• Title/Summary/Keyword: 강내치료

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Accuracy of Dose Estimation in High Dose Rate Intracavitary Radiotherapy of Carcinoma of the Uterine Cervix (자궁경부암 고선량율 강내치료의 치료선량 정확도에 관한 연구)

  • Huh, Seung-Jae;Ha, Sung-Whan;Chai, Kyu-Young
    • Radiation Oncology Journal
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    • v.5 no.2
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    • pp.137-140
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    • 1987
  • In brachytherapy of uterine conical cancer using a high dose rate remote afterloading system, it is of prime importance to deliver a accurate dose in each fractionated treatment by minimizing the difference between the pre-treatment planned and post-treatment calculated doses. The post-treatment calculated point A dose was not much different from the pretreatment planned dose (500 cGy). The $average{\pm}standard$ deviation was $500\pm18cGy$ and 84 percent of 82 intracavitary radiotherapy was within the range of $500\pm25cGy$.

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Comparison between the Calculated and Measured Doses in the Rectum during High Dose Rate Brachytherapy for Uterine Cervical Carcinomas (자궁암의 고선량율 근접 방사선치료시 전산화 치료계획 시스템과 in vivo dosimetry system 을 이용하여 측정한 직장 선량 비교)

  • Chung, Eun-Ji;Lee, Sang-Hoon
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.396-404
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    • 2002
  • Purpose : Many papers support a correlation between rectal complications and rectal doses in uterine cervical cancer patients treated with radical radiotherapy. In vivo dosimetry in the rectum following the ICRU report 38 contributes to the quality assurance in HDR brachytherapy, especially in minimizing side effects. This study compares the rectal doses calculated in the radiation treatment planning system to that measured with a silicon diode the in vivo dosimetry system. Methods : Nine patients, with a uterine cervical carcinoma, treated with Iridium-192 high dose rate brachytherapy between June 2001 and Feb. 2002, were retrospectively analysed. Six to eight-fractions of high dose rate (HDR)-intracavitary radiotherapy (ICR) were delivered two times per week, with a total dose of $28\~32\;Gy$ to point A. In 44 applications, to the 9 patients, the measured rectal doses were analyzed and compared with the calculated rectal doses using the radiation treatment planning system. Using graphic approximation methods, in conjunction with localization radiographs, the expected dose values at the detector points of an intrarectal semiconductor dosimeter, were calculated. Results : There were significant differences between the calculated rectal doses, based on the simulation radiographs, and the calculated rectal doses, based on the radiographs in each fraction of the HDR ICR. Also, there were significant differences between the calculated and measured rectal doses based on the in-vivo diode dosimetry system. The rectal reference point on the anteroposterior line drawn through the lower end of the uterine sources, according to ICRU 38 report, received the maximum rectal doses in only 2 out of the nine patients $(22.2\%)$. Conclusion : In HDR ICR planning for conical cancer, optimization of the dose to the rectum by the computer-assisted planning system, using radiographs in simulation, is improper. This study showed that in vivo rectal dosimetry, using a diode detector during the HDR ICR, could have a useful role in quality control for HDR brachytherapy in cervical carcinomas. The importance of individual dosimeters for each HDR ICR is clear. In some departments that do not have the in vivo dosimetry system, the radiation oncologist has to find, from lateral fluoroscopic findings, the location of the rectal marker before each fractionated HDR brachytherapy, which is a necessary and important step of HDR brachytherapy for cervical cancer.

High versus Low Dose-Rate Intracavitary Irradiation for Adenocarcinoma of the Uterine Cervix (자궁경부 선암 환자에서 고선량률 강내치료와 저선량률 강내치료의 비교)

