Re-irradiation with Moderate Hypo-Fractionation Using Intensity Modulated Photon or Proton Radiation Therapy in Locally Recurrent Squamous Cell Carcinoma of Nasopharynx

남희림,안용찬,양경미,오동렬,노재명 대한암학회 2022 Cancer Research and Treatment Vol.54 No.1

Purpose This study aimed to analyze the treatment outcomes of locally recurrent nasopharyngeal cancer (NPC) patients following moderate hypo-fractionation re-irradiation (re-RT). Materials and Methods Sixty locally recurrent NPC patients underwent hypo-fractionation re-RT. Forty-eight point three percentage had rT3-4, and 30.0% did keratinizing squamous cell carcinoma. Intensity-modulated radiation therapy (IMRT), with or without intensity-modulated proton therapy (IMPT), was used in 66.7% of patients. Results With the median follow-up of 22 months (range, 2 to 254 months), 31 patients (51.7%) died, 38 (63.3%) developed further treatment failure, and 30 (50.0%) developed ≥ grade 3 toxicity (including seven grade 5) at time of analysis. The 2- and 5-year rates of overall survival, local failure-free survival, and ≥ grade 3 toxicity-free survival were 57.9% and 45.8%, 64.1% and 52.5%, and 54.8% and 44.9%, respectively. In multivariate analyses, worse factors for overall survival (OS) were iT3-4 (p=0.010) and age at re-RT ≥ 53 years (p=0.003), those for local failure-free survival (LFFS) were rT3-4 (p=0.022) and rN0-1 (p=0.035), and those for toxicity-free survival (TFS) were iT3-4 (p=0.020) and re-IMRT/IMPT (p=0.030), respectively. Cumulative dose or fraction size ≥ 3 Gy at re-RT, however, showed no significance for OS, LFFS and TFS. Conclusion Current re-RT with modern RT techniques by moderate hypo-fractionation scheme seemed feasible in treating locally recurrent NPC patients.

두개 내 다형성아교모세포종 환자의 방사선치료 결과

남희림(Hee Rim Nam),임도훈(Do Hoon Lim),안용찬(Yong Chan Ahn),이정일(Jung Il Lee),남도현(Do-Hyun Nam),김종현(Jong Hyun Kim),홍승철(Seung-Chyul Hong),이정은(Jeong Eun Lee),강민규(Min Kyu Kang),박영제(Young Je Park),김경주(Kyung Ju Kim 대한방사선종양학회 2004 Radiation Oncology Journal Vol.22 No.2

