• Tuberculosis and Respiratory Diseases
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• v.57 no.3
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• pp.257-264
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• 2004

Background : There are many combinations of treatment for locally advanced non-small cell lung cancer (NSCLC). Recent studies have showed the efficacy of concurrent chemoradiotherapy (CCRT) in NSCLC. At present, however, there is no consensus about the optimal dosages and timing of radiation and chemotherapeutic agents. The aims of study were to determine the feasibility, toxicity, response rate, and survival rate in locally advanced NSCLC patients treated with doxetaxel and cisplatin based CCRT. Method : Sixteen patients with unresectable stage III NSCLC were evaluated from May 2000 until September 2001. Induction chemoradiotherapy consisted of 3 cycles of docetaxel (75 $mg/m^2/IV$ on day 1) and cisplatin (60 $mg/m^2/IV$ on day 1) chemotherapy every 3 weeks and concomitant hyperfractionated chest irradiation (1.15 Gy/BID, total dose of 69 Gy) in 6 weeks. Patient who had complete or partial response, and stable disease were applied consolidation chemotherapy of docetaxel and cisplatin. Results : All patients showed response to CCRT. Four patients achieved complete response (25%), partial responses in 12 patients (75%). The major common toxicities were grade III or more of neutropenia (87.3%), grade III esophagitis (68.8%), pneumonia (18.8%) and grade III radiation pneumonitis (12.5%). Thirteen patients were ceased during follow-up period. Median survival time was 19.9 months (95% CI; 4.3-39.7 months). The survival rates in one, two, and three years are 68.7%, 43.7%, and 29.1%, respectively. Local recurrence was found in 11 patients (66.8%), bone metastasis in 2, and brain metastasis in 1 patient. Conclusion : The response rate and survival time of CCRT with docetaxel/cisplatin in locally advanced NSCLC were encouraging, but treatment related toxicities were high. Further modification of therapy seems to be warranted.

• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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• pp.6311-6316
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• 2015

Background: In mainland China, awareness of disease of elderly cancer patients largely relies on the patients' families. We developed a staged procedure to improve their awareness of disease. Materials and Methods: Participants were 224 elderly cancer patients from 9 leading hospitals across Southern China. A questionnaire was given to the oncologists in charge of each patient to evaluate the interaction between family and patients, patient awareness of their disease and participation in medical decision-making. After first cycles of treatment, increased information of disease was given to patients with cooperation of the family. Then patient awareness of their disease and participation in medical decision-making was documented. Results: Among the 224 cancer elderly patients, 26 (11.6%) made decisions by themselves and 125 (55.8%) delegated their rights of decision-making to their family. Subordinate family members tended to play a passive role in decision-making significantly. Patients participating more in medical decision-making tended to know more about their disease. However, in contrast to the awareness of disease, patient awareness of violation of medical recommendations was reversely associated with their participation in medical decision-making. Improvement in awareness of diagnosis, stages and prognosis was achieved in about 20% elderly cancer patients. About 5% participated more actively in medical decision-making. Conclusions: Chinese elderly cancer patient awareness of disease and participation in medical decision-making is limited and relies on their family status. The staged procedure we developed to improve patient awareness of disease proved effective.

• Journal of radiological science and technology
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• v.8 no.2
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• pp.21-28
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• 1985

