• Radiation Oncology Journal
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• v.36 no.1
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• pp.54-62
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• 2018

Purpose: To investigate set-up errors, suggest the adequate planning target volume (PTV) margin and image-guided radiotherapy frequency in head and neck (H&N) cancer treated with intensity-modulated radiotherapy (IMRT) assessed by kV cone-beam computed tomography (CBCT). Methods: We analyzed 360 CBCTs in 60 patients with H&N cancer treated with IMRT. The target delineation was contoured according to ICRU62. PTVs were generated by adding a 3-5 mm margin in all directions to the respective clinical target volumes. The kV CBCT images were obtained at first three days of irradiation and weekly thereafter. The overall mean displacement, range, systematic (${\Sigma}$) and random (${\sigma}$) errors were calculated. Adequate PTV margins were calculated according to the van Herk formula ($2.5{\Sigma}+0.7r$). Results: The mean of set-up errors was less than 2 mm in any direction. The overall frequency of set-up displacements greater than 3 mm was 3.9% in medial-lateral (ML) direction, 8% in superior-inferior (SI) direction, and 15.5% in anterior-posterior (AP) direction. The range of translations shifts was 0-9 mm in ML direction, 0-5 mm in SI direction and 0-10 mm in AP direction, respectively. After systematic set-up errors correction, the adequate margin to overcome the problem of set-up errors was found to be less than 3 mm. Conclusion: Image-guided kV CBCT was effective for the evaluation of set-up accuracy in H&N cancer. The kV CBCT at first three fractions and followed-by weekly appears adequate for reducing significantly set-up errors in H&N cancer treated with IMRT technique. Finally, 3-5 mm PTV margins appear adequate and safe to overcome the problem of set-up errors.

• Korean Journal of Head & Neck Oncology
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• v.33 no.1
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• pp.79-83
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• 2017

Hemangioma is the most common benign tumor in neonatal and infant stage. In the head and neck region, the lesion mostly occurs in the masseter, trapezoidal or sternocleidomastoid muscle. Due to its rarity and non-specific symptoms, it is difficult to diagnose precisely. Intramuscular hemangioma can be misdiagnosed as sialolithiasis of the parotid gland. There are several treatment options for hemangiomas such as sclerotherapy, radiotherapy, embolization, and surgery. Of all these, definitive surgical resection is considered most effective in preventing future recurrence. Here we report a case of intramuscular hemangioma that was detected in the patient's right masseter muscle which was initially misdiagnosed as parotid sialolithiasis and was consequently managed with surgical resection.

• Korean Journal of Head & Neck Oncology
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• v.23 no.2
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• pp.188-191
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• 2007

Kimura disease is an uncommon chronic inflammatory disorder of unknown etiology. Clinically, patients present nontender subcutaneous swelling in the head and neck region. Peripheral eosinophilia, an elevated serum IgE are also present. The clinical course of Kimura disease is often progressive, and the main problem with treatment is disease recurrence. Treatment options in the recurrent cases range from observation to surgical excision, steroid therapy, and radiotherapy. We report a case of recurrent Kimura disease, initially thought to be chronic submandibular sialadenitis, along with the appropriate review.

• Journal of Yeungnam Medical Science
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• v.7 no.2
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• pp.109-114
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• 1990

The basic strategy of irradiation is to deliver a dose to the cancer that is high enough to make cancer cells incapable of reproduction, while keeping the doses to the various healthy tissues below tolerable levels. In order to improve local control and survival, as a boost therapy after external radiotherapy, high dose rate transcatheteric irradiation using remote control afterloading system(RALSTRON-20B) was used for twelve patients with head and neck cancers. Present results showed complete remission of cancer in 9 out of 12 patients without treatment related complications. Although this procedure is easy to operate, well trained skillful hand is essential for good results. Furthermore our experience suggested that meticulous treatment planning should be developed for better results.

• Radiation Oncology Journal
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• v.30 no.1
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• pp.36-42
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• 2012

Purpose: To evaluate the radial displacement of clinical target volume in the patients with node negative head and neck (H&N) cancer and to quantify the relative positional changes compared to that of normal healthy volunteers. Materials and Methods: Three node-negative H&N cancer patients and five healthy volunteers were enrolled in this study. For setup accuracy, neck thermoplastic masks and laser alignment were used in each of the acquired computed tomography (CT) images. Both groups had total three sequential CT images in every two weeks. The lymph node (LN) level of the neck was delineated based on the Radiation Therapy Oncology Group (RTOG) consensus guideline by one physician. We use the second cervical vertebra body as a reference point to match each CT image set. Each of the sequential CT images and delineated neck LN levels were fused with the primary image, then maximal radial displacement was measured at 1.5 cm intervals from skull base (SB) to caudal margin of LN level V, and the volume differences at each node level were quantified. Results: The mean radial displacements were 2.26 (${\pm}1.03$) mm in the control group and 3.05 (${\pm}1.97$) in the H&N cancer patients. There was a statistically significant difference between the groups in terms of the mean radial displacement (p = 0.03). In addition, the mean radial displacement increased with the distance from SB. As for the mean volume differences, there was no statistical significance between the two groups. Conclusion: This study suggests that a more generous radial margin should be applied to the lower part of the neck LN for better clinical target coverage and dose delivery.

