Journey to hypofractionation in radiotherapy for breast cancer: critical reviews for recent updates

Nalee Kim(Nalee Kim),Yong Bae Kim(Yong Bae Kim) 대한방사선종양학회 2022 Radiation Oncology Journal Vol.40 No.4

Historical conventional fractionated radiation therapy (RT) for breast cancer consisted of 1.8–2.0 Gy per fraction with a total dose of 45–60 Gy over 5–7 weeks. Based on radiobiological characteristics, a low α/β is suspected of breast cancer resulting in sensitivity to higher dose per fraction (2.5–3.0 Gy). Over the past 10 years, multiple clinical trials support the application of shorter treatment regimen with hypofractionated RT (HypoRT). Recently, ultra-HypoRT with 5 fractions showed favorable outcomes. Although the safety and efficacy of HypoRT has been supported by high-quality randomized trials, there are still some worries and doubts around HypoRT from radiation oncologists. However, the radiation oncology community have now reached an important timepoint for adopting HypoRT during the COVID-19 pandemic. The aim of this review is to provide an overview of HypoRT in breast cancer based on prospective randomized trials and discuss the special consideration regarding HypoRT.

Early hypopharyngeal cancer treated with different therapeutic approaches: a single-institution cohort analysis

Nalee Kim,Jeongshim Lee,Kyung Hwan Kim,Jong Won Park,Chang Geol Lee,Ki Chang Keum 대한방사선종양학회 2016 Radiation Oncology Journal Vol.34 No.4

Purpose: Early hypopharyngeal squamous cell carcinoma (HPSCC) is a rarely diagnosed disease, for which the optimal treatment has not been defined yet. We assessed patterns of failure and outcomes in early HPSCC treated with various therapeutic approaches to identify its optimal treatment. Materials and Methods: Thirty-six patients with stage I (n = 10) and II (n = 26) treated between January 1992 and March 2014 were reviewed. Patients received definitive radiotherapy (RT) (R group, n = 10), surgery only (S group, n = 19), or postoperative RT (PORT group, n = 7). All patients in both the R and PORT groups received elective bilateral neck irradiation. In the S group, 7 patients had ipsilateral and 8 had bilateral dissection, while 4 patients had no elective dissection. Results: At a median follow-up of 48 months, the 5-year locoregional control (LRC) rate was 65%. Six patients had local failure, 1 regional failure (RF), 3 combined locoregional failures, and 2 distant failures. There was no difference in 5-year LRC among the R, S, and PORT groups (p = 0.17). The presence with a pyriform sinus apex extension was a prognosticator related to LRC (p = 0.01) in the multivariate analysis. Patients with a bilaterally treated neck showed a trend toward a lower RF rate (p = 0.08). Conclusion: This study shows that patients with early stage HPSCC involving the pyriform sinus apex might need a tailored approach to improve LRC. Additionally, our study confirms elective neck treatment might have an efficacious role in regional control.

Clinical Outcomes of Moderately Hypofractionated Concurrent Chemoradiotherapy for Newly Diagnosed Glioblastoma

Nalee Kim,임도훈,최정원,이정일,공두식,설호준,남도현 연세대학교의과대학 2023 Yonsei medical journal Vol.64 No.2

Purpose: Hypofractionated radiotherapy (HypoRT) has recently been implemented in patients with glioblastoma (GBM) receiv ing concurrent temozolomide. Lymphopenia during treatment (LDT) is considered an important prognostic factor of clinical outcomes for GBM. We aimed to investigate the outcomes of HypoRT. Materials and Methods: Among 223 patients with GBM, 145 and 78 were treated with conventionally fractionated RT (ConvRT, 60 Gy in 30 fractions) and HypoRT (58.5 Gy in 25 fractions), respectively. To balance characteristics between the two groups, pro pensity score matching (PSM) was performed. Results: Patients in the HypoRT group were older and had smaller tumors than those in the ConvRT group (p<0.05). Further more, dose distributions to the brain were significantly lower in HypoRT than in ConvRT (p<0.001). Changes in absolute lympho cyte counts (ALC) during treatment were significantly lower after HypoRT than after ConvRT (p=0.018). With a median follow-up of 16.9 months, HypoRT showed comparable progression-free survival (9.9 months vs. 10.5 months) and overall survival (27.2 months vs. 26.6 months) to ConvRT (all p>0.05). Multivariable analysis before PSM revealed that ≥grade 2 LDT at 6 months was associated with inferior outcomes. Subsequent analysis demonstrated that HypoRT significantly reduced the rate of ≥grade 2 LDT at 6 months post-RT before and after PSM. Conclusion: HypoRT with 58.5 Gy in 25 fractions could provide comparable oncologic outcomes and significantly reduce the ALC changes. In addition, HypoRT decreased the LDT. Further investigation should be warranted to suggest the significance of reduced LDT through HypoRT affecting survival outcomes.

