A multicenter retrospective cohort study of practice patterns and clinical outcome on radiotherapy for hepatocellular carcinoma in Korea

Seong, Jinsil,Lee, Ik Jae,Shim, Su Jung,Lim, Do Hoon,Kim, Tae Hyun,Kim, Jong Hoon,Jang, Hong Seok,Kim, Mi Sook,Chie, Eui Kyu,Kim, Jin Hee,Nam, Taek-Keun,Lee, Hyung Sik,Han, Chul Joo Blackwell Publishing Ltd 2009 Liver International Vol.29 No.2

<P>Abstract</P><P>Aim</P><P>To determine the national practice processes of care and outcomes of radiotherapy for hepatocellular carcinoma (HCC) in Korea.</P><P>Patients and Methods</P><P>A national survey of 53 institutions nationwide was conducted by requesting data on their experience of radiotherapy for HCC. Among them, 10 institutions were selected for performing more detailed analysis, based on the radiotherapy experience of at least five HCC patients between 2004 and 2005.</P><P>Results</P><P>This study covered the treatment of 398 HCC patients for 2 years. Most patients (78%) were in stage III or IV. Radiotherapy was chosen after the failure of other treatments, most frequently transarterial chemoembolization. Radiotherapy was performed predominantly using the three-dimensional conformal technique (3D-CRT, 81.9%) mostly with a total dose of ≥45 Gy. In 9.3% of the patients, radiotherapy was performed using radiosurgery. In a biologically effective dose (BED) with 10 Gy of α/β, 4.2–124.3 Gy<SUB>10</SUB> was delivered. The median survival time was 12 months, and the 2-year overall survival rate was 27.9%. A tumour size <5 cm, a negative lymph node and BED >53.1 Gy<SUB>10</SUB> were shown by multivariate analysis to be significant factors for a better prognosis. In a subset analysis for the 326 patients treated with 3D-CRT, better liver function with Child–Pugh class A was shown to be an additional factor for a better prognosis.</P><P>Conclusions</P><P>Radiotherapy has been used to treat advanced HCC in various modes, but mostly as a salvage treatment. Although this study was retrospective, it indicates that radiotherapy is a quite effective modality for HCC patients.</P>

Patterns of Care 연구 개발을 위한 직장암의 수술 후 방사선치료 시 적정 방사선치료 조사영역 제안

김종훈(Jong Hoon Kim),박진홍(Jin Hong Park),김대용(Dae Yong Kim),김우철(Woo Cheol Kim),성진실(Jinsil Seong),안용찬(Yong Chan Ahn),유미령(Mi Ryeong Ryu),전미선(Mison Chun),홍성언(Seong Eon Hong),오도훈(Do Hoon Oh),김일한(Il Han Kim) 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.3

