• Radiation Oncology Journal
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• v.33 no.4
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• pp.276-283
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• 2015

Purpose: We evaluated the efficacy and toxicity of repeated high dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with unresectable hepatocellular carcinoma. Materials and Methods: Between 1998 and 2011, 45 patients received hepatic re-irradiation with high dose 3D-CRT in Samsung Medical Center. After excluding two ineligible patients, 43 patients were retrospectively reviewed. RT was delivered with palliative or salvage intent, and equivalent dose of 2 Gy fractions for ${\alpha}/{\beta}=10Gy$ ranged from $31.25Gy_{10}$ to $93.75Gy_{10}$ (median, $44Gy_{10}$). Tumor response and toxicity were evaluated based on the modified Response Evaluation Criteria in Solid Tumors criteria and the Common Terminology Criteria for Adverse Events (CTCAE) ver. 4.0. Results: The median follow-up duration was 11.2 months (range, 4.1 to 58.3 months). An objective tumor response rate was 62.8%. The tumor response rates were 81.0% and 45.5% in patients receiving ${\geq}45Gy_{10}$ and $<45Gy_{10}$, respectively (p = 0.016). The median overall survival (OS) of all patients was 11.2 months. The OS was significantly affected by the Child-Pugh class as 14.2 months vs. 6.1 months (Child-Pugh A vs. B, p < 0.001), and modified Union for International Cancer Control (UICC) T stage as 15.6 months vs. 8.3 months (T1-3 vs. T4, p = 0.004), respectively. Grade III toxicities were developed in two patients, both of whom received ${\geq}50Gy_{10}$. Conclusion: Hepatic re-irradiation may be an effective and tolerable treatment for patients who are not eligible for further local treatment modalities, especially in patients with Child-Pugh A and T1-3.

• Radiation Oncology Journal
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• v.38 no.1
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• pp.35-43
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• 2020

Purpose: This retrospective study compares higher-dose whole-brain radiotherapy (hdWBRT) with reduced-dose WBRT (rdWBRT) in terms of clinical efficacy and toxicity profile in patients treated for primary central nervous system lymphoma (PCNSL). Materials and Methods: Radiotherapy followed by high-dose methotrexate (HD-MTX)-based chemotherapy was administered to immunocompetent patients with histologically confirmed PCNSL between 2000 and 2016. Response to chemotherapy was taken into account when prescribing the radiation dose to the whole brain and primary tumor bed. The whole brain dose was ≤23.4 Gy for rdWBRT (n = 20) and >23.4 Gy for hdWBRT (n = 68). Patients manifesting cognitive disturbance, memory impairment and dysarthria were considered to have neurotoxicity. A median follow-up was 3.62 years. Results: The 3-year overall survival (OS) and progression-free survival (PFS) were 70.0% and 48.9% with rdWBRT, and 63.2% and 43.2% with hdWBRT. The 3-year OS and PFS among patients with partial response (n = 45) after chemotherapy were 77.8% and 53.3% with rdWBRT, and 58.3% and 45.8% with hdWBRT (p > 0.05). Among patients with complete response achieved during follow-up, the 3-year freedom from neurotoxicity (FFNT) rate was 94.1% with rdWBRT and 62.4% with hdWBRT. Among patients aged ≥60 years, the 3-year FFNT rate was 87.5% with rdWBRT and 39.1% with hdWBRT (p = 0.49). Neurotoxicity was not observed after rdWBRT in patients aged below 60 years. Conclusion: rdWBRT with tumor bed boost combined with upfront HD-MTX is less neurotoxic and results in effective survival as higher-dose radiotherapy even in partial response after chemotherapy.

