• The Journal of Korean Society for Radiation Therapy
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• v.24 no.2
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• pp.123-135
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• 2012

Purpose: It is essential to minimize the movement of tumor due to respiratory movement at the time of respiration controlled radiotherapy of non-small cell lung cancer patient. Accordingly, this Study aims to evaluate the usefulness of restricted respiratory period by comparing and analyzing the treatment plans that apply free and restricted respiration period respectively. Materials and Methods: After having conducted training on 9 non-small cell lung cancer patients (tumor n=10) from April to December 2011 by using 'signal monitored-breathing (guided- breathing)' method for the 'free respiratory period' measured on the basis of the regular respiratory period of the patents and 'restricted respiratory period' that was intentionally reduced, total of 10 CT images for each of the respiration phases were acquired by carrying out 4D CT for treatment planning purpose by using RPM and 4-dimensional computed tomography simulator. Visual gross tumor volume (GTV) and internal target volume (ITV) that each of the observer 1 and observer 2 has set were measured and compared on the CT image of each respiratory interval. Moreover, the amplitude of movement of tumor was measured by measuring the center of mass (COM) at the phase of 0% which is the end-inspiration (EI) and at the phase of 50% which is the end-exhalation (EE). In addition, both observers established treatment plan that applied the 2 respiratory periods, and mean dose to normal lung (MDTNL) was compared and analyzed through dose-volume histogram (DVH). Moreover, normal tissue complication probability (NTCP) of the normal lung volume was compared by using dose-volume histogram analysis program (DVH analyzer v.1) and statistical analysis was performed in order to carry out quantitative evaluation of the measured data. Results: As the result of the analysis of the treatment plan that applied the 'restricted respiratory period' of the observer 1 and observer 2, there was reduction rate of 38.75% in the 3-dimensional direction movement of the tumor in comparison to the 'free respiratory period' in the case of the observer 1, while there reduction rate was 41.10% in the case of the observer 2. The results of measurement and comparison of the volumes, GTV and ITV, there was reduction rate of $14.96{\pm}9.44%$ for observer 1 and $19.86{\pm}10.62%$ for observer 2 in the case of GTV, while there was reduction rate of $8.91{\pm}5.91%$ for observer 1 and $15.52{\pm}9.01%$ for observer 2 in the case of ITV. The results of analysis and comparison of MDTNL and NTCP illustrated the reduction rate of MDTNL $3.98{\pm}5.62%$ for observer 1 and $7.62{\pm}10.29%$ for observer 2 in the case of MDTNL, while there was reduction rate of $21.70{\pm}28.27%$ for observer 1 and $37.83{\pm}49.93%$ for observer 2 in the case of NTCP. In addition, the results of analysis of correlation between the resultant values of the 2 observers, while there was significant difference between the observers for the 'free respiratory period', there was no significantly different reduction rates between the observers for 'restricted respiratory period. Conclusion: It was possible to verify the usefulness and appropriateness of 'restricted respiratory period' at the time of respiration controlled radiotherapy on non-small cell lung cancer patient as the treatment plan that applied 'restricted respiratory period' illustrated relative reduction in the evaluation factors in comparison to the 'free respiratory period.

• The Korean Journal of Nuclear Medicine
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• v.32 no.2
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• pp.143-150
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• 1998

Purpose: T1-201 SPECT has been used in differentiating benign and malignant pulmonary lesions. While its sensitivity may be high, the specificity and predictive values are reported to be variable depending on the type of benign lung lesion. The purpose of this study was to prospectively assess the efficacy of T1-201 SPECT for differentiating benign and malignant single pulmonary lesion in a population with a high prevalence of benign pulmonary lesion, especially, tuberculosis. Materials and Methods: One-hundred thirty-three patients, having 89 malignant and 44 benign lesions(23 active tuberculosis, 5 inactive tuberculosis, 3 aspergil-loma, 3 focal pneumonia, 2 thymoma, and 8 others), were imaged using a dual-headed system at 15 minute(early) and 3 hour (delayed) following administration of 111MBq T1-201. The images were read visually and lesion-to-background ratios(L/B) were obtained from transverse tomographic slices. Retention index was expressed as [(delayed L/B- early L/B) $\div$ early L/B]. Results: 82/89(92%) and 83/89(93%) of the malignant lesions were visually positive on the early and delayed images, and 27/44(61%) and 26/44(59%) of the benign lesions were also visually positive on both images. Although a statistically significant difference was found between the mean L/B's of the malignant and benign lesions, L/B was not useful for differentiating the two due to a large overlap. There was no difference in retention indices. Conclusion: Despite of its high sensitivity, the specificity of T1-201 SPECT was unacceptably low in patients with active benign lesions. The positive and negative predictive values for lung cancer in a population with a high prevalence of the benign single pulmonary lesion was only marginal.

• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.137-144
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• 2021

Purpose : The usability of X-Jaw split VMAT was evaluated by comparative analysis of the dose distribution between the treatment plan divided by X-Jaw and Full field VMAT treatment plan in left breast cancer treatment including supraclavicular lymph nodes. Materials and Methods : 10 patients with left breast cancer, including supraclavicular lymph nodes, were simulated using vacuum cushion, and 2 Full field Arc VMAT and 4 X-Jaw split Arc VMAT were planned The treatment plan was designed to include more than 95% of the Planning Target Volume (PTV) and to be minimally irradiated in the surrounding Organ at risk (OAR). Dose analysis of PTV and OAR was performed through dose volume histogram (DVH). Results : The Full field VMAT treatment plan and the X-Jaw split VMAT treatment plan of 10 patients were expressed as average values and compared. The difference between the two treatment plans was not large, with a Conformity index (CI) of 1.05±0.04, 1.04±0.03, and a Homogeneity index (HI) of 1.07±0.008, 1.07±0.009. For OAR, V5 in the left lung is 56.1±6.50%, 50.4±6.30%, and V20 is 20.0±4.15%, 13.52±3.61%. Compared to Full field VMAT, V5 decreased by 10.0% V20 by 32.6% in X-Jaw split VMAT. The V30 of the heart is 3.68±1.85%, 2.23±1.52%, and the Mean dose is 8.93±1.65 Gy, 7.67±1.52 Gy. In the X-Jaw split VMAT, V30 decreased by 39.3% and the Mean dose decreased by 14.1%. The left lung and heart, which are normal tissues, were found to have a statistical significance of that p-value is less than 0.05. Conclusion : In the case of left breast cancer treatment, which includes Supraclavicular lymph nodes with a large PTV volume and a length of X Jaw of 15 cm or more, the X-Jaw split VMAT shows improved dose distribution, which can reduce radiation dose of OAR such as lungs and heart, while maintaining similar PTV coverage with HI and CI equivalent to Full field VMAT. It is thought to be effective in reducing radiation complications.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.91-97
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• 1995

Synovial sarcoma is a malignant soft tissue tumor which is the most prevalent in adolescents and young adults between 10 and 40 years of age. It occurs primarily in the para-articular regions, usually in close association with tendon sheath, bursae and joint capsules. Favorable clinical factors are young age of the patients, tumor size smaller than 5cm, and distal rather than proximal location in the extremities. We analysed clinical findings of 13 cases of synovial sarcoma that had been experienced from January 1983 to December 1992. There were 8 females and 5 males, whose age was averaged as 28 years and 10 months ranging from 6 years to 54 years. The mean follow-up was 3 years(range : 9 months- 9 years 1 month). Palpable mass was frequent clinical symptom and lower extremity especially around the knee was the most prevalent site. Treatment modalities were the combination of surgery, radiotherapy and chemotherapy. Distant metastasis occured in 5(38%) cases : 4 cases to lung and 1 case to neck, and 2 cases had local recurrences. At final follow-up 6 cases were continous disease free, 2 alive with disease and 5 died of disease. The Kaplan-Meier's estimated 5 year survival rate of total 13 cases was 66% and satisfactory results were obtained with mass size smaller than 5cm.

• Tuberculosis and Respiratory Diseases
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• v.66 no.6
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• pp.467-470
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• 2009

Serum CA 125 is the most useful marker for monitoring patients with epithelial ovarian cancer. However, it can be elevated above normal level in a variety of conditions other than ovarian cancer such as endometriosis, pelvic inflammation disease, and other malignant or nonmalignant disorders, including pulmonary diseases. Recently, we experienced a case of bronchiectasis in which the serum CA 125 level was elevated, changing with the patient's condition. There was no evidence of underlying malignant disease on positron emission tomography or on gynecologic examination, including transvaginal ultrasonography. During follow-up for 14 months, we could not find any clue of malignant disease that could have been the cause of the elevated levels of serum CA 125. Elevated serum CA 125 level should be interpreted carefully according to the patient's clinical condition. In addition, our case suggests that CA 125 may be used as a surrogate marker for acute inflammatory status for chronic pulmonary diseases.

