• Journal of Korean Neurosurgical Society
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• 제54권2호
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• pp.107-111
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• 2013

Objective : We investigated the effectiveness of stereotactic gamma knife Radiosurgery (GKR) for radioresistant brain metastases with the impact upon histology. Methods : Between April 2004 and May 2011, a total of 23 patients underwent GKR for 67 metastatic brain tumors from 12 renal cell cancers, 5 sarcomas and 6 melanomas. The mean age was 56 years (range, 18 to 79 years). Most of the patients were classified as the Radiation Therapy Oncology Group recursive partitioning analysis class II (91.3%). The synchronous metastasis was found in 6 patients (26.1%) and metachronous metastasis in 17 patients (73.9%). We analyzed the local control rate, intracranial progression-free survival (PFS) and overall survival (OS). Results : The mean tumor volume for GKR was 2.24 cc and the mean prescription dose was 19.4 Gy (range, 10 to 24) to the tumor margin. Out of metachronous metastases, the median duration to intracranial metastasis was 3.3 years in renal cell cancer (RCC), 2.4 years in melanoma and 1.1 years in sarcoma (p=0.012). The total local control rate was 89.6% during the mean 12.4 months follow-up. The six-month and one-year local control rate was 90.2% and 83% respectively. Depending on the pathology, the control rate of RCC was 95.7%, sarcoma 91.3% and melanoma 80.5% during the follow-up. The common cause of local failure was the tumor bleeding in melanoma. The median PFS and OS were 5.2 and 8.4 months in RCC patients, 6.5 and 9.8 months in sarcoma, and 3.8 and 5.1 months in melanoma. Conclusion : The GKR can be one of the effective management options for the intracranial metastatic tumors from the radioresistant tumors. The melanoma showed a poor local control rate compared to other pathologies because of the hemorrhage.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10319-10323
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• 2015

Background: The incidence rate of brain tumors has increased more than 40% in the past 20 years, especially in adults. We aimed to study the clinical and pathological findings of central nervous system (CNS) tumor patients and to evaluate their 5 year survival rates. Materials and Methods: The archives of all patients with CNS tumors in 6 health care centers in Yazd, Iran, from 2006 to 2013, were studied. Patients data were extracted using a checklist which included age, sex, date of reference and diagnosis, date of death, clinical signs, radiography findings, pathology report, size and location of tumor, patient treatment and grade of tumor. Results: A total of 306 patient records were studied in the 8 year period. The most prevalent type of tumor was astrocytoma (n=113, 36.9%). The frequency of almost all tumor types was statistically higher in male patients (p=0.025). In most cases surgery with radiotherapy was the treatment of choice (49.3%). The most frequent symptom reported was headache (in 60.8% of patients) followed by convulsions (15.7%). Most of the tumors were located in the right hemisphere (46.1%) and the frontal and parietal lobe (26% and 12%, respectively). Radiography findings displayed edema with a nonhomogeneous lesion in majority of the patients (87%). The survival fraction of the patients with malignant tumors decreased over time (0.807 in the first year and 0.358 at the end of the $5^{th}$ year). Conclusions: Astrocytoma was the more common CNS tumor with male predominance. Overall survival rates of malignant tumors decreased over time and this was in relation with tumor grade.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.345-351
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• 2002

The purpose of this study was to assess clinical proton MR spectroscopy (MRS) as a noninvasive method for evaluating brain tumor malignancy at 3T high field system. Using 3T MRI/MRS system, localized water-suppressed single-voxe1 technique in patients with brain tumors was employed to evaluate spectra with peaks of N-acetyl aspartate (NAA), choline-containing compounds (Cho), creatine/phosphocreatine (Cr) and lactate. On the basis of Cr, these peak areas were quantificated as a relative ratio. The variation of metabolites measurements of the designated region in 10 normal volunteers was less than 10%. Normal ranges of NAA/Cr and Cho/Cr ratios were 1.67${\pm}$018 and 1.16${\pm}$0.15, respectively. NAA/Cr ratio of all tumor tissues was significantly lower than that of the normal tissues (p=0.005), but Cho/Cr ratio of all tumor tissue was significantly higher (p=0.001). Cho/Cr ratio of high-grade gliomas was significantly higher than that of low-grade gliomas (P=0.001). Except 4 menigiomas, lactate signal was observed in all tumor cases. The present study demonstrated that the neuronal degradation or loss was observed in all tumor tissues. Higher grade of brain tumors was correlated with higher Cho/Cr ratio, indicating a significant dependence of Cho levels on malignancy of gliomas. Our results suggest that clinical proton MR spectroscopy could be useful to predict tumor malignancy.

