Results of breast-conserving therapy for multifocal or multicentric breast cancers

CHIE, Eui Kyu,KIM, Kyubo,HAN, Wonshik,NOH, Dong-Young,OH, Do-Youn,IM, Seock-Ah,KIM, Tae-You,BANG, Yung-Jue,HA, Sung W Wiley (Blackwell Publishing) 2009 Asia-Pacific journal of clinical oncology Vol.5 No.3

Carbon Fiber as Material for Radiation Fixation Device : A comparative study with acrylic

Eui Kyu Chie,Jang Pil Park,Soon Nyung Huh,Semie Hong,In-Ah Kim,Hong-Gyun Wu,Jae-Sung Kim,Wee-Saing Kang,Il Han Kim,Sung Whan Ha,Charn Il Park 대한방사선방어학회 2005 방사선방어학회지 Vol.30 No.1

Radiation Pneumonitis after Adjuvant Radiotherapy for Breast Cancer: A Volumetric Analysis Using CT Simulator

Chie, Eui Kyu,Shin, Kyung Hwan,Kim, Dae Yong,Kim, Tae-Hyun,Kang, Han-Sung,Lee, Eun Sook,Cho, Kwan Ho Korean Breast Cancer Society (KAMJE) 2009 Journal of breast cancer Vol.12 No.2

Radiation Pneumonitis after Adjuvant Radiotherapy for Breast Cancer: A Volumetric Analysis Using CT Simulator

Eui Kyu Chie,Kyung Hwan Shin,김대용,Tae-Hyun Kim,Han-Sung Kang,Eun Sook Lee,조관호 한국유방암학회 2009 Journal of breast cancer Vol.12 No.2

Purpose: To assess clinical factors and volumetric parameters associated with clinically significant symptomatic radiation pneumonitis (RP), which requires steroid medication after radiotherapy (RT). Methods: Medical records of 204 irradiated breast cancer patients were reviewed. Percent lung volume (PLV) receiving more than 20 Gy was measured from CT-based treatment plan and was correlated with the central lung distance (CLD) of local and regional fields. PLV was also evaluated as a predictive factor of symptomatic RP, along with other previously reported clinical factors. Results: Average (±standard deviation) actual irradiated lung volume and PLV for breast/chest wall irradiation were 169 (±50.6) cm3 and 14.9 (±3.8)%, respectively. Addition of regional irradiation resulted in increase of 183 (±80.2) cm3 in actual irradiated lung volume and 16.5 (±6.2)% in PLV. The correlation between CLD of the local fields and PLV was significant, with 1 cm of CLD corresponding to approximately 6% of PLV. CLD of the regional field was also significantly associated with PLV: a CLD of 3 cm corresponds to a PLV of approximately 13%; a CLD of 4 cm, approximately 17%; and a CLD of 5 cm, approximately 21%. RP developed in 11 patients (5.4%). There was an increased incidence of RP among patients who underwent local RT vs local and regional RT (2.4% vs 12.1%, p=0.0192). In terms of PLV, total PLV ≥23% was associated with the development of RP (p=0.0467). Previously reported clinical factors failed to show statistically significant association. Conclusion: Correlation between CLD and PLV for local and regional fields was significant on volumetric analysis. Although symptomatic RP requiring steroid medication was a rare complication, regional irradiation increased the incidence of RP, and such relationship can be expressed with a volumetric parameter of PLV.

Controversial issues of neoadjuvant treatment in pancreatic cancer

Eui Kyu Chie 대한외과학회 2012 대한외과학회 학술대회 초록집 Vol.2012 No.11

Radiation Exposure of Opera색 in Intracoronary Radiotherapy Using 188Re

Eui Kyu Chie,Myung-Mook Lee,Hong-Gyun Wu 대한방사선방어학회 2000 방사선방어학회지 Vol.25 No.4

간세포암종의 새로운 치료: Local therapy : 선형가속기를 이용한 간세포암의 방사선치료

지의규 ( Eui Kyu Chie ) 대한간학회 2008 Clinical and Molecular Hepatology(대한간학회지) Vol.14 No.2(S)

유방암에서 유방보존수술 및 수술 후 방사선치료의 결과

지의규(Eui Kyu Chie),김규보(Kyubo Kim),최진화(Jin-Hwa Choi),장나영(Na-Young Jang),한원식(Wonshik Han),노동영(Dong-Young Noh),임석아(Seock-Ah Im),김태유(Tae-You Kim),방영주(Yung-Jue Bang),하성환(Sung Whan Ha) 대한방사선종양학회 2008 Radiation Oncology Journal Vol.26 No.3

