• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.161-169
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• 2016

Purpose : To quantify the inter-fractional variation in prostate displacement and their dosimetric effects for prostate cancer treatment. Materials and Methods : A total of 176 daily cone-beam CT (CBCT) sets acquired for 6 prostate cancer patients treated with volumetric-modulated arc therapy (VMAT) were retrospectively reviewed. For each patient, the planning CT (pCT) was registered to each daily CBCT by aligning the bony anatomy. The prostate, rectum, and bladder were delineated on daily CBCT, and the contours of these organs in the pCT were copied to the daily CBCT. The concordance of prostate displacement, deformation, and size variation between pCT and daily CBCT was evaluated using the Dice similarity coefficient (DSC). Results : The mean volume of prostate was 37.2 cm3 in the initial pCT, and the variation was around ${\pm}5%$ during the entire course of treatment for all patients. The mean DSC was 89.9%, ranging from 70% to 100% for prostate displacement. Although the volume change of bladder and rectum per treatment fraction did not show any correlation with the value of DSC (r=-0.084, p=0.268 and r=-0.162, p=0.032, respectively), a decrease in the DSC value was observed with increasing volume change of the bladder and rectum (r=-0.230,p=0.049 and r=-0.240,p=0.020, respectively). Conclusion : Consistency of the volume of the bladder and rectum cannot guarantee the accuracy of the treatment. Our results suggest that patient setup with the registration between the pCT and daily CBCT should be considered aligning soft tissue.

• The Journal of Korean Society for Radiation Therapy
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• v.17 no.2
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• pp.113-124
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• 2005

Purpose : The using of endo-rectal balloon has proposed as optimal method that minimized the motion of prostate and the dose of rectum wall volume for treated prostate cancer patients, so we make the customized rectal balloon device. In this study, we analyzed the efficiency of the Self-customized rectal balloon in the aspects of its reproducibility. Materials and Methods : In 5 patients, for treatment planning, each patient was acquired CT slice images in state of with and without rectal balloon. Also they had CT scanning samely repeated third times in during radiation treatment (IMRT). In each case, we analyzed the deviation of rectal ballon position and verified the isodose distribution of rectum wall at closed prostate. Results : Using the rectal balloon, we minimized the planning target volume (PTV) by decreased the internal motion of prostate and overcome the dose limit of radiation therapy in prostate cancer by increased the gap between the rectum wall and high dose region. Conclusion : The using of rectal balloon, although, was reluctant to treat by patients. View a point of immobilization of prostate internal motion and dose escalation of GTV (gross tumor volume), its using consider large efficients for treated prostate cancer patients.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.75-81
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• 2019

Purpose: Tomo therapy and Proton therapy treatment plans for the treatment of prostate cancer patients were established, and the characteristics of dose distribution according to beam delivery method using Tomo therapy IMRT method and Proton therapy PBS method to compare and analyze the treatment effect were sought. Materials and Methods: Tomo IMRT treatment plan and Proton PBS treatment plan were established using the Hi.art planning station 5.1.1.6 of Tomo therapy and Eclipse 13.7 of VARIAN for three prostate cancer patients who were treated with radiotherapy only for radical purposes without surgery. For the evaluation of two treatment plans, the average dose (Dmean) and maximum dose (Dmax) of PGTV were calculated from dose volume histogram (DVH) to confirm the coverage and calculate CI and HI. In OAR evaluation, the dose received from the rectal volume 25% and the dose received from the bladder were evaluated to compare the normal long-term protection effect. Results: The mean maximum doses of the three patients were 71.4Gy, 75.3Gy and the mean doses were 70.4Gy and 72.8Gy in the DVH of the Tomo IMRT and Proton PBS. The CI was 1.16 and 1.31, and the HI was 0.04 and 0.12 respectively, and the Tomo IMRT was superior to the Proton PBS in dose suitability. Conclusion: The mean dose of PGTV in prostate cancer patients was 3.4% higher in Proton PBS than in Tomo IMRT. This is because the Dose suitability of Tomo IMRT was better, but it is considered to be a small difference to be seen as a significant result. However, the results of the two methods were 51.2% in D 25% and 55.7% less in the average dose of bladder, which could reduce the side effects of patients in proton PBS.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.70-77
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• 1999

