• Radiation Oncology Journal
• /
• v.26 no.4
• /
• pp.213-221
• /
• 2008

Purpose: The objective of this retrospective study was to identify predictive factors for the complete pathologic response and tumor downstaging after preoperative concurrent chemoradiotherapy for locally advanced rectal cancer. Materials and Methods: Between the years 2000 and 2008, 39 patients with newly diagnosed rectal cancer without prior evidence of distant metastasis received preoperative concurrent chemoradiotherapy followed by surgery. The median radiation dose was 50.4 Gy (range, $45{\sim}59.4\;Gy$)). Thirty-eight patients received concurrent infusional 5-fluorouracil and leucovorin, while one patient received oral capecitabine twice daily during radiotherapy. Results: A complete pathologic response (CR) was demonstrated in 12 of 39 patients (31%), while T-downstaging was observed in 24 of 39 patients (63%). N-downstaging was observed in 18 of 28 patients (64%), with a positive node in the CT scan or ultrasound. Two patients with clinical negative nodes were observed in surgical specimens. The results from a univariate analysis indicated that the tumor circumferential extent was less than 50% (p=0.031). Moreover, the length of the tumor was less than 5 cm (p=0.004), while the post-treatment carcinoembryonic antigen (CEA) levels were less than or equal to 3.0 ng/mL (p=0.015) and were significantly associated with high pathologic CR rates. The univariate analysis also indicated that the adenocarcinoma (p=0.045) and radiation dose greater than or equal to 50 Gy (p=0.021) were significantly associated with high T-downstaging, while a radiotherapy duration of less than or equal to 42 days (p=0.018) was significantly associated with N-downstaging. The results from the multivariate analysis indicated that the lesser circumferential extent of the tumor (hazard ratio [HR] 0.150; p=0.028) and shorter tumor length (HR, 0.084; p=0.005) independently predicted a higher pathologic CR. The multivariate analysis also indicated that a higher radiation dose was significantly associated with higher T-downstaging (HR, 0.115; p=0.025), while the shorter duration of radiotherapy was significantly associated with higher N-downstaging (HR, 0.028; p=0.010). Conclusion: The circumferential extent of the tumor and its length was a predictor for the pathologic CR, while radiation dose and duration of radiotherapy were predictors for tumor downstaging. Hence, these factors may be used to predict outcomes for patients and to develop further treatment guidelines for high-risk patients.

• Proceedings of the KSMRM Conference
• /
• 2002.11a
• /
• pp.103-103
• /
• 2002

목적：자화율 대조법을 사용한 관류 영상에서 동시획득 $T_{1}T_{2}^{*}$ 강조 경사 자장 펄스열을 사용하여 Gd-DTPA에 의한 $T_{1}T_{2}^{*}$ 감소 효과를 동시에 획득하여 종양의 치료 효과, 판정에 중요한 기준을 제시할 수 있는 정확한 관류 정보를 얻고자 한다. 대상 및 방법： Gd-DTPA에 의한 $T_{1}T_{2}^{*}$ 감소 효과를 동시에 획득하기 위하여 기존의 이중 경사자장 펄스열을 수정, 동시획득 $T_{1}T_{2}^{*}$ 강조 경사자장 펄스열을 개발하였고, 시간 해상도를 높이기 위하여 key-hole 방법을 사용하였다. 고정 phantom으로 Sephadex를 다양한 농도의 Gd-DTPA 용액에 swelling하여 사용하였고, 관류 phantom으로는 Sephadex와 Dialyzer를 사용하였다. Sephadex는 swelling 하였을 때 $T_1$, $T_2$값이 생체 조직의 값과 비슷하고, 물을 관류시킬 수 있어 생체 모형에 적합한 phantom이다 .관류 phantom은 정량 펌프에 연결하여 사용하였다. Sephadex 관류 phantom에서는 분당 약 4$m\ell$ 속도로 관류시키면서 25 mM Gd-DTPA을 0.1$m\ell$ 일시 주입하여 관류 방향에 수직인 coronal 영상을 약 15분 동안 얻었다. 투과도를 구하기 위한 phantom으로는 hollow fiber type Dialyzer를 사용하였고, in vivo에서 1차 관류 이후에 현관 밖에서의 Gd농도가 높고 혈관 내부의 농도가 낮은 상태를 만들기 위하여 fiber 바깥쪽으로 500 mM Gd-DTPA 2 ml를 미리 넣어두고 fiber 내부로 이보다 낮은 농도의 Gd 용액을 관류시키면서 약 1시간동안 영상을 얻었다. 관류 영상에서 $T_1$/$T_{2}^{*}$ 감소 효과를 구분하여 구한 $\DeltaR_1$, $\DeltaR_2$ 곡선의 적분값으로부터 관류량을 구하고, 2 구획 모델을 적용하여 투과도를 구했다.

