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Intensity Modulated Whole Pelvic Radiotherapy in Patients with Cervix Cancer: Analysis of Acute Toxicity (자궁경부암 환자에서 전골반 강도변조방사선치료에 의한 급성부작용)

  • Choi, Young-Min;Lee, Hyung-Sik;Hur, Won-Joo;Cha, Moon-Seok;Kim, Hyun-Ho
    • Radiation Oncology Journal
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    • v.24 no.4
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    • pp.248-254
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    • 2006
  • $\underline{Purpose}$: To evaluate acute toxicities in cervix cancer patients receiving intensity modulated whole pelvic radiation therapy (IM-WPRT). $\underline{Materials\;and\;Methods}$: Between August 2004 and April 2006, 17 patients who underwent IM-WPRT were analysed. An intravenous contrast agent was used for radiotherapy planning computed tomography (CT). The central clinical target volume (CTV) included the primary tumor, uterus, vagina, and parametrium. The nodal CTV was defined as the lymph nodes larger than 1 cm seen on CT and the contrased-enhanced pelvic vessels. The planning target volume (PTV) was the 1-cm expanded volume around the central CTV, except for a 5-mm expansion from the posterior vagina, and the nodal PTV was defined as the nodal CTV plus a 1.5 cm margin. IM-WPRT was prescribed to deliver a dose of 50 Gy to more than 95% of the PTV. Acute toxicity was assessed with common toxicity criteria up to 60 days after radiotherapy. $\underline{Results}$: Grade 1 nausea developed in 10 (58.9%) patients, and grade 1 and 2 diarrhea developed in 11 (64.7%) and 1 (5.9%) patients, respectively. No grade 3 or higher gastrointestinal toxicity was seen. Leukopenia, anemia, and thrombocytopenia occurred in 15 (88.2%). 7 (41.2%), and 2 (11.8%) patients, respectively, as hematologic toxicities. Grade 3 leukopenia developed in 2 patients who were treated with concurrent chemoradiotherapy. $\underline{Conclusion}$: IM-WPRT can be a useful treatment for cervix cancer patients with decreased severe acute toxicities and a resultant improved compliance to whole pelvic irradiation.

Effect of Suboptimal Chemotherapy on Preoperative Chemoradiation in Rectal Cancer (직장암 환자의 수술 전 항암화학방사선치료에서 비적정 항암화학요법의 영향)

  • Lee, Ji-Hye;Kang, Hyun-Cheol;Chie, Eui-Kyu;Kang, Gyeong-Hoon;Park, Jae-Gahb;Oh, Do-Youn;Im, Seock-Ah;Kim, Tae-You;Bang, Yung-Jue;Ha, Sung-Whan
    • Radiation Oncology Journal
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    • v.27 no.2
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    • pp.78-83
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    • 2009
  • Purpose: To examine the effect of suboptimal chemotherapy in patients undergoing preoperative chemoradiotherapy for the treatment of rectal cancer. Materials and Methods: The medical records of 43 patients who received preoperative concurrent chemoradiotherapy, followed by radical surgery for the treatment of pathologically proven adenocarcinoma of the rectum from April 2003 to April 2006 were retrospectively reviewed. The delivered radiation dose ranged from 41.4 to 50.4 Gy. The standard group consisted of patients receiving two cycles of a 5-FU bolus injection for three days on the first and fifth week of radiotherapy or twice daily with capecitabine. The standard group included six patients for each regimen. The non-standard group consisted of patients receiving one cycle of 5-FU bolus injection for three days on the first week of radiotherapy. The non-standard group included 31 patients. Radical surgery was performed at a median of 58 days after the end of radiotherapy. A low anterior resection was performed in 36 patients, whereas an abdominoperineal resection was performed in 7 patients. Results: No significant difference was observed between the groups with respect to pathologic responses ranging from grades 3 to 5 (83.3% vs. 67.7%, p=0.456), downstaging (75.0% vs. 67.7%, p=0.727), and a radial resection margin greater than 2 mm (66.7% vs. 83.9%, p=0.237). The sphincter-saving surgery rate in low-lying rectal cancers was lower in the non-standard group (100% vs. 75%, p=0.068). There was no grade 3 or higher toxicity observed in all patients. Conclusion: Considering that the sphincter-saving surgery rate in low-lying rectal cancer was marginally lower for patients treated with non-standard, suboptimal chemotherapy, and that toxicity higher than grade 2 was not observed in the both groups, suboptimal chemotherapy should be avoided in this setting.

