• Radiation Oncology Journal
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• 제33권4호
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• pp.301-309
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• 2015

Purpose: To identify prognostic factors for disease progression and survival of patients with extracranial oligometastatic breast cancer (EOMBC), and to investigate the role of radiation therapy (RT) for metastatic lesions. Materials and Methods: We retrospectively reviewed the medical records of 50 patients who had been diagnosed with EOMBC following standard treatment for primary breast cancer initially, and received RT for metastatic lesions, with or without other systemic therapy between January 2004 and December 2008. EOMBC was defined as breast cancer with five or less metastases involving any organs except the brain. All patients had bone metastasis (BM) and seven patients had pulmonary, hepatic, or lymph node metastasis. Median RT dose applied to metastatic lesions was 30 Gy (range, 20 to 60 Gy). Results: The 5-year tumor local control (LC) and 3-year distant progression-free survival (DPFS) rate were 66.1% and 36.8%, respectively. High RT dose (${\geq}50Gy_{10}$) was significantly associated with improved LC. The 5-year overall survival (OS) rate was 49%. Positive hormone receptor status, pathologic nodal stage of primary cancer, solitary BM, and whole-lesion RT (WLRT), defined as RT whose field encompassed entire extent of disease, were associated with better survival. On analysis for subgroup of solitary BM, high RT dose was significantly associated with improved LC and DPFS, shorter metastasis-to-RT interval (${\leq}1month$) with improved DPFS, and WLRT with improved DPFS and OS, respectively. Conclusion: High-dose RT in solitary BM status and WLRT have the potential to improve the progression-free survival and OS of patients with EOMBC.

• Radiation Oncology Journal
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• 제2권2호
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• pp.303-309
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• 1984

Radiation therapy(RT) has been used in the treatment of breast cancer for over 80years. Technically, it should include a part or all of such areas as chest wall or breast, axilla, internal mammary nodes (IM) and supraclavicular nodes (SCL). Authors tried three-field technique for the treatment of breast cancer using 6-MV linear accelerator, exclusively the department of radiology. Kang-Nam St. Mary's Hospital, at Catholic Medical College. The field junction was checked by a Phantom study and radiation doses measured by film densitometry and TLD. The 3 fields we used in this study were two isocentric opposing tangential fields encompassing the breast, chest wall and occasionally IM and one single anterior field encompassing the axilla and SCL. sing appropriate beam blocks and boluses, we were able to avoid unwanted intrinsic divergency of photon beam. Blocking also enabled us to set-up precise radiation field with ease.

• Journal of Radiation Protection and Research
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• 제48권2호
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• pp.100-106
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• 2023

Background: As breast tissue expanders consist of metallic materials in the needle guard and ferromagnetic injection port, irradiation can produce radioactivation. Materials and Methods: A CPX4 (Mentor Worldwide LLD) breast tissue expander was exposed using the Versa HD (Elekta) linear accelerator. Two photon energies of 6 and 10 MV-flattening filter free (FFF) beams with 5,000 monitor units (MU) were irradiated to identify the types of radiation. Furthermore, 300 MU with 10 MV-FFF beam was exposed to the CPX4 breast tissue expander by varying the machine dose rates (MDRs) 600, 1,200, and 2,200 MU/min. To assess the instantaneous dose rates (IDRs) solely from the CPX4, a tissue expander was placed outside the treatment room after beam irradiation, and a portable radioisotope identification device was used to identify the types of radiation and measure IDR. Results and Discussion: After 5,000 MU delivery to the CPX4 breast tissue expander, the energy spectrum whose peak energy of 511 keV was found with 10 MV-FFF, while there was no resultant one with 6 MV-FFF. The time of each measurement was 1 minute, and the mean IDRs from the 10 MV-FFF were 0.407, 0.231, and 0.180 μSv/hr for the three successive measurements. Following 10 MV-FFF beam irradiation with 300 MU indicated around the background level from the first measurement regardless of MDRs. Conclusion: As each institute room entry time protocol varies according to the working hours and occupational doses, we suggest an addition of 1 minute from the institutes' own room entry time protocol in patients with CPX4 tissue expander and the case of radiotherapy vaults equipped with a maximum energy of 10 MV photon beams.

• 대한간호학회지
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• 제31권3호
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• pp.454-466
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• 2001

Purpose: The purpose of this study was to determine the effects of exercise program on cardiopulmonary functions and shoulder joint functioning in breast cancer patients who under- went radiation therapy after surgery. Method: Subjects in the experimental group(N=12) participated in an exercise program for eight weeks. The Exercise program consisted of shoulder stretching, arm weight training, and walking on treadmill. Maximal oxygen uptake (v2max), maximal running time, shoulder joint range of motion, and shoulder functional assessment were determined before and after the exercise program. Baseline sociodemographic and medical data were compared between experimental group and control group using the Fisher's exact test and Mann- Whitney U test. For effects of the exercise program, repeated measures ANOVA were used. Result: 1) Following the exercise program for eight weeks, both v$\alpha$ max and maximal running time tended to increase in experimental group comparing with the control group. 2) Shoulder abduction, extension and flexion of the operated upper extremity in the experimental group comparing with control significantly increased after the exercise program(p<0.05). 3) Shoulder flexion of the normal upper extremity in the experimental group comparing with control significantly increased after the exercise program(p<0.05). Conclusion: The results suggest that the exercise program for breast cancer patients undergoing radiation therapy after breast surgery can improve shoulder functions and increase cardiopulmonary functions, which are maximal oxygen uptake and maximal running time.

