• Radiation Oncology Journal
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• 제12권1호
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• pp.9-16
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• 1994

마우스 종양인 SCCVll과 RIF-1에서 선택적 저산소세포 치사제인 SR 4233 (tirapazamine)과 분할 방사선조사를 병용하면 저산소분획이 큰 종양에서 방사선 감수성이 더욱 증강될 것인가를 확인하기 위하여 본 연구를 실시하였다. 종양세포 이식이전에 방사선조사를 받은 정상조직에서 성장한 종양의 저산소세포 분획이 크다는 사실을 이용하여 저산소세포분획이 큰 종양 모델을 수립 사용하였다. 일정 용적의(100$mm^{3}$) 종양에 대하여 1회 2 Gy를 1일 2회씩 6회 또는 1회 2.5 Gy를 1일 2회씩 8회 조사하는 등의 분할조사법을 사용하여 방사선조사를 시행하였다. SR 4233를 병용한 경우에는 매회 방사선조사 30분 전에 0.08 mmol/kg를 복강내 주사하였다. 정상조직에서 성장한 종양에 비하여 방사선 조사를 받은 조직에서는 성장한 종양은 분할 방사선조사에 대하여 약 5배의 내성을 보였으나 SR 4233 분할 치료에 대하여는 약 5배의 감수성을 나타내었다. 정상 종양 및 저산소세포 분획이 큰 종양의 방사선 감수성은 공통적으로 SR 4233의 병용후 증강되었으며 저산소세포 분획이 큰 종양에서의 증강율이 정상종양에서의 증강율과 동일하거나 더욱 높았다. 따라서 선택적 저산소세포 치사제인 SR 4233과 분할 방사선조사를 병용할 경우 저산소분획이 큰 종양에서 치사효과가 더욱 증강된 사실을 확인하였다. 이러한 결과는 높은 저산소세포 분획에 의한 방사선내성을 보이는 종양중 일부는 저산소세포치사제와 방사선치료를 병용함으로써 국소적 종양관해 실패의 요인인 저산소 세포를 극복하는 임상 적용 가능성을 시사한다.

• Radiation Oncology Journal
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• 제38권1호
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• pp.35-43
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• 2020

Purpose: This retrospective study compares higher-dose whole-brain radiotherapy (hdWBRT) with reduced-dose WBRT (rdWBRT) in terms of clinical efficacy and toxicity profile in patients treated for primary central nervous system lymphoma (PCNSL). Materials and Methods: Radiotherapy followed by high-dose methotrexate (HD-MTX)-based chemotherapy was administered to immunocompetent patients with histologically confirmed PCNSL between 2000 and 2016. Response to chemotherapy was taken into account when prescribing the radiation dose to the whole brain and primary tumor bed. The whole brain dose was ≤23.4 Gy for rdWBRT (n = 20) and >23.4 Gy for hdWBRT (n = 68). Patients manifesting cognitive disturbance, memory impairment and dysarthria were considered to have neurotoxicity. A median follow-up was 3.62 years. Results: The 3-year overall survival (OS) and progression-free survival (PFS) were 70.0% and 48.9% with rdWBRT, and 63.2% and 43.2% with hdWBRT. The 3-year OS and PFS among patients with partial response (n = 45) after chemotherapy were 77.8% and 53.3% with rdWBRT, and 58.3% and 45.8% with hdWBRT (p > 0.05). Among patients with complete response achieved during follow-up, the 3-year freedom from neurotoxicity (FFNT) rate was 94.1% with rdWBRT and 62.4% with hdWBRT. Among patients aged ≥60 years, the 3-year FFNT rate was 87.5% with rdWBRT and 39.1% with hdWBRT (p = 0.49). Neurotoxicity was not observed after rdWBRT in patients aged below 60 years. Conclusion: rdWBRT with tumor bed boost combined with upfront HD-MTX is less neurotoxic and results in effective survival as higher-dose radiotherapy even in partial response after chemotherapy.

• Journal of Korean Neurosurgical Society
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• 제56권2호
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• pp.98-102
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• 2014

Objective : The purpose of this study was to assess the feasibility and clinical efficacy of motor evoked potential (MEP) monitoring for supratentorial tumor surgery. Methods : Between 2010 and 2012, to prevent postoperative motor deterioration, MEP recording after transcranial stimulation was performed in 84 patients with supratentorial brain tumors (45 males, 39 females; age range, 24-80 years; median age, 58 years). MEP monitoring results were correlated with postoperative motor outcome compared to preoperative motor status. Results : MEP recordings were stable in amplitude (<50% reduction in amplitude) during surgery in 77 patients (91.7%). No postoperative motor deficit was found in 66 out of 77 patients with stable MEP amplitudes. However, postoperative paresis developed in 11 patients. False negative findings were associated with edema in peri-resectional regions and postoperative bleeding in the tumor bed. MEP decrease in amplitude (>50%) occurred in seven patients (8.3%). However, no deficit occurred postoperatively in four patients following preventive management during the operation. Three patients had permanent paresis, which could have been associated with vascular injury during tumor resection. Conclusions : MEP monitoring during supratentorial tumor surgery is feasible and safe. However, false negative MEP results associated with postoperative events may occur in some patients. To achieve successful monitoring, collaboration between surgeon, anesthesiologist and an experienced technician is mandatory.