Purpose : The expression of p53, P211WAF/CIP, Bcl-2, and Bax underlying the radiation-induced apoptosis in different pH environments using SCK mammary adenocarcinoma cell line was investigated. Materials and Methods Mammary adenocarcinoma cells of hi) mice (SCK cells) in exponential growth phase were irradiated with a linear accelerator at room temperature. The cells were irradiated with 12 Gy and one hour later, the media was replaced with fresh media at a different pHs. After Incubation at 37Microbioiogy, College of Medicine Dong A University for 0$\~$48 h, the extort of apoptosis was determined using agarose gel electrophoresis and flow cytometry. The progression of cells through the cell cycle after irradiation in different pHs was also determined with flow cytometry. Western blot analysis was used to monitor p53, p211WAFfCIP, Bcl-2, and Bu protein levels. Results : The induction of apoptosis by irradiation in pH 6.6 medium was markedly less than that in pH 7.5 medium. The radiation-induced G2IM arrest in pH 6.6 medium lasted markedly longer than that in pH 7.5 medium. Considerable amounts of p53 and p21 proteins already existed at pH 7.5 and increased the level of p53 and p21 significantly after 12 Gy X-irradiation. An incubation at pH 6.6 after 12 Gy X-irradiation did not change the level of p53 and p21 protein levels significantly. Bcl-2 proteins were not significantly affected by radiation and showed no correlation with cell susceptibility to radiation-induced apoptosis in different pHs. An exposure to 12 Gy of X-rays increased the level of Bax protein at pH 7.5 but at pH 6.6, it was slight. Conclusions : The molecular mechanism underlying radiation-induced apoptosis in dinerent pH environments using SCK mammary adenocarcinoma cell line was dependent of the expression p53 and P211YVAF/CIP proteins. We may propose following hypothesis that an acidic stress augments the radiation-induced G2iM arrest, which inhibiting the irradiated cells undergo post-mitotic apoptosis. The effects of environmental acidity on anti-apoptotic and pro-apoptotic function of Bcl-2 family was unclear in SCK mammary adenocarcinoma cell line.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.16-22
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• 1999

Purpose : This study was done to analyze prognostic factors and patterns of failure of patients with histologically confirmed adenocarcinoma of the uterine cervix. Materials and Methods : From June 1988 to December 1990, a retrospective analysis was undertaken for 45 patients who were treated with curative radiation therapy for adenocarcinoma of the uterine cervix at the department of Therapeutic Radiology of Keimyung University Hospital. According to FIGO staging classification, f2 patients were stage Ib, 9 patients were lla, 19 patients were IIB, and 5 patients were lIIb. Median age of the patients was 54 years. The radiation therapy consisted of a combination of external and intracavitary irradiation. Only the pelvis was treated for external irradiation, but 6 patients were treated with extended field irradiation including paraaortic nodes. Intracavitary irradiation was performed with high dose rate sources (Co-60). Neoadiuvant chemotherapy was undertaken for 10 patients. Median and maximum follow-up duration was 64 and 116 months, respectively. Results : The overall 5-year survival rate was 55.2$\%$, and the 5-year survival rates for stage Ib, IIa, IIb, and IIIb were 100$\%$, 50.8$\%$, 46.8$\%$, and 40$\%$ (3-year survival rate), respectively. Of the many clinicopathologic variables evaluated for prognosis, only the stage and the tumor size were significant prognostic factors. Statistically, pelvic failure rates for stage Ib, IIa, IIb, and IIIb were 0$\%$, 33.3$\%$, 57.9$\%$, and 60$\%$, respectively. Distant metastasis rates were 0$\%$, 33.3$\%$, 21.1$\%$, and 40$\%$ for stage Ib, IIa, IIb, and IIIb, respectively. Especially the 6 patients who were irradiated with extended field to treat the paraaortic nodes were free of distant metastasis all. But, 9 patients (23.1$\%$) of the 39 patients who were not irradiated the paraaortic nodes were suffered and expired from uncontrolled distant metastasis. Conclusions : As compared with other studies, the survival rates were similar, but distant metastasis rates including paraaortic nodes metastasis were likely somewhat higher than expected, especially for patients with stage II. So, we think that the effect of prophylactic paraaortic nodes irradiation should be studied prospectively, especially for patients with pelvic nodes involvement or advanced stage of disease.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.1
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• pp.28-31
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• 2016

