• Radiation Oncology Journal
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• 제3권1호
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• pp.51-58
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• 1985

외음부에서 발생하는 악성종양은 부인과 영역의 악성종양 중에서는 드물게 발생하는 것으로 알려져 있으며 치료에 있어서도 수술 또는 방사선치료 단독의 경우보다는 수술 후 보조적으로 방사선 치료를 시행하는 것이 더 효과적이고 치료율도 높은 것으로 알려져 있다. 이에 1971년 1월부터 1985년 4월 사이에 연세대학교 의과대학 치료방사선과에서 외음부 악성 종양으로 진단되어 방사선 치료를 받았던 15예에 대하여 후향성 분석을 시행한 바 다음과 같은 결과를 얻었기에 보고하는 바이다. 1. 15예의 외음부 종양 환자 중 4예는 수술요법 시행 후 보조적요법의 방사선 치료를 받았으며, 1예는 수술전 방사선 치료를 받았고, 나머지 10예는 근치적 목적의 방사선 치료를 받았다. 2. 방사선치료만을 시행한 군과 방사선치료 및 수술요법을 병행한 군과의 국소제어율을 비교하여 본 결과, 전 15예의 국소제어율은 $53\%(8/15)$였으며, 단지 방사선 치료만을 시행한 군에서는 $40\%$(4/10), 방사선 치료 및 수술요법을 병행한 군에서는 $80\%(4/5)$의 국소제어율을 보였다. 3. 치료 실패율은(국소적 잔존+국소재발 또는 원격전이) 단지 방사선 치료만을 시행한 군에서는 $70\%(7/10)$, 수술 후 방사선 치료를 시행한 군에서는$40\%(2/5)$의 성적을 보였으며, 치료실패 호발부위는 원발병소(외음부)였다.

• 대한방사선치료학회지
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• 제3권1호
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• pp.11-18
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• 1989

Brachytherapy is known to be a good modality to achieve local control as a boost treatment following limited external irradiation, which may reduce the external beam related complication particularly in head and neck cancer. The authors developed iridium-192 ribbons recently to replace the radium needles in the field of brachytherapy. Total of 48 cases of head and neck and pelvic-perineal cancer patients had been treated with Ir-192 ribbons during last two years from October 1986 to September 1988, and the results were analyzed to assess the applicability of the fabricated sources. The conclusion is as follows; 1. Iridium implant resulted excellent tumor control effect in clinical application. 2. Iridium is superior than radium and cecium in brachytherapy because of easier to use and lesser exposure to the personnel. 3. Afterloading technique is useful to modify dose distribution, to expand treatment site and method, and to develop interstitial hyperthermia.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제46권4호
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• pp.240-249
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• 2020

Objectives: Although the side effects of radiation therapy vary from mucositis to osteomyelitis depending on the dose of radiation therapy, to date, an experimental animal model has not yet been proposed. The aim of this study was to develop an animal model for assessing complications of irradiated bone, especially to quantify the dose of radiation needed to develop a rat model. Materials and Methods: Sixteen Sprague-Dawley rats aged seven weeks with a mean weight of 267.59 g were used. Atraumatic extraction of a right mandibular first molar was performed. At one week after the extraction, the rats were randomized into four groups and received a single dose of external radiation administered to the right lower jaw at a level of 14, 16, 18, or 20 Gy, respectively. Clinical alopecia with body weight changes were compared and bony volumetric analysis with micro-computed tomography (CT), histologic analysis with H&E were performed. Results: The progression of the skin alopecia was different depending on the irradiation dose. Micro-CT parameters including bone volume, bone volume/tissue volume, bone mineral density, and trabecular spaces, showed no significant differences. The progression of osteoradionecrosis (ORN) along with that of inflammation, fibrosis, and bone resorption, was found with increased osteoclast or fibrosis in the radiated group. As the radiation dose increases, osteoclast numbers begin to decrease and osteoclast tends to increase. Osteoclasts respond more sensitively to the radiation dose, and osteoblasts are degraded at doses above 18 Gy. Conclusion: A standardized animal model clinically comparable to ORN of the jaw is a valuable tool that can be used to examine the pathophysiology of the disease and trial any potential treatment modalities. We present a methodology for the use of an experimental rat model that incorporates a guideline regarding radiation dose.

