• Radiation Oncology Journal
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• 제35권2호
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• pp.112-120
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• 2017

Purpose: To evaluate the effect of adjuvant external beam radiation therapy (EBRT) on local failure-free survival rate (LFFS) for papillary thyroid cancer (PTC) invading the trachea. Materials and Methods: Fifty-six patients with locally advanced PTC invading the trachea were treated with surgical resection. After surgery, 21 patients received adjuvant EBRT and radioactive iodine therapy (EBRT group) and 35 patients were treated with radioactive iodine therapy (control group). Results: The age range was 26-87 years (median, 56 years). The median follow-up period was 43 months (range, 4 to 145 months). EBRT doses ranged from 50.4 to 66 Gy (median, 60 Gy). Esophagus invasion and gross residual disease was more frequent in the EBRT group. In the control group, local recurrence developed in 9 (9/35, 26%) and new distant metastasis in 2 (2/35, 6%) patients, occurring 4 to 68 months (median, 37 months) and 53 to 68 months (median, 60 months) after surgery, respectively. Two patients had simultaneous local recurrence and new distant metastasis. There was one local failure in the EBRT group at 18 months after surgery (1/21, 5%). The 5-year LFFS was 95% in the EBRT group and 63% in the control group (p = 0.103). In the EBRT group, one late grade 2 xerostomia was developed. Conclusion: Although, EBRT group had a higher incidence of esophagus invasion and gross residual disease, EBRT group showed a better 5-year LFFS. Adjuvant EBRT may have contributed to the better LFFS in these patients.

• 핵의학기술
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• 제21권2호
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• pp.49-54
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• 2017

Purpose The high-dose administration of I-131 has been standing for the basic therapy method of thyroid cancer. In korea, it is not necessary for patients to be hospitalized if the administration dose are under 1.2 GBq. However, if the dose are over 1.2 GBq, the patients should be stay in special ward with radiation shield. In such cases, the radioactivity level upon release should be under a dose of $70{\mu}Sv/hr$ at a distance of approx. 1m. This regulation bring the patients to stay for about 2 to 3 days in ward before the release. Materials and Methods Using the inpatients' release data of severance hospital, an inpatient-days were retrospectively calculated and compared with practical data and estimate the inpatient-days with the conditions of korea ($70{\mu}Sv/hr$), Japan ($30{\mu}Sv/hr$), germany ($3.5{\mu}Sv/hr$ at a distance of approx. 2 m), and other european countries. Results When a effective half-life of 15.4 was used, the expected inpatient-days were calculated as 2.15 days in the condition of Japanese regulation and 1.37 days in the condition of korean regulation. The practical inpatient-days of patients in Severance hospital were 1.32 days. Conclusion As ICRP 94 has been mentioned that the release of patients administrated with I-131 for the therapy should be carefully considered because each patients has different thyroid uptake rate and their conditions with family members after the release from the ward. Nonetheless, efforts to bring more aquate data which is for getting closer to the practical data should be continuously studied.

• 대한두경부종양학회지
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• 제27권1호
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• pp.59-65
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• 2011

Background and Objectives : Papillary thyroid carcinoma(PTC) frequently metastasize to the regional neck, however, lateral neck lymph node metastasis is less common. The aim of this study is to investigate clinical and immunohistochemical features of PTC with lateral LN metastasis, and determine the predictive factors for lateral LN metastases. Material and Methods : We undertook a retrospective study of 83 patients treated between January 2007 and December 2009 for PTC by thyroidectomy with or without lateral neck dissection. The following criteria were used to study the clinical predictive value of lateral LN. metastases : sex, age, tumor size, multifocality, extracapsular spread(ECS) and lymphovascular emboli. Immunohistochemical staining for VEGF-A, VEGF-C, Bax, Bcl-2, Cyclin D1, Cyclin E, $p27^{kip1}$ and $p57^{kip2}$ was performed, and quantified blindly by three pathologists who had no clinical information of the patients. Immunohistochemical expression was scored as high(>50% of cells stained) or low(0-49%). Results : With use of univariate and multivariate analysis, tumor size(>2cm) and ECS were independent correlates of lateral LN metastasis in PTC. Expression of VEGF-C, Bax, and Cyclin D1 in the PTC with lateral LN metastasis was scored higher than in PTC without lateral LN metastasis(p<0.05). Conclusion : The important risk factors for lateral LN metastasis in PTC are primary tumor size and the presence of ECS. And expression of VEGF-C, Bax and cyclin D1 may be considered of lateral LN metastatic potential in PTC.

