• Tuberculosis and Respiratory Diseases
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• v.60 no.1
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• pp.57-64
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• 2006

Background : Recently, there have been several studies showing that irinotecan hydrochloride, a topoisomerase I inhibitor, is effective against extensive disease(ED) small cell lung cancer (SCLC). We conducted a phase II trial to evaluate the efficacy and toxicity of irinotecan plus cisplatin as a 1st line therapy for both limited and extensive disease SCLC. Methods : The study was conducted between January 2002 and June 2004. Patients were treated with $60mg/m^2$ irinotecan on day 1, 8, 15 and $60mg/m^2$ cisplatin on day 1, every 4 weeks. During concurrent thoracic irradiation for limited disease (LD)-SCLC patients, dose of irinotecan was reduced to $40mg/m^2$. Prophylactic cranial irradiation was given to patients with complete remission (CR) after chemotherapy. Results : Median ages of LD- and ED- SCLC were 64 years and performance status (PS) was 0-2. In patients with LD-SCLC, the response rate after concurrent chemoradiotherapy was 85% (CR, 6; Partial response [PR], 11). The median survival was 20 months (95% CIs, 15.6 to 24.4) with 1-and 2-year survival rates of 85% and 35%, respectively. Median progression free survival (PFS) was 12 months (95% CIs, 6.2 to 18.1) with 1- year PFS of 36%. In ED-SCLC, the response rate was 83.4% (CR, 1; PR, 14). The median survival was 14.5 months (95% CIs, 8.8 to 20.1) with 1-year survival rates of 75%. Median PFS was 6.3 months (95% CIs, 5.6 to 7.1) with 1- year PFS of 20%. The major toxicities (grade 3 or 4) of this regimen included leukopenia, anemia, thrombocytopenia, nausea/vomiting, and diarrhea without life threatening complication. Conclusion : Our data shows that the combination of irinotecan plus cisplatin as a first line therapy is effective and tolerable in the treatment of both LD- and ED- SCLC.

• Radiation Oncology Journal
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• v.25 no.3
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• pp.151-159
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• 2007

Purpose: The purpose of this study is to present the treatment results and to identify possible prognostic indicators in patients with locally advanced hypopharyngeal carcinoma. Materials and Methods: Between October 1985 to December 2000, 90 patients who had locally advanced stage IV hypopharyngeal carcinoma were studied retrospectively. Twelve patients were treated with radiotherapy alone, 65 patients were treated with a combination of chemotherapy and radiotherapy, and 13 patients were treated with surgery and postoperative radiotherapy with or without neoadjuvant chemotherapy. Total radiation dose ranged from 59.0 to 88.2 Gy (median 70 Gy) for radiotherpay alone. Most patients had ciplatin and 5-fluorouracil, and others had cisplatin and pepleomycin or vincristin. Median follow-up period was 15 months. Kaplan-Meier method was used for survival rate and Cox proportional hazard model for multivariate analysis of prognostic factors. Results: Overall 3-and 5-year survival rates were 27% and 17%, respectively. The 2-year locoregional control rates were 33% for radiotherapy alone, 32% for combined chemotherapy and radiotherapy, and 81 % for combined surgery and radiotherapy (p=0.006). The prognostic factors affecting overall survival were T stage, concurrent chemoradiation and treatment response. Overall 3-and 5-year laryngeal preservation rates in combined chemotherapy and radiotherapy were 26% and 22%, respectively. Of these, the 5-year laryngeal preservation rates were 52% for concurrent chemoradiation group (n=11), and 16% for neoadjuvant chemotherapy and radiotherapy (n=54, p=0.012). Conclusion: Surgery and postoperative radiotherapy showed better results than radiotherapy alone or with chemotherapy. Radiotherapy combined with concurrent chemotherapy is an effective modality to achieve organ preservation in locally advanced hypopharyngeal cancer. Further prospective randomized studies will be required.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.222-228
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• 2008

