• Radiation Oncology Journal
• /
• v.27 no.3
• /
• pp.140-144
• /
• 2009

Purpose: This study was performed to retrospectively analyze patient survival by weighting according to the primary tumor oncotype in 160 patients with brain metastasis and who underwent whole brain radiotherapy. Materials and Methods: A total of 160 metastatic brain cancer patients who were treated with whole brain radiotherapy of 30 Gy between 2002 and 2008 were retrospectively analyzed. The primary tumor oncotype of 20 patients was breast cancer, and that of 103 patients was lung cancer. Except for 18 patients with leptomeningeal seeding, a total of 142 patients were analyzed according to the prognostic factors and the Recursive Partitioning Analysis (RPA) class. Weighted Partitioning Analysis (WPA), with the weighting being done according to the primary tumor oncotype, was performed and the results were correlated with survival and then compared with the RPA Class. Results: The median survival of the patients in RPA Class I (8 patients) was 20.0 months, that for Class II (76 patients) was 10.0 months and that for Class III (58 patients) was 3.0 months (p<0.003). The median survival of patients in WPA Class I (3 patients) was 36 months, that for the patients in Class II (9 patients) was 23.7 months, that for the patients in Class III (70 patients) was 10.9 months and that for the patients in Class IV (60 patients) was 8.6 months (p<0.001). The WPA Class might have more accuracy in assessing survival, and it may be superior to the RPA Class for assessing survival. Conclusion: A new prognostic index, the WPA Class, has more prognostic value than the RPA Class for the treatment of patients with metastatic brain cancer. This WPA Class may be useful to guide the appropriate treatment of metastatic brain lesions.

• The Journal of Korean Society for Radiation Therapy
• /
• v.31 no.2
• /
• pp.33-41
• /
• 2019

Purpose: The purpose of this study is to improve the reduction of coverage of PTVs adjacent to organ at risk (OAR) by setting up overlapping Planning Target Volume (PTV) during Volumetric Modulated Arc Therapy(VMAT). Materials and Methods: In patients who received Whole Brain, Gall Bladder and Rectum radiation therapy, We compared the cover change, maximum dose, Homogenicity Index and Conformity Index of PTV and also compared the maximum dose and average dose change of Organ At Risk by organizing treatment plans that are not applied overlaped PTV and treatment plans that are applied overlaped PTV in areas where coverage is insufficient. Results: overage of treatment plans with overlapping PTVs was increased in all patients, and overall coverage was also increased in each of the four patients. The maximum dose for PTV was increased in five patients, and the Homogenicity Index and Conformity Index for all patients did not differ much. The maximum dose of the lens was increased by 1.12 times, and the maximum dose was decreased in two patients for brain stem. The mean dose of the eyeball was increased by a maximum of 1.15 times, and there was no significant difference between both parotid gland. In case of gallbladder cancer patients, the mean dose in the liver and colon was decreased, and the mean dose in the duodenum was increased. In the case of rectal cancer patients, the mean dose was reduced for both femur and bladder set as OARs. The overall MU was shown to be similar in four patients, excluding one. Conclusion: If the critical dose of OAR is considered and used properly, I think it is a useful way to improve coverage of PTV.

• Radiation Oncology Journal
• /
• v.9 no.1
• /
• pp.47-52
• /
• 1991

From April,1983 through April,1989, we have treated histologically proven 21 patients with oligodendroglioma using 6 MV linear accelerator at the Division of Radiation Therapy, Kangnam 51. Mary's Hospital Catholic University Medical College. These are 8% of the irradiated 246 primary brain tumors during the same period. To investigate influencing factors on the survival of irradiated U patients with oligodendroglioma, we analyzed the cerebral location of the involvements, initial symptoms, CT findings and survival rates, retrospectively. One case was lost to follow up and excluded from survival data. Of the 28 patients, thirteen were male and 8 female. Ages ranged from 5 to 68 years with a median age of 38 years. Radiation doses varied from 3900 cGy to 0480 cGy and were given for 5 to 8 weeks. All but one were supratentorial. The involvement of the frontal and parietal lobes were 10 (48%) patients in each and temporal lobe in 8 (38.1%). Histological diagnosis was made by stereotactic biopsy in 3 and postoperatively in 18. The type of surgery was divided into partial, subtotal and total resection in 7,9 and 2 cases respectively. In 6 cases, chemotherapy was also tried during or after radiation therapy. Major presenting symptoms were headache, cerebral motor, nausea & vomiting and epilepsy in 18,12, 7 and 5 respectively in decreasing order. In CT analysis, low density (02%), cystic mass (33%), calcifiestion (66%) and positive contrast enhancement (42.8%) were observed as the highest frequency. Mean survival duration after radiation therapy was 38 months (K-M methods). We could not achieve statistically significant factors influencing on the survival rate after radiation therapy for oligodendrogliomas by one or two tail test.

