• Radiation Oncology Journal
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• v.21 no.2
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• pp.112-117
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• 2003

Purpose: The effects of hypefractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Materials and Methods: Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department of Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7 : 1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 75.8 Gy). Follow-up periods ranged between 3 and 136 months, with the median of 52 months. Results: The overall survival rates at 3 and 5 years in all patients were 66.7$\%$, and 52.4$\%$. The disease-free survival rates at 3 and S years (3YDFS, 5YDFS) in all patients were 66.7$\%$ and 47.6$\%$. The 3YDFS and 5YDFS in stage III patients were 81.8$\%$ and 63.6$\%$, and those in stage IV patients were 53.8$\%$ and 32.3$\%$. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25$\%$) died due to distant metastasis and 12.5$\%$ died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteo-radionecrosis of the mandible 58 months after treatment. Conclusion: Although this study was peformed on small patients group, we considered hypefractionated radiation therapy for the treatment of advanced stage head and neck cancer might improve the disease free survival and decrease the local failure with no increase in late complications despite of the slight Increase in acute complications.

• Radiation Oncology Journal
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• v.22 no.2
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• pp.98-105
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• 2004

Purpose : To evaluate whether positron omission tomography (PET) with 2-[F-18]fluoro-2-deoxy-D-giucose(FDG) can be used to predict of early response to definitive aim radlotherapy (RT) in squamous cell carcinoma of the head and neck using response rate and locoreglonal control as study endpoints. Materials and Methods : Twenty-two patients with head and neck cancer underwent a FDG-PET study before RT, after a flrst dose of 45 Gy, and after a second dose on more 4han 70 Gy. Standard uptake value (SUV) was calculated for primary tumor (n=22) and neck lymph node (n:10). Attenuation corrected PET scans acquired 60 min after tracer injection were used for evaluation of FDG uptake In tumors. A quantitative FDG uptake index was expressed as Suvlean (corrected for iean body mass). The follow-up time was at least 5 months (range S-1 S months). Results : A total of 22 primary tumors and 10 metastatic lymph nodes were analyzed In FDG-PET. In the first PET study the mean SUVlean the primary tumors and nodes were 5.4 (SD, 2.5) and 4.6 (SD, 2.3), respectively. In the second PET, study peformed after 46 Gy RT the mean SUV in primary tumor and node decreased to 2.9 (SD, 1.9, p<0.001) and 1.7 (SD, 1.3) respectively. in the third PET study peformed at the full dose (more than 70 Gy), RT the mean SUV In the primary tumors and nodes decreased to 2.3 (SD, 1.5, p<0.001) and 1.5 (SD, 1 .1) respectively. Conclusions: FDG uptake In tumors showed a significant decrease after the 45 Gy and more than 70 Gy of RT for squamous cell carcinoma of the head and neck. Reduction of metabolic activity after 46 Gy of radiotherapy Is closely correlated with radiation response.

• Journal of Chest Surgery
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• v.36 no.5
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• pp.348-355
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• 2003

Background: The prognostic significance of lymph node micrometastasis in non-small cell lung cancer remains controversial. We therefore investigated the clinicopathologic factors related to lymph node micrometastsis and evaluated the clinical relevance of micrometastasis with regard to recurrence. Material and Method: Five hundred six lymph nodes were obtained from 41 patients with stage 1 non-small ceil lung cancer who underwent curative resection between 1994 and 1998. Immunohistochemical staining using anti-cytokeratin Ab was used to detect micrometastasis in these lymph nodes. Result: Micrometastatic tumor cells were identified in pN0 lymph nodes in 14 (34.1%) of 41 patients. The presence of lymph node micrometastasis was not related to any clinicopathoiogic factor (p) 0.05). The recurrence rate was higher in patients with micrometastasis (57.1%) than in those without (37.0%), but the difference was not significant (p=0.22). Patients with micrometastasis had a lower 5-year recurrence-free survival rate (48.2%) than those without micrometastasis (64.1%), with a borderline significance (p=0.11), The S-year recurrence-free survival rate (25.0%) in the patients with 2 or more micrometastatic lymph nodes was significantly lower than that in the patients with no or single micrometastasis (p=0.02). In multivariate analysis, multiple lymph node micromestasis us was a significant independent predictor of recurrence (p=0.028, Risk ratio=3.568). Conclusion: Immunehistochemical anti-cytokeratin staining was a rapid, sensitive, and easy way of detecting lymph node micrometastasis. The presence of lymph node micrometastasis was not significantly associated with the recurrence, but had a tendency toward a poor prognosis in stage 1 non-small cell lung cancer. Especially, the presence of multiple micrometastatic lymph nodes was a significant and independent predictor of recurrence.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.265-276
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• 2000

