• Molecules and Cells
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• 제38권8호
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• pp.669-676
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• 2015

Genome instability, primarily caused by faulty DNA repair mechanisms, drives tumorigenesis. Therapeutic interventions that exploit deregulated DNA repair in cancer have made considerable progress by targeting tumor-specific alterations of DNA repair factors, which either induces synthetic lethality or augments the efficacy of conventional chemotherapy and radiotherapy. The study of Fanconianemia (FA), a rare inherited blood disorder and cancer predisposition syndrome, has been instrumental in understanding the extent to which DNA repair defects contribute to tumorigenesis. The FA pathway functions to resolve blocked replication forks in response to DNA interstrand cross-links (ICLs), and accumulating knowledge of its activation by the ubiquitin-mediated signaling pathway has provided promising therapeutic opportunities for cancer treatment. Here, we discuss recent advances in our understanding of FA pathway regulation and its potential application for designing tailored therapeutics that take advantage of deregulated DNA ICL repair in cancer.

• Archives of Plastic Surgery
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• 제46권3호
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• pp.272-276
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• 2019

Hidradenitis suppurativa (HS) is a chronic inflammatory follicular occlusive disease that involves the intertriginous areas. Treatment methods include conventional topical and systemic medication, radiotherapy, biologic agents, and surgical excision. Of late, there has been an increased focus on the use of biologic agents in patients with moderate to severe HS. Here, we present the case of a 46-year-old man with Hurley stage III HS for whom wide excision was ultimately curative, after aggressive medical therapy with the use of infliximab and adalimumab had succeeded in limiting the body surface area affected by the disease. This case demonstrates the effective treatment of severe HS with a combination of biologic therapy and surgery.

• Radiation Oncology Journal
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• 제20권1호
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• pp.68-72
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• 2002

최근 들어 새로운 방사선치료법인 강도변조방사선치료가 많은 종류의 종양치료에 적용되어 치료에 따른 부작용을 줄이고 치료율을 향상시키려는 노력들이 이루어지고 있다. 특히 전립선암에서 강도변조방사선치료법을 적용하여 삼차원입체조형치료에 비해 향상된 선량분포와 이로 인한 주위 정상조직의 방사선량을 줄임으로써 더욱 많은 양의 방사선을 전립선에 투여할 수 있고 이로 인하여 치료율의 상승을 기대할 수 있게 되었다. 저자들은 강도변조방사선치료를 전립선암에 적용하였기에 이에 대한 문헌고찰과 함께 치료과정을 보고하고자 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1675-1682
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• 2012

Aim: The study aim was to determine the frequency with which women decline clinicians' treatment recommendations and variations in this frequency by age, cancer and service descriptors. Design: The study included 36,775 women diagnosed with early invasive breast cancer in 1998-2005 and attending Australian and New Zealand breast surgeons. Rate ratios for declining treatment were examined by descriptor, using bilateral and multiple logistic regression analyses. Proportional hazards regression was used in exploratory analyses of associations with breast cancer death. Results: 3.4% of women declined a recommended treatment of some type, ranging from 2.6% for women under 40 years to 5.8% for those aged 80 years or more, and with parallel increases by age presenting for declining radiotherapy (p<0.001) and axillary surgery (p=0.006). Multiple regression confirmed that common predictors of declining various treatments included low surgeon case load, treatment outside major city centres, and older age. Histological features suggesting a favourable prognosis were often predictive of declining various treatments, although reverse findings also applied with women with positive nodal status being more likely to decline a mastectomy and those with larger tumours more likely to decline chemotherapy. While survival analyses lacked statistical power due to small numbers, higher risks of breast cancer death were suggested, after adjusting for age and conventional clinical risk factors, (1) for women not receiving breast surgery for unstated reasons (RR=2.29; p<0.001); and (2) although not approaching statistical significance $p{\geq}0.200$), for women declining radiotherapy (RR=1.22), a systemic therapy (RR1.11), and more specifically, chemotherapy (RR=1.41). Conclusions: Women have the right to choose their treatments but reasons for declining recommendations require further study to ensure that choices are well informed and clinical outcomes are optimized.

