Long-term results of forward intensity-modulated radiation therapy for patients with early-stage breast cancer

하보람,서현숙,이지혜,이경자,이리나,문병인 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.4

Purpose: To observe long-term clinical outcomes for patients with early-stage breast cancer treated with forward intensity-modulated radiation therapy (IMRT), including local control and clinical toxicities. Materials and Methods: We retrospectively analyzed a total of 214 patients with stage I–II breast cancer who were treated with breast conserving surgery followed by adjuvant breast radiation therapy between 2001 and 2008. All patients were treated using forward IMRT. The whole breast was irradiated to a dose of 50 to 50.4 Gy followed by an 8 to 12 Gy electron boost to the surgical bed. Results: The median age was 46 years (range, 21 to 82 years) and the medial follow-up time was 7.3 years (range, 2.4 to 11.7 years). Stage T1 was 139 (65%) and T2 was 75 (35%), respectively. Ipsilateral breast recurrence was observed in 3 patients. The 5- and 10-year local control rates were 99.1% and 97.8%, respectively. The cosmetic outcome was evaluated according to the Harvard scale and 89.4% of patients were scored as excellent or good. Conclusion: The whole breast radiation therapy as an adjuvant treatment using a forward IMRT technique showed excellent long-term local control as well as favorable outcomes of toxicity and cosmesis.

The Effect of Hospital Case Volume on Clinical Outcomes in Patients with Nasopharyngeal Carcinoma: A Multi-institutional Retrospective Analysis (KROG-1106)

하보람,조관호,문성호,이창걸,금기창,김연실,우홍균,김진호,안용찬,오동률,노재명,이종훈,김성환,김원택,오영택,강민규,김진희,김지윤,조문준,계철승,최진화 대한암학회 2019 Cancer Research and Treatment Vol.51 No.1

Purpose The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). Materials and Methods Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume  10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS). Results At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170). Conclusion A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.

從現代性問題探廢名文學的意義與實踐

하보람 ( Pao Lan Ho ) 전북대학교 인문학연구소 2012 건지인문학 Vol.7 No.-

The characteristic that disconnect into silence was borned in Fei-Ming literature. Its works keep tradition, there is innovation too. According to this prerequisite, the text discusses the relation between modernity and Modern Chinese Literature. Further probe into the important meaning of Fei-Ming literature in modern literature, understand the ``modernization`` for having any meaning, and subjectivity and practice in the works in literature by this.

웬트의 관념주의의 저구체성(低具體性)

하보람 ( Boram Ha ),박건영 ( Kun Young Park ) 서강대학교 동아연구소 2016 東亞 硏究 Vol.35 No.1

International Relations (IR) scholar recognize Wendtian constructivism to be a major step forward because of its emphasis on ideational variables in analyzing international relations. However, the authors of this paper argue that Wendt’s characterization of shared values, ideas, and identities is underspecified. We suggest that “the 2014 Virginia decision” is an obvious case in which it loses its explanatory power as Americans in Virginia chose to support the Korean cause despite the fact that Japan rather than Korea is closer to the United States in terms of shared values, ideas, and identities. We believe that the problem derives from Wendt’s “one-size-fits-all” categorization of his conceptual variable. We suggest that, in order to rectify the lack of specificity inherent to constructivism, a distinction between different levels of the ideational variables is necessary. Utilizing this insight, we attempt to identify the contexts under which the “superordinate” values, ideas, or identities split from the “general” ones.

바톤: 공유 전동 킥보드 서비스의 주차 문제 해결을 위한 유저 간 바른 주차 평가 및 딜리버리 서비스 제안

하보람(Boram Ha),김은정(Eunjung Kim),배민관(Mingwan Bae),신도연(Doyeon Shin),정나림(Nalim Jeong),연명흠(Myeong-heum Yeon) 한국디자인학회 2020 한국디자인학회 학술발표대회 논문집 Vol.2020 No.11

Factors predicting radiation pneumonitis in locally advanced non-small cell lung cancer

