• Journal of Korean Neurosurgical Society
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• v.29 no.7
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• pp.868-876
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• 2000

Objective : Parkinsonian rat models have generally been characterized by unilateral destruction of both the nigrostriatal pathway and the mesolimbic pathway using the neurotoxin 6-hydroxydopamine. The induction of contraversive turning by apomorphine in these models is thought to reflect the stimulation of supersensitive dopamine D2 receptor or receptor-mediated mechanisms in denervated neostriatum. The present study was undertaken to investigate the expression of dopamine D2 receptor in denervated striatum according to modalities of apomorphine(dopamine agonist) treatment after creating a hemiparkinsonian rat model in which there is 6-hydroxydopamine induced destruction of the unilateral dopaminergic nigrostriatal pathway. Methods : After making complete lesion in left side substantia nigra pars compacta(SNpc) by stereotactic injection of 6-hydroxydopamine into medial and lateral areas of SNpc, and confirming successful animal model by apomorphine induced contraversive turning behavior without recovery and complete destruction of ipsilateral SNpc with tyrosine hydroxylase immunostaining in 7th day after operation, 15 rats of parkinsonian model were studied with or without administration of apomorphine at varying doses and durations. According to the modalities of apomorphine treatment for 4 days, these rats were divided into 3 groups, as not-treated group, intermittently treated group and constantly treated group. For investigating the extent of the expression of dopamine D2 receptor in denervated striatum, immunohistochemical staining by dopamine D2 receptor antibody and Western blot were performed. Results : In the D2 receptor antibody immunohistochemical staining, the mean number of positive stained neurons was highest in not-treated group($20.5{\pm}1.14$) of 3 groups. In constantly treated group, the mean number of positive stained neurons was less($3.9{\pm}1.79$) than intermittently treated group(p<0.05). The Western blotting with the D2 receptor antibody revealed that expression of receptors was also highest in not-treated group and less in constantiy treated group than intermittently treated group. Conclusion : Dopamine D2 receptors in denervated striatum of parkinsonian rat models, which were not treated with apomorphine, revealed to be most highly expressed. And, according to doses and durations of apomorphine administration, desensitization of the receptor was more apt to develop with constant treatment than intermittent treatment. In clinical setting, the authors believe that, in long-term treated parkinsonian patients, desensitization of dopamine receptors due to chronic dopaminergic stimulation seems to be partially related to mechanisms of drug tolerance.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1030-1036
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• 2000

Objective : The aim of this study was to retrospectively analyze the safety and effect of Linac based Photon Knife Radiosugery System(PKRS) for treatment of cerebral arteriovenous malformation. Patients and Methods : The authors analyzed the clinical method and results of ten patients who were followed up more than two years, among the 18 patients who had radiosurgery on arteriovenous malformation from June, 1992, to Dec. 1997, with Linac based Photon knife radiosurgery system(PKRS) which was developed in our hospital. Results : The average age of the patients was 30.4(with the range of 13-49), and the sex was seven males and three females. For the initial clinical symptoms, there were five patients with headache, three with seizure, one with hemiparesis, and one with vomiting. Before the radiosurgery, computed tomography, MRI, and cerebral angiogram were done. For the location of arteriovenous malformation, it was found on six patients of cerebral hemisphere, two of thalamus, one of brainstem, and one of corpus callosum. Regarding the size of nidus, there were seven patients of smaller than 3cm, and three patients of larger than 3cm. Computed tomography, MRI, and cerebral angiogram were done periodically for sixth months, first year, and second year after the radiosurgery of PKRS for the completeness of obliteration. Six cases showed complete obliteration, and four partial obliterations were observed among ten cases, and interestingly, six cases of complete obliteration were observed among seven cases of small AVM of smaller than 3cm(the rate of complete obliteration : 85.7%). All patients tolerated the treatment and no significant complication were seen. Conclusion : In this study, linac based radiosurgery using PKRS onto arteriovenous malformation showed excellent effects, therefore authors believe that it is an ideal method for small sized or deep seated AVM.

• Journal of Korean Neurosurgical Society
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• v.29 no.8
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• pp.1024-1029
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• 2000

