• 대한방사선치료학회지
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• 제23권2호
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• pp.103-108
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• 2011

목 적: 뇌전이 환자에게 시행하는 고전적인 헬멧(Helmet field)형태의 대향2문방사선조사는 환자두피에 과 선량을 일으키며 이는 탈모의 원인이 된다. 이에 본 연구에서는 환자두피를 보호하기 위한 두피보호 형태(Scalp-shielding shape)의 대향 2문 조사와 토모 치료법을 고전적 방사선치료법과 비교하여 보다 효과적인 탈모 예방의 두피선량을 정량적으로 분석하고자 한다. 대상 및 방법: 두피선량은 RANDO 팬톰을 사용하여 열형광선량계를 전두엽의 중심선에 따라서 5개를 위치시킨 후, 세 가지 치료방법(HELMET, MLC, TOMO)으로 피부선량을 측정하였고, 전산화치료계획장치(Pinnacle3, Philips Medical System, USA), 6MV X선(Clinac 6EX, VARIAN, USA)을 이용하여 방사선치료계획을 수립한 후, DVH로 선량분포변화와 두피선량을 비교 분석하였다. 결 과: 열형광선량계를 사용하여 두피의 표면선량을 측정한 결과 기존의 HELMET field 치료방법과 비교했을 때 MLC technique에서는 각 포인트 지점에서 평균 87.44% 두피선량이 감소하는 것으로 측정되었으며 TOMO에서는 평균 88.03% 두피 선량이 감소하는 것으로 측정되었다. 또한 세 가지 치료방법의 두피내의 과다선량 영역(Hotspot)의 존재정도를 평가하기 위해 선량체적히스토그램(Dose volume histogram, DVH)을 사용하여 처방선량의 95%, 100%, 105%가 받는 용적의 백분율(Percentage of volume: V95, V100, V105)을 계산한 결과 MLC technique과 TOMO plan에서 과다선량 없이 Dose coverage가 우수함을 보여주었다. 결 론: 전뇌 방사선치료를 받는 환자에게 탈모현상을 줄여주는 것은 환자의 삶의 질을 높여주는 측면에서 중요하다. 이에 본 실험결과를 바탕으로 두피보호 형태(Scalp-shielding shape)의 대향 2문 조사와 토모 치료법을 사용하여 환자의 두피를 보호함으로써 환자의 탈모현상을 줄여주는 효과를 기대할 수 있을 것이라 사료된다.

• Journal of Korean Neurosurgical Society
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• 제52권4호
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• pp.334-338
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• 2012

Objective : We compared the survival time between patients with multiple gamma knife radiosurgery (GKRS) and patients with a single GKRS plus whole brain radiation therapy (WBRT), in patients with multiple metachronous brain metastases from lung cancer. Methods : From May 2006 to July 2010, we analyzed 31 patients out of 112 patients who showed multiple metachronous brain metastases. 20 out of 31 patients underwent multiple GKRS (group A) and 11 patients underwent a single GKRS plus WBRT (group B). We compared the survival time between group A and B. Kaplan-Meier method and Cox proportional hazards were used to analyze relationship between survival and 1) the number of lesions in each patient, 2) the average volume of lesions in each patient, 3) the number of repeated GKRS, and 4) the interval of development of new lesions, respectively. Results : Median survival time was 18 months (range 6-50 months) in group A and 6 months (range 3-18 months) in group B. Only the average volume of individual lesion (over 10 cc) was negatively related with survival time according to Kaplan-Meier method. Cox-proportional hazard ratio of each variable was 1.1559 for the number of lesions, 1.0005 for the average volume of lesions, 0.0894 for the numbers of repeated GKRS, and 0.5970 for the interval of development of new lesions. Conclusion : This study showed extended survival time in group A compared with group B. Our result supports that multiple GKRS is of value in extending the survival time in patients with multiple metachronous brain metastases, and that the number of the lesions and the frequency of development of new lesions are not an obstacle in treating patients with GKRS.

• Asian Pacific Journal of Cancer Prevention
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• 제16권13호
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• pp.5401-5406
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• 2015

Background: Brain metastases are the most common intra-cranial neoplasms. The incidence is on a rise due to advanced imaging techniques. Aims: The objective of the study was to analyse the clinical and demographic profile of patients with brain metastases from primary solid tumors. Materials and Methods: This is a retrospective single institutional study covering 130 consecutive patients with brain metastases from January 2007 to August 2014. Results: Some 64.6% of the patients were females. The majority were in the sixth decade of life. The site of the primary tumor was the lungs in 50.8% of the cases. The overall median time from the diagnosis of the primary malignancy to detection of brain metastases was 21.4 months. Survival was found to be significantly improved in patients with solitary brain lesions when compared to patients with multiple brain metastases, and in patients undergoing surgical excision with or without cranial irradiation when compared to whole brain irradiation alone. The majority of the cases belonged to the recursive partitioning analysis class II group. Whole brain radiation therapy was delivered to 79% of the patients. Conclusions: Most of the patients with brain metastases in the study belonged to recursive partitioning analysis classes II or III, and hence had poor prognosis. Most of the patients in the Indian context either do not satisfy the indications for surgical excision or are incapable of bearing the high cost associated with stereotactic radiosurgery. Treatment should be tailored on an individual basis to all these patients.