Purpose $^{223}Ra-Dichloride$ is used for the medicine of castration-resistant prostate cancer (CRPC) and which emits ${\alpha}-ray$ of 28 Mev that is used for therapy. However $^{223}Ra-Dichloride$ emits ${\beta}-ray$ of 3.6% and ${\gamma}-ray$ of 1.1%(80,156,270 keV) aside from ${\alpha}-ray$ in decay. Therefore we would like to evaluate external radiation expose dose rate of ${\gamma}-ray$ of $^{223}Ra-Dichloride$. Materials and Methods We calculated external radiation expose dose rate using ${\gamma}-constant$ of $^{223}Ra-Dichloride$, $^{99m}Tc$ based on Health physics(2012). $^{223}Ra-Dichloride$ of 3.5 MBq and $^{99m}Tc-MDP$ of 740 MBq were applied. external radiation expose dose rate 15 times from 1m by survey meter. Results ${\gamma}-contant$ of $^{223}Ra$, $^{99m}Tc-MDP$ from 1m distance based on Health physics(2012) is 0.0469, 0.0215. calculated value of external radiation expose dose rate was $16{\mu}Sy$, $34{\mu}Sy$ which activity is $^{223}Ra-Dichloride$ of 3.5 MBq and $^{99m}Tc-MDP$ of 740 MBq from 1 m and measured mean value of 1 m was $0.7{\mu}Sy/h$, $18{\mu}Sy/h$. Conclusion ${\gamma}-constant$ of $^{223}Ra$ is higher than $^{99m}Tc$ based on Health physics(2012). however calculated maximum external radiation expose dose rate of $^{223}Ra-Dichloride$ is lower than $^{99m}Tc$ due to actually used quantity of activity of $^{223}Ra-Dichloride$ is small. measured value of $^{223}Ra-Dichloride$ is also lower than $^{99m}Tc-MDP$. Therefore external radiation expose dose rate of ${\gamma}-ray$ of $^{223}Ra-Dichloride$ is very low.

• Radiation Oncology Journal
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• v.17 no.2
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• pp.136-140
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• 1999

Purpose : Prostate specific antigen (PSA) is a useful tumor marker, which is widely used as a diagnostic index and predictor of both treatment and follow-up result in prostate cancer. A prospective analysis was carried out to obtain the period of PSA normalization and the half life of PSA and to analyze the factors influencing the period of PSA normalization. The PSA level was checked before and serially after radical radiotherapy. Materials and Method : Twen쇼 patients with clinically localized prostate cancer who underwent radical external beam radiotherapy were enrolled in this study. Accrual period was from April 1993 to May 1998. Median follow-up period was 20 months. Radiotherapy was given to whole pelvis followed by a boost to prostate. Dose range for the whole pelvis was from 45 Gy to 50 Gy and boost dose to prostate, from 14 Gy to 20 Gy. The post-irradiation PSA normal value was under 3.0 ng/ml. The physical examination and serum PSA level evaluation were performed at 3 month interval in the first one year, and then at every 4 to 6 months. Results : PSA value was normalized in nineteen patients (95%) within 12 months. The mean period of PSA normalization was 5.3 (${\pm}$2.7) months. The half life of PSA Of the nonfailing patients was 2.1 (${\pm}$0.9) month. The nadir PSA level Of the nonfailing Patients waS 0.8 (${\pm}$0.5) ng/ml. The period of PSA normalization had the positive correlation with pretreatment PSA level (R$^{2}$=0.468). The nadir PSA level had no definite positive correlation with the pretreatment PSA level (R$^{2}$=0.075). The half life of serum PSA level also had no definite correlation with pretreatment PSA level (R$^{2}$=0.029). Conclusion :The PSA level was mostly normalized within 8 months (85%). If it has not normalized within 12 months, we should consider the residual disease in prostate or distant metastasis. In 2 patients, the PSA level increased 6 months or 20 months before clinical disease was detected. So the serum PSA level can be used as early diagnostic indicator of treatment failure.

• Tuberculosis and Respiratory Diseases
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• v.39 no.4
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• pp.310-317
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• 1992

Background: Angiotensin converting enzyme is a glycoprotein peptidyldipeptide hydrolase which cleaves the c-terminal dipeptides of several oligopeptides. It is a menbrane-bound protein mainly synthesized by the endothelial cells. Since the lung has the largest capillary bed of any organ in the body, it is here that ACE acts on circulating substrates like angiotensin I and bradykinin. It is well known that ACE correlates with disease activity in sarcoidosis and also there are reports that changes in serum ACE activity are found in many acute and chronic lung diseases. So we planned this study to see if serum ACE activity can act as a prognostic factor in lung cancer. Methods: Forty-one newly diagnosed lung cancer patients were included in the study group. There were 19 patients with squamous cell lung cancer, 13 with adenocarcinoma, and 9 with small cell carcinoma. Patients were excluded from the study if they had high blood pressure, heart disease, liver disease, renal disease, or other lung disease. Serum ACE activity was analyzed according to cell type, staging, mode of treatment, and clinical response to treatment. Results: 1) There was no difference in serum ACE activity between lung cancer patients and the control group. Also no difference in serum ACE activity was found according to cancer cell type or staging. 2) In patients who underwent curative resection of lung cancer, serum ACE activity was decreased significantly after the operation. 3) In patients who were diagnosed as non-small cell lung cancer and were treated with 4 cycles of anti-cancer chemotherapy without clinical improvement, changes in serum ACE activity were not seen after the treatment. 4) In patients diagnosed as small cell lung cancer treated with 4 cycles of anti-cancer chemotherapy with clinical improvement, changes in serum ACE activity were also not observed. Conclusion: Serum ACE activity was decreased after lung resection but had no relation to cell type, staging, or clinical response to treatment in lung cancer patients. Therefore, serum ACE activity is not suitable in predicting clinical outcome of lung cancer patients.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.45-56
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• 1998

