척추 전이암에서 확산강조 자기공명 영상을 이용한 치료반응의 평가

이장진,신세원 영남대학교 기초/임상의학연구소 2001 Yeungnam University Journal of Medicine Vol.18 No.1

Background: The purpose of this study was to evaluate the usefulness of diffusion-weighted magnetic resonance imaging for monitoring the response to radiation therapy in metastatic bone marrow of the spines. Materials and Methods: Twenty-one patients with metastatic bone marrow of the spines were examined with MRI. Diffusion-weighted and spin-echo MRI were performed in 10 patients before and after radiation therapy with or without systemic chemotherapy, and performed in 11 patients after radiation therapy alone. Follow up spin-echo and diffusion-weighted MRI were obtained at 1 to 6 months after radiation therapy according to patients' condition. The diffusion-weighted imaging sequence was based on reversed fast imaging with steady-state precession(PSIF). Signal intensity changes of the metastatic bone marrows before and after radiation therapy on conventional spin-echo sequence MRI and diffusion-weighted MRI were evaluated. Bone marrow contrast ratios and signal-to-noise ratios before and after radiation therapy of diffusion- weighted MRI were analyzed. Results: All metastatic bone marrow of the spinal bodies were hyperintense to normal bone marow of the spinal bodies on pretreatment diffusion-weighted MRI and positive bone marrow contrast ratios(p<0.001), and hypointense to normal spinal bodies on posttreatment diffusion-weighted MRI and negative bone marrow contrast ratios(p<0.001). The signal to noise ratios after treatment decreased comparing with those of pretreatment. Decreased signal intensity of the metastatic bone marrows on diffusion-weighted MRI began to be observed at average more than one month after the initation of the radiation therapy. Conclusion: These results suggest that diffusion-weighted MRI would be an excellent method for monitoring the response to therapy of metastatic bone marrow of the spinal bodies, however, must be investigated in a larger series of patients with longer follow up period.

18MeV 선형가속기의 ARC Therapy에 관한 고찰

신세원,김명세,김성규 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.2

회전조사시 회전각도에 따른 계산치와 측정치를 비교, 검토하여 다음과 같은 결과를 얻었다. 90°회전시에는 계산치와 측정치와는 4.5%의 차이를 나타내었고, 120°회전시에는 4.4%, 180°회전시에는 3.9%, 240°회전시에는 2.9%, 360°회전시에는 2.1%의 차이를 나타내어 회전각도가 클수록 계산치와 측정치와의 차이는 적은 것으로 나타났다. 또한 회전각도에 따라 최고선량지점이 상부로 이동하는 정도는 90°에서 240°까지 회전할 때 tumor depth가 4.5㎝일 경우에는 1.67㎝에서 1.10㎝정도 상부로 이동하였으며, tumor depth가 8㎝일 경우에는 2.45㎝에서 1.40㎝정도 상부로 이동하는 것으로 나타났다. In recent years there has been a growing interest in all forms of rotational therapy and many different types of therapy machines designed for this kind of treatment have become available. To the medical radiation physicist, the dosimetry of rotation therapy has presented a number of interesting problems, and much useful work has been published on the basic data of dose distribution and dosage calculation. The setting dose for ARC therapy were obtained by computer calculation and measurement with cylindrical phantom. Authors compared computer calculation with measured value. And in ARC therapy, the region of maximum dose is shifted from the tumor center. The extent of shift was analyzed by isodose distribution for ARC therapy techniques.

단전이성 뇌종양의 임상 양상과 예후 인자

이재련(Jae Lyun Lee),신창진(Chang Jin Shin),강희정(Hee Jeong Kang),오현아(Hyun Ah Oh),이구(Gu Lee),최재혁(Jae Hyuk Choi),배성화(Sung Hwa Bae),이경희(Kyung Hee Lee),현명수(Myung Soo Hyun),신세원(Sei One Shin),류헌모(Hyun Mo Ryoo) 대한내과학회 2002 대한내과학회지 Vol.62 No.4

