• Radiation Oncology Journal
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• 제31권1호
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• pp.12-17
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• 2013

Purpose: Parotid gland can be considered as a risk organ in whole brain radiotherapy (WBRT). The purpose of this study is to evaluate the parotid gland sparing effect of computed tomography (CT)-based WBRT compared to 2-dimensional plan with conventional field margin. Materials and Methods: From January 2008 to April 2011, 53 patients underwent WBRT using CT-based simulation. Bilateral two-field arrangement was used and the prescribed dose was 30 Gy in 10 fractions. We compared the parotid dose between 2 radiotherapy plans using different lower field margins: conventional field to the lower level of the atlas (CF) and modified field fitted to the brain tissue (MF). Results: Averages of mean parotid dose of the 2 protocols with CF and MF were 17.4 Gy and 8.7 Gy, respectively (p < 0.001). Mean parotid dose of both glands ${\geq}20$ Gy were observed in 15 (28.3%) for CF and in 0 (0.0%) for MF. The whole brain percentage volumes receiving >98% of prescribed dose were 99.7% for CF and 99.5% for MF. Conclusion: Compared to WBRT with CF, CT-based lower field margin modification is a simple and effective technique for sparing the parotid gland, while providing similar dose coverage of the whole brain.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2004년도 제29회 추계학술대회 발표논문집
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• pp.126-129
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• 2004

Leaf width가 다른 다엽 콜리메터 (MLCs)를 이용한 강도변조 방사선 치료 (IMRT)계획을 비교하였다. micro-MLCs를 사용하여 이미 시행된 12 case를 Varian사의 120 MLC와 80 MLC를 사용하여 다시 치료계획 하였다. 이들 콜리메터는 중심에서의 leaf width가 각각 3 mm, 5 mm, 10 mm이다. 이 치료계획들을 uniformity index, conformity Index, 정상조직 내선량으로 서로 비교하였다. PTV의 uniformity Index경우, mMLCs와 120 MLCs가 통계적으로 차이가 없었다 (p = 0.06). 그러나 mMLCs와80 MLCs는 통계적으로 약간의 차이를 보였다 (p = 0.001). PTV에 대한 최대목표선량은 leaf width와 연관성이 없었다. conformity index의 경우, mMLCs와 120 MLCs (p = 0.003)에서, mMLCs와 80 MLCs (p = 0.003)에서 통계적인 차이를 보였다. leaf width의 변화에 따라 방사선에 조사되는 정상조직의 부피를 비교하였고, leaf width가 3mm인 경우 정상조직 보존에 보다 적합함을 확인하였다.

• Archives of Plastic Surgery
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• 제41권4호
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• pp.366-373
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• 2014

Background The advent of skin-sparing mastectomy has allowed for the reconstruction of the breast and nipple with improved cosmesis. However, the nipple-areolar complex (NAC) in Asian patients is more pigmented and scars easily. Therefore, commonly described incisions tend to result in poor aesthetic outcomes in Asian patients with breast cancer. Methods We describe an algorithmic approach to skin-sparing mastectomy incisions in Asian patients on the basis of the location of the biopsy scar and the tumor site and size. Four incision types are described: peri-areolar, a peri-areolar incision with a second distant skin paddle, "racquet handle," and peri-areolar with adjacent skin excision. Results 281 immediate breast reconstructions were performed between May 2001 and February 2012 after skin-sparing mastectomy. The mastectomy incisions used included the peri-areolar design (n=124, 44%), peri-areolar design with a second distant skin paddle (n=39, 14%), "racquet handle" (n=21, 7.5%), and peri-areolar design with adjacent skin excision (n=42, 14%). The traditional elliptical incision and other variants where the NAC outline was not preserved were performed in the remaining 55 patients. The average follow-up was 44.7 months during which there was 1 case of total flap loss and 7 cases of partial flap necrosis; all remaining flaps survived. 24% of the patients (68/281) underwent subsequent nipple reconstruction. Conclusions Our algorithm avoids breast incisions that are randomly placed or excessively long and prevents the unnecessary sacrifice of normal breast skin. This allows skin-sparing mastectomy and immediate breast reconstruction to be performed with a consistently achievable aesthetic result in Asian women without neglecting oncological safety.

