• Radiation Oncology Journal
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• 제34권3호
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• pp.186-192
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• 2016

Purpose: To determine whether large rectal volume on planning computed tomography (CT) results in lower tumor regression grade (TRG) after neoadjuvant concurrent chemoradiotherapy (CCRT) in rectal cancer patients. Materials and Methods: We reviewed medical records of 113 patients treated with surgery following neoadjuvant CCRT for rectal cancer between January and December 2012. Rectal volume was contoured on axial images in which gross tumor volume was included. Average axial rectal area (ARA) was defined as rectal volume divided by longitudinal tumor length. The impact of rectal volume and ARA on TRG was assessed. Results: Average rectal volume and ARA were 11.3 mL and $2.9cm^2$. After completion of neoadjuvant CCRT in 113 patients, pathologic results revealed total regression (TRG 4) in 28 patients (25%), good regression (TRG 3) in 25 patients (22%), moderate regression (TRG 2) in 34 patients (30%), minor regression (TRG 1) in 24 patients (21%), and no regression (TRG0) in 2 patients (2%). No difference of rectal volume and ARA was found between each TRG groups. Linear correlation existed between rectal volume and TRG (p = 0.036) but not between ARA and TRG (p = 0.058). Conclusion: Rectal volume on planning CT has no significance on TRG in patients receiving neoadjuvant CCRT for rectal cancer. These results indicate that maintaining minimal rectal volume before each treatment may not be necessary.

• Radiation Oncology Journal
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• 제31권1호
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• pp.34-40
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• 2013

Purpose: To evaluate the predictive factors of radiation pneumonitis (RP) and associated changes in pulmonary function after definitive concurrent chemoradiotherapy (CCRT) in patients with non-small cell lung cancer (NSCLC). Materials and Methods: Medical records of 60 patients with NSCLC who received definitive CCRT were retrospectively reviewed. Dose volumetric (DV) parameters, clinical factors, and pulmonary function test (PFT) data were analyzed. RP was graded according to the CTCAE ver. 4.0. Percentage of lung volume that received a dose of threshold (Vdose) and mean lung dose (MLD) were analyzed for potential DV predictors. PFT changes were calculated as the difference between pre-RT and post-RT values at 3, 6, and 12 months after RT. Results: Twenty-two patients (37%) developed grade ${\geq}2$ RP. Among clinical factors, tumor location in lower lobe was associated with RP. Among the DV parameters, only MLD >15 Gy was associated with grade ${\geq}2$ RP. There were statistically significant decreases in PFT at all points compared with pre-RT values in grade ${\geq}2$ RP group. MLD was associated with forced vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) changes at 6 and 12 months. V10 was associated with FVC changes at 12 months. V20 and V30 were associated with FEV1 changes at 6 months and FVC changes at 12 months. Conclusion: After definitive CCRT in patients with NSCLC, MLD >15 Gy and lower lobe tumor location were predictors of grade ${\geq}2$ RP. Pulmonary functions were decreased after CCRT and the magnitude of changes was associated with DV parameters.

• Radiation Oncology Journal
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• 제20권4호
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• pp.334-342
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• 2002