We serveyed the actual condition of business of the departments of radiology of 45 health conters (except 3) in the area of Seoul, Kyungki and Inchon from March, 1984 to November, 1984. The results are summarized as follows : 1. T.O. of the radiologic technologist is three persons in each health center of Seoul area, and one person in each one of Kyungki and Inchon area. P.O. is 2-5 persons in Seoul area, 1-2 persons in Kyungki or Inchon area. 2. The number of all the radiologic technologists employed now is 75 persons, and among all of them, when analized by position class 7th is 54.7%, class 8th 28.0%, class 9th is 13.3%, and class 6th is 2.7%, and by sex, female is 68.0%, male is 32.0%, by educational background, for the most part, junior college graduates come to 73.3%, by age group 60% of them is in their twenties, 16.0% is in their thirties and forties, 8.0% is in their fifties, and by career after certificate 60% have the career of 1-5 years, 13.3% have the one of 6-7 years or mor than 21 years, and 6.7% have the one of 11-15 years of 16-20 years. 3. All the diagnostic x-ray equipment being kept is 62, and among them flxing equipment is 71.0%, portable equipment is 29.0% and by rating of X-ray equipment, maximum tube current 100 mA is 46.8%, maximum KV 100KVP is 72.6%, the most part. 4. Photofluorographic camera and hood are equipped in every health center. While, as to the radiographic cassettes, $14{\times}14"$ cassetts are equipped in every health center, but cassettes of other sizes are in half of them. 5. Bucky's table is equipped in 11.9% health centers, the automatic processor is in 21.4%, the photofluorographic film changer is 9.5%, the grid is 73.8%, the protective apron is in 88.1%, and the protective glove is in 57.1% health centers. 6. The number of the people who got the x-ray examination for one year (by the year 1989) is the most, 1,000-6,000 in direct radiography of the chest, or 15,0001-45,000 in the health centers of Seoul area, 5,000-20,000 in Kyungki and Inchon area in photofluorography of the chest. Moreover, other radiographies are being taken extremely limitedly in all health centers. 7. In processing types of x-ray film, automatic processing is used in 9 health centers (21.4%), manual tank processing is in 30 (71.4%), and manual tray processing in 3 (7.2%). 8. As for collimation of x-ray exposure field, "continual using restricted by a subject size" has the most part, 78.6% "restricted using at every radiography" has 19%, and the case of "never considered" has 2.4% response. 9. As for the dosimeter used for radiation control, film badge (35.7%) and pocket dosimeter (26.2%) are used, and in 38.1% health centers the dosimeter is not equipped at all. Consideration of the previous radiation exposure is being done in only one health center. 10. Reading of radiographs is mainly depended on the radiologists electively (45.2%) or on the genral practitioners(45.2%).

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.495-500
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• 1993

Background: For the relief of the occlusion of major bronchi, laser therapy, radiation therapy or combined therapy is generally used. But the effect of radiation therapy is very slow and not consistent and laser therapy requires expensive equipments and technical expertise with occasional serious side effects. Direct ethanol injection has been widely used for the control of bleeding in gastrointestinal lesion, esophageal varices or renal cell carcinoma with good results. So we tried direct injection of ethanol into the tumor to relieve the obstruction of major bronchus in 11 patients. Method: All procedures were done under the fiberoptic bronchoscopy with continuous oxygen supplement and aliquoted 0.5-1.0 ml of absolute ethanol directly into the tumor through the endobronchial aspiration needle. The tumor was endoscopically removed with a biopsy forceps immediately after ethanol injection. The whole procedure was repeated 3-4 days interval until the lumen opens. Usually after 2-3 trials of ethanol injection, the lumen opened up. Results: The immediate effect of ethanol injection was whitening of the mucosa and prompt cessation of bleeding. The late effect was necrosis of the tumor. The final results of this procedure were improvement of symptoms and reexpnasion of the lung in all patients. $FEV_{1.0}$ and FVC were improved and $PaO_2$ was increased from $68.1{\pm}9.2$ mmHg to $83.9{\pm}8.1$ mmHg, $SaO_2$: from $94{\pm}8.5%$ to $96.6{\pm}1.1%$, and $AaDO_2$ was reduced from $26.5{\pm}8.5$ mmHg to $10.9{\pm}9.1$ mmHg. Conclusion: Direct ethanol injection into the tumor tissue is a rapid, cheap and relatively safe method of relieving the complete occlusion of major bronchus.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.13
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• pp.5259-5264
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• 2014

