• Radiation Oncology Journal
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• 제38권2호
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• pp.109-118
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• 2020

Purpose: Hypofractionated radiotherapy (RT) is becoming a new standard in postoperative treatment of patients with early stage breast cancer after breast conservation surgery. However, data on hypofractionation in patients with advanced stage disease who undergo mastectomy followed by local and regional nodal irradiation (RNI) is lacking. In this retrospective study, we report late-term effects of 3 weeks post-mastectomy hypofractionated local and RNI with two-dimensional (2D) technique in patients with stage II and III breast cancer. Methods: Between January 1990 and December 2007, 1,770 women with breast cancer who were given radical treatment with mastectomy, systemic therapy and RT at least 10 years ago were included. RT dose was 35 Gy/15 fractions/3 weeks to chest wall by two tangential fields and 40 Gy in same fractions to supraclavicular fossa (SCF) and internal mammary nodes (IMNs). SCF and IMNs dose was prescribed at d_max and 3 cm depth, respectively. Chemotherapy and hormonal therapy was given in 64% and 74% patients, respectively. Late-term toxicities were assessed with the Radiation Therapy Oncology Group (RTOG) scores and LENT-SOMA scales (the Late Effects Normal Tissue Task Force-Subjective, Objective, Management, Analytic scales). Results: Mean age was 48 years (range, 19 to 75 years). Median follow-up was 12 years (range, 10 to 27 years). Moderate/marked arm/shoulder pain was reported by 254 (14.3%) patients. Moderate/marked shoulder stiffness was reported by 219 (12.3%) patients. Moderate/marked arm edema was seen in 131 (7.4%) patients. Brachial plexopathy was not seen in any patient. Rib fractures were noted in 6 (0.3%) patients. Late cardiac and lung toxicity was seen in 29 (1.6%) and 23 (1.3%) patients, respectively. Second malignancy developed in 105 (5.9%) patients. Conclusion: RNI with 40 Gy/15 fractions/3 weeks hypofractionation with 2D technique seems safe and comparable to historical data of conventional fractionation (ClinicalTrial.gov Registration No. NCT04175821).

• Journal of Chest Surgery
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• 제22권2호
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• pp.357-363
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• 1989

We experienced very rare case of pulmonary blastoma in a 5 year old girl. She complained of right chest pain and productive cough for 3 months. With computerized tomography and echocardiography it is disclosed that huge mediastinal solid tumor is occupied to whole right thoracic cavity and compressed mediastinal structures to left and extended to left atrium. We removed the thoracic tumor and its extended intracardiac portion completely using the technique of intrapericardial pneumonectomy with cardiopulmonary bypass. Postoperatively the patient recovered without any problem and received adjuvant chemotherapy and radiotherapy. But she was succumbed 2 months later because of opportunistic pulmonary infection with pneumocystis carinii.

• Radiation Oncology Journal
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• 제37권4호
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• pp.271-278
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• 2019

Purpose: To investigate the differences in treatment outcomes between two radiation techniques, intensity-modulated radiotherapy (IMRT) and three-dimensional conformal radiotherapy (3DCRT). Materials and Methods: We retrospectively analyzed 160 (IMRT = 23, 3DCRT = 137) patients with stage I glottic cancer treated from January 2005 through December 2016. The IMRT was performed with TomoTherapy (16 patients), volumetric-modulated arc therapy (6 patients), and step-and-shoot technique (1 patient), respectively. The 3DCRT was performed with bilateral parallel opposing fields. The median follow-up duration was 30 months (range, 31 to 42 months) in the IMRT group and 65 months (range, 20 to 143 months) in the 3DCRT group. Results: The 5-year overall survival and 3-year local control rates of the 160 patients were 95.7% and 91.4%, respectively. There was no significant difference in 3-year local control rates between the IMRT and 3DCRT groups (94.4% vs. 91.0%; p = 0.587). Thirteen of 137 patients in the 3DCRT group had recurrences. In the IMRT group, one patient had a recurrence at the true vocal cord. Patients treated with IMRT had less grade 2 skin reaction than the 3DCRT group, but this had no statistical significance (4.3% vs. 21.2%; p = 0.080). Conclusion: IMRT had comparable outcomes with 3DCRT, and a trend of less acute skin reaction in stage I glottic cancer patients.