Purpose : Between January 1983 and December 1988, 218 female Patients with known breast cancer and positive axillary nodes were treated with adjuvant radiotherapy and chemotherapy following radical mastectomy. Treatment results were retrospectively analysed at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University of College of Medicine. Materials and Methods : The patients were classified into 3 groups; group I included II patients treated with adjuvant chemotherapy alone; in group 2, 52 patients treated with radiotherapy alone; and in group 3, n patients treated with combined chemo-radiotherapy. The mean age was 44 years and ranged from 27 to 70. The median follow-up time was 51 months. Results :Seven-year relapse free and overall survival rates were 56$\%$ and 67$\%$; in group 1, 50$\%$ and 56$\%$ in group 2, 51$\%$ and 65$\%$ and in group 3, 62$\%$ and 75$\%$ respectively. This difference was not statistically significant(p<0.05). The loco-regional failure rates were 13$\%$ and distant failure rates were 33$\%$. There was less risk of loco-regional failure in group 2 and 3 which included radiotherapy (p<0.05). But there was no significantly difference in the rates of distant failure( p>0.05). By univariate analysis, the only significant prognostic factor affecting relapse-free survival was the percentage of positive axillary nodes; and the overall survival significantly correlated with the primary tumor site, the number or percentage of positive axillary nodes, and stage. But in multivariate analysis, the only significant prognostic factor was treatment modality. By univariate analysis of prognostic factors affecting the rates of overall failure and distant failure, the significant prognostic factors was the percentage of positive axillary nodes; and the risk of the loco-regional failure significantly correlated with the treatment modality. Conclusion :In conclusion, these results suggest a potential for decreasing the risk of loco-regional failure with the addition of postoperative radiotherapy to chemotherapy in the premenopausal patients, and in the patients with number or percentage of positive nodes more than 4 or 1/3. The results of this study suggest that the combined chemo-radiotherapy as adjuvant treatment following radical mastectomy was the most effective modaliw in groups of 2$\~$5 cm sized tumor, stage IIB, and in patients with more than 4 or 1/3 of number or percentage of positive nodes.

• Radiation Oncology Journal
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• v.16 no.1
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• pp.63-69
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• 1998

Purpose : This study is to evaluate the efficacy of small bowel displacement system(SBDS) in post-operative pelvic radiation therapy(RT) of rectal cancer patients by measurement of small bowel volume included in the radiation fields receiving therapeutic dose. Materials and Method : Ten consecutive new rectal cancer patients referred to the department of Radiation Oncology of Samsung Medical Center in May of 1997 were included in this study. All patients were asked to drink $Castrographin^(R)$ before simulation and were laid prone for conventional simulation and CT scans with and without SBDS. The volume of opacified small bowel on CT scans, which was to be included in the radiation fields receiving therapeutic dose, was measured using Picture archiving and communication system (PACS). Results : The average small bowel volumes with and without SBDS were 176.0ml(5.2-415.6ml) and 185.1ml(54.5-434.2ml), respectively The changes of small bowel volume with SBDS compared to those without SBDS were more than $10\%$ decrease in three, less than 10% decrease in two, less than $10\%$ increase in three, and more than $10\%$ increase in two patients. Conclusion : No significant advantage of using SBDS in post-operative pelvic RT for rectal cancer patients has been shown by small bowel volume measurement using CT scan considering additional effort and time needed for simulation and treatment setup.

