• Asian Pacific Journal of Cancer Prevention
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• 제15권24호
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• pp.10675-10681
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• 2015

Background: The ataxia telangiectasia mutated (ATM) protein and p53 play key roles in sensing and repairing radiation-induced DNA double strand breaks (DSBs). Accumulating epidemiological evidence indicates that functional genetic variants in ATM and TP53 genes may have an impact on the risk of radiotherapy-induced side effects. Here we performed a meta-analysis to investigate the potential interaction between ATM Asp1853Asn and TP53 polymorphisms and risk of radiotherapy-induced adverse effects quantitatively. Materials and Methods: Relevant articles were retrieved from PubMed, ISI Web of Science and the China National Knowledge Infrastructure (CNKI) databases. Eligible studies were selected according to specific inclusion and exclusion criteria. Odds ratios (ORs) and 95% confidence intervals (CIs) were pooled to estimate the association between ATM Asp1853Asn and TP53 Arg72Pro polymorphisms and risk of radiotherapy adverse effects. All analyses were performed using the Stata software. Results: A total of twenty articles were included in the present analysis. In the overall analysis, no significant associations between ATM Asp1853Asn and TP53 Arg72Pro polymorphisms and the risk of radiotherapy adverse effects were found. We conducted subgroup analysis stratified by type of cancer, region and time of appearance of side effects subsequently. No significant association between ATM Asp1853Asn and risk of radiotherapy adverse effects was found in any subgroup analysis. For TP53 Arg72Pro, variant C allele was associated with decreased radiotherapy adverse effects risk among Asian cancer patients in the stratified analysis by region (OR=0.71, 95%CI: 0.54-0.93, p=0.012). No significant results were found in the subgroup analysis of tumor type and time of appearance of side effects. Conclusions: The TP53 Arg72Pro C allele might be a protective factor of radiotherapy-induced adverse effects among cancer patients from Asia. Further studies that take into consideration treatment-related factors and patient lifestyle including environmental exposures are warranted.

• 한국의학물리학회지:의학물리
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• 제27권3호
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• pp.139-145
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• 2016

With the development in field of industry and medicine, new machines and techniques are being launched. Moreover, the complexity of the techniques is associated to an increasing risk of incident. Especially, a small error in radiotherapy can lead to a serious patient-related incident, risk management is necessary in radiotherapy in order to reduce the risk of incident. However, in field of radiotherapy, there are no legally binding clauses for risk management and there is an absence of risk management systems at an institutional level. Therefore, we analyzed institutional status of risk management, reporting & classification systems, and risk assessment & analysis in 31 countries. For risk management and reporting systems, 65% of countries investigated had legislation or regulations; however, only 35% of countries used classification systems. It was found that 43% more countries had legislation for risk management in healthcare than those for radiotherapy; 19% more countries had reporting systems for healthcare than those for radiotherapy. For classification systems, 60% more countries had legislation, recommendation, and guidelines in the field of radiotherapy than those for healthcare. Recently, international institutes have published several reports for risk management and patient safety in radiotherapy, owing to which, countries adopting risk management for radiotherapy will gradually increase. Before adopting risk management in Korea, we should precisely understand the procedures and functions of risk management, in order to increase efficiency of risk management because classification & reporting system and risk assessment & analysis are connected organically, and institutional management is needed for high quality of risk management in Korea.

• Radiation Oncology Journal
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• 제19권4호
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• pp.327-334
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• 2001

