• Radiation Oncology Journal
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• v.14 no.1
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• pp.69-76
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• 1996

Purpose : The aim of this study is to investigate the random and systematic errors and tumor movement using electronic portal imaging device in lung cancer patients for the adequate margin in the treatment planning of 3-dimensional conformal therapy. Material and Methods : The electronic portal imaging device is matrix ion chamber type(Portal Vision, Varian). Ten patients of lung cancer treated with chest irradiation were selected for this study. Patients were treated in the supine position without immobilization device. All treatments were delivered by an 10 MV linear accelerator that had the portal imaging system mounted to its ganrty. AP or PA field Portal images were only analyzed. Radiation therapy field included the tumor, mediastinum and supraclavicular lymph nodes. A total of 103 portal images were analyzed for set-up deviation and 10 multiple images were analyzed for tumor movement because of respiration and cardiac motion. Result : The average values of setup displacements in the x, y direction was 1.41 mm, 1 78 mm, respectively. The standard deviation of systematic component was 4.63 mm, 4.11 mm along the x, y axis, respectively while the random component was 4.17 mm in the x direction and 3.31 mm in the y direction. The average displacement from respiratory movement was 12.2 mm with a standard deviation of 4.03 mm. Conclusion : The overall set-up displacement includes both random and systematic component and respiratory movement. About 10 mm, 25 mm margins along x, y axis which considered the set-up displacement and tumor movement were required for initial 3-dimensional conformal treatment planning in the lung cancer patients and portal images should be made and analyzed during first week of treatment, individually.

• Radiation Oncology Journal
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• v.36 no.2
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• pp.103-113
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• 2018

Purpose: Anaplastic thyroid cancer (ATC) is a rare tumor with a lethal clinical course despite aggressive multimodal therapy. Intensity-modulated radiotherapy (IMRT) may achieve a good therapeutic outcome in ATC patients, and the role of IMRT should be assessed. We retrospectively reviewed outcomes for ATC treated with three-dimensional conformal radiotherapy (3D-CRT) or IMRT to determine the optimal treatment option and explore the role of radiotherapy (RT). Materials and Methods: Between December 2000 and December 2015, 41 patients with pathologically proven ATC received RT with a sufficient dose of ${\geq}40Gy$. Among them, 21 patients (51%) underwent surgery before RT. Twenty-eight patients received IMRT, and 13 received 3D-CRT. Overall survival (OS) and progression-free survival (PFS), patterns of failure, and toxicity were examined. Results: The median follow-up time for survivors was 38.0 months. The median and 1-year OS and PFS rates were 7.2 months and 29%, 4.5 months and 15%, respectively. Surgery significantly improved the prognosis (median OS: 10.7 vs. 3.9 months, p = 0.001; median PFS: 5.9 vs. 2.5 months, p = 0.007). IMRT showed significantly better PFS and OS than 3D-CRT, even in multivariate analysis (OS: hazard ratio [HR] = 0.30, p = 0.005; PFS: HR = 0.33, p = 0.005). Significantly higher radiation dose could be delivered with IMRT than 3D-CRT ($EQD2_{10}$ 66 vs. 60 Gy, p = 0.005). Only 2 patients had grade III dermatitis after IMRT. No other severe toxicity ${\geq}grade$ III occurred. Conclusion: Patients with ATC showed better prognosis through multimodal treatment. Furthermore, IMRT could achieve favorable survival rates by safely delivering higher dose than 3D-CRT.