• Radiation Oncology Journal
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• 제18권2호
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• pp.120-126
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• 2000

목적 : 종양내 저산소상태는 저산소세포치사제에 의하여 극복이 가능하다. 방사선의 반응을 증강시키는 tirapazamine 의 효과가 마우스 종양에서 분할방사선조사와 병용된 상태에서 종양내 산소상태에 따라 어떠한 영향을 받는가를 확인하고자 하였다. 대상 및 방법 : 대조군 및 저산소 상태의 종양을 수립하기 위하여 정상 및 4주전에 방사선 조사를 받았던 마우스의 등과 하지에 RIF-1 종양을 이식하였다. 종양이 일정한 크기에 도달하면, 대조군 및 저산소 상태 종양에 대하여 생리식염수(0.02 mlg), tirapazamine (0.08 mMkg), 방사선조사(2.5 Gy), tirapazamine 과 방사선조사의 병용 등을 사용하여 4일간 8회의 과분할 치료를 시행하였다. 등의 종양 체적이 4 배로 증가하거나 하지의 종양 단면이 2배로 증가할 때 까지 종양의 크기 변화를 측정하여 얻은 종양성장의 지연을 기준으로 각 치료에 대한 반응을 평가하였다. 결과 : 등 및 하지의 정상 및 저산소종양의 평균증식양상으로 부터 tirapazamine이 방사선의 반응을 증강시켰음을 알 수 있다. tirapazamine에 의한 방사선증강효과는 호기의 종양체적 또는 종양단면적을 기준으로 한 증식지연실험 결과 등의 정상종양에서는 1.9배, 저산소종양에서는 2.4배였으며 하지의 정상종양에서는 1.85배, 저산소종양에서는 1.6배였다. 초기종양체적의 4배 증식 또는 종양단면적의 2배 증식까지의 기간을 기준으로 설정한 증식지연실험결과 등의 정상종양에서는 1.48배, 저산소종양에서는 2.0배였으며 하지의 정상종양에서는 1.85배, 저산소종양에서는 1.6배였다. 결론 :분할 방사선조사에 tirapazamine을 병용할 경우 방사선조사효과는 증강되며, 저산소상태에 있는 마우스 종양에서의 증강효과가 대조 종양에서의 증강효과와 동일하거나 더욱 양호할 가능성을 제시할 수 있었다.었으나 $7.4\%$만이 심한 증상을 보였고, 만성 합병증은 $7.9\%$에서 관찰되었으며, 장폐색, 비뇨기계증상의 악화, 방사선 방광염등의 순이었다.전에 예방하기 위해 중점 관리해야 할 지점에 대해 더 많은 정보를 얻을 수 있으리라고 사료된다.이었고(p<0.01) 포장에 대해서는 주택형태에 따라 농가나 아파트에 거주하는 주부가 단독주택이나 연립주택에 거주하는 주부보다 더 나쁘게 평가하는 경향이었다. (p<0.05) (9) 조사대상주부들은 시판제품의 가장 개선해야 할 점으로 위생성(37.0%), 가격(23.8%), 포장(15.6%), 맛(11.1%), 저장성(10.1%) 및 색(2.4%) 등의 순으로 지적하였고 주부의 거주지에 따라 대도시에 거주할수록 위생성을, 농어촌에 거주할수록 가격을 가장 개선해야 할 점으로 보는 경향이었다. (p<0.05)3.2%는 채소에는 cholesterol이 함유되어 있지 않으므로 채식이 건강에 좋다고 하였다. 또한 질병치료에 유효한 채소는 당근 등 42가지, 질병을 유발시키는 채소는 고사리 등 10종을 지적하였으며 이들은 과학적 증명이 가능하거나 민간요법으로 전해지고 있는 내용이다. 이상과 같이 덕성여자대학교 평생교육원에 다니는 주부의 채소 소비 형태에 대하여 살펴보았는데 가공된 채소반찬과 김치의 구입은 현재까지 일반화되지 않고 있음을 알 수 있으나 김치보다 채소반찬의 구입경험이 더 많은 것으로 나타났다. 본 논문은 덕성여자대학교 평생교육원에 다니는 주부를 대상으로 하였으나 앞으로 다양한 계층의 주부를 대상으로 하여 폭 넓은 채소소비에 관련된 연구가 이루어져야 한다고 사료된다.할 경우 적정 첨가 수준으로 당화액과 추출액의 비가 3:7의 범위를 넘지 않아야 버섯의 장점을 살리면서 기존 조청의 특성을 변화시키지 않는 제품을 제조할 수 있을 것으로 보인다.mic acid의 생성량(生成量)

