다발성 원격전이와 SIADH를 동반한 원발성 충수돌기 악성유암종 (Carcinoid Tumor) 1예

안광진,정현철,노재경,박중원,이화영,서창옥,노준규,이종태,최수임,김병수 대한내과학회 1990 대한내과학회지 Vol.38 No.1

Carcinoid tumors are the most trequently occurring neoplasms of the appendix and small bowel. Most carcinoid tumors of the appendix are incidentally discovered during other surgical procedures. Its natural course is usually benign and the size of the tumor is closely related with the liability of regional or distant metastasis, so this affects the mode of therapy. Lesions less than 2㎝ in greatest dimension are never shown to have metastatic lesions and those larger than 2㎝ are likely to metastasize to regional lymph nodes and occasionally to distant organs such as liver, lung and bones. We experienced a malignant carcinoid tumor of the appendix with metastasis to regional lymph nodes, lung, ribs and thoracic vertebrae, cervical lymphnodes, and the right adrenal gland without liver metastasis. The patient had no signs of carcinoid syndrome but showed hyponatremia which was corrected by fluid restriction, suggesting SIADH. The patient was treated with a combination regimen of 5-fluorouracil and doxorubicin after surgical removal of the appendiceal mass, and a palliative radiotherapy for the osteolytic lesion of the right 12th rib. A review of our experience suggests a more extensive program in disseminated malignant carcinoid tumors is required.

송과체부위종양 및 중추신경계 배아세포종양의 치료 : 치료방법의 변천에 따른 치료성적 Evolution of Treatment Policy and Result

서창옥,김귀언,이규성,최중언,정상섭,이규창,노준규 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.6

A retrospective analysis has been made of 40 patients with pineal region tumors and CNS germ cell tumors who were treated at Yonsei University Hospital, Department of Radiation Oncology between 1971 and 1985. A tissue diagnosis was obtained before radiotherapy in 19 patients and 21 patients were irradiated without histological diagnosis. Among 19 biospyproven cases, 14 were germinomas, 2 were teratomas, and the others were two pineocytomas and one pineoblastoma. In the earlier period, every attempt was made to obtain a tissue pathology by either stereotaxic biopsy or open craniotomy before irradiation. However, in recent years, wityh the advent of CT scan, a trial radiotherapy with a modest dose of 20 ㏉m 2 weeks was attempted in cases of highly suspected germinomas by CT scan findings. Further management after trial radiation depended on the radiation response shown on the follow up CT scan and tumor marker study. Radiation fields varied from a small local field to whole brain or entire neuroaxis irradiation. Most patients received 40-50 ㏉ to the primary tumor site and 20-30 ㏉ to the neuroaxis. Twenty-nine of the total 40 patients are alive without of disease 22-144 months after treatment and the overall 5-year recurrence-free survival rate was 74.4%, Univariate analysis of prognostic factors at presentation showed that tumor type was highly correlated with outcome. Two of fourteen biopsy-proven germinomas and none of nine presumed germinomas by trial radiation recurred. On the other hand, five of six patients who showed poor response to trial radiation died of uncontrolled disease and only one patient with elevated AFP in serum and CSF was salvaged by chemotherapy. On the basis of the results of this study, application of trial radiation therapy without tissue biopsy is well justified as a treatment modality in a suspected germinoma by CT scan finding. Aggressive combined modality approaches with surgery, radiotherapy and chemotherapy need to be investigated to improve results in radioresistant tumors.

Linear Accelerator를 이용한 Stereotactic Radiosurgery

정상섭,윤도흠,오성훈,김선호,서창옥,추성실,노준규,김동익,서정호 대한신경외과학회 1988 Journal of Korean neurosurgical society Vol.17 No.6

A Modified irradiation technique utilizing a linear accelerator for radiation surgery within the brain was performed in 4 patients. Three of them had brain tumors and one small arteriovenous malformation in midbrain. A Hitchcock stereotactic apparatus and a 10 MeV linear accelerator have been adapted and special computer programs for dosimetry were obtained and studied experimentally with a phantom model. Stereotactic radiosurgery is a valuable tool in the treatment of inoperable, deep seated intracranial lesions, the major advantage being high efficacy and smoothness of the procedure, as well as short hospitalization times.

