Radiation Therapy (RT) of Midline Granuloma

권형철(Hyoung Cheol Kwon),오윤경(Yoon Kyeong Oh),길학준(Hak Jun Gil),윤세철(Sei Chul Yoon),박용휘(Yong Whee Bahk) 대한방사선종양학회 1986 Radiation Oncology Journal Vol.4 No.2

중앙성육아종 환자 7예에 대하여 가톨릭의대 강남성모병원 방사선치료실에서는 1983년 3월 부터 1986년 6월까지, 사이에 외부방사선치료를 시행하였다. 임상증상으로서, 모든 환자에서 침습부위에 궤사를 동반한 부비동염 증세를 보였고, 1예에선 대장(결장)병변도 나타냈다. 방사선치료는 6MV선형가속기를 사용하여 비강 및 부비동 부위를 포함하는 상기도 부위에 2~3문 조사를 실시하여, 총선량 4,000~5,000cGy/5~6주를 조사하였다. 방사선치료 반응으로서 방사선치료 종료 후 1.5~20개월 추적관찰 한 결과 완전 및 부분관해가 각각 3예, 대장부위에 병변을 보였던 1예에선 병이 진행되고 있음이 관찰되었다. Seven patients having midline granuloma received local irradiation from March 1983 to June 1986. Clinically, all of the 7 patients had pansinusitis with necrotic destruction of the involved sites and one case revealed colonic lesion. Each of the patients received a tumor dose of 4,000~5,000 cGy/5~6 wks to the upper aerodigestive tract using a 6-MV linear accelerator. Complete and partial remission occured in 3 patients each, and in one case, the disease progressed despite of the irradiation.

쥐 섬유육종에서 베타카로틴과 방사선조사 병용의 항종양 효과

권형철(Hyoung-Cheol Kwon),양문식(Moon-Sik Yang) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.2

