• Korean Journal of Bronchoesophagology
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• v.15 no.2
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• pp.49-56
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• 2009

Purpose : To evaluate the treatment outcome for patients with locally advanced, unresectable esophageal cancer treated with relatively high dose radiation therapy(RT). Materials and Methods : From January 2000 to December 2008, 32 patients with locally advanced unresectable or medically inoperable esophageal cancer were treated with radiation therapy(RT) with or without concurrent chemotherapy. Ten patients were excluded from analysis because of distant metastasis and drop off. Patient distributions according to AJCC stages II, III IVa were 7(31.8%), 12(54.6%), 3(13.6%) respectively. The locations of tumor were cervical/upper thorax 3 (13.6%), mid thorax 13(59.1%), and lower thorax/abdominal 6(27.3%), respectively. Eleven patients received RT only, and 11 patients received cisplatin based concurrent chemoradiotherapy(CCRT). Median radiation dose was 65 Gy(range 57.6~72 Gy). Results : The median follow-up was 9.1 months(range 1.9~43.8 months). The response rates for complete response, Partial response, stable disease and Persistent disease were 6(27.3%), 11(50.0%), 4(18.2%) and 1(4.5%), respectively. Two patients(9.1%) suffered from esophageal stenosis and stents were inserted. Two patients(9.1%) had Grade 3 radiation pneumonitis and one of them expired due to acute respiratory distress syndrome(ARDS) at 36 days after completion of radiation therapy. The recurrence rate was 11(50.0%). The patterns of recurrence were persistent disease and local progression in 5(22.7%), local recurrence 3(13.7%) and concomitant local and distant recurrence in 3(13.7%). The overall survival(OS) rate was 32.1% at 2 years and 21.4% at 3 years(median 12.0 months). Disease free survival(DFS) rate was 17.3% at 2 and 3 years. All patients who had no dysphagia at diagnosis showed complete response after treatment and 100% OS at 3 years(p=0.0041). The OS for above 64.8 Gy group and 64.8 Gy or below group at 3 years were 60.6% and 9.1%(p=0.1341). The response to treatment was the only significant factor affecting OS(p=0.004). Conclusion : Relatively high dose radiation therapy in unresectable esophageal cancer tended to have a better outcome without increased complication rate. Further study with more patients is warranted to justify improved result.

• Journal of radiological science and technology
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• v.34 no.3
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• pp.209-214
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• 2011

Goal of this study was to measure effective radiation dose of highly exposed patients who were treated by TACE, interventional radiology from June to September 2010. The effective radiation dose was approximately measured by weighted DAP (dose area product) with the ionization chamber which is inserted in angiography equiment (Philips Allura Xper FD 20). Radiation dose was measured by TLD which was attached to patients' thyroid and genital gland. The average of ED (effective dose) was 18.43${\pm}$6.63 mSv per person and the average of radiation dose of thyroid and genital gland was 0.37 mSv, 0.77 mSv, respectively. The mean radiation dose of operators who wear the protector was 0.07 mSv for thyroid, and 0.01 mSv for genital gland, respectively. All staffs involved in TACE treatment, have to keep them aware and use the appropriate protectors to reduce the radiation dose of patient.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.179-186
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• 2014

Purpose: To study the long-term outcomes and tolerance in our patients who received dose escalated radiotherapy in the early salvage post-prostatectomy setting. Materials and Methods: The medical records of 54 consecutive patients who underwent radical prostatectomy subsequently followed by salvage radiation therapy (SRT) to the prostate bed between 2003-2010 were analyzed. Patients included were required to have a pre-radiation prostate specific antigen level (PSA) of 2 ng/mL or less. The median SRT dose was 70.2 Gy. Biochemical failure after salvage radiation was defined as a PSA level >0.2 ng/mL. Biochemical control and survival endpoints were analyzed using the Kaplan-Meier method. Univariate and multivariate Cox regression analysis were used to identify the potential impact of confounding factors on outcomes. Results: The median pre-SRT PSA was 0.45 ng/mL and the median follow-up time was 71 months. The 4- and 7-year actuarial biochemical control rates were 75.7% and 63.2%, respectively. The actuarial 4- and 7-year distant metastasis-free survival was 93.7% and 87.0%, respectively, and the actuarial 7-year prostate cancer specific survival was 94.9%. Grade 3 late genitourinary toxicity developed in 14 patients (25.9%), while grade 4 late genitourinary toxicity developed in 2 patients (3.7%). Grade 3 late gastrointestinal toxicity developed in 1 patient (1.9%), and grade 4 late gastrointestinal toxicity developed in 1 patient (1.9%). Conclusion: In this series with long-term follow-up, early SRT provided outcomes and toxicity profiles similar to those reported from the three major randomized trials studying adjuvant radiation therapy.

