• Radiation Oncology Journal
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• v.11 no.2
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• pp.387-395
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• 1993

To identify pretreatment prognostic factors in carcinoma of the uterine cervix, a retrospective analysis was undertaken of 510 patients treated with curative radiation therapy in Seoul National University Hospital during the 7 year period, from March 1979 through December 1986. According to FIGO classification,35 patients were stage I B,89 were stage IIA, 232 were stage IIB,8 were stage IIIA, 134 were IIIB, and 12 were stage IVA. Five year locoregional control (LRC) rates in stage I B, II A, II B, IIIA, IIIB, and IVA were $79\%,78\%,70\%,58\%,51\%\;and\;27\%,$ respectively. Five year disease free survival (DFS) rates were $76\%,67\%,60\$,57\%,40\%,\;and\;25\%,$ respectively. Overall survival (OS) rates at five years were $82\%,72\%,67\%,67\%,51\%,\;and\;33\%,$ respectively. In univariate analyses, stage, age, initial hemoglobin level, type of histology, tumor size, and several CT findings including pelvic lymph node (LN) status, paraaortic lymph node (PAN) status, extent of parametrial invasion, bladder invasion, and rectal invasion were significant factors in terms of LRC. All these factors and elevation of BUN or creatinine were associated with DFS. In terms of overall survival, stage, initial hemoglobin level, type of histology, tumor size, elevation of BUN or creatinine, and five CT findings associated with LRC were prognostically significant. In multivariate analysis excluding CT findings, stage IV disease, non-squamous histology, and tumor size $\ge$4 cm were associated with poor LRC and DFS. Stage IV disease and tumor size significantly affected OS. in multivariate analysis including CT findings, histology, tumor size, and pelvic LN status on CT were uniformly significant in terms of LRC, DFS, and 05, PAN status on CT affected overall survival only.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.128-139
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• 1998

Background: It is well known that various cytokines and growth factors secreted mainly from alveolar macrophages do the key role in the pathogenesis of IPF. But recently it has been known that structural cells like fibroblast can also release cytokines. So the phenotypic changes in fibroblasts of IPF may do a role in continuous progression of fibrosis. The aim of this study is to find out whether there is a change in the biologic properties of the lung fibroblasts of IPF. Subjects and Method: The study was done on 13 patients with IPF diagnosed by open or thoracoscopic lung biopsy and 7 control patients who underwent resectional surgery for lung cancer. Lung fibroblast cell lines (FB) were established by explant culture technique from the biopsy or resected specimen Result: Basal proliferation of the fibroblast of IPF(IFB) measured by BrdU uptake tended to be highter than control fibroblast(NFB) (0.212 0.107 vs $0.319{\pm}0.143$, p=0.0922), also there was no significant difference in proliferation after the stimulation with PDGF or 10% serum. On the contrary, the degree of inhibition in proliferation by PGE2 was significantly lower($33.0{\pm}13.1%$) in IFB than control($46.7{\pm}10.0%$, p=0.0429). The IFB secreted significantly higher amount of MCP-l($l574{\pm}1283$ pg/ml) spontaneously than NFB($243{\pm}100$ pg/ml) and also after the stimulation with TGF-$\beta$($3.23{\pm}1.31$ ng/ml vs $0.552{\pm}0.236$ ng/ml, p=0.0012). Similarly IL-8 and IL-6 seretion of IFB was significantly higher than NFB at basal state and with TGF-$beta$ stimulation. But after the maximal stimulation with IL-1,8, no significant difference in cytokine secretion was found between IFB and NFB. Conclusion : Above data suggest that the fibroblasts of IPF were phenotypically changed and these change may do a role in the pathogenesis of IPF.

• Journal of Gastric Cancer
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• v.6 no.1
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• pp.36-42
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• 2006

