• Radiation Oncology Journal
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• 제35권2호
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• pp.163-171
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• 2017

Purpose: Although stereotactic ablative body radiotherapy (SABR) is widely used therapeutic technique, predictive factors of radiation pneumonitis (RP) after SABR remain undefined. We aimed to investigate the predictive factors affecting RP in patients with primary or metastatic lung tumors who received SABR. Materials and Methods: From 2012 to 2015, we reviewed 59 patients with 72 primary or metastatic lung tumors treated with SABR, and performed analyses of clinical and dosimetric variables related to symptomatic RP. SABR was delivered as 45-60 Gy in 3-4 fractions, which were over 100 Gy in BED when the ${\alpha}/{\beta}$ value was assumed to be 10. Tumor volume and other various dose volume factors were analyzed using median value as a cutoff value. RP was graded per the Common Terminology Criteria for Adverse Events v4.03. Results: At the median follow-up period of 11 months, symptomatic RP was observed in 13 lesions (12 patients, 18.1%), including grade 2 RP in 11 lesions and grade 3 in 2 lesions. Patients with planning target volume (PTV) of ${\leq}14.35mL$ had significantly lower rates of symptomatic RP when compared to others (8.6% vs. 27%; p = 0.048). Rates of symptomatic RP in patients with internal gross tumor volume (iGTV) >4.21 mL were higher than with ${\leq}4.21mL$ (29.7% vs. 6.1%; p = 0.017). Conclusions: The incidence of symptomatic RP following treatment with SABR was acceptable with grade 2 RP being observed in most patients. iGTV over 4.21 mL and PTV of over 14.35 mL were significant predictive factors related to symptomatic RP.

• Genomics & Informatics
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• 제19권1호
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• pp.3.1-3.12
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• 2021

Functional interpretation of noncoding genetic variants associated with complex human diseases and traits remains a challenge. In an effort to enhance our understanding of common germline variants associated with lung cancer, we categorize regulatory elements based on eight major cell types of human lung tissue. Our results show that 21.68% of lung cancer-associated risk variants are linked to noncoding regulatory elements, nearly half of which are cell type-specific. Integrative analysis of high-resolution long-range chromatin interactome maps and single-cell RNA-sequencing data of lung tumors uncovers number of putative target genes of these variants and functionally relevant cell types, which display a potential biological link to cancer susceptibility. The present study greatly expands the scope of functional annotation of lung cancer-associated genetic risk factors and dictates probable cell types involved in lung carcinogenesis.

• Asian Pacific Journal of Cancer Prevention
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• 제15권11호
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• pp.4535-4538
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• 2014

Objective: To explore the value of porous titanium alloy plates for chest wall reconstruction after resection of chest wall tumors. Materials and Methods: A total of 8 patients with chest wall tumors admitted in our hospital from Jan. 2006 to Jan. 2009 were selected and underwent tumor resection, then chest wall repair and reconstruction with porous titanium alloy plates for massive chest wall defects. Results: All patients completed surgery successfully with tumor resection-induced chest wall defects being $6.5{\times}7cm{\sim}12{\times}15.5$ cm in size. Two weeks after chest wall reconstruction, only 1 patient had subcutaneous fluidify which healed itself after pressure bandaging following fluid drainage. Postoperative pathological reports showed 2 patients with costicartilage tumors, 1 with squamous cell carcinoma of lung, 1 with lung adeno-carcinoma, 1 with malignant lymphoma of chest wall, 2 with chest wall metastasis of breast cancers and 1 with chest wall neurofibrosarcoma. All patients had more than 2~5 years of follow-up, during which time 1 patient with breast cancer had surgical treatment due to local recurrence after 7 months and none had chest wall reconstruction associated complications. The mean survival time of patients with malignant tumors was ($37.3{\pm}5.67$) months. Conclusions: Porous titanium alloy plates are safe and effective in the chest wall reconstruction after resection of chest tumors.

• Journal of Chest Surgery
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• 제22권1호
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• pp.163-169
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• 1989

Sclerosing hemangiomas of the lung are uncommon benign tumors. Although their histologic appearances are distinct and well-defined, their histogenesis is uncertain. Liebow and Hubbell reported seven cases of unusual pulmonary lesions which they named sclerosing hemangiomas in 1856. Similar cases had previously been reported under different names: Xanthoma, pulmonary histiocytoma, Xanthofibroma. We have experienced 3 cases of sclerosing hemangioma of lung at the Department of Thoracic and Cardiovascular Surgery, Yonsei University, college of Medicine, Seoul, Korea during a period of December 1985 through September 1988. This report is an early result of surgical treatment of three patients with pulmonary sclerosing hemangioma and their pathologic findings.