• Journal of Korean Neurosurgical Society
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• v.29 no.3
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• pp.317-323
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• 2000

Objective : To evaluate the role of stereotactic LINAC radiosurgery in treatment of meningiomas, the authors retrospectively analyzed the result of radiosurgery in our institute. Method: During last ten years, twenty patients underwent stereotactic LINAC radiosurgery(LINAC SRS) for meningiomas. The mean age of the patients was 51 years(22-78 years). The most common tumor location for radiosurgery was parasagittal, sphenoid wing and tentorial area. With regards to indications of radiosurgery for meningiomas, LINAC radiosurgery was done for primary treatment in six patients, for postoperative residual tumors in eleven patients, for postoperative regrowth in three patients. Mean tumor volume was $5.14cm^3$($0.28-15.1cm^3$), mean field diameter was 2.01cm(1.2-3cm). The mean marginal dose was 20.55Gy(13-30Gy). The follow-up evaluation was done annually with radiologic findings and clinical status. The mean follow-up period was 46.8(24-120) months. Result : In the radiologic response, the tumor volume was reduced in five(25%) of twenty patients, fourteen showed arrested growth(70%), but one patient showed increased growth(5%). In the clinical response, nine patients improved clinically(45%), ten patients was stable(50%) and one patient worsened during follow-up period. With regards to correlation with radiologic and clinical response, in nineteen patients who showed radiologic response to radiosurgery(decreased and arrested growth after radiosurgery), nine patients(47.4%) improved and ten patients (52.6%) showed no change, one patient(5%) had symptomatic radiation necrosis at four years after SRS, which needed craniotomy. Conclusion : The overall control rate of meningiomas with LINAC radiosurgery was 95% in radiologic follow up and 95% clinically. The radiation complication rate was 5%. These results indicate that LINAC radiosurgery can be considered as safe and effective method for meningiomas.

• Radiation Oncology Journal
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• v.18 no.2
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• pp.120-126
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• 2000

Purpose : Tumor hypoxia can be overcome with hypoxic cytotoxin. In mouse tumor, tirapazamine's efficacy of the potentiating radiation effect was tested by the tumor oxygenation status combined with hype facti on ated rad iotherapy .:The control and hypoxic mouse tumors we established by inoculation of RIF-1 tumor cells into the normal or previously irradiated back and thigh of C3H mice. When the tumors reached a proper size, both the control and hypoxic tumors were given hypefractionated treatments (8fractions/4 days) with saline (0.02 ml/g), tirapazamin (0.08 mM/0.02 ml/kg), irradiation (2.5 Gy), irradiation combined with tirapazamine given 30 minutes prior to each irradiation. The response was evaluated by the growth delay assay by measuring tumor size from day 0 (12 hrs prior to the first fractionation) to the day when the volume had 4-fold increase or cross sectional area had 2-fold increase. Results : Overall growth pattern showed that tirapazamine Potentiated radiation effect in back and thigh tumors grew in the normal and preirradiated tumor bed. With growth delay assay using reference point of initial tumor volume or cross sectional area, tirapazamine potentiated radiation effect 1.9 times for the control and 2.4 times for the hypoxic tumors in back, and 1.85 times for the control and 1.6 times for the hypoxic tumors. With reference of 4-fold increase of the initial volume or 2-fold increase of the cross sectional area, tirapazamine potentiated radiation effect 1.48 times for the control and 2.02 times for the hypxic tumors in back, and 1.85 times for the control and 1.6 times for the hypoxic tumors. Conclusions : Present result indicated that radiation response of hypoxic tumors was potentiated by tirapazamine in the back or thigh tumors grew in the control or preirradiated tumor bed, and potentiation of the hypoxic tumors was eDual to or greater than that of the control tumors in the back or thigh.

• Journal of Korean Neurosurgical Society
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• v.30 no.3
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• pp.334-341
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• 2001

