• Radiation Oncology Journal
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• 제34권2호
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• pp.96-105
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• 2016

Purpose: The standard radiation dose for patients with locally rectal cancer treated with preoperative chemoradiotherapy is 45-50 Gy in 25-28 fractions. We aimed to assess whether a difference exists within this dose fractionation range. Materials and Methods: A retrospective analysis was performed to compare three dose fractionation schedules. Patients received 50 Gy in 25 fractions (group A), 50.4 Gy in 28 fractions (group B), or 45 Gy in 25 fractions (group C) to the whole pelvis, as well as concurrent 5-fluorouracil. Radical resection was scheduled for 8 weeks after concurrent chemoradiotherapy. Results: Between September 2010 and August 2013, 175 patients were treated with preoperative chemoradiotherapy at our institution. Among those patients, 154 were eligible for analysis (55, 50, and 49 patients in groups A, B, and C, respectively). After the median follow-up period of 29 months (range, 5 to 48 months), no differences were found between the 3 groups regarding pathologic complete remission rate, tumor regression grade, treatment-related toxicity, 2-year locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival, or overall survival. The circumferential resection margin width was a prognostic factor for 2-year locoregional recurrence-free survival, whereas ypN category was associated with distant metastasis-free survival, disease-free survival, and overall survival. High tumor regression grading score was correlated with 2-year distant metastasis-free survival and disease-free survival in univariate analysis. Conclusion: Three different radiation dose fractionation schedules, within the dose range recommended by the National Comprehensive Cancer Network, had no impact on pathologic tumor regression and early clinical outcome for locally advanced rectal cancer.

• Radiation Oncology Journal
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• 제16권4호
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• pp.357-366
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• 1998

Brachytherapy is an essential part of radiotherapy for uterine cervical cancer. The low dose rate (LDR) regimen has been the major technique of intracavitary therapy for cervical cancer. However, there has been an expansion in the last 20 years of high dose rate (HDR) machines using Ir-192 sources. Since 1979, HDR brachytherapy has been used for the treatment of uterine cervical cancer in Korea. The number of institutions employing HDR has been increasing, while the number of low dose rate system has been constant. In 1995, there was a total 27 HDR brachytherapy units installed and 1258 cases of patients with cervical cancer were treated with HDR Most common regimens of HDR brachytherapy are total dose of 30-39 Gy at point A with 10-13 fractions in three fractions per week. 24-32 Gy with 6-8 fractions in two fractions per week, and 30-35 Gy with 6-7 fractions in two fractions per week. The average fractionation regimen of HDR brachytherapy is about 8 fractions of 4.1 Gy each to Point A. In Korea, treatment results for HDR brachytherapy are comparable with the LDR series and appears to be a safe and effective alternative to LDR therapy for the treatment of cervical carcinoma. Studies from the major centers report the five-year survival rate of cervical cancer as. 78-86$\%$ for Stage 1, 68-85$\%$ for stage 11, and 38-56$\%$ for Stage III. World-wide questionnaire study and Japanese questionnaire survey of multiple institutions showed no survival difference in any stages and dose-rate effect ratio (HDR/LDR) was calculated to be 0.54 to 0.58. However the optimum treatment doses and fractionation schemes appropriate to generate clinical results comparable to conventional LDR schemes have yet to be standardized. In conclusion, HDR intracavitary radiotherapy is increasingly practiced in Korea and an effective treatment modality for cervical cancer. To determine the optimum radiotherapy dose and fractionation schedule, a nation-wide prospective study is necessary in Korea. In addition, standardization of HDR application (clinical, computer algorithms, and dosimetric aspects) is necessary.

