• Radiation Oncology Journal
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• v.17 no.4
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• pp.269-274
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• 1999

Purpose : To evaluate the Possibility of decreasing the radiation dose and to determine optimum treatment volume in intracranial germinomas. Materials and Methods : Forty five patients with pathologically-verified or presumed germinomas by a radiosensitivity test who had been treated with radiotherapy (RT) alone between 1971 and 1992 were retrospectively analyzed. The average age was 17.2 years with 68.9$\%$ of the patients being between the ages of 10$\~$20. The male and female ratio was 2.2:1. The locations of the primary tumors were at the pineal regions in 14 patients; the suprasellar regions in 12 patients; and multiple sites in 12 patients. Treatment volumes varied from a small local field (10) to the whole brain (7) or entire neuroaxis irradiation(28). All the cases after 1982 received craniospinal irradiation (CSI). Radiation doses were 41-59 Gy (median 48.5 Gy) to the primary tumor site and 19.5$\~$36 Gy (median 24 Gy) to the neuroaxis. The median follow-up period was 82 months with a range of 2$\~$260 months. Results : All the patients showed complete response after RT. Four patients sufferred from recurrence 14, 65, 76, and 170 months after RT, respectively, and two patients died with intercurrent disease. One of four recurrent cases was salvaged by re-irradiation. Therefore, a 5 and 10 year overall suNival was 95.3$\%$ and 84.7 $\%$ respectively. Five and ten year disease-free survival was 97.6 $\%$ and 88.8 $\%$ respectively. All the recurrences occurred in the patients who received local RT (3/10) or whole brain RT (1/7) with a radiation dose of 48-50 Gy. None of the patients who received CSI suffered recurrence. There was no recurrence among the 15 patients who received $\leq$45 Gy to the primary site and the 18 patients who received $\leq$24 Gy (6 patients received 19.5 Gy) to the neuroaxis. Conclusion : CSI is recommended for the treatment of intracranial germinomas. The radiation dose can be safely decreased to $\leq$45 Gy on a primay tumor site and 19.5 Gy on the spine.

• Radiation Oncology Journal
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• v.18 no.3
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• pp.182-186
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• 2000

Purpose : To determine treatment or이ecol for inoperable esophageal cancer patients, 껜e evaluated survival rate and prognostic factors. Materials and Methods : We evaluated esophageal cancer treated by curative or palliative am in KCCH from 1992 to 1996, retrospectively. Recurrent or underdose case below 40 Gy were excluded. The number of male and female were 35 and 5, respectively. Thirty-eight patients were squamous carcinoma and 2 patients were not biopsy proven. Ten patients were treated with radiation therapy and chemotherapy Median dose of radiation therapy was 59.4 Gy and the range was $40\~60$ Gy. Results : The median survival is 6.5 months and 1-year survival rate was $28.3\%$. Age, location, radiation dose and chemotherapy were not significant prognostic factors. Median survivals of patients with below stage III and over stage IVA were 7.6 and 6.2 months respectively, but it is not significant. Conclusions : The survival for esophageal cancer is very poor. For patients with curative aim, chemotherapy must be considered. For patients with palliative aim, short-term external beam radiation therapy and/or brachytherapy must be considered.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.1-9
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• 2003