Objective : We have currently changed treatment strategies to methotrexate(MTX)-based preirradiation chemotherapy with subsequent planned radiation for the initial therapy of primary central nervous system lymphoma (PCNSL). The aim of this study was to evaluate the results of treating PCNSL with chemotherapy plus radiotherapy (CRT) or radiotherapy(RT) alone. Method and Material : This study involved 10 females and 3 males patients with a mean age of 54.2 years. All patients underwent surgery, open(8 cases) or stereotactic biopsy(5 cases) for histological diagnosis. Eleven tumors were diffuse large B-cell lymphomas. Tumor volume change in the follow-up images and survival time were evaluated in patients treated with CRT and RT alone. In the beginning, two patients received ProMACE-Cytabom chemotherapeutic regimen, but did not complete the course and died of progressive tumor 8 and 9 months after diagnosis, respectively. One patient died at 6 months before chemotherapy. These three were excluded from the survival analysis. Five patients(RT group) completed full courses of cranial irradiation with or without boost. For the current combined modality treatment, high-dose MTXbased chemotherapy(systemic and intrathecal MTX, IV vincristine, and oral procarbazine) followed by whole brain irrdiation to 45Gy to tumor was introduced in 5 patients of CRT group. Result : A complete response was achieved in three of five who received RT only and in all of five who received CRT. All patients in CRT groups are in disease free status at a mean 23 months following therapy. The RT group patients refused any additional salvage therapy at tumor relapse and survived at mean 20 months from diagnosis. The Karnofsky performance status improved in eight of ten patients with treatment. The treatment toxicity included leukoencephalopathy in RT group and severe leukopenia, transient hepatitis, avascular necrosis of femoral head, hearing loss, and amenorrhea in CRT group, respectively. Conclusion : The combined modality therapy of MTX-based chemotherapy plus radiotherapy for PCNSL may enhance tumor response and improve patient survival. The patients who received CRT should be carefully followed up because of the higher risk of treatment-induced late neurotoxicity.

• Journal of Korean Neurosurgical Society
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• v.38 no.2
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• pp.126-131
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• 2005

Objective : The choice of tumor antigen for dendritic cell[DC]-loading has still been an unresolved problem in the DC-based vaccine strategies against malignant gliomas that has not been found well-characterized tumor specific antigens. In this study, we compare tumor-specific T cell response induced by glioma apoptotic body[GAB]-pulsed DCs to response induced by glioma cell lysate-pulsed ones quantitatively. Methods : DCs generated in the presence of granulocyte macrophage-colony stimulating factor and interleukin[IL]-4 from peripheral blood mononuclear cells[PBMCs] of HLA-A2 positive healthy donors were cultured. Each GABs and glioma cell lysate generated from HLA-A2 positive T98G glioblastoma cells were co-incubated with DCs. $CD8^+$ T lymphocytes isolated from PBMCs of same donors were cultured in media containing IL-2 and either stimulated by GAB- or lysate-pulsed DCs three times at a weekly interval. The interferon[IFN]-${\gamma}$ concentrations of each cell culture supernate were measured by enzyme immunoassay technique. Cytolytic activity of the generated cytotoxic $CD8^+$ T cells either stimulated with GAB- or lysate-pulsed DCs was determined by a standard 4-h $^{51}Cr$-release assay. Results : IFN-${\gamma}$ production and cytolytic activity of effector T cells stimulated by GAB-pulsed DCs were significantly higher than those of T cells stimulated by lysate-pulsed ones. Conclusion : These results indicate the choice of antigen is a critical determinant in the induction of antitumor immunity against malignant glioma. Antigen preparations from GABs represent a promising alternative to glioma cell lysate in DC-based glioma vaccine strategies.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.10-18
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• 2003

Purpose : To evaluate the role of fractlonated sterotactic radiotherapy (FSRT) in the management of benign brain tumors, we reviewed the clinical, and radiographic responses of patients treated. Methods and Materials : Between March 1995 and March 2002, 36 patients with benign brain tumors were treated by FSRT. The pathological diagnoses consisted of pituitary adenomas (12 patients), cranio-pharyngiomas (5 patients), meningiomas (10 patients), and acoustic neurinomas (9 patients). Radiotherapy doses of 25 to 35 Gy (3~6 Gy/fraction, 5~10 fractions) were prescribed to the 85~90% isodose line, depending upon the location, size and volume of the tumors. The median clinical and radiographical follow up periods were 31 (range, 2~74) and 21 (range, 4~56) months, respectively. Results : In the 35 patients that could be evaluated for their clinical response, 13 (37.1%) were considered improved, 16 (45.7%) stable and 6 (17.2%) worse. Of the 33 patients who had radiographic studies, tumor shrinkage was noted in 17 (51.5%), tumor stabilization in 13 (39.4%), and tumor progression in 3 (9.1%). Of the 17 tumor shrinkage patients, 7 (21.2%) showed a complete response. Acute radiation-induced complications occurred iin 11 (30.6%) patients. Conclusions : FSRT is considered a safe and effective treatment method for begin brain tumors, but large numbers of patients, with relatively long follow-up periods are needed to assess the exact role or effect of FSRT.