목 적: 두개 내 다형성아교모세포종 환자의 방사선치료 후 생존율을 조사하고 그 예후 인자의 중요성을 알아보고자 하였다. 대상 및 방법: 1994년부터 2003년까지 삼성서울병원에서 병리학적으로 다형성아교모세포종으로 확진된 환자 중 근치적 목적으로 방사선치료를 시행한 120명을 대상으로 분석하였다. 남자는 64명(53%), 여자는 56명(47%)이었으며, 20례(17%)의 종양은 다발성이었다. 수술은 육안적 완전 절제, 부분 절제 및 조직검사를 각각 22례(18%), 69례(58%), 29례(24%)에서 시행하였고, 방사선치료는 4∼10 MV 선형가속기를 이용하여 54∼72 Gy (중앙값 60 Gy)를 조사하였다. 대상 환자의 추적관찰기간은 2개월에서 62개월(중앙값 12개월)이었다. 결 과: 전체 환자군의 1년 및 2년 생존율은 52%와 14%이었으며, 중앙생존기간은 13개월이었다. 예후 인자에 따른 1년 생존율은 50세 미만은 64%, 50세 이상은 41% (p<0.01), 수술 전 활동도가 ECOG 0 혹은 1인 경우는 57%, 2 이상은 44% (p=0.03)였다. 두개 내 병변 수에 따른 1년 생존율은 단일병변은 57%, 다발성 병변은 23% (p=0.02)이었으며, 절제정도에 따른 생존율은 육안적 완전 절제, 부분 절제, 조직검사만 시행한 경우에 각각 67%, 48%, 47% (p=0.04)였다. 다변량 분석에 따른 예후인자로는 여자(p<0.01), 50세 미만(p<0.01), 활동도가 ECOG 0 혹은 1 (p=0.05), 육안적 완전절제(p=0.05)가 좋은 예후 인자이었다. 결 론: 근치적 목적으로 방사선치료를 시행한 두개 내 다형성아교모세포종 환자의 중앙생존기간은 13개월로 기존의 문헌보고와 비슷한 수준이었다. 치료성적의 향상을 위하여 다양한 방사선치료 기술의 적용을 통한 방사선량의 증가와 효과적인 항암화학요법 약제의 개발 및 사용 등의 연구가 필요하고, 환자의 예후인자에 따라 개별화된 치료방법이 적용되어야 할 것으로 판단된다. Purpose: To analyze the survival outcomes and prognostic factors in glioblastoma patients treated with surgery and radiation therapy. Materials and Methods: One hundred twenty glioblastoma patients treated with postoperative radiation therapy from 1994 to 2003 at Samsung Medical Center were retrospectively reviewed. Surgical extents were gross total resection in 22 patients (18%), subtotal resection in 69 (58%), and biopsy only in 29 (24%). The median radiation dose was 60 Gy, ranging from 45 Gy to 72 Gy. The median follow-up period was 12 months ranging from 2 to 62 months. Results: The overall 1- and 2-year survival rates were 52% and 14%, respectively, and the median survival duration was 13 months. Favorable prognostic factors by Uunivariate analyses of prognostic factors on 1-year survival rate wererevealed that age under 50 (p<0.01), ECOG performance status 0 or 1 (p=0.03), single lesion (p=0.02), and gross total resection (p=0.04), were the favorable prognostic factors. and by Mmultivariate analyses wererevealed that female (p<0.01), age under 50 (p<0.01), ECOG performance status 0 or 1 (p=0.05) and gross total resection (p=0.05) were the favorable prognostic factors. Conclusions: The results of our study were comparable with those previously reported. To improve treatment outcome, various modifications, including radiation dose escalation through newer radiation therapy techniques and use of effective chemotherapy regimen, should be further investigated. investigated. Also Furthermore, the application of individualized treatment strategy based on the patient's' prognostic factors might be needed.

대학생의 음식점 선택속성이 고객감정, 고객만족 및 충성도에 미치는 영향

남희림(Nam, Hee-Rim),이종호(Lee, Chong-Ho) 한국외식경영학회 2017 외식경영연구 Vol.20 No.5

본 연구의 목적은 대학생들을 대상으로 음식점 선택속성이 고객감정, 고객만족 및 충성도에 미치는 영향관계를 분석하는 것이다. 연구 자료는 인천과 부천의 2년제 대학생 265명과 청주 및 광주지역의 4년제 대학생 260명 총 525명을 대상으로 설문지를 통하여 수집하였으며 분석은 SPSS를 이용하였다. 본 연구의 결과는 다음과 같다. 첫째, 대학생들이 지각하는 음식점 선택속성은 서비스, 음식품질, 평판으로 나타났으며 4년제 대학생의 경우 편리성을 한 요인으로 생각하고 있는 것으로 밝혀졌다. 둘째, 음식점 선택속성은 고객감정에 유의한 영향을 주는 것으로 나타났다. 셋째, 음식점 선택속성은 고객만족과 충성도에 정(+)의 영향을 주는 것으로 나타났다. 넷째, 고객감정은 직접적으로 고객만족과 충성도에 긍정적인 영향을 주는 것으로 나타났다. 이러한 결과는 대학생들이 음식점을 선택하는 속성은 정해져 있으며, 음식점에 경험하는 감정이 만족을 유도하기 때문에 음식점을 재방문하거나 추천 등의 충성도에 영향을 미친다는 것을 의미한다. 따라서 학교주변의 외식기업들이 경쟁력을 유지하거나 높이기 위해서는 대학생들의 음식점 선택속성에 대해 살펴볼 필요가 있으며, 음식점 이용 시 우호적인 감정을 갖도록 서비스 및 음식품질 등을 개선하기 위한 노력이 필요할 것이다. The purpose of this research is to analyze the effect of college students selection attributes of restaurants on customer emotion, satisfaction and loyalty. The research data are obtained through a survey targeted for 265 college students in metropolitan area and 260 college students in the province area. The results of the research are as follow: college students selection attributes(service, food quality) in metropolitan area positively influences customer emotion. Also college students selection attributes(service, food quality, reputation) in province area has direct effect on customer emotion, which has favorable effect on customer satisfaction and loyalty. Therefore, in order for restaurants near by college to maintain its competitiveness in the market, it is critical to consider college students selection attributes of restaurants and their emotion in the period of visit. Furthermore, the restaurants also need to pay attention to their service and food quality.