• Proceedings of the KSMRM Conference
• /
• 2002.11a
• /
• pp.127-127
• /
• 2002

목적： 자화율 대조법을 사용한 관류 영상에서 동시획득 $T_{1}{/}T_{2}^{*}$ 강조 경사 자장 펄스열을 사용하여 Gd-DTPA에 의한 $T_{1}{/}T_{2}^{*}$ 감소 효과를 동시에 획득하여 종양의 치료 효과, 판정에 중요한 기준을 제시할 수 있는 정확한 관류 정보를 얻고자 한다. 대상 및 방법： Gd-DTPA에 의한 $T_{1}{/}T_{2}^{*}$ 감소 효과를 동시에 획득하기 위하여 기존의 이중 경사자장 펄스열을 수정, 동시획득 $T_{1}{/}T_{2}^{*}$ 강조 경사자장 펄스열을 개발하였고, 시간 해상도를 높이기 위하여 key-hole 방법을 사용하였다. 고정 phantom으로 Sephadex를 다양한 농도의 Gd-DTPA 용액에 swelling하여 사용하였고, 관류 phantom으로는 Sephadex와 Dialyzer를 사용하였다. Sephadex는 swelling 하였을 때 $T_1$, $T_2$값이 생체 조직의 값과 비슷하고, 물을 관류시킬 수 있어 생체 모형에 적합한 phantom이다. 관류 phantom은 정량 펌프에 연결하여 사용하였다. Sephadex 관류 phantom에서는 분당 약 4$m\ell$ 속도로 관류시키면서 25 mM Gd-DTPA을 0.1$m\ell$ 일시 주입하여 관류 방향에 수직인 coronal 영상을 약 15분 동안 얻었다. 투과도를 구하기 위한 phantom으로는 hollow fiber type Dialyzer를 사용하였고, in vivo에서 1차 관류 이후에 혈관 밖에서의 Gd 농도가 높고 혈관 내부의 농도가 낮은 상태를 만들기 위하여 fiber 바깥쪽으로 500mM Gd-DTPA 2$m\ell$를 미리 넣어두고 fiber 내부로 이보다 낮은 농도의 Gd 용액을 관류시키면서 약 1시간동안 영상을 얻었다. 관류 영상에서 $T_{1}{/}T_{2}^{*}$ 감소 효과를 구분하여 구한 $\Delta{R}_{1}$, $\Delta{R}_{2}^{*}$ 곡선의 적분값으로부터 관류량을 구하고, 2 구획 모델을 적용하여 투과도를 구했다.

• Journal of the Korean Society of Radiology
• /
• v.81 no.5
• /
• pp.1216-1221
• /
• 2020

Neoadjuvant concurrent chemoradiotherapy has been increasingly used to obtain secondary resectability for locally advanced pancreatic cancers. Although most patients require biliary decompression, only a few studies have investigated the safety of biliary stenting with chemoradiotherapy. Herein, we report a rare case of delayed hemorrhage of the hepatic artery caused by biliary stenting after chemoradiotherapy. The serial follow-up CT demonstrated that the biliary stent was approaching the right hepatic artery and eventually caused acute angulation and indentation. Diagnostic catheter angiography revealed contrast extravasation at the right hepatic artery, and endovascular embolization was performed. This report highlights the relevance of anatomical deformation after chemoradiotherapy, which can result in fatal complications. Indentation of the hepatic artery caused by biliary stents should be recognized as a warning sign of vascular injury.