The Study of Shielding Effect on Ovoids of Three Different Gynecological Applicator Sets in microSelectron-HDR System

Loh,John J.K.,Kim,Woo C.,Cho,Young K.,Kim,Hung J.,Choi,Jin H.,Park,Sung Y.,Kim,Joo Y. 대한방사선 방어학회 1998 방사선방어학회지 Vol.23 No.4

Nucletron사의 microSelectron-High Dose-Rate(HDR) System에서 부인암의 강내 근접치료에 사용되는 standard shielded applicator set(SSAS)와 Fletcher-Williamson applicator set(FWAS)는 standard applicator set(SAS) 와 비교해서 다른 점이 ovoids 위와 아래 부분에 방광과 직장으로 가는 선량을 줄이기 위해 각각 스테인레스 강철(밀도 (밀도 ρ=8,000 ㎏/㎥)과 텅스텐 합금(밀도 ρ=14,000 ㎏/㎥)으로 차폐가 되어 있다. 이에 본 연구에서는 특별히 고안한 지지장치를 사용해서 국제방사선단위위원회(ICRU) 보고서 38에서 권고한 직장과 방광의 위치에 대하여 두 shielded ovoids의 차례효과가 어느 정도인가를 알아보고자 하였다. 지지장치를 PTW사의 전산화된 3차원 물팬톰에 부착하고 SAS의 ovoids를 지지장치에 고정하였다. Ovoids의 끝 부분을 전리함(PTW 0.125cc)의 측정점 높이와 일치시키고 전리함을 좌우로 이동시키면서 선량을 측정하여 두 ovoids의 중간 위치를 확인하였다. 직장에 미치는 선량은 ovoids의 중간에 위치한 선원 M5로부터 posterior방향으로 수직으로 위치한 점들인 20(R1), 25(R2), 30(R3), 40(R4), 50(R5), 60(R6) mm 에서 측정하였다. 방광에 미치는 선량은 M5로 부터 anterior방향으로 수직으로 위치한 점들인 20(B1), 30(B2), 40(B3), 50(B4), 60(B5) mm에서 측정하였다. 위와 같은 방법으로 SSAS와 FWAS의 ovoids에서도 각각의 점들에 대한 선량을 측정하였다. SAS와 SSAS의 직장에 미치는 선량차이는 실제 임상에서의 관심 점들과 가장 가까운 25 mm(R2) 30 mm(R3)거리에서 각각 8.0%, 6.0%였고 SAS와 FWAS의 직장에 미치는 선량차이는 25 mm(R2)와 30 mm(R3)거리에서 각각 25.0%, 23.0%로 나타났다. SAS와 SSAS의 방광에 미치는 선량차이는 20 mm(B1)와 30 mm(B2)거리에서 각각 8.0%, 3.0%였고 SAS와 FWAS의 방광에 미치는 선량차이는 20 mm(B1)와 30 mm(B2)거리에서 각각 23.0%, 17.0%로 나타났다. SAS를 SSAS나 FWAS가 SSAS보다 차폐효과가 더 좋은 것으로 나타났으며 이 두 종류의 shielded applicator set는 부인암의 근접치료시 직장과 방광으로 가는 선량을 감소시켜 환자치료의 최적화를 이룰 수 있을 것으로 생각된다. There are three different types of gynecological applicator sets available in microSelectron-high dose-rate(HDR) System by Nucletron; standard applicator set(SAS), standard shielded applicator set(SSAS), and Fletcher-Williamson applicator set(FWAS). Shielding effect of a SAS without shielding material was compared with that of a SSAS with shielding material made of stainless steel(density ρ=8,000 ㎏/㎥) at the top and bottom of each ovoid, and of a FWAS with shielding material made of tungsten alloy(density ρ=14,000 ㎏/㎥) at the top and bottom of each ovoid. The shielding effects to the rectum and bladder of these two shielded applicator sets were to be measured at reference points with an ion chamber and specially designed supporting system for applicator ovoids inside of the computerized 3-dimensional water phantom. To determine the middle point of two ovoids the measurement was performed with the reference tip of ion chamber placed at the same level and at the middle point from the two ovoids, while scanning the dose with the ion chamber on each side of ovoids. The doses to the reference points of rectum were measured at 20(R1), 25(R2), 30(R3), 40(R4), 50(R5), and 60(R6) mm located posteriorly on the vertical line drawn from M5(the middle dwell position of ovoid), and the doses to the bladder were measured at 20(B1), 30(B2), 40(B3), 50(B4), and 60(B5) mm located anteriorly on the vertical line drawn from M5. The same technique was employed to measure the doses on each reference point of both SSAS and FWAS. The differences of measured rectal doses at 25 mm(R2) and 30 mm(R3) between SAS and SSAS were 8.0 % and 6.0 %: 25.0% and 23.0% between SAS and FWAS. The differences of measured bladder doses at 20 mm(B1) and 30 mm(B2) between SAS and SSAS were 8.0% and 3.0%: 23.0% and 17.0% between SAS and FWAS. The maximum shielding effects to the rectum and bladder of SSAS were 8.0% and 8.0%, whereas those of FWAS were 26.0% and 23.0%, respectively. These results led to the conclusion that FWAS has much better shielding effect than SSAS does, nd when SSAS and FWAS were used for gynecological intracavitary brachytherapy in microSelectron-HDR system, the dose to the rectum and bladder was significantly reduced to optimize the treatment outcome and to lower the complication rates in the rectum and bladder.