• Radiation Oncology Journal
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• 제26권3호
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• pp.149-159
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• 2008

목 적: 본 연구는 자궁내막암 병기 $1{\sim}2$ 환자에 수술 후 방사선치료의 결과와 예후인자를 분석하여 향후 치료원칙을 결정하는 데 도움을 얻고자 시행하였다. 대상 및 방법: 1991년 1월부터 2005년 12월까지 이화여자대학교 의과대학부속병원에서 자궁내막암으로 진단받고 수술 후 방사선치료를 받은 병기 $1{\sim}2$환자를 대상으로 후향적 분석을 하였다. 전체 환자는 35명이었으며 17명은 자궁절제술과 양측 난소제거술을 시행하였고 18명은 완전한 수술적 병기의 수술을 시행하였다. 골반강 방사선치료를 받은 환자는 17명, 질강내근접치료를 받은 환자는 12명, 골반강 방사선치료와 질강내근접치료를 받은 환자는 6명이었다. 결 과: 추적기간의 중앙값은 54개월이었다. 전체 환자의 5년 생존율은 91.4%, 무병생존율은 81.7%이었다. 저위험군, 중간위험군, 고위험군의 위험군에 따른 5년 생존율은 각각 100%, 100%, 55.6%이었으며 무병생존율은 각각 100%, 70.0%, 45.7%이었다. 국소재발된 환자는 없었으며 5명(14%)에서 원격전이가 발생하였으며 호발부위는 폐, 뼈, 간, 부신, 전복강의 순이었다. 원격전이에 대한 단변량 통계분석에 따르면 위험군, 조직학적 세포형태와 조직학적 등급이 유의성이 있었으며, 다변량 통계분석에 따르면 조직학적 세포형태로서 유두형, 장액형, 그리고 투명세포암은 자궁내막양암과 샘암편평암에 비하여 원격전이율이 높고 생존율이 낮았다. 골반강 방사선치료에 의한 후유증은 장염이 30%에서 나타났으며 다음으로 직장염이었으나 대부분 등급 $1{\sim}2$로 등급 $3{\sim}4$의 후유증은 발생하지 않았다. 결 론: 수술 후 골반강 방사선치료 혹은 질강내근접치료를 시행한 자궁내막암 병기 $1{\sim}2$환자들의 경우 저위험군과 중간위험군은 국소제어율과 생존율이 높았으나, 고위험군은 골반강 방사선치료를 시행하여 국소제어율은 높으나 원격전이율이 높고 생존율이 낮았다. 따라서 고위험군은 방사선치료와 동시에 항암화학요법이 요구된다. 중간 위험군의 더 효율적인 치료를 위하여 많은 환자를 대상으로 골반강 방사선치료와 강내근접치료를 비교하는 전향적 무작위연구가 필요하다.

• 한국의학물리학회:학술대회논문집
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• 한국의학물리학회 2002년도 Proceedings
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• pp.100-102
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• 2002

The demand for a better immobilization device has been increased in the radiation oncology field. Especially, it is essential to have a reliable and practical immobilization tool for the whole body radiosurgery and the IMRT (intensity modulated radiation therapy). A useful method to immobilize the abdomen for the external beam radiation treatment is developed. The air-injected balloon blanket (AIBB) was designed as an immobilization device. As the air was injected into it, it pressed down the patient's abdomen and fixed the patient. The AIBB played a role not only to grab the patients' motion, but also to increase the patients' setup reproducibility. Patients' movements due to the respiration were reduced and the reconstruction could be maximized. The experimental results revealed that the AIBB could be used for the clinic.

• 한국의학물리학회지:의학물리
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• 제29권4호
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• pp.123-136
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• 2018

The complex dose distribution and dose transfer characteristics of intensity-modulated radiotherapy increase the importance of precise beam data measurement and review in the acceptance inspection and preparation stages. In this study, we propose a process map for the introduction and installation of high-precision radiotherapy devices and present items and guidelines for risk management at the acceptance test procedure (ATP) and commissioning stages. Based on the ATP of the Varian and Elekta linear accelerators, the ATP items were checked step by step and compared with the quality assurance (QA) test items of the AAPM TG-142 described for the medical accelerator QA. Based on the commissioning procedure, dose quality control protocol, and mechanical quality control protocol presented at international conferences, step-by-step check items and commissioning guidelines were derived. The risk management items at each stage were (1) 21 ionization chamber performance test items and 9 electrometer, cable, and connector inspection items related to the dosimetry system; (2) 34 mechanical and dose-checking items during ATP, 22 multileaf collimator (MLC) items, and 36 imaging system items; and (3) 28 items in the measurement preparation stage and 32 items in the measurement stage after commissioning. Because the items presented in these guidelines are limited in terms of special treatment, items and practitioners can be modified to reflect the clinical needs of the institution. During the system installation, it is recommended that at least two clinically qualified medical physicists (CQMP) perform a double check in compliance with the two-person rule. We expect that this result will be useful as a radiation safety management tool that can prevent radiation accidents at each stage during the introduction of radiotherapy and the system installation process.