• Radiation Oncology Journal
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• 제34권3호
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• pp.202-208
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• 2016

Purpose: Our institution has implemented two different adjuvant protocols in treating patients with non-small cell lung cancer (NSCLC): chemotherapy followed by concurrent chemoradiotherapy (CT-CCRT) and sequential postoperative radiotherapy (PORT) followed by postoperative chemotherapy (POCT). We aimed to compare the clinical outcomes between the two adjuvant protocols. Materials and Methods: From March 1997 to October 2012, 68 patients were treated with CT-CCRT (n = 25) and sequential PORT followed by POCT (RT-CT; n = 43). The CT-CCRT protocol consisted of 2 cycles of cisplatin-based POCT followed by PORT concurrently with 2 cycles of POCT. The RT-CT protocol consisted of PORT followed by 4 cycles of cisplatin-based POCT. PORT was administered using conventional fractionation with a dose of 50.4-60 Gy. We compared the outcomes between the two adjuvant protocols and analyzed the clinical factors affecting survivals. Results: Median follow-up time was 43.9 months (range, 3.2 to 74.0 months), and the 5-year overall survival (OS), locoregional recurrence-free survival (LRFS), and distant metastasis-free survival (DMFS) were 53.9%, 68.2%, and 51.0%, respectively. There were no significant differences in OS (p = 0.074), LRFS (p = 0.094), and DMFS (p = 0.490) between the two protocols. In multivariable analyses, adjuvant protocol remained as a significant prognostic factor for LRFS, favouring CT-CCRT (hazard ratio [HR] = 3.506, p = 0.046) over RT-CT, not for OS (HR = 0.647, p = 0.229). Conclusion: CT-CCRT protocol increased LRFS more than RT-CT protocol in patients with completely resected NSCLC, but not in OS. Further studies are warranted to evaluate the benefit of CCRT strategy compared with sequential strategy.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2005년도 제30회 춘계학술대회
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• pp.71-74
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• 2005

To introduce the four-dimensional computed tomography (4DCT, Light Speed RT, General Electric, USA) scanner newly installed in our department and evaluate its feasibility for gated radiotherapy. Respiratory signal measured by real-time position management (RPM$^{\circledR}$, Varian Medical, USA) was recorded in synchronization with the 4DCT scanner. 4DCT data were acquired in axial cine mode and sorted retrospective image based on respiratory phase. PTVs delineated from helical CT and 4DCT images were compared. The PTV delineated from conventional helical CT images was 2 cc larger than that from 4DCT images. Dose in PTV of the plan from retrospective CT was 99.3% (minimum=72.0%, maximum=106.5%) and that of helical CT plan was 95.2% (minimum=24.1%, maximum=106.4%) of prescribed dose. Comparing with DVHs of both plan, the coverage for 4CDT plan was 3.7% improved. It is expected that 4DCT could improve tumor control and reduce radiation toxicity for liver cancer.

• Nuclear Engineering and Technology
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• 제50권6호
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• pp.937-943
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• 2018

Background: This work presents the performance of a novel electronic brachytherapy (EBT) device and radiotherapy (RT) experiments on both skin cancer cells and animals using the device. Methods and materials: The performance of the EBT device was evaluated by measuring and analyzing the dosimetric characteristics of X-rays generated from the device. The apoptosis of skin cancer cells was analyzed using B16F10 melanoma cancer cells. Animal experiments were performed using C57BL/6 mice. Results: The X-ray characteristics of the EBT device satisfied the accepted tolerance level for RT. The results of the RT experiments on the skin cancer cells show that a significant apoptosis induction occurred after irradiation with 50 kVp X-rays generated from the EBT device. Furthermore, the results of the animal RT experiments demonstrate that the superficial X-rays significantly delay the tumor growth and that the tumor growth delay induced by irradiation with low-energy X-rays was almost the same as that induced by irradiation with a high-energy electron beam. Conclusions: The developed new EBT device has almost the same therapeutic effect on the skin cancer with a conventional linear accelerator. Consequently, the EBT device can be practically used for human skin cancer treatment in the near future.

• Archives of Plastic Surgery
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• 제51권1호
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• pp.52-61
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• 2024

Background Although prepectoral implant-based breast reconstruction has recently gained popularity, dual-plane reconstruction is still a better option for patients with poor-quality mastectomy skin flaps. However, shoulder morbidity is aggravated by subpectoral reconstruction, especially in irradiated patients. This study aimed to demonstrate shoulder exercise improvement in subpectoral reconstruction by delayed prepectoral conversion with an acellular dermal matrix (ADM) inlay graft technique at the time of expander-to-implant exchange after irradiation. Methods Patients with breast cancer treated for expander-to-implant exchange after subpectoral expander insertion and subsequent radiotherapy between January 2021 and June 2022 were enrolled. An ADM inlay graft was inserted between the pectoralis major muscle and the previously inserted ADM. The ADM was sutured partially overlapping the pectoralis muscle from the medial side with the transition part, to the muscle border at the lateral side. Perioperative shoulder joint active range-of-motion (ROM) for forward flexion, abduction, and external rotation was also evaluated. Results A total of 35 patients were enrolled in the study. Active shoulder ROM significantly improved from 163 degrees preoperatively to 176 degrees postoperatively in forward flexion, 153 to 175 degrees in abduction, and 69 to 84 degrees in external rotation. There was no difference in patient satisfaction regarding the final outcome between the conventional prepectoral reconstruction group and the study group. Conclusion Shoulder exercises in irradiated patients who underwent subpectoral reconstruction were improved by delayed prepectoral conversion using an ADM inlay graft. It is recommended that subpectoral reconstruction not be ruled out due to concerns regarding muscle contracture and shoulder morbidity in radiation-planned patients with poor mastectomy skin flaps.

