• Radiation Oncology Journal
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• v.19 no.2
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• pp.87-94
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• 2001

Purpose : To evaluate the role of LINAC-based stereotactic radiosurgery (SRS) in the management of meningiomas, we reviewed clinical response, image response, neurological deficits for patients treated at our institution. Methods and materials : Between February 1995 and December 1999, twenty-six patients were treated with SRS. Seven patients had undergone prior resection. Nineteen patients received SRS as the initial treatment. There were 7 male and 19 female patients. The median age was 51 years (range, $14\~67\;years$). At least one clinical symptom presented at the time of SRS in 17 patients and cranial neuropathy was seen in 7 patients. The median tumor volume was $4.7\;cm^3\;(range,\;0.7\~16.5\;m^3)$. The mean marginal dose was 15 Gy (range, $10\~20\;Gy$), delivered to the $80\%$ isodose surface (range, $46\~90\%$). The median clinical and imaging follow-up periods were 27 months (range, 1-71 months) and 25 months (range, $1\~52\;months$), respectively. Results : Of 14 patients who had clinical follow-up of one year or longer, thirteen patients $(93\%)$ were improved clinically at follow-up examination. Clinical symptom worsened in one patient at 4 months after SRS as a result of intratumoral edema, who underwent surgical resection at 7 months. OF 14 patients who had radiologic follow-up of one year or longer, tumor volume decreased in 7 patients $(50\%)$ at a median of 11 months (range, $6\~25\;months$), remained stable in 6 patients $(43\%)$, and increased in one patient $(7\%)$, who underwent surgical resection at 44 months. New radiation-induced neurological deficits developed in six patients $(23\%)$. Five patients $(19\%)$ had transient neurological deficits, completely resolved by conservative treatment including steroid therapy. Radiation-induced brain necrosis developed in one patient $(3.8\%)$ at 9 months after SRS who followed by surgical resection of tumor and necrotic tissue. Conclusions : LINAC-based SRS proves to be an effective and safe management strategy for small to moderate sized meningiomas, inoperable, residual, and recurrent, but long-term follow-up will be necessary to fully evaluate its efficacy. To reduce the radiation-induced neurological deficit for large size meningioma and/or in the proximity of critical and neural structure, more delicate treatment planning and optimal decision of radiation dose will be necessary.

• Radiation Oncology Journal
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• v.24 no.2
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• pp.144-148
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• 2006

Trigeminal neuralgia is defined as an episodic electrical shock-like sensation in a dermatomal distribution of the trigeminal nerve. When medications fail to control pain, various procedures are used to attempt to control refractory pain. Of available procedures, stereotactic radiosurgery is the least invasive procedure and has been demonstrated to produce significant pain relief with minimal side effects. Recently, linear accelerators were introduced as a tool for radiosurgery of trigeminal neuralgia beneath the already accepted gamma unit. Author have experienced one case with trigeminal neuralgia treated with linear accelerator. The patient was treated with 85 Gy by means of 5 mm collimator directed to trigeminal nerve root entry zone. The patient obtained pain free without medication at 20 days after the procedure and remain pain free at 6 months after the procedure. He didn't experience facial numbness or other side effects.

• Progress in Medical Physics
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• v.15 no.2
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• pp.84-93
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• 2004

Stereotactic radiosurgery (SRS) is a technique that delivers a high dose to a target legion and a low dose to a critical organ through only one or a few irradiations. For this purpose, many mathematical methods for optimization have been proposed. There are some limitations to using these methods: the long calculation time and difficulty in finding a unique solution due to different tumor shapes. In this study, many clinical target shapes were examined to find a typical pattern of tumor shapes from which some possible ideal geometrical shapes, such as spheres, cylinders, cones or a combination, are assumed to approximate real tumor shapes. Using the arrangement of multiple isocenters, optimum variables, such as isocenter positions or collimator size, were determined. A database was formed from these results. The optimization procedure consisted of the following steps: Any shape of tumor was first assumed to an ideal model through a geometry comparison algorithm, then optimum variables for ideal geometry chosen from the predetermined database, followed by a final adjustment of the optimum parameters using the real tumor shape. Although the result of applying the database to other patients was not superior to the result of optimization in each case, it can be acceptable as a plan starling point.

