척추뼈전이암 환자의 체부정위방사선치료계획 비교: 동시통합추가치료법 대 RTOG 0631 프로토콜

박수연,오동렬,박희철,김진성,김종식,신은혁,김혜영,정상훈,한영이,Park, Su Yeon,Oh, Dongryul,Park, Hee Chul,Kim, Jin Sung,Kim, Jong Sik,Shin, Eun Hyuk,Kim, Hye Young,Jung, Sang Hoon,Han, Youngyih 한국의학물리학회 2014 의학물리 Vol.25 No.3

척추뼈전이암 환자를 대상으로 본원의 동시통합추가치료법(SIB)과 RTOG 0631 프로토콜에 따른 체부정위방사선치료계획을 세우고, 선량분포를 비교하였다. 간암 원발인 척추 뼈 전이암 환자 5명을 대상으로 전산화단층촬영 영상과 자기공명영상(T1, T2)를 바탕으로 영상융합을 시행하였다. 본원에서 시행하는 SIB방법은 영상에서 보이는 종양을 GTV로 설정하고, GTV를 포함한 전체 척추체부(entire vertebral body, VB)를 CTV1로 정의하였고 GTV에 18 Gy CTV1에 10 Gy를 1회 처방하였다. RTOG 0631 프로토콜 방법은 GTV의 침윤 정도에 따라 주변부의 추근, 좌우 횡돌기 및 극돌기 등을 선택적으로 포함하여 CTV2로 정의하였고 18 Gy 1회 처방하여 체부정위방사선치료계획을 시행하였다. 선량체적화 결과값을 선량-체적 히스토그램을 통해 분석한 결과, 두 방법 모두 표적에 대하여 처방 선량을 만족하였으며, 척수 및 정상 장기에 대하여는 SIB방법이 RTOG 0631프로토콜보다는 낮은 값을 보였다. 또한, 전체 VB의 조사선량분포를 정량화한 결과, RTOG 0631프로토콜에서도 SIB방법과 동일한 처방선량 허용치 85%이상을 포함하는 것으로 나타났다. 하지만 정상 장기에 대한 선량은 RTOG 0631 프로토콜에 따른 치료 방법이 높은 편이었다. 주변부 장기의 부작용이 우려되는 임상적 상황의 경우 조사 체적이 적은 SIB방법이 좋은 선택이 될 수 있을 것이다. 결론적으로 SIB방법이나 RTOG 0631 프로토콜에 따른 표적체적 설정을 통한 체부정위방사선치료계획 모두 유사한 결과를 보였으며, 향후 다양한 연구를 통해 종양제어확률 및 부작용 확률의 차이를 분석해야 할 것이다. In this study, we compared dose distributions from simultaneously integrated boost (SIB) method versus the RTOG 0631 protocol for spine radiosurgery. Spine radiosurgery plans were performed in five patients with localized spinal metastases from hepatocellular carcinoma. The computed tomography (CT) and T1- and T2-weighted magnetic resonance imaging (MRI) were fused for delineating of GTV and spinal cord. In SIB plan, the clinical target volume (CTV1) was included the whole compartments of the involved spine, while RTOG 0631 protocol defines the CTV2 as the involved vertebral body and both left and right pedicles. The CTV2 includes transverse process and posterior element according to the extent of GTV. The doses were prescribed 18 Gy to GTV and 10 Gy to CTV1 in SIB plan, while the prescription of RTOG 0631 protocol was applied 18 Gy to CTV2. The results of dose-volume histogram (DVH) showed that there were competitive in target coverage, while the doses of spinal cord and other normal organs were lower in SIB method than in RTOG 0631 protocol. The 85% irradiated volume of VB in RTOG 0631 protocol was similar to that in the SIB plan. However, the dose to normal organs in RTOG 0631 had a tendency to higher than that in SIB plan. The SIB plan might be an alternative method in case of predictive serious complications of surrounded normal organs. In conclusion, although both approaches of SIB or RTOG 0631 showed competitive planning results, tumor control probability (TCP) and normal tissue complication probability (NTCP) through diverse clinical researches should be analyzed in the future.

간세포암에 의한 뼈전이의 방사선치료

김태규(Tae Gyu Kim),박희철(Hee Chul Park),임도훈(Do Hoon Lim),김철진(Cheol Jin Kim),이혜빈(Hye Bin Lee),곽금연(Keum Yeon Kwak),최문석(Moon Seok Choi),이준혁(Joon Hyoek Lee),고광철(Kwang Cheol Koh),백승운(Seung Woon Paik),유병철(Byung 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.2

