• Journal of Korean Neurosurgical Society
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• v.29 no.10
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• pp.1383-1388
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• 2000

We report a case of 54 years old male with malignant meningioma originating in the posterior fossa with multiple recurrences, intracranial and extracranial metastases. In spite of gross total removal of tumor and conventional external radiation therapy(CERT), 2 more recurrences, 5 more intracranial metastases and 1 extracranial metastasis to the rib were developed. We tried fractionated stereotactic radiation therapy(FSRT) and CERT to the intracranial metastasis with satisfactory result. Extracranial metastasis to the rib was resected and histological finding was similar to that of original tumor.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.265-275
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• 2015

Despite the increasing use of stereotactic body radiation therapy (SBRT) and stereotactic radiation surgery (SRS) in recent years, the biological base of these high-dose hypo-fractionated radiotherapy modalities has been elusive. Given that most human tumors contain radioresistant hypoxic tumor cells, the radiobiological principles for the conventional multiple-fractionated radiotherapy cannot account for the high efficacy of SBRT and SRS. Recent emerging evidence strongly indicates that SBRT and SRS not only directly kill tumor cells, but also destroy the tumor vascular beds, thereby deteriorating intratumor microenvironment leading to indirect tumor cell death. Furthermore, indications are that the massive release of tumor antigens from the tumor cells directly and indirectly killed by SBRT and SRS stimulate anti-tumor immunity, thereby suppressing recurrence and metastatic tumor growth. The reoxygenation, repair, repopulation, and redistribution, which are important components in the response of tumors to conventional fractionated radiotherapy, play relatively little role in SBRT and SRS. The linear-quadratic model, which accounts for only direct cell death has been suggested to overestimate the cell death by high dose per fraction irradiation. However, the model may in some clinical cases incidentally do not overestimate total cell death because high-dose irradiation causes additional cell death through indirect mechanisms. For the improvement of the efficacy of SBRT and SRS, further investigation is warranted to gain detailed insights into the mechanisms underlying the SBRT and SRS.

• The Journal of Korean Society for Radiation Therapy
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• v.9 no.1
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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.

• 대한두경부종양학회:학술대회논문집
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• 1995.11a
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• pp.208.3-209
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• 1995

• 대한두경부종양학회:학술대회논문집
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• 1996.11a
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• pp.250.2-251
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• 1996

• Radiation Oncology Journal
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• v.16 no.2
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• pp.185-194
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• 1998

Purpose : With the development of stereotactic immobilization systems capable of reliable serial repositioning, fractionated stereotactic radiation therapy (FSRT) offers the Potential for an improved treatment outcome by excellent dose delivery, and dose distribution characteristics with the favorable radiobiological properties of fractionated irradiation. We describe our initial experience using FSRT for the treatment of intracranial benign tumor. Materials and Methods : Between August 1995 and December 1996. 15 patients(7 males and 8 females aged 6-70 years) were treated with FSRT. The patients had the following diagnosis pituitary adenoma(10) including one patient who previously had received radiotherapy, craniopharyngioma (2), acoustic neurinoma (1), meningioma (2). Using the Gill-Thomas-Cosman relocatable head frame and multiple non-coplanar therapy, the daily dose of 2Gy was irradiated at 90% to 100% isodose surface of the isocenter The collimator sizes ranged from 26mm to 70mm. Results : In all patients except one follow-up lost, disease was well-controlled. Acute complication was negligible and no patient experienced cranial nerve neuropathies and radiation necrosis. In overall patient setup with scalp measurements, reproducibility was found to have mean of $1.1{\pm}0.6mm$ from the baseline reading. Conclusion : Relocatable stereotactic system for FSRT is highly reproducible and comfortable. Although the follow-up period was relatively short. FSRT is considered to be a safe and effective radiation technique as the treatment of intracranial tumor. But the fractionation schedule(fraction size, overall treatment time and total dose) still remains to be solved by further clinical trials.

• Radiation Oncology Journal
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• v.15 no.1
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• pp.19-26
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• 1997

Purpose : This study is to report experience with Fractionated Stereotactic Radiation Therapy (FSRT) for locally recurrent nasopharynx cancer after curative conventional radiation therapy. Materials and Methods : Three Patients with locally recurrent and symptomatic nasopharynx cancer were given FSRT as reirradiation method between the Period of September of 1995 and August of 1996 For two Patients, application of FSRT is their third radiation therapy directed to the nasopharynx. Two patients were given low dose chemotherapy as radiation sensitizer concurrently with FSRT Authors used 3-dimensional coordinate system by individually made, relocatable Gill-Thomas-Cosman (GTC) stereotactic frame and multiple non-coplanar arc therapy dose Planning was done using Xknife-3. Total of 45 Gy/18 fractions or 50 Gy/20 fractions were given. Results : Authors observed satisfactory symptomatic improvement and remarkable objective tumor size decrease by follow-up MR images taken 1 month Post-FSRT in ali three patients, while no neurologic side effect attributable to reirradiation was noticed. Two died at 7 and 9 months with loco-regional and distant seeding outside FSRT field, while one patient is living for 4 month. Conclusion Authors experienced satisfactory therapeutic effectiveness and safety of FSRT as reirradiatlon method for locally recurrent nasopharynx cancer Development of more effective systemic chemotherapeutic regimen is desired for distant metastasis

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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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.

