• Radiation Oncology Journal
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• v.27 no.3
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• pp.133-139
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• 2009

Purpose: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. Results: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). Conclusion: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.314-320
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• 2000

Purpose :To investigate whether changes in plasma concentrations of transforming growth factor-$\beta$1(TGF-$\beta$1), tumor necrosis factor-alpha (TNF-$\alpha$) and interleukin-6 (IL-6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. Methods and Materials :Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-$\beta$1, TNF-$\alpha$ and IL-6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. Results : Thirteen patients eventually developed signs and symptoms of clinical pneumonitis 씬file four patients did not. TGF-$\beta$ 1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF- $\alpha$ and IL-6 were also elevated In the group of patients who developed pneumonitis but the pattern was not characteristic. Conclusions : Changes in plasma TGF$\beta$-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF- $\alpha$ and IL-6 shows no meaningful changes in association with radiation pneumonitis.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.37-48
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• 2017

Purpose: The most basic conditions of radiation therapy is to prevent unnecessary exposure of normal tissue. The risk factors that are important o evaluate the dose emitted to the lung and heart from radiation therapy for breast cancer. Therefore, comparing the dose factors of a normal tissue according to the radion treatment position and Seeking an effective radiation treatment for breast cancer through the analysis of the correlation relationship. Materials and Methods: Computed tomography was conducted among 30 patients with left breast cancer in supine and prone position. Eclipse Treatment Planning System (Ver.11) was established by computerized treatment planning. Using the DVH compared the incident dose to normal tissue by position. Based on the result, Using the SPSS (ver.18) analyzed the dose in each normal tissue factors and Through the correlation analysis between variables, independent sample test examined the association. Finally The HI, CI value were compared Using the MIRADA RTx (ver. ad 1.6) in the supine, prone position Results: The results of computerized treatment planning of breast cancer in the supine position were V20, $16.5{\pm}2.6%$ and V30, $13.8{\pm}2.2%$ and Mean dose, $779.1{\pm}135.9cGy$ (absolute value). In the prone position it showed in the order $3.1{\pm}2.2%$, $1.8{\pm}1.7%$, $241.4{\pm}138.3cGy$. The prone position showed overall a lower dose. The average radiation dose 537.7 cGy less was exposured. In the case of heart, it showed that V30, $8.1{\pm}2.6%$ and $5.1{\pm}2.5%$, Mean dose, $594.9{\pm}225.3$ and $408{\pm}183.6cGy$ in the order supine, prone position. Results of statistical analysis, Cronbach's Alpha value of reliability analysis index is 0.563. The results of the correlation analysis between variables, position and dose factors of lung is about 0.89 or more, Which means a high correlation. For the heart, on the other hand it is less correlated to V30 (0.488), mean dose (0.418). Finally The results of independent samples t-test, position and dose factors of lung and heart were significantly higher in both the confidence level of 99 %. Conclusion: Radiation therapy is currently being developed state-of-the-art linear accelerator and a variety of treatment plan technology. The basic premise of the development think normal tissue protection around PTV. Of course, if you treat a breast cancer patient is in the prone position it take a lot of time and reproducibility of set-up problems. Nevertheless, As shown in the experiment results it is possible to reduce the dose to enter the lungs and the heart from the prone position. In conclusion, if a sufficient treatment time in the prone position and place correct confirmation will be more effective when the radiation treatment to patient.

• Journal of radiological science and technology
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• v.33 no.3
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• pp.213-221
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• 2010

The Purpose of this study was to determine the effective dose to an average patient from Coronary Angiography (CA) and Percutaneous Coronary Intervention (PCI). And to estimate the lifetime attributable risk (LAR) of cancer associated with radiation exposure from CA and PCI. The dose-area product (DAP) values to the patient were recorded from 60 CA and 58 PCI. A Monte Carlo based program PCXMC was used to calculate the effective dose from DAP values for each patient. Lifetime attributable risks were estimated with models developed in the National Academies' Biological Effects of Ionizing Radiation VII report. The mean DAP values was $53.76\;Gy{\cdot}cm^2$ for CA and $165.82\;Gy{\cdot}cm^2$ for PCI. Mean effective dose were 1.28 mSv in CA, 3.94 mSv in PCI. Results of Calculate organ dose, lung doses was 2.17 mSv in CA and 6.71 mSv in PCI. Female breast doses was 5.45 mSv in CA and 16.82 mSv in PCI. LAR estimates for CA varied from 1 in 1,508 for man to 1 in 1,357 for women. In PCI procedure varied from 1 in 553 for man to 1 in 482 for women. DAP can be used as the dose indicator to calculate the organ dose and effective dose of patient based on Monte Carlo simulation. These dose estimates derived from our simulation models suggest that CA and PCI are associated with a nonnegligible LAR of cancer. This risk varies markedly and is considerably greater for women, PCI than for man, CA.

