• Laboratory Medicine Online
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• v.6 no.1
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• pp.25-30
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• 2016

Background: The cell cycle-dependent enzyme thymidine kinase 1 (TK1) is known to increase during cancer cell proliferation and has been reported as a prognostic marker for various hematologic malignancies and solid tumors. This study aimed to determine the reference interval in Korean healthy controls and to evaluate the usefulness of TK1 as a biomarker for aggressive clinical behavior in B-cell lymphoma patients. Methods: We enrolled 72 previously untreated patients with B-cell lymphoma and 143 healthy controls. Serum TK1 levels were measured by chemiluminescence immunoassay ($Liaison^{(R)}$, DiaSorin, USA). We established the reference intervals in healthy controls. The diagnostic performance of serum TK1 was studied using receiver operating characteristic (ROC) analysis, and the correlation between the cutoff level for serum TK1 and clinical characteristics of B-cell lymphoma was evaluated. Results: The reference range (95th percentile) of serum TK1 in healthy controls was 5.4-21.8 U/L. There was a clear difference in TK1 levels between patients with B-cell lymphoma and healthy controls ($40.6{\pm}68.5$ vs. $11.8{\pm}4.4U/L$, P <0.001). The area under the curve of serum TK1 for the diagnosis of B-cell lymphoma was 0.73 (cutoff, 15.2 U/L; sensitivity, 59.7%; specificity, 83.2%). An increased TK1 level (${\geq}15.2U/L$) correlated with the advanced clinical stage (P <0.001), bone marrow involvement (P =0.013), international prognostic index score (P =0.001), lactate dehydrogenase level (P =0.001), low Hb level (<12 g/dL) (P =0.028), and lymphocyte count (P =0.023). Conclusions: The serum TK1 level could serve as a useful biomarker for aggressive clinical behavior in B-cell lymphoma patients.

• Journal of Korean Neurosurgical Society
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• v.64 no.6
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• pp.983-994
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• 2021

Objective : The effectiveness of gamma knife radiosurgery (GKR) in the treatment of brain metastases is well established. The aim of this study was to evaluate the efficacy and safety of maximizing the radiation dose in GKR and the factors influencing tumor control in cases of small and medium-sized brain metastases from non-small cell lung cancer (NSCLC). Methods : We analyzed 230 metastatic brain tumors less than 5 mL in volume in 146 patients with NSCLC who underwent GKR. The patients had no previous radiation therapy for brain metastases. The pathologies of the tumors were adenocarcinoma (n=207), squamous cell carcinoma (n=18), and others (n=5). The radiation doses were classified as 18, 20, 22, and 24 Gy, and based on the tumor volume, the tumors were categorized as follows : small-sized (less than 1 mL) and medium-sized (1-3 and 3-5 mL). The progression-free survival (PFS) of the individual 230 tumors and 146 brain metastases was evaluated after GKR depending on the pathology, Eastern Cooperative Oncology Group (ECOG) performance score (PS), tumor volume, radiation dose, and anti-cancer regimens. The radiotoxicity after GKR was also evaluated. Results : After GKR, the restricted mean PFS of individual 230 tumors at 24 months was 15.6 months (14.0-17.1). In small-sized tumors, as the dose of radiation increased, the tumor control rates tended to increase (p=0.072). In medium-sized tumors, there was no statistically difference in PFS with an increase of radiation dose (p=0.783). On univariate analyses, a statistically significant increase in PFS was associated with adenocarcinomas (p=0.001), tumors with ECOG PS 0 (p=0.005), small-sized tumors (p=0.003), radiation dose of 24 Gy (p=0.014), synchronous lesions (p=0.002), and targeted therapy (p=0.004). On multivariate analyses, an improved PFS was seen with targeted therapy (hazard ratio, 0.356; 95% confidence interval, 0.150-0.842; p=0.019). After GKR, the restricted mean PFS of brain at 24 months was 9.8 months (8.5-11.1) in 146 patients, and the pattern of recurrence was mostly distant within the brain (66.4%). The small and medium-sized tumors treated with GKR showed radiotoxicitiy in five out of 230 tumors (2.2%), which were controlled with medical treatment. Conclusion : The small-sized tumors were effectively controlled without symptomatic radiation necrosis as the radiation dose was increased up to 24 Gy. The medium-sized tumors showed potential for symptomatic radiation necrosis without signifcant tumor control rate, when greater than 18 Gy. GKR combined targeted therapy improved the tumor control of GKR-treated tumors.