Background: CT based brachytherapy allows 3-dimensional (3D) assessment of organs at risk (OAR) doses with dose volume histograms (DVHs). The purpose of this study was to compare computed tomography (CT) based volumetric calculations and International Commission on Radiation Units and Measurements (ICRU) reference-point estimates of radiation doses to the bladder and rectum in patients with carcinoma of the cervix treated with high-dose-rate (HDR) intracavitary brachytherapy (ICBT). Materials and Methods: Between March 2011 and May 2012, 20 patients were treated with 55 fractions of brachytherapy using tandem and ovoids and underwent post-implant CT scans. The external beam radiotherapy (EBRT) dose was 48.6Gy in 27 fractions. HDR brachytherapy was delivered to a dose of 21 Gy in three fractions. The ICRU bladder and rectum point doses along with 4 additional rectal points were recorded. The maximum dose ($D_{Max}$) to rectum was the highest recorded dose at one of these five points. Using the HDRplus 2.6 brachyhtherapy treatment planning system, the bladder and rectum were retrospectively contoured on the 55 CT datasets. The DVHs for rectum and bladder were calculated and the minimum doses to the highest irradiated 2cc area of rectum and bladder were recorded ($D_{2cc}$) for all individual fractions. The mean $D_{2cc}$ of rectum was compared to the means of ICRU rectal point and rectal $D_{Max}$ using the Student's t-test. The mean $D_{2cc}$ of bladder was compared with the mean ICRU bladder point using the same statistical test. The total dose, combining EBRT and HDR brachytherapy, were biologically normalized to the conventional 2 Gy/fraction using the linear-quadratic model. (${\alpha}/{\beta}$ value of 10 Gy for target, 3 Gy for organs at risk). Results: The total prescribed dose was $77.5Gy{\alpha}/{\beta}10$. The mean dose to the rectum was $4.58{\pm}1.22Gy$ for $D_{2cc}$, $3.76{\pm}0.65Gy$ at $D_{ICRU}$ and $4.75{\pm}1.01Gy$ at $D_{Max}$. The mean rectal $D_{2cc}$ dose differed significantly from the mean dose calculated at the ICRU reference point (p<0.005); the mean difference was 0.82 Gy (0.48-1.19Gy). The mean EQD2 was $68.52{\pm}7.24Gy_{{\alpha}/{\beta}3}$ for $D_{2cc}$, $61.71{\pm}2.77Gy_{{\alpha}/{\beta}3}$ at $D_{ICRU}$ and $69.24{\pm}6.02Gy_{{\alpha}/{\beta}3}$ at $D_{Max}$. The mean ratio of $D_{2cc}$ rectum to $D_{ICRU}$ rectum was 1.25 and the mean ratio of $D_{2cc}$ rectum to $D_{Max}$ rectum was 0.98 for all individual fractions. The mean dose to the bladder was $6.00{\pm}1.90Gy$ for $D_{2cc}$ and $5.10{\pm}2.03Gy$ at $D_{ICRU}$. However, the mean $D_{2cc}$ dose did not differ significantly from the mean dose calculated at the ICRU reference point (p=0.307); the mean difference was 0.90 Gy (0.49-1.25Gy). The mean EQD2 was $81.85{\pm}13.03Gy_{{\alpha}/{\beta}3}$ for $D_{2cc}$ and $74.11{\pm}19.39Gy_{{\alpha}/{\beta}3}$ at $D_{ICRU}$. The mean ratio of $D_{2cc}$ bladder to $D_{ICRU}$ bladder was 1.24. In the majority of applications, the maximum dose point was not the ICRU point. On average, the rectum received 77% and bladder received 92% of the prescribed dose. Conclusions: OARs doses assessed by DVH criteria were higher than ICRU point doses. Our data suggest that the estimated dose to the ICRU bladder point may be a reasonable surrogate for the $D_{2cc}$ and rectal $D_{Max}$ for $D_{2cc}$. However, the dose to the ICRU rectal point does not appear to be a reasonable surrogate for the $D_{2cc}$.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.502-512
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• 1995