Purpose: Various treatment techniques have been attempted for the radiotherapy of anal cancer because of acute side effects such as perineal skin reactions. This study was performed to investigate an optimal radiotherapy technique in anal cancer. Materials and Methods: The study subjects included 35 patients who underwent definitive concurrent chemoradiotherapy for anal cancer in Yonsei Cancer Center between 1990 and 2007. The patients' clinical data, including irradiation technique, were reviewed retrospectively. The primary lesion, regional lymph nodes, and both inguinal lymph nodes were irradiated by $41.4{\sim}45\;Gy$ with a conventional schedule, followed by a boost does to the primary lesion or metastatic lymph nodes. The radiotherapy technique was classified into four categories according to the irradiation field and number of portals. In turn, acute skin reactions associated with the treatment interruption period were investigated according to each of the four techniques. Results: 28 patients (80.0%) had grade 2 radiation dermatitis or greater, whereas 10 patients (28.6%) had grade 3 radiation dermatitis or greater during radiotherapy. Radiation dermatitis and the treatment interruption period were relatively lower in patients belonging to the posterior-right-left 3 x-ray field with inguinal electron boost and in patients belonging to electron thunderbird techniques. The interruption periods were $8.2{\pm}10.2$ and $5.7{\pm}7.7$ for the two technique groups, respectively. Twenty-seven patients (77.1%) went into complete remission at 1 month after radiotherapy and the overall 5 year survival rates were 67.7%. Conclusion: Field size and beam arrangement can affect patients' compliance in anal cancer radiotherapy, whereas a small x-ray field for the perineum seems to be helpful by decreasing severe radiation dermatitis.

• Radiation Oncology Journal
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• v.14 no.3
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• pp.201-209
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• 1996

Purpose : To assess the efficacy of high dose rate - intracavitary radio-therapy (HDR-ICR) in the radiotherapy of FIGO stage IB squamous cell carcinoma of uterine cervix and to determine the optimum dose combination scheme of external radiotherapy and ICR to achieve acceptable local control without severe complication. Materials and Methods : One hundred and sixty two patients with FIGO stage Ib squamous cell carcinoma of uterine cervix who received definitive radiotherapy between May 1979 and December 1990 were retrospectively analyzed. All the patients received external radiotherapy combined with HDR-ICR. External dose of 40-46 Gy in 4.5-5 weeks was given to whole pelvis(median 45 Gy) and ICR dose of 30-39 Gy in 10-13 times was given to the point A. Midline shielding was done after 20-45 Gy of external radiotherapy(median 40 Gy) Summation of external dose Plus ICR dose to the point A range were 64.20-95.00 Gy. and mean was 83.94 Gy. We analyzed the local control rate, survival rate, and late complication rate. Rusults : Initial complete response rate was $99.4\%$ for all patients. Overall 5-year survival rate was $91.1\%$ and 5-year disease free survival rate was $90.9\%$. Local failure rate was $4.9\%$ and distant failure rate was $4.3\%$. Tumor size was the only significant prognostic factor. When tumor size greater than 3cm, 5-rear survival rate was $92.6\%$ and less than 3cm, that was $79.6\%$. Late complication rate was $23.5\%$ with $18.5\%$ of rectal complication and $4.9\%$ of bladder complication. Mean rectal dose summation of external midline dose plus ICR rectal point dose was lower in the patients without rectal complication(74.88 Gr) than those with rectal complication (78.87 Gy). Complication rate was increased with low rate of improvement of survival rate when summation of external midline dose plus point A or point R dose by ICR was greater than 70-75 Gy. Conclusion : The definitive radiation therapy using high dose rate ICR in FIGO stage IB uterine cervical cancer is effective treatment modality with good local control and survival rate without severe complication.

• Tuberculosis and Respiratory Diseases
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• v.45 no.4
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• pp.785-794
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• 1998

Background: Chemical pleurodesis is a widely used method for the control of symptomatic and recurrent malignant pleural effusions. Talc has been accepted to be the most effective sclerosing agent for chemical pleurodesis. This study was undertaken to evaluate the usefulness of talc pleurodesis via video-assisted thoracoscopic surgery (VATS) in treatment of malignant pleural effusions. Methods : A retrospective analysis of the medical records and radiographic findings was performed. The success of the procedure was defined as daily pleural fluid drainage below 100ml within 1 week after pleurodesis and complete expansion of the lung on simple chest radiograph. Recurrence was defined as reaccumulation of pleural fluid on follow-up chest radiographs, and complete response as no fluid accumulation on follow-up chest radiographs. Results: Between October 1994 and August 1996, talc pleurodesis via VATS was performed in 35 patients. Duration of follow-up ranged from 5 days to 828 days(median 79days). The initial success rate of procedure was 88.6%(31 of 35 cases). Complete responses were observed in 92.8% at 30 days, 75.7% at 90 days and 64.9% at 180 days. Postoperative complications were fever (54.3%), subcutaneous emphysema(11.4%), reexpansion pulmonary edema(2.9%) and respiratory failure(5.7%). But procedure related mortality or respiratory failure was not found. Conclusion: Talc pleurodesis via VATS is a safe and effective method for the control of symptomatic malignant pleural effusions.