성별과 인구통계학적 특성이 객실승무원의 LMX 및 TMX에 미치는 상호작용효과에 관한 연구

이종호,남희림 대한관광경영학회 2018 觀光硏究 Vol.33 No.8

The purpose of this study is to analyze the variety of flight attendants’ LMX and TMX in accordance with the interactive effect of gender and demographic characteristics. Data was obtained from a survey of 328 flight attendants. Two-way ANOVA test were conducted for the analysis. The results are as follows. There were interactive effects of between gender and marital status, gender and age, gender and length of service, gender and status in LMX. However there was only interactive effect between gender and length of service in TMX. Specifically, there were significant differences in the mean level of LMX and TMX between men and women according to marital status, age, length of service and status. Flight attendants who were men, unmarried, young(below 40 years), short length of service and lower status showed high level of LMX. In contrast, flight attendants who were women, married, old(over 40years), higher status revealed low level of LMX. The relevance of TMX female flight attendant marked higher than male flight attendants if they are married, 20~29years or over 40years, purser or senior purser. Research are discussed regarding how to increase flight attendants’ LMX and TMX for Teamwork. 본 연구는 항공사 객실승무원의 리더-멤버 교환관계(LMX)와 팀-멤버 교환관계(TMX)를 성별과 인구통계학적 특성(결혼, 연령, 근무기간, 직급)의 상호작용효과를 통해 분석하였다. 분석결과는 다음과 같다. 첫째, 성별과 결혼여부의 상호작용은 LMX에만 효과가 나타났다. 구체적으로 LMX는 미혼자가 기혼자보다 높으며, 남승무원이 여승무원보다 높은 수준을 보이고 있었다. 둘째, 성별과 연령의 상호작용 효과는 LMX와 TMX에 모두 유의한 영향을 미치고 있었다. 구체적으로 LMX의 경우 40세 이하는 남승무원이 높고, 40세 이상은 여승무원이 높았다. TMX는 30~39세 연령집단에서 남승무원이 높았으나, 20대와 40대 이상에서는 여승무원이 높았다. 셋째, 성별과 근무기간의 상호작용 효과는 LMX에만 나타났다. 구체적으로 남승무원의 LMX는 근무기간이 10년 미만일 때는 근무기간이 짧을수록 높고 여승무원보다 높은 수준을 보이지만, 10년 이상일 경우 여승무원보다 낮았다. 넷째, 성별과 직급의 상호작용효과는 LMX에만 나타났다. 구체적으로 대부분 직급에서 남승무원의 LMX는 직급이 낮을수록 높은 수준을 보이면서 여성보다 높았으나, 선임사무장의 경우 여승무원의 LMX가 남승무원보다 높은 수준을 보이고 있었다. 이러한 연구결과는 팀제로 운영되는 객실승무원 조직에서 팀워크를 제고하기 위한 방안의 초석이 될 것으로 여겨진다.

A Simple DVH Generation Technique for Various Radiotherapy Treatment Planning Systems for an Independent Information System

민병준,남희림,정인선,이혜빈 한국물리학회 2015 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.67 No.1

