Helical tomotherapy for spine oligometastases from gastrointestinal malignancies

Yunseon Choi,Jun Won Kim,Ik Jae Lee,Hee Ji Han,Jonggeal Baek,Jinsil Seong 대한방사선종양학회 2011 Radiation Oncology Journal Vol.29 No.4

Purpose: This study evaluated the treatment effectiveness and proper radiation dose of helical tomotherapy (HT) in spine oligometastases from gastrointestinal cancers. Materials and Methods: From 2006 to 2010, 20 gastrointestinal cancer patients were treated with HT for spine oligometastases (31 spine lesions). The gross tumor volume (GTV) was the tumor evident from magnetic resonance imaging images fused with simulation computed tomography images. Clinical target volume (CTV) encompassed involved vertebral bodies or dorsal elements. We assumed that the planning target volume was equal to the CTV. We assessed local control rate after HT for 31 spine metastases. Pain response was scored by using a numeric pain intensity scale (NPIS, from 0 to 10). Results: Spine metastatic lesions were treated with median dose of 40 Gy (range, 24 to 51 Gy) and median 5 Gy per fraction (range, 2.5 to 8 Gy) to GTV with median 8 fractions (range, 3 to 20 fraction). Median biologically equivalent dose (BED, α/β = 10 Gy) was 52 Gy₁₀ (range, 37.5 to 76.8 Gy₁₀) to GTV. Six month local control rate for spine metastasis was 90.3%. Overall infield failure rate was 15% and outfield failure rate was 75%. Most patients showed pain relief after HT (93.8%). Median local recurrence free survival was 3 months. BED over 57 Gy₁₀ and oligometastases were identified as prognostic factors associated with improved local progression free survival (p = 0.012, p = 0.041). Conclusion: HT was capable of delivering higher BED to metastatic lesions in close proximity of the spinal cord. Spine metastases from gastrointestinal tumors were sensitive to high dose radiation, and BED (α/β = 10 Gy) higher than 57 Gy₁₀ could improve local control.

Aggressive clinical course of extramammary Paget disease after radiotherapy

Yunseon Choi,MD,Won Park,MD,PhD,Jeeyun Lee,MD,PhD,Eun Yoon Cho,MD,PhD,Goo-Hyun Moon,MD,PhD 대한방사선종양학회 2014 Radiation Oncology Journal Vol.32 No.2

Extramammary Paget disease (EMPD) is a rare disease, especially in Asian populations. Surgical resection is considered the primary treatment option. Recently, radiotherapy has been suggested as an EMPD treatment, either as an alternative to surgical resection or in combination with surgical resection. This report reviewed a patient with EMPD who was treated with wide excision of the EMPD site followed by radiotherapy for remaining gross lymph node metastases. The aim of this report was to determine the optimal treatment for advanced EMPD.

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

Choi, Yunseon,Lee, Ik Jae,Lee, Chang Young,Cho, Jae Ho,Choi, Won Hoon,Yoon, Hong In,Lee, Yun-Han,Lee, Chang Geol,Keum, Ki Chang,Chung, Kyung Young,Haam, Seok Jin,Paik, Hyo Chae,Lee, Kang Kyoo,Moon, Su The Korean Society for Radiation Oncology 2015 Radiation Oncology Journal 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.

Aggressive clinical course of extramammary Paget disease after radiotherapy

Choi, Yunseon,Park, Won,Lee, Jeeyun,Cho, Eun Yoon,Moon, Goo-Hyun The Korean Society for Radiation Oncology 2014 Radiation Oncology Journal Vol.32 No.2

Extramammary Paget disease (EMPD) is a rare disease, especially in Asian populations. Surgical resection is considered the primary treatment option. Recently, radiotherapy has been suggested as an EMPD treatment, either as an alternative to surgical resection or in combination with surgical resection. This report reviewed a patient with EMPD who was treated with wide excision of the EMPD site followed by radiotherapy for remaining gross lymph node metastases. The aim of this report was to determine the optimal treatment for advanced EMPD.

