• Radiation Oncology Journal
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• 제37권2호
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• pp.67-72
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• 2019

Concurrent chemoradiation therapy (CCRT) has played the most important and central role in the definitive therapy for the patients with locoregionally advanced stage nasopharynx cancer. The addition of induction chemotherapy (IC) or adjuvant chemotherapy (AC) to CCRT have been widely accepted with the rationale of improving distant control in the clinical practices. This review article investigated the role of IC and AC based on 11 recent meta-analysis publications, and found that the clinical benefits obtained by the additional IC or AC to CCRT, at the cost of the increased risks of more frequent and more severe side effects, seemed not big enough. More intervention is not always better, however, less seems frequently good enough. The author would speculate that 'less is more' and would advocate CCRT alone as the current standard.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6129-6132
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• 2012

Objectives: To evaluate the feasibility and efficacy of simultaneous accelerated radiation therapy (SMART) and concurrent weekly paclitaxel in the treatment of locally advanced nasopharyngeal carcinoma. Methods: Forty-one patients with pathologically confirmed nasopharyngeal carcinoma were treated by SMART with concurrent weekly paclitaxel. Daily fraction doses of 2.5 Gy and 2.0 Gy were prescribed to the gross tumor volume (GTV) and clinical target volume (CTV) to a total dose of 70 Gy and 56 Gy, respectively. Paclitaxel of $45mg/m^2$ was administered concurrently with radiation therapy every week. Adjuvant chemotherapy was given four weeks after the completion of the radiotherapy (RT) if the tumor demonstrated only a partial response (PR). Results: All patients completed the radiotherapy (RT) course. Adjuvant chemotherapy was administered to 12 patients due to PR. The CR (complete remission) rate was 82.9% three months after RT. Thirty-nine (95.1%) patients completed the concurrent weekly chemotherapy with paclitaxel, and two patients skipped their sixth course. Seven patients had a 15% dosage reduction at the fifth and sixth course due to grade 3 mucositis. The median follow-up was 30 (range, 14-42) months. The three-year overall survival (OS), metastases-free survival (MFS), and local control rates were 77.0%, 64.4%, and 97.6%, respectively. No correlation between survival rate and T or N stage was observed. Grade 3 acute mucositis and xerostomia were present in 17.1% and 7.1%, respectively. Conclusion: SMART with concurrent weekly paclitaxel is a potentially effective and toxicity tolerable approach in the treatment of locally advanced NPC.

• Radiation Oncology Journal
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• 제11권2호
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• pp.355-361
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• 1993

본 연구는 1991년 5월부터 국소적으로 진행된 자궁경부암 (FIGO stage IIB~IVA) 환자를 대상으로 5-FU와 Cis-platinum을 방사선 치료와 동시에 투여하여 치료 독성, 치료의 적합성과 국소관해율을 평가하기 위해 시행되었다. 방사선 치료는 외부방사선 조사로 전골반부에 23회에 걸쳐 4140 cGy 시행후, 고선량 근접치료기로 강내조사를 6회 내지 7회 (A점에 $3000\~3500$ cGy) 시행하였으며, B점에 추가조사를 시행하여 IIB병기 환자는 6000 cGy까지 IIIB병기 환자는 6500 cGy가지 B점에 조사되도록 하였다. 첫 번째 항암화학요법은 외부방사선 치료 시행의 두번째 주에 5-FU는 $1000 mg/m^2/24hr$를 96시간 동안에 걸쳐 토여하고 Cis-platinum은 $20mg/m^2/day$를 3일 투여하였다. 두번째 항암화학요법은 처음과 동일한 방법으로 첫번째 고선량 근접 강내 치료가 시행될 때 투여 되었다. 1993년 8월까지 총 16명의 환자(10 IIB 병기, 4 IIIB병기, 2 IVA 병기)가 등록되었으며, 이중 2명은 외부방사선 2회 조사후 치료를 중단하였으며, 1명은 강내치료중 3등급의 비뇨기계독성으로 치료를 중단하였다. 2회의 항암화학 요법이 종료된 후 독성의 평가가 가능했던 14명의 환자중 5명이 3등급의 위장관독성이 발생하였으나, 4명은 치료종료후 평가에서 회복되었다. 1명은 병기 IIIB환자로 초기에 서혜부 임파절 전이가 있어 다량의 방사선이 조사되었는데, 치료종료 후에 위장관독성이 악화되었고, 1개월후 원격전이로 사망하였다. 치료후 치료전 체중의 $10\%$ 이상 감소된 환자는 2명이었고, 1명이 3등급의 백혈구 감소를 보였다. 환자의 평균 치료 기간은 75일(포준 치료 기간은 $70\pm7$일)이었고, 80일 이상인 환자는 3명 (84, 84, 89일)이었다. 추적관찰 가능했던 13명 환자중 8명이 완전관해를 보였고, 특히 IIB병기 환자의 경우 9명중 8명이 완전관해를 보였다. 본 연구결과 진전된 자궁 경부암에서 방사선과 항암화학요법 병행치료는 효과나 독성면에서 수용가능 하였으나 향후 근치적 방사선치료 단독으로 시행된 경우와의 전향적 비교연구가 필요할 것으로 생각된다.

