• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.36 no.6
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• pp.473-480
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• 2010

Introduction: Tooth requiring extraction before radiotherapy in head and neck cancer patients should be performed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it is not uncommon for the radiotherapist and cancer patient to feel an urgent need to proceed with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy were considered and applied based on a literature review Materials and Methods: The clinical study involved 120 head and neck cancer patients who were treated at Wonju Christian Hospital, Wonju College of Medicine, Yonsei University, from January 1995 to December 2004. Results: In the clinical study, there were no specific complications, such as, post-extraction wound infections, radiation osteitis and osteoradionecrosis over the recent 10 years despite the early radiotherapy. Conclusion: Based on the clinical study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for early radiotherapy in head and neck cancer patients.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.37 no.3
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• pp.169-175
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• 2011

Background: Teeth requiring extraction before radiotherapy in head & neck cancer patients should be removed as long as possible before the initiation of radiation therapy. Conventionally, a minimum 2-week waiting primary healing period is recommended. Although the above 2-week period is ideal, it was not uncommon for the radiotherapist and cancer patient to feel an urgent need to process with radiotherapy despite the need for dental care. Therefore, alternative approaches for early radiotherapy, including conservative endodontic treatment and a 1-week waiting primary healing period after dental extraction at the time of radiotherapy, were considered and applied based on the experimental study Materials and Methods: Eighteen dogs were processed for histopathologic wound healing. The effect of the primary endodontic treatment and extraction before early radiotherapy was examined. Results: No specific complication, such as, post-extraction wound infection, radiation osteitis and osteoradionecrosis, were encountered despite the early radiotherapy. Conclusion: Based on the experimental study, a minimum 1-week waiting primary healing period for oral care before radiotherapy is suitable for the early radiotherapy in head and neck cancer patients.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.37
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• pp.7.1-7.7
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• 2015

Background: Osteoradionecrosis is a delayed complication from radiation therapy which causes chronic pain, infection and constant deformity after necrosis. Most of the osteoradionecrosis occurs spontaneously or after the primary oncologic surgery, dental extraction or by trauma of prosthesis. The treatment of osteoradionecrosis relies on both conservative measures and surgical measures. The fibular osteocutaneous free flap has become more popular choice for reconstruction of maxillofacial defects as a treatment of osteoradionecrosis. Methods: We presented our experiences from 7 patients with osteoradionecrosis who have had reconstruction surgery with fibular osteocutaneous free flap at National Cancer Center during the recent 5 years. We performed segmental mandibular resection with fibular osteocutaneous free flap for all 7 patients of advanced osteoradionecrosis who were not controlled by conservative treatment such as wound irrigation, debridement, and antibiotics. Results: A wide range of techniques were available for the reconstruction of composite defects resulted from the treatment of advanced mandibular osteoradionecrosis. Significant improvement was noted in relieving pain and treating trismus after the surgery however difficulty in swallowing and xerostomia showed less improvement. Conclusions: We concluded that fibular osteocutaneous free flap can be performed safely in patients with osteoradionecrosis and yields positive outcomes with significantly increased success rate. The fibular osteocutaneous free flap was our preferred choice for the mandibular reconstruction due to its versatility and predictability.

• Radiation Oncology Journal
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• v.27 no.3
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• pp.153-162
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• 2009

Purpose: To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. Materials and Methods: One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10~16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13~179 months, with a median of 92.5 months. Results: The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy ($\leq$6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). Conclusion: Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.11
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• pp.4727-4732
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• 2014

Background: Breast cancers are becoming more frequently diagnosed at early stages with improved long term outcomes. Late normal tissue complications induced by radiotherapy must be avoided with new breast radiotherapy techniques being developed. The aim of the study was to compare dosimetric parameters of planning target volume (PTV) and organs at risk between conformal (CRT) and intensity-modulated radiation therapy (IMRT) after breast-conserving surgery. Materials and Methods: A total of 20 patients with early stage left breast cancer received adjuvant radiotherapy after conservative surgery, 10 by 3D-CRT and 10 by IMRT, with a dose of 50 Gy in 25 sessions. Plans were compared according to dose-volume histogram analyses in terms of PTV homogeneity and conformity indices as well as organs at risk dose and volume parameters. Results: The HI and CI of PTV showed no difference between 3D-CRT and IMRT, V95 gave 9.8% coverage for 3D-CRT versus 99% for IMRT, V107 volumes were recorded 11% and 1.3%, respectively. Tangential beam IMRT increased volume of ipsilateral lung V5 average of 90%, ipsilateral V20 lung volume was 13%, 19% with IMRT and 3D-CRT respectively. Patients treated with IMRT, heart volume encompassed by 60% isodose (30 Gy) reduced by average 42% (4% versus 7% with 3D-CRT), mean heart dose by average 35% (495cGy versus 1400 cGy with 3D-CRT). In IMRT minimal heart dose average is 356 cGy versus 90cGy in 3D-CRT. Conclusions: IMRT reduces irradiated volumes of heart and ipsilateral lung in high-dose areas but increases irradiated volumes in low-dose areas in breast cancer patients treated on the left side.

