• Radiation Oncology Journal
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• 제33권2호
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• pp.75-82
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• 2015

Purpose: We evaluated the prognostic significance of T3 subtypes and the role of adjuvant radiotherapy in patients with resected the American Joint Committee on Cancer stage IIB T3N0M0 non-small cell lung cancer (NSCLC). Materials and Methods: T3N0 NSCLC patients who underwent resection from January 1990 to October 2009 (n = 102) were enrolled and categorized into 6 subgroups according to the extent of invasion: parietal pleura chest wall invasion, mediastinal pleural invasion, diaphragm invasion, separated tumor nodules in the same lobe, endobronchial tumor <2 cm distal to the carina, and tumor-associated collapse. Results: The median overall survival (OS) and disease-free survival (DFS) were 55.3 months and 51.2 months, respectively. In postoperative T3N0M0 patients, the tumor size was a significant prognostic factor for survival (OS, p = 0.035 and DFS, p = 0.035, respectively). Patients with endobronchial tumors within 2 cm of the carina also showed better OS and DFS than those in the other T3 subtypes (p = 0.018 and p = 0.016, respectively). However, adjuvant radiotherapy did not cause any improvement in survival (OS, p = 0.518 and DFS, p = 0.463, respectively). Only patients with mediastinal pleural invasion (n = 25) demonstrated improved OS and DFS after adjuvant radiotherapy (n = 18) (p = 0.012 and p = 0.040, respectively). Conclusion: The T3N0 NSCLC subtype that showed the most favorable prognosis is the one with endobronchial tumors within 2 cm of the carina. Adjuvant radiotherapy is not effective in improving survival outcome in resected T3N0 NSCLC.

• 대한방사선기술학회지:방사선기술과학
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• 제39권3호
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• pp.391-397
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• 2016

저병기 폐암은 정위적 체부 방사선치료 방식이 높은 효과를 나타내지만, 호흡에 의한 움직임으로 인해 정확한 선량의 조사가 쉽지 않다. 이에 본 연구는 움직이는 표적을 대상으로 영상획득 방식에 따른 체적을 분석하고, 체적 설정방식 및 호흡주기에 따른 선량을 유리선량계를 이용하여 평가하였다. 그 결과, 체적 획득의 경우 4D CT가 $10.4cm^3$로 실제 체적인 $12.3cm^3$에 가장 근접한 결과를 나타냈다. 선량평가에서는 ITV가 처방선량 10, 15, 20 Gy에서 각각 10.82, 16.88, 21.90 Gy로 가장 높은 값을 보였으며, RGRT가 좀 더 높은 값을 나타내었으나 호흡주기에 따른 결과는 유의한 차이를 나타내지 않았다. 따라서 움직이는 종양의 치료 시 4D CT를 이용하여 영상을 획득 후 ITV를 설정하여 RGRT방식으로 치료하는 것이 유리할 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권9호
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• pp.4091-4094
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• 2014

Background: This study used the receiver operating characteristic curve (ROC) to analyze Surveillance, Epidemiology and End Results (SEER) bronchioaveolar carcinoma data to identify predictive models and potential disparity in outcomes. Materials and Methods: Socio-economic, staging and treatment factors were assessed. For the risk modeling, each factor was fitted by a Generalized Linear Model to predict cause specific survival. The area under the ROC was computed. Similar strata were combined to construct the most parsimonious models. A random sampling algorithm was used to estimate modeling errors. Risk of cause specific death was computed for the predictors for comparison. Results: There were 7,309 patients included in this study. The mean follow up time (S.D.) was 24.2 (20) months. Female patients outnumbered male ones 3:2. The mean (S.D.) age was 70.1 (10.6) years. Stage was the most predictive factor of outcome (ROC area of 0.76). After optimization, several strata were fused, with a comparable ROC area of 0.75. There was a 4% additional risk of death associated with lower county family income, African American race, rural residency and lower than 25% county college graduate. Radiotherapy had not been used in 2/3 of patients with stage III disease. Conclusions: There are socio-economic disparities in cause specific survival. Under-use of radiotherapy may have contributed to poor outcome. Improving education, access and rates of radiotherapy use may improve outcome.