• Radiation Oncology Journal
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• v.9 no.2
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• pp.277-284
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• 1991

Survival data, prognostic factors, and patterns of failure were retrospectively analyzed for a total of 76 patients with adenocarcinoma of the uterine cervix treated between January 1981 and December 1987, which represents $4.1\%$ of all primary cervical carcinomas treated, at Department of Radiation Oncology, Yensei Cancer Center, Yonsei University College of Medicine. The mean age of the patients was 49 years (range, $27\~79$ years) and the peak incidence was in the group 50 to 59 years of age. More half of the patients were postmenopausal (46/76= $60.5\%$). Most patients ($76\%$) had abnormal vaginal bleeding either alone or in combination with other symptoms. The proportion of stage IIb was $43.4\%$. There were 4 major histologic subtypes: pure adenocarcinoma (48/76=$63.2\%$), adenosquamous carcinoma (20/76=$26.3\%$), papillary (5/76=$6.6\%$) and clear cell carcinoma (3/76=$3.9\%$). Of the many clinicopathologic variables evaluated for prognosis, the most significant prognostic factors were stage of disease and the size of tumor. The overall 5-year survival rate was $68\%$, and the 5-year survival rates for stage Ib, II and III were $90\%,\;66\%\;and\;54\%$, respectively. Control of pelvic tumors was achieved in $93.8\%,\;90.2\%\;and\;50.0\%$ of cases of stage Ib, II and III disease, respectively. In present study, treatment modalities (radiation therapy alone/combined operative and radiation therapy) did not affect the local control of tumor and the survival.

• Radiation Oncology Journal
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• v.24 no.1
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• pp.1-10
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• 2006

Puroose: To present preliminary results of intensity-modulated radiotherapy (IMRT) using the simultaneous modulated accelerated radiation therapy (SMART) boost technique in patients with nasopharyngeal carcinoma (NPC). Materials and Methods: Twenty patients who underwent IMRT for non-metastatic NPC at the Asan Medical Center between September 2001 and December 2003 were prospectively evaluated. IMRT was delivered using the 'step and shoot' SMART technique at prescribed doses of 72 Gy (2.4 Gy/day) to the gross tumor volume (GTV), 60 Gy (2 Gy/day) to the clinical target volume (CTV) and metastatic nodal station, and 46 Gy (2 Gy/day) to the clinically negative neck region. Eighteen patients also received concurrent chemotherapy using cisplatin once per week. Results: The median follow-up period was 27 months. Nineteen patients completed the treatment without interruption; the remaining patient interrupted treatment for 2 weeks owing to severe pharyngitis and malnutrition. Five patients (25%) had RTOG grade 3 mucositis, whereas nine (45%) had grade 3 pharyngitis. Seven patients (35%) lost more than 10% of their pretreatment weight, whereas 11 (55%) required intravenous fluids and/or tube feeding. There was no grade 3 or 4 chronic xerostomia. All patients showed complete response. Two patients had distant metastases and loco-regional recurrence, respectively. Conclusion: IMRT using the SMART boost technique allows parotid sparing, as shown clinically and by dosimetry, and may also be more effective biologically. A larger population of patients and a longer follow-up period are needed to evaluate ultimate tumor control and late toxicity.

• Radiation Oncology Journal
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• v.29 no.1
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• pp.11-19
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• 2011

Purpose: To evaluate the pathological and clinical effects of preoperative chemoradiation (CCRT) in cases of locally advanced rectal cancer and to determine the predictive factors for tumor downstaging. Materials and Methods: From March 2004 to August 2008, 33 patients with locally advanced rectal cancer were treated with preoperative CCRT. Twenty-eight patients (84.8%) were treated using a concomitant boost technique while five (15.2%) patients were treated using a cone down boost technique. All patients received 50.4 Gy of irradiation and concurrent chemotherapy with 5-fluorouracil. The median follow-up duration was 24.2 months (range, 9.8 to 64.7 months). Results: Thirty-one (93.9%) patients underwent surgery. Twenty-four patients (72.7%) underwent anal sphincter-preserving surgery. The 3-year disease free survival (DFS) and overall survival rates were 63.4% and 78.8%, respectively. Post-operative factors were more important for DFS. Pathologic N stage, margin status, and pathologic differentiation were significant prognostic factors (p=0.001, 0.029, 0.030). Tumor size and lymphovascular invasion were also associated with marginal significance (p=0.081, 0.073). However, only pre-treatment T stage was a significant pre-operative factor (p=0.018). The complete pathological response rate was 9.1 %. T-downstaging was observed in ten (30.3%) patients, whereas N-downstaging was found in 24 (72.7%) patients. Pre-treatment T stage and the interval between CCRT and operation were the predictive factors for downstaging in a univariate analysis (p=0.029, 0.027). Pre-treatment carcinoembryogenic antigen was also associated with marginal significance (p=0.068). Conclusion: The survival of rectal cancer patients can be better determined based on post-operative findings. Therefore, pre-operative CCRT for downstaging of the tumor seems to be important. Pre-treatment T stage and the interval between CCRT and operation can be used to predict downstaging.

