• Imaging Science in Dentistry
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• 제30권1호
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• pp.33-48
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• 2000

Purpose : To investigate osseointergration of titanium implants into the tibia of rabbits, which were fed a low calcium diet and irradiated. Materials and Methods : To prepare the experimental model, control group was fed a normal diet and experimental group was fed a low calcium diet for 4 weeks. And then, titanium implants were inserted into the tibia of each rabbit. Experimental group was subdivided into two groups; low calcium diet/non-irradiation group and low calcium diet/irradiation group. The low calcium diet/irradiation group was irradiated with a single absorbed dose of 15 Gy at the 5th postoperative day. At 12, 19, 33, 47, and 61 days after implantation (1, 2, 4, 6, and 8 weeks after irradiation), the bone formation in the bone-implant interface area was examined by light microscopy and fluorescent microscopy. Results and Conclusions: 1. In the control group, there began to form woven bone in the bone-implant interface area at 12 days after implantation. As the experimental time was going on, the amount of bone which was in contact with the implant was increased. 2. In the low calcium diet/non-irradiation group, there began to form woven bone in the bone-implant interface area at 19 days after implantation. Although the amount of bone which was in contact with the implant was increased as the experimental time was going on, the extent of increased bone was weak as compared with control group. 3. In the low calcium diet/irradiation group, there began to form woven bone incompletely in the bone-implant interface area at 19 days after implantation, but there were vascular connective tissues in the bone-implant interface area over the entire experimental period. 4. In the control group and low calcium diet/non-irradiation group, bone labeling bands were observed at 33 days after implantation, which suggests that the bone formation and remodeling was in process, but interstitial bone remodeling was not observed in the low calcium diet/irradiation group.

• Radiation Oncology Journal
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• 제28권3호
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• pp.125-132
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• 2010

목 적: 자궁경부암에서 근치적 절제술 후 림프절 침범은 중요한 예후인자 중 하나이다. 본 연구에서는 총장골동맥림프절 침범 시 대동맥주위림프절에 대한 예방적 방사선조사의 효과를 알아보고자 하였다. 대상 및 방법: 1985년 5월부터 2004년 10월까지 총 909명의 환자가 서울대병원에서 자궁경부암으로 근치적 절제술 후 방사선치료를 시행받았다. 골반 내 림프절 침범이 있는 환자는 375명이었고 총장골동맥림프절 침범이 있는 환자는 69명이었다. 이 중 총장골동맥림프절 침범이 있으면서 대동맥주위림프절 침범은 없었던 54명의 환자를 대상으로 후향적 분석을 시행하였다. 대상환자의 FIGO 병기는 IB, IIA, IIB가 각각 22명, 21명, 11명이었다. 이 중 10명은 전골반과 대동맥주위림프절을 포함하는 확장조사야로 방사선치료를 받았고 모두 항암화학치료를 병용하였으며, 나머지 44명은 전골반 만을 포함하는 표준조사야로 방사선치료를 받았고 이 중 16명이 항암화학치료를 병용하였다. 확장조사군과 표준조사군의 추적관찰기간은 각각 21~58개월(중간값, 47개월)과 6~201개월(중간값, 58개월)이었다. 결 과: 전체 환자의 4년 생존율, 4년 무병생존율, 4년 무전이생존율은 각각 70.0%, 61.1%, 71.7%였다. 단변량 분석 시 절제연 침범(p<0.001), 림프관내 종양 침범(p=0.041)이 있는 경우 유의하게 생존율이 낮았고, 양측 림프절침범(p=0.001), 5개 이상의 림프절 전이(p=0.006)가 있는 경우 유의하게 낮은 무병생존율을 보여주었다. 낮은 무전이생존율과 관련 있는 인자는 양측 림프절 침범(p=0.009), 5개 이상의 림프절 전이(p=0.003), 자궁경부 전층 침범(p=0.013), 절제연 침범(p=0.014), 림프관내 종양 침범(p=0.041)이었다. 확장조사군과 표준조사군의 4년 생존율은 90.0%와 67.2% (p=0291), 4년 무병생존율은 70.0%와 59.0% (p=0.568), 4년 무전이생존율은 90.0%와 67.5% (p=0.196), 4년 대동맥주위림프절 전이율은 0%와 14.3% (p=0.249)로 통계적으로 유의한 차이가 없었다. 3등급 이상의 중등도 급성합병증은 확장조사군 10명 중 4명(40%; 조혈계 2명, 위장관계 2명)에서 발생하였고, 표준조사군 44명 중에서는 11명(25%; 조혈계 2명, 위장관계 6명, 비뇨생식계 3명)에서 발생하였다. 결론: 자궁경부암의 근치적 절제술 후 총장골동맥림프절 침범이 있는 경우 예방적 대동맥주위림프절 방사선조사의 생존율에 대한 통계적 유용성은 확인할 수 없었다. 그러나 확장조사야로 치료받은 환자수가 적고 추적관찰기관이 짧았던 점을 고려하면 추가적인 추적관찰이 필요할 것으로 생각한다.

