The recogition that the vast majority of patients with small cell lung cancer have distant metastatic disease at the time of diagnosis lead to the use of systemic chemotherapy and consequent major improvement in survival, but recently evaulated treatment strategies, integration of large field chest irradiation with chemotherapy lead to the improved the local control and relapse free survival in limited SCLC. Therefore, it is logical to combine the two modalities in an effort to maximize the therapeutic effect. Authors performed the combination chemotherapy of CAV (Cyclophosphamide, Adriamycin, an6 Vincristine) and radiotherapy of primary tumor and regional lymphatics with prophylatic cranial irradiation in 42 patients of limited SCLC, from Mar. 1978 to Dec. 1982 Seoul National University Hospital. The results are as follows : 1. CR and PR after 2 cycles chemotherapy is $7\%$ and $43\%$, respectively however, subsequent response to radiotherapy is $38\%$ and $43\%$ in CR and PR. 2. Overall median survival peroid is 8.6 months. 3. 1 year and 2 years survival rate is $46.3\%$ and $20.5\%$, respectively. 4. Incidence of proven brain metastasis is $5\%$.
Various techniques were evaluated to determine the best method for reducing small bowel involvement in pelvic irradiation. Fourteen patients receiving radiation in pelvic area were enrolled for this study. Five sets of small bowel images were obtained. Patients were positioned on a simulation couch with full bladder in prone and supine positions and 2 sets of images were taken. Then they were asked to empty their bladder and 2 sets of images were taken in prone and supine positions. A belly board device (BBD) was placed and one set of images was obtained. Using a software, the area of small bowel inside treatment field was contoured, measured, and analyzed. In both full and empty bladder cases, small bowel area reduction was observed in prone position as compared to supine position. Especially statistically significant reduction is noted in lateral film. An average decreases of 13% in PA and 26% in lateral direction were noted with bladder distention as compared to empty bladder. With the use of BBD for empty bladder, a significant reduction of $62.8{\pm}27.1%$ and $63.1{\pm}32.9%$ in PA and lateral directions were observed as compared to without BBD in prone position, respectively. In conclusion, the best sparing of small bowel concerning the area included in the treatment fields was achieved with BBD in prone position with empty bladder. However, further reduction is expected if the bladder was filled fully because the analysed data with empty vs full bladder study shows increased sparing of small bowel with distended bladder.
To evaluate natural history of ovarian dysgerminoma and role of radiation therapy in treatment of ovarian dysgerminoma, retrospective study was carried out in 5 nonirradiated cases and 20 irradiated cases. Conclusions are as follows: 1. Radiation therapy is essential in treatment of ovarian dysgerminoma. 2. Even in stage 1 a, significant recurrence rate is expected in surgery only group. 3. Even in recurrent cases, if adequate radiotherapy is given in stage 1-3, we can predict near complete curability and in stage 4, we can get considerable benefit. 4. Dysgerminoma beyond stage 2 is highly fatal without radiotherapy. 5. Involved field irradiation including whole abdomen and booster RT on bulky tumor area is sufficient in radiotherapy of stage 1, 2, 3, without paraaortic node involvement. Further mediastinal and supraclavicular irradiation is indicated in stage 4 or stage 1, 2, 3, with paraaortic involvement. 6. If bilateral salphingoophorectomy was done. Elective irradiation is recommended in any condition because preservation of ovarian function is not further needed. 7. In cases of small encapsulated stage 1a, We can delay post op. RT under close observation in order to preserve fertility.
The industrial techniques of ultrasound have been used in the various fields, such as cleaning, medical surgery, emulsification, cell disruption etc. Especially the application of cell disruption was interested in the field of disinfection process in water by ultrasonic irradiation. It has been recognized that the ultrasounds are irradiated in aqueous solution, cavitation bubbles are generated and shock waves of high temperature and pressure are emitted as the bubbles are developed and finally broken, which function as a energy source to promote reaction efficiencies of various kinds of chemical reactions such as disinfection reaction in water. Therefore, this study was performed to apply the ultrasound for the disinfection method of infected drinking raw water and to discuss the limiting factors such as pH, sample volume and reaction temperature influenced on the removal efficiency of E. coli from experimental analysis of the results obtained in bench-scale plant. For the experiments to measure the influence of reaction parameters in the ultrasonic disinfection process, escalated reactivity of aqueous solutions was excellent when pH in aqueous solution was low, and sample volume was small. On the contrary, the reactivity of disinfection became elevated when reaction temperature was high. It was found that the rate constant of disinfection reaction was applied by Chick's law, reaction kinetics of Chick's law was irreversible and pseudo-first order at all the tested conditions.As a conclusion it appeared that the technology using ultrasonic irradiation can be applied to the treatment of disinfection in infected water which are difficult to be treated by conventional methods.