• Korean Journal of Head & Neck Oncology
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• v.7 no.1
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• pp.45-51
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• 1991

최근 횡문근육종을 치료함에 있어서 수술적 요법, 방사선 치료, 강암 약물요법을 적절히 병행함으로써 치료에 따르는 후유증을 극소화하면서 괄목할만한 생존율 향상을 가져오게 되었다. 특히 두경부의 횡문근육종은 소아에서 다발하고 병소의 위치에 따라서 각각 다른 임상적 특성을 가지며 수술적 절제를 했을 때 기능 및 외견상 결손이 크므로 별도의 연구 대상이 되어 왔으며 수술적 방법보다는 방사선 치료 및 항암 약물요법이 강조되고 있다. 저자들은 1976년부터 1987년까지 두경부 횡문근육종으로 진단받고 연세 암센터에서 항암 약물요법 및 방사선 치료를 받은 22명의 환자를 대상으로 하여 발생 부위, 조직 병리, 병기별 분포 및 생존율, 치료 방법에 따른 생존율을 후향성으로 분석하였다. 22명의 환자중 10 세 미만이 12 예로 가장 많았고, 13명이 배아세포형이였으며, 임상병기는 병기 III 이 가장 많아서 14 예였다. 병소의 위치는 안와가 6명으로 가장 많았고, 뇌수막주변부가 7명 (상악동 3명, 중이도 2명, 비강 l명, 비인강 1명), 기타 9명 (경부 5명, 이하선 2명, check 2명) 이었다. 5년 무병 생존율은 안와 종양에서 가장 높아서 50% 였고, 안와외 두경부가 37.5%, 뇌수막주변부가 16.7% 로 가장 낮았으며, 낮은 병기(병기 III), 배아세포형, 항암 약물 요법 병용군에서 상대적으로 높은 생존율이 관찰되었다.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.9-15
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• 2003

Purpose: To introduce our early experience with intensity-modulated radiotherapy (IMRT) in the treatment of nasopharyngeal carcinoma. Methods and Materials: Eight patients who underwent IMRT for no disseminated nasopharyngeal carcinoma at the Asan Medical Center between September 2001 and November 2002 were evaluate by prospective analysis. According to the 1997 American Joint Committee on Cancer staging classification, 5 had Stage III, and 3 had Stage IVB disease. The IMRT plans were designed to be delivered as a 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) using the 'step and shoot' technique with a MLC (multileaf collimator). Daily fractions of 2.2-2.5Gy and 1.9-2Gy were prescribed and delivered to the GTV and CTV and clinically negative neck node, respectively. The prescribed dose was 70A-79.0Gy to the gross tumor volume (GTV), 60Gy to the clinical target volume (CTV) and metastatic nodal station, and 46Gy to the clinically negative neck. All patients also received weekly cisplatin during radiotherapy. Acute and late normal tissue effects were graded according to the Radiation Therapy Oncology Group (RTOG) radiation morbidity scoring criteria. Results: Follow-up period was ranging from 5 to 18 months. All patients showed complete response and loco-regional control rate was 100% but one patient died of malnutrition due to treatment related toxicity. There were no Grade 3 or 4 xerostomia and all patients had experienced improvement of salivary gland function. Conclusion: 'Simultaneous Modulated Accelerated Radiation Therapy' (SMART) boost intensity-modulated radiotherapy technique allows parotid sparing as evidenced both clinically and by dosimetry. Initial tumor response and loco-regional control was promising. It is clinically feasible. A larger population of patients and a long-term follow-up are needed to evaluate ultimate tumor control and late toxicity.

• Korean Journal of Head & Neck Oncology
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• v.10 no.2
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• pp.218-224
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• 1994

Soft tissue sarcoma of the head and neck is not frequent neoplasm, accounting for less than 1% of all malignant neoplasm in the region. The histological varieties include osteogenic sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, fibrosarcoma, tenosynovial sarcoma, angiosarcoma and chondrosarcoma. Rhabdomyosarcomas of the head and neck usually occur in children under the age of 10 years (over 70%) and rarely develop in adults over the age of 20 years. The prevalent sites of involvement include the orbit, nasal cavity, external ear, paranasal sinus and soft tissue of mouth and the primary location of tumor is considered to be one of the important prognostic factors. Before the 1960s, when surgical resection was the only method of treatment, the 5-year survival rate was less than 20%, but recently it has been greatly improved by the multimodality treatment, combining surgery with chemotherapy and radiation therapy. Here we treated a rhabdomyosarcoma woman with three cycles of high dose chemotherapy followed by radiation therapy. After the, completion of preoperative treatments, successful result of more than partial response was achieved. Three months later total maxillectomy and radical neck dissection was performed. There was no evidence of tumor infiltration in the resected tumor and regional lymphnodes but metastasized tumor cells in cervical lymphnodes were detected. Tumor cell infiltration was also found on the bone marrow biopsy to evaluate the pancytopenia which occurred during postoperative recovery. Two months later she died of secondary bone marrow failure. We think that this multimodality treatment combining pre-operative chemotherapy, radiotherapy and surgery might play an important role in curative resection and eyeball preservation in patients with rhabdomyosarcoma involving the eyeball.

• Korean Journal of Head & Neck Oncology
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• v.22 no.1
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• pp.47-50
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• 2006

Angiosarcoma is a rare and high aggressive malignant tumor originated from endothelial cell. Angiosarcoma has four clinical types that are in the scalp and face of old age, in chronic lymphedema, in previously irradiated sites, and malignant angioendothlioma. We report one case of angiosarcoma of the scalp in a 74-year-old male patient. The patient had $4.0{\times}4.5cm,\;4.0{\times}3.5cm$ sized, localized, asymmetric several dome-shaped nodule and plaque with crust and ulcer on the parieto-frontal area of the scalp. We performed wide excision and subsequently covered with split-thickness skin graft. Postoperatively the patient underwent radiotherapy for prevention of recurrence and he had been followed up for 1 year without evidence of recurrence.

• 대한두경부종양학회:학술대회논문집
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• 2009.05a
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• pp.70-70
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• 2009