Evaluation of Efficacy and Safety Using Low Dose Radiation Therapy with Alzheimer’s Disease: Interim Results of Multicenter Phase II Clinical Trial

Weon Kuu Chung,Doo Yeul Lee,Woo-Yoon Park,Byoung Hyuk Kim,Eun-Hee Hong,Hak Young Rhee,Aryun Kim,KeunYou Kim 대한방사선방어학회 2023 대한방사선방어학회 학술발표회 논문요약집 Vol.2023 No.4

폐 부위 Planning Target Volume(PTV)설정시 폐 움직임의 객관적 측정

정원규(Weon Kuu Chung),조정길(Jeong Gill Cho) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.4

목 적 : ICRU 50의 권고에 따라 치료 범위를 Planning Target Volume(PTV)으로 설정하고 있다. 진단 영상장치의 발달과 특히 CT Simulator 등의 도움으로 Gross Tumor Volume(GTV) 설정은 쉬워지고 있으나, 내부장기의 움직임에 의한 경계의 선정에 대하여는 특별한 지침이 없고, 단지 경험에 의존하고 있는 실정이다. 본 연구에서는 폐의 움직임 유형을 분석하여 폐 부위의 PTV 설정시 폐의 움지임을 고려하기 위한 정량적인 지침을 마련하려는데 있다. 대 상 및 방 법 : 폐암, 식도암 등 폐 및 흉부 주변의 방사선으로 치료받는 환자 10명을 대상으로 Simulator 투시 촬영기로 폐의 움직임을 관찰하였다. 우측 폐는 12부위와, 좌측폐는 10부위로 각각 나누었다. 우측 폐 부위는 상엽은 2부분, 중엽은 2부분, 하엽은 2부분으로 나누었고, 그 각각을 측면에서 전, 후 2부분으로 나누었다. 좌측 폐 부위는 상엽, 하엽 모두 2부분으로 나누고, 측면에서 다시 전, 후로 다시 2부분으로 나누었다. 부위마다 4-5점을 택해 X선 투시 장치에서 생성된 영상을 컴퓨터에 입력시켜 폐포의 움직임을 x, y, z 3좌표 방향으로 수치화 하였다. 결 과 : 우측과 좌측 폐 부위 중 양측 상엽 부위의 움직임이 상대적으로 적었으며, 좌우이동이 전후 이동에 비해 크게 나타났다. 좌우 이동은 심장 박동 효과로 심장 또는 대동맥 근처에서 가장 두드러지게 나타나서 양측 폐문 부위가 가장 큰 이동을 보였으며(평균 6.6mm), 상하 이동은 호흡 효과로 양측 폐 하엽 부위, 횡격막 근처에서 가장 컸다(평균 14.1mm). 결 론 : X선 투시로 폐의 움직임을 관찰할 수 있으며 컴퓨터의 궤적 추적으로 정량화 할 수 있었다. 폐 부위의 방사선 치료시 설정되는 PTV에는 장기의 움직임을 고려해야 하는데 본 연구의 결과를 이용하여 치료 부위에 따라 여유를 차등을 둔다면 치료 조사면을 최적화 하는데 도움이 될 것으로 생각된다. Purpose:To quantify the movement of lung parenchyma for ICRU 50 Planning Target Volume(PTV) delineation of the lung region. Materials and Methods :Fluoroscopic observations and measurements are performed on 10 patients with chest region cancer who have normal pulmonary functions. We have divided the lung region into 12 parts for the right lung, 10 parts for the left lung and four to five points of lung parenchyma were selected for anatomical analysis points. Fluoroscopic images are sent to a computer and then movements are measured. Results:Both lower lobes showed the longest longitudinal movements because of breathing (average 14.1mm, maximum 22.1mm), while antero- posterior displacement showed the smallest value. Lateral movements of the lung parenchyma averaged 6.6mm, and the maximum value was 9.1mm. (both hilar regions showed maximum values because of cardiac motion) Conclusion:We could quantify the lung movements by measuring parenchyma displacements. The movements of both upper lobes were less than those of the middle and upper lobes in longitudinal and transverse movements. Optimal margins can be selected for PTV delineation using these results.

