• The Journal of Korean Society for Radiation Therapy
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• v.33
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• pp.137-144
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• 2021

Purpose : The usability of X-Jaw split VMAT was evaluated by comparative analysis of the dose distribution between the treatment plan divided by X-Jaw and Full field VMAT treatment plan in left breast cancer treatment including supraclavicular lymph nodes. Materials and Methods : 10 patients with left breast cancer, including supraclavicular lymph nodes, were simulated using vacuum cushion, and 2 Full field Arc VMAT and 4 X-Jaw split Arc VMAT were planned The treatment plan was designed to include more than 95% of the Planning Target Volume (PTV) and to be minimally irradiated in the surrounding Organ at risk (OAR). Dose analysis of PTV and OAR was performed through dose volume histogram (DVH). Results : The Full field VMAT treatment plan and the X-Jaw split VMAT treatment plan of 10 patients were expressed as average values and compared. The difference between the two treatment plans was not large, with a Conformity index (CI) of 1.05±0.04, 1.04±0.03, and a Homogeneity index (HI) of 1.07±0.008, 1.07±0.009. For OAR, V5 in the left lung is 56.1±6.50%, 50.4±6.30%, and V20 is 20.0±4.15%, 13.52±3.61%. Compared to Full field VMAT, V5 decreased by 10.0% V20 by 32.6% in X-Jaw split VMAT. The V30 of the heart is 3.68±1.85%, 2.23±1.52%, and the Mean dose is 8.93±1.65 Gy, 7.67±1.52 Gy. In the X-Jaw split VMAT, V30 decreased by 39.3% and the Mean dose decreased by 14.1%. The left lung and heart, which are normal tissues, were found to have a statistical significance of that p-value is less than 0.05. Conclusion : In the case of left breast cancer treatment, which includes Supraclavicular lymph nodes with a large PTV volume and a length of X Jaw of 15 cm or more, the X-Jaw split VMAT shows improved dose distribution, which can reduce radiation dose of OAR such as lungs and heart, while maintaining similar PTV coverage with HI and CI equivalent to Full field VMAT. It is thought to be effective in reducing radiation complications.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.1
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• pp.419-422
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• 2014

Background: Lymphadenopathy is a common presentation in both benign and malignant diseases which need to be diagnosed without delay. Fine needle aspiration cytology (FNAC) helps us diagnose a disease and follow its course, including the response to therapy. Aim: This study aimed to analyze the clinicopathological features of metastatic lymphadenopathy and the diagnostic utility of FNAC in our setting. Materials and Methods: This two-year prospective study included all the patients with metastatic lymphadenopathy, diagnosed with FNAC. Results: A total of 412 cases (male:female ratio, 1.3:1; age range, 3 to 90 years) were studied. Supraclavicular lymph nodes were involved most commonly (50.5%). The commonest metastatic tumor was squamous cell carcinoma in general (30.1%) and in males (37.6%), and infiltrating ductal carcinoma (25.3%) in females. Lung, with 64 (15.5%) cases followed by esophagus, 60 (14.6%) cases; breast, 49 (11.9%) cases; skin, 32 (7.8%) cases; and stomach, 25 (6.1%) cases were the most common primary sites of malignancy. In 69 patients, excision biopsy was performed. Histopathological findings correlated well with that of cytology in all these cases. Conclusions: FNAC is an important tool in the diagnostic work up of metastatic lymphadenopathy, which in the hands of an experienced and skilful cytopathologist can avoid the need for excision biopsy.

