Re-irradiation of unresectable recurrent head and neck cancer: using Helical Tomotherapy as image-guided intensity-modulated radiotherapy

정송미,계철승,유은정,김지윤,한치화,김기준 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.4

Purpose: Re-irradiation (re-RT) is considered a treatment option for inoperable locoregionally recurrent head and neck cancer (HNC) after prior radiotherapy. We evaluated the efficacy and safety of re-RT using Helical Tomotherapy as image-guided intensity-modulated radiotherapy in recurrent HNC. Materials and Methods: Patients diagnosed with recurrent HNC and received re-RT were retrospectively reviewed. Primary endpoint was overall survival (OS) and secondary endpoints were locoregional control and toxicities. Results: The median follow-up period of total 9 patients was 18.7 months (range, 4.1 to 76 months) and that of 3 alive patients was 49 months (range, 47 to 76 months). Median dose of first radiotherapy and re-RT was 64.8 and 47.5 Gy10. Median cumulative dose of the two courses of radiotherapy was 116.3 Gy10 (range, 91.8 to 128.9 Gy10) while the median interval between the two courses of radiation was 25 months (range, 4 to 137 months). The response rate after re-RT of the evaluated 8 patients was 75% (complete response, 4; partial response, 2). Median locoregional relapse-free survival after re-RT was 11.9 months (range, 3.4 to 75.1 months) and 5 patients eventually presented with treatment failure (in-field failure, 2; in- and out-field failure, 2; out-field failure, 1). Median OS of the 8 patients was 20.3 months (range, 4.1 to 75.1 months). One- and two-year OS rates were 62.5% and 50%, respectively. Grade 3 leucopenia developed in one patient as acute toxicity, and grade 2 osteonecrosis and trismus as chronic toxicity in another patient. Conclusion: Re-RT using Helical Tomotherapy for previously irradiated patients with unresectable locoregionally recurrent HNC may be a feasible treatment option with long-term survival and acceptable toxicities.

전자발찌사업의 확대와 비용효과성 분석

정송미,김대진 한국정책분석평가학회 2015 政策分析評價學會報 Vol.25 No.1

본 연구는 전자발찌사업이 우리나라 교정정책의 주요수단으로 자리잡아가는 시점에서 해당 사업의 지속적인 확대가 정책의 효과성에 어떠한 변화를 가져왔는지를 분석, 평가하였다. 전자발찌사업은 비용 및 부작용에 대한 문제가 지속적으로 제기되는 과정 속에서도 지속적으로 확장, 강화되어 왔는데, 비용효과분석은 전자발찌사업의 성과의 흐름 속에 상당한 수준의 규모의 경제효과가 존재하고 있으며, 성범죄 외의 다른 강력범죄들이 전자발찌부착 대상이 됨에 따라 규모의 경제효과가 더 커지고 있음을 보여주었다. 이러한 분석결과는 전자발찌사업의 적용대상을 넓혀감에 따라 사업 효과성은 지속적으로 나아질 것이라는 예측을 뒷받침할 뿐만 아니라, 비용과 부작용에 대한 우려에도 불구하고 전자발찌사업에 대한 정책참여자들의 관심이 유지되는 한 사업의 축소나 종결보다는 사업의 보완과 확대가 이루어질 가능성이 높음을 시사한다.

Postoperative Radiotherapy Alone Versus Chemoradiotherapy in Stage I-II Endometrial Carcinoma: An Investigational and Propensity Score Matching Analysis

이종훈,이효전,김성환,정미주,정송미,이성종,윤주희,박동춘 대한암학회 2015 Cancer Research and Treatment Vol.47 No.2

