• Radiation Oncology Journal
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• v.12 no.2
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• pp.159-164
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• 1994

Purpose : To evaluate the role of postoperative radiotherapy in the management of primary or recurrent intracranial meningiomas. Methods and Materials : A retrospective review of 34 intracranial meningioma patients referred to the Yonsei Cancer Center for postoperative radiotherapy between 1981 and 1990 was undertaken. Of the 34 patients, 24 patients received elective postoperative radiotherapy after total or subtotal resection(Group 1), and 10 patients received postoperative radiotherapy as a salvage treatment for recurrent tumors(Group 2). Ten patients received postoperative radiotherapy after total resection, and twenty-four after subtotal resection. Ten patients who had total tumor resection were referred for radiotherapy either because of angioblastic or malignant histologic type(4 patients in Group 1) or because of recurrent disease after initial surgery(6 patients in Group 2). Radiation dose of 50-56 Gy was delivered over a period of 5-5.5 weeks using 4MV LINAC or Co-60 teletherapy unit. Results : Overall actuarial progression free survival(PFS) at 5 years was $80\%$. Survival was most likely affected by histologic subtypes. Five year PFS rate was $52\%$ for benign angioblastic histology as compared with $100\%$ for classic benign histology. For malignant meningiomas, 5 year PFS rate was $44\%$. The recurrence rates of classic, angioblastic, and malignant type were $5\%(1/21),\;80\%(4/5)$, and $50\%(4/8)$, respectively. The duration between salvage post-operative radiotherapy and recurrence was longer than the duration between initial surgery and recurrence in the patients of group 2 with angioblastic or malignant histology. Conclusion . Postoperative radiotherapy of primary or recurrent intracranial meningiomas appears to be effective modality, especially in the patients with classic meningiomas. In angioblastic or malignant histologies, a more effective approach seems to be needed for decreasing recurrence rate.

• Journal of Korean Neurosurgical Society
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• v.58 no.5
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• pp.432-441
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• 2015

Objective : To assess the impact of the complete resection of craniopharyngioma (CP) in adults on oncologic and functional outcomes. Methods : We retrospectively analyzed 82 patients with CP who were surgically treated by the same neurosurgeon at our institution between January 1994 and December 2012. Results : Gross total resection (GTR) was achieved in 71 patients (86.6%), near total resection (NTR) in 7 patients (8.5%), and subtotal resection (STR) in 3 patients (3.7%). The disease-specific overall survival rate was 100% with the exclusion of 2 surgery-related mortalities. The overall recurrence rate was 12.2% (10 of 82 patients), however the recurrence rate according to extent of resection (EOR) was 9.9% (7 of 71 patients) after GTR, 14.3% (1 of 7 patients) after NTR, and 66.7% (2 of 3 patients) after STR. The overall recurrence-free survival (RFS) rates at 5 and 10 years were 87.0% and 76.8%, respectively. Postoperatively, most patients (86.3%) needed hormone replacement for at least 1 hypothalamic-pituitary axis. Vision improved in 56.4% of the patients with preoperative abnormal vision, but deteriorated in 27.4% of patients. Hypothalamic dysfunction developed in 32.9% of patients. There were no significant differences in the risks of pituitary dysfunction, visual deterioration, or hypothalamic dysfunction between the groups with complete vs. incomplete removal. The overall rate of postoperative complications was 22.0%, which did not differ between groups (p=0.053). Conclusion : The complete removal of a CP at first surgery can provide a chance for a cure with acceptable morbidity and mortality risks.

• Journal of Chest Surgery
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• v.47 no.1
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• pp.13-19
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• 2014

