• Radiation Oncology Journal
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• 제17권3호
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• pp.261-267
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• 1999

목적 : Multiple arc FSRT (fractionated stereotactic radiotherapy)와 conformal FSRT의 치료계획에 있어서 종양의 모양과 DVH (dose volume histogram)를 비교하여 두 기법간의 유용성에 대하여 논하고자 한다. 대상 및 방법 : 16명의 뇌종양 환자들을 대상으로 1997년 8월부터 1998년 12월까지 충남대학교병원 치료방사선과에서 112회의 FSRT를 실시하였다. 치료 전 모의치료에서 얻은 AP(Anterior-posterior), Lateral 필름상의 금속표지자의 좌표값을 ISOLOC프로그램에 입력하여 얻은 기준점과의 오차를 확인한 후 치료계획을 하였다. 치료계획은 종양용적과 종양표면적를 계산한 후 if (Irregular factor)를 고려하여 multiple arc FSRT 혹은 conformal FSRT를 선택하였다. Multiple arc FSRT는 종양의 IF값이 1-1.2인 경우에 고려하였고, conformal FSRT는 IF값이 1.3 이상인 경우에 고려한 후 종양용적에 대하여 처방선량 이상의 선량에 대한 DVH곡선에 의한 면적이 최소이면서 처방선량 이하의 선량에 대한 DVH곡선에 의한 면적이 최대가 되도록 하는 치료계획을 선택하여 평가하였다. 결과 : 치료전 모의치료에서 시행한 금속표지자의 좌표값을 ISOLOC프로그램에 입력하여 얻은 기준점과의 오차는 1 mm 이내였다. Huitlple arc FSRT는 누적DVH상에서 처방선량의 90, 91, 92, $93\%$에서 전체 종양용적을 포함하고 있었으며 평균값은 $90.6\%$이었고, conformal FSRT 는 누적DVH상에서 처방선량의 81, 85, 86, 87, $91\%$에서 전체 종양용적을 포함하고 있었으며 평균값은 $8\%$이었다. 두 방식 모두 결정장기들에는 최대선량의 $5\%$이하의 적은 선량이 조사되었다. 결론 : Multiple arc FSRT와 conformal FSRT를 IF를 기준으로 치료 계획하여 구형의 종양에 multiple arc FSRT를 시행하였으며, 불규칙한 모양의 종양에는 conformal FSRT를 시행하여 종양의 모양에 관계없이 적절한 FSRT치료계획을 수립할 수 있었다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.446-449
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• 2002

The video based electronic portal imaging device (EPID), which could display the portal image in near real time, was implemented to verify treatment position error in FSRT(Fractionated Stereotatic Radiation Therapy) instead of a portal film. Also, Developed FSRT system was composed of the stereotactic frame, frame mounting system and collimator cones. The verification of treatment position is very crucial in special therapies like FSRT. In general, the FSRT uses high dpse rate at small field size for treating small intracranial lesions. To evaluate quantitative positioning errors in FSRT, we used the first FSRT image as reference image and obtained the second FSRT image that was moved 2mm intentionally and detected intracranial contours after image processing. The generated 2mm error could be verified by overlapping only contours of two images. Through this study, the radiation treatment efficiency could be improved by performing precise radiation therapy with a developed video based EPID and FSRT.

• Asian Pacific Journal of Cancer Prevention
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• 제16권13호
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• pp.5279-5284
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• 2015

Background: The study analyzed the long term clinical outcomes of pituitary adenoma cases treated with the first Thailand installation of a dedicated Linac-based stereotactic radiation machine (X-Knife). Materials and Methods: A retrospective review of 115 consecutive pituitary adenoma patients treated with X-Knife at the Faculty of Medicine, Ramathibodi Hospital, Bangkok, Thailand from 1997 to 2003 was performed. Stereotactic radiosurgery (SRS) was selected for 21 patients (18%) including those with small tumors (${\leq}3cm$) located ${\geq}5mm$. from the optic apparatus, whereas the remaining 94 patients (82%) were treated with fractionated stereotactic radiotherapy (FSRT). Results: With a median follow-up time of 62 months (range, 21-179), the six-year progression free survival was 95% (93% for SRS and 95% for FSRT). The overall hormone normalization at 3 and 5 years was 20% and 30%, respectively, with average time required for normalization of approximately 16 months for SRS and 20 months for FSRT. The incidence of new hypopituitarism was 10% in the SRS group and 9% in the FSRT group. Four patients (5%) developed optic neuropathy (1 in the SRS group and 3 in the FSRT group). Conclusions: Linac-based SRS and FSRT achieved similar high local control rates with few complications in pituitary adenoma cases. However, further well designed, randomized comparative studies between SRS versus FSRT particularly focusing on hormone normalization rates are required.