목 적 : 전국의 각 병원 방사선종양학과전문의들이 시행하고 있는 직장암의 수술 후 방사선치료 조사영역 결정 원칙들을 취합하여 이를 바탕으로 표준적인 조사영역을 제시하고 향후 Patterns ofCare 연구를 위한 기본자료로 삼고자 한다. 대 상 및 방 법 : 경인지역 소재 18개 병원의 방사선종양학과 전문의들이 모인 합의도출 위원회에서 직장암의 수술 후 방사선치료 조사영역 결정 원칙을 파악하기 위해 개발한 항목들을 이용하여 직장암의 방사선치료를 담당하고 있는 전국의 48개 병원 방사선 종양학과 전문의들을 대상으로 설문조사를 시행하였다.전문의 별 치료원칙의 파악에 사용된 설문 항목들은 모의치료 시 조사영역 결정 19개 항목으로서 전후방 치료시의 상연,하연 및 측연과 측면 치료 시 전연, 후연 및 차폐물의 적용 범위 등을 묻는 내용이었고, 48개 병원 중 33개 병원의 전문의들로부터 회신된 내용과 해부학적,임상적 결과들을 바탕으로 일반적으로 권장할 만한 적절한 방사선 조사영역을 도출하였다. 결 과: 직장암의 수술후 방사선치료 조사영역 결정에 있어 권고 할만한 일반적인 원칙으로 다음의 사항들을 개발하였다. 상연은 제5요추 하단이나 중간부위,또는 천장골관절 상단,하 연 은 전 하방 절제수술 시에는 문합부로부터 일정거리 하방,복회음부 절제수술시는 회음부 봉합부로부터 일정거리 하방,전후방 치료시의 측연은 골반강내 벽면으로부터 일정거리 외측,측면 치료시의 전연은 치골결합부 후 단,그리고 후연은 천골전면 또는 후면으로 부터 일정거리 후방으로 정하여 천골 전면부의 공간을 충분히 포함시키는 것이 합리적인 것으로 나타났다. 권고안과 비교할 때, 상연의 경우 23건(70%), 하연의 경우 전하방 절제수술시 13건(39%), 복회음부 절제수술시 32건(97%),측연의 경우 32건(97%), 후연의 경우 32건(97%), 그리고 전연의 경우 16건(45%)에서 부합되는 것으로 나타났다. 결 론: 직장암의 수술 후 방사선치료 시 적절한 방사선치료 조사영역의 결정을 위하여 표준적인 조사영역을 제시하였으나 개별 환자의 병변위치와 진행상태,수술 소견 등에 따라 적절한 변형은 필수적이라 하겠다.이 권고안의 임상적 타당성은 향후 시행될 Patterns of Care연구를 통하여 증명하는 것이 필요하겠다. Purpose To suggest the optimal radiation fields after a surgical resection based on a nationwide survey on the principles of radiotherapy for rectal cancer in the Korean Patterns of Care Study . Materials andmethods A consensus committee, composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area, developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer after a surgical resection. The survey format included 19 questions on the principles of defining field margins, and was sent to the radiation oncologists in charge of gastrointestinal malignancies in all Korean hospitals (48 hospitals). Thirty three (69%) oncologists replied. On the basis of the replies and literature review, the committee developed guidelines for the optimal radiation fields for rectal cancer. Results: The following guidelines were developed: superior border between the lower tip of the L5 vertebral body and upper sacroiliac joint; inferior border 23cm distal to the anastomosis in patient whose sphincter was saved, and 23cm distal to the perineal scar in patients whose an alsphincter was sacrificed; anterior margin a t t he posterior tip of the symphysis pubis or 2 3 cm anterior to the vertebral body, to include the internal iliac lymph node and posterior margin 1.52cm posterior to the anterior surface of the sacrum, to include the presacral space with enough margin. Comparison with the guidelines, the replies on the superior margin coincided in 23 cases (70%), the inferior margin after sphincter saving surgery in 13 (39%), the inferior margin after abdominoperineal resection in 32 (97%), the lateral margin in 32 (97%), the posterior margins in 32 (97%) and the anterior margin in 16 (45%). Conclusion These recommendations should be tailored to each patient according to the clinical charac-teristics such a s tumor location, pathological and operative findings, for the optimal treatment. Theadequacy of these guidelines should be proved by following the Korean Patterns of Care Study.

방사선치료 Patterns of Care Study 개발을 위한 2002년 한국 방사선종양학과 전문의들의 직장암 방사선치료 원칙 조사연구

김종훈(Jong Hoon Kim),김대용(Dae Yong Kim),김용호(Yong Ho Kim),김우철(Woo Cheol Kim),김철용(Chul Yong Kim),성진실(Jinsil Seong),송승창(Seung Chang Sohn),신현수(Hyun Soo Shin),안용찬(Yong Chan Ahn),오도훈(Do Hoon Oh),오원용(Wong Yong 대한방사선종양학회 2003 Radiation Oncology Journal Vol.21 No.1