목 적 : 베타카로틴과 방사선조사의 병용효과에 관한 평가를 목적으로, 베타카로틴을 병용한 경우 방사선조사 단독의 경우 보다 세포독성의 차이는 어떠하며, 또한 쥐 섬유육종에서 두 군간의 종양성장의 지연 정도에 어떠한 차이가 있는가를 관찰하고자 본 연구를 시행하였다. 대상 및 방법 : 2% 베타카로틴 유제를 2 mg/ml 으로 만든 다음 단계적으로 희석하여 사용하였으며, 섬유육종세포와 태생 5∼6주의 C3H/N의 실험쥐를 이용하였다. 방사선조사는 6 MV 선형가속기를 이용하였고, 세포내 독성은 쥐 섬유육종세포의 생존을 감소시키는 능력으로 평가하였으며, 베타카로틴 2 mg/ml을 방사선조사 1시간 전 섬유육종세포주에 접촉시켰다. 종양성장 지연 실험을 위하여 베타카로틴과 방사선조사 병용군(n=6)과 방사선조사 단독군(n=5)으로 분류하였으며, 베타카로틴 20 mg/kg을 방사선조사 30분전 섬유육종이 접종된 쥐의 복강내 일회 주사하였고, 방사선조사량은 20 Gy를 주었다. 종양용적은 장경×장경×장경/2 (mm3) 공식을 사용하였으며, 2∼3일 마다 측정하였다. 결 과 : 섬유육종세포에 베타카로틴 0.002, 0.02, 0.2, 2 mg/ml 농도액을 1시간 동안 접촉 후 얻은 각각 생존분율은 0.69±0.07, 0.59±0.08, 0.08±0.008 및 0.02±0.006이었다. 그리고 방사선조사 1시간 전 섬유육종세포에 베타카로틴 2 mg/ml을 접촉한 후 조사량 2, 4, 6 및 8 Gy에서 얻은 각각의 생존분율은 0.13±0.05, 0.03±0.005, 0.01±0.002 및 0.009±0.0008이었으며 방사선조사 단독군의 경우 동일 조사량에서 얻은 생존분율은 각각 0.66±0.05, 0.40±0.04, 0.11±0.01 및 0.03±0.006으로 나타났다(p<0.05). 종양성장의 지연정도를 나타내는 실험에서 섬유육종을 쥐에 접종한 후 종양의 용적이 1,000 mm3 에 달하는 기간은 베타카로틴 병용군과 방사선조사 단독군에서 각각 18일과 19일로 나타났다(p>0.05). 결 론 : 쥐 섬유육종세포에 베타카로틴을 접촉한 경우 세포독성이 나타났으며, 베타카로틴 농도 증가에 따라 세포독성도 증가하였다. 그리고 쥐 섬유육종세포의 세포독성은 베타카로틴 병용군에서 방사선조사 단독군의 경우 보다 부가적으로 증가하였으며, 두 군간에 통계학적으로 현저한 차이를 보였다. 그러나 쥐 섬유육종 성장 지연정도에 있어서 베타카로틴 병용군과 방사선조사 단독군간의 통계학적으로 뚜렷한 차이는 없었다. Purpose :To investigate whether combined beta- carotene with X- irradiation has more enhanced radition response than X- irradiation or not, we performed a experiment about in vitro cytotoxicity of beta- carotene and/or X- irradiation in the fibrosarcoma cells, tumor growth delay of combined beta- caroten with/or X- irradiation in the mouse fibrosarcoma. Materials and Methods :2% emulsion of beta- carotene was serially diluted and used. X- irradiation was given by 6 MeV linear accelerator. The cytotoxicity of beta- carotene in vitro was evaluated from clonogenic assay. To compare the cytotoxicity between combined beta- carotene with X- irradiation and X- irradiation group, 2 mg/ml of beta- carotene was contacted to fibrosarcoma (FSaII) cells for 1 hour before X- irradiation. For the tumor growth delay, single 20 Gy was given to FSaII tumor bearing C3H/N mice whic was classified as beta- crotene with X- irradiation group (n=6) and X- irradiation alone group (n=5). 0.2 ml of 20 mg/kg of beta- carotene were i.p. injected to mice 30 minute before X- irradiation in the beta- crotene with X- irradiation group. The tumor growth delay defined as the time which reach to 1,000 mm3 of tumor volume. Result : (1) Cytotoxicity in vitro; 1) survival fraction at beta- carotene concentration of 0.002, 0.02, 0.2 and 2mg/ml were 0.69±0.07, 0.59±0.08, 0.08±0.008 and 0.02±0.006, respectively. 2) each survival fraction at 2, 4, 6 and 8 Gy in the 2 mg/ml of beta- carotene +X- irradiation group were 0.13±0.05, 0.03±0.005, 0.01±0.002 and 0.009±0.0008, respectively. But each survival fraction at same irradiation dose in the Xirradiation group were 0.66±0.05, 0.40±0.04, 0.11±0.01 and 0.03±0.006, respectively(p<0.05). (2) The time which reach to 1,000 mm3 of tumor volume of beta- carotene + X- irradiation group and X- irradiation alone group were 18, 19 days, respectively(p>0.05). Conclusion :The contact of beta- caroten to FSaII cells showed mild cytotoxicity which was increased according to concentration. The cytotoxicity of combined beta- carotene with X- irradiation more increased than that of X- irradiation, additionaly. And there was significant difference of cytotoxicity between two groups. But there were no significant difference of the growth delay of fibrosarcoma between two groups.

가시오갈피 뿌리 추출물의 분획율과 성분에 따른 마우스 종양세포의 세포독성 효과

권형철 ( Hyoung Cheol Kwon ),김진기 ( Jhin Kee Kim ),김정수 ( Jung Soo Kim ),김부길 ( Bu Gil Kim ),최동성 ( Dong Seong Choi ) 전북대학교 의과학연구소 2008 全北醫大論文集 Vol.32 No.2