• Radiation Oncology Journal
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• 제5권2호
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• pp.119-129
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• 1987

With the introduction of X-rays of higher energy that have higher penetrability, it has become possible to treat the deep-seated tumor with increased local control rate. But at the same time it has incrased the damage to the deep seated organs, especially to the lung which is known to be the less radiotolerable tissue in the body. This study analyses the 66 patients who were exposed to the irradiation of the lung, and examines the development of radiation pneumonitis and its related factors. The results of the study are summarized as follows: 1, The 66 patients were consisted of 40 cases of lung cancer, 15 cases of breast cancer and 11 cases of mediastinal tumors. There were 37 males and 29 females with the male to female ratio 1.3: 1. A male to female ratio in the lung cancer was 3: 1. 2. Among 66 patients, 26 patients $(39\%)$ developed the radiographical changes of acute radiation pneumonitis and 13 out of 26 patients $(50\%)$ showed the clinical features of acute radiation pneumonitis. 3. The onest of acute radiation pneumonitis ranged from 10 days to 6 months after the completion of radiotherapy. 4. There was a statistically significant close relationship between the development of radiation pneumonitis and the radiation dose. 5. As the irradiated lung volume increased, the development of radiation pneumonitis increased. But the statistical significance was not strong. 6. The increased incidence of radiation pneumonitis was observed when the chemotherapy was given before or concomittantly with radiotherapy. 7 There was no significant correlation between the development of radiation pneumonitis and the age, smoking and the presence of underlying lung disease.

• Tuberculosis and Respiratory Diseases
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• 제84권2호
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• pp.148-158
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• 2021

Background: Radiotherapy is a common treatment option for lung or esophageal cancer, particularly when surgery is not feasible for patients with poor lung function. However, radiotherapy can affect pulmonary function and thereby induce pneumonitis or pneumonia, which can be fatal in patients with respiratory impairment. The purpose of this study is to evaluate if reductions in pulmonary function after radiotherapy can be minimized through simultaneous pulmonary rehabilitation (PR). Methods: In this matched case control study, we retrospectively analyzed patients who had undergone radiotherapy for thoracic malignant disease between January 2018 and June 2019. We analyzed results from pulmonary function tests and 6-minute walking tests (6MWT) conducted within the six months before and after radiotherapy treatment. Results: In total, results from 144 patients were analyzed, with 11 of the patients receiving PR and radiotherapy simultaneously. Of the 133 patients in the control group, 33 were matched with 11 patients in the PR group. Changes in forced expiratory volume in one second (FEV₁) and FEV₁/forced vital capacity were significantly different between the PR group and the matched control group (240 mL vs. -10 mL, p=0.017 and 5.5% vs. 1.0%, p=0.038, respectively). The median distance of 6MWT in the PR group also increased significantly, from 407.5 m to 493.0 m after radiotherapy (p=0.017). Conclusion: Simultaneous PR improved pulmonary function, particularly in measures of FEV₁, and exercise capacity for patients with lung or esophageal cancer even after radiotherapy treatment. These findings may provide an important base of knowledge for further large population studies with long-term follow-up analysis in the identification of the PR's effects during thoracic radiotherapy.

• 한국방사선학회논문지
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• 제9권6호
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• pp.393-401
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• 2015

폐암에 대한 방사선치료는 단독치료 또는 병용치료 시에 효과적인 치료이다. 연구에 의하면 최적의 방사선치료 이용률은 61%에서 74% 범위로 추정되고 있으나, 우리나라의 방사선치료 이용률은 낮은 것으로 조사되어 이에 대한 연구가 필요하다. 본 연구는 부산, 경남 지역에서 폐암환자의 방사선치료 이용률을 조사하여 방사선 이용의 적절성을 평가하고 방사선치료 이용관련 인자를 밝히고자 하는 것이다. 본 연구는 폐암으로 진단된 부산, 경남 지역 인구를 대상으로 하였다. 연구를 위하여 2개의 병원에 등록된 환자 1,036명의 환자 자료를 수집하여 최종적으로 연구에 적합한 897명을 대상으로 연구를 수행하였다. 연구는 적정 이용비율과 실제 방사선치료 비율을 비교하였고, 방사선치료 이용의 적정성과 관련인자를 확인하고자 하였다. 연구대상자 897명 중에서 503명(56%)은 내과적 치료가 시행되었고, 394명 (44%)는 방사선치료가 시행되었다. 전체 폐암환자의 방사선치료 이용률은 42%이었다. 조직학적 분류에 의한 비소세포 폐암의 비율은 33%이었고, 소세포 폐암은 90%이었다. 폐암의 방사선치료 이용과 관련 인자는 연령, 조직학적 유형, 임상병기, 의뢰의사, 임상검사이었다. 부위(site)별 방사선치료 이용률을 비교했을 때 근치적 흉부치료는 42%이었고, 완화적 치료는 26%이었다. 조직학적 유형의 비교에서 소세포 폐암의 이용률은 낮았고 특히 병기 III기에서 이용률은 가장 낮았다. 부산, 경남지역에서 방사선치료의 이용률은 적정한 이용률 보다 낮게 나타났다. 이용률 차이는 환자요인, 종양요인, 의료 서비스 요인으로 설명할 수 있었다. 이용률 개선을 위해서는 아웃리치 서비스(outreach service) 프로그램의 개발과 다 학제적 팀의 활성화가 필요하다.