Scatter-air ratios are used for the purpose of calculating scattered dose in the medium. The computation of the primary and the scattered dose separately is particularly useful in the dosimetry of irregular fields with shielding block in radiation field, dose distribution of scattered radiation using 18MeV Linear accelerator and Co-50 teletherapy measured. The effect of scattered radiation dose by protecting block was been ignored in radiation therapy, 2-3% of scattered radiation may be 90-200 cGy which could be influence vitial complications such as cataract, oligospermia or sterility. So that exect calculation of such scattered radiation especially for large field $\bar{c}$ small protection of vitial organ is very important. The purpose of this article is to calculate scattered radiation by protecting block exactly for irregular field $\bar{c}$ Linac or Co-60 irradiation and to applicate these data in clinical radiation field. Authors could obtain following results. 1. The lesser angle between shielding block showed more scattered radiation. 2. With decreasing distance between shielding blocks, the dependent of scattered radiation were increased. 3. Output of 18MeV Linear accelerator and Co-60 was related linear proportion on field size, but independent according to the size of shielding block in 18MeV Linear accelerator.
Proceedings of the Korean Society of Medical Physics Conference
/
2002.09a
/
pp.144-145
/
2002
Stereotactic radiotherapy is required to irradiate a small tumor accurately. The radiotherapy showing improves when making an accidental error little boundlessly. It is performed according to treatment planning that is established by the outside landmark of head. At present, when stereotactic radiotherapy for a head is done, the Leksell Flame is fixed on the head, and positioning based on the point and so on which it is in that fixed implement is performed. However, there are problems on the method done at present in the point such as reappearance when the fractionated irradiation method in which the Leksell Flame is removed and installed at every treatment is done because there are landmarks outside the head. Landmarks in the skull were decided, and that precision was examined for the purpose of the improvement of the radiation therapeutic gain. Linac-graphy with longitudinal and lateral view were taken with 6 MV photon beams. A distance to base point inside the skull, each film measured the angle from a center of the small irradiation field, and comparison was done. From the results, a large accidental error wasn't seen as a result of the measurement by every film. Stereotactic radiotherapy for a head treatment had an accidental error of about several millimeters when treatment positioning was done. Therefore, it was thought that there was no problem about an accidental error to arise by putting a landmark in the skull. And, because an accidental error was easy to discover, we thought that modification could be done easily. It was suggested that a landmark in the skull on thus study were useful for improvement of stereotactic radiotherapy.
Chu Sung Sil;Suh Chang Ok;Loh John J.K.;Chung Sang Sup
Radiation Oncology Journal
/
v.7
no.1
/
pp.101-112
/
1989
The treatment planning and dosimetry of small fields for stereotactic radiosurgery with 10 MV x-ray isocentrically mounted linear accelerator is presented. Special consideration in this study was given to the variation of absorbed dose with field size, the central axis percent depth doses and the combined moving beam dose distribution. The collimator scatter correction factors of small fields $(1\times1\~3\times3cm^2)$ were measured with ion chamber at a target chamber distance of 300cm where the projected fields were larger than the polystyrene buildup caps and it was calibrated with the tissue equivalent solid state detectors of small size (TLD, PLD, ESR and semiconductors). The central axis percent depth doses for $1\timesl\;and\;3\times3cm^2$ fields could be derived with the same acuracy by interpolating between measured values for larger fields and calculated zero area data, and it was also calibrated with semiconductor detectors. The agreement between experimental and calculated data was found to be under $2\%$ within the fields. The three dimensional dose planning of stereotactic focusing irradiation on small size tumor regions was performed with dose planning computer system (Therac 2300) and was verified with film dosimetry. The more the number of strips and the wider the angle of arc rotation, the larger were the dose delivered on tumor and the less the dose to surrounding the normal tissues. The circular cone, we designed, improves the alignment, minimizes the penumbra of the beam and formats ball shape of treatment area without stellate patterns. These dosimetric techniques can provide adequate physics background for stereotactic radiosurgery with small radiation fields and 10MV x-ray beam.