Background: One quarter to one third of patients with NSCLC present with primary tumors that although confined to the thorax are too extensive for surgical resection. Until resently standard treatment for these patients had been thoracic radiation, which produces tumor regression in most patients but few cures and dismal 5-year survival rate. The fact that death for most patients with stage III tumors is caused by distant metastases has promped a reevaluation of combined modality treatment approaches that include systemic chemotherapy. Therefore, we report the results observed in a study to evaluate the effect of multimodality treatment in locally advanced non-small cell lung cancer from 1/91 to 8/93 in CNUH. Method: We grouped the patients according to the treatment modalities and evaluated response rate, median survival and the effect of prognostic variables. Among 67 patients evaluated, twenty seven patients classified with group A, received cisplatin and etoposide containing combination chemotherapy alone, eighteen patients, classified with group B, received chemotherapy and radiotherapy, fifteen patients, group C, received neoadjuvant or adjuvant chemotherapy and surgery with/without radiation therapy, seven patients, group D, received only supportive care. Result: The major response rate for group A and B was 37% and 61% respectively. There was no statistically significant difference in response rate between A and B groups(p=0.97). The analysis of prognostic factors showed that differences of age, sex, pathology, blood type, smoking year, stage and ECOG performance did not related to improvement in survival. Median survival time was 8.6 months for group A, 13.4 months for group B, 19.2 months for group C, and 5.4 months for group D, respectively and there was statistically significant difference(p=0.003), suggesting that multimodality therapy was associated with signigicant improvement in survival. Subset survival analysis showed a significant therapeutic effect for earlier stage and good performance state(p=0.007, 0.009, respectively). A possible survival advantages were observed for major response groups. Conclusion: It was suggested that multimodality therapy for the management of patients who had stage III disease, has yielded good median survival and long survival for seleted patients. But, it is necessory to validate above result with further investigation in large scale and in prospective randomized trials.

• The Korean Journal of Nuclear Medicine
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• v.31 no.3
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• pp.330-338
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• 1997

This study investigated the method to adjust acquisition time(a) and injection dose (i) to make the best basal and subtraction images in consecutive SPECT. Image quality was assumed to be mainly affected by signal to noise ratio(S/N). Basal image was subtracted from the second image consecutively acquired at the same position. We calculated S/N ratio in basal SPECT images($S_1/N_1$) and subtraction SPECT images(Ss/Ns) to find a(time) and i(dose) to maximize S/N of both images at the same time. From phantom images, we drew the relation of image counts and a(time) and i(dose) in our system using fanbeam-high-resolution collimated triple head SPECT. Noise by imaging process depended on Poisson distribution. We took maximum tolerable duration of consecutive acquisition as 30 minutes and maximum injectible dose as 1,850MBq(50 mCi)(sum of two injections) per study. Counts of second-acquired image($S_2$), counts($S_s$) and noise($N_s$) of subtraction SPECT were as follows. $C_1$ was the coefficient of measurement with our system. $$S_2=S_1{\cdot}(\frac{30-a}{a})+background{\cdot}(1-\frac{30-a}{a})+C_1{\cdot}(30-a){\cdot}{\epsilon}{\cdot}(50-i)$$ $$Ss=S_2-\{S_1{\cdot}(\frac{30-a}{a})+background{\cdot}(1-\frac{(30-a)}{a})\}$$ $$Ns={\sqrt{N_2^2+N_1^2{\cdot}\frac{(30-a)^2}{a^2}}={\sqrt{S_2+S_1{\cdot}\frac{(30-a)^2}{a^2}}$$ In case of rest/acetazolamide study, effect(${\epsilon}$) of acetazolamide to increase global brain uptake of Tc-99m-HMPAO could be 1.5 or less. Varying ${\epsilon}$ from 1 to 1.5, a(time) and i(dose) pair to maximize both $S_1/N_l$ and Ss/Ns was determined. 15 mCi/17 min and 35mCi/13min was the best a(time) and i(dose) pair for rest/acetazolamide study(when ${\epsilon}$ were 1.2) and came to be used for our clinical routine after this study. We developed simple method to maximize S/N ratios of basal and subtraction SPECT from consecutive acquisition. This method could be applied to ECD/HMPAO and brain activation studies as well as rest/acetazolamide studies.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.2
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• pp.27-31
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• 2016

