국소 진행된 비인강암의 방사선-항암제 병용요법

손석현(Seok Hyun Son),김지윤(Ji Yoon Kim),김연실(Yeon Sil Kim),김성환(Sung Whan Kim),문성권(Seong Kwon Mun),조승호(Seung Ho Cho),박영학(Young Hak Park),홍영선(Young Seon Hong) 대한두경부종양학회 2006 대한두경부 종양학회지 Vol.22 No.2

Objective :This retrospective study was designed to evaluate the anti-tumor efficacy and toxicities of the radia-tion therapy(RT) combined with cisplatin-based chemotherapy in locally advanced nasopharyngeal cancer(NPC). Materials and Methods :Fifty three patients with locally advanced NPCs(AJCC stage II, III, IV) received curative RT and cisplatin-based chemotherapy. Duration of follow-up ranged from 5.5 to 201 months(median 50.8 months). Nineteen patients(35.8%) were treated with induction chemotherapy including cisplatin 100mg/m 2 for 1 day and 5-fluorouracil 1g/m 2 for 5 days followed by RT(Induction CTx-RT). Another 34 patients (64.2%) were treated with concurrent chemoradiation(CCRT) using cisplatin 100 mg/m 2 (D1, 22, 43). Results :Thirty-six(67.9%) and 11(20.8%) patients achieved clinical complete response and partial response, respectively. The pattern of failure was as follows:14 locoregional recurrence(26.4%) and 7 distant metastasis (13.2%). Among them, two patients(3.8%) had both locoregional and distant failure. Median overall survival (OS) and progression-free survival(PFS) were 85.5 months and 87.5 months, respectively. Five-year OS rate was 57.1%. The stage(AJCC), tumor response to chemoradiation and T stage were significant prognostic fac-tors for OS(p=0.0113, p=0.0362 and p=0.0469). The stage(AJCC), tumor response to chemoradiation were also significant prognostic factors for PFS(p=0.0329, p=0.0424). Compared to each treatment group(Induction CTx-RT vs. CCRT), there were no significant differences in OS and PFS(p=0.7000, p=0.8261). Grade 3-4 mucositis, nausea/vomiting and hematological toxicities were noticed in 35.8%, 11.3% and 13.2%, respec-tively. Delayed RT over 2 weeks was inevitable in 26.5%. Seventeen patients(50%) successfully completed planned 3 courses of cisplatin in CCRT group. Conclusions :RT combined with cisplatin-based chemotherapy in locally advanced NPC showed high res-ponse rate, good locoregional control, and survival rate. As expected, frequency of acute toxicities increased, and the patient’s compliance to treatment was need to be improved. Although our data could not show additional survival benefit of CCRT compare to that of induction chemotherapy followed by RT, patients’ accrual and further follow-up are required due to limitation of retrospective study.

가상현실(VR)기반 지하공동구 안전관리시스템의 구성

손석현(Son, Seok Hyun),권성구(Kwon, Sung Gu),정주익(Jung, Joo Ik),원인식(Weon, Ihn Sik),서병석(Seo, Byung Seok) 대한토목학회 2022 대한토목학회 학술대회 Vol.2022 No.10

공공데이터 인프라기반 b-Traffic 서비스 플랫폼 연구

손석현(Seok-Hyun Son),송석현(Seok-Hyun Song),신효섭(Hyo-Seop Shin) 한국컴퓨터정보학회 2014 한국컴퓨터정보학회 학술발표논문집 Vol.22 No.2

핵심성능지표(KPI)기반 인천국제공항 Airside 운영지원 시스템

손석현(Seok Hyun Son),차희준(Hee Jun Cha) 한국항공우주학회 2023 한국항공우주학회 학술발표회 논문집 Vol.2023 No.4

직장암의 수술 전 항암화학방사선치료 후 병리학 및 임상적 효과 분석

송진호(Jin-Ho Song),장홍석(Hong-Seok Jang),김연실(Yeon-Sil Kim),정수미(Su-Mi Chung),손석현(Seok-Hyun Son),강진형(Jin-Hyeong Kang),육의곤(Eui-Gon Youk),이두석(Doo-Seok Lee),이숙희(Suk-Hi Lee),윤세철(Sei-Chul Yoon) 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.1

