Parotid gland sparing effect by computed tomography-based modified lower field margin in whole brain radiotherapy

Oyeon Cho,Mison Chun,Sung Ho Park,Young-Taek Oh,Mi-Hwa Kim,Hae-Jin Park,Sang Soo Nam,Jaesung Heo,O Kyu Noh 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.1

Purpose: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. Materials and Methods: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). Results: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands ≥20 Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. Conclusion: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

Management for locally advanced cervical cancer: new trends and controversial issues

Cho, Oyeon,Chun, Mison The Korean Society for Radiation Oncology 2018 Radiation Oncology Journal Vol.36 No.4

This article reviewed new trends and controversial issues, including the intensification of chemotherapy and recent brachytherapy (BT) advances, and also reviewed recent consensuses from different societies on the management of locally advanced cervical cancer (LACC). Intensive chemotherapy during and after radiation therapy (RT) was not recommended as a standard treatment due to severe toxicities reported by several studies. The use of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) for pelvic RT planning has increased the clinical utilization of intensity-modulated radiation therapy (IMRT) for the evaluation of pelvic lymph node metastasis and pelvic bone marrow. Recent RT techniques for LACC patients mainly aim to minimize toxicities by sparing the normal bladder and rectum tissues and shortening the overall treatment time by administering a simultaneous integrated boost for metastatic pelvic lymph node in pelvic IMRT followed by MRI-based image guided adaptive BT.

Met inactivation by S-allylcysteine suppresses the migration and invasion of nasopharyngeal cancer cells induced by hepatocyte growth factor

Cho, Oyeon,Hwang, Hye-Sook,Lee, Bok-Soon,Oh, Young-Taek,Kim, Chul-Ho,Chun, Mison The Korean Society for Radiation Oncology 2015 Radiation Oncology Journal Vol.33 No.4

Purpose: Past studies have reported that S-allylcysteine (SAC) inhibits the migration and invasion of cancer cells through the restoration of E-cadherin, the reduction of matrix metalloproteinase (MMP) and Slug protein expression, and inhibition of the production of reactive oxygen species (ROS). Furthermore, evidence is emerging that shows that ROS induced by radiation could increase Met activation. Following on these reports of SAC and Met, we investigated whether SAC could suppress Met activation. Materials and Methods: Wound healing, invasion, 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium (MTT), soft agar colony forming, western blotting, and gelatin zymography assays were performed in the human nasopharyngeal cancer cell lines HNE1 and HONE1 treated with SAC (0, 10, 20, or 40 mM) and hepatocyte growth factor (HGF). Results: This study showed that SAC could suppress the migration and invasion of HNE1 and HONE1 cell lines by inhibiting p-Met. An increase of migration and invasion induced by HGF and its decrease in a dose dependent manner by SAC in wound healing and invasion assays was observed. The reduction of p-Met by SAC was positively correlated with p-focal adhesion kinase (p-FAK) and p-extracellular related kinase (p-ERK in both cell lines). SAC reduced Slug, MMP2, and MMP9 involved in migration and invasion with the inhibition of Met-FAK signaling. Conclusion: These results suggest that SAC inhibited not only Met activation but also the downstream FAK, Slug, and MMP expression. Finally, SAC may be a potent anticancer compound for nasopharyngeal cancer treated with radiotherapy.

Parotid gland sparing effect by computed tomography-based modified lower field margin in whole brain radiotherapy

Cho, Oyeon,Chun, Mison,Park, Sung Ho,Oh, Young-Taek,Kim, Mi-Hwa,Park, Hae-Jin,Nam, Sang Soo,Heo, Jaesung,Noh, O Kyu The Korean Society for Radiation Oncology 2013 Radiation Oncology Journal Vol.31 No.1

Purpose: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. Materials and Methods: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). Results: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands ${\geq}20$ Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. Conclusion: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

Met inactivation by S-allylcysteine suppresses the migration and invasion of nasopharyngeal cancer cells induced by hepatocyte growth factor