Association between obesity and local control of advanced rectal cancer after combined surgery and radiotherapy

Choi, Yunseon,Lee, Yun-Han,Park, Sung Kwang,Cho, Heunglae,Ahn, Ki Jung The Korean Society for Radiation Oncology 2016 Radiation Oncology Journal Vol.34 No.2

Purpose: The association between metabolism and cancer has been recently emphasized. This study aimed to find the prognostic significance of obesity in advanced stage rectal cancer patients treated with surgery and radiotherapy (RT). Materials and Methods: We retrospectively reviewed the medical records of 111 patients who were treated with combined surgery and RT for clinical stage 2-3 (T3 or N+) rectal cancer between 2008 and 2014. The prognostic significance of obesity (body mass index [BMI] ${\geq}25kg/m^2$) in local control was evaluated. Results: The median follow-up was 31.2 months (range, 4.1 to 85.7 months). Twenty-five patients (22.5%) were classified as obese. Treatment failure occurred in 33 patients (29.7%), including local failures in 13 patients (11.7%), regional lymph node failures in 5, and distant metastases in 24. The 3-year local control, recurrence-free survival, and overall survival rates were 88.7%, 73.6%, and 87.7%, respectively. Obesity (n = 25) significantly reduced the local control rate (p = 0.045; 3-year local control, 76.2%), especially in women (n = 37, p = 0.021). Segregation of local control was best achieved by BMI of $25.6kg/m^2$ as a cutoff value. Conclusion: Obese rectal cancer patients showed poor local control after combined surgery and RT. More effective local treatment strategies for obese patients are warranted.

The impact of radiotherapy on clinical outcomes in parameningeal rhabdomyosarcoma

Choi, Yunseon,Lim, Do Hoon The Korean Society for Radiation Oncology 2016 Radiation Oncology Journal Vol.34 No.4

Purpose: Radiotherapy (RT) is considered a mainstay of treatment in parameningeal rhabdomyosarcoma (PM-RMS). We aim to determine the treatment outcomes and prognostic factors for PM-RMS patients who treated with RT. In addition, we tried to evaluate the adequate dose and timing of RT. Materials and Methods: Twenty-two patients with PM-RMS from 1995 to 2013 were evaluated. Seven patients had intracranial extension (ICE) and 17 patients had skull base bony erosion (SBBE). Five patients showed distant metastases at the time of diagnosis. All patients underwent chemotherapy and RT. The median radiation dose was 50.4 Gy (range, 40.0 to 56.0 Gy). Results: The median follow-up was 28.7 months. Twelve patients (54.5%) experienced failure after treatment; 4 local, 2 regional, and 6 distant failures. The 5-year local control (LC) and overall survival (OS) were 77.7% and 38.5%, respectively. The 5-year OS rate was 50.8% for patients without distant metastases and 0% for patients with metastases (p < 0.001). Radiation dose (<50 Gy vs. ${\geq}50Gy$) did not compromise the LC (p = 0.645). However, LC was affected by ICE (p = 0.031). Delayed administration (>22 weeks) of RT was related to a higher rate of local failure (40.0%). Conclusion: RT resulted in a higher rate of local control in PM-RMS. However, it was not extended to survival outcome. A more effective treatment for PM-RMS is warranted.

Adverse effect of excess body weight on survival in cervical cancer patients after surgery and radiotherapy

Choi, Yunseon,Ahn, Ki Jung,Park, Sung Kwang,Cho, Heunglae,Lee, Ji Young The Korean Society for Radiation Oncology 2017 Radiation Oncology Journal Vol.35 No.1

Purpose: This study aimed to assess the effects of body mass index (BMI) on survival in cervical cancer patients who had undergone surgery and radiotherapy (RT). Materials and Methods: We retrospectively reviewed the medical records of 70 cervical cancer patients who underwent surgery and RT from 2007 to 2012. Among them, 40 patients (57.1%) had pelvic lymph node metastases at the time of diagnosis. Sixty-seven patients (95.7%) had received chemotherapy. All patients had undergone surgery and postoperative RT. Median BMI of patients was $22.8kg/m^2$ (range, 17.7 to $35.9kg/m^2$). Results: The median duration of follow-up was 52.3 months (range, 16 to 107 months). Twenty-four patients (34.3%) showed recurrence. Local failure, regional lymph nodal failure, and distant failure occurred in 4 (5.7%), 6 (8.6%), and 17 (24.3%) patients, respectively. The 5-year actuarial pelvic control rate was 83.4%. The 5-year cancer-specific survival (CSS) and disease-free survival (DFS) rates were 85.1% and 65.0%, respectively. The presence of pelvic lymph node metastases (n = 30) and being overweight or obese (n = 34, $BMI{\geq}23kg/m^2$) were poor prognostic factors for CSS (p = 0.003 and p = 0.045, respectively). Of these, pelvic lymph node metastasis was an independent prognostic factor (p = 0.030) for CSS. Conclusion: Overweight or obese cervical cancer patients showed poorer survival outcomes than normal weight or underweight patients. Weight control seems to be important in cervical cancer patients to improve clinical outcomes.