• Journal of Chest Surgery
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• 제22권3호
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• pp.498-502
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• 1989

Carcinosarcoma is the group of neoplasms possessing both carcinomatous parenchyma and sarcomatous stroma. These tumors are relatively uncommon and may arise in variable organs. In this case, a 62-year-old male patient was admitted to our department due to left chest pain and general weakness of three months duration. The chest x-ray revealed egg-sized, relatively well defined lobulated soft tissue mass in left paracardiac area. Left lower lobectomy was performed under the preoperative impression of lung cancer. Pathologic examination of the resected lung revealed carcinosarcoma without regional lymph node metastasis. Patient is doing well at present without any chemotherapy.

• Asian Pacific Journal of Cancer Prevention
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• 제15권22호
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• pp.9865-9869
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• 2014

Background: Transthoracic fine needle aspiration (FNA) is one of several methods for establishing tissue diagnosis of lung lesions. Other tissue or cell sources for diagnosis include sputum, endobronchial biopsy, washing and brushing, endobronchial FNA, transthoracic core needle biopsy, biopsy from thoracoscopy or thoracotomy. The purpose of this study was to compare the sensitivity and specificity of FNA and other diagnostic tests in diagnosing lung lesions. Materials and Methods: The population included all patients undergoing FNA for lung lesions at Meir Medical Center from 2006 through 2010. Information regarding additional tissue tests was derived from the electronic archives of the Department of Pathology, patient records and files from the Department of Oncology. Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values were calculated for each test. Results: FNA was carried out in 245 patients. Malignant tumors were diagnosed in 190 cases (78%). They included adenocarcinoma (43%), squamous cell carcinoma (15%), non-small cell carcinoma, not otherwise specified (19%), neurondocrine tumors (7%), metastases (9%) and lymphoma (3%). The specificity of FNA for lung neoplasms was 100%; sensitivity and diagnostic accuracy were 87%. Conclusions: FNA is the most sensitive procedure for establishing tissue diagnoses of lung cancer. Combination with core needle biopsy increases the sensitivity. Factors related to the lesion (nature, degenerative changes, location) and to performance of all stages of test affect the ability to establish a diagnosis.

• 대한의용생체공학회:의공학회지
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• 제44권5호
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• pp.303-314
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• 2023

This study aimed to assess the practical feasibility of advanced deformable image registration (DIR) algorithms in radiotherapy by employing two distinct datasets. The first dataset included 14 4D lung CT scans and 31 head and neck CT scans. In the 4D lung CT dataset, we employed the DIR algorithm to register organs at risk and tumors based on respiratory phases. The second dataset comprised pre-, mid-, and post-treatment CT images of the head and neck region, along with organ at risk and tumor delineations. These images underwent registration using the DIR algorithm, and Dice similarity coefficients (DSCs) were compared. In the 4D lung CT dataset, registration accuracy was evaluated for the spinal cord, lung, lung nodules, esophagus, and tumors. The average DSCs for the non-learning-based SyN and NiftyReg algorithms were 0.92±0.07 and 0.88±0.09, respectively. Deep learning methods, namely Voxelmorph, Cyclemorph, and Transmorph, achieved average DSCs of 0.90±0.07, 0.91±0.04, and 0.89±0.05, respectively. For the head and neck CT dataset, the average DSCs for SyN and NiftyReg were 0.82±0.04 and 0.79±0.05, respectively, while Voxelmorph, Cyclemorph, and Transmorph showed average DSCs of 0.80±0.08, 0.78±0.11, and 0.78±0.09, respectively. Additionally, the deep learning DIR algorithms demonstrated faster transformation times compared to other models, including commercial and conventional mathematical algorithms (Voxelmorph: 0.36 sec/images, Cyclemorph: 0.3 sec/images, Transmorph: 5.1 sec/images, SyN: 140 sec/images, NiftyReg: 40.2 sec/images). In conclusion, this study highlights the varying clinical applicability of deep learning-based DIR methods in different anatomical regions. While challenges were encountered in head and neck CT registrations, 4D lung CT registrations exhibited favorable results, indicating the potential for clinical implementation. Further research and development in DIR algorithms tailored to specific anatomical regions are warranted to improve the overall clinical utility of these methods.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.2393-2398
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• 2012