국내에서 생산되는 가시오갈피 추출물 분획율을 알아보고 나아가서 마우스 종양세포에서 어느 정도의 세포독성 및 방사선보조 효과를 나타내는지를 알아보았다. 가시오갈피 추출물 중 메탄을 추출을 이용한 분획율이 가장 높았다. 그리고 메탄을 추출물 분획 2mg/mℓ 을 마우스 섬유육종세포에 접촉하여 얻은 시험관내 세포독성 효과는 0.05를 나타내어 다른 클로르프롬, 부탄올 및 수용성 분획에 비해 우수한 세포독성 효과가 인정되었다. 또한 방사선조사와 가시오갈피 추출물 2mg/mℓ을 병용한 경우 방사선 조사 단독군에 비해 세포생존을 50% 이상 경감시켰다. 이러한 결과로 말미암아 생체 내에서 가시오갈피 추출물이 암세포의 생육을 어느 정도 억제할 수 있다는 것과 방사선조사와 병용할 경우 방사선 반응의 보조효과를 가져다 줄 수 있다고 추정할 수 있다. Objectives: To know the the yield of Eleutherococcus senticosus(E.S.) root and its component, the extraction with freezing dry was performed. After that, we compared the in vitro cytotoxicity of E.S according to its components in mouse tumor cell. Also we investigated whether combined Eleutherococcus senticosus(E.S.) and X-irradiation has more enhanced radiation response or not. Methods: 250g of E.S was made into power and distilled with water, extracted with 80% methanol and lyophilized, then 23.74g of the yield was taken. The 19g of lyophilized methanol extracted powder was mixed with 500mℓ of water, washed with 500mℓ of chloroform, butanol, chloroform fraction and butanol fraction, respectively. Aqueous fraction was taken finally. As a cell line, mouse fibrosarcoma cell was used. For the evaluation of the cytotoxicity of E.S. A clonogenic assay was used. 10% of RPMI 1640 media was exposed to cells for 1 hour, cultured and then colony was counted. The survival fraction was taken. In radiation alone group, 2,4,6 Gy of radiation dose was given to cells. In combined group, 0.2mℓ of E.S. with 10% of RPMI 1640 media was exposed to fibrosarcoma cells, then same dose of X-irradiation was given. Also, each survival fraction was taken. X-irradiation was given to tumor cells using low energy X-ray machine. Rusults: The yields of E.S. root extract with methanol, chloroform, butanol, chloroform were 13.74, 1.8, 5.5, 11.54, respectively. The cytotoxicity of each fraction of the E.S. extract on mouse fibrosarcoma cells was as following; The survival fractions at 2mℓ/mg of methanol, chloroform, aqueous extract were 0.05, 0.42, 0.34, respectively. and that at 0.6mℓ/mg of butanol extract was 0.42. In combined 0.2mℓ/mg of E.S. with X-irradiation group, the mean survival fraction at 2,4,6 Gy were 0.39, 0.22, 0.06, respectively. But in radiation alone group, that were 0.76, 0.47, 0.37, respectively. Conclusion: A cytotoxicity of methanol fraction of E.S. extract was superior to other fraction. When the extract of E.S. was combined with X-irradiation on mouse tumor cells, a cytotoxicity was more increased. Therefore we suggest that E.S. extract are good for antitumor supportive regimen and radiation response modifier.

영지버섯의 항암효과

권형철(Hyoung Cheol Kwon),김정수(Jung Soo Kim),최기철(Ki Chul Choi),최동성(Dong Seong Choi),송창원(Chang Won Song) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.3

Purpose : To investigate the effect of aqueous extract of Ganoderma lucidum(G.I.) on the survival of tumor cells in vitro and on the growth of tumors in vivo. Materials and Methods : Dried G.I. was made into powder extracted with distilled water filtered and diluted from a maximum concentration of 100mg/ml in sequence. The cytotoxicity of G.I. in vitro was evaluated from its ability to reduce the clonogenicity of SCK tumor cells. For the tumor growth delay study, about 2X10⁵ of SCK tumor cells were subcutaneously inoculated in the legs of a/J mice. The first experimental group of mice were injected i.p. with 0.2ml of 250mg/kg of G.I. from the first day after tumor inoculation for 10 days. The second experimental group of mice were injected i.p. with 0.2ml of 250mg/kg of G.I. either once a day for 10 days or twice a day for 5 days beginining from the 7th day after tumor inoculation Results : 1. Cytotoxicity in vitro; survival fraction, as judged from the curve, at G.I. concentration of 0.5, 1, 5, 10, 25, 50 and 100mg/ml were 1.0, 0.74±0.03, 0.18±0.03, 0.15±0.02, 0.006±0.002, 0.015 and 0.0015 repectively. 2. Tumor growth delay in vivo; a) the time required for the mean tumor volume to grow to 1,000mm³ was 11days in the control group and 14days in the experimental group. b) the time required for tumor volume to increase 4 times was 11 days in the control group while it was 10,5 and 12 days in the groups injected with G.I. once a day and twice a day from the 7th day after tumor inoculation respectively. Conclusion : Aqueous extracts of G.I. showed a marked cytotoxicity on the SCK mammary cells in vitro. Tumor growth delay was statistically significant when G.I. injection was started soon after tumor inoculation but it was not significant when injection was started after the tumors were firmly established.