• Radiation Oncology Journal
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• 제6권2호
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• pp.283-288
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• 1988

초기 유방암의 치료는 근치적 절제술이 오랫동안 주된 치료방법으로써 선택되어 왔으나, 근래에는 여성의 유방을 보존하고 미용효과를 기대할 수 있는 보조적 절제술 후 근치적 방사선치료법이 개발되어 지대한 관심과 상당한 논란이 거듭되어 왔다. 이러한 논란을 해결하기 위하여 그동안 세계적으로 많은 후향성 또는 전향성 분석을 시행하여 두 치료방법사이의 치료효과를 비교하여 본 결과, 국소치료율, 재발을, 그리고 생존율에 있어서 큰 차이를 보이지 않았다. 이와 같은 치료성적의 결과를 토대로 하여 최근에는 보조적 절제술 후 근치적 방사선치료법이 여성들의 유방을 보존하고 미용효과를 향상시킬 수 있을 뿐만 아니라 국소치료율, 재발율, 생존율도 근치적 절제술의 성적과 대동소이하므로 초기 유방암의 치료에 활발히 이용되기에 이르렀다. 본원에서도 이러한 추세에 따라서 보조적 절제술 후 근치적 방사선치료를 시행한 초기 유방암 1예를 보고하면서 아울러 많은 문헌고찰과 함께 향후 치료방침을 세우고자 한다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2577-2581
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• 2014

Background: Triple negative breast cancer is associated with aggressive behavior and high risk of local and regional failure. Aggressive surgical intervention is considered suitable. This makes role of breast conserving therapy (BCT) debatable in these patients. The objective of this study was to compare outcome of BCT for triple negative versus non-triple negative breast cancer. Materials and Methods: Medical records of patients who underwent breast conserving therapy from 1999 to 2009 at Shaukat Khanum Cancer Hospital and had complete receptor status information were extracted. Patients were divided into triple negative breast cancer (TNBC) and non-TNBC. Patient characteristics, medical treatment modalities and adverse events were compared. Expected five year locoregional recurrence free, disease free and overall survival was calculated. The Cox proportional hazard model was used to identify independent predictors of outcome. Results: A total of 194 patients with TNBC and 443 with non-TNBC were compared. Significant difference was present for age at presentation (p<0.0001), family history (p=0.005), grade (p<0.0001) and use of hormonal therapy (p<0.0001). The number of locoregional failures, distant failures and mortalities were not significantly different. No significant difference was present in 5 year locoregional recurrence free (96% vs 92%, p=0.3), disease free (75% vs 74%, p=0.7) and overall survival (78% vs 83%, p=0.2). On multivariate analysis, tumor size, nodal involvement and hormonal treatment were independent predictors of negative events. Conclusions: Breast conserving therapy has comparable outcomes for triple negative and non-triple negative breast cancers.

• Radiation Oncology Journal
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• 제28권1호
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• pp.16-22
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• 2010

목 적: 방사선치료를 받은 유방암 환자에서 치료로 인한 방사선 피부염의 발생을 감소시킬 수 있는지 알아보기 위해서 전단계로서 피부염 발생정도와 이와 관련된 인자들을 분석해 보았다. 대상 및 방법: 2007년 1월부터 2009년 6월까지 전북대병원 방사선종양학과에서 근치적 목적의 유방 보존 절제술 및 방사선 치료를 받은 침윤성 유방암 환자 338명 중, 보상체를 사용하거나 반대측 유방의 방사선 치료 기왕력이 있는 환자를 제외한 284명에서, 전자선 추가 치료를 시행하기 전 전체 유방에 50 Gy 방사선 조사 후, 방사선 피부염이 발생된 정도와 Radiation Therapy Oncology Group (RTOG) 2도 이상의 중증 피부염을 보인 환자에서 발생 정도에 영향을 미칠 수 있는 요인들을 분석하였다. 결 과: RTOG 등급 0 또는 1과 2도 이상의 경증 및 중증 방사선 피부염은 각각 207명과 77명에서 관찰되었다. 2도 이상 중등도 이상의 방사선 피부염이 발생한 77명의 환자에서 림프액 저류에 의한 림프낭과 림프부종은 방사선 피부염의 회복을 방해하는데 관련된 요소로 분석되었으며 각각 통계적으로 유의한 수준을 나타냈다(p=0.003, p=0.001). 그리고 피부 면역세포 및 사이토카인 활성화에 의한 반창고 과민반응과 호르몬치료 병용도 피부에 영향을 미치는 관련요소로 분석되었으며 각각 통계학적으로 유의한 수준을 나타냈다(p=0.001, p=0.025). 결 론: 방사선치료를 받은 대부분의 유방암 환자에서 경증 또는 중증 정도의 방사선 피부염이 발생되었으며, 림프낭, 림프부종 및 반창고 과민반응 등은 방사선 피부염의 정도에 통계학적으로 유의한 수준의 영향을 미치는 요소로 분석되었다. 따라서 림프낭이 존재하는 경우 방사선치료 전 제거가 우선되어야 하며, 반창고 과민반응이 있는 환자의 경우 치료 중 주의 깊은 관찰과 특히 중등도 이상의 피부염 환자들에게는 치료부위의 피부에 대한 지속적인 보습 교육이 필요하다고 본다.

