• Radiation Oncology Journal
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• 제33권2호
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• pp.109-116
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• 2015

Purpose: To analyze prognostic factors for locoregional recurrence (LRR), distant metastasis (DM), and overall survival (OS) in cervical cancer patients who underwent radical hysterectomy followed by postoperative radiotherapy (PORT) in a single institute. Materials and Methods: Clinicopathologic data of 135 patients with clinical stage IA2 to IIA2 cervical cancer treated with PORT from 2001 to 2012 were reviewed, retrospectively. Postoperative parametrial resection margin (PRM) and vaginal resection margin (VRM) were investigated separately. The median treatment dosage of external beam radiotherapy (EBRT) to the whole pelvis was 50.4 Gy in 1.8 Gy/fraction. High-dose-rate vaginal brachytherapy after EBRT was given to patients with positive or close VRMs. Concurrent platinum-based chemoradiotherapy (CCRT) was administered to 73 patients with positive resection margin, lymph node (LN) metastasis, or direct extension of parametrium. Kaplan-Meier method and log-rank test were used for analyzing LRR, DM, and OS; Cox regression was applied to analyze prognostic factors. Results: The 5-year disease-free survival was 79% and 5-year OS was 91%. In univariate analysis, positive or close PRM, LN metastasis, direct extension of parametrium, lymphovascular invasion, histology of adenocarcinoma, and chemotherapy were related with more DM and poor OS. In multivariate analysis, PRM and LN metastasis remained independent prognostic factors for OS. Conclusion: PORT after radical hysterectomy in uterine cervical cancer showed excellent OS in this study. Positive or close PRM after radical hysterectomy in uterine cervical cancer correlates with poor prognosis even with CCRT. Therefore, additional treatments to improve local control such as radiation boosting need to be considered.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.5075-5079
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• 2015

Background: Adverse effects of treatment prolongation beyond 8 weeks with radiotherapy for cervical cancer have been established. Clinical data also show that cisplatin increases the biologically effective dose of radiotherapy. However, there are no data on the effect of overall treatment time in patients with locally advanced cervical cancer treated with concomitant chemo-radiotherapy (CCRT) in an Indian population. The present study concerned the feasibility of concurrent chemotherapy and interspacing brachytherapy during the course of external radiotherapy to reduce the overall treatment time and compare the normal tissue toxicity and loco-regional control with a conventional schedule. Materials and Methods: Between January 2009 and March 2012 fifty patients registered in the Gynaecologic Oncology Clinic of Institute Rotary Cancer Hospital with locally advanced cervical cancer (FIGO stage IIB-IIIB) were enrolled. The patients were randomly allocated to treatment arms based on a computer generated random number. Arm I (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions, and weekly cisplatin $40mg/m^2$. High dose rate intra-cavitary brachytherapy (HDR-ICBT) was performed after one week of completion of external beam radiotherapy (EBRT). The prescribed dose for each session was 7Gy to point A for three insertions at one week intervals. Arm II (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions. Mention HDR-ICBT ICRT was performed after 40Gy and 7Gy was delivered to point A for three insertions (days 23, 30, 37) at one week intervals. Cisplatin $20mg/m^2/day$ was administered from D1-5 and D24-28. Overall treatment time was taken from first day of EBRT to last day of HDR brachytherapy. The overall loco-regional response rate (ORR) was determined at 3 and 6 months. Results: A total of 46 patients completed the planned treatment. The overall treatment times in arm I and arm II were $65{\pm}12$ and $48{\pm}4$ days, respectively (p=0.001). At three and six months of follow-up the ORR for arm I was 96% while that for arm II was 88%. No statistically significant difference was apparent between the two arms. The overall rate of grade ${\geq}3$ toxicity was numerically higher in arm I (n=7) than in arm II (n=4) though statistical significance was not reached. None of the predefined prognostic factors like age, performance status, baseline haemoglobin level, tumour size, lymph node involvement, stage or histopathological subtype showed any impact on outcome. Conclusions: In the setting of concurrent chemoradiotherapy a shorter treatment schedule of 48 days may be feasible by interspacing brachytherapy during external irradiation. The response rates and toxicities were comparable.