Purpose The purpose of this study was to compare the results of postoperative adjuvant radiotherapy(RT) and concurrent chemoradiotherapy (CRT) in stage I-II endometrial carcinoma. Materials and MethodsWe analyzed a total of 64 patients with surgically staged I-II endometrial carcinoma whowere treated with postoperative adjuvant RT or concurrent CRT between March 1999 andJuly 2013. Thirty-two patients who received postoperative RT alone were matched withthose who received postoperative CRT (n=32) in accordance to age, stage, and tumorhistology. Overall survival and relapse-free survival, as well as toxicity of the RT and CRTarms were evaluated and compared. ResultsThe 5-year overall survival rate was 90.0% for the RT arm and 91.6% for the CRT arm. Therewas no significant difference in overall survival between the two treatment arms (p=0.798). The 5-year relapse-free survival rate was 87.2% in the RT arm and 88.0% in the CRT arm. Again, no significant difference in relapse-free survival was seen between the two arms(p=0.913). In a multivariate analysis, tumor histology was an independent prognostic factorfor relapse-free survival (hazard ratio, 3.67; 95% of CI, 2.34 to 7.65; p=0.045). Acute grade3 or 4 hematologic toxicities in the CRT arm were significantly higher than in the RT alonearm (6.2% vs. 31.2%, p=0.010). ConclusionAdjuvant pelvic concurrent chemoradioherapy did not show superior results in overallsurvival and relapse-free survival compared to RT alone in stage I-II endometrial carcinoma.

Significance of elevated SCC-Ag level on tumor recurrence and patient survival in patients with squamous-cell carcinoma of uterine cervix following definitive chemoradiotherapy: a multi-institutional analysis

최규혜,이시원,유미나,정송미,이정원,이종훈 대한부인종양학회 2019 Journal of Gynecologic Oncology Vol.30 No.1

Objective: There is no definitive guideline for the significance and cut-off value of squamouscell carcinoma antigen (SCC-Ag) in cervical cancer. Thus, we analyzed the significance and optimal cut-off value of SCC-Ag for predicting tumor recurrence and patient survival in squamous-cell carcinoma of uterine cervix. Methods: From January 2010 to October 2016, we enrolled 304 cervical cancer patients with squamous-cell carcinoma staging International Federation of Gynecology and Obstetrics (FIGO) Ib–IVa and treated with definitive chemoradiotherapy (CRT) followed by intracavitary radiotherapy (ICR). The cut-off value of SCC-Ag level for tumor recurrence was calculated using the receiver operating characteristic (ROC) curve. The recurrence-free survival (RFS) and overall survival (OS) were assessed using Kaplan-Meier method to estimate the significance of SCC-Ag level. Results: The optimal cut-off value of SCC-Ag level for predicting tumor recurrence was calculated and set at 4.0 ng/mL in the ROC curve. After a median follow-up period of 36.5 months, the 3-year RFS (56.6% vs. 80.2%, p<0.001) and OS (72.1% vs. 86.8%, p=0.005) were significantly lower in SCC-Ag ≥4 ng/mL arm than in <4 ng/mL arm. The 3-year locoregional recurrence (17.6% vs. 7.0%, p=0.012), distant metastasis (20.4% vs. 6.9%, p=0.002), and para-aortic recurrence (9.4% vs. 2.1%, p=0.012) rates were significantly higher in SCC-Ag ≥4 ng/mL arm than in SCC-Ag <4 ng/mL arm. Conclusion: Pre-treatment SCC-Ag level higher than 4 ng/mL may be a useful predictor of tumor recurrence in patients with squamous-cell carcinoma of uterine cervix treated with definitive CRT and ICR.

Comparison between preoperative and postoperative concurrent chemoradiotherapy for rectal cancer: an institutional analysis

이정원,이종훈,김준기,오승택,정혁준,이명아,전후근,정송미,윤세철,장홍석 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.3

