진행된 안구내 및 안와내 망막모세포종에서 안구적출술과 항암화학치료 및 방사선조사 유무에 따른 효과

이재민,이현동,하정옥 대한소아청소년과학회 2008 Clinical and Experimental Pediatrics (CEP) Vol.51 No.1

Purpose:Radiotherapy is effective in local treatment for retinoblastoma. However, asymmetric facial hypoplasia after radiation is a serious late effect. This study was performed to investigate the effects of enucleation and chemotherapy with or without radiotherapy in advanced intraocular and intraorbital retinoblastoma. Methods:Between 1985 October and 2006 December, the records of thirty five patients who were diagnosed as retinoblastoma at Yeungnam University Hospital were reviewed. Advanced intraocular and intraorbital retinoblastoma patients classified as Reese-Ellsworth group III, IV, and V and Grabowski- Abramson class II were selected for the study. Results:Eighteen patients were enrolled in this study. All patients were enucleated and had received chemotherapy. Nine patients received radiotherapy and nine patients didn't receive radiotherapy. Tumor cells were found on resection margin of optic nerve in five of nine patients who received radiotherapy, but none of nine who didn't receive radiotherapy. Chemotherapy included vincristine, adriamycin, cyclophosphamide, VM-26, cisplatin before 2001, and vincristine, etoposide, and carboplatin after 2001. There were no recurrences or metastases in nine patients who didn't receive radiotherapy. But two of nine patients who received radiotherapy had metastases to brain. However, all survivors who received radiotherapy had significant facial asymmetry. Conclusion:In advanced intraocular and intraorbital retinoblastoma without tumor cell on resection margin of optic nerve, enucleation and chemotherapy without local radiotherapy appears to be safe for long-term survival. However, in those with tumor cells on resection margin of optic nerve, enucleation and chemotherapy with local radiotherapy seems to be necessary to improve survival. (Korean J Pediatr 2008;51:84-88) Purpose:Radiotherapy is effective in local treatment for retinoblastoma. However, asymmetric facial hypoplasia after radiation is a serious late effect. This study was performed to investigate the effects of enucleation and chemotherapy with or without radiotherapy in advanced intraocular and intraorbital retinoblastoma. Methods:Between 1985 October and 2006 December, the records of thirty five patients who were diagnosed as retinoblastoma at Yeungnam University Hospital were reviewed. Advanced intraocular and intraorbital retinoblastoma patients classified as Reese-Ellsworth group III, IV, and V and Grabowski- Abramson class II were selected for the study. Results:Eighteen patients were enrolled in this study. All patients were enucleated and had received chemotherapy. Nine patients received radiotherapy and nine patients didn't receive radiotherapy. Tumor cells were found on resection margin of optic nerve in five of nine patients who received radiotherapy, but none of nine who didn't receive radiotherapy. Chemotherapy included vincristine, adriamycin, cyclophosphamide, VM-26, cisplatin before 2001, and vincristine, etoposide, and carboplatin after 2001. There were no recurrences or metastases in nine patients who didn't receive radiotherapy. But two of nine patients who received radiotherapy had metastases to brain. However, all survivors who received radiotherapy had significant facial asymmetry. Conclusion:In advanced intraocular and intraorbital retinoblastoma without tumor cell on resection margin of optic nerve, enucleation and chemotherapy without local radiotherapy appears to be safe for long-term survival. However, in those with tumor cells on resection margin of optic nerve, enucleation and chemotherapy with local radiotherapy seems to be necessary to improve survival. (Korean J Pediatr 2008;51:84-88)

The Role of Radiotherapy in the Treatment of Gastric Mucosa-Associated Lymphoid Tissue Lymphoma

남택근,안재숙,최유덕,정재욱,김용협,윤미선,안성자,정웅기 대한암학회 2014 Cancer Research and Treatment Vol.46 No.1