  • Kim Woo Chul;Kim Gwi Eon;Chung Eun Ji;Suh Chang Ok;Hong Soon Won;Cho Young Kap;Loh JK
    • Radiation Oncology Journal
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    • v.18 no.1
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    • pp.32-39
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    • 2000
  • Purpose :The incidence of adenocarcinoma of the uterine cervix is low. Traditionally, Low Dose Rate (LDR) brachytherapy has been used as a standard modality in the treatment for patients with carcinoma of the uterine cervix. The purpose of this report is to evaluate the effects of the High dose rate (HDR) brachytherapy in the patients with adenocarcinoma of the uterine cervix compared with the LDR. : From January 1971 to December 1992, 106 patients of adenocarcinoma of uterine cervix were treated with radiation therapy in the Department of Radiation Oncology, Yonsei University with curative intent. LDR brachytherapy was carried out on 35 patients and 71 patients were treated with HDR brachytherapy. In LDR Group, 8 patients were in stage I, 18 in stage II and 9 in stage III. External radiation therapy was delivered with 10 MV X-ray, daily 2 Gy fractionation, total dose 40$\~$46Gy (median 48 Gy). And LDR Radium intracavitary irradiation was peformed with Henschke applicator, 22$\~$59 Gy to point A (median 43 Gy). In HDR Group, there were 16 patients in stage 1, 38 in stage II and 17 in stage III. The total dose of external radiation was 40$\~$61 Gy(median 45 Gy), daily 1.8$\~$2.0 Gy. HDR Co-60 intracavitary irradiation was peformed with RALS (Remote Afterloading System), 30 $\~$ 57 Gy(median 39 Gy) to point A, 3 times a week, 3 Gy per fraction. Conclusion : The 5-year overall survival rate in LDR Group was 72.9$\%$, 61.9$\%$, 45.0$\%$ in stage I, II, III, respectively and corresponding figures for HDR were 87.1$\%$, 58.3$\%$, 41.2$\%$, respectively (p>0.05). There was no statistical difference in terms of the 5-year overall survival rate between HDR Group and LDR Group in adenocarcinoma of the uterine cervix. There was 11$\%$ of late complication rates in LDR Group and 27$\%$ in HDR Group. There were no prognostic factors compared HDR with LDR group. The incidence of the late complication rate in HDR Group stage II, III was higher than that in LDR Group(16.7$\%$ vs. 31.6$\%$ in stage II, 11.1$\%$ vs. 35.3$\%$ In stage III, p>0.05). Although the incidence of radiation induced late complication rate was higher in HDR Group stage II and III patients than that in the LDR Group, statistical significance was not detected and within acceptable level. Conclusion : There was no difference in terms of 5-year survival rate and failure pattern in the patients with adenocarcinoma of the uterine cervix treated with HDR and LDR brachytherapy. Even late complication rates were higher in the HDR group It was an acceptable range. This retrospective study suggests that HDR brachytherapy seems to replace the LDR brachytherapy in the adenocarcinoma of the uterine cervix. However, further studies will be required to refine the dose rate effects.

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강내 조사용 $^192$Ir 치료선원 제조

  • 조운갑;한현수;박춘득;홍순복;최태진
    • Proceedings of the Korean Nuclear Society Conference
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    • 1998.05b
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    • pp.757-762
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    • 1998
  • “하나로”를 이용하여 강내 조사용으로 사용되는 $^{192}$ Ir 선원의 제조법을 확립하였다. HTS (Hydraulic Transfer System)조사공에서 48시간 조사한 $\psi$2.5 mm x t 0.25 mm의 원판형 Ir 표적 10장을 쌓아서 방사능이 1.012 Ci인 선원을 시험제조하였다. 선원 제작에 관련된 생성방사능, 중성자 자기홉수효과 인자를 이론적으로 계산하여 시험제조에 사용하였고 ${\gamma}$선 자기흡수효과는 실험으로 측정하여 암 치료에 요구되는 10-20 Ci 선원의 상용생산에 필요한 자료를 확보하였다. 치료용 소선원 제작에 관련된 표적제작, 중성자조사, 방사능 측정, 선원조립, 밀봉용접, 품질관리 등의 제작기술을 확립하고 선원의 안전성은 밀봉시험, 표면오염검사 등을 수행하여 확인하였다. 제조된 선원은 실제 사용되는 조사장치에 장착하여 기능시험을 수행할 것이다. 이번 실험을 통하여 강내 조사용으로 사용되는 10-20 Ci 방사능의 $^{192}$ Ir 선원을 안정적으로 공급할 수 있음을 확인하였으며 하나로를 이용하여 캡슐 직경 4 mm의 치료용 소선원 제작기술을 확립하였다. 개발된 /spp 192/Ir 강내 조사용 선원은 국내 5-6개 병원에 공급할 것이며 이 기술을 바탕으로 직경 1.1-1.6 mm의 강내 조사용 선원도 개발할 예정이다.