• Radiation Oncology Journal
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• 제29권3호
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• pp.181-190
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• 2011

Purpose: Thoracic radiotherapy is a major treatment modality of stage III non-small cell lung cancer. The normal lung tissue is sensitive to radiation and radiation pneumonitis is the most important dose-limiting complication of thoracic radiation therapy. This study was performed to identify the clinical and dosimetric parameters related to the risk of radiation pneumonitis after definitive radiotherapy in stage III non-small cell cancer patients. Materials and Methods: The medical records were reviewed for 49 patients who completed definitive radiation therapy for locally advanced non-small cell lung cancer from August 2000 to February 2010. Radiation therapy was delivered with the daily dose of 1.8 Gy to 2.0 Gy and the total radiation dose ranged from 50.0 Gy to 70.2 Gy (median, 61.2 Gy). Elective nodal irradiation was delivered at a dose of 45.0 Gy to 50.0 Gy. Seven patients (14.3%) were treated with radiation therapy alone and forty two patients (85.7%) were treated with chemotherapy either sequentially or concurrently. Results: Twenty-five cases (51.0%) out of 49 cases experienced radiation pneumonitis. According to the radiation pneumonitis grade, 10 (20.4%) were grade 1, 9 (18.4%) were grade 2, 4 (8.2%) were grade 3, and 2 (4.1%) were grade 4. In the univariate analyses, no clinical factors including age, sex, performance status, smoking history, underlying lung disease, tumor location, total radiation dose and chemotherapy were associated with grade ${\geq}2$ radiation pneumonitis. In the subgroup analysis of the chemotherapy group, concurrent rather than sequential chemotherapy was significantly related to grade ${\geq}2$ radiation pneumonitis comparing sequential chemotherapy. In the univariate analysis with dosimetric factors, mean lung dose (MLD), $V_{20}$, $V_{30}$, $V_{40}$, MLDipsi, $V_{20}$ipsi, $V_{30}$ipsi, and $V_{40}$ipsi were associated with grade ${\geq}2$ radiation pneumonitis. In addition, multivariate analysis showed that MLD and V30 were independent predicting factors for grade ${\geq}2$ radiation pneumonitis. Conclusion: Concurrent chemotherapy, MLD and $V_{30}$ were statistically significant predictors of grade ${\geq}2$ radiation pneumonitis in patients with stage III non-small cell lung cancer undergoing definitive radiotherapy. The cutoff values for MLD and $V_{30}$ were 16 Gy and 18%, respectively.