목적 : 전이성 뇌종양은 성인 악성 종양환자의 흔한 합병증이다. 저자 등은 전이성 뇌종양의 임상적인 특징, 치료 효과, 생존에 영향을 미치는 예후 인자를 알아보고자 하였다. 대상 및 방법 : 1991년 1월부터 1997년 12월까지 본원에서 전이성 뇌종양으로 진단 받은 97예의 환자를 대상으로 하여 후향적으로 분석하였다. 결과 : 뇌전이의 원발종양으로는 폐암 (61예, 63%)이 가장 흔하였으며 그 외 원발 불명 전이성 뇌암 (15예, 16%), 위장관암 (13예, 13%), 유방암 (6예, 6%), 신장암 (2예, 2%) 순이었다. 단일성 뇌전이는 44예 (45%)였으며 다발성 뇌전이는 53예 (55%)였다. 치료 유무 및 종류를 고려하지 않을 경우 중앙생존기간은 3개월이었으며 1년 생존율은 8%였다. 생존율에 영향을 미치는 유의한 예후인자로는 진단당시 활동능과 신경손상의 정도 (p< 0.01)였다. 어떠한 치료도 시행하지 않는 군에 비해 스테로이드를 포함한 치료를 시행한 군에서 유의한 생존기간의 증가를 관찰할 수 있었다 (1.1개월 대 3.7개월). 스테로이드 단독 치료에 비해 전뇌 방사선 조사를 추가한 군에서 유의하게 생존기간이 연장되었다 (2.2개월 대 4.8개월). 추가적인 항암화학요법은 유의한 생존기간의 향상을 가져오지는 못하였다. 수술적 절제술을 시행한 군의 중앙생존기간은 8.8개월로 스테로이드와 전뇌 방사선치료만 시행한 군에 비해 유의한 생존기간의 증가를 보였다. 결론 : 전이성 뇌종양 환자에서 전뇌 방사선치료와 스테로이드는 유용한 완화치료 방법이며 진단 당시 활동능과 신경손상의 정도가 중요한 예후 인자로 분석되었다. 후향적인 연구로 인해 결과 해석에 한계가 있으나 수술적 절제 및 항암화학요법이 일부 선택된 환자 치료시 중요한 수단이 될 것으로 사료된다. Background : Brain metastasis is a common complication in cancer patients. We evaluated the clinical characteristics, treatment outcome and prognostic factors for patients with metastatic brain tumor. Methods : The records of 97 patients with metastatic brain tumor during the period from January 1991 to November 1997 were reviewed retrospectively. Results : The most common primary tumor is lung cancer (61 cases, 63%) followed by metastatic cancer unknown primary site (15 cases, 16%), gastrointestinal cancer (13 cases, 13%), breast cancer (6 cases, 6%) and renal cancer (2 cases, 2%). There were 44 patients with a single brain metastasis and 53 patients with multiple brain metastases. The median survival was 3.0 months and one-year survival rate was 8% irrespective of treatment. Favorable prognostic factors which affect survival were ambulatory status (p<0.01) and functional neurologic class 1, 2 (p<0.01). Median survival was 3.7 months for patients with steroid therapy and 1.1 months with no therapy (p<0.01). Median survival was 4.8 months for patients with steroid therapy plus whole brain radiotherapy (WBRT) and 2.2 months with steroid therapy alone (p<0.01). Additional chemotherapy did not appear to affect the survival. The patients treated with surgery had median survival time of 8.8 months compared with 2.5 months for patients treated with steroid therapy plus WBRT (p<0.05). Conclusion : In present study, we confirmed that whole brain irradiation and corticosteroid administration are effective palliative treatment for patients with metastatic brain tumor. Initial performance status and neurological function were identified as important prognostic factors. Although confounded by the limitations of retrospective study, more aggressive treatments including surgery and chemotherapy could be regarded to have a significant role to achieve better treatment outcome in some selected cases.(Korean J Med 62:444-452, 2002)

Sequential Combination Chemotherapy and Radiotherapy of an Isolated Non-Hodgkin`s Lymphoma of the Larynx -Report of a Case-

( Sei One Shin ),( Myung Se Kim ),( Sung Kyu Kim ),( Young Ran Shim ) 영남대학교 기초/임상의학연구소 1997 Yeungnam University Journal of Medicine Vol.14 No.2