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Optimum Dose Combination of External Radiation and High Dose Rate ICR in FIGO IB Uterine Cervical Cancer (병기 IB 자궁경부암의 방사선치료에서 외부방사선치료와 고선량율 강내치료의 최적선량 배합)

  • Lee Sang Wook;Suh Chang Ok;Chung Eun Ji;Kim Woo Cheol;Chang Sei Kyung;Keum Ki Chang;Kim Gwi Eon
    • Radiation Oncology Journal
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    • v.14 no.3
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    • pp.201-209
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    • 1996
  • Purpose : To assess the efficacy of high dose rate - intracavitary radio-therapy (HDR-ICR) in the radiotherapy of FIGO stage IB squamous cell carcinoma of uterine cervix and to determine the optimum dose combination scheme of external radiotherapy and ICR to achieve acceptable local control without severe complication. Materials and Methods : One hundred and sixty two patients with FIGO stage Ib squamous cell carcinoma of uterine cervix who received definitive radiotherapy between May 1979 and December 1990 were retrospectively analyzed. All the patients received external radiotherapy combined with HDR-ICR. External dose of 40-46 Gy in 4.5-5 weeks was given to whole pelvis(median 45 Gy) and ICR dose of 30-39 Gy in 10-13 times was given to the point A. Midline shielding was done after 20-45 Gy of external radiotherapy(median 40 Gy) Summation of external dose Plus ICR dose to the point A range were 64.20-95.00 Gy. and mean was 83.94 Gy. We analyzed the local control rate, survival rate, and late complication rate. Rusults : Initial complete response rate was $99.4\%$ for all patients. Overall 5-year survival rate was $91.1\%$ and 5-year disease free survival rate was $90.9\%$. Local failure rate was $4.9\%$ and distant failure rate was $4.3\%$. Tumor size was the only significant prognostic factor. When tumor size greater than 3cm, 5-rear survival rate was $92.6\%$ and less than 3cm, that was $79.6\%$. Late complication rate was $23.5\%$ with $18.5\%$ of rectal complication and $4.9\%$ of bladder complication. Mean rectal dose summation of external midline dose plus ICR rectal point dose was lower in the patients without rectal complication(74.88 Gr) than those with rectal complication (78.87 Gy). Complication rate was increased with low rate of improvement of survival rate when summation of external midline dose plus point A or point R dose by ICR was greater than 70-75 Gy. Conclusion : The definitive radiation therapy using high dose rate ICR in FIGO stage IB uterine cervical cancer is effective treatment modality with good local control and survival rate without severe complication.

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The evaluation of absorbed dose of rectum for the patient of intracavitary treatment $^{60}$ Co by MgB$_4$O$_{7}$ (Mn) TLD (MgB$_4$O$_{7}$ (Mn) TLD에 의한 $^{60}$ Co 강내 치료 환자의 직장의 흡수선량 평가)

  • 유명진;신병철;문창우;정태식;염하용;도시홍
    • Progress in Medical Physics
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    • v.5 no.2
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    • pp.21-26
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    • 1994
  • By measuring with TLD, absorbed dose of rectum will be determined more accurately than calculated value. MgB$_4$O$\sub$7/(Mn) TLD phosphor was prepared and its characteristic was studied. To measure the absorbed dose of rectum with TLD, 33 patients who had intracavitary treatment with $\^$60/Co from April 1994 to September 1994 at Kosin Medical center. There were 10-59% differecne in most cases between the calculation and the measurement for the absorbed dose of rectum. The difference was less the case with tandem and ovoid than the case with only ovoid.

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Dose Distribution&Calibration in HDR Intracavitary Irradiation for Uterine Cervical Cancer (자궁경부암의 강내치료를 위한 선량측정)

  • 김진기;김정수;김형진;권형철
    • Progress in Medical Physics
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    • v.6 no.1
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    • pp.13-18
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    • 1995
  • Dose distribution of HDR-RALS source represents an inverse square law as the distance. Difference of measurement value and calculation value according of brachytherapy. Therefore, in HDR-RALS dose calibration and calculation have an important effect in treatment of uterine cervical cancer and absorbed dose of interesting points. In intracavitary therapy, particula attention is paid for precise determination of the doses to be applied. In this report, we have discussed that the calibration of a HDR-RALS, differences between calculation dose use of isodose chart and measurement in rectum. Dose rate calibration of radiation sources are obtained from air kerma and Г factor with calibraed ion chamber for cobalt source. and used semiconductor detector for compared with measurement in phantom. Eighteen patients were treated with a HDR-RALS for intrcavitarty irradiation (ICR) using a cobalt-cesium source. Repoductivity of dose measurements were 0.3 -1.1% in phantom. The means of dose distribution was -6- +21% between calculation of isodose chart and measurement of recyum, and was same mean value upper 6.3% in measurement value than calculation does.