• Radiation Oncology Journal
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• 제24권2호
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• pp.96-102
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• 2006

목적: 국한성병기 소세포폐암 환자에서 하루 두 번 분할조사에 의한 동시 화학방사선치료의 효율성을 치료 반응률, 생존율, 실패양상, 치료부작용 등의 관점에서 평가하기 위해 후향적 연구를 수행하였다. 대상 및 방법: 1993년 2월부터 2002년 10월까지 총 76명의 환자가 조직학적으로 증명된 국한성병기 소세포폐암으로 하루 두 번 분할조사에 의한 동시 화학방사선치료를 시행 받았다. 대상환자 중 남성은 84% (64/76)이었고, 중앙연령은 57세였다(32-75세). 흉부방사선치료는 120 또는 150 cGy/fraction로 최소 6시간의 간격을 두고 하루 두 번, 한 주에 5일 시행하였다. 총 흉부조사선량의 중앙값은 50.4 Gy였다(45-51 Gy). 동시 화학치료은 3주 간격으로 교대 CAV ($cytoxan\;1000mg/m^2,\;adriamycin\;40mg/m^2,\;vincristine\;1mg/m^2$)/PE ($cisplatin\;60mg/m^2,\;etoposide\;100mg/m^2$)이거나, 혹은 단독 PE 요법이 사용되었다. 화학치료 횟수의 중앙값은 6회였다(1-9회). 예방적 전뇌조사는 완전관해를 보인 환자에게 25 Gy/10 fractions로 시행되었다. 중앙추적관찰기간은 18개월이었다(1-136개월). 결과: 치료의 반응률은 86%이었다: 완전관해가 39명(52%), 부분관해가 26명(34%)이었다. 중앙생존기간은 23개월이었다. 1년, 2년, 3년 생존율은 각각 72%, 50%, 30%이었다. 단변량분석에서 치료 반응률이 생존율의 유의한 예후인자로 밝혀졌다(p<0.001). 등급 3 이상의 급성부작용은 백혈구감소 46명(61%), 적혈구 감소 5명 (6%), 혈소판 감소 10명(13%), 식도염 5명(6%), 그리고 폐독성이 2명(2%)에서 있었다. 추척관찰이 가능했던 73명의 환자 중 총 38명(52%)에서 병의 진행이 관찰되었다. 첫 번째 원격전이 장소의 빈도는 뇌가 가장 높았다. 결론: 하루 두 번 분할조사에 의한 동시 화학방사선치료는 국한성병기 소세포폐암 환자에서 나쁘지 않은 부작용과 함께 양호한 치료반응 및 생존율의 결과를 보였다. 생존율의 유의한 예후인자로 밝혀진 치료 반응률을 향상시키기 위해 방사선치료 분할방식, 화학요법제제, 화학방사선치료의 결합방식에 대한 추가적인 연구가 필요할 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2793-2796
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• 2014

Background: Glioblastoma multiform (GBM) is a highly aggressive tumor with median survival of approximately 14 months. Management consists of maximal surgical resection followed by post-operative chemoradiation with concurrent then adjuvant temozolamide. The standard radiotherapy dose is 60Gy in 2-Gy fractions recommended by the radiation therapy oncology group (RTOG). With the vast majority of tumor recurrences occurring within the previous irradiation field and the poor outcome associated with standard therapy, regimens designed to deliver higher radiation doses to improve local control and enhance survival are needed. In this study, we report a single institutional experience in treatment of 68 consecutive patients with GBM, treated with resection, and given post-operative radiotherapy followed by concurrent and/or adjuvant chemotherapy. Results: Of the 80 patients who entered this study, 68 completed the treatment course; 45 (66.2%) males and 23 (33.8%) females with a mean age at diagnosis of $49.0{\pm}12.9$ (21-75) years. At a median follow up of 19 months, 39 (57.3%) patients had evidence of tumor progression and 36 (52.9%) had died. The median over all survival for all patients was 16 months and progression free survival for all patients was 6.02 months. All potential prognostic factors were analyzed to evaluate their effects on overall survival. Age ${\leq}50$ year, concurrent and adjuvant chemotherapy and extent of surgery had significant p values. We found lower progression rate among patients who received higher doses of radiotherapy (>60Gy). Higher radiation doses improved progression free survival (p=0.03). Despite increasing overall survival, this elevation was not significant. Conclusions: This study emphasize that higher radiation doses of (>60Gy) can improve local control and potentially survival, so we strongly advise prospective multi centric studies to evaluate the role of higher doses of radiotherapy on GBM patient outcome.

