• Radiation Oncology Journal
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• 제16권4호
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• pp.357-366
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• 1998

Brachytherapy is an essential part of radiotherapy for uterine cervical cancer. The low dose rate (LDR) regimen has been the major technique of intracavitary therapy for cervical cancer. However, there has been an expansion in the last 20 years of high dose rate (HDR) machines using Ir-192 sources. Since 1979, HDR brachytherapy has been used for the treatment of uterine cervical cancer in Korea. The number of institutions employing HDR has been increasing, while the number of low dose rate system has been constant. In 1995, there was a total 27 HDR brachytherapy units installed and 1258 cases of patients with cervical cancer were treated with HDR Most common regimens of HDR brachytherapy are total dose of 30-39 Gy at point A with 10-13 fractions in three fractions per week. 24-32 Gy with 6-8 fractions in two fractions per week, and 30-35 Gy with 6-7 fractions in two fractions per week. The average fractionation regimen of HDR brachytherapy is about 8 fractions of 4.1 Gy each to Point A. In Korea, treatment results for HDR brachytherapy are comparable with the LDR series and appears to be a safe and effective alternative to LDR therapy for the treatment of cervical carcinoma. Studies from the major centers report the five-year survival rate of cervical cancer as. 78-86$\%$ for Stage 1, 68-85$\%$ for stage 11, and 38-56$\%$ for Stage III. World-wide questionnaire study and Japanese questionnaire survey of multiple institutions showed no survival difference in any stages and dose-rate effect ratio (HDR/LDR) was calculated to be 0.54 to 0.58. However the optimum treatment doses and fractionation schemes appropriate to generate clinical results comparable to conventional LDR schemes have yet to be standardized. In conclusion, HDR intracavitary radiotherapy is increasingly practiced in Korea and an effective treatment modality for cervical cancer. To determine the optimum radiotherapy dose and fractionation schedule, a nation-wide prospective study is necessary in Korea. In addition, standardization of HDR application (clinical, computer algorithms, and dosimetric aspects) is necessary.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.7167-7170
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• 2015

Background: Although 3D image based brachytherapy is currently the standard of treatment in cervical cancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due to financial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitary brachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eight fractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicity with higher doses per fraction. Objective: To assess the treatment efficacy and late complications of HDR ICBT with 9 Gy per fraction in two fractions. Materials and Methods: This is a prospective institutional study in Southern India carried on from $1^{st}$ June 2012 to $31^{st}$ July 2014. In this period, 76 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy per fraction in two fractions, five to seven days apart. Results: The median follow-up period in the study was 24 months (range 10.6 - 31.2 months). The 2 year actuarial local control rate, disease-free survival and overall survival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3 patients had grade III late toxicity. Conclusions: In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.

• Radiation Oncology Journal
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• 제5권2호
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• pp.137-140
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• 1987

자궁경부암의 고선량율 강내치료의 매 분할 치료시마다 강내 applicator의 위치 차이로 인하여 조사 선량이 치료전 계획된 선량과 차이가 있을 수 있다. 저자는 자궁경부암 환자의 강내치료시 치료전 계획된 A점 선량 500 cGy와 치료직후에 촬영한 전후 및 측면 선 사진을 이용하여 계산된 A점 선량을 비교한 결과, 82예의 강내치료에서 치료 후 계산된 조사 선량과 계획 선량은 $500\pm18 cGy$이었으며 $84\%$에서 $500\pm25 cGy$의 범위에 포함되었다. 이러한 결과에서 계획 선량과 치료 후 계산된 조사 선량사이에 비교적 높은 일치율을 확인할 수 있었다.

• Radiation Oncology Journal
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• 제4권2호
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• pp.183-186
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• 1986

고선량율을 이용한 자궁강내 치료시 정확하고 신속한 계산을 위하여 저자들은 개인용 컴퓨터를 이용하여 기준점의 선량분포 및 방사선조사 시간을 간편하게 계산할 수 있는 software를 개발하였다. 치료 계획용 software를 이용하여 짧은 시간내에 선량 분포 및 조사시간을 용이하고 정확하게 계산할 수 있으며, 고선량을 자궁경부암 임상적응에 효과적으로 이용할 수 있어서 보고한다.