목 적 : 한국에서 발생빈도가 높은 암의 하나인 직장암의 치료에 있어 전국의 각 병원 치료방사선과(방사선종양학과)에서 시행하고 있는 치료 형태를 세부 항목별로 파악하여 방사선종양학 전문의 간의 치료원칙의 차이점을 분석하고 이를 바탕으로 향후 Patterns of Care Study를 위한 연구의 기본 자료로 제시하고자 한다. 대상 및 방법 : 경인지역 소재 18개 대학병원 및 방사선종양학과가 있는 병원들의 방사선종양학과 전문의들이 모여 직장암의 방사선치료 원칙 분석을 위한 consensus committee를 구성하고, 회합 및 설문조사를 통하여 각 의사들의 방사선치료 원칙을 파악하기 위한 세부 항목 설정과 이를 토대로 직장암 환자 개개인의 치료 내용을 측정하는 구체적인 항목들을 개발하였다. 이 항목들을 이용하여 직장암의 방사선치료를 담당하고 있는 전국의 방사선종양학과 전문의들을 대상으로 설문조사를 시행한 후 각 전문의들의 의견이 일치하는 부분과 상이한 부분들을 분석하였다. 결 과 : 전문의 별 치료원칙의 측정에 사용된 항목들은 1) 치료대상환자의 선정기준 8개 항목, 2) 수술 전후 병기 및 예후 인자 검사 20개 항목, 3) 수술 및 항암화학요법과의 병용기준 7개 항목, 4) 환자의 setup 및 처치 9개 항목, 5) 모의치료시 조사야 결정 19개 항목, 6) 치료계획 5개 항목, 7) 치료 중 상태 확인 위한 이학적/병리학적 검사 4개 항목, 8) 치료 후 추적 관찰시 검사할 10개 항목 등 총 82개의 항목이 개발되었다. 이 항목들은 전국 각 병원들의 방사선종양학과 전문의를 대상으로 설문조사 되어 치료원칙에 대한 분석이 항목별로 이루어졌다. 설문조사 결과 전국의 각 병원 방사선종양학과에서 시행되고 있는 직장암의 방사선치료 형태는 일정 범위를 유지하고 있으나, 일부 항목에 있어서는 치료자 간 의견차이가 큰 것으로 나타났으며 이들 중 전체 응답자의 50% 이상에서 합의가 되지 못한 항목들은, 1) 치료환자의 선정 기준 중 수술 전 방사선치료 대상, 2) 병기 결정 검사 중 직장내 초음파(EUS, endorectal ultrasound), 흉부 CT, 뼈 스캔 등의 시행 여부, 3) 항암제와의 병용 원칙, 4) 모의치료시 소장 위치 확인을 위한 조영제 사용, 5) 조사야의 경계선 결정, 6) 치료 후 추적 관찰 시 CEA와 대장내시경의 시행여부 등이었다. 결 론 : 이견이 많은 항목들에 대해선는 향후 담당 전문의들을 대상으로 consensus meeting등을 통한 체계적인 분석 및 합의의 도출이 필요한 것으로 보이며, 본 연구에서 밝혀진 각 병원들의 치료 내용을 토대로 향후 표준화된 치료 모델 개발을 위한 Patterns of Care Study가 진행될 예정이다. Purpose : To conduct a nationwide survery on the principles in radiotherapy for rectal cancer, and develop the framework of a database of Korean Patterns of Care. Study. Materials and Methods : A consensus committee was established to develop a tool for measuring the patterns in radiotherapy protocols for rectal cancer. The panel was composed of radiation oncologists from 18 hospitals in Seoul Metropolitan area. The committee developed a survey format to analyze radiation oncologist's treatment principles for rectal cancer. The survey items developed for measuring the treatment principles were composed of 1) 8 eligibility criteria, 2) 20 items for staging work-ups and prognostic factor, 3) 7 items for principles of combined surgery and chemotherapy, 4) 9 patient set-ups, 5) 19 determining radiation fields, 6) 5 radiotherapy treatment plans, 7) 4 physical/laboratory examination to monitor a patient's condition during treatment, and 8) 10 follow-up evaluations. These items were sent to radiation oncologists in charge of gastrointestinal malignancies in all hospitals (48 hospitals) in Korea to which 30 replies were received (63%). Results : Most of the survey items were replied to without no major differences between the repliers, but with the following items only 50% of repliers were in agreement : 1) indications of preoperative radiation, 2) use of endorectal ultrasound, CT scan, and bone scan for staging work-ups, 3) principles of combining chemotherapy with radiotherapy, 4) use of contrast material for small bowel delineation during simulation, 5) determination of field margins, and 6) use of CEA and colonoscopy for follow-up evaluations. Conclusion : The items where considerable disagreement was shown among the radiation oncologists seemed to make no serious difference in the treatment outcome, but a practical and reasonable consensus should be reached by the committee, with logical processes of agreement. These items can be used for a basic database for the Patterns of Care Study, which will survey the practical radiotherapy patterns for rectal cancer in Korea.

