• Title/Summary/Keyword: breast cancer patients

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EGFR and HER2 Expression in Papillary Thyroid Carcinoma

  • Kim, Yong-Seon;Kim, Jeong-Soo;Kim, Yong-Seok
    • Journal of Endocrine Surgery
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    • v.18 no.4
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    • pp.228-235
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    • 2018
  • Purpose: The epidermal growth factor receptor (EGFR) family plays a crucial role in the growth of malignant tumors. EGFR and human EGFR 2 (HER2) protein overexpression are associated with an unfavorable prognosis and are important therapeutic targets in breast cancer. The aim of this study was to evaluate the relationship between EGFR and HER2 expression and clinicopathological factors in papillary thyroid carcinoma (PTC) at a single institution. Methods: A total of 129 consecutive patients with PTC were enrolled in this study and underwent thyroid surgery between October 2013 and February 2015. EGFR and HER2 protein expression was evaluated in the 129 primary tumors by immunohistochemistry, and the results were compared with the clinicopathological features. Results: Of the 129 PTC tumors, 20 (15.5%) were HER2 positive, and 109 (84.5%) were HER2 negative. Moreover, EGFR positivity were observed in 111 (86%) tumors. The mean age of the patients was $46.3{\pm}11.9years$ (range, 20-74 years), and the mean tumor size was $1.08{\pm}0.75cm$ (range, 0.2-3.5 cm). Tumor size, extrathyroidal extension, histological subtype, and TNM stage were not significantly associated with EGFR or HER2 expression. Meanwhile, high Ki-67 labeling index was significantly associated with EGFR expression (P=0.002), HER2 expression was significantly associated with younger age (${\leq}45years$) and cervical lymph node metastasis. Conclusion: Based on our data, it is not clear whether EGFR and HER2 expression is associated with tumor aggressiveness in PTC.

Survey on the Side Effects of the Vesicant Chemotherapy (정맥으로 투여하는 발포성 항암제의 합병증)

  • Choi Eun-Sook;Kim Keum-Soon;Joo Myung-Soon;Kim Bok-Ja
    • Journal of Korean Academy of Fundamentals of Nursing
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    • v.7 no.3
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    • pp.415-428
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    • 2000
  • The purpose of this study was to identify side effects of the vesicant chemotherapy. The study was designed to be a descriptive survey. The subjects of this study were 88 patients with various types of cancer, primary lung cancer(25.0%), advanced gastric cancer(25.0%), breast cancer(20.5%), etc. The mean age was 44.8 years old(range: 16-68). The questionnaire was completed by nurses of the outpatient unit and chemotherapy ward, and intravenous nurse specialist. The results of the study were as follows: 1) Chemotherapy was administered with a 23G scalp needle and 24G insyte. Injection site was dorsum of hands(64.7%), cephalic vein(19.3%). Successful rate for the first attempt was 88.6%. The first & second cycle chemotherapy was 29.5% each.. Mainly used drugs were Navelbine(34.1%), Adriamycin(20.5%). 2) Venous Problems after chemotherapy were pain(13.6%) incurred by venous, mainly due to the administration of Navelbine; redness at the inravenous site(12.5%) and itching sense 2.3% Non-venous problems were nausea (18.2%), dullness(14.8%), vomiting(8.0%), facial flushing(6.8%), anxiety(5.7%). Subjective discomforts after chemotherapy were generalized arm pain at the injection side(14.8%), dizziness(6.8%), weakness(5.7%) and general bodyache(5.7%). Systemic anaphylactic reaction and extravasation did not occur. 3) Non-venous problem after chemotherapy were nausea, vomiting & anorexia. Frequency of chemotherapy related to side effects were itching, facial flushing, and nausea(p< .05). Day of chemotherapy related to side effects were nausea & vomiting(p< .05). Site of chemotherapy related to side effects were redness(p< .05). Frequency of venipuncture related to side effects were redness(p< .05). Conclusively, cancer chemotherapy patients have had some venous problem. They need appropriate venous access devices for chemotherapy. And other non-venous problem will be managed appropriately. Further research was required to identify the rate of venous complication or side effects of vesicant chemotherapy.