고 선량률 강내 치료기를 이용한 식도암 치험 1례

김경애,김성규,신세원,김명세 영남대학교 의과대학 1988 Yeungnam University Journal of Medicine Vol.5 No.1

식도암 환자에서 외부 방사선 치료와 고 선량률 강내 치료를 병용하여 자각 증상의 호전은 물론 식도 촬영상에서도 좋은 반응을 보인 환자에서 장기간이 경과후에 발생한 식도 출혈과 식도 기관루를 경험하였기에 문헌 고찰도 함께 하였다. Esophageal cancers are highly malignant neoplasms. Prognosis of esophageal cancer treated by external irradiation alone is rather poor because of local recurrence and distant metastasis. Recently intracavitary irradiation has been used as a boost therapy after external irradation to optain better local control. One case of esophageal cancer has been treated by high dose rate remote-controlled afterloading unit as boost therapy after external irradiation. The result was excellent in short term follow up esophagogram but esophageal bleeding and esophagotracheal fistula were noted in further follow up examination after inappropriate posttreatment management including insufficient chemotherapy due to poor general condition. We reviewed possible causes of esophageal bleeding and esophagotracheal fistula after external irradiation and high dose rate ICR.

Stereotactic Radiosurgery for Recurrent Glioblastoma Multiforme using Yeungnam Localization Device

신세원(Sei One Shin),김성규(Sung Kyu Kim),김명세(Myung Se Kim),김오룡(Oh Lyong Kim),조수호(Soo Ho Cho) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.1

재발성 두개강내 악성종양의 치료는 관습적으로 재수술이나 고식적 항암요법이 주된 치료법으로 이용되어 왔으나 치료효과는 만족스럽지 못하였다. 일부분의 치료기관에서는 뇌정위적으로 근접치료를 시도하였으나 선량분포의 불균일성과 시술상의 어려움으로 널리 사용되지 못하였다. 최근 방사선 영상진단기술의 발달과 치료기술의 발달에 힘입어 뇌정위적 방사선 절제술이 도입되어 그 이용범위가 넓어지면서 기능적 뇌절제술을 비롯하여 뇌동정맥기형의 치료나 뇌종양의 치료에도 많이 이용되고 있으며 고무적인 보고가 많다. 영남대학교 의과대학 치료방사선과학교실에서는 신경외과학교실과 합동으로 뇌정위적 방사선 뇌절제술에 필수적인 위치선정을 특수기구를 자체제작하여 전산화 단층촬영장치와 치료용 선형가속기에 적용가능성 여부를 검토한 후 인형 인체 모형과 필름을 이용하여 기계적 정확성과 방사선 선량 분포의 안정성을 확인한 후 과거에 근치적 뇌부분 절제술과 수술후 방사선치료를 시행후 재발된 두명의 악성 성상 세포종 환자에서 자체제작한 기구를 이용하여 뇌정위적 방사선절제술을 시행하여 고식적치료에 합당한 증상개선의 만족스런 결과를 얻었으므로 위치선정용 기구의 특성과 치료성적을 문헌고찰과 함께 보고한다. Authors performed a stereotactic radiosurgery with multiple noncoplanar convergent photon beams of linear accelerator (NELAC-1018 18 MeV, NEC) using a specially designed Yeungnam localization device for two patients with recurrent gliobiastoma multiforme One patient had 2 cm sized and the other 4 cm sized mass on the CT images. After single session of treatment with 15 and 20 Gy, headache was improved in a few days after radiosurgery with no remarkable untoward reactions. Our experience with these two patients were endcouraging and we found that our localization device, which is easily adjustable and inexpensive, could be a valuable tool for stereotactic radiosurgery particularly in the treatment of recurrent brain tumor.

