• Title/Summary/Keyword: 4D radiotherapy

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Fabrication of a Patient-Customized Helmet with a Three-Dimensional Printer for Radiation Therapy of Scalp

  • Oh, Se An;Lee, Chang Min;Lee, Min Woo;Lee, Yeong Seok;Lee, Gyu Hwan;Kim, Seong Hoon;Kim, Sung Kyu;Park, Jae Won;Yea, Ji Woon
    • Progress in Medical Physics
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    • v.28 no.3
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    • pp.100-105
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    • 2017
  • The purpose of the present study was to develop and evaluate patient-customized helmets with a three-dimensional (3D) printer for radiation therapy of malignant scalp tumors. Computed tomography was performed in a case an Alderson RANDO phantom without bolus (Non_Bolus), in a case with a dental wax bolus on the scalp (Wax_Bolus), and in a case with a patient-customized helmet fabricated using a 3D printer (3D Printing_Bolus); treatment plans for each of the 3 cases were compared. When wax bolus was used to fabricate a bolus, a drier was used to apply heat to the bolus to make the helmet. $3-matic^{(R)}$ (Materialise) was used for modeling and polyamide 12 (PA-12) was used as a material, 3D Printing bolus was fabricated using a HP JET Fusion 3D 4200. The average Hounsfield Unit (HU) for the Wax_Bolus was -100, and that of the 3D Printing_Bolus was -10. The average radiation doses to the normal brain with the Non_Bolus, Wax_Bolus, and 3D Printing_Bolus methods were 36.3%, 40.2%, and 36.9%, and the minimum radiation dose were 0.9%, 1.6%, 1.4%, respectively. The organs at risk dose were not significantly difference. However, the 95% radiation doses into the planning target volume (PTV) were 61.85%, 94.53%, and 97.82%, and the minimum doses were 0%, 77.1%, and 82.8%, respectively. The technique used to fabricate patient-customized helmets with a 3D printer for radiation therapy of malignant scalp tumors is highly useful, and is expected to accurately deliver doses by reducing the air gap between the patient and bolus.

The Results of Definitive Radiation Therapy and The Analysis of Prognostic Factors for Non-Small Cell Lung Cancer (비소세포성 폐암에서 근치적 방사선치료 성적과 예후인자 분석)

  • Chang, Seung-Hee;Lee, Kyung-Ja;Lee, Soon-Nam
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.409-423
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    • 1998
  • Purpose : This retrospective study was tried to evaluate the clinical characteristics of patients, patterns of failure, survival rates, prognostic factors affecting survival, and treatment related toxicities when non-small cell lung cancer patients was treated by definitive radiotherapy alone or combined with chemotherapy. Materials and Methods : We evaluated the treatment results of 70 patients who were treated by definitive radiation therapy for non-small cell lung cancer at the Department of Radiation Oncology, Ewha Womans University Hospital, between March 1982 and April 1996. The number of patients of each stage was 2 in stage I, 6 in stage II, 30 in stage III-A, 29 in stage III-B, 3 in stage IV. Radiation therapy was administered by 6 MV linear accelerator and daily dose was 1.8-2.0 Gy and total radiation dose was ranged from 50.4 Gy to 72.0 Gy with median dose 59.4 Gy. Thirty four patients was treated with combined therapy with neoadjuvant or concurrent chemotherapy and radiotherapy, and most of them were administered with the multi-drug combined chemotherapy including etoposide and cisplatin. The survival rate was calculated with the Kaplan-Meier methods. Results : The overall 1-year, 2-year, and 3-year survival rates were 63$\%$, 29$\%$, and 26$\%$, respectively. The median survival time of all patients was 17 months. The disease-free survival rate for 1-year and 2-year were 23$\%$ and 16$\%$, respectively. The overall 1-year survival rates according to the stage was 100$\%$ for stage I, 80$\%$ for stage II, 61$\%$ for stage III, and 50$\%$ for stage IV. The overall 1-year 2-year, and 3-year survival rates for stage III patients only were 61$\%$, 23$\%$, and 20$\%$, respectively. The median survival time of stage III patients only was 15 months. The complete response rates by radiation therapy was 10$\%$ and partial response rate was 50$\%$. Thirty patients (43$\%$) among 70 patients assessed local control at initial 3 months follow-up duration. Twenty four (80$\%$) of these 30 Patients was possible to evaluate the pattern of failure after achievement of local control. And then, treatment failure occured in 14 patients (58$\%$): local relapse in 6 patients (43$\%$), distant metastasis in 6 patients (43$\%$) and local relapse with distant metastasis in 2 patients (14$\%$). Therefore, 10 patients (23$\%$) were controlled of disease of primary site with or without distant metastases. Twenty three patients (46$\%$) among 50 patients who were possible to follow-up had distant metastasis. The overall 1-year survival rate according to the treatment modalities was 59$\%$ in radiotherapy alone and 66$\%$ in chemoirradiation group. The overall 1-year survival rates for stage III patients only was 51$\%$ in radiotherapy alone and 68$\%$ in chemoirradiation group which was significant different. The significant prognostic factors affecting survival rate were the stage and the achievement of local control for all patients at univariate- analysis. Use of neoadjuvant or concurrent chemotherapy, use of chemotherapy and the achievement of local control for stage III patients only were also prognostic factors. The stage, pretreatment performance status, use of neoadjuvant or concurrent chemotherapy, total radiation dose and the achievement of local control were significant at multivariate analysis. The treatment-related toxicities were esophagitis, radiation pneunonitis, hematologic toxicity and dermatitis, which were spontaneously improved, but 2 patients were died with radiation pneumonitis. Conclusion : The conventional radiation therapy was not sufficient therapy for achievement of long-term survival in locally advanced non-small cell lung cancer. Therefore, aggressive treatment including the addition of appropriate chemotherapeutic drug to decrease distant metastasis and preoperative radiotherapy combined with surgery, hyperfractionation radiotherapy or 3-D conformal radiation therapy for increase local control are needed.

