• Radiation Oncology Journal
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• v.24 no.3
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• pp.171-178
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• 2006

[ $\underline{Purpose}$ ]: To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. $\underline{Materials\;and\;Methods}$: From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range $34{\sim}74$) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follows: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of $45{\sim}50.4\;Gy$ (median: 50.4 Gy) over $5{\sim}5.5$ weeks. Ir-192 HDR intracavitary brachytherapy (ICBT) was given after a total dose of 41.4 Gy. HDR-ICBT was performed twice a week, with a fraction point A dose of 4 Gy and median dose to point A was 28 Gy (range: $16{\sim}32\;Gy$) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT+ICBT) was $88\;Gy_{10}$ (range: $77{\sim}94\;Gy_{10}$). The median cumulative BED at ICRU 38 reference point (EBRT+ICBT) was $131\;Gy_3$ (range: $122{\sim}140\;Gy_3$) at point A, $109\;Gy_3$ (range: $88{\sim}125\;Gy_3$) at the rectum and $111\;Gy_3$ (range: $91{\sim}123\;Gy_3$) at the urinary bladder. Cisplatin ($60\;mg/m^2$) and 5-FU ($1,000\;mg/m^2$) was administered intravenously at 3 weeks interval from the first day of radiation for median 5 (range: $2{\sim}6$) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range: $8{\sim}50$ months). $\underline{: The complete response rate after concurrent chemoradiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure rate was 13% and distant metastatic rate was 3.3%. The crude rate of minor hematologic complications (RTOG grade 1-2) occurred in 3 patients (10%) and one patient had suffered from severe leukopenia (RTOG grade 4) during concurrent treatment. Acute minor enterocolitis (RTOG grade 1-2) occurred in 11 patients (37%) and one patient (3%) was suffered from colon perforation during radiation therapy. Late colitis of RTOG grade 1 occurred in 5 patients (15%). Acute cystitis of RTOG grade 1 occurred in 12 patients (40%) and late cystitis of RTOG grade 2 occurred in one patient (3%). No treatment related death was seen. $\underline{Conclusion}$: The results of this study suggest that the concurrent chemoradiation therapy with HDR brachytherapy could be accepted as an effective and safe treatment for cervical cancer.

• The Journal of Korean Society for Radiation Therapy
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• v.32
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• pp.17-29
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• 2020

Purpose: The purpose of this work was to investigate the dosimetric impact of mixed energy partial arc technique on prostate cancer VMAT. Materials and Methods: This study involved prostate only patients planned with 70Gy in 30 fractions to the planning target volume (PTV). Femoral heads, Bladder and Rectum were considered as oragan at risk (OARs). For this study, mixed energy partial arcs (MEPA) were generated with gantry angle set to 180°~230°, 310°~50° for 6MV arc and 130°~50°, 310°~230° for 15MV arc. Each arc set the avoidance sector which is gantry angle 230°~310°, 50°~130° at first arc and 50°~310° at second arc. After that, two plans were summed and were analyzed the dosimetry parameter of each structure such as Maximum dose, Mean dose, D2%, Homogeneity index (HI) and Conformity Index (CI) for PTV and Maximum dose, Mean dose, V70Gy, V50Gy, V30Gy, and V20Gy for OARs and Monitor Unit (MU) with 6MV 1 ARC, 6MV, 10MV, 15MV 2 ARC plan. Results: In MEPA, the maximum dose, mean dose and D2% were lower than 6MV 1 ARC plan(p<0.0005). However, the average difference of maximum dose was 0.24%, 0.39%, 0.60% (p<0.450, 0.321, 0.139) higher than 6MV, 10MV, 15MV 2 ARC plan, respectively and D2% was 0.42%, 0.49%, 0.59% (p<0.073, 0.087, 0.033) higher than compared plans. The average difference of mean dose was 0.09% lower than 10MV 2 ARC plan, but it is 0.27%, 0.12% (p<0.184, 0.521) higher than 6MV 2 ARC, 15MV 2 ARC plan, respectively. HI was 0.064±0.006 which is the lowest value (p<0.005, 0.357, 0.273, 0.801) among the all plans. For CI, there was no significant differences which were 1.12±0.038 in MEPA, 1.12±0.036, 1.11±0.024, 1.11±0.030, 1.12±0.027 in 6MV 1 ARC, 6MV, 10MV, 15MV 2 ARC, respectively. MEPA produced significantly lower rectum dose. Especially, V70Gy, V50Gy, V30Gy, V20Gy were 3.40, 16.79, 37.86, 48.09 that were lower than other plans. For bladder dose, V30Gy, V20Gy were lower than other plans. However, the mean dose of both femoral head were 9.69±2.93, 9.88±2.5 which were 2.8Gy~3.28Gy higher than other plans. The mean MU of MEPA were 19.53% lower than 6MV 1 ARC, 5.7% lower than 10MV 2 ARC respectively. Conclusion: This study for prostate radiotherapy demonstrated that a choice of MEPA VMAT has the potential to minimize doses to OARs and improve homogeneity to PTV at the expense of a moderate increase in maximum and mean dose to the femoral heads.

