• Asian Pacific Journal of Cancer Prevention
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• 제15권15호
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• pp.6415-6419
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• 2014

Purpose: To explore the relationship between SER (time between the start of any treatment and the end of radiation therapy) and the survival of patients with limited-stage small cell lung cancer. Materials and Methods: Between 2008 and 2013, 135 cases of limited-stage small cell lung cancer (LS-SCLC) treated with consecutively curative chemoradiotherapy were included in this retrospective analysis. In terms of SER, patients were divided into early radiotherapy group (SER<30 days, n=76) and late radiotherapy group ($SER{\geq}30$ days, n=59) with a cut-off of SER 30 days. Outcomes of the two groups were compared for overall survival. Results: For all analyzable patients, median follow-up time was 23.8 months and median overall survival time was 16.8 months. Although there was no significant differences in distant metastasis free survival between the two groups, patients in early radiotherapy group had a significantly better PFS (p=0.003) and OS (p=0.000). Conclusions: A short SER may be a good prognostic factor for LD-SCLC patients treated with concurrent chemoradiotherapy.

• Radiation Oncology Journal
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• 제36권3호
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• pp.241-247
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• 2018

Purpose: A hybrid-dynamic conformal arc therapy (HDCAT) technique consisting of a single half-rotated dynamic conformal arc beam and static field-in-field beams in two directions was designed and evaluated in terms of dosimetric benefits for radiotherapy of lung cancer. Materials and Methods: This planning study was performed in 20 lung cancer cases treated with the VERO system (BrainLAB AG, Feldkirchen, Germany). Dosimetric parameters of HDCAT plans were compared with those of three-dimensional conformal radiotherapy (3D-CRT) plans in terms of target volume coverage, dose conformity, and sparing of organs at risk. Results: HDCAT showed better dose conformity compared with 3D-CRT (conformity index: 0.74 ± 0.06 vs. 0.62 ± 0.06, p < 0.001). HDCAT significantly reduced the lung volume receiving more than 20 Gy (V₂₀: 21.4% ± 8.2% vs. 24.5% ± 8.8%, p < 0.001; V₃₀: 14.2% ± 6.1% vs. 15.1% ± 6.4%, p = 0.02; V₄₀: 8.8% ± 3.9% vs. 10.3% ± 4.5%, p < 0.001; and V₅₀: 5.7% ± 2.7% vs. 7.1% ± 3.2%, p < 0.001), V₄₀ and V₅₀ of the heart (V₄₀: 5.2 ± 3.9 Gy vs. 7.6 ± 5.5 Gy, p < 0.001; V₅₀: 1.8 ± 1.6 Gy vs. 3.1 ± 2.8 Gy, p = 0.001), and the maximum spinal cord dose (34.8 ± 9.4 Gy vs. 42.5 ± 7.8 Gy, p < 0.001) compared with 3D-CRT. Conclusions: HDCAT could achieve highly conformal target coverage and reduce the doses to critical organs such as the lung, heart, and spinal cord compared to 3D-CRT for the treatment of lung cancer patients.

• Radiation Oncology Journal
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• 제37권1호
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• pp.30-36
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• 2019

Purpose: This study aimed to identify the feasibility of the maximum standardized uptake value (SUVmax) on baseline 18F-fluorodeoxyglucose positron emission tomography-computed tomography (FDG PET/CT) as a predictive factor for prognosis in early stage primary lung cancer treated with stereotactic body radiotherapy (SBRT). Materials and Methods: Twenty-seven T1-3N0M0 primary lung cancer patients treated with curative SBRT between 2010 and 2018 were retrospectively evaluated. Four patients (14.8%) treated with SBRT to address residual tumor after wedge resection and one patient (3.7%) with local recurrence after resection were included. The SUVmax at baseline PET/CT was assessed to determine its relationship with prognosis after SBRT. Patients were divided into two groups based on maximum SUVmax on pre-treatment FDG PET/CT, estimated by receiver operating characteristic curve. Results: The median follow-up period was 17.7 months (range, 2.3 to 60.0 months). The actuarial 2-year local control, progression-free survival (PFS), and overall survival were 80.4%, 66.0%, and 78.2%, respectively. With regard to failure patterns, 5 patients exhibited local failure (in-field failure, 18.5%), 1 (3.7%) experienced regional nodal relapse, and other 2 (7.4%) developed distant failure. SUVmax was significantly correlated with progression (p = 0.08, optimal cut-off point SUVmax > 5.1). PFS was significantly influenced by pretreatment SUVmax (SUVmax > 5.1 vs. SUVmax ≤ 5.1; p = 0.012) and T stage (T1 vs. T2-3; p = 0.012). Conclusion: SUVmax at pre-treatment FDG PET/CT demonstrated a predictive value for PFS after SBRT for lung cancer.

