Purpose : To see the relationship between the response to chemotherapy and the final outcome of neoadiuvant chemotherapy and radiotherapy in patients with mocanry advanced hypopharyngeal cancer. Methods and Materials :A retrospective analysis was done for thirty-two patients with locally advanced hypopharyngeal cancer treated in the Seoul National University Hospital with neoadiuvant chemotherapy and radiotherapy from August 1979 to July 1997. The patients were treated with Co-60 teletherapy unit or 4MV or 6MV photon beam produced by linear accelerator. Daily fractionation was 1.75 to 2 Gy, delivered five times a week. Total dose ranged from 60.8 Gy to 73.8 Gy. Twenty-nine patients received continuous infusion of cisplatin and 5-FU. Other patients were treated with cisplatin combined with bleomycin or vinblastin. Twenty-four (75$\%$) patients received all three prescribed cycles of chemotherapy delivered three weeks apart. Six patients received two cycles, and two patients received only one cycle. Results :The overall 2-year and 5-year survival rates are 65.6$\%$ and 43.0$\%$, respectively. 5-year local control rate is 34$\%$. Organ preservation for more than five years is achieved in 12 patients (38$\%$). After neoadjuvant chemotherapy, 24 patients achieved more than partial remission (PR): the response rate was 75$\%$ (24/32). Five patients had complete remission (CR), 19 patients PR, and 8 patients no response (NR). Among the 19 patients who had PR to chemotherapy, 8 patients achieved CR after radiotherapy. Among the 8 non-responders to chemotherapy, 2 patients achieved CR, and 6 patients achieved PR after radiotherapy. There was no non-responder after radiotherapy. The overall survival rates were 60$\%$ for CR to chemotherapy group, 35.1$\%$ for PR to chemotherapy group, and 50$\%$ for NR to chemotherapy group, respectively (p=0.93). There were significant difference in five-year overall survival rates between the patients with CR and PR after neoadjuvant chemotherapy and radiotherapy (73.3$\%$ vs. 14.7$\%$, p<0.01). The prognostic factor affecting overall survival was the response to overall treatment (CR vs. PR, p<0.01). Conclusion :In this study, there were only five patients who achieved CR after neoadiuvant chemotherapy. Therefore the difference of overall survival rates between CR and PR to chemotherapy group was not statistically significant. Only the response to chemo-radiotherapy was the most important prognostic factor. There needs to be more effort to improve CR rate of neoadjuvant chemotherapy and consideration for future use of concurrent chemoradiotherapy.
The Journal of Korean Society for Radiation Therapy
/
v.16
no.1
/
pp.91-99
/
2004
Purpose : For the head and neck radiotherapy, abutting photon field with electron field is frequently used for the irradiation of posterior neck when tolerable dose on spinal cord has been reached. Materials and methods : Using 6 MV X-ray and 9 MeV electron beams of Clinac1800(Varian, USA) linear accelerator, we performed film dosimetry by the X-OMAT V film of Kodak in solid water phantom according to depths(0 cm, 1.5 cm, 3 cm, 5 cm). 6 MV X-ray and 9 MeV electron(1Gy) were exposes to 8cm depth and surface(SSD 100cm) of phantom. The dose distribution to the junction line between photon($10cm{\times}10cm$ field with block) and electron($15cm{\times}15cm$ field with block) fields was also measured according to depths(0 cm, 0.5 1.5 cm, 3 cm, 5 cm). Results : At the junction line between photon and electron fields, the hot spot was developed on the side of the photon field and a cold spot was developed on that of the electron field. The hot spot in the photon side was developed at depth 1.5 cm with 7 mm width. The maximum dose of hot spot was increased to $6\%$ of reference doses in the photon field. The cold spot in the electron side was developed at all measured depths(0.5 cm-3 cm) with 1-12.5 mm widths. The decreased dose in the cold spot was $4.5-30\%$ of reference dose in the electron field. Conclusion : When we make use of abutting photon field with electron field for the treatment of head and neck cancer we should consider the hot and cold dose area in the junction of photon and electron field according to location of tumor.