• Quality Improvement in Health Care
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• v.3 no.2
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• pp.36-51
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• 1997

Background : Clinical practice guidelines define "systematically developed statements to assist practitioner and patient decisions about appropriate health care for specific clinical circumstances" and help to improve patient care. The purpose of this study is to develop a clinical practice guideline for the most effective diagnoses and treatments of benign prostatic hyperplasia based on patient preference and clinical need. Methods : For this research project, extensive literature searches (208 articles) were conducted. As well, critical reviews and syntheses (meta-analysis) were used to evaluate empirical evidence and significant outcomes of the BPH literature. Questionnaires about clinical practice for BPH patients were distributed and consensus meetings were undertaken to grasp variations in clinical practice and to reach agreement on the guideline's development. The guideline was promoted under the sponsorship of the Korean Medical Association and the Korean urological Cancer. Society. For the task, the Benign Prostatic Hyperplasia Guideline Panel was composed of multidisciplinary experts in the field. Results : BPH is a disease that affects a patient's quality of life. This Clinical Practice Guideline was developed for the typical man over age 50 with symptoms of prostatism, but with no significant medical morbidities such as diabetes or other known causes of voiding dysfunction, such as urethral stricture or neurogenic bladder. The guidelines detail the relative benefits and obstacles associated with all diagnostic and treatment approaches, including watchful waiting. Conclusion : This guideline provides a cornerstone for our medical association. It represents the most current scientific knowledge regarding the development, diagnosis, and treatment of BPH. It will be revised and updated as needed.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.69-76
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• 1992

To identify pretreatment prognostic factors in locally advanced carcinoma of the uterine cervix, retrospective analysis was undertaken of 154 patients treated with curative radiation therapy at Seoul National University Hospital, from March 1979 through December 1986. According to FIGO classification, eight patients were stage IIIA, 134 were stage IIIB, and 12 were stage IVA. Five year locoregional control rate was $58\%$, $51\%$, and $27\%$ in stage IIIA, IIIB, and IVA, respectively. Five year disease free survival was $57\%$, $40\%$, and $25\%$ for each stage respectively. Five year overall survival was $67\%$, $51\%$, and $33\%$ in stage IIIA, IIIB, and IVA, respectively. In univariate analysis, fewer than or equal to four of pregnancies, initial hemoglobin of lower than $10\;g\%$, and pelvic sidewall invasion on CT were associated with poor locoregional control. Number of pregnancies, initial hemoglobin level, obstructive uropathy on intavenous pyelography (IVP), pelvic lymph node (LN) status on CT, and pelvic sidewall invasion on CT were significant factors in disease free survival. In terms of overall survival, pelvic sidewall invasion on CT and bladder invasion on CT were prognostically significant. In multivariate analysis, no factor was found to affect locoregional control and pelvic LN status was a sole significant factor affecting disease free survival. in terms of overall survival, the size.

• Progress in Medical Physics
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• v.15 no.2
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• pp.63-69
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• 2004

HDR brachytherapy administers a large dose of radiation in a short time compare with LDR, and its optimization for treatment is related to several complex factors, such as physical, radiation and optimization algorithms, so there is a need for these to be verified for accurate dose delivery. In our approach, a previous study concerning the phantom for dose verification has been modified, and a new pelvic phantom fabricated for the purpose of localization, including a structure enabling the use of a CT or MRI system. In addition, a comparison study was performed to verify an orthogonal method that is commonly used for brachytherapy localization by comparing target coordinates from a CT system. Since the developed phantom was designed to simulate the clinical setups of cervix cancer, it included an air-filled bladder and a rectum structure shaped sphere and cylinder An N-shaped localizer was used to obtain precision coordinates from both CT and films. Moreover, the IDL 5.5 software program for Windows was used to perform coordinates analysis based on an orthogonal algorithm. The film results showed differences within 1.0 mm of the selected target points compare with the CT coordinates. For these results, a Plato planning system (Nucletron, Netherlands) could be independently verified using this phantom and software. Furthermore, the new phantom and software will be efficient and powerful qualify assurance (QA) tools in the field of brachytherapy QA.

• Radiation Oncology Journal
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• v.6 no.1
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• pp.93-99
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• 1988

Some modern accerelators provide a dual energy for photon beam treatment. The main advantages of dual energy in the treatment of rectosigmoid or rectal cancer are as fellows. 1. Dose in the critical organ such as small intestine, bladder and genital organ are reduced. 2. Presacral and perineal area is fully covered. Dose distribution analysis such as calculation of dose in a target volume, isocenter, $D_{nax}$ and dose spectrum in any region of interest are possible. Examples of plan are given and results are discussed.