• Journal of Korean Neurosurgical Society
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• v.49 no.1
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• pp.37-42
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• 2011

Objective: The author measured levels of fluoroscopic radiation exposure to the surgeon's body based on the different beam directions during kyphoplasty. Methods: This is an observational study. A series of 84 patients (96 vertebral bodies) were treated with kyphoplasty over one year. The patients were divided into four groups based on the horizontal and vertical directions of the X-Ray beams. We measured radiation exposure with the seven dosimetry badges which were worn by the surgeon in each group (total of 28 badges). Twenty-four procedures were measured in each group. Cumulative dose and dose rates were compared between groups. Results: Fluoroscopic radiation is received by the operator in real-time for approximately 50% (half) of the operation time. Thyroid protectors and lead aprons can block radiation almost completely. The largest dose was received in the chest irrespective of beam directions. The lowest level of radiation were received when X-ray tube was away from the surgeon and beneath the bed (dose rate of head, neck, chest, abdomen and knee: 0.2986, 0.2828, 0.9711, 0.8977, 0.8168 mSv, respectively). The radiation differences between each group were approximately 2.7-10 folds. Conclusion: When fluoroscopic guided-KP is performed, the X-Ray tube should be positioned on the opposite side of the operator and below the table, otherwise the received radiation to the surgeon's body would be 2.7-10 times higher than such condition.

• Journal of the Korea Safety Management & Science
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• v.17 no.4
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• pp.193-198
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• 2015

This study analyzed the total number of 19,636 patients and radiation technologists, 11,433 of male and 8,203 of female by examined body parts, age, types of detectors, the using contrast enhancement and working condition of the technologists, regular staffs or rotation-duty staffs, based on the K-DOS program distributed by FDA with the DLP value of diagnostic evaluation. The result shows that the effective radiation dose was 0.7mSv~41.7mSv for each region and male patients had more radiation exposure than females. And the amount of exposure was also affected by the types and the method of detectors. Furthermore, the regular staffs took the role of helping the patient to get reduced amount of radiation exposure than rotation duty-staffs. Computed tomography (CT) use has increased dramatically over the past several decades. In this reason, to support the patients and the workers' health in the field, the hospitals should apply specialized regular working radiation technologist system and manufacturing companies of those CTs should develop low medical radiation exposure devices.

• Korean Journal of Digital Imaging in Medicine
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• v.12 no.1
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• pp.5-8
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• 2010

Opened a court in February 10, 2006, a rule of safety management of the diagnosis radiation system was promulgated for safety of the radiation worker, patients and patients' family members. The purpose of this rule is to minimize the risk of being exposed to radiation during the process of handling X-ray. For this reason, we manufactured shielding device of mobile X-ray unit collimator for diminution of skin dose. Shielding device is made to a thickness of Pb 0.375mm. For portable chest radiography, we measured skin dose 50cm from center ray to 200cm at intervals of 20cm by Unfors Xi detector. As a result, a rule of safety management of the diagnosis radiation system has been strengthened. But there are exceptions, such as ER, OR, ICU to this rule. So shielding device could contribute to protect unnecessary radiation exposure and improve nation's health.

• Radiation Oncology Journal
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• v.36 no.3
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• pp.227-234
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• 2018

Purpose: We compared how doses delivered via two-dimensional (2D) intracavitary brachytherapy (ICBT) and three-dimensional (3D) ICBT varied anatomically. Materials and Methods: A total of 50 patients who received 30 Gy of 3D ICBT after external radiotherapy (RT) were enrolled. We compared the doses of the actual 3D and 2D ICBT plans among patients grouped according to six anatomical variations: differences in a small-bowel V_2Gy, small bowel circumference, the direction of bladder distension, bladder volume, sigmoid V_3.5Gy, and sigmoid circumference. Seven dose parameters were measured in line with the EMBRACE recommendations. Results: In terms of bladder volume, the bladder and small-bowel D_2cc values were lower in the 150-250 mL bladder volume subgroup; and the rectum, sigmoid, and bladder D_2mL values were all lower in the >250 mL subgroup, for 3D vs. 2D ICBT. In the sigmoid V_3.5Gy >2 _mL subgroup, the sigmoid and bladder D_2mL values were significantly lower for 3D than 2D ICBT. The bladder D_2mL value was also significantly lower for 3D ICBT, as reflected by the sigmoid circumference. In patients with a small bowel V_2.0Gy >10 mL or small bowel circumference >15%, most dose parameters were significantly lower for 3D than 2D ICBT. The bladder distension direction did not significantly affect the doses. Conclusion: Compared to 2D ICBT, a greater bladder volume can reduce the internal 3D ICBT organ dose without affecting the target dose.