• Tuberculosis and Respiratory Diseases
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• 제44권4호
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• pp.776-784
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• 1997

서 론 : 비소세포폐암은 전체 폐암의 약 75%를 차지하고 있으며 조기 발견에 이은 외과적 절제가 유일한 완치방법으로 알려져 있다. 그러나 병기 III기에서는 정립된 치료방법이 없고 여러 종류 및 조합의 치료방법이 시도되고 있다. 이에 연구자들은 수술이 불가능한 병기 IIIA 및 악성흉수를 제외한 병기 IIIB의 과거 치료력이 없는 비소세포폐암 환자에서 cisplatin, etoposide 이용한 복합화학요법을 동시에 시행하여 그의 효과 및 순응성을 조사하였다. 대상 및 방법 : 1995년 10월부터 1996년 12월까지 원자력병원에 입원하여 조직학적으로 비소세포폐암으로 진단된 병기 III기의 환자중 수술이 불가능한 IIIA 및 IIIB의 환자를 대상으로 하였다. 복합화학요법은 cisplatin 30mg/$m^2$/D, etoposide 80mg/$m^2$/D를 방사선요법과 동시에 시작하여 3일간 투여후 4주 간격으로 총 3회 투여하였고, 방사선요법은 5940cGy까지 진행후 치료효과를 평가하였다. 결 과 : 총 대상환자 32명 중 조기종료한 3명을 제외한 29명에서 평가가 가능하였으며, 완전관해는 없었고 부분관해 22명(75.9%), 불변 5명(17.2%), 치료중 진행하였던 경우가 2명(6.9%)으로 전체관해율은 75.9%, 중앙 생존기간 12.1개월, 1년 생존률은 50.6%로 나타났다. 치료에 의한 주된 독성은 백혈구감소로 WHO기준으로 3등급이상이 13명(45%)에서 나타났고 혈소판감소는 3등급이상이 3명(11%)에서 나타났으나 모두 회복되었고, 그밖에 오심과 구토는 대부분의 환자에서 2등급이하이었으며 방사성폐렴은 13명(46%)에서 나타났다. 결 론 : 수술이 불가능한 병기 IIIA 및 악성흉수를 제외한 병기 IIIB기 비소세포폐암환자에서 EP 복합화학요법과 방사선요법을 동시 병행한 치료는 비교적 안전하면서 효과적이었으며, 이에 대한 평가는 방사선요법을 단독으로한 치료와의 3상 연구를 요할 것으로 사료된다.

• Radiation Oncology Journal
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• 제33권4호
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• pp.294-300
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• 2015

Purpose: To evaluate survival rates and prognostic factors related to treatment outcomes after bladder preserving therapy including transurethral resection of bladder tumor, radiotherapy (RT) with or without concurrent chemotherapy in bladder cancer with a curative intent. Materials and Methods: We retrospectively studied 50 bladder cancer patients treated with bladder-preserving therapy at Keimyung University Dongsan Medical Center from January 1999 to December 2010. Age ranged from 46 to 89 years (median, 71.5 years). Bladder cancer was the American Joint Committee on Cancer (AJCC) stage II, III, and IV in 9, 27, and 14 patients, respectively. Thirty patients were treated with concurrent chemoradiotherapy (CCRT) and 20 patients with RT alone. Nine patients received chemotherapy prior to CCRT or RT alone. Radiation was delivered with a four-field box technique (median, 63 Gy; range, 48.6 to 70.2 Gy). The follow-up periods ranged from 2 to 169 months (median, 34 months). Results: Thirty patients (60%) showed complete response and 13 (26%) a partial response. All patients could have their own bladder preserved. Five-year overall survival (OS) rate was 37.2%, and the 5-year disease-free survival (DFS) rate was 30.2%. In multivariate analysis, tumor grade and CCRT were statistically significant in OS. Conclusion: Tumor grade was a significant prognostic factor related to OS. CCRT is also considered to improve survival outcomes. Further multi-institutional studies are needed to elucidate the impact of RT in bladder cancer.