• Journal of Korean Neurosurgical Society
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• 제50권6호
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• pp.503-506
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• 2011

Objective : The aim of this study was to assess the safety and efficacy of radiation-sterilized allografts of iliac bone and fascia lata from cadaver specimens to repair skull base defects after transsphenoidal surgery. Methods : Between May 2009 and January 2010, 31 consecutive patients underwent endonasal transsphenoidal surgery and all patients received sellar reconstruction using allografts following tumor removal. The allografts were obtained from the local tissue bank and harvested from cadaver donors. The specimens used in our approach were tensor fascia lata and the flat area of iliac bone. For preparation, allografts were treated with gamma irradiation after routine screening by culture, and then stored at $-70^{\circ}C$. Results : The mean follow-up period after surgery was 12.6 months (range, 7.4-16 months). Overall, postoperative cerebrospinal fluid (CSF) leaks occurred in three patients (9.7%) and postoperative meningitis in one patient (3.2%). There was no definitive evidence of wound infection at the routine postoperative follow-up examination or during re-do surgery in three patients. Postoperative meningitis in one patient was improved with the use of antibiotics and prolonged CSF diversion. Conclusion : We suggest that allograft materials can be a feasible alternative to autologous tissue grafts for sellar reconstruction following transsphenoidal surgery under selected circumstances such as no or little intraoperative CSF leaks.

• Journal of Korean Neurosurgical Society
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• 제59권6호
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• pp.597-603
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• 2016

Introduction : Perioperative irradiation is often combined with spine tumor surgery. Radiation is known to be detrimental to healing process of bone fusion. We tried to investigate bone fusion rate in spine tumor surgery cases with perioperative radiation therapy (RT) and to analyze significant factors affecting successful bone fusion. Methods : Study cohort was 33 patients who underwent spinal tumor resection and bone graft surgery combined with perioperative RT. Their medical records and radiological data were analyzed retrospectively. The analyzed factors were surgical approach, location of bone graft (anterior vs. posterior), kind of graft (autologous graft vs. allograft), timing of RT (preoperative vs. postoperative), interval of RT from operation in cases of postoperative RT (within 1 month vs. after 1 month) radiation dose (above 38 Gy vs. below 38 Gy) and type of radiation therapy (conventional RT vs. stereotactic radiosurgery). The bone fusion was determined on computed tomography images. Result : Bone fusion was identified in 19 cases (57%). The only significant factors to affect bony fusion was the kind of graft (75% in autograft vs. 41 in allograft, p=0.049). Other factors proved to be insignificant relating to postoperative bone fusion. Regarding time interval of RT and operation in cases of postoperative RT, the time interval was not significant (p=0.101). Conclusion : Spinal fusion surgery which was combined with perioperative RT showed relatively low bone fusion rate (57%). For successful bone fusion, the selection of bone graft was the most important.

• Radiation Oncology Journal
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• 제31권4호
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• pp.228-233
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• 2013

Purpose: The aim of this study was to evaluate changes in breast tumor bed volume during whole breast irradiation (WBI). Materials and Methods: From September 2011 to November 2012, thirty patients who underwent breast-conserving surgery (BCS) followed by WBI using computed tomography (CT) simulation were enrolled. Simulation CT scans were performed before WBI (CT1) and five weeks after the breast irradiation (CT2). The tumor bed was contoured based on surgical clips, seroma, and postoperative change. We retrospectively analyzed the factors associated with tumor bed volumetric change. Results: The median tumor bed volume on CT1 and CT2 was 29.72 and 28.6 mL, respectively. The tumor bed volume increased in 9 of 30 patients (30%) and decreased in 21 of 30 patients (70%). The median percent change in tumor bed volume between initial and boost CT was -5%. Seroma status (p = 0.010) was a significant factor in tumor bed volume reduction of 5% or greater. However, patient age, body mass index, palpability, T stage, axillary lymph node dissection, and tumor location were not significant factors for tumor bed volumetric change. Conclusion: In this study, volumetric change of tumor bed cavity was frequent. Patients with seroma after BCS had a significant volume reduction of 5% or greater in tumor bed during breast irradiation. Thus, resimulation using CT is indicated for exquisite boost treatment in breast cancer patients with seroma after surgery.