• Radiation Oncology Journal
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• 제13권1호
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• pp.55-61
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• 1995

Purpose : Despite a development of therapeutic machines and advance in modern radiation therapy techniques, locally advanced cervical carcinoma has shown high rate of local failure and poor survival rate, Combination of chemotherapy and radiotherapy demonstrated benefit in improving local control and possibly the overall survival. Our study was performed to evaluate effect of concurrent chemoradiation on locally advanced uterine cervical cancer. Methods and Materials : Twenty six patients with locally advanced stage(FIGO stage IIB with ${\geq}5cm$ in diameter, III, IVA) were treated with combination of radiation therapy and concurrent cisplatinum between May of 1988 and September of 1993 at our hospital. Radiation therapy consisted of external irradiaton and 1-2 sessions of intracavitary irradiation. Cisplatinum was administered in bolus injection of 25mg/$m^2$ at weekly intervals during the course of external radiation therapy. Results : Of the 26 Patients, twenty-five patients were evaluable for estimation of response. Median follow-up period was 25 months with ranges from 3 to 73 months. Stage IIB, III, and IVA were 16, 5, 4 patients, respectively, Twenty patients were squamous cell carcinoma. Response was noted in all 25 patients: complete response(CR) in 17/25($68\%$), Partial response(PR) in 8/25($32\%$). Of the 24 patients except one who died of sepsis at 3 months follow-up, seventeen patients($70.8\%$) maintained local control in the pelvis: 16/17($94.1\%$) in CR, 1/17($14.3\%$) in PR. Fourteen of the 17 patients with CR are alive disease free on the completion of follow-up. Median survival is 28 months for CR and 15 months for PR. Analysis of 5-year survival by stage shows 11/16($59.8\%$) in IIB, 3/5($60.0\%$) in III, and 1/4($25.0\%$) in IVA. Overall 5-year survival rate was $55.2\%$. Ten patients recurred: 4 at locoregional, 3 in distant metastasis and 3 with locoregional and distant site. Toxicity by addition of cisplatinum was not excessive. Conclusion : Although the result of this study was obtained from small number of patients, it is rather encouraging in view of markedly improved response rate compared with the results of historical group.

• Radiation Oncology Journal
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• 제11권1호
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• pp.91-96
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• 1993

From September 1989 to June 1992,22 patients with nasopharyngeal carcinoma were treated in Asan Medical Center with an external beam of 60 Gy followed by a boost dose of 15 Gy HDR brachytherapy. There were 5 females and 17 males with median age of 44 years (range: 20-69 years). All patients were histologically confirmed and staged by physical examination, CT scan and/or MRI. By the AJCC TNM staging system, there were 2 patients with stge II (T2NO), 4 with stage III (T3NO, T1-3N1), and 16 with stage IV (T4 or N2-3). Four patients received chemotherapy with 5-FU and cisplatin prior to radiotherapy. All patients were followed up periodically by a telescopic examination and radiologic imaging study of CT scan or MRI with a median follow-up time of 13 months (range: 3-34 months). Twenty one patients showed a complete response ore month after completing therapy and one patient showed a complete response after three months. At the time of this analysis, seventeen patients remain alive without evidence of disease, but four patients developed distant metastasis and one patient died a month after treatment. The local control rate was $100{\%}$ in a median follow-up time of 13 months. The two year overall and disease free survival rates by the Kaplan-Meier method were $94{\%}$ and $67{\%}$, respectively. Serious radiation sequelae have not been observed yet. Although longer follow-up is needed, this retrospective analysis suggests that HDR brachytherap. given as a boost therapy for nasoharyngeal carcinoma may improve the local control. To reduce the incidence of distant metastasis, we need to develop a more effective systemic chemotherapy.