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Impact of Respiratory Motion on Breast Cancer Intensity-modulated Radiation Therapy (유방암 세기조절방사선치료에서의 호흡운동 영향)

  • Chung, Weon Kuu;Chung, Mijoo;Shin, Dong Oh;Kim, Dong Wook
    • Progress in Medical Physics
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    • v.27 no.2
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    • pp.93-97
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    • 2016
  • In this study, we evaluate the effect of respiration on the dose distribution in patient target volume (PTV) during intensity-modulated radiation therapy (IMRT) and research methods to reduce this impact. The dose distributions, homogeneity index (HI), coverage index (CVI), and conformity index of the PTV, which is calculated from the dose-volume histogram (DVH), are compared between the maximum intensity projection (MIP) image-based plan and other images at respiration phases of 30%, 60% and 90%. In addition, the reducing effect of complication caused by patient respiration is estimated in the case of a bolus and the expended PTV on the skin. The HI is increased by approximately twice, and the CVI is relatively decreased without the bolus at other respiration phases. With the bolus and expended PTV, the change in the dose distribution of the PTV is relatively small with patient respiration. Therefore, the usage of the bolus and expended PTV can be considered as one of the methods to improve the accuracy of IMRT in the treatment of breast cancer patients with respiratory motion.

Clinical Application Analysis of 3D-CRT Methods Using Tomotherapy (토모테라피를 이용한 3차원 입체 조형 치료의 임상적 적용 분석)

  • Cho, Kang-Chul;Kim, Joo-Ho;Kim, Hun-Kyum;Ahn, Seung-Kwon;Lee, Sang-Kyoo;Yoon, Jong-Won;Cho, Jeong-Hee;Lee, Jong-Seok;Yoo, Beong-Gyu
    • Journal of radiological science and technology
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    • v.36 no.4
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    • pp.327-335
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    • 2013
  • This study investigates the case of clinical application for TomoDirect 3D-CRT(TD-3D) and TomoHelical 3D-CRT(TH-3D) with evaluating dose distribution for clinical application in each case. Treatment plans were created for 8 patients who had 3 dimensional conformal radiation therapy using TD-3D and TH-3D mode. Each patients were treated for sarcoma, CSI(craniospinal irradiaion), breast, brain, pancreas, spine metastasis, SVC syndrome and esophagus. DVH(dose volume histogram) and isodose curve were used for comparison of each treatment modality. TD-3D shows better dose distribution over the irradiation field without junction effect because TD-3D was not influenced by target length for sarcoma and CSI case. In breast case, dosimetric results of CTV, the average value of D 99%, D 95% were $49.2{\pm}0.4$ Gy, $49.9{\pm}0.4$ Gy and V 105%, V 110% were 0%, respectively. TH-3D with the dosimetric block decreased dose of normal organ in brain, pancreas, spine metastasis case. SCV syndrome also effectively decreased dose of normal organ by using dose block to the critical organs(spinal cord <38 Gy). TH-3D combined with other treatment modalities was possible to boost irradiation and was total dose was reduced to spinal cord in esophagus case(spinal cord <45 Gy, lung V 20 <20%). 3D-CRT using Tomotherapy could overcomes some dosimetric limitations, when we faced Conventional Linac based CRT and shows clinically proper dose distribution. In conclusion, 3D-CRT using Tomotherapy will be one of the effective 3D-CRT techniques.

Dosimetric comparison of IMRT versus 3DCRT for post-mastectomy chest wall irradiation

  • Rastogi, Kartick;Sharma, Shantanu;Gupta, Shivani;Agarwal, Nikesh;Bhaskar, Sandeep;Jain, Sandeep
    • Radiation Oncology Journal
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    • v.36 no.1
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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.

Comparison of Monitor Units Obtained from Measurements and ADAC Planning System for High Energy Electrons (측정과 ADAC 치료계획 시스템에서 계산된 고에너지 전자선의 Monitor Unit Value 비교)

  • Lee, Re-Na;Choi, Jin-Ho;Suh, Hyun-Suk
    • Progress in Medical Physics
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    • v.13 no.4
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    • pp.202-208
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    • 2002
  • The purpose of this study is to evaluate the monitor unit obtained from various methods for the treatment of superficial cancers using electron beams. Thirty-three breast cancer patients who were treated in our institution with 6, 9, and 12 MeV electron beams, were selected for this study. For each patient, irregularly shaped treatment blocks were drawn on simulation film and constructed. Using the irregular blocks, monitor units to deliver 100 cGy to the dose maximum (dmax) were calculated from measurement and three-dimensional radiation treatment planning (3D RTP) system (PINNACLE 6.0, ADAC Laboratories, Milpitas CA) Measurements were made in solid water phantom with plane parallel (PP) chamber (Roos, OTW Germany) at 100 cm source-to surface distances. CT data was used to investigate the effect of heterogeneity. Monitor units were calculated by overriding CT values with 1 g/㎤ and in the presence of heterogeneity. The monitor unit values obtained by the above methods were compared. The dose, obtained from measurement in solid water phantom was higher than that of RTP values for irregularly shaped blocks. The maximum differences between monitor unit calculated in flat water phantom at gantry zero position were 4% for 6 MeV and 2% for 9 and 12 MeV electrons. When CT data was used at a various gantry angle the agreement between the TPS data with and without density correction was within 3% for all energies. These results indicate that there are no significant difference in terms of monitor unit when density is corrected for the treatment of breast cancer patients with electrons.