• Radiation Oncology Journal
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• 제17권3호
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• pp.187-194
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• 1999

목적: 국소적으로 진행된 갑상선 유두암환자에서 수술 후 방사선치료의 성적을 분석하고, 수술과 방사선 동위원소치료를 받은 환자의 치료성적과 비교하여 방사선치료의 효과를 알아보고자 하였다. 대상 및 방법: 본 연구는 1981년 8월부터 1997년 9월까지 국소적으로 진행된 갑상선 유두암(capsular Invasion, extracapsular Invasion or LN metastasis) 환자 91명을 대상으로 하였다. 방사선치료군(23명)의 연령분포는 18세부터 71세였고, 평균연령은 44세였으며, 여자 21명, 남자 2명였다. 원발병소는 주변조직의 침습이 있는 경우(capsular invasion, extracapsular extension)가 22명, 림프절 전이는 16명에서 있었고, 원격전이는 2명에서 있었다. 모든 환자에서 근치적 수술를 시행하였고, 1-125치료는 12명에서 시행하였다. 방사선치료는 Co-60 과 4 MV X-ray를 이용하여 일일선량 $1.8\~2.0$ Gy씩 주 5회 치료하였고 원발병소에 $50\~70$ Gy의 방사선을 조사하였다. 수술과 방사선 동위원소치료군(68명)의 연령분포는 10세부터 74세였고, 평균연령은 43세였으며, 여자 51명, 남자 17명였다. 원발병소는 주변조직의 침습이 있는 경우 51명, 림프절 전이는 45명에서 있었고, 원격전이는 없었다. 모든 환자에서 근치적 수술과 방사선 동위원소치료를 시행하였다. 전체환자의 평균 추적기간은 55.7개월이었다. 결과: 방사선치료군은 국소재발이 2명, 원격전이가 2명(폐전이, 다발성 골전이)에서 있었고, 5년 국소제어율은 $95.2\%$였고, 수술과 동위원소 치료군은 국소재발이 16명, 원격전이가 4명(폐전이) 에서 있었으며, 5년 국소제어율은 $67.5\%$였다. 결론: 국소적으로 진행된 갑상선 유두암 환자에서 방사선치료는 국소재발을 감소시킬 수 있는 효과적인 치료 방법이 될 수 있음을 확인할 수 있었다.

• Radiation Oncology Journal
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• 제13권1호
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• pp.41-48
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• 1995

목적 :조기 자궁경부암 환자에서 보조적 방사선치료요법은 근치적수술을 시행하고 재발의 위험이 높은 불량한 예후를 갖는 환자에서 시행되고 있다. 이에 저자는 수술후 방사선치료를 받았던 환자의 생존과 치료실패에 영향을 주는 예후인자를 분석하고자 하였다. 대상 및 방법 :전남대학교병원 치료방사선과에서 1985년 8월부터 1988년 12월까지 수술후 방사선치료를 받았던 자궁경부암 병기 IB와 IIA환자 106명중 기록이 충분한 90명을 대상으로 후향적 분석을 시행하였다. 추적율은 $88\%$(78/90)였고 추적기간의 중간간은 64개월이었다. 결과 : 90명에 대한 5년 생존율및 5년 무병생존율은 각각 $80.0\%$, $80.2\%$였다. 다변량생존분석에서 65명을 대상으로 환자의 연령, 병기, 조직학적 분류, 수술전 혈중 CIA 농도, 출산력, 경부침윤정도, 종양의 육안적 크기, 종양의 궤양성 유무, 임파선 전이 유무, 수술절단면의 소견, 항암제치료 유무를 변수로 분석결과 수술절단면의 조직학적인 소견(p=0.005), 임파선전이유무(p=0.005)가 통계학적으로 의미있는 예후인자였다. 추적기간중 13명에서 재발이 확인되었고 부위별로 보면 골반내 국소재발이 5명, 원격전이가 8명 이었으며 수술후 3개월에서 39개월사이에 발견되었으며 중간값은 19개월이었다. 골반내 전이는 선암(p=0.034)과 경부침윤 10mm 이상(p=0.02) 그리고 항암제치료(p=0.023)를 시행하였던 환자군에서, 원격 전이에 있어서는 임파선전이와 수술절단면에서 암세포가 양성을 보였던 환자군에서 각각 더 높은 전이율을 보였다. 치료에 의한 합병증을 호소하였던 환자는 15명이었으며 가장 흔한 증상은 혈변이나 혈뇨였고 중증의 합병증을 보인 환자는 없었다. 결론 : 이에 저자는 조기자궁경부암 IB와 IIA환자에서 수술병리학적소견중 임파선전이와 불충분한 수술적절제가 예후에 있어서 가장 큰 영향을 보임을 알 수 있었으며 이러한 소견을 보인 환자는 보다 적극적인 보조치료가 필요하리라 사료된다.