• Progress in Medical Physics
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• v.17 no.1
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• pp.24-31
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• 2006

Automated analysis software was developed to measure the magnitude of the intrafractional and interfractional errors during breast radiation treatments. Error analysis results are important for determining suitable planning target volumes (PTV) prior to Implementing breast-conserving 3-D conformal radiation treatment (CRT). The electrical portal imaging device (EPID) used for this study was a Portal Vision LC250 liquid-filled ionization detector (fast frame-averaging mode, 1.4 frames per second, 256X256 pixels). Twelve patients were imaged for a minimum of 7 treatment days. During each treatment day, an average of 8 to 9 images per field were acquired (dose rate of 400 MU/minute). We developed automated image analysis software to quantitatively analyze 2,931 images (encompassing 720 measurements). Standard deviations ($\sigma$) of intrafractional (breathing motion) and intefractional (setup uncertainty) errors were calculated. The PTV margin to include the clinical target volume (CTV) with 95% confidence level was calculated as $2\;(1.96\;{\sigma})$. To compensate for intra-fractional error (mainly due to breathing motion) the required PTV margin ranged from 2 mm to 4 mm. However, PTV margins compensating for intefractional error ranged from 7 mm to 31 mm. The total average error observed for 12 patients was 17 mm. The intefractional setup error ranged from 2 to 15 times larger than intrafractional errors associated with breathing motion. Prior to 3-D conformal radiation treatment or IMRT breast treatment, the magnitude of setup errors must be measured and properly incorporated into the PTV. To reduce large PTVs for breast IMRT or 3-D CRT, an image-guided system would be extremely valuable, if not required. EPID systems should incorporate automated analysis software as described in this report to process and take advantage of the large numbers of EPID images available for error analysis which will help Individual clinics arrive at an appropriate PTV for their practice. Such systems can also provide valuable patient monitoring information with minimal effort.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.10
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• pp.4577-4581
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• 2016

Objective: The aim of this study was to assess thyroid function in breast cancer patients exposed to therapeutic external beam radiation. The focus was on possible progressive changes and any relationships between the incidence of primary hypothyroidism, the time required to become hypothyroid, and factors such as chemotherapy, hormonotherapy and immunotherapy. Materials and Methods: Seventy females undergoing 3D conformal and IMRT radiation therapy for breast cancers were enrolled in a non-randomized prospective study. The patients was divided into two groups: those after mastectomy or breast conserving surgery (BCS) were irradiated to a scar of the chest wall/breast and the ipsilateral supraclavicular and the axillary areas (supraclavicular radiotherapy group - SC-RT group - 32 patients) and the control group receiving adjuvant chest wall/breast RT only (BCT group - 38 patients).The total doses were 50.0 to 70 Gy in 5 to 7 weeks. The median follow-up term was 24 months (range, 1-40 months). Thyroid function was evaluated by measuring thyroid stimulating hormone (TSH), free thyroxine (fT4), and free triiodothyronine (fT3) levels. The minimum, maximum and mean thyroid gland doses for 20 Gy (V20) were calculated for all patients. Results: Statistically significant results were obtained for the SC-RT group. Two yearsa fter the end of RT the chance of an event was increased in 6% of the population (p=0.009) in the SC-RT group. In the BCT group no significance was noted. No statistically significant differences were found for V20, chemio-, immunotherapy and hormonotherapy or Ki67 values (p=0.12). No significant results were obtained for development of hypothyroidism and clinical factors (age, thyroid volume, treatment modalities). Conclusion: Radiotherapy is associated with a higher incidence of thyroid toxicity in breast cancer patients. Routine thyroid function monitoring should be recommended in such cases.

• The Journal of Korean Society for Radiation Therapy
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• v.18 no.1
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• pp.35-41
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• 2006