• Radiation Oncology Journal
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• 제33권3호
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• pp.233-241
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• 2015

Purpose: To compare volumetric modulated arc therapy of RapidArc with robotic stereotactic body radiation therapy (SBRT) of CyberKnife in the planning and delivery of SBRT for hepatocellular carcinoma (HCC) treatment by analyzing dosimetric parameters. Materials and Methods: Two radiation treatment plans were generated for 29 HCC patients, one using Eclipse for the RapidArc plan and the other using Multiplan for the CyberKnife plan. The prescription dose was 60 Gy in 3 fractions. The dosimetric parameters of planning target volume (PTV) coverage and normal tissue sparing in the RapidArc and the CyberKnife plans were analyzed. Results: The conformity index was $1.05{\pm}0.02$ for the CyberKnife plan, and $1.13{\pm}0.10$ for the RapidArc plan. The homogeneity index was $1.23{\pm}0.01$ for the CyberKnife plan, and $1.10{\pm}0.03$ for the RapidArc plan. For the normal liver, there were significant differences between the two plans in the low-dose regions of $V_1$ and $V_3$. The normalized volumes of $V_{60}$ for the normal liver in the RapidArc plan were drastically increased when the mean dose of the PTVs in RapidArc plan is equivalent to the mean dose of the PTVs in the CyberKnife plan. Conclusion: CyberKnife plans show greater dose conformity, especially in small-sized tumors, while RapidArc plans show good dosimetric distribution of low dose sparing in the normal liver and body.

• Asian Pacific Journal of Cancer Prevention
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• 제14권11호
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• pp.6549-6556
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• 2013

Leukemia stem cells (LSCs) play important roles in leukemia initiation, progression and relapse, and thus represent a critical target for therapeutic intervention. Hence, it is extremely urgent to explore new therapeutic strategies directly targeting LSCs for acute myelogenous leukemia (AML) therapy. We show here that Angelica sinensis polysaccharide (ASP), a major active component in Dong quai (Chinese Angelica sinensis), effectively inhibited human AML $CD34^+CD38^-$ cell proliferation in vitro culture in a dose-dependent manner while sparing normal hematopoietic stem and progenitor cells at physiologically achievable concentrations. Furthermore, ASP exerted cytotoxic effects on AML K562 cells, especially LSC-enriched $CD34^+CD38^-$ cells. Colony formation assays further showed that ASP significantly suppressed the formation of colonies derived from AML $CD34^+CD38^-$ cells but not those from normal $CD34^+CD38^-$ cells. Examination of the underlying mechanisms revealed that ASP induced $CD34^+CD38^-$ cell senescence, which was strongly associated with a series of characteristic events, including up-regulation of p53, p16, p21, and Rb genes and changes of related cell cycle regulation proteins P16, P21, cyclin E and CDK4, telomere end attrition as well as repression of telomerase activity. On the basis of these findings, we propose that ASP represents a potentially important agent for leukemia stem cell-targeted therapy.

• 한국의학물리학회지:의학물리
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• 제15권4호
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• pp.173-178
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• 2004

목적: Leaf width가 다른 다엽 콜리메터(MLCs)를 이용, 두개내 병변에 관하여 각각의 세기조절방사선치료(IMRT) 계획을 수립하여, 이를 선량학적으로 비교하였다. 재료 및 방법: BrainSCAN ver. 5.2. 소프트웨어를 사용하여 micro-MLC로 이미 치료가 수행된 12명의 환자를 Varian사의 120 MLC와 80 MLC로 다시 치료계획하였으며 이 다엽 콜리메터들은 중심에서의 leaf width가 각각 3 mm, 5 mm, 10 mm이다. 이 때, 계획용 표적체적은 3.3～339.2 cc였고, 조사된 빔의 수는 3～7개이다. 이들을 uniformity Index, conformity index, 결정장기와 정상조직 내 선량으로 서로 비교하였다. 결과: 계획용 표적체적의 uniformity Index경우, mMLCs와 120 MLCs 사이에서 (p=0.057) 120 MLCs와 80 MLCs 사이에서(p=0.388) 통계적으로 차이가 없었다. 그러나 mMLCs와 80 MLCs 사이에서 차이를 보였다(p<0.001). 계획용 표적체적에 대한 최대 목표선량은 leaf width와 연관성이 없었다. 반면에, conformity Index의 경우는 mMLCs와 120 MLCs (p=0.003), mMLCs와 80 MLCs (p=0.003), 50 MLCs와 120 MLCs (p=0.003) 사이에서 통계적인 차이를 보였다. 처방선량의 70%와 50% 이상 조사되는 뇌간의 부피는 다엽 콜리메터의 leaf width가 증가함에 따라 증가하였다. 특히, leaf width의 변화에 따라 방사선에 조사되는 정상 뇌조직의 부피가 분명하게 변하였다. Leaf width가 3 mm인 다엽 콜리메터와 비교하였을 때, leaf width가 5 mm, 10 mm인 다엽 콜리메터의 부피 증가는 처방선량의 50% 이상 조사되는 정상조직의 경우, 각각 6.3%, 23.2%였고, 처방선량의 70% 이상 조사되는 정상조직의 경우, 각각 8.7%, 32.7%였다. 결론: 계획용 표적체적의 uniformity Index와 최대 목표선량은 leaf width와 연관성이 없었다. 그렇지만 conformity Index 는 leaf width가 감소함에 따라 향상되었다. 두개내 병변 치료시, 정상 뇌조직의 보존에 있어 leaf width 5 mm, 10 mm인 다엽 콜리메터를 이용한 치료계획보다 leaf width 3 mm인 다엽 콜리메터를 이용한 치료계획이 보다 효과적임을 알 수 있었다.