Radiation Therapy in Malignant Tumors of the Parotid Gland

K.R. Park(박경란),W.Y. Oh(오원용),C.O. Suh(서창옥),G.E. Kim(김귀언),J.K. Loh(노준규),J.S. Park(박정수),J.S. Min(민진식) 대한방사선종양학회 1986 Radiation Oncology Journal Vol.4 No.1

이하선 악성종양의 치료는 근치적 수술이 주된 치료법으로 알려져 왔으나 이하선이 해부학적으로 주위의 근육, 골조직, 혈관, 신경등과 밀접하게 부착되어 있어 피막 및 주위 조직의 침윤이 있거나 조직학적으로 high grade tumor, 임파절 전이가 있는 경우 등에서 광범위한 근치적 수술로도 종양을 완전히 제거하기가 어렵고 수술 후 국소재발이 빈번한 것으로 알려져 있다. 수술만으로는 국소재발율이 상당히 높은 데도 북구하고 이 종양이 방사선치료에 반응하지 않는 것으로 잘못 인식되어져와서 수술후 방사선치료를 시행해 오지 않다가 근래에 와서 수술후 방사선치료가 실시되었고 수술만 시행한 경우에서보다 국소재발율이 현저히 감소한 것으로 보고되고 있어 현재는 방사선치료가 치료 결과를 향상시키는 중요한 치료방법으로 인식되고 있다. 이에 저자들은 1970년 1월부터 1982년 12월 사이 연세대학교 의과대학 연세암센터, 치료방사선과에서 이하선암으로 치료를 받은 31예를 대상으로 후향적 추적조사를 통하여 치료방법과 치료실패 양상을 분석하여 향후 치료방법의 실정과 치료 결과의 향상을 위하여 본 연구를 실시하였다. From 1970 to 1982, thirty one patients with malignant tumors of the parotid gland were treated with radiation therapy at department of Radiation Oncology, Yonsei University College of Medicine, Yonsei Cancer Center. Indication for radiotherapy were as follows: 1) when there were microscopic or gross residual diseases (6 patients), 2) when the patients considered to have high risk factors (15 patients), 3) when the tumor found to be inoperable (6 patients), 4) when there was recurrence after surgery (4 patients). Most patients were treated with a total of 5,000 to 6,500cGy in 5 to 6 weeks except when there were gross diseases, in which patients received slightly higher dose up to 7,000 cGy in 7 weeks. Locoregional failure rate was 43% in patients with microscopic or gross residual disease and high risk factors (postoperative radiotherapy group) and 20 in patients with inoperable tumor and recurrence after surgery (Primary radiotherapy group). There was no difference in the failure rates amen!1 the various histological types. Eight patients failed distantly, Severe complications appeared only in 2 patients irradiated for inoperable advanced diseases.

두경부암의 온열요법

박경란(K R Park),이창걸(C G Lee),김수곤(S K Kim),조관호(K H Cho),서창옥(C O Suh),김귀언(G E Kim),노준규(J K Loh),김병수(B S Kim)홍원표(W P Hong),박정수(C S Park) 대한두경부종양학회 1987 대한두경부 종양학회지 Vol.3 No.1

Clinical application of hyperthermia using 8 MHz radiofrequency (capacitive type THER-MOTRON RF-8) in cancer treatment was begun at Yonsei Cancer Center in 19&5. From April 1985 to April 1986, 23 patients with loco-regionally advanced and persistent or recurrent carcinomas of the head and neck were treated with hyperthermia at the Department of Radiation Oncology, Yonsei University College of Medicine. Radiation therapy and/orchemotherapy were combined with hyperthermia to improve the tumor response. The response rate of 23 patients was 52%, 4 had complete response, and 7 had partial response. The factors affecting the tumor response were dose of irradiation (P= 0.009). Complications related to treatment were found in 8 patients and all of them were self-limited. The result of this study indicates that localized hyperthermia as a combined modality has a significant role in palliation of advanced and recurrent head and neck cancer.

