• Title/Summary/Keyword: 강내방사선 치료

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Late Rectal Complication in Patients treated with High Dose Rate Brachytherapy for Stage IIB Carcinoma of the Cervix (FIGO병기 IIB 자궁경부암에서 고선량 강내 방사선치료후의 후기 직장 합병증)

  • Chung, Eun-Ji;Kim, Gwi-Eon;Suh, Chang-Ok;Keum, Ki-Chang;Kim, Woo-Cheol
    • Radiation Oncology Journal
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    • v.14 no.1
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    • pp.41-52
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    • 1996
  • Purpose : This paper reports a dosimetric study of 88 patients treated with a combination of external radiotherapy and high dose rate ICR for FIGO stage IIB carcinoma of the cervix. The purpose is to investigate the correlation between the radiation doses to the rectum, external radiation dose to the whole pelvis, ICR reference volume, TDF BED and the incidence of late rectal complications, retrospectively. Materials and Methods : From November 1989 through December 1992, 88 patients with stage IIB cervical carcinoma received radical radiotherapy at Department of Radiation Oncology in Yonsei University Hospital. Radiotherapy consisted of 44-54 Gy(median 49 Gy) external beam irradiation plus high dose rate intracavitary brachytherapy with 5 Gy per fraction twice a week to a total dose of 30 Gy on point A. The maximum dose to the rectum by contrast(r, R) and reference rectal dose by ICRU 38(dr, DR) were calculated. The ICR reference volume was calculated by Gamma Dot 3.11 HDR planning system, retrospectively The time-dose factor(TDF) and the biologically effective dose (BED) were calculated. Results : Twenty seven($30.7\%$) of the 88 patients developed late rectal complications:12 patients($13.6\%$) for grade 1, 12 patients($13.6\%$) for grade 2 and 3 patients($3.4\%$) for grade 3. We found a significant correlation between the external whole pelvis irradiation dose and grade 2, 3 rectal complication. The mean dose to the whole pelvis for the group of patients with grade 2, 3 complication was Higher, $4093.3\pm453.1$ cGy, than that for the patients without complication, $3873.8\pm415.6$ (0.05$7163.0\pm838.5$ cGy, than that for the Patients without rectal complication, $0772.7\pm884.0$ (p<0.05). There was no correlation of the rate of grade 2, 3 rectal complication with the iCR rectal doses(r, dr), ICR reference volume, TDF and BED. Conclusion : This investigation has revealed a significant correlation between the dose calculated at the rectal dose by ICRU 38(DR) or the most anterior rectal dose by contrast(R) dose to the whole pelvis and the incidence of grade 2, 3 late rectal complications in patients with stage IIB cervical cancer undergoing external beam radiotherapy and HOR ICR. Thus these rectal reference points doses and whole pelvis dose appear to be useful Prognostic indicators of late rectal complication in high dose rate ICR treatment in cervical carcinoma.

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Preliminary Results of Concurrent Chemotherapy and Radiation Therapy using High-dose-rate Brachytherapy for Cervical Cancer (자궁경부암에 항암화학요법과 동시 병용요법으로 외부 방사선조사와 고선량률 강내조사의 예비적 치료 결과)

  • Lee, Kyung-Ja;Lee, Ji-Hye;Lee, Re-Na;Suh, Hyun-Suk
    • Radiation Oncology Journal
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    • v.24 no.3
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    • pp.171-178
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    • 2006
  • [ $\underline{Purpose}$ ]: To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. $\underline{Materials\;and\;Methods}$: From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range $34{\sim}74$) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follows: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of $45{\sim}50.4\;Gy$ (median: 50.4 Gy) over $5{\sim}5.5$ weeks. Ir-192 HDR intracavitary brachytherapy (ICBT) was given after a total dose of 41.4 Gy. HDR-ICBT was performed twice a week, with a fraction point A dose of 4 Gy and median dose to point A was 28 Gy (range: $16{\sim}32\;Gy$) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT+ICBT) was $88\;Gy_{10}$ (range: $77{\sim}94\;Gy_{10}$). The median cumulative BED at ICRU 38 reference point (EBRT+ICBT) was $131\;Gy_3$ (range: $122{\sim}140\;Gy_3$) at point A, $109\;Gy_3$ (range: $88{\sim}125\;Gy_3$) at the rectum and $111\;Gy_3$ (range: $91{\sim}123\;Gy_3$) at the urinary bladder. Cisplatin ($60\;mg/m^2$) and 5-FU ($1,000\;mg/m^2$) was administered intravenously at 3 weeks interval from the first day of radiation for median 5 (range: $2{\sim}6$) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range: $8{\sim}50$ months). $\underline{: The complete response rate after concurrent chemoradiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure rate was 13% and distant metastatic rate was 3.3%. The crude rate of minor hematologic complications (RTOG grade 1-2) occurred in 3 patients (10%) and one patient had suffered from severe leukopenia (RTOG grade 4) during concurrent treatment. Acute minor enterocolitis (RTOG grade 1-2) occurred in 11 patients (37%) and one patient (3%) was suffered from colon perforation during radiation therapy. Late colitis of RTOG grade 1 occurred in 5 patients (15%). Acute cystitis of RTOG grade 1 occurred in 12 patients (40%) and late cystitis of RTOG grade 2 occurred in one patient (3%). No treatment related death was seen. $\underline{Conclusion}$: The results of this study suggest that the concurrent chemoradiation therapy with HDR brachytherapy could be accepted as an effective and safe treatment for cervical cancer.

