Prognostic analysis of uterine cervical cancer treated with postoperative radiotherapy: importance of positive or close parametrial resection margin

Yi-Jun Kim,MD,Kyung-Ja Lee,MD,PhD,Kyung Ran Park,MD,PhD,Jiyoung Kim,MD,Yi-Jun Kim,MD,Kyung-Ja Lee,MD,PhD,Kyung Ran Park,MD,PhD,Jiyoung Kim,MD,Woong Ju,MD,PhD,Yun Hwan Kim,MD,PhD,Jihae Lee,MD 대한방사선종양학회 2015 대한방사선종양학회지 Vol.33 No.2

Purpose: To analyze prognostic factors for locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) in cervical cancer patients who underwent radical hysterectomy followed by postoperative radiotherapy (PORT) in a single institute. Materials and Methods: Clinicopathologic data of 135 patients with clinical stage IA2 to IIA2 cervical cancer treated with PORT from 2001 to 2012 were reviewed, retrospectively. Postoperative parametrial resection margin (PRM) and vaginal resection margin (VRM) were investigated separately. The median treatment dosage of external beam radiotherapy (EBRT) to the whole pelvis was 50.4 Gy in 1.8 Gy/fraction. High-dose-rate vaginal brachytherapy after EBRT was given to patients with positive or close VRMs. Concurrent platinum-based chemoradiotherapy (CCRT) was administered to 73 patients with positive resection margin, lymph node (LN) metastasis, or direct extension of parametrium. Kaplan-Meier method and log-rank test were used for analyzing LRR, DM, and OS; Cox regression was applied to analyze prognostic factors. Results: The 5-year disease-free survival was 79% and 5-year OS was 91%. In univariate analysis, positive or close PRM, LN metastasis, direct extension of parametrium, lymphovascular invasion, histology of adenocarcinoma, and chemotherapy were related with more DM and poor OS. In multivariate analysis, PRM and LN metastasis remained independent prognostic factors for OS. Conclusion: PORT after radical hysterectomy in uterine cervical cancer showed excellent OS in this study. Positive or close PRM after radical hysterectomy in uterine cervical cancer correlates with poor prognosi

Postoperative radiation therapy following the incomplete resection of a non-small cell lung cancer

Jaehyeon Park,MD,Si Yeol Song,MD,PhD,Su Ssan Kim,MD,PhD,Sang-We Kim,MD,PhD,Woo Sung Kim,MD,PhD,Seung-Il Park,MD,PhD,Dong Kwan Kim,MD,PhD,Yong-Hee Kim,MD,PhD,Jongmoo Park,MD,Sang-wook Lee,MD,PhD,Jong H 대한방사선종양학회 2014 대한방사선종양학회지 Vol.32 No.2

Purpose: To review the results of postoperative radiation therapy (PORT) for residual non-small cell lung cancer (NSCLC) following surgical resection and evaluate multiple clinicopathologic prognostic factors. Materials and Methods: A total of 58 patients, who completed scheduled PORT for positive resection margin, among 658 patients treated with PORT from January 2001 to November 2011 were retrospectively analyzed. Radiation therapy was started at 4 to 6 weeks after surgery. Chemotherapy was also administered to 35 patients, either sequentially or concurrently with PORT. Results: The median age of patients was 63 years (range, 40 to 82 years). The postoperative pathological stage I NSCLC was diagnosed in 10 (17.2%), stage II in 18 (31.0%), and stage III in 30 patients (51.7%). Squamous cell carcinoma was identified in 43, adenocarcinoma in 10, large cell in 1, others in 4 patients. Microscopic residual disease (R1) was diagnosed in 55 patients (94.8%), and the remaining three patients were diagnosed with gross residual disease (R2). The median dose of PORT was 59.4 Gy (range, 50.0 to 64.8 Gy). Chemotherapy was administered to 35 patients (60%), and the median follow-up time was 22.0 months (range, 6.0 to 84.0 months). The 3-year locoregional relapse-free survival and distant metastasis-free survival rates were 82.1% and 52.9%, respectively. The median overall survival was 23.8 months (range, 6.0 to 84.1 months), and the 3-year overall survival rate was 58.2%. Chemotherapy did not influence the failure pattern or survival outcome. Conclusion: PORT is an effective modality for improving local tumor control in incompletely resected NSCLC patients. Major failure pattern was distant metastasis despite chemotherapy.