A Study on Optimization of Photoneutron Shielding in a Medical Accelerator Room by Using Monte Carlo Simulation

Kim, Yong Nam,Choi, Sang Hyun,Jeong, Kyoungkeun,Kim, Joo Young,Lee, Chang Geol,Seong, Jinsil,Kim, Chan Hyeong Informa UK (Taylor Francis) 2008 Journal of nuclear science and technology Vol.45 No.suppl5

The role of adjuvant pelvic radiotherapy in rectal cancer with synchronous liver metastasis: a retrospective study

Kim, Jun Won,Kim, Yong Bae,Kim, Nam-Kyu,Min, Byung-Soh,Shin, Sang Joon,Ahn, Joong Bae,Koom, Woong Sub,Seong, Jinsil,Keum, Ki Chang BioMed Central 2010 Radiation oncology Vol.5 No.-

<P><B>Background</B></P><P>Synchronous liver metastases are detected in approximately 25% of colorectal cancer patients at diagnosis. The rates of local failure and distant metastasis are substantial in these patients, even after undergoing aggressive treatments including resection of primary and metastatic liver tumors. The purpose of this study was to determine whether adjuvant pelvic radiotherapy is beneficial for pelvic control and overall survival in rectal cancer patients with synchronous liver metastasis after primary tumor resection.</P><P><B>Methods</B></P><P>Among rectal cancer patients who received total mesorectal excision (TME) between 1997 and 2006 at Yonsei University Health System, eighty-nine patients diagnosed with synchronous liver metastasis were reviewed. Twenty-seven patients received adjuvant pelvic RT (group S + R), and sixty-two patients were managed without RT (group S). Thirty-six patients (58%) in group S and twenty patients (74%) in group S+R received local treatment for liver metastasis. Failure patterns and survival outcomes were analyzed.</P><P><B>Results</B></P><P>Pelvic failure was observed in twenty-five patients; twenty-one patients in group S (34%), and four patients in group S+R (15%) (<I>p </I>= 0.066). The two-year pelvic failure-free survival rates (PFFS) of group S and group S+R were 64.8% and 80.8% (<I>p </I>= 0.028), respectively, and the two-year overall survival rates (OS) were 49.1% and 70.4% (<I>p </I>= 0.116), respectively. In a subgroup analysis of fifty-six patients who received local treatment for liver metastasis, the two-year PFFS were 64.9% and 82.9% (<I>p </I>= 0.05), respectively; the two-year OS were 74.1% and 80.0% (<I>p </I>= 0.616) in group S (n = 36) and group S+R (n = 20), respectively.</P><P><B>Conclusions</B></P><P>Adjuvant pelvic RT significantly reduced the pelvic failure rate but its influence on overall survival was unclear. Rectal cancer patients with synchronous liver metastasis may benefit from adjuvant pelvic RT through an increased pelvic control rate and improved quality of life.</P>

Multi-constellation Local-area Differential GNSS for Unmanned Explorations in the Polar Regions

Kim, Dongwoo,Kim, Minchan,Lee, Jinsil,Lee, Jiyun The Institute of Positioning 2019 Journal of Positioning, Navigation, and Timing Vol.8 No.2