치료계획용 컴퓨터를 이용한 부정형조사면의 선량분포에 관한 실험

권형철(Hyoung Cheol Kwon),오윤경(Yoon Kyeong Oh),윤세철(Sei Chul Yonn),박용휘(Young Whee Bahk) 대한방사선종양학회 1984 Radiation Oncology Journal Vol.2 No.2

The authors have intended to measure intrinsic dose distribution by Farmer dosimeter in irregularly shaped fields such as L.M. and T shape models in order to determine dose inhomogeneity in those models. We made 2 off-axis points in each model and measured the depth dose at 1.5, 5 and 9 cm below surface. The results showed 1~3% dose discrepancy between 2 points. We also measure the depth dose by geometric approximation and computer calculation in those models and came to the conclusion that computer calculation using Clarkson's principle is simpler and the measurements are closer to the ideal data obtained by the experiment in three models of irregularly shaped fields than those of geometric approximation method.

마우스 종양세포의 세포독성에 미치는 인삼 추출액과 방사선조사의 병용 효과

권형철(Hyoung-Cheol Kwon),김진기(Jin-Ki Kim),김정수(Jung-Soo Kim),최동성(Dong-Seong Choi) 대한방사선종양학회 2000 Radiation Oncology Journal Vol.18 No.3

목 적 : 수용성 인삼 추출물의 현저한 세포독성에 관한 저자의 이전 실험결과를 토대로 하여 본 연구에서는 인삼과 방사선의 병용처리가 종양세포의 세포독성에 미치는 영향을 살펴보고자 하였다. 대상 및 방법 : 고려인삼 50 g과 증류수 1 L를 혼합하여 100℃에서 5시간 동안 열탕 환류추출한 다음 여과하였다. 이 여액을 원심분리한 후 동결건조하여 수용성 인삼 추출물 시료로 하였다. 방사선조사는 6 MeV 선형가속기를 이용하였고, 인삼의 세포내 독성은 마우스 섬유육종세포의 생존을 감소시키는 능력으로 평가하였으며, 인삼 1 mg/mL를 방사선조사 1시간전 종양세포에 접촉시켰다. 결 과 : 환류추출과 동결건조에 의해 최종적으로 얻어진 고려인삼 50 g의 수용성 추출물은 3.13 g으로서 수율은 6.3% 이었다. 인삼 추출액의 시험관내 세포독성 지표로서 0.001, 0.01, 0.1 및 1 mg/mL에서의 생존분율은 각각 0.89±0.04, 0.86±0.06, 0.73±0.1, 0.09±0.02로 나타났다. 방사선조사 단독의 경우 2, 4, 6 및 8 Gy에서의 생존분율은 0.81±0.07, 0.42±0.08, 0.15±0.02, 0.03±0.01으로 나타났으며, 인삼 추출물(0.2 mg/mL)과 방사선조사의 병용시 동일 조사량에서의 생존분율은 각각 0.28±0.01, 0.18±0.03, 0.08±0.02, 0.006±0.002 이었다( p<0.05). 결 론 : 환류추출과 동결건조 과정을 통해 얻어진 고려인삼 수용성 추출물의 수율은 6.3%이었다. 방사선조사시 인삼을 병용한 경우, 종양세포의 세포독성이 방사선조사 단독의 경우 보다 부가적으로 증가하였다. Purpose : We already reported the results that aqueous extract of Korean ginseng roots showed a marked cytotoxicity. In this study, we investigated whether combined ginseng product with X-irradiation increase the cytotoxicity of tumor cells than X-irradiation or not. Materials and Methods : Fifty gram of Korean ginseng powder mixed with 1 L of distilled water was extracted with reflux flask under condition of 100℃ for 5 hrs. This aquaous ginseng extract was filtered, centrifuged and then was freezed under condition of -90℃ for 16-18 hrs. The freezing extract was dried with freeze drier, and then diluted. X-irradiation was given to tumor cells by 6 MeV linear accelerator. The cytotoxicity of ginseng in vitro was evaluated from its ability to reduce the clonogenecity of fibrosarcoma (FSa II) cells. In X-irradiation alone group, each 2, 4, 6 and 8 Gy was given to tumor cells. In X-irradiation with ginseng group, 0.2 mg/mL of ginseng extract was exposed to tumor cells for 1 hour before X-irradiation. Result : The yield for 50 g of ginseng extract which was treated with freezing drier was 3.13 g(6.3%). Cytotoxicity in vitro was measured as survival fraction which was judged from the curve, at ginseng concentration of 0.001, 0.01, 0.1 and 1 mg/mL were 0.89±0.04, 0.86±0.06, 0.73±0.01 and 0.09±0.02, respectively. Survival fraction at X-irradiation alone of 2, 4, 6 and 8 Gy were 0.81±0.07, 0.42±0.08, 0.15±0.02, 0.03±0.01, respectively. But, survival fraction in combined group of X-irradiation and ginseng (0.2mg/mL) at each same radiation dose were 0.28±0.01, 0.18±0.03, 0.08±0.02, 0.006±0.002, respectively ( p<0.05). Conclusion : The yield for ginseng extract which was treated with freezing drier was 6.3%. Cytotoxicity of Fsa II in combined ginseng with X-irradiation group was increased than that of X-irradition alone group, and its enhancing effect seemed to be added.

