다발성 원격전이와 SIADH를 동반한 원발성 충수돌기 악성유암종 (Carcinoid Tumor) 1예

안광진,정현철,노재경,박중원,이화영,서창옥,노준규,이종태,최수임,김병수 대한내과학회 1990 대한내과학회지 Vol.38 No.1

Carcinoid tumors are the most trequently occurring neoplasms of the appendix and small bowel. Most carcinoid tumors of the appendix are incidentally discovered during other surgical procedures. Its natural course is usually benign and the size of the tumor is closely related with the liability of regional or distant metastasis, so this affects the mode of therapy. Lesions less than 2㎝ in greatest dimension are never shown to have metastatic lesions and those larger than 2㎝ are likely to metastasize to regional lymph nodes and occasionally to distant organs such as liver, lung and bones. We experienced a malignant carcinoid tumor of the appendix with metastasis to regional lymph nodes, lung, ribs and thoracic vertebrae, cervical lymphnodes, and the right adrenal gland without liver metastasis. The patient had no signs of carcinoid syndrome but showed hyponatremia which was corrected by fluid restriction, suggesting SIADH. The patient was treated with a combination regimen of 5-fluorouracil and doxorubicin after surgical removal of the appendiceal mass, and a palliative radiotherapy for the osteolytic lesion of the right 12th rib. A review of our experience suggests a more extensive program in disseminated malignant carcinoid tumors is required.

Linear Accelerator를 이용한 Stereotactic Radiosurgery

정상섭,윤도흠,오성훈,김선호,서창옥,추성실,노준규,김동익,서정호 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

A Modified irradiation technique utilizing a linear accelerator for radiation surgery within the brain was performed in 4 patients. Three of them had brain tumors and one small arteriovenous malformation in midbrain. A Hitchcock stereotactic apparatus and a 10 MeV linear accelerator have been adapted and special computer programs for dosimetry were obtained and studied experimentally with a phantom model. Stereotactic radiosurgery is a valuable tool in the treatment of inoperable, deep seated intracranial lesions, the major advantage being high efficacy and smoothness of the procedure, as well as short hospitalization times.

송과체부위종양 및 중추신경계 배아세포종양의 치료 : 치료방법의 변천에 따른 치료성적 Evolution of Treatment Policy and Result

서창옥,김귀언,이규성,최중언,정상섭,이규창,노준규 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.6

A retrospective analysis has been made of 40 patients with pineal region tumors and CNS germ cell tumors who were treated at Yonsei University Hospital, Department of Radiation Oncology between 1971 and 1985. A tissue diagnosis was obtained before radiotherapy in 19 patients and 21 patients were irradiated without histological diagnosis. Among 19 biospyproven cases, 14 were germinomas, 2 were teratomas, and the others were two pineocytomas and one pineoblastoma. In the earlier period, every attempt was made to obtain a tissue pathology by either stereotaxic biopsy or open craniotomy before irradiation. However, in recent years, wityh the advent of CT scan, a trial radiotherapy with a modest dose of 20 ㏉m 2 weeks was attempted in cases of highly suspected germinomas by CT scan findings. Further management after trial radiation depended on the radiation response shown on the follow up CT scan and tumor marker study. Radiation fields varied from a small local field to whole brain or entire neuroaxis irradiation. Most patients received 40-50 ㏉ to the primary tumor site and 20-30 ㏉ to the neuroaxis. Twenty-nine of the total 40 patients are alive without of disease 22-144 months after treatment and the overall 5-year recurrence-free survival rate was 74.4%, Univariate analysis of prognostic factors at presentation showed that tumor type was highly correlated with outcome. Two of fourteen biopsy-proven germinomas and none of nine presumed germinomas by trial radiation recurred. On the other hand, five of six patients who showed poor response to trial radiation died of uncontrolled disease and only one patient with elevated AFP in serum and CSF was salvaged by chemotherapy. On the basis of the results of this study, application of trial radiation therapy without tissue biopsy is well justified as a treatment modality in a suspected germinoma by CT scan finding. Aggressive combined modality approaches with surgery, radiotherapy and chemotherapy need to be investigated to improve results in radioresistant tumors.