PurposeTo assess radiotherapy for patients with early stage gastric mucosa-associatedlymphoid tissue (MALT) lymphoma with respect to survival, treatment response, andcomplications. Materials and MethodsEnrolled into this study were 48 patients diagnosed with gastric MALT lymphoma fromJanuary 2000 to September 2012. Forty-one patients had low grade and seven hadmixed component with high grade. Helicobacter pylori eradication was performed in33 patients. Thirty-four patients received radiotherapy alone. Ten patients receivedchemotherapy before radiotherapy, and three patients underwent surgery followedby chemotherapy and radiotherapy. One patient received surgery followed by radiotherapy. All patients received radiotherapy of median dose of 30.6 Gy. ResultsThe duration of follow-up ranged from 6 to 158 months (median, 48 months). Five-year overall survival and cause-specific survival rates were 90.3% and 100%. Allpatients treated with radiotherapy alone achieved pathologic complete remission(pCR) in 31 of the low-grade and in three of the mixed-grade patients. All patientstreated with chemotherapy and/or surgery prior to radiotherapy achieved pCR exceptone patient who received chemotherapy before radiotherapy. During the follow-upperiod, three patients developed diffuse large B-cell lymphoma in the stomach, andone developed gastric adenocarcinoma after radiotherapy. No grade 3 or higher acuteor late complications developed. One patient, who initially exhibited gastroptosis,developed mild atrophy of left kidney. ConclusionThese findings indicate that a modest dose of radiotherapy alone can achieve a highcure rate for low-grade and even mixed-grade gastric MALT lymphoma without serioustoxicity. Patients should be carefully observed after radiotherapy to screen forsecondary malignancies.

Treatment outcome in patients with vulvar cancer : comparison of concurrent radiotherapy to postoperative radiotherapy

Jayoung Lee,Sung Hwan Kim,Giwon Kim,Mina Yu,Dong-Choon Park,Joo-Hee Yoon,Sei-Chul Yoon 대한방사선종양학회 2012 Radiation Oncology Journal Vol.30 No.1

Purpose: To evaluate outcome and morbidity in patients with vulvar cancer treated with radiotherapy, concurrent chemoradiotherapy or postoperative radiotherapy. Materials and Methods: The records of 24 patients treated with radiotherapy for vulvar cancer between July 1993 and September 2009 were retrospectively reviewed. All patients received once daily 1.8-4 Gy fractions external beam radiotherapy to median 51.2 Gy (range, 19.8 to 81.6 Gy) on pelvis and inguinal nodes. Seven patients were treated with primary concurrent chemoradiotherapy, one patient was treated with primary radiotherapy alone, four patients received palliative radiotherapy, and twelve patients were treated with postoperative radiotherapy. Results: Twenty patients were eligible for response evaluation. Response rate was 55% (11/20). The 5-year disease free survival was 42.2% and 5-year overall survival was 46.2%, respectively. Fifty percent (12/24) experienced with acute skin complications of grade III or more during radiotherapy. Late complications were found in 8 patients. 50% (6/12) of patients treated with lymph node dissection experienced severe late complications. One patient died of sepsis from lymphedema. However, only 16.6% (2/12) of patients treated with primary radiotherapy developed late complications. Conclusion: Outcome of patients with vulvar cancer treated with radiotherapy showed relatively good local control and low recurrence. Severe late toxicities remained higher in patients treated with both node dissection and radiotherapy.

식도암의 방사선치료에서 부분 각도에 의한 회전 치료를 이용한 조사체적의 감소

황철환(Chulhwan Hwang),김성후(Seong Hu Kim),구재흥(Jae Heung Koo),손종기(Jong Ki So) 한국방사선학회 2018 한국방사선학회 논문지 Vol.12 No.5

