• Title/Summary/Keyword: radiotherapy response

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Hyperfractionated Radiotherapy and Concurrent Chemotherapy for Stage III Unresectable Non Small Cell Lung Cancer : Preliminary Report for Response and Toxicity (절제 불가능한 제 3기 비소세포성 페암의 다분할 방사선 치료와 MVP 복합 항암요법의 동시 치료에 대한 예비적 결과)

  • Choi, Eun-Kyung;Kim, Jong-Hoon;Chang, Hye-Sook;Kim, Sang-We;Suh, Cheol-Won;Lee, Kyoo-Hyung;Lee, Jung, Shin;Kim, Sang-Hee;Ko, Youn-Suk;Kim, Woo-Sung;Kim, Dong-Soon;Kim, Won-Dong;Song, Koun-Sik
    • Radiation Oncology Journal
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    • v.13 no.2
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    • pp.157-162
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    • 1995
  • Lung cancer study group at Asan Medical Center has conducted the second prospective study to determine the efficacy and feasibility of MVP chemotherapy with concurrent hyperfractionated radiotherapy for Patients with stage III unresectable non-small cell lung cancer(NSCLC). All eligible Patients with stage III unresectable NSCLC were treated with hyperfractionated radiotherapy(120 cGy/fx BID. 6480 cGy/54fx) and concurrent 2 cycles of MVP(Mitomycin C $6mg/m^2,$ d2 & d29.Vinblastine $6mg/m^2,$ d2 & d29, Cisplatin $60mg/m^2,$ dl & d28) chemotherapy. Between Aug. 1993 and Nov. 1994, 62 patients entered this study; $6(10\%)$ had advanced stage IIIa and $56(90\%)$ had IIIb disease including 11 with pleural effusion and 10 with supraclavicular metastases. Among 62 patients, $48(77\%)$ completed planned therapy. Fourteen patients refused further treatment during chemoradiotherapy. Of 46 patients evaluable for response, $34(74\%)$ showed major response including $10(22\%)$ with complete and $24(52\%)$ with partial responses. Of 48 patients evaluable for toxicity, $13(27\%)$ showed grade IV hematologic toxicity but treatment delay did not exceed 5 days Two patients died of sepsis during chemoradiotherapy. Severe weight loss(more than $10\%)$ occurred in 9 patients$(19\%)$ during treatment. Nine patients$(19\%)$ developed radiation pneumonitis Six of these patients had grade 1 (mild) Pneumonitis with radiographic changes within the treatment fields Three other patients had grade 11 Pneumonitis, but none of these patients had continuous symptoms after steroid treatment. Concurrent chemoradiotherapy for patients with advanced NSCLC was well tolerated with acceptable toxicity and achieved higher response rates than the first study, but rather low compliance $rate(77\%)$ in this study is worrisome. We need to improve nutritional support during treatment and to use G-CSF to improve leukopenia and if necessary. supportive care will be given as in patients, Longer follow-up and larger sample size is needed to observe survival advantage.

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Palliative Irradiation Using Helical Tomotherapy in Recurrent Pelvic Tumors with Prior Radiotherapy (방사선치료 후 재발한 골반암에서 토모테라피를 이용한 고식적 재치료)

  • Kay, Chul-Seung;Yoo, Eun-Jung;Kim, Ji-Hoon;Ro, Duck-Young;Kim, Ki-Jun
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.133-140
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    • 2010
  • Purpose: We retrospectively investigated the effect of irradiation using helical tomotherapy in recurrent pelvic tumors that underwent prior irradiation. Materials and Methods: Fourteen patients with recurrent pelvic tumors consisting of rectal cancer (57.1%), cervical cancer (35.7%) and cancer with an unknown origin (7.1%) were treated with tomotherapy. At the time of irradiation, median tumor size was 3.5 cm and 7 patients complained of pain originating from a recurrent tumor. The median radiation dose delivered to the gross tumor volume, clinical target volume, and planning target volume was 50 Gy, 47.8 Gy and 45 Gy, respectively and delivered at 5 fractions per week over the course of 4 to 5 weeks. Treatment response and duration of local disease control were evaluated using the Response Evaluation Criteria in Solid Tumors (ver. 1.0) and the Kaplan-Meyer method. Treatment-related toxicities were assessed through Common Terminology Criteria for Adverse Events (ver. 3.0). Results: The median follow-up time was 17.3 months, while the response rate was 64.3%. Symptomatic improvement appeared in 6 patients (85.7%). The median duration time of local disease control was 25.8 months. The rates of local failure, distant failure, and synchronous local and distant failure were 57.1%, 21.4%, and 7.1%, respectively. Acute toxicities were limited in grade I or II toxicities, except for one patient. No treatment related death or late toxicity was observed. Conclusion: Helical tomotherapy could be suggested as a feasible palliative option in recurrent pelvic tumors with prior radiotherapy. However, to increase treatment effect and overcome the limitation of this outcome, a large clinical study should be performed.