The Journal of Korean Society for Radiation Therapy
/
v.16
no.1
/
pp.57-65
/
2004
Introduction : The phantom that includes high density materials such as steel was custom-made to fix lung and bone in order to evaluation inhomogeneity correction at the time of conducting radiation therapy to treat lung cancer. Using this, values resulting from the inhomogeneous correction algorithm are compared on the 2 and 3 dimensional radiation therapy planning systems. Moreover, change in dose calculation was evaluated according to inhomogeneous by comparing with the actual measurement. Materials and Methods : As for the image acquisition, inhomogeneous correction phantom(Pig's vertebra, steel(8.21g/cm3), cork(0.23 g/cm3)) that was custom-made and the CT(Volume zoom, Siemens, Germany) were used. As for the radiation therapy planning system, Marks Plan(2D) and XiO(CMS, USA, 3D) were used. To compare with the measurement value, linear accelerator(CL/1800, Varian, USA) and ion chamber were used. Image, obtained from the CT was used to obtain point dose and dose distribution from the region of interest (ROI) while on the radiation therapy planning device. After measurement was conducted under the same conditions, value on the treatment planning device and measured value were subjected to comparison and analysis. And difference between the resulting for the evaluation on the use (or non-use) of inhomogeneity correction algorithm, and diverse inhomogeneity correction algorithm that is included in the radiation therapy planning device was compared as well. Results : As result of comparing the results of measurement value on the region of interest within the inhomogeneity correction phantom and the value that resulted from the homogeneous and inhomogeneous correction, gained from the therapy planning device, margin of error of the measurement value and inhomogeneous correction value at the location 1 of the lung showed $0.8\%$ on 2D and $0.5\%$ on 3D. Margin of error of the measurement value and inhomogeneous correction value at the location 1 of the steel showed $12\%$ on 2D and $5\%$ on 3D, however, it is possible to see that the value that is not correction and the margin of error of the measurement value stand at $16\%$ and $14\%$, respectively. Moreover, values of the 3D showed lower margin of error compared to 2D. Conclusion : Revision according to the density of tissue must be executed during radiation therapy planning. To ensure a more accurate planning, use of 3D planning system is recommended more so than the 2D Planning system to ensure a more accurate revision on the therapy plan. Moreover, 3D Planning system needs to select and use the most accurate and appropriate inhomogeneous correction algorithm through actual measurement. In addition, comparison and analysis through TLD or film dosimetry are needed.
Journal of the Korean Recycled Construction Resources Institute
/
v.4
no.4
/
pp.388-395
/
2016
This paper explores the photocatalytic sensitivity of cement mortar incorporated with recycled $TiO_2$ from waste water sludge. Basically, $TiO_2$ cluster sank down slowly to the bottom of cement mortar specimen before setting and hardening process. This leads the mismatch of $TiO_2$ concentration on the top and the bottom faces of a specimen. This poorly dispersed $TiO_2$-cement mortar naturally exhibits poor NOx removal efficiency especially on the top of cementitious structure. In architectural engineering application such as building or housing structures, one can simply filp over from the bottom so that more $TiO_2$ concentrated surface can be placed outward into the air. However, in highway pavement case, this could not be applicable due to in-situ installation of concrete pavement. Hence, the dispersion of $TiO_2$ cluster inside the cementitous material is getting important issue onto road construction application. To elaborate this issue, according to our results, silica fume, high-ranged water reducer, viscosity agent, blast furnace slag were not enhanced much of dispersion characteristics of $TiO_2$ cluster. The combination of foaming agent and accelerator of hardening with viscosity agent and small grain size of fine aggregate may help the dispersion of $TiO_2$ inside cementitious materials. Even though the enhanced dispersion were applied to the specimen, NOx removal efficiency doest not change much for the top surface of the specimen. This concurrently affected by the presence of tiny air voids and the dispersion of $TiO_2$ in that these voids could easily adsorbed NOx gas with the aid of large surface area.
