로 생각되며 더욱 방사선 감수성을 증가시키기 위하여 여러 농도의 PENTO의 단독 또는 NA와의 병용등에 대한 지속적인 연구가 필요하다. Pentoxifylline (PENTO) has been known to improve RBC fluidity, and thus improve the flux of RBC through narrow capillaries. Additionally, PENTO also decreases the O₂ affinity of hemoglobin by increasing 2, 3-DPG levels, thereby increasing the O₂ release from RBC. Nicotinamide (NA) has been reported to decrease the number of acutely hypoxic cells in tumors by temporarily increasing tumor blood flow. Therefore, the purpose of this study was to examine whether the combination of PENTO and NA (PENTO+NA) would reduce the radioresistance of the FSaⅡ murine fibrosar-coma by oxygenating the hypoxic cells. We observed a significaantly enhanced radiation-induced growth delay of the FSaⅡ tumors by PENTO+NA. Thus the enhancement ratio was between 2.5 and 2.8 in growth delay assay. The TCD₅₀ of control tumors was about 57 Gy, but that of PENTO+NA treated tumors was about 32 Gy. Thus TCD₅₀ was modified by a factor of 1.8. We also observed that PENTO+NA exerted no effect on the radiation-induced skin damage after the legs without bearing tumors were exposed to X-irradiation. In order to clarify radiosensitizing effects of PENTO+NA, changes in tumor blood flow and intratumor pO₂ were measured using laser Doppler flowmetry and O₂ microelectrode methods. The tumor blood flow significantly increased at 10 min. after injection of PENTO+NA. Furthemore, we also found that PENTO+NA significantly in-creased intratumor pO₂ from 8 to 19 mmHg. We concluded that PENTO+NA was far more effective than NA alone or PENTO alone. The increase in the response of tumors in vivo to X-irradiation appeared to be due mainly to an increase in the tumor oxygenation. Further studies using various concentrations of PENTO alone and in combination with NA to obtain better sequencing and maximal radiosensitization are warranted.