• Journal of the Korean Society of Radiology
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• v.16 no.4
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• pp.373-379
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• 2022

The radiation source used for non-destructive testing have permeability and cause a scattered radiation through collisions of surrounding materials, which causes changes in the surrounding spatial dose. Therefore, this study attempted to evaluate and analyze the distribution of spatial dose by source in the working environment during the non-destructive test using monte carlo simulation. In this study, Using FLUKA, a simulation code, simulates ⁶⁰Co, ¹⁹²Ir, and ⁷⁵Se source used in non-destructive testing, The reliability of the source term was secured by comparing the calculated dose rate with the data of the Health and Physics Association. After that, a non-destructive test in the radiation safety facility(RT-room) was designed to evaluate the spatial dose according to the distance from the source. As a result of the spatial dose evaluation, ⁷⁵Se source showed the lowest dose distribution in the frontal position and ⁶⁰Co source showed a dose rate of about 15 times higher than that of ⁷⁵Se and about 2 times higher than that of ¹⁹²Ir. In addition, the spatial dose according to the distance tends to decrease according to the distance inverse square law as the distance from the source increases. Exceptionally, ⁶⁰Co, ¹⁹²Ir, and ⁷⁵Se sources confirmed a slight increase within 2 m of position. Based on the results of this study, it is believed that it will be used as supplementary data for safety management of workers in radiation safety facilities during non-destructive testing using radioactive isotopes.

• Journal of the Korean Society of Radiology
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• v.17 no.2
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• pp.231-242
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• 2023

This study aims to provide basic data to reduce the incidence of radiation dermatitis and improve patient satisfaction by investigating the management status and satisfaction level of radiation dermatitis in patients undergoing radiation therapy. From October 28, 2022, to April 4, 2023, a survey was conducted on 137 breast cancer patients who received radiation therapy at G Hospital in Busan. The Radiation Therapy Oncology Group (RTOG) cutaneous acute radiotherapy toxicity score was used as the standard for measuring skin reactions, and the association between cancer stage and RTOG was analyzed. SPSS program (ver. 18.0) was used for statistical analysis. The frequency of radiation dermatitis occurrence was relatively low, with 73% in the RTOG 0-1 group and 27% in the 2-3 group. Patient satisfaction after radiation therapy varied significantly depending on the RTOG group, with lower levels of dermatitis resulting in higher satisfaction and higher levels resulting in dissatisfaction (p=0.001). Although there was no statistically significant difference in RTOG group and skin satisfaction depending on the frequency of aloe mist use (p=0.065), the group that used it 1-2 times a day (69.3%) showed a higher satisfaction level. The perceived effects of aloe mist use were statistically significant for decreasing heat sensation (p=0.001), pain (p=0.033), itching (p=0.001), and psychological stability (p=0.027), especially in the higher RTOG groups. Additionally, as cancer stage increased, the severity of radiation dermatitis also increased, which was statistically significant (p=0.001). In conclusion, radiation dermatitis is the most common side effect of radiation therapy, and it can appear in various forms depending on individual skin sensitivity and external factors during treatment. Adequate education before treatment and the use of MD Cream and aloe vera mist are recommended to reduce the incidence and manage radiation dermatitis effectively.

• Journal of the Korean Society of Radiology
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• v.17 no.3
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• pp.305-314
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• 2023

With the development of medical technology and radiation treatment equipment, the frequency of high-precision radiation therapy such as intensity modulation radiation therapy has increased. Image-guided radiation therapy has become essential for radiation therapy in precise and complex treatment plans. In particular, with the introduction of imaging equipment for diagnosis in a linear accelerator, CBCT scanning became possible, which made it possible to calibrate and correct the patient's posture through 3D images. Although more precise reproduction of the patient's posture has become possible, the exposure dose delivered to the patient during the image acquisition process cannot be ignored. Radiation optimization is necessary in the field of radiation therapy, and efforts to reduce exposure are necessary. However, when acquiring 3D CBCT images by changing the imaging conditions to reduce exposure, there should be no image quality or artefacts that would make it impossible to align the patient's position. In this study, Rando phantom was used to scan and evaluate images for each shooting condition. The highest SNR was obtained at 100 kV 80 mA 25 ms F1 filter 180°. As the tube voltage and tube current increased, the noise decreased, and the bowtie filter showed the optimal effect at high tube current. Based on the actual scanned images, it was confirmed that patient alignment was possible under all imaging conditions, and that image-guided radiation therapy for patient alignment was possible under the condition of 70 kV 10 mA 20 ms F0 filter 180°, which showed the lowest SNR. In this study, image evaluation was conducted according to the imaging conditions, and low tube voltage, tube current, and small rotation angle scan are expected to be effective in reducing radiation exposure. Based on this, the patient's exposure dose should be kept as low as possible during CBCT imaging.