• Radiation Oncology Journal
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• 제13권1호
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• pp.55-61
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• 1995

Purpose : Despite a development of therapeutic machines and advance in modern radiation therapy techniques, locally advanced cervical carcinoma has shown high rate of local failure and poor survival rate, Combination of chemotherapy and radiotherapy demonstrated benefit in improving local control and possibly the overall survival. Our study was performed to evaluate effect of concurrent chemoradiation on locally advanced uterine cervical cancer. Methods and Materials : Twenty six patients with locally advanced stage(FIGO stage IIB with ${\geq}5cm$ in diameter, III, IVA) were treated with combination of radiation therapy and concurrent cisplatinum between May of 1988 and September of 1993 at our hospital. Radiation therapy consisted of external irradiaton and 1-2 sessions of intracavitary irradiation. Cisplatinum was administered in bolus injection of 25mg/$m^2$ at weekly intervals during the course of external radiation therapy. Results : Of the 26 Patients, twenty-five patients were evaluable for estimation of response. Median follow-up period was 25 months with ranges from 3 to 73 months. Stage IIB, III, and IVA were 16, 5, 4 patients, respectively, Twenty patients were squamous cell carcinoma. Response was noted in all 25 patients: complete response(CR) in 17/25($68\%$), Partial response(PR) in 8/25($32\%$). Of the 24 patients except one who died of sepsis at 3 months follow-up, seventeen patients($70.8\%$) maintained local control in the pelvis: 16/17($94.1\%$) in CR, 1/17($14.3\%$) in PR. Fourteen of the 17 patients with CR are alive disease free on the completion of follow-up. Median survival is 28 months for CR and 15 months for PR. Analysis of 5-year survival by stage shows 11/16($59.8\%$) in IIB, 3/5($60.0\%$) in III, and 1/4($25.0\%$) in IVA. Overall 5-year survival rate was $55.2\%$. Ten patients recurred: 4 at locoregional, 3 in distant metastasis and 3 with locoregional and distant site. Toxicity by addition of cisplatinum was not excessive. Conclusion : Although the result of this study was obtained from small number of patients, it is rather encouraging in view of markedly improved response rate compared with the results of historical group.

• Radiation Oncology Journal
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• 제34권1호
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• pp.59-63
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• 2016

Purpose: To evaluate the clinical outcomes of symptomatic bone lesions in patients with multiple myeloma (MM) who received local radiotherapy (LRT). Materials and Methods: Fifty-one patients with 87 symptomatic bone lesions treated via LRT were analyzed. LRT was delivered at a median total dose of 21 Gy (range, 12 to 40 Gy) in a median of 7 fractions (range, 4 to 20 fractions). The clinical outcomes of LRT and the factors affecting treatment response were assessed. Results: After a median follow-up time of 66.7 weeks, symptom relief was achieved for 85 of 87 lesions (97.7%). The median time to symptom relief was 7 days from the start of LRT (range, 1 to 67 days). The duration of in-field failure-free survival ranged from 1.1 to 450.9 weeks (median, 66.7 weeks). The radiation dose or use of previous and concurrent chemotherapy was not significantly associated with in-field failure for LRT (p = 0.354, 0.758, and 0.758, respectively). Conclusion: Symptomatic bone lesions in patients with MM can be successfully treated with LRT. A higher radiation dose or the use of concurrent chemotherapy may not influence the in-field disease control. A relatively low radiation dose could achieve remission of symptoms in patients with MM.