Purpose : The purpose of this study was to analyze the effect of a Linear accelerator based Photon Knife Radiosurgery System developed by the staff of Keimyung University Dongsan Medical Center for the treatment of cerebral arterlovenous malformation Material and Methods : Between December 1993 and October 2000, 30 patients with cerebral arteriovenous malformation (AVM) were treated with the Linac based Photon knife Radlosurgery System In the Department of Therapeutlc Radiology at Keimyung University Dongsan Medical Center. The median age was 34, ranging from 7 to 63 years, with a 2 : 1 male to female ratio. The locations of the AVM nidi were the frontal lobe (motor cortex), parletal lobe, and the thalamus, In that order. The diameters of the AVM nidi ranged 1.2 to 5.5 cm with a mean on 2.9 cm, and target volumes of between 0.5 and 20.5 cc, with a mean of 5.8 cc. The majority of patients received radiation doses of between 1,500 and 2,500 cGy, w14h a mean of 2,000 cGy, at 80% the isodose line. Twenty-five patients were treated with one isocenter, 4 with two, and 1 with four. The follow-up radiological evaluations were peformed with cranial computed tomogram (CT) or MRI between 6 month and one year interval, and if the AVM nidus had completely disappeared in the CT or MRI, we confirmed thls was a complete obliteration, with a cerebral or magnetic resonance angiogram (MRA). The median iollow-up period was 39 months with a range of 10 to 103 months. Results : Twenty patients were radloiogicaiiy followed up ior over 20 months, with complete obliteration observed in 14 (70%). According to the maximal diameter, all four of the small AVM (<2 cm) completely obliterated, 8 of the 10 patients with a medium AVW (2~3 cm) showed a complete obliteration, and two showed partial obliteration. Among the patients with a large AVM (>3 cm), only one showed complete obliteration, and S showed partial obliteration, but 3 oT these underwent further radiosurgery 3 years later. One who followed up for 20 months fellowing further radiosurgery eventually showed complete obliteration. Ten patients with seizure symptoms had no recurrent seizure due to radiosurgery and medication. One of the eleven patients who suffered intracranlal bleeding developed further bleeding at 9 and 51 months fellowing the radiosurgery although complete obliteration was eventually observed and the patient was managed in hospital then recovered. No patient suffered severe complications fellowing the radiosurgery. Conclusion : The radiosurgery with Linac-based Photon knife radiosurgery system, developed by the staff at our hospital, is a safe and effective treatment for AVM patients having diameters or volumes of less than 3 cm or 10 cm$^{3}$, respectively, located In Inoperable areas or who refused neurosurgery. We suggest that staged AVM radiosurgery may initially be considered, if the AVM target volume is above 10 cm$^{3}$

• Radiation Oncology Journal
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• v.21 no.4
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• pp.283-290
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• 2003

Purpose: To evaluate the long term significance of the squamous cell carcinoma (SCC) antigen (Ag) as a tumor marker in uterine cervix carcinoma. Materials and Methods: The SCC antigen levels of pre-radiotherapy and serial post-radiotherapy serum were analyzed in 48 patients who received radiotherapy with histologically proven primary SCC of the uterine cervix. Results: Pre-radiotherapy SCC Ag level was high ($\geq$2 ng/ml) at 79.2$\%$. After the treatment, the SCC Ag level was significantly decreased. The SCC Ag level measured at about 3 months after radiotherapy was high at 23.0$\%$. In further follow up measurements, a rise of the SCC Ag to a high level was well associated with clinical relapse. The specificity of the elevated SCC Ag level in association with recurrent or persistent disease was 100$\%$, and the sensitivity was 85.7$\%$. In 3 of 4 lung metastasis cases, lung lesions were detected in chest PA before elevation of the SCC Ag level. The median lead time of the high SCC Ag level to clinical recurrence was 4 months. Conclusion: SCC Ag was a good tumor marker for monitoring treatment effect in patients with increased pre-treatment levels except in case of early lung metastasis. Elevation of the SCC Ag level after radiotherapy accurately predicted the treatment failure with lead time of 4 months. But, in early lung metastasis cases, the SCC level may be normal temporarily. Thus, chest PA should be checked to evaluate the presence of lung metastasis.

• Radiation Oncology Journal
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• v.26 no.3
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• pp.135-141
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• 2008

Purpose: To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. Materials and Methods: The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, $8{\sim}240$ months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, $3{\sim}50\;cm$). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. Results: The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (>60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (>60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. Conclusion: Our results were comparable to previous reports in that adjacent organ invasion and patient age (>60 years) were significant predictors of poor survival and tumor recurrence, respectively.

• Maxillofacial Plastic and Reconstructive Surgery
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• v.28 no.2
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• pp.95-110
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• 2006