김명수,이지혜,하보람,이레나,이경자,서현숙 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.3

Purpose: Thoracic radiotherapy is a major treatment modality of stage III non-small cell lung cancer. The normal lung tissue is sensitive to radiation and radiation pneumonitis is the most important dose-limiting complication of thoracic radiation therapy. This study was performed to identify the clinical and dosimetric parameters related to the risk of radiation pneumonitis after defi nitive radiotherapy in stage III non-small cell cancer patients. Materials and Methods: The medical records were reviewed for 49 patients who completed defi nitive radiation therapy for locally advanced non-small cell lung cancer from August 2000 to February 2010. Radiation therapy was delivered with the daily dose of 1.8 Gy to 2.0 Gy and the total radiation dose ranged from 50.0 Gy to 70.2 Gy (median, 61.2 Gy). Elective nodal irradiation was delivered at a dose of 45.0 Gy to 50.0 Gy. Seven patients (14.3%) were treated with radiation therapy alone and forty two patients (85.7%) were treated with chemotherapy either sequentially or concurrently. Results: Twenty-fi ve cases (51.0%) out of 49 cases experienced radiation pneumonitis. According to the radiation pneumonitis grade, 10 (20.4%) were grade 1, 9 (18.4%) were grade 2, 4 (8.2%) were grade 3, and 2 (4.1%) were grade 4. In the univariate analyses, no clinical factors including age, sex, performance status, smoking history, underlying lung disease, tumor location,total radiation dose and chemotherapy were associated with grade ≥2 radiation pneumonitis. In the subgroup analysis of the chemotherapy group, concurrent rather than sequential chemotherapy was signifi cantly related to grade ≥2 radiation pneumonitis comparing sequential chemotherapy. In the univariate analysis with dosimetric factors, mean lung dose (MLD), V20, V30, V40, MLDipsi,V20ipsi, V30ipsi, and V40ipsi were associated with grade ≥2 radiation pneumonitis. In addition, multivariate analysis showed that MLD and V30 were independent predicting factors for grade ≥2 radiation pneumonitis. Conclusion: Concurrent chemotherapy, MLD and V30 were statistically signifi cant predictors of grade ≥2 radiation pneumonitis in patients with stage III non-small cell lung cancer undergoing defi nitive radiotherapy. The cutoff values for MLD and V30 were 16 Gy and 18%, respectively.

Treatment outcomes after adjuvant radiotherapy following surgery for patients with stage I endometrial cancer

김지영,이경자,박경란,하보람,김이준,정원근,이레나,김승철,문혜성,주웅,김윤환,이지혜 대한방사선종양학회 2016 Radiation Oncology Journal Vol.34 No.4

Purpose: The purpose of this study is to evaluate the treatment outcomes of adjuvant radiotherapy using vaginal brachytherapy (VB) with a lower dose per fraction and/or external beam radiotherapy (EBRT) following surgery for patients with stage I endometrial carcinoma. Materials and Methods: The subjects were 43 patients with the International Federation of Gynecology and Obstetrics (FIGO) stage I endometrial cancer who underwent adjuvant radiotherapy following surgery between March 2000 and April 2014. Of these, 25 received postoperative VB alone, while 18 received postoperative EBRT to the whole pelvis; 3 of these were treated with EBRT plus VB. The median EBRT dose was 50.0 Gy (45.0–50.4 Gy) and the VB dose was 24 Gy in 6 fractions. Tumor dose was prescribed at a depth of 5 mm from the cylinder surface and delivered twice per week. Results: The median follow-up period for all patients was 57 months (range, 9 to 188 months). Five-year disease-free survival (DFS) and overall survival (OS) for all patients were 92.5% and 95.3%, respectively. Adjuvant radiotherapy was performed according to risk factors and stage IB, grade 3 and lymphovascular invasion were observed more frequently in the EBRT group. Five-year DFS for EBRT and VB alone were 88.1% and 96.0%, respectively (p = 0.42), and 5-year OS for EBRT and VB alone were 94.4% and 96%, respectively (p = 0.38). There was no locoregional recurrence in any patient. Two patients who received EBRT and 1 patient who received VB alone developed distant metastatic disease. Two patients who received EBRT had severe complications, one each of grade 3 gastrointestinal complication and pelvic bone insufficiency fracture. Conclusion: Adjuvant radiotherapy achieved high DFS and OS with acceptable toxicity in stage I endometrial cancer. VB (with a lower dose per fraction) may be a viable option for selected patients with early-stage endometrial cancer following surgery.