세기변조방사선치료와 입체적세기조절회전치료 시 조사체적과 선량 퍼짐 현상을 줄이기 위한 방법으로 조사 각도를 제한하는 부분 각도에 의한 회전치료 기능을 적용하여 표적체적과 주변 정상장기의 선량에 대해 입체조형방사선치료와 비교 분석하였다. 치료계획에 따른 표적체적의 선량분포는 통계적으로 유의한 차이를 확인할 수 없었으며, 폐의 5 Gy(V5) 체적에서 입체조형방사선치료 56.53%, 세기변조방사선치료 52. 03%, 입체적세기조절회전치료 47.84%를 나타내어 유의한 차이를 나타내었다(CRT-IMRT p=0.035, CRT-VMAT p<0. 001, IMRT-VMAT p<0.001). 10 Gy 체적(V10)에서는 입체조형방사선치료 35.12%, 세기변조방사선치료 34.04%, 입체적세기조절회전치료 33.28%를 보여, 입체조형방사선치료와 세기변조방사선치료(p=0.018), 입체적세기 조절회전치료(p=0.035)에서 유의한 차이를 나타내었으나 20 Gy 체적(V20)에서는 유의한 선량 차이를 확인할 수 없었다. 심장의 평균선량과 20 Gy 체적은 치료계획에 따라 유의한 차이를 확인할 수 없었으나, 30, 40 Gy 체적은 입체적세기조절회전치료에서 37.16%, 22.46%를 나타내어 입체조형방사선치료와 비교에서 유의한 차이(p=0.028)를 보였다. 이와 같이 조사체적 감소에 따른 폐의 저 선량 체적(V5, V10)의 감소를 확인할 수 있었으며, 세기변조방사선치료와 입체적세기조절회전치료 시 조사 각도를 일부 제한함으로써 표적체적의 선량분포는 동일하게 유지함과 동시에 조사체적을 줄일 수 있었다. 이로 인해 폐의 선량 퍼짐 현상의 감소로부터 폐의 독성을 낮추는데 기여할 수 있을 것으로 사료된다. In this study, plans to apply 3D conformal radiotherapy, intensity modulated radiotherapy, and volumetric intensity modulated arc radiotherapy to esophageal cancer radiotherapy were compared. In particular, arc therapy was applied to reduce irradiated volume and spread of low-dose during intensity modulated radiation therapy and volumetric intensity modulated arc radiotherapy by limiting part of irradiated angle, in order to compare target doses and dose for surrounding normal tissues of the two methods and those of 3D conformal radiotherapy. No significant difference in target dose was found among the three methods. The 5 Gy volume(V5) of the lung showed 56.53% of conformal radiotherapy, 52.03% of intensity modulated radiotherapy, and 47.84% of volumetric modulated arc therapy(CRT-IMRT p=0.035, CRT-VMAT p<0.001, IMRT-VMAT p<0.001). The 10 Gy volume(V10) showed a significant difference in conformal radiotherapy 35.12%, intensity modulated radiotherapy 34.04%, and volumetric modulated arc radiotherapy 33.28%, showing significant difference in intensity modulated radiotherapy(p=0.018), volumetric modulated arc therapy(p=0.035), no significant difference in dose was found at 20 Gy volume. The mean dose and 20 Gy volume of the heart were not significantly different according to the treatment plan, but the 30 and 40 Gy volumes were 37.16% and 22.46% in the volumetric modulated arc radiotherapy, showing significant differences(p=0.028) in comparison with conformal radiotherapy. It is believed that, by limiting part of the irradiated angle during intensity modulated radiotherapy and volumetric intensity modulated arc radiotherapy, the irradiated volume and, thereby, the 5-10 Gy area and toxicity of the lung can be reduced while maintaining dose distribution of the target dose.

전립선암의 소분할 방사선치료 시에 위치표지자 삽입의 유용성

최영민(Youngmin Choi),안성환(Sung-Hwan Ahn),이형식(Hyung-Sik Lee),허원주(Won-Joo Hur),윤진한(Jin-Han Yoon),김태효(Tae-Hyo Kim),김수동(Soo-Dong Kim),윤성국(Seong-Guk Yun) 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.2