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The Action Mechanism of Tamoxifen Via Estrogen Receptor on Uterine Leimyoma (자궁근종에서 타목시펜의 수용체를 통한 기전)

  • Lee, Byung-Seok;Cha, Dong-Hyun;Jung, Kyung-Ah;Lee, Hye-Dae;Park, Ki-Hyun;Cho, Dong-Jae;Song, Chan-Ho
    • Clinical and Experimental Reproductive Medicine
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    • v.29 no.4
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    • pp.337-343
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    • 2002
  • Objectives: To investigate the distribution of $ER{\alpha}$, $ER{\beta}$, c-fos and c-jun in the uterine myoma and myometrium in oder to know how the tamoxifen cause the growth of myoma. Methods: Myoma and myometrial tissue were obtained from the postmenopausal women treated with tamoxifen in the patients with breast cancer and in the premenopausal patients, who were undergoing myoma of uterus from 1998 through 2000. The espression of each gene was quantitated with quantitative RT-PCR. Results: The expression of $ER{\alpha}$ was slightly increased in the myoma than the myometrium in the proliferative phase, and was slightly decreased in the myometrium than the myoma in the secretory phase. However it was not significant statistically. In the postmemopausal women treated with tamoxifen, $ER{\alpha}$ was expressed in all myoma and myome1rial tissues and the expression was not statistically significant. The expression ofER~ was slightly increased in the myome1rium than the leiomyoma in the proliferative and secretory phase, but it was not significant statistically. In the postmemopausal women treated with tamoxifen, the expression of ER~ was significantly incresed in the myome1rium than the leiomyoma. The expression of c-fos was significantly increased in the myome1rium than the leiomyoma in the proliferative and secretory phase. In the postmemopausal women treated with tamoxifen, the expression of c-fos was slightly increased in the leiomyoma than the myomelrium, however, it was not statistically significant. Conclusion: Tamoxifen may cause the growth of leiomyoma by $ER{\alpha}$ with AP-l pathway reducing the counteraction of 6$ER{\beta}$ to $ER{\alpha}$.

Analysis of the Movement of Surgical Clips Implanted in Tumor Bed during Normal Breathing for Breast Cancer Patients (유방암 환자의 정상 호흡에서 종양에 삽입된 외과적 클립의 움직임 분석)

  • Lee, Re-Na;Chung, Eun-Ah;Suh, Hyun-Suk;Lee, Kyung-Ja;Lee, Ji-Hye
    • Radiation Oncology Journal
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    • v.24 no.3
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    • pp.192-200
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    • 2006
  • [ $\underline{Purpose}$ ]: To evaluate the movement of surgical clips implanted in breast tumor bed during normal breathing. $\underline{Materials\;and\;Methods}$: Seven patients receiving breast post-operative radiotherapy were selected for this study. Each patient was simulated in a common treatment position. Fluoroscopic images were recorded every 0.033 s, 30 frames per 1 second, for 10 seconds in anterior to posterior (AP), lateral, and tangential direction except one patient's images which were recorded as a rate of 15 frames per second. The movement of surgical clips was recorded and measured, thereby calculated maximal displacement of each clip in AP, lateral, tangential, and superior to inferior (SI) direction. For the comparison, we also measured the movement of diaphragm in SI direction. $\underline{Results}$: From AP direction's images, average movement of surgical clips in lateral and SI direction was $0.8{\pm}0.5\;mm$ and $0.9{\pm}0.2\;mm$ and maximal movement was 1.9 mm and 1.2 mm. Surgical clips in lateral direction's images were averagely moved $1.3{\pm}0.7\;mm$ and $1.3{\pm}0.5\;mm$ in AP and SI direction with 2.6 mm and 2.6 mm maximal movement in each direction. In tangential direction's images, average movement of surgical clips and maximal movement was $1.2{\pm}0.5\;mm$ and 2.4 mm in tangential direction and $0.9{\pm}0.4\;mm$ and 1.7 mm in SI direction. Diaphragm was averagely moved $14.0{\pm}2.4\;mm$ and 18.8 mm maximally in SI direction. $\underline{Conclusion}$: The movement of clips caused by breathing was not as significant as the movement of diaphragm. And all surgical clip movements were within 3 mm in all directions. These results suggest that for breast radiotherapy, it may not necessary to use breath-holding technique or devices to control breath.