• Radiation Oncology Journal
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• 제30권1호
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• pp.27-35
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• 2012

Purpose: To evaluate the effect of common three photon energies (6-MV, 10-MV, and 15-MV) on intensity-modulated radiation therapy (IMRT) plans to treat prostate cancer patients. Materials and Methods: Twenty patients with prostate cancer treated locally to 81.0 Gy were retrospectively studied. 6-MV, 10-MV, and 15-MV IMRT plans for each patient were generated using suitable planning objectives, dose constraints, and 8-field setting. The plans were analyzed in terms of dose-volume histogram for the target coverage, dose conformity, organs at risk (OAR) sparing, and normal tissue integral dose. Results: Regardless of the energies chosen at the plans, the target coverage, conformity, and homogeneity of the plans were similar. However, there was a significant dose increase in rectal wall and femoral heads for 6-MV compared to those for 10-MV and 15-MV. The $V_{20Gy}$ of rectal wall with 6-MV, 10-MV, and 15-MV were 95.6%, 88.4%, and 89.4% while the mean dose to femoral heads were 31.7, 25.9, and 26.3 Gy, respectively. Integral doses to the normal tissues in higher energy (10-MV and 15-MV) plans were reduced by about 7%. Overall, integral doses in mid and low dose regions in 6-MV plans were increased by up to 13%. Conclusion: In this study, 10-MV prostate IMRT plans showed better OAR sparing and less integral doses than the 6-MV. The biological and clinical significance of this finding remains to be determined afterward, considering neutron dose contribution.

• 대한두경부종양학회지
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• 제7권1호
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• pp.3-9
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• 1991

Brachytherapy is a method of radiotherapy in advantage to achieve better local control with minimum radiation toxicity in comparison with external irradiation because radiation dose is distributed according to the inverse square low of gamma-ray emitted from the implanted sources. The main characteristics of brachytherapy are delivering of higher dose to target volume shortening of total treatment period and sparing of normal tissue. Recent development of iridium ribbons for low dose rate implant provides improvement of technology of brachytherapy in terms of safety and efficiency. High dose rate method. on the other hand, is effective to avoid unnecessary expoure of medical personnel.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3365-3370
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• 2015

Radiotherapy has an important role in the treatment of prostate cancer. Three-dimensional conformal radiation therapy (3D-CRT), intensity modulated radiation therapy (IMRT) and volumetric modulated arc therapy (VMAT) techniques are all applied for this purpose. However, the risk of secondary radiation-induced bladder cancer is significantly elevated in irradiated patients compared surgery-only or watchful waiting groups. There are also reports of risk of secondary cancer with low doses to normal tissues. This study was designed to compare received volumes of low doses among 3D-CRT, IMRT and VMAT techniques for prostate patients. Ten prostate cancer patients were selected retrospectively for this planning study. Treatment plans were generated using 3D-CRT, IMRT and VMAT techniques. Conformity index (CI), homogenity index (HI), receiving 5 Gy of the volume (V5%), receiving 2 Gy of the volume (V2%), receiving 1 Gy of the volume (V1%) and monitor units (MUs) were compared. This study confirms that VMAT has slightly better CI while thev olume of low doses was higher. VMAT had lower MUs than IMRT. 3D-CRT had the lowest MU, CI and HI. If target coverage and normal tissue sparing are comparable between different treatment techniques, the risk of second malignancy should be a important factor in the selection of treatment.

• Radiation Oncology Journal
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• 제5권2호
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• pp.141-148
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• 1987

방사선 치료의 궁극적인 목적은 정상 조직의 후유증을 최소화하면서 암종의 완전 국소 관해를 도모하는데 있다. 1970년대에 전산화 단층 촬영법이 대두된 후로 환자의 해부학적 정상 조직과 암종의 부위와 침윤 정도를 거의 정확하게 알게 되었고, 표적 암조직에 인체 외부에서 가해지는 방사선의 등선량 곡선을 각 단면에서 확인할 수 있었다. 특히 두경부 종양의 방사선 치료 계획에 있어서 재구성 영상으로 암종과 주위 정상 조직의 상관관계를 삼차원적으로 파악하고 영상 위에서 바로 등 선량 곡선을 볼 수 있으므로 암종에는 관해에 충분한 방사선을 투여하면서 정상 조직 (예, 척수 등)에 가해지는 방사선량을 명확히 알 수 있어 최소한의 선량으로 후유증을 방지할 수 있었다. 이는 축, 종, 횡, 단면의 재구성 영상을 얻어서 이루어질 수 있고 종래의 이차원적인 한 개의 단면에서만 시행하던 치료 계획을 서로 다른 세 개의 단면에서 삼차원적으로 시행함으로서 입체적으로 분포 선량을 추정할 수 있어 두경부 종양 환자의 치료에 더 유익하였다.