• Journal of the Korean Society of Radiology
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• v.17 no.5
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• pp.641-649
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• 2023

This study compares and analyzes the performance of a shield manufactured using 3D printing technology to find out its applicability as a shield in high-energy electron beam therapy. Actual measurement and monte carlo simulations were performed to evaluate the shielding performance of 3D printing materials for high-energy electron beams. First, in order to secure reliability for the simulation, a source term evaluation was conducted by referring to the IAEA's TRS-398 recommendation. Second, to analyze the shielding performance of PLA+W (93%), a specimen was manufactured using a 3D printer, and the shielding rate by thickness according to electron beam energy was evaluated. Third, the shielding thickness required for electron beam treatment was calculated through a comparative analysis of shielding performance between PLA+W (93%) and existing shielding bodies. First, as a result of the evaluation of the source term through actual measurement and simulation, the TRS-398 recommendation was satisfied with an error of less than 1%, thereby securing the reliability of the simulation. Second, as a result of the shielding performance analysis for PLA+W (93%), 6 MeV electron beams showed a shielding rate of more than 95% at 3.12 mm, and 15 MeV electron beams showed a shielding rate of more than 90% at 10 mm thickness. Third, through simulations, comparative analysis between PLA+W (93%) materials and existing shields showed high shielding rates within the same thickness in the order of tungsten, lead, copper, PLA+W (93%), and aluminum. 6 MeV electron beams showed almost similar shielding rates at 5 mm or more and 15 MeV electron beams. Through this study in the future, it is judged that it can be used as basic data for the production and application of shielding bodies using PLA+W (93%) materials in high-energy electron beam treatment.

• Clinical and Experimental Pediatrics
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• v.50 no.1
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• pp.65-73
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• 2007

Purpose : Short stature is an important complication that impairs the quality of life in survivors of childhood brain tumors. We studied their final adult height (FAH) to evaluate risk factors for short stature. Methods : We reviewed the medical data of 95 survivors of childhood brain tumors (64 males and 31 females) who had been followed up from 1982 to 2006, reached FAH, and had a more than five year-disease-free survival. Results : Final adult height standard deviation score (FAHTSDS: $mean{\pm}SD$) of the patients was lower than those of general population ($-1.15{\pm}1.72$), HTSDS at diagnosis ($-0.13{\pm}1.57$), and target HTSDS ($-0.49{\pm}0.69$). FAHTSDS of craniopharyngioma patients did not decrease ($0.57{\pm}1.17$), but those of germ cell tumor and medulloblastoma patients were significantly reduced ($-1.20{\pm}1.45$, $-2.70{\pm}1.46$; P<0.05). The patients treated with craniospinal radiation or chemotherapy had lower FAHTSDS ($-1.93{\pm}1.58$, $-2.27{\pm}1.44$; P<0.01). In the spinal irradiation group, the younger the age at diagnosis was, the more the loss of FAH (r=0.442, P<0.01). Growth hormone replacement (GHR) didn't improve FAHTSDS, but starting GHR under 12 years was an independent factor for improving FAH once treatment methods were taken into account (P=0.01). Conclusion : The younger age at diagnosis, spinal radiation and chemotherapy were all important risk factors of height loss, and height gain was expected in patients who received GHR under the age of 12 years. Therefore, regular check-ups of growth and early intervention with growth hormones are needed for high risk groups to improve FAH.

• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.30-38
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• 1998