Current Status and Future Perspective of PET (PET 이용 현황 및 전망)

  • Lee, Myung-Chul
    • The Korean Journal of Nuclear Medicine
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    • v.36 no.1
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    • pp.1-7
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    • 2002
  • Positron Emission Tomography (PET) is a nuclear medicine imaging modality that consists of systemic administration to a subject of a radiopharmaceutical labeled with a positron-emitting radionuclide. Following administration, its distribution in the organ or structure under study can be assessed as a function of time and space by (1) defecting the annihilation radiation resulting from the interaction of the positrons with matter, and (2) reconstructing the distribution of the radioactivity from a series of that used in computed tomography (CT). The nuclides most generally exhibit chemical properties that render them particularly desirable in physiological studies. The radionuclides most widely used in PET are F-18, C-11, O-15 and N-13. Regarding to the number of the current PET Centers worldwide (based on ICP data), more than 300 PET Centers were in operation in 2000. The use of PET technology grew rapidly compared to that in 1992 and 1996, particularly in the USA, which demonstrates a three-fold rise in PET installations. In 2001, 194 PET Centers were operating in the USA. In 1994, two clinical and research-oriented PET Centers at Seoul National University Hospital and Samsung Medical Center, was established as the first dedicated PET and Cyclotron machines in Korea, followed by two more PET facilities at the Korea Cancer Center Hospital, Ajou Medical Center, Yonsei University Medical Center, National Cancer Center and established their PET Center. Catholic Medical School and Pusan National University Hospital have finalized a plan to install PET machine in 2002, which results in total of nine PET Centers in Korea. Considering annual trends of PET application in four major PET centers in Korea in Asan Medical Center recent six years (from 1995 to 2000), a total of 11,564 patients have been studied every year and the number of PET studies has shown steep growth year upon year. We had 1,020 PET patients in 1995. This number increased to 1,196, 1,756, 2,379, 3,015 and 4,414 in 1996,1997,1998,1999 and 2000, respectively. The application in cardiac disorders is minimal, and among various neuropsychiatric diseases, patients with epilepsy or dementia can benefit from PET studios. Recently, we investigated brain mapping and neuroreceptor works. PET is not a key application for evaluation of the cardiac patients in Korea because of the relatively low incidence of cardiac disease and less costly procedures such as SPECT can now be performed. The changes in the application of PET studios indicate that, initially, brain PET occupied almost 60% in 1995, followed by a gradual decrease in brain application. However, overall PET use in the diagnosis and management of patients with cancer was up to 63% in 2000. The current medicare coverage policy in the USA is very important because reimbursement policy is critical for the promotion of PET. In May 1995, the Health Care Financing Administration (HCFA) began covering the PET perfusion study using Rubidium-82, evaluation of a solitary pulmonary nodule and pathologically proven non-small cell lung cancer. As of July 1999, Medicare's coverage policy expanded to include additional indications: evaluation of recurrent colorectal cancer with a rising CEA level, staging of lymphoma and detection of recurrent or metastatic melanoma. In December of 2001, National Coverage decided to expand Medicare reimbursement for broad use in 6 cancers: lung, colorecctal, lymphoma, melanoma, head and neck, and esophageal cancers; for determining revascularization in heart diseases; and for identifying epilepsy patients. In addition, PET coverage is expected to further expand to diseases affecting women, such as breast, ovarian, uterine and vaginal cancers as well as diseases like prostate cancer and Alzheimer's disease.

Comparison of Dosimetric Parameters of Patient with Large and Pendulous Breast Receiving Breast Radiotherapy in the Prone versus Supine Position (유방 크기가 큰 유방암 환자의 방사선 치료 시 환자의 자세에 따른 선량 비교)

  • Moon, Sun Young;Yoon, Myonggeun;Chung, Weon Kuu;Chung, Mijoo;Shin, Dong Oh;Kim, Dong Wook
    • Progress in Medical Physics
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    • v.26 no.4
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    • pp.234-240
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    • 2015
  • The purpose of this study is to analyze dosimetric parameters of patient with large and pendulous breast receiving breast radiotherapy in the prone versus supine position. The patient underwent computed tomography simulation in both prone and supine position. The homogeneity index (HI), conformity index (CI), coverage index (CVI) to the left breast as planning target volume (PTV) and the doses to the lung, heart, and right breast as organ at risk (OAR) were compared by using dose-volume histogram. The lifetime attributable risk (LAR) according to the prone and supine position was measured for the lung and right breast. The HI, CI of the PTV decreased 21.7%, 6.49%, respectively and the CVI increased 10.8% with the prone position. The mean and maximum dose to the left lung decreased 91.6%, 87.0%, respectively and the volume parameters also decreased over 99% with the prone position. The parameters to the right lung were same regardless of the position. The mean and maximum dose to the heart decreased 51.6%, 14.2% with the prone position. But the mean and maximum dose to the right breast increased unlike the other OARs. The LARs to the lung decreased 80.3% (left), 24.2% (right) but the LAR to the right breast doubled with the prone position. The prone position is a favorable alternative for irradiation of breast in patients with large and pendulous breasts.