The treatment for oral and maxillofacial carcinoma with chemotherapeutic agents is evaluated by many effective methods to reduce the tumor mass and cancer cell proliferation. However these chemotherapy have many serious side effects, such as bone marrow suppression, renal toxicity, G-I troubles. Therefore a possible approach to develop a clinically applicable chemotherapeutic agent is to screen anticancer activity of Taxol which is known to have very little side effect and have been used to breast cancer and ovarian carcinoma. Taxol is a new anti-microtubular anti-cancer agent extracted from the bark of the Pacific yew, Taxus brevifolia. Paclitaxel(Taxol) acts by promoting tubulin polymerization and over stabilizing microtubules agianst depolymerization. Despite the constant improvements of methods of the cancer treatment especially chemotherapy, the rate of cancer metastasis and recurrent are not decreased. Thus the investigation of new drug which have very little side effect and a possible clinically application continues to be a high priority. Considering that the Taxol have shown very effective chemotherapeutic agent with relatively low toxicity in many solid tumors, it deserves to evaluate its efficacy in oral squamous cell carcinoma. In this study, to investigate the in-vivo and in-vitro anti-cancer efficacy of Taxol in oral squamous cell carcinoma and lastly, the potency of Paclitaxel in the clinical application for oral cancer was evaluated. In vivo study, after HN22 cell line were xenografted in nude mice, the growth of tumor mass was observed, 3 mg/Kg taxol was injected intraperitoneally into nude mice containing tumor mass. The methods of these study were measurement of total volume of tumor mass, histopathologic study, immunohistochemical study, drug resistance assay, growth curve, MTT assay, flow cytometry, cDNA microarray in vivo and in vitro. The results were obtained as following. 1. The visual inspection of the experimental group showed that the volume of the tumor mass was slightly decreased but no significant difference with control group. 2. Ki-67 index was decreased at weeks 4 in experimental group. 3. Microscopic view of the xenografted tumor mass showed well differentiated squamous cell carcinoma and after Taxol injection, some necrotic tissue was seen weeks 4. 4. The growth curve of the tumor cells were decreased after 1day Taxol treatment. 5. According to the MTT assay, HN22 cell line showed relative drug resistancy above $5\;{\mu}g/ml$ concentrations of Taxol. 6. In drug resistance assay, the decrease of cell counts was seen relatively according to concentration. 7. In Flow cytometry, G2M phase cell arrests were seen in low concentration of the Taxol, while S phase cell arrests were seen in high concentration of the Taxol. 8. Using cDNA microarray technique, variable gene expression of ANGPTL4, TXNRD1, FAS, RRAGA, CTGF, CYCLINEA, P19, DUSP5, CEBPG, BTG1 were detacted in the oral squamous cell carcinoma cell after taxol treatment. In this study paclitaxel is effective against oral squamous cell carcinoma cell lines in vitro, but week effect was observed in vivo. So we need continuous study about anticancer effect of taxol in vivo in oral squamous cell carcinoma.

• Journal of Chest Surgery
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• v.32 no.6
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• pp.510-517
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• 1999

Background: Total anomalous pulmonary venous connection (TAPVC) is still one of the more challenging congenital heart defects in newborns and young infants. The purpose of the study is to evaluate the early and midterm results of the surgical corrections for patients in early infancy with isolated TAPVC. Material and Method: Hospital records of 15 consecutive patients in early infancy (January 1993 to August 1998) were retrospectively reviewed. There were 8 boys and 7 girls whose ages ranged from 4 days to 3.5 months (median age 22 days). Their body weight ranged from 1.75 kg to 4.9 kg (mean 3.54 kg). The abnormal anatomical connections were supracardiac in 11, cardiac in 3, and infracardiac in 1. In 6 patients (40%), the pulmonary venous drainage was obstructive. Total circulatory arrest was used in 13 patients. Anastomosis between the common pulmonary vein and the left atrium was performed with a continuous suture technique using a fine nonabsorbable polypropylene suture through a lateral approach behind the right atrium. Result: There was one hospital death (6.5%) caused by a sepsis 17 days after the operation in a neonate who had supracardiac drainage and was dependent on a ventilator preoperatively. There were 2 late deaths. One died sudde`nly of an unknown cause at home 2.5 years after the operation and the other died of a recurrent pulmonary hypertension 3 months after the reoperation due to pulmonary venous obstruction (PVO). Two patients required reoperations because of PVO 5 months and 10 months respectively after the initial operation. Of these patients, one patient is alive at the present time with persistent pulmonary hypertension. All survivors without postoperative PVO (78.6%) were in NYHA functional class I at mean follow-up of 25.8 months (0.5∼67 months). Conclusion: Surgical correction of TAPVC in early infancy can be performed at low risk. However, there were 2 postoperative PVOs (14.3%) which had bad results. The survivors without postoperative PVO had excellent functional status.