Comparing Concurrent Chemoradiotherapy to Chemotherapy Alone for Locally Advanced Unresectable Pancreatic Cancer (절제 불가능한 췌장암의 동시 항암화학 방사선 요법과 항암화학 단독 요법의 비교)

  • Park, Jeong-Hoon;Kim, Woo-Chul;Kim, Hun-Jung;Gwak, Hee-Keun
    • Radiation Oncology Journal
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    • v.27 no.2
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    • pp.64-70
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    • 2009
  • Purpose: Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced unresectable pancreatic cancer. However, the introduction of gemcitabine and the recognition of a benefit in patients with advanced disease stimulated the design of trials that compare chemotherapy alone to concurrent chemoradiation. Therefore, we evaluated role of CCRT for locally advanced unresectable pancreatic cancer. Materials and Methods: We carried out a retrospective analysis of treatment results for patients with locally advanced unresectable pancreatic cancer between January 2000 and January 2008. The radiation was delivered to the primary tumor and regional lymph nodes with a 1~2 cm margin at a total dose of 36.0~59.4 Gy (median: 54 Gy). The chemotherapeutic agent delivered with the radiation was 5-FU (500 mg/$m^2$). The patients who underwent chemotherapy alone received gemcitabine (1,000 mg/$m^2$) alone or gemcitabine with 5-FU. The follow-up period ranged from 2 to 38 months. The survival and prognostic factors were analyzed using Kaplan-Meier method and log-rank test, respectively. Results: Thirty-four patients received concurrent chemoradiotherapy, whereas 21 patients received chemotherapy alone. The median survival time was 12 months for CCRT patients, compared to 11 months for chemotherapy alone patients (p=0.453). The median progression-free survival was 8 months for CCRT patients, compared to 5 months for chemotherapy alone patients (p=0.242). The overall response included 9 partial responses for CCRT and 1 partial response for chemotherapy alone. In total, 26% of patients from the CCRT group experienced grade 3~4 bowel toxicity. In contract, no grade 3~4 bowel toxicity was observed in the chemotherapy alone group. The significant prognostic factors of overall survival were lymph node status, high CA19-9, and tumor location. Conclusion: The response rate and progression-free survival were more favorable in the CCRT group, when compared with the chemotherapy alone group. Therefore, radiation therapy seems to be an effective tool for local tumor control.

Results of Preoperative Concurrent Chemoradiotherapy for Locally Advanced Rectal Cancer (국소진행성 직장암의 수술 전 동시화학방사선요법의 결과)

  • Choi, Sang-Gyu;Kim, Su-Ssan;Bae, Hoon-Sik
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.34-42
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    • 2007
  • [ $\underline{Purpose}$ ]: We performed a retrospective non-randomized clinical study of locally advanced rectal cancer, to evaluate the anal sphincter preservation rates, down staging rates and survival rates of preoperative chemoradiotherapy. $\underline{Materials\;and\;Methods}$: From January 2002 to December 2005, patients with pathologically confirmed rectal cancer with clinical stage T2 or higher, or patients with lymph node metastasis were enrolled in this study. A preoperative staging work-up was conducted in 36 patients. All patients were treated with preoperative chemoradiotherapy, and curative resection was performed for 26 patients at Hallym University Sacred Heart Hospital. Radiotherapy treatment planning was conducted with the use of planning CT for all patients. A total dose of $45.0{\sim}52.2\;Gy$ conventionally fractionated three-dimensional radiotherapy was delivered to the whole pelvis. Chemotherapy was given at the first and fifth week of radiation therapy with continuous infusion i.v. 5-FU (Fluorouracil) and LV (Leucovorine). Surgical resection was performed 2 to 4 weeks after the completion of the chemoradiotherapy regimen. $\underline{Results}$: The complete resection rate with negative resection margin was 100% (26/26). However, a pathologically complete response was not seen after curative resection. Surgery was done by LAR (low anterior resection) in 23 patients and APR (abdomino-perineal resection) in 3 patients. The sphincter preservation rate was 88.5% (23/26), down staging of the tumor occurred in 12 patients (46.2%) and down-sizing of the tumor occurred in 19 patients (73%). Local recurrence after surgical resection developed in 1 patient, and distant metastasis developed in 3 patients. The local recurrence free survival rate, distant metastasis free survival rate, and progression free survival rate were 96.7%, 87% and 83.1%, respectively. Treatment related toxicity was minimal except for one grade 3, one grade 4 anemia, one grade 3 leukopenia, and one grade 3 ileus. $\underline{Conclusion}$: Preoperative concurrent chmoradiotherapy for locally advanced rectal cancer seems to have some potential benefits: high sphincter preservation and down staging. Treatment related toxicity was minimal and a high compliance with treatment was seen in this study. Further long-term follow-up with a larger group of patients is required.

