• 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.

• Radiation Oncology Journal
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• 제30권3호
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• pp.146-151
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• 2012

Purpose: This treatment planning study was undertaken to evaluate the impact of beam angle configuration of intensity-modulated radiotherapy (IMRT) on the dose of the normal liver in hepatocellular carcinoma (HCC). Materials and Methods: The computed tomography datasets of 25 patients treated with IMRT for HCC were selected. Two IMRT plans using five beams were made in each patient; beams with equidistance of $72^{\circ}$ (Plan I), and beams with a $30^{\circ}$ angle of separation entering the body near the tumor (Plan II). Both plans were generated using the same constraints in each patient. Conformity index (CI), homogeneity index (HI), gamma index, mean dose of the normal liver (Dmean_NL), Dmean_NL difference between the two plans, and percentage normal liver volumes receiving at least 10, 20, and 30 Gy (V10, V20, and V30) were evaluated and compared. Results: Dmean_NL, V10, and V20 were significantly better for Plan II. The Dmean_NL was significantly lower for peripheral (p = 0.001) and central tumors (p = 0.034). Dmean_NL differences between the two plans increased in proportion to gross tumor volume to normal liver volume ratios (p = 0.002). CI, HI, and gamma indices were not significantly different for the two plans. Conclusion: The IMRT plan based on beams with narrow separations reduced the irradiated dose of the normal liver, which would allow radiation dose escalation for HCC.

• Radiation Oncology Journal
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• 제36권4호
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• pp.276-284
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• 2018

Purpose: Traditionally, three-dimensional conformal radiation therapy (3D-CRT) is used for neoadjuvant chemoradiation in locally advanced rectal cancer. Intensity-modulated radiation therapy (IMRT) was later developed for more conformal dose distribution, with the potential for reduced toxicity across many disease sites. We sought to use the National Cancer Database (NCDB) to examine trends and predictors for IMRT use in rectal cancer. Materials and Methods: We queried the NCDB from 2004 to 2015 for patients with rectal adenocarcinoma treated with neoadjuvant concurrent chemoradiation to standard doses followed by surgical resection. Odds ratios were used to determine predictors of IMRT use. Univariable and multivariable Cox regressions were used to determine potential predictors of overall survival (OS). Propensity matching was used to account for any indication bias. Results: Among 21,490 eligible patients, 3,131 were treated with IMRT. IMRT use increased from 1% in 2004 to 22% in 2014. Predictors for IMRT use included increased N stage, higher comorbidity score, more recent year, treatment at an academic facility, increased income, and higher educational level. On propensity-adjusted, multivariable analysis, male gender, increased distance to facility, higher comorbidity score, IMRT technique, government insurance, African-American race, and non-metro location were predictive of worse OS. Of note, the complete response rate at time of surgery was 28% with non-IMRT and 21% with IMRT. Conclusion: IMRT use has steadily increased in the treatment of rectal cancer, but still remains only a fraction of overall treatment technique, more often reserved for higher disease burden.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.74-82
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• 2002

In Intensity Modulated Radiotherapy (IMRT), radiation is delivered in a multiple of Multileaf Collimator (MLC) subfields. A subfield with a small leaf-to-leaf opening is highly sensitive to a leaf-positional error. We introduce a method of identifying and rejecting IMRT plans that are highly sensitive to a systematic MLC gap error (sensitivity to possible random leaf-positional errors is not addressed here). There are two sources of a systematic MLC gap error: Centerline Mechanical Offset (CMO) and, in the case of a rounded end MLC, Radiation Field Offset (RFO). In IMRT planning system, using an incorrect value of RFO introduces a systematic error ΔRFO that results in all leaf-to-leaf gaps that are either too large or too small by (2ㆍΔRFO), whereas assuming that CMO is zero introduces systematic error ΔCMO that results in all gaps that are too large by ΔCMO = CMO. We introduce a concept of the Average Leaf Pair Opening (ALPO) that can be calculated from a dynamic MLC delivery file. We derive an analytic formula for a fractional average fluence error resulting from a systematic gap error of Δ$\chi$ and show that it is inversely proportional to ALPO; explicitly it is equal to, (equation omitted) in which $\varepsilon$ is generally of the order of 1 mm and Δx=2ㆍΔRFO+CMO. This analytic relationship is verified with independent numerical calculations.