• The Journal of Korean Society for Radiation Therapy
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• v.29 no.1
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• pp.27-35
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• 2017

Purpose: On the left side, breast cancer patients have more side effects than those on the right side because of unnecessary doses in normal organs such as heart and lung. DIBH is performed to reduce this. To evaluate the dose of peripheral organs in the left breast cancer including supraclavicular lymph nodes and internal mammary lymph nodes according to the treatment planning method of Conventional Radiation Therapy, Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy. Materials and Methods: We performed CT-simulation using free breathing and deep inspiration breath-hold technique for 8 patients including left supraclavicular lymph nodes and internal mammary lymph nodes. Based on the acquired CT images, the contour of the body is drawn and the convention is performed so that $95%{\leftarrow}PTV$, $Dmax{\leftarrow}110%$. Conventional Radiation Therapy used a one portal technique on the supraclavicular lymph node and used a field in field technique tangential beam on the breast. Intensity Modulated Radiation Therapy was composed of 7 static fields. Volumetric Modulated Arc Therapy was planned using 2 ARC with a turning radius of $290^{\circ}$ to $179^{\circ}$. The peripheral normal organs dose was analyzed by referring to the dose volume of Eclipse. Results: By applying the deep inspiration breath-hold technique, the mean interval between the heart and chest wall increased $1.6{\pm}0.6cm$. The mean dose of lung was $19.2{\pm}1.0Gy$, which was the smallest value in Intensity Modulated Radiation Therapy. The V30 (%) of the heart was $2.0{\pm}1.9$, which was the smallest value in Intensity Modulated Radiation Therapy. In the left anterior descending coronary artery, the dose was $25.4{\pm}5.4Gy$, which was the smallest in Intensity Modulated Radiation Therapy. The maximum dose value of the Right breast was $29.7{\pm}4.3Gy$ at Intensity Modulated Radiation Therapy. Conclusion: When comparing the values of surrounding normal organs, Intensity Modulated Radiation Therapy and Volumetric Modulated Arc Therapy were applicable values for treatment. Among them, Intensity Modulated Radiation Therapy is considered to be a suitable treatment planning method.

• Journal of Digestive Cancer Research
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• v.5 no.1
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• pp.70-72
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• 2017

A 41-year old woman with dysphagia visited, which was aggravated after eating. On physical examination, there was a palpable mass on the left supraclavicular area. Endoscopic examination revealed a mass on the distal esophagus with irregular mucosa, erythema and a whitish plaque with luminal narrowing. The patient was diagnosed with unresectable esophageal cancer (squamous cell carcinoma, T3N2M1, Stage IV). The patient received CCRT (total 63 Gy) with cisplatin and 5-fluorouracil (5-FU). After CCRT, the patient took an additionally 2 cycles of chemotherapy for consolidation (cisplatin and 5-FU every 4 weeks). After additional chemotherapy, endoscopic examination showed no residual tumor, a chest CT scan revealed that the mass in the distal esophagus had decreased and there was no enlargement of the lymph nodes around the left supraclavicular area. The patient has been in complete remission for 5 years.

• Tuberculosis and Respiratory Diseases
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• v.71 no.6
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• pp.464-469
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• 2011

Adalimumab is a full human monoclonal antibody that inhibits tumor necrosis factor-alpha (TNF-${\alpha}$). This has recently been shown to be effective in the treatment of rheumatoid arthritis (RA), ankylosing spondylitis, and other conditions. Sacoidosis is known to be the target for adalimumab but we describe a patient who has developed sarcoidosis with lung involvement during adalimumab therapy for RA. A 48-year-old woman, who was treated with adalimumab for 5 months, was admitted because of chronic cough and both hilar lymphadenopathy on chest radiography. Chest computed tomography revealed the enlargement of multiple lymph nodes in the right supraclavicular, subcarinal, both hilar and right axillary area. She was diagnosed with sarcoidosis based on the biopsy of supraclavicular lymph node, skin and lung through video-associated thoracoscopic surgery, which was non-caseating epitheloid cell granuloma and excluded from a similar disease. She was treated for sarcoidosis with prednisolone and methotrexate instead of adalimumab.