Seo, Sung-Man;Kim, Ghyung-Hwa;Lee, Seok-Hee;Bae, Jun-Seok;Lim, Woo-Taik
Bulletin of the Korean Chemical Society
/
v.30
no.6
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pp.1285-1292
/
2009
Large single crystals of zeolite, |$Na_{75}$|[$Si_{117}Al_{75}O_{384}$]-FAU (Na-Y, Si/Al = 1.56), were synthesized from gels with composition of 3.58Si$O_2$ : 2.08NaAl$O_2$ : 7.59NaOH : 455$H_2$O : 5.06TEA : 2.23TCl. One of these, a colorless single-crystal was ion exchanged by allowing aqueous 0.02 M CsOH to flow past the crystal at 293 K for 3 days, followed by dehydration at 673 K and 1 ${\times}\;10^{-6}$ Torr for 2 days. The crystal structure of fully dehydrated partially $Cs^+$-exchanged zeolite Y, |$Cs_{45}Na_{30}$|[$Si_{117}Al_{75}O_{384}$]-FAU per unit cell (a = 24.9080(10) $\AA$) was determined by single-crystal X-ray diffraction technique in the cubic space group Fd $\overline{3}$ m at 294(1) K. The structure was refined using all intensities to the final error indices (using only the 877 reflections with $F_o\;>\;4{\sigma}(F_o))\;R_1$ = 0.0966 (Based on F) and $R_2\;=\;0.2641\;(Based\;on\;F^2$). About forty-five $Cs^+$ ions per unit cell are found at six different crystallographic sites. The 2 $Cs^+$ ions occupied at site I, at the centers of double 6-ring (D6Rs, Cs-O = 2.774(10) $\AA$ and O-Cs-O = 88.9(3) and 91.1(3)$^o$). Two $Cs^+$ ions are found at site I’ in the sodalite cavity; the $Cs^+$ ions were recessed 2.05 $\AA$ into the sodalite cavity from their 3-oxygen plane (Cs-O = 3.05(3) $\AA$ and O-Cs-O = 77.4(13)$^o$). Site-II’ positions (opposite single 6-rings in the sodalite cage) are occupied by 7 $Cs^+$ ions, each of which extends 2.04 $\AA$ into the sodalite cage from its 3-oxygen plane (Cs-O = 3.067(11) $\AA$ and O-Cs-O = 80.1(3)$^o$). The 26 $Cs^+$ ions are nearly three-quarters filled at site II in the supercage, being recessed 2.34 $\AA$ into the supercage (Cs-O = 3.273(8) $\AA$ and O-Cs-O = 74.3(3)$^o$). The 4 $Cs^+$ ions are found at site III deep in the supercage (Cs-O = 3.321(19) and 3.08(3) $\AA$), and 4 $Cs^+$ ions at another site III’ (Cs-O = 2.87(4) and 3.38(4) $\AA$). About 30 $Na^+$ ions per unit cell are found at one crystallographic site; The $Na^+$ ions are located at site I’ in the sodalite cavity opposite double 6-rings (Na-O = 2.578(11) $\AA$ and O-Na-O = 97.8(4)$^o$).
Kim Yong-Eun;Cho Moon-June;Kim Jun-Sang;Oh Young-Kee;Kim Jhin-Kee;Shin Kyo-Chul;Kim Jeung-Kee;Jeong Dong-Hyeok;Kim Ki-Hwan
Progress in Medical Physics
/
v.17
no.1
/
pp.1-5
/
2006
A parallel plate detector containing PTFE films in FEP film for relative dosimetry was designed to measure the response of detectors to S and 10 MV X-rays from a medical linear accelerator through different thicknesses of lead. The dielectric materials were 100 m thick. The set-up conditions for measurements with this detector were as follows: SSD=100 cm the test detector was at a depth of 5 cm and the reference chamber was at a depth of 10 cm from the phantom surface for 6 and 10 MV X-rays. Lead blocks were designed to cover the irradiated field. They were added to the tray to increase thickness sequentially. We found that the detector response decreased exponentially with the thickness of lead added. The linear attenuation coefficients of the test detector and reference chamber were 0.1414 and 0.541, respectively, for 6 MV X-rays and 0.1358 and 0.5279 for 10 MV X-rays. The test detector response was greater than that of the reference chamber. The response function was calculated from the measured values of the test detector and reference chamber using optimization. These optimized constants for the detector response function were independent of theenergy. As a result of optimizing the response function between detectors, the use of a relative dosimeter was validated, because the response of the test detector was 1% for 6 MV X-rays and 4% for 10 MV X-rays.