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Rapidly and Accurately Processing of Low Melting Block for Shielding of Radiotherapy (방사선(放射線) 치료(治療)의 신속정확(迅速正確)을 위한 저온용융(低溫熔融) 차폐물(遮蔽物)의 제작(製作)과 응용(應用))

  • Chu, S.S.;Lee, D.H.;Park, C.Y.
    • Journal of Radiation Protection and Research
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    • v.4 no.1
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    • pp.14-20
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    • 1979
  • For accurate and easily shielding irregular shaped organ, its minimized penumbra region and a low melting point alloy 'Lead Y' and synchronizing instrument have been developed. The 'Lead Y' is the quaternary eutectic alloy and it is composed of Lead 30.0% Tin 11.5% Bismuth 48 5% Cadmium 10.0% The density of its at $22^{\circ}C$ is $9.8g/cm^3$ and the melting temperature has $40^{\circ}C\;to\;68^{\circ}C$. The thickness of 'Lead Y' for perfect shielding of Co-60 gamma ray and LINAC 10MeV x-ray is 6cm and 7cm respectively. The 'Lead Y' shielding block is casted directly on the styrofoam from which is cut with hot wire of synchronizer device. The special features and advantages of the Lead Y shielding block could be summarized as follows; 1. The shielding block for radiotherapy is rapidly processed only with boiling water and styrofoam. 2. It is not injure one's health and not danger of a fire, because of not generating of any metals vapor and evil smelling. 3. It is very effective to minimize secondary penumbra for the protection of healthy tissue from unnecessary ionizing radiation regardless of the magnification source to skin distance. 4. The HVL of the Lead Y is 1.2cm for Co-60 gamma ray and it's shielding effect is almost same as the pure lead block. 5. The hardness of Lead Y is 1.5 times higher than lead block. 6. It's reavailability is higher than lead block and then one block of Lead Y is reavailable about 30 to 40 times. 7. It is usefull for shielding of x-ray, gamma ray, beta-ray, electron and neutron radiation. 8. The materials for Lead Y are easy to acquire with reasonable price and tractable.