목 적: 수술 전 항함화학방사선치료는 국소 진행된 직장암에서 표준치료로 알려져 있다. 이 연구는 동시 항암화학 방사선치료를 받은 국소 진행된 직장암 환자의 생존율 및 병기하향률에 영향을 미치는 인자들을 분석하였다. 대상 및 방법: 2004년 3월부터 2008년 8월까지 수술 전 항암화학방사선치료를 받은 국소 진행된 직장암 환자 33명을 대상으로 하였다. 모든 환자는 전 골반 방사선조사를 시행하였으며, 28명(84.8%)은 동시적 소조사야 추가 방사선치료, 5명(15.2%)은 조사영역축소 방사선치료를 실시하였다. 총 방사선량은 50.4 Gy이었으며, 5-fluorouracil를 동시 투여하였다. 추적관찰 기간은 중앙값 24.2개월(9.8∼64.7개월)이었다. 결 과: 33명 중 31명(93.9%)에서 수술이 시행되었으며, 24명(72.7%)은 항문괄약근보존술, 7명(21.2%)은 복회음부 절제술이 시행되었다. 3년 생존율과 무병생존율은 각각 78.8%, 63.4% 이었다. 무병생존율에 영향을 미치는 인자로 수술 후 병리학적 소견이 중요하였다. 병리학적 N 병기(p=0.001), 절제면 침윤 여부(p=0.029) 및 분화도 (p=0.030)가 통계학적으로 의미 있게 영향을 미치는 인자였다. 종양 크기(p=0.081), 림프혈관과 신경주위 침윤여부 (p=0.073) 모두 영향을 미치는 인자로서의 경향성을 보였다. 한편, 수술 전 임상 소견으로는 임상적 T 병기만이 유의한 결과를 보였다(p=0.018). 병리학적 완전관해율은 9.1%였으며, T병기하향률은 30.3%, N 병기하향률은 72.7%로 나타났다. 단변량 분석에서 항암화학방사선치료 후 수술까지의 기간 및 임상적 T 병기가 의미 있는 병기하향의 예측인자로 분석되었다(p=0.029, 0.027). 치료 전 carcinoembryonic antigen 수치는 예측인자의 경향성을 보였다 (p=0.068). 결 론: 국소 진행된 직장암 환자의 생존율은 임상적 병기보다 수술 후 병리학적 소견에 더 의존되었다. 그러므로 수술 전 항암화학방사선치료로 병기하향을 얻는 것이 의미가 있으며, 수술까지의 기간, 임상적 T 병기가 이러한 병기하향을 예측하는 인자였음을 알 수 있었다. Purpose: To evaluate the pathological and clinical effects of preoperative chemoradiation (CCRT) in cases of locally advanced rectal cancer and to determine the predictive factors for tumor downstaging. Materials and Methods: From March 2004 to August 2008, 33 patients with locally advanced rectal cancer were treated with preoperative CCRT. Twenty-eight patients (84.8%) were treated using a concomitant boost technique while five (15.2%) patients were treated using a cone down boost technique. All patients received 50.4 Gy of irradiation and concurrent chemotherapy with 5-fluorouracil. The median follow-up duration was 24.2 months (range, 9.8 to 64.7 months). Results: Thirty-one (93.9%) patients underwent surgery. Twenty-four patients (72.7%) underwent anal sphincter-preserving surgery. The 3-year disease free survival (DFS) and overall survival rates were 63.4% and 78.8%, respectively. Post-operative factors were more important for DFS. Pathologic N stage, margin status, and pathologic differentiation were significant prognostic factors (p=0.001, 0.029, 0.030). Tumor size and lymphovascular invasion were also associated with marginal significance (p=0.081, 0.073). However, only pre-treatment T stage was a significant pre-operative factor (p=0.018). The complete pathological response rate was 9.1%. T-downstaging was observed in ten (30.3%) patients, whereas N-downstaging was found in 24 (72.7%) patients. Pre-treatment T stage and the interval between CCRT and operation were the predictive factors for downstaging in a univariate analysis (p=0.029, 0.027). Pre-treatment carcinoembryogenic antigen was also associated with marginal significance (p=0.068). Conclusion: The survival of rectal cancer patients can be better determined based on post-operative findings. Therefore, pre-operative CCRT for downstaging of the tumor seems to be important. Pre-treatment T stage and the interval between CCRT and operation can be used to predict downstaging.