• Radiation Oncology Journal
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• 제36권1호
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• pp.79-84
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• 2018

Deep inspiration breathing hold (DIBH) compared to free-breathing (FB) during radiotherapy (RT) has significantly decreased radiation dose to heart and has been one of the techniques adopted for patients with breast cancer. However, patients who are unable to make suitable deep inspiration breath may not be eligible for DIBH, yet still need to spare the heart and lung during breast cancer RT (left-sided RT in particular). Continuous positive airway pressure (CPAP) is a positive airway pressure ventilator, which keeps the airways continuously open and subsequently inflates the thorax resembling thoracic changes from DIBH. In this report, authors applied CPAP instead of FB during left-sided breast cancer RT including internal mammary node in a patient who was unable to tolerate DIBH, and substantially decreased radiation dose the heart and lung with CPAP compared to FB.

• 대한한의학회지
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• 제39권4호
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• pp.171-176
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• 2018

Background: Small cell lung cancer (SCLC) tends to grow more rapidly and spread much faster than non-small cell lung cancer (NSCLC). A concurrent combination of chemotherapy and thoracic radiotherapy is suggested as the standard conventional treatment, but it is more challenging for elderly patients having pulmonary and cardiovascular comorbidities. Case presentation: Here we present a case of an 80-year-old male, current smoker diagnosed with SCLC in limited stage T3N0M0 (36mm right upper lobe, satellite nodule) in Dec, 2015. The standard concurrent chemoradiotherapy was not available for his comorbidities, which included chronic obstructive pulmonary disease (COPD) and angina pectoris. Furthermore, he and his family refused the recommended chemotherapy or radiotherapy exclusively. Alternatively, he received various non-conventional treatments including local radiofrequency hyperthermia, mistletoe, and Traditional Korean medicine including acupuncture, moxibustion and herbs since Jan. 2016. Despite the progression in primary tumor size, there have been no other distant relapse so far, and the patient has been in stable condition ever since. Conclusion: We suggest that a combination of various alternative treatments could be a candidate for elderly patients intolerable to conventional cytotoxic treatments.

• 대한한의학회지
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• 제16권1호통권29호
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• pp.71-95
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• 1995

To be helpful to the treatment of pulmonary cancer with oriental medicine, we got clinical reports together and analyzed the data. The results were obtained as follows: 1. The treating methods could be summarized as three methods that were reinforcing vital energy, eliminating harmful Qi, and reinforcing vital energy with eliminating harmful Qi. The methods of reinforcing vital energy were supplementing Qi & Yin, increasing pahological heat & reinforcing kidney, augmenting Qi & blood, supplementing vital energy and strengthening fundermental energy, reinforcing spleen and increasing Qi, lubricate Yin and lung, and the other methods of eliminating harmful Qi were transforming pathological fluid and softening, clarifying heat and eliminating poison, dipersing lung and softening, toxicding and softening, guiding Qi and activating blood, clarifying heat and dispersing lung, guiding Qi and counteracting stress etc., and the methods of supplementing vital energy with eliminating poison were reinforcing spleen and transforming pathological fluid, increasing Qi and activating blood, supplementing Yin and clarifying heat, reinforcing spleen and dry the dampness, lubricating lung and transforming patholigical fluid and supplementing Qi and activating blood. 2. The oriental prescriptions used for pulmonary cancer were Chunkeum-Weekyungtang & Sohamhwingtang, Jinhayookgunjatang, Hyulboochukeotang, Bokbangkyogonamtang was reported to be effective in the treatment of metastasis. 3. Bokbangshinjingtang and haewool were applied for the complications of pulmonary cancer, Soshihotang for fever, hangamryung for tumor pain. Prunus ansu Komarov, Eriobotrya japonica Lirdley, Pyrrosiae lingua Farwel, Steomon japonica Miguel, Maximowiczia chinensis Ruprecht var, Morus bombycis Koidzumi for cough, Panax Pseudo-ginseng Wall. var, Bletilla striata Reichenbach f., Acacia catechu(兒茶) for hemoptysis, Lonicerae flos, Aspongopus chinensis(九香蟲) for chest pain, Cypsum Fibrosum, Gazella gutturosa, Scutellaria baicalensis Georgi, Gypsophila oldhamiana Miquel for fever, Lepidii semen descurainiae semen, Belamcanda chinensis D.C, Gnaphalium affine(佛耳草) for asthma. 4. For the reduction of side effect by chemotherapy and radiotherapy it was known that supplementing Qi was used chiefly for side effect of chemotherapy and augmenting Yin applied to side effect of radiotherapy. 5. The oriental presciptions were suggested for the side effect by chemotherapy and radiotherapy ; Sammaekaek(參麥液), Whaebokwontang(化瘀復元湯), Hwangjungomitang(黃精五味湯), Yukmijihwangtang(六味地黃湯), Hyangsayukgunjatang(香砂六君子湯), Samlyeekulsan for side effect by chemotherapy while Geumgweisingiwhan, Hwanglyentang(黃連湯), Hwanglyenhaedoktang(黃連解毒湯), Yangyeunchungpeitang(養陰淸肺湯), Idongtang(二冬湯), Jayeunkanghwatang(滋陰降火湯) for side effect by radiotherapy.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3257-3265
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• 2015