목적 : 본 연구는 AJCC 병기 II기와 III기의 국소진행성 직장암으로 근치적 절제술을 받은 환자들을 대상으로 각 병기에서 보조 화학요법 단독에 비해 화학방사선 병행요법이 생존율 및 무병생존율을 향상시키는지에 대하여 알아보고자 하였다. 대상 및 방법 : 1989년 1월부터 1999년 12월까지 AJCC 병기 II기와 III기의 직장암으로 근치적 절제술이 시행된 144명을 대상으로 하였다. 그 중 보조 치료방법에 따라 분류를 하면 화학요법 단독군이 72명이었고, 화학방사선 병행요법군은 72명이었다. 화학요법은 수술 후 UFT를 매일 경구복용하거나(중앙값 12개월) 5-FU를 기초로 한 항암제를 4주 간격으로 정맥주사하였고, 투여기간은 $1\~18$차례(중앙값 6차례)이였다. 방사선치료는 직장과 골반 내 영역 림프절 영역에 4,500 cGy를 조사한 후 수술 부위에 $540\~1,440\;cGy$ (중앙값 540 cGy) 추가조사를 시행하였다. 추적관찰 기간은 $20\~150$개월로 중앙값은 44개월이었다. 결과 : 5년 생존율은 화학요법 단독군과 화학방사선 병행요법군에서 각각 $60.9\%$와 $68.9\%$ (p=0.0915)였고, 5년 무병생존율은 각각 $56.1\%$와 $63.8\%$ (p=0.3510)로 두 군사이에 유의한 차이를 보이지 않았다. 병기별로 분석하였을 때 II기에서의 5년 생존율은 화학요법 단독군이 $71.1\%$, 화학방사선 병행요법군은 $92.2\%$로 두 군간에 통계적으로 유의한 차이를 보였으나(p=0.0379), 5년 무병생존율에서는 화학요법 단독군이 $57.3\%$, 화학방사선 병행요법군은 $85.4\%$로 두군간에 통계적으로 유의한 차이를 보이지 않았다(p=0.1482). III기에서는 5년 생존율과 무병생존율이 화학요법 단독군에서는 $52.0\%$와 $47.8\%$였고, 화학방사선 병행요법군에서는 $55.0\%$와 $49.8\%$로 두 군 사이에는 유의한 차이를 보이지 않았다(p=0.4280, p=0.7891). 국소재발율은 화학요법 단독군이 $16.7\%$, 화학방사선 병행요법군은 $12.5\%$였고, 원격재발율은 화학요법 단독군이 $25.0\%$, 화학방사선 병행요법군은 $26.4\%$였다. 결론 : 본 연구에서는 II기에서 보조 화학요법에 방사선치료를 병행함으로써 보조 화학요법 단독 치료시와 비교하여 생존율의 유의한 증가를 보였고, 비록 통계적으로 유의한 차이를 보이지는 못했지만 국소재발율의 감소를 보였다.

• Journal of Korean Neurosurgical Society
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• 제44권4호
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• pp.222-227
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• 2008

Objective : Malignant gliomas are the most common primary cerebral neoplasms in adults. Despite multimodality treatments, the prognosis for patients with malignant glioma remains poor. However, recently, the effectiveness of concomitant chemoradiotherapy (CCRT) with temozolomide (TMZ) has been reported. We report for the first time preliminary results of the treatment with CCRT of newly diagnosed malignant gliomas in Korean people. Methods : Thirty-two patients over the age of 17 years with newly diagnosed and histologically confirmed high-grade gliomas (HGG), from June 2004 to August 2007 were the subjects of this study. There were 17 men and 15 women, with a median age of 53.5 years (range, 17-74). Pathologically, glioblastoma, anaplastic astrocytoma, anaplastic oligodendroglioma, and gliomatosis cerebri had been diagnosed in eighteen, eight, four, and two patients, respectively. These 32 patients were treated with CCRT with TMZ. Results : The median follow-up period was 12.5 months (range 3-48). At the time of this analysis, 13 patients died and three patients had been lost to follow-up. There was no mortality caused by drug toxicity. The median progression-free survival (PFS) of these patients was 9.0 months, and the six-month PFS rate was 72.4%. The median overall survival (OS) was 26 months, and the one-year OS rate was 83.6%. The 18 patients with glioblastoma were analyzed separately from the other patients with HGG, and the median OS was 18 months, and the one-year OS rates were 81.8%. The median PFS was seven months, and the six-month PFS rate was 75.0%. Conclusion : Our results are consistent with many other reports, confirming that CCRT with TMZ achieves good clinical outcomes in the treatment of HGG. Therefore, we suggest that CCRT with TMZ as adjuvant chemotherapy be considered as a standard therapy for patients with HGG.

• 대한두경부종양학회지
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• 제27권1호
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• pp.47-53
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• 2011

Purpose : Concurrent chemoradiotherapy(CCRT) with 3 weekly cisplatin is the standard treatment of locally advanced head and neck cancer(HNC). The aim is to evaluate the efficacy and toxicities of low-dose weekly cisplatin-based CCRT, which was devised to reduce the toxicity of CCRT. Method : We retrospectively analyzed HNC patients who received low-dose weekly cisplatin-based CCRT between 2008 and 2010. Cisplatin 35mg/$m^2$ was weekly given to all patients during radiotherapy. The efficacy was evaluated by the degree of clinical response, treatment failure and survival. The toxicity was evaluated by hematologic toxicities and oral mucositis. Results : A total of 27 patients were analyzed and median age was 59(range 31-81). The ratio of administered dose of radiotherapy and cisplatin to planned dose were 0.98 and 0.93, respectively. Complete remission and partial remission were 73% and 23%, respectively. Treatment failure was observed in 8(30%) patients. 1-year survival rate and 1-year disease free survival rate were 82% and 59%, respectively. Overall survival and progression-free survival did not reach median time. Grade 3/4 anemia, neutropenia, thrombocytopenia and oral mucositis were observed in 11%, 19%, 7% and 32% of patients, respectively. In terms of administered cycles, however, only 1-3% of grade 3/4 hematologic toxicities occurred among total 190 cycles. Severe oral mucositis were statistically associated with old age(p=0.003). Treatment failure had no statistical relation with age, pathology, primary site and stage. Conclusion : Low-dose weekly cisplatin-based CCRT seemed to deliver enough dose of cisplatin and to show low drop-out rate and good efficacy with low hematologic toxicities.