Effects of total body irradiation-based conditioning on allogeneic stem cell transplantation for pediatric acute leukemia: a single-institution study

Jongmoo Park,MD,PhD,Eun Kyung Choi,MD,Jong Hoon Kim,MD,Sang-wook Lee,MD,PhD,Si Yeol Song,MD,PhD,Sang Min Yoon,MD,Young Seok Kim,MD,PhD,Su Ssan Kim,MD,PhD,Jin-hong Park,MD,PhD,Jaehyeon Park,MD,Seung Do 대한방사선종양학회 2014 대한방사선종양학회지 Vol.32 No.3

Purpose: To evaluate the effects of total body irradiation (TBI), as a conditioning regimen prior to allogeneic stem cell transplantation (allo-SCT), in pediatric acute leukemia patients. Materials and Methods: From January 2001 to December 2011, 28 patients, aged less than 18 years, were treated with TBI-based conditioning for allo-SCT in our institution. Of the 28 patients, 21 patients were diagnosed with acute lymphoblastic leukemia (ALL, 75%) and 7 were diagnosed with acute myeloid leukemia (AML, 25%). TBI was completed 4 days or 1 day before stem cell infusion. Patients underwent radiation therapy with bilateral parallel opposing fields and 6-MV X-rays. The Kaplan-Meier method was used to calculate survival outcomes. Results: The 2-year event-free survival and overall survival rates were 66% and 56%, respectively (71.4% and 60.0% in AML patients vs. 64.3% and 52.4% in ALL patients, respectively). Treatment related mortality rate were 25%. Acute and chronic graft-versus-host disease was a major complication; other complications included endocrine dysfunction and pulmonary complications. Common complications from TBI were nausea (89%) and cataracts (7.1%). Conclusion: The efficacy and toxicity data in this study of TBI-based conditioning to pediatric acute leukemia patients were comparable with previous studies. However, clinicians need to focus on the acute and chronic complications related to allo-SCT.

A Case of Gallbladder Perforation with Acute Cholecystitis Treated by ENGBD (Endoscopic Naso-Gallbladder Drainage)

Gun Woo Kim, Md · Chan Woo Park, MD · Jong Hoon Lee, MD · Seung Ho Choi, MD · Doo Jin Kim, MD · Hyung Chiel Moon, MD · Kun Young Hong, MD · Sang Wook Park, MD 조선대학교 의학연구원 2011 The Medical Journal of Chosun University Vol.36 No.2

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Outcome of postoperative radiotherapy following radical prostatectomy: a single institutional experience

Sea-Won Lee,MD,Tae-Kon Hwang,MD,Sung-Hoo Hong,MD,Ji-Youl Lee,MD,Mi Joo Chung,MD,Song Mi Jeong,MD,Sung Hwan Kim,MD,Jong Hoon Lee,MD,Hong Seok Jang,MD,Sei Chul Yoon,MD 대한방사선종양학회 2014 대한방사선종양학회지 Vol.32 No.3

Purpose: This single institutional study is aimed to observe the outcome of patients who received postoperative radiotherapy after radical prostatectomy. Materials and Methods: A total of 59 men with histologically identified prostate adenocarcinoma who had received postoperative radiation after radical prostatectomy from August 2005 to July 2011 in Seoul St. Mary’s Hospital of the Catholic University of Korea, was included. They received 45–50 Gy to the pelvis and boost on the prostate bed was given up to total dose of 63–72 Gy (median, 64.8 Gy) in conventional fractionation. The proportion of patients given hormonal therapy and the pattern in which it was given were analyzed. Primary endpoint was biochemical relapse-free survival (bRFS) after radiotherapy completion. Secondary endpoint was overall survival (OS). Biochemical relapse was defined as a prostate-specific antigen level above 0.2 ng/mL. Results: After median follow-up of 53 months (range, 0 to 104 months), the 5-year bRFS of all patients was estimated 80.4%. The 5-year OS was estimated 96.6%. Patients who were given androgen deprivation therapy had a 5-year bRFS of 95.1% while the ones who were not given any had that of 40.0% (p < 0.01). However, the statistical significance in survival difference did not persist in multivariate analysis. The 3-year actuarial grade 3 chronic toxicity was 1.7% and no grade 3 acute toxicity was observed. Conclusion: The biochemical and toxicity outcome of post-radical prostatectomy radiotherapy in our institution is favorable and comparable to those of other studies.