• Asian Pacific Journal of Cancer Prevention
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• 제17권12호
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• pp.5107-5111
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• 2016

Background: Epidemiological studies have indicated an increasing incidence of radiation induced secondary cancer (SC) in breast cancer patients after radiotherapy (RT), most commonly in the contra-lateral breast (CLB). The present study was conducted to estimate the SC risk in the CLB following 3D conformal radiotherapy techniques (3DCRT) including wedge field and forward intensity modulated radiotherapy (fIMRT) based on the organ equivalent dose (OED). Material and Methods: RT plans treating the chest wall with conformal wedge field and fIMRT plans were created for 30 breast cancer patients. The risks of radiation induced cancer were estimated for the CLB using dose-response models: a linear model, a linear-plateau model and a bell-shaped model with full dose response accounting for fractionated RT on the basis of OED. Results: The plans were found to be ranked quite differently according to the choice of model; calculations based on a linear dose response model fIMRT predict statistically significant lower risk compared to the enhanced dynamic wedge (EDW) technique (p-0.0089) and a non-significant difference between fIMRT and physical wedge (PW) techniques (p-0.054). The widely used plateau dose response model based estimation showed significantly lower SC risk associated with fIMRT technique compared to both wedge field techniques (fIMRT vs EDW p-0.013, fIMRT vs PW p-0.04). The full dose response model showed a non-significant difference between all three techniques in the view of second CLB cancer. Finally the bell shaped model predicted interestingly that PW is associated with significantly higher risk compared to both fIMRT and EDW techniques (fIMRT vs PW p-0.0003, EDW vs PW p-0.0032). Conclusion: In conclusion, the SC risk estimations of the CLB revealed that there is a clear relation between risk associated with wedge field and fIMRT technique depending on the choice of model selected for risk comparison.

• Radiation Oncology Journal
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• 제37권4호
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• pp.249-253
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• 2019

Purpose: We aimed to analyze the trend in intensity-modulated radiation therapy (IMRT) use in Korea from 2011 to 2018. Materials and Methods: We collected data from the Health and Insurance Review and Assessment Service (HIRA) big data based on the National Health Insurance Service claims and reimbursements records using primary treatment planning codes (HD 041) for IMRT from 2011 to 2018. We analyzed the changing patterns in clinical application to specific tumor sites and regional differences in IMRT utilization. Results: The use of IMRT has exhibited an 18-fold steep rise from 1,921 patients in 2011 to 34,759 in 2018. With regard to IMRT in 2018, 70% of patients (24,248/34,759) were treated in metropolitan areas (Seoul, Incheon, and Gyeonggi Province). IMRT was most commonly used to treat breast, lung, and prostate cancers in 2018. Among these, the use of IMRT for breast cancer shows the most remarkable increase from 2016 when the National Health Insurance began to cover IMRT for all solid tumors. Conclusion: The use of IMRT is steadily increasing to treat cancer and is concentrated in metropolitan areas.

• Radiation Oncology Journal
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• 제27권3호
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• pp.120-125
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• 2009

목 적: 편도암 환자를 대상으로 시행한 세기조절방사선치료의 예비적 임상결과를 보고하고자 하였다. 대상 및 방법: 2002년 11월부터 2007년 2월까지 서울아산병원에서 세기조절방사선치료를 시행 받은 12명의 편도암 환자를 대상으로 후향적 분석을 시행하였다. 수술 후 방사선치료는 5명, 근치적방사선치료는 7명에서 시행되었고, 이중 6명의 환자가 cisplatin을 기본으로 하는 항암화학요법과 병용으로 치료를 받았다. 세기조절방사선치료는 9명의 환자에서 동시차등조사가속치료(simultaneous modulated accelerated radiation therapy)가 이용되었다. 근치적치료의 경우 일회선량 2.4 Gy 씩 총 72 Gy, 그리고 수술 후 치료의 경우 일회선량 2.2 Gy 씩 총 61.6 Gy의 방사선량이 조사되도록 하였다. 전체 환자의 추적 관찰 기간은 24~80개월(중앙값 34개월)이었다. 결 과: 전체 대상 환자 12명 모두 치료 중단 없이 계획된 치료를 수행 받았다. 방사선치료 종료 후 11명의 환자에서 완전반응을 보였고 한 명의 환자에서 잔존림프절종양이 발견되어 구제 경부곽청술을 시행하였으나 3개월 후 국소림프절종양이 재발하였다. 완전 반응을 보인 11명의 환자는 마지막 추적 관찰 시점까지 국소림프절 재발 및 원격전이는 관찰되지 않았다. 치료 기간 중 급성 합병증은 Radiation Therapy Oncology Group 3도 이상의 구강 점막염, 인두염과 구강건조증이 각각 3명, 3명, 6명에서 관찰되었다. 결 론: 세기조절방사선치료는 편도암의 치료에 있어서 초기 종양반응과 국소제어면에서 임상적으로 적용 가능한 치료법임을 확인 할 수 있었다. 향후 궁극적인 종양반응과 만성 합병증을 알기 위해서는 추가적인 연구대상과 추적 관찰이 필요하겠다.