The mission tasks of polar exploration utilizing unmanned systems such as glacier monitoring, ecosystem research, and inland exploration have been expanded. To facilitate unmanned exploration mission tasks, precise and robust navigation systems are required. However, limitations on the utilization of satellite navigation system are present due to satellite orbital characteristics at the polar region located in a high latitude. The orbital inclination of global positioning system (GPS), which was developed to be utilized in mid-latitude sites, was designed at $55^{\circ}$. This means that as the user is located in higher latitudes, the satellite visibility and vertical precision become worse. In addition, the use of satellite-based wide-area augmentation system (SBAS) is also limited in higher latitude regions than the maximum latitude of signal reception by stationary satellites, which is $70^{\circ}$. This study proposes a local-area augmentation system that additionally utilizes Global Navigation Satellite System (GLONASS) considering satellite navigation system environment in Polar Regions. The orbital inclination of GLONASS is $64.8^{\circ}$, which is suitable in order to ensure satellite visibility in high-latitude regions. In contrast, GLONASS has different system operation elements such as configuration elements of navigation message and update cycle and has a statistically different signal error level around 4 m, which is larger than that of GPS. Thus, such system characteristics must be taken into consideration to ensure data integrity and monitor GLONASS signal fault. This study took GLONASS system characteristics and performance into consideration to improve previously developed fault detection algorithm in the local-area augmentation system based on GPS. In addition, real GNSS observation data were acquired from the receivers installed at the Antarctic King Sejong Station to analyze positioning accuracy and calculate test statistics of the fault monitors. Finally, this study analyzed the satellite visibility of GPS/GLONASS-based local-area augmentation system in Polar Regions and conducted performance evaluations through simulations.

Analysis of ATP Degradation Products as Freshness Indicators in Flat Fish during Storage

Jinsil Kim,Kwang-geun Lee 한국식품영양과학회 2012 한국식품영양과학회 학술대회발표집 Vol.2012 No.10

Dosimetric comparisons of three-dimensional conformal radiotherapy, intensity-modulated radiotherapy, and helical tomotherapy in whole abdominopelvic radiotherapy for gynecologic malignancy.

Kim, Yong Bae,Kim, Joo Ho,Jeong, Kyung Keun,Seong, Jinsil,Suh, Chang Ok,Kim, Gwi Eon Adenine Press 2009 Technology in cancer research & treatment Vol.8 No.5

<P>OBJECTIVES: The goal of this study was to dosimetrically compare 3-dimensional radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and helical tomotherapy (TOMO) plans for whole abdominopelvic radiotherapy (WART) in patients with gynecologic cancer. METHODS: Ten patients were selected for WART planning. Doses were prescribed to planning target volumes (PTVs) as the followings: 30 Gy to PTV-whole abdominopelvis (PTV-WA), 40 Gy to PTV-para-aortic lymph node (PTV-PALN), 44 Gy to PTV-pelvis, and 50 Gy to gross target volume (GTV) in 20 fractions. Dose to whole liver, both kidneys, and spinal cord were constrained below each tissue tolerance, and bone marrow (BM)-sparing technique was adopted in IMRT and TOMO. Dosimetric parameters and treatment times were compared among plans. RESULTS: Calculated doses in TOMO came most closely to the prescribed dose for coverage of PTV-WA, PTV-PALN, PTV-pelvis, and GTV compared to 3DCRT, and IMRT. In normal organs, TOMO had significantly better dosimetric profiles compared to IMRT and 3DCRT. TOMO significantly reduced V(20Gy), and mean dose of whole liver, both kidneys, and spinal cord. The use of BM-sparing technique (BMS) did not impair coverage of target volume in IMRT and TOMO. While IMRT showed no differences of irradiated BM dose using BMS, TOMO with BMS reduced half V(20Gy) of BM compared to TOMO without BMS. CONCLUSIONS: TOMO showed dosimetric superiority in target coverage, sparing BM, and other normal organs compared to 3DCRT and IMRT. Clinical experiences will be needed for evaluation of feasibility of WART using TOMO in patients with gynecologic cancer.</P>