Oyeon Cho,Hye-Sook Hwang,Bok-Soon Lee,Young-Taek Oh,Chul-Ho Kim,Mison Chun 대한방사선종양학회 2015 Radiation Oncology Journal Vol.33 No.4

Purpose: Past studies have reported that S-allylcysteine (SAC) inhibits the migration and invasion of cancer cells through the restoration of E-cadherin, the reduction of matrix metalloproteinase (MMP) and Slug protein expression, and inhibition of the production of reactive oxygen species (ROS). Furthermore, evidence is emerging that shows that ROS induced by radiation could increase Met activation. Following on these reports of SAC and Met, we investigated whether SAC could suppress Met activation. Materials and Methods: Wound healing, invasion, 3-[4,5-dimethylthiazol-2-yl]-2,5-diphenyltetrazolium (MTT), soft agar colony forming, western blotting, and gelatin zymography assays were performed in the human nasopharyngeal cancer cell lines HNE1 and HONE1 treated with SAC (0, 10, 20, or 40 mM) and hepatocyte growth factor (HGF). Results: This study showed that SAC could suppress the migration and invasion of HNE1 and HONE1 cell lines by inhibiting p-Met. An increase of migration and invasion induced by HGF and its decrease in a dose dependent manner by SAC in wound healing and invasion assays was observed. The reduction of p-Met by SAC was positively correlated with p-focal adhesion kinase (p-FAK) and p-extracellular related kinase (p-ERK in both cell lines). SAC reduced Slug, MMP2, and MMP9 involved in migration and invasion with the inhibition of Met-FAK signaling. Conclusion: These results suggest that SAC inhibited not only Met activation but also the downstream FAK, Slug, and MMP expression. Finally, SAC may be a potent anticancer compound for nasopharyngeal cancer treated with radiotherapy.

CT-based quantitative evaluation of radiation-induced lung fibrosis: a study of interobserver and intraobserver variations

Jaesung Heo,Oyeon Cho,O Kyu Noh,Young-Taek Oh,Mison Chun,Mi-Hwa Kim,Hae-Jin Park 대한방사선종양학회 2014 Radiation Oncology Journal Vol.32 No.1

Purpose: The degree of radiation-induced lung fibrosis (RILF) can be measured quantitatively by fibrosis volume (VF) on chest computed tomography (CT) scan. The purpose of this study was to investigate the interobserver and intraobserver variability in CT-based measurement of VF. Materials and Methods: We selected 10 non-small cell lung cancer patients developed with RILF after postoperative radiation therapy (PORT) and delineated VF on the follow-up chest CT scanned at more than 6 months after radiotherapy. Three radiation oncologists independently delineated VF to investigate the interobserver variability. Three times of delineation of VF was performed by two radiation oncologists for the analysis of intraobserver variability. We analysed the concordance index (CI) and inter/intra-class correlation coefficient (ICC). Results: The median CI was 0.61 (range, 0.44 to 0.68) for interobserver variability and the median CIs for intraobserver variability were 0.69 (range, 0.65 to 0.79) and 0.61(range, 0.55 to 0.65) by two observers. The ICC for interobserver variability was 0.974 (p < 0.001) and ICCs for intraobserver variability were 0.996 (p < 0.001) and 0.991 (p < 0.001), respectively. Conclusion: CT-based measurement of VF with patients who received PORT was a highly consistent and reproducible quantitative method between and within observers.

