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  • Title/Summary/Keyword: 선량적인 영향

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Effects of Adjuvant Radiation Therapy and Chemotherapy Following Curative Surgery in Locally Advanced Rectal Cancer (국소 진행된 직장암에서 근치적 절제술 후 방사선치료와 항암화학요법과의 병용치료에 대한 효과)

  • Kang, Ki-Mun;Choi, Ihl-Bohng;Kim, In-Ah;Jang, Jee-Young;Shin, Kyung-Sub;Jang, Suck-Kyun;Lee, Jae-Hak;Kim, Young-Ha;Won, Chong-Man;Choi, Dong-Hwan;Kim, Jin-Seung;Park, Shinn-Hee
    • Radiation Oncology Journal
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    • v.15 no.2
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    • pp.121-128
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    • 1997
  • Purpose : To evaluate the effect of postoperative adjuvant radiation therapy and chemotherapy on the survival, pattern of failure and complication for locally advanced rectal carcinoma Materials and Methods : From October 1992 to September 1995, twenty eight patients with rectal carcinoma were treated by postoperative adjuvant radiation therapy and chemotherapy Radiation therapy was delivered with 6MV and 15MV linear accelerator, 180c0y fractions 5 day per week. Total radiation doses were 5040cGy in B2+3 and 5580cGy in C2+3. Within 4 weeks after radical surgery. 5-FU(400mg/m2/day)andLeucovorin(20mg/m2/day) were administered by intravenous injection for 4 days during the first and fifth week of radiation therapy. The median follow up was 19 months with a range 2 to 47 months. Results : The 2 year overall survival and disease free survival rates were 78.6%and70.8%, respectively. The 2 year overall survival was 93.0%inB2+3 and 76.2%inC2+3(p=0.11) The 2 year disease free survival was 79.4%inB2+3and69.2%inC2+3(p=0.13). The overall failure rate was 21.42%(6/28) including 10.72%(3/28) locoregional recurrence, 3.62%(1/28) distant metastasis and 7.12%(2/28) locoregional recurrence with distant metastasis. The overall locoregional recurrence rate was 17.92%(5/28). The 2 year locoregional recurrence rates were 13.32%(2/15)and23.12%(3/13) for respectively for B2+3andC2+3 The difference between the locoregional recurrence of B2+3andC2+3 patients was not significant(p=0.07). Complications developed in 13 patients(46.42%), including 8 dermatitis, 7 loose stool, 6 leukopenia, 4 tenesmus, 2 diarrhea. In Univariate analysis, there was no statistically significant factor except for tumor grade in locoregional recurrence, disease free survival and overall survival rate(p=0.04, 0.05, 0.04). Conclusion : This study sugges1s that postoperative adjuvant radiation therapy and chemotherapy is effective in patients with locally advanced rectal cancer. Therefore these results need to be confirmed with a long term follow-up and larger number of patients with the further clinical trials including prospective controlled studies.

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The Role of Primary Radiotherapy for Squamous Cell Carcinoma of the Suprag1ottic Larynx (성문상부 상피세포암에서의 근치적 방사선치료의 역할)

