• The Journal of Korean Society for Radiation Therapy
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• v.29 no.2
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• pp.109-117
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• 2017

Objectives: The purpose of this study was to evaluate the change of body shape and the patient alignment state during image-guided volumetric modulated arc therapy in head and neck cancer patients, Materials and Methods: We performed a image-guided volumetric modulated arc therapy plan for 89 patients with head and neck cancer who underwent curative radiotherapy. Ten of them were evaluated for set up error. The landmarks of the ramus, chin, posterior neck, and clavicle were specified using ARIA software (Offline review), and the positional difference was analyzed. Results: The re-CT simulation therapy was performed in 60 men with $17{\pm}4$ cycles of treatment. The weight loss rate was $-6.47{\pm}3.5%$. 29 women performed re-CT simulation at $17{\pm}5$ cycles As a result, weight loss rate was $-5.73{\pm}2.7%$. The distance from skin to C1, C3, and C5 was measured, and both clavicle levels were observed to measure the skin shrinkage changes. The skin shrinkage standard deviations were C1 (${\pm}0.44cm$), C3 (${\pm}0.83cm$), and C5 (${\pm}1.35cm$), which is about 1 mm shrinkage per 0.5 kg reduction. Skin shrinkage according to the number of treatments was 1 ~ 4 fractions (no change), 5 ~ 13 fractions (-2 mm), 14 ~ 22 fractions (-4 mm) and 23 ~ 30 fractions (-6 mm). Conclusion: When the body shape changes about 5 mm, the central dose starts to differ about 3 % or more. Therefore, the CT simulation treatment for the adaptive therapy should be additionally performed. In addition, it is necessary to actively study the CT simulation therapy method and set up method of the lower neck and to examine the use of a new immobilization device.

• Radiation Oncology Journal
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• v.23 no.2
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• pp.123-130
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• 2005

Purpose: We wanted to improve the setup reproducibility of breast cancer patients when utilizing a commercially available breast board for radiation therapy. The breast board was modified by using a new head rest and 2 types of board fixation devices. Materials and Methods: A conventional head/neck rest was modified to be positioned in various slots of the breast board, and it was fabricated 1 cm thinner to provide more comfort to a patient when the patient's neck was rotated. This rest improves the uncertainty of the daily setup. Also, the sagging problems at the left and right sides became negligible with the two types of board fixation devices: (1) the stair type, and (2) the arm type. The first device consists of an upper/lower holder with 4 stair-types of grooves and 4 rectangular Inserts. In order to cover the whole range of vertical setup of the breast board, 4 rectangular inserts were needed, and each covered 10 steps. The arm-type fixation device was also fabricated and attached to the breast board, It had two aluminum bars that were fixed by utilizing a lock-type of screw. These devises were evaluated with two volunteers in order to prove the effectiveness of the improved setup accuracy. Results; The developed cranio-caudal fixation device demonstrated that it could reduce the cranio-caudal error by nearly $55\%$ compared to the old device. As for left-and-right inclination, the stair-type and arm-type fixation devices can reduce the relative inclination by nearly $80\%$ and $90\%$, respectively, compared to the breast board without the fixation device. Conclusion: It was verified that the developed devices were effective for positioning the patients and for avoiding inclination of the breast board.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.26 no.1
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• pp.18-23
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• 2000

The changes of the microorganism composition after therapeutic radiation for oral cancer patients are not well known and the long-term follow-up data are not reported. To obtain basic data for understanding of pathogenesis and prevention and treatment of dental caries and mucositis occuring after radiation therapy, 7 of the oral cancer patients presented at the Seoul National University Oral & Maxillofacial Department between 1997 and 1998 whose treatment plan included radiation therapy were recruited to investigate the changes in bacterial composition(total aerobic count, Candida, Staphylococci, Lactobacilli, S. mutans, and S. salivarius (mitis, sanguis)) of the saliva before, during, and after radiation therapy. The basic data obtained from this study on identification and composition change of the bacteria in saliva of patients treated with radiation therapy can be used (1) as a reference for deciding on the ideal anti-microbial spectrum of the oral rinsing agent to be used in patients treated with radiation therapy for malignant tumor of the head and neck region. (2) to enhance the understanding of increase of opportunistic infection after immunochemical changes of the saliva and its relation to specific bacterial infection. (3) as a reference in prescribing prophylactic antibiotics in immunodepressed patients after radiation therapy.