• 한국생물공학회:학술대회논문집
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• 한국생물공학회 2001년도 추계학술발표대회
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• pp.537-540
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• 2001

A parallel TBF system that is consisted of two TBFs was developed f ‘ or the long-term treatment of gas-phase trichloroethylene (TCE). Each TBF was operated for TCE degradation or reactivation in a parallel mode, and the effect of switching time and operation variables between the two reactors was investigated. Within 12 hr after switching from TCE degradation to reactivation mode, the MO activity increased up to the initial level. More than 50 % of TCE was degraded for feed concentrations ranging from 5 to 17 ppmv, and completely 100 % removed at concentration of less than 5 ppmv, while TCE removal decreased severely over 28 ppmv. In various empty bed retention times (EBRTs), ranging 상 om 5.2 to 10.7 min, the optimal EBRT was 10.7 min that TCE conversion achieved more than 50 %. For the inlet loading below 23.4 mg TCE/L/day, TCE was entirely removed. The maximal TCE elimination capacity in this system was about 66.63 mg TCE/L/day. During the continuous treatment of TCE over 3 months, TCE removal efficiency was maintained at the range of about 50 %. In these results, the parallel TBF system can be available for the continuously TCE biodegrading operation.

• 한국환경과학회지
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• 제17권1호
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• pp.7-17
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• 2008

Simultaneous removal of $NH_3,\;H_2S$ and toluene in a contaminated air stream was investigated over 185 days in a biofilter packed with Zeocarbon granule as microbial support. In this study, multi-microorganisms including Nitrosomonas and Nitrobacter for nitrogen removal, Thiobacillus thioparus (ATCC 23645) for $H_2S$ removal, and Pseudomonas aeruginosa (ATCC 15692), Pseudomonas putida (ATCC 17484) and Pseudomonas putida (ATCC 23973) for toluene removal were used simultaneously. The empty bed residence time (EBRT) was 40-120 seconds and the feed (inlet) concentrations of $NH_3,\;H_2S$ and toluene were 0.02-0.11, 0.05-0.23 and 0.15-0.21 ppmv, respectively. The observed removal efficiency was 85%-99% for $NH_3$, 100% for $H_2S$, and 20-90% for toluene, respectively. The maximum elimination capacities were 9.3, 20.6 and $17g/m^3/hr\;for\;NH_3,\;H_2S$ and toluene, respectively. The results of kinetic model analysis showed that there were no particular evidences of interactions or inhibitions among the microorganisms, and that the three bio degradation reactions took place independently within a finite area of biofilm developed on the surface of the Zeocarbon carrier.

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6251-6255
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• 2012

Radiation proctitis and radiation cystitis are major complications for patients with cervical carcinoma following radiotherapy. In the present study, we aimed to determine the potential risk factors for the development of radiation proctitis and radiation cystitis after irradiation. A total of 1,518 patients with cervical carcinoma received external beam radiotherapy (EBRT) followed by high-dose-rate intracavitary brachytherapy (HDRICB) in our hospital. The incidences of radiation proctitis and radiation cystitis were recorded and associations with different factors (age, time period, tumor stage) were analyzed with ${\chi}^2$ (chi-squared) and Fisher exact tests. We found that 161 and 94 patients with cervical carcinoma were diagnosed with radiation proctitis and radiation cystitis, respectively, following radiotherapy. The prevalence of Grade I-II radiation proctitis or radiation cystitis was significantly lower than that of Grade III (radiation proctitis: 3.82% vs. 6.76%, P < 0.05; radiation cystitis: 2.31% vs. 3.87%, P < 0.05) and was significantly enhanced in patients with late stage (IIIb) tumor progression compared to those in early stage (Ib, IIa) (P < 0.05). Moreover, the incidence of radiation proctitis and cystitis was not correlated with age or, time period following radiation, for each patient (P > 0.05). These observations indicate that a late stage of tumor progression is a potential risk factor for the incidence of radiation proctitis and cystitis in cervical carcinoma patients receiving radiotherapy.