Purpose: The $p21^{Waf1/Cip1}$ protein Inhibits the cell cycle by Inhibiting the phosphorylation at the $G1{\rightarrow}S$ check point, and the $p27^{kip1}$ protein similarly performs the suppressor function by controlling the p27-mediated G1 arrest. In this study, we analysed the clinical status and survival rates in correlations with p21 and p27 expression patterns in gastric cancer. Materials and Methods: Between 1993 and 1997, 192 patients who underwent surgeries in Catholic Medical Center were analysed retrospectively in this study. Immunohistochemical staining was performed and if the nuclei of the tumor cells were stained, we assumed those as positive results. Statistical analysis was based on clinicopathological findings and differences in survival rates. Results: The expression rate of p27 was 28.1% and 15.6% in p21 each. The ratio of T1-2(80.0%) was significantly high in p21 (+), but the ratio of T3-4 (50.6%) was slightly high in p21 (-). There was no statistical significance regarding other factors. The results in p27 was not much different from expression rate of p21 in T-stage. In addition, p27 expression in diffuse type (91.3%) was higher than in intestinal type (62.7%) by Lauren's classification (P<0.05). Also, there was no statistical significance in other factors. In the correlation of p21 and p27, p27 was positive when p21 was positive (53.5%). Conversely, p27 was negative when p21 was negative (76.5%, p<0.05). In the p21 and p27 combination test, there was higher rate of T1-2 (87.5%) in p21 (+)/p27 (+), and higher rate of T3-4 (58.1%) in p21 (-)/p27 (-) (P<0.05). Results showed higher rate of intestinal type (100%) in p21 (+)/p27 (+), and diffuse type (87.0%) was dominant in p21 (-)/p27 (-) (P<0.05) by Lauren's classification. Moreover, there was no statistical significance in the 5-year survival rate in the expression of p21 and p27, and the 5-year survival rate was highest in the case of p21 (+)/p27 (+) without statistical significance. Conclusion: In our study, $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ expressed similar patterns. The expression of $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ affected the degree of invasiveness of the tumor, and. Combined examination result revealed the correlation of $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ with Lauren's classification and depth of invasion of the tumor. However, we assumed that little difference between the survival rates depending on expression of $p21^{Waf1/Cip1}\;and\;p27^{kip1}$ has limited their value as predictable prognostic indicators.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.2
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• pp.355-362
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• 2014

Purpose : When head&neck cancer radiation therapy, thermoplastic mask is applied for patients with fixed. The purpose of this study is to evaluate usefulness of thermoplastic mask for SRS in tomotherapy by conparison with the conventional mask. Materials and Methods : Typical mask(conventional mask, C-mask) and mask for SRS are used to fix body phantom(rando phantom) on the same iso centerline, then simulation is performed. Tomotherapy plan for orbit and salivary glands is made by treatment planning system(TPS). A thick portion and a thin portion located near the treatment target relative to the mask S-mask are defined as region of interest for surface dose dosimetry. Surface dose variation depending on the type of mask was analyzed by measuring the TPS and EBT film. Results : Surface dose variation due to the type of mask from the TPS is showed in orbit and salivary glands 0.65~2.53 Gy, 0.85~1.84 Gy, respectively. In case of EBT film, -0.2~3.46 Gy, 1.04~3.02 Gy. When applied to the S-mask, in TPS and Gafchromic EBT3 film, substrantially 4.26%, 5.82% showed maximum changing trend, respectively. Conclusion : To apply S-mask for tomotherapy, surface dose is changed, but the amount is insignificant and be useful when treatment target is close critical organs because decrease inter and intra fractional variation.

• Journal of Oral Medicine and Pain
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• v.30 no.3
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• pp.301-317
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• 2005

The number of patients with tongue carcinoma is increasing rapidly among young individuals in many parts of the world. Oral carcinoma progresses from hyperplastic lesion through dysplasia to invasive carcinoma and the concept of "field cancerization" with molecular alteration has been suggested for oral cavity carcinogenesis. Significant improvement in treatment and prognosis will depend on more detailed understanding of the multi-step process leading to cancer development. To induce tongue carcinoma in rat by 4-NQO, each drinking water was made to 10 ppm, 25 ppm, 50 ppm and control (only D.W. without 4-NQO). Specimens were classified into 4 groups such as control, I (mild & moderate dysplasia), II (severe dysplasia and carcinoma in situ), III (carcinoma). The mRNA expressions of Bcl-2 family were evaluated by RT-PCR technique. For anti-apoptotic Bcl-2 family, mRNA expression of Bcl-w was down-regulated in all stages of tongue carcinogenesis model. However, mRNA expression of Bcl-2 was up-regulated. For pro-apoptotic Bcl-2 family, all members were down-regulated in all stages of tongue carcinogenesis model except for Bad mRNA in group III. In terms of BH3 only protein, mRNA expressions of Bok and Mcl-1 were down regulated in all stages of specimen, but Bmf in group II and BBC3 in group III were up-regulated. Our current findings demonstrated the involvements of mRNA expression of Bcl-2 family in multi-step tongue carcinogensis. This highlights the necessity for continued efforts to discover suitable biomakers (Bcl-2 family) for early diagnosis of the disease, and to understand its pathogenesis as a first step in improving methods of treatment. The discovery of these potential biomarkers and molecular targets for cancer diagnostics and therapeutics has the potential to significantly change the clinical approach and outcome of the disease.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.31-43
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• 2015