목적: 전립선암의 소분할 방사선치료에서 골반뼈를 기준으로 한 준비자세(setup)와 전립선에 삽입된 위치표지자(fiducial marker)를 이용한 준비자세를 비교하였다. 대상 및 방법: 2009년 9월부터 2010년 8월까지 전립선암으로 근치적 소분할 방사선치료를 받은 4명의 환자를 대상으로 하였다. 방사선치료 1주일 전경에 경직장초음파 검사 하에 3개의 위치표지자를 직장을 통하여 전립선에 삽입하였다. 방사선치료계획용 컴퓨터단층촬영과 매 방사선치료 전에 직장 관장을 하였다. 소분할 방사선치료는 노발리스 장치를 이용하여, 매일 3.5 Gy씩 총 59.5 Gy를 계획하였다. 분할조사 전에 서로 수직인 두 방향의 kV X-선을 촬영하여 얻은 영상의 위치표지자와 방사선치료계획의 디지털재구성사진에서 관찰되는 위치표지자를 융합하여, 환자의 자세를 조정하고 준비자세를 하였다. 위치표지자 기준 준비자세에서 방사선치료계획의 디지털재구성사진과 kV X-선 영상의 골반뼈를 가상적으로 융합하여, 골반뼈 기준 준비자세를 구하였다. 결과: 67회의 분할조사를 분석하였다. 위치표지자 기준 준비자세에서 방사선치료 중심점과의 3차원적 위치 차이의 평균은 0.94±0.62 ㎜ (범위, 0.09~3.01 ㎜; 중앙값, 0.81 ㎜)였고, 좌우, 상하, 전후 방향으로 위치 차이의 평균은 각각 0.39±0.34 ㎜, 0.46±0.34 ㎜, 0.57±0.59 ㎜였다. 골반뼈 기준 준비자세에서 방사선치료 중심점과의 3차원적 위치 차이의 평균은 3.15±2.03 ㎜ (범위, 0.25~8.23; 중앙값, 2.95 ㎜)였고, 상하 방향의 위치 차이(평균, 2.29±1.95 ㎜)가 전후(평균, 1.73±1.31 ㎜), 좌우(평균, 0.45±0.37 ㎜) 방향보다 유의하게 컸다(p<0.05). 위치표지자 기준 준비자세와 골반뼈 기준 준비자세들에서 방사선치료 중심점과의 3차원적 위치 차이가 3㎜ 이상이었던 경우는 전체 분할방사선조사 횟수의 1.5%와 49.3%였고, 5㎜ 이상이었던 경우가 각각 0%, 17.9%였다. 결론: 위치표지자를 이용하여 보다 정확하게 준비자세를 함으로써 계획용표적체적의 여유를 줄일 수 있고, 따라서 전립선 주변의 정상조직에 대한 방사선량을 감소시켜 보다 안전하게 소분할 방사선치료를 할 수 있을 것으로 예상된다. Purpose: To assess the usefulness of implanted fiducial markers in the setup of hypofractionated radiotherapy for prostate cancer patients by comparing a fiducial marker matched setup with a pelvic bone match. Materials and Methods: Four prostate cancer patients treated with definitive hypofractionated radiotherapy between September 2009 and August 2010 were enrolled in this study. Three gold fiducial markers were implanted into the prostate and through the rectum under ultrasound guidance around a week before radiotherapy. Glycerin enemas were given prior to each radiotherapy planning CT and every radiotherapy session. Hypofractionated radiotherapy was planned for a total dose of 59.5 Gy in daily 3.5 Gy with using the Novalis system. Orthogonal kV X-rays were taken before radiotherapy. Treatment positions were adjusted according to the results from the fusion of the fiducial markers on digitally reconstructed radiographs of a radiotherapy plan with those on orthogonal kV X-rays. When the difference in the coordinates from the fiducial marker fusion was less than 1㎜, the patient position was approved for radiotherapy. A virtual bone matching was carried out at the fiducial marker matched position, and then a setup difference between the fiducial marker matching and bone matching was evaluated. Results: Three patients received a planned 17-fractionated radiotherapy and the rest underwent 16 fractionations. The setup error of the fiducial marker matching was 0.94±0.62㎜ (range, 0.09 to 3.01㎜; median, 0.81㎜), and the means of the lateral, craniocaudal, and anteroposterior errors were 0.39±0.34㎜, 0.46±0.34㎜, and 0.57±0.59㎜, respectively. The setup error of the pelvic bony matching was 3.15±2.03㎜ (range, 0.25 to 8.23㎜; median, 2.95㎜), and the error of craniocaudal direction (2.29±1.95㎜) was significantly larger than those of anteroposterior (1.73±1.31㎜) and lateral directions (0.45±0.37㎜), respectively (p<0.05). Incidences of over 3㎜ and 5㎜ in setup difference among the fractionations were 1.5% and 0% in the fiducial marker matching, respectively, and 49.3% and 17.9% in the pelvic bone matching, respectively. Conclusion: The more precise setup of hypofractionated radiotherapy for prostate cancer patients is feasible with the implanted fiducial marker matching compared with the pelvic bony matching. Therefore, a less marginal expansion of planning target volume produces less radiation exposure to adjacent normal tissues, which could ultimately make hypofractionated radiotherapy safer.