• Journal of Korean Neurosurgical Society
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• 제40권3호
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• pp.154-158
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• 2006

Objective : We treated 10 pediatric diffuse intrinsic brain stem glioma[BSG] patients with Novalis system [linac based radiotherapy unit, Germany] and examined the efficacy of the Fractionated Stereotactic Radiotherapy[FSRT]. Methods : A retrospective review was conducted on 10 pediatric diffuse intrinsic BSG patients who were treated with FSRT between May, 2001 and August, 2004. The mean age of the patient group was 7.7 years old. Male to female ratio was 4 to 1. The mean dose of FSRT was 38.7Gy, mean fractionated dose was 2.6Gy, mean fractionation size was 16.6, and target volume was $42.78cm^3$. The mean follow up period was 14 months. Results : Four weeks after completion of FSRT, improvements on neurological status and Karnofsky performance scale[KPS] score were recorded in 9/10 (90%] patients and magnetic resonance imaging[MRI] showed decrease in target tumor volume in 8 pediatric patients. The median survival period was 13.5 months after FSRT and treatment toxicity was mild. Conclusion : It is difficult for surgeons to choose surgical treatment for diffuse intrinsic BSG due to its dangerous anatomical structures. FSRT made it possible to control the tumor volume to improve neurological symptoms with minimal complications. We expect that FSRT is a feasible treatment modality for pediatric diffuse intrinsic BSG with tolerable toxicities.

• 한국의학물리학회지:의학물리
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• 제14권1호
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• pp.28-33
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• 2003

본 연구는 무고정틀정위방사선치료의 다중호형 기법과 입체조형기법간의 회전중심점의 오차를 알아보고자 하였다. 1997년부터 2000년 12월까지 무고정틀정위방사선치료를 받은 47명의 환자를 대상으로 하였다. 다양한 종양형태와 크기를 고려하여 다중호형 또는 입체조형정위방사선치료를 선택하였다. 각 치료기법에 따른 회전중심점의 오차를 계산하였다. 다중호형과 입체조형정위방사선치료의 공간적 편차값($\Delta$r)은 각각 0.41 mm와 0.54 mm이었다. 다중호형정위방사선치료에서의 회전중심점의 정확도는 x, y, z 방향에서 각각 0.2 mm (SD 0.2 mm), 0.2 mm (SD 0.2), 0.3 mm (SD 0.2 mm)이었고, 입체조형정위방사선치료에서는 각각 0.2 mm (SD 0.2 mm), 0.3 mm (0.2 mm), 0.4 mm (SD 0.2 mm)이었다. 무고정틀 정위방사선치료를 이용한 회전중심점의 오차는 다중호형기법과 입체조형기법간에 차이가 없었다.

• Journal of Korean Neurosurgical Society
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• 제40권2호
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• pp.110-113
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• 2006

Surgery and radiotherapy are mainly used for plasma cell neoplasm which constitutes about $1{\sim}2%$ of human malignancy. The authors carried out Fractionated Stereotactic Radiotherapy[FSRT] on the residual tumor after the subtotal removal of Intracranial plasmacytoma. A huge mass lesion was observed on MRI [magnetic resonance image] in the left anterior and middle cranial fossa of a 63-year-old man with left exophthalmus which lasted for a month, and was suspected as a meningioma with strong contrast enhancement. Extramedullary plasmacytoma was diagnosed on histopathological examination. After the surgery, FSRT was also carried out on the residual tumor which invaded the skull base. One-year follow up after FSRT showed contrast enhancement only in the left sphenoid bone on MRI, which indicated significant decrease in the size of the tumor without any abnormal neurologic deficits. We treated intracranial plasmacytoma which invaded left anterior and middle cranial fossa and surrounded cavernous sinus without cranial nerve deficit through subtotal tumor removal and FSRT.