  • Kim, Won-Taek;Kim, Dong-Won;Kwon, Byung-Hyun;Nam, Ji-Ho;Hur, Won-Joo
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.233-243
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    • 2000
  • Purpose : First of all, this study was performed to assess the result of curative radiotherapy and to evaluate different possible prognostic factors for squamous cell carcinoma of the supraglottic larynx treated at the Pusan National University Hospital. The second goal of this study was by comparing our data with those of other study groups, to determine the better treatment policy of supraglottic cancer in future. Methods and Material : Thirty-two patients with squamous cell carcinoma of the supraglottic larynx were treated with radiotherapy at Pusan National University Hospital, from August 1985 to December 1996. Minimum follow-up period was 29 months, Twenty-seven patients (84.4%) were followed up over 5 years. Radiotherapy was delivered with 6 MV photons to the primary laryngeal tumor and regional iymphatics with shrinking field technique. Ail patients received radiotherapy under conventional fractionated schedule (once a day). Median total tumor dose was 70.2 Gy (range, 55.8 to 75.6 Gy) on primary or gross tumor lesion. Thirteen patients had Induction chemotherapy with cisplatln and 5-fluorouracil (1-3 cycles). Patient distribution, according to the different stages, were as follows: stage I, 5/32 (15.6%): stage II, 10/32 (31.3%); stage III, 8/32 (25%): stage IV, 9/32 (28.1%). Results :The 5-year overall survival rate of the whole series (32 patients) was 51.7%. The overall survival rate at 5-years was 80% in stage I, 66.7% in stage II, 42.9% in stage III, 25% in stage IV (p=0.0958). The S-year local control rates after radiotherapy were as fellows: stage I, 100%; stage II, 60% stage III, 62.5%; stage IV, 44.4% (p=0.233). Overall vocal preservation rates was 65.6%, 100% In stage I, 70% in stage II, 62.5% In stage III, 44.4% in stage IV (p=0.210). There was no statistical significance in survival and local control rate between neoadjuvant chemotherapy followed by radiotherapy group and radiotherapy alone group. Severe laryngeal edema was found in 2 cases after radiotllerapy, emergent tracheostomy was done. Four patients were died from distant metastsis, . three in lung, one in brain. Double primary tumor was found in 2 cases, one in lung (metachronous), another in thyroid (synchronous). Ulcerative lesions were revealed as unfavorable prognostic factor ( p=0.0215), and radiation dose (more or less than 70.2 Gy) was an important factor on survival (p=0.002). Conclusion : The role of radiotherapy treatment of supraglottic carcinoma is to important factor on survival and to preserve the laryngeal function. Based on our data and other studies, early and moderately advanced supragiottic carcinomas could be successfully treated with either consewative surgery or radiotherapy alone. Both modalities showed similar results in survival and vocal preservation. For the advanced cases, radiotherapy alone is Inadequate for curative aim and surgery combined with radiotherapy should be done in operable patients. When patients refuse operation or want to preserve vocal function, or for the patients with inoperable medical conditions, combined chemoradiotherapy (concurrent) or altered fractionated radiotherapy with or without radiosensitizer should be taken into consideration in future.

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The Evaluation of SUV Variations According to the Errors of Entering Parameters in the PET-CT Examinations (PET/CT 검사에서 매개변수 입력오류에 따른 표준섭취계수 평가)

  • Kim, Jia;Hong, Gun Chul;Lee, Hyeok;Choi, Seong Wook
    • The Korean Journal of Nuclear Medicine Technology
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    • v.18 no.1
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    • pp.43-48
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    • 2014
  • Purpose: In the PET/CT images, The SUV (standardized uptake value) enables the quantitative assessment according to the biological changes of organs as the index of distinction whether lesion is malignant or not. Therefore, It is too important to enter parameters correctly that affect to the SUV. The purpose of this study is to evaluate an allowable error range of SUV as measuring the difference of results according to input errors of Activity, Weight, uptake Time among the parameters. Materials and Methods: Three inserts, Hot, Teflon and Air, were situated in the 1994 NEMA Phantom. Phantom was filled with 27.3 MBq/mL of 18F-FDG. The ratio of hotspot area activity to background area activity was regulated as 4:1. After scanning, Image was re-reconstructed after incurring input errors in Activity, Weight, uptake Time parameters as ±5, 10%, 15%, 30%, 50% from original data. ROIs (region of interests) were set one in the each insert areas and four in the background areas. SUVmean and percentage differences were calculated and compared in each areas. Results: SUVmean of Hot. Teflon, Air and BKG (Background) areas of original images were 4.5, 0.02. 0.1 and 1.0. The min and max value of SUVmean according to change of Activity error were 3.0 and 9.0 in Hot, 0.01 and 0.04 in Teflon, 0.1 and 0.3 in Air, 0.6 and 2.0 in BKG areas. And percentage differences were equally from -33% to 100%. In case of Weight error showed SUVmean as 2.2 and 6.7 in Hot, 0.01 and 0.03 in Tefron, 0.09 and 0.28 in Air, 0.5 and 1.5 in BKG areas. And percentage differences were equally from -50% to 50% except Teflon area's percentage deference that was from -50% to 52%. In case of uptake Time error showed SUVmean as 3.8 and 5.3 in Hot, 0.01 and 0.02 in Teflon, 0.1 and 0.2 in Air, 0.8 and 1.2 in BKG areas. And percentage differences were equally from 17% to -14% in Hot and BKG areas. Teflon area's percentage difference was from -50% to 52% and Air area's one was from -12% to 20%. Conclusion: As shown in the results, It was applied within ±5 of Activity and Weight errors if the allowable error range was configured within 5%. So, The calibration of dose calibrator and weighing machine has to conduct within ±5 error range because they can affect to Activity and Weight rates. In case of Time error, it showed separate error ranges according to the type of inserts. It showed within 5% error when Hot and BKG areas error were within ±15. So we have to consider each time errors if we use more than two clocks included scanner's one during the examinations.