Purpose: A various find of radiotherapy treatment plans have been made to determine appropriate doses for breasts, chest walls and loco-regional lymphatics in the radiotherapy of breast cancers. The aim of this study was to evaluate the optimum radiotherapy plan technique method by analyzing dose distributions qualitatively and quantitatively. Materials and Methods: To evaluate the optimum breast cancer radiotherapy plan technique, the traditional method(two dimensional method) and computed tomography image are adopted to get breast volume, and they are compared with the three-dimensional conformal radiography (3DCRT) and the intensity modulated radiotherapy (IMRT). For this, the regions of interest (ROI) such as breasts, chest walls, loco-regional lymphatics and lungs were marked on the humanoid phantom, and the computed tomography(Volume, Siemens, USA) was conducted. Using the computed tomography image obtained, radiotherapy treatment plans (XiO 5.2.1, FOCUS, USA) were made and compared with the traditional methods by applying 3DCRT and IMRT. The comparison and analysis were made by analyzing and conducting radiation dose distribution and dose-volume histogram (DVH) based upon radiotherapy techniques (2D, 3DCRT, IMRT) and point doses for the regions of interest. Again, treatment efficiency was evaluated based upon time-labor. Results: It was found that the case of using 3DCRT plan techniques by getting breast volume is more useful than the traditional methods in terms of tumor delineation, beam direction and confirmation of field boundary. Conclusion: It was possible to present the optimum radiotherapy plan techniques through qualitative and quantitative analyses based upon radiotherapy plan techniques in case of breast cancer radiotherapy. However, further studies are required for the problems with patient setup reproducibility arising from the difficulties of planning target volume (PVT) and breast immobilization in case of three-dimensional radiotherapy planning.

• The Journal of Korean Society for Radiation Therapy
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• v.28 no.2
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• pp.131-137
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• 2016

Purpose : The bladder volume change was measured using ultrasonography for helping decrease the side effects and other organ variations in the location of radiation therapy for cervical cancer patients. An experiment was performed targeting patients who were treated with radiation therapy at PNUH within the period from September to December 2015. Materials and Methods : To maintain the bladder volume, each patient was instructed to drink 500 cc water before and after CT simulation, 60 minutes before the dry run. Also, the bladder volume was measured in each patient CT scan, and a 3D conformal therapy plan was designed. The bladder volumes measured before and after the CT simulation, dry run, and radiation treatment planning were compared and analyzed. Results : The average volume and average error of the bladder that were obtained from the measurement based on the CT scan images had the lowest standard deviation in the CT simulation. This means that the values that were obtained before and after the CT simulation were statistically relevant and correlative. Moreover, the bladder volume measured via ultrasonography was larger size, the average volume in the CT scan. But the values that were obtained Dry run and after the CT simulation were not statistically relevant. Conclusion : Drinking a certain amount of water helps a patient maintain his/her bladder volume for a dry run. Even then, it is difficult to maintain the bladder volume for the dry run. Also, whether or not the patients followed the directions for the dry run correctly is important.

• Radiation Oncology Journal
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• v.22 no.4
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• pp.237-246
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• 2004

Purpose: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). Materials and Methods: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received $63\~70$ Gy (Median 66 Gy, fraction size $1.8\~2$ Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. Results: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were $15{\pm}1.65$ and $11{\pm}0.95$ months, respectively. The was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were $21{\pm}5.03$ and $12{\pm}1.59$ months, respectively, while for Arm 2 patients they were $14{\pm}0.94$ and $10{\pm}1.63$ months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; $44.7\%$ versus $19.2\%$. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. Conclusion: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.

• The Journal of Korean Society for Radiation Therapy
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• v.15 no.1
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• pp.35-40
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• 2003