• 대한방사선치료학회지
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• 제18권2호
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• pp.67-73
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• 2006

목 적: 암 환자의 증가와 함께 방사선 치료기술도 날로 발전하고 있으며 이로인해 치료를 위해 사용되는 영상 및 데이터의 양들도 대폭 증가하는 결과를 가져오게 되어 이들을 저장, 보관, 관리하는데 많은 어려움이 있었다. 이러한 문제점 해결을 위해 과에서 발생되는 모든 영상 및 data의 PACS (picture archiving and communication system)화를 목적으로 의료정보팀의 협조 하에 본 System을 개발, 적용하게 되었다. 대상 및 방법: 본과 방사선치료 관리 시스템(RO-radiation oncology)에서 PACS에 접근할 수 있는 code를 부여한 후 영상은 R&V (Record and Verify: Varis vision, Varian, USA) 시스템 및 planning system에서 export 한다. 이때 DICOM (digital image and communication system) head에 있는 많은 정보들 중에서 필요한 정보를 이용하여 프로그램화 하였다. 결 과: 방사선종양학과에서 발생되는 모든 영상 및 자료 즉, 모의치료, CT, L-gram 영상, structure (normal organ & target volume), DRR (Digital Reconstruction Radiography), 선량 분포도, DVH (dose volume histogram) 등을 PACS에 구현 하였으며 과내 어느 컴퓨터에서도 선명히 영상을 볼 수 있고 출력할 수 있도록 하였다. 결 론: 본 시스템의 개발로 film less화가 가능하게 되어 현상 처리에 관련한 암실 공간과 유지비용이 소멸되었고 film 저장공간 및 film을 찾는데 소요되는 인력과 시간을 포함한 유, 무형의 경제적 비용뿐만 아니라 영상 저장을 위한 별도의 저장장치의 구입도 불필요하게 되었다. 아울러 방사선 치료를 위해 복잡하게 행해졌던 일련의 과정들이 본 시스템을 통해서 현재는 전산 상에서 쉽게 처리할 수 있게 되어 업무에 많은 도움이 될 것으로 사료된다.

• Radiation Oncology Journal
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• 제18권3호
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• pp.167-176
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• 2000

최근의 방사선치료는 치료의 질을 향상시켜서 치료 후의 삶의 질을 높이는 것을 목표로 하고 있다. 국내에서도 방사선치료 환자와 치료 시설의 빠른 증가로 방사선종양학 분야는 많은 발전이 되고 있으며, 치료기술 또한 3-dimensional conformal radiotherapy의 보편화, liuac based stereotactlc radiosurgery의 활발한 적용과 luteuslty modulated radiation tferapy (IMRT)의 도입 준비 등 고난도의 치료 기술도입이 시도되고 있다. 저자는 최근 20년간 한국에서의 방사선 종양학의 발전을 조망하고 최근 발전되는 4차원적 방사선치료, IMRT의 현황, blologlcai conformailty치료의 개념, 항암제와 방사선치료의 병용에 대하여 살펴보고 최근 정보기술 혁명에 따른 인터넷과 방사선종양학 분야의 정보관리 시스템의 중요성 및 원격진료의 세계적 현황 등에 대해서 알아보고, 21 세기 한국에서의 방사선치료의 질을 올리기 위한 방법들을 제시하였다. 이들은 1) OA (qualify assurance) 향상, 2) 공동 프로토콜에 의한 3상 임상 연구의 필요성, 3) 특정 암에 대한 통일된 치료 프로토콜 또는 가 이드라인, 4) 전국적인 방사선종양학 관련 자료의 광역 data base구축과 중요 암에 대한 patterns of care study 등 시행의 필요성이다

• 한국의학물리학회지:의학물리
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• 제26권3호
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• pp.185-191
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• 2015