Wrinkle-free graphene with spatially uniform electrical properties grown on hot-pressed copper

Mun, J. H.,Oh, J. G.,Bong, J. H.,Xu, H.,Loh, K. P.,Cho, B. J. Springer Science + Business Media 2015 NANO RESEARCH Vol.8 No.4

The Study of shielding Effect on Ovoids of Three Different Gynecological Application Sets in microSelectron-HDR System

Young K. Cho,Sung Y. Park,Jin H. Choi,Hung J. Kim,Woo C. Kim,John J.K. Loh,Joo Y. Kim 대한방사선방어학회 1998 방사선방어학회지 Vol.23 No.4

Young Age Cancer of the Cervix: Its Clinical Significance

( C. H. Lee ),( T. K. Park ),( D. H. Choi ),( J. W. Kim ),( S. N. Kim ),( C. O. Suh ),( G. E. Kim ),( J. J. J. Loh ) 대한산부인과학회 1989 대한산부인과학회 학술대회 Vol.64 No.-

Effect of Radiofrequency Induced Local Hyperthermia on Normal Canine Liver

Chang Ok Suh(서창옥) , John J.K.Loh(노준규) , Jin Sil Seong(성진실) , Sun Rock Moon(문성록) Hyung Sik Lee(이형식) , Hyun Soo Shin(신현수) , Sung Sil Chu(추성실) , Gwi Eon Kim(김귀언) , Chan Il Park(박찬일) ,Eun Kyung Han(한은경) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

간조직에 온열치효를 시행시 출현하는 조직병리학적 소견 및 혈액의 생화학적 소견을 관찰하고자 13마리의 정상 간에 8MHz 라디오파를 이용한 온열치료를 시행하였다. 42.5±0.5°C로 30분간 온열치료를 받은 군 (제1군, n=5), 45±0.5°C로 30분간 온열치료를 받은 군 (제2군, n=5) 및 온열치료를 받지않은 대조군(n=3)으로 나누어 분석하였을때, 혈액의 SGOT의 SGPT는 온열치료를 시행한 두군 공히 증가된 소견을 보였고 제 1군에서는 간세포의 부종소견의 특이한 조직병리학적소견이 관찰되지않아 가역성 변화로 생각되었지만 제2군에서는 간 세포의 심한 괴사소견이 관찰되어 있는 불가역성의 가조직 손상으로 생각되었다. 이상의 결론으로 유추할 때 임상에서 행하여지는 간암의 온열치료시에 정상 가조직의 손상을 가능한 방지하기위하여는 정확한 종괴의 구역에 치료온도의 주의깊은 관찰이 요구된다. In order to assess the effects of radiofrequency-induced local hyperthermia on the normal liver, histopathologic findings and biochemical changes after localized hyperthermia in canine liver were studied. Hyperthemia was externally adminsitered using the Thermotron RF-8 (Yamamoto Vinyter Co., Japan; Capacitive type heating machine) with parallel opposed electrodes. Thirteen dogs were used and allocated into one control group (N=3) and two treatment groups according to the treatment temperature. Group I (N=5) was heated with 42.5±0.5°C for 30 minutes, and Group Ⅱ (N=5) was heated with 45±0.5°C for 15-30 minutes. Samples of liver tissue were obtained through a needle biopsy immediately after hyperthermia and 7, 14, and 28 days after treatment. Blood samples were obtained before treatment and 1, 3, 5, 7, 14 and 28 days after treatment and examined for SGOT, SGPT and alkaline phosphatase. Although SGOT and SGPT were elevated after hyperthermia in both groups (three of five in each group), there was no liver cell necrosis or hyperthermia related mortality in Group Ⅰ. A hydropic swelling of hepatocytes was prominent histologic finding. Hyperthermia with 45°C for 30 minutes was fatal and showed extensive liver cell necrosis. In conclusion, liver damage dy heat of 42.5±0.5°C for 30 minutes is reversible, and liver damage by heat of 45±0.5°C for 30 minutes can be fatal or irreversible. However, these results cannot be applied directly to human trial. Therefore, in order to apply hyperthermic treatment on human liver tumor safely, close observation of temperature with proper thermometry is mandatory. Hyperthermic treatment should be confined to the tumor area while sparing a normal liver as much as possible.