• Korean Journal of Head & Neck Oncology
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• v.14 no.2
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• pp.156-163
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• 1998

Background & Objectives: Frameless fractionated stereotactic radiotherapy(FFSRT) is a modification of stereotactic radiosurgery(SRS) with radiobiologic advantage of fractionation without losing mechanical accuracy of SRS. Local recurrence of head and neck cancer at or near skull base benefit from reirradiation. Main barrier to successful palliation is dose limitation secondary to normal tissue tolerance. We try to evaluate the efficacy and safety of FFSRT as a new modality of reirradaton in these challenging patients. Materials & Methods: Seven patients with recurrent head & neck cancer involving at or near skull base received FFSRT from September 1995 to November 1997. Six patients with nasopharyngeal cancer had received induction chemotherapy and curative radiation therapy. One patient with maxillary sinus cancer had received total maxillectomy and postoperative radiation therapy as a initial treatment. Follow-up ranged from 11 to 32 months with median of 24 months. Three of 7 patients received hyperfractionated radiation therapy(1.1-1.2Gy/fraction, bid, total 19.8-24Gy) just before FFSRT. All patients received FFSRT(3-5Gy/fraction, total 15-30Gy/5-10fractions). Chemotherapy(cis-platin $100mg/m^2$) were given concurrently with FFSRT in four patients. Second course of FFSRT were given in 4 patients with progression or recurrence after initial FFSRT. Because IF(irregularity factor; ratio of surface area of target to the surface area of sphere with same volume as a target) is too big to use conventional stereotactic RT using multiple arc method for protection of radiation damage to critical normal tissue, all patients received FFSRT with conformal method using irregular static ports. Results: Five of 7 patients showed complete remission in follow-up CT &/or MRI. Three of these five patients who developed marginal, in-field, and out-field recurrences, respectively. Another one of complete responders has been dead of G-I bleeding without evidence of local recurrence. One partial responder who showed progressive disease 15 months after initial FFSRT has received additional FFSRT, and then he is well-being with symptomatic improvement. One minmal responder who showed progression of locoregional disease 9 months after $1^{st}$ FFSRT has received 2nd FFSRT, and then he is alive with stable disease. Five of 7 case had showed direct invasion to skull base and had complaint headache and various symptoms of cranial nerve involvement. Four of these five case showed improvement of neurologic symptoms after FFSRT. No significant neurologic complicaltion related to FFSRT was observed during follow-up periods. Tumor volumes were ranged from 3.9 to 50.7 cc and surface area ranged from 16.1 to $114.9cm^2$. IF ranged from 1.21 to 1.74. The average ratio of volume of prescription isodose shell to target volume was 1.02 that indicated the improvement of target coverage and dose distribution with FFSRT with conformal method compared to target coverage with FFSRT with multiple arc method. Conclusion: Our initial experience suggests that FFSRT with conformal method was relatively effective and safe modality in the treatment of recurrent head and neck cancer involving at or near skull base. Treatment benefit included good palliation of symptoms and reasonable radiographic response. However, more experience and additional follow-up are needed to better assess its ultimate role in treating these challenging patients.

• Progress in Medical Physics
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• v.31 no.3
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• pp.63-70
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• 2020

Stereotactic radiosurgery is one of the most sophisticated forms of modern advanced radiation therapy. Unlike conventional fractionated radiotherapy, stereotactic radiosurgery uses a high dose of radiation with steep gradient precisely delivered to target lesions. Lars Leksell presented the principle of radiosurgery in 1951. Gamma Knife^® (GK) is the first radiosurgery device used in clinics, and the first patient was treated in the winter of 1967. The first GK unit had 179 cobalt 60 sources distributed on a hemispherical surface. A patient could move only in a single direction. Treatment planning was performed manually and took more than a day. The latest model, Gamma Knife^® Icon^TM, shares the same principle but has many new dazzling characteristics. In this article, first, a brief history of radiosurgery was described. Then, the physical properties of modern radiosurgery machines and physicists' endeavors to assure the quality of radiosurgery were described. Intrinsic characteristics of modern radiosurgery devices such as small fields, steep dose distribution producing sharp penumbra, and multi-directionality of the beam were reviewed together with the techniques to assess the accuracy of these devices. The reference conditions and principles of GK dosimetry given in the most recent international standard protocol, International Atomic Energy Agency TRS 483, were shortly reviewed, and several points needing careful revisions were highlighted. Understanding the principles and physics of radiosurgery will be helpful for modern medical physicists.