• Radiation Oncology Journal
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• 제4권1호
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• pp.67-73
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• 1986

1978년 1월부터 1985년 12월까지 경희의대 부속병원 치료방사선과에서 상행정맥 증후군으로 방사선치료를 받은 환자 21명을 대상으로, 분할조사방법과 치료 총선량에 따른 초기종상의 완화와 치료에 대한 반응 및 생존율을 관찰하여 다음과 같은 결과를 얻었다. 1) 고 선량 치료군에서는 $54.5\%(6/11)$에서 치료 $1\~2$일 후에 증상의 판화를 보였으며 $81.7\%(9/11)$에서 치료 $3\~4$일내에 증상의 완화를 나타내었다. 2) 일반분할조사가 각각 $29\%,\;50\%$를 나타낸 것보다는 월등히 많은 환자에서 조기에 증상완화를 보였으나 두 군간의 생존율에는 유의한 차이가 없었다. 3) 치료후의 반응 판정에서는 총 선량 3,000c0y이상 치료한 군에서는 대부분이 반응을 나타냈으나, 3,000cGy이하를 치료한 군의 5예에서는 모두 반응을 나타내지 않았다.

• Radiation Oncology Journal
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• 제12권3호
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• pp.387-392
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• 1994

Purpose : This study was done to confirm the reference point variation according to variation in applicator configuration in each fractioation of HDR ICR. Materials and Methods : We analyzed the treatment planning of HDRICR for 33 uterine cervical cancer patients treated in department of therapeutic radiology from January 1992 to February 1992. Analysis was done with respect to three view points-Interfractionation A point variation, interfractionation bladder and rectum dose ratio variation, interfractionation treatment volume variation. Interfractionation A point variation was defined as difference between maximum and minimum distance from fixed rectal point to A point in each patient. Interfractionation bladder and rectum dose ratio variation was defined as difference between maximum and minimum dose ratio of bladder or rectum to A point dose in each patient, Interfractionation treatment volume variation was defined as difference between miximum and minimum treatment volume which absorbed over the described dose-that is, 350 cGy or 400 cGy-in each patient. Results The mean of distance from rectum to A point was 4.44cm, and the mean of interfractionation distance variation was 1.14 cm in right side,1.09 cm in left side. The mean of bladder and rectum dose ratio was $63.8\%$ and $63.1\%$ and the mean of interfractionation variation was $14.9\%$ and $15.8\%$ respectively. With fixed planning administration of same planning to all fractionations as in first fractionation planning-mean of bladder and rectum dose ratio was $64.9\%$ and $72.3\%$.and the mean of interfraction variation was $28.1\%$ and $48.1\%$ reapectively. The mean of treatment volume was $84.15cm^3$ and the interfractionation variation was $21.47cm^2$. Conclusion : From these data, it was confirmed that there should be adapted planning for every fractionation ,and that confirmation device installed in ICR room would reduce the interfractionation variation due to more stable applicator configuration.

• Journal of Yeungnam Medical Science
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• 제4권1호
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• pp.25-32
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• 1987

전복부조사에 대한 X-선의 영향을 체중과 말초혈액 변화를 분석하여 적정 분할회수 및 치료기간설정에 응용하기 위하여 도합 160마리의 백색마우스를 두개의 조사군으로 나누어 제1군은 100cGy과, 제2군은 200cGy으로 나누고 일령이 $30{\pm}3$일로서 체중은 수컷이 $25{\pm}2gm$, 암컷은 $23{\pm}1gm$의 동수를 재료로 하여 방사선조사를 시행한 후, 체중의 변화와 말초혈액 변화를 분석하여 다음과 같은 결과를 얻었다. 체중과 혈색소의 변화는 성별이나 분할조사량에 따른 현저한 차이를 발견할 수 없었다. 백혈구의 감소는 3,000cGy에서 최소치를 나타내었으며 암, 수 모두에서 100cGy군에 비해 200cGy군에서 현저하였다. 감별백혈구의 변화는 조사선량이 증가함에 따라 암, 수 모두에서 임파구의 감소가 급격하였으나 호중구는 이와 반대로 증가함을 보였으며 이런 변화는 일회 조사량이 더 많은 제1군에서 현저하였다. 위의 결과를 종합하여 보면 방사선조사 자체로 인한 체중과 혈색소의 변화는 일회조사량이나 총 조사기간에 따른 차이를 발견할 수 없었으며 일회조사량이 많은 경우에 백혈구의 감소가 더 현저하였으며 이는 주로 임파구의 감소에 기인하며 이와는 반대로 호중구의 비율증가가 나타났다. 실험적으로 분할조사량의 선정에 말초혈액상에 미치는 영향이 큼을 보여주어 실제 치료에서 분할조사량의 올바른 책정이 중요함을 시사하였다.