Buchler 강내조사장치의 선량계산에 대한 연구

정원규(Weon Kuu Chung),김수곤(Soo Kon Kim),강정구(Jeong Ku Kang),이정옥(Jeong Ok Lee),문성록(Sun Rock Moon),김승곤(Seung Kon Kim) 대한방사선종양학회 1996 Radiation Oncology Journal Vol.14 No.3

목적 : Buchler type의 강내조사장치에 대한 선량계산 프로그램을 개발하였다. 방법 : 프로그램 디스크를 5도씩 72 분할하여 구한 좌표에서 선원의 왕복 크기와 activity의 분포를 결정하였다. 각각의 프로그램 디스크별 그리고 각 선원별로 선량율을 계산하여 선량율 표를 작성하였다. 이 선량율표를 이용하여 인체내 관심점에 대한 선량율 계산에 이용하도록 하였다. 각 관심점에 대한 선량율을 계산한 후 등선량 분포곡선을 작성하여 화면에 표시하였다. 결과 : 각 프로그램 디스크와 선원별로 선량율표를 작성하므로써 저장 용량은 다소 증가한다. 그러나 인체내 관심점의 선량 계산이 빠르게 이루어지기 때문에 환자 치료시 바로 이용할 수 있다. 또한 등선량곡선을 바로 확인할 수 있어 선원의 배열 등을 즉시 교정 할 수 있다. 결론 : 종전의 등선량 분포곡선을 이용한 근사적 계산보다 정확한 선량 계산을 훨씬 빠르게 할 수 있다. 선량계산 문제점의 해결로 Buchler type의 강내조사장치를 다양하게 치료에 응용할 수 있다. 또한 다양한 선원에 대한 선량계산에도 이용할 수 있다. Purpose : The dose calculation program for the Buckler type remote after-loading system was developed. This program also can be used to calculate dose for various sealed sources. Materials and Methods : We determined the source length and distribution by dividing the program disk to 72 points. The dose rate for the each program disk and source was calculated. The dose rate table for the xy coordinate was established. The dose rate for the interesting points of the patient were calculated by using this table, We also made isodose curve from this calculations. Results : The storage size for the dose rate table were increased. But the calculation of the dose rate for the patient were carried out rapidly. So we could get real time calculation. Conclusion : By using this program, we could calculate the dose rate for the various points of the patient quickly and accurately. This program will be useful for the treatment with various linear sources.

항문암의 동시 화학 방사선 요법 치료결과

정원규(Weon Kuu Chung),김수곤(Soo Kon Kim),이창걸(Chang Geol Lee),성진실(Jin Sil Seong),김귀언(Gwi Eon Kim) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.1

Among the 63 patients with histopathlogically proven primary squamous cell anal cancer who were managed in Prebyteriam Medical Center and Yonsei University Cancer from Jan. 1971 to Dec. 1991. 34 patients, who were managed with surgery alone(abdominoperineal resection) or post-operative radiotherapy and concurrent chemoradiotherapy were analysed. With mean follow up time of 81.3 months, 30 patients(88%) were followed up from 17 to 243 months. In methods, 10 patients were treated with surgery alone, 9 patients were treated with combined surgery and postoperative radiotherapy(50~60 Gy in 28~30 fractions). 15 patients were treated with concurrent chemoradiotherapy. Chomotherapy (Mitomycin c 15mg/squ, bolus injection day 1;5-FU, 750mg/squ, 24hr infusion, day 1 to 5) and radiotherapy started the same day. A dose of 30 Gy was given to the tumor and to the pelvis including inguinal nodes, in 15 fractions, After 2 weeks a boost of radiotherapy(20 Gy) to the ano-perineal area and second cycle of chemotherapy completed the treatment. The overall 5-year survival rate was 56.2%. Concurrent chemoradiotherapy group was 70% and surgery alone group was 16.7%. According to cox proportional harzard model, there was significant difference between survival with concurrent was 64.8%, which was not stastically significant(p=0.1412). In concurrent chemoradiotherapy group, the anal funtion preservation rate was 87% and the severe complication rate(grade 3 stenosis and incontinence) was 13.3%. In conclusion, we conclude that the concurrent chemoradiotherapy may be effective treatment modality in patients with anal cancer.