Objectives: The purpose of this study was to evaluate the geometric accuracy of thoracic anatomic landmarks as target surrogates of intrapulmonary tumors for manual rigid registration during image-guided radiotherapy (IGRT). Methods: Kilovolt cone-beam computed tomography (CBCT) images acquired during IGRT for 29 lung cancer patients with 33 tumors, including 16 central and 17 peripheral lesions, were analyzed. We selected the "vertebrae", "carina", and "large bronchi" as the candidate surrogates for central targets, and the "vertebrae", "carina", and "ribs" as the candidate surrogates for peripheral lesions. Three to six pairs of small identifiable markers were noted in the tumors for the planning CT and Day 1 CBCT. The accuracy of the candidate surrogates was evaluated by comparing the distances of the corresponding markers after manual rigid matching based on the "tumor" and a particular surrogate. Differences between the surrogates were assessed using 1-way analysis of variance and post hoc least-significant-difference tests. Results: For central targets, the residual errors increased in the following ascending order: "tumor", "bronchi", "carina", and "vertebrae"; there was a significant difference between "tumor" and "vertebrae" (p = 0.010). For peripheral diseases, the residual errors increased in the following ascending order: "tumor", "rib", "vertebrae", and "carina"; There was a significant difference between "tumor" and "carina" (p = 0.005). Conclusions: The "bronchi" and "carina" are the optimal surrogates for central lung targets, while "rib" and "vertebrae" are the optimal surrogates for peripheral lung targets for manual matching of online and planned tumors.

• 한국콘텐츠학회논문지
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• 제14권9호
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• pp.362-370
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• 2014

본 연구는 자유로운 호흡 상태에서 사이버나이프 영상유도 방사선 치료장치(IGRT)를 이용하여 흉 복부 종양의 움직임과 외부호흡과의 상관관계 측정하여 분석하였다. 대상은 방사선 치료를 시행한 폐종양(n=10), 간종양(n=10), 췌장암(n=10) 환자 총 30명으로, 종양추적시스템(MTS)의 로그 데이터를 변환하여 분석하였다. 자유로운 호흡 중에서 폐종양과 외부호흡의 Peason 상관관계는 두미 방향 0.646(p<0.05), 좌우 방향 0.365(p<0.088), 전후 방향 0.196(p<0.115)로 나타났다. 간종양의 상관관계는 두미 방향 0.841(p<0.000), 좌우 방향 0.346 (p<0.179), 전후 방향 0.691(p<0.001)로 나타났다. 췌장 종양의 상관관계는 두미 방향 0.683(p<0.000), 좌우 방향에서는 0.397(p<0.006), 전후 방향 0.268(p<0.127)로 나타났다. 영상유도장치를 이용한 흉 복부 종양의 움직임 측정 결과는 정확한 치료 체적의 결정에 유용하게 적용할 수 있을 것이다. 또한 외부 호흡과 내부 종양 움직임의 상관관계를 분석을 통하여 다양한 방사선 치료 기술에서 종양의 움직임을 보상해 줄 수 있는 중요한 정보를 제공할 것이다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2573-2577
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• 2016

Objective: The aim of this study was to determine a method of dose prescription that minimizes normal tissue irradiation outside the planning target volume (PTV) during stereotactic body radiotherapy (SBRT) for patients with non-small cell lung cancer. Methods: Previous research and patients with typical T1 lung tumors with peripheral lesions in the lung were selected for analysis. A PTV and several organs at risk (OARs) were constructed for the dose calculated; six treatment plans employing intensity modulated radiotherapy (IMRT) were produced, in which the dose was prescribed to encompass the PTV, with the prescription isodose level (PIL) set at 50, 60, 70, 80, 90 or 95% of the isocenter dose. Additionally, four OARs around the PTV were constructed to evaluate the dose received in adjacent tissues. Results: The use of higher PILs for SBRT resulted in improved sparing of OARs, with the exception of the volume of lung treated with a lower dose. Conclusions: The use of lower PILs is likely to create significant inhomogeneity of the dose delivered to the target, which may be beneficial for the control of tumors with poor conformity indices.