Early hypopharyngeal cancer treated with different therapeutic approaches: a single-institution cohort analysis

Kim, Nalee,Lee, Jeongshim,Kim, Kyung Hwan,Park, Jong Won,Lee, Chang Geol,Keum, Ki Chang The Korean Society for Radiation Oncology 2016 Radiation Oncology Journal Vol.34 No.4

Purpose: Early hypopharyngeal squamous cell carcinoma (HPSCC) is a rarely diagnosed disease, for which the optimal treatment has not been defined yet. We assessed patterns of failure and outcomes in early HPSCC treated with various therapeutic approaches to identify its optimal treatment. Materials and Methods: Thirty-six patients with stage I (n = 10) and II (n = 26) treated between January 1992 and March 2014 were reviewed. Patients received definitive radiotherapy (RT) (R group, n = 10), surgery only (S group, n = 19), or postoperative RT (PORT group, n = 7). All patients in both the R and PORT groups received elective bilateral neck irradiation. In the S group, 7 patients had ipsilateral and 8 had bilateral dissection, while 4 patients had no elective dissection. Results: At a median follow-up of 48 months, the 5-year locoregional control (LRC) rate was 65%. Six patients had local failure, 1 regional failure (RF), 3 combined locoregional failures, and 2 distant failures. There was no difference in 5-year LRC among the R, S, and PORT groups (p = 0.17). The presence with a pyriform sinus apex extension was a prognosticator related to LRC (p = 0.01) in the multivariate analysis. Patients with a bilaterally treated neck showed a trend toward a lower RF rate (p = 0.08). Conclusion: This study shows that patients with early stage HPSCC involving the pyriform sinus apex might need a tailored approach to improve LRC. Additionally, our study confirms elective neck treatment might have an efficacious role in regional control.

KCNT1 돌연변이가 확인된 영아 이동성 부분 발작 뇌전증 환아에서의 Quinidine 치료를 시도한 영아 1예

지나리(Nalee Jee),고아라(Ara Ko),김세희(Se Hee Kim),이준수(Joon Soo Lee),김흥동(Heung Dong Kim),이승태(Seung-Tae Lee),최종락(Jong Rak Choi),강훈철(Hoon Chul Kang) 대한소아신경학회 2017 대한소아신경학회지 Vol.25 No.3

Epilepsy of infancy with migrating focal seizure (MFEI) is an early-onset epileptic encephalopathy characterized by randomly migrating focal seizures and psychomotor deterioration. It is associated with mutations in a variety of genes, with potassium sodium-activated channel subfamily T member 1 (KCNT1) being an example. Previously reported KCNT1 mutations in MFEI are gain-of-function mutations. Therefore, quinidine therapy targeted at reduction of pathologically increased KCNT1 channel-mediated potassium conductance has been proposed as a target treatment for MEFI with KCNT1 mutation. The authors report a case involving a patient with MFEI and a missense mutation in KCNT1 (c.7129G>A; p.Phe346Leu) treated with quinidine therapy. Seizure activity was poorly responsive to quinidine.