• Radiation Oncology Journal
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• 제31권3호
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• pp.125-130
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• 2013

Purpose: We investigated the role of radiotherapy (RT) for pancreatobiliary neuroendocrine tumors (PB-NETs). Materials and Methods: We identified 9 patients with PB-NETs who received RT between January 2005 and March 2012. Of these 9 patients, 4 were diagnosed with NETs in the pancreas and 5 were diagnosed with NETs in the gallbladder. All patients received RT to the primary tumor or resection bed with a median total irradiation dose of 50.4 Gy, with or without chemotherapy. Results: The tumor response rate and tumor control rate in the RT field were 60% and 100 %, respectively. All 4 patients who underwent surgery had no evidence of disease in the RT field. Of the 5 patients who received RT to the primary gross tumor, 1 had complete response, 2 had partial response, and 2 had stable disease in the RT field. The median time to progression was 11 months. Of the 9 patients, four patients had no progression, and 5 patients had progression of disease (locoregional, 2; distant, 2; locoregional/distant, 1). Of the 4 patients without progression, 3 were treated with RT in adjuvant or neoadjuvant setting, and one received RT to primary tumor. One patient experienced radiation-induced duodenitis at 3 months after concurrent chemoradiation without treatment-related mortality. Conclusion: RT can yield local control for advanced PB-NETs. RT should be considered an essential part of multimodality treatment in management of advanced PB-NETs.

• Archives of Plastic Surgery
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• 제38권4호
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• pp.398-400
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• 2011

Purpose: Subungual tumors are a common cause of nail plate deformity, and may be caused by fibrokeratoma, Koene's tumor and glomus tumors. Neurofibromas, either as part of neurofibromatosis or as a solitary tumor are exceptionally rare in the digits. Methods: A 44-year-old man presented with painless onychodystrophy and nail plate elevation of the right thumb due to a small subungual mass that had started growing 3 years ago. Sensory evaluation of the distal phalanx was normal, and no discoloration nor infection signs were seen. The nail plate was extracted under local anesthesia, and the mass was delicately removed without injury to the nail bed. The nail matrix was repaired with primary closure. Results: Histopathology shows a well circumscribed, cellular tumor with myxoid stroma. Tumor cells were S-100 protein positive, and the patient was diagnosed with myxoid neurofibroma. There has been no sign of recurrence to date, 14 months after the operation. Conclusion: Presentation of cutaneous neurofibromas in the digits is an uncommon finding. They may occur as a manifestation of neurofibromatosis or as a solitary tumor. Subungual neurofibromas are exceptionally rare. To our knowledge, there are only ten reports of solitary subungual neurofibroma unrelated to neurofibromatosis to date. We report a rare case of solitary subungual myxoid neurofibroma of the thumb, that was treated through total excision, with preservation of the nail matrix.

• Journal of Radiation Protection and Research
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• 제36권3호
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• pp.160-167
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• 2011

본 연구는 두경부 방사선치료에서 산란판(beam spoiler)과 볼루스(bolus)를 사용함에 따라 깊이가 다른 원발종양과 림프절 전이성 종양의 선량 변화를 이온함과 광자극발광선량계(optically stimulated luminescence detectors. OSLDs)를 이용하여 치료계획검증 방법으로 교차 비교하였다. 치료계획검증은 치료계획시스템에서 얻은 동일 조사 조건을 검출기가 삽입 가능한 고체 팬텀에 모사하는 방법으로 산란판과 0.5, 1 cm 볼루스를 비교하였으며 두 선량계의 교차비교는 측정 오차가 ${\pm}$2% 미만일 때 신뢰성이 있다고 판단하였다. 연구 결과 0.5 cm 두께의 산란판과 피부간 거리가 10 cm 일 때 최적의 선량분포를 얻을 수 있었으며 볼루스에 비하여 피부선량이 작고 중심부 원발종양 선량의 감소가 작았다. 또한 두 선량계의 교차 비교는 ${\pm}$1% 이내로 유의한 결과를 보였다. 두경부 종양의 방사선치료시 산란판을 사용함으로써 피부 부작용을 줄이면서 종양에 최적의 선량분포를 달성할 수 있다고 판단되었으며 향후 임상에 적용하기 위한 연구가 시행되어야 할 것이다.