Wedge shaped isodoses are desired in a number of clinical situations. Hard wedge filters have provided nominal angled isodoses with dosimetric consequences of beam hardening, increased peripheral dosing, nonidealized gradients at deep depths along with the practical consequendes of filter handling and placement problems. Dynamic wedging uses a combination of a moving collimator and changing monitor dose to achieve angled isodoses. The segmented treatment tables(STT) that monitor unit setting by every distance of moving collimator, was induced by numerical formular. The characteristics of dynamic wedge by STT compared with real dosimetry. Methods and Materials : The accelerator CLINAC 2100C/D at Yonsei Cancer Center has two photon energies (6MV and 10MV), currently with dynamic wedge angles of 15$^{\circ}$, 30$^{\circ}$, 45$^{\circ}$ and 60$^{\circ}$. The segmented treatment tables(STT) that drive the collimator in concert with a changing monitor unit are unique for field sizes ranging from 4.0cm to 20.0cm in 0.5cm steps. Transmission wedge factors were measured for each STT with an standard ion chamber. Isodose profiles, isodose curves, percentage depth dose for dynamic wedge filters were measured with film dosimetry. Dynamic wedge angle by STT was well coincident with film dosimetry. Percent depth doses were found to be closer to open field but more shallow than hard wedge filter. The wedge transmission factor were decreased by increased the wedge angle and more higher than hard wedge filters. Dynamic wedging probided more consistent gradients across the field compared with hard wedge filters. Dynamic wedging has practical and dosimetric advantages over hard filters for rapid setup and keeping from table collisions. Dynamic wedge filters are positive replacement for hard filters and introduction of dynamic conformal radiotherapy and intensity modulation radiotherapy in a future.
Huh, Hyun Do;Cho, Kwang Hwan;Cho, Sam Ju;Choi, Sang Hyoun;Kim, Dong Wook;Hwang, Ui-Jung;Kim, Ki Hwan;Min, Chul Kee;Choi, Tae Jin;Oh, Young Kee;Lee, Seoung Jun;Park, Dahl;Park, Sung-Kwang;Ji, Young Hoon
Progress in Medical Physics
/
v.24
no.4
/
pp.315-322
/
2013
The aim of this work is to verify the self-quality assurances in medical institutions in Korea through the external audits by the group of experts and have a mutual discussion of the systematic problems. In order to validate the external audits 30 of 80 medical institutions across the nation were picked out considering the regional distribution and the final 25 institutions applied voluntarily to take part in this work. The basic rules were setup that any information of the participants be kept secrete and the measurements be performed with the dosimetry system already verified through intercomparision. The outputs for 2 or more photon beams, the accuracy of gantry rotation and collimator rotation and the poistional accuracy of MLC movement were measured. The findings for the output measurement showed the differences of -0.8%~4.5%, -0.79%~3.01%, and -0.7%~0.07% with respect to that of the verified dosimetry system for the 6MV, 10MV, and 15MV, respectively. For the reference absorbed dose 8 (16%) of 50 photon beams in 25 medical institutions differed 2.0% or greater from the reference value. The coincidences of Field size with x-ray beam and radiation isocenters of Gantry roration and collimator rotation gave the results of within ${\pm}2$ mm for every institute except 2 institutions. The positional accuracy of MLC movement agreed to within ${\pm}1$ mm for every institute. For the beam qualities of 6 MV photon beams kQ values showed the distribution within 0.4% between maximum and minimum. For the protocols 21 institutions (84%) used absorbed dose to water based protocol while 4 insitutions (16%) used air kerma based one. 22 institutions employed the SSD technique while 3 institutions did the SAD one. External audit plays an important role in discovering the systematic problems of self-performing Quality Assurances and having in depth discussion for mutual complementation. Training experts of international level as well as national support system are required so that both the group of experts of medical physicists and government laboratory could perform together periodical and constant external audits.