Background: Lung cancer continues to increase worldwide. Also, the proportion of female patients incease and adenocarcinoma is the predominant histological type among lung cancer in many western countries. So, we studied these current trends of lung cancer by clinical approach of recent patients from our department Method: We conducted a retrospective analysis on 212 subjects who were diagnosed with lung cancer at the department of chest medicine in National Medical Center between January 1990 and July 1996. The contents of analysis were patient's profile, clinical manifestation, smoking habits, accuracy of diagnostic methods, histological cell type, staging and treatment, etc. Results: The results were as follows. 1) The ratio of male to female was 5.2 : 1. The peak incidence of age was 7th decade(35.4%). 2) Chief complaints were cough, dyspnea and chest pain, etc. The most common duration of symptoms before the first admission was less than 3 months(57.7%). On the other side, duration more than 1 year represented 6.5%. The early diagnosed patients has been increased from the 1980s. 3) Smokers among the total patients were 77.2%. The proportion of smokers in sqamous cell carcinoma, small cell carcinoma and adenocarcinoma were 88.4%, 85.7% and 55.7%, respectively. Smoking history and histological cell type were correlated in squamous and small cell carcinoma. 4) Squamous cell carcinoma is still the predominant histological type (44.8%), but, adenocarcinoma increased more than the previous study(30.7%). The other histological types were small cell carcinoma(17.0%) and large cell carcinoma(3.8%) in order of their proportions. 5) The accuracy of diagnostic methods were as follows: sputum cytology 75.3%, bronchoscopic biopsy 65.7%, lymph node aspiration cytology 95.8%, percutaneous lung aspiration cytology 94.6% and open lung biopsy 100%. The general accuracies of diagnostic methods were improved than previous studies. 6) Performance status scales on admission were relatively good. After diagnosis, chemotherapy and/or radiotherapy were undertaken in 69.3% of the patients, and only 7.5% of the patients were operated. Conclusion: In our study, squamous cell carcinoma is still the predominant histological cell type, but, adenocarcinoma continues to increase. Because adenocarcinoma is less correlated with smoking habits, further evaluation of other carcinogens than smoking is requested. Screening and early diagnosis of lung cancer is important for good performance status scales in spite of advanced stages. But, we think that the prevention, for example, stop smokings is more important as because of no perfect treatment for lung cancer.

• Journal of the Korean Society of Radiology
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• v.83 no.5
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• pp.1059-1070
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• 2022

Purpose To compare the sensitivity of tumor detection and inter-observer agreement between acquired diffusion-weighted imaging (aDWI) b2000 and computed DWI (cDWI) b2000 in patients with prostate cancer (PCa). Materials and Methods Eighty-eight patients diagnosed with PCa by radical prostatectomy and having undergone pre-operative 3 Tesla-MRI, including DWI (b, 0, 100, 1000, 2000 s/mm²), were included in the study. cDWI b2000 was obtained from aDWI b0, b100, and b1000. Two independent reviewers performed a review of the aDWI b2000 and cDWI b2000 images in random order at 4-week intervals. A region of interest was drawn for the largest tumor on each dataset, and a Prostate Imaging-Reporting and Data System (PI-RADS) score based on PI-RADS v2.1 was recorded. Histologic topographic maps served as the reference standard. Results The study population's Gleason scores were 6 (n = 16), 7 (n = 53), 8 (n = 9), and 9 (n = 10). According to the reviewers, the sensitivities of cDWI b2000 and aDWI b2000 showed no significant differences (for reviewer 1, both 94% [83/88]; for reviewer 2, both 90% [79/88]; p = 1.000, respectively). The kappa values of cDWI b2000 and aDWI b2000 for the PI-RADS score were 0.422 (95% confidence interval [CI], 0.240-0.603) and 0.495 (95% CI, 0.308-0.683), respectively. Conclusion cDWI b2000 showed comparable sensitivity with aDWI b2000, in addition to sustained moderate inter-observer agreement, in the detection of PCa.