Treatment Results of Radical Radiotherapy in Uterine Cervix Cancer (자궁경부암 환자의 근치적 방사선치료성적)

  • Huh Seung Jae;Kim Bo Kyong;Lim Do Hoon;Shin Seong Soo;Lee Jeong Eun;Kang Min Kyu;Ahn Yong Chan
    • Radiation Oncology Journal
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    • v.20 no.3
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    • pp.237-245
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    • 2002
  • Purpose : This study was conducted to evaluate the treatment results, prognostic factors, and complication rates after high dose rate (HDR) brachytherapy in patients with uterine cervix cancer who were treated with curative aim. Materials and Methods : Of 269 cervix cancer patients treated at the department of radiation oncology, Samsung Medical Center from September 1994 to July 1998, the 106 who were treated with radical radio-therapy were analyzed. The median age was 61 years (range 22 to 89). All patients except 4 with carcinoma in situ (CIS) were given external beam radiotherapy (range $30.6\~50.4\;Gy$ to whole pelvis) and HDR brachytherapy. The common regimens of HDR brachytherapy were a total dose of $24\~28\;Gy$ with $6\~7$ fractions to point A at two fractions per week. The median overall treatment time was 55 days (range 44 to 104) in patients given both external beam radiotherapy and HDR brachytherapy. Results : Early responses of radiotherapy were evaluated by gynecologic examination and follow-up MRI 1 month after radiotherapy. Treatment responses were complete remission in 72 patients, partial response in 33 and no response in 1. The overall survival (OS) rate of all patients was $82\%,\;and\;73\%$, and the disease free survival (DFS) rate was $72\%,\;and\;69\%$, at 3, and 5 years, respectively. The pelvic control rate (PCR) was $79\%$ at both 3 and 5 years. According to the FIGO stage,3 and 5 year OS were $100\%\;and\;50\%$ in CIS/IA, $100\%\;and\;100%$ in IB, $83\%\;and\;69\%$ in IIA, $87\%\;and\;80\%$ in IIB, and $62\%\;and\;62\%$ in III, respectively. The 3 year OS in 4 patients with stage IVA was $100\%$. Three-year DFS were $80\%$ in CIS/IA, $88\%$ in IB, $100\%$ in IIA, $64\%$ in IIB, $58\%$ in III, and $75\%$ in IVA. Three-year PCR were $100\%$ in CIS/IA, $94\%$ in IB, $100\%$ in IIA, $84\%$ in IIB, $69\%$ in III, and $50\%$ in IVA. By univariate analysis, FIGO stage and treatment response were significant factors for OS. The significant factors for DFS were age, FIGO stage, treatment response and overall treatment time (OTT). For pelvic control rate, treatment response and OTT were significant factors. By multivariate analysis, FIGO stage had a borderline significance for OS (p=0.0825) and treatment response had a borderline significance for DFS (0=0.0872). A total of 14 patients $(13\%)$ experienced rectal bleeding, which occurred from 3 to 44 months (median, 13 months) after the completion of radiotherapy. Conclusion : HDR brachytherapy protocol of Samsung Medical Center combined with properly optimal external beam pelvic irradiation is a safe and effective treatment for patients with uterine cervix cancer. The authors found that OTT of less than 55 days had a positive impact on pelvic control and survival rate.