• Biotechnology and Bioprocess Engineering:BBE
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• 제9권1호
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• pp.65-68
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• 2004

The purpose of the present study was to examine the efficacy and mechanism of fraction IV cold ethanol fractionation and pasteurization (60$^{\circ}C$ heat treatment for 10 h), involved in the manufacture of albumin from human plasma, in the removal and/or inactivation of the hepatitis A virus (HAV). Samples from the relevant stages of the production process were spiked with HAV and the amount of virus in each fraction then quantified using a 50% tissue culture infectious dose (TCID$\_$50/). HAV was effectively partitioned from albumin during the fraction IV cold ethanol fractionation with a log reduction factor of 3.43. Pasteurization was also found to be a robust and effective step in inactivating HAV, where the titers were reduced from an initial titer of 7.60 log TCID$\_$50/ to undetectable levels within 5 h of treatment. The log reduction factor achieved during pasteurization was $\geq$4.76. Therefore, the current results indicate that the production process for albumin has sufficient HAV reducing capacity to achieve a high margin of virus safety.

• Asian Pacific Journal of Cancer Prevention
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• 제16권16호
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• pp.7167-7170
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• 2015

Background: Although 3D image based brachytherapy is currently the standard of treatment in cervical cancer, most of the centres in developing countries still practice orthogonal intracavitary brachytherapy due to financial constraints. The quest for optimum dose and fractionation schedule in high dose rate (HDR) intracavitary brachytherapy (ICBT) is still ongoing. While the American Brachytherapy Society recommends four to eight fractions of each less than 7.5 Gy, there are some studies demonstrating similar efficacy and comparable toxicity with higher doses per fraction. Objective: To assess the treatment efficacy and late complications of HDR ICBT with 9 Gy per fraction in two fractions. Materials and Methods: This is a prospective institutional study in Southern India carried on from $1^{st}$ June 2012 to $31^{st}$ July 2014. In this period, 76 patients of cervical cancer satisfying our inclusion criteria were treated with concurrent chemo-radiation following ICBT with 9 Gy per fraction in two fractions, five to seven days apart. Results: The median follow-up period in the study was 24 months (range 10.6 - 31.2 months). The 2 year actuarial local control rate, disease-free survival and overall survival were 88.1%, 84.2% and 81.8% respectively. Although 38.2% patients suffered from late toxicity, only 3 patients had grade III late toxicity. Conclusions: In our experience, HDR brachytherapy with 9 Gy per fraction in two fractions is an effective dose fractionation for the treatment of cervical cancer with acceptable toxicity.

• Radiation Oncology Journal
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• 제23권3호
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• pp.143-156
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• 2005