Background: Radiotherapy is an important treatment of choice for breast cancer patients after breast-conserving surgery, and we compare the feasibility of using dual arc volumetric modulated arc therapy (VMAT2), single arc volumetric modulated arc therapy (VMAT1) and Multi-beam Intensity Modulated Radiotherapy (M-IMRT) on patients after breast-conserving surgery. Materials and Methods: Thirty patients with breast cancer (half right-sided and half left-sided) treated by conservative lumpectomy and requiring whole breast radiotherapy with tumor bed boost were planned with three different radiotherapy techniques: 1) VMAT1; 2) VMAT2; 3) M-IMRT. The distributions for the planning target volume (PTV) and organs at risk (OARs) were compared. Dosimetries for all the techniques were compared. Results: All three techniques satisfied the dose constraint well. VMAT2 showed no obvious difference in the homogeneity index (HI) and conformity index (CI) of the PTV with respect to M-IMRT and VMAT1. VMAT2 clearly improved the treatment efficiency and can also decrease the mean dose and V5Gy of the contralateral lung. The mean dose and maximum dose of the spinal cord and contralateral breast were lower for VMAT2 than the other two techniques. The very low dose distribution (V1Gy) of the contralateral breast also showed great reduction in VMAT2 compared with the other two techniques. For the ipsilateral lung of right-sided breast cancer, the mean dose was decreased significantly in VMAT2 compared with VMAT1 and M-IMRT. The V20Gy and V30Gy of the ipsilateral lung of the left-sided breast cancer for VMAT2 showed obvious reduction compared with the other two techniques. The heart statistics of VMAT2 also decreased considerably compared to VMAT1 and M-IMRT. Conclusions: Compared to the other two techniques, the dual arc volumetric modulated arc therapy technique reduced radiation dose exposure to the organs at risk and maintained a reasonable target dose distribution.

• Radiation Oncology Journal
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• 제36권1호
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• pp.71-78
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• 2018