CT-based quantitative evaluation of radiation-induced lung fibrosis: a study of interobserver and intraobserver variations

Heo, Jaesung,Cho, Oyeon,Noh, O Kyu,O, Young-Taek,Chun, Mison,Kim, Mi-Hwa,Park, Hae-Jin The Korean Society for Radiation Oncology 2014 Radiation Oncology Journal Vol.32 No.1

Purpose: The degree of radiation-induced lung fibrosis (RILF) can be measured quantitatively by fibrosis volume (VF) on chest computed tomography (CT) scan. The purpose of this study was to investigate the interobserver and intraobserver variability in CT-based measurement of VF. Materials and Methods: We selected 10 non-small cell lung cancer patients developed with RILF after postoperative radiation therapy (PORT) and delineated VF on the follow-up chest CT scanned at more than 6 months after radiotherapy. Three radiation oncologists independently delineated VF to investigate the interobserver variability. Three times of delineation of VF was performed by two radiation oncologists for the analysis of intraobserver variability. We analysed the concordance index (CI) and inter/intra-class correlation coefficient (ICC). Results: The median CI was 0.61 (range, 0.44 to 0.68) for interobserver variability and the median CIs for intraobserver variability were 0.69 (range, 0.65 to 0.79) and 0.61(range, 0.55 to 0.65) by two observers. The ICC for interobserver variability was 0.974 (p < 0.001) and ICCs for intraobserver variability were 0.996 (p < 0.001) and 0.991 (p < 0.001), respectively. Conclusion: CT-based measurement of VF with patients who received PORT was a highly consistent and reproducible quantitative method between and within observers.

Quick Sequential Organ Failure Assessment Score and the Modified Early Warning Score for Predicting Clinical Deterioration in General Ward Patients Regardless of Suspected Infection

Ko Ryoung-Eun,Kwon Oyeon,Cho Kyung-Jae,Lee Yeon Joo,Kwon Joon-myoung,Park Jinsik,Kim Jung Soo,Kim Ah Jin,Jo You Hwan,Lee Yeha,Jeon Kyeongman 대한의학회 2022 Journal of Korean medical science Vol.37 No.16

Background: The quick sequential organ failure assessment (qSOFA) score is suggested to use for screening patients with a high risk of clinical deterioration in the general wards, which could simply be regarded as a general early warning score. However, comparison of unselected admissions to highlight the benefits of introducing qSOFA in hospitals already using Modified Early Warning Score (MEWS) remains unclear. We sought to compare qSOFA with MEWS for predicting clinical deterioration in general ward patients regardless of suspected infection. Methods: The predictive performance of qSOFA and MEWS for in-hospital cardiac arrest (IHCA) or unexpected intensive care unit (ICU) transfer was compared with the areas under the receiver operating characteristic curve (AUC) analysis using the databases of vital signs collected from consecutive hospitalized adult patients over 12 months in five participating hospitals in Korea. Results: Of 173,057 hospitalized patients included for analysis, 668 (0.39%) experienced the composite outcome. The discrimination for the composite outcome for MEWS (AUC, 0.777; 95% confidence interval [CI], 0.770–0.781) was higher than that for qSOFA (AUC, 0.684; 95% CI, 0.676–0.686; P < 0.001). In addition, MEWS was better for prediction of IHCA (AUC, 0.792; 95% CI, 0.781–0.795 vs. AUC, 0.640; 95% CI, 0.625–0.645; P < 0.001) and unexpected ICU transfer (AUC, 0.767; 95% CI, 0.760–0.773 vs. AUC, 0.716; 95% CI, 0.707–0.718; P < 0.001) than qSOFA. Using the MEWS at a cutoff of ≥ 5 would correctly reclassify 3.7% of patients from qSOFA score ≥ 2. Most patients met MEWS ≥ 5 criteria 13 hours before the composite outcome compared with 11 hours for qSOFA score ≥ 2. Conclusion: MEWS is more accurate that qSOFA score for predicting IHCA or unexpected ICU transfer in patients outside the ICU. Our study suggests that qSOFA should not replace MEWS for identifying patients in the general wards at risk of poor outcome.