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Planning and Dosimetric Study of Volumetric Modulated Arc Based Hypofractionated Stereotactic Radiotherapy for Acoustic Schwannoma - 6MV Flattening Filter Free Photon Beam

  • Swamy, Shanmugam Thirumalai;Radha, Chandrasekaran Anu;Arun, Gandhi;Kathirvel, Murugesan;Subramanian, Sai
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.12
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    • pp.5019-5024
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    • 2015
  • Background: The purpose of this study was to assess the dosimetric and clinical feasibility of volumetric modulated arc based hypofractionated stereotactic radiotherapy (RapidArc) treatment for large acoustic schwannoma (AS >10cc). Materials and Methods: Ten AS patients were immobilized using BrainLab mask. They were subject to multimodality imaging (magnetic resonance and computed tomography) to contour target and organs at risk (brainstem and cochlea). Volumetric modulated arc therapy (VMAT) based stereotactic plans were optimized in Eclipse (V11) treatment planning system (TPS) using progressive resolution optimizer-III and final dose calculations were performed using analytical anisotropic algorithm with 1.5 mm grid resolution. All AS presented in this study were treated with VMAT based HSRT to a total dose of 25Gy in 5 fractions (5fractions/week). VMAT plan contains 2-4 non-coplanar arcs. Treatment planning was performed to achieve at least 99% of PTV volume (D99) receives 100% of prescription dose (25Gy), while dose to OAR's were kept below the tolerance limits. Dose-volume histograms (DVH) were analyzed to assess plan quality. Treatments were delivered using upgraded 6 MV un-flattened photon beam (FFF) from Clinac-iX machine. Extensive pretreatment quality assurance measurements were carried out to report on quality of delivery. Point dosimetry was performed using three different detectors, which includes CC13 ion-chamber, Exradin A14 ion-chamber and Exradin W1 plastic scintillator detector (PSD) which have measuring volume of $0.13cm^3$, $0.009cm^3$ and $0.002cm^3$ respectively. Results: Average PTV volume of AS was 11.3cc (${\pm}4.8$), and located in eloquent areas. VMAT plans provided complete PTV coverage with average conformity index of 1.06 (${\pm}0.05$). OAR's dose were kept below tolerance limit recommend by American Association of Physicist in Medicine task group-101(brainstem $V_{0.5cc}$ < 23Gy, cochlea maximum < 25Gy and Optic pathway <25Gy). PSD resulted in superior dosimetric accuracy compared with other two detectors (p=0.021 for PSD.

A Study of Dose Stability at Low Monitor Unit Setting for Multiple Irradiated Field (다중 조사면 치료 시 기계적 입력치(MU)에 따른 선량적 안정성에 대한 연구)

  • Kim Joo-Ho;Lee Sang-Gyu;Shin Hyun-Kyung;Lee Suk;Na Soo-Kyung;Cho Jung-Hee;Kim Dong-Wook
    • The Journal of Korean Society for Radiation Therapy
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    • v.17 no.2
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    • pp.155-160
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    • 2005
  • Purpose : Many authors have been introduced field in field technique and 3-D conformal radiotherapy that increased the tumor dose as well as decreased the dose of abutting critical organ. These technique have multiple beam direction and small beam segments even below 10 MU(monitor unit)for each field. we have confirmed the influence of low MU on dose output and beam stability. Materials and Methods : To study the dose output, the dose for each field was always 90MU, but it divided into different segment size: 1, 2, 3, 5, 10, 15 segments, 90, 45, 30, 18, 9, 6 MU the measurements were carried out for X-ray energy 4 MV, 6 MV, 10 MV of three LINAC(Varian 600C, 2100C, 2100C, 2100C/D), in addition each measurement was randomly repeated three times for each energy. To study the field symmetry and flatness, X-omat V films were irradiated. After being developed, films were scanned and analyzed using densitometer. Results : Influence of low MU on dose is slightly more increase output about $1.2{\sim}2.9%$ in cGy/mu than 90MU, but may not changed beam quality(flatness or symmetry), Output stability depends on dose rate(PRF)rather than beam energy, field size. Conclusion : Presented result are under the limits(out put<3%, flatness<${\pm}3%$, symmetry<2%). The 3 accelerators are safe to use and to perform conformal radiotherapy treatments in small segments, small MU around 10MU. but Even if the result presented here under the limits, continuous adjustments and periodic QA should be done for use of small MU

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Evaluation of the Usefulness of Restricted Respiratory Period at the Time of Radiotherapy for Non-Small Cell Lung Cancer Patient (비소세포성 폐암 환자의 방사선 치료 시 제한 호흡 주기의 유용성 평가)

  • Park, So-Yeon;Ahn, Jong-Ho;Suh, Jung-Min;Kim, Yung-Il;Kim, Jin-Man;Choi, Byung-Ki;Pyo, Hong-Ryul;Song, Ki-Won
    • 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.