Background: The aim of this study is to evaluate prognostic factors for survival in pathologic stage IIIA/N2 non-small-cell lung cancer (NSCLC), to identify the prognostic significance of the metastatic patterns of mediastinal lymph nodes (MLNs) relating to survival and to recurrence and metastasis. Methods: A total of 129 patients who underwent radical resection for pathologic stage IIIA-N2 NSCLC from July 1998 to April 2011 were retrospectively reviewed. The end points of this study were rates of loco-regional recurrence and distant metastasis, and survival. Results: The overall 5-year survival rate was 47.4%. A univariate analysis showed that age, pathologic T stage, and adjuvant chemotherapy were significant prognostic factors, while in multivariate analysis, pathologic T stage and adjuvant chemotherapy were significant prognostic factors. The metastasis rate was higher in patients with multi-station N2 involvement and with more than 3 positive MLNs. Further, non-regional MLN metastasis was associated with a higher loco-regional recurrence rate. Conclusion: Pathologic T stage and adjuvant chemotherapy were independent prognostic factors for long-term survival in pathologic stage IIIA/N2 NSCLC. The recurrence and the metastasis rate were affected by the metastatic patterns of MLNs. These results may be helpful for planning postoperative therapeutic strategies and predicting outcomes.

• Radiation Oncology Journal
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• v.38 no.1
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• pp.26-34
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• 2020

Purpose: Intensity-modulated radiotherapy (IMRT) allows for more precise treatment, reducing unwanted radiation to nearby structures. We investigated the safety and feasibility of IMRT for anaplastic ependymoma patients below 3 years of age. Materials and Methods: A total of 9 anaplastic ependymoma patients below 3 years of age, who received IMRT between October 2011 and December 2017 were retrospectively reviewed. The median equivalent dose in 2 Gy fractions was 52.0 Gy (range, 48.0 to 60.0 Gy). Treatment outcomes and neurologic morbidities were reviewed in detail. Results: The median patient age was 20.9 months (range, 12.1 to 31.2 months). All patients underwent surgery. The rates of 5-year overall survival, freedom from local recurrence, and progression-free survival were 40.6%, 53.3%, and 26.7%, respectively. Of the 9 patients, 5 experienced recurrences (3 had local recurrence, 1 had both local recurrence and cerebrospinal fluid [CSF] seeding, and 1 had CSF seeding alone). Five patients died because of disease progression. Assessment of neurologic morbidity revealed motor dysfunction in 3 patients, all of whom presented with hydrocephalus at initial diagnosis because of the location of the tumor and already had neurologic deficits before radiotherapy (RT). Conclusion: Neurologic morbidity is not caused by RT alone but may result from mass effects of the tumor and surgical sequelae. Administration of IMRT to anaplastic ependymoma patients below 3 years of age yielded encouraging local control and tolerable morbidities. High-precision modern RT such as IMRT can be considered for very young patients with anaplastic ependymoma.

• Journal of Chest Surgery
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• v.52 no.3
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• pp.131-140
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• 2019

Background: The purposes of this study were to evaluate the appropriateness of the stage migration of stage IIA non-small cell lung cancer (NSCLC) in the seventh edition of the tumor, node, and metastasis classification for lung cancer to stage IIB lung cancer in the eighth edition, and to identify prognostic factors in patients with eighth-edition stage IIB disease. Methods: Patients with eighth-edition stage IIB disease were subclassified into those with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease, and their recurrence-free survival and disease-specific survival rates were compared. Risk factors for recurrence after curative resection were identified in all included patients. Results: Of 122 patients with eighth-edition stage IIB NSCLC, 101 (82.8%) had seventh-edition stage IIA disease and 21 (17.2%) had seventh-edition stage IIB disease. Nonsignificant differences were observed in the 5-year recurrence-free survival rate and the 5-year disease-specific survival rate between the patients with seventh-edition stage IIA disease and those with seventh-edition stage IIB disease. Visceral pleural invasion was a significant risk factor for recurrence in patients with eighth-edition stage IIB NSCLC. Conclusion: The stage migration from seventh-edition stage IIA NSCLC to eighth-edition stage IIB NSCLC was appropriate in terms of oncological outcomes. Visceral pleural invasion was the only prognostic factor in patients with eighth-edition stage IIB NSCLC.

• Radiation Oncology Journal
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• v.31 no.3
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• pp.118-124
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• 2013

Purpose: The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. Materials and Methods: Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, $500mg/m^2$) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. Results: At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. Conclusion: Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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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.