방사선 치료를 받은 유방암 환자의 방사선 피부염 발생 정도 및 관련 인자들의 분석

이선영(Sun Young Lee)ㆍ권형철(Hyoung Cheol Kwon)ㆍ김정수(Jung Soo Kim)ㆍ이희관(Heui-Kwan Lee) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.1

목 적: 방사선치료를 받은 유방암 환자에서 치료로 인한 방사선 피부염의 발생을 감소시킬 수 있는지 알아보기 위 해서 전단계로서 피부염 발생정도와 이와 관련된 인자들을 분석해 보았다.대상 및 방법: 2007년 1월부터 2009년 6월까지 전북대병원 방사선종양학과에서 근치적 목적의 유방 보존 절제술및 방사선 치료를 받은 침윤성 유방암 환자 338명 중, 보상체를 사용하거나 반대측 유방의 방사선 치료 기왕력이있는 환자를 제외한 284명에서, 전자선 추가 치료를 시행하기 전 전체 유방에 50 Gy 방사선 조사 후, 방사선 피부염이 발생된 정도와 Radiation Therapy Oncology Group (RTOG) 2도 이상의 중증 피부염을 보인 환자에서 발생 정도에 영향을 미칠 수 있는 요인들을 분석하였다.결 과: RTOG 등급 0 또는 1과 2도 이상의 경증 및 중증 방사선 피부염은 각각 207명과 77명에서 관찰되었다. 2도이상 중등도 이상의 방사선 피부염이 발생한 77명의 환자에서 림프액 저류에 의한 림프낭과 림프부종은 방사선 피부염의 회복을 방해하는데 관련된 요소로 분석되었으며 각각 통계적으로 유의한 수준을 나타냈다(p=0.003,p=0.001). 그리고 피부 면역세포 및 사이토카인 활성화에 의한 반창고 과민반응과 호르몬치료 병용도 피부에 영향을 미치는 관련요소로 분석되었으며 각각 통계학적으로 유의한 수준을 나타냈다(p=0.001, p=0.025).결 론: 방사선치료를 받은 대부분의 유방암 환자에서 경증 또는 중증 정도의 방사선 피부염이 발생되었으며, 림프낭, 림프부종 및 반창고 과민반응 등은 방사선 피부염의 정도에 통계학적으로 유의한 수준의 영향을 미치는 요소로분석되었다. 따라서 림프낭이 존재하는 경우 방사선치료 전 제거가 우선되어야 하며, 반창고 과민반응이 있는 환자의 경우 치료 중 주의 깊은 관찰과 특히 중등도 이상의 피부염 환자들에게는 치료부위의 피부에 대한 지속적인 보습 교육이 필요하다고 본다. Purpose: We analyzed the incidence and related factors of radiation dermatitis; at first, to recognize whether a decrease in radiation dermatitis is possible or not in breast cancer patients who received radiation therapy. Materials and Methods: Of 338 patients, 284 with invasive breast cancer who received breast conservation surgery with radiotherapy at Chonbuk National University Hospital from January 2007 to June 2009 were evaluated. Patients who also underwent bolus, previous contralateral breast irradiation and irradiation on both breasts were excluded. For patients who appeared to have greater than moderate radiation dermatitis, the incidence and relating factors for radiation dermatitis were analyzed retrospectively. Results: A total of 207 and 77 patients appeared to have RTOG grade 0/1 or above RTOG grade 2 radiation dermatitis, respectively. The factors found to be statistically significant for the 77 patients who appeared to have greater than moderate radiation dermatitis include the presence of lymphocele due to the stasis of lymph and lymph edema which affect the healing disturbance of radiation dermatitis (p=0.003, p=0.001). Moreover, an allergic reaction to plaster due to the immune cells of skin and the activation of cytokine and concomitant hormonal therapy were also statistically significant factors (p=0.001, p=0.025). Conclusion: Most of the breast cancer patients who received radiation therapy appeared to have a greater than mild case of radiation dermatitis. Lymphocele, lymphedema, an allergy to plaster and concomitant hormonal therapy which affect radiation dermatitis were found to be significant factors. Consequently, we should eliminate lymphocele prior to radiation treatment for patients who appear to have an allergic reaction to plaster. We should also instruct patients of methods to maintain skin moisture if they appear to have a greater than moderate case of radiation dermatitis.