Treatment outcome in patients with vulvar cancer:comparison of concurrent radiotherapy to postoperative radiotherapy

이자영,김성환,김지원,유미나,박동춘,윤주희,윤세철 대한방사선종양학회 2012 Radiation Oncology Journal Vol.30 No.1

Purpose: To evaluate outcome and morbidity in patients with vulvar cancer treated with radiotherapy, concurrent chemoradiotherapy or postoperative radiotherapy. Materials and Methods: The records of 24 patients treated with radiotherapy for vulvar cancer between July 1993 and September 2009 were retrospectively reviewed. All patients received once daily 1.8-4 Gy fractions external beam radiotherapy to median 51.2 Gy (range, 19.8 to 81.6 Gy) on pelvis and inguinal nodes. Seven patients were treated with primary concurrent chemoradiotherapy, one patient was treated with primary radiotherapy alone, four patients received palliative radiotherapy, and twelve patients were treated with postoperative radiotherapy. Results: Twenty patients were eligible for response evaluation. Response rate was 55% (11/20). The 5-year disease free survival was 42.2% and 5-year overall survival was 46.2%, respectively. Fifty percent (12/24) experienced with acute skin complications of grade III or more during radiotherapy. Late complications were found in 8 patients. 50% (6/12) of patients treated with lymph node dissection experienced severe late complications. One patient died of sepsis from lymphedema. However, only 16.6% (2/12) of patients treated with primary radiotherapy developed late complications. Conclusion: Outcome of patients with vulvar cancer treated with radiotherapy showed relatively good local control and low recurrence. Severe late toxicities remained higher in patients treated with both node dissection and radiotherapy.

Treatment outcome in patients with vulvar cancer: comparison of concurrent radiotherapy to postoperative radiotherapy

Lee, Ja-Young,Kim, Sung-Hwan,Kim, Gi-Won,Yu, Mi-Na,Park, Dong-Choon,Yoon, Joo-Hee,Yoon, Sei-Chul The Korean Society for Radiation Oncology 2012 Radiation Oncology Journal Vol.30 No.1

Purpose: To evaluate outcome and morbidity in patients with vulvar cancer treated with radiotherapy, concurrent chemoradiotherapy or postoperative radiotherapy. Materials and Methods: The records of 24 patients treated with radiotherapy for vulvar cancer between July 1993 and September 2009 were retrospectively reviewed. All patients received once daily 1.8-4 Gy fractions external beam radiotherapy to median 51.2 Gy (range, 19.8 to 81.6 Gy) on pelvis and inguinal nodes. Seven patients were treated with primary concurrent chemoradiotherapy, one patient was treated with primary radiotherapy alone, four patients received palliative radiotherapy, and twelve patients were treated with postoperative radiotherapy. Results: Twenty patients were eligible for response evaluation. Response rate was 55% (11/20). The 5-year disease free survival was 42.2% and 5-year overall survival was 46.2%, respectively. Fifty percent (12/24) experienced with acute skin complications of grade III or more during radiotherapy. Late complications were found in 8 patients. 50% (6/12) of patients treated with lymph node dissection experienced severe late complications. One patient died of sepsis from lymphedema. However, only 16.6% (2/12) of patients treated with primary radiotherapy developed late complications. Conclusion: Outcome of patients with vulvar cancer treated with radiotherapy showed relatively good local control and low recurrence. Severe late toxicities remained higher in patients treated with both node dissection and radiotherapy.

Evolving Clinical Cancer Radiotherapy: Concerns Regarding Normal Tissue Protection and Quality Assurance

Choi, Won Hoon,Cho, Jaeho The Korean Academy of Medical Sciences 2016 JOURNAL OF KOREAN MEDICAL SCIENCE Vol.31 No.1

