• Radiation Oncology Journal
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• 제37권2호
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• pp.91-100
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• 2019

Purpose: Internal mammary lymph node (IMN) involvement is associated with poor prognosis in breast cancer. This study investigated the treatment outcomes of initial clinically IMN-positive breast cancer patients who received adjuvant radiotherapy (RT), including IMN irradiation, following primary breast surgery. Materials and Methods: We retrospectively reviewed data of 95 breast cancer patients with clinically detected IMNs at diagnosis treated with surgery and RT between June 2009 and December 2015. Patients received adjuvant RT to the whole breast/chest wall and regional lymph node (axillary, internal mammary, and supraclavicular) areas. Twelve patients received an additional boost to the IMN area. Results: The median follow-up was 43.2 months (range, 4.5 to 100.5 months). Among 77 patients who received neoadjuvant chemotherapy, 52 (67.5%) showed IMN normalization and 19 (24.6%) showed a partial response to IMN. There were 3 and 24 cases of IMN failure and any recurrence, respectively. The 5-year IMN failure-free survival, disease-free survival (DFS), and overall survival (OS) were 96%, 70%, and 84%, respectively. IMN failure-free survival was significantly affected by resection margin status (97.7% if negative, 87.5% for close or positive margins; p = 0.009). All three patients with IMN failure had initial IMN size ≥1 cm and did not receive IMN boost irradiation. The median age of the three patients was 31 years, and all had hormone receptor-negative tumors. Conclusion: RT provides excellent IMN control without the support of IMN surgery. Intensity-modulated radiotherapy, including IMN boost for breast cancer patients, is a safe and effective technique for regional lymph node irradiation.

• Radiation Oncology Journal
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• 제37권2호
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• pp.101-109
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• 2019

Purpose: The purpose of this study is to evaluate the safety and efficacy of the multimodality treatment with neoadjuvant intensity-modulated radiotherapy (IMRT) for resectable clinical T1-3N0-1M0 malignant pleural mesothelioma (MPM). Materials and Methods: A total of eleven patients who received neoadjuvant chemotherapy and radiotherapy between March 2016 and June 2018 were reviewed. Patients received 25 Gy in 5 fractions to entire ipsilateral hemithorax with helical tomotherapy. Results: All of patients were men with a median age of 56 years. Epithelioid subtype was found in 10 patients. All patients received neoadjuvant chemotherapy with pemetrexed-cisplatin regimen. Ten patients (90.9%) completed 25 Gy/5 fractions and one (9.0%) completed 20 Gy/4 fractions of radiotherapy. IMRT was well tolerated with only one acute grade 3 radiation pneumonitis. Surgery was performed 1 week (median, 8 days; range, 1 to 15 days) after completing IMRT. Extrapleural pneumonectomy was performed in 4 patients (36.3%), extended pleurectomy/decortication in 2 (18.2%) and pleurectomy/decortications in 5 (63.6%). There was no grade 3+ surgical complication except two deaths after EPP in 1 month. Based on operative findings and pathologic staging, adjuvant chemotherapy was delivered in 7 patients (63.6%), and 2 (18.2%) were decided to add adjuvant radiotherapy. After a median follow-up of 14.6 months (range, 2.8 to 30 months), there were 3 local recurrence (33.3%) and 1 distant metastasis (11.1%). Conclusion: Neoadjuvant entire pleural IMRT can be delivered with a favorable radiation complication. An optimal strategy has to be made in resectable MPM patients who would benefit from neoadjuvant radiation and surgery. Further studies are needed to look at long-term outcomes.

• Radiation Oncology Journal
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• 제37권2호
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• pp.110-116
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• 2019

Purpose: This study aimed to identify prognostic factors for locoregional recurrence (LRR) in pT3N0 rectal cancer patients who were treated with surgery alone and had negative resection margin including circumferential resection margin (CRM) for optimal indication of adjuvant radiotherapy. Materials and Methods: We reviewed patients with pT3N0 rectal cancer who were treated via upfront surgery and had no other adjuvant treatment from January 2003 to December 2012. In total, 122 patients who had negative resection margin including negative CRM were included in the analysis. Results: The median follow-up period after surgery was 60 months (range, 3 to 161 months). During this time, 6 patients (4.9%) experienced LRR at the anastomotic site (4 patients), and regional lymphatic area (2 patients). The estimated 5-year rates of overall survival, recurrence-free survival, and LRR-free survival were 96.7%, 84.6%, and 94.0%, respectively. Multivariate analysis showed that level of tumor ≤5 cm was a significant prognostic factor for LRR-free survival (LRRFS) (p = 0.04; hazard ratio = 7.08; 95% confidence interval, 1.06-47.30). Patients with level of tumor ≤5 cm had an estimated 5-year LRRFS of 66.8%, which was much higher than 2.3% in patients with level of tumor >5 cm. There was no significant factor for recurrence-free survival or overall survival. Conclusion: In T3N0 rectal cancer, adjuvant chemoradiotherapy should be recommended in patients with level of tumor ≤5 cm for better local control. However, in patients with pT3N0 disease, negative resection margin, and level of tumor >5 cm, adjuvant chemoradiotherapy should be carefully suggested.