The Study of Shielding Effect on Ovoids of Three Different Gynecological Applicator Sets in microSelectron-HDR System

Loh,John J.K.,Kim,Woo C.,Cho,Young K.,Kim,Hung J.,Choi,Jin H.,Park,Sung Y.,Kim,Joo Y. 대한방사선 방어학회 1998 방사선방어학회지 Vol.23 No.4

Nucletron사의 microSelectron-High Dose-Rate(HDR) System에서 부인암의 강내 근접치료에 사용되는 standard shielded applicator set(SSAS)와 Fletcher-Williamson applicator set(FWAS)는 standard applicator set(SAS) 와 비교해서 다른 점이 ovoids 위와 아래 부분에 방광과 직장으로 가는 선량을 줄이기 위해 각각 스테인레스 강철(밀도 (밀도 ρ=8,000 ㎏/㎥)과 텅스텐 합금(밀도 ρ=14,000 ㎏/㎥)으로 차폐가 되어 있다. 이에 본 연구에서는 특별히 고안한 지지장치를 사용해서 국제방사선단위위원회(ICRU) 보고서 38에서 권고한 직장과 방광의 위치에 대하여 두 shielded ovoids의 차례효과가 어느 정도인가를 알아보고자 하였다. 지지장치를 PTW사의 전산화된 3차원 물팬톰에 부착하고 SAS의 ovoids를 지지장치에 고정하였다. Ovoids의 끝 부분을 전리함(PTW 0.125cc)의 측정점 높이와 일치시키고 전리함을 좌우로 이동시키면서 선량을 측정하여 두 ovoids의 중간 위치를 확인하였다. 직장에 미치는 선량은 ovoids의 중간에 위치한 선원 M5로부터 posterior방향으로 수직으로 위치한 점들인 20(R1), 25(R2), 30(R3), 40(R4), 50(R5), 60(R6) mm 에서 측정하였다. 방광에 미치는 선량은 M5로 부터 anterior방향으로 수직으로 위치한 점들인 20(B1), 30(B2), 40(B3), 50(B4), 60(B5) mm에서 측정하였다. 위와 같은 방법으로 SSAS와 FWAS의 ovoids에서도 각각의 점들에 대한 선량을 측정하였다. SAS와 SSAS의 직장에 미치는 선량차이는 실제 임상에서의 관심 점들과 가장 가까운 25 mm(R2) 30 mm(R3)거리에서 각각 8.0%, 6.0%였고 SAS와 FWAS의 직장에 미치는 선량차이는 25 mm(R2)와 30 mm(R3)거리에서 각각 25.0%, 23.0%로 나타났다. SAS와 SSAS의 방광에 미치는 선량차이는 20 mm(B1)와 30 mm(B2)거리에서 각각 8.0%, 3.0%였고 SAS와 FWAS의 방광에 미치는 선량차이는 20 mm(B1)와 30 mm(B2)거리에서 각각 23.0%, 17.0%로 나타났다. SAS를 SSAS나 FWAS가 SSAS보다 차폐효과가 더 좋은 것으로 나타났으며 이 두 종류의 shielded applicator set는 부인암의 근접치료시 직장과 방광으로 가는 선량을 감소시켜 환자치료의 최적화를 이룰 수 있을 것으로 생각된다. There are three different types of gynecological applicator sets available in microSelectron-high dose-rate(HDR) System by Nucletron; standard applicator set(SAS), standard shielded applicator set(SSAS), and Fletcher-Williamson applicator set(FWAS). Shielding effect of a SAS without shielding material was compared with that of a SSAS with shielding material made of stainless steel(density ρ=8,000 ㎏/㎥) at the top and bottom of each ovoid, and of a FWAS with shielding material made of tungsten alloy(density ρ=14,000 ㎏/㎥) at the top and bottom of each ovoid. The shielding effects to the rectum and bladder of these two shielded applicator sets were to be measured at reference points with an ion chamber and specially designed supporting system for applicator ovoids inside of the computerized 3-dimensional water phantom. To determine the middle point of two ovoids the measurement was performed with the reference tip of ion chamber placed at the same level and at the middle point from the two ovoids, while scanning the dose with the ion chamber on each side of ovoids. The doses to the reference points of rectum were measured at 20(R1), 25(R2), 30(R3), 40(R4), 50(R5), and 60(R6) mm located posteriorly on the vertical line drawn from M5(the middle dwell position of ovoid), and the doses to the bladder were measured at 20(B1), 30(B2), 40(B3), 50(B4), and 60(B5) mm located anteriorly on the vertical line drawn from M5. The same technique was employed to measure the doses on each reference point of both SSAS and FWAS. The differences of measured rectal doses at 25 mm(R2) and 30 mm(R3) between SAS and SSAS were 8.0 % and 6.0 %: 25.0% and 23.0% between SAS and FWAS. The differences of measured bladder doses at 20 mm(B1) and 30 mm(B2) between SAS and SSAS were 8.0% and 3.0%: 23.0% and 17.0% between SAS and FWAS. The maximum shielding effects to the rectum and bladder of SSAS were 8.0% and 8.0%, whereas those of FWAS were 26.0% and 23.0%, respectively. These results led to the conclusion that FWAS has much better shielding effect than SSAS does, nd when SSAS and FWAS were used for gynecological intracavitary brachytherapy in microSelectron-HDR system, the dose to the rectum and bladder was significantly reduced to optimize the treatment outcome and to lower the complication rates in the rectum and bladder.