Clay Mineral Distribution in the Yellow Sea Surface Sediments: Absolute Mineral Composition and Relative Mineral Composition (황해 표층퇴적물의 점토광물 분포; 절대광물조성과 상대광물조성)

  • Moon, Dong-Hyeok;Yi, Hi-Il;Shin, Dong-Hyeok;Shin, Kyung-Hoon;Cho, Hyen-Goo
    • Journal of the Mineralogical Society of Korea
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    • v.21 no.3
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    • pp.289-295
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    • 2008
  • We studied the difference between the clay mineral content in the bulk marine sediments (absolute clay mineral composition) and clay mineral content only in total clay minerals (relative clay mineral composition) of the Yellow Sea marine sediments, and correlated the relationship between their distribution patterns. We used 56 Yellow Sea Surface sediments collected at the second cruise in 2001 of KORDI, and determined the absolute mineral composition using the quantitative X-ray diffraction analysis. Yellow Sea surface sediments consist of primary rock forming minerals including quartz (average 44.7%), plagioclase (15.9%), alkali feldspar (10.0%), hornblende (2.8%) together with clay minerals (illite 15.3%, chlorite 2.6% and kaolinite 1%) and carbonates (calcite 1.7%, aragonite 0.6%). Absolute clay mineral contents are very high in the region extending from the southeast of Sandong Peninsula to the southwest of Jeju Island. In contrast, it is very low along the margin of the Yellow Sea. Such distribution patterns of absolute clay mineral content are very similar to those of fine-grained sediments in the study area. The average relative clay mineral composition of illite, chlorite, and kaolinite is respectively 80.3%, 14.9% and 4.8%. The distribution pattern of relative mineral composition shows very different phenomenon when compared with those of absolute mineral composition, and also do not exhibit any positive relationship with that of fine-grained sediments in which clay mineral composition is abundant. Therefore, we suggest that the relative clay mineral compositions and their distribution patterns must be used very carefully when interpreting the origin of sediment provenance.

Soft Tissue Sarcomas Presented with Hematoma (혈종을 동반한 연부 조직 육종)

  • Chung, Yang-Guk;Kang, Yong-Koo;Bahk, Won-Jong;Rhee, Seung-Koo;Lee, An-Hi;Park, Jeong-Mi;Cho, Hyun-Min
    • The Journal of the Korean bone and joint tumor society
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    • v.14 no.2
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    • pp.163-171
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    • 2008
  • Purpose: We analyze the characteristics of soft tissue sarcomas presented with hematoma, which were misdiagnosed as simple hematoma initially and the proper management were delayed. Materials and Methods: The 7 patients with histologically proven soft tissue sarcoma with hematoma presented since February 1997 were evaluated retrospectively. Neither patient had a medical history of bleeding tendency nor anticoagulant therapy. Two of them had minor traumas. There were 2 men and 5 women. Average follow up period was 58 months. MRI findings, provided treatments and oncologic outcome were reviewed with the reference of related articles. Results: Retrospective review of initial MR images revealed deep seated intramuscular masses with focal solid enhanced nodules at the peripheral margin. The diagnoses were delayed at least 1 month in 3 of them which included 2 cases of simple hematoma evacuation without biopsy initially. After histologic diagnosis of soft tissue sarcoma, wide resections were performed in 4 cases. one patient underwent above knee amputation and the remained 2 patients were managed with wide resection followed by amputation due to local recurrence. At last follow up there were CDF and NED in 2 cases, respectively and AWD in 3 cases. Conclusion: To avoid the delay of diagnosis and treatment of soft tissue sarcomas presented with hematoma, high degree of clinical suspicion, careful analysis of MR images and early biopsy were important.