목적: 간세포암에 의한 뼈전이 환자의 방사선 조사선량에 따른 통증 감소 정도 및 전이성 병소의 영상학적 치료 반응을 분석하고 고선량 방사선치료가 도움이 될 수 있는지 알아보고자 하였다. 대상 및 방법: 2007년 1월부터 2010년 6월까지 병리 혹은 임상적으로 간세포암에 의한 뼈전이로 진단받고 증상 완화 목적의 방사선치료를 받은 103명에서 뼈전이 병소 223개 부위를 대상으로 연구하였다. 조사받은 생물학적 유효선량이 39 Gy10 이하인 경우 저선량군, 39 Gy10를 초과하는 경우 고선량군으로 대상환자를 구분하였다. 통증 감소 정도는 숫자통증등급(numeric rating scale)을 이용하였고 통증이 감소한 경우, 통증 정도에 변화가 없는 경우, 통증이 증가한 경우로 나누었다. 영상학적 반응은 modified Response Evaluation Criteria In Solid Tumors (RECIST) 기준을 이용하였으며 환자의 생존율에 영향을 미치는 인자를 분석하였다. 결과: 중앙추적관찰기간은 6개월이었다(범위, 0∼46개월). 저선량군에서는 67개 병소(66.3%) 부위에서, 고선량군에서는 44개 병소(89.8%) 부위에서 영상학적 반응이 있었다. 저선량군과 고선량군 사이에 영상학적 치료 반응 정도는 유의하게 차이를 보였다(p=0.02). 저선량군과 고선량군은 각각 65%와 75%의 통증 감소를 보였으나 통계적으로 유의한 차이는 없었다(p=0.24). 저선량군과 고선량군 사이에 급성 및 만성 치료 독성은 통계적으로 유의한 차이가 없었다(p>0.05). 뼈전이 진단 시부터 사망까지 생존기간은 0∼46개월(중앙값, 11개월) 범위였고 1년 생존율은 41.6%였다. 잔존 간 기능(Child-Pugh 점수)이 생존율에 유의한 영향을 미치는 인자였고 Child-Pugh 점수에 따른 중앙생존기간은 A 14개월, B와 C는 2개월로 나타났다. 결론: 간세포암에 의한 뼈전이는 고선량군에서 영상학적 반응 정도가 더 높았다. 잔존 간 기능이 좋은 환자에게 고선량의 방사선치료 시 높은 치료 반응을 얻음으로써 삶의 질의 향상에 도움을 줄 수 있음을 알 수 있었다. Purpose: To evaluate the extent of pain response and objective response to palliative radiotherapy (RT) for bone metastases from hepatocellular carcinoma according to RT dose. Materials and Methods: From January 2007 to June 2010, palliative RT was conducted for 103 patients (223 sites) with bone metastases from hepatocellular carcinoma. Treatment sites were divided into the high RT dose and low RT dose groups by biologically effective dose (BED) of 39 Gy10. Pain responses were evaluated using the numeric rating scale. Pain scores before and after RT were compared and categorized into ‘Decreased’, ‘No change’ and ‘Increased’. Radiological objective responses were categorized into complete response, partial response, stable disease and progression using modified RECIST (Response Evaluation Criteria In Solid Tumors) criteria; the factors predicting patients’ survival were analyzed. Results: The median follow-up period was 6 months (range, 0 to 46 months), and the radiologic responses existed in 67 RT sites (66.3%) and 44 sites (89.8%) in the high and low RT dose group, respectively. A dose-response relationship was found in relation to RT dose (p=0.02). Pain responses were 75% and 65% in the high and low RT dose groups, respectively. However, no statistical difference in pain response was found between the two groups (p=0.24). There were no differences in the toxicity profiles between the high and low RT dose groups. Median survival from the time of bone metastases diagnosis was 11 months (range, 0 to 46 months). The Child-Pugh classification at the time of palliative RT was the only significant predictive factor for patient survival after RT. Median survival time was 14 months under Child-Pugh A and 2 months under Child-Pugh B and C. Conclusion: The rate of radiologic objective response was higher in the high RT dose group. Palliative RT with a high dose would provide an improvement in patient quality of life through enhanced tumor response, especially in patients with proper liver function.

소라페닙 및 방사선 병합 치료 후 좋은 반응을 보인 간문맥 침윤을 동반한 진행성 간세포암종 1예

백남영 ( Namyoung Paik ),신동현 ( Dong Hyun Sinn ),박희철 ( Hee Chul Park ),정우경 ( Woo Kyung Jeong ),김민선 ( Min Sun Kim ),김지혜 ( Ji Hye Kim ),양범희 ( Bumhee Yang ) 대한간암학회 2016 대한간암학회지 Vol.16 No.2

A prognosis of hepatocellular carcinoma (HCC) with portal vein tumor thrombosis (PVTT) is dismal that the median survival is 2 to 4 months without treatment. Sorafenib, the standard regimen of advanced HCC, can prolong median survival only 1.5 months. A 50-year-old man with a history of chronic hepatitis B was diagnosed advanced HCC with PVTT. By a multidisciplinary medical team approach, the combination of 3-demensional conformal radiation therapy with sequential sorafenib was challenged. 4 months after initiation of treatment, he achieved partial response as modified response evaluation criteria in solid tumors criteria. Sorafenib was continued so far, and stable disease has been maintained up to now, without significant adverse effect. (J Liver Cancer 2016;16:134-138)