• 한국의학물리학회지:의학물리
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• 제34권4호
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• pp.48-54
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• 2023

Purpose: In this study, the dosimetric characteristics of lung stereotactic body radiotherapy (SBRT) plans using the new Halcyon system were analyzed to assess its suitability. Methods: We compared the key dosimetric parameters calculated for the Halcyon SBRT plans with those of a conventional C-arm linear accelerator (LINAC) equipped with a high-definition multileaf collimator (HD-MLC)-Trilogy Tx. A total of 10 patients with non-small-cell lung cancer were selected, and all SBRT plans were generated using the RapidArc technique. Results: Trilogy Tx exhibited significant superiority over Halcyon in terms of target dose coverage (conformity index, homogeneity index, D_{0.1 cc}, and D_95%) and dose spillage (gradient). Trilogy Tx was more efficient than Halcyon in the lung SBRT beam delivery process in terms of the total number of monitor units, modulation factor, and beam-on time. However, it was feasible to achieve a dose distribution that met SBRT plan requirements using Halcyon, with no significant differences in satisfying organs at risk dose constraints between both plans. Conclusions: Results confirm that Halcyon is a viable alternative for performing lung SBRT in the absence of a LINAC equipped with HD-MLC. However, extra consideration should be taken in determining whether to use Halcyon when the planning target volume setting is enormous, as in the case of significant tumor motions.

• 한국의학물리학회지:의학물리
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• 제23권4호
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• pp.219-228
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• 2012

기존의 쐐기(wedge) 필터를 사용하는 접선조사(tangential irradiation) 방식의 일반적인 유방암 방사선치료와 동일한 접선 조사야(filed)를 사용하면서 쐐기 필터를 삽입하는 대신 다엽콜리메터의 움직임을 통해 치료부위의 선량분포를 균일하게 형성토록 하는 접선 세기조절 방사선치료(tangential breast Intensity modulated radiotherapy, T-B IMRT)가 유방암치료에 적용되고 있다. 본 연구에서는 T-B IMRT치료계획에서 계산된 선량분포를 기존의 쐐기 필터를 사용한 일반적인 접선조사 방식의 치료계획과 비교하여 치료표적 및 중요장기에서의 선량분포 측면에서 T-B IMRT의 타당성을 살펴보고, 실제 T-B IMRT치료 빔 조사 시 선량 측정 및 치료계획 결과와의 오차 분석을 통해 선량 분포의 정확도를 확인하고자 하였다. 기존의 쐐기필터를 이용한 접선조사 방식으로 치료한 유방암 환자 15명을 대상으로 T-B IMRT치료계획을 세운 후, 계산된 선량분포를 비교, 분석하였다. T-B IMRT치료계획에서 치료표적 부피 내 선량분포의 균일도가 기존의 쐐기를 사용한 접선조사 방식보다 향상된 결과를 보였으며, 주변의 정상조직과 중요장기의 선량을 상대적으로 줄일 수 있음을 확인할 수 있었다. T-B IMRT의 실제 치료조사 시 선량정확도를 분석하기 위해 적합한 팬텀을 사용하여 품질보증(QA) 치료계획을 수립하였다. 원기둥 형태의 아크릴에 이온전리함을 삽입한 형태의 팬텀을 사용하여 치료계획과 실제 치료 빔 조사를 통해 측정된 절대선량 값을 비교하였으며, 평균 오차는 $0.7{\pm}1.4%$로 분석되었다. 이차원 다이오드 검출기 배열장치를 이용한 선량분포의 정확도 분석에서는 치료계획 시 계산된 선량분포와 실제 측정된 선량분포의 gamma evaluation (3%, 3 mm 기준)를 통해 평균 $97.3{\pm}2.9%$의 합격률(pass rate)로 타당성 있는 정확도를 보여주었다. 본 연구를 통해 선량분포 측면에서 기존 쐐기필터를 이용한 접선 조사방식의 방사선치료 대비 T-B IMRT의 장점을 확인할 수 있었고, T-B IMRT에 적합하게 수립된 품질보증 과정을 통해 실제 조사되는 선량의 정확도를 확인할 수 있었다.