• 대한골관절종양학회지
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• 제13권1호
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• pp.14-21
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• 2007

Bone is a common site for metastatic spread from many kinds of malignancies. The morbidity associated with this metastatic spread can be significant, including severe pain. When it comes to spinal metastasis, occupying nearly 40% of skeletal metastases, the risks of complications, such as vertebral body collapse, nerve root impingement, or spinal cord compression, are also significant. Because of the necessity of preserving the integrity of the spinal column and the proximity of critical structures, surgical treatment has limitations when durable local control is desired. Radiotherapy, therefore, is often used as an adjunct treatment or as a sole treatment. A considerable limitation of standard radiotherapy is the reported recurrence rate or ineffective palliation of pain, either clinically or symptomatically. This may be due to limited radiation doses to tumor itself because of the proximity of critical structures. CyberKnife is an image-guided robotic radiosurgical system. The image guidance system includes a kilovoltage X-ray imaging source and amorphous silica detectors. The radiation delivery device is a mobile X-band linear accelerator (6 MV) mounted on a robotic arm. Highly conformal fields and hypofractionated radiotherapy schedules are increasingly being used as a means to achieve biologic dose escalation for body tumors. Therefore, we can give much higher doses to the targeted tumor volume with minimizing doses to the surrounding critical structures, resulting in more effective local control and less severe side effects, compared to conventional fractionated radiotherapy. A description of this technology and a review of clinical applications to bone metastases are detailed herein.

• Journal of Korean Neurosurgical Society
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• 제50권3호
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• pp.216-223
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• 2011

Objective : The purposes of this study are to estimate postoperative survival and ambulatory outcome and to identify prognostic factors thereafter of metastatic spinal tumors in a single institute. Methods : We reviewed the medical records of 182 patients who underwent surgery for a metastatic spinal tumor from January 1987 to January 2009 retrospectively. Twelve potential prognostic factors (age, gender, primary tumor, extent and location of spinal metastases, interval between primary tumor diagnosis and metastatic spinal cord compression, preoperative treatment, surgical approach and extent, preoperative Eastern Cooperative Oncology Group (ECOG) performance status, Nurick score, Tokuhashi and Tomita score) were investigated. Results : The median survival of the entire patients was 8 months. Of the 182 patients, 80 (44%) died within 6 months after surgery, 113 (62%) died within 1 year after surgery, 138 (76%) died within 2 years after surgery. Postoperatively 47 (26%) patients had improvement in ambulatory function, 126 (69%) had no change, and 9 (5%) had deterioration. On multivariate analysis, better ambulatory outcome was associated with being ambulatory before surgery (p=0.026) and lower preoperative ECOG score (p=0.016). Survival rate was affected by preoperative ECOG performance status (p<0.001) and Tomita score (p<0.001). Conclusion : Survival after metastatic spinal tumor surgery was dependent on preoperative ECOG performance status and Tomita score. The ambulatory functional outcomes after surgery were dependent on preoperative ambulatory status and preoperative ECOG performance status. Thus, prompt decompressive surgery may be warranted to improve patient's survival and gait, before general condition and ambulatory function of patient become worse.

• Radiation Oncology Journal
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• 제18권4호
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• pp.309-313
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• 2000

자궁 평활근육종의 경부림프절로의 전이는 지금까지 보고되지 않았으며 타 부위로의 전이 시에도 방사선치료는 드물게 이용되어왔다. 저자들은 자궁 평활근육종 환자에서 수술과 골반부 방사선치료를 시행 받고 10개월 후에 경부림프절 전이가 발생하여 인접한 후두주위공간, 척추골, 척추관을 함께 침습하였기에 방사선치료와 화학요법의 경험과 함께 보고하는 바이다. 전이된 종양은 수술이 불가능하여 방사선치료가 의뢰되었으며 총 6,000 Gy의 경부 방사선치료와 taxol과 carboplatin으로 화학요법을 시행하였다. 전이 암은 점차로 크기가 감소하여서 거의 만져지지 않을 정도로 되었다. 환자는 경부 방사선치료와 화학요법을 시행 받은 후 8개월간 척수압박증상을 발생하지 않았고, 연하곤란은 회복되어서 좋은 상태를 유지하였다. 광범위한 경부전이 암이 고선량 경부방사선치료와 화학요법에 좋은국소 반응을 보였기에 수술이 불가능한 전이성 평활근육종 환자에서 이 두 가지 치료법이 고려될 수도 있겠다.