• Journal of Gastric Cancer
• /
• v.6 no.4
• /
• pp.237-243
• /
• 2006

Purpose: This study was conducted to evaluate the treatment outcomes and the prognosis for gastric cancer patients with hepatic metastasis. Materials and Methods: This retrospective study was based on the medical records of 85 gastric cancer patients with hepatic metastasis (62 synchronous and, 23 metachronous) who received chemotherapy with or without resectional therapy from March 1990 to March 2006. The survival rate was analyzed according to clinicopathologic factors and therapeutic factors, such as whether or not a gastrectomy, a hepatic resection, and/or chemotherapy had been performed. Results: The median survival of gastric cancer patients with hepatic metastasis was 11 months (synchronous: 11 months and metachronous: 17 months). The rates of gastrectomies and hepatic resections in the synchronous group were 24.1% and 16.1%, respectively A 23.5% prevalence of extra-hepatic metastasis was observed. The median survivals of patients who underwent a gastrectomy with a hepatic resection, a gastrectomy alone, and non-surgical treatment were 60, 18, and 9 months, respectively (P<0.05). The disease-free median survival of the metachronous group was 8 ($3{\sim}39$) months. There was no difference in initial pathologic stage and frequency of hepatic metastasis after the gastrectomy in the metachronous group. In the synchronous group, extra-hepatic metastasis, a gastrectomy as the operative procedure, a hepatic resection as the operative procedure and the response to chemotherapy were statistically significant in the univariate analysis, and a hepatic resection as the operative procedure, the response to chemotherapy, and extra-hepatic metastasis were independant prognostic factors identified by the multivariate analysis. In the metachronous group, extra-hepatic metastasis, the response to chemotherapy and differentiation were statistically significant in the univariate analysis, and extra-hepatic metastasis was an independent prognostic factor identified by the multivariate analysis. Conclusion: An aggressive surgical therapy and effective chemotherapy are necessary in the treatment of gastric cancer patients with hepatic metastasis. (J Korean Gastric Cancer Assoc 2006;6:237-243)

• Therapeutic Science for Rehabilitation
• /
• v.10 no.3
• /
• pp.23-41
• /
• 2021

Objective : The purpose of this study was to analyze the effects of simultaneous dual-task training to assess executive function in older adults. Methods : We searched the PubMed, EMBASE, Cochrane, Web of Science, and RISS databases of publicated studies in the past decade. Seven studies were selected based on the inclusion and exclusion criteria. Qualitative assessment and meta-analysis were performed for the seven studies. Results : A randomized controlled trial design was used in the selected studies, and PEDro Scores above seven were obtained. The Trial Making Test (TMT) evaluated the effects of dual-task training on executive function in four studies. The Color Trail Test (CTT) was used in two studies, and Stroop test was used in three studies. The effect size for total executive function was 0.38, which was small. The effect sizes for TMT and CTT were 0.37. Stroop Test was 0.34, demonstrating that their effect sizes were also small. Only significant effects in total executive function, TMT, and CTT showed significant effects (all p<0.05). Conclusion : This study confirmed that dual-task training was effective in improving executive function in older adults. To improve the effectiveness of dual-task training, the difficulty of the dual-task training should be considered. It is also necessary to implement assessments that can evaluate performance under dual-task conditions as well as conventional test tools for executive function. In the future, dual-task training could be used as an appropriate intervention for executive function in older adults to delay the onset of dementia.

• Radiation Oncology Journal
• /
• v.20 no.1
• /
• pp.53-61
• /
• 2002

Purpose : To determine the optimal scheme of postoperative chemoradiotherapy in rectal cancer by comparing survival, Patterns of failure, toxicities in early and late radiotherapy groups using a Phase III randomized prospective clinical trial. Materials and Methods : From January 1996 to March 1999, 307 patients with curatively resected AJCC stage II and III rectal cancer were assigned randomly to an 'early (151 patients, arm 1)' or a 'late (156 patients, arm II)' and were administered combined chemotherapy (5-FU $375\;mg/m^2/day$, leucovorin $20\;mg/m^2$, IV bolus daily, for 3 days with RT, 5 days without RT, 8 cycles with 4 weeks interval) and radiation therapy (whole pelvis with 45 Gy/25 fractions/5 weeks). Patients of arm I received radiation therapy from day 1 of the first cycle of chemotherapy and those of arm II from day 57 with a third cycle of chemotherapy. The median follow-up period of living patients was 40 months. Results : Of the 307 patients enrolled, fifty patients did not receive scheduled radiation therapy or chemotherapy. The overall survival rate and disease free survival rate at 5 years were $78.3\%\;and\;68.7\%$ in arm I, and $78.4\%\;and\;67.5\%$ in arm II. The local recurrence rate was $6.6\%\;and\;6.4\%$ (p=0.46) in arms I and II, respectively, no significant difference was observed between the distant metastasis rates of the two arms ($23.8\%\;and\;29.5\%$, p=0.16). During radiation therapy, grade 3 diarrhea or more, by the NCI common toxicity criteria, was observed in $63.0\%\;and\;58.2\%$ of the respective arms (p=N.S.), but most were controlled with supportive care. Hematologic toxicity (leukopenia) greater than RTOG grade 2 was found in only $1.3\%\;and\;2.6\%$ of patients in each respective arm. Conclusion : There was no significant difference in survival, patterns of failure or toxicities between the early and late radiation therapy arms. Postoperative adjuvant chemoradiation was found to be a relatively safe treatment but higher compliance is needed.