CR 시스템을 이용한 방사선 종양학과의 Filmless 환경 구축

김동영,이지혜,김명수,하보람,이천희,김소영,안소현,이레나,Kim, Dong-Young,Lee, Ji-Hae,Kim, Myung-Soo,Ha, Bo-Ram,Lee, Cheon-Hee,Kim, So-Yeong,Ahn, So-Hyun,Lee, Re-Na 한국의학물리학회 2011 의학물리 Vol.22 No.3

The analog image based system consisted of a simulator and medical linear accelerator (LINAC) for radiotherapy was upgraded to digital medical image based system by exchanging the X-ray film with Computed Radiography (CR). With minimum equipments shift and similar treatment process, it was possible that the new digital image system was adapted by the users in short time. The film cassette and the film developer device were substituted with a CR cassette and a CR Reader, where the ViewBox was replaced with a small size PC and a monitor. The viewer software suitable for radiotherapy was developed to maximize the benefit of digital image, and as the result the convenience and the effectiveness was improved. It has two windows to display two different images in the same time and equipped various search capability, contouring, window leveling, image resizing, translation, rotation and registration functions. In order to avoid any discontinuance of the treatment while the transition to digital image, the film and the CR was used together for 1 week, and then the film developer was removed. Since then the CR System has been operated stably for 2 months, and the various requests from users have been reflected to improve the system. 방사선치료를 위한 아날로그영상기반의 시뮬레이터와 의료용 선형가속기로 이루어진 시스템을 X-ray 필름을 Computed Radiography (CR)로 교체하여 디지털영상기반의 시스템으로 개선하였다. 장비교체를 최소화하였고 기존의 치료과정과 유사하도록 하여 사용자들이 짧은 시간에 적응할 수 있도록 하였다. 필름카세트와 필름현상기는 CR카세트와 CR리더기로 대신하였고, ViewBox는 소형PC와 모니터로 대체되었다. 디지털영상의 장점을 충분히 활용하기 위해 방사선종양학과에 적합한 Viewer 소프트웨어를 개발하여 업무의 편리성과 효율성을 도모하였다. Viewer 소프트웨어는 2개의 이미지를 동시에 볼 수 있으며, 이들 영상의 비교도 가능하다. 다양한 검색기능과 Contouring 기능, 윈도우폭/레벨 조절기능을 갖추었다. 업무의 중단이 없도록 하기 위해 1주일간 기존 필름과 CR을 공동으로 운용하며 문제점을 수정한 후 필름시스템을 제거하고 CR시스템을 운용하였다. CR시스템은 안정적으로 운용되고 있으며, 본격적으로 CR시스템이 이용되면서 사용자로부터 제기되는 여러 요구사항을 반영하여 기능을 개선하였다.

Clinical outcome of proton therapy for patients with chordomas

윤상희,조관호,김주영,하보람,임영경,정종휘,이상현,유헌,곽호신,신상훈,홍은경,김한규,홍제범 대한방사선종양학회 2018 Radiation Oncology Journal Vol.36 No.3

Purpose: To investigate the clinical outcome of proton therapy (PT) in patients with chordoma. Materials and Methods: Fifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and diseasespecific survival (DSS) rates were calculated by the Kaplan–Meier method. Results: With the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4. Conclusion: PT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.

일반논문 : 헌법재판과 사회과학적 연구의 활용; 소수자 인권의 관점에서

권민지 ( Min Ji Kwon ),배정훈 ( Jeong Hun Bae ),장윤호 ( Yoon Ho Chang ),조성제 ( Seong Je Jo ),하보람 ( Bo Ram Ha ) 서울대학교 BK21 법학연구단 공익인권법연구센터 2013 공익과 인권 Vol.13 No.-