자궁경부암의 근치적 방사선치료 성적

김형진(Hyoung Jin Kim),김정수(Jung Soo Kim),김진기(Jin Kee Kim),권형철(Hyoung Cheol Kwon),오병찬(Byung Chan Oh) 대한방사선종양학회 1996 Radiation Oncology Journal Vol.14 No.3

목적 : 자궁경부암에서 근치적 방사선치료후 치료결과 및 예후에 영향을 미치는 인자와 치료후 합병증, 실패 양상을 알고자 후향적 연구를 시행하였다. 대상 및 방법 : 1986년 3월부터 1990년 5월까지 조직학적 검사로 확진되고 근치적 목적으로 외부조사 및 강내치료를 받은 59명의 환자를 대상으로 후향적 분석을 시행하였다. FIGO 병기에 따른 환자분포는 병기 IIa이하인 Ib, IIa가 각각 2예(3.4%), IIb가 31예(52.5%), IIIb가 15예 (25.4%), IV가 9예(15.3%)였다. 외부조사를 시행한 후, 강내조사를 실시하였는 데, 강내치료는 A점을 기준으로 병기에 따라서 중앙값 3460 cGy(범위: 3000-4366 cGy)까지 조사하였으며, 강내 치료와 외부방사선 치료 전체조사량의 중앙값은 8500 cGy(범위: 8040-10980 cGy)였다. 추적조사 기간은 2개월에서 110개월이었고, 중앙값은 61개월이었다. 결과 : 전체환자의 5년생존율 및 무병생존율은 각각 55.9%와 55.0%였으며, FIGO 병기에 따른 5년 생존율은 병기 IIa이하인 경우 75.0%, 병기 IIb는 74.8%, 병기 IIIb는 26.7%, 병기 IV는 33.3%였다. 단변량 분석에 의하면 병기 IIb이하인 경우 5년 생존율은 74.8%였고, IIIb이상인 경우 29.2% (p<0.005)였다 방사선치료중 혈색소 수준이 한 번이라도 10 gm/dL미만인 환자군의 5년 생존율은 0%였고, 10 gm/dL이상 군은 73.3% (p<0.005)였다. 종양의 크기가 5 cm이상인 18예(30.5%)에서 5년 생존율은 22.2%였고, 5cm미만인 39예(66.1%)에서는 71.8%(p<0.005)였다. 또한 50세이상인 경우와 50세미만인 경우 5년 생존율은 각각 65.3%, 34.2% (p<0.05)였다. ECOG 수행능력 정도, 병리소견, 전체 선량, 전체 치료기간은 통계학적 의미는 없었다. 다변량분석에 의하면 방사선 치료중 혈색소 수준(p=0.0001), 종양의 크기(p=0.0390), FIGO병기 (p=0.0468)가 통계학적 의의를 나타냈다. 전체 환자의 재발율은 23.7%(14/59)로 국소재발이 15.2%(6/59), 원격전이가 6.8%(4/59), 국소재발과 원격전이가 1.7%(1/59)를 보였다. 결장직장과 비뇨생식기에서 각각 15.3%(9/59), 8.5%(5/59)를 보이고, Grade 2는 10예(17.0%), Grade 3은 3예(5.1%), Grade 4도 1예(1.7%)를 나타내고 있다 빈도는 방사선 직장염, 직장 출혈, 방사선 대장염, 설사, 방사선 방광염 순서로 발생하였다. 결론 : 치료결과를 향상시키기 위해서는 전향적인 무작위 표본에 의한 새로운 예후인자 발견 및 예후가 좋지 않을 것으로 예상되는 경우, 치료방법의 개선 및 방사선 감작제 또는 항암제를 병용하여 국소재발과 원격전이 억제를 위한 적극적인 치료방법이 연구되어져야 한다고 사료된다. Purpose : To evaluate 5-year survival rate, patterns of failure and complications of cervical cancer treatment, fifty nine patients treated by curative radiotherapy for the uterine cervical cancer were analyzed retrospectively. Materials and Methods : From March 1986 to May 1990, fifty nine patients with histologically proven uterine cervical cancer were analyzed. According to FIGO stage, there were 2 patients (3.4%) in stage Ib, 2 patients (3.4%) in stage IIa, 31 patients (52.5%) in stage IIb, 15 patients (25.4%) in stage IIIb, 9 patients (15.3%) in stage IV. External RT was per formed by 6 MVLINAC with daily 1.8 Gy, 5 times per week and followed by ICR. A point dose of ICR was calculated to 30-43.66 Gy (median: 34.6 Gy). These techniques delivered total A Point dose of 80.4 to 109.8 Gy (median: 85 Gy). Patients had been followed up from 2 to 110 months (median: 61 months) Results : The overall 5-year survival rate & disease free survival rate were 55.9% and 55.0% respectively. According to FIGO stage, the 5-year survival rate for less than IIa, IIb, IIIb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage IIb and below versus stage IIIa and above revealed 74.8%, 29.2% respectively (P<0.005). According to the hemoglobin level during RT, the 5-rear survival rate of was 73.3% for patients with Hg 10 gm/dL or higher, in contrast to 0% for those with lower than 10 gm/dL (p<0.005). In 18 patients with nonbulky tumor (<5cm), the 5-year survival rates were 71.8%. The 5-rear survival rates for 18 patients with 5 cm or greater in tumor diameter were 22.2% (p<0.005). The 5-year survival rate for Patient age of above 50 years and below were 65.3% 34.2% respectively (p<0.05). ECOG performance status. pathologic finding, total dose, total treatment time were not statistically significant factors. The significant prognostic factors affecting overall 5-year survival rate by multivariate analysis showed the hemoglobin level during RT (P=0.0001), tumor size (p=0.0390), FIGO stage (p=0.0468). Total recurrence rate was 23.7% local failure 15.2% (9/59), distant metastasis 6.8% (4/59), local and distant metastasis 1.7% (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59) The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively: 10 patients (17.0%) were grade 2, 3 Patients (5.1%) were grade 3 and one patient (1.7%) was grade 4. The late complications were radiation proctitis, rectal bleeding, radiation colitis, diarrhea and radiation cystitis in decreasing order. Conclusion : For improvement of therapeutic results, prospective randomized trials are recomended to discover new prognostic factors and more aggressive radiation therapeutic methods are needed for poor prognostic patients. The adjuvant chemotherapy or radiation-sensitizing agents must be considered to inhibit regional and distant metastasis.