• 한국환경성돌연변이발암원학회지
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• 제18권1호
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• pp.9-14
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• 1998

By far, the largest known preventable cause of cancer is cigarette smoking. The percentage of cancer deaths in Korea due to tobacco is still increasing. Smoking cigarette at an early age has become more common among women. Tobacco consumption is related causally to cancer to the lung, mouth, larynx, esophagus, bladder, kidney, uterine cervix, and pancreas. Recently, several studies demonstrated that there is very strong correlation between cigarette smoking and p53 mutations in lung cancer, head and neck cancer, and bladder cancer. The recent findings of cigarette smoking and cancer, p53 and bcl-2 mutations, adverse effects of smoking on the effects of radiotherapy, and benefits of quitting will be discussed.

• 대한두경부종양학회지
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• 제8권1호
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• pp.25-30
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• 1992

The causes of treatment failure in head and neck cancer are locoregional recurrence, distant metastasis and second primary cancer. The favorite sites of second primary cancer are head and neck, lung and esophagus. But, the incidence of stomach cancer in Korea is the highest of all, high incidence of stomach cancer is expected in head and neck cancer patients. We experienced 2 cases of stomach cancer after successful treatment of primary head and neck cancer at Kang Nam St. Mary's hospital. The first case was a 60-year-old male with nasopharyngeal non-keratinizing carcinoma(stage III, T1N1M0). He received three cycles of induction chemotherapy including cisplatin and 5-fluorouracil followed by radiotherapy which resulted in complete response. Five months after completion of radiotherapy. stomach adenocarcinoma(stage IV, T4N2M1) was diagnosed. He received one cycle of FAM chemotherapy and died 4 months after diagnosis of stomach cancer. The second case was a 50-year-old male with pyriform sinus squamous cell carcinoma(stage II, T2N0M0). He received curative partial pharyngolaryngectomy followed by radiotherapy which result in free of disease. Four months after completion of radiotherapy. stomach adenocarcinoma(stage IV, T4N2M1) was diagnosed. Bypass gastrojejunostomy was performed. The screening test for stomach cancer including upper gastrointestinal X-xay series and/or endoscope of the stomach should be performed periodically for the patients with head and neck cancer in Korea.

• Tuberculosis and Respiratory Diseases
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• 제50권6호
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• pp.718-725
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• 2001

세침흡인생검을 통한 폐암의 파종성 체벽 전이는 매우 드물기는 하나 환자의 예후를 현저히 악화시킬 수 있는 매우 심각한 합병증이다. 그러나 그 보고가 매우 드문데, 본 저자등은 2예를 경험하여 이를 성공적으로 치료하였기에 문헌고찰과 함께 보고하고자 한다. 43세 여자환자는 선암 IB로 수술 후 2년후에 이식성 체벽 전이암이 발생하여 이를 종양 적출술 및 방사선 치료를 하였다. 다른 65세 남자환자는 편평상피세포암 IB로 수술을 시행한 8개월 후 무통성 체벽 전이암이 발생하여 종양 적출술과 방사선 치료를 병행하였다. 그 후 이들은 체벽의 이식성 전이암을 제거한지 각각 15개월과 37개월이 지난 현재까지 생존해 있다. 아직까지 세침흡인 생검 후 발생한 암의 이식성 체벽전이에 대한 확립된 치료 지침은 없으나, 그간의 문헌의 고찰 및 본 저자등의 경험을 비추어 암 적출술과 방사선 치료를 병행하였을 경우 성공적으로 치료될 수 있을 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권3호
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• pp.909-914
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• 2012

Background: Gefitinib, a tyrosine kinase inhibitor (TKI) of epidermal growth factor receptor (EGFR), is used both as a single drug and concurrently with whole brain radiotherapy (WBRT) the standard treatment for brain metastases (BM), and is reported to be effective in a few small studies of patients with BM from non-small-cell lung cancer (NSCLC). However, no study has compared the two treatment modalities. This retrospective analysis was conducted to compare the efficacy of gefitinib alone with gefitinib plus concomitant WBRT in treatment of BM from NSCLC. Methods: We retrospectively reviewed 90 patients with BM from NSCLC who received gefitinib alone (250mg/day, gefitinib group) or with concomitant WBRT (40Gy/20f/4w, gefitinib-WBRT group) between September 2005 and September 2009 at Sun Yat-Sen University Cancer Center. Forty-five patients were in each group. Results: The objective response rate of BM was significantly higher in gefitinib-WBRT group (64.4%) compared with gefitinib group (26.7%, P<0.001). The disease control rate of BM was 71.1% in gefitinib-WBRT group and 42.2% in gefitinib group (P=0.006). The median time to progression of BM was 10.6 months in gefitinib-WBRT group and 6.57 months in gefitinib group (P<0.001). The median overall survival(OS) of gefitinib-WBRT and gefitinib alone group was 23.40 months and 14.83 months, respectively (HR, 0.432, P=0.002). Conclusion: Gefitinib plus concomitant WBRT had higher response rate of BM and significant improvement in OS compared with gefitinib alone in treatment of BM from NSCLC.