• Radiation Oncology Journal
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• v.13 no.2
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• pp.163-171
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• 1995

Purpose: Primary radiation therapy following breast-conserving surgery has been an accepted alternative to mastectomy during the past 2 decades. In this country, however, the practice of conservative therapy for early invasive breast cancer has not been generalized yet. The purpose of this report was to evaluate the results and complications of breast conservation therapy in Korean Cancer Center Hospital(KCCH). Materials and Methods: From January 1987 to December 1989. 45 Patients with early breast cancer treated with conservative treatment in KCCH were studied retrospectively Median follow up was 54 months(range, 4 to 82 months) . All patients received partial mastectomy (biopsy, tumorectomy. or quadrantectomy) and radiation therapy. Twenty eight patients received axillary dissection The breast was treated with two opposing tangential fields (total 50 Gy or 50.4 Gy in 5 weeks with daily target dose of 2 Gy or 1.8 Gy) Thirty patients received chemotherapy before and after radio-therapy Eleven patients received hormonal therapy. Results: Five-year survival rate, 5-rear disease free survival rate and 5-year local control rate were 87.2%, 86.5% and 97.6%,$ respectively. Administration of systemic Therapy (chemotherapy or hormonal therapy) correlated with good prognosis but statistically not significant (0.05 < p < 0.1). The severe late complication rate was 8.9% Conclusion: Primary radiation therapy following breast-conserving surgery for early breast cancer is an alternative treatment comparing to radical treatment. Long term follow-up and more patients collection is needed to evaluate the Prognostic factor and cosmetic outcome.

• Radiation Oncology Journal
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• v.19 no.1
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• pp.27-33
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• 2001

Purpose : To evaluate interim results in terms of failure, cosmetic results and survival after breast conserving operation and radiation therapy in early breast cancer. Material and Methods : From January 1992 through December 1997, seventy two patients with early stage 0, I and II breast cancer were treated with conservative surgery plus radiotherapy at Keimyung University Dongsan Medical Center. Age distribution was 25 to 77 years old with median age of 43. According to TNM stage, five patients had stage 0, thirty three were stage I, twenty five were IIa, and nine were IIb. Most patients underwent excision of all gross tumor and ipsilateral axillary dissection. Breast was irradiated through medial and lateral tangential fields of 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks. We delivered a boost irradiation dose of 10 to 16 Gy in 1 to 2 weeks to excision site. Adjuvant chemotherapy was administered in forty one patients with CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens of 6 cycles concurrently or before radiation. Cosmetic results were assessed by questionnaire to patients grading of excellent, good, fair, poor. Follow-up periods were 22 to 91 months with median 40 months. Results : Five year disease free survival rate (5YDFS) was $95.8\%$. According to stage, 5YDFS was $100\%,\;96.9\%,\;96\%\;and\;88.9\%$ in stage 0, I, IIa and IIb, respectively. Two patients had distant metastasis and one had local and distant failure. One patient with distant failure had bone and liver metastasis at 14 months after treatment and the other had lung and both supraclavicular metastasis at 21 months after treatment. Patient with local and distant failure had local recurrence on other quadrant in same breast and then salvaged with total mastectomy and chemotherapy but she died due to brain metastasis at 55 months. Complications were radiation pneumonitis in five patients (four patients of asymptomatic, one patients of symptomatic) and hand or arm edema(4 patients). Fifty nine patients answered our cosmetic result questionnaire and cosmetic results were good to excellent in fifty one patients $(86\%)$. Conclusion : We considered that conservative surgery and radiation for the treatment of early stage invasive breast cancer was safe and had excellent survival and cosmetic results. We need to assess about prognostic factors with longer follow up and with large number of patients.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.3
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• pp.1357-1362
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• 2014

