• Asian Pacific Journal of Cancer Prevention
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• 제15권16호
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• pp.6519-6524
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• 2014

The aim of this study was to evaluate the clinical outcomes of radical cystectomy (RC) and concurrent chemoradiotherapy (CRT) with methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with locally advanced bladder cancer (BC). From December 2000 to February 2012, 72 patients with locally advanced BC (T3-4a, N0 or N+, M0) received either RC or CRT. RC with bilateral pelvic lymph node dissection including the common iliac region as the standard procedure. Patients in the CRT group received one cycle of MVAC followed by radiotherapy with a half dose of MVAC and then two more cycles of MVAC. Standard fractionation at a daily dose of 1.8-2.0 Gy was used, with a median total dose of 50 Gy (range, 45-60 Gy). The 3-year progression-free survival (PFS) rates in the RC and CRT groups were 56.2% and 25.6%, respectively (p=-0.015) and the 3-year overall survival (OS) rates were 63.5% and 48.1% (p=0.272). Multivariate Cox proportional hazards regression analysis with application of a propensity score indicated that RC was a significant predictor of PFS (p=0.033) but not of OS (p=0.291). Among patients with locally advanced BC, PFS was significantly prolonged in the RC group compared with the CRT group. However, RC was not a significant predictor of OS. Although the sample size in this study was small, the results suggest that patient background and postoperative quality of life should be considered when choosing treatment strategy for locally advanced BC.

• Radiation Oncology Journal
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• 제36권4호
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• pp.254-264
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• 2018

This article reviewed new trends and controversial issues, including the intensification of chemotherapy and recent brachytherapy (BT) advances, and also reviewed recent consensuses from different societies on the management of locally advanced cervical cancer (LACC). Intensive chemotherapy during and after radiation therapy (RT) was not recommended as a standard treatment due to severe toxicities reported by several studies. The use of positron emission tomography-computed tomography (PET-CT) and magnetic resonance imaging (MRI) for pelvic RT planning has increased the clinical utilization of intensity-modulated radiation therapy (IMRT) for the evaluation of pelvic lymph node metastasis and pelvic bone marrow. Recent RT techniques for LACC patients mainly aim to minimize toxicities by sparing the normal bladder and rectum tissues and shortening the overall treatment time by administering a simultaneous integrated boost for metastatic pelvic lymph node in pelvic IMRT followed by MRI-based image guided adaptive BT.

• Radiation Oncology Journal
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• 제34권2호
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• pp.145-155
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• 2016

Purpose: Radiation therapy targeting axilla and groin lymph nodes improves regional disease control in locally advanced and high-risk skin cancers. However, trials generally used conventional two-dimensional radiotherapy (2D-RT), contributing towards relatively high rates of side effects from treatment. The goal of this study is to determine if three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or volumetric-modulated arc therapy (VMAT) may improve radiation delivery to the target while avoiding organs at risk in the clinical context of skin cancer regional nodal irradiation. Materials and Methods: Twenty patients with locally advanced/high-risk skin cancers underwent computed tomography simulation. The relevant axilla or groin planning target volumes and organs at risk were delineated using standard definitions. Paired t-tests were used to compare the mean values of several dose-volumetric parameters for each of the 4 techniques. Results: In the axilla, the largest improvement for 3D-CRT compared to 2D-RT was for homogeneity index (13.9 vs. 54.3), at the expense of higher lung $V_{20}$ (28.0% vs. 12.6%). In the groin, the largest improvements for 3D-CRT compared to 2D-RT were for anorectum $D_{max}$ (13.6 vs. 38.9 Gy), bowel $D_{200cc}$ (7.3 vs. 23.1 Gy), femur $D_{50}$ (34.6 vs. 57.2 Gy), and genitalia $D_{max}$ (37.6 vs. 51.1 Gy). IMRT had further improvements compared to 3D-CRT for humerus $D_{mean}$ (16.9 vs. 22.4 Gy), brachial plexus $D_5$ (57.4 vs. 61.3 Gy), bladder $D_5$ (26.8 vs. 36.5 Gy), and femur $D_{50}$ (18.7 vs. 34.6 Gy). Fewer differences were observed between IMRT and VMAT. Conclusion: Compared to 2D-RT and 3D-CRT, IMRT and VMAT had dosimetric advantages in the treatment of nodal regions of skin cancer patients.

• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.2137-2140
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• 2016