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Rectal Complication Following Radical Radiotherapy in Carcinoma of the Uterine Cervix (자궁경부암에서 근치적 방사선치료 후의 직장 합병증)

  • Kim Won-Dong;Park Woo-Yoon
    • Radiation Oncology Journal
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    • v.24 no.1
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    • pp.44-50
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    • 2006
  • Puroose: This study evaluated the late rectal complications in cervix cancer patients following treatment with external beam radiotherapy (EBRT) and high dose rate intracavitary radiation (HDR ICR). The factors affecting the risk of developing late rectal complications and its incidence were analyzed and discussed. Materials and Methods: The records of 105 patients with cervix cancer who were treated with radical radiotherapy using HDR ICR between July, 1995 and December, 2001 were retrospectively reviewed. The median dose of EBRT was 50.4Gy $(41.4{\sim}56.4 Gy)$ with a daily fraction size of 1.8Gy. A total of $5{\sim}7$ (median: 6) fractions of HDR ICR were given twice weekly with a fraction size of $4{\sim}5 Gy$ (median: 4Gy) to A point using an Ir (Iridium)-192 source. The median dose of ICR was 24 Gy $(20{\sim}35 Gy)$. During HDR ICR, the rectal dose was measured in vivo by a semiconductor dosimeter. The median follow-up period was 32 months, ranging from 5 to 84 months. Results: Of the 105 patients, 12 patients (11%) developed late rectal complications: 7 patients with grade 1 or 2, 4 patients with grade 3 and 1 patient with grade 4. Rectal bleeding was the most frequent chief complaint. The complications usually began to occur $5{\sim}32$ (median: 12) months after the completion of radiotherapy. Multivariate analysis revealed that the measured cumulative rectal BED over 115 Gy3 (Deq over 69 Gy) and the depth (D) of a 5 Gy isodose volume more than 50 mm were the independent predictors for late rectal complications. Conclusion: With evaluating the cumulative rectal BED and the depth of a 5 Gy isodose volume as predictors, we can individualize treatment planning to reduce the probability of late rectal complications.

Treatment of Carcinoma of the Uterine Cervix with High-Dose-Rate Intracavitary Irradiation using Ralstron (고선량률 강내조사를 사용한 자궁경부암의 치료)

  • Suh Chang Ok;Kim Gwi Eon;Loh John J.K.
    • Radiation Oncology Journal
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    • v.8 no.2
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    • pp.231-239
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    • 1990
  • From May 1979 through December 1981 a total of 524 patients with carcinoma of the uterine cervix were treated by radiation therapy with curative intent. Among the 524 patients, 350 were treated with a high-dose-rate (HDR), remote-controlled, afterloading intracavitary irradiation (ICR) system using a cobalt source (Ralstron), and 168 patients received a low-dose-rate (LDR) ICR using a radium source. External beam irradiation with a total dose of 40-50 Gy to the whole pelvis followed by intracavitary irradiation with a total dose of 30-39 Gy in 10-13 fractions to point A was the treatment protocol. ICR was given three times a week with a dose of 3 Gy per fraction. Five-year actuarial survival rates in the HDR-ICR group were $77.6{\%}$ in stage IB (N=20), $68.2{\%}$ in stage II (N=182), and $50.9{\%}$ in stage III (N=148). In LDR-ICR group, 5-year survival rates were $87.5{\%}$ in stage IB (N=22), $66.3{\%}$ in stage II (N=91), and $55.4{\%}$ in stage III (N=52). Survival rates showed a statistically significant difference by stage, but there was no significant difference between the two ICR groups. Late bowel complications after radiotherapy were noted in $3.7{\%}$ of the HDR-ICR group and $8.4{\%}$ of the LDR-ICR group. There was no severe complication requiring surgical management. The incidence of bladder complications was $1.4{\%}$ in the HDR-ICR group and $2.4{\%}$ in the LDR-ICR group. The application of HDR-ICR was technically simple and easily performed on an outpatient basis without anesthesia, and the patients tolerated it very well. Radiation exposure to personnel was virtually nil in contrast to that of LDR-ICR. Within a given period of time, more patients can be treated with HDR-ICR because of the short treatment time. Therefore, the HDR-ICR system is highly recommended for a cancer center, particularly one with a large number of patients to be treated. In order to achieve an improved outcome, however, the optimum dose-fractionation schedule of HDR-ICR and optimum combination of intracavitary irradiation with external beam irradiation should be determined through an extensive protocol.

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