• Radiation Oncology Journal
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• 제36권2호
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• pp.139-146
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• 2018

Purpose: IBTR! 2.0 nomogram is web-based nomogram that predicts ipsilateral breast tumor recurrence (IBTR). We aimed to validate the IBTR! 2.0 using an external data set. Materials and Methods: The cohort consisted of 2,206 patients, who received breast conserving surgery and radiation therapy from 1992 to 2012 at our institution, where wide surgical excision is been routinely performed. Discrimination and calibration were used for assessing model performance. Patients with predicted 10-year IBTR risk based on an IBTR! 2.0 nomogram score of <3%, 3%-5%, 5%-10%, and >10% were assigned to groups 1, 2, 3, and 4, respectively. We also plotted calibration values to observe the actual IBTR rate against the nomogram-derived 10-year IBTR probabilities. Results: The median follow-up period was 73 months (range, 6 to 277 months). The area under the receiver operating characteristic curve was 0.607, showing poor accordance between the estimated and observed recurrence rate. Calibration plot confirmed that the IBTR! 2.0 nomogram predicted the 10-year IBTR risk higher than the observed IBTR rates in all groups. High discrepancies between nomogram IBTR predictions and observed IBTR rates were observed in overall risk groups. Compared with the original development dataset, our patients had fewer high grade tumors, less margin positivity, and less lymphovascular invasion, and more use of modern systemic therapies. Conclusions: IBTR! 2.0 nomogram seems to have the moderate discriminative ability with a tendency to over-estimating risk rate. Continued efforts are needed to ensure external applicability of published nomograms by validating the program using an external patient population.

• Radiation Oncology Journal
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• 제21권2호
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• pp.143-148
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• 2003

목적: 자궁경부암으로 진단을 받고 수술단독 치료만 시행 받은 후 재발암에서 방사선치료를 시행하고 생존율 및 실패양상을 알아보고자 하였다. 대상 및 방법: 1990년 1월부터 1999년 12월까지 계명대학교 동산의료원 방사선종양학과에선 초기(I, IIa) 자궁경부암으로 진단을 받고 수술 후 재발하여 방사선치료를 받은 환자 27명을 대상으로 하였다. 연령분포는 31세에서 70세로 평균 48세이며 수술 당시 병기 1기가 20명, 2기가 7명이었고 23명이 편평상피암이었고 4명은 선암이었다. 수술 후 재발까지의 기간은 2개월에서 90개월로 평균 29개월이었다. 재발부위로는 질 부위가 14명, 골반강이 9명, 복합재발이 4명이었다. 수술은 25명에서 전자궁적출술과 골반내림프절절제술을 시행하였으며 2명은 전자궁적출술만을 시행하였다. 방사선치료는 13명에서는 외부방사선치료만을 받았고 13명에서는 외부방사선치료와 질강내방사선 치료를 받았으며 1명은 질강내방사선치료만을 받았다. 방사선치료 후 추적관찰기간은 6개월에서 128개월로 중앙값 55개월이었다. 결과: 전체 환자의 5년 생존율과 5년 무병생존율은 각각 71.9$\%$, 68.2$\%$이었다. 재발부위에 따른 생존율의 차이가 통계적으로 유의하지는 않았으나 질 부위에만 재발하여 방사선치료를 받은 환자에서 가장 높은 5년 무병생존율을 나타내었다(5년 무병생존율, 질 부위에만 재발한 환자는 85.7$\%$, 질 부위를 제외한 골반부위에 재발한 환자 53.3$\%$, p=0.09). 재발시기에 따른 생존율의 차이는 보이지 않았다. 실패양상으로는 질 부위에만 재발하여 방사선치료를 받은 환자들에서 7$\%$의 국소재발만 있었고 골반강내에 재발하여 방사선치료를 받은 환자들은 국소재발이 주된 실패이었고 골반과 복벽, 복막 등에 같이 재발되었던 환자들은 방사선치료 후 원격전이가 주된 실패이었다. 방사선치료 후 3도 이상의 부작용은 없었다. 결론: 이상으로 볼 때, 초기 자궁경부암에서 수술단독치료 후 재발암에서는 방사선치료는 효과적이고 안전한 치료법이라고 생각되며 특히 수술 후 질 부위에만 재발한 경우에는 외부방사선치료와 질강내방사선치료로 좋은 생존율을 기대할 수 있겠다.