목 적: 조기유방암의 치료에 있어 과거에는 유방 전적출술이 주된 치료였으나 현재는 유방보존술이 표준 치료방법 으로 정립되었다. 저자들은 서울대학교병원에서 유방보존수술 및 방사선치료를 받은 환자의 임상적 특성을 조사 하고 치료결과 및 예후인자를 분석하고자 하였다. 대상 및 방법: 1992년 2월부터 2002년 1월까지 침윤성 유방암으로 유방보존수술 및 수술 후 방사선치료를 받은 424명을 대상으로 후향적으로 분석하였다. 대부분의 환자는 사분절제술 및 액와림프절 청소술을 시행 받았다(396명, 93.4%). 302명이 T1이었고 122명은 T2 병기였으며, 림프절 전이는 107명에서 확인되었다. 방사선치료는 전체 유방에 28회에 걸쳐 50.4 Gy를 조사한 후 종양이 있었던 부위에 10 Gy의 추가조사를 실시하였다. 영역림프절 조사는 57명에서 시행되었다. 항암화학요법은 231명에서 시행되었으며, 그 중 170명이 cyclophosphamide, methotrexate 및 5-fluorouracil을 투여 받았다. 중앙추적기간은 64개월이었다. 결 과: 전체 환자의 5년 국소제어율은 95.6%이었다. 추적관찰 중 15명의 환자에서 국소재발이 확인되었다. 5년 생존율은 93.1%이었고, 병기에 따른 5년 생존율은 I기 94.8%, IIA기 95.0%, IIB기 91.1%, IIIA기 75.9%, IIIC기 57.1% 이었다. 5년 무병생존율은 88.7%이었고, 병기별로는 I기 93.1%, IIA기 89.4%, IIB기 82.8%, IIIA기 62.0%, IIIC기 28.6%이었다. 예후인자 분석에서는 N 병기(p=0.0483)가 생존율에, 연령(p=0.0284)과 N 병기(p=0.0001)가 무병생존율에 각각 유의한 영향을 보였다. 결 론: 조기유방암에서 유방보존수술 및 수술 후 방사선치료는 우수한 국소제어율 및 생존율을 기대할 수 있는 치료법임을 확인할 수 있었다. Purpose: We analyzed the treatment outcomes and prognostic factors of breast conserving surgery, followed by postoperative radiotherapy. Materials and Methods: A total of 424 breast cancer patients treated with breast conserving surgery and postoperative radiotherapy between February 1992 and January 2001 were retrospectively analyzed. A quadrantectomy and axillary lymph node dissection was performed in 396 patients. A total of 302 patients had T1 disease, and 122 patients had T2 disease. Lymph node involvement was confirmed in 107 patients. Whole breast irradiation was administered at up to 50.4 Gy in 28 fractions, followed by a 10 Gy boost in 5 fractions to the tumor bed. In addition, 57 patients underwent regional lymph node irradiation. Moreover, chemotherapy was administered in 231 patients. A regimen consisting of cyclophosphamide, methotrexate, and 5-fluorouracil was most frequently used with 170 patients. The median follow-up time was 64 months. Results: The 5-year local control rate was 95.6%. During the follow-up period, local tumor recurrence was observed in 15 patients. The 5-year overall and disease-free survival rates were 93.1% and 88.7%, respectively. The 5-year overall survival rates, by stage, were 94.8% for stage I, 95.0% for stage IIA, 91.1% for stage IIB, 75.9% for stage IIIA, and 57.1% for stage IIIC. As for disease-free survival, the corresponding figures, by stage (in the same order), were 93.1%, 89.4%, 82.8%, 62.0%, and 28.6%, respectively. The advanced N stage (p=0.0483) was found to be a significant prognostic factor in predicting poor overall survival, while the N stage (p=0.0284) and age at diagnosis (p=0.0001) were associated with disease-free survival. Conclusion: This study has shown that breast conserving surgery and postoperative radiotherapy for early breast cancer results was excellent for local control and survival.