목적: 고선량률 강내근접치료와 외부방사선의 병합치료는 자궁경부암의 표준치료법이지만, 최적의 병합 방식 및 선량 분할 스케줄은 아직 정해지지 않고 있다. 부분적으로는 이에 영향을 미치는 인자들의 다양성 및 기존의 문헌들의 방사선 선량에 관한 자세한 정보 부족을 그 이유로 들 수 있다. 이에 본 연구는 고선량률 강내근접치료에 대한 풍부한 경험을 바탕으로 단일기관에서 비교적 균일한 치료를 받은 많은 수의 환자 모집단을 대상으로 이들 다양한 인자들 및 방사선치료에 대한 자세한 분석을 통해서 최적의 방사선치료를 위한 지침을 얻고자 하였다. 대상 및 방법: 1990년부터 1996년까지 연세암센터에서 고선량률 강내근접치료 및 외부방사선치료로 자궁경부암에 대한 근치적 치료를 받은 743명의 환자들을 대상으로 하였으며, 중앙추적관찰 기간은 52개월이었다. FIGO 병기 분포는 IB 198명, IIA 77명, IIB 364명, IIIA 7명, IIIB 89명, IVA 8명이었다. 전골반방사선 선량은 $23.4\~59.4$ Gy (중앙값 45 Gy)의 분포를 보였으며, 진단 시 종양의 크기 및 외부방사선치료에 대한 종양의 반응에 따라서 그 시기를 조절하는 중앙차폐는 495예에서 시행되었으며, 그 시기는 $14.4\~43.2$ Gy (중앙값 36.0 Gy)로 비교적 광범위하고 다양한 분포를 보였다. 강내근접치료와 외부방사선치료의 분할 선량 차이를 극복하기 위해 생물학적 유효선량(Biologically Effective Dose, BED) 개념을 적용하였으며, 종양 및 정상 조직에 대한 $\alpha/\beta$비는 각각 10 및 3으로 하였다. 모든 개별 환자의 직장 전벽 및 방광 흡수선량을 분석하였고, 합병증 및 골반제어율과의 상관 관계를 규명하고자 하였다. 이외에도 방사선치료 스케줄에 영향을 미칠 수 있는 인자들인 총 치료기간, 강내근접치료의 분할 선량 크기, 주치의의 선호도에 따른 치료 스케줄 차이 등도 함께 고려하여 분석하였다. 결과: 전체 환자에서 RTOG Grade 1-4독성 발생률은 $33.1\%$였다. 전체 환자의 5년 골반제어율은 $83\%$로 분석되었다. 중앙차폐이전 외부방사선선량과 강내근접치료의 합산 BED값(=MD-BED $Gy_{\alpha/\beta}$은 $\alpha/\beta$=10인 경우 $62.0\~121.9\;Gy_{10}$ (중앙값: $93.0\;Gy_{10}$)의 분포를, ${\alpha/\beta}=3$인 경우 $93.6\~187.3\;Gy_3$ (중앙값=$137.6\;Gy_3$ )의 분포를 보였다. MD-BED $Gy_3$는 직장합병증 발생과의 관계는 통계적으로 유의하였고, 방광합병증과는 유의하지 않았다. 직장합병증과의 연관성은 MD-BED $Gy_3$보다 개별 환자의 직장전벽 총 선량 BED값인 R-BED $Gy_3$가 훨씬 더 높았다. 요도카테터 풍선의 후방지점이 대변하는 방광의 총 선량 BED값인 V-BED $Gy_3$도 방광합병증과 경향성 테스트에서 통계적 유의성을 보였다. 하지만, 어떠한 방사선선량도 골반제어율과 의미 있는 상관관계를 보이지 않았다. 본 기관에서 주치의의 선호도에 따라 강내근접치료가 외부방사선치료의 중간에 시행되는 형태인 샌드위치기법과 외부방사선치료 후반부에 시행되는 순차적 기법으로 구분하였을 때, 두 방식간 치료성적 및 합병증의 차이는 없었다. 총 치료기간에 대한 분석에서는 치료기간이 길어질수록 재발 위험이 커지는 경향을 보였으나, 나이 및 병기, 종양의 크기, MD-BED $Gy_{10}$ 등의 예후 인자를 보정한 다변량분석에서는 치료기간이 100일 이상인 경우에만 통계적으로 유의하게 증가하였다. 강내근접치료 분할선량 크기인 3 Gy와 5 Gy 사이에 골반제어율 및 합병증의 차이는 없었다. 결론: 자궁경부암의 최적방사선치료 스케줄에 대한 지침을 세우기 어렵게 만드는 가장 중요한 이유는 강내근접치료가 갖는 선량분포 특성에서 기인하는 방사선선량-골반제어율 상관 관계의 부재 및 개별 종양의 방사선에 대한 반응 속도가 환자마다 크게 다를 수 있다는 점이다. 따라서 전체적인 원칙과 함께 개인화된 맞춤치료가 필요하다. 치료 지침에 영향을 미칠 수 있는 요소들의 복합적인 고려도 중요하다고 할 수 있겠다. 합병증 발생이 우려되는 경우 생물학적 유효선량을 낮추기 위해 적절한 조기 중앙차폐 및 강내근접치료의 분할선량 크기 감소를 고려해볼 수 있다.