공공데이터 활용실태 분석을 위한 웹 기반 시각화 연구

김선홍(Sun-Hong Kim),신효섭(Hyo-Seop Shin),손석현(Seok-Hyun Son),구민서(Min-Seo Koo) 한국정보과학회 2015 한국정보과학회 학술발표논문집 Vol.2015 No.6

건설현장 내 위험작업구역 접근 시 위험도 예측 프로세스

하민우 ( Ha Min-woo ),조유진 ( Cho Yu-jin ),손석현 ( Son Seok-hyun ),한승우 ( Han Seung-woo ) 한국건축시공학회 2020 한국건축시공학회 학술발표대회 논문집 Vol.20 No.2

Accidents in the construction industry are very high compared to other industries, and the number is also increasing steeply every year. Relevant studies were limited for solving the problems. The purpose of this study is to develop a comprehensive risk prediction process for personnel deployed at construction sites on safety management. First of all, the variables were divided into fixed, real-time and working types variables, and the relevant comprehensive data were collected. Second, the probability of a disaster was derived based on the collected data, and weights for each variable were calculated using the dummy regression analysis method using statistical methodology. Lastly, the resulting weighting and disaster probability equation was constructed, and The Final Risk Calculation Formula was developed. The Final Risk Calculation Formula presented in this study is expected to have a significant impact on the establishment of effective safety management measures to prevent possible safety accidents at construction sites

Comparison of Virtual Wedge versus Physical Wedge Affecting on Dose Distribution of Treated Breast and Adjacent Normal Tissue for Tangential Breast Irradiation

김연실(Yeon-Sil Kim),․,김성환(Sung-Whan Kim),․,윤세철(Sei-Chul Yoon),․,이정석(Jung-Seok Lee),․,손석현(Seok-Hyun Son),․,최일봉(Ihl-Bong Choi) 대한방사선종양학회 2004 Radiation Oncology Journal Vol.22 No.3