In recent years, the use of a picture archiving and communication system (PACS) for radiation therapy has become the norm in hospital environments and has been suggested for collecting and managing data using Digital Imaging and Communication in Medicine (DICOM) objects from different treatment planning systems (TPSs). However, some TPSs do not provide the ability to export the dose-volume histogram (DVH) in text or other format. In addition, plan review systems for various TPSs often allow DVH recalculations with different algorithms. These algorithms result in inevitable discrepancies between the values obtained with the recalculation and those obtained with TPS itself. The purpose of this study was to develop a simple method for generating reproducible DVH values by using the TPSs. Treatment planning information, including structures and delivered dose, was exported in the DICOM format from the Eclipse v8.9 or the Pinnacle v9.6 planning systems. The supersampling and trilinear interpolation methods were employed to calculate the DVH data from 35 treatment plans. The discrepancies between the DVHs extracted from each TPS and those extracted by using the proposed calculation method were evaluated with respect to the supersampling ratio. The volume, minimum dose, maximum dose, and mean dose were compared. The variations in DVHs from multiple TPSs were compared by using the MIM software v6.1, which is a commercially available treatment planning comparison tool. The overall comparisons of the volume, minimum dose, maximum dose, and mean dose showed that the proposed method generated relatively smaller discrepancies compared with TPS than the MIM software did compare with the TPS. As the structure volume decreased, the overall percent difference increased. The largest difference was observed in small organs such as the eye ball, eye lens, and optic nerve which had volume below 10 cc. A simple and useful technique was developed to generate a DVH with an acceptable error from a proprietary TPS. This study provides a convenient and common framework that will allow the use of a single well-managed storage solution for an independent information system.

Clinical outcomes of stereotactic body radiotherapy for spinal metastases from hepatocellular carcinoma

이은주,남희림,김태규,박희철,유정일,임도훈,이혜빈,이준혁 대한방사선종양학회 2015 Radiation Oncology Journal Vol.33 No.3

Purpose: To investigate the outcomes of patients with spinal metastases from hepatocellular carcinoma (HCC), who were treated by stereotactic body radiotherapy (SBRT). Materials and Methods: This retrospective study evaluated 23 patients who underwent SBRT from October 2008 to August 2012 for 36 spinal metastases from HCC. SBRT consisted of approximately 2 fractionation schedules, which were 18 to 40 Gy in 1 to 4 fractions for group A lesions (n = 15) and 50 Gy in 10 fractions for group B lesions (n = 21). Results: The median follow-up period was 7 months (range, 2 to 16 months). Seven patients developed grade 1 or 2 gastrointestinal toxicity, and one developed grade 2 leucopenia. Compression fractures occurred in association with 25% of the lesions, with a median time to fracture of 2 months. Pain relief occurred in 92.3% and 68.4% of group A and B lesions, respectively. Radiologic response (complete and partial response) occurred in 80.0% and 61.9% of group A and B lesions, respectively. The estimated 1-year spinal-tumor progression-free survival rate was 78.5%. The median overall survival period and 1-year overall survival rate were 9 months (range, 2 to 16 months) and 25.7%, respectively. Conclusion: SBRT for spinal metastases from HCC is well tolerated and effective at providing pain relief and radiologic response. Because compression fractures develop at a high rate following SBRT for spinal metastases from primary HCC, careful follow up of the patient is required.

Clinical outcomes after sentinel lymph node biopsy in clinically node-negative breast cancer patients

한희지,김주리,남희림,금기창,서창옥,김용배 대한방사선종양학회 2014 Radiation Oncology Journal Vol.32 No.3

To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. Materials and Methods: From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. Results: The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. Conclusion: In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

High Dose Involved Field Radiation Therapy as Salvage for Loco-Regional Recurrence of Non-Small Cell Lung Cancer

배선현,안용찬,남희림,박희철,표홍렬,심영목,김진국,Kwhanmien Kim,안진석,안명주,박근칠 연세대학교의과대학 2012 Yonsei medical journal Vol.53 No.6

Purpose: To determine the effectiveness of salvage radiation therapy (RT) in patients with loco-regional recurrences (LRR) following initial complete resection of non-small cell lung cancer (NSCLC) and assess prognostic factors affecting survivals. Materials and Methods: Between 1994 and 2007, 64 patients with LRR after surgery of NSCLC were treated with high dose RT alone (78.1%) or concurrent chemo-radiation therapy (CCRT, 21.9%) at Samsung Medical Center. Twenty-nine patients (45.3%) had local recurrence, 26 patients (40.6%) had regional recurrence and 9 patients (14.1%) had recurrence of both components. The median RT dose was 54 Gy (range, 44-66 Gy). The radiation target volume included the recurrent lesions only. Results: The median follow-up time from the start of RT in survivors was 32.0 months. The rates of in-field failure free survival, intra-thoracic failure free survival and extra-thoracic failure free survival at 2 years were 52.3%, 33.9% and 59.4%, respectively. The median survival after RT was 18.5 months, and 2-year overall survival (OS) rate was 47.9%. On both univariate and multivariate analysis, the interval from surgery till recurrence and CCRT were significant prognostic factors for OS. Conclusion: The current study demonstrates that involved field salvage RT is effective for LRR of NSCLC following surgery.