Purpose: To evaluate the treatment outcomes of preoperative versus postoperative concurrent chemoradiotherapy (CRT) on locally advanced rectal cancer. Materials and Methods: Medical data of 114 patients with locally advanced rectal cancer treated with CRT preoperatively (54 patients) or postoperatively (60 patients) from June 2003 to April 2011 was analyzed retrospectively. 5-Fluorouracil (5-FU) or a precursor of 5-FU-based concurrent CRT (median, 50.4 Gy) and total mesorectal excision were conducted for all patients. The median follow-up duration was 43 months (range, 16 to 118 months). The primary end point was disease-free survival (DFS). The secondary end points were overall survival (OS), locoregional control, toxicity, and sphincter preservation rate. Results: The 5-year DFS rate was 72.1% and 48.6% for the preoperative and postoperative CRT group, respectively (p = 0.05, the univariate analysis; p = 0.10, the multivariate analysis). The 5-year OS rate was not significantly different between the groups (76.2% vs. 69.0%, p = 0.23). The 5-year locoregional control rate was 85.2% and 84.7% for the preoperative and postoperative CRT groups (p = 0.98). The sphincter preservation rate of low-lying tumor showed significant difference between both groups (58.1% vs. 25.0%, p = 0.02). Pathologic tumor and nodal down-classification occurred after the preoperative CRT (53.7% and 77.8%, both p < 0.001). Acute and chronic toxicities were not significantly different between both groups (p=0.10 and p = 0.62, respectively). Conclusion: The results confirm that preoperative CRT can be advantageous for improving down-classification rate and the sphincter preservation rate of low-lying tumor in rectal cancer.

Outcome of postoperative radiotherapy following radical prostatectomy: a single institutional experience

이시원,이종훈,황태곤,홍성후,이지열,정미주,정송미,김성환,윤세철,장홍석 대한방사선종양학회 2014 Radiation Oncology Journal Vol.32 No.3

This single institutional study is aimed to observe the outcome of patients who received postoperative radiotherapy after radical prostatectomy. Materials and Methods: A total of 59 men with histologically identified prostate adenocarcinoma who had received postoperative radiation after radical prostatectomy from August 2005 to July 2011 in Seoul St. Mary’s Hospital of the Catholic University of Korea, was included. They received 45–50 Gy to the pelvis and boost on the prostate bed was given up to total dose of 63–72 Gy (median, 64.8 Gy) in conventional fractionation. The proportion of patients given hormonal therapy and the pattern in which it was given were analyzed. Primary endpoint was biochemical relapse-free survival (bRFS) after radiotherapy completion. Secondary endpoint was overall survival (OS). Biochemical relapse was defined as a prostate-specific antigen level above 0.2 ng/mL. Results: After median follow-up of 53 months (range, 0 to 104 months), the 5-year bRFS of all patients was estimated 80.4%. The 5-year OS was estimated 96.6%. Patients who were given androgen deprivation therapy had a 5-year bRFS of 95.1% while the ones who were not given any had that of 40.0% (p < 0.01). However, the statistical significance in survival difference did not persist in multivariate analysis. The 3-year actuarial grade 3 chronic toxicity was 1.7% and no grade 3 acute toxicity was observed. Conclusion: The biochemical and toxicity outcome of post-radical prostatectomy radiotherapy in our institution is favorable and comparable to those of other studies.

Value of imaging study in predicting pelvic lymph node metastases of uterine cervical cancer

정원근,박경란,이경자,김규보,이지혜,정송미,김이준,김지영,윤혜전,강병철,구혜수,성순희,조민선,박상희 대한방사선종양학회 2017 Radiation Oncology Journal Vol.35 No.4

Purpose: To evaluate the diagnostic accuracy of computed tomography (CT), magnetic resonance imaging (MRI), and positron emission tomography/computed tomography (PET/CT) in predicting pelvic lymph node (LN) metastases in patients with cervical cancer. Materials and Methods: From January 2009 to March 2015, 114 patients with FIGO stage IA1-IIB uterine cervical cancer who underwent hysterectomy with pelvic lymphadenectomy and took CT, MRI, and PET/CT before surgery were enrolled in this study. The criteria for LN metastases were a LN diameter ≥1.0 cm and/or the presence of central necrosis on CT, a LN diameter ≥1.0 cm on MRI, and a focally increased FDG uptake on PET/CT. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy for pelvic LN metastases were estimated. Results: The sensitivity, specificity, PPV, NPV, and accuracy for detection of pelvic LN metastases were 51.4%, 85.9%, 41.3%, 90.1%, and 80.3% for CT; 24.3%, 96.3%, 56.3%, 86.8%, and 84.6% for MRI; and 48.6%, 89.5%, 47.4%, 90.0%, and 82.9% for PET/ CT, respectively. The sensitivity of PET/CT and CT was higher than that of MRI (p=0.004 and p= 0.013, respectively). The specificity of MRI was higher than those of PET/CT and CT (p=0.002 and p=0.001, respectively). The difference of specificity between PET/CT and CT was not statistically significant (p=0.167). Conclusion: These results indicate that preoperative CT, MRI, and PET/CT showed low to moderate sensitivity and PPV, and moderate to high specificity, NPV, and accuracy. More efforts are necessary to improve sensitivity of imaging modalities in order to predict pelvic LN metastases.