• Radiation Oncology Journal
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• v.17 no.2
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• pp.113-119
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• 1999

Purpose : To evaluate possible acute toxicity and early response of concurrent radiation therapy and low dose daily cisplatin as a radiosensitizer in patients with locally advanced uterine cervical carcinomas. Materials and Method : From December 1996 to January 1999, 38 previously untreated Patients with locally advanced squamous cell carcinoma of the uterine cervix (from stage IIB to stage IIIB) were treated at Inha University Hospital. All patients underwent standard pretreatment staging Procedures after the initial evaluation by gynecologists and radiation oncologists. Sixteen Patients with huge cervical mass (>4 cm) were submitted to the group treated with concurrent radiation therapy and low dose daily cisplatin while the remainder was treated with radiation therapy alone. Radiation therapy consisted of 4500 cGy external beam irradiation to whole pelvis (midline block after 3000 cGy), 900$\~$1000 cGy boost to involved parametrium, and high dose-rate intracavitary brachytherapy (a total dose of 3000$\~$3500 cGy/500 cGy per fraction to point A, twice per week). In the group treated with low dose cisplatin concurrently, 10 mg of daily intravenous cisplatin was given from the 1st day of radiation therapy to the 20th day of radiation therapy. Acute toxicity was measured according to expanded common toxicity criteria of the NCI (C) Clinical Trials. Early response data were analyzed at minimum 4 weeks' follow-up after completion of the treatment protocol. Results: Hematolgic toxici쇼 was more prominent in patients treated with radiation therapy and cisplatin. Six of 16 patients (37.5$\~$) treated with radiation therapy and cisplatin and one of 22 patients (4.5$\~$) treated with radiation therapy alone experienced grade 3 leukopenia. In Fisher's exact test, there was statistically significant difference between two groups regarding leukopenia (P=0.030). There was no apparent difference in the frequency of gastrointestinal and genitourinary toxicity between two groups (P=0.066). Three of 16 patients (18.7$\~$) treated with radiation therapy and cisplatin and two of 22 patients (9.1$\~$) treated with radiation therapy alone experienced more than 5 kg weight loss during the treatment. There was no statistically significant difference on weight loss between two groups (P=0.63). Two patients on each group were not evaluable for the early response because of incomplete treatment. The complete response rate at four weeks' follow-up was 80$\~$(16/20) for the radiation therapy alone group and 78$\~$ (11/14) for the radiation therapy and cisplatin group. There was no statistically significant difference in early response between two treatment groups (P=0.126). Conclusion : This study led to the conclusion that the hematologic toxicity from the treatment with concurrent radiation therapy and low dose daily cisplatin seems to be more prominent than that from the treatment of radiation therapy alone. There was no grade 4 hematologic toxicity or mortality in both groups. The hematologic toxicity in both treatment groups seems to be well managable modically. Since the risk factors were not balanced between two treatment groups, the direct comparison of early response of both groups was not possible. However, preliminary results regarding early response for patients with bulky cervical tumor mass treated with radiation therapy and low dose daily cisplatin was encouraging. Longer follow-up is necessary to evaluate the survival data. A phase III study is needed to evaluate the efficacy of concurrent daily low dose cisplatin with radiation therapy in bulky cervical cancer.

• Radiation Oncology Journal
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• v.32 no.1
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• pp.7-13
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• 2014

Purpose: To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. Materials and Methods: Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). Results: The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (${\geq}50$ Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). Conclusion: In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.

• Korean Journal of Digital Imaging in Medicine
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• v.13 no.4
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• pp.165-169
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• 2011

The purpose of this study is to compare the measurement result of radiation dose by using standard thoracic phantom and ionization chamber to advice proposal in the shooting condition of chest PA projection at hospitals recently. And to understand the change between radiation dose and resolution in different conditions. The period this study was from August 2010 to September 2010 and the subjects of the study was 3 general hospitals, 4 personal hospitals and 1 laboratory at the college. Finally we study with 6 DR, 1 CR, and 4 F/S equipments. Most hospitals met advice proposal, but some of the hospitals exceed advice dose from the result of our study. We can lower radiation dose about 25% when kVp is lowered about 20% in DR equipment. And we can lower radiation dose about 50% when mAs is lowered about 35%. The image quality was similar to the original in the study. Most hospitals which exceed advice dose were personal hospitals. The reason why it happened is that radiation dose for chest PA projection at personal hospitals is higher than general hospitals and the personal hospitals' equipments are older than general hospitals' equipments. We guess that patients' radiation dose of chest PA projection can be lowered from the result.