• Journal of Yeungnam Medical Science
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• 제17권2호
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• pp.123-128
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• 2000

본 연구에서 인체공학적으로 개선된 새로운 2-채널 고선량을 근접치료용 적용구(Shin's Applicator)를 개발하였으며, 기존의 단일 선원 근접치료 적용구와 비교하여 질벽에 더 균등한 방사선치료가 가능하고 방광과 직장선량이 적어 근접치료 후 발생할 수 있는 부작용이 감소될 가능성을 확인하였다. 임상적으로 Shin's Applicator는 자궁 경부암이나 자궁 체부암의 수술 후 국소재발이나, 절강에 발생한 다발설 악성종양을 효과적으로 치료하는 데 유용하게 사용될 수 있을 뿐 만 아니라, 방사선 치료 후 흔히 나타나는 질강의 협착을 예방할 수 있는 질 확장기(vaginal dilator)로도 사용 가능하였다. 이상의 결과에서 Shin's Applicator는 부인과 종양환자들의 방사선치료 뿐만 아니라 치료 후 삶의 질의 개선에도 크게 기여할 것으로 생각되었다.

• Radiation Oncology Journal
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• 제2권1호
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• pp.129-137
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• 1984

In brachytherapy, it is important to determine the positions of the radiation sources which are inserted into a patient and to estimate the dose resulting from the treatment. Calculation of the dose distribution throughout an implant is so laborious that it is rarely done by manual methods except for model cases. It is possible to calculate isodose distributions and tumor doses for individual patients by the use of a microcomputer. In this program, the dose rate and dose distributions are calculated by numerical integration of point source and the localization of radiation sources are obtained from two radiographs at right angles taken by a simulator developed for the treatment planning. By using microcomputer for brachytherapy, we obtained the result as following 1. Dose calculation and irradiation time for tumor could be calculated under one or five seconds after input data. 2. It was same value under$\pm2\%$ error between dose calculation by computer program and measurement dose. 3. It took about five minutes to reconstruct completely dose distribution for intracavitary irradiation. 4. Calculating by computer made remarkly reduction of dose errors compared with Quimby's calculation in interstitial radiation implantation. 5. It could calculate the biological isoffect dose for high and low dose rate activities.

• Asian Pacific Journal of Cancer Prevention
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• 제15권15호
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• pp.6115-6120
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• 2014

Background: To compare the KKU-model rectal tube (KKU-tube) and the conventional rectal tube (CRT) for checking rectal doses during high-dose-rate intracavitary brachytherapy (HDR-ICBT) of cervical cancer. Materials and Methods: Between February 2010 and January 2011, thirty -two patients with cervical cancer were enrolled and treated with external beam radiotherapy (EBRT) and intracavitary brachytherapy (ICBT). The KKU-tube and CRT were applied intrarectally in the same patients at alternate sessions as references for calculation of rectal doses during ICBT. The gold standard references of rectum anatomical markers which are most proximal to radiation sources were anterior rectal walls (ARW) adjacent to the uterine cervix demonstrated by barium sulfate suspension enema. The calculated rectal doses derived from actual anterior rectal walls, CRT and the anterior surfaces of the KKU-tubes were compared by using the paired t-test. The pain caused by insertion of each type of rectal tube was assessed by the visual analogue scale (VAS). Results: The mean dose of CRT was lower than the mean dose of ARW ($Dmean_0-Dmean_1$) by $80.55{\pm}47.33cGy$ (p-value <0.05). The mean dose of the KKU-tube was lower than the mean dose of ARW ($Dmean_0-Dmean_2$) by $30.82{\pm}24.20cGy$ (p-value <0.05). The mean dose difference [($Dmean_0-Dmean_1$)-($Dmean_0-Dmean_2$)] was $49.72{\pm}51.60cGy$, which was statistically significant between 42.32 cGy -57.13 cGy with the t-value of 13.24 (p-value <0.05). The maximum rectal dose by using CRT was higher than the KKU-tube as much as 75.26 cGy and statistically significant with the t-score of 7.55 (p-value <0.05). The mean doses at the anterior rectal wall while using the CRTs and the KKU-tubes were not significantly different (p-value=0.09). The mean pain score during insertion of the CRT was significantly higher than the KKU-tube by a t-score of 6.15 (p-value <0.05) Conclusions: The KKU-model rectal tube was found to be an easily producible, applicable and reliable instrument as a reference for evaluating the rectal dose during ICBT of cervical cancer without negative effects on the patients.

• 대한방사선치료학회지
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• 제24권2호
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• pp.61-66
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• 2012