• Tuberculosis and Respiratory Diseases
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• v.56 no.1
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• pp.18-28
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• 2004

Background : Many diseases like lung cancer and tuberculosis can involve cervical lymph node. Fine needle aspiration cytology(FNAC) was known as a useful screening test for the evaluation of enlarged lymph node. But the usefulness and limitations of FNAC according to disease category or physical characteristics of lymph node were not yet fully established. Methods : Retrospective analysis of three hundred forty two adult patients who performed FNAC due to enlarged cervical lymph nodes at the Seoul Municipal Boramae Hospital during the period from January 1999 to December 2002 and final diagnosis could be made by surgical biopsy, microbiology or clinical observation. Results : Among the 342 cases, 176(51.5 %) were finally diagnosed as benign nature ncluding reactive hyperplasia, Kikuchi's disease and acute suppuration. Eighty eight(25.7 %) were diagnosed as tuberculous lymphadenitis, 66(19.3 %) as metastasis, and 12(3.5 %) as lymphoma. Tuberculosis, metastasis, and lymphoma all showed significantly larger diameter, longer duration of lymph node enlargement. There were higher frequency of supraclavicular involvement in the cases of tuberculosis and metastasis. The overall diagnostic sensitivity of FNAC was 88.0 %, and 88.6 % in benign nature lesion, 77.3 % in tuberculosis, 90.1% in metastasis and 58.3 % in lymphoma. The diagnosis of tuberculosis was made by FNAC in 68 cases (77.3 %) among 88 cases. Lung cancer(43.9 percent) was most frequent cause of cervical lymph node metastasis. Diagnostic sensitivity of FNAC was significantly lower in the supraclavicular than other cervical lymph node(80 % vs. 91.3 %) and not correlated with disease nature, node size or number. Conclusion : Though FNAC was a reliable screening test for enlarged cervical lymph node enlargement, the diagnostic sensitivity was low in the case of lymphoma or when the enlarged lymph node was located at the supraclavicular area.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.9
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• pp.4639-4643
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• 2012

The burden of lung cancer in terms of mortality is the highest among all types of cancers globally. The present study aimed to evaluate lifestyle related habits, clinico-pathological profile and treatment details of lung cancer patients who were registered at Malabar Cancer Centre (MCC), Kerala, during the calendar year 2010. A retrospective evaluation was made from medical records to gather data from 281 registered lung cancer cases in 241 males and 40 females, with a male to female ratio of 6.03: 1. Approximately 89% of the cases were above 50 years of age. Among males about 91% of the cases were smokers and 62% of them had a chronic smoking habit. Adenocarcinomas, squamous cell carcinomas, non-small cell carcinomas and small cell cancers accounted for 10.7, 13.9, 17.0 and 5.7% respectively. Out of 281 cases around 67% were diagnosed with distant metastasis and the remainder had regional lymph node involvement. However, no statistically significant difference was observed for secondary site of tumor according to gender. As majority of the cases reported at MCC were in an advanced stage of the disease, histology of the secondary site from supraclavicular lymph nodes or liver was taken for diagnosis. Initiation of population based screening for early detection of cancer, and primary and secondary prevention strategies for reducing the prevalence of tobacco consumption are high priorities to reduce the lung cancer burden in Kerala.

• Radiation Oncology Journal
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• v.35 no.3
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• pp.241-248
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• 2017

Purpose: To evaluate the efficacy and safety of extended-field radiation therapy for patients with thoracic superficial esophageal cancer (SEC). Materials and Methods: From May 2007 to October 2016, a total of 24 patients with thoracic SEC (T1a and T1b) who underwent definitive radiotherapy and were analyzed retrospectively. The median total radiotherapy dose was 64 Gy (range, 54 to 66 Gy) in conventional fractionation. All 24 patients received radiotherapy to whole thoracic esophagus and 23 patients received elective nodal irradiation. The supraclavicular lymph nodes, the celiac lymph nodes, and both of those nodal areas were included in 11, 3, and 9 patients, respectively. Results: The median follow-up duration was 28.7 months (range 7.9 to 108.0 months). The 3-year overall survival, local control, and progression-free survival rates were 95.2%, 89.7%, and 78.7%, respectively. There were 5 patients (20.8%) with progression of disease, 2 local failures (8.3%) and 3 (12.5%) regional failures. Three patients also experienced distant metastasis and had died of disease progression. There were no treatment-related toxicities of grade 3 or higher. Conclusion: Definitive extended-field radiotherapy for thoracic SEC showed durable disease control rates in medically inoperable and endoscopically unfit patients. Even extended-field radiotherapy with elective nodal irradiation was safe without grade 3 or 4 toxicities.