• Radiation Oncology Journal
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• 제24권3호
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• pp.171-178
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• 2006

목 적: 자궁경부암 환자에 항암화학요법과 동시에 외부 방사선조사와 고선량률의 강내조사를 시행하여 국소제어율, 생존율 및 독성을 후향적으로 분석하여 그 효과와 안전성을 알아보기 위한 연구이다. 대상 및 방법: 2001년 1월부터 2002년 12월까지 자궁경부암으로 진단받고 완치목적의 방사선치료가 필요한 30명의 환자를 대상으로 항암화학요법과 방사선조사를 동시에 시행하였다. 환자 나이의 중앙값은 58세($34{\sim}74$세)였다. 병리조직학적 소견은 29명이 편평상피세포암이고 1명은 선암이었다. FIGO 병기에 따라 IB 7명(23%), IIA 3명(10%), IIB 12명(40%), IIIA 3명(10%), IIIB 5명(17%)이었다. 외부 방사선조사는 골반강에 1회 180 cGy로 총 선량 $45{\sim}50.4\;Gy$ (중앙값: 50.4 Gy)를 시행하였다. 강내조사는 외부 방사선조사 41.4 Gy 조사 후 Ir-192를 이용한 고선량률로 point A에 1회 4 Gy를 주 2회 시행하여 총 $4{\sim}8$회 조사하여 $16{\sim}32\;Gy$ (중앙값 28 Gy) 조사하였다. Point A에 외부조사와 강내조사의 합산 선량의 생물학적 동등선량(biological effective dose, BED)은 $77{\sim}94\;GY_{10}$ (중앙값 $88\;Gy_{10}$)이었다. ICRU 38에 따른 직장의 선량은 $88{\sim}125\;Gy_3$ (중앙값 $109\;Gy_3$), 방광의 선량은 $91{\sim}123\;Gy_3$ (중앙값 $111\;Gy_3$)이였다. 항암제는 cisplatin ($60\;mg/m^2$)과 5-FU ($1,000\;mg/m^2$)를 외부 방사선조사와 동시에 시작하여 3주 간격으로 정맥 주입하였으며 총 $2{\sim}6$회(중앙값 5회) 시행하였다. 방사선조사 완료 후 4주에 진찰소견과 복부-골반 전산화단층촬영을 시행하여 관해정도를 관찰하였다. 추적기간은 $8{\sim}50$개월(중앙값 36개월)이었으며 국소제어율, 3년 생존율, 직장과 방광의 급성 및 만성 합병증을 관찰하였다. 결 과: 방사선조사와 항암화학요법을 동시에 시행하여 완전관해는 30명 중 28명으로 완전관해율은 93%였다. 3년 국소제어율은 87%, 전체환자의 3년 생존율은 93%, 무병생존율은 87%였다. 4명(13%)에서 국소실패를 보였고 1명(3%)에서 원격전이를 보였다. 치료 중 급성 합병증으로 11명(37%)에서 RTOG grade 1-2의 장염을 보였으며 1명은 대장의 천공이 발생하여 수술로 치유되었다. 12명(40%)에서 RTOG grade 1-2의 급성 방광염을 보였다. 3명(10%)에서 RTOG grade 1-2의 백혈구 감소증이 보였으며 1명에서 심한 백혈구 감소증(RTOG grade 4)이 나타났으나 회복되어 치료를 완료하였다. 만성 합병증으로 5명(15%)에서 RTOG grade 1-2의 만성 장염을 보였으며 별다른 치료 없이 지내고 있으며 1명(3%)에서 RTOG grade 2의 만성 방광염을 보였다. 그러나 치료에 의해 사망한 환자는 없었다. 결 론: 자궁경부암 환자에 항암화학요법과 동시에 외부 방사선조사와 고선량률의 강내조사를 시행한 결과 독성이 심하지 않고 국소제어율과 단기 생존율이 양호하여 안전하고 효율적인 치료방법으로 생각된다. 그러나 장기 생존율과 만성 합병증을 파악하기 위해서는 더 많은 환자를 대상으로 장기 추적관찰이 요구된다.