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Comparative study in marginal fit of a pressed ceramic and feldspathic porcelain fused to metal restoration (열-가압을 이용한 금속 도재관과 전통적인 금속 도재관의 변연 적합도 비교 연구)

  • Kim, Yoon-Young;Park, Won-Hee;Yoo, Dong-Yeob;Lee, Young-Soo
    • The Journal of Korean Academy of Prosthodontics
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    • v.48 no.4
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    • pp.273-279
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    • 2010
  • Purpose: The purpose of this in vitro study was to compare the marginal adaptation of a ceramic-pressed-to-metal restoration with traditional metal-ceramic restoration. Materials and methods: Duplicating the prepared resin tooth, 20 metal dies were fabricated. Twenty metal copings of 2 groups which were metal ceramic restoration and pressed to metal restoration were fabricated. The marginal opening of each coping was measured with Microscope (BX 60M-36E $41D^{(R)}$: Olympus, Japan). After porcelain build-up, the marginal opening of metal ceramic restoration and pressed to metal restoration ($PoM^{(R)}$: Ivoclar vivadent., Liechtenstein) were also evaluated in the same method. The measurements were analyzed using Wilcoxon Signed Ranks test and Mann-Whitney U test. Results: Within the limits of this study, the results were as follows. 1. Metal-ceramic restorations in coping state ($64.93{\pm}12.48\;{\mu}m$) in compared with Metal ceramic restorations after porcelain build-up ($63.43{\pm}12.86\;{\mu}m$) had no significant difference in marginal adaptation. 2. Pressed-metal-ceramic restorations in coping state ($50.00{\pm}12.28\;{\mu}m$) in compared with Pressed metal ceramic restorations after porcelain build-up ($56.72{\pm}13.80\;{\mu}m$) had no significant difference in marginal adaptation. 3. Metal-ceramic restorations in compared Pressed-metal-ceramic restorations had no significant difference in marginal adaptation. Conclusion: Pressed-metal-ceramic restorations have the advantage of being technically less change through using of the lost-wax technique and this allows for the convenience of a full-contour ceramic wax-up as opposed to the more technique-sensitive layering method. Pressed-metal-ceramic restorations may be considered in clinic on the basis of the result of this study and the advantage of this system.

Petrological Study on the Cretaceous Volcanic Rocks in the southwest Ryeongnam Massif: (1) the Mt. Moonyu volcanic mass, Seungju-gun (영남육괴 남서부에 분포하는 백악기 화산암류에 대한 암석학적 연구: (1) 승주군 문유산 화산암복합체)

  • Kim, Young-La;Koh, Jeong-Seon;Lee, Jeong-Hyun;Yun, Sung-Hyo
    • The Journal of the Petrological Society of Korea
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    • v.17 no.2
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    • pp.57-82
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    • 2008
  • The volcanic sequence of the late Cretaceous Moonyu volcanic mass which distributed in the southwestern part of Ryeongnam massif, can be divided into felsic pyroclastic rocks, andesite and andesitic pyroclastic rocks, rhyolite in ascending order. The earliest volcanic activity might commence with intermittent eruptions of felsic magma during deposition of volcaniclastic sediments. Explosive eruptions of felsic pyroclastic rocks began with ash-falls, to progressed through pumice-falls and transmitted with dacitic to rhyolitic ash-flows. Subsequent andesite and andesitic pyroclastic rocks were erupted and finally rhyolite was intruded as lava domes along the fractures near the center of volcanic mass. Petrochemical data show that these rocks are calc-alkaline series and have close petrotectonic affinities with subduction-related continental margin arc volcanic province. Major element compositions range from medium-K to high-K. Petrochemical variation within the volcanic sequence can be largely accounted for tractional crystallization processes with subordinate mixing. The most mafic rocks are basaltic andesite, but low MgO and Ni contents indicate they are fractionated by fractional crystallization from earlier primary mafic magma, which derived from less than 20% partial melting of ultramafic rocks in upper mantle wedge. Based on the stratigraphy, the early volcanic rocks are zoned from lower felsic to upper andesitic in composition. The compositional zonation of magma chamber from upper felsic to lower andesitic, is interpreted to have resulted from fractionation within the chamber and replenishment by an influx of new mafic magma from depth. Replenishment and mixing is based on observations of disequilibrium phenocrysts in volcanic rocks. REE patterns show slight enrichment of LREE with differentiation from andesite to rhyolite. Rhyolite in the final stage can be derived from calc-alkaline andesite magma by fractional crystallization, but it might have underwent crustal contamination during the fractional crystallization.