Social Design for future society

Yunseon Choi(최윤선) 한국디자인학회 2015 한국디자인학회 국제초대전도록 Vol.2015 No.5

HCC : PE-066 ; Prognostic significance of portal vein tumor thrombosis response in locally advanced hepatocellular carcinoma treated with radiation and concurrent intra-arterial chemotherapy

( Yunseon Choi ),( Jun Won Kim ),( Hye Jung Cha ),( Kwang Hyub Han ),( Jin Sil Seong ) 대한간학회 2012 춘·추계 학술대회 (KASL) Vol.2012 No.1

Purpose: The aim of this study was to investigate prognostic significance of portal vein tumor thrombosis (PVTT) response in hepatocellular carcinoma (HCC) patients treated with concurrent chemoradiotherapy (CCRT). Methods and Materials: One hundred patients (28 with helical tomotherapy and 72 with 3-dimensional conformal radiotherapy) treated with CCRT for the International Union Against Cancer (UICC) stage T2-4N0M0 HCC with PVTT between 2002 and 2011 were analyzed retrospectively. The radiotherapy (RT) volume included primary tumor and PVTT, and median radiation dose was 45 Gy (range 45-60 Gy) delivered in 1.8 to 3 Gy per fraction. Treatment response was evaluated up to 6 months after RT. Results: Tumor thrombus in the main PV, first and second branches of PV were detected in 38 (38%), 44 (44.0%) and 18 (18.0%) patients, respectively. In terms of PVTT response to treatment, complete response (CR) and partial response (PR) were achieved in 14% and 51% of patients, respectively, giving objective response (OR) rate of 65.0%. Progression-free rate of PVTT was 91.0%. PVTT size (> 3 cm in diameter) was associated with the lower rate of complete response (CR) (p=0.001). Median overall survival (OS) was 10.5 months, and the 1- and 2-year survival rates were 42.8% and 20.3%, respectively. Significant variables associated with OS included alpha-fetoprotein level (400 ng/ml ≤), and OR of tumor to RT and CR of PVTT. Independent prognostic factors for OS were OR of tumor to RT and CR of PVTT. Achieving OR in both tumor and PVTT had significant correlation with improved survival (p=0.017). Conclusions: PVTT showed a substantial response (65%) to CCRT with a higher CR rate for PVTT smaller than 3 cm. CR of PVTT was associated with an improved overall survival. Patients achieving OR of both PVTT and tumor showed the best outcome (p=0.017).

The impact of radiotherapy on clinical outcomes in parameningeal rhabdomyosarcoma

Yunseon Choi,Do Hoon Lim 대한방사선종양학회 2016 Radiation Oncology Journal Vol.34 No.4

Purpose: Radiotherapy (RT) is considered a mainstay of treatment in parameningeal rhabdomyosarcoma (PM-RMS). We aim to determine the treatment outcomes and prognostic factors for PM-RMS patients who treated with RT. In addition, we tried to evaluate the adequate dose and timing of RT. Materials and Methods: Twenty-two patients with PM-RMS from 1995 to 2013 were evaluated. Seven patients had intracranial extension (ICE) and 17 patients had skull base bony erosion (SBBE). Five patients showed distant metastases at the time of diagnosis. All patients underwent chemotherapy and RT. The median radiation dose was 50.4 Gy (range, 40.0 to 56.0 Gy). Results: The median follow-up was 28.7 months. Twelve patients (54.5%) experienced failure after treatment; 4 local, 2 regional, and 6 distant failures. The 5-year local control (LC) and overall survival (OS) were 77.7% and 38.5%, respectively. The 5-year OS rate was 50.8% for patients without distant metastases and 0% for patients with metastases (p < 0.001). Radiation dose (<50 Gy vs. ≥50 Gy) did not compromise the LC (p = 0.645). However, LC was affected by ICE (p = 0.031). Delayed administration (>22 weeks) of RT was related to a higher rate of local failure (40.0%). Conclusion: RT resulted in a higher rate of local control in PM-RMS. However, it was not extended to survival outcome. A more effective treatment for PM-RMS is warranted.