• Journal of Korean Neurosurgical Society
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• 제47권6호
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• pp.415-419
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• 2010

Objective : It is usually difficult to perform the neuroendoscopic procedure in patients without hydrocephalus due to difficulties with ventricular cannulation. The purpose of this study was to find out the value of navigation guided neuroendoscopic biopsy in patients with peri- or intraventricular tumors without hydrocephalus. Methods : Six patients with brain tumors without hydrocephalus underwent navigation-guided neuroendoscopic biopsy. The procedure was indicated for verification of the histological diagnosis of the neoplasm, which was planned to be treated by chemotherapy and/or radiotherapy as the first line treatment, or establishment of the pathological diagnosis for further choice of the most appropriate treatment strategy. Results : Under the guidance of navigation, targeted lesion was successfully approached in all patients. Navigational tracking was especially helpful in entering small ventricles and in approaching the third ventricle through narrow foramen Monro. The histopathologic diagnosis was established in all of 6 patients : 2 germinomas, 2 astrocytomas, 1 dysembryoplastic neuroepithelial tumor and 1 pineocytoma. The tumor biopsy sites were pineal gland (n = 2), suprasellar area (n = 2), subcallosal area (n = 1) and thalamus (n = 1). There were no operative complications related to the endoscopic procedure. Conclusion : Endoscopic biopsy or resection of peri- or intraventricular tumors in patients without hydrocephalus is feasible. Image-guided neuroendoscopic procedure improved the accuracy of the endoscopic approach and minimized brain trauma. The absence of ventriculomegaly in patients with brain tumor may not be served as a contraindication to endoscopic tumor biopsy.

• 대한방사선기술학회지:방사선기술과학
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• 제35권2호
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• pp.165-172
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• 2012

VX2 암종을 이식한 토끼 뇌종양 모델에서, perfusion CT(computed tomography, CT)를 이용하여 종양과 정상 뇌조직의 혈류 특성을 알아보고자 하였다. 체중 2.4~3.0kg(평균 2.6kg)의 토끼(New Zealand white rabbit) 수놈 9마리를 대상으로, 토끼 뇌에 VX2 세포 현탁액 $1{\times}10^7$ cells/ml, 0.1 ml을 이식하고 종양이 5mm 정도 크기로 자라면 perfusion CT를 시행 하였다. GE사의 AW(advantage windows workstation, version 4.2)로 종양의 용적과 perfusion 값을 산출 하였다. 뇌종양의 평균 용적은 $316{\pm}181mm^3$ 이었고, 가장 큰 종양은 497 $mm^3$, 가장 작은 종양은 195 $mm^3$ 이었 이식된 종양 모두 단일 결절형으로 만들어졌고, 두개강 내로 전이는 발견되지 않았다. perfusion CT에서 종양 중심부의 혈류량(cerebral blood volume, CBV)은 $74.40{\pm}9.63$ 이었고, 종양쪽 정상 뇌조직에서는 $16.08{\pm}0.64$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $15.24{\pm}3.23$이었다. 혈류 속도(cerebral blood flow, CBF)는 종양 중심부에서 $962.91{\pm}75.96$ 이였고, 종양쪽 정상 뇌조직에서는 $357.82{\pm}12.82$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $323.19{\pm}83.24$ 이었다. 평균 통과시간(mean transit time, MTT)은 종양 중심부에서 $4.37{\pm}0.19$ 이었고, 종양쪽 정상 뇌조직에서는 $3.02{\pm}0.41$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $2.86{\pm}0.22$ 이었다. 투과성 표면적(permeability surface, PS)은 종양 중심부에서 $47.23{\pm}25.45$ 이었고, 종양쪽 정상 뇌조직에서는 $14.54{\pm}1.60$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $6.81{\pm}4.20$이었다. 또한, 종양 중심부에서 최고치 도달 시간(time to peak, TTP)은 $19.33{\pm}0.42$ 이었고, 종양쪽 정상 뇌조직에서는 $16.43{\pm}1.72$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $15.14{\pm}0.88$이었지만 통계적으로 유의하지 않았다. PEI(positive enhancement integral, PEI)은 종양 중심부에서 $61.56{\pm}16.07$ 이었고, 종양쪽 정상 뇌조직에서는 $12.58{\pm}2.61$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $8.26{\pm}5.55$ 이었다. 최대 증가 기울기(maximum slope of increase, MSI)는 종양 중심부에서 $13.18{\pm}2.81$ 이었고, 종양쪽 정상 뇌조직에서는 $6.99{\pm}1.73$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $6.41{\pm}1.39$ 이었다. 최대 감소 기울기(maximum slope of decrease, MSD)는 종양 중심부에서 $4.02{\pm}1.37$ 이었고, 종양쪽 정상 뇌조직에서는 $4.66{\pm}0.83$ 이었으며, 종양 반대쪽 정상 뇌조직에서는 $6.47{\pm}1.53$ 으로 나타났다. 결과적으로 정위적(stereotactic)으로 이식된 종양은 단일 결절형으로 두개강 내에 전이가 없어 정상 조직과 종양 조직의 비교 연구에 적합하며, perfusion CT 에서 얻어진 매개 변수(parameter)들은 종양과 정상 조직의 혈관 관류 상태 차이를 잘 반영해 주었다.