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The Results of Curative Radiotherapy for the Uterine Cervical Cancer (자궁경부암의 근치적 방사선치료 성적)

  • Kim, Hyoung-Jin;Kim, Jung-Soo;Kwon, Hyoung-Cheol;Kim, Jin-Kee;Oh, Byung-Chan
    • Radiation Oncology Journal
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    • v.14 no.3
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    • pp.191-199
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    • 1996
  • Purpose : To evaluate 5-year survival rate, patterns of failure and complications of cervical cancer treatment, fifty nine patients treated by curative radiotherapy for the uterine cervical cancer were analyzed retrospectively. Materials and Methods : From March 1986 to May 1990, fifty nine patients with histologically proven uterine cervical cancer were analyzed. According to FIGO stage, there were 2 patients (3.4%) in stage Ib, 2 patients (3.4%) in stage IIa, 31 patients (52.5%) in stage IIb, 15 patients (25.4%) in stage IIIb, 9 patients (15.3%) in stage IV. External RT was per formed by 6 MVLINAC with daily 1.8 Gy, 5 times per week and followed by ICR. A point dose of ICR was calculated to 30-43.66 Gy (median: 34.6 Gy). These techniques delivered total A Point dose of 80.4 to 109.8 Gy (median: 85 Gy). Patients had been followed up from 2 to 110 months (median: 61 months) Results : The overall 5-year survival rate & disease free survival rate were 55.9% and 55.0% respectively. According to FIGO stage, the 5-year survival rate for less than IIa, IIb, IIIb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage IIb and below versus stage IIIa and above revealed 74.8%, 29.2% respectively (P<0.005). According to the hemoglobin level during RT, the 5-rear survival rate of was 73.3% for patients with Hg 10 gm/dL or higher, in contrast to 0% for those with lower than 10 gm/dL (p<0.005). In 18 patients with nonbulky tumor (<5cm), the 5-year survival rates were 71.8%. The 5-rear survival rates for 18 patients with 5 cm or greater in tumor diameter were 22.2% (p<0.005). The 5-year survival rate for Patient age of above 50 years and below were 65.3% 34.2% respectively (p<0.05). ECOG performance status. pathologic finding, total dose, total treatment time were not statistically significant factors. The significant prognostic factors affecting overall 5-year survival rate by multivariate analysis showed the hemoglobin level during RT (P=0.0001), tumor size (p=0.0390), FIGO stage (p=0.0468). Total recurrence rate was 23.7% local failure 15.2% (9/59), distant metastasis 6.8% (4/59), local and distant metastasis 1.7% (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59) The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively: 10 patients (17.0%) were grade 2, 3 Patients (5.1%) were grade 3 and one patient (1.7%) was grade 4. The late complications were radiation proctitis, rectal bleeding, radiation colitis, diarrhea and radiation cystitis in decreasing order. Conclusion : For improvement of therapeutic results, prospective randomized trials are recomended to discover new prognostic factors and more aggressive radiation therapeutic methods are needed for poor prognostic patients. The adjuvant chemotherapy or radiation-sensitizing agents must be considered to inhibit regional and distant metastasis.