Purpose $^{99m}Tc-DMSA$ renal scan is a test for the comparison of the function by imaging the parenchyma of the kidneys by the cortex of a kidney and by computing the intake ratio of radiation by the left and right kidney. Since the distance between the kidneys and the bladder is not far given the bodily structure of an infant, the bladder is included in the examination domain. Research was carried out with the presumption that counts of bladder would impart an influence on the kidneys at the time of this renal scan. In consideration of the special feature that only a trace amount of a RI is injected in a pediatric examination, research on the method of injection was also carried out concurrently. Materials and Methods With 34 infants aged between 1 month to 12 months for whom a $^{99m}Tc-DMSA$ renal scan was implemented on the subjects, a Post IMAGE was acquired in accordance with the test time after having injected the same quantity of DMSA of 0.5mCi. Then, after having acquired an additional image by shielding the bladder by using a circular lead plate for comparison purposes, a comparison was made by illustrating the percentile of (Lt. Kidney counts + Rt. Kidney counts)/ Total counts, by drawing the same sized ROI (length of 55.2mm X width of 70.0mm). In addition, in the format of a 3-way stopcock, a Heparin cap and direct injection into the patient were performed in accordance with RI injection methods. The differences in the count changes in accordance with each of the methods were compared by injecting an additional 2cc of saline into the 3-way stopcock and Heparin cap. Results The image prior to shielding of the bladder displayed a kidney intake rate with a deviation of $70.9{\pm}3.18%$ while the image after the shielding of the bladder displayed a kidney intake rate with a deviation of $79.4{\pm}5.19%$, thereby showing approximately 6.5~8.5% of difference. In terms of the injection method, the method that used the 3-way form, a deviation of $68.9{\pm}2.80%$ prior to the shielding and a deviation of $78.1{\pm}5.14%$ after the shielding were displayed. In the method of using a Heparin cap, a deviation of $71.3{\pm}5.14%$ prior to the shielding and a deviation of $79.8{\pm}3.26%$ after the shielding were displayed. Lastly, in the method of direct injection into the patient, a deviation of $75.1{\pm}4.30%$ prior to the shielding and a deviation of $82.1{\pm}2.35%$ after the shielding were displayed, thereby illustrating differences in the kidney intake rates in the order of direct injection, a Heparin cap and the 3-way methods. Conclusion Since a substantially minute quantity of radiopharmaceuticals is injected for infants in comparison to adults, the cases of having shielded the bladder by removing radiation of the bladder displayed kidney intake rates that are improved from those of the cases of not having shielded the bladder. Although there are difficulties in securing blood vessels, it is deemed that the method of direct injection would be more helpful in acquisition of better images since it displays improved kidney intake rate in comparison to other methods.

• The Korean Journal of Nuclear Medicine Technology
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• v.20 no.2
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• pp.14-20
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• 2016