• Sleep Medicine and Psychophysiology
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• v.22 no.1
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• pp.30-34
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• 2015

Obesity hypoventilation syndrome (OHS) is characterized by severe obesity, excessive daytime sleepiness, hypoxemia and hypercapnea. Because OHS mimics pulmonary hypertension or cor pulmonale, clinicians should recognize and treat this syndrome appropriately. A 58-year-old female visited the emergency room because of dyspnea. She was obese and had kyphoscoliosis. The patient also experienced snoring, recurrent choking during sleep and daytime hypersomnolence which worsened after gaining weight in the recent year. The arterial blood gas analysis showed she experienced hypoxemia and hypercapnea not only during nighttime but also daytime. We suspected OHS and the patient underwent polysomnography to confirm whether obstructive sleep apnea was present. During the polysomnography test, sleep obstructive apnea was observed and apnea-hypopnea index was 9.2/hr. The patient was treated with bilevel positive airway pressure therapy (BiPAP). After BiPAP for 4 days, hypoxemia and hypercapnia were resolved and she is currently well without BiPAP. We report a case successfully treated with clinical improvement by presuming OHS early in a patient who had typical OHS symptoms, even while having other conditions which could cause hypoventilation.

• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.42-49
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• 1995

Background: Hemoptysis always merits thorough investigation because even minimal bleeding may be an early indicator of the presence of significant bronchopulmonary disease. But in patients with hemoptysis & a normal chest roentgenogram, there are no clear guidelines for a diagnostic approach, including the indications of bronchoscopy. Methods: Eighty patients with hemoptysis and a normal chest roentgenogram were involved in this study. We evaluated the cause of hemoptysis in these patients by bronchoscopy and/or bronchogram or high-resolution CT of the lung and we analyzed the relationship of clinical features, such as age, sex, smoking and properties of hemoptysis, to the cause of hemoptysis. Results: 1) They were 34 men and 46 women, with the mean age of 46.7 and 41.8 years old, respectively. 2) Initial bronchoscopy provided a diagnosis in 8 patients - bronchogenic carcinoma in 3 patients (3.8%), metastatic cancer in 1 patient(1.3%) and endobronchial tuberculosis in 4 patients(5.0%). 3) Two clinical findings of patients over 50 years and/or with more than 30 pack-year smoking history were associated with bronchogenic carcinoma, and among these two factors, a more than 30 pack-year smoking history was the best predictor for diagnosis of bronchogenic cancer. 4) The 72 patients in whom no specific cause of hemoptysis was identified by initial bronchoscopy underwent bronchogram and/or high resolutional CT of the lung. Then, 6 patients were diagnosed as bronchiectasis and 5 patients rebleeded in the follow up period of 9 to 90 weeks. Of the remaining 66 patients, 33 were followed for 7 to 80 weeks. Among these patients, only 5 patients had recurrent episodes of hemoptysis & they were diagnosed as bronchiectasis in 1 patient, tuberculosis in 2 patients and catamenial hemoptysis in 2 patients. Conclusion: We conclude that patients with hemoptysis and a normal chest roentgenogram who are more than 50 years old or have more than 30 pack-year smoking history should undergo bronchoscopy to exclude possible bronchogenic carcinoma. In patients without these clinical features, a conservative approach with observation appears justified. If hemoptysis recurs to these patients, bronchogram or high-resolutional CT of the lung with sputum examination are necessary.

• Tuberculosis and Respiratory Diseases
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• v.42 no.1
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• pp.50-57
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• 1995

Background: Transcather arterial embolization has been established as an effective means to control hemoptysis, especially in patients with decreased pulmonary function such as postpneumonectomy patients and those with advanced chronic obstructive pulmonary disease. We evaluated the effect of arterial embolization and analysed the correlation of the clinical and angiographic characteristics and investigated the clinical course and outcome after arterial embolization in the patients with significant hemoptysis. Method: 58 patients with massive or recurrent hemoptysis underwent transcatheter arterial embolization for the treatment of hemoptysis from April 1992 to Sept. 1993. Results: Most common cause of hemoptysis was pulmonary tuberculosis(34 cases, 58.3%). Embolized vessels responsible for hemoptysis were 56 bronchial arteries and 32 nonbronchial systemic arteries. Initial most common angiographic findings were hypervascularity and shunt. Initial success rate of hemoptysis control revealed 81.1%. However, 15 of 58 patients(25.9%) showed recurrence of hemoptysis after transcatheter arterial embolization. The complications(18 cases, 31%) such as chest pain, fever, voiding difficulty, atelectasis, paralytic ileus and unwanted embolization were occured. Conclusion: Transcatheter arterial embolization is useful and relatively safe treatment modality for immediate bleeding control of patients with massive hemoptysis or inoperable cases. The further evaluation of the long term results according to the embolized material and underlying pulmonary disease will be required.