헌법재판소의 결정에 사회과학적 논의들을 반영하여 설득력을 높여야 한다는 주장은 2000년대 이후로 지속적으로 제기되어 왔다. 그러나 이와 관련한 기존 연구들은 헌법재판 과정에서 사회과학적 논증과 변론의 유용성을 탐구하거나 헌법재판소의 결정례를 사회과학적 연구의 대상으로 삼는 데 그친다. 헌법재판제도의 개선과 발전을 모색하기 위해서는 사회과학적 논의의 활용이 실제 헌법재판과정에서 소수자의 인권 보장에 어떻게 기여할 수 있을지 탐색할 필요가 있다. 헌법재판은 기본적으로 국가권력으로부터 헌법이 보장하는 각 개인의 고유한 기본권이 침해당하지 않도록 공권력을 통제하는 제도다. 헌법재판소는 사법작용을 하는 ‘비다수파 기관(non-majoritarian institution)’으로서 소수의 의견에 충분히 귀를 기울일 수 있고, 다수가 만들어낸 법률에 대한 위헌심사권을 가지고 있기 때문에 소수자의 인권을 보호하는 데 가장 적합한 헌법기관이다. 그러므로 헌법은 헌법재판의 본질 또는 목적을 소수자와 사회적 약자의 기본적 인권을 보장하는 데 두고 있다고 볼 수 있다. 그런데 현행 헌법재판에서는 이러한 본질을 달성할 수 없게 하는 문제들이 복합적으로 작동하고 있다. 이 글에서는 헌법재판소의 현행 운영상 발견되는 세 가지 차원의 한계들이 헌법재판제도가 소수자 인권을 보호하는 데 장애물로 기능하고 있음을 보이고자 한다. 세 가지 차원의 한계란, 첫째, 논증의 불성실함에서 비롯되는 논리적 한계, 둘째, 헌법재판관들의 인권과 소수자 문제에 대한 이해의 부족에서 나오는 내재적 한계, 마지막으로 권력분립원칙과 민주적 정당성의 부재라는 외재적 한계이다. 이러한 한계들을 극복하기 위해서는 기본적으로 소수자 문제에 관한 사회과학적 논의를 활용하여 논증의 성실함을 높이고, 재판관들의 소수자 인권문제에 대한 주의를 환기시켜야 한다. 더 나아가 결정과정에 실질적인 변화를 불러오기 위해서는 객관규범과 주관규범을 구분하고 구체적 주관과 추상적 주관을 분리하는 새로운 논증과정, 분리논증을 채택할 필요가 있다. 분리논증과 사회과학적 논의가 헌법재판에 폭넓게 반영된다면, 헌법재판소는 본질적 사명인 소수자와 사회적약자의 인권보장에 더욱 가까워질 수 있을 것이다. Arguments that the Consitutional Court`s decision should embrace or reflect social-scientific findings have continuously been raised since the 2000s. However, previous studies have been limited to researching the usefulness of social-scientific arguments and pleading in the course of the constitutional trial, or to merely treating the constitutional court`s decisions as a research subject. In order to seek progress and improvement of constitutional court system, there is a pressing need to study how the utilization of social-scientific studies can contribute to the protection of rights of minorities. The constitutional trial is basically a system to control governmental force, thereby preventing the violation of constitutional rights of each and every individuals. The Constitutional Court is the most suitable constitutional institution for protecting rights of minorities: as a non-majoritarian institution, it is capable of remaining sensitive and responsive to the needs of the minorities, and it is also authorized to rule on the constitutionality of laws legislated by the majority. Therefore, it can be argued that the essence or aim of the Consitutional Court lies in the protection of basic rights of minorities and the socially disadvantaged. However, under the current constitution trial, there are multiple and complex obstacles that threaten the achievement of such fundamental aims of the Court. This paper will discuss that three levels of limitations function as obstacles to the protection of the rights of minorities, under the current operation of the Constitutional Court. First, there is a limitation on the logical level, which arises as a result of insufficient or insincere argumentation. Second, limitation exists on an internal level as judges lack understanding on the issues of human rights and minorities. Lastly, external limitation arises from the absence of democratic legitimacy and division of powers. In order to overcome such limitations, it is necessary to utilize social-scientific arguments in strengthening and improving the judges` argumentation. Moreover, it is also necessary to call the constitutional judges` attention to the issues of minorities and human rights. Furthermore, a new reasoning method, separate-reasoning, which separates objective and subjective norms and divides subjective and abstract processes, needs to be adopted in order to induce substantial changes in the decision-making process, If separation-reasoning and social-scientific discussions become broadly reflected in the constitutional trial, the Constitutional Court will be closer to ensuring the rights of minorities and the underprivileged.