식도암의 근치적 치료성적 및 예후인자

정원규(Weon Kuu Chung),김수곤(Soo Kon Kim),김민철(Min Chul Kim),장명(Myoung Jang),문성록(Sun Rock Moon) 대한방사선종양학회 1995 Radiation Oncology Journal Vol.13 No.3

Purpose : To analyse clinical outcome and prognostic factors according to treatment modality, this paper report out experience of retrospective study of patients with esopahgeal cancer. Materials and Methods : One hundred and ten patients with primary esopahgeal cancer who were treated in Presbyterian Medical Center from May 1985 to December 1992. We analysed these patients retrospectively with median follow up time of 28 months, one hundred and four patients(95%) were followed up from 15 to 69 months. In methods, twenty-eight patients were treated with median radiation dose irradiated 54.3Gy only. Fifty-sex patients were treated with combined chemoradiothearpy. Sixteen cases of these patients were treated with concurrent chemoradiation and the other patients(forty cases) were treated sequential chemoradiotherapy. In concurrent chemoradiotherapy group, patients received 5-FU continuous Ⅳ infusion for 4 days. Cisplatin Ⅳ bolus, and concurrent esophageal irradiation to 30 Gy. After that patients received 5-FU continuous Ⅳ. Cisplatin bolus injection and Mitomycin-C bolus Ⅳ. Bleomycin continuous Ⅳ, and irradiation to 20 Gy. In sequential chemoradiotherapy group, the chmotherapy consisted of 5-FU 1,000mg/m² administred as a continuous 24 hour intravenous infusion during five days and Cisplatin 80-100mg/m² bolus injected, or Bleomycin. Vinblastine, Cisplatin, Methotrexate were used of 1 or 2 cycles. After preoperative concurrent chemoradiation, twenty-six patients underwent radical esopagectomy. Results : Ninety-three patients could be examined for response assessment. By treatment modality, response rates were 85.1% for radiation alone group and 86.3% for combined chemoradaition group. But in operation group, after one cycle of concurrent chemoradiation treatment, response rate was 61.9%. The pathologic complete response were 15.4% in peration group. Overall median survival was 11 months and actuarial 5-year survival rate was 8%. The median survival interval was 6 months for radiation alone group. 11 months for combined chemoradiation group and 19 months for operation group. And also median survival was 19 months for complete responder group that 8 months for noncomplete responder group. In univariative analysis, statistically significant prognostic factors were tumor size, clinical stage, tumor response, and operation. In multivariative analysis, significantly better survival was associated with clinical stage, tumor response, radiation dose, and operation. Conclusion : Compared with radiotherapy alone, combined multimodality may imporve the median survival in patients with localized carcinoma of the esopahgus and toxicity is acceptable.

Feasibility Assessment of Physical Factors of Rectal Cancer Short-Course Chemoradiotherapy with Delayed Surgery

Koo, Jihye,Chung, Mijoo,Chung, Weon Kuu,Jin, Sunsik,Kim, Dong Wook Korean Society of Medical Physics 2018 의학물리 Vol.29 No.4

To verify the correlations between the clinical outcomes and physical factors of short-course chemoradiotherapy (SCRT) and long-course chemoradiotherapy (LCRT) with delayed surgery in patients with rectal cancer. Seventy-two patients with rectal cancer were enrolled in this study. Nineteen patients were treated with SCRT (25 Gy, 5 fractions) by intensity-modulated radiation therapy (IMRT), and 53 patients were treated with LCRT (50.4 Gy, 28 fractions) by three-dimensional conformal radiation therapy (3DCRT). Various physical factors for the target and organs at risk (OARs) were calculated to compare the clinical outcomes. The organ equivalent dose (OED) and lifetime attributable risk (LAR) of bowels and bladders were similar between the SCRT and LCRT groups, whereas the values of femurs were higher in the LCRT group. The equivalent uniform dose and normal tissue complication probability were higher in the LCRT than the SCRT group for most organs. Treatment complications, including anastomotic leakage, bowel adhesion, and hematologic toxicity, were not significantly different between SCRT and LCRT groups. CIs were $0.84{\pm}0.2$ and $0.61{\pm}0.1$ for SCRT and LCRT, respectively. The CVIs were $1.07{\pm}0.0$ and $1.10{\pm}0.1$, and the HIs were $0.09{\pm}0.0$ and $0.11{\pm}0.1$ for SCRT and LCRT, respectively. The sphincter-saving rates were 89.5% and 94.3% for SCRT and LCRT, respectively. The complete pathologic remission rates were 21.1% and 13.2%, and the down-staging rates were 47.4% and 26.4% for SCRT and LCRT, respectively. SCRT with IMRT is comparable to conventional LCRT in both physical indexes and clinical outcome. The preoperative SCRT, compensated by IMRT, is an effective and safe modality.

