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김인아,장홍석,유미령,윤세철,김문찬,신경섭,박용휘,Kim In Ah,Jang Hong Suk,You Mi Ryung,Yoon Sei Chul,Kim Moon Chan,Shinn Kyung Sub,Bahk Yong Whee The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2
가톨릭의대 방사선치료실에서는 1987년 2월부터 1990년 7월까지 41개월 동안에 뇌동정맥성 기형으로 확진된 17예에 대해서 6MV선형가속기를 사용하여 SAD법으로 외부방사선 치료를 시행하였다. 치료방법은 총 14예중 4예 $(24\%)$에 대해서는 보통분할방식으로, 13예 $(70\%)$는 정위다방향 고선량 단일 조사로 치료하였다. 이들의 임상적 및 방사선학적 추적검사를 분석하여 다음과 같은 결과를 얻었다. 1. 연령분포는 $10\sim51$세 (중앙값 26세)였고, 남녀 비는 14 : 3으로 나타났다. 2.주증상은 두통이 12예$(70.1\%)$, 경련 5예$(29.4\%)$, 편부전마비 4예$(23.5\%)$ 등의 순이었고, 파열에 따른 출혈을 동반한 경우가 5예 $(29.4\%)$있었다. 3. 각 뇌동정맥성 기형은 중뇌동맥 분지에서 기원한 경우가 7예$(41.2\%)$, 전뇌동맥 3예$(17.6\%)$, 후뇌동맥 2예 $(11.8\%)$, 전뇌 및 후동맥 1예 $(5.9\%)$순으로 나타났다. 4. 보통 분할방식 치료군의 조사량은 $3,020\sim4,500\;cGy/3\sim4$주, 정위다방향 단일고선량 치료는 $1,200\sim3,000$ cGy를 조사하였다. 5. 추적조사기간은 보통분할방식 치료군이 $4\sim43$개월 (중앙값 33개월), 정위 다방향 단일고선량 치료군이 $3\sim21$개월(중앙값 13개월)이었다. 6. 보통분할방식 치료군중 방사선학 추적검사를 실시한 2예에서는 경미한 반응을 보였고, 임상적 추적만을 실시한 2예 중 1예에서는 임상중상의 호전을 보였다. 7. 정위다방향 고선량 단일치료군은 13명 전예에서 방사선학적 추적 검사상 완전반응 2예 $(15.4\%)$, 부분반응 5예 $(38.5\%)$, 경미반응 2예 $(15.4\%)$, 무반응 4예 $(30.7\%)$로 각각 나타났으며, 임상증상의 호전을 보였다. From February 1987 through July 1990, the seventeen cases of inoperable intracranial arteriovenous malformation (AVM) were treated using 6 MV linear accelerator at the Division of Therapautic Radiology, Kang Nam 51. Mary's Hospital. Of seventeen cases, fourteen were male and three were female. Ages ranged from 10 to 51 years (median age of 25 years). The main symtoms were headache, epilepsy and hemiparesis in decreasing order of frequency. The middle cerebral artery is the most common origin of the feeding vessel $(41.2\%)$. Four were treated by conventionally fractionated radiation therapy (CRT, thirteen were treated by stereotactic radiosurgery (RS). duration or follow-up in CRT and RS group were 4 to 43 months (median 33 months) and 3 to 12 months (median 13 months), respectively. When the response was assessed by radiologic follow-up study, two of four CRT group showed minimal response. Of thirteen cases of RS group, two $(15.4\%)$ showed complete response, five $(38\%)$ partial response, two $(15.4\%)$ minimal response and four $(30.7\%)$ no response by the same assessment. There was no statistical significance in terms of follow-up period (p=0.22), size of lesion (p=0.82) and treated dose (p=0.05). Further accumulation of experience is recommended with proper case selection and sufficient follow-up period.
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천막 상부 신경 교세포종에 대한 과분할 방사선치료의 효과에 대한 임상적 분석
정석원,김한규,황용순,이화동,염하용 대한신경외과학회 1991 Journal of Korean neurosurgical society Vol.20 No.12
Fractionation dose and number have been known as radiation factor affecting the radiation complication and the effectiveness in radiotherapy for brain tumors. In this study hyperfractionation technique with 115cGy/fraction 2 fractions daily 5days/wk, upto 5750-6900cGy to partial brain volume was compared with conventional fractionation technique with daily 200cGy/fraction 5 fractions/wk, upto 5400-6000cGy, in regarding to the effectiveness of hyperfractionated radiotherapy and eraly and later radiation reavtion. The survival period was longer in hyperfractionated irradiated group particularly if the tumors were located in the posterior portion of brain, however there was no singificant statistics due to small number of patients. Mean survival period for glioblastoma multiforme was 11.8 months in hyperfractionated group vs 8.7 months in conventional fractionated group and for high grade astrocytoma 36month in hyperfractionated group, but in conventional fractionated group all was died in 18 months. Actue radiation reaction occurred less frequently in hyperfractionated group, 15.8% vs 47.8% in conventional fractionated group(p<0.024). Alopecia was developed in 31.6% of the hyperfractionated group vs 82.6% of the conventional fractionated group(p<0.0031). One case of later radiation necrosis in cancer region was suspected in the hyperfractionated group but we has been in a dilemma for confirmatory diagnosis in present available diagnostic technique. The hyperfractionated irradiation technique was proven to be superior to conventional fractionated technique regarding the radiation reaction and the effectiveness of the treatment.