• Radiation Oncology Journal
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• 제26권4호
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• pp.195-203
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• 2008

목 적: 절제 불가능한 식도암에서의 근치적 동시항암화학방사선치료의 치료 성적과 재발 양상에 대해 알아보고자하였다. 대상 및 방법: 1994년 2월부터 2002년 12월까지 서울아산병원에서 절제불가능한 국소진행된 식도암으로 진단 받거나 내과적으로 수술이 불가능한 식도암으로 진단 받은 후 근치적 목적의 동시항암화학방사선치료를 시행 받은 168명을 대상으로 하였다. 방사선치료는 원발병소와 종격동, 그리고 원발병소와 림프절 전이의 위치에 따라 쇄골상부림프절과 복강림프절을 포함하여 $42{\sim}46\;Gy$의 외부방사선을 조사하였고, 이후 원발병소와 림프절 전이 부위에는 $54{\sim}66\;Gy$까지 추가 조사하였다. 분할조사 방법은 분할조사선량 $1.8{\sim}2\;Gy$씩 1일 1회 조사하거나, 1.2 Gy씩 1일 2회 조사하였다. 고선량률관내 방사선치료를 실시하는 경우에는 Ir-192를 이용한 고선량률 방식으로 3 Gy씩 $3{\sim}4$회 시행하였다. 항암치료는 5-FU와 cisplatin을 이용하여 동시항암화학방사선치료(5-FU $1,00\;mg/m^2$/day, days $2{\sim}6$, $30{\sim}34$, cispiatin $60\;mg/m^2$/day, days 1, 29)를 2주기 시행하고 방사선치료 후에 2 주기를 추가하여 시행하였다. 결 과: 분석 가능한 환자는 160명 이었으며, 추적관찰 기간은 1개월에서 149개월(중앙값 10개월)이었다. 환자의 AJCC 병기는 I, II, III, IV 기가 각각 5명(3.1%), 38명(23.8%), 68명(42.5%), 49명(30.6%)이었다. 26명(16.3%)의 환자에서는 $9{\sim}12\;Gy$의 추가 관내방사선치료를 시행하였다. 관내방사선치료를 포함하여 총 40 Gy 이상 조사받은 144명의 환자에서 외부 방사선조사량의 범위는 $44.4{\sim}66\;Gy$ (중앙값 59.4)이었고, 총 방사선 조사량의 범위는 $44.4{\sim}72\;Gy$ (중앙값 60)이었다. 분석가능한 160명의 환자 중에서 101명(63.1%)에서 재발하였으며, 재발 양상으로는 국소 재발이 20명(12.5%), 지속적 병변 또는 국소 진행이 61명(38.1%), 원격전이가 15명(9.4%), 국소재발과 원격전이가 함께 있는 경우가 5명(3.)%)이었다. 전체환자의 중앙생존기간은 11.1개월이었고, 2년 및 5년 전체생존율은 각각 31.8%, 14.2%이었다. 중앙무병 생존기간은 10.4개월이었고, 2년 및 5년 무병생존율은 각각 29.0%, 22.7%이었다. 항암화학방사선치료 후에 종양 반응 및 림프절 병기만이 전체생존율에 유의하게 영향을 미치는 예후인자였다. 방사선 조사량(${\geq}50$ Gy vs. < 50 Gy), 관내 방사선치료의 추가 유무, 분할조사(1회/day vs. 2회/day)에 따른 전체 생존율 및 무병생존율에 유의한 차이는 관찰되지 않았다. 결 론: 식도암에서 근치적 동시 항암화학방사선치료의 성적은 다른 연구 결과와 유사한 결과를 보였다. 동시 항암화학 방사선치료 후의 주된 재발 양상은 국소 재발이었다. 방사선 조사량의 증가(${\geq}50\;Gy$), 고선량률관내방사선치료 및 과분할조사법의 시행은 치료 성적을 향상시키지 못하였다.

