• Radiation Oncology Journal
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• v.18 no.1
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• pp.11-16
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• 2000

Purpose :We peformed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. Methods and Materials : One hundred and six Patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (94$\%$) and ranged from 1 month to 92 months (median; 6 months). Results :The median age was 62 years old and male to female ratio was 104 2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was peformed in 83$\%$. Mean tumor dose delivered with curative aim was 58.6 Gy (55$\~$70.8 Gy) and median duration of the radiation therapy was 53 days. The median survival of all patients was 6 months and )-year and 2-year overall survival rate was 27$\%$ and 12$\%$, respectively, Improvement of dysphagia was obtained in most patients except for 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32$\%$ (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30$\%$ respectively, while those of the nonresponder was 4 months and 0$\%$ respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 months and 16$\%$ while those of the patients who could not tolerate regular diet was 3 months and 0$\%$, respectively (p=0.004). The survival difference between the patients with S cm or less tumor length and those with more than 5 cm tumor length was marginally statistically significant (u=0,06). However, the survival difference according to the periesophageal invasion or mediastinal tyrnphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9$\%$). Conclusion :The survival outcome for advanced esophageal cancer patients treated by external beam radiotherapy alone was very poor. In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.

• Radiation Oncology Journal
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• v.26 no.1
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• pp.17-23
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• 2008

Purpose: The best treatment for advanced esophageal cancer is chemoradiotherapy followed by surgery. In spite of the advance of multimodality therapy, most patients with esophageal cancer are treated with radiation therapy alone. This study reports the outcome of the use of conventional external beam radiotherapy alone for the treatment of esophageal cancer. Materials and Methods: Between January 1998 and December 2005, 30 patients with squamous cell carcinoma of the esophagus were treated with external beam radiotherapy using a total dose exceeding 40 Gy. Radiotherapy was delivered with a total dose of 44-60 Gy(median dose, 57.2 Gy) over $36{\sim}115$ days(median time, 45 days). Thirteen patients(43.3%) had a history of disorders such as diabetes, hypertension, tuberculosis, lye stricture, asthma, cerebral infarct, and cancers. Four patients metachronously had double primary cancers. The most common location of a tumor was the mid-thoracic portion of the esophagus(56.7%). Tumor lengths ranged from 2 cm to 11 cm, with a median length of 6 cm. For AJCC staging, stage III was the most common (63.3%). Five patients had metastases at diagnosis. Results: The median overall survival was 8.3 months. The survival rates at 1-year and 2-years were 33.3% and 18.7%, respectively. The complete response rate $1{\sim}3$ months after radiotherapy was 20%(6/30) and the partial response rate was 70%(21/30). Sixteen patients(53.3%) had an improved symptom of dysphagia. Significant prognostic factors were age, tumor length, stage, degree of dysphagia at the time of diagnosis and tumor response. Cox regression analysis revealed the aim of treatment, clinical tumor response and tumor length as independent prognostic factors for overall survival. Twenty-eight patients had local failure and another four patients had metastases. Three patients were detected with double primary cancers in this analysis. A complication of esophageal stricture was observed in three patients(10%), and radiation pneumonitis occurred in two patients(6.7%). Conclusion: The prognosis of esophageal cancer remains poor, in spite of advances in radiotherapy techniques. Radiotherapy is one of the main treatment modalities for the relief of dysphagia and treatment related complications are minimal. It is expected that the addition of chemotherapy or another systemic modality to radiotherapy will improve tumor control and increase the survival rate in advanced esophageal cancer.

• Journal of Yeungnam Medical Science
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• v.7 no.2
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• pp.109-114
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• 1990

The basic strategy of irradiation is to deliver a dose to the cancer that is high enough to make cancer cells incapable of reproduction, while keeping the doses to the various healthy tissues below tolerable levels. In order to improve local control and survival, as a boost therapy after external radiotherapy, high dose rate transcatheteric irradiation using remote control afterloading system(RALSTRON-20B) was used for twelve patients with head and neck cancers. Present results showed complete remission of cancer in 9 out of 12 patients without treatment related complications. Although this procedure is easy to operate, well trained skillful hand is essential for good results. Furthermore our experience suggested that meticulous treatment planning should be developed for better results.

• Radiation Oncology Journal
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• v.29 no.2
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• pp.121-126
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• 2011

The author reports a bile duct cancer patient whose stent shifted significantly from right to left over the course of radiotherapy. The 80-year-old female patient had a short stature with thoracic kyphosis and mutiple spinal compression fractures. She was also emaciated and very lean. By comparing the weekly scanned computed tomography images, the author found her stent to have shifted by more than 4 cm from right to left over the course of external beam radiotherapy. The results of this case study suggest that for a very lean and emaciated kyphotic bile duct cancer patient, the possibility of large interfractional movement of the bile duct or stent during radiotherapy should be considered.