목적 : 직장암에 대한 수술 단독 또는 수술후 방사선치료를 받은 환자를 대상으로 골반종양제어율과 생존율, 합병증 발생률, 예후인자 등을 후향적으로 비교 분석하여 방사선치료의 역할을 평가한다. 대상 및 방법 : 1982년 2월부터 1996년 12월까지 총 212명의 환자가 modified Astler-Coiler 병기 $B2\~C3$ 직장암으로 진단되어 근치적목적의 수술단독 또는 수술후 방사선치료를 시행하였는데, 이중 39.6 Gy 미만의 방사선치료를 받은 18명을 제외한 194명을 대상으로 하였다. 104명은 수술후 방사선치료를 받았고 90명은 수술 단독을 시행하였다. 방사선치료는 일일 조사량 $1.8\~2.0\;Gy$로 주 5회씩 전골반강에 $39.6\~55.8\;Gy$ (평균:49.9 Gy)를 조사하였고 필요시 원발 종양 절제부위에 $5.4\~10\;Gy$를 추가 조사하였다. 생존율과 골반종양제어율의 산출은 Kaplan-Meier방법으로, 이들의 통계적 유의성검증은 Log-rank test로 하였다. 다요인 분석은 Cox proportional hazards model을 이용하였다. 결과 : 전체 환자의 5년 생존율 및 무병 생존율은 각각 $53\%,\;49\%$이었다. 수술단독군과 방사선치료 추가군의 5년 생존율은 각각 $63\%$와 $45\%$로 유의한 차이를 보였다(p=0.03). 그러나 이러한 차이는 방사선치료 추가군에서 진행된 병기의 환자가 더 많이 분포함에 기인한 것으로 생각되었다(p<0.05 by $\chi^2-test$). 수술단독군과 방사선치료 추가군의 5년생존율은 병기 B2+3, C1, C2+3 군에서 각각 $68\%$ 대 $55\%$ (p=0.09), $100\%$ 대 $100\%,\;40\%$ 대 $33\%$ (p=0.71)로 두 군간의 유의한 차이는 없었다. 위의 병기별 5년 무병생존율은 각각 $65\%$ 대 $49\%$ (p=0.14), $100\%$ 대 $100\%,\;33\%$ 대 $31\%$ (p=0.46)로 역시 유의한 차이는 없었다. 전체 환자의 5년 골반종양제어율은 $72.5\%$이었다. 수술단독군과 방사선치료 추가군의 골반종양제어율은 각각 $71\%,\;74\%$이었다(p=0.41). 병기 B2+3, C1, C2+3군에서 수술달독군과 방사선치료 추가군의 골반종양제어율은 각각 $79\%$ 대 $75\%$ (p=0.88), $100\%$ 대 $100\%,\;44\%$ 대 $68\%$ (p=0.01)이었다. 전체 환자를 대상으로 다요인 분석을 시행한 결과 생존율과 무병생존율에 병기만이 유의하였고 두 치료 군에서도 역시 병기가 유의한 인자로 나타났다. 전체환자에서 골반종양제어율에 유의한 예후인자로 다요인분석을 시행한 결과 병기와 수술방법이 유의하였다. 수술단독군에서는 병기만이 유의하였고 방사선치료 추가군에서는 수술방법만이 유의하여 복부회음절제술군의 골반종양재발률이 높았다. 결론 : 본 후향적 연구에서 수술 후 보조적 방사선치료를 시행하여 수술단독군에 비해 병기 C2+3군에서 골반종양제어율이 향상되었음을 알 수 있었다. 그러나 병기 B2이상의 모든 환자에서 골반종양제어율 뿐만 아니라 생존율의 향상을 가져오기 위해서는 최근 효용성이 널리 입증된 연속주사법의 5-FU를 포함한 동시적 항함화학방사선 병용요법이 시도되어야 할 것으로 생각된다.

• 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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• 제29권2호
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• pp.121-126
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• 2011

담도암 환자의 방사선치료 기간 중, 총담도에 삽입된 스텐트가 환자 복부의 우측부터 좌측까지 매우 넓은 범위로 움직인 경우를 발견하였다. 환자는 80세 노령의 여자로 흉추가 심한 척추 후만증을 보였고 흉추와 요추 몇 부위들에 압박골절이 있어서 키가 작았고 복부장기들이 아래로 내려와 있었다. 환자는 쇠약하고 야윈 상태였는데 방사선치료 기간 중 매주 컴퓨터단층촬영을 시행하여 비교한 결과 몸의 좌우방향으로 4 cm 이상의 스텐트의 위치 이동을 보였다. 따라서 흉추 후만증이 있으며서 몸이 매우 야윈 담도암 환자의 경우 방사선치료 범위 설정 시에 치료 기간 중 담도나 스텐트가 크게 움직일 가능성을 고려해야 할 것이다.

• 대한두경부종양학회지
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• 제6권1호
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• pp.40-45
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• 1990

Thirty five lesions of 35 patients with locally advanced malignant tumors of head and neck were received thermoradiotherapy with ultrasound and/or 915 MHz microwave. Most of all patients were failed with previous conventional therapeutic trial. Hyperthermia had been done immediately after radiotherapy, twice a week, $43^{\circ}C$ for one hour and radiotherapy had been done 5 fractions per week with a fraction size of 2 Gy up to total 30 to 60 Gy. Conclusions are as follows; 1) Total response rate (CR+PR) of thermoradiotherapy with microwave and ultrasound was 80%. 2) Tumor depth, minimum temperature of tumor center, number of heat fraction and irradiation dose were statistically significant factors affecting response. 3) Hyperthermia with microwave and ultrasound can be used efficiently to control locally advanced malignant tumors in head and neck whether previously received near tolerance dose of radiotherapy or not.