A Validation of deep learning based early warning score to predict in-hospital cardiac arrest in patients admitted to general wards

( Yeon-joo Lee ),( Kyung-jae Cho ),( Oyeon Kwon ),( Hyunho Park ),( Yeha Lee ),( Joon-myoung Kwon ),( Jinsik Park ),( Jung Soo Kim ),( Man-jong Lee ),( Ah Jin Kim ),( Ryoung-eun Ko ),( Kyeongman Jeon 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Track and trigger system (TTS) are important component of rapid response system for identifying deteriorating patients but the performance of traditional TTS such as Modified Early Warning Score (MEWS) has been unsatisfactory. Deep-learning-based early warning score (DEWS) was recently developed and has shown a potential to predict deteriorating patients. We aimed to validate DEWS in multiple centers and compare the prediction ability with MEWS to identify at risk of in-hospital cardiac arrest (IHCA). Methods: This was a retrospective cohort study of adult patients who admitted to general ward in five hospitals during 12-months study period. We validated DEWS internally from two hospitals and externally from the remaining three hospitals. DEWS was computed from five vital signs (systolic blood pressure, diastolic blood pressure, heart rate, respiratory rate, and body temperature) and MEWS was also calculated at the same times as DEWS. IHCA within 24hours of vital sign observation was the outcome of interest. We used the area under the receiver-operating characteristics curve (AUROC), sensitivity, and specificity as comparative measures. Results: The study population consisted of 173,656 patients, of which 139 IHCA cases. We used 3 point as threshold for MEWS and compared the performance of DEWS with the same specificity. The DEWS (AUROC: 0.86, sensitivity: 0.50, specificity: 0.95) outperformed the MEWS (AUROC: 0.75, sensitivity: 0.44, specificity: 0.95) in the internal validation cohort (N = 14,365, IHCA = 23) in predicting IHCA within 24hours. Similarly, DEWS (AUROC: 0.84, sensitivity: 0.55, specificity: 0.92) showed improved performance compared to MEWS (AUROC: 0.77, sensitivity: 0.44, specificity: 0.92) in the external validation cohort (N= 159,018, IHCA = 116). Conclusions: We demonstrated that the performance of DEWS for predicting IHCA within 24 hours of vital sign observation was superior to MEWS in this multicenter validation.

Comparison of concurrent chemoradiotherapy versus sequential radiochemotherapy in patients with completely resected non-small cell lung cancer

Kim, Hwan-Ik,Noh, O Kyu,Oh, Young-Taek,Chun, Mison,Kim, Sang-Won,Cho, Oyeon,Heo, Jaesung The Korean Society for Radiation Oncology 2016 Radiation Oncology Journal Vol.34 No.3

Purpose: Our institution has implemented two different adjuvant protocols in treating patients with non-small cell lung cancer (NSCLC): chemotherapy followed by concurrent chemoradiotherapy (CT-CCRT) and sequential postoperative radiotherapy (PORT) followed by postoperative chemotherapy (POCT). We aimed to compare the clinical outcomes between the two adjuvant protocols. Materials and Methods: From March 1997 to October 2012, 68 patients were treated with CT-CCRT (n = 25) and sequential PORT followed by POCT (RT-CT; n = 43). The CT-CCRT protocol consisted of 2 cycles of cisplatin-based POCT followed by PORT concurrently with 2 cycles of POCT. The RT-CT protocol consisted of PORT followed by 4 cycles of cisplatin-based POCT. PORT was administered using conventional fractionation with a dose of 50.4-60 Gy. We compared the outcomes between the two adjuvant protocols and analyzed the clinical factors affecting survivals. Results: Median follow-up time was 43.9 months (range, 3.2 to 74.0 months), and the 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 53.9%, 68.2%, and 51.0%, respectively. There were no significant differences in OS (p = 0.074), LRFS (p = 0.094), and DMFS (p = 0.490) between the two protocols. In multivariable analyses, adjuvant protocol remained as a significant prognostic factor for LRFS, favouring CT-CCRT (hazard ratio [HR] = 3.506, p = 0.046) over RT-CT, not for OS (HR = 0.647, p = 0.229). Conclusion: CT-CCRT protocol increased LRFS more than RT-CT protocol in patients with completely resected NSCLC, but not in OS. Further studies are warranted to evaluate the benefit of CCRT strategy compared with sequential strategy.