• Radiation Oncology Journal
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• 제28권2호
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• pp.111-116
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• 2010

부갑상선암은 매우 드문 내분비악성 종양으로 부갑상선기능 항진증의 0.5~4%를 차지하며 흔히 고칼슘 혈증과 부갑상선호르몬의 증가를 보인다. 비기능성 부갑상선암은 부갑상선기능 항진증으로 나타나는 증상이 없으며 병리조직학적 진단기준이 분명하지 않아 늦게 진단이 되는 질환이다. 근치적 절제술이 가장 표준적인 치료이지만 수술 후 국소재발이 흔하기 때문에 불완전 절제가 시행되었거나 미세 잔류 종양이 있는 경우 외부 방사선치료를 시행하여 국소 조절률 향상을 얻을 수 있다고 보고되고 있다. 저자는 부갑상선에 발생한 비기능성 악성종양으로 근치적 절제술 후 외부 방사선치료를 시행한 1예를 경험하였기에 문헌 고찰과 함께 이를 보고하고자 한다.

• 대한방사선치료학회지
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• 제3권1호
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• pp.11-18
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• 1989

Brachytherapy is known to be a good modality to achieve local control as a boost treatment following limited external irradiation, which may reduce the external beam related complication particularly in head and neck cancer. The authors developed iridium-192 ribbons recently to replace the radium needles in the field of brachytherapy. Total of 48 cases of head and neck and pelvic-perineal cancer patients had been treated with Ir-192 ribbons during last two years from October 1986 to September 1988, and the results were analyzed to assess the applicability of the fabricated sources. The conclusion is as follows; 1. Iridium implant resulted excellent tumor control effect in clinical application. 2. Iridium is superior than radium and cecium in brachytherapy because of easier to use and lesser exposure to the personnel. 3. Afterloading technique is useful to modify dose distribution, to expand treatment site and method, and to develop interstitial hyperthermia.

• Journal of Korean Neurosurgical Society
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• 제40권4호
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• pp.245-248
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• 2006

Objective : To evaluate the effectiveness of Novalis shaped beam radiation treatment as an adjuvant treatment in patients with craniopharyngiomas. Methods : We reviewed 8 patients with craniopharyngiomas who had recurring tumors during follow-up or had residual lesions after primary surgery. Three of 8 patients were found to have recurrence after gross total excision of the tumor and 5 patents had residual lesions after subtotal resection. All patients were treated with fractionated stereotactic radiation treatment[FSRT] using Novalis system. The mean age of patients was 28 years [range $16{\sim}52$]. The median irradiation dose per fraction was 17Gy [range $1.7{\sim}2.0$]. The median fraction number was 23 [range $15{\sim}25$], and the median total dose was 39.1 Gy [range $25.5{\sim}42.5$]. Follow-up included MR imaging, and ophthalmologic and endocrine examinations. Results : The median follow-up period was 23 months [range $12{\sim}43$]. The local tumor control rate was 87.5%. One patient had a recurring tumor, in which cystic change developed 2 months after FSRT. Four patients showed a decrease in size of their tumor, while 3 patients remained stable. Seven out of 8 patients had hormonal dysfunction that remained unchanged after initial surgery. No further progression of visual impairment was observed. Conclusion : FSRT using Novais system is effective and safe for the treatment of recurring or residual craniopharyngiomas without toxicity like optic neuropathy.

• Clinical and Experimental Pediatrics
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• 제50권7호
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• pp.606-612
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• 2007

Since the introduction of chemotherapy for the treatment of childhood leukemia more than 50 years ago, the results of childhood cancer have improved dramatically. The 5-year survival rate of disease, many of which were uniformly fatal in the prechemotherapy era, reached to more than 75%. This remarkable improvement in survival is a direct result of the incorporation of chemotherapeutics into treatment regimens that previously relied only on surgery or radiotherapy for the primary tumor. The multimodality approach, which integrates surgery and radiotherapy to control local disease with chemotherapy to eradicate systemic or metastatic disease, has become the standard approach to treating most childhood cancers. The overall improvement in outcomes in childhood solid tumors has been related to the development of multidisplinary cooperative studies that has permitted the development of well-designed tumor treatment protocols characterized by uniform staging criteria, sharing informations in pathologic classification, uniform methods for tumor markers, oncogenes, and other biologic and genetic factors. Important advances in the biologic study of cancer and its genetic basis led to a number of observations that impact directly on the management of childhood solid tumors. Identification of specific genes, oncogenes, tumor markers, and other biologic and pathologic factors plays an important role in both staging and clarifying the risk categorization of individual patients. Treatment of the patient is influenced by the recognition of specific risk factors. This knowledge has resulted in a change in the approach to care based not only on staging criteria, but also on risk-based management. This concept uses various risk factors of outcomes. Risk-based management allows for each patient to maximize survival, minimize long-term morbidity and improve the quality of life, especially for children's growth and development.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.295-301
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• 2015

Background Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings. Methods Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach. Results Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence. Conclusions Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity.