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Impact of Adjuvant Chemoradiation Therapy on the Postoperative 5-year Survival Rates for Stage-II Gastric Cancer (2기 위암환자의 수술 후 보조 항암요법 및 방사선 치료가 생존율에 미치는 영향)

  • Hong, Seong-Kweon;Choi, Min-Gew;Baik, Yong-Hae;Noh, Jae-Hyung;Sohn, Tae-Sung;Kim, Sung
    • Journal of Gastric Cancer
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    • v.5 no.4 s.20
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    • pp.281-287
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    • 2005
  • Purpose: This study was conducted to evaluate the effectiveness and the role of post-operative adjuvant chemoradiation therapy in a stage-II (UICC, 1997) primary gastric cancer. Materials and Methods: From September 1994 to December 2004, 954 stage-II gastric-cancer patients were seen, and all of them underwent a curative resection with extensive (D2) lymph-node dissection. The chemotherapy consisted of fluorouracil $(400mg/m^2)$ plus leucovorin $(20mg/m^2)$ for 5 days, followed by 4,500 cGy of radiotherapy for 5 weeks with fluorourcil and leucovorin on the first 4 days and the last 3 days of radiotherapy. Two five-day cycles of chemotherapy were given four weeks after the completion of radiotherapy. The Kaplan-Meier method was used to estimate the survival rates. To assess the importance of potential prognostic factors, we performed univariate and multivariate analyses using a log-rank test and Cox's proportional hazards regression model. A P value <0.05 was considered significant. Results: Univariate analysis revealed that age, tumor size, gross type, surgical method, and postoperative adjuvant therapy had statistical significance. Among these factors, age, surgical method, tumor size, surgical method, and postoperative adjuvant therapy were found to be independent prognostic factors by using a multivariate analysis. The postoperative adjuvant chemotherapy group and the chemoradiation therapy group had survival benefit compared to the surgery-only group. However the chemoradiation therapy group had no significant survival benefit compared to the chemotherapy group. Conclusion: The postoperative adjuvant therapy in stage-II gastric-cancer patients had significant benefit. Therefore, postoperative adjuvant chemoradiation therapy has an acceptable effect. A large-scale, randomized study is needed to evaluate the effectiveness and the role of postoperative radiation therapy.

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Outcomes of Metastatic Gestational Trophoblastic Neoplasia: Fourteen Year Experience from a Northern Thailand Tertiary Care Center

  • Suprasert, Prapaporn;Siriaree, Sitthicha;Manopunya, Manatsawee
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.3
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    • pp.1357-1362
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    • 2016
  • Metastatic gestational trophoblastic neoplasia (GTN) is an uncommon cancer. The principal treatment consists of chemotherapy with or without surgery or radiotherapy. We here retrospectively reviewed the outcomes of metastatic GTN treated at our institute between January, 1999 and December, 2013. Sixty-three patients met the criteria. The median age was 30.0 years and almost 90% were referral cases. Nearly 40% of the studied patients presented with vaginal bleeding while 22.2% were asymptomatic. The most common antecedent pregnancy was hydatidiform mole (57.1%) followed by term pregnancy (20.6%). The median interval time from antecedent pregnancy to the development of GTN was three months and the median pretreatment B-hCG was 58,274 mIU/ml. Stage III (74.6%) was the most common staging followed by stage IV (20.6%) and stage II (4.8%). The most frequent surgery was hysterectomy (31.7%). Thoracotomy and craniotomy were performed in three and two patients, respectively. The most common first line chemotherapy regimen was methotrexate and folinic acid (36.5%) followed by EMA (etoposide, methotrexate, actinomycin D) (34.9%), EMACO (etoposide, methotrexate, actinomycin D, cyclophosphamide, vincristine) (17.5%) with the remission rate of 66.7%. Nearly one-third of the patients were given a subsequent chemotherapy regimen after failure with the first line therapy and showed a final response rate of 73.0%. However, in stage IV, the response to first line treatment was only 38.5%. In conclusion, the outcomes of metastatic GTN were poor especially with the higher stages.