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Preliminary Study for Imaging of Therapy Region from Boron Neutron Capture Therapy (붕소 중성자 포획 치료에서 치료 영역 영상화를 위한 예비 연구)

  • Jung, Joo-Young;Yoon, Do-Kun;Han, Seong-Min;Jang, HongSeok;Suh, Tae Suk
    • Progress in Medical Physics
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    • v.25 no.3
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    • pp.151-156
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    • 2014
  • The purpose of this study was to confirm the feasibility of imaging of therapy region from the boron neutron capture therapy (BNCT) using the measurement of the prompt gamma ray depending on the neutron flux. Through the Monte Carlo simulation, we performed the verification of physical phenomena from the BNCT; (1) the effects of neutron according to the existence of boron uptake region (BUR), (2) the internal and external measurement of prompt gamma ray dose, (3) the energy spectrum by the prompt gamma ray. All simulation results were deducted using the Monte Carlo n-particle extended (MCNPX, Ver.2.6.0, Los Alamos National Laboratory, Los Alamos, NM, USA) simulation tool. The virtual water phantom, thermal neutron source, and BURs were simulated using the MCNPX. The energy of the thermal neutron source was defined as below 1 eV with 2,000,000 n/sec flux. The prompt gamma ray was measured with the direction of beam path in the water phantom. The detector material was defined as the lutetium-yttrium oxyorthosilicate (Lu0,6Y1,4Si0,5:Ce; LYSO) scintillator with lead shielding for the collimation. The BUR's height was 5 cm with the 28 frames (bin: 0.18 cm) for the dose calculation. The neutron flux was decreased dramatically at the shallow region of BUR. In addition, the dose of prompt gamma ray was confirmed at the 9 cm depth from water surface, which is the start point of the BUR. In the energy spectrum, the prompt gamma ray peak of the 478 keV was appeared clearly with full width at half maximum (FWHM) of the 41 keV (energy resolution: 8.5%). In conclusion, the therapy region can be monitored by the gamma camera and single photon emission computed tomography (SPECT) using the measurement of the prompt gamma ray during the BNCT.

Effect of Cytarabine, Melphalan, and Total Body Irradiation as Conditioning for Autologous Stem Cell Transplantation for Patients with AML in First Remission (1차 관해된 급성 골수성 백혈병에서 자가 조혈모세포 이식을 위한 Cytarabine, Melphalan, 전신 방사선치료의 효과)

  • Kang Ki Mun;Choi Byung Ock;Chai Gyu Young;Kang Young Nam;Jang Hong Sek;Kim Hee Jae;Min Wo Sung;Kim Chun Choo;Choi Ihl Bohng
    • Radiation Oncology Journal
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    • v.21 no.3
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    • pp.192-198
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    • 2003
  • Purpose: Current results of autologous stem cell transplantation (SCT) suggest that this procedure may prolong disease free survival In patients with acute myeloid leukemia (AML). Autologous SCT is increasingly used as treatment for AML in first remission. The aim of this study was to evaluate the outcome of autologous SCT for patients with AML in first remission treated by autologous SCT using cytarabine, melphalan and total body irradiation (TBI) as the conditioning regimen. Materials and Methods: Between January 1995 and December 1999, 29 patients with AML in first remission underwent autologous SCT. The median age of patients was 33 years (range, 16 to 47). The conditioning regimen consisted of cytarabine (3.0gm/m2 for 3 days), melphalan (100gm/m2 for 1 day) and TBI (total 1000 cGy in five fractions over 3 days). Results: The median follow up was 40 months with a range of 3 to 58 months. The 4-year cumulative probability of disease free survival was 69.0%, and median survival was 41.5 months. The 4-year relapse rate was 27.6%. The factor Influencing disease free survival and relapse rate was the French-American-British (FAB) classification (M3 group vs. other groups; p=0.048, p=0.043). One patient died from treatment-related toxicity. Conclusion:: Although the small number of patients does not allow us to draw any firm conclusion, our results were encouraging and suggest that the association of cytarabine, melphalan and TBI as a conditioning regimen for autologous SCT for AML on first remission appears to be safe and effective.