Effect of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

Chang Ok Suh(서창옥) , John J.K.Loh(노준규) , Jin Sil Seong(성진실) , Sun Rock Moon(문성록) Hyung Sik Lee(이형식) , Hyun Soo Shin(신현수) , Sung Sil Chu(추성실) , Gwi Eon Kim(김귀언) , Chan Il Park(박찬일) ,Eun Kyung Han(한은경) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8MHz 라디오파를 이용한 온열치료를 시행하였다. 42.5±0.5°C로 30분간 온열치료를 받은 군 (제1군, n=5), 45±0.5°C로 30분간 온열치료를 받은 군 (제2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견의 특이한 조직병리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제2군에서는 간 세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할 때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthemia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with 42.5±0.5°C for 30 minutes, and Group Ⅱ (N=5) was heated with 45±0.5°C for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and 7, 14, and 28 days after treatment. Blood samples were obtained before treatment and 1, 3, 5, 7, 14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group Ⅰ. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with 45°C for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liver damage dy heat of 42.5±0.5°C for 30 minutes is reversible, and liver damage by heat of 45±0.5°C for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in order to apply hyperthermic treatment on human liver tumor safely, close observation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.

비인강암의 방사선 치료 성적

이종영(Jong Young Lee)·노준규(John J.K. Loh)·서창옥(Chang Ok Suh)·이연구(Yonu Goo Lee)·홍원표(Won Pyo Hong) 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.1

This study is the retrospective evaluation of ninety-six patients with biopsy-proven carcinoma of nasopharynx treated with radiotherapy at Yonsei University, College of Medicine Radiation Oncology from January 1971 to December 1985. Patient's age ranged from 15 to 71 years with a median age of 49 years. Fifty-two point five percent of local control and 47.5% of actuarial 5 year survival were achieved with radical radiotherapy. Five year survival rate for Stage I & II, III and IV were 75.0%, 74.6% and 41.4%, respectively. Distant metastasis rate was related with N stage (N1 12.5%, N1 0%, N2 23.5%, N3 32.1%) and histologic type (lymphoepithelioma 41.7% squamous cell carcinoma 6.5%) but not with T stage. Thirty-one of sixty-seven patient covered adequate radiation field received induction chemotherapy. However induction chemotherapy does not appear to improve over all survival.

The Study of shielding Effect on Ovoids of Three Different Gynecological Application Sets in microSelectron-HDR System

Young K. Cho,Sung Y. Park,Jin H. Choi,Hung J. Kim,Woo C. Kim,John J.K. Loh,Joo Y. Kim 대한방사선방어학회 1998 방사선방어학회지 Vol.23 No.4

Air Density Correction of Ionization Chamber using 90Sr Radioactive Check Device

Cho,Young K.,Kim,Woo C.,Kwon,Soo I.,Lee,Kil D.,Park,Sung Y.,Ji,Young H.,Shin,Dong O.,Loh,John J. 대한방사선 방어학회 1998 방사선방어학회지 Vol.23 No.4

전리함을 사용한 흡수선량 측정시대기 보정계수의 측정은 필수적인 요소이다. 일반적으로는 기압계 및 온도계를 이용하여 대기 보정계수를 얻고 있는데 본 실험에서는 Sr 방사성 동위원소를 사용하여 보정계수를 얻고 그 값들을 비교하고자 한다. PTW 사의 Radioactive Check Device, Unidos Electrometer 및 0.6 cc Ion Chamber를 이용하여 각각의 다른 환경 조건하에서 대기 보정계수를 구하고 온도계와 기압계를 사용하여 구한대기 보정계수를 비교해 본 결과 그들은 0.2% 이내로 잘 일치가 되었다. 이론적으로 온도계 및 기압계를 사용할 경우 전체 선량의 불확정도는 ±1.2 - 1.6% 인데 반하여 Sr 방사성 동위원소를 사용할 경우 전체 선량의 불확정도는 ±1.02%로 계산할 수 있다. Sr 방사성 동위원소를 사용한 방법은 온도계 및 기압계의 정기적인 검교정이 없을 경우 발생할 수 있는 오차를 줄일 수 있으며 보다 정확한 보정계수를 얻을 수 있다. It is required to measure air density correction factor at the time of absorbed dose calibration or measurement. In general, thermometer and barometer are widely used for air density correction. However, this can be done using the radioactive check device with better accuracy. The measurements of air density correction were performed by using the radioactive check device, Unidos electrometer, and 0.6 cc Farmer-type ion chamber of PTW under the different environmental conditions. Above experiments were repeated with termometer and barometer. By comparing the two methods, they were within the difference of 0.2%. The overall uncertainty for the dose found in termometer and barometer was 1.2 - 1.6%, depending upon either one step or two, whereas the overall uncertainty for the radioactive check device was 1.02%. This method may reduce the possible error which couldoccur when thermometer and barometer are not calibrated at regular basis.