Surveying and Optimizing the Predictors for Ependymoma Specific Survival using SEER Data

  • Cheung, Min Rex
    • Asian Pacific Journal of Cancer Prevention
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    • v.15 no.2
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    • pp.867-870
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    • 2014
  • Purpose: This study used receiver operating characteristic curve to analyze Surveillance, Epidemiology and End Results (SEER) ependymoma data to identify predictive models and potential disparity in outcome. Materials and Methods: This study analyzed socio-economic, staging and treatment factors available in the SEER database for ependymoma. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict the outcome ('brain and other nervous systems' specific death in yes/no). The area under the receiver operating characteristic curve (ROC) was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate the modeling errors. Risk of ependymoma death was computed for the predictors for comparison. Results: A total of 3,500 patients diagnosed from 1973 to 2009 were included in this study. The mean follow up time (S.D.) was 79.8 (82.3) months. Some 46% of the patients were female. The mean (S.D.) age was 34.4 (22.8) years. Age was the most predictive factor of outcome. Unknown grade demonstrated a 15% risk of cause specific death compared to 9% for grades I and II, and 36% for grades III and IV. A 5-tiered grade model (with a ROC area 0.48) was optimized to a 3-tiered model (with ROC area of 0.53). This ROC area tied for the second with that for surgery. African-American patients had 21.5% risk of death compared with 16.6% for the others. Some 72.7% of patient who did not get RT had cerebellar or spinal ependymoma. Patients undergoing surgery had 16.3% risk of death, as compared to 23.7% among those who did not have surgery. Conclusion: Grading ependymoma may dramatically improve modeling of data. RT is under used for cerebellum and spinal cord ependymoma and it may be a potential way to improve outcome.

Panax ginseng Meyer prevents radiation-induced liver injury via modulation of oxidative stress and apoptosis

  • Kim, Hyeong-Geug;Jang, Seong-Soon;Lee, Jin-Seok;Kim, Hyo-Seon;Son, Chang-Gue
    • Journal of Ginseng Research
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    • v.41 no.2
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    • pp.159-168
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    • 2017
  • Background: Radiotherapy is one of the most important modalities in cancer treatment; however, normal tissue damage is a serious concern. Drug development for the protection or reduction of normal tissue damage is therefore a clinical issue. Herein, we evaluated the protective properties of Panax ginseng Meyer and its corresponding mechanisms. Methods: C56BL/6 mice were orally pretreated with P. ginseng water extract (PGE; 25 mg/kg, 50 mg/kg, or 100 mg/kg) or intraperitoneally injected melatonin (20 mg/kg) for 4 d consecutively, then exposed to 15-Gy X-ray radiation 1 h after the last administration. After 10 d of irradiation, the biological properties of hematoxicity, fat accumulation, histopathology, oxidative stress, antioxidant activity, pro-inflammatory cytokines, and apoptosis signals were examined in the hepatic tissue. Results: The irradiation markedly induced myelosuppression as determined by hematological analysis of the peripheral blood. Steatohepatitis was induced by X-ray irradiations, whereas pretreatment with PGE significantly attenuated it. Oxidative stress was drastically increased, whereas antioxidant components were depleted by irradiation. Irradiation also notably increased serum liver enzymes and hepatic protein levels of pro-inflammatory cytokines. Those alterations were markedly normalized by pretreatment with PGE. The degree of irradiation-induced hepatic tissue apoptosis was also attenuated by pretreatment with PGE, which was evidenced by a terminal deoxynucleotidyl transferase 2'-deoxyuridine 5'-triphosphate nick-end labeling assay, western blotting, and gene expressions analysis, particularly of apoptotic molecules. Conclusion: We suggest that PGE could be applicable for use against radiation-induced liver injury, and its corresponding mechanisms involve the modulation of oxidative stress, inflammatory reactions, and apoptosis.