• Radiation Oncology Journal
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• v.25 no.4
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• pp.278-282
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• 2007

Purpose: Diffuse pigmented villonodular synovitis (PVNS) is an uncommon aggressive synovial proliferative disorder of unknown etiology affecting the joint linings. Though a histologically benign inflammatory process, because of its aggressive growth with bone destruction or recurrence, it is frequently suggested to occur as a low malignant neoplasm. Optimal treatment is surgery, but the local recurrence rate after radical synovectomy for diffuse PVNS is relatively high due to the infiltrative growth pattern. External beam radiotherapy with moderate doses or intra-articular instillation of radioactive isotopes may improve the likelihood of local control and long-term function in patients with incompletely resected or recurrent diffuse PVNS. I report one case of diffuse PVNS of the right knee joint treated with arthroscopic synovectomy and external beam radiotherapy is presented.

• Radiation Oncology Journal
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• v.26 no.4
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• pp.229-236
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• 2008

Purpose: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. Materials and Methods: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from $6{\sim}70\;Gy$ (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from $1{\sim}104$ months (median, 5 months; mean, 20 months). Results: Five patients started the ERT without the presence of a gross mass and all of the patients competed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, $1{\sim}104$ months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. Conclusion: This study suggests that patients with a small initial tumor (${\leq}5\;cm$), which was treated by surgery (curative resection or palliative resection) before ERT, and without rapid re-growth of the mass seen at the surgical site at the beginning of the ERT course, would be the best candidates for postoperative ERT. In contrast, patients with a large initial tumor (>5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.

• Radiation Oncology Journal
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• v.21 no.3
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• pp.199-206
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• 2003

Purpose: This study was undertaken to evaluate the efficacy of postoperative radiotherapy, and to investigate the prognostic factors for FIGO stages IB-IIB cervical cancer patients who were treated with simple hysterectomy, or who had high-risk factors following radical hysterectomy and pelvic lymph node dissection. Materials and Methods: Between March 1986 and December 1998, 58 patients, with FIGO stages IB-IIB cervical cancer were included in this study. The indications for postoperative radiation therapy were based on the pathological findings, including lymph node metastasis, positive surgical margin, parametrial extension, lymphovascular invasion, invasion of more than half the cervical stroma, uterine extension and the incidental finding of cervix cancer fellowing simple hysterectomy. All patients received external pelvic radiotherapy, and 5 patients, received an additional intracavitary radiation therapy. The radiation dose from the external beam to the whole pelvis was $40\~50$ Gy. Vagina cuff Irradiation was peformed, after completion of the external beam irradiation, at a low-dose rate of Cs-137, with the total dose of $4488\~4932$ chy (median: 4500 chy) at 5 mm depth from the vagina surface. The median follow-up period was 44 months ($15\~108$ months). Results: The 5-yr actuarial local control rate, distant free survival and disease-free survival rate were $98\%,\;95\%\;and\;94\%$, respectively. A univariate analysis of the clinical and pathological parameters revealed that the clinical stage (p=0.0145), status of vaginal resection margin (p=0.0002) and parametrial extension (p=0.0001) affected the disease-free survival. From a multivariate analysis, only a parametrial extension independently influenced the disease-free survival. Five patients ($9\%$) experienced Grade 2 late treatment-related complications, such as radiation proctitis (1 patient), cystitis (3 patients) and lymphedema of the leg (1 patient). No patient had grade 3 or 4 complications. Conclusion: Our results indicate that postoperative radiation therapy can achieve good local control and survival rates for patients with stages IB-IIB cervical cancer, treated with a simple hysterectomy, as well as for those treated with a radical hysterectomy, and with unfavorable pathological findings. The prognostic factor for disease-free survival was invasion of the parametrium. The prognosic factor identified in this study for treatment failure can be used as a selection criterion for the combined treatment of radiation and che motherapy.

• Radiation Oncology Journal
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• v.4 no.2
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• pp.135-139
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• 1986

Seven patients having midline granuloma received local irradiation from March 1983 to June 1986. Clinically, all of the 7 patients had pansinusitis with necrotic destruction of the involved sites and one case revealed colonic lesion. Each of the patients received a tumor dose of $4,000\~5,000 cGy/5\~6$ wks to the upper aerodigestive tract using a 6-MV linear accelerator. Complete and partial remission occured in 3 patients each, and in one case, the disease progressed despite of the irradiation.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2003.09a
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• pp.60-60
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• 2003