목 적: 유방의 방사선조사 시 결손조직을 보상하고 방사선 균질선량 분포를 얻기 위해 통상적으로 physical wedge를 사용하여 왔다. Physical wedge 사용 시 주변의 폐, 심장, 반대편 유방, 피부에 조사되는 방사선량의 증가에 따른 급성, 만성 부작용의 증가가 문제시 된다. 본 연구에서는 일반적인 Physical wedge와 virtual wedge를 비교하여 동측 유방, 반대편 유방, 폐, 심장, 주변연부조직에 미치는 선량분포의 개선점을 알아보고자 하였다. 재료 및 방법: Solid water phantom을 이용하여 Dmax와 10 cm 깊이에서 physical wedge와 virtual wedge 사용시 조사야 주변선량을 비교하였다. Humanoid Phantom (Anderson Rando Phantom)을 사용하여 Lt. breast의 tangential irradiation 시 physical wedge와 virtual wedge 사용에 따른 동측 유방선량과 피부선량, 반대편 유방 선량과 반대편 유방의 피부선량, 주변 연부조직선량, 동측 폐선량 및 심장에 조사되는 선량을 TLD를 이용하여 비교하였으며 Helax 5.0 RTP system을 이용한 computer planning으로 선량분포 및 관심부의 DVH를 비교하였다. 이때 virtual wedge와 physical wedge의 사용에 따른 총조사 시간을 측정하였다. 또한 7명의 유방암 환자에서 virtual wedge, physical wedge 사용에 따른 동측 유방 피부선량, 반대편 유방 피부선량, 조사야에서 1.5 cm 떨어진 주변 선량을 측정하여 비교하였다. 결 과: Virtual wedge는 15o, 30o, 45o, 60o 모두에서 physical wedge에 비해 주변선량이 감소하였으며 방사선조사 시간을 53∼55% 감소시켜 유용한 결과를 나타냈다. 15o, 30o wedge를 사용한 Humanoid Phantom의 TLD 측정에서도 virtual wedge에서 반대편 유방선량은 1.35%, 2.55% 감소하였고, 반대편 유방 피부선량은 0.87%, 1.9% 감소하였다. 또한 동측 폐선량은 2.7%, 6.0%, 심장선량은 0.96%, 2.5% 감소하였다. 또한 조사야 경계부위의 선량은 1.8%, 2.33% 감소하였으며 동측 유방의 피부선량은 2.4%, 4.58% 증가하였다. Helax 5.0 RTP system을 이용한 DVH analysis에서 동측 유방내 선량균질정도는 physical wedge와 virtual wedge에서 차이 없이 유사하였다. 결 론: 유방암치료에서 virtual wedge는 통상 사용하는 physical wedge에 비하여 주변 연부조직선량, 반대편 유방선량, 동측 폐선량 및 심장선량을 감소시켜 급, 만성 방사선 부작용의 위험을 감소시킬 수 있는 임상적으로 매우 유용한 방법이며 또한 방사선조사시간을 단축시킴으로써 선형가속기의 부하를 줄일 수 있다. Purpose: The ideal breast irradiation method should provide an optimal dose distribution in the treated breast volume and a minimum scatter dose to the nearby normal tissue. Physical wedges have been used to improve the dose distribution in the treated breast, but unfortunately introduce an increased scatter dose outside the treatment field, particularly to the contralateral breast. The typical physical wedge (PW) was compared with the virtual wedge (VW) to determine the difference in the dose distribution affecting on the treated breast and the contralateral breast, lung, heart and surrounding peripheral soft tissue. Method and Materials: The data collected consisted of a measurement taken with solid water, a Humanoid Alderson Rando phantom and patients. The radiation doses at the ipsilateral breast and skin, contralateral breast and skin, surrounding peripheral soft tissue, and ipsilateral lung and heart were compared using the physical wedge and virtual wedge and the radiation dose distribution and DVH of the treated breast were compared. The beam-on time of each treatment technique was also compared. Furthermore, the doses at treated breast skin, contralateral breast skin and skin 1.5 cm away from the field margin were also measured using TLD in 7 patients of tangential breast irradiation and compared the results with phantom measurements. Results: The virtual wedge showed a decreased peripheral dose than those of a typical physical wedge at 15o, 30o, 45o, and 60o. According to the TLD measurements with 15o and 30o virtual wedge, the irradiation dose decreased by 1.35% and 2.55% in the contralateral breast and by 0.87% and 1.9% in the skin of the contralateral breast respectively. Furthermore, the irradiation dose decreased by 2.7% and 6.0% in the ipsilateral lung and by 0.96% and 2.5% in the heart. The VW fields had lower peripheral doses than those of the PW fields by 1.8% and 2.33%. However the skin dose increased by 2.4% and 4.58% in the ipsilateral breast. VW fields, in general, use less monitor units than PW fields and shortened beam-on time about half of PW. The DVH analysis showed that each delivery technique results in comparable dose distribution in treated breast. Conclusions: A modest dose reduction to the surrounding normal tissue and uniform target homogeneity were observed using the VW technique compare to the PW beam in tangential breast irradiation The VW field is dosimetrically superior to the PW beam and can be an efficient method for minimizing acute, late radiation morbidity and reduce the linear accelerator loading by decreasing the radiation delivery time.

Metronidazole에 의한 뇌병증의 자기공명영상소견 1예 보고

은충기,손석현,김성은,김응규 인제대학교 1999 仁濟醫學 Vol.20 No.1

Metronidazole은 아메바병 등과 무산소성 염증을 치료하기 위하여 사용되는 약물이나 드물게 그 부작용으로 신경학적 이상을 초래할 수 있다. 저자들은 metronidazole의 부작용에 의한 뇌병증과 말초신경병증를 야기한 증례를 경험하여 자기공명영상소견및 문헌고찰과 함께 보고한다. 병변은 T2 강조영상 및 액체감쇠역전회복 영상에서 소뇌의 백질에 부종이나 종괴 효과를 동반하지 않는 양측성, 대칭성 병변을 보였고 약제 투여의 중단으로 임상증상과 병변은 호전되었다. Metronidazole is used for treatment of amebiasis, anaerobic infection and many other illness, but it produces a number of neurologic side effects. We report a case of metronidazole induced encephalopathy and peripheral neuropathy with MRI findings. Both T2-weighted and FLAIR images revealed bilateral and symmetrical lesions in the cerebellar white matter without surrounding edema and mass effect. With discontinuity of metronidazole, the lesions on MRI and clinical symptorms were completely improved.