Petrochemical study on the Daejeon-sa basalt in the Mt. Juwang area, Cheongsong (청송 주왕산지역 대전사 현무암의 암석화학적 연구)

  • 윤성효;이문원;고정선;김영라;안지영
    • The Journal of the Petrological Society of Korea
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    • v.9 no.2
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    • pp.84-98
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    • 2000
  • Daejeon-sa basalt in the Mt. Juwang area composed of 12 basalt flows alternate with 9 peperites and each basalt and peperite has the variety of thickness. Peperites yielded in Daejeon-sa basalt are mixed of basalt with reddish shale, of which textural type is globular peperite. Basalts yielded in Daejeon-sa basalt are massive basalt without vesicule, although sometimes vesicules are founded in upper within a flow unit. The basalt has mainly pseudomorph of olivine as phenocryst, and also plagioclase and clinopyroxene phenocryst. Matrix is mainly subophitic texture. The plotting result on the TAS diagram shows these basalts belong to the sub-alkaline, and it can be subdivided into calc-alkaline series on the basis of the diagram of Si02 vs. K20 and of alkali index vs. A1203 diagram. According to plots of wt.% oxides vs. wt.% MgO, abundances of A1203 and CaO increase with decreasing MgO while F ~ dOecre~ase . With decreasing MgO compatible elements decrease while incompatible elements increase. In spider diagram of MORB-normalized trace element patterns, HFS elements are nearly similiar with MORB, but LIL elements are enriched. Especially, contents of Ce, F: and Sm are enriched but Nb is depleted. In the chondrite-normalized REE patterns light REEs are enriched than heavy REEs. Tectomagmatic discrimination diagrams shows basalts in the study area are formed in the tectonomagmatic environment of subduction zone under continental margin. This result accord with characters of chemical composition mentioned above. Cr vs. Y diagram and CeM, vs. Ce diagram show that the primary magma of the basalts may formed by the about 15% partial melting of garnet-peridotite in the mantle wedge. After then, Daejeon-sa basalts may formed from evolved magma undergone mainly olivine fractional crystallization and contarnination of crustal materials before eruption.

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Tumor Prosthetic Arthroplasty and Arthroplasty with Bone Cement for the Metastatic Malignant Bone Tumor in the lower Extremity (하지 관절 부위에 발생한 전이성 종양 환자의 종양 대치물 및 골시멘트와 인공관절 삽입술)

  • Yang, Jun-Young;Lee, June-Kyu;Hwang, Deuk-Soo;Shin, Hyun-Dae;Kwak, Sang-Koo;Kim, Kyung-Cheon;Nam, Dae-Cheul
    • The Journal of the Korean bone and joint tumor society
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    • v.9 no.1
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    • pp.12-17
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    • 2003
  • Purpose: In this report we are going to discuss about the functional evaluation and the outcome of treatment of metastatic tumor in the lower extremities treated with tumor prosthetic arthroplasty. Materials and Methods: This report is based on nine patients diagnosed as a metastatic tumor and treated by tumor prosthetic arthroplasty, from June 1998 to December 2001. Age of the patients ranged from 49 to 63 with the average of 56.3. The average follow up period was 23.4 months. Two patients had lung cancer, three had breast cancer, two had renal cancer, one colon cancer, and one had multiple myeloma. All these were primary cancers. The site of metastasis were six in proximal femur, two in distal femur, and one in proximal tibia. Tumor excision was performed after biopsy in following the principle of primary tumor management. Excision with wide surgical margin was tried as possible could. Six cases were treated with tumor prosthesis, and the other three cases were reconstructed with bone cement and arthroplasty. Results: The functional evaluation in the extremities at the last follow up was performed on Enneking evaluation score with 6 categories. The highest scored 26, and the lowest scored 10, with an average of 19.5. A case in which the patient died 15 days after the operation was excluded from the evaluation. Among the categories, emotional acceptance to postoperative function and pain relief were highly scored. At the final follow up, seven patients survived, and one colon cancer patient died 68 days after operation. Conclusion: Metastatic tumor occurring in joints of lower extremities could be treated in accordance to the treatment principle of primary tumor. By insertion of tumor prosthesis, we can get satisfactory results of function in the lower extremity and pain relief especially. So, this aspect of medical favor must be considered in treating patients.

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