• 제목, 요약, 키워드: extended field radiotherapy

검색결과 14건 처리시간 0.04초

Extended Field Radiotherapy With or Without Chemotherapy in Patients with Cervical Cancer and Positive Para-Aortic Lymph Nodes: a Single Institution Retrospective Review

  • Ng, Boon Huat;Rozita, AM;Adlinda, A;Lee, Wei Ching;Zamaniah, WI Wan
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.9
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    • pp.3827-3833
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    • 2015
  • Background: Positive para-aortic lymph node (PALN) at diagnosis in cervical cancer patients confers an unfavorable prognosis. This study reviewed the outcomes of extended field radiotherapy (EFRT) and concurrent chemotherapy with extended field RT (CCEFRT) in patients with positive PALN at diagnosis. Materials and Methods: Medical records of 407 cervical cancer patients between 1st January 2002 to 31st December 2012 were reviewed. Some 32 cases with positive PALN were identified to have received definitive extended field radiotherapy with or without chemotherapy. Treatment outcomes, clinicopathological factors affecting survival and radiotherapy related acute and late effects were analyzed. Results: Totals of 13 and 19 patients underwent EFRT and CCEFRT respectively during the period of review. The median follow-up was 70 months. The 5-year overall survival (OS) was 40% for patients who underwent CCEFRT as compared to 18% for patients who had EFRT alone, with median survival sof 29 months and 13 months, respectively. The 5-years progression free survival (PFS) for patients who underwent CCEFRT was 32% and 18% for those who had EFRT. Median PFS were 18 months and 12 months, respectively. Overall treatment time (OTT) less than 8 weeks reduced risk of death by 81% (HR=0.19). Acute side effects were documented in 69.7% and 89.5% of patients who underwent EFRT and CCEFRT, respectively. Four patients (12.5%) developed radiotherapy late toxicity and there was no treatment-related death observed. Conclusions: CCEFRT is associated with higher 5-years OS and median OS compared to EFRT and with tolerable level of acute and late toxicities in selected patients with cervical cancer and PALN metastasis.

Treatment outcomes of extended-field radiation therapy for thoracic superficial esophageal cancer

  • Lee, Doo Yeul;Moon, Sung Ho;Cho, Kwan Ho;Kim, Tae Hyun;Kim, Moon Soo;Lee, Jong Yeul;Suh, Yang-Gun
    • Radiation Oncology Journal
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    • v.35 no.3
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    • pp.241-248
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    • 2017
  • Purpose: To evaluate the efficacy and safety of extended-field radiation therapy for patients with thoracic superficial esophageal cancer (SEC). Materials and Methods: From May 2007 to October 2016, a total of 24 patients with thoracic SEC (T1a and T1b) who underwent definitive radiotherapy and were analyzed retrospectively. The median total radiotherapy dose was 64 Gy (range, 54 to 66 Gy) in conventional fractionation. All 24 patients received radiotherapy to whole thoracic esophagus and 23 patients received elective nodal irradiation. The supraclavicular lymph nodes, the celiac lymph nodes, and both of those nodal areas were included in 11, 3, and 9 patients, respectively. Results: The median follow-up duration was 28.7 months (range 7.9 to 108.0 months). The 3-year overall survival, local control, and progression-free survival rates were 95.2%, 89.7%, and 78.7%, respectively. There were 5 patients (20.8%) with progression of disease, 2 local failures (8.3%) and 3 (12.5%) regional failures. Three patients also experienced distant metastasis and had died of disease progression. There were no treatment-related toxicities of grade 3 or higher. Conclusion: Definitive extended-field radiotherapy for thoracic SEC showed durable disease control rates in medically inoperable and endoscopically unfit patients. Even extended-field radiotherapy with elective nodal irradiation was safe without grade 3 or 4 toxicities.

I, II기 Intermediate Grade 임파종에서 방사선 치료의 역할 (The Role of Radiotherapy in Stage I , II Intermediate Grade Non-Hodgkin's Lymphoma)