Preliminary Results of Concurrent Radiation Therapy and Chemotherapy in Locally Advanced Cervical Carcinoma (국소적으로 진행된 자궁 경부암에서 방사선과 항암화학요법 병행치료의 예비적 결과)

  • Yang KM;Ahn SD;Choi EK;Chang HS;Kim YT;Nam JH;Mok JE
    • Radiation Oncology Journal
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    • v.11 no.2
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    • pp.355-361
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    • 1993
  • Since May 1991, authors have conducted a pilot study to determine the feasibility and evaluate the effect of concurrent radiation therapy and chemotherapy with 5-FU and Cis-platinum for locally advanced cervical cancer (stage IIB-IVA). Radiation therapy consisted of external irradiation to whole pelvis (4140 cGy/23 fx) in 4.5 weeks followed by high dose rate intracavitary radiation therapy (HDR ICRT) to deliver a dose of 30 to 35 Gy to A point in 6 to 7 fractions. After the intracavitary radiation therapy, parametrial boost was delivered for B point dose of 60 Gy in Stage IIB and 65 Gy in stage IIIB. 5-FU (1000 $mg/m^2/24hr$ for 96 hour iv infusion) and Cis-platinum (20 $mg/m^2/day$ IV bolus for 3 days) were given during the second week of external RT and the second course chemotherapy administered at the first HDR ICRT with the same method as the first chemotherapy. Sixteen patients (10 stage IIB,4 stage IIIB,2 stage IVA) were registered to this protocol. Among these 16 patients, two refused treatment after 2 fractions of external irradiation, and one could not continue intracavitary irradiation because of treatment related genitourinary toxicity. So 14 patients were evaluated for toxicity and 13 patients were evaluated for response analysis. Five of 14 patients developed grade 3 gastrointestinal toxicity but 4 of them recovered at the completion of treatment. One stage IIIB patient with inguinal lymph node metastasis who received higher dose of radiation in spite of initial poor performance status did not recover from gastrointestinal toxicity at the completion of treatment. And she died of distant metastasis at one month after the completion of treatment. Two of 14 evaluable patients showed weight loss, more than $10\%$ of initial weight. One patient developed grade 3 leukopenia. In this study, the average total treatment period of completely treated patients was 75 days and three of them took more than 80 days (84, 84, 89 days). Toxicities were generally acceptable and there were no treatment related death. At the last follow-up, complete response was achieved in $62\%(8/13)$ and especially of nine patients with stage IIB, eight patients showed complete response. This study suggests that concurrent radiation therapy and chemotherapy (5-FU and Cis-platinum) is tolerable and effective. Further follow-up is needed to determine whether this protocol will have a favorable impact on survival and to evaluate the late effect on normal tissues. In future, prospective randomized trials are needed to compare the standard radiation therapy alone with concurrent chemotherapy and radiation therapy for locally advanced cervical carcinoma.

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Fabrication of Backscatter Electron Cones for Radiation Therapy (산란전자선을 이용한 강내측방조사기구의 제작과 특성)

  • Chu, Sung-Sil;Suh, Chang-Ok;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.19 no.1
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    • pp.74-80
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    • 2001
  • Purpose : Irradiation cones by using backscatter electrons are made for the treatment of superficial small lesions of skin, oral cavity, and rectum where a significant dose gradient and maximum surface dose is desired. Methods and Materials : Backscatter electrons are produced from the primary electron beams from the linear accelerators. The design consists of a cylindrical cone that has a thick circular plate of high atomic number medium (Pb or Cu) attached to the distal end, and the plate can be adjusted the reflected angle. Primary electrons strike the metal plate perpendicularly and produce backscatter electrons that reflect through the lateral hole for treatment. Using film and a parallel plate ion chamber, backscatter electron dose characteristics are measured. Results : The depth dose characteristic of the backscatter electron is very similar to that of the hard x-ray beam that is commonly used for the intracavitary and superficial lesions. The basckscatter electron energy is nearly constant and effectively about 1.5 MeV from the clinical megavoltage beams. The backscatter electron dose rate of $35\~85\;cGy/min$ could be achieved from modern accelerators without any modification. and the depth in water of $50\%$ depth dose from backscatter electron located at 6mm for $45^{\circ}$ angled lead scatter. The beam flatness is dependent on the slit size and the depth of treatment, but is satisfactory to treat small lesions. Conclusions : The measured data for backscatter electron energy, depth dose flatness dose rate and absolute dose indicates that the backscatter electrons are suitable for clinical use.