• Archives of Plastic Surgery
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• 제42권3호
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• pp.295-301
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• 2015

Background Glomus tumors were first described by Wood in 1812 as painful subcutaneous tubercles. It is an uncommon benign neoplasm involving the glomus body, an apparatus that involves in thermoregulation of cutaneous microvasculature. Glomus tumor constitutes 1%-5% of all hand tumors. It usually occurs at the subungual region and more commonly in aged women. Its classical clinical triad consists of pain, tenderness and temperature intolerance, especially cold sensitivity. This study reviews 15 cases of glomus tumor which were analyzed according to its anatomic location, surgical approach and histologic findings. Methods Fifteen patients with subungual glomus tumors of the hand operated on between January 2006 and March 2013, were retrospectively reviewed. Patients were evaluated preoperatively with standard physical examination including ice cube test and Love's test. Diagnostic imaging consisted of ultrasonography, computed tomography, and magnetic resonance imaging. All procedures were performed with tourniquet control under local anesthesia. Eleven patients underwent excision using the transungual approach, 3 patients using the volar approach and 1 patient using the lateral subperiosteal approach. Results Total of 15 cases were reviewed. 11 tumors were located in the nail bed, 3 in the volar pulp and 1 in the radial aspect of the finger tip. After complete excision, patients remained asymptomatic in the immediate postoperative period. In the long term follow up, patients exhibited excellent cosmetic results with no recurrence. Conclusions Accurate diagnosis should be made by physical, radiologic and pathologic examinations. Preoperative localization and complete extirpation is essential in preventing recurrence and subsequent nail deformity.

• Radiation Oncology Journal
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• 제33권4호
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• pp.320-327
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• 2015

Purpose: To investigate the treatment outcome and the toxicity of helical tomotherapy (HT) in patients with metastatic colorectal cancer (mCRC). Materials and Methods: We retrospectively reviewed 18 patients with 31 lesions from mCRC treated with HT between 2009 and 2013. The liver (9 lesions) and lymph nodes (9 lesions) were the most frequent sites. The planning target volume (PTV) ranged from 12 to 1,110 mL (median, 114 mL). The total doses ranged from 30 to 70 Gy in 10-30 fractions. When the ${\alpha}/{\beta}$ value for the tumor was assumed to be 10 Gy for the biologically equivalent dose (BED), the total doses ranged from 39 to $119Gy_{10}$ (median, $55Gy_{10}$). Nineteen lesions were treated with concurrent chemotherapy (CCRT). Results: With a median follow-up time of 16 months, the median overall survival for 18 patients was 33 months. Eight lesions (26%) achieved complete response. The 1- and 3-year local progression free survival (LPFS) rates for 31 lesions were 45% and 34%, respectively. On univariate analysis, significant parameters influencing LPFS rates were chemotherapy response before HT, aim of HT, CCRT, PTV, BED, and adjuvant chemotherapy. On multivariate analysis, $PTV{\leq}113mL$ and $BED>48Gy_{10}$ were associated with a statistically significant improvement in LFPS. During HT, four patients experienced grade 3 hematologic toxicities, each of whom had also received CCRT. Conclusion: The current study demonstrates the efficacy and tolerability of HT for mCRC. To define optimal RT dose according to tumor size of mCRC, further study should be needed.

• Radiation Oncology Journal
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• 제35권2호
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• pp.144-152
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• 2017

Purpose: The role of radiotherapy (RT) was largely deserted after the introduction of platinum-based chemotherapy, but still survival rates are disappointingly low. This study focuses on assessing the clinical efficacy of RT in relation to chemotherapy resistance. Materials and Methods: From October 2002 to January 2015, 44 patients were diagnosed with epithelial ovarian cancer (EOC) and treated with palliative RT for persistent or recurrent EOC. All patients received initial treatment with optimal debulking surgery and adjuvant platinum-based chemotherapy. The biologically effective dose (BED) was calculated with ${\alpha}/{\beta}$ set at 10. Ninety-four sites were treated with RT with a median BED of 50.7 Gy (range 28.0 to 79.2 Gy). The primary end-point was the in-field local control (LC) interval, defined as the time interval from the date RT was completed to the date any progressive or newly recurring disease within the RT field was detected on radiographic imaging. Results: The median follow-up duration was 52.3 months (range 7.7 to 179.0 months). The 1-year and 2-year in-field LC rates were 66.0% and 55.0%, respectively. Comparisons of percent change of in-field tumor response showed similar distribution of responses among chemoresistant and chemosensitive tumors. On multivariate analysis of predictive factors for in-field LC analyzed by sites treated, $BED{\geq}50Gy$ (hazard ratio, 0.4; confidence interval, 0.2-0.9; p = 0.025) showed better outcomes. Conclusion: Regardless of resistance to platinum-based chemotherapy, RT can be a feasible treatment modality for patients with persistent of recurrent EOC. The specific role of RT using updated approaches needs to be reassessed.