• 성인간호학회지
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• 제27권2호
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• pp.188-197
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• 2015

Purpose: The purpose of this study was to examine fatigue, sleep disturbances, and quality of life (QOL) among patients with breast cancer receiving radiotherapy. Methods: A cross-sectional, descriptive design was used. Data were collected through questionnaires distributed to 201 breast cancer patients in a hospital. The data were analyzed using SPSS 21.0. Results: The fatigue scores showed significant differences depending on exercise and duration since diagnosis. The sleep disturbance scores showed significant differences depending on duration since diagnosis. QOL scores showed significant differences depending on exercise, duration since diagnosis, and treatment site. Fatigue and sleep disturbances (r=.40, p<.001) showed statistically significant positive correlations, while fatigue and QOL (r=-.55, p<.001), and sleep disturbances and QOL (r=-.45, p<.001) showed statistically significant negative correlations. The multiple regression analysis, which was used to determine the variables influencing on QOL after radiotherapy, resulted in a significant regression model (F=23.88, p<.001), which accounted for approximately 45% of the explanatory power. Fatigue (${\beta}=-.39$, p<.001) and sleep disturbances (${\beta}=-.27$, p<.001) were revealed to adversely affect quality of life. Conclusion: The nursing intervention is necessary to reduce fatigue and sleep disturbance and to promote exercise in order to enhance QOL of patients with breast neoplasm while receiving radiotherapy.

• Radiation Oncology Journal
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• 제35권2호
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• pp.180-184
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• 2017

Patients with locally advanced lung cancer and very limited pulmonary function (forced expiratory volume in 1 second $[FEV1]{\leq}1L$) have dismal prognosis and undergo palliative treatment or best supportive care. We describe two cases of locally advanced node-positive non-small cell lung cancer (NSCLC) patients with very limited lung function treated with induction chemotherapy and moderate hypofractionated image-guided radiotherapy (Hypo-IGRT). Hypo-IGRT was delivered to a total dose of 45 Gy to the primary tumor and involved lymph nodes. Planning was based on positron emission tomography-computed tomography (PET/CT) and four-dimensional computed tomography (4D-CT). Internal target volume (ITV) was defined as the overlap of gross tumor volume delineated on 10 phases of 4D-CT. ITV to planning target volume margin was 5 mm in all directions. Both patients showed good clinical and radiological response. No relevant toxicity was documented. Hypo-IGRT is feasible treatment option in locally advanced node-positive NSCLC patients with very limited lung function ($FEV1{\leq}1L$).

• Asian Pacific Journal of Cancer Prevention
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• 제13권12호
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• pp.6523-6526
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• 2012

Objective: This study was designed to investigate treatment efficacy and side effects of concomitant Aisu$^{(R)}$ (docetaxel) with three-dimensional conformal external beam radiotherapy for the treatment of inoperable patients with esophageal cancer. Methods: Inoperable patients were treated with three-dimensional conformal external beam radiotherapy (5/week, 2 GY/day, and total dose 60GY) plus docetaxel ($30-45mg/m^2$, iv, d1, 8). Results: Twenty eight patients met the study eligibility criteria and the response rate was evaluated according to RICIST guidelines. Among 28 patients, 2 achieved CR, 22 PR, 3 SD and 1 patient was documented PD. Mild gastrointestinal reaction and bone marrow suppression were also documented. All treatment related side effects were tolerable. Conclusion: Three-dimensional conformal external beam radiotherapy combined with docetaxel is an active and safe regimen for inoperable patients with esophageal cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제15권5호
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• pp.2297-2302
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• 2014

Objective: To evaluate early treatment for extranodal natural killer/T cell lymphoma (ENK/TCL) in China and provide reference for clinical treatment of these patients. Methods: Computer-based retrieval was performed in PubMed, CNKI, CBM, VIP and WanFang Data to search for randomized controlled trials (RCTs) of treatment for early ENK/TCL, and a meta-analysis was conducted with RevMan 5.0 software. Results: A total of 11 RCTs, including 871 patients, were selected, of which the first radiotherapy had a higher complete response (CR) than the first chemotherapy [OR=14.16, 95%CI (8.68, 23.10), P<0.00001] and CR was not different between combined treatment group and radiotherapy group [OR=1.86, 95%CI (0.47, 3.58), P=0.61], but long-term survival rate was higher with combined treatment[OR=1.88, 95%CI (1.09, 3.19), P=0.02]. No difference in survival rate was observed between radio-chemotherapy and chemo-radiotherapy groups [OR=1.11, 95%CI (0.73, 1.69), P=0.63]. Conclusions: Radiotherapy is of great significance in the treatment of early ENK/TCL, but combined therapy could further enhance long-term survival rate of patients. This conclusion still requires further confirmation using RCTs with high quality and large sample size.