• Radiation Oncology Journal
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• 제1권1호
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• pp.69-77
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• 1983

20 cases of midline pineal tumors and 3 suprasellar germinomas received radiation therapy at Yonsei University Medical College, Severance hospital from 1971 to 1982 were reviewed. 12 cases were pathologically proved; 10 germinomas, 1 pineoblastoma, and 1 pineocytoma. 11 cases received radiotherapy without biopsy confirmation. Although treatment fields varied from small field to whole brain irradiation, but not to the spinal cord, most patients received 4000-5000 rads irradiation to the primary tumor site. 17 patients are alive without evidence of disease and 5 year actuarial NED survival is 73.2%. 9 of 10 biopsy proved germinomas and all 6 presumed germinomas are alive and well. Optimum radiation dose, adequate irradiation field, tumor response to radiation observed in serial CT scan and role of radiation therapy in the management of pineal tumors are also discussed.

• Radiation Oncology Journal
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• 제3권2호
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• pp.163-168
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• 1985

원발성 안구 흑색종은 20세 이상의 성인에서 가장 많이 발생되는 안주의 악성종양이지만 한국에서의 발생빈도는 그리 흔하지 않은 것으로 되어 있다. 안구 흑색종의 치료전에는 문진, 이학적검사, 기본적인 혈액상검사와, 특히 간, 폐, 골에 세심한 주의를 하여야 하며, 그래서 흉부 X-선과 LDH, SGPT, Transpeptidase를 포함한 간기능 검사 등을 시행하여야 하고 만약 임상적으로 증상이 있거나 위의 검사상 비정상적인 소견을 보일 매에는 전신뼈 스캔, 간-지 라 스캔을 시행하여야 한다. 일반적으로 악성 흑색종은 방사선 치료에 대해 치료효과가 나쁜 것으로 알려져 있지만 때로는 총 종양조사선량 $7,000\~8,000 cG/8\~9$주로 매우 빠른 종괴의 감소를 보여 주기도 한다. 그리하여 저자등은 외부방사선조사로 빠른 치료반응을 보인 원발성 안주 흑색종의 치료와 문헌고찰을 보고하는 바이다.

• Journal of Korean Neurosurgical Society
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• 제60권6호
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• pp.667-675
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• 2017

Objective : Total resection without consecutive postoperative whole brain radiation therapy is indicated for patients with a single or two sites of brain metastasis, with close follow-up by serial magnetic resonance imaging (MRI). In this study, we explored the effectiveness, usefulness, and safety of this follow-up regimen. Methods : From January 2006 to December 2015, a total of 109 patients (76 males, 33 females) underwent tumor resection as the first treatment for brain metastases (97 patients with single metastases, 12 with two metastases). The mean age was 59.8 years (range 27-80). The location of the 121 tumors in the 109 patients was supratentorial (n=98) and in the cerebellum (n=23). The origin of the primary cancers was lung (n=45), breast (n=17), gastrointestinal tract (n=18), hepatobiliary system (n=8), kidney (n=7), others (n=11), and unknown origin (n=3). The 121 tumors were totally resected. Follow-up involved regular clinical and MRI assessments. Recurrence-free survival (RFS) and overall survival (OS) after tumor resection were analyzed by Kaplan-Meier methods based on clinical prognostic factors. Results : During the follow-up, MRI scans were done for 85 patients (78%) with 97 tumors. Fifty-six of the 97 tumors showed no recurrence without adjuvant local treatment, representing a numerical tumor recurrence-free rate of 57.7%. Mean and median RFS was 13.6 and 5.3 months, respectively. Kaplan-Meier analysis revealed the cerebellar location of the tumor as the only statistically significant prognostic factor related to RFS (p=0.020). Mean and median OS was 15.2 and 8.1 months, respectively. There were no significant prognostic factors related to OS. The survival rate at one year was 8.2% (9 of 109). Conclusion : With close and regular clinical and image follow-up, initial postoperative observation without prompt postoperative radiation therapy can be applied in patients of brain metastasi(e)s when both the tumor(s) are completely resected.