• Tuberculosis and Respiratory Diseases
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• v.63 no.3
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• pp.251-260
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• 2007

Purpose: An imbalance of cell proliferation and cell apoptosis is an important mechanism in carcinogenesis. Capase 3, survivin and p53 have been identified as important members of the apoptotic related proteins. This study evaluated the proliferating cell nuclear antigen(PCNA), apoptosis, apoptotic related protein such as capase 3, survivin and p53 using urethane-induced mouse lung carcinogenesis, which provides reproducible steps from hyperplasia to adenocarcinoma. Methods: Urethane was administered to the ICR mice through an intra-peritoneal injection, The mice were sacrificed at 5, 15, and 25 weeks after urethane intervention. The sequential morphological changes and immunohistochemical expression of PCNA, apoptosis, capase 3, survivin, and p53 were examined during mouse lung carcinogenesis. Results: During carcinogenesis, the sequential histological changes were observed from hyperplasia of type II pneumocytes, to anadenoma, and ultimately to an overt adenocarcinoma. The PCNA Labeling index (LI) was 9.6% in hyperplasia, 23.2% in adenoma, and 55.7% in adenocarcinoma, respectively. The apoptotic LI was 0.24% in hyperplasia, 1.25% in adenoma, and 5.27% in adenocarcinoma. A good correlation was observed between the PCNA LI and apoptotic LI. The expression of caspase 3 was remarkable- i.e., 46.7% in adenocarcinoma, in contrast to 15% in hyperplasia and 16% in adenoma. Survivin was detected weakly in the alveolar hyperplasia and showed an increasing expressional pattern in adenoma and adenocarcinoma. p53 expression was detected only in the adenocarcinoma lesions with an expression rate of 13.3%. The level of caspase 3 expression correlated with the increase in the apoptotic index. The positive expression of caspase 3 was associated with an increased apoptotic index. Conclusions: These results suggest that the PCNA LI and apoptotic LI might be useful markers for evaluating the risk of a malignant transformation. In addition, caspase, survivin and p53 might play a role in the early and late steges of urethane-induced mouse lung carcinogenesis.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.19
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• pp.8265-8270
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• 2014

Background: Smoking tobacco is considered as a leading cause of preventable death, mostly in developing countries like India. One of the primary goals of international tobacco control is to educate smokers about the risks associated with tobacco consumption. Tobacco warning labels (TWLs) on cigarette packages are one of the most common statutory means to communicate health risks of smoking to smokers, with the hope that once educated, they will be more likely to quit the habit. Materials and Methods: The present survey was conducted to assess the effectiveness of TWLs in communicating health risks of tobacco usage among 263 adult smokers working as bus drivers in Karnataka State Road Transport Corporation (KSRTC), Mangalore, India. Information was collected on demographic details, exposure and response to health warnings on tobacco products, intention to quit and nicotine dependency. Results: The majority (79.5%) of the respondents revealed negative intentions towards quitting smoking. Nearly half of the participants had a 'low' nicotine dependency (47.5%) and 98.1% of the respondents had often noticed warning labels on tobacco packages. These health warnings made 71.5% of the respondents think about quitting smoking. Respondents who noticed advertisement or pictures about dangers of smoking had better knowledge, with respect to lung cancer and impotence as a consequence of tobacco. A higher exposure to warning labels was significantly associated with lower nicotine dependency levels of smokers among the present study population. A significantly higher number of respondents who noticed advertisement or pictures about the dangers of smoking thought about the risks of smoking and were more inclined to think about quitting smoking. As exposure increased, an increase in the knowledge and response of participants was also observed. Conclusions: Exposure to tobacco warning labels helps to educate smokers about health risks of tobacco smoking. It may be possible to promote oral health among bus drivers by developing strategies to educate them about these risk factors.