• Tuberculosis and Respiratory Diseases
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• v.70 no.6
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• pp.504-510
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• 2011

Background: $^{67}Ga$ scintigraphy has been used for years in sarcoidosis for diagnosis and to determine the extent of the disease. The present report is a study of various findings of $^{67}Ga$ scintigraphy in patients with sarcoidosis. Methods: Between 1998 and 2007, 16 patients (male：female, 6:10; age, $35.9{\pm}15.3$ years) with histologically proven sarcoidosis underwent clinical evaluation and $^{67}Ga$ scintigraphy. According to the site of involvement, they were divided into subtypes and analyzed. Results: Sixteen patients with sarcoidosis had involvement of various organs, including lymph nodes (13/16, 81.3%), lung (3/16, 18.8%), muscle (1/16, 6.3%), subcutaneous tissue (1/16, 6.3%), glands (1/16, 6.3%), and bone (1/16, 6.3%). Sites of involved lymph nodes were thorax (12/13, 92.3%), supraclavicular area (5/13, 38.5%), inguinal area (2/13, 15.4%), abdomen (2/13, 15.4%), and pelvis (1/13, 7.7%). Conclusion: Because sarcoidosis frequently involves multiple organs, $^{67}Ga$ scintigraphy is a useful method in for evaluating the whole body. Nuclear medicine physicians should be familiar with the various findings of gallium uptake in sarcoidosis.

• Tuberculosis and Respiratory Diseases
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• v.50 no.1
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• pp.84-93
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• 2001

Backgrounds : In the absence of distant metastasis, small cell lung cancer (SCLC) patients presenting with supraclavicular lymph node (SCLN) involvement and pleural effusion can benefit from thoracic radiotherapy. But there are some debate as to the prognostic significance of both SCLN involvement and pleural effusion. The purpose of this study was to determine the prognostic significance of SCLN involvement and pleural effusion in SCLC. Methods : Two Hundred and fifteen patients with histologically confirmed small cell lung cancer, who were treated either at the Keimyung university Dongsan hospital and Kyungpook national university hospital from January 1994 to June 1998, were evaluated retrospectively. The patients were classified as having either limited or extensive stage using the Veterans Administration staging system. Results : SCLN was presented in 10.5% of patients(n=21). The median survival was 247 days for patients with SCLN(n=21) and 264 days for patients without(n=194) (p=0.52). After treatment, the median survival was 298 days for patients with SCLN(n=13) and 348 days for patients without(n=115) (p=0.52). SCLN involvement was not correlated with the presence of distant metastases. Median survival was 459 days for patients with a limited stage without SCLN(n=66), 650 days for those with a limited stage with SCLN (n=7) (p=0.96). Pleural effusion was presented in 24.7% of patients(n=52). The median survival was 198 days for patients with pleural effusion(n=52) and 275 days for patients without(n=163) (p<0.05). After treatment, the median survival was 294 days for patients with a pleural effusion(n=25) and 286 days for patients without(n=103) (p=0.39). The presence of pleural effusion was not correlated with that of distant metastases. The median survival was 395 days for patients with a limited stage without a pleural effusion(n=63), 451 days for those with a limited stage with pleural effusion(n=10) (p=0.92). Conclusionsa : In this study, SCLN involvement does not explain the poor survival rate and the relevance to extensive staged disease. Furthermore, the existence of a pleural effusion did not correlated with the presence of distant metastases. However, the presence of a pleural effusion appears to be a minor prognostic factor in our study. Therefore supraclavicular lymph node involvement and the presence of a pleural effusion in SCLC are not poor prognostic factors, which does not justify any amendment to the staging system currently used.