Background: Vitamin D deficiency is a potentially modifiable risk factor that may be targeted for breast cancer (BC) prevention. It may also be related to prognosis after diagnosis and treatment. The aim of our study was to determine the prevalence of vitamin D deficiency as measured by serum 25-hydroxy vitamin D (25-OHD) levels in patients with BC and to evaluate its correlations with life-style and treatments. Materials and Methods: This study included 186 patients with stage 0-III BC treated in our breast center between 2010-2013. The correlation between serum baseline 25-OHD levels and supplement usage, age, menopausal status, diabetes mellitus, usage of bisphosphonates, body-mass index (BMI), season, dressing style, administration of systemic treatments and radiotherapy were investigated. The distribution of serum 25-OHD levels was categorized as deficient (<10ng/ml), insufficient (10-24 ng/ml), and sufficient (25-80 ng/ml). Results: The median age of the patients was 51 years (range: 27-79 years) and 70% of them had deficient/insufficient 25-OHD levels. On univariate analysis, vitamin D deficiency/insufficiency was more common in patients with none or low dose vitamin D supplementation at the baseline, high BMI (${\geq}25$), no bisphosphonate usage, and a conservative dressing style. On multivariate analysis, none or low dose vitamin D supplementation, and decreased sun-exposure due to a conservative dressing style were found as independent factors increasing risk of vitamin D deficiency/insufficiency 28.7 (p=0.002) and 13.4 (p=0.003) fold, respectively. Conclusions: The prevalence of serum 25-OHD deficiency/insufficiency is high in our BC survivors. Vitamin D status should be routinely evaluated for all women, especially those with a conservative dressing style, as part of regular preventive care, and they should take supplemental vitamin D.

• The Journal of the Korean bone and joint tumor society
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• v.11 no.2
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• pp.213-218
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• 2005

Dedifferentiated chondrosarcoma is a most highly malignant variant of chondrosarcoma and approximately 10% of chondrosarcomas dedifferentiated into more anaplastic lesions. In addition to the surgical treatment, adjuvant chemotherapy or radiation therapy has been used but with little success. Thus, the primary treatment remains wide excision and chemotherapy or radiation therapy can be used for palliation. This article shows the case of a dediffderentiated chondrosarcoma occuring in proximal femur after conservative surgical treatment of a low grade chondrosarcoma.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1001-1007
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• 2000

Objective : We analysed diverse clinical features of the cavernous angioma. Also, we report the experience in differ-ent methods of the management and their results. Method : Data from 80 patients who were confirmed pathologically or diagnosed radiologically between Jan. 1990 and Sept. 1998 at our hospital were analysed. Variable factors that were examined were : clinical features, effects of treatment, and complications. Results : There were 47 male and 33 female patients. The age at the first presentation was from 3 to 57(mean 34.1) years old. Clinical features were seizure in 28 cases(38%), bleeding in 24 cases(32%), neurologic deficits in 12 cases(16%), headache in 10 cases(14%), and six incidental cases. The locations of lesion were cerebral and cerebellar hemisphere in 45 cases(56.2%), brainstem, basal ganglia, and thalamus in 32 cases(40%), multiple in 3 cases (3.8%). Seizure was common at the third decade and occurred frequently with the cavernous angioma in temporal (43%) or frontal lobe(39%). Bleeding was frequent after the third decade with peak at the fourth decade and had high incidence in brainstem or thalamus. The gamma-knife radiosurgery was done in 47 cases. Rebleeding occurred in 3 cases, but it was within postradiosurgery 1 year. Symptomatic radiation change occurred in 2 cases of 8 radiation change on MRI. On follow-up MRI, no evidence of rebleeding was found in 30 cases. Also, The lesion size was decreased in 3 cases. Resection was performed in 23 cases ; total 20, subtotal 2, partial 1. Postoperative complication occurred in 6 cases(26.1%). After surgery, 7(63.6%) of 11 seizure patients had outcome of seizure-free. Subclinical rebleeding occurred in one of two subtotal resected cases. In 11 patients, conservative management was done. There was neither rebleeding nor symptom aggravation during follow-up period of mean 17.2 months. Conclusion : The solution for prevention of rebleeding is complete removal of the lesion located at noneloquent area or accessible region, especially for the patients who presented symptoms or intractable seizure. However, the Gamma knife radiosurgery is considered when the lesions are located at eloquent area or when severe postoperative morbidity is expected.