• 대한두경부종양학회지
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• 제35권2호
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• pp.11-17
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• 2019

Background/Objectives: Papillary thyroid carcinoma (PTC) has generally an indolent character with a good prognosis. However, recurrence remains a major concern for the patients during their lifetime. Despite the slowly progressing character of PTC, recurrence can occur within a short period after initial surgery. This study aimed to determine the clinical findings and cause of recurrence in patients who underwent re-operative surgery due to neck node recurrence by reviewing the CT (computed tomographic) scan imaging of the recurrence of PTC retrospectively. Materials & Methods: We reviewed the medical records of patients referred to Ajou University Hospital from January 2002 to January 2018. All patients had re-operative surgery due to neck node recurrence and CT scan results of preoperative evaluation and postoperative follow up. Over this period, 110 patients who underwent re-operation due to neck node recurrence with a CT scan were included in our cohort, resulting in a total of 220 re-operations. Results: The time from initial operation to first re-operation was examined in 110 patients. The median time to re-operation was 28 months, with a range of 4 months to 186 months. Most re-operations (82.7%) occurred within the first five years, 43.6% were in the first two years from the initial surgery. The result of the retrospective CT review showed newly developed cases (21,19.1%), missed diagnosis cases (42,38.2%), real recur cases after surgery (33,30.0%), and remnant lymph nodes (LNs) cases (14,12.7%). We further sub-analyzed 14 cases with remnant LNs. Reasons for remnant LNs included insufficient operation (N=5) and beyond general surgical extent. (N=9). Conclusion: Re-operation due to cervical lymph node recurrence is mostly a persistent disease. They included a missed diagnosis and incomplete operation. These finding may reduce the reoperation of cervical lymph node recurrence by accurate preoperative evaluation and complete surgical resection at the initial surgery.

• 대한환경공학회지
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• 제28권7호
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• pp.776-781
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• 2006

제초제, 로켓 추진제 등에 주로 사용되는 과염소산(perchlorate, $ClO_4^-$)은 갑상선의 요오드 섭취를 방해하여 갑상선 암을 유발할 수 있으며 임산부가 섭취 시 태아의 뇌 발달을 저해하는 등 인체 독성을 나타내는 것으로 알려져 있다. 최근 미국을 중심으로 perchlorate 관련 연구가 활발하게 진행되고 있으며 2006년 US. EPA에서 먹는물에서의 perchlorate 가이드라인을 설정하였다. 그러나 아직 국내에서는 perchlorate에 관한 독성 및 환경 내 오염 정도 등에 관해 구체적으로 조사된 바가 없다. 따라서 본 연구에서 국내 수 환경에서의 Perchlorate 오염 정도 파악을 위해 영남권 지역 주민들의 주 상수원수로 사용되고 있는 낙동강 수계와 낙동강 권역에 위치한 도시들의 수돗물을 대상으로 perchlorate를 분석하였다. 분석 결과 낙동강 수계 중에서는 $ND{\sim}278.4$ ${\mu}g/L$의 범위로 perchlorate가 검출되었으며 구미공단천(2차)에서 가장 높게 나타났으며 하류로 내려올수록 perchlorate 농도가 감소하였다. 수돗물의 경우 대상 도시에 따라 다소 편차를 나타냈으며 농도 범위는 $ND{\sim}34.1$ ${\mu}g/L$이었다. 조사 대상 지역 중 대구 달서 감삼동에서 가장 높게 검출되었고 부산에서는 비슷한 농도($9{\sim}11$ ${\mu}g/L$)로 대부분의 구에서 검출되었다. 본 조사결과는 낙동강 수계에 perchlorate 오염원이 있으며 낙동강을 상수원수로 사용하는 지역은 수돗물에서 perchlorate 관리대책이 필요함을 의미한다.