• 대한방사선치료학회지
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• 제20권1호
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• pp.11-15
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• 2008

목 적: 방사선치료계획에 있어서 정상조직과 치료부위의 선량 분포는 매우 중요하다. 이에 본원에서는 유방암 환자를 대상으로 Three-dimensional conformal radiation therapy (3D-CRT), Helical tomotherapy (TOMO)의 방법으로 방사선치료계획을 세웠으며 이에 선량분포를 분석하여 실제 임상에서의 적용여부를 알아보고자 한다. 대상 및 방법: 20명의(좌측: 10명, 우측: 10명) 유방보존절제술 환자를 대상으로 시행하였으며 방법으로는 같은 조건에서 3D-CRT는 Philips사의 Pinnacle을, TOMO는 TomoTherapy사의 TOMO Planning System을 이용해 치료계획을 세웠다. Dose-Volume Histogram (DVH)의 prescribed dose (PD)에 대한 PTV의 Homogeneity index (HI)와 Conformity index (CI)를 구하였고, 정상조직의 dose- volume 관계를 비교하였다. 결 과: Homogeneity index (HI)와 Conformity, index (CI)는 TOMO에서 우수한 결과를 나타났다. $V_{-50-IB-NPTV}$ (the percentage ipsilateral non-PTV breast volume that was delivered 50% of the prescribed dose)는 3D-CRT: 40.4%, TOMO: 18.3%, $V_{20-IL}$ (the average ipsilateral lung volume percentage receiving 20% of the prescribed dose)는 3D-CRT: 4.8%, TOMO: 14.2%, $V_{20-10H}$ (the average heart volume percentage delivered 20% and 10% of the prescribed dose in left breast cancer)는 3D-CRT: 1.6%, 3% TOMO: 9.7%, 26.3%의 결과를 보여준다. 결 론: 유방암 환자의 방사선치료계획 방법들은 PTV에서 원하는 선량분포를 보여줬다. 그러나 TOMO는 좋은 Homogeneity index (HI), Conformity index (CI)와 Breast를 보호하는 장점이 있는 반면에 Lung과 Heart에서는 많은 피폭선량이 있음을 알 수 있기에 TOMO의 방사선치료계획시 주의해야 할 점으로 사료된다.

• 대한영상의학회지
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• 제83권1호
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• pp.246-251
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• 2022

Li-Fraumeni 증후군(이하 LFS)은 TP53 종양 억제 유전자의 생식세포 돌연변이로 인한 상염색체 우성 종양 유발 유전 질환이다. LFS 환자에서는 치료 후 치료와 관련된 암이 발생하기 때문에 LFS 환자에서 발생한 유방암의 치료에 있어 방사선 요법을 피해야 한다. 저자들은 LFS 환자에서 발생한 유방 육종의 방사선 및 화학 요법 치료 후 발생한 유방암 증례를 보고한다.

• Radiation Oncology Journal
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• 제29권4호
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• pp.277-282
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• 2011

Purpose: This study was performed to evaluate the change in the lumpectomy cavity volumes before and after whole breast radiation therapy (WBRT) and to identify factors associated with the change of volume. Materials and Methods: From September 2009 to April 2010, the computed tomography (CT) simulation data from 70 patients obtained before and after WBRT was evaluated. The lumpectomy cavity volumes were contoured based on surgical clips, seroma, and postoperative changes. Significant differences in the data from pre-WBRT CT and post-WBRT CT were assessed. Multiple variables were examined for correlation with volume reduction in the lumpectomy cavity. Results: The mean and median volume reduction in the lumpectomy cavity after WBRT were 17.6 $cm^3$ and 16.1 $cm^3$, respectively with the statistical significance (p < 0.001). The volume reduction in the lumpectomy cavity was inversely correlated with time from surgery to radiation therapy (R = 0.390). The presence of seroma was significantly associated with a volumetric change in the lumpectomy cavity after WBRT (p = 0.011). Conclusion: The volume of lumpectomy cavity reduced significantly after WBRT. As the time from surgery to the start ot WBRT increased, the volume reduction in the lumpectomy cavity during WBRT decreased. A strong correlation was observed between the presence of seroma and the reduced volume. To ensure appropriate coverage and to limit normal tissue exposure during boost irradiation in patients who has seroma at the time of starting WBRT, repeating CT simulation at boost planning is suggested.