Background : Hepatocellular carcinomoma is the 3rd most common malignancy and the 2nd most common cause of death in Korea. The prediction of life-expectancy in terminal cancer patients is a major problem for patients, families, and physicians. We would like to investigate the prognostic factors of hepatocellular carcinoma, and therefore contribute to the prediction of the survival time of patients with hepatocellular carcinoma. Methods : A total of 91 patients(male 73, female 18) with hepatocellular carcinoma who were admitted to the hospital between January and lune 1995 were entered into the study, and data were collected prospectively on 28 clinical parameters through medical obligation record. We surveyed an obligation and local district office records, and confirmed the surivival of patients till July, 1996. Using Cox-proportional hazard model, give the significant variables related to survival. These determined prognostic factors. Life regressional analysis was used, there were calculated predicted survival day based on combinations of the significant prognostic factors. Results : 1) Out of 91 patients, 73 were male, and 18 were female. The mean age was $56.7{\pm}10.6$ ears. During the study, except for 16 patients who could not follow up, out of 75 patients, the number of deaths was 57(76%) and the number of survivals was 18(24%). 2) Out of the 28 clinical parameters, the prognostic factors related to reduced survival rate were prothrombin time<40%(relative risk:10.8), weight loss(RR:4.4), past history of hypertension (RR:3.2), ascites(RR:2.8), hypocalcemia(RR:2.5)(P<0.001). 3) Out of five factors, the survival day is 1.7 in all of five, $4.2{\sim}10.0$ in four, $10.4{\sim}41.9$ in three, $29.5{\sim}118.1$ in two, $124.0{\sim}296.6$ in one, 724.0 in none. Conclusion : In hepatocellular carcinoma we found that the prognostic factors related to reduce survival rate were prolonged prothrombin time(<40%), weight loss, past history of hypertension, ascites, and hypocalcemia(<8.7mg/dl). The five prognostic factors enabled the prediction of life-expectancy in patients with hepatocellular carcinoma and may assist in managing patients with hepatocellular carcinomal.

• Journal of Hospice and Palliative Care
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• v.1 no.1
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• pp.14-22
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• 1998

Purpose : Cancer is a common cause for admission to emergency room(ER). Cancer patient present to ER with undiagnosed cancer, acute vague problem of cancer, or treatment related complication. But there is little information on the magnitute of the problems in the Korea. The purposes of our study were to evaluate the appropriateness of care for oncologic emergencies in Korea. Materials and Methods : This study was undertaken of all cancer patients above 15 years old presenting to the Seoul National University Hospital ER, who visited during the period from Oct. 16 to Nov. 15, 1997. ER record was reviewed and ER doctors evaluated patients' reason for visiting ER, appropriateness in patients' utilization of ER, oncology emergency Results : 266 cancer patients(17.4% of total patients) visited ER during this period and 166 cancer patients(62.4%) utilized inappropriately ER. Their average stay is 32.0 hours and 65.8% of them stayed for 6 hours. There were complaints of patients such as pain(44.8%), abdomen distension(9.4%), and dyspnea(7.5%). The most common oncologic emergency in ER during this study were gastrointestinal(34.0%), neurologic(21%), hematologic(8.0%), infectious(7.0%), respiratory(6.0%), and genitourinary(5.0%). Conclusion : For the care of symptoms like pain, most of cancer patients utilize ER inappropriately due to lack of attention from primary health delivery system. For the better care, the palliative medicine should be established in Korea.

• Journal of Radiation Protection and Research
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• v.35 no.2
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• pp.49-56
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• 2010

Developments of radioprotective agents are important issues for minimizing the troubles and the effective treatments in radiotherapy. But few agents are useful in clinical and practical fields. It was shown that trace elements in alcohol beverages might have radioprotective effect. In this study, the types of cell death of lymphocytes according to the commercial alcohol beverage was investigated. Normal healthy volunteers ingested distilled water, beer or soju containing $81.5mg{\cdot}dl^{-1}$ ethyl ahcohol, respectively. After 2 hours, their blood were sampled with their consents. Fraction of lymphocytes was isolated by density gradient method with Histopaque-1077 (Sigma) and irradiated with dose from 0.5 to 5 Gy. After 60 hour incubation, the cells were harvested and analysed by flow cytometry. Cell viability was decreased by dose dependent manner. Cell viability of beer group was reduced about 15% compared with control group. Apoptosis in soju group was reduced about 20% compared with control group. Apoptosis of beer and control groups are similar. Necrosis of soju group significantly increased about 35% compared with control group. Early apoptosis of beer group was increased compared with control group. Early apoptosis of soju group was decreased about 25% compared with control group. Late apoptosis of beer and control group was increased by dose dependent manner. Late apoptosis of soju group was increased about 20-30% compared with control group. Late apoptosis of soju was increased and the radioprotective effect of soju was minimal because late apoptosis induced the cell necrosis. In case of soju trace elements, total cell apoptosis was decreased about 20% and early cell apoptosis was remarkably low. In this case, mitotic cells death may be dominant mechanism. Therefore, trace elements in soju may not be effective radioprotective agents.