• 대한방사선치료학회지
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• 제9권1호
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• pp.25-28
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• 1997

With the advances in radiation therapy technology and equipment, the need for more accurate and safer radiation delivery to the target region has been continuously growing. Stereotactic Radiosurgery(SRS) is a good example of $^{\ast}Accuracy^{\ast}$ but has a substantial risk of causing severe late neurological damages. Fractionated Stereotactic Radiation Therapy(FSRT) is a modification of SRS enabling conventional fractionation with maintaining accuracy using noninvasive and relocatable frame. Verification of mechanical accuracy in FSRT has been done according to the manufacture's recommendations using RLPP, LTLF, and Depth-helmet. In order to reinforce this, we have developed additional novel verification procedure using Linac-grams with the Angiolocalizer attached on the GTC frame, which are then digitized into the planning software(X-Knife) to generate the three dimensional coordinates for cmoparison. This method has been successful in such ways that the anatomical landmarks are identifiable on the Linac-gram films and that the serial comparisons of the stereotactic coordinates of the isocenter are possible with more certainty a along the FSRT course than before.

• 전자공학회논문지SC
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• 제46권3호
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• pp.44-51
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• 2009

고 에너지 방사선을 이용하여 종양을 치료하는 과정 중 발생하는 오차를 확인하여 보다 정교한 치료를 시행하는 것은 매우 중요하다. 특히, 두경부 종양을 치료하기 위해 작은 조사면에 방사선을 집중 조사하는 정위 방사선 분할치료와 같은 특수 치료에서는 치료위치의 확인을 더욱 요구하고 있다. 작은 조사면에 고선량의 방사선을 표적체적에 집중 조사하는 정위 방사선 분할 치료법에서 치료 중심점의 정확도 검증은 매우 중요하므로 표적에 3mm 납 볼을 놓고 정위 방사선 분할 치료용 25mm 콘을 장착한 후 얻은 전자 포탈 영상으로부터 콘 원의 중심점과 볼 원의 중심점을 영상처리를 통해 서로 비교해 본 결과 1픽셀(0.76mm)의 정확도까지 얻을 수 있었다. 정위 방사선 분할 치료에 전자 포탈 영상 장치를 적용하여 치료위치오차 여부를 검증하였다. 이를 위해 첫 번째 정위 방사선 분할 치료 영상과 임의로 2mm 이동시킨 후 얻은 영상의 두개골 외곽선을 검출한 후 서로 비교해 본 결과 발생된 2mm 오차를 검증할 수 있었다. 본 논문에서는 개발된 비디오 기반 전자포탈영상장치와 정위 방사선 분할치료장치를 이용하여 실시간적으로 포탈영상을 획득할 수 있었으며 치료위치 검증을 통해 보다 정교한 방사선 치료를 할 수 있으리라 본다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 1999년도 Japanese Journal of Medical Physics
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• pp.90-90
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• 1999

• Asian Pacific Journal of Cancer Prevention
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• 제15권8호
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• pp.3561-3566
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• 2014

Background: Recurrent nasopharyngeal carcinoma (NPC) after previous radiotherapy is challenging. There is no standard approach for salvage treatment. Here we present toxicity and treatment results for recurrent NFC patients who underwent fractionated stereotactic radiotherapy (FSRT) as second line radiotherapy (RT). Materials and Methods: Between April 2009 and July 2012, 24 patients, with a male to female ratio of 3:1, were treated with CykerKnife$^{(R)}$ FSRT for recurrent NFC in our institution. Seven out of 24 patients had metastatic recurrent disease. Median age was 53 years (range, 20-70 years). Initial RT dose was 70Gy. The time period between initial RT and FSRT was a median of 33.2 months. The median prescription dose for FSRT was 30Gy (range, 24-30 Gy) in a median of 5 fractions (range, 4-6). Results: The median follow-up for all patients was 19.5 months (IQR: 12.2.-29.2 months). The locoregional control; progression free survival and overall survival (OS) rates for 1-, 2- and 3-year were 64%, 38%, 21%; 60%, 30%, 17% and 83%, 43%, 31%, respectively. Median OS for the entire cohort was 22 months (95% CI: 16.5-27.5). On multivariate analysis recurrent tumor stage was the only prognostic factor for OS (p=0.004). One patient exhibited grade III temporal lobe necrosis. One died because of grade IV mucositis and overlapping infection. Conclusions: The treatment of recurrent NPC is controversial. Fractionated stereotactic radiotherapy is promising. However, the published trials are heterogeneous with respect to the selection criteria and treatment details. Prospective studies with long term follow-up data are warranted.