치료계획용 콤퓨터를 이용한 부정형 조사면의 선량분포에 관한 실험

박주선,이귀원,한용문,권형철,윤세철,Park, Joo-Sun,Lee, Gui-Won,Han, Yong-Moon,Kwon, Hyoung-Cheol,Yoon, Sei-Chul 대한방사선치료학회 1987 大韓放射線治療技術學會誌 Vol.2 No.1

The authors have intended to measure intrinsic dose distribution by Farmer dosimeter in irregularly shaped fields such as L, M, T,-shape model in order to determine dose inhomogeneity in those models. We made 2 off-axis points in each model and measured the depth dose at 1.5,5, and 9cm below surface. The results showed $1-3\%$ dose discrepancy between 2 points. We also measured the depth dose by geometric approximation and computer calculation in those models, and came to the conclusion that computer calculation using Clarkson's principle is simpler and the measurements are to the ideal data obtained by the experiment in those three models of irregularly shaped fields than those of geometric approximation method.

Lung RPO 선량전달시, Carbon Couch Side Rail과 Vac-lok이 미치는 영향

김석민,곽근탁,이승훈,김정수,권형철,김양수,이선영,Kim, Seok Min,Gwak, Geun Tak,Lee, Seung Hun,Kim, Jung Soo,Kwon, Hyoung Cheol,Kim, Yang Su,Lee, Sun Young 대한방사선치료학회 2018 대한방사선치료학회지 Vol.30 No.1