Definitive Radiation Therapy for Early Glottic Cancer: Experience of Two Fractionation Schedules

김태규,안용찬,남희림,정만기,정한신,손영익,백정환 대한이비인후과학회 2012 Clinical and Experimental Otorhinolaryngology Vol.5 No.2

Objectives. The authors would report the results of definitive radiation therapy (RT) for early glottic cancer by two different radiation dose schedules. Methods. From February of 1995 till June of 2008, 157 patients with T1-2N0 glottic cancer were treated with curative RT at Samsung Medical Center. All patients had squamous cell carcinoma, and there were 89 patients (56.7%) with T1a,36 (22.9%) with T1b, and 32 (20.4%) with T2. Two different radiation dose schedules were used: 70 Gy in 35 fractions to 64 patients (40.8%, group A); and 67.5 Gy in 30 fractions to 93 patients (59.2%, group B). The median treatment durations were 50 days (range, 44 to 59 days) and 44 days (range, 40 to 67 days) in the groups A and B, respectively. Results. The median follow-up durations were 85 and 45 months for the groups A and B. No severe late complication of RTOG grade 3 or higher was observed, and there was no difference in acute or chronic complication between the groups. Twenty-four patients experienced treatment failure: local recurrence only in 19 patients; regional recurrence only in one; combined local and regional recurrence in four; and systemic metastasis in none. The overall 5-year disease-free survival and disease-specific survival rates were 84.7% and 94.8%. The disease-free survival rate in the group B was better (78.3% vs. 90.8%, P=0.031). This difference was significant only in T1 stage (83.4% vs. 94.6%, P=0.025), but not in T2 (62.7% vs. 60.6%, P=0.965). Univariate analysis showed that the tumor extent, cord mobility,T-stage, and the dose schedule had significant influence on the disease-free survival, and multivariate analysis showed that only the tumor extent and the dose schedule were associated with the disease-free survival. Conclusion. Superior disease-free survival could be achieved by 2.25 Gy per fraction without increased toxicity over shorter RT duration, when compared with 2.0 Gy per fraction.

Treatment Results of Major Salivary Gland Cancer by Surgery with or without Postoperative Radiation Therapy

노재명,안용찬,남희림,박원,백정환,손영익,정한신 대한이비인후과학회 2010 Clinical and Experimental Otorhinolaryngology Vol.3 No.2

Objectives. This is to report treatment results of major salivary gland cancer by surgery with or without postoperative radiation therapy (PORT). Methods. Between March 1995 and January 2006, 94 patients with primary major salivary cancer underwent curative surgical resection at Samsung Medical Center. The parotid gland was the most commonly involved (73, 77.7%),followed by the submandibular and the sublingual. Neck dissection was added in 28 patients, and PORT was individually recommended to those with risk factors. Seventy-five (79.8%) patients received PORT. PORT volume included primary tumor bed and pathologically involved regional lymphatics, and no additional effort was made for elective nodal irradiation. The median total doses were 56.0 Gy to primary site and 58.7 Gy to regional lymphatics. Results. After median follow-up of 49 months, 21 patients had relapsed: 20 in PORT; and one in surgery alone group. As the first site of failure, distant metastasis was the most common (17 patients). Local recurrence occurred in three, and regional relapse in one. The lung was the most common site (10 patients), followed by the bone, and the brain. Fiveyr disease free survival (DFS), local control, and overall survival (OS) rates were 74.4% and 94.7%, 96.0% and 100%, and 78.2% and 100% in PORT and surgery alone groups, respectively. On multivariate analysis, DFS was significantly affected by pN+ (hazard ratio [HR], 3.624; P=0.0319), while OS was by pN+ (HR, 7.138; P=0.0034)and perineural invasion (HR, 5.073; P=0.0187). Conclusion. Based on our experience, the patients with early stage major salivary gland cancer with low risk can be effectively treated by surgery alone, and those who with risk factors can achieve excellent local and regional control by adding PORT. Omitting elective neck irradiation in patients with N0 disease seems a feasible strategy under accurate clinical evaluation. An effort is needed to decrease distant metastasis through further clinical trials.