• 대한두경부종양학회지
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• 제17권2호
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• pp.205-209
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• 2001

Purpose: Most cases of primary hyperparathyroidism are due to parathyroid adenoma or parathyroid hyperplasia. Parathyroid carcinoma is a very rare cause of hyperparathyroidism. Although the diagnosis of parathyroid carcinoma is usually established by pathologic criteria especially of vascular or capsular invasion, some clinical and biochemical features differentiate it from benign forms of hyperparathyroidism. We under-took a retrospective study in 6 patients with parathyroid carcinoma, with the aim of conveying experience from management for this rare cause of hyperparathyroidism. Methods: Clinical symptoms, biochemical laboratory, radiologic, and intraoperative findings, local recurrence and distant metastasis were analyzed in 6 patients diagnosed pathologically as a parathyroid carcinoma after operation from 1992 to 2001. Results: Mean age was 50.2 years (33.0-60.0 years) and male to female ratio was 1:1. Neck mass was found in 5 patients, multiple bone pain in 3 patients and renal stone in 1 patient. One case has suffered from chronic renal failure for 19 years. Although preoperative laboratory evaluations showed the aspects of hyperparathyroidism in all cases, mean serum calcium level was 11.2mg/dl(10.5-12.1mg/dl), slightly elevated. Laboratory values after surgery were within the normal range in 5 cases. However, in one case with chronic renal failure, serum PTH levels, serially checked, were above the normal range. Any of imaging methods failed to suggest a parathyroid carcinoma preoperatively. Parathyroid adenoma was suspected in 3 cases, thyroid cancer in the other cases before surgery. The extent of resection was radical resection of parathyroid lesion with more than unilateral thyroid lobectomy and central compartment neck node dissection and in 2 cases, the resection of recurrent laryngeal nerve or strap muscles was added. During follow-up period, any local or systemic recurrence were not evident in all the cases. Conclusion: Although parathyroid carcinoma is a rare disease and its preoperative diagnosis, in our experience, could not easily be made, the understanding of characteristic clinical and biochemical feature could help diagnosis at first surgery. Radical resection without remaining residual tumor is most important for the management of the parathyroid cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6267-6272
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• 2015

Background: Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum. Materials and Methods: We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma. Results: We retrieved data of 75consecutive patients HNENL. Median age was 47years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI- 68.6- 95.35) and 88% (95%CI- 60.82 - 92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid. Conclusions: Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.

• 대한방사선기술학회지:방사선기술과학
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• 제39권4호
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• pp.565-570
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• 2016

방사성 요오드($^{131}I$) 치료는 분화성 갑상선암 환자에서 재발을 감소시키고 생존률을 증가시키나, 환자에서 방출되는 방사능으로 인하여 피폭을 야기시킬 수 있으므로 환자로부터 발생되는 방사선량률을 측정하는 것이 방사선안전관리 측면에서 중요하다. 방사성 요오드($^{131}I$) 치료시 널리 사용되는 측정기 중 전리함과 GM계수관으로 측정된 방사선량률의 감도와 측정효율을 구하였다. 방사성 요오드($^{131}I$)를 150mCi 경구투여 받은 분화성 갑상선암 환자의 상복부로부터 1 m거리에서 경과 시간에 따라 방사선량률을 측정하였다. 시간에 따른 변화를 직접적으로 비교한 결과, 고선량률에서의 감도와 측정효율은 GM계수관보다 전리함이 높게 나타났고, 통계적으로 유의하였다(p<0.05). 저선량률에서의 감도와 측정효율은 GM계수관보다 전리함이 낮게 나타났지만 통계적으로 유의한 차이를 나타내지 않았다(p>0.05). 방사성 요오드($^{131}I$) 치료시에 검 교정이 완료된 전리함과 GM계수관으로 정확하고 신속한 방사선량률을 측정하여 환자에게 설명함으로써 방사성 요오드 치료 후 퇴원하는 환자에게 환자가족 또는 주변 사람들에게 미칠 수 있는 방사선피폭을 예측하고, 불필요한 예단을 줄여줄 수 있을 것이다.