• 대한한방종양학회지
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• 제6권1호
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• pp.1-18
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• 2000

The present study was performed in order to evaluate the effects of the gamihyangsayukgunjatang on radioprotection and apoptosis in small intestines of mice after whole body irradiation. Two hundred forty mice were divided into 40 groups according to the radiation dose and the gamihyangsayukgunjatang treatment. The extracts of the herbal medicines were orally administered to each group differently before and/or after irradiation. The gamihyangsayukgunjatang treated groups were divided into 3 groups. Sample Ⅰ was the group treated with the gamihyangsayukgunjatang for 3 days before the radiation, sample Ⅱ was the group treated with the gamihyangsayukgunjatang for 3 days after the radiation. Sample Ⅲ was the group treated with the gamihyangsayukgunjatang for both 3 days before and after the radiation. To analyze the crypt survival, the micradony survival assay was used according to the Withers and Elind's method. To analyze the apptosis, the TUNEL assay was done. The results obtained are a follows : 1. From the microcolony survival assay, the gamihyangsayukgunjatang treated groups showed the radioprotective effect with a statistical significance(p<0.05), as compared to the control group. Comparing the radioprotective effect among the 3 groups, sample III was statistically more significant than sample I and II (p<0.05). Sample I showed no effect. In accordance with the research mentioned above, it is suggested that the radioprotective effect of the gamihyangsayukgunjatang is more useful for the treatment of the radiation injury rather that the prevention. 2. The results of the TUNEL assay showed that the apoptotic index in the gamihyangsayukgunjatang treated group was slightly decreased with no effectiveness, as compared to the control group. According to the above results, it could be suggested that the gamihyangsayukgujatang has a prominent protective effect in mice intestines against the radiation damage. However, the radioprotective effect does not seem to be related to inhibition of the apoptosis.

• Radiation Oncology Journal
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• 제7권1호
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• pp.93-100
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• 1989

전자선의 선량을 측정하기 위하여 수종의 측정기와 팬톰의 조합에 대해서 실험 및 결과를 분석하였다. 전자선의 선축상 선량분포가 조사면의 크기에 좌우되는지를 알기 위하여 실리콘 PN 접합형 다이오드를 사용하였다. 50 및 80, $90\%$ 선량점의 깊이가 작은 조사면에 대해서는 조사면의 크기에 따라 증가하지만, 큰 조사면에 대해서는 거의 일정했다. 그러나 그 깊이가 일정한 경우 최소 조사면의 크기가 뚜렷하지는 않으나 전자선의 에너지가 증가함에 따라 증가하였다. $6\~18MeV$의 전자선에 대해 조사면의 크기가 $10\times10cm^2$ 이상인 경우 그 깊이 가 어느 에너지에 대해서도 조사면의 크기에 무관함이 측정치에서 관찰되었다. 그래서 수종의 측정기와 팬톰의 결합에 따른 전자선의 선축상 선량분포의 차이점을 관찰하고자 하는 실험에서 조사면의 크기로 $10\times10cm^2$을 선택하였다. 원주형 전리함과 평판형 전리함, 필름은 폴리스티렌 팬톰과 함에, 실리콘다이오드는 물팬톤과 함께 선량측정에 이용되었다. 원주형 전리함은 표면선량이나 6MeV처럼 낮은 에너지의 선량증가 영역에서 선량을 측정할 수 없었다. 몇 가지를 제외하고는 측정된 변수들은 서로 다른 측정기 및 팬톰의 결합에 관계없이 거의 동일하였다. 어떤 에너지에서는 서로 다른 측정기에 의한 표면선량이 $4\%$ 정도 차이가 났으며, 에너지가 증가함에 따라 그 대소가 반전되기도 하였다. 18MeV의 경우 필름에 의한 80 및 $90\%$ 선량점의 깊이가 다른 측정기에 의한 것보다 꽤 얕았다. 평판형 전리함과 실리콘 다이오드는 전자선의 선량분포측정에 사용될 수 있겠으나 평판형 전리함은 큰 조사면에서만 사용하는 것이 바람직할 것이 다. 표면선량 측정이나 저 에너지 전자선의 선량증가 부분에서 선량측정에는 원주형 전리함을 사용하지 않는 것이 바람직할 것이다. 18 MeV와 같이 높은 에너지의 전자선의 선량분포 측정에 필름이 사용되어도 좋을지 의심스럽다.