Background: Gall bladder cancer (GBC) usually presents as unresectable or metastatic disease. We conducted a feasibility study to evaluate the effect of neoadjuvant therapy (NAT) on radiologic downstaging and resectability in unresectable GBC cases. Materials and Methods: Patients with locally advanced disease were treated with chemoradiotherapy [CTRT] ( external radiotherapy (45Gy) along with weekly concurrent cisplatin $35mg/m^2$ and 5-FU 500 mg) and those with positive paraaortic nodes were treated with neoadjuvant chemotherapy [NACT (cisplatin $25mg/m^2$ and gemcitabine $1gm/m^2$ day 1 and 8, 3 weekly for 3 cycles). Radiological assessment was according to RECIST criteria by evaluating downstaging of liver involvement and lymphadenopathy into complete response (CR), partial response (PR), stable disease (SD) and progressive disease (PD). Results: A total of 40 patients were evaluated from January 2012 to December 2014 (CTRT=25, NACT=15). Pretreatment CT scans revealed involvement of hilum (19), liver infiltration (38), duodenum involvement (n=22), colon involvement (n=11), N1 involvement (n=11), N2 disease (n=8), paraaortic LN (n=15), and no lymphadenopathy (n=6). After neoadjuvant therapy, liver involvement showed CR in 11(30%), PR in 4 (10.5%), SD in 15 (39.4%) and lymph node involvement showed CR in 17 (50%), PR in 6 (17.6%), SD in 4 (11.7 %). Six patients (CTRT=2, NACT=4) with 66.6 % and 83% downstaging of liver and lymphnodes respectively underwent extended cholecystectomy. There was 16.6 % and 83.3% rates of histopathological CR of liver and lymph nodes. All resections were R0. Conclusions: Neoadjuvant therapy in unresectable gall bladder cancer results in a 15% resectability rate. This approach has a strong potential in achieving R0 and node negative disease. Radiologic downstaging (CR+PR) of liver involvement is 40.5% and lymphadenopathy is 67.5%. Nodal regression could serve as a predictor of response to neoadjuvant therapy.

• Radiation Oncology Journal
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• 제10권1호
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• pp.69-76
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• 1992

국소진행된 자궁경부암에 있어서의 예후인자를 알아보기 위하여 1979년 3월부터 1986년 12월까지 서울대학교병원에서 근치적방사선치료를 시행받은 154명의 환자를 대상으로 후향적 분석을 시행하였다. FIGO 병기 IIIA, IIIB, IVA의 환자 수는 각각 8, 134, 12명 이었고 병기에 따른 5년 국소치료율은 각각 $58\%$, $51\%$, $27\%$이었으며 5년 무병생존율은 각각 $57\%$, $40\%$, $25\%$, 5년 생존율은 각각 $67\%$, $51\%$, $33\%$이었다. 단변수분석에 의하면 임신 횟수, 혈색소치, 전산화단층촬영상 골반측벽 침범소견이 국소치료율에 영향을 미치는 인자 이었고 임신 횟수, 혈색소치, 전산화단층촬영상의 골반측벽 침범소견과 함께 요로조영술상의 요로패쇄증, 전산화단층촬영상의 골반임파절 비대가 무병생존율에 영향을 미치는 인자 이었으며 생존율에 영향을 미치는 인자는 전산화단층촬영상의 골반측벽 침범소견 및 방광침범소견 이었다. 다변량분석에 의하면 국소치료율에 영향을 미치는 인자는 없었고 무병생존율에 영향을 미치는 인자는 전산화단층촬영상의 골반임파절 비대이었으며 생존율에 영향을 미치는 인자는 원발병소의 크기였다.

• Radiation Oncology Journal
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• 제9권2호
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• pp.311-317
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• 1991

1989년 2월부터 1990년 6월까지 조선대학교 부속병원 치료방사선과에서 침윤성 방광암으로 경요도적절제술 및 Cisplatin과 방사선을 병용하여 치료를 받았던 10예에 대하여 저자는 후향적으로 국소관해율, 생존기간, 치료실패양상 및 부작용을 분석하였다. 이들은 원발병소가 근치적방광절제술이 불가능하였거나, 환자의 전신상태 또는 고령의 나이나 합병된 내과적인 질환때문에 근치적수술을 할 수 없었던 경우였다. 원발병소의 병기는 T3a-T4b였고, N병기는 NO가 9예이고 N1가 1예였으며, 10예 모두 MO 였다. 추적기간은 $16\~32$개월이었다. 수술요법은 경요도적절제술, 화학요법은 Cisplatin $1\~5$회, 방사선치료는 골반부위에 $3960\~5400$ cGy의 선량으로 치료하였다. 원발병소의 병기에 따른 완전관해율은 cT3a에서 80$\%$, cT3b에서 67$\%$ 그리고 cT4b에서 0$\%$였고 전체적으로 60$\%$의 완전관해율을 보였다. 부분관해율은 20$\%$이어서 전체의 국소관해율은 80$\%$였다. 조직학적 검사상모두 이행상피암이었고 조직학적 등급에 따른 완전관해의 차이를보면 I, II등급인 6예에서는 모두 완전관해를 보였고 III, IV등급인 4예에서는 부분관해가 2예이고 무반응이 2예였다. 완전관해를 보였던 6예는 모두 생존하여 있고 이중 1예에서만 치료후 10개월후에 국소재발을 보였다. 완전관해를 보이지 않았던 4예는 모두 조직학적 등급이 III, IV등급으로 방광암으로 사망하였다. 원격전이는 3예에서 보였으며 2예 (cT4b)는 폐, 1예(cT3b)는 척추부위였다. 방사선치료후 부작용은 설사가 가장 심한 부작용으로 1예에서 나타났으나 보존요법으로 호전되었다. 따라서 침윤성방광암에 있어서 방광기능의 보존측면에서 병용치료는 심한 부작용없이 치료가 가능하며 완전관해율을 높이기위하여 방사선선량을 높이고, T4b병기에서는 원격전이 가 큰 문제이므로 효과적인 복합화학요법을 시도하는 것이 필요하다고 사료된다.