• Progress in Medical Physics
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• v.21 no.4
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• pp.311-322
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• 2010

In proton therapy, the analysis of secondary particles is important due to delivered dose outside the target volume and thus increased potential risk for the development of secondary cancer. The purpose of this study is to analyze the influence of secondary particles from proton beams on fluence and energy deposition in the presence of inhomogeneous material by using Geant4 simulation toolkit. The inhomogeneity was modeled with the condition that the adipose tissue, bone and lung equivalent slab with thickness of 2 cm were inserted at 30% (Plateau region) and 80% (Bragg peak region) dose points of maximum dose in Bragg curve. The energy of proton was varied with 100, 130, 160 and 190 MeV for energy dependency. The results for secondary particles were presented for the fluence and deposited energy of secondary particles at inhomogeneous condition. Our study demonstrates that the fluence of secondary particles is neither influenced insertion of inhomogeneties nor the energy of initial proton, while there is a little effect by material density. The deposited energy of secondary particles has a difference in the position placed inhomogeneous materials. In the Plateau region, deposited energy of secondary particles mostly depends on the density of inserted materials. Deposited energy in the Bragg region, in otherwise, is influenced by both density of inserted material and initial energy of proton beams. Our results suggest a possibility of prediction about the distribution of secondary particles within complex heterogeneity.

• Journal of radiological science and technology
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• v.40 no.1
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• pp.57-62
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• 2017

The purpose of this study is to reconstruct the treatment plan by applying CBCT and DIR to dose changes according to the change of the patient's motion and breast shape in the large breast cancer patients and to compare the doses using TWF, FIF and IMRT. CT and CBCT were performed with MIM6 to create DIRCT and each treatment plan was made. The patient underwent computed tomography simulation in both prone and supine position. The homogeneity index (HI), conformity index (CI), coverage index (CVI) to the left breast as planning target volume (PTV) were determined and the doses to the lung, heart, and right breast as organ at risk (OAR) were compared by using dose-volume histogram and the unique property of each organ. The value of HI of the PTV breast increased in all treatment planning methods using DIRCT, and CVI and CI were decreased in the treatment planning methods using DIRCT.

• Radiation Oncology Journal
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• v.33 no.3
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• pp.242-249
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• 2015

Purpose: The purpose of this study is to compare the dosimetry of electron beam (EB) plans and three-dimensional helical tomotherapy (3DHT) plans for the patients with left-sided breast cancer, who underwent breast conserving surgery. Materials and Methods: We selected total of 15 patients based on the location of tumor, as following subsite: subareolar, upper outer, upper inner, lower lateral, and lower medial quadrants. The clinical target volume (CTV) was defined as the area of architectural distortion surrounded by surgical clip plus 1 cm margin. The conformity index (CI), homogeneity index (HI), quality of coverage (QC) and dose-volume parameters for the CTV, and organ at risk (OAR) were calculated. The following treatment techniques were assessed: single conformal EB plans; 3DHT plans with directional block of left anterior descending artery (LAD); and 3DHT plans with complete block of LAD. Results: 3DHT plans, regardless of type of LAD block, showed significantly better CI, HI, and QC for the CTVs, compared with the EB plans. However, 3DHT plans showed increase in the $V_{1Gy}$ at skin, left lung, and left breast. In terms of LAD, 3DHT plans with complete block of LAD showed extremely low dose, while dose increase in other OARs were observed, when compared with other plans. EB plans showed the worst conformity at upper outer quadrants of tumor bed site. Conclusion: 3DHT plans offer more favorable dose distributions to LAD, as well as improved target coverage in comparison with EB plans.

• Tuberculosis and Respiratory Diseases
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• v.59 no.3
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• pp.326-329
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• 2005

A case of 51-year-old woman with a malignant solitary pulmonary nodule (SPN) that exhibited no growth over a period of 4 years is reported. Surgical wedge resection revealed an adenocarcinoma upon intra-operative frozen examination. The operation was completed with a right upper lobectomy and complete lymphadenectomy. The authors recommend an early surgical procedure for any SPNs due to risk factors for developing lung cancer.