• Radiation Oncology Journal
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• 제28권2호
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• pp.64-70
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• 2010

목 적: 국소 진행된 두경부암 환자에서 방사선치료를 포함한 근치적 치료 후 갑상샘기능저하증의 발생률을 분석하고자 후향적 연구를 실시하였다. 대상 및 방법: 2000년 1월부터 2005년 12월까지 본원에서 국소 진행된 두경부암으로 진단받고 근치적 목적으로 방사선치료 단독 또는 수술 후 방사선치료를 받은 환자 중 수술로 갑상샘을 절제하지 않았고, 방사선치료 전 갑상샘기능이 정상이며, 하부 경부림프절이 방사선치료 범위에 포함된 115명의 환자를 대상으로 본 연구를 시행하였다. 환자의 중앙연령은 59세(28~85세)이고 남자 73명, 여자 42명이었다. 원발병소의 위치는 구강, 구인두, 하인두, 후두, 그 외가 각각 18, 40, 28, 22, 7명이었으며, 편측 경부절제술을 받은 환자가 19명(16.5%), 양측 경부절제술을 받은 환자가 18명(15.7%), 방사선치료만을 시행한 환자가 78명(67.8%)이었다. 방사선치료는 6-MV X-ray를 사용하였으며, 통상 분할 조사법에 의해 하루 1.8~2 Gy 씩, 주 5회 조사하였다. 원발병소에 조사된 방사선량은 중앙값 70.2 Gy (59.4~79.4 Gy)이었으며, 하부 경부림프절에 조사된 방사선량은 중앙값 50.0 Gy (44.0~66.0 Gy)이었다. 추적관찰기간은 2~91개월이었으며, 중앙값은 29개월이었다. 결 과: 전체 115명 환자 중에서 38명(33.0%)의 환자에서 갑상샘기능저하증이 관찰되었다. 전체 환자의 1년, 3년의 갑상샘기능저하증 발생률은 각각 28.7% (33명), 33.0% (38명)이었으며, 갑상샘기능저하증 발생시기의 중앙값은 8.5개월(0~36개월)이다. 갑상샘기능저하증 발생에 영향을 주는 인자로 단변량분석결과 경부절제술 여부가 위험인자로 분석되었으나, 다변량분석에서는 통계적으로 유의한 관련 인자는 없었다. 결 론: 두경부 종양환자의 방사선치료를 포함한 근치적 치료 후 갑상샘기능저하증이 발생할 수 있으며, 대부분이 1년 이내 발생하므로 치료 후 갑상샘기능검사를 정기적으로 실시할 필요가 있다. 특히 경부 림프절제술 후 방사선 치료를 시행하는 경우 더욱 주의하여 갑상샘기능저하증의 발생을 확인해야 한다.

• 대한영상의학회지
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• 제82권3호
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• pp.654-669
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• 2021

목적 신보강화학요법을 시행한 유방암 환자에서 병리학적 관해와 잔류 암의 크기를 평가하는 데 있어 유방자기공명영상의 정확도를 분석하고 이에 영향을 미치는 인자들이 무엇인지 알아본다. 대상과 방법 2010년부터 2017년까지 본원에서 신보강화학요법 후 수술을 시행한 88명의 유방암 환자를 대상으로 하였다. 병리학적 관해는 수술 병리 결과에서 침윤성 유방암이 발견되지 않는 것으로 정의하였고 자기공명영상과 병리 조직의 잔류 암 크기 차이는 최대 직경으로 비교하였다. 병리학적 관해 및 자기공명영상과 병리 조직에서의 잔류 암 크기 차이에 영향을 미치는 인자를 알아보기 위해 통계분석을 시행하였다. 결과 전체 환자의 10%가 병리학적 관해에 도달하였다. 자기공명영상으로 관해를 예측할 때의 정확도와 곡선하부면적은 각각 90.91%, 0.8017이었다. 신보강화학요법 시행 후 유방자기 공명영상과 병리 조직에서 측정한 잔류 암의 크기는 매우 강한 연관성을 보였고(r = 0.9, p < 0.001), 특히 영상에서 단일 종괴로 보였던 병변에서(p = 0.047) 그러하였다. 자기공명영상과 병리 조직 간의 잔류 암 크기는 내강형(p = 0.023), 그리고 자기공명영상에서 다초점 종괴 및 비종괴성 조영증강을 보인(p = 0.047) 환자군에서 유의미하게 큰 차이를 보였다. 결론 자기공명영상은 유방암의 병리학적 완전 관해와 잔류 암 크기의 평가에 있어서 정확도가 높은 검사이다. 유방암 아형과 병변의 영상의학적 소견이 자기공명영상의 정확도에 영향을 미친다.