Setup Error and Effectiveness of Weekly Image-Guided Radiation Therapy of TomoDirect for Early Breast Cancer

정미주,이국진,서영진,이효천,이시원,정송미,이정원,김성환,강대규,이종훈 대한암학회 2015 Cancer Research and Treatment Vol.47 No.4

Purpose This study investigated setup error and effectiveness of weekly image-guided radiotherapy(IGRT) of TomoDirect for early breast cancer. Materials and MethodsOne hundred and fifty-one breasts of 147 consecutive patients who underwent breastconserving surgery followed by whole breast irradiation using TomoDirect in 2012 and 2013were evaluated. All patients received weekly IGRT. The weekly setup errors from simulationto each treatment in reference to chest wall and surgical clips were measured. Random,systemic, and 3-dimensional setup errors were assessed. Extensive setup error wasdefined as 5 mm above the margin in any directions. ResultsAll mean errors were within 3 mm of all directions. The mean angle of gantry shifts was0.6°. The mean value of absolute 3-dimensional setup error was 4.67 mm. In multivariateanalysis, breast size (odds ratio, 2.82; 95% confidence interval, 1.00 to 7.90) was a significantfactor for extensive error. The largest significant deviation of setup error was observedin the first week of radiotherapy (p < 0.001) and the deviations gradually decreased withtime. The deviation of setup error was 5.68 mm in the first week and within 5 mm after thesecond week. ConclusionIn this study, there was a significant association between breast size and significant setuperror in breast cancer patients who received TomoDirect. The largest deviation occurred inthe first week of treatment. Therefore, patients with large breasts should be closely observedon every fraction and fastidious attention is required in the first fraction of IGRT.

Optimal Definition of Biochemical Recurrence in Patients Who Receive Salvage Radiotherapy Following Radical Prostatectomy for Prostate Cancer

이성욱,김재성,김영석,조재호,최서희,남택근,정송미,김영경,최영민,이동은,박원,조관호 대한암학회 2022 Cancer Research and Treatment Vol.54 No.4