• Radiation Oncology Journal
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• 제27권2호
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• pp.64-70
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• 2009

목 적: 국소 진행되어 절제가 불가능한 췌장암에 있어 동시 항암화학 방사선 요법이 표준 요법으로 자리 잡아 왔다. 그러나 최근 들어 항암화학 단독 요법만으로도 좋은 결과를 보이는 연구 결과가 발표되고 있다. 이에 저자들은 국소 진행된 췌장암 환자들의 치료법에 따른 생존율 등을 비교하여 동시 항암화학 방사선 요법의 역할을 재조명하여 보고자하였다. 대상 및 방법: 2000년 1월부터 2008년 1월까지 인하대학교에서 절제 불가능한 췌장암으로 진단되어 치료를 받았던 55명의 환자를 대상으로 후향적 분석을 시행하였다. 동시 항암화학 방사선 요법은 5-FU에 기반한 항암화학 요법과 동시에 원발병소와 주위 림프절을 포함한 부분에 54 Gy (36~59.4 Gy)를 조사하였다. 항암화학 단독 요법은 gemcitabine단독 또는 5-FU와 병용하여 치료하였다. 치료 방법에 따른 치료반응과 전체 생존율 및 무진행생존율을 비교하였으며 예후인자들을 분석하였다. 결 과: 55명의 환자 중 동시 항암화학 방사선 요법을 받은 환자가 34명, 항암화학 단독 요법을 받은 환자가 21명이었다. 치료 방법에 따른 중앙 생존 기간은 각각 12개월, 11개월, 1년 생존율은 43%, 46%로 통계적으로 차이를 보이지 않았다. 중앙 무진행 생존기간은 각각 8개월, 5개월로 다소간 차이를 보였으나 통계적으로 의미있는 결과를 보이지는 않았다. 치료 반응도는 두 군 모두에서 완전 관해는 없었지만 부분 관해는 동시 항암화학 방사선 요법이 26%, 항암화학 단독 요법이 6%로 통계학적으로 의미 있는 차이를 보였다. 치료 중 독성은 동시 항암화학 방사선 요법이 장독성이 더 많았으나 다른 독성에는 차이가 없었다. 예후인자는 림프절 전이가 있는 경우, CA19-9이 1,000 U/ml 이상인 경우, 췌장암이 꼬리부분에 있는 경우가 나빴다. 결 론: 절제 불가능한 췌장암 치료에 있어서 동시 항암화학 방사선 요법이 항암화학 단독 요법에 비하여 무진행생존율을 향상 시키는 경향을 보였고, 치료 반응도에서도 더 좋은 결과를 보였다. 따라서 방사선 치료가 종양의 국소 제어에는 효과적인 것으로 생각된다.

• Radiation Oncology Journal
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• 제29권3호
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• pp.214-217
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• 2011

To avoid improper tumor volume contouring in radiation therapy (RT) and other invasive procedures, we report a case of uterine adenomyosis showing increased $^{18}F$-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT) mimicking malignant tumor in a 44-year-old woman during concurrent chemoradiation therapy (CCRT) for uterine cervical cancer. The adenomyosis was not associated with her menstrual cycle or with normal endometrium uptake, and it resolved one month after completion of RT. This case indicates that uterine adenomyosis in a premenopausal woman may show false positive uptake of $^{18}FDG$-PET/CT associated with CCRT.