Kim, Yon-Lae;Suh, Tae-Suk;Ko, Shin-Gwan;Lee, Jeong-Woo
Journal of radiological science and technology
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v.33
no.3
/
pp.261-268
/
2010
This study is compared that the dose distribution by experimentation and radiation therapy planning (RTP) when the air cavity region was treated high energy photon. The dose measurements were performed with a 6 MV photon beam of linear accelerator. The polystyrene and self made acyl phantom were similar to tissue density of the human body. A parallel plate chamber was connected to an electrometer. The measurement setup was SCD (Source Chamber Distance) 100 cm and the distance of surface from air cavity was 3 cm. Absorbed dose of interface were measured by area and height. The percent depth dose were measured presence and absence of air cavity, depth according to a ratio of field size and air cavity size. The dose distribution on planning was expressed to do the inhomogeneity correction. As the area of air cavity was increased, the absorbed dose were gradually reduced. It was slightly increased, when the height of air cavity was changed from 0 cm to 0.5 cm. After the point, dose was decreased. In case of presence of air cavity, dose after distal air cavity interface was more great than absence of air cavity. The rebuild up by field size and area of air cavity occurred for field size, $4{\times}4\;cm^2$, $5{\times}5\;cm^2$ and $6{\times}6\;cm^2$, with fixed on area of air cavity, $5{\times}5\;cm^2$. But it didn't occur at $10{\times}10\;cm^2$ field size. On the contrary, the field size was fixed on $5{\times}5\;cm^2$, rebuild up occurred in area of air cavity, $4{\times}4\;cm^2$, $5{\times}5\;cm^2$. but, it did not occur for air cavity, $2{\times}2\;cm^2$, $3{\times}3\;cm^2$. All of the radiation therapy planning were not occurred rebuild up. It was required to pay attention to treat tumor in air cavity because the dose distribution of planning was different from the dose distribution of patient.
Lee HwaJung;Kim DaeYoung;Kim WonTaek;Lee KangHyeok
The Journal of Korean Society for Radiation Therapy
/
v.16
no.2
/
pp.69-79
/
2004
In the process of photon treatments, linear accelerators with energies higher than 10 MV produce neutrons through the (${\gamma}$, n) interactions with the composite materials of the linac head md these materials further produce the induced radiations. We investigate the possible risks from these induced radiations especially in the wedge filters to the radiation workers. Wedge filters are used to modify the isodose profiles in the radiation treatment using the linear accelerator and always be handled by the radiation workers. For the background radiation, we measured the radiation in both the waiting room and the outside of the building for two hospitals, S and H. The results of S hospital were $0.11\;{\mu}Sv/hr$ and $0.10\;{\mu}Sv/hr$ for waiting room and outside respectively, and in the case of H hospital, they were $0.12\;{\mu}Sv/hr$ and $0.11\;{\mu}Sv/hr$. Using a survey meter, we measured the radiation from wedge filters inserted in 10 MV and 15 MV Siemens linear accelerators. The time series measurements were done in ${\sim}1$ minutes after exposure of 5 Gy of monitor units for the field size of $25{\times}25cm^2$. The starting value of 10 MV machine was about $3.26\;{\mu}Sv/hr$, which was three times higher than that of 10 MV. The measured radiation was from $^{28}Al$ and $^{53}Fe$ with a half life of 3.5 min. If the treatment patients are $20{\sim}50$ per day and the number of process of wedge filter change per patient is one or two, the annual dose equivalent is $0.08{\sim}0.4\;mSv$ for 10 MV, and $0.27{\sim}1.36\;mSv$ for 15 MV, which are in the range of dose equivalent limits of radiation workers.
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