• Journal of Korean Neurosurgical Society
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• 제59권2호
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• pp.83-90
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• 2016

Ependymomas occur in both the brain and spine. The prognosis of these tumors sometimes differs for different locations. The genetic landscape of ependymoma is very heterogeneous despite the similarity of histopathologic findings. In this review, we describe the genetic differences between spinal ependymomas and their intracranial counterparts to better understand their prognosis. From the literature review, many studies have reported that spinal cord ependymoma might be associated with NF2 mutation, NEFL overexpression, Merlin loss, and 9q gain. In myxopapillary ependymoma, NEFL and HOXB13 overexpression were reported to be associated. Prior studies have identified HIC-1 methylation, 4.1B deletion, and 4.1R loss as common features in intracranial ependymoma. Supratentorial ependymoma is usually characterized by NOTCH-1 mutation and p75 expression. TNC mutation, no hypermethylation of RASSF1A, and GFAP/NeuN expression may be diagnostic clues of posterior fossa ependymoma. Although MEN1, TP53, and PTEN mutations are rarely reported in ependymoma, they may be related to a poor prognosis, such as recurrence or metastasis. Spinal ependymoma has been found to be quite different from intracranial ependymoma in genetic studies, and the favorable prognosis in spinal ependymoma may be the result of the genetic differences. A more detailed understanding of these various genetic aberrations may enable the identification of more specific prognostic markers as well as the development of customized targeted therapies.

• 한국임상보건과학회지
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• 제2권2호
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• pp.133-147
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• 2014

Purpose. Radiation therapy for oncologic emergencies is an important modality in the management of cancer patients. The aim of the present study was to review the roles of RT in oncologic emergencies based on literature review. Methods. The oncologic emergencies requiring rapid treatment include superior vena cava syndrome, spinal cord compression, brain metastasis, and bone metastasis. We reviewed the literatures on the pathophysiology, diagnosis, and treatment of oncologic emergencies. Results. In this literature review, radiation therapy among treatment modalities for oncologic emergencies has been shown to be fast and very effective treatment modality for oncologic emergencies. Conclusions. Based on this review, we conclude that the literature provides support for the role of radiation therapy in the situation of oncologic emergencies. As the number of cancer patients increase, the prevalence of oncologic emergencies will increase. In the future, the development of RT techniques will provide the improvement of not only patient's quality of life but also the survival.

• The Korean Journal of Pain
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• 제1권2호
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• pp.177-180
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• 1988

Transsacral neurolytic block with 2.5ml of phenol in glycerine or bupivacaine was performed in 6 patients with malignant diseases and a patient with sphincter spasm of bladder due to spinal cord injury. Pain relief was satisfactory in all patints except one patient with very low pain threshold. In one patient, second transsacral neurolytic block alone was not sufficient because of widespread pain along distant metastasis of the malignant disease, although the first block was satisfactory. The complications include transient motor weakness(4), voiding difficulty(1), subarachnoid puncture(1), and epidural venous puncture(1), but they were all spontaneously recovered within a sbort period of time and did not give any limitation to the block.

• Tuberculosis and Respiratory Diseases
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• 제75권4호
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• pp.165-169
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• 2013

An inflammatory myofibroblastic tumor (IMT) is a rare disease entity reported to arise in various organs. It is thought to be a neoplastic or reactive inflammatory condition, controversially. The treatment of choice for myofibroblastic tumor is surgery, and recurrence is known to be rare. The optimal treatment method is not well-known for patients ineligible for surgery. We report a 47-year-old patient with aggressive recurrent IMT of the lungs. The patient had been admitted for an evaluation of back-pain two years after a complete resection of pulmonary IMT. Radiation therapy was performed for multiple bone recurrences, and the symptoms were improved. However the patient presented again with aggravated back-pain six months later. High-dose steroid and non-steroidal anti-inflammatory drugs were administered, but the disease progressed aggressively, resulting in spinal cord compression and metastasis to intra-abdominal organs. This is a very rare case of aggressively recurrent pulmonary IMT with multi-organ metastasis.

• Journal of Yeungnam Medical Science
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• 제30권2호
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• pp.116-119
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• 2013

A burnt-out prostate cancer tumor is a very rare clinical entity. The term 'burnt-out' refers to a primary tumor that has spontaneously and nearly completely regressed without treatment. Since metastasis of prostate cancer is usually encountered in the presence of advanced disease, distant metastasis with an undetectable primary tumor is very rare. We report herein a case of a burnt-out prostate cancer tumor that metastasized to the thoracic (T) spine and caused cord compression. A 66-year-old man visited the Emergency Department due to weakness of both legs for the past two days. His blood and urine tests were normal at the time. His spine magnetic resonance imaging (MRI) scans looked like bone metastasis that involved the T-7 vertebral body and a posterior element, and caused spinal cord compression. Other images, including from the brain MRI, neck/chest/abdomino-pelvic computed tomography (CT) scan and 18F-fluorodeoxyglucose (FDG)-positron emission tomography (PET) and endoscopy, revealed no lesions that suggested malignancy. After total corpectomy T-7 and screw fixation/fusion at T5 to T10, the pathology report revealed a metastatic carcinoma that was strongly positive for prostate-specific antigen (PSA). The serum PSA value was 1.5 ng/mL. The transrectal 12-core prostate biopsy and ultrasonography showed no definitive hypoechoic lesion, but one specimen had slight (only 1%) adenocarcinoma with a Gleason score of 6 (3+3). The final diagnosis was burned-out prostate cancer with an initial normal PSA value. Although metastatic disease with an unknown primary origin was confirmed, a more aggressive approach in seeking the primary origin could provide a more specific treatment strategy and greater clinical benefit to patients.