• Radiation Oncology Journal
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• v.30 no.4
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• pp.158-164
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• 2012

Purpose: To evaluated the patterns of failure, survival rate, treatment-related toxicity and prognostic factors in postoperative radiotherapy of patients with ependymoma. Materials and Methods: Thirty patients who underwent surgery and postoperative radiotherapy for ependymoma between the period of June 1994 and June 2008 were reviewed retrospectively. The age of patients ranged from 21 months to 66 years (median, 19 years). Seventeen patients had grade II ependymoma, and 13 had grade III anaplastic ependymoma according to the World Health Organization grading system. The postoperative irradiation was performed with 4 or 6 MV photon beam with median dose of 52.8 Gy (range, 45 to 63 Gy), and radiation field including 2 cm beyond the preoperative tumor volume. Median follow-up period was 51 months (range, 12 to 172 months). Results: Fourteen out of 30 (46.7%) patients experienced recurrence, and 12 of those died. Among those 14 patients who experienced recurrence, 11 were in-field and 3 were out-of-field recurrence. The 5-year overall survival (OS) and progression-free survival (PFS) rates were 66.7% and 56.1%, respectively. On univariate analysis, tumor grade was a statistically significant prognostic factor for OS and PFS. There were two complications after surgery and postoperative radiotherapy, including short stature and facial palsy on the left side. Conclusion: We observed good survival rates, and histologic grade was a prognostic factor affecting the OS and PFS. Almost all recurrence occurred in primary tumor site, thus we suggest further evaluation on intensity-modulated radiotherapy or stereotatic radiosurgery for high-risk patients such as who have anaplastic ependymoma.

• Journal of Chest Surgery
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• v.40 no.10
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• pp.680-684
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• 2007

Background: Complete surgical resection is the most effective treatment for stage IB non-small cell lung cancer (NSCLC). Recurrence accounts for the disappointing survival rates after resection. There has been renewed interest in adjuvant therapy after complete resection. Appropriate selection of effective adjuvant therapy will depend on the prognostic factors for recurrence. Material and Method: The study included 114 patients with completely resected stage IB NSCLC. The variables selected for the study were gender, age, the type of resection, cell type, the degree of differentiation, the tumor size and the presence of visceral pleura invasion. The Kaplan-Meier method was used to estimate the survival and disease-free survival rate. The results were compared using the log rank test. Multivariate analysis was performed by Cox's proportional hazard model. Two-sided p-valves < 0.05 were considered to be statistically significant. Result: The 3-year overall survival and the disease-free survival rates were 87.0% and 79.4%, respectively. The degree of differentiation showed a significant influence on disease-free survival according to the univariate analysis. According to the multivariate analysis, a poor grade of differentiation was a significant poor prognostic factor. Conclusion: These results demonstrate that poor differentiation may be a poor prognostic factor for patients with completely resected IB NSCLC. Therefore, the patients with a poor grade of differentiation may require adjuvant therapies.

• Radiation Oncology Journal
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• v.36 no.2
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• pp.139-146
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• 2018

Purpose: IBTR! 2.0 nomogram is web-based nomogram that predicts ipsilateral breast tumor recurrence (IBTR). We aimed to validate the IBTR! 2.0 using an external data set. Materials and Methods: The cohort consisted of 2,206 patients, who received breast conserving surgery and radiation therapy from 1992 to 2012 at our institution, where wide surgical excision is been routinely performed. Discrimination and calibration were used for assessing model performance. Patients with predicted 10-year IBTR risk based on an IBTR! 2.0 nomogram score of <3%, 3%-5%, 5%-10%, and >10% were assigned to groups 1, 2, 3, and 4, respectively. We also plotted calibration values to observe the actual IBTR rate against the nomogram-derived 10-year IBTR probabilities. Results: The median follow-up period was 73 months (range, 6 to 277 months). The area under the receiver operating characteristic curve was 0.607, showing poor accordance between the estimated and observed recurrence rate. Calibration plot confirmed that the IBTR! 2.0 nomogram predicted the 10-year IBTR risk higher than the observed IBTR rates in all groups. High discrepancies between nomogram IBTR predictions and observed IBTR rates were observed in overall risk groups. Compared with the original development dataset, our patients had fewer high grade tumors, less margin positivity, and less lymphovascular invasion, and more use of modern systemic therapies. Conclusions: IBTR! 2.0 nomogram seems to have the moderate discriminative ability with a tendency to over-estimating risk rate. Continued efforts are needed to ensure external applicability of published nomograms by validating the program using an external patient population.