고령 암 환자의 방사선치료

전미선(Mison Chun),조선미(Sunmi Jo) 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.1

평균수명이 길어짐에 따라 암 발생률이 증가하고 있고, 보다 고령의 환자가 많아졌다. 자연적으로 고령의 암 환자는 장기 기능이 퇴화되고 동반질환을 갖는 경우가 흔하다. 사회적인 지지부족이나 조기진단의 부족으로 고령 암 환자의 치료는 일반적으로 빈약하다. 그러나 발표된 논문들을 바탕으로 하였을 때 신중히 환자 선택을 하여 암 치료기간 동안 적극적인 지지치료를 한다면 대부분의 고령환자는 표준 치료를 잘 견디면서 좋은 결과를 얻을 수 있었다. 이에 저자들은 각각의 암에 대한 고령 환자의 치료 순응도와 치료 결과에 대한 논문들을 리뷰해 보았다. Due to improved life spans, cancer incidence has increased with more aged patients presenting with cancer. Elderly cancer patients could have compromised organ function and/or comorbidities. Due to poor social support or lack of early diagnosis, treatment outcomes for elderly cancer patients are poor in general. However, with aggressive support during cancer management as well as careful selection, most elderly cancer patients can tolerate standard radiation therapy with good results based on published articles. Here, we reviewed existing articles regarding compliance and treatment results in elderly cancer patients based on tumor site.

기저세포 및 편평상피세포 피부암에 대한 방사선 치료

전미선,김주리,이은소,강원형 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

Skin cancers other than melanoma are highly curative disease because they are localized. In the last 14 months period, 11 patients with skin cancers(7 basal cell carcinomas, 3 squamous cell carcinomas, 1 metastasis from the lung cancer) were referred to the radiation oncology department for curative purpose in 9 patients and palliative purpose in 2 patients. Among the curative purpose patients, six patients had after one or few recurrences previously. Except 1 patient who had unusual multiple basal cell carcinomas sparing facial part, all other lesions were located in the face. Masses were a few mm to 5x6 cm in diameter. Since 3 patients had lesion near an eye, a lead eye shield was used for the prevention of cataract and keratitis/conjunctivitis. Also for lesions near or at the nose, a shield to protect nasal mucosa was used. Among patients who completed radiotherapy, all lesions disappeared except residual pigmentation which left some elevated mass effect. Careful irradiation technique and dose schedules were described with a follow-up time of I month to 14 months. In the future, cosmetic care for residual pigmentation needs to be followed.

Metabolic comorbidities and medical institution utilization among breast cancer survivors: a national population-based study

( Jaesung Heo ),( Mison Chun ),( Young-taek Oh ),( O Kyu Noh ),( Logyoung Kim ) 대한내과학회 2020 The Korean Journal of Internal Medicine Vol.35 No.2

Background/Aims: We investigated metabolic comorbidity status and patterns of medical institution utilization among breast cancer survivors using medical claims data from the Health Insurance Review and Assessment Service (HIRA). Methods: Using claims data obtained from the HIRA, we selected breast cancer survivors between 2010 and 2015. Descriptive statistics were calculated to determine the frequency of metabolic comorbidities, as well as to analyze patterns of medical institution utilization in accordance with disease status. Results: A total of 89,953 breast cancer survivors were identified. Among these, 12,364 (13.7%) had hypercholesterolemia, 20,754 (23.1%) had hypertension (HTN), and 11,102 (12.3%) had diabetes mellitus (DM). In particular, more than half of breast cancer survivors older than 60 years had HTN, and other diseases sharply increased beginning at age 50 years. For HTN, a total of 531,292 claims were submitted; more than 80% (n = 473,737) were from primary medical institutions, whereas only 2.4% (n = 12,551) were from tertiary medical institutions. The number of claims submitted for DM was 231,526; those from primary medical institutions accounted for 68.5% (n = 158,566), whereas claims from tertiary medical institutions accounted for 12.0% (n = 27,693). In subgroup analyses, the utilization of secondary and tertiary medical institutions was higher among patients with severe diseases and those diagnosed following their breast cancer diagnosis. Conclusions: More than 10% of breast cancer survivors were diagnosed with a metabolic comorbidity. Through analysis of medical institution utilization patterns, we ascertained that a communication system linking secondary and tertiary medical institutions with primary medical institutions is needed.

전자선을 이용한 방사선 치료에 있어서 Bayer-Dental을 이용한 내부차폐물의 제작과 그 특성

강해진,전미선 아주대학교 의과학연구소 1996 아주의학 Vol.1 No.1

During certain treatment using an electron beam, internal shielding using high atomic number material is used. But this high atomic number material as an internal shielding causes unnecessarily high dose to the tissue right above the internal shielding by the electron backscattering effect. This study shows the amount of the unnecessary dose delivered by the electron backscattering and the effectiveness of the Bayer-dental as a mold for fabricating internal shielding made with cerrobend.