• Journal of Korean Neurosurgical Society
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• 제37권4호
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• pp.296-299
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• 2005

We report a case of primary central nervous system(CNS) lymphoma in an organ recipient. A 33-years-old man who underwent a renal transplantation 3years previously presented with headache and vomiting. In Brain computed tomography scans and magnetic resonance images showed multiple periventricular cystic rim enhancing masses. Pathologic diagnosis by stereotactic biopsy revealed malignant non-Hodgkins B-cell lymphoma. After pathologic confirmation, methotrexate chemotherapy and whole brain radiation therapy were done. Having experienced such a case, the authors strongly recommend to add primary CNS lymphoma as one of the differential diagnoses to brain abscess, metastatic brain tumor and glioblastoma multiforme in cases of multiple ring enhancing periventricular lesions of immunocompromised patient or organ recipient.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.1995-1997
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• 2012

Background: Brain metastasis from cholangiocarcinoma (CCA) is a rare but fatal event. To the best of our knowledge, only few cases have been reported. Herein, we report the incident rate and a first case series of brain metastases from CCA. Methods: Between January 2006 and December 2010 5,164 patients were treated at Srinagarind hospital, Khon Kaen University; of those, 8 patients developed brain metastasis. Here we reviewed clinical data and survival times. Results: The incident rate of brain metastases from CCA was 0.15%. The median age of the patients was 60 years. Tumor subtypes were intrahepatic in 6 and hilar in 2 patients. All suffered from symptoms related to brain metastasis. Three patients were treated with whole-brain radiation therapy (WBRT), one of whom also underwent surgery. The median survival after the diagnosis of brain metastasis was 9.5 weeks (1-28 weeks). The longest survival observed in a patient in RPA class I with two brain lesions and received WBRT. Conclusion: This is a first case series of brain metastases from CCA with the incident rate of 0.15%. It is rare and associated with short survival time.

• 대한방사선기술학회지:방사선기술과학
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• 제34권1호
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• pp.59-64
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• 2011

소아암 환자에 대한 양성자치료 시 정밀한 자세재현 확인 및 종양의 위치파악을 위한 DIPS 촬영으로 인하여 발생하는 방사선 피폭에 관하여 확인하여 보았다. 2007년 3월부터 2009년 10월까지 일산의 K 암전문 병원에서 양성자치료를 받은 50명의 소아암 환자를 대상으로 DIPS의 촬영조건을 비교 분석하였으며, 1회 DIPS 촬영 시 피폭선량은 전후 측면촬영에서 0.09~1.57 mGy로 측정 되었으며, 1일 DIPS 촬영이 가장 많은 소아암 환자는 뇌척수조사 환자로 23.55 mGy로 측정되었다. 전뇌조사 환자에서 1일 DIPS 촬영 시 피폭선량이 1.13 mGy로 1일 처방선량을 가장 많이 초과하였으며, 권고선량의 2%를 초과하지 않았다. 치료기간 중 DIPS 피폭선량이 가장 많은 환자는 전뇌조사 환자로 632.71 mGy로 이는 처방선량의 1.13%로 권고선량의 2%를 초과하지 않는 합당한 선량으로 나타났다. 소아암 환자에 대한 DIPS 촬영 시 피폭선량은 처방선량에 대하여 2%를 초과하지 않는 피폭선량으로 나타났지만, 방사선감수성이 높고 평균 잔여 수명이 긴 소아암 환자에게는 유전적 영향 등의 확률적 영향과 관련된 방사선 장해를 초래할 수 있음을 인식하여 소아암 환자의 DIPS 촬영에 대한 가이드라인 제시로 방사선 피폭을 최소화할 수 있는 방안을 마련해야 할 것으로 사료된다.

• Journal of Korean Neurosurgical Society
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• 제57권5호
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• pp.315-322
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• 2015

Intracranial germ cell tumors (ICGCT) occur in 2-11% of children with brain tumors between 0-19 years of age. For treatment of germinoma, relatively low radiation doses with or without chemotherapy show excellent 10 year survival rate of 80-100%. Past studies showed that neoadjuvant chemotherapy combined with focal radiotherapy resulted in unacceptably high rates of periventricular tumor recurrence. The use of generous radiation volume which covers the whole ventricular space with later boost treatment to primary site is considered as standard treatment of intracranial germinomas. For non-germinomatous germ cell tumors (NGGCT), 10-year overall survival rate is still much inferior than that of intracranial germinoma despite intensive chemotherapy and high-dose radiotherapy. Craniospinal radiotherapy combined with cisplatin-based chemotherapy provides the best treatment outcome for NGGCT; 60-70% of overall survival rate. There is a debate on the surgical role whether surgery can contribute to improved treatment outcome of NGGCT when added to combined chemoradiotherapy. Because higher dose of radiotherapy is required for treatment of NGGCT than for germinoma, it is tested whether whole ventricular irradiation can replace craniospinal irradiation in intermediate risk group of NGGCT to minimize radiation-related late toxicity in the recent studies. To minimize the treatment-related neural deficit and late sequelae while maintaining long-term survival rate of ICGCT patients, optimized administration of chemotherapy and radiotherapy should be selected. Use of technically upgraded radiotherapy modalities such as intensity-modulated radiotherapy or proton beam therapy is expected to bring an improved neurocognitive outcome with longitudinal assessment of the patients.