Search for practical scaling factors of Bragg peak arrangement for line-scanning proton beam therapy in RayStation

Chung Kwangzoo,Kim Nalee,Cho Won Kyung,Kim Haeyoung,Oh Dongryul,Park Won,Park Hee Chul,Lim Do Hoon 한국물리학회 2024 THE JOURNAL OF THE KOREAN PHYSICAL SOCIETY Vol.84 No.5

To enhance the efciency of treatment planning and beam delivery in line-scanning proton beam therapy, we conducted a comparative analysis of various strategies for arranging the Bragg peak within the optimization of treatment plans. In RayStation, we had the fexibility to manipulate optimization parameters, specifcally energy layer and line spacing, to control the Bragg peak’s location. To assess the impact of these parameters, we created a virtual spherical target and generated treatment plans employing both single and dual beams with diverse arrangement strategies. We then evaluated the target volume coverage using the homogeneity index. Furthermore, we selected 15 line-scanning plans. For each line-scanning plan, we generated nine comparative plans, employing distinct Bragg peak arrangement strategies. These strategies involved variations in energy layer and line spacing settings. We optimized these plans and compared their quality to the default setting. In addition, treatment planning and beam delivery efciency were estimated. Our analysis indicated that smaller energy layer and line spacing generally resulted in improved homogeneity indices. Notably, reducing line spacing proved to be more efcient than decreasing energy layer spacing, a trend that remained consistent in the line-scanning plans. For linescanning plans, adjustments in line spacing produced more efcient improvements in the conformity index and D1cc. Based on our fndings, adjusting line spacing is a more efective strategy for optimizing Bragg peak placement in RayStation. This adjustment not only enhances treatment planning but also improves beam delivery efciency by reducing the time required for energy layer switching.

Morphologic change of rectosigmoid colon using belly board and distended bladder protocol

Cho, Yeona,Chang, Jee Suk,Kim, Mi Sun,Lee, Jaehwan,Byun, Hwakyung,Kim, Nalee,Park, Sang Joon,Keum, Ki Chnag,Koom, Woong Sub The Korean Society for Radiation Oncology 2015 Radiation Oncology Journal Vol.33 No.2

Purpose: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. Materials and Methods: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. Results: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). Conclusion: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.

Morphologic change of rectosigmoid colon using belly board and distended bladder protocol

Yeona Cho,MD,Jee Suk Chang,MD,Mi Sun Kim,MD,Jaehwan Lee,MD,Hwakyung Byun,MD,Nalee Kim,MD,Sang Joon Park,MD,Ki Chnag Keum,MD,Woong Sub Koom,MD 대한방사선종양학회 2015 Radiation Oncology Journal Vol.33 No.2

Purpose: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. Materials and Methods: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. Results: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). Conclusion: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.

Pulmonary function and toxicities of proton versus photon for limited-stage small cell lung cancer

Sang Hoon Seo,Hongryull Pyo,Yong Chan Ahn,Dongryul Oh,Kyungmi Yang,Nalee Kim,Jong-Mu Sun,Sehhoon Park,Hyun Ae Jung,Se-Hoon Lee,Jin Seok Ahn,Myung-Ju Ahn,Jae Myoung Noh 대한방사선종양학회 2023 Radiation Oncology Journal Vol.41 No.4

Purpose: We aimed to compare the oncological outcomes and toxicities of definitive proton beam therapy (PBT) and photon beam therapy in patients with limited-stage small cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively reviewed 262 patients with newly diagnosed LS-SCLC who underwent definitive PBT (n = 20; proton group) or photon beam therapy (n = 242; photon group) with concurrent chemotherapy between January 2016 and February 2021 and compared overall survival (OS), progression-free survival (PFS), dose-volume parameters, and toxicities between the groups. Results: The median follow-up duration was 24.5 months (range, 3.7 to 78.7). Baseline lung function was significantly worse and clinical target volume (CTV) was larger in the proton group (CTV: 296.6 vs. 215.3 mL; p = 0.080). The mean lung V10 was 37.7% ± 16.8% and 51.6% ± 24.5% in the proton and photon groups, respectively (p = 0.002). Two-year OS and PFS rates were 57.2% and 35.7% in the proton group and 65.3% and 40.8% in the photon group, respectively (p = 0.542 and 0.748, respectively). Grade ≥2 radiation pneumonitis and esophagitis occurred in 5 (25.0%) and 7 (35.0%) PBT-treated patients and 66 (27.3%) and 40 (16.5%) photon beam therapy-treated patients, respectively (p = 0.826 and 0.062, respectively). Conclusion: Although the proton group had poorer lung function and a larger CTV than that in the photon group, both groups exhibited comparable treatment outcomes and radiation-related toxicities in LS-SCLC. PBT may be a valuable therapeutic modality in patients with poor pulmonary function or extensive disease burden owing to its lung-sparing ability.