• Radiation Oncology Journal
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• v.16 no.1
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• pp.27-33
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• 1998

Purpose : To improve the therapeutic results of postoperative recurrent disease and inoperable disease of stomach cancer, we used the thermoradiotherapy. We conducted a retrospective analysis of the results and compared the results of hyperthermia before radiotherapy and those of hyperthermia after radiotherapy Materials and Methods : From July 1994 to November 1996, we treated twenty patients with locally advanced stomach cancer and recurrent stomach cancer with thermoradiotherapy. We divided those patients into two groups : hyperthermia before radiotherapy group (PreRT group : 13 Patients) and hyperthermia after radiotherapy group (PostRT group : 7 patients). We performed radiation therapy with the total tumor dose of 3000-5040cGy in a traction of 180-300cGy and 5 fractions per week. Hyperthermia was performed with 8 MHz radiofrequency apparatus. PreRT group patients were treated daily for 30 minutes before the radiation therapy within the interval of ten minutes. And PostRT group patients were treated with 1-2 sessions Per week for 40-60 minutes after the radiation therapy within the interval of 10 minutes. Results : Overall response rate was $33.3\%$. This response rate appeared the same in both groups. Mean survival and 1 rear survival rate were 10.3 months and $16.5\%$. In PreRT group, mean survival and 1 year survival rate were 6.8 months and $9.0\%$, and in PostRT group, mean survival and 1 year survival rate were 7.7 months and $34\%$. There were no statistically significant difference between the prognostic factors and therapeutic results. Conclusion : The thermoradiotherapy was a safe treatment method in advanced and recurrent gastric cancer when compared with other treatment. Because the number of patients we treated was small and the follow up period was short. we were not able to draw any conclusions about the therapeutic efficacy of the sequence of radiation therapy and hyperthermia. Therefore, further clinical trials of thermoradiotherauy for stomach cancer appear to be warranted.

• Journal of the Korean Arthroscopy Society
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• v.6 no.2
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• pp.195-199
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• 2002

This article is to report a new technique for reconstruction of the anteromedial and posterolateral bundles of anterior cruciate ligament by separate tensioning and fixation of the each bundle. Method : Tibial and femoral tunnels were made with conventional technique of anterior cruciate ligament reconstruction. Tibial tunnel was enlarged $5\~7$ mm in anterior-posterior direction to make oval it in cross section. When preparing the Achilles tendon allograft, bone plug portion was trimmed as the conventional technique. The tendinous portion was trimmed as two separate bundles by dividing the tendinous portion longitudinally, so the graft is shaped like 'Y'. The bone plug portion of allograft was inserted into the femoral tunnel and fixed with absorbable cross pins. Two ligamentous portionss of the distal part of the grafts were tensioned separately at the external orifice. Anteromedial bundle was fastened under maximum tension with the knee flexed 90 degrees by post-tie method. The posterolateral bundle was fixed by the same technique with the knee in full extension. Then, an absorbable interference screw was inserted between the two bundles upto the upper end of the tibial tunnel, to get more initial rigidity of the reconstructed graft as well as to locate the two bundles in more anatomic position.

• The Journal of the Korean bone and joint tumor society
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• v.16 no.1
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• pp.8-13
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• 2010

Purpose: This study was performed to evaluate the effi ciency of Platelet-rich plasma (PRP) for acceleration of bone healing process on allograft transplantation after curettage in benign bone tumor. Materials and Methods: From December 2007 to February 2009, twenty-one patients who had benign bone tumor and underwent allograft transplantation after curettage were evaluated. Mean follow-up period was 14.6 months (range, 12-26 months). We compared with 13 cases of PRP group and 8 cases of non-PRP group in terms of size of lesion, bone resorption, amount of applied PRP and complications. The mean age at surgery was 23.6 years (range, 4-73 years). The most common diagnosis was simple bone cyst (7) followed by enchondroma (4), giant cell tumor (3), undifferentiated benign bone tumor (3) and so on. Results: The mean size of lesion was 33.5 $cm^3$ (range, 2.3-181.9 $cm^3$) (29.4 $cm^3$ in PRP group and 40.2 $cm^3$ in non-PRP group). The mean volume of injected PRP was 7.4 cc (range, 3-12 cc). Bone union started at 3.0 months (range, 1.5-5.8 months) in PRP group and 5.3 months (range, 4-8 months) in non-PRP group. Three cases for each group were excluded due to recurrence and pathologic fracture. One patient had febrile episode 3 weeks later after surgery which subsided with antibiotics. Conclusion: The PRP could accelerate bone union in allograft transplantation after curettage of benign bone tumor. Furthermore, we expect that PRP can accelerate bone union in fracture or non-union.