• Radiation Oncology Journal
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• 제25권4호
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• pp.201-205
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• 2007

목적: 데스모이드 종양의 수술 후 방사선치료 성적을 분석하고 예후인자를 평가하기 위하여 후향적 연구를 진행하였다. 대상 및 방법: 1984년 5월부터 2005년 10월까지 서울대학교병원에서 데스모이드 종양으로 수술 후 방사선치료를 시행 받은 환자 27명에 대한 의무기록을 분석하였다. 남자 13예, 여자 14예였으며 연령은 $3{\sim}79$세였다(중앙값, 28세). 종양은 복부 외(21예), 복벽(5예)에 위치하였고 종양의 크기는 장경 기준 $2.5{\sim}25$ cm (중앙값, 7.5 cm)였다. 첫 수술 후 방사선치료를 받은 환자가 13예, 국소 재발 종양에 대한 반복 수술 후 방사선치료를 받은 환자가 14예였다. 방사선치료는 분할 선량 $1.8{\sim}2.0$ Gy로 총 $45{\sim}66$ Gy (중앙값, 59.4 Gy)를 조사하였다. 결 과: 추적관찰 기간의 중앙값은 61개월(범위, $12{\sim}203$개월)이었다. 병변의 국소 진행은 2예에서, 국소 계발은 5예에서 관찰되었다. 5년 무병생존율과 5년 무진행 생존율은 각각 61%와 70%였다. 다변량 분석 결과 광범위절제술을 시행한 경우 용적축소수술을 시행한 경우보다 무병생존율이 높았고(p=0.028), 첫 수술 후 방사선치료를 시행하는 경우와(p=0.046) 방사선 선량이 60 Gy이상인 경우에(p=0.049) 무진행 생존율이 높았다. 첫 수술 후 방사선치료를 시행한 경우 최종 관찰까지 수술 횟수가 중앙값 1회(범위, $1{\sim}3$회)였으나 첫 수술 후 방사선치료를 시행하지 않은 경우 수술 횟수가 중앙값 3.5회(범위, $2{\sim}6$회)였다(p<0.001). 결 론: 처음 진단 시 수술 후 방사선치료를 시행한 경우 국소 제어율은 높았고 총 수술 횟수는 적었다. 따라서 재발의 위험도가 높은 용적축소수술을 받은 환자 등에서는 수술 후 조기 방사선치료의 시행이 바람직하다.

• Radiation Oncology Journal
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• 제11권1호
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• pp.103-108
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• 1993

Among the patients with rectal cancer who entered Yonsei University Hospital for management from Jan. 1980 to Dec. 1990, we selected 23 subjects who were received surgical resection of tumor in rectum, and who proved to have liver metastasis during the diagnostic work-up, at the time of the operation, or within 3 months after starting definitive treatment. With those subjects, we investigated the role of radiation therapy by comparison of the treatment results of the patients without radiation therapy (S group) with those of the patients with radiation therapy to the primary site (S+R group). The local control rates of S group and S+R group were $64{\%}$ and $89{\%}$, and 2-year survival rates were $50{\%}$ and $78{\%}$, respectively. Although there was not statistically meaningful difference, local control rate and 2-year survival rate were higher in the group with radiation therapy to primary site than that without radiation therapy. The 2-year survival rates of the case with resection of the liver and the case without it were $63.6{\%}$ and $58.3{\%}$ respectively, which was not statistically significant. Also, the 2-year survival rate of the case with sustained local control was higher than that of the case with local failure, which was statistically significant ($76.5{\%}$ and $16.7{\%}$, p<0.005). From the above results, it is thought that radiation therapy to the primary site might improve the local control rate even in the patients with liver metastasis, which seems to be correlated to the higher survival rate.

• Radiation Oncology Journal
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• 제33권2호
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• pp.89-97
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• 2015