• Asian Pacific Journal of Cancer Prevention
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• 제17권9호
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• pp.4335-4340
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• 2016

Background: Bone metastasis is a single condition but presents with various patterns and severities. Skeletal-related events (SREs) deteriorate overall performance status and reduce quality of life. However, guidelines for early detection and management are limited. This study includes a survey of the prevalence of bone metastasis in cases with common cancers in Thailand as well as a focus on survival patterns and SREs. Materials and Methods: A retrospective cohort analysis was conducted using a database of the Chiang Mai Cancer Registry and the Musculoskeletal Tumor Registry of the OLARN Center, Chiang Mai University. The prevalence of bone metastasis from each type of primary cancer was noted and time-to-event analysis was performed to estimate cancer survival rates after bone metastasis. Results: There were 29,447 cases of the ten most common cancers in Thailand, accounting for 82.2% of the entire cancer registry entries during the study period. Among those cases, there were 2,263 with bone metastases, accounting for 7.68% of entries. Bone metastasis from lung, liver, breast, cervix and prostate are common in the Thai population, accounting for 83.4% of all positive cases. The median survival time of all was 6 months. Of the bone metastases, 48.9% required therapeutic intervention, including treatment of spinal cord and nerve root compression, pathological fractures, and bone pain. Conclusions: The frequency of the top five types of bone metastasis in Thailand were different from the frequencies in other countries, but corresponded to the relative prevalence of the cancers in Thailand and osteophilic properties of each cancer. The results of this study support the establishment of country specific guidelines for primary cancer identification with skeletal lesions of unknown origin. In addition, further clinical studies of the top five bone metastases should be performed to develop guidelines for optimal patient management during palliative care.

• 대한방사선기술학회지:방사선기술과학
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• 제36권4호
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• pp.327-335
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• 2013

토모테라피를 이용한 3D-CRT의 임상적 적용 사례를 Helical mode와 Direct mode로 구분하여 치료목적에 따라 주 치료목적 및 보조적 치료 목적으로 적용된 사례에 대해 선량학적 평가를 시행하였고 기존의 라이낙을 이용한 기법과 종양의 발생 부위별 선량학적 분포의 차이를 비교, 분석하였다. 선량 분석은 육종, 뇌척수조사, 유방, 뇌, 췌장, 척추 전이, 상대정맥 증후군, 식도에 토모테라피를 이용한 3차원 입체조형 방사선치료로 치료받는 환자 8명을 대상으로 Helical mode와 Direct mode, 라이낙 기반 치료 기법 사이의 치료 계획 간 비교하였으며, 선량분석은 선량 체적 히스토그램과 등선량 곡선을 이용했다. Direct mode로 치료한 육종, 뇌척수 조사 환자의 경우 체적 길이에 대한 영향을 받지 않아 Junction effect 없는 선량적 결과를 보여주었고, 유방 환자는 D 99%와 D 95%의 선량에서 $49.2{\pm}0.4$ Gy와 $49.9{\pm}0.4$ Gy, V 105%와 V 110%에서 0%로 나타났다. Helical mode로 치료한 뇌, 췌장, 척추 전이 환자에서 dosimetric block을 이용해 정상조직의 선량을 효과적으로 줄일 수 있었고, 상대정맥 증후군 환자는 선량 제한(dose limitation)을 통해 방사선 치료를 재 실시해도 척수선량을 38 Gy이하로 효과적으로 제한할 수 있었다. 식도 환자에서는 기존에 다른 기법과 함께 추가조사 목적으로 사용하여 총 척수선량을 45 Gy 이하로 하고 폐의 V 20%을 20% 이하로 제한할 수 있었다. 토모테라피를 이용한 3차원 입체조형치료는 기존 선형가속기를 이용한 3차원 입체조형 방사선치료에 비해 선량적으로 제한되는 부분을 개선해주고 임상적으로 적절한 선량분포를 구현하는데 효과적인 방법 중의 하나라고 사료된다.