• The Korean Journal of Nuclear Medicine
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• v.33 no.4
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• pp.422-429
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• 1999

Purpose: The measurement of radiation absorbed dose is useful to predict the response after I-131 labeled metaiodobenzylguanidine (MIBG) therapy and determine therapy dose in patients with unresectable or malignant pheochromocytoma. We estimated the absorbed dose in tumor tissue after high dose I-131 MIBG in a patient with pheochromocytoma using a gamma camera and Medical Internal Radiation Dose (MIRD) formula. Materials and Methods: A 64-year old female patient with pheochromocytoma who had multiple metastases of mediastinum, right kidney and periaortic lymph nodes, received 74 GBq (200 mCi) of I-131 MIBG. We obtained anterior and posterior images at 0.5, 16, 24, 64 and 145 hours after treatment. Two standard sources of 37 and 74 MBq of I-131 were imaged simultaneously. Cummulated I-131 MIBG uptake in tumor tissue was calculated after the correction of background activity, attenuation, system sensitivity and count loss at a high count rate. Results: The calculated absorbed radiation dose was 32-63 Gy/ 74 GBq, which was lower than the known dose for tumor remission (150-200 Gy). follow-up studies at 1 month showed minimally reduced tumor size on computed tomography, and mildly reduced I-131 MIBG uptake. Conclusion: We estimated radiation absorbed dose after therapeutic I-131 MIBG using a gamma camera and MIRD formula, which can be peformed in a clinical nuclear medicine laboratory. Our results suggest that the measurement of radiation absorbed dose in I-131 MIBG therapy is feasible as a routine clinical practice that can guide further treatment plan. The accuracy of dose measurement and correlation with clinical outcome should be evaluated further.

• Korean Journal of Heritage: History & Science
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• v.47 no.1
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• pp.134-151
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• 2014

This paper deals with a review of the structure and production techniques of the Dried-lacquer Amitabha Buddha statue enshrined in Geungnakjeon Hall of Simhyangsa Temple, located in Daeho-dong, Naju-si, Jeollanam-do, Korea. To achieve this goal, X-ray date and two rounds of field research were performed. The data collected were reviewed, and a sample peeled off from the damaged part was analyzed to investigate the structure and material of the background layer. The results revealed that the Simhyangsa Temple Buddha statue was an almost empty Dried-lacquer(Hyeopjeo) Buddha statue where wood core had not been framed and inserted in the statue. It was thus observed that considering that the clothes wrinkles clearly remained, the same one as the irregularity of the outer clothes wrinkles, the Dried-lacquer layer was lifted made in an almost complete shape in the process of forming the clay figure as the origin form. The statue was found to be diagonally incised from the top of the head to the back of the neck to remove the clay and wood core. But in other sites, no incision was confirmed. It was observed that on the site of the head where the incision was made, an adhesives(lacquer or paste) was used. In addition, the black eyes were impacted with beads and the ears, hands, bands, and knots were made of wood. These features are identically shown in the Dried-lacquer Amitabha Buddha statue from Seonguksa Temple, known as a work of the late Goryeo dynasty; the Seated Dried-lacquer Buddha statue in Okura Museum of Art in Tokyo, Japan; the Seated Dried-lacquer Amitabha Buddha statue from Jungnimsa Temple, know as a work of the early Joseon dynasty; and the Seated Vairocana Buddha statue in Bulhoesa Temple, the Seated Dried-lacquer Amitabha Buddha and the Seated Dried-lacquer Buddha statue from Silsangsa Temple. The analysis of the back layer demonstrated that the ground layer and the red lacquer were the production of the time. In particular, the bone ash used for the ground layer was also coated for the ground layer of Buddha statues as well as for the production of the lacquerware during the Goryeo dynasty. It was also found that gold mending was conducted more than twice even in modern times and that the layer of the production time was well preserved despite gold mending several times.