MDM2, p53 and pRb Expression Prior to Definitive Chemoradiotherapy in Esophageal Carcinoma (식도암에서 MDM2, p53, pRb 발현과 동시적 항암화학방사선요법의 결과)

  • Yoon, Mee-Sun;Lee, Jae-Hyuk;Cho, Sang-Hee;Song, Ju-Young;Ahn, Sung-Ja;Chung, Ik-Joo;Chung, Woong-Ki;Nah, Byung-Sik;Nam, Taek-Keun
    • Radiation Oncology Journal
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    • v.25 no.4
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    • pp.193-200
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    • 2007
  • Purpose: This study evaluated the pretreatment expression patterns of MDM2, p53, and pRb proteins to determine if the expression patterns could predict the outcome of concurrent chemoradiotherapy (CCRT) for esophageal squamous cell carcinoma and aid in the decisions for the selection of treatment modalities. Materials and Methods: Fifty-one patients that were treated with definitive chemoradiotherapy for stage $I{\sim}IVa$ esophageal squamous cell carcinoma were selected for this study. Radiotherapy was administered with daily $1.8{\sim}2\;Gy$ fractions up to a median dose of 54 Gy for primary tumors, and with four cycles of cisplatin/5-fluorouracil chemotherapy that was administered every 4 weeks, the first two cycles of which were administered concurrently with radiotherapy. Expression of MDM2, p53, and pRb was investigated by immunohistochemical analysis using pretreatment biopsy specimens. Results: MDM2, p53, and pRb were detected with high immunoreactivity in 19.6%, 27.5%, and 66.7% of the patients, respectively. However, there was no significant correlation between expression of these factors and clinical outcome. By the use of multivariate analysis with nine covariates-age, tumor location, tumor length, stage, pathological response, clinical response, MDM2 expression, p53 expression, and pRb expression, only pathological response and stage were significant factors for cause-specific survival. Conclusion: Expression of MDM2, p53, and pRb was not found to be clinically significant for predicting outcomes after CCRT in this study. Further studies with a larger patient population and longer follow-up periods are needed to re-evaluate the expression pattern and to identify new predictors for CCRT response.

Evaluation of Dosimetric Characteristics of Reproducibility, Linearity and Dose Dependence of Optically Stimulated Luminescence Dosimeters in Co-60 Gamma-rays (Co-60 감마선을 이용한 광자극발광선량계의 재현성, 선형성, 선량의존성에 대한 특성평가)

  • Han, Su Chul;Choi, Sang Hyoun;Park, Seungwoo;Kim, Chul Hang;Jung, Haijo;Kim, Mi-Sook;Yoo, Hyung Jun;Kim, Chan Hyeong;Ji, Young Hoon;Yi, Chul Young;Kim, Kum Bae
    • Progress in Medical Physics
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    • v.25 no.1
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    • pp.31-36
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    • 2014
  • We aimed to evaluate the dosimetric characteristics of reproducibility, linearity and dose dependence of optical stimulated luminance dosimeter (OSLD) in the Co-60 Gamma-rays and to analyze with a precedent study in field of the diagnostic radiography and radiotherapy. The reproducibility was 0.76% of the coefficient of variation, the homogeneity was within 1.5% of the coefficient of variation and OSLD had supra-linear response more than 3 Gy. So the correlation between dose and count was fitted by quadratic function. The count depletion by repeated reading was 0.04% per reading regardless of the irradiated dose. And the half time of decay curve according to the irradiated dose was 0.68 min. with 1 Gy, 1.04 min. with 5 Gy, and 1.10 min. with 10 Gy, respectively. In case of annealing for 30 min, the removal rate was 88% with 1 Gy, 90% with 5 Gy, and 92% with 10 Gy, respectively and 99% in case of annealing time for 4 hour. It is feasible to use OSLDs for dose evaluation in Co-60 Gamma-rays when considering the uncertainty on the procedure according to the irradiated dose.