• Journal of Chest Surgery
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• 제23권4호
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• pp.825-830
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• 1990

Esophageal cancer is relatively uncommon except in isolated endemic areas, but it generally devastating to the patient. Usually, by the time the disease becomes clinically evident, it is incurable. The aim of treatment is then relegated to attempting to palliate the symptoms in the best possible manner with the least morbidity and mortality. Squamous cell carcinoma in by far the commonest type of malignancy involving the body of the esophagus, accounting for more than 95 percent of all esophageal malignancies. Because the tumor’s microscopic spread is much greater than its macroscopic extent, it is necessary to resect a sufficiently long segment of the esophagus. And second tumors may occur either in the esophagus as a manifestation of a field change or in other organs. Recently we had experienced a case with in situ carcinoma away from the invasive squamous cell carcinoma of the esophagus. A 58 year-old male was admitted with the chief complaint of swallowing difficulty for a month prior to admission. While we studied the esophagogram and chest CT, we found that the mass was protruded to the lumen of esophagus at the level of the 7th-9th thoracic vertebral columns. We performed esophagectomy with lymph node dissection and esophagogastrostomy by thoracic and abdominal approaches. The pathologic result showed separation of another in situ carcinoma away from the invasive squamous cell carcinoma of esophagus at the level of esophagogastric junctions. Postoperative course was uneventful. Now he is taking the postoperative irradiation at out patient department.

• Radiation Oncology Journal
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• 제29권4호
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• pp.277-282
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• 2011

Purpose: This study was performed to evaluate the change in the lumpectomy cavity volumes before and after whole breast radiation therapy (WBRT) and to identify factors associated with the change of volume. Materials and Methods: From September 2009 to April 2010, the computed tomography (CT) simulation data from 70 patients obtained before and after WBRT was evaluated. The lumpectomy cavity volumes were contoured based on surgical clips, seroma, and postoperative changes. Significant differences in the data from pre-WBRT CT and post-WBRT CT were assessed. Multiple variables were examined for correlation with volume reduction in the lumpectomy cavity. Results: The mean and median volume reduction in the lumpectomy cavity after WBRT were 17.6 $cm^3$ and 16.1 $cm^3$, respectively with the statistical significance (p < 0.001). The volume reduction in the lumpectomy cavity was inversely correlated with time from surgery to radiation therapy (R = 0.390). The presence of seroma was significantly associated with a volumetric change in the lumpectomy cavity after WBRT (p = 0.011). Conclusion: The volume of lumpectomy cavity reduced significantly after WBRT. As the time from surgery to the start ot WBRT increased, the volume reduction in the lumpectomy cavity during WBRT decreased. A strong correlation was observed between the presence of seroma and the reduced volume. To ensure appropriate coverage and to limit normal tissue exposure during boost irradiation in patients who has seroma at the time of starting WBRT, repeating CT simulation at boost planning is suggested.

• 대한골관절종양학회지
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• 제1권1호
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• pp.84-90
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• 1995

To evaluate the role of radiation and chemotherapy after limb-saving operation in the management of soft tissue sarcoma, the authors analysed retrospectively 33 patients treated in department of Orthoaepdic Surgery and Radiation Therapy, Catholic University Medical College, in terms of survival rate, local recurrence rate and prognostic factors. There were 16 males and 17 females. The age distribution ranged from 16 to 81 years with mean age of 48. The follow-up period ranged from 2 to 10 years with average of 5.5 years. The histologic diagnoses were 9 liposarcoma(27.2%), 8 malignant fibrohistiocytoma(24.2%), 7 unclassifiable(21.2%), 3 rhabdomyosarcoma(9.1%), 2 malignant schwannoma, 2 synovral sarcoma, and 2 fibrosarcoma(6.1%) in orders. While marginal and intralesional margins were gained in 24 patients(72.7%), wide and radical margins were obtained only in 9 patients(27.3%). On postoperative 3 weeks, local irradiation of 5000-7000 cGy was delivered to all patients by shrinking field technique for 5-8 weeks. Of 33 patients, 16(45.5%) patients were received adjuvant chemotherapy in combination of adriamycin, cyclophosphamide & vicristine, or VP16 & ifosfamide based on histologic type and obtained surgical margin. The survival rates by direct method at 2 years and 5 years were 58% and 37% respectively. Local recurrences occured in 15 patients(45.5%) at average 16 months after operation. Survival rates at 2 years and 5 years were 37% and 22% in case of intralesional and manginal excision, 75% and 47% in case of wide and radical excision respectively with statistical significance(p<0.05). They were 25% and 17% in the presence of local recurrence, 67% and 42% in the absence of local recurrence respectively with statistical significance(p<0.05). Even though there was no statistical correlation between survival rate and tumor size(p>0.05), the authors considered tumor size as a significant prognostic factors as well as surgical margin and the presence of local recurrence.