방사선치료는 수술, 항암치료와 함께 암의 3대 치료방법으로 많은 암환자들이 방사선치료를 받게 된다. 방사선은 눈에 보이지 않아 방사선 치료기계에서 나가는 방사선의 질과 양을 확인하기 쉽지 않고 산란되는 특성 때문에 다른 장기에 2차암이 유도할 수 있고 최근 치료기술의 발달로 치료 방사선에 대한 보다 정밀한 검증이 필요하게 되었다. 따라서 방사선 치료기기에 대한 품질관리를 철저히 해야만 한다. 국제원자력기구, 미국의학물리학회 등 해외에서는 보고서들을 제시하여 각 지역적인 차원에서 방사선 치료기기의 품질관리에 대한 권고를 제시한다. 하지만 국내는 외국에 비해 규모가 작아 각 병원에서 국외의 권고 중 일부를 선택적으로 사용한다. 국내 병원을 대상으로만 한 방사선치료의 품질관리 권고가 존재하지 않지만 국외의 권고들이 갱신되고 있으며 향후 국내 품질관리 권고를 제작하기 위해 국내 품질관리의 현황 역시 조사 및 갱신 될 필요성이 있으므로 본 연구에서는 방사선치료기에 대한 품질관리 설문지를 제작하여 국내 품질관리 경향에 대한 조사를 실시하였다. 초본으로 제작된 설문지를 국내 5개 기관의 의학물리학자에게 배포하여 설문지의 부족한 점을 파악하고 보충하여 최종 설문지를 제작한 후 이를 전국 72개 병원의 방사선 종양학과에 배포하여 조사를 실시하였다. 72개 병원 중 37개 병원에서 요청에 응답해주었으며 이들 중 97.3%의 병원이 선형가속기를 보유하고 있으며 40.54%, 18.92%, 24.32%의 병원이 각각 근접치료장치, 토모치료장치, 방사선수술장치를 보유하고 있는 것으로 나타났다. 이 밖에 품질관리 인력 및 장치, 국내의 환자 품질관리 현황, 각 치료기별 품질관리 현황에 대한 설문이 실시되었으며 이 결과는 향후 표준 품질관리 절차서가 제작될 경우 사용되기에 좋은 자료가 될 것이다.

• Archives of Plastic Surgery
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• 제47권6호
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• pp.574-582
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• 2020

Background Several oncoplastic approaches have been implemented in recent years to enhance cosmetic results and to reduce complications. The round block technique is a volume displacement technique for breast reconstruction after breast-conserving surgery (BCS). However, its indications are currently limited according to tumor location, and its cosmetic results and complications have not been clearly established. We hypothesized that the round block technique could produce favorable cosmetic results without major complications regardless of tumor location or nipple-tumor distance, below a certain resected tumor volume and tumor-breast volume ratio. Methods All breast reconstructions using the round block technique after BCS were included in this analysis. Patients' data were reviewed retrospectively to investigate complications during follow-up, and clinical photos were used to evaluate cosmetic results. The relationships of tumor location, nipple-tumor distance, tumor volume, and the tumor-breast volume ratio with cosmetic results were investigated. Results In total, 108 breasts were reconstructed. The mean resected tumor volume was 30.2±15.0 mL. The cosmetic score was 4.5±0.6 out of 5. Tumor location, nipple-tumor distance, tumor volume, tumor-breast volume ratio, radiotherapy, and chemotherapy had no significant effects on cosmetic results or complications. There were no major complications requiring reoperation. Conclusions Breast reconstruction using the round block technique after BCS can lead to good cosmetic results without major complications regardless of the tumor location, nippletumor distance, radiotherapy, or chemotherapy. Below the maximum tumor volume (79.2 mL) and the maximum tumor-breast volume ratio (14%), favorable results were consistently obtained.