• The Korean Journal of Nuclear Medicine
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• v.31 no.3
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• pp.372-380
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• 1997

The purpose of this study was to evaluate the usefulness of whole body F-18 FDG PET scan for detecting postoperative recurrence of cancer. One hundred four cancer patients after operation were enrolled(14 brain tumor, 15 head and neck cancer, 23 gynecologic cancer, 16 gastrointestinal cancer, 16 thyroid cancer, and 20 other cancers). Besides conventional images(CI) including CT and MRI, F-18 FDG PET scan was obtained on ECAT EXACT 47 scanner(Siemens-CTI), beginning 60 minutes after injection of 370MBq(10mCi) of F-18 FDG. Regional scan was also obtained with emission image. Transmission images using Ge-68 were carried out for attenuation correction in both whole body and regional images. Findings of PET, and CI were confirmed by pathology or clinical follow up. The sensitivity and specificity of PET for detecting recurrence were 94% and 92%, respectively. Contrarily, the sensitivity and specificity of CI were 78% and 68%. CI results were negative and PET results were positive in 11 cases. The biopsy or clinical follow-up of those cases confirmed recurrence of tumor. False negative cases of CI were frequent in patients with gynecologic cancers. Also we measured the serum concentration of tumor markers in patients with gynecologic cancer(CA125), thyroid cancer(thyroglobulin), and colorectal cancer(CEA). The sensitivity and specificity of tumor markers were 71% and 84%, respectively, We conclude that F-18 FDG PET can be used valuably in detecting recurrent foci of a wide variety of malignancy compared to conventional diagnostic methods.

• Radiation Oncology Journal
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• v.14 no.4
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• pp.339-345
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• 1996

Purpose : This study was performed for adequate irradiating tumor area when 6 MV linear accerelator photon was used to treat the head and neck tumor. The skin surface dose and maximum build-up region was measured by using a spoiler which was located between skin surface and collimator. Methods : A spoiler was made of tissue equivalent material and the skin surface dose and maximum build-up region was measured varing with field size, thickness of spoiler and interval between skin and collimator. The results of skin surface dose and maximum build-up dose was represented as a build-up ratio and it was compared with dose distribution by using a bolus. Results : The skin surface dose was increased with appling spoiler and decreased by distance of the skin-spoiler separation. The maxium build-up region was 1.5 cm below the skin surface and it was markedly decreased near the skin surface. By using a 1.0-cm thickness spoiler, Dmax moved to 5, 10.2, 12.3 13.9 and 14.8 mm from the skin surface by separation of the spoiler from the skin 0, 5, 10, 15. 20 cm, respectively. Conclusion : The skin surface dose was increased and maximum build-up region was moved to the surface by using a spoiler. Therefore spoiler was useful in treating by high energy photon in the head and neck tumor.

• Physical Therapy Korea
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• v.20 no.1
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• pp.36-46
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• 2013

This study examined the effects of a physical therapy program on quality of life (QOL), and neck and shoulder disability in head and neck cancer patients. The program included neck and shoulder range of motion (ROM) exercises, massage, progressive strengthening exercises, and stretching exercises. Sixteen patients who were assigned to an experimental group performed physical therapy for 40 minutes three times a week for eight weeks. Fifteen other patients were assigned to a control group who did not performed the physical therapy program. The European organization for research and treatment of cancer (EORTC QLQ-C30) and head and neck (EORTC QLQ-H&N) instruments, and the Neck Disability Index (NDI) were assessed before and after the rehabilitation program. The 40-minute program consisted of a 10-minute ROM exercise for the neck and shoulder, a 10-minute massage and 15-minute of progressive resistance exercises, followed by a five-minute stretching exercises. Statistically significant differences were noted for changes in global health, physical function in the EORTC QLQ-C30 and cancer related symptoms in the EORTC QLQ-H&N35 (p<.05). The NDI also showed significant differences (p<.05). Physical therapy may therefore benefit the physical aspects and QOL and improve neck and shoulder disability in patients with head and neck cancer.