항문암의 치료성적

지의규(Eui Kyu Chie),하성환(Sung Whan Ha),박재갑(Jae-Gahb Park),방영주(Yung-Jue Bang),허대석(Dae Seog Heo),김노경(Noe Kyeong Kim) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.1

목적: 항문암의 치료에 있어 고전적으로는 복회음부절제술이 주된 치료였으나 현재는 화학방사선병용요법이 주된 치료방법으로 정립되었다. 저자들은 서울대학교병원에서 항문암으로 치료 받은 환자의 임상적 특성을 조사하고, 치료방법에 따른 치료성적과 예후인자를 분석하고자 하였다. 대상 및 방법: 1979년 8월부터 1998년 7월까지 서울대학교병원 치료방사선과에서 근치적 또는 수술 후 방사선 치료를 받은 42명의 환자를 대상으로 후향적으로 분석하였다. 표피양암종이 38명으로 방사선치료가 4명에서, 복회음부절제술 및 수술 후 방사선치료±화학요법이 19명에서, 화학방사선요법이 15명에서 시행되었다. 화학방사선요법은 복합화학요법(5-FU 1,000 ㎎/㎡ D1~5, cisplatin 60 ㎎/㎡ D1)을 3회 시행 후 원발병소 및 영역림프절에 50.4 Gy를 조사하였고, 양측 서혜림프절에도 동일양을 조사하였다. 잔존암이 있는 경우 복합화학요법을 3회 추가 실시하였다. 중앙추적기간은 85개월이었다. 결과: 전체 항문암 환자의 5년 생존율은 80.3%이었다. 치료방법에 따른 5년 생존율은 복회음부절제술 및 수술 후 방사선치료±화학요법군, 화학방사선요법군에서 각각 88.9%, 79.4%이었으며 두군간의 생존율의 차이의 통계적인 의미는 없었다(p=0.4923). 화학방사선요법을 시행 받은 환자군에서의 항문보존율은 86.7%였다. 예후인자 중 단변량분석에서는 연령(p=0.0164)과 수행능력(p=0.0007)이 유의성을 보였으며, 다변량분석에서는 연령(p=0.0426)과 수행능령 (p=0.0068) 및 서혜림프절 전이여부(p=0.0093)가 통계학적으로 유의하였다. 결론: 항문암의 치료에 있어서 화학방사선요법을 시행할 경우 기존에 알려진 바와 같이 복회음부절제술과 유사한 생존율을 보이며, 항문기능을 보존할 수 있는 치료 방법임을 확인할 수 있었다. 나아가 병행화학요법이 아닌 선행화학요법을 시행하여 수반되는 합병증을 줄일 수 있는 가능성을 확인하였다. Purpose: This study was undertaken to analyze the efficacy and sphincter preservation rate of platinum based neoadjuvant chemotherapy plus radiotherapy versus abdominoperineal resection and postoperative radiotherapy for anal cancer. Materials and Methods: Data of forty-two patients with anal cancer were retrospectively analyzed. A,mong thirty-eight patients with epidermoid histology, four patients received radiotherapy, and nineteen patients received abdominoperineal resection and adjuvant radiotherapy with or without chemotherapy (APR+RT±CT), and fifteen patients received neoagjuvant chemotherapy and radiotherapy (CRT). The CRT regimen was composed of three cycles of 5-fluorouracil (1,000 ㎎/㎡ bolus on D1~5) and cisplaltin (60 ㎎/㎡ bolus on D1) followed by 50.4 Gy to the tumor bed and regional lymphatics over 5.5 weeks. Both inguinal lymphatics were treated with an identical dose schedule. Residual disease was treated with an additional three cycles of identical adjuvant chemotherapy/ An identical dose schedule was used for post-operative radiotherapy. Median follow-up period was eighty-five months Results: Overall five-year survival rates were 80.3%, 88.9 and 79.4% for entire patients, APR+RT±CT group, and the CRT group, respectively. No significant difference was found between the two groups (p=0.49). Anus preservation rate for the CRT group was 86.7%. Age (p=0.0164) and performance status (p=0.0007) were found to be significant prognostic factors by univariate analysis. Age (p=0.0426), performance status (p=0.0068), and inguinal lymph node metastasis (p=0.0093) were statistically significant prognostic factors by multivariate analysis. No case of RTOG grade 3 complication or higher was reported. Conclusion: This and other recent studies have shown that combined chemotherapy plus radiotherapy for anal cancer results in a high rate of anal sphincter preservation as well as local control and survival. Furthermore, neoadjuvant use of chemotherapy with a cisplatin based regimen rather than a concurrent regimen may lead to a decrease in complications.

인체 및 인형 팬톰에서 전신방사선조사시 열형광선량계(TLD)를 이용한 선량분포 균일성 확인

지의규(Eui Kyu Chie),박석원(Suk Won Park),강위생(Wee-Saing Kang),김일한(Il Han Kim) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.4

목 적 : 면역억제, 악성림프종 및 백혈병의 치료, 골수이식 등에 적용되는 전신방사선치료에 시행되는 좌우 이문대향조사법의 표면 방사선량 및 중심 방사선량의 균일성을 열형광선량계를 이용하여 확인하고자 하였다. 대상 및 방법 : 1996년 9월부터 1998년 8월까지 좌우 이문대향조사법으로 전신방사선치료를 시행한 10명의 환자 중 매번 방사선량이 측정된 8명의 환자를 대상으로 하였다. 열형광선량계를 사용하여 두부, 경부, 액와부, 대퇴부, 족관절부 등의 표면 선량을 측정하였고 인형 팬톰에서 동일한 조건하에서 두부, 경부, 액와부, 복부, 둔부 등의 표면 선량과 중심 선량을 측정하였다. 결 과 : 중심부인 복부 처방 선량을 기준으로 할 때 부위별로 환자의 두부, 경부, 액와부, 대퇴부, 족관절부에서 표면 방사선량은 각각 91.3±7.8, 98.3±7.5, 95.1±6.3, 98.3±5.5, 95.3±6.3%였다. 인형 팬톰에서 처방 선량에 대하여 두부, 경부, 액와부, 복부 및 둔부에서의 표면 방사선량은 각각 85.0±4.0, 86.6±5.8, 83.9±4.9, 94.8±5.3, 94.8±2.8%였고, 중심 방사선량은 각각 96.6±2.2, 95.3±3.2, 80.4±1.9, 100.0±3.1, 90.5±2.2%였다. 표면 선량 대비 중심 선량의 비는 두부, 경부, 액와부, 복부 및 둔부에서 각각 1.14±0.06, 1.10±0.09, 0.96±0.05, 1.06±0.06, 0.95±0.02였다. 인형 팬톰에서 얻은 표면 선량 대비 중심 선량의 비를 이용하여 환자에서의 중심 선량을 계산하였을 때, 두부, 경부, 액와부, 대퇴부, 족관절부에서 각각 103.4±9.0, 107.8±10.5, 91.1±6.1, 93.8±4.5, 104.5±9.3%였다. 결 론 : 환자에서의 측정된 표면 선량과 계산한 중심 선량의 분포는 -8.9 ∼ +7.8%였으나, 선량 분포가 +5% 이상 증가 또는 감소된 부위인 경부와 액와부에서는 인형 팬톰과 환자와의 좌우 두께의 차이에 의해서 실제보다 크게 계산되었으므 로 실제 환자에서의 전신 선량 분포는 이보다 더 우수할 것으로 생각된다. Purpose : Total body irradiation (TBI) or whole bo dy irradiation is used to acquire immune suppression, to treat malignant lymphoma and leukemia, and as an conditioning regimen for bone marrow transplantation. For these purposes, many methods were developed to obtain homogenous dose distribution. The obje ctive of this study was to analyze and confirm the accuracy and the homogeneity of the treatment setup, the parallel opposed lateral technique, currently used in Seoul National University Hospital. Materials and Methods : Surface dose data, measured with a thermoluminescent dosimeter, of 8 patients among 10 patients, who were given total body irradiation with the parallel opposed lateral technique between September 1996 to August 1998, at Seoul National University Hospital were analyzed. Surface doses were measured at the head, neck, axilla, thigh, and ankle level. Surface and midline doses were measured with similar set -up and technique in the Humanoid phantom. Results : Measured surface doses relative to prescribed dose for the head, neck, axilla, thigh, and ankle level were 91.3±7.8, 98.3±7.5, 95.1±6.3, 98.3±5.5, and 95.3±6.3%, respectively. The midline doses of the head, neck, axilla, thigh, and ankle level estimated from the surface-t o-midline ratios in the Humanoid phantom were 103.4±9.0, 107.8±10.5, 91.1±6.1, 93.8±4.5, and 104.5±9.3%, respectively. Measured surface doses and estimated midline doses ranged from -8.9% to +7.8%. Midline doses at the neck and the axilla level deviated more than 5% from the prescribed doses. The difference of the estimated midline doses at the neck and the axilla level and the actual doses were attributed to the thickness differences between the Humanoid phantom and the patients. Conclusion : Distribution of the midline doses as well as the surface doses were measured to be within -8.7∼+ 7.8% range. Actual dose distribution in the patient is expected to be better than the measured dose range mainly attributed to thickness difference between the patient and the Humanoid phantom.