• Radiation Oncology Journal
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• 제29권4호
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• pp.228-235
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• 2011

Purpose: To evaluate the impact of postoperative radiotherapy (PORT) on patterns of failure and survivals in uterine carcinosarcoma patients treated with radical surgery. Materials and Methods: Between October 1998 and August 2010, 19 patients with stage I-III uterine carcinosarcoma received curative hysterectomy and bilateral salpingo-oophorectomy with or without PORT at Seoul National University Hospital. Their hospital medical records were retrospectively reviewed. PORT and non-PORT groups included 11 and 8 patients, respectively. They were followed for a mean of 22.7 months (range, 7.8 to 126.6 months). Results: At 5 years, the overall survival rates were 51.9% for entire, 61.4% for PORT, and 41.7% for non-PORT groups, respectively. There was no statistical difference between PORT and non-PORT groups with regard to overall survival (p = 0.682). Seven out of 19 (36.8%) patients showed treatment failures, which all happened within 12 months. Although the predominant failures were distant metastasis in PORT group and loco-regional recurrence in non-PORT group, there was no statistically significant difference in locoregional recurrence-free survival (LRRFS) (p = 0.362) or distant metastasis-free survival (DMFS) (p = 0.548). Lymph node metastasis was found to be a significant prognostic factor in predicting poor LRRFS (p = 0.013) and DMFS (p = 0.021), while the International Federation Gynecology and Obstetrics (FIGO) stage (p = 0.043) was associated with LRRFS. Conclusion: Considering that adjuvant radiotherapy after surgical resection was effective to decrease loco-regional recurrence and most treatment failures were distant metastasis, multimodal therapy including surgery, radiotherapy, and chemotherapy might be an optimal treatment for uterine carcinosarcoma patients.

• Radiation Oncology Journal
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• 제30권3호
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• pp.140-145
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• 2012

Purpose: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. Materials and Methods: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. Results: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. Conclusion: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.

• Radiation Oncology Journal
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• 제30권3호
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• pp.132-139
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• 2012

Purpose: The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. Materials and Methods: A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). Results: The mean age of patients in this study was $59.4{\pm}11.9$ years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss ${\geq}5%$ (OR, 2.299). Conclusion: SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.

• Radiation Oncology Journal
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• 제30권3호
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• pp.117-123
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• 2012

Purpose: Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. Materials and Methods: We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. Results: The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. Conclusion: Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.

• Radiation Oncology Journal
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• 제29권4호
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• pp.260-268
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• 2011

Purpose: To evaluate the treatment outcome and prognostic factor after postoperative radiotherapy in retroperitoneal sarcoma. Materials and Methods: Forty patients were treated with surgical resection and postoperative radiotherapy for retroperitoneal sarcoma from August 1990 to August 2008. Treatment volume was judged by the location of initial tumor and surgical field, and 45-50 Gy of radiation was basically delivered and additional dose was considered to the high-risk area. Results: The median follow-up period was 41.4 months (range, 3.9 to 140.6 months). The 5-year overall survival (OS) was 51.8% and disease free survival was 31.5%. The 5-year locoregional recurrence free survival was 61.9% and distant metastasis free survival was 50.6%. In univariate analysis, histologic type (p = 0.006) was the strongest prognostic factor for the OS and histologic grade (p = 0.044) or resection margin (p = 0.032) had also effect on the OS. Histologic type (p = 0.004) was unique significant prognostic factor for the actuarial local control. Conclusion: Retroperitoneal sarcoma still remains as a poor prognostic disease despite the combined modality treatment including surgery and postoperative radiotherapy. Selective dose-escalation of radiotherapy or combination of effective chemotherapeutic agent must be considered to improve the treatment result especially for the histopathologic type showing poor prognosls.