• 한국환경과학회지
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• 제15권6호
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• pp.513-525
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• 2006

In recent decades, biofiltration has been widely accepted for the treatment of contaminated air stream containing low concentration of odorous compounds or volatile organic compounds (VOCs). In this study, conventional biofilters packed with flexible synthetic polyurethane (PU) foam carriers were operated to remove toluene from a contaminated air stream. PU foams containing various amounts of pulverized activated carbon (PAC) were synthesized for the biofilter media and tested for toluene removal. Four biofilter columns were operated for 60 days to remove gaseous toluene from a contaminated air stream. During the biofiltration experiment, inlet toluene concentration was in the range of 0-150 ppm and EBRT (i.e., empty bed residence time) was kept at 26-42 seconds. Pressure drop of the biofilter bed was less than 3 mm $H_2O/m$ filter bed. The maximum removal capacity of toluene in the biofilters packed with PU-PAC foam was in the order of column II (PAC=7.08%) > column III (PAC=8.97%) > column I (PAC=4.95%) > column IV (PAC=13.52%), while the complete removal capacity was in the order of column II > column I > column III > column IV. The better biofiltration performance in column II was attributed to higher porosity providing favorable conditions for microbial growth. The results of biodegradation kinetic analysis showed that PU-PAC foam with 7.08% of PAC content had higher maximum removal rate ($V_m$=14.99 g toluene/kg dry material/day) than the other PU-PAC foams. In overall, the performance of biofiltration might be affected by the structure and physicochemical properties of PU foam induced by PAC content.

• Environmental Engineering Research
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• 제13권1호
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• pp.19-27
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• 2008

Simultaneous removal of ternary gases of $NH_3$, $H_2S$ and toluene in a contaminated air stream was investigated over 180 days in a biofilter. A commercially available inorganic/polymeric composite chip with a large void volume (bed porosity > 0.80) was used as a microbial support. Multiple microorganisms including Nitrosomonas and Nitrobactor for nitrogen removal, Thiobacillus thioparus (ATCC 23645) for $H_2S$ removal and Pseudomonas aeruginosa (ATCC 15692), Pseudomonas putida (ATCC 17484) and Pseudomonas putida (ATCC 23973) for toluene removal were used simultaneously. The empty bed residence time (EBRT) ranged from 60 - 120 seconds and the inlet feed concentration was $0.0325\;g/m^3-0.0651\;g/m^3$ for $NH_3$, $0.0636\;g/m^3-0.141\;g/m^3$ for $H_2S$, and $0.0918\;g/m^3-0.383\;g/m^3$ for toluene, respectively. The observed removal efficiency was 2% - 98% for $NH_3$, 2% - 100% for $H^2S$, and 2% - 80% for toluene, respectively. Maximum elimination capacity was about $2.7\;g/m^3$/hr for $NH_3$, > $6.4\;g/m^3$/hr for $H_2S$ and $4.0\;g/m^3$/hr for toluene, respectively. The inorganic/polymeric composite carrier required 40 - 80 days of wetting time for biofilm formation due to the hydrophobic nature of the carrier. Once the surface of the carrier was completely wetted, the microbial activity became stable. During the long-term operation, pressure drop was negligible because the void volume of the carrier was two times higher than the conventional packing materials.

• 대한환경공학회지
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• 제27권6호
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• pp.573-580
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• 2005

본 연구에서는 제올라이트/폴리에틸렌 복합 담체를 충진한 biotrickling filter에서 톨루엔 제거특성을 살펴보았다. 본 연구에 사용된 메디아의 물리적 특성을 살펴본 결과 비표면적과 공극율이 각각 $500\;m^2/m^3$, 82%로 나타났으며, 특히 미생물 부착과 생물막 형성에 영향을 주는 표면거칠기는 첨가된 제올라이트에 의해 담체표면이 상당히 거칠어짐을 확인할 수 있었다. 본 담체를 충진한 biotrickling filter 장치에서 톨루엔의 제거효율은 유입농도와 처리유량이 증가할수록 감소하였으며, 톨루엔의 최대 제거용량은 $64\;g/m^3{\cdot}hr$를 보였다. 또한 200일 동안의 연속실험결과, 미생물 순응이 완료된 뒤부터 167일까지 $90{\sim}98%$의 제거효율을 보였으며, 이후 과잉 미생물의 중식으로 인한 압력손실의 증가로 시간에 따라 제거효율은 감소하는 경향을 보였다. 역세척 후 압력강하와 톨루엔 제거능은 신속히 회복되어 정상상태를 유지하였다.