Purpose: To compare the dose distribution of three-dimensional conformal radiation therapy (3DCRT) with intensity-modulated radiation therapy (IMRT) for post-mastectomy radiotherapy (PMRT) to left chest wall. Materials and Methods: One hundred and seven patients were randomised for PMRT in 3DCRT group (n = 64) and IMRT group (n = 43). All patients received 50 Gy in 25 fractions. Planning target volume (PTV) parameters-$D_{near-max}$ ($D_2$), $D_{near-min}$ ($D_{98}$), $D_{mean}$, $V_{95}$, and $V_{107}$-homogeneity index (HI), and conformity index (CI) were compared. The mean doses of lung and heart, percentage volume of ipsilateral lung receiving 5 Gy ($V_5$), 20 Gy ($V_{20}$), and 55 Gy ($V_{55}$) and that of heart receiving 5 Gy ($V_5$), 25 Gy ($V_{25}$), and 45 Gy ($V_{45}$) were extracted from dose-volume histograms and compared. Results: PTV parameters were comparable between the two groups. CI was significantly improved with IMRT (1.127 vs. 1.254, p < 0.001) but HI was similar (0.094 vs. 0.096, p = 0.83) compared to 3DCRT. IMRT in comparison to 3DCRT significantly reduced the high-dose volumes of lung ($V_{20}$, 22.09% vs. 30.16%; $V_{55}$, 5.16% vs. 10.27%; p < 0.001) and heart ($V_{25}$, 4.59% vs. 9.19%; $V_{45}$, 1.85% vs. 7.09%; p < 0.001); mean dose of lung and heart (11.39 vs. 14.22 Gy and 4.57 vs. 8.96 Gy, respectively; p < 0.001) but not the low-dose volume ($V_5$ lung, 61.48% vs. 51.05%; $V_5$ heart, 31.02% vs. 23.27%; p < 0.001). Conclusions: For left sided breast cancer, IMRT significantly improves the conformity of plan and reduce the mean dose and high-dose volumes of ipsilateral lung and heart compared to 3DCRT, but 3DCRT is superior in terms of low-dose volume.

• Genomics & Informatics
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• 제6권1호
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• pp.36-43
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• 2008

Radiotherapy would be the choice of treatment for human cancers, because of high cost-effectiveness. However, a certain population of patients shows a resistance to radiotherapy and recurrence. In an effort to increase the efficacy of radiotherapy, many efforts were driven to find the genes causing the unresponsiveness to ionizing radiation. In this paper, we compared the gene expression profiles of two lung cancer cell lines, H460 and H1299, which showed differential responses to ionizing radiations. Each cell were irradiated at 2 Gy, and harvested after 0, 2, 4, 8, 12 and 24 hours to examine the expressions. Two-way ANOVA analysis on time-series experiments of two cells could select 2863 genes differentially expressed upon ionizing radiation among 32,321 genes in microarray (p<0.05). We classified these genes into 21 clusters by SOM clustering according to the interaction between cell types and time. Two SOM clusters were enriched with apoptosis-related genes in pathway analysis. One cluster contained higher levels of phosphatidyl inositol 3-phosphate kinase (PI3K) subunits in H1299, radio-resistant cells than H460, radiosensitive cells. TRAIL receptors were expressed in H460 cells while the decoy receptor for TRAIL was expressed in H1299 cells. From these results, we could characterize the differential responsiveness to ionizing radiation according to their differential expressions of apoptosis-related genes, which might be the candidates to increase the power of radiotherapy.

• Journal of Radiation Protection and Research
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• 제48권3호
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• pp.117-123
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• 2023

Background: We investigated the impact of 0.35 T magnetic field on dose calculation for non-small cell lung cancer (NSCLC) stereotactic ablative radiotherapy (SABR) in the ViewRay system (ViewRay Inc.), which features a simultaneous use of magnetic resonance imaging (MRI) to guide radiotherapy for an improved targeting of tumors. Materials and Methods: Here, we present a comprehensive analysis of the effects induced by the 0.35 T magnetic field on various characteristics of SABR plans including the plan qualities and dose calculation for the planning target volume, organs at risk, and outer/inner shells. Therefore, two SABR plans were set up, one with a 0.35 T magnetic field applied during radiotherapy and another in the absence of the field. The dosimetric parameters were calculated in both cases, and the plan quality indices were evaluated using a Monte Carlo algorithm based on a treatment planning system. Results and Discussion: Our findings showed no significant impact on dose calculation under the 0.35 T magnetic field for all analyzed parameters. Nonetheless, a significant enhancement in the dose was calculated on the skin surrounding the tumor when the 0.35 T magnetic field was applied during the radiotherapy. This was attributed to the electron return effect, which results from the deviation of the electrons ejected from tissues upon radiation due to Lorentz forces. These returned electrons re-enter the tissues, causing a local dose increase in the calculated dose. Conclusion: The present study highlights the impact of the 0.35 T magnetic field used for MRI in the ViewRay system for NSCLC SABR treatment, especially on the skin surrounding the tumors.