• Tuberculosis and Respiratory Diseases
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• v.66 no.2
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• pp.127-131
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• 2009

Most mediastinal teratomas are histologically well-differentiated tumors and benign. The majority of patients with a mediastinal teratoma are asymptomatic and their tumors are usually discovered incidentally on chest radiography. On rare occasions this tumor will rupture spontaneously into the adjacent organs. A 72-year-old female patient was admitted for dyspnea and she had a multiloculated pleural effusion in the left lung field. Although repeated pleural biopsy and pleural fluid cytology did not prove the presence of malignancy, we assumed that this was a malignant effusion because it revealed consistently high levels of carcinoembryonic antigen and carbohydrate antigen 19-9, and the chest CT scan did not show typical fat or bone density in the mass. Secondary infection and an uncontrolled septic condition due to pleural empyema finally compelled the patient to undergo a surgical operation. Mature teratoma was the final diagnosis and she has done well without recurrence for 2 months.

• Journal of the Korea Convergence Society
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• v.9 no.3
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• pp.257-263
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• 2018

Hyperthermia supplies RF high-frequency energy above 1MHz to the tumor tissue through the electrodes. And the temperature of the tumor tissue is increased to $42^{\circ}C$ or more to cause thermal necrosis. A mathematical model can be derived a human body model for absorption and transmission of electromagnetic energy in the human model and It is possible to evaluate the distribution of temperature fields in biological tissues. In this paper, we build the human model based on the adult standard model of the geometric shape of the 3D model and use the FVM code. It is assumed that Joule heat is supplied to the anatomical model to simulate the magnetic field induced by the external electrode and the temperature distribution was analyzed for 0-1,200 seconds. As a result of the simulation, it was confirmed that the transferred energy progressively penetrates from the edge of the electrode to the pulmonary tumors and from the skin surface to the subcutaneous layer.

• Korean Journal of Bronchoesophagology
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• v.3 no.1
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• pp.27-36
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• 1997

초기후두암에 있어서 보존적 술식의 장점은 후두 전적출술시와 같은 국소치료효과를 얻을 수 있으면서도 후두의 생리적 기능을 최대한 보존하는데 있다. 성공적인 후두부분절제술을 위해서는 후두내에서 종양의 발생위치 및 그 확산에 대한 연부조직들의 해부학적 역할에 대한 이해가 필요하다. 과거에는 초기후두암환자에서 정상적인 목소리를 보존할 수 있다는 이점 때문에 방사선 치료가 일차적 치료요법으로 많이 시행되어 왔다. Wang 과 Wong은 성대 막양부에 국한된 병변에서 방사선치료에 대한 5년간 조절율(5-year control rate)이 92%, 전연합부를 침범한 경우가 81%, 그리고 후방으로 전파된 경우 76%로 감소된다고 보고하였다. Olofsson 등은 전연합부를 침범한 57례의 환자에서 방사선 치료를 시행하여 85.7%의 5년 생존율을 얻었으나, 57례중 15례에서 재발하여 구제수술(salvage surgery)을 시행하였고, Jesse 등$^{13)}$ 은 전연합부를 침범한 91례의 T1, T2 성문암을 방사선 치료를 시행하여 8.8%의 실패율을 보였으나 22례의 환자에서 재발하여 후에 salvage surgery를 시행하였다. 그러나 Ogura 등은 피열 연골을 침범한 79례의 환자에서 보존적 수술을 시행한 결과 6례의 환자에서 재발하여 90%의 3-years control rate를 얻을 수 있었다고 보고하였다. 이처럼 병변이 전연합부, 피열연골 혹은 후방성문하부로의 침범이 있는 경우는 방사선 치료 효과가 떨어지고, 따라서 방사선 치료에 실패할 가능성이 보다 높기 때문에 비록 방사선 치료 후 실패한 경우에서 구제 수술을 시행할 수는 있지만 후두기능을 보존하려는 궁극적인 목표를 생각할 때 보존적 수술을 우선적으로 시행하는 것이 바람직하다고 할 수 있다. Biller 등은 방사선 요법에서 실패한 성문부 종양에서는 대부분 전적출술을 시행하지만 일부는 보존적 수술을 시행할 수 있다고 보고하였다. 이들은 반대측 성문부에 종양의 침범이 없어야 하고, 전연 합으로의 파급은 있어도 가능하며 성대돌기를 제외한 피열연골이 정상이어야 하고, 종양의 성문하부로의 파급이 5mm 이내라야 하며, 연골에 침범이 없어야 하고, 성대고정이 없어야 하며, 재발 병소가 방사선요법 전의 원발병소와 상관관계가 있어야 하며, 원발병소가 후두부분적출술에 합당할 경우 보존적 술식을 시행할 수 있다고 하였다. 최근에는 다양한 후두 재건술의 발달로 보다 진행된 후두암에 대한 보존적 후두절제술들이 소개되고 있다. 단측 T3,T4 후두암 혹은 경성문암, 이상와에 위치한 암의 경우 음성만을 재건하는 후두근적출술 (near total laryngectomy)을 시행하기도 한다. 본원 이비인후과에서 1986년부터 초기성문암 51례 중 24례(47.1%)와 초기성문상암 17례 중 12례 (70.6%)에 대하여 보존적 술식을 시행하였다. 초기 성문암의 보존적 술식을 시행한 24례중, 2례(8.3%)에서 경부재발, 1례(4.2%)에서 경부재발과 동반된 폐의 원격전이가 있었으나 원발부위의 재발은 관찰되지 않았고, 술후 합병증으로 1례(4.2%)에서 후두협착, 3례(12.5%)에서 수술부위의 육아종형성, 그리고 1례(4.2%)에서 기관지염이 발생하였으나 오연으로 인한 폐렴은 발생하지 않았다. 초기성문 상암의 보존적 술식을 시행한 12례 중 1례(8.3%)에서 원발병소의 재발, 2례(16.7%)에서 경부재발이 있었으며, 술후 합병증으로 3례(16.7%)에서 오연으로 인한 폐렴의 발생이 있었지만 다른 합병증은 발생하지 않았다. 초기성문암 24례 중 재발이 나타난 3례의 환자를 제외한 21례(97.5%)와 초기성문상암 12례 중 재발이 나타난 3례의 환자를 제외한 9례 (75%)에서는 현재까지 재발소견을 보이지 않고 있다. 이러한 결과는 다른 보고자들과 유사한 결과를 보이고 있지만 아직까지 증례가 많지 않기 때문에 생존율을 얻기에는 미흡한 점이 있으며, 향후 지속적인 추적관찰이 필요할 것으로 사료된다.

