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정미주,김연실,김지윤,이윤희,장지현,강진형,유이령,이연수 대한암학회 2016 Cancer Research and Treatment Vol.48 No.4
Purpose We investigated the prognostic factors for distant metastasis (DM) in patients with locally advanced oropharyngeal cancer (OPC) treated with surgery and adjuvant radiotherapy with or without concurrent chemotherapy. Materials and Methods Eighty-five patients treated between January 1995 and August 2014 were evaluated retrospectively. Data regarding the pathological tumour and nodal status, human papillomavirus (HPV) status, treatment characteristics, and pretreatment maximum standardized uptake value (SUVmax) of 18-fluoro-2-deoxyglucose positron emission tomography–computed tomography scan (18F-FDG PET-CT) were evaluated, and their influence on DM and survival outcomes were analyzed. Results Median follow-up period was 48.0 months. Recurrence was observed in 20 patients, including locoregional recurrence and DM. DM was observed in 13 patients. A multivariate analysis confirmed that the presence of lymphovascular invasion (p=0.031), lower neck lymph node (LN) involvement (p=0.006), SUVmax 9.7 (p=0.014), and tumour size 3 cm (p=0.037) significantly affected DM. HPV status was not associated with DM. Perineural invasion (p=0.048), lower neck LN involvement (p=0.008), SUVmax 9.7 (p=0.019), and tumour size 3 cm (p=0.033) were also significant factors for the DM-free survival rate. Conclusion Lower neck LN involvement, high SUVmax in pretreatment 18F-FDG PET-CT, and large tumour size were predictive factors for DM in patients of OPC.
정미주,김성환,이종훈,서영진 한국유방암학회 2015 Journal of breast cancer Vol.18 No.1
Purpose: The purpose of this study is to compare dosimetric parametersof intensity-modulated mode of TomoDirect and threedimensionalconformal radiotherapy (3D-CRT) in patients withearly breast cancer. Methods: TomoDirect and 3D-CRT planningwere carried out for 26 patients with early breast cancer whohad received breast-conserving surgery. A total of 50.4 Gy in 28fractions were prescribed to the planning target volume. The organsat risk (OAR) such as lung and heart were contoured. Planningtarget volume (PTV) dose coverage, radiation conform-ityindex (RCI), radical dose homogeneity index (rDHI), and irradiationdose of organs at risk were compared between TomoDirectand 3D-CRT planning. Results: The mean PTV dose (51.65±0.37Gy) and V47.8 (100%) in TomoDirect were significantly higher thanthe mean PTV dose (50.88±0.65 Gy) and V47.8 (89.23%±0.06%)in 3D-CRT (all, p<0.001). The RCI value in TomoDirect was significantlybetter than that in 3D-CRT (1.00 vs. 1.13, p<0.001). However, the rDHI value in TomoDirect was not significantly betterthan that in 3D-CRT (0.72 vs. 0.67, p=0.056). The mean lungdose and V10, V20, V30, and V40 values of ipsilateral lung in Tomo-Direct were significantly lower than those in 3D-CRT (all,p<0.05). There is no significant difference in the V10, V20, V30, andV40 values of heart between TomoDirect and 3D-CRT. And themean dose for heart in TomoDirect was .marginally lower thanthat in 3D-CRT (1.05 Gy vs. 1.62 Gy, p=0.085). The mean dosefor left anterior descending coronary artery in left breast cancerwas significantly lower in TomoDirect than in 3D-CRT (7.2 Gy vs. 12.1 Gy, p<0.001). Conclusion: Compared to 3D-CRT, TomoDirectcould result in favorable target coverage while reducing theirradiation dose of the ipsilateral lung for patients with earlybreast cancer.
Tumor bed volumetric changes during breast irradiation for the patients with breast cancer
정미주,이종훈,서영진,이효천,강대규,김은중,김성환 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.4
Purpose: The aim of this study was to evaluate changes in breast tumor bed volume during whole breast irradiation (WBI). Materials and Methods: From September 2011 to November 2012, thirty patients who underwent breast-conserving surgery (BCS) followed by WBI using computed tomography (CT) simulation were enrolled. Simulation CT scans were performed before WBI (CT1) and five weeks after the breast irradiation (CT2). The tumor bed was contoured based on surgical clips, seroma, and postoperative change. We retrospectively analyzed the factors associated with tumor bed volumetric change. Results: The median tumor bed volume on CT1 and CT2 was 29.72 and 28.6 mL, respectively. The tumor bed volume increased in 9 of 30 patients (30%) and decreased in 21 of 30 patients (70%). The median percent change in tumor bed volume between initial and boost CT was -5%. Seroma status (p = 0.010) was a significant factor in tumor bed volume reduction of 5% or greater. However, patient age, body mass index, palpability, T stage, axillary lymph node dissection, and tumor location were not significant factors for tumor bed volumetric change. Conclusion: In this study, volumetric change of tumor bed cavity was frequent. Patients with seroma after BCS had a significant volume reduction of 5% or greater in tumor bed during breast irradiation. Thus, resimulation using CT is indicated for exquisite boost treatment in breast cancer patients with seroma after surgery.
정미주,정수미,김지윤,유미령 대한암학회 2013 Cancer Research and Treatment Vol.45 No.3
Purpose The purpose of this retrospective study was to identify factors predictive of survival in rectal cancer patients who received surgery with curative intent after preoperative chemoradiotherapy (CRT). Materials and Methods Between July 1996 and June 2010, 104 patients underwent surgery for rectal cancer after preoperative CRT. The median dose of radiotherapy was 50.4 Gy (range, 43.2to 54.4 Gy) for 6 weeks. Chemotherapy was a bolus injection of 5-fluorouracil and leucovorin for the first and last week of radiotherapy (n=84, 77.1%) or capecitabine administered daily during radiotherapy (n=17, 16.3%). Low anterior resection (n=86,82.7%) or abdominoperineal resection (n=18, 17.3%) was performed at a median 47days from the end of radiotherapy, and four cycles of adjuvant chemotherapy was administered. The serum carcinoembryonic antigen (CEA) level was checked at initial diagnosis and just before surgery. Results After a median follow-up of 48 months (range, 9 to 174 months), 5-year disease free survival (DFS) was 74.5% and 5-year overall survival (OS) was 86.4%. Down staging of T diagnoses occurred in 32 patients (30.8%) and of N diagnoses in 40 patients (38.5%). The CEA change from initial diagnosis to pre-surgery (high-high vs. highnormal vs. normal-normal) was a statistically significant prognostic factor for DFS (p=0.012), OS (p=0.002), and distant metastasis free survival (p=0.018) in a multivariate analysis. Conclusion Patients who achieve normal CEA level by the time of surgery have a more favorable outcome than those who retain a high CEA level after preoperative CRT. The normalization of CEA levels can provide important information about the prognosis in rectal cancer treatment.