목 적 : 폐의 우측후사방향 선량전달시, Carbon Side Rail과 환자 고정기구인 Vac-lok이 미치는 영향을 보고자 한다. 대상 및 방법 : Vac-lok의 오른쪽 부분을 10, 20, 30 mm 두께로 제작하였다. 측정은 유리선량계를 이용하여 측정하였고, 측정점은 팬텀 우측 폐의 center Point를 기준으로 좌, 우, 하, 상 방향 각각 A, B, C, D Point로 설정 하였다. 각 point에 유리선량계를 삽입한 후 couch의 Side Rail을 외측(Out)으로 뺀 후 vac-lok을 놓지 않은 no vac-lok, 그리고 10, 20, 30 mm의 vac-lok 위에 팬텀을 세팅하였다. 중심점에 6 MV 광자선을 조사야 $10{\times}10cm^2$, SAD 100 cm, 겐트리 각도 $225^{\circ}$로 하여 300 MU/min 선량률과 100 MU 조사선량을 전달하였다. 측정은 5회씩 실시하였고, 마찬가지로 Side Rail을 내측(In)으로 넣은 후 각 point에 대해서도 같은 조건으로 5 회씩 측정하여 평균값을 산출하였다. 결 과 : side rail에 따라서는 중심점, A, B, C, D Point 각각 -11.8 %, -12.3 %, -4.1 %, -12.3 %, -7.3 %의 선량 감소를 보였다. Side-Rail-Out에서 10 mm vac-lok의 경우 약 -0.9 %가 감소되었고, 20 mm vac-lok 사용 시 약 -2.0 %, 30 mm vac-lock 사용 시 약 -3.0 %가 감소되었다. Side-Rail-In에서 10 mm vac-lok의 경우 약 -1.0 %가 감소되었고, 20 mm vac-lok 사용 시 약 -2.1 %, 30 mm vac-lok 사용 시 약 -3.0 %가 감소되었다. Side-Rail-In 상태의 no vac-lok 선량 값을 기준으로 Side-Rail-Out 상태의 10, 20, 30 mm vac-lok을 사용할 때, side rail에 대한 선량 감소에 더하여 중심점에서는 약 -0.9 %, -1.8 % -2.4 %, A point에서는 -0.5 %, -1.6 %, -2.1 %, B point에서는 약 -0.9 %, -2.0 %, -3.2 %, C Point에서는 -1.0 %, -2.1 %, -3.1 %, D point에서는 약 -1.0 %, -1.6 %, -3.1 %의 추가적인 선량 감소를 나타냈다. 결 론 : 폐를 비롯한 우측후사방향 방사선 치료 시 side rail에 대해 주의를 기울이고, vac-lok 제작 시 vaclok 두께에 대해 관심을 갖는다면 더 나은 치료 효과를 기대해 볼 수 있으리라 사료된다. Purpose : To evaluate the effect of carbon couch side rail and vacuum immobilization device in case of lung RPO irradiation. Materials and Methods : The 10, 20, 30 mm thickness of vac-lok's right side were obtained. To measure of doses, glass dosimeters were used and measured reference point is left lung center at the phantom. A, B, C, and D points are left, right, down, and up directions based on the center point. In the state of Side-Rail-Out, place the without vac-lok, with the thickness of 10, 20, and 30 mm vac-lok. After the glass dosimeters was inserted in center, A, B, C, and D points, 100 MU of 6 MV X-ray were irradiated to the referenced center point in the condition of $10{\times}10cm^2$ field size, SAD 100 cm, gantry angle 225, 300 MU/min dose rate. Five measurements were made for each point. In the state of Side-Rail-In, five measurement were made for each point under the same conditions. The average is measured on each of the five Side-Rail-Out and Side-Rail-In measurements. Results : In the presence of side rail, the dose reduction ratio was -11.8 %, -12.3 %, -4.1 %, -12.3 %, -7.3 % for each A, B, C, and D points. In the state of Side-Rail-Out, the dose reduction ratio for the using 10 mm thickness of vac-lok was -0.9 % than without vac-lok. The dose reduction ratio for the using 20 mm thickness of vac-lok was -2.0 %, for the using 30 mm thickness of the vac-lok was -3.0 % than without vac-lok. In the state of Side-Rail-In, the dose reduction ratio for the using 10 mm thickness of vac-lok was -1.0 % than without vac-lok. The dose reduction ratio for the using 20 mm vac-lok was -2.1 %, for the using 30 mm vac-lok was -3.0 % than without vac-lok. Based on the value of no vac-lok dose in the Side-Rail-In state, The dose reduction ratios for the using 10 mm, 20 mm and 30 mm thickness of vac-loks In the Side-Rail-Out that the center point were -12.7 %, -13.7 %, -14.2 % and -12.8 %, -13.8 %, -14.5 % respectively at point A. The dose reduction ratios for the same conditions to the B point were -4.9 %, -6.1 %, -7.1 % and -13.4 %, -14.4 %, -15.5 % respectively at point C. The dose reduction ratios for the same conditions to the D point were -8.4 %, -9.0 %, -10.4 % respectively. Conclusion : The attenuation was caused by presence of side rails and thickness of vac-lok. Pay attention to these attenuation factors, making it a more effective radiation therapy.