정상인에서 근시가 시야검사에 미치는 영향

신용균, 이명원, 조경진, 장무환Yong Kyun Shin MD Myung Won Lee MD Kyoung Jin Cho MD PhD Moo Hwan Chang MD PhD 대한안과학회 2014 대한안과학회지 Vol.55 No.9

Purpose: To investigate the effect of lens-corrected myopia on Humphrey Matrix and Humphrey Field Analyser (HFA). Methods: A total of 59 lens-corrected myopic eyes of 59 normal volunteers underwent Humphrey Field Analyser and Humphrey Matrix (FDP) testing. Spherical equivalent divided into 3 groups: -3 ≤ D < 0, -6 ≤ D < -3, D < -6. HFA and FDP sensitivity for mean deviation (MD) and pattern standard deviation (PSD), as well as axial length and astigmatism, were compared between these 3 groups. Results: The MD of the fields as determined by the HFA decreased significantly as the refractive errors increased, despite correction. However, there were no significant differences in MD or PSD of FDP, or in the PSD of HFA. There were no significant differences in axial length or astigmatism as calculated by MD and PSD for HFA and FDP. Conclusions: The spherical equivalent showed that lens correction alters the MD for HFA but not for FDP.J Korean Ophthalmol Soc 2014;55(9):1355-1360

백내장과 녹내장이 합병된 환자에서 백내장 수술 후 Visual Field Index의 변화

전소희, 최정훈, 양지욱, 이영춘, 김수영Sohee Jeon MD Jeong Hoon Choi Ji Wook Yang MD Young Chun Lee MD Su Young Kim MD 대한안과학회 2010 대한안과학회지 Vol.51 No.3

Purpose: To investigate the changes of visual field index (VFI) compared with mean deviation (MD) and pattern standard deviation (PSD) before and after cataract surgery. Methods: The present study included 77 eyes of 77 patients who were diagnosed with both glaucoma and cataracts and underwent cataract surgery. Preoperative and postoperative VFI, MD, and PSD were examined. Lens opacity type was classified as cortical, nucleosclerosis, or posterior subcapsular opacity (PSCO), and the MD, PSD, and VFI were compared before and after cataract surgery. Results: Preoperative and postoperative MD were -13.64±8.97, -11.94±9.67(p=0.113), PSD were 6.18±3.30, 5.91±3.31(p=0.344), and VFI were 67.00±33.43, 70.55±33.19(p=0.440), respectively. MD showed statistically significant difference in cortical and PSCO type before and after cataract surgery. PSD (p=0.025) and VFI (p=0.020) showed a statistically significant difference in cortical type. Conclusions: VFI is an effective parameter to monitor the progression of glaucoma in cataract patients with nucleosclerosis and PSCO, but has limitations in cataract patients with cortical opacity. J Korean Ophthalmol Soc 2010;51(3):386-392

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 대한방사선종양학회지 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.

Multi-institutional analysis of T3 subtypes and adjuvant radiotherapy effects in resected T3N0 non-small cell lung cancer patients

Yunseon Choi,MD,Ik Jae Lee,MD,Chang Young Lee,MD,Jae Ho Cho,MD,Won Hoon Choi,PhD,Hong In Yoon,MD,Yun-Han Lee,PhD,Chang Geol Lee,MD,Ki Chang Keum,MD,Kyung Young Chung,MD,Seok Jin Haam,MD,Hyo Chae Paik 대한방사선종양학회 2015 대한방사선종양학회지 Vol.33 No.2

Purpose: We evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC). Materials and Methods: T3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse. Results: The median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively). Conclusion: The T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC

Can we omit prophylactic inguinal nodal irradiation in anal cancer patients?

Hakyoung Kim,MD,Hee Chul Park,MD,Jeong Il Yu,MD,Doo Ho Choi,MD,Yong Chan Ahn,MD,Seung Tae Kim,MD,Joon Oh Park,MD,Young Suk Park,MD,Hee Cheol Kim,MD 대한방사선종양학회 2015 대한방사선종양학회지 Vol.33 No.2

Purpose: To evaluate the appropriateness of prophylactic inguinal nodal irradiation (PINI), we analyzed patterns of failure in anal cancer patients who were inguinal node-negative at presentation and did not receive PINI. Materials and Methods: We retrospectively reviewed the records of 33 anal cancer patients treated by definitive concurrent chemoradiation therapy (CCRT) between 1994 and 2013. Radiotherapy consisted of a total dose of 44–45 Gy (22–25 fractions in 5 weeks) on the whole pelvis, anus, and perineum. Except inguinal lymphadenopathy was present at initial diagnosis, the entire inguinal chain was not included in the radiation field. In other words, there was no PINI. Results: The median follow-up duration was 50 months (range, 4 to 218 months). Median survival and progression-free survival (PFS) were 57 months (range, 10 to 218 months) and 50 months (range, 4 to 218 months), respectively. Among the survival, the median follow-up duration was 51 months (range, 12 to 218 months). The 5-year overall survival and PFS rates were 93.4% and 88.8%, respectively. Although none of the patients received inguinal node irradiation for prophylactic purposes, there was no inguinal recurrence. Conclusion: Treatment of anal cancer by omitting PINI might be considered in selected patients with clinically uninvolved inguinal nodes.