  • 윤형근;김일한;김흥태;안용찬;김재성;하성환;박찬일
    • Radiation Oncology Journal
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    • v.9 no.1
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    • pp.103-109
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    • 1991
  • I, II기 intermediate grade악성 임파종에서 방사선 치료의 역할을 극인하기 위하여 서울대학교 병원 치료 방사선과에서 치료받은 162예의 방사선 치료 성적을 분석하였다. 초기의 치료 실패 양상 이 확인 가능한 68 예 중 38.2%는 조사야 내에서 61.8%는 조사야 밖에서 치료 실패 또는 재발 하였다. I기에서는 조사야 내 및 외에서 발생한 치료 실패 양상은 국소 조사야 치료시 각각 30.0%와 70.0%였고, 확대 조사야 치료시는 각각 43.8% 와 56.2%였다. II기에서는 각각 16.7% 와 83.3% 및 41.7%와 58.3%였다. 5년 무병 생존율은 전 환자에서 48.1%였고, I기 및 II기에서 각각 56.3%와 40.4%로 병기에 따른 유의한 차이가 있었다. 10cm 이상의 종괴나 전신적 증상은 무병 생존율에 영향을 미치지 못하였다. 방사선 치료 범위가 큰 경우에 5년 무병 생존율이 양호하였고 특히 I기에서는 유의하였다. 재발후에 시행한 전신 화학요법의 효과를 감안한 5년 생존율은 I, II기에서 각각 65.3% 및 52.2%였으며 병기에 따른 유의한 차이는 없었다. 따라서 5년 무병 생존율을 향상시키기 위해서는 원발 병소와 인접한 임파절 부위를 포함하는 화대 조사야로 치료할 필요가 있으며 재발된 경우에는 전신 화학 요법이 유용할 것으로 시사된다.

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Effects of Radiotherapy on the Risk of Developing Secondary Malignant Neoplasms in Hodgkin's Lymphoma Survivors

  • Abou-Antoun, Tamara;Mikhael, Rachelle;Massoud, Marcel;Chahine, Georges;Saad, Aline
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.2
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    • pp.749-754
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    • 2016
  • Extended follow-up of Hodgkin lymphoma (HL) survivors indicates that these patients are at high risk of secondary malignant neoplasms (SMNs) contributing to increased morbidity and mortality. This study examined the characteristics of HL survivors who developed SMNs with the aim to report any correlation with radiotherapy (RT) dose. In this retrospective multi-center cohort study of HL patients treated between 1990 and 2011 at three major teaching hospitals in Lebanon, classification was into two groups including those treated with combined modality (RT and chemotherapy-CHT) and those treated with CHT alone. Approval from the University Institutional Review Board (IRB) was obtained. Of the 112 patients evaluated, 52.7% (59) received the combined modality while 47.3% (53) received CHT alone. There were 6 cases of SMNs in the combined modality cohort and 5 cases in the CHT cohort. The mean RT dose in the combined modality cohort was 34.5 Gray (Gy) ($SD{\pm}5.3$). A statistically significant increase (1.5 fold) in the risk of developing SMNs was observed among patients who received a dose higher than 41 Gy compared to a dose between 20 to 30 Gy (OR= 1.5; 95% confidence interval= 0.674 to 3.339, p=0.012). The risk of SMNs was not significantly higher among patients who received extended field compared to involved field RT (p=0.964). This study showed that the risk of developing SMNs is higher among patients treated with RT dose greater than 31 Gy, independent of the RT type used.

Prophylactic extended-field irradiation with concurrent chemotherapy for pelvic lymph node-positive cervical cancer

  • Oh, Jinju;Seol, Ki Ho;Lee, Hyun Joo;Choi, Youn Seok;Park, Ji Y.;Bae, Jin Young
    • Radiation Oncology Journal
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    • v.35 no.4
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    • pp.349-358
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    • 2017
  • Purpose: This study aimed to evaluate whether prophylactic extended-field pelvic radiotherapy (EF-PRT) yields better results than standard whole pelvic radiotherapy (WPRT) in patients with pelvic lymph node-positive cervical cancer treated with concurrent chemoradiotherapy (CCRT). Materials and Methods: A total of 126 cases of stage IB-IVA cervical cancer that had pelvic lymph node involvement in magnetic resonance imaging and were treated with CCRT between 2000 and 2016 were reviewed. None of the patients had para-aortic lymph node (PALN) metastases. The patients were classified to two groups, namely, those treated with EF-PRT, including prophylactic para-aortic radiotherapy, and those treated only with WPRT. The median dose to the PALN area in patients treated with EF-PRT was 45 Gy. All patients received concurrent cisplatin-based chemotherapy. Results: Overall, 52 and 74 patients underwent EF-PRT and WPRT, respectively. Patient characteristics and irradiated dose were not significantly different, except the dose to the para-aortic area, between the two groups. The median follow-up period was 75.5 months (range, 5 to 195 months). The 10-year cumulative recurrence rate of PALN for EF-PRT vs. WPRT was 6.9% and 10.1% (p = 0.421), respectively. The 10-year disease-free survival and overall survival for EF-PRT vs. WPRT were 69.7% vs. 66.1% (p = 0.748) and 71.7% vs. 72.3% (p = 0.845), respectively. Acute gastrointestinal complications were significantly higher in EF-PRT (n = 21; 40.4%) than WPRT (n = 26; 35.1%) (p = 0.046). Late toxicities were not significantly different in both groups. Conclusion: In this study, prophylactic radiotherapy for PALN does not have an additional benefit in patients with pelvic lymph node-positive cervical cancer treated with CCRT.