Photon Energy Dependence of the Sensitivity of LiF TLDs Loaded with Thin Material

민병민,김수길,노준규,조영갑,Min Byongim J,Kim Sookil,Loh John J.K,Cho Young Kap The Korean Society for Radiation Oncology 1999 Radiation Oncology Journal Vol.17 No.3

목적 : 얇은 박막을 위에 얹은 TLD 선량계의 반응 값에 영향을 미치는 인자를 조사하였고, 특히, 금속박막을 얹은 TLD 선량계의 광자에너지와 표면 흡수선량에 대한 의존성을 조사하였다. 방법 및 재료 : 본 연구에서는 TLD-100과 TLD-100 위에 얹은 Slt은 물질로는 주석, 금, 그리고 TE 플라스틱 판을 사용하였다. 각 금속 박막의 두께는 0.1 mm, TE 플라스틱 판의 두께는 1 mm였고 각 박막의 면적은 TLD-100의 면적과 같이 하였다. 방사선치료에 많이 산이는 6 MV에서 15 MV사이의 광자에너지에 대한 TLD-100의 반응감도와 금박막을 얹은 TLD-100의 반응감도, 그리고 주석 박막을 얹은 TLD-100의 반응감도를 비교해 보았다. 결과 : 금속 박막을 얹은 TLD의 경우 표면 흡수선량의 증가가 명백히 나타나고, 금 박막을 얹은 TLD의 경우 10MV에서 정상 TLD보다 약 1.83배 정도 과잉 반응하는 것으로 관측되었으며, 흡수선량에 따른 반응감도의 변화는 주석을 얹은 TLD의 경우가 가장 작았다 금속 박막을 얹은 TLD의 일반 TLD에 대한 상대 반응감도는 에너지에 대한 의존성을 거의 나타내지 않았다. 그리고 311은 박막의 조직에 대한 등가 두께에 따라 반응감도가 증가하였다. 결론 : 금속박막을 얹은 TLD 선량계의 반응값이 고 에너지(6-15 MV)에 대한 의존성을 거의 나타내지 않았으며, 흡수선량에 대한 선형성도 뛰어난 것으로 관측되었다. 따라서 금속박막을 얹은 TLD 선량계는 매우 작은 크기의 광자빔과 표면흡수선량의 측정에 매우 적합한 것으로 사료된다. Purpose : An investigation has been carried out on the factors which affect the response reading of thermoluminescent dosimeters (TLD-100) loaded with thin material in high energy Photon. The aim of the study was to assess the energy response of TLD-100 to the therapeutic ranges of photon beam. Materials and Methods : In this technique, TLD-100 (abbreviated as TLD) chips and three different thin material (Tin, Gold, and Tissue equivalent plastic plate) which mounted on the TLD chip were used in the clinical photon beam. The thickness of each metal plates was 0.1 mm and TE plastic plate was 1 mm thick. These compared with the photon energy dependence of the sensitivities of TLD (normal chip), TLD loaded with Tin or Gold plate, for the photon energy range 6 MV to 15 MV, which was of interest in radiotherapy. Results : The enhancement of surface dose in the TLD with metal plate was clearly detected. The TLD chips with a Gold plate was found to larger response by a factor of 1.83 in 10 MV photon beam with respect to normal chip. The sensitivity of TLD loaded with Tin was less than that for normal TLD and TLD loaded with Gold. The relative sensitivity of TLD loaded with metal has little energy dependence. Conclusion : The good stability and linearity with respect to monitor units of TLD loaded with metal were demonstrated by relative measurements in high energy Photon ($6\~15$ MV) beams. The TLD laminated with metals embedded system in solid water phantom is a suitable detector for relative dose measurements in a small beam size and surface dose.