• Journal of the Korean Society of Radiology
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• v.13 no.3
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• pp.325-332
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• 2019

This study analyzed the movement of tumors using 4DCT. Appropriate uniform IM were identified using TC, II and CI depending on ITV margins. DVH and NTCP were also compared in each case. Dose analysis on tumors with uniform IM showed that the optimal treatment plan for satisfying all TC, CI, II was evaluated as 2 mm in phase 20 and 3 mm in 40%. That was compared to the dose from the normal tissues of $PTV_{20}$, $PTV_{40}$. In the 20% radiation field, V5, V10, and V20 for the lungs increased 1.49, 1.26, and 0.65%, while 40% increased by 1.9, 2.41 and 1.23%. NTCP had a dose increase of 0.57 to 0.029% from 20% and 40%. There was a dose increase in the spinal cord and heart at uniform IM, but there was no significant difference. These data suggest that the ITV setting of 20%, phase for Respiratory Gated Radiotherapy using Novalis ExacTrac system can be applied with a uniform IM 2 mm and 40% with 3 mm for optimal treatment plan.

• Journal of Chest Surgery
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• v.39 no.5 s.262
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• pp.376-381
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• 2006

Background: The Ki-67 protein is a biomarker associated with cell proliferation and a valuable negative prognostic factor in non-small cell lung cancer. We investigated the Ki-67 protein expression in resected non-small cell lung cancer to evaluate the impact on clinicopathological characteristics and postoperative prognosis. Material and Method: Using monoclonal antibody Ki-67, we immunohistochemically examined 38 surgically resected non-small ceil lung cancers to determine Ki-67 Labeling Index (LI). We analysed the differences of clinicopathological characteristics and postoperative recurrence and survival between High Ki-67 Group $(LI{\ge}20%)$ and Low Ki-67 Group (LI<20%). Result: The Ki-67 LIs were heterogenous and a mean values was $20.0{\pm}20.05%$. There were no significant differences in age, sex, smoking, TNM stage, and vascular invasion between High Ki-67 Group and Low Ki-67 Group. A High Ki-67 Group was significantly associated with squamous cell type, poor differentiation, and lymphatic invasion $(p{\le}0.05)$. High Ki-67 Group showed a trend of lower survival (median 47.2 vs. 90.5 months, p=0.312) and lower disease-free survival (median 18.2 vs. 72.3 months, p=0.327) than Low Ki-67 Group. Conclusion: These results indicate that increased Ki-67 protein expression may be a negative prognostic factor and showed a trend of shortened survival and disease-free survival. To evaluate the pivotal role of Ki-67 protein expression, a long-term follow-up and further study are required.