Importance of PET/CT Scan Use in Planning Radiation Therapy for Lymphoma

  • Milana, Mitric-Askovic;Marko, Erak;Miroslav, Latinovic;Tihomir, Dugandzija
    • Asian Pacific Journal of Cancer Prevention
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    • v.16 no.5
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    • pp.2051-2054
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    • 2015
  • Background: Radiation therapy is a key part of the combined modality treatment for Hodgkin's lymphoma (HL) and non-Hodgkin's lymphoma (NHL), which can achieve locoregional control of disease. The 3D-conformal radiation oncology can be extended-field (EFRT), involved-field (IFRT) and involved node (INRT). New techniques have resulted in a smaller radiation field and lower dose for critical organs such as lung heart and breast. Materials and Methods: In our research, we made a virtual simulation for one patient who was treated in four different radiotherapeutic techniques: mantle field (MFRT), EFRT, IFRT and INRT. After delineatiion we compared dose-volume histograms for each technique. The fusion of CT for planning radiotherapy with the initial PET/CT was made using Softver Xio 4.6 in the Focal program. The dose for all four techniques was 36Gy. Results: Our results support the use of PET/CT in radiation therapy planning. With IFRT and INRT, the burden on the organs at risk is less than with MFRT and EFRT. On the other hand, the dose distribution in the target volume is much better with the latter. Conclusions: The aim of modern radiotherapy of HL and NHL is to reduce the intensity of treatment and therefore PET/CT should be used to reduce and not increase the amount of tissue receiving radiation.

Postoperative radiotherapy for endometrial cancer

  • Choi, Eun Cheol;Kim, Jin Hee;Kim, Ok Bae;Byun, Sang Jun;Park, Seung Gyu;Kwon, Sang Hoon
    • Radiation Oncology Journal
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    • v.30 no.3
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    • pp.108-116
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    • 2012
  • Purpose: To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma. Materials and Methods: Sixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended field. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months. Results: Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications. Conclusion: Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.

Treatment results of radiotherapy following CHOP or R-CHOP in limited-stage head-and-neck diffuse large B-cell lymphoma: a single institutional experience

  • Jeong, Jae-Uk;Chung, Woong-Ki;Nam, Taek-Keun;Yang, Deok-Hwan;Ahn, Sung-Ja;Song, Ju-Young;Yoon, Mee Sun;Kim, Yong-Hyeob
    • Radiation Oncology Journal
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    • v.35 no.4
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    • pp.317-324
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    • 2017
  • Purpose: This study evaluated outcomes of radiotherapy (RT) after chemotherapy in limited-stage head-and-neck diffuse large B-cell lymphoma (DLBCL). Materials and Methods: Eighty patients who were treated for limited-stage head-and-neck DLBCL with CHOP (n = 43) or R-CHOP (n = 37), were analyzed. After chemotherapy, RT was administered to the extended field (n = 60) or the involved field (n = 16), or the involved site (n = 4). The median dose of RT ranged from 36 Gy in case of those with a complete response, to 45-60 Gy in those with a partial response. Results: In all patients, the 5-year overall survival (OS) and disease-free survival (DFS) rates were 83.9% and 80.1%, respectively. In comparison with the CHOP regimen, the R-CHOP regimen showed a better 5-year DFS (86.5% vs. 73.9%, p = 0.027) and a lower rate of treatment failures (25.6% vs. 8.1%, p = 0.040). The volume (p = 0.047) and dose of RT (p < 0.001) were significantly reduced in patients treated with R-CHOP compared to that in those treated with CHOP. Conclusion: The outcomes of RT after chemotherapy with R-CHOP were better than those of CHOP regimen for limited-stage head-and-neck DLBCL. In patients treated with R-CHOP, a reduced RT dose and volume might be feasible without increasing treatment failures.