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The Results of Postoperative Radiotherapy for Endometrial Carcinoma (자궁 내막암의 수술 후 방사선치료 결과)

  • Noh, O-Kyu;Lee, Sang-Wook;Ahn, Seung-Do;Choi, Eun-Kyung;Kim, Jong-Hyeok;Kim, Yong-Man;Nam, Joo-Hyun;Mok, Jung-Eun;Kim, Jong-Hoon;Shin, Seong-Soo
    • Radiation Oncology Journal
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    • v.25 no.2
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    • pp.93-100
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    • 2007
  • [ $\underline{Purpose}$ ]: To evaluate the outcome and prognostic factors of postoperative radiotherapy in endometrial carcinoma. $\underline{Materials\;and\;Methods}$: From September 1991 to August 2003, 76 patients with endometrial carcinoma received postoperative adjuvant radiotherapy after hysterectomy at Asan Medical Center. Stage was classified as FIGO I in 41 (53.9%), II in 12 (53.9%), and III in 23 (30.3%). Histologic grade 1, 2 and 3 were in 29 (38.2%), 20 (26.3%), and 27 (35.5%) respectively. Forty two patients received both external beam radiation therapy (EBRT) and intracavitary radiation (ICR), 34 patients were treated with EBRT or ICR alone. EBRT dose was 50.4 Gy, ICR was performed in $4{\sim}6$ fractions with $4{\sim}5\;Gy$ per fraction. Median follow-up period was 51 (range $5{\sim}121$) months. $\underline{Results}$: Five-year overall survival was 89.6%. In univariate analysis, statistically significant factors to overall survival were FIGO stage, lymph node metastasis and histologic grade. In disease free survival, FIGO stage, lymph node metastasis and lymphovascular invasion were significant prognostic factors. Recurrence was seen in 11 patients. Of these, systemic failure was in 10 patients. There were no moderate to severe complications after radiation therapy. $\underline{Conclusion}$: The outcome of postoperative adjuvant radiotherapy in endometrial carcinoma was good. Main pattern of failure after postoperative radiotherapy was distant metastasis. So, adjuvant chemotherapy may help in improving outcome. Further study on chemotherapy in combined with postoperative radiotherapy will be needed, especially for patients with high risk factors such as high FIGO stage, lymphovascular invasion, and high histologic grade.

Prediction of Late Rectal Complication Following High-dose-rate Intracavitary Brachytherapy in Cancer of the Uterine Cervix (자궁경부암 환자의 고선량률 강내치료 시행 시 직장합병증의 예측)

  • Lee, Jeung-Eun;Huh, Seung-Jae;Park, Won;Lim, Do-Hoon;Ahn, Yong-Chan
    • Radiation Oncology Journal
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    • v.21 no.4
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    • pp.276-282
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    • 2003
  • Purpose: Although high-dose-rate intracavitary radiotherapy (HDR ICR) has been used in the treatment of cervical cancer, the potential for increased risk of late complication, most commonly in the rectum, is a major concern. We have previously reported on 136 patients treated with HDR brachytherapy between 1995 and 1999. The purpose of this study is to upgrade the previous data and confirm the correlation between late rectal complication and rectal dose in cervix cancer patients treated with HDR ICR. Materials and Methods: A retrospective analysis was peformed for 222 patients with cevix cancer who were treated for curative intent with external beam radiotherapy (EBRT) and HDR ICR from July 1995 to December 2001. The median dose of EBRT was 50.4 (30.6$\~$56.4) Gy with a daily fraction size 1.8 Gy. A total of six fractions of HDR ICR were given twice weekly with fraction size of 4 (3$\~$5.5) Gy to A point by Iridium-192 source. The rectal dose was calculated at the rectal reference point using the barium contrast criteria. in vivo measurement of the rectal dose was peformed with thermoluminescent dosimeter (TLD) during HDR ICR. The median follow-up period was 39 months, ranging from 6 to 90 months. Results: Twenty-one patients (9.5$\%$) experienced late rectal bleeding, from 3 to 44 months (median, 13 months) after the completion of RT. The calculated rectal doses were not different between the patients with rectal bleeding and those without, but the measured rectal doses were higher in the complicated patients. The differences of the measured ICR rectal fractional dose, ICR total rectal dose, and total rectal biologically equivalent dose (BED) were statistically significant. When the measured ICR total rectal dose was beyond 16 Gy, when the ratio of the measured rectal dose to A point dose was beyond 70$\%$, or when the measured rectal BED was over 110 Gy$_{3}$, a high possibility of late rectal complication was found. Conclusion: Late rectal complication was closely correlated with measured rectal dose by in vivo dosimetry using TLD during HDR ICR. If data from in vivo dosimetry shows any possibility of rectal bleeding, efforts should be made to reduce the rectal dose.