Objectives : With recent improvements in neuroimaging and the development of third and fourth-generation radiosurgical dose-planning soft ware, came a renewed interest in using radiosurgery for the treatment of movement disorders. Radiosurgery involves no opening of the cranium and no incisions, eliminating both the risk of hemorrhage from passing an electrode to the depths of meningitis from operative infection. It is for these reasons stereotactic radiosurgical treatment of movement disorders has value in a small subgroup of patients. The authors report four cases of Parkinson's disease and one case of dystonia that were treated by Gamma knife. Methods : Radiosurgical nucleus ventralis intermedius thalamotomy using the gamma knife unit was performed to make lesion in two Parkinson's disease patients. A radiation dose of 120Gy was delivered to nucleus using a single 4-mm collimator plug pattern following classic anatomical landmarks. Patients were followed for a median of 10.5 months(range 9-12 months). An independent neurological evaluation of tremor, based on the change in the United Parkinson's Disease Rating Scale tremor score(UPDRS), was correlated with a subjective evaluation. Gamma knife ventrolateral(V.O.P) thalamotomy was performed in one case of dystonia. A central dose of 150Gy was delivered and the patient was followed for 18 months. Gamma knife globus pallidus interna pallidotomy was performed in two Parkinson's disease patients. A radiation dose of 130Gy(range 120-140Gy) was delivered. Patients were followed for a median of 13 months(range 9-14 months). Result : Ventrolateral thalamotomy in dystonia produced regained left hand usage in order to be able to use the telephone. Ventralis intermedius thalamotomy produced an excellent improvement of the tremor in one case, mild improvement of the tremor in the other case of Parkinson's disease. A globus pallidus internalis(GPi) pallidotomy produced improvement of rigidity and dyskinesia : one other showed no change. There were no neurological complications. Conclusion : Gamma Knife thalamotomy considered a safe and effective technique for the treatment of tremor in Parkinson's disease. Although the results from Longer follow-up is not available yet, the short-term results seem to be encouraging.

• Journal of Korean Neurosurgical Society
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• v.63 no.3
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• pp.397-405
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• 2020

Objective : We retrospectively evaluated the efficacy of Gamma Knife radiosurgery (GKS) for recurrent nasopharyngeal carcinoma (NPC) in patients who previously underwent radiotherapy, and analyzed the treatment outcomes over 14 years. Methods : Ten patients with recurrent NPC who had previously received radiotherapy underwent stereotactic radiosurgery using a Gamma Knife^® (Elekta Inc, Atlanta, GA, USA) between 2005 and 2018. The median target volume was 8.2 ㎤ (range, 1.7-17.8), and the median radiation dose to the target was 18 Gy (range, 12-30). The median follow-up period was 18 months (range, 6-76 months). Overall and local failure-free survival rates were determined using the Kaplan-Meier method. Results : The NPCs recurred at the primary cancer site in seven patients (70%), as distant brain metastasis in two (20%), and as an extension into brain in one (10%). The recurrent tumors in seven of the 10 patients (70%) were found on the routine follow-up imaging studies. Two patients presented with headache and one with facial pain. Local failure after GKS occurred in five patients (50%) : two of whom died eight and 6 months after GKS, respectively. No adverse radiation effects were noted after GKS. The 1- and 3-year overall survival rates after GKS were 90% and 77%, respectively. The local failure-free survival rates at 6 months, 1 year, and 3 years after GKS were 80%, 48%, and 32%, respectively. The median interval from GKS to local failure was 8 months (range, 6-12). Univariate analysis revealed that using co-registration with positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) was associated with a lower local failure rate of recurrent NPC (p=0.027). Conclusion : GKS is an acceptable salvage treatment option for patients with recurrent NPC who previously received radiation therapy. PET-CT and MRI co-registration for dose planning can help achieve local control of recurrent NPC.

• Journal of radiological science and technology
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• v.30 no.2
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• pp.139-145
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• 2007

Dose evaluation for small field such as stereotactic radiosurgery was performed using $Gafchromic^{(R)}$ EBT film. Every film which irradiated 6MV photon beam was scanned and obtained the optical density(OD) by flat bed scanner after 24 hours of irradiation. This study compared dose from diode in water and Gafchromic $EBT^{(R)}$ film in acrylic phantom to verify the reliability of the film, and to evaluate the SRS in clinical dose distributions from calculation and measurement in the region of virtual target in humanoid and cylindrical phantoms were compared. The Gafchromic $EBT^{(R)}$ film was found to be linear up to 9Gy. The $D_{max}$ for 6 MV was measured at 1.5 cm from the surface by both of diode and the film. As the depth is deeper, the error was measured within $2{\sim}3%$ at $10{\sim}20\;cm$ depth. Comparing between distribution from calculation and measurement, we found that there is 5% error at 90% isodose line. We found that given dose could be measured accurately by using the phantoms. It was feasible to use the Gafchromic $EBT^{(R)}$ film in quality assurance of SRS.

• Progress in Medical Physics
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• v.14 no.3
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• pp.167-174
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• 2003

In the radiation treatment planning (RTP) process, especially for stereotactic radiosurgery (SRS), knowing the exact volume and shape and the precise position of a lesion is very important. Sometimes X-ray projection images, such as angiograms, become the best choice for lesion identification. However, while the exact target position can be acquired by bi-projection images, 3D target reconstruction from bi-projection images is considered to be impossible. The aim of this study was to reconstruct the 3D target volume from multiple projection images. It was assumed that we knew the exact target position in advance, and all processes were performed in Target Coordinates, where the origin was the center of the target. We used six projections: two projections were used to make a Reconstruction Box and four projections were for image acquisition. The Reconstruction Box was made up of voxels of 3D matrices. Projection images were transformed into 3D in this virtual box using a geometric back-projection method. The resolution and the accuracy of the reconstructed target volume were dependent on the target size. An algorithm was applied to an ellipsoid model and a horseshoe-shaped model. Projection images were created geometrically using C program language, and reconstruction was also performed using C program language and Matlab ver. 6(The Mathwork Inc., USA). For the ellipsoid model, the reconstructed volume was slightly overestimated, but the target shape and position proved to be correct. For the horseshoe-shaped model, reconstructed volume was somewhat different from the original target model, but there was a considerable improvement in determining the target volume.