• Nuclear Engineering and Technology
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• 제54권10호
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• pp.3816-3823
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• 2022

This work analyzed the dosimetric difference between the intensity modulated radiotherapy (IMRT), partial/single/double-arc volumetric modulated arc therapy (PA/SA/DA-VMAT) techniques in treatment planning for treating more than one target of lung cancer at different isocenters. IMRT and VMAT plans at different isocenters were created systematically using a Harold heterogeneous lung phantom. The conformity index (CI), homogeneity index (HI), gradient index (GI), dose-volume histogram and mean and maximum dose of the PTV were calculated and analyzed. Furthermore, the dose-volume histogram and mean and maximum doses of the OARs such as right lung, contralateral lung and non GTV were determined from the plans. The IMRT plans showed the superior target dose coverage, higher mean and maximum values than other VMAT techniques. PA-VMAT technique shows more lung sparing and DA-VMAT increases the V_5/10/20 values of contralateral lung than other VMAT and IMRT techniques. The IMRT technique achieves highly conformal dose distribution to the target than other VMAT techniques. Comparing to the IMRT plans, the higher V_5/10/20 and mean lung dose were observed in the contralateral lung in the DA-VMAT.

• Asian Pacific Journal of Cancer Prevention
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• 제13권3호
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• pp.803-807
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• 2012

For patients with neck and upper thoracic esophageal carcinoma, it is difficult to control lymph node metastases with conventional dose therapy. In this study, we assessed the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy for 44 patients and boosted high-dose to metastatic lymph nodes. Three radiation treatment volumes were defined: PGTVnd, with which 68.1Gy was delivered in high dose group (hsIMRT group), and 60Gy in the conventional dose group (csIMRT group); PTV1, featuring 63.9Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54Gy given to both groups. The sIMRT plan included 5 equi-angular coplanar beams. All patients received the cisplatin and 5-FU regimen concurrently with radiotherapy. The treatment was completed within six weeks and one case with grade three acute bronchitis was observed in hsIMRT group. For esophageal lesions, 80% complete response (CR) and 20% partial response (PR) rates were found in the hsIMRT group, and 79.2% CR, with 20.8% PR, in the csIMRT group; for lymph node lesions, 75% CR and 25% PR rates were observed in the hsIMRT group, with 45.8% and 37.5% respectively in the csIMRT group (P<0.05). The differences in 1-, 2- and 3-year relapse-free survival rates were all statistically significant (P<0.05). The major toxicity observed in both groups was Grade I~II leucopenia. sIMRT can generate a desirable dose distribution in treatment of neck and upper thoracic esophageal carcinoma with a better short-term efficacy. Boosted high dosing to metastatic lymph nodes can increase the relapse-free survival rate.

• Radiation Oncology Journal
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• 제36권3호
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• pp.200-209
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• 2018

Purpose: To evaluate the effectiveness and feasibility of chemoradiotherapy (CRT) using simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in locally advanced pancreatic cancer (LAPC) patients. Materials and Methods: Between January 2011 and May 2015, 47 LAPC patients received CRT using SIB-IMRT. Prior to SIB-IMRT, 37 patients (78.7%) received induction chemotherapy (IC-CRT group) and remaining 10 patients (21.3%) did not received induction chemotherapy (CRT group). During SIB-IMRT, all patients received concomitant chemotherapy, with gemcitabine (n = 37) and capecitabine (n = 10). Results: At the time of analysis, 45 patients had died and 2 patients remained alive and the median follow-up time was 14.2 months (range, 3.3 to 51.4 months). For all patients, the median times of local progression-free survival (LPFS), progression-free survival (PFS), and overall survival (OS) were 18.1, 10.3, and 14.2 months, respectively. The median time of LPFS between IC-CRT and CRT groups was similar (18.1 months vs. 18.3 months, p = 0.711). IC-CRT group had a higher trend in PFS (10.9 months vs. 4.1 months, p = 0.054) and had significantly higher OS (15.4 months vs. 9.5 months, p = 0.007) than CRT group. In multivariate analysis, the use of induction chemotherapy and tumor response were significant factors associated with OS (p < 0.05, each). During SIB-IMRT, toxicity of grade ≥3 was observed in 7 patients (14.9%) in all patients. Conclusions: CRT using SIB-IMRT is feasible and promising in LAPC patients.