Treatment of Carcinoma of the Uterine Cervix with High-Dose-Rate Intracavitary Irradiation using Ralstron

Chang Ok Suh(서창옥),Gwi Eon Kim(김귀언),John J.K. Loh(노준규) 대한방사선종양학회 1990 Radiation Oncology Journal Vol.8 No.2

1979년 5월부터 1981년 12월까지 총 524명의 자궁경부암 환자가 근치적 목적하에 방사선 치료를 받았다. 524명의 환자중, 356명이 코발트 선원을 사용한 원격 조정 아프터로딩 고선량률 강내조사 시스템(Rastron)으로써 치료받았으며 168명의 환자는 라듐 선원을 사용한 저선량률 강내 조사를 받았다. 외부조사는 골반부 전체에 총 40-50 Gy가 주어졌으며, 이어서 A지점에 10-13번에 걸쳐 30-38Gy의 강내 조사를 시행하는 치료지침이 사용되었다. 강내조사는 3Gy씩, 일주일에 세 번 주어졌다. 고선량률 강내조사를 받은 군에서의 5년 실제생존율은 ⅠB기 (N=20)가 77.6% Ⅱ기 (N=182)가 68.2% 그리고 Ⅲ기(N=148)가 50.9%였다. 저산량률 강내조사군에서의 5년 생존율은 ⅠB기(N=22)가 87.5% Ⅱ기(N=91)가 66.3%, 그리고 Ⅲ기 (N=52)가 55.4%였다. 생존율은 병기에 따라서는 통계학적으로 유의한 차이를 보였지만, 두 강내조사군 간에는 유의한 차이가 없었다. 방사선 치료후 내장의 후기 합병증은 고선량률 강내조사 군에서 3.7%, 저산량률 강내조사군은 8.4%에서 관찰되었다. 그러나 외과적 치료가 필요할 만큼 심한 합병증은 없었다. 방광에서 발생한 합병증의 빈도는 고선량률 강내조사군이 1.4%, 저산량률 강내조사군은 2.4%였다. 고선량률 강내조사의 시술은 외래 환자에 시행하기에 기술적으로 간단하고 쉬우며 마취가 필요없고, 환자가 매우 잘 견딘다. 담당자에 대한 방사선 피폭도 저선량률 강내조사에 비해 사실상 거의 없다. 고선량률 강내조사의 경우 치료시간이 짧기 때문에 주어진 시간내에 더 많은 환자를 치료할 수 있어진다. 따라서 많은 환자를 치료해야 하는 암센터의 경우, 고선량률 강내조사 시스템이 훨씬 더 권장되어 진다. 그러나 더욱 향상된 결과를 얻기 위하여, 다른 치료 방식으로 광범위한 연구를 통해, 고선량률 강내조사의 적절한 선량-분할조사 계획과 외부조사와 강내조사의 적절한 배합이 이루어져야 할 것이다. From May 1979 through December 1981 a total of 524 patients with carcinoma of the uterine cervix were treated by radiation therapy with curative intent. Among the 524 patients, 356 were treated with a high-dose-rate(HDR), remote-controlled, afterloading intracavitary irradiation(ICR) system using a cobalt source(Ralstron), and 168 patients received a low-dose-rate (LDR) ICR using a radium source. External beam irradiation with a total dose of 40-50 Gy to the whole pelvis followed by intracavitary irradiation with a total dose of 30-39 Gy in 10-13 fractions to point A was the treatment protocol. ICR was given three times a week with a dose of 3 Gy per fraction. Five-year actuarial survival rates in the HDR-ICR group were 77.6% in stage ⅠB(N=20), 68.2%% in stage Ⅱ(N=182), and 50.9% in stage Ⅲ(N=148). In LDR-ICR group, 5-year survival rates were 87.5% in stage ⅠB(N=22), 66.3% in stage Ⅱ(N=91), and 55.4% in stage Ⅲ(N=52). Survival rates showed a statistically significant difference by stage, but there was no significant difference between the two ICR groups. Late bowel complications after radiotherapy were noted in 3.7% of the HDR-ICR group and 8.4% of the LDR-ICR group. There was no severe complication requiring surgical management. The incidence of bladder complications was 1.4% in the HDR-ICR group and 2.% inthe LDR-ICR group. The application of HDR-ICR was technically simple and easily performed on and outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually nil in contrast to that of LDR-ICR. Within a given period of time, more patients can be treated with HDR-ICR because of the short treatment time. Therefore, the HDR-ICR system is highly recommended for a cancer center, particularly one with a large number of patients can be treated. In order to achieve an improved outcome, however, the optimum dose-fractionation schedule of HDR-ICR and optimum combination of intracavitary irradiation with external beam irradiation should be determined through an extensive protocol study with different treatment regimens.