• Radiation Oncology Journal
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• 제35권2호
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• pp.163-171
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• 2017

Purpose: Although stereotactic ablative body radiotherapy (SABR) is widely used therapeutic technique, predictive factors of radiation pneumonitis (RP) after SABR remain undefined. We aimed to investigate the predictive factors affecting RP in patients with primary or metastatic lung tumors who received SABR. Materials and Methods: From 2012 to 2015, we reviewed 59 patients with 72 primary or metastatic lung tumors treated with SABR, and performed analyses of clinical and dosimetric variables related to symptomatic RP. SABR was delivered as 45-60 Gy in 3-4 fractions, which were over 100 Gy in BED when the ${\alpha}/{\beta}$ value was assumed to be 10. Tumor volume and other various dose volume factors were analyzed using median value as a cutoff value. RP was graded per the Common Terminology Criteria for Adverse Events v4.03. Results: At the median follow-up period of 11 months, symptomatic RP was observed in 13 lesions (12 patients, 18.1%), including grade 2 RP in 11 lesions and grade 3 in 2 lesions. Patients with planning target volume (PTV) of ${\leq}14.35mL$ had significantly lower rates of symptomatic RP when compared to others (8.6% vs. 27%; p = 0.048). Rates of symptomatic RP in patients with internal gross tumor volume (iGTV) >4.21 mL were higher than with ${\leq}4.21mL$ (29.7% vs. 6.1%; p = 0.017). Conclusions: The incidence of symptomatic RP following treatment with SABR was acceptable with grade 2 RP being observed in most patients. iGTV over 4.21 mL and PTV of over 14.35 mL were significant predictive factors related to symptomatic RP.

• 한국의학물리학회지:의학물리
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• 제30권4호
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• pp.104-111
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• 2019

Purpose: Online magnetic resonance-guided adaptive radiotherapy (MRgART), an emerging technique, is used to address the change in anatomical structures, such as treatment target region, during the treatment period. However, the electron density map used for dose calculation differs from that for daily treatment, owing to the variation in organ location and, notably, air pockets. In this study, we evaluate the dosimetric effect of electron density override on air pockets during online ART for pancreatic cancer cases. Methods: Five pancreatic cancer patients, who were treated with MRgART at the Seoul National University Hospital, were enrolled in the study. Intensity modulated radiation therapy plans were generated for each patient with 60Co beams on a ViewrayTM system, with a 45 Gy prescription dose for stereotactic body radiation therapy. During the treatment, the electron density map was modified based on the daily MR image. We recalculated the dose distribution on the plan, and the dosimetric parameters were obtained from the dose volume histograms of the planning target volume (PTV) and organs at risk. Results: The average dose difference in the PTV was 0.86Gy, and the observed difference at the maximum dose was up to 2.07 Gy. The variation in air pockets during treatment resulted in an under- or overdose in the PTV. Conclusions: We recommend the re-contouring of the air pockets to deliver an accurate radiation dose to the target in MRgART, even though it is a time-consuming method.

• Radiation Oncology Journal
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• 제35권1호
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• pp.25-31
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• 2017

Purpose: The purpose of this study was to describe treatment patterns of radiotherapy (RT) for prostate cancer in Korea. Materials and Methods: A questionnaire about radiation treatment technique and principles in 2013 was sent to 83 radiation oncologists and data from 57 hospitals were collected analyzed to find patterns of RT for prostate cancer patients in Korea. Results: The number of patients with prostate cancer treated with definitive RT ranged from 1 to 72 per hospital in 2013. RT doses and target volumes increased according to risk groups but the range of radiation doses was wide (60 to 81.4 Gy) and the fraction size was diverse (1.8 to 5 Gy). Intensity-modulated radiation therapy was used for definitive treatment in 93.8% of hospitals. Hormonal therapy was integrated with radiation for intermediate (63.2%) and high risk patients (77.2%). Adjuvant RT after radical prostatectomy was performed in 46 hospitals (80.7%). Indications of adjuvant RT included positive resection margin, seminal vesicle invasion, and capsular invasion. The total dose for adjuvant RT ranged from 50 to 72 Gy in 24-39 fractions. Salvage RT was delivered with findings of consecutive elevations in prostate-specific antigen (PSA), PSA level over 0.2 ng/mL, or clinical recurrence. The total radiation doses ranged from 50 to 80 Gy with a range of 1.8 to 2.5 Gy per fraction for salvage RT. Conclusion: This nationwide patterns of care study suggests that variable radiation techniques and a diverse range of dose fractionation schemes are applied for prostate cancer treatment in Korea. Standard guidelines for RT in prostate cancer need to be developed.