• Progress in Medical Physics
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• v.23 no.3
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• pp.169-176
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• 2012

Frameless method in brain radiosurgery has advantages relative to rigid head-frame method in terms of patient friendly and flexible application of multi-fractionation. However, it has also disadvantages and the most negative point is that it cannot control the patient motion during treatment as lowly as the level of the frame-based radiosurgery, which could affect to the treatment accuracy. In the present study, we analyzed the geometric uncertainty of the intra-fraction motion using the actual treatment records of 294-CyberKnife treatments for brain tumors. Based on the analysis, we statistically presented the magnitude of intra-fraction motion in frameless radiosurgy. The result could provide the quantitative information to determine the adequate treatment margins to compensate the intra-fraction movements.

• Progress in Medical Physics
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• v.20 no.2
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• pp.106-111
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• 2009

Total scatter factor ($S_{cp}$), head scatter factor ($S_c$) and phantom scatter factor ($S_p$) are very important for accurate radiation therapy at stereotactic radiosurgery (SRS) with irregular field shape using micro-MLC and intensity modulated radiation therapy (IMRT) including many small field sizes. In this study we measured and compared $S_{cp}$ with reference ion chamber, pinpoint chamber and diode detector and adapted the resuls form diode detector. Head scatter factors for small field sizes were also measured with diode detector covered 1.5 cm-thick solid water build-up cap. Some errors like as electron contamination of 1~3% were included in the values of Sc but trend of total results of $S_c$ was coincided with basic theory. Phantom scatter factors for small field sizes were calculated form $S_{cp}$ and $S_c$. The results of $S_p$ were compared and were well-agreed with those of other authors.

• Journal of the Korean Society of Radiology
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• v.13 no.7
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• pp.901-907
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• 2019

The aim of this study is to evaluate the ability of target localizations of Leksell GammaPlan(LGP) in Gamma Knife Subthalamotomy(or Pallidotomy, Thalamotomy) of functional diseases. To evaluate the accuracy of LGP's location settings, the difference Δr of the target coordinates calculated by LGP (or LSP) and author's algorithm was reviewed for 10 patients who underwent Deep Brain Stimulation(DBS) surgery. Δr ranged from 0.0244663 mm to 0.107961 mm. The average of Δr was 0.054398 mm. Transformation matrix between stereotactic space and brain atlas space was calculated using PseudoInverse or Singular Value Decomposition of Mathematica to determine the positional relationship between two coordinate systems. Despite the precise frame positioning, the misalignment of yaw from -3.44739 degree to 1.82243 degree, pitch from -4.57212 degree to 0.692063 degree, and rolls from -6.38239 degree to 7.21426 degree appeared. In conclusion, a simple in-house algorithm was used to test the accuracy for location settings of LGP(or LSP) in Gamma Knife platform and the possibility for Gamma Knife Subthalamotomy. The functional diseases can be treated with Gamma Knife Radiosurgery with safety and efficacy. In the future, the proposed algorithm for target localizations' QA will be a great contributor to movement disorders' treatment of several Gamma Knife Centers.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.22
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• pp.9599-9602
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• 2014

Background: Postoperative adjuvant radiotherapy (RT) in the management of early stage endometrial cancer (EC) is still controversial. Here we report our institutional experience with patients who received postoperative RT for stage I-II EC over a period of 35 years and assess potential predictors of local recurrence (LR), distant metastasis (DM), and overall survival (OS). Materials and Methods: A total of 188 patients undergoing postoperative RT for stage IA-II EC between 1977 and 2012 were evaluated. Some 96 received median 46 Gy whole pelvic radiotherapy (WPRT) (range: 40-60 Gy), 37 were given WPRT with vaginal cuff therapy (VCT), and 55 received only VCT either with brachytherapy (BT) or stereotactic body radiotherapy (SBRT). Chemotherapy was given to 5 patients with uterine papillary serous carcinoma (UPSC). Logistic regression analysis was used to assess the effect of clinicopathological factors on LR, DM, and OS. Results: Median follow-up time was 11 years (range: 1-35 years). At the time of analysis, 34 patients were not alive. Of the 15 patients with LR, 7 (46.7%) recurred in the vaginal stump, 5 (33.3%) in the pelvic region, and 3 (20%) in the paraaortic nodal region, while 12 had distant metastasis. UPSC histology (p=0.027), sole VCT (p=0.041), high histologic grade (p=0.034), and age ${\geq}71$ (p=0.04) were poor prognostic factors on univariate analysis. Conclusions: In our patients receiving radiotherapy for early-stage EC, grade III disease and age ${\geq}71$ were associated with shorter OS whereas UPSC histology was an independent predictor for both LR and DM.