• Journal of the Korean Society of Food Science and Nutrition
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• v.34 no.9
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• pp.1330-1335
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• 2005

Red brownish p-pheylenediamine (PPD) has been widely used hair dye for women. The dye was known to cause systemic anaphylaxis, dermatitis and bladder cancer. But the effect of PPD toxicity with oxygen free radical has not been studied. This study investigated the degree of skin injury by PPD. PPD ($2.5\%$ PPD in $2\%\;NH_{4}OH$) was applied to the rat skin ($25 mg/16.5\;cm^2$) 3 or 5 times every other day. Histopathological findings demonstrated the proliferation of epithelial cells and the increased keratinization by PPD. The activities of glucose 6-phosphatase (G6Pase) was decreased and acid phosphatase (ACP) was increased in PPD-applied rat skin. Groups in which PPD was applied 5 times were more damaged than groups applied 3 times. To examine the relationship between tissue damage and oxygen free radicals, effect of PPD on xanthine oxidase (XO) activity was measured and XO activity was more significantly increased in the group treated with PPD 5 times than 3 times. However, reduced glutathione (GSH) content, and the activities of catalase (CAT), super-oxide dismutase (SOD) and glutathione S -transferase (GST) were more decreased in PPD-applied groups than in controls. Even though the activities of XOD was not changed in the group treated with PPD 3 times, the decreased activities of oxygen free radical system and the damaged skin tissue were observed. This result might be caused by the production of toxic PPD metabolites in rat skin. In conclusion, topical PPD application led to skin injury in a dose-dependent manner, probably due to the generation rate of oxygen free radical.

• Journal of Life Science
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• v.23 no.10
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• pp.1252-1259
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• 2013

To investigate the effects of a fibrinolytic enzyme, BK-17, on the growth of human cancer cells, we performed various biochemical experiments, including cell proliferation and viability, and investigated subsequent morphological changes and apoptosis induction. BK-17 treatment of AGS human gastric and T24 human bladder carcinoma cells decreased the viability and the proliferation of the cells in a concentration-dependent manner. Microscopic studies indicated that the antiproliferative effects of the BK-17 treatment were associated with morphological changes, such as membrane shrinking, cell rounding up, and the formation of apoptotic bodies, indicating that BK-17 induced apoptosis in the cell lines. Of note, RT-PCR and Western blotting data indicated that the BK-17 treatment induced the down-regulation of antiapoptotic Bcl-2 members, Bcl-2 and $Bcl-X_L$, and the up-regulation of proapoptotic Bax members, Bax and Bad, in the AGS cells. BK-17-induced apoptosis of AGS cells was involved in the proteolytic activation of caspase-3, caspase-8, and caspase-9. Taken together, these findings suggest that BK-17 is associated with the induction of apoptotic cell death.

• The Korean Journal of Pain
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• v.1 no.1
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• pp.34-46
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• 1988