The treatment of tumors along curved surfaces with stationary electron beams using cone collimation may lead to non-uniform dose distributions due to a varying air gap between the cone surface and patient. For large tumors, more than one port may have to be used in irradiation of the chest wall, often leading to regions of high or low dose at the junction of the adjacent ports. Electron-beam arc therapy may elimination many of these fixed port problems. When treating breast tumors with electrons, the energy of the internal mammary port is usually higher than that of the chest wall port. Bolus is used to increase the skin dose or limit the range of the electrons. We invertiaged the effect of various arc beam parameters in the isodose distributions, and combined into a single arc port for adjacent fixed ports of different electron beam eneries. The higher fixed port energy would be used as the arc beam energy while the beam penetration in the lower energy region would be controlled by a proper thickness of bolus. We obtained the results of following: 1. It is more uniform dose distribution of electron to use rotation than stationary irradiation. 2. Increasing isocenter depth on arc irradiation, increased depth of maximum dose, reduction in surface dose and an increasing penetration of the linear portion of the curve. 3. The deeper penetration of the depth dose curve and higher X-ray background for the smaller field sized. 4. If the isocenter depth increase, the field effect is small. 5. The decreasing arc beam penetration with decreasing isocenter depth and the isocenter depth effect appears at a greater depth as the energy increases. 6. The addition of bolus produces a shift in the penetration that is the same for all depths leaving the shape of the curves unchanged. 7. Lead strips 5 mm thick were placed at both ends of the arc to produce a rapid dose drop-off.
In electron therapy, low melting point alloy is used for shaping of the field. Electron field shaping material affect the output factor as well as the collimator system. The output factors of electron beams for shaped fields from NELAC-1018 were measured using ionization chamber of Farmer type in water phantom. The output factors of electron beams depend on the incident energy, inherent collimator system and the size of shaped field. Obtained results were followings. 1. In the smaller applicator, output varied extremely according to extent of collimator opening. 2. The higher energy, the output is less varied according to treatment field at small field.
Purpose: To evaluate the efficacy of a belly-board device (BBD) in reducing the volume of small bowel during four-field pelvic irradiation. Materials and Methods: Twenty-two cancer patients (14 uterine cervical cancer, 6 rectal cancer, and 2 endometrial cancer) scheduled to receive pelvic irradiation were selected for this study. Two sets of CT images were taken with and without the belly-board device using the Siemens 16 channel CT scanner. All patients were set in the prone position. The CT images were transferred to a treatment planning system for dose calculation and volume measurements. The external surfaces of small bowel and the bladder were contoured on all CT scans and the 4-pelvic fields were added. The dose-volume-histogram of the bladder and small bowel, with and without the BBD, were plotted and analyzed. Results: In all patients, the total small bowel volume included in the irradiated fields was reduced when the BBD was used. The mean volume reduction was 35% (range, $1{\sim}79%$) and was statistically significant (p<0.001). The reduction in small bowel volume receiving $10{\sim}100%$ of the prescribed dose was statistically significant when the BBD was used in all cases. Almost no change in the total bladder volume involved was observed in the field (<8 cc, p=0.762). However, the bladder volume receiving 90% of the prescribed dose was 100% in 15/22 patients (68%) and $90{\sim}99%$ in 7/22 patients (32%) with the BBD. In comparison, the bladder volume receiving 90% of the prescribed dose was 100% in 10/22 patients (45%), $90{\sim}99%$ in 7/22 patients (32%), and $80{\sim}89%$ in 5/22 patients (23%) without the BBD. When the BBD was used, an increase in the bladder volume receiving a high dose range was observed Conclusion: This study shows that the use of a BBD for the treatment of cancer in the pelvic area significantly improves small bowel sparing. However, since the BBD pushed the bladder into the treatment field, the bladder volume receiving the high dose could increase. Therefore it is recommended to be considerate in using the BBD when bladder damage is of concern.
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