목적 : 감마나이프 치료계획용 소프트웨어인 감마플렌에서 처방선량을 계산하는 단위와 실제 시간을 설정하는 하드웨어인 조정판의 시간설정 단위의 차이에 의한 실제 처방선량에 끼치는 영향을 계산하였다. 대상 및 방법 : 감마나이프는 주어진 4 개의 헬멧을 가지고 최소 한번 또는 최대 20 번 이상의 방사선 조합으로 한번에 많은 방사선을 목표물에 조사한다. 감마나이프 방사선 수술을 위한 치료계획용 소프트웨어인 감마플렌 5.32에서는 처방선량에 대한 치료시간을 최대 지점 또는 지정하는 지점에 규격화하여 소숫점 두 자리 즉 0.6 초까지 계산한다. 그러나 실제 치료를 위한 조정판의 시간설정은 모델 B 에서는 소숫점 한자리까지 가능하게 되어있다. 그러므로 모델 B를 사용하는 기관의 치료계획 컴퓨터인 감마플렌에서는 소숫점 한자리로 만들기 위해 반올림과 내림을 하게 되며 이것을 프린트하여 사용하게 된다. 실제 임상에서 멀티삿에 대한 반올림과 내림에 대한 효과를 선량으로 환산하여 처방선량에 끼치는 영향을 연구하였다. 치료 계획에 서 처방선량을 입력한 후 계산된 각 조사에 대한 소숫점 두자리 시간을 화면에 표시한 후 스냅tit으로 스크린 캡쳐하여 프린트하였으며, 소숫점 한자리로 된 최종 치료계획을 프린트하여 서로 비교 계산하였다. 결과 : 20 여명의 환자에 대한 치료 결과에 대한 분석은 조사의 수나 처방선량에 관계하지 않고 우연히 올림이 많으냐 내림이 많으냐에 의존하였다. 최대지점에 대하여 분석한 결과는 -0.48부터 +0.47로 -2%부터 +1.9%의 정도로 영향을 끼쳤다. 결론 : 반올림과 내림의 결과는 처방선량을 줄일 수도 있고 늘일 수도 있었다. 그러나 이 연구는 최대선량 지점에 대해 비교를 하였으나 실제로는 각 조사의 위치가 서로 다르므로 영향은 이보다 훨씬 적을 것으로 생각되어 소숫점 한자리로 치료하여도 무방할 것으로 보인다.mm, AP 방향에서는 2.1$\pm$0.82 mm이었다. 그리고 복부의 later의 방향에서는 7.0$\pm$2.1 mm, AP 방향에서는 6.5$\pm$2.2 mm 이었다. 또한 표적 위치측정을 위해서 환자의 피부에 임의의 가상표적을 부착하고 CT 촬영한 영상결과, 프레임으로 가상표 적에 대한 위치를 정확히 파악할 수 있었다. 결론 : 제작된 프레임을 적용하여 방사선투과율 측정실험, 환자 외부자세에 대한 오차 측정실험, 가상표적 위치측정 실험 등을 수행하였다. 환자 외부자세에 대한 오차 측정실험 경우, 더 많은 Volunteer를 적용하여 보다 정확한 오차 측정실험이 수행되어야 할 것이며 정확한 표적 위치 측정실험을 위해서 내부 마커를 삽입한 환자를 적용한 임상실험이 수행되어야 할 것이다. 또한 위치결정에서 획득한 좌표값의 정확성을 알아보기 위해서 팬톰을 이용한 방사선조사 실험이 추후에 실행되어져야 할 것이다. 그리고 제작된 프레임에 Rotating X선 시스템과 내부 장기의 움직임을 계량화하고 PTV에서의 최적 여유폭을 설정함으로써 정위 방사선수술 및 3 차원 업체 방사선치료에 대한 병소 위치측정과 환자의 자세에 대한 setup 오차측정 결정에 도움이 될 수 있을 것이라고 사료된다. 상대적으로 우수한 것으로 나타났으며, 혼합충전재는 암모니아의 경우 코코넛과 펄라이트의 비율이 7：3인 혼합 재료 3번과 소나무수피와 펄라이트의 비율이 7：3인 혼합 재료 6번에서 다른 혼합 재료에 비하여 우수한 것으로 나타났다. 4. 코코넛과 소나무수피의 경우 암모니아 가스에 대한 흡착 능력은 거의 비슷한 것으로 사료되며, 코코넛의 경우 전량을 수입에 의존하고 있다는 점에서 국내 조달이 용이하며, 구입 비용도 적게 소요되는 소나무수피를 사용하는 것이 경제적이라고 사료된다. 5. 마지막으로

• Radiation Oncology Journal
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• v.5 no.2
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• pp.173-176
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• 1987

Carcinoma of extrahepatic biliary tract is slow growing tumor but curative resection is rarely successful. Radiation therapy has been introduced for enhancing palliation and possible longterm survival. We treated a case of advanced extrahepatic biliary tract carcinoma with high dose rate remote afterloading system through T-tube as a initial irradiation postoperatively. We hope that this treatment may affect not only ennancing palliation and better quality of life but also in local tumor control.