I. Purpose Confirming an error to be able to break out in a method to move couch manually while operator sees the skin marks on patient in case of curing head who got 2 targets adjoined, so we analyze coordinates price of couch, evaluate reproducibility and precision of change movements between targets. II. Materials and Methods In radiotherapy, for confirming errors in manual movements by operators by exchanging between two targets to treat patient head, we read coordinates price(vertical, longitudinal, lateral three directions of couch) shown on a monitor of LINAC( CL 2100, Varian, USA) in order to evaluate accuracy about the length that moved in time for moving couch manually. After reading movement length of coordinates recorded in three directions of all treatment, we compared distance between targets recorded in RTP(Pinnacle, ADAC, USA) with reading coordinates price of couch, setting actually done the same patient for ten times, coordinates were recorded, treated for evaluating averages and degrees of errors and standard deviations. III. Results In method to confirm skin marks of patient by operators' view and to move couch manually, average standard deviations of movements between two targets are vertical 1.4mm, longitudinal 0.9mm, lateral 2.2mm in each direction. As for the error in straight dimension, it is about 3.6mm averages and 5.1mm maximum. The average of errors in each directions was vertical 1mm, longitudinal 0.7mm, lateral 2.7mm. The greatest error broke out in lateral direction with $25\%$ of all cases ; to exceed an error average. IV. Conclusions If operators moved manually couch for changing target points, errors about 3.6mm average degrees occur. It is important that operators confirm the errors prices of actual couch coordinates for asking a correct movement between the targets adjoined each other ; in case of treatment demanding high precision like 3D conformal therapy or IMRT. Therefore, if we apply couch coordinates confirmation to reproducibility and to precision evaluation of treatment, it's expected that we can execute high-quality radiotherapy.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.473-479
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• 2023

In this study, the dose of photoneutrons generated during radiotherapy of prostate cancer using high energy was measured using a photo-stimulated luminescence dosimeter. In addition, this study was intended to study the probability of side effects occurring in the abdomen. A medical linear accelerator capable of generating 15 MV energy, True Beam STx (Varian Medical Systems, USA) and a radiation treatment planning system (Eclipse, Varian Medical Systems, USA) were used. A human body phantom was installed on the couch of the linear accelerator, and an Albedo Neutron Optical Stimulation Luminescence Neutron Detector (Landauer Inc., IL, USA) was used to measure the photoneutron dose. The photoneutron dose value in the abdomen of VMAT and 3C-CRT was 52.8 mSv, more than twice as high as VMAT compared to 3D-CRT. During radiotherapy of prostate cancer, the probability of causing side effects in the abdomen due to light neutron dose was calculated to be 3.2 per 1,000 for VMAT and 1.4 for 3D-CRT. By studying the abdomen, which has a major side effect that can occur during radiotherapy of prostate cancer, it is expected that it will be used as a meaningful study to study the quality of life and stochastic effect of prostate cancer patients

• Progress in Medical Physics
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• v.27 no.1
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• pp.14-24
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• 2016

Since the head and neck region is densely located with organs at risk (OAR), OAR-sparing is an important issue in the treatment of head and neck cancers. This study-in which different treatment plans were performed varying the head tilt angle on brain tumor patients-investigates the optimal head elevation angle for sparing normal organs (e.g. the hippocampus) and further compares the dosimetric characteristics of different types of radiation equipment. we performed 3D conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), and tomotherapy on 10 patients with brain tumors in the frontal lobe while varying the head tilt angle of patients to analyze the dosimetric characteristics of different therapy methods. In each treatment plan, 95% of the tumor volume was irradiated with a dose of 40 Gy in 10 fractions. The step and shoot technique with nine beams was used for IMRT, and the same prescription dose was delivered to the tumor volume for the 3D-CRT and tomotherapy plans. The homogeneity index, conformity index, and normal tissue complication probability (NTCP) were calculated. At a head elevation angle of $30^{\circ}$, conformity of the isodose curve to the target increased on average by 53%, 8%, and 5.4%. In 3D-CRT, the maximum dose received by the brain stem decreased at $15^{\circ}$, $30^{\circ}$, and $40^{\circ}$, compared to that observed at $0^{\circ}$. The NTCP value of the hippocampus observed in each modality was the highest at a head and neck angle of $0^{\circ}$ and the lowest at $30^{\circ}$. This study demonstrates that the elevation of the patients' head tilt angle in radiation therapy improves the target region's homogeneity of dose distribution by increasing the tumor control rate and conformity of the isodose curve to the target. Moreover, the study shows that the elevation of the head tilt angle lowers the NTCP by separating the tumor volume from the normal tissues, which helps spare OARs and reduce the delivered dose to the hippocampus.