• Radiation Oncology Journal
• /
• v.26 no.2
• /
• pp.118-125
• /
• 2008

Purpose: On-line image guided radiation therapy(on-line IGRT) and(kV X-ray images or cone beam CT images) were obtained by an on-board imager(OBI) and cone beam CT(CBCT), respectively. The images were then compared with simulated images to evaluate the patient's setup and correct for deviations. The setup deviations between the simulated images(kV or CBCT images), were computed from 2D/2D match or 3D/3D match programs, respectively. We then investigated the correctness of the calculated deviations. Materials and Methods: After the simulation and treatment planning for the RANDO phantom, the phantom was positioned on the treatment table. The phantom setup process was performed with side wall lasers which standardized treatment setup of the phantom with the simulated images, after the establishment of tolerance limits for laser line thickness. After a known translation or rotation angle was applied to the phantom, the kV X-ray images and CBCT images were obtained. Next, 2D/2D match and 3D/3D match with simulation CT images were taken. Lastly, the results were analyzed for accuracy of positional correction. Results: In the case of the 2D/2D match using kV X-ray and simulation images, a setup correction within $0.06^{\circ}$ for rotation only, 1.8 mm for translation only, and 2.1 mm and $0.3^{\circ}$ for both rotation and translation, respectively, was possible. As for the 3D/3D match using CBCT images, a correction within $0.03^{\circ}$ for rotation only, 0.16 mm for translation only, and 1.5 mm for translation and $0.0^{\circ}$ for rotation, respectively, was possible. Conclusion: The use of OBI or CBCT for the on-line IGRT provides the ability to exactly reproduce the simulated images in the setup of a patient in the treatment room. The fast detection and correction of a patient's positional error is possible in two dimensions via kV X-ray images from OBI and in three dimensions via CBCT with a higher accuracy. Consequently, the on-line IGRT represents a promising and reliable treatment procedure.

• Radiation Oncology Journal
• /
• v.24 no.2
• /
• pp.123-127
• /
• 2006

Purpose: The purpose of this study was to investigate the clinical findings, treatment, and outcome of patients with glassy cell carcinoma of cervix. Materials and Methods: We reviewed all cases of glassy cell carcinoma of the uterine cervix confirmed and treated at the Dongsan Medical Center, Keimyung University, between January 1993 and December 2005. There were 7 cases with histopathologically confirmed gassy cell carcinoma. A tumor was diagnosed as glassy cell carcinoma if over 50% of the tumor cell type displayed glassy cell features. Six patients with stage IB had radical hysterectomy and bilateral pelvic node dissection, and 2 of them received adjuvant external pelvic irradiation with concurrent chemotherapy. Remaining one patient with stage IIA had curative concurrent chemoradiotherapy with external pelvic irradiation and brachytherapy. Results: There were 7 patients diagnosed as glassy cell carcinoma among the 3,745 (0.2%) patients of carcinoma of uterine cervix. The mean age of 7 patients was 44 years with range of 35 to 53 years of age. The most frequent symptom was vaginal bleeding (86%). By the punch biopsy undertaken before treatment of 7 cases, 2 only cases could diagnose as glassy cell carcinoma of uterine cervix, but remaining of them confirmed by surgical pathological examination. The mean follow up duration was 73 months with range of 13 to 150 months. All 7 patients were alive without disease after treatment. Conclusion: Glassy cell carcinoma of the uterine cervix is a distinct clinicopathologic entity that demonstrates an aggressive biologic behavior. However for early-stage disease, we may have more favorable clinical outcome with radical surgery followed by chemoradiothery.

• Progress in Medical Physics
• /
• v.21 no.1
• /
• pp.60-69
• /
• 2010

For treatment of Total Skin Electron beam Therapy (TSET), measurement of dose at various conditions is need on the contrary to usual radiotherapy. When treating TSET with modified Stanford technique based on linear accelerator, the energy of treatment electron beam, the spatial dose distribution and the actual doses deposited on the surface of the patient were measured by using EBT2. The measured energy of the electron beam was agreed with the value that measured by ionization chamber, and the spatial dose distribution at the patient position and the doses at several point on the patient's skin could be easily measured by EBT2 film. The dose on the patient that was measured by EBT2 film showed good agreement with the data measured simultaneously by TLD. With the results of this study, it was proven that the EBT2 film can be one of the useful dosimeter for TSET.