• Archives of Plastic Surgery
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• 제42권5호
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• pp.588-595
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• 2015

Background Radiotherapy treatment after keloidectomy is known to be an effective method for reducing the rate of recurrence. However, to date, the appropriate total radiation dose and fractionation have not yet been confirmed. The authors performed a retrospective analysis to identify the appropriate radiation dose and fractionation in post-keloidectomy radiotherapy. Methods From May 2000 to February 2011, postoperative radiotherapy was performed on 39 lesions in 28 patients after total keloidectomy. The keloid lesions were confined to the ear lobes. Between May 2000 and May 2004, 14 keloids were treated with surgical excision, followed by a total radiation dose of 1,200 cGy in three fractions over four to five days (group 1). Between June 2004 to February 2011, 25 keloids were treated with surgical excision, followed by a total radiation dose of 1,500 cGy in three fractions over four to five days (group 2). Patients were given a survey asking them to report their experiences regarding reoperation, recurrence of symptoms, recurrence of the lesion, and satisfaction with the operation. Results Of the 28 patients who were treated, 20 underwent follow-up. Group 2 had more cases showing elevation with erythematous changes, whereas group 1 had more cases showing progressive stages of elevation than group 2. These differences were statistically significant. Moreover, a correlation was observed between the level of keloid elevation and the extent of symptoms. Conclusions We suggest 1,500 cGy of radiation in three fractions following keloidectomy for ear lobe keloids. A further randomized study is needed to assess the recurrence of keloids after radiotherapy.

• Journal of Microbiology and Biotechnology
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• 제10권6호
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• pp.858-864
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• 2000

The purpose of the present study was to examine the efficacy and mechanism of the fraction IV cold ethanol fractionation and pasteurization ($60^{\circ}C$ heat treatment for 10h) steps, involved in the manufacture of albumin from human plasma, in the removal and/or inactivation of blood-born viruses. A variety of experimental model viruses for human pathogenic viruses, including the Bovine viral diarrhoea virus (BVDV), Bovine herpes virus (BHV), Murine encephalomyocarditis virus (EMCV), and Porcine parvovirus (PPV), were selected for this study. Samples from the relevant stages of the production process were spiked with the viruses, and the amount of virus in each fraction was then quantified using a 50% tissue culture infectious dose ($TCID_{50}$). The mechanism of reduction for the enveloped viruses (BHV and BVDV) during fraction IV fractionation was inactivation rather than partitioning, however, it was partitioning in the case of the non-enveloped viruses (EMCV and PPV). The log reduction factors achieved during fraction IV fractionation were ${\geq}6.9$ BHV, $\geq5.2$ for BBDV, 4.9 for EMC, and 4.0 for PPV. Pasteurization was found to be a robust and effective step in inactivating the enveloped viruses as well as EMCV. The log reduction factors achieved during pasteurization were $\geq7.0$ for BHV, $\geq6.1$ for BVDV, $\geq6.3$ for EMCV, and 1.7 for PPV. These results indicate that the production process for albumin has sufficient virus-reducing capacity to achieve a high margin for virus safety.