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두개강내·외로 다발성 전이를 일으킨 악성 뇌수막종 : 분할 정위적 방사선치료 및 통상적 방사선치료의 유용성 -1례보고 -
정한섭,이명기,박정호,강정수,김혜숙,김대조,Jeong, Han Seob,Lee, Myung Ki,Park, Jeong Ho,Kang, Jeong Su,Kim, Hye Sook,Kim, Dae Jo 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.10
We report a case of 54 years old male with malignant meningioma originating in the posterior fossa with multiple recurrences, intracranial and extracranial metastases. In spite of gross total removal of tumor and conventional external radiation therapy(CERT), 2 more recurrences, 5 more intracranial metastases and 1 extracranial metastasis to the rib were developed. We tried fractionated stereotactic radiation therapy(FSRT) and CERT to the intracranial metastasis with satisfactory result. Extracranial metastasis to the rib was resected and histological finding was similar to that of original tumor.
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The Effect of External Radiation Therapy for Intracranial Arteriovenous Malformation
In Ah Kim(김인아) , Hong Suk Jang(장홍석) , Mi Ryung You(유미령) , Sei Chul Yoon(윤세철 , Moon Chan Kim(김문찬) , Kyung Sub Shinn(신경섭) , Yong Whee Bahk(박용휘) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1
가톨릭의대 방사선치료실에서는 1987년 2월부터 1990년 7월까지 41개월 동안에 뇌동정맥성 기형으로 확진된 17예에 대해서 6MV 선형가속기를 사용하여 SAD법으로 외부방사선 치료를 시행하였다. 치료방법은 총 14예중 4예(24%)에 대해서는 보통분할방식으로, 13예(76%)는 정위다방향 고선량 단일 조사로 치료하였다. 이들의 임상적 및 방사선학적 추적검사를 분석하여 다음과 같은 결과를 얻었다. 1. 연령분포는 10~51세(중앙값 26세)였고, 남녀비는 14 : 3으로 나타났다. 2. 주증상은 두통이 12예(70.1%), 경련 5예(29.4%), 편부전마비 4예(23.5%) 등의 순이었고, 파열에 따른 출혈을 동반한 경우가 5예(29.4%)있었다. 3. 각 뇌동정맥성 기형은 중뇌동맥 분지에서 기원한 경우가 7예(41.2%), 전뇌동맥 3예(17.6%), 후뇌동맥 2예(11.8%), 전뇌 및 후동맥 1예(5.9%)순으로 나타났다. 4. 보통 분할방식 치료군의 조사량은 3,020~4,500cGy/3~4주, 정위다방향 단일고선량 치료는 1,200~3,000cGy를 조사하였다. 5. 추적조사기간은 보통분할방식 치료군이 4~43개월 (중앙값 33개월), 정위다방향 단일고선량 치료군이 3~21개월(중앙값 13개월)이었다. 6. 보통분할방식 치료군중 방사선학 추적검사를 실시한 2예에서는 경미한 반응을 보였고, 임상적 추적만을 실시한 2예 중 1예에서는 임상증상의 호전을 보였다. 7. 정위다방향 고선량 단일치료군은 13명 전예에서 방사선학적 추적검사상 완전반응 2예(15.4%), 부분반응 5예(38.5%), 경미반응 2예(15,4%), 무반응 4예(30.7%)로 각각 나타났으며, 임상증상의 호전을 보였다. From February 1987 through July 1990, the seventeen cases of inoperable intracranial arter-iovenous malformation (AVM) were treated using 6 MV linear accelerator at the Division of Therapeutic Radiology, Kang Nam St. Mary's Hospital. Of seventeen cases, fourteen were male and three were female. Ages ranged from 10 to 51 years (median age of 26 years). The main symtoms were headache, epilepsy and hemiparesis in decreasing order of frequency. The middle cerebral artery is the most common origin of the feeding vessel (41.2%). Four were treated by conventionally fractionated radiation therapy (CRT), thirteen were treated by stereotactic radiosurgery (RS). Duration of follow-up study, two of four CRT group showed minimal response. Of thirteen cases of RS group, two (15.4%) showed complete response, five (38%) partial response, two (15.4%) minimal response and four (30.7%) no response by the same assessment. There was no statistical significance in terms of follow-up period (p=0.22), size of lesion (p=0.82) and treated dose (p=0.65). Further accumulation of experience is recommended with proper case selection and sufficient follow-up period.
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