• Journal of Korean Neurosurgical Society
• /
• v.30 no.11
• /
• pp.1340-1344
• /
• 2001

This is a rare case of cerebral metastasis from malignant fibrous histiocytoma(MFH) of the soft tissue. A 62-year-old man underwent craniotomy for resection of multiple intracerebral masses under the impression of metastatic brain tumor with unknown primary site. Preoperative investigation failed to detect any extracranial lesion. At six months after the operation and whole brain radiotherapy, right shoulder mass was detected to grow and excised. Specimen from the brain and shoulder lesions revealed identical pathological findings of malignant fibrous histiocytoma except existence of glial fibrillary acidic protein(GFAP)-positive cells only in brain lesions. Palliative radiotherapy was performed for subsequently developing metastatic lesions in skeletal system. At twelve months after initial diagnosis recurrent lesion at right shoulder was detected and chemotherapy is given. This case is unique because metastatic brain lesion from MFH is rare and also cerebral metastasis as an initial manifestaion of MFH has not been reported before. Another important finding is that there was expression of GFAP only in brain lesions but not in extracranial primary site lesion. Although the presence of GFAP-positive cells is thought as one of characteristic histological findings of primary intracrainal MFH, our observation supports the hypothesis that GFAP-positive cells in primary intracranial MFH may be nonneoplastic astrocytes secondarily involved by MFH.

• Journal of the Korean Society of Radiology
• /
• v.8 no.4
• /
• pp.171-180
• /
• 2014

In this study, the authors attempted to measure the skin dose by irradiating the actual dose on to the TLD(Thermo-Luminescence Dosimeter) and EBT3 Film used as the In-vivo dosimetry after planning the same treatment as the actual patient on a Phantom, because the erythema or dermatitis is frequently occurred on the patients' skin at the time of the proton therapy of medulloblastoma patient receiving the proton therapy. They intended to know whether there is the usefulness for the dosimetry of skin by the comparative analysis of the measured dose values with the treatment planned skin dose. The CT scan from the Brain to the Pelvis was done by placing a phantom on the CSI(Cranio-spinal irradiation) Set-up position of Medulloblastoma, and the treatment Isocenter point was aligned by using DIPS(Digital Image Positioning System) in the treatment room after planning a proton therapy. The treatment Isocenter point of 5 areas that the proton beam was entered into them, and Markers of 2 areas shown in the Phantom during CT scans, that is, in all 7 points, TLD and EBT3 Film pre-calibrated are alternatively attached, and the proton beam that the treatment was planned, was irradiated by 10 times, respectively. As a result of the comparative analysis of the average value calculated from the result values obtained by the repeated measurement of 10 times with the Skin Dose measured in the treatment planning system, the measured dose values of 6 points, except for one point that the accurate measurement was lacked due to the measurement position with a difficulty showed the distribution of the absolute dose value ${\pm}2%$ in both TLD and EBT Film. In conclusion, in this study, the clinical usefulness of the TLD and EBT3 Film for the Enterance skin dose measurement in the first proton therapy in Korea was confirmed.

• The Journal of Korean Society for Radiation Therapy
• /
• v.29 no.1
• /
• pp.69-76
• /
• 2017

Purpose: The purpose of this study was to verify dosimetric results and reproducibility of position during craniospinal irradiation (CSI) using tomotherapy (Accuray Incorporated, USA). Also, by comparing with conventional CSI Technique, we confirmed the efficiency of using a Tomotherapy. Materials and Methods: 10 CSI patients who get tomotherapy participate. Patient-specific quality assurances (QA) for each patient are conducted before treatment. When treating, we took Megavoltage Computed Tomography (MVCT) that range of head and neck before treatment, L spine area after treatment. Also we conducted in-vivo dosimetry to check a scalp dose. Finally, we made a 3D conventional radiation therapy(3D-CRT) of those patients to compare dosimetric differences with tomotherapy treatment planning. Results: V107, V95 of brain is 0 %, 97.2 % in tomotherapy, and 0.3 %, 95.1 % in 3D-CRT. In spine, value of V107, V95 is 0.2 %, 18.6 % in tomotherapy and 89.6 %, 69.9 % in 3D-CRT. Except kidney and lung, tomotherapy reduced normal organ doses than 3D-CRT. The maximum positioning error value of X, Y, Z was 10.2 mm, -8.9 mm, -11.9 mm. Through in-vivo dosimetry, the average of scalp dose was 67.8 % of prescription dose. All patient-specific QA were passed by tolerance value. Conclusion: CSI using tomotherapy had a risk of parallel organ such as lung and kidney because of integral dose in low dose area. However, it demonstrated dosimetric superiority at a target and saved normal organ to reduce high dose. Also results of reproducibility were not exceeded margins that estimated treatment planning and invivo dosimetry showed to reduce scalp dose. Therefore, CSI using tomotherapy is considered to efficient method to make up for 3D-CRT.