콘빔 CT를 이용한 전이성 뇌암의 영상 유도 방사선수술

신세원 ( Sei One Shin ),윤상모 ( Sang Mo Yun ) 영남대학교 기초/임상의학연구소 2007 Yeungnam University Journal of Medicine Vol.24 No.2S

Background:This study was performed to test feasibility of CBCT(cone-beam computerized tomography) guided radiosurgery. Materials and Methods:We used CBCT which was mounted on a retractable arm at 90° to the treatment source. CBCT images were overlapped on the digitally reconstructed images from simulation CT scan. Then, 3 dimensional volumetric CT image matching was performed. If there were any positioning errors, automated patient re-positioning was done. Results:A radiosurgery treatment plan was carried out with a set of specially designed multiple non-coplanar arcs. The goal of plan was to deliver single session 18 Gy at periphery of the target. We treated a patient with a solitary brain metastasis from left upper lung cancer. Serial imaging study for treatment response revealed a satisfactory result with no remarkable treatment related side effects. Conclusion:CBCT image guided radiosurgery system is very simple and could be a convenient image guiding modality for stereotactic radiosurgery or fractionated radiotherapy with an acceptable geometric accuracy and radiation exposure.

자궁 경부암의 수술후 방사선 치료에서 선량 분포에 관한 연구

신세원,김성규,김명세 영남대학교 의과대학 1991 Yeungnam University Journal of Medicine Vol.8 No.1

Uterine cervical cancer is the most common malignancy in korean women. In spite of recent development of early diagnostic and therapeutic modalities, about 40% of treated patient will develop relapse. So more aggressive local treatment such as more extensive surgery and higher radiation dose and administration of systemic chemotherapy will promote the curability but treatment related complications can not be avoidable. We used 22 cases of early cervical cancer, treated with surgery and post-operative radiotherapy, clinical data of these patients were analized to determine relationship between clinical parameters and final outcome. Three out of 22 cases revealed relapse and one patient showed rectovaginal fistula and another patient showed small bowel obstruction and the other patient showed rectal obstruction. Two out of three recurrence were stage Ⅱa and the other one case was stage Ib adenocarcinoma with lymphovascular involvement. Nineteen out of 22 cases were followed without remarkable side effect or treatment related complication or sequelae. We concluded that our treatment policy was safe and effective to eradicate high risk postoperative cervical cancer with acceptable side effects or complication.

HeLa.S3(SC) 세포계의 집락형성에 미치는 방사선의 효과

신세원,김명세,김성규 영남대학교 의과대학 1993 Yeungnam University Journal of Medicine Vol.10 No.1

임상적으로 많이 이용되는 범위의 방사선조사에서는 증식능의 상실을 세포사망으로 정의를 내린다. 본 연구는 실험용 orthovotage조사기를 이용하여 확립된 세포주인 Hela.S3(SC)를 대상으로 각각 100 cGy, 200 cGy, 400 cGy 및 600 cGy 방사선조사 후 2주일간 배양후 crystal violet 염색을 하여 육안적으로 판별가능한 크기의 집락의 수를 산출하여 다음의 결과를 얻었다. HeLa.S3(SC)세포의 집락 형성능은 0.464이었다. 세포의 생존곡선의 형태는 다표적, 1 hit 형태를 보였다. Do는 150 cGy, Dq는 80 cGy, 외삽치는 1.7이었다. 이 연구결과는 향후 다양한 방사선 생물학연구에 참고자료로 이용 가능하리라 사료된다. Since discovery of X-rays, radiotherapy has evolved into one of the most scientific branches of medicine and has established its role as the primary line or the secondary line of attack, after surgery, in the treatment of malignant cancers. Nowadays its importance is illustrated by the fact that as many as 70 per cent of all patients with cancer will receive radiation therapy at sometime during their disease process. Biologic effects of X-rays began to be apparent soon after the discovery by Roentgen in 1895. In clinical radiotherapy, the biologic endpoint of most importance is loss of cellular reproductive ability or clonogenicity. One of the commonest ways to assess cell survival to use an in vitro plating assay. We analyzed radiation effect on colony formation of HaLa.S3(SC) cell line and obtained results are as follows : The plating efficiency is 0.464. The shape of cell survival curve is similar to multi-target plus single hit component model. Estimated values of Do, Dq, and extrapolation number are 150 cGy, 80 cGy and 1.7 respectively. We reported these experimental data with review of literature.

안와 및 안와부속기 비호지킨림프종 22례의 임상적 분석

이재련,이경희,현명수,정화선,신세원,류헌모 大韓血液學會 2001 大韓血液學會誌 Vol.36 No.4