• Herbal Formula Science
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• v.5 no.1
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• pp.127-145
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• 1997

This study was aimed to investigate the anti-tumor and immune response effect of Samyongtang(S1; this medicine represents for 'ENERGIZER'), Yangjeongjejeoktang(S2; this is the 'INTERMEDIATE METHOD' of S1 and S3) and Onbeakwon(S3; this is 'ATTACK' the disease of mass) on the experimental rats induced by Sarcoma-180 and Methotrexate. And to observed the differences S1, S2, and S3 treatment groups. Tumor weight(TW) in vivo, interleukin-2(IL-2), hemagglutinin titer(H.A), hemolysin titer(HL), rossete forming cell(RFC), delayed type hypersensitivity(DTH), and natural killer cell activity(NKCA) in vivo were measured in rats. The obtained results were summarized as follows. 1. Tumor weight was decreased in all treatment groups (S2>S3>S1) as compared with control group, but the difference was not statistically significant each treatment groups. 2. Interleukin-2 was increased in all treatment groups (S1>S2>Ss) as compared with control group, but the difference was not statistically significant each treatment groups. 3. Hemagglutinin titer was increased in all treatment groups (S1>S2>S3) as compared with control group, but the difference was not statistically significant each treatment groups. 4. Hemolysin titer was increased in all treatment groups (S1>S2>S3) as compared with control group, but the difference was not statistically significant each treatment groups. 5. Rossete forming cell(RFC) was increased in all treatment groups (S1>S2>S3) as compared with control group, but the difference was not statistically significant each treatment groups. 6. Delayed type hyperseneitivity(DTH) was increased in S1, S2 treatment groups (S1>S2) as compared with control group, but it was decreased in S3 treatment group. Therefore, S1 group was statistically significant compared with S3 groups. 7. Natural killer cell activity(NKCA) was increased in all treatment groups (S2>S3>S1) as compared with control group, but the difference was not statistically significant each treatment groups. Based on the above mentioned results, it is suggested that S1, S2 and S3 will have anti-tumor substances and enhance effect of immune response. But the differences were not statistically significant in each treatment groups, except for delayed type hypersensitivity.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.6
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• pp.2935-2941
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• 2012

Biological response modifiers (BRMs) can alter interactions between the immune system and cancer cells to boost, direct, or restore the body's ability to fight disease. Mice with ethylnitrosourea- (ENU) induced leukemia were here used to monitor the therapeutic efficacy of lipopolysaccaride (LPS), Bacillus Calmette Guerin (BCG) and sheep erythrocytes (SRBC). Flow cytometry based CD34+ positivity analysis, clonogenicity, proliferation and ultrastructure studies using scanning electron microscopy (SEM) of stem cells in ENU induced animals with and without BRMs treatment were performed. BRMs improved the stem-stromal relationship structurally and functionally and might have potential for use as an adjunct in human stem cell therapy.

• Proceedings of the Korean Society of Medical Physics Conference
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• 2002.09a
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• pp.174-176
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• 2002

A total of 134 patients with stage 1 of non-small cell lung cancer treated by carbon ion beam of HIMAC NIRS were investigated for control rate and delivered dose. The delivered dose of every patient was converted to biological effective dose (BED) of LQ model using fraction number, dose per fraction and alpha beta ratio which shows the maximum correlation between BED and tumor control. The BED of every patient was classified to establish a BED response curve for control. Assuming fraction numbers, dose response curves were introduced from BED response curve. The total doses to realize several control rates were obtained for the treatment of small fraction number.