Clinical significance of soluble programmed cell death ligand-1 (sPD-L1) in hepatocellular carcinoma patients treated with radiotherapy

Kim, Hyun Ju,Park, Sangjoon,Kim, Kyoung-Jin,Seong, Jinsil Elsevier Science Publishers 2018 Radiotherapy and oncology Vol.129 No.1

<P><B>Abstract</B></P> <P><B>Purpose</B></P> <P>To investigate the clinical implications of the soluble programmed cell death-ligand 1 (sPD-L1) level in hepatocellular carcinoma (HCC) patients treated with radiotherapy (RT).</P> <P><B>Materials/methods</B></P> <P>HCC patients treated with RT between June 2011 and March 2015 were prospectively recruited and sPD-L1 levels were measured using an enzyme-linked immunosorbent assay. Blood samples were obtained at the RT start, RT end, and 1-month follow-up. The associations of the sPD-L1 level with the clinical features and outcomes were analyzed.</P> <P><B>Results</B></P> <P>Fifty-three patients with HCC were included. Thirty-four patients received conventional fractionated RT with hepatic arterial infusional chemotherapy, while 19 patients received stereotactic body radiotherapy (SBRT). The initial sPD-L1 level was significantly associated with stage, tumor size, portal vein tumor thrombosis, and venous invasion. The overall-survival was significantly poorer in patients with a higher level of initial sPD-L1 (≥1.315 pg/mL). A higher level of sPD-L1 at 1 month (≥12.9 pg/mL) was significantly related to early lung metastasis. The sPD-L1 level was significantly increased after RT and the change pattern of sPD-L1 was different between two RT schemes.</P> <P><B>Conclusions</B></P> <P>The level of sPD-L1 was associated with tumor aggressiveness and outcomes, suggesting its role as a possible predictive biomarker. The increases in sPD-L1 after RT suggests that combined treatment with RT and immune checkpoint inhibitors may be a promising therapeutic strategy in HCC.</P>

Phase I/II trial of helical IMRT-based stereotactic body radiotherapy for hepatocellular carcinoma

Kim, Jun Won,Kim, Do Young,Han, Kwang-Hyub,Seong, Jinsil Elsevier 2019 Digestive and liver disease Vol.51 No.3

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>To report the results of a phase I/II study of helical IMRT-based stereotactic body radiotherapy (SBRT) for hepatocellular carcinoma (HCC).</P> <P><B>Methods</B></P> <P>Eligibility included Child–Turcotte–Pugh class A or B, ≤3 lesions, and cumulative tumor diameter ≤6 cm. Dose was escalated from 36 Gy to 60 Gy delivered in 4 fractions. Grade ≥3 gastrointestinal toxicities (CTCAE v3.0) or radiation-induced liver disease defined dose-limiting toxicity (DLT).</P> <P><B>Results</B></P> <P>Thirty-two patients were enrolled: seven in dose levels 1–2 (36–44 Gy) and 25 in levels 3–4 (42–60 Gy). Failures included 1 local, 14 outfield intrahepatic, 2 distant, 1 concurrent local and outfield, 1 concurrent outfield and distant, and 1 concurrent local, outfield, and distant. Nine had grade 3 hematologic toxicities and 5 had grade 2 hepatic toxicities; no patient experienced DLT. Two-year local control (LFFS), outfield intrahepatic control (OutFFS), and overall survival (OS) rates were 80.9%, 46.7%, and 81.3%, respectively. Dose levels 3–4 and pre-radiotherapy multi-segment recurrence were independent prognostic factors for LFFS and OutFFS, respectively. Two-year LFFS, OutFFS, and OS were significantly higher for patients who were treated with dose-levels 3/4 for tumor(s) involving single segment compared with the rest of the patients.</P> <P><B>Conclusions</B></P> <P>Helical IMRT-based SBRT was safe and effective, and patients with multi-segment recurrences prior to SBRT need to be closely followed.</P>