• Radiation Oncology Journal
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• 제36권1호
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• pp.35-44
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• 2018

Purpose: To evaluate clinical outcomes according to radiation dose in patients with limited-stage small-cell lung cancer (LS-SCLC) treated with concurrent chemoradiotherapy (CCRT). Materials and Methods: From January 2006 to December 2015, 38 patients with LS-SCLC were treated with CCRT with etoposide and cisplatin. Total radiation doses ranged from 45 Gy to 66 Gy (1.8-2 Gy/fraction) and were classified into three groups: 45-54 Gy, 60-63 Gy, and 66 Gy. The impact of radiation dose on survival outcomes were evaluated. Toxicities were evaluated according to the Common Terminology Criteria for Adverse Events version 4.03. Results: The median follow-up period was 21 months. The 2-year overall survival (OS) and local failure-free survival (LFFS) rates were 45.8% and 67.5%, respectively. The 2-year LFFS rates were 33.3% for 45-54 Gy group, 68.6% for 60-63 Gy group, and 87.1% for 66 Gy group (p = 0.014). In multivariate analysis, radiation dose was a significant factor for LFFS (p = 0.015). Although radiation dose was not a significant factor for OS and disease-free survival (DFS) in multivariate analysis, both OS and DFS of 66 Gy group tended to be better than that of 45-63 Gy group in univariate analysis. However, there were no differences in severe toxicities among three groups. Conclusion: Higher radiation dose achieved better local control in patients with LS-SCLC treated with CCRT. In addition, a total dose of 66 Gy tended to improve OS and DFS.

• Radiation Oncology Journal
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• 제35권1호
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• pp.55-64
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• 2017

Purpose: The outcomes and toxicities of locoregionally recurrent non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy were evaluated in the modern era. Materials and Methods: Fifty-seven patients receiving radical radiotherapy for locoregionally recurrent NSCLC without distant metastasis after surgery from 2004 to 2014 were reviewed. Forty-two patients were treated with concurrent chemoradiotherapy (CCRT), and 15 patients with radiotherapy alone. The median radiation dose was 66 Gy (range, 45 to 70 Gy). Lung function change after radiotherapy was evaluated by comparing pulmonary function tests before and at 1, 6, and 12 months after radiotherapy. Results: Median follow-up was 53.6 months (range, 12.0 to 107.5 months) among the survivors. The median overall survival (OS) and progression-free survival (PFS) were 54.8 months (range, 3.0 to 116.9 months) and 12.2 months (range, 0.8 to 100.2 months), respectively. Multivariate analyses revealed that single locoregional recurrence focus and use of concurrent chemotherapy were significant prognostic factors for OS (p = 0.048 and p = 0.001, respectively) and PFS (p = 0.002 and p = 0.026, respectively). There was no significant change in predicted forced expiratory volume in one second after radiotherapy. Although diffusing lung capacity for carbon monoxide decreased significantly at 1 month after radiotherapy (p < 0.001), it recovered to pretreatment levels within 12 months. Acute grade 3 radiation pneumonitis and esophagitis were observed in 3 and 2 patients, respectively. There was no chronic complication observed in all patients. Conclusion: Salvage radiotherapy showed good survival outcomes without severe complications in postoperative locoregionally recurrent NSCLC patients. A single locoregional recurrent focus and the use of CCRT chemotherapy were associated with improved survival. CCRT should be considered as a salvage treatment in patients with good prognostic factors.

• Radiation Oncology Journal
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• 제35권1호
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• pp.39-47
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• 2017

Purpose: The purpose of this study was to analyze clinical outcomes from cervical cancer and stratify patients into risk groups for prognostic factors for early-stage disease. Materials and Methods: We retrospectively reviewed patients with stage IB or IIA cervical cancer treated with adjuvant radiotherapy (RT) or concurrent chemoradiotherapy (CCRT) following primary surgery at Samsung Medical Center from 2001 to 2011. Adjuvant RT was added for patients with intermediate-risk factors, and adjuvant CCRT was performed on high-risk patients after surgery. Results: We reviewed 247 patients-149 in the high-risk group and 98 in intermediate-risk group. The median follow-up was 62 months. Loco-regional failure (LRF) alone occurred in 7 patients (2.8%), distant metastasis alone in 37 patients (15.0%) and LRF with DM in 4 patients (1.6%). The 5-year disease-free survival (DFS) and overall survival (OS) rates for both groups were 79.7% and 87.6%, respectively. In the high-risk group, the 5-year DFS and OS probabilities were 72.5% and 81.9%, respectively. Histologic type, pathologic tumor size, and the number of pelvic lymph node (PLN) metastasis were significant prognostic factors for DFS and OS. We suggest a scoring system (0-3) using these prognostic factors to predict poor prognosis in high-risk patients. Using this system, patients with higher scores have higher recurrence and lower survival rates. Conclusion: In the high-risk cervical-cancer group who received primary surgery and adjuvant CCRT, non-squamous type, large tumor size and the number of PLN metastasis were significant prognostic factors, and the number of these factors was associated with survival rates.