A Study on Intracavitary Therapy in Cervix Cancer Using Needle for Interstitial Therapy (조직 내 삽입용 바늘을 이용한 자궁경부암의 강내치료에 관한 연구)

  • Cho, Jung-Keun;Jung, Hong-Ryang;Lim, Cheong-Hwan;Kim, Jeong-Koo;Lee, Man-Koo
    • Journal of radiological science and technology
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    • v.29 no.2
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    • pp.83-92
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    • 2006
  • Based on the data of cervical cancer patients who were treated by the radiotherapy with concurrent chemotherapy at the radiation oncology department of National Cancer Center from January 2002 to February 2003, we have studied the method recommended by ICRU 38 to maximize the prescription dose to the planing target volume (PTV) with minimizing the dose to surrounding normal organs. Clinical stage of the patients are 1 patient for stage IB, 3 patients for IIA, 19 patients for IIB, 3 patients for IIIA, 3 patients for IIIB and 1 patient for IV. All patients took the MRI before treatment and the maximum size of the gross tumor volume were under 4cm for 17 patients and from 4 cm to 6 cm for 12 patients and above 6 cm for 1 patient. The results show that while the irradiated volume can be reduced with optimized dose distribution using PTV treatment planning (p<0.0001) when the remained tumor size is small, the surrounding normal organs will receive unnecessarily large dose when the irradiated tumor volume is relatively large. This is because there is some limitation in controling the intensity of radiation in Fletcher Williamson Applicator. To overcome the limit of applicator and to achieve the optimal dose distribution, we have virtually applied 4 needles with Fletcher Williamson Applicator for 10 patients who have relatively large tumor and studied the change in dose distribution before and after application. The results show that this new virtual treatment plan reduces the volume covered by 100 % isodose (p=0.0608, p=0.0607) and reduces the dose of normal organs (p=0.0162, p=0.008). This evidence suggest that this method is superior than the currently used method such as PTV treatment and ICRU treatment.

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Fabrication and Dosimetry Characteristics of Intracavitary Cones for Radiotherapy (방사선 강내치료를 위한 소조사면 전자선cone의 선량분포 특성)

  • 나수경;권수일
    • Progress in Medical Physics
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    • v.12 no.1
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    • pp.95-102
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    • 2001
  • The intracavitary cones were designed which were made of stainless steel and have scratched inside cone to be generated electron scatter and designed to be attached easily to the LINAC collimator and controlled cones length to be contacted smoothly between the patient and the cone tip. Two types of intracavitary cones were designed. One is the straight end cones with circular opening on the distal end and the other is 30 degree beveled end cones with elliptical opening on the distal end. Each type of intracavitary cone ranged in daimeter from 2.5 cm to 3.5 cm and required a separate set of lower trimmer annulias cone diameter. The film phantom was designed with an internal cassette that accurately aligned the film edge with the film phantom surface. Film optical density data were measured by photodensitometer(Wellhofer 700i) Dosimetry measurements were made to commission the LINAC for 6 - 20 MeV electron using the intracavitary cones. Isodose curves were measured for all energy and cones combinations. Output is defined as the maximum dose per MU along the clinical central axis in water at 113 cm SSD. Calibration output, defined to be the output for the 15cm$\times$15cm diameter straight cone, was adjusted to 1.00 cGy/MU at each energy according to the TG-21 protocol.

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Bowel Complication after Radiotherpy of Uterine Cervix Carcinoma (자궁경부암의 방사선치료후 대장 및 직장합병증에 대한 분석)

  • Ha, Sung-Whan;Chung, Woong-Ki;Kim, Jong-Hoon
    • Radiation Oncology Journal
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    • v.10 no.2
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    • pp.237-245
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    • 1992
  • Five hundred and fifty patients treated for carcinoma of the uterine cervix at the Department of Therapeutic Radiology, Seoul National University Hospital from 1979 to 1986, were analyzed retrospectively for late rectal complications. Of them, 468 patients received primary radiotherapy for the cervix cancer in intact uterus, and the other eighty two patients were treated postoperatively. The cumulative incidence of radiation induced rectal complication of grade 2 or 3 was 6.7% at five years. The mean rectal dose for the group of patients with complication was higher than the group without complication, and the difference was statistically significant (p<0.01). But relationship between mean rectal dose and severity of complication was not found. The frequency of complication (grade 1, 2, 3) increased as a function of radiation dose to rectum; from 16.1% for patients with rectal dose less than 6,000 cGy to 71.2% for patients with rectal dose higher than 8,000 cGy. Among various factors analyzed, history of diabetes mellitus, number of intracavitary irradiation, size of ovoid, retroflexion of uterus and the total dose delivered to rectum turned out to have significant effect on the complication.

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