목 적: 본 연구에서는 자궁강 내 근접치료 시 ABS (American Brachytherapy Society)에서 권고한 H점(point H)을 이용한 치료계획을 수립해 보았고, 이를 A점(point A)에 처방한 치료계획과 비교하고자 한다. 대상 및 방법: 2010년 3월부터 2012년 1월까지 본원에 내원한 자궁경부암 환자 중 탄뎀(tandem)과 난형체(ovoid)를 이용해 고선량률 강내 근접치료(high dose rate intracavitary brachytherapy)를 시행한 103명을 대상으로 하였다. 치료계획은 Manchester System에 따라 A점, 방광 기준점, 직장 기준점을 지정하였고, ABS의 권고에 따라 H점을 지정하였다. 또한 임의로 S자 결장기준점과 질 기준점을 설정하였다. A점과 H점의 위치가 얼마나 차이가 나는지 살펴보았으며, H점에 100%의 선량을 처방하였을 때 A점에 들어가는 선량을 계산하였다. 그리고 A점과 H점에 각각 선량을 처방하였을 때 직장, 방광, S자 결장, 질 기준점에 들어가는 선량을 비교 분석하였다. 결 과: H점이 A점보다 미측에 있는 경우 A점의 상대선량은 기존의 A점이 아닌 H점에 처방하였을 때 더 적어지는 경향을 보였다. 방광 기준점과 직장 기준점, S자결장 기준점, 질 기준점에서의 상대선량은 H점이 두측에 있는 경우 H점에 처방하였을때의 선량이 A점에 처방하였을 때보다 크며, 미측에 있는 경우 더 적어지는 양상을 보였다. 결 론: H점이 A점보다 두측에 위치할수록 주변 장기의 흡수선량이 커지고, 미측에 위치할수록 주변 장기의 흡수선량이 적어지는 경향을 보였다. 그 선량 차이가 치료에 큰 영향을 미칠 정도는 아니지만, 두 치료계획에서의 선량 분포 및 주변 장기 흡수선량 차이가 크다면 두 점의 치료계획은 비교 또는 참고할 만한 가치가 있는 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권9호
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• pp.4835-4837
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• 2012

Objectives: To evaluate residual disease in uterine cervical cancer patients treated with teletherapy using combined high dose rate Cobalt-60 brachytherapy. Materials and Methods: A retrospective study of uterine cervical cancer patients, FIGO stages IB-IVB (International Federation of Gynecologists and Obstetricians recommendations), treated by radiotherapy alone between April 1986 and December 1988 was conducted and the outcomes analysed. The patients were treated using teletherapy 50 Gy/25 fractions, five fractions per week to the whole pelvis together with HDR Cobalt -60 afterloading brachytherapy of 850 cGy/fraction, weekly to point A for 2 fractions. Results: The study covered 141 patients with uterine cervical cancer. The mean age was 50.0 years with a range of 30-78 years. The mean tumor size was 4.1 cm in diameter (range 1-8 cm). Mean follow - up time was 2.94 years (range 1 month-6.92 years). The overall incidence of residual locoregional disease was 3.5%. Residual disease, according to stage IIB, IIIB and IVA was present in 2.78%, 3.37% and 50.0%. It was noted that there was no evidence of residual disease in stage IB and IIA cases. Conclusion: Combined teletherapy along with high dose rate Cobalt -60 brachytherapy of 850 cGy/fraction, weekly to point A for 2 fractions resulted in overall 3.5% residual disease and a 96.5% complete response. The proposed recommendation for improving outcome is initiation of measurements for early detection of disease.

• 한국의학물리학회지:의학물리
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• 제13권2호
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• pp.79-84
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• 2002

항문암 및 자궁경부암 치료시 사용되는 고선량률 강내 근접치료기와 병행하여 사용할 원통형 초음파 온열치료가 개발되었다. 온열치료를 위한 에너지원으로 원통형 트랜스듀서가(PZT-8 물질, 길이=1.5 cm 두께=1.5 mm 외경= 2.5cm) 사용되었다. PZT-8 물질의 특성을 측정하기위해 세 개의 단일 엘리멘트 어플리케이터가 제작되었다. PZT 물질을 작동하기 위한 주파수를 결정하기 위하여 벡터 임피던스가 측정되었다. 선택된 물질이 온열치료에 사용될 수 있는지 가능성을 타진하기위해 방사능력을 측정하는 방법으로 각 엘리맨트의 초음파발생 효율을 입력한 전기량과 발생한 초음파량의 비로 계산하였다. 마지막으로 질암의 온열치료에 사용할 수 있는 다채널 초음파 치료기가 디자인 되었다. 임피던스 실험결과 각 엘리맨트 1, 2, 그리고 3에 대해 1.78, 1.77, 그리고 1.77 MHz의 주파수에서 최대 임피더스 값을 얻었다. 방사능력 측정 실험결과 본 연구에서 사용된 에너지 소스는 40와트 이상의 초음파량이 방출되었다. 또한 각 엘리맨트 1, 2, 그리고 3의 평균 효율은 61.4, 65.2, 그리고 54.0% 이다. 본 연구에서 디자인되어진 원통형 초음파 치료기는 질 또는 항문 치료 시 고선량 강내근접치료와 더불어 사용할 수 있음이 증명되었다. 따라서 본 연구에서 개발된 온열 치료기구가 고 선량 강내 근접치료와 함께 사용하여 병변조직의 방사능 민감도를 증가시켜 암 치료효율을 높일수 있다.