• The korean journal of orthodontics
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• v.27 no.4 s.63
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• pp.585-597
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• 1997

The purpose of this study was to evaluate the effect of estrogen on the periodontium and alveolar bone tissue response during experimental tooth movement in ovariectomized rats. Eighty female rats, 250gm in body weight, were classified into four groups ; sham operated group(NN), ovariectomized group(ON), ovariectomized & estrogen injected group(OE), sham operated & estrogen injected group(NE). flats were ovariectomized before 3 weeks to begin the experiment, which resulted in estrogen-deficient osteoporosis. In OE group & NE group, estrogen was injected $50{\mu}g/kg\;B.W.$ every other days. The left maxillary 1st molar was moved mesially with 60g force. Each foot rats were sacrificed after 1, 3, 7, 15 days from application of orthodontic appliance and alter additional 7 days from removal of orthodontic appliance. Histological findings on mesial roots of upper 1st molar in pressure and tension side are observed. The results were summarized as follows ; 1. In pressure side of alveolar bone, the number of osteoclasts and Howship's lacuna of ON group was significantly more than that of NN group from 1 day to 15 days(P<0.05). Especially the number of Howship's lacuna of ON group was significantly more than that of OE group during all experimental period(P<0.05). 2. In tension side of alveolar tune, the number of osteoclasts of ON group was significantly increased from 1 day to 3 days and decreased after 7 days. But the number of osteoclast of ON group was significantly mote than that of NN group during all experimental period(P<0.05). Also the number of Howship's lacuna of all groups was abruptly increased at 1 day, but slowly decreased till experimental 15 days. And the number of Howship's lacuna of of group was significantly more than that of NN group from 0 hr to 7 days(P<0.05). 3. The speed of tooth movement of OE group & NE group was similar to that of NN group(P>0.05). The amount of tooth movement of ON group between 7 days and 15 days was significantly greater than those of other groups(P<0.05). 4. The degree of relapse of ON group after 7 days from removal of orthodontic appliance was similar to those of other groups(P>0.05).

• Electronics and Telecommunications Trends
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• v.28 no.4
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• pp.23-34
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• 2013

X-선 혹은 감마선 등 종래의 방서선 치료는 양성자 혹은 이온에 의한 치료방법의 등장함에 따라 퇴조할 것으로 보인다. 그 이유는, 양성자 등 전하를 띄는 입자치료기술이 치료 후 후유증이나 암의 재발을 현저히 억제시킬 수 있기 때문이다. 전하를 띄는 입자는 암 조직 전후의 정상 조직에 최소한의 피폭을 주나, X-선이나 감마선과 같은 광자들은 암 조직 전후의 정상세포가 암세포로 변화될 수 있는 정도의 피폭량을 주는 것으로 알려져 있다. 현재 임상 중인 양성자(혹은 극히 일부의 탄소이온 치료기)치료기는 1990년 미국의 로마린다(Loma Linda) 대학에서 최초로 건립된 방식인 사이클로트론 혹은 싱클로트론 가속기와 빔라인 및 겐트리(gantry)로 구성된다. 그 장치의 거대함만큼이나 가격과 유지비 등에서 일반 소형병원에서 운영하기에는 쉽지 않아 보인다. 이에 본고에서는 소형병원에서도 운영할 수 있는 저비용의 레이저 양성자(이온) 가속방식의 등장 배경과 향후 전망을 논하고자 한다.