Purpose: To evaluate the treatment results in early stage non-small cell lung cancer patients who have undergone fiducial-less CyberKnife radiosurgery (CKRS). Materials and Methods: From June 2011 to November 2013, 58 patients underwent CKRS at Asan Medical Center for stage I lung cancer. After excluding 14 patients, we retrospectively reviewed the records of the remaining 44 patients. All analyses were performed using SPSS ver. 21. Results: The median age at diagnosis was 75 years. Most patients had inoperable primary lung cancer with a poor pulmonary function test with comorbidity or old age. The clinical stage was IA in 30 patients (68.2%), IB in 14 (31.8%). The mean tumor size was 2.6 cm (range, 1.2 to 4.8 cm), and the tumor was smaller than 2 cm in 12 patients (27.3%). The radiation dose given was 48-60 Gy in 3-4 fractions. In a median follow-up of 23.1 months, local recurrence occurred in three patients (2-year local recurrence-free survival rate, 90.4%) and distant metastasis occurred in 13 patients. All patients tolerated the radiosurgery well, only two patients developing grade 3 dyspnea. The most common complications were radiation-induced fibrosis and pneumonitis. Eight patients died due to cancer progression. Conclusion: The results showed that fiducial-less CKRS shows comparable local tumor control and survival rates to those of LINAC-based SABR or CKRS with a fiducial marker. Thus, fiducial-less CKRS using Xsight lung tracking system can be effectively and safely performed for patients with medically inoperable stage I non-small cell lung cancer without any risk of procedure-related complication.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9949-9953
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• 2014

Objective: To evaluate the long term results among patients with soft tissue sarcoma of the thoracic wall. Materials and Methods: Twenty-six patients who were treated with pre-or postoperative radiotherapy between December 1980-December 2007, with a diagnosis of soft tissue sarcoma of the thoracic wall were retrospectively evaluated. Results: The median age was 44 years (14-85 years) and 15 of them were male. A total of 50% of patients were grade 3. The most common histologic type of tumor was undifferentiated pleomorphic sarcoma (26.9%). Tumor size varied between 2-25 cm (median 6.5 cm). Seventeen of the cases had marginal and 9 had wide local resection. Four cases received preoperative radiotherapy and 22 postoperative radiotherapy. Six of the patients with large and high grade tumors received chemotherapy. Median follow-up time was 82 months (9-309 months). Local recurrence and metastasis was detected in 34.6% and 42.3% of patients, respectively. Five-year local control (LC), disease-free survival (DFS), overall survival (OS), and disease-specific survival (DSS) were 62%, 38%, 69%, and 76% respectively. On univariate analysis, the patients with positive surgical margins had a markedly lower 5-year LC rate than patients with negative surgical margin, but the difference was not significant (43% vs 78%, p=0.1). Five-year DFS (66% vs 17%) and DSS (92% vs 60%) rates were significantly worse for the patients who had high grade tumors (p=0.01, p=0.008 respectively). Conclusions: Tumor grade and surgical margin are essential parameters for determining the prognosis of thoracic wall soft tissue sarcoma both in our series and the literature.

• Radiation Oncology Journal
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• 제28권2호
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• pp.85-90
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• 2010

목 적: 크기가 작은 5 cm 미만의 재발성 간세포암 환자를 대상으로 소분할 방사선치료 후 종양의 반응, 국소제어율 및 소분할 방사선치료와 연관된 부작용을 평가하였다. 대상 및 방법: 2006년부터 2007년까지 국소요법으로 치료한 후 재발한 간세포암 환자 중 구제치료로 소분할 방사선치료를 받은 12명의 환자를 대상으로 후향적 분석을 시행하였다. 소분할 방사선치료의 적용기준은 종양의 크기가 5 cm 미만이고, 중요 정상조직에 인접하지 않으면서, 간세포암에 의한 간문맥 종양 혈전증이 없으며, 처방된 방사선량의 50%가 조사되는 정상 간 용적이 15% 미만인 경우로 제한하였다. 소분할 방사선치료의 1회 조사량은 5 Gy였고, 주 5회 치료하여 2주 동안 총 50 Gy를 조사하였다. 종양의 반응도는 방사선치료 종료 후 3개월에 시행된 간 컴퓨터단층촬영으로 평가하였다. 치료와 연관된 부작용은 Common Terminology Criteria for Adverse Events version 3.0으로 평가하였다. 방사선치료 종료 후 추적관찰기간은 8~33개월(중앙값 18개월)이었다. 결 과: 방사선치료 후 3개월에 시행한 간 컴퓨터단층촬영에서 완전관해율은 41.7%였고 추적관찰기간에 확인한 전체 완전관해율은 58.3%였다. 방사선치료 부위 내 국소제어율은 83.3%였다. 두 명을 제외한 모든 환자에서 간 내 재발이 발생하였다. 전체 환자의 1년 및 2년 생존율은 각각 90.0%, 67.5%였다. 치료와 연관된 부작용은 3명의 환자가 치료 중 1도의 오심, 식욕부진이 발생하였고 방사선치료 종료 후 복수가 진행한 환자가 1명 있었다. 3도 이상의 중대한 부작용은 없었다. 결 론: 작은 크기의 재발성 간세포암의 구제 치료로서 소분할 방사선치료는 58.3%의 완전관해율과 83.3%의 국소 제어율을 보여주었다. 소분할 방사선치료로 5 Gy씩 총 50 Gy를 조사하는 것은 치료와 연관된 심각한 독성 없이 비교적 안전하고 효과적인 방법으로 판단된다.