• 한국산학기술학회논문지
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• 제15권10호
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• pp.6187-6192
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• 2014

전이성 뇌종양의 증가에 따라 전뇌 방사선치료가 증가하게 되었다. 그리고 치료기법의 발전은 삶의 질 향상의 중요성을 증가시키게 되었다. 체적변조회전 전뇌조사는 용적별 선량을 차등시킬 수 있는 우수한 치료기법이다. 이에 두피선량 증가에 따른 탈모에 대하여 기존 전뇌조사와 체적변조회전 전뇌조사를 비교하고자 하였다. 두정부 인체모형을 이용하여 치료계획을 비교하였다. 뇌 실질의 경우 정합지수, 동질성지수, 범위의 질지수를 적용하였으며, 두피, 안구, 수정체, 경추의 경우 20%선량의 용적, 50%선량의 용적을 적용하여 비교하였다. 비교결과 뇌 실질은 기존 전뇌조사가 10%정도 우수하였지만, 두피, 안구, 수정체, 경추의 경우는 체적변조회전 전뇌조사가 1000%정도 우수하였다. 향후 체적변조회전 전뇌조사의 처방선량을 조정한다면 탈모를 방지하는 전이성 뇌종양 방사선치료로 선정될 것이다.

• 핵의학기술
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• 제28권1호
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• pp.41-47
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• 2024

Purpose: ¹⁸F-FET, a radiopharmaceutical based on a Tyrosine amino acid derivative using the Sodium-Potassium Pump-independent Transporter (System L) for non-invasive evaluation of primary, recurrent, and metastatic brain tumors, exhibits distinct characteristics. Unlike the widely absorbed ¹⁸F-FDG in both tumor and normal brain tissues, ¹⁸F-FET demonstrates specific uptake only in tumor tissue while almost negligible uptake in normal brain tissue. This study aims to compare and evaluate the usefulness of ¹⁸F-FDG and ¹⁸F-FET Brain PET/CT quantitative analysis in brain tumor diagnosis. Materials and Methods: In 46 patients diagnosed with brain gliomas (High Grade: 34, Low Grade: 12), Brain PET/CT scans were performed at 40 minutes after ¹⁸F-FDG injection and at 20 minutes (early) and 80 minutes (delay) after ¹⁸F-FET injection. SUV_max and SUV_peak of tumor areas corresponding to MRI images were measured in each scan, and the SUV_max-to-SUV_peak ratio, an indicator of tumor prognosis, was calculated. Differences in SUV_max, SUV_peak, and SUV_max-to-SUV_peak ratio between ¹⁸F-FDG and ¹⁸F-FET early/delay scans were statistically verified using SPSS (ver.28) package program. Results: SUV_max values were 3.72±1.36 for ¹⁸F-FDG, 4.59±1.55 for ¹⁸F-FET early, and 4.12±1.36 for ¹⁸F-FET delay scans. The highest SUV_max was observed in ¹⁸F-FET early scans, particularly in HG tumors (4.85±1.44), showing a slightly more significant difference (P<0.0001). SUV_peak values were 3.33±1.13 for ¹⁸F-FDG, 3.04±1.11 for ¹⁸F-FET early, and 2.80±0.96 for ¹⁸F-FET delay scans. The highest SUV_peak was in ¹⁸F-FDG scans, while the lowest was in ¹⁸F-FET delay scans, with a more significant difference in HG tumors (P<0.001). SUV_max-to-SUV_peak ratio values were 1.11±0.09 for ¹⁸F-FDG, 1.54±0.22 for ¹⁸F-FET early, and 1.48±0.17 for ¹⁸F-FET delay scans. This ratio was higher in ¹⁸F-FET scans for both HG and LG tumors (P<0.0001), but there was no statistically significant difference between ¹⁸F-FET early and delay scans. Conclusion: This study confirms the usefulness of early and delay scans in ¹⁸F-FET Brain PET/CT examinations, particularly demonstrating the changes in objective quantitative metrics such as SUV_max, SUV_peak, and introducing the SUV_max-to-SUV_peak ratio as a new evaluation metric based on the degree of tumor malignancy. This is expected to further contributions to the quantitative analysis of Brain PET/CT images.