Intractable pain from advanced carcinoma of the upper abdomen is difficult to manage. One method used to control pain associated with these malignancies is to block off the splanchnic nerve. In 1919 Kappis described a technique by which the splanchnic nerve of the upper abdomen could be anesthetized, using a percutaneous injection. This method has been used for the relief of upper abdominal pain due to hematoma and cancer of the pancreas, stomach, gall bladder, bile duct, and colon. During the Period from November 1968 to January 1986, this method was used in 208 cases of malignancy at Severance Hospital and clinically evaluated. Patients were retroactively grouped according to the stage of development of technique used. Twelve patients who received the treatment in the period from November 1968 to March 1977 were designate4i as group 1, 26 patients from April 1977 to April 1979 as group 2, and 170 from May 1979 to January 1986 as group 3. The results are as follows: 1) The number of patients receiving splanchnic nerve block has been increasing since 1977. 2) A total of 208 patients, including 133 males and 75 females, ranging in age from 18 to 84 and averaging 51. 3) The causes of pain were stomach cancer 90, pancreatic cancer 69, and miscellaneous cancer 49 cases respectively. 4) There were 57.7% who had surgery. and 3.7% of whom had chemotherapy before the splanchnic nerve block was done. 5) These blocks were carried out with the patient in the prone position as described by Dr. Moore. For group 2 and 3, C-arm image intensifier was used. In group 1, a 22 gauze loom long needle was inserted at the lower border of the 12th rib on each aide about 7\;cm from the midline. The average distance from the midline was $6.60{\pm}0.61\;cm$ on the left side and $6.60{\pm}0.83\;cm$ on the right side in group 2, and $5.46{\pm}0.76\;cm$ on the left side and $5.49{\pm}0.69\;cm$ on the right side in group 3. The average depth to which the needle was inserted was $8.60{\pm}0.52\;cm$ on the left side and $8.74{\pm}0.60\;cm$ on the right side in group 2, and $8.96{\pm}0.63\;cm$ on the left side and $9.18{\pm}0.57\;cm$ on the right side in group 3. 6) The points of the inserted needles were positioned in the upper quarter anteriorly, 51.8% on the left side and 54.4% n the right side of the L1 vertebra by lateral roentgenogram in group 3. The inserted needle points were located in the upper and anterolateral part, of the L1 vertebra 68.5% on the left side and 60.6won the right side, on the anteroposterior rentgenogram in group 3. The needle tip was not advanced beyond the anterior margin of the vertebral body. 7) In some case of group 3, contrast media was injected before the block was done. It shows, the spread upward along the anterior mal gin of the vertebral body. 8) The concentration and the average amount of drug used in each group was as follows: In group 1, $39.17{\pm}6.69\;ml$ of 0.5% -l% lidocaine or 0.25% bupivacaine were injected for the test block and one to three days after the test block $40.00{\pm}4.26\;ml$ of 50% alcohol was injected for the semipermanent block. In group 2, $13.75{\pm}4.88\;ml$ of 1% lidocaine were used as the test block and followed by $46.17{\pm}4.37\;ml$ of 50% alcohol was injected as the semipermanent block. In group 3, $15.63{\pm}1.19\;ml$ of 1% lidocaine for test block followed by $15.62{\pm}1.20\;ml$ of pure alcohol and $16.05{\pm}2.58\;ml$ of 50% alcohol for semipermanent block were injected. 9) The result of the test block was satisfactory in all cases. However the semipermanent block was 83.3 percent of the patients in group 1 who received relief from pain for at least 2 weeks after the block, 73.1% in group 2, and 91.8% in group 3. In these unsuccessful cases, 2 cases in group 1 were controlled by narcotics but 7 cases in group 2 and 14 cases in group 3 received the same splanchnic nerve block 1 or 2 times again within 2 weeks. But, in some cases it was 3 to i months before the 2nd block and in 1 cases even 7 years. 10) The most common complications of splanchnic nerve block were hypotensino(25.5%) occasional flushing of the face, nausea, vomiting, and chest discomfort. 11) For the patients in group 3, the supplemental block most commonly used was a continuous epidural block; it was used as a diagnostic block and to afford relief from pain before the splanchnic nerve block was done. 12) The interval between the receiving of the alcohol block and discharge was from 5 to 8 days in 61 cases(31.1%) and from 1 to 2 days in 48 cases(24.5%). From the above results, it can be concluded that the splanchnic nerve block done in the prone position with pure and 50% alcohol immediately after an effective test block with 1% lidocaine under C-arm fluoroscopic control is satisfactory and reliable. How to minimize the repeat block is still a problem to be solved.

• Applied Microscopy
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• v.30 no.1
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• pp.45-59
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• 2000

Cis-platin is a widely used anticancer drug against certain solid tumors such as malignant ovarian tumor, malignant carcinoma of head and neck, bladder cancer and cervical cancer of uterus, and its major mechanism of action is inhibition of DNA synthesis of the tumor cell. To investigate the inhibitory effects of cis-platin on the ciliogensis of the ciliated cells in the mucosa of oviduct, the author pursued the alterations of $\alpha-tubulin$, which is the main constituent of the microtubles in cilia, after cis-platin treatment. To eliminate the possible variations due to ovarian cycle, female Spargue-Dawley rats ($150\sim200gm$ in B.W.) were pretreated with estradiol benzoate (20 mg/kg, once a day, for 4 consecutive days). Animals were administrated with cis-platin (6 mg/kg, i.p.) and sacrificed at 1day, 3days, 5days and 7days after treatment, respectively. Immunohistochemistry for $\alpha-tubulin$ using mouse anti-rat $\alpha-tubulin$ monoclonal antibody as primary antibody was done. Immunogold electronmicroscopy for intracellular distributions of $\alpha-tubulin$ was also performed with same primary antibody and Goat anti- mouse IgM which is preconjugated with gold particles of 15 nm as secondary antibody. The results obtained were as follows; 1. Strong immunoreactivity of $\alpha-tubulin$ was observed in ciliated cells of oviducts at 1, 3 and 5 days after estradiol pretreatment. 2. Weak immunoreactivity of $\alpha-tubulin$ was observed in ciliated cells of oviducts at 1 and 3 days after cis-platin treatment but it was recovered to strong immunoreactivity in 5 days 3. In immunogold electronmicroscopy, density of gold particles for $\alpha-tubulin$ reactions was decreased in apical cytoplasm, but few changes were observed in basal body or cilia at 1 and 3 days after cis-platin treatment. From these above results, it is indicated that synthesis of $\alpha-tubulin$ in ciliated cells of rat oviduct is inhibited by cis-platin treatment.