• Korean Journal of Head & Neck Oncology
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• v.36 no.2
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• pp.9-15
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• 2020

Background/Objectives: To analyze the clinical characteristics of differentiated thyroid cancer (DTC) in children and adolescents. Materials & Methods: Medical records of 31 DTC cases that were diagnosed and treated at Korea Cancer Center Hospital between 2002 and 2018 were retrospectively reviewed. Results: Most cases were papillary carcinoma (n=26), with female predominance (n=25). Median age was 16.4 years (range, 11.9-18.6 years). Extrathyroidal extension was present in 24 cases. Twenty cases had tumor involvement at cervical lymph nodes and three had lung metastasis. Twenty-two patients received radioactive iodide treatment with a median cumulative dose of 300 mCi (range, 100-920 mCi). During a median follow-up of 68.2 months (range, 2.3-191.4 months), serum thyroglobulin level was elevated in 15 patients. Among them, two cases had remnant thyroid tissue, 4 had recurrence at cervical lymph nodes, and the remaining 9 did not have any detectable lesion. All were alive, and 5-year event-free survival (EFS) was 45.2±10.1%. Age £15 years, tumor size, lymph node status (N1b), and distant metastasis had negative effects on EFS. On multivariate analysis, age and tumor size had prognostic significance. Conclusion: For DTC of children and adolescents (£18 years old), age ≤15 years and tumor size were prognostic factor. Therefore, patients in this age group need meticulous follow-up. Further studies are necessary to answer the potential influence of age on the incidence and behavior of DTC.

• The Journal of Korean Society for Radiation Therapy
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• v.9 no.1
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• pp.64-70
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• 1997

The goal of radiation treatment planning is to deliver the dose to the patient within $5\%$ of that prescribed. We have often encountered the situation that the area which have not only several irregular contours but also tissue heterogeneities should be treated. With conventional devices such as wedges, missing tissue compensator. there are some limitations to achieve the uniform dose distribution in treatment volume. The use of CT simulator, 3-D planning system, computer-controlled milling machine enables it to deliver the dose uniformally. This report includes the whole procedure which have patient data acquisition 3D planning, computer-controlled milling, performance verification of 3D compensator, and TLD evaluation. We applied it for the treatment of head and heck cancer only. In Spite of the irregular contour and different electron density of tessue, we have achieved the uniformity of the dose distribution within ${\pm}3\%$ relatively. Although there are some problems which are not only verification of performance but uncertainties of using the new treatment device, we believe that the improvement of dosimetry will eliminate the uncertainties of that application. so the other lesions besides head and neck can will be ale to use the 3D compensator to achieve the dose uniformity

• Korean Journal of Head & Neck Oncology
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• v.16 no.2
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• pp.206-211
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• 2000

Objectives: Any uptake of I-131 after total thyroidectomy means the remant thyroid tissue or distant metastasis of the thyroid cancer. However diffuse hepatic uptake of I-131 without abnormal uptake was showen in many cases on I-131 whole body scan. The aim of this study was to classify the liver uptake after I-131 scan and to evaluate the analysis of this finding. Materials and Methods: Between 1982 and 1998, 104 patients(l4 males, 90 females) with normal liver function underwent I-131 scan after total thyroidectomy. Prospectively we reviewed the films of the whole body scan and analysed the correlations between results of radioiodine uptake, pathologic diagnosis, prognostic factors, lymphatic metastasis, and thyroid function test. Result: Diffuse hepatic uptake was found in 44 of 104(42%) patients. 10 of 39(26%) patients on I-131 100mCi, and 34 of 63(54%) on I-131 150mCi showed hepatic uptake. 52 of 104(50%) patients was locally invasive thyroid cancer. The rate of the hepatic uptake was no significant differences with the thyroid hormone levels(T3, Free T4) and thyroglobulin between uptake group and non-uptake group. Conclusion: The rate of I-131 uptake was high in high-dose radioiodine treatment group. However, we can not find any correlation among the thyroid functions, the extent of metastasis or the extent of local invasion. We need further study to find out the causes of the hepatic uptake of I-131 after total thyroidectomy, besides liver metabolism of I-131 attached thyroid hormones.

• Korean Journal of Head & Neck Oncology
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• v.27 no.2
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• pp.222-225
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• 2011

에크린 한공암종은 흔하지 않으며, 전이성 에크린 한공암종은 매우 드문 암이다. 에크린 한공암종은 표피내 한관에서 기원하는 피부 부속기 악성 종양으로, 대부분 에크린 한공암종은 항암치료와 방사선치료에 효과가 없으며, 따라서 유일한 치료방법은 전이되기 전에 국소 및 광범위 절제술을 시행하여야 한다. 본 환자는 두피에 발생한 에크린 한공암종이 점점 진행하여 피부, 림프절, 폐 등으로 전이하였고, 다수의 광범위 절제술에 이어 항암치료와 방사선치료를 받았지만, 결국 폐전이가 악화되어 사망하였다. 본 저자들은 항암치료와 방사선치료에 불응한 에크린 한공암종 1예를 치료에 대한 문헌고찰과 더불어 보고하는 바이다.