• 대한한방소아과학회지
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• 제15권2호
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• pp.69-73
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• 2001

The neurofibromatosis (NF) are a set of genetic disorders which cause tumors to grow along various types of nerves and, in addition, can affect the development of non-nervous tissues such as bones and skin. NF causes tumors to grow anywhere on or in the body. It also leads to developmental abnormalities. For example, individuals with NF have a higher incidence of learning disabilities. Neurofibromatosis(NF) has been classified into two distinct types: NF-I and NF-II. neurofibromatosis 1(NF-I), also known as von Recklinghausen NF or Peripheral NF, occurring in 1:4,000 births, is characterized by multiple cafe-au-lait spots and neurofibromas on or under the skin. Enlargement and deformation of bones and curvature of the spine (scoliosis) may also occur. Occasionally, tumors may develop in the brain, on cranial nerves, or on the spinal cord. About 50% of people with NF also have learning disabilities. Neurofibromatosis 2(NF-II), also known as Bilateral Acoustic NF(BAN), is much rarer occurring in 1:50,000 births. NF-II is characterized by multiple tumors on the cranial and spinal nerves, and by other lesions of the brain and spinal cord. Tumors affecting both of the auditory nerves are the hallmark. Hearing loss beginning in the teens or early twenties is generally the first symptom. We reported a 10-year-old female patient with NF-I, she has pain and edema in left leg, no symptoms of NF.

• Journal of Korean Biological Nursing Science
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• 제7권1호
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• pp.47-56
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• 2005

nm23-H1 gene expression has been inversely correlated with tumor metastatic potential in certain tumors including melanomas, breast carcinomas, and hepatocellular carcinomas. However, its role with respect to the invasive behavior of central nervous system tumors has scarcely been addressed Because cell motility and invasion plays an essential role in metastatic dissemination, we have studied whether motile human glioma cell(U87MG) transfected with nm23-H1 complementary DNA have any alterations in their ability to migrate and invade. There was no significant changes in the shape and size of the cells following nm23-H1 transfection. The role of nm23-H1 in glioma migration and invasion have been evaluated by in vitro simple scratch technique and brain slice invasion model Basal migration ability of nm23-H1 transfectants cell(U87MG-pEGFP-nm23) were lesser than U87MG. Accordingly, U87MG-pEGFP-nm23 didn't migrate away apparently from the tumors implanted site comparing U87MG in brain slice invasion model. These results suggest that nm23-H1 may play an important role in suppressing the human glioma migration and invasion.

• Asian Pacific Journal of Cancer Prevention
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• 제14권12호
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• pp.7401-7407
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• 2013

Aim: To compare survival outcomes after whole brain radiation therapy (WBRT), stereotactic radiosurgery (SRS), and WBRT plus SRS combination therapy in Korea, by performing a quantitative systematic review. Materials and Methods: We searched 10 electronic databases for reports on Korean patients treated with WBRT or SRS for brain metastases published prior to July 2010. Independent reviewers screened all articles and extracted the data. When a Kaplan-Meier survival curve was available, median survival time and standard errors were calculated. Summary estimates for the outcomes in each study were calculated using the inverse variance random-effects method. Results: Among a total of 2,761 studies, 20 studies with Korean patients (n=1,053) were identified. A combination of 12 studies (n=566) with WBRT outcomes showed a median survival time of 6.0 months (95%CI: 5.9-6.2), an overall survival rate of 5.6% (95%CI: 1-24), and a 6-month survival rate of 46.5% (95%CI: 37.2-56.1). For nine studies (n=412) on SRS, the median survival was 7.9 months (95%CI: 5.1-10.8), and the 6-month survival rate was 63.1% (95%CI: 49.8-74.8). In six studies (n=75) using WBRT plus SRS, the median survival was 10.7 months (95%CI: 4.7-16.6), and the overall and 6-month survival rates were 16.8% (95%CI: 6.2-38.2) and 85.7% (95%CI: 28.3-96.9), respectively. Conclusions: WBRT plus SRS showed better 1-year survival outcome than of WBRT alone for Korean patients with metastatic brain tumors. However, the results of this analysis have to be interpreted cautiously, because the risk factors of patients were not adjusted in the included studies.