조직학적으로 확진된 두개내 배아종의 전보조화학요법 후 방사선치료의 성적 - 예비적 결과 (Efficacy of Neoadjuvant Chemotherapy and Radiotherapy for the Histology-confirmed Intracranial Germinoma - Preliminary Report)

  • 노영주;김학재;허대석;신희영;김일한
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.93-99
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    • 2002
  • 목적 : 두개내 배아종은 방사선치료 단독으로도 완치율이 높은 종양이나 방사선치료로 인한 부작용의 감소를 위해 현재 서울대학교 병원에서는 전보조화학요법 후 방사선치료를 하고 있으며 이 환자들의 치료 성적과 부작용을 분석하고자 하였다. 대상 및 방법 : 1995년에서 2001년까지 치료를 받은 두개내 배아종으로 조직학적으로 진단된 18명의 환자를 대상으로 하였다. 12명은 BEP (bleomycin, VP-16, cisplatin) 항암치료, 5명은 9921A (cisplatin, cyclophosphamide, VP-16, vincristine) 항암치료, 1명은 EP (VP-16, cisplatin) 항암치료를 받았고 5명은 두개척수조사, 1명은 두개방사선조사, 12명은 종양 부위에만 방사선치료를 받았다. 원발 종양에 조사된 방사선량은 39.6에서 54 Gy였다. 결과 : 남자는 16명, 여자는 2명이었고 중간 나이는 16세였다. 자기공명영상 상 12명은 송과체에, 각각 1명에서 안상, 시상, 대뇌기저핵에 원발성 종괴가 있었고 3명에서 다발성 종괴가 있었다. 6명은 뇌실 내 전이 소견이 보였고 3명은 뇌척추액검사 상 종양 세포가 관찰되었고 2명에서는 척수 자기공명영상에서 전이 소견이 있었다. 종양지표검사 상 1명에서 $\beta-human$ chorionic gonadotropin의 수치가 44 mlU/mL로 상승되어 있었다. 항암치료 후 5명은 완전 관해, 12명은 부분 관해를 보였고, 1명은 반응이 없었다. 현재 중앙 추적 기간 20개월로 17명은 무병 상태로 관찰되고 있고 1명은 bleomycin으로 인한 것으로 추정되는 폐의 부작용으로 사망하였다. 사망한 환자를 제외한 다른 환자들은 방사선치료 후 모두 완전 관해 상태이다. 6명에서 백혈구 감소로 인한 감염이 발생하였으며 $3\~4$도의 혈액학적 부작용이 11명에서 발생하였다. 방사선조사 중 두개척수조사를 받은 5명의 환자를 제외한 나머지 환자에서는 2도 이상의 부작용은 보이지 않았다. 결론 : 서울대학교병원에서의 전보조화학요법 후 방사선치료는 기존의 보고와 마찬가지로 높은 관해율을 보이고 있고 항암치료로 인한 치료 중이나 치료 후의 부작용의 정도와 빈도는 다른 보고와 비슷하였다. 방사선이나 항암치료로 인한 만성 부작용에 대해서는 좀더 관찰이 필요하며 이 결과가 나온 후에 두개내 배아종에서 가장 적절한 치료에 대해 결론을 내릴 숱 있을 것으로 보인다.

Primary Malignant Melanoma in the Pineal Region

  • Park, Jae-Hyun;Hong, Yong-Kil
    • Journal of Korean Neurosurgical Society
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    • v.56 no.6
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    • pp.504-508
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    • 2014
  • A 59-year-old male patient had 5-month history of gait disturbance and memory impairment. His initial brain computed tomography scan showed $3.5{\times}2.8cm$ sized mass with high density in the pineal region. The tumor was hypointense on T2 weighted magnetic resonance images and hyperintense on T1 weighted magnetic resonance images with heterogenous enhancement of central portion. The tumor was totally removed via the occipital transtentorial approach. Black mass was observed in the operation field, and after surgery, histopathological examination confirmed the diagnosis of malignant melanoma. Whole spine magnetic resonance images and whole body 18-fluoro-deoxyglucose positron emission tomography could not demonstrate the primary site of this melanoma. Scrupulous physical examination of his skin and mucosa was done and dark pigmented lesion on his left leg was found, but additional studies including magnetic resonance images and skin biopsy showed negative finding. As a result, final diagnosis of primary pineal malignant melanoma was made. He underwent treatment with the whole brain radiotherapy and extended local boost irradiation without chemotherapy. His preoperative symptoms were disappeared, and no other specific neurological deficits were founded. His follow-up image studies showed no recurrence or distant metastasis until 26 weeks after surgery. Primary pineal malignant melanomas are extremely rare intracranial tumors, and only 17 cases have been reported since 1899. The most recent case report showed favorable outcome by subtotal tumor resection followed by whole brain and extended local irradiation without chemotherapy. Our case is another result to prove that total tumor resection with radiotherapy can be the current optimal treatment for primary malignant melanoma in the pineal region.