Purpose : Stereotactic body radiation therapy (SBRT) has proved its efficacy in several patient populations with primary and metastatic limited tumors. Because SBRT prescription is high dose level than Conventional radiation therapy. SBRT plan is necessary for effective Organ at risk (OAR) protection and sufficient Planning target volume (PTV) dose coverage. In particular, multi-target cases may result excessive doses to OAR and hot spot due to dose overlap. This study evaluate usefulness of Volumetric modulated arc therapy (VMAT) in dosimetric and technical considerations using Flattening filter free (FFF) beam. Materials and Methods : The treatment plans for five patients, being treated on TrueBeam STx(Varian$^{TM}$, USA) with VMAT using 10MV FFF beam and Standard conformal radiotherapy (CRT) using 15MV Flattening filter (FF) beam. PTV, liver, duodenum, bowel, spinal cord, esophagus, stomach dose were evaluated using the dose volume histogram(DVH). Conformity index(CI), homogeneity index(HI), Paddick's index(PCI) for the PTV was assessed. Total Monitor unit (MU) and beam on time was assessed. Results : Average value of CI, HI and PCI for PTV was $1.381{\pm}0.028$, $1.096{\pm}0.016$, $0.944{\pm}0.473$ in VMAT and $1.381{\pm}0.042$, $1.136{\pm}0.042$, $1.534{\pm}0.465$ in CRT respectively. OAR dose in CRT plans evaluated 1.8 times higher than VMAT. Total MU in VMAT evaluated 1.3 times increase than CRT. Average beam on time was 6.8 minute in VMAT and 21.3 minute in CRT. Conclusion : VMAT for SBRT in multi-target liver cancer using FFF beam is effective treatment techniqe in dosimetric and technical considerations. VMAT decrease intra-fraction error due to treatment time shortening using high dose rate of FFF beam.

• Tuberculosis and Respiratory Diseases
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• v.43 no.1
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• pp.46-53
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• 1996

Background: Endotoxin or lipopolysaccharide(LPS) can prime phagocytic cells such as polymorphonuclear leukocytes, monocytes or animal peritoneal macrophages to generate increased amounts of secretory products such as oxygen free radicals and tumor necrosis factor, which play an important role in developing adult respiratory distress syndrome in gram negative sepsis. Human alveolar macrophages(HAM) are continuously exposed to various stimuli inhaled into the alveoli, and the response to LPS might be different in HAM. Therefore, we investigated the effect of LPS pre-exposure on HAM adhered to plastic surface and A549 cell(type II human alveolar epithelial cell line) monolayer. Methods: HAM were isolated from bronchoalveolar lavage fluid from normal lung of the patients with localized lung cancer and esophageal cancer. LPS was exposed to HAM for 2hrs before or after adherence to plastic surface of 24-well Linbro plate and A549 cell monolayer. And then HAM was stimulated with PMA(phorbol myristate acetate) or fMLP(N-formyl-methionylleucyl-phenylalanine). The amount of hydrogen peroxide($H_2O_2$) production in the supernatant was measured on the principle of peroxidase-dependent oxidation of phenol red by hydrogen peroxide. Results: LPS pre-exposure could not enhance $H_2O_2$ production in neither HAM adhered to plastic surface nor one to A549 cell monolayer. But LPS even in the absence of PMA or fMLP stimulation directly increased $H_2O_2$ release in HAM if added after the adherence to A549 cell monolayer. Conclusion: Endotoxin does not prime HAM, but may directly activate HAM adhered to alveolar epithelial cells. Further investagation will be necessary.

• The Korean Journal of Nuclear Medicine
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• v.28 no.3
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• pp.384-390
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• 1994

Authors retrospectively compared the 99mTc MDP bone scans and corresponding MR imagings in 20 patients with histologically proven malignancy, Mean interval of the two studies was 16.6 days, Cancer diagnosis Included 8 lung, 2 each of colon, breast, stomach, 1 each of prostate, thyroid, malignant lymphoma and 3 adenocarcinoma of unknown primary site. Of the 105 regions compared, :t6 regions were positive for metastases in bone scans or MR imagings. 30 regions(65.2%) were positive by bone scan and 44 regions(95.7%) by MR imaging. 87 regions(82.9%) were concordantly positive or negative by bone scan and MR imaging, but 18 regions(17.1%) were discordant. In the discordant regions, 16 regions positive in MR imaging were negative in bone scan. The greatest number of discordant findings occured in the cervical region and in the patient with stomach cancer. Our results suggest that the sensitivity of MR Imaging is greater than that of bone scan in detecting spinal metastases. And bone scan is useful screening test of metastasis for evaluating entire skeleton including spine.