Secondary scattered doses of IMRT for lung cancer cases

Dongwook Kim,Weon Kuu Chung,Myonggeun Yoon,Sung Ho Park 대한방사선방어학회 2012 대한방사선방어학회 학술발표회 논문요약집 Vol.2012 No.11

Risk of secondary cancers from scattered radiation during intensity-modulated radiotherapies for hepatocellular carcinoma

Kim, Dong Wook,Chung, Kwangzoo,Chung, Weon Kuu,Bae, Sun Hyun,Shin, Dong Oh,Hong, Seongeon,Park, Sung Ho,Park, Sung-Yong,Hong, Chae-Seon,Lim, Young Kyung,Shin, Dongho,Lee, Se Byeong,Lee, Hyun-ho,Sung, BioMed Central 2014 Radiation oncology Vol.9 No.-

<P><B>Purpose</B></P><P>To evaluate and compare the risks of secondary cancers from therapeutic doses received by patients with hepatocellular carcinoma (HCC) during intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT), and tomotherapy (TOMO).</P><P><B>Methods</B></P><P>Treatments for five patients with hepatocellular carcinoma (HCC) were planned using IMRT, VMAT, and TOMO. Based on the Biological Effects of Ionizing Radiation VII method, the excess relative risk (ERR), excess absolute risk (EAR), and lifetime attributable risk (LAR) were evaluated from therapeutic doses, which were measured using radiophotoluminescence glass dosimeters (RPLGDs) for each organ inside a humanoid phantom.</P><P><B>Results</B></P><P>The average organ equivalent doses (OEDs) of 5 patients were measured as 0.23, 1.18, 0.91, 0.95, 0.97, 0.24, and 0.20 Gy for the thyroid, lung, stomach, liver, small intestine, prostate (or ovary), and rectum, respectively. From the OED measurements, LAR incidence were calculated as 83, 46, 22, 30, 2 and 6 per 10<SUP>4</SUP> person for the lung, stomach, normal liver, small intestine, prostate (or ovary), and rectum.</P><P><B>Conclusions</B></P><P>We estimated the secondary cancer risks at various organs for patients with HCC who received different treatment modalities. We found that HCC treatment is associated with a high secondary cancer risk in the lung and stomach.</P>

Dosimetric comparison of different radiation treatment modalities for acoustic neuromas

Dong Wook Kim,Weon Kuu Chung,Dong Oh Shin,Dongho Shin 대한방사선방어학회 2014 대한방사선방어학회 학술발표회 논문요약집 Vol.2014 No.11

Secondary neutron dose measurement for proton eye treatment using an eye snout with a borated neutron absorber

Kim, Dong Wook,Chung, Weon Kuu,Shin, Jungwook,Lim, Young Kyung,Shin, Dongho,Lee, Se Byeong,Yoon, Myongguen,Park, Sung-Yong,Shin, Dong Oh,Cho, Jung Keun BioMed Central 2013 Radiation oncology Vol.8 No.-

<P><B>Background</B></P><P>We measured and assessed ways to reduce the secondary neutron dose from a system for proton eye treatment.</P><P><B>Methods</B></P><P>Proton beams of 60.30 MeV were delivered through an eye-treatment snout in passive scattering mode. Allyl diglycol carbonate (CR-39) etch detectors were used to measure the neutron dose in the external field at 0.00, 1.64, and 6.00 cm depths in a water phantom. Secondary neutron doses were measured and compared between those with and without a high-hydrogen–boron-containing block. In addition, the neutron energy and vertices distribution were obtained by using a Geant4 Monte Carlo simulation.</P><P><B>Results</B></P><P>The ratio of the maximum neutron dose equivalent to the proton absorbed dose (H(10)/D) at 2.00 cm from the beam field edge was 8.79 ± 1.28 mSv/Gy. The ratio of the neutron dose equivalent to the proton absorbed dose with and without a high hydrogen-boron containing block was 0.63 ± 0.06 to 1.15 ± 0.13 mSv/Gy at 2.00 cm from the edge of the field at depths of 0.00, 1.64, and 6.00 cm.</P><P><B>Conclusions</B></P><P>We found that the out-of-field secondary neutron dose in proton eye treatment with an eye snout is relatively small, and it can be further reduced by installing a borated neutron absorbing material.</P>