Parotid gland sparing effect by computed tomography-based modified lower field margin in whole brain radiotherapy

Cho, Oyeon,Chun, Mison,Park, Sung Ho,Oh, Young-Taek,Kim, Mi-Hwa,Park, Hae-Jin,Nam, Sang Soo,Heo, Jaesung,Noh, O Kyu The Korean Society for Radiation Oncology 2013 Radiation Oncology Journal Vol.31 No.1

Purpose: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. Materials and Methods: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). Results: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands ${\geq}20$ Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. Conclusion: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

Management for locally advanced cervical cancer: new trends and controversial issues

Cho, Oyeon,Chun, Mison The Korean Society for Radiation Oncology 2018 Radiation Oncology Journal Vol.36 No.4

This article reviewed new trends and controversial issues, including the intensification of chemotherapy and recent brachytherapy (BT) advances, and also reviewed recent consensuses from different societies on the management of locally advanced cervical cancer (LACC). Intensive chemotherapy during and after radiation therapy (RT) was not recommended as a standard treatment due to severe toxicities reported by several studies. The use of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) for pelvic RT planning has increased the clinical utilization of intensity-modulated radiation therapy (IMRT) for the evaluation of pelvic lymph node metastasis and pelvic bone marrow. Recent RT techniques for LACC patients mainly aim to minimize toxicities by sparing the normal bladder and rectum tissues and shortening the overall treatment time by administering a simultaneous integrated boost for metastatic pelvic lymph node in pelvic IMRT followed by MRI-based image guided adaptive BT.

Stereotactic body radiotherapy for solitary spine metastasis

Lee, Sunyoung,Chun, Mison,Lee, MiJo The Korean Society for Radiation Oncology 2013 Radiation Oncology Journal Vol.31 No.4

A clear consensus has not been established regarding the best treatment for solitary bone metastasis. Here, we reviewed the medical records of patients with a controlled primary malignancy who had only solitary spine metastasis without metastasis to the extraspinal bone or viscera and underwent treatment between April 2007 and December 2012 with stereotactic body radiosurgery using CyberKnife, with a total dose of 24 Gy in three to four fractions. During that time, there were only four cases. This was effective in each case, and all the four patients had no local failure and remained alive at a median follow-up of 68 months (range, 64 to 80 months). Although our experience is limited, this study suggests that stereotactic body radiotherapy could be a feasible, safe, effective, and noninvasive alternative treatment for solitary spine metastasis in patients who are medically inoperable or unsuitable for surgery.

골반 방사선치료후 발생한 골변화의 증례 및 고찰 : Cases and Review

강승희,전미선,박찬희,오영택 아주대학교 의과학연구소 1998 아주의학 Vol.3 No.1

A few patients who received pelvic radiotherapy have experienced low back pain and presented with various radiographic changes of pelvic bone during the follow up prekid. In these cases, it is important to differentiate diagnoses between insufficiency fracture of pelvic bone and bony metastases. In the present work, we report 5 patients who received radiation for uterine cervical cancer (3), rectal cancer (1), and malignant lymphoma (1) and later developed bone pain and radiographic changes such as insufficiency fracture of the sacroiliac joints, symphysis pubis or acetabulum, osteosderosis, and compression fracture of the lumbar spine. These women were in postmenopausal status. The prescribed external radiation dose ranged from 4500 c㏉ to 5400 c㏉. The patients complained of low back pain which was radiating to leg either immediately after the completion of radiotherapy or up to 14 months after the completion of irradiation. Medical image findings were based on pelvic X-rays, whole body bone scan, CT scan, MRI, and other special radionuctide studies. Those patients with typical radiographic bony changes were treated conservatively with analgesics and bed rest as much as they could. In two cases out of five, the symptoms were subsided or reduced in 3 months and 10 months, respectively. To be aware of such clinical situation is important since it might otherwise be mistaken as symptoms and signs of metastasis. The purpose of this report is to describe the clinical and radiographic characteristics of these cases and to discuss their management.

Parotid gland sparing effect by computed tomography-based modified lower field margin in whole brain radiotherapy

Oyeon Cho,Mison Chun,Sung Ho Park,Young-Taek Oh,Mi-Hwa Kim,Hae-Jin Park,Sang Soo Nam,Jaesung Heo,O Kyu Noh 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.1

Purpose: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. Materials and Methods: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). Results: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands ≥20 Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. Conclusion: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

Stereotactic body radiotherapy for solitary spine metastasis

Sunyoung Lee,Mison Chun,MiJo Lee 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.4

A clear consensus has not been established regarding the best treatment for solitary bone metastasis. Here, we reviewed the medical records of patients with a controlled primary malignancy who had only solitary spine metastasis without metastasis to the extraspinal bone or viscera and underwent treatment between April 2007 and December 2012 with stereotactic body radiosurgery using CyberKnife, with a total dose of 24 Gy in three to four fractions. During that time, there were only four cases. This was effective in each case, and all the four patients had no local failure and remained alive at a median follow-up of 68 months (range, 64 to 80 months). Although our experience is limited, this study suggests that stereotactic body radiotherapy could be a feasible, safe, effective, and noninvasive alternative treatment for solitary spine metastasis in patients who are medically inoperable or unsuitable for surgery.