• The Journal of Korean Society for Radiation Therapy
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• v.26 no.1
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• pp.29-35
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• 2014

Purpose : This study has already started commercial Gated RapidArc automation equipment which was not previously in the Gated radiation therapy can be performed simultaneously with the VMAT Gated RapidArc radiation therapy to the accuracy of the analysis to evaluate the usability, Amplitude mode applied to the patient. Materials and Methods : The analysis of the distribution of radiation dose equivalent quality solid water phantom and GafChromic film was used Film QA film analysis program using the Gamma factor (3%, 3 mm). Three-dimensional dose distribution in order to check the accuracy of Matrixx dosimetry equipment and Compass was used for dose analysis program. Periodic breathing synchronized with solid phantom signals Phantom 4D Phantom and Varian RPM was created by breathing synchronized system, free breathing and breath holding at each of the dose distribution was analyzed. In order to apply to four patients from February 2013 to August 2013 with liver cancer targets enough to get a picture of 4DCT respiratory cycle and then patients are pratice to meet patient's breathing cycle phase mode using the patient eye goggles to see the pattern of the respiratory cycle to be able to follow exactly in a while 4DCT images were acquired. Gated RapidArc treatment Amplitude mode in order to create the breathing cycle breathing performed three times, and then at intervals of 40% to 60% 5-6 seconds and breathing exercises that can not stand (Fig. 5), 40% While they are treated 60% in the interval Beam On hold your breath when you press the button in a way that was treated with semi-automatic. Results : Non-respiratory and respiratory rotational intensity modulated radiation therapy technique absolute calculation dose of using computerized treatment plan were shown a difference of less than 1%, the difference between treatment technique was also less than 1%. Gamma (3%, 3 mm) and showed 99% agreement, each organ-specific dose difference were generally greater than 95% agreement. The rotational intensity modulated radiation therapy, respiratory synchronized to the respiratory cycle created Amplitude mode and the actual patient's breathing cycle could be seen that a good agreement. Conclusion : When you are treated Non-respiratory and respiratory method between volumetric intensity modulated radiation therapy rotation of the absolute dose and dose distribution showed a very good agreement. This breathing technique tuning volumetric intensity modulated radiation therapy using a rotary moving along the thoracic or abdominal breathing can be applied to the treatment of tumors is considered. The actual treatment of patients through the goggles of the respiratory cycle to create Amplitude mode Gated RapidArc treatment equipment that does not automatically apply to the results about 5-6 seconds stopped breathing in breathing synchronized rotary volumetric intensity modulated radiation therapy facilitate could see complement.

• Progress in Medical Physics
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• v.25 no.2
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• pp.100-109
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• 2014

In stereotactic body radiotherapy (SBRT), the accurate location of treatment sites should be guaranteed from the respiratory motions of patients. Lots of studies on this topic have been conducted. In this letter, a new verification method simulating the real respiratory motion of heterogenous treatment regions was proposed to investigate the accuracy of lung SBRT for Volumetric Modulated Arc Therapy. Based on the CT images of lung cancer patients, lung phantoms were fabricated to equip in $QUASAR^{TM}$ respiratory moving phantom using 3D printer. The phantom was bisected in order to measure 2D dose distributions by the insertion of EBT3 film. To ensure the dose calculation accuracy in heterogeneous condition, The homogeneous plastic phantom were also utilized. Two dose algorithms; Analytical Anisotropic Algorithm (AAA) and AcurosXB (AXB) were applied in plan dose calculation processes. In order to evaluate the accuracy of treatments under respiratory motion, we analyzed the gamma index between the plan dose and film dose measured under various moving conditions; static and moving target with or without gating. The CT number of GTV region was 78 HU for real patient and 92 HU for the homemade lung phantom. The gamma pass rates with 3%/3 mm criteria between the plan dose calculated by AAA algorithm and the film doses measured in heterogeneous lung phantom under gated and no gated beam delivery with respiratory motion were 88% and 78%. In static case, 95% of gamma pass rate was presented. In the all cases of homogeneous phantom, the gamma pass rates were more than 99%. Applied AcurosXB algorithm, for heterogeneous phantom, more than 98% and for homogeneous phantom, more than 99% of gamma pass rates were achieved. Since the respiratory amplitude was relatively small and the breath pattern had the longer exhale phase than inhale, the gamma pass rates in 3%/3 mm criteria didn't make any significant difference for various motion conditions. In this study, the new phantom model of 4D dose distribution verification using patient-specific lung phantoms moving in real breathing patterns was successfully implemented. It was also evaluated that the model provides the capability to verify dose distributions delivered in the more realistic condition and also the accuracy of dose calculation.