간세포암종에서 초치료로 양성자를 사용하여 양호한 결과를 보인 증례 1예

오진명 ( Jinmyeong Oh ),신동현 ( Dong Hyun Sinn ),성결 ( Gyeol Seong ),정혜교 ( Hye Gyo Chung ),허찬미 ( Chanmi Heo ),유정일 ( Jeongil Yu ),박희철 ( Hee Chul Park ) 대한간암학회 2018 대한간암학회지 Vol.18 No.1

Although first-line treatment option for single, small sized hepatocellular carcinoma in patients with preserved liver function and good performance status is resection or ablation, sometimes these modalities cannot be applied for variable reasons. For them, alternative options such as transarterial chemoeombolization, ethanol injection, and external radiation therapy can be considered, with variable success rates. Herein, we describe 45 year-old male who presented with a single small tumor located at caudate lobe. After multi-disciplinary discussion, the patient was treated with proton beam therapy, which resulted in favorable treatment outcome. (J Liver Cancer 2018;18:80-85)

기관지 점액표피양 종양 치험 1 례

이원진(Won Jin Lee),신호승(Ho Seung Shin),김병주(Byung Joo Kim),박희철(Hee Chul Park),홍기우(Ki Woo Hong),양인석(In Seok Yang),이혜란(Hae Ran Lee),안혜경(Hye Kyung Ahn) 대한소아알레르기호흡기학회 1994 소아알레르기 및 호흡기학회지 Vol.4 No.1

We experienced one case of mucoepidermoid carcinoma on right lower lobar bronchus in a 13 year-old male patient and he was treated by RLL lobectomy. Mucoepidermoid carcinoma is an uncommon tracheobronchial neoplasm, and the incidence is estimated about 2 to 5 per 1,000 primary bronchial neoplasms. In the AFIP(Armed Forces Institute of Pathology) series, the average age of individuals with low-grade tumors was 35 years, and that of persons with high-grade forms was 45 years. Symptoms are related to intraluminal growth including cough, hemoptysis, wheeze, and recurrent pneumonia. When these recurrent symptoms suggest endobronchial obstruction, diagnostic bronchoscopy should be performed. The majority of tumors present as polypoid mass in the lumen of a main or lobar bronchus, The overall 5-year survival is 45%. Bronchoscopic follow-up is recommended and computed tomography of the chest every 1 to 2 years may be of additional diagnostic value. We report this case with the brief review of literatures.

초전도 케이블의 퀜치 특성에 대한 계통안전성 제어방식

이근준(Geun-Joon Lee),황시돌(Si-Dol Hwang),이정필(Jeong-Phil Lee),김창현(Chang-Hyun Kim),박희철(Hye-Chul Park) 한국조명·전기설비학회 2004 한국조명·전기설비학회 학술대회논문집 Vol.2004 No.11월

This paper presents the basic quench protection idea for the HTS(High-Temperature Supeconducting) cable. In Korea power system, the transfer capability of transmission line is limited by the voltage stability, and HTS cable could be one of the countermeasure to solve the transfer limit as its higher current capacity and lower impedance[1]. However, the quench characteristic of HTS cable makes HTS cable to loss its superconductivity, and therefore change the impedance of the line and power system operating condition dramatically. This pheonominum threats not only HTS cable safety but also power system security, therefore a proper protection scheme and security control counterplan have to be established before HTS cable implementation. In this paper, the quench characteristics of HTS cable for the fault current based on heat balance equation was established and a proper protection method by FCL(Fault Current Limiter) was suggested.

Epstein-Barr 바이러스와 연관된 B세포 역형성대세포림프종과 Human Immunodeficiency 바이러스 감염증이 동반된 1례

박진아,김기원,박석영,박희철,윤종현,김희정,이은희,이혜경,계철승 大韓血液學會 2001 大韓血液學會誌 Vol.36 No.4

피부생검으로 확진한 관동맥 조영술 후의 중증 콜레스테롤 색전증 2예

김종진,박준철,채장성,김재형,홍순조,최규보,장성희,진승원,박희철,장이선,윤희정,김희열,이혜경 대한내과학회 2002 대한내과학회지 Vol.63 No.1

Cholesterol embolism is due to dislodgment of cholesterol crystals from the atheromatous aorta resulting in an occlusion of small arteries. Cholesterol emboli may occur spontaneously but usually develops as a complication of vascular procedures. The organs most frequently involved are the skin and the kidneys but any organ can be affected. Cutaneous manifestations include livedo reticularis, indurated firm violaceous painful plaques and noduli tending to show central necrosis and tender blue toes. We report two cases of cutaneous cholesterol embolization of lower extremities with the impairment of renal function after coronary angiography, proven by skin biopsy.