Treatment outcome of hepatic re-irradiation in patients with hepatocellular carcinoma

  • Seol, Seung Won;Yu, Jeong Il;Park, Hee Chul;Lim, Do Hoon;Oh, Dongryul;Noh, Jae Myoung;Cho, Won Kyung;Paik, Seung Woon
    • Radiation Oncology Journal
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    • v.33 no.4
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    • pp.276-283
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    • 2015
  • Purpose: We evaluated the efficacy and toxicity of repeated high dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with unresectable hepatocellular carcinoma. Materials and Methods: Between 1998 and 2011, 45 patients received hepatic re-irradiation with high dose 3D-CRT in Samsung Medical Center. After excluding two ineligible patients, 43 patients were retrospectively reviewed. RT was delivered with palliative or salvage intent, and equivalent dose of 2 Gy fractions for ${\alpha}/{\beta}=10Gy$ ranged from $31.25Gy_{10}$ to $93.75Gy_{10}$ (median, $44Gy_{10}$). Tumor response and toxicity were evaluated based on the modified Response Evaluation Criteria in Solid Tumors criteria and the Common Terminology Criteria for Adverse Events (CTCAE) ver. 4.0. Results: The median follow-up duration was 11.2 months (range, 4.1 to 58.3 months). An objective tumor response rate was 62.8%. The tumor response rates were 81.0% and 45.5% in patients receiving ${\geq}45Gy_{10}$ and $<45Gy_{10}$, respectively (p = 0.016). The median overall survival (OS) of all patients was 11.2 months. The OS was significantly affected by the Child-Pugh class as 14.2 months vs. 6.1 months (Child-Pugh A vs. B, p < 0.001), and modified Union for International Cancer Control (UICC) T stage as 15.6 months vs. 8.3 months (T1-3 vs. T4, p = 0.004), respectively. Grade III toxicities were developed in two patients, both of whom received ${\geq}50Gy_{10}$. Conclusion: Hepatic re-irradiation may be an effective and tolerable treatment for patients who are not eligible for further local treatment modalities, especially in patients with Child-Pugh A and T1-3.

Prospective phase II trial of regional hyperthermia and whole liver irradiation for numerous chemorefractory liver metastases from colorectal cancer

  • Yu, Jeong Il;Park, Hee Chul;Choi, Doo Ho;Noh, Jae Myoung;Oh, Dongryul;Park, Jun Su;Chang, Ji Hyun;Kim, Seung Tae;Lee, Jeeyun;Park, Se Hoon;Park, Joon Oh;Park, Young Suk;Lim, Ho Yeong;Kang, Won Ki
    • Radiation Oncology Journal
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    • v.34 no.1
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    • pp.34-44
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    • 2016
  • Purpose: A prospective phase II trial was conducted to evaluate the effectiveness and toxicity of regional hyperthermia and whole liver irradiation (WLI) for numerous chemorefractory liver metastases from colorectal cancer. Materials and Methods: Enrolled patients had numerous chemorefractory hepatic metastases from colorectal cancer. Five sessions of hyperthermia and seven fractions of 3-gray WLI were planned. Health-related quality of life (HRQoL) was determined using the Korean version of the European Organization for Research and Treatment of Cancer quality of life questionnaire C-30 and the Functional Assessment of Cancer Therapy-Hepatobiliary version 4.0. Objective and pain response was evaluated. Results: A total of 12 patients consented to the study and the 10 who received WLI and hyperthermia were analyzed. WLI was completed as planned in nine patients and hyperthermia in eight. Pain response was partial in four patients and stable in four. Partial objective response was achieved in three patients (30.0%) and stable disease was seen in four patients at the 1-month follow-up. One patient died 1 month after treatment because of respiratory failure related to pleural metastasis progression. Other grade III or higher toxicities were detected in three patients; however, all severe toxicities were related to disease progression rather than treatment. No significant difference in HRQoL was noted at the time of assessment for patients who were available for questionnaires. Conclusion: Combined WLI and hyperthermia were well tolerated without severe treatment-related toxicity with a promising response from numerous chemorefractory hepatic metastases from colorectal cancer.

Effect of Induction Chemotherapy Followed by Radiation Therapy of Locally Advanced Hypopharyngeal Carcinoma (국소진행된 하인두암에서 선행 항암화학요법과 방사선치료의 효과)

  • Kim, Jae-Won;Son, Hee-Young;Jeon, Sea-Yuong;Park, Jung-Je;Ahn, Seong-Ki;Kang, Ki-Mun;Kim, Jin-Pyeong
    • Korean Journal of Head & Neck Oncology
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    • v.24 no.1
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    • pp.26-32
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    • 2008
  • