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김귀언 한국의료QA학회 1995 한국의료질향상학회지 Vol.2 No.1
The Comprehensive quality assurance for radiation oncology provides an overall organizational structures, responsibilities, procedures, processes and resources for assuring the quality of patient management by radiation treatment. Superior performance of modern radiotherapy equipment will be essential part of quality assurance in radiation oncology, which high degree of accuracy and consistency should be maintained under the optimal quality assurance program. Besides quality control of all radiation equipment, this review also emphasizes quality assurance of clinical aspect such as adequacy of the medical decision-making which eventually leads to the treatment prescription, accuracy of treatment procedure from treatment preparation to radiation delivery, and the significance of assessment of treatment outcomes with structure and process.
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Kim, Hyun Ju,Rhee, Woo Joong,Choi, Seo Hee,Nam, Eun Ji,Kim, Sang Wun,Kim, Sunghoon,Kim, Young Tae,Kim, Gwi Eon,Kim, Yong Bae The Korean Society for Radiation Oncology 2015 Radiation Oncology Journal Vol.33 No.2
Purpose: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. Materials and Methods: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. Results: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. Conclusion: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.
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Hyun Ju Kim,Woo Joong Rhee,Seo Hee Choi,Eun Ji Nam,Sang Wun Kim,Sunghoon Kim,Young Tae Kim,Gwi Eon Kim,Yong Bae Kim 대한방사선종양학회 2015 Radiation Oncology Journal Vol.33 No.2
Purpose: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. Materials and Methods: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. Results: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. Conclusion: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.
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Kim, Songyih,Lee, Ik Jae,Kim, Yong Bae,Koom, Woong Sub,Jeon, Byeong Chul,Lee, Chang Geol,Kim, Gwi Eon,Keum, Ki Chang Adenine Press 2009 Technology in cancer research & treatment Vol.8 No.4
<P>This study evaluated whether helical tomotherapy (TOMO) planning could achieve better isodose distribution for the maxillary sinus while concomitantly sparing the adjacent _critical normal organs than linac-based step-and-shoot IMRT (s-IMRT) planning. TOMO and s-IMRT were established for 10 patients with maxillary sinus cancer. The prescription (66 Gy, 30 fractions) was used to cover the planning target volume (PTV) with a 95% isodose line. Each plan was independently optimized using the CORVUS planning system and Tomotherapy Hi-Art system. The treatment plans were compared using dose volume histogram (DVH), a dose homogeneity index (DHI) of the PTV, and equivalent uniform dose (EUD) and DVH of organs at risk (OARs). The TOMO plans demonstrated better dose homogeneity compared to the s-IMRT plans. The average V95% of the TOMO plans was similar to that of the s-IMRT (92.92% vs. 95.07%, respectively), but the average V107% was 0% for TOMO compared with 18.74% for s-IMRT. The average maximum dose reduction was 7 Gy, and DHI increased by 8% for PTV1 in TOMO compared with s-IMRT (79 Gy vs. 71 Gy and, 89% vs. 97%, respectively). The average EUD reduction for the optic nerve was 17%. In summary, planning with TOMO was superior to s-IMRT planning with respect to dose homogeneity within the PTV and sparing of the optic nerve.</P>
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Kim, Yong Bae,Kim, Joo Ho,Jeong, Kyung Keun,Seong, Jinsil,Suh, Chang Ok,Kim, Gwi Eon Adenine Press 2009 Technology in cancer research & treatment Vol.8 No.5
<P>OBJECTIVES: The goal of this study was to dosimetrically compare 3-dimensional radiotherapy (3DCRT), intensity-modulated radiotherapy (IMRT), and helical tomotherapy (TOMO) plans for whole abdominopelvic radiotherapy (WART) in patients with gynecologic cancer. METHODS: Ten patients were selected for WART planning. Doses were prescribed to planning target volumes (PTVs) as the followings: 30 Gy to PTV-whole abdominopelvis (PTV-WA), 40 Gy to PTV-para-aortic lymph node (PTV-PALN), 44 Gy to PTV-pelvis, and 50 Gy to gross target volume (GTV) in 20 fractions. Dose to whole liver, both kidneys, and spinal cord were constrained below each tissue tolerance, and bone marrow (BM)-sparing technique was adopted in IMRT and TOMO. Dosimetric parameters and treatment times were compared among plans. RESULTS: Calculated doses in TOMO came most closely to the prescribed dose for coverage of PTV-WA, PTV-PALN, PTV-pelvis, and GTV compared to 3DCRT, and IMRT. In normal organs, TOMO had significantly better dosimetric profiles compared to IMRT and 3DCRT. TOMO significantly reduced V(20Gy), and mean dose of whole liver, both kidneys, and spinal cord. The use of BM-sparing technique (BMS) did not impair coverage of target volume in IMRT and TOMO. While IMRT showed no differences of irradiated BM dose using BMS, TOMO with BMS reduced half V(20Gy) of BM compared to TOMO without BMS. CONCLUSIONS: TOMO showed dosimetric superiority in target coverage, sparing BM, and other normal organs compared to 3DCRT and IMRT. Clinical experiences will be needed for evaluation of feasibility of WART using TOMO in patients with gynecologic cancer.</P>
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Kim, Young Suk,Choi, Jae Hyuck,Kim, Kwang Sik,Lim, Gil Chae,Kim, Jeong Hong,Kang, Ju Wan,Song, Hee-Sung,Lee, Sang Ah,Hyun, Chang Lim,Choi, Yunseon,Kim, Gwi Eon The Korean Society for Radiation Oncology 2017 Radiation Oncology Journal Vol.35 No.2
Purpose: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. Materials and Methods: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). Results: The age range was 26-87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. Conclusion: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.
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Kim, Gwi Eon,Song, Hee-Sung,Ahn, Ki Jung,Kim, Young Suk The Korean Society for Radiation Oncology 2017 Radiation Oncology Journal Vol.35 No.3
Sorafenib is widely used for unresectable and metastatic hepatocellular carcinomas. Radiation recall dermatitis (RRD) is an acute inflammatory reaction confined to previously irradiated skin that occurs after the administration of certain drugs. RRD after sorafenib treatment is rare; five cases have been reported thus far. We describe a 44-year-old man irradiated for chest wall bone metastasis from hepatocellular carcinoma. Eight days after radiotherapy completion, systemic therapy for metastatic hepatocellular carcinoma was initiated with sorafenib treatment. Eleven days after starting sorafenib, the patient complained of erythematous rash with pruritus in the chest wall, in a location consistent with the previous radiation field. Sorafenib was continued at the same dose, despite the RRD. The skin reaction subsided over the next 2 weeks without any medical intervention.
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Picosecond Fluorescence Lifetimes of Hematoporphyrin Derivatives in Solutions and in vitro
Kim, Hyun-Soo,Chu, Sung-Sil,Kim, Gwi-Eon,Lee, Won-Young,Kim, Ung Korean Society of Medical Physics 1995 의학물리 Vol.6 No.2
헤마토포르피린 유도체는 광역학 치료를 위한 활성감응제로 이용되고 있다. 본 연구는 헤마토포르피린 유도체 분자의 암세포와의 에너지 전달과정을 조사하기 위하여 동시 모드록킹된 색소 레이저와 ~70 피코초 ($10^{-12}$ sec) 시산 분해능을 갖는 단일광자 계수장치 장치를 이용하여 용액에서와 암세포에서 각각 시간분해 형광 스펙트럼을 측정 분석하였다. 측정된 스펙트럼은 deconvolution 방법으로 곡선맞춤되었는데 단량체의 느린 소멸 ($\tau$$_1$=6.3 ㎱)과 이량체의 빠른 소멸 ($\tau$$_1$= 250 ㎰)로 분석되었으며 정상상태에서의 흡수 및 형과 스펙트럼의 결과와 일치하였다. 농도를 일정하게 하고 극성 분자를 5%에서 95%까치 증가시키면서 형광 소멸 곡선을 측정하여 곡선 맞춤과 결과 빠른 소멸성분 ( $A_2$) 값이 증가하였으며 그 증가 폭이 비극성 분자인 메탄올에서 보다 현저하게 나타났다. 헤마토포르피린 유도체 용액에 암세포를 자연 부유시켜 형광 소멸 곡선을 비교 분석한 결과 암세포에 흡착되었을 때 유효 형광 수명 시간이 감소하였다. 이것은 단량체에 비하여 이량체가 암세포의 흡착에 관여하고 있다는 증거로 분석되었다. The picosecond time resolved fluorescence spectra of Hematoporphyrin Derivative (HPD) in both solutions and cancer cell are measured by a time correlated single photon counting system with a synchronously mode locked dye laser. Two exoponential decay components in the fluorescence spectra were observed. The slow decay(6.3 ㎱)and the fast one(350 ㎰)are attributed to be originated from monomers and dimers, respectively. The absorption and fluorescence measurements in steady state also showed the presence of a monomeric and dimeric forms of HPD molecules. The monomer lifetime in the cancer cell was measured to be longer than that in solution, which was expected from the blue shift and narrowing of the absorption spectra for HPD-treated in vitro. The relative amplitude of the fast component was found to be enhanced in cancer cell, strongly indicating the higher affinity of the dimer for the cancer cell.
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