Purpose This study proposed the optimal definition of biochemical recurrence (BCR) after salvage radiotherapy (SRT) following radical prostatectomy for prostate cancer. Materials and Methods Among 1,117 patients who had received SRT, data from 205 hormone-naïve patients who experienced post-SRT prostate-specific antigen (PSA) elevation were included in a multi-institutional database. The primary endpoint was to determine the PSA parameters predictive of distant metastasis (DM). Absolute serum PSA levels and the prostate-specific antigen doubling time (PSA-DT) were adopted as PSA parameters. Results When BCR was defined based on serum PSA levels ranging from 0.4 ng/mL to nadir+2.0 ng/mL, the 5-year probability of DM was 27.6%-33.7%. The difference in the 5-year probability of DM became significant when BCR was defined as a serum PSA level of 0.8 ng/ml or higher (1.0-2.0 ng/mL). Application of a serum PSA level of ≥ 0.8 ng/mL yielded a c-index value of 0.589. When BCR was defined based on the PSA-DT, the 5-year probability was 22.7%-39.4%. The difference was significant when BCR was defined as a PSA-DT ≤ 3 months and ≤ 6 months. Application of a PSA-DT ≤ 6 months yielded the highest c-index (0.660). These two parameters complemented each other; for patients meeting both PSA parameters, the probability of DM was 39.5%-44.5%; for those not meeting either parameter, the probability was 0.0%-3.1%. Conclusion A serum PSA level > 0.8 ng/mL was a reasonable threshold for the definition of BCR after SRT. In addition, a PSA-DT ≤ 6 months was significantly predictive of subsequent DM, and combined application of both parameters enhanced predictability. Purpose This study proposed the optimal definition of biochemical recurrence (BCR) after salvage radiotherapy (SRT) following radical prostatectomy for prostate cancer.Materials and Methods Among 1,117 patients who had received SRT, data from 205 hormone-naïve patients who experienced post-SRT prostate-specific antigen (PSA) elevation were included in a multi-institutional database. The primary endpoint was to determine the PSA parameters predictive of distant metastasis (DM). Absolute serum PSA levels and the prostate-specific antigen doubling time (PSA-DT) were adopted as PSA parameters.Results When BCR was defined based on serum PSA levels ranging from 0.4 ng/mL to nadir+2.0 ng/mL, the 5-year probability of DM was 27.6%-33.7%. The difference in the 5-year probability of DM became significant when BCR was defined as a serum PSA level of 0.8 ng/ml or higher (1.0-2.0 ng/mL). Application of a serum PSA level of ≥ 0.8 ng/mL yielded a c-index value of 0.589. When BCR was defined based on the PSA-DT, the 5-year probability was 22.7%-39.4%. The difference was significant when BCR was defined as a PSA-DT ≤ 3 months and ≤ 6 months. Application of a PSA-DT ≤ 6 months yielded the highest c-index (0.660). These two parameters complemented each other; for patients meeting both PSA parameters, the probability of DM was 39.5%-44.5%; for those not meeting either parameter, the probability was 0.0%-3.1%.Conclusion A serum PSA level > 0.8 ng/mL was a reasonable threshold for the definition of BCR after SRT. In addition, a PSA-DT ≤ 6 months was significantly predictive of subsequent DM, and combined application of both parameters enhanced predictability.

Clinical Outcomes of Postoperative Radiotherapy Following Radical Prostatectomy in Patients with Localized Prostate Cancer: A Multicenter Retrospective Study (KROG 18-01) of a Korean Population

이성욱,조관호,박원,조원경,김재성,위찬우,김영석,김진호,남택근,조재호,정송미,김영경,심수정,최영민,김준상 대한암학회 2020 Cancer Research and Treatment Vol.52 No.1

Purpose The purpose of this study was to investigate the clinical outcomes of postoperative radiotherapy (PORT) patients who underwent radical prostatectomy for localized prostate cancer. Materials and Methods Localized prostate cancer patients who received PORT after radical prostatectomy between 2001 and 2012 were identified retrospectively in a multi-institutional database. In total, 1,117 patients in 19 institutions were included. Biochemical failure after PORT was defined as prostate-specific antigen (PSA) ! nadir+2 after PORT or initiation of androgen deprivation therapy (ADT) for increasing PSA regardless of its value. Results Ten-year biochemical failure-free survival, clinical failure-free survival, distant metastasisfree survival, overall survival (OS), and cause-specific survival were 60.5%, 76.2%, 84.4%, 91.1%, and 96.6%, respectively, at a median of 84 months after PORT. Pre-PORT PSA " 0.5 ng/ml and Gleason’s score " 7 predicted favorable clinical outcomes, with 10-year OS rates of 92.5% and 94.1%, respectively. The 10-year OS rate was 82.7% for patients with a PSA > 1.0 ng/mL and 86.0% for patients with a Gleason score of 8-10. The addition of longterm ADT (! 12 months) to PORT improved OS, particularly in those with a Gleason score of 8-10 or ! T3b. Conclusion Clinical outcomes of PORT in a Korean prostate cancer population were very similar to those in Western countries. Lower Gleason score and serum PSA level at the time of PORT were significantly associated with favorable outcomes. Addition of long-term ADT (! 12 months) to PORT should be considered, particularly in unfavorable risk patients with Gleason scores of 8-10 or ! T3b.