<P>Radiotherapy, which is one of three major cancer treatment methods in modern medicine, has continued to develop for a long period, more than a century. The development of radiotherapy means allowing the administration of higher doses to tumors to improve tumor control rates while minimizing the radiation doses absorbed by surrounding normal tissues through which radiation passes for administration to tumors, thereby reducing or removing the incidence of side effects. Such development of radiotherapy was accomplished by the development of clinical radiation oncology, the development of computers and machine engineering, the introduction of cutting-edge imaging technology, a deepened understanding of biological studies on the effects of radiation on human bodies, and the development of quality assurance (QA) programs in medical physics. The development of radiotherapy over the last two decades has been quite dazzling. Due to continuous improvements in cancer treatment, the average five-year survival rate of cancer patients has been close to 70%. The increases in cancer patients’ complete cure rates and survival periods are making patients’ quality of life during or after treatment a vitally important issue. Radiotherapy is implemented in approximately 1/3 to 2/3s of all cancer patients; and has improved the quality of life of cancer patients in the present age. Over the last century, as a noninvasive treatment, radiotherapy has unceasingly enhanced complete tumor cure rates and the side effects of radiotherapy have been gradually decreasing, resulting in a tremendous improvement in the quality of life of cancer patients.</P>

The effects of pulmonary rehabilitation during chest radiotherapy in patients with malignancy

( Myeong Geun Choi ),( Jae Seung Lee ),( Yeon-mok Oh ),( Sang-do Lee ),( Sei Won Lee ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Radiotherapy become a treatment of choice for lung cancer or esophageal cancer when surgery cannot be an option due to poor lung function. Radiotherapy can affect pulmonary function and induce pneumonitis or pneumonia, which can be fatal in patients with poor lung function. The purpose of this study is to ensure that the reduction of pulmonary function tests (PFT) after radiotherapy can be minimized through pulmonary rehabilitation (PR). Methods: The patients, who initiated pulmonary rehabilitation with radiotherapy for lung cancer from January 2018 to June 2019, were enrolled. The results of the pulmonary function test and 6 minute walk test (6MWT) conducted within six months prior and after radiotherapy were analyzed. Results: A total of 10 patients performed pulmonary rehabilitation at least once a week during chest radiotherapy, and conducted pulmonary function test prior and after radiotherapy. The mean age was 68 and they were all male. Nine patients had non-small cell lung cancer, one had esophageal cancer and seven had COPD. The FEV1 (%) and FEV/FVC (%) were significantly increased by 10.5% (p=0.004) and 6.2% (p=0.038), respectively, compared with baseline (55.6%, 51.6%). The 6MWT results were also significantly increased from 405.6m to 466.9m (p=0.009). Conclusions: Pulmonary rehabilitation during chest radiotherapy improved pulmonary function and exercise capacity in patients with lung or esophageal cancer. This can be an important basis for further studies to identify the effects of pulmonary rehabilitation during chest radiotherapy through large study with long-term follow up period.

방사선치료 안내동영상 제작

왕철환,강승희,문봉기,박동욱,원영진,박광현,김주현,방승미,Wang, Chul-Hwan,Kang, Seung-Hee,Moon, Bong-Ki,Park, Dong-Wook,Won, Yeong-Jin,Park, Kwang-Hyeon,Kim, Joo-Hyeon,Bang, Seung-Mi 한국의료질향상학회 2013 한국의료질향상학회지 Vol.19 No.1

Objectives: This video has been produced to provide better awareness for our patients about radiotherapy treatment for anxiety and stress. This video will give inexperienced patients a better understanding of the processes and expectations of the radiotherapy. We have produced a radiotherapy guidance video regarding work flow and a method of radiotherapy to relieve anxiety and stress. It also improves patients satisfaction and understanding of radiotherapy to provide a high-quality health care for radiotherapy patients with indirect experience. Methods: We have evaluated the effectiveness of the video compared to our existing verbal method. See below for the evaluation criteria; 1) Patients satisfaction rate of guidance 2) a comparison of understanding of radiotherapy 3) a comparison of a time of education for patients 4) a researching of an incidence rate of radiotherapy. Results: When compared to the verbal explanation the patients had a increased level of understanding of the radiotherapy treatment. The time to educate patient was decreased and the level of incidents during the treatment was decreased due to the patient having a better understanding of the whole process. Conclusion : In conclusion, the audiovisual education increased the understanding of radiotherapy for patients compared to verbal education. The video also helped patients to cooperate in treatment room so we can provide premium radiotherapy treatment. By reducing the treatment time and education processa we improved the patients overall experience.