Purpose Tongue cancer is 1.8% of all cancer tumors occur in the tongue, it is known that the high incidence enough to account for 75% of oral cancer conducted a PET / CT examination for early diagnosis, metastasis, staging, etc. and. Tongue when PET / CT scan of a cancer patient and a Torso taken to close mouth lesions if the condition was caused due to the overlapping or corresponding artifacts are not clearly observed. The purpose of this study is to evaluate the changes that occur during PET / CT scan with open mouth and its usefulness under. Materials and Methods From June 2015 to March 2016 complained of herein by May 21 had received a diagnosis of tongue cancer underwent PET / CT scan patients were treated with a target (16 males, 5 female). The first was taken to close mouth Torso state, it was taken to add 1 bed open mouth condition. Tumor (T), measuring the Normal Tongue (NT), Lymph Node (LN) standard intake coefficient by setting a region of interest in the (standardized uptake value, SUV) SUVmean, the average value was measured SUVmax, drawn to each region of interest 3 times and Background (Carotid artery) was out of the SUV. In Chapter 3 of the slice to the tumor clearly visible by setting the region of interest to measure the change Tumor size was calculated average value. Gross Image resolution assessment were analyzed statistically through were divided into 1-5 points by the Radiation 7 people in 2, more than five years worked in specialized nuclear medicine compare to proceed with the blind test nonparametric test (wilcoxon signed rank test). (SPSS ver.18) Results $SUV_{mean}$ T's were in close mouth $5.01{\pm}2.70$ with open mouth $5.48{\pm}2.88$ (P<0.05), $SUV_{max}$ were respectively $8.78{\pm}5.55$ and $9.70{\pm}5.99$ (P<0.05). $SUV_{mean}$ in the NT were respectively $0.43{\pm}0.30$ and $0.34{\pm}0.24$ (P=0.20), $SUV_{max}$ was $0.56{\pm}0.34$ and $0.45{\pm}0.25$ (P=0.204). LN $SUV_{mean}$ were respectively $1.62{\pm}1.43$ and $1.69{\pm}1.49$ (P=0.161), $SUV_{mean}$ was $2.09{\pm}1.88$ and $1.99{\pm}1.74$ (P=0.131). Tumor size change is close mouth $4.96{\pm}4.66cm^2$ $5.33{\pm}4.64cm^2$ with 7.45% increase was (P<0.05), gross image resolution evaluation is $2.87{\pm}0.73$, $3.77{\pm}0.68$ with open mouth examinations 30.5% increase was (P<0.05). Conclusion Tumor SUV on the changes that had an increase in open mouth during inspection, the normal tongue and lymph node, but there was no significant difference in the change slightly. It is also one open mouth PET / CT scan will provide improved image to all patients with tongue cancer, but it could be confirmed that similar overall through the blind test, or tumor size changes and showing a high resolution image. It can be the perfect alternative method for problems that occur when the close mouth Open mouth PET / CT scan, but is believed to be through the open mouth to observe the boundary of overlapping or tumor of the oral cavity other structures a little more clearly. Tongue cancer patients how to recommend that the shooting further open mouth PET / CT.

• Tuberculosis and Respiratory Diseases
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• v.57 no.4
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• pp.351-357
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• 2004

Background : Paclitaxel is highly beneficial anticancer drug for the treatment of non-small cell lung cancer and has shown remarkable radiosensitizing effect in vitro. We evaluated whether concurrent chemoradiation therapy with weekly paclitaxel (60 $mg/m^2$) could be tolerated and effective in the treatment of locally advanced non-small cell lung cancer (NSCLC). Methods : Twenty-two stage III (IIIA:6, IIIB:16) NSCLC patients were treated with weekly administration of paclitaxel (60 $mg/m^2$) on days 1, 8, 15, 22, 29, and 36 in addition to concurrent radiation therapy of 54 Gy. After the initial phase of concurrent chemoradiation, patients received additional two cycles of consolidation chemotherapy with paclitaxel (175 $mg/m^2$)/cisplatin (75 $mg/m^2$) or paclitaxel (175 $mg/m^2$)/carboplatin (6AUC) every 3 weeks. Results : Overall response rate was 81.8% (18/22) with 9.1% (2/22) of complete response and 72.7% (16/22) of partial response rate. Two patients (9.1%) died of chemoradiation-induced pneumonitis after completion of therapy. In total, grade 3 toxicities included pneumonitis (22.7%), esophagitis (22.7%), neuropathy (13.6%), and neutropenia (13.6%). The median survival time was 15 months and 2-year overall survival were 31.8%. Conclusion : Concurrent chemoradiation therapy with weekly paclitaxel in locally advanced NSCLC showed good local response, but survival rate was not completely satisfactory due to potentially fatal chemoradiation-induced pneumonitis.