Consideration about Ozone Generation in the Treatment Room While Treating a Patient (방사선 치료 시 치료실 내에서 발생하는 오존에 관한 고찰)

  • Kwak, Yong-Kuk;Yoon, Il-Kyu;Lee, Jae-Hee;Yoo, Suk-Hyun
    • The Journal of Korean Society for Radiation Therapy
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    • v.21 no.2
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    • pp.75-82
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    • 2009
  • Purpose: Measure the ozone level in the treatment room while treating a patient so want to know the degree of contamination caused by ozone occurrence. Materials and Methods: Use the linear accelerator (Clinac 21EX, Varian, USA) with the ozone meter (series-200, aeroQual, New Zealand) and water phantom (Wellhofer, IBA, Germany) is irradiated the radiation so that measured the ozone generation level according to MU, dose-rate, SSD, field size, energy, delay time and put the ozone meter in the treatment room actually while treating a patient so measured the daily ozone level variation. Results: While irradiating the radiation, degree of ozone contamination wasn't affected by the energy but mostly in case of electron beam, ozone level was higher than photon beam. The higher dose-rate (0.016~0.025 ppm/hr), the farther SSD (0.018~0.030 ppm/hr), the wider field sizes (0.016~0.025 ppm/hr), the more MU (0.018~0.046 ppm/hr), it occurred high ozone level. Ozone decrement according to delay time changed the background level (0.016 ppm/hr) after elapsed time of 10 minutes from irradiating radiation. And daily ozone occurrence level in the treatment room was below ozone standard level 0.1 ppm/hr (average:0.06 ppm/8 hr) but it could confirm that ozone generation level was included the level (max:0.038 ppm/hr) above 0.02 ppm/hr which patient could perceive. Conclusion: Through ozone level according to variation of certain conditions, actually in the treatment room ozone generation level didn't damaged to patients or workers. Commonly peoples think that ozone was harmful gas but it thought that small amount of ozone generation level while treating a patient was beneficial in the treatment room through air purge action of pathogenic germ or virus sterilization.

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A Study for Reappearance Acording to the Scan Type, the CT Scanning by a Moving Phantom (팬톰을 이용한 전산화 단층촬영방법에 따른 재현성에 대한 고찰)

  • Choi, Jae-Hyock;Jeong, Do-Hyeong;Suk, Choi-Gye;Jang, Yo-Jong;Kim, Jae-Weon;Lee, Hui-Seok
    • The Journal of Korean Society for Radiation Therapy
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    • v.19 no.2
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    • pp.123-129
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    • 2007
  • Purpose: CT scan shows that significant tumor movement occurs in lesions located in the proximity of the heart, diaphragm, and lung hilus. There are differences concerning three kinds of type to get images following the Scan type called Axial, Helical, Cine (4D-CT) mode, when the scanning by CT. To know how each protocol describe accurately, this paper is going to give you reappearance using the moving phantom. Materials and Methods: To reconstruct the movement of superior-inferior and anterior-posterior, the manufactured moving phantom and the motor following breathing were used. To distinguish movement from captured images by CT scanning, a localizer adhered to the marker on the motor. The moving phantom fixed the movement of superior-inferior upon 1.3 cm /1 min. The motor following breathing fixed the movement of anterior-posterior upon 0.2 cm /1 min. After fixing each movement, CT scanning was taken by following the CT protocols. The movement of A localizer and volume-reappearance analyzed by RTP machine. Results: Total volume of a marker was 88.2 cm3 considering movement of superior-inferior. Total volume was 184.3 cm3. Total volume according to each CT scan protocol were 135 cm3 by axial mode, 164.9 cm3 by helical mode, 181.7 cm3 by cine (4D-CT) mode. The most closely describable protocol about moving reappearance was cine mode, the marker attached localizer as well. Conclusion: CT scan should reappear concerning a exact organ-description and target, when the moving organ is being scanned by three kinds of CT protocols. The cine (4D-CT) mode has the advantage of the most highly reconstructible ability of the three protocols in reappearance of the marker using a moving phantom. The marker on the phantom has always regular motion but breathing patients don't move like a phantom. Breathing education and devices setting patients were needed so that images reconstruct breathing as exactly as possible. Users should also consider that an amount of radiation to patients is being bombed.