• Radiation Oncology Journal
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• v.20 no.4
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• pp.391-395
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• 2002

Purpose : To confirm the accuracy of the radiation dose at the isocenter by the standard linear accelerator-based stereotactic radiosurgery technique which was developed at Seoul National University Hospital. Materials and Methods : Radiation dosimetry was undertaken during standard 5-arc radiosurgery using 6 MV X-ray beam from CL2100C linac. The treatment head was attached with circular tertiary collimators of 10 and 20 mm diameter. We measured the absorbed dose at the isocenter of a multi-purpose phantom using two kinds of detector : a 0.125 co ionization chamber and a silicon diode detector. Results : The dose differences at each arc plane between the planned dose and the measured dose at the isocenter raged from $-0.73\%\;to\;-2.69\%$ with the 0.125 cc ion chamber, and from $-1.29\%\;to\;-2.91\%$ with the diode detector during radiosurgery with the tertiary collimator of 20 mm diameter. Those with the 10-mm tertiary collimator ranged from $-2.39\%\;to\;-4.25\%$ with the diode. Conclusion : The dose accuracy at the isocenter was ${\pm}3\%$. Therefore, further efforts such ws modification in processing of the archived image through DICOM3.0 format are required to lessen the dose difference.

• The Journal of Korean Society for Radiation Therapy
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• v.11 no.1
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• pp.94-99
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• 1999

• The Journal of Korean Society for Radiation Therapy
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• v.11 no.1
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• pp.122-124
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• 1999

• The Journal of Korean Society for Radiation Therapy
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• v.9 no.1
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• pp.82-86
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• 1997

• 대한방사선치료학회:학술대회논문집
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• 2004.06a
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• pp.16-16
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• 2004

• Radiation Oncology Journal
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• v.13 no.4
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• pp.403-409
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• 1995

Purpose : Authors tried to enhance the safety and accuracy of radiosurgery by verifying stereotacitc target point in actual treatment position prior to irradiation. Materials and Methods : Before the actual treatment, several sections of anthropomorphic head phantom were used to create a condition of unknown coordinates of the target point. A film was sandwitched between the phantom sections and punctured by sharp needle tip. The tip of the needle represented the target point. The head phantom was fixed to the stereotactic ring and CT scan was done with CT localizer attached to the ring. After the CT scanning, the stereotactic coordinates of the target point were determined. The head phantom was secured to accelerator's treatment couch and the movement of laser isocenter to the stereotactic coordinates determined by CT scanning was performed using target positioner. Accelerator's anteroposterior and lateral portal films were taken using angiographic localizers. The stereotactic coordinates determined by analysis of portal films were compared with the stereotactic coordinates previously determined by CT scanning. Following the correction of discrepancy the head phantom was irradiated using a stereotactic technique of several arcs. After the irradiation, the film which was sandwitched between the phantom sections was developed and the degree of coincidence between the center of the radiation distribution with the target point represented by the hole in the film was measured. In the treatment of the actual patients, the way of determining the stereotactic coordinates with CT localizers and angiograuhic localizers was the same as the phantom study. After the correction of the discrepancy between two sets of coordinates, we proceeded to the irradiation of the actual patient. Results : In the phantom study, the agreement between the center of the radiation distribution and the localized target point was very good. By measuring optical density profiles of the sandwitched film along axes that intersected the target point, authors could confirm the discrepancy was 0.3 mm. In the treatment of an actual patient, the discrepancy between the stereotactic coordinates with CT localizers and angiographic localizers was 0.6 mm. Conclusion : By verifying stereotactic target point in actual treatment position prior to irradiation, the accuracy and safety of streotactic radiosurgery procedure were established.

• Journal of The Korean Radiological Technologist Association
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• v.25 no.1
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• pp.65.1-65.1
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• 1999