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The Electron Trap Analysis in Thermoluminescent LiF Crystal

  • Park, Dae-Yoon;Ko, Chung-Duck;Lee, Sang-Soo
    • Nuclear Engineering and Technology
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    • v.4 no.3
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    • pp.214-222
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    • 1972
  • In the optic,11 grade LiF crystal, the electron traps corresponding to the thermoluminescence(abbreviated to TL) glow peak develop as irradiation dose is increased. Originally the electron trap of the crystal has two levels but as the dose reaches to the order of 104rontgen, it attains five levels as observed in the TL glow curves. The five trap depths are determined from the glow peak temperatures for two different heating rates, θ=6.6C/sec and 3.4C/sec. The electron trap depths have the following values E1=0.79 eV, E2=0.93 eV, E3=1.02 eV, E4=1.35 eV, E5=1.69eV. The special feature of thermoluminescence of optical grade LiF is that the traps, except E1and E2corresponding to 120C glow peak and 150C glow peak for θ=6.6C/sec, have severe thermal instability, namely E3, E4and E5 levels disappear during bleaching process. These defects in the optical grade LiF crystal seem annealed out during the course of TL measurement. The fresh or long time unused LiF(Mg) crystal shows only two glow peaks at 170C and 230C for θ=6.6C/sec, but upon sensitization with r-ray irradiation, it converts to the six glow peak state. The four electron traps, E1, E2, E3, and E6 created by r-ray irradiation and corresponding to the glow peaks at T=100C 130C, 150C and 290C are stable and not easily annealed out thermally, The sensitization essentially required to LiF(Mg) dosimeter is to give the crystal the stable six levels in the electron trap. In optical grade LiF, the plot between logarithm of total TL output versus logarithm of r-ray dose gives more supra-linear feature than that of LiF(Mg). However, if one takes the height of 120C glow peak(S=6.6C/sec), instead of the total TL output, the curve becomes close to that of LiF(Mg).

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Evaluation of Average CT to Reduce the Artifact in PET/CT (PET/CT 검사에서 호흡에 따른 인공산물을 줄이기 위한 Average CT의 유용성)

  • Kim, Jung-Sun;Nam, Ki-Pyo;Park, Seung-Yong;Ryu, Jae-Kwang;Cha, Min-Kyeong
    • The Korean Journal of Nuclear Medicine Technology
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    • v.14 no.1
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    • pp.3-7
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    • 2010
  • Purpose: The usefulness of Positron Emission Tomography (PET) images in diagnosis, staging, recurrent and treatment response evaluation has already been known. However, tumors which are small size, located in lower lobe of lung or upper lobe of liver are shown misalignment, distortion and different Standard Uptake Value (SUV) by respiration in PET images. Therefore, if radiotherapy based on normal respiration, it may cause low treatment response or more side effects because targets which had to treat, out of treat range or over dose to normal tissue. The purpose of this study is to evaluate attenuation-correction with Average CT (ACT) for more accuracy SUV measurement and minimize artifact by respiration. Materials and Methods: 13 patients, who had tumors which are around the diaphragm, underwent ACT scan after Helical CT (HCT) scan with PET/CT (Discovery DSTE 8; GE Healthcare). We quantified the differences between attenuation corrected image with HCT and attenuation corrected image with ACT in artifact size and maximum SUV (SUVmax). Artifacts were evaluated by measurement of the curved photogenic area in the lower thorax of the PET images for all patients. SUVmax was measured separately at the primary tumors. Analysis program was Advantage Workstation v4.3 (GE Healthcare). Patients were injected with 7.4 MBq (0.2 mCi) per kg of 18F-FDG and scanned 1 hour after injection. The PET acquisition was 3 minute per bed. Results: Significantly lower artifact were observed in PET/ACT images than in PET/HCT images (below-thoracic artifacts caused by under corrected 1.5±3.5 cm vs. 13.4±4.2 cm). Significantly higher SUVmax were noted in PET/ACT images than in PET/HCT images in the primary tumor. Compared with PET/HCT images, SUVmax in PET/ACT images were higher by 5.3±3.9 (mean value) tumor. The highest difference was observed in Lower lobe of lung (7.7 to 8.7; 13%). Conclusion: Due to its significantly reduced artifacts in lower thoracic, attenuation corrected image with ACT images provided more reliable SUVmax and may be helpful in monitoring treatment response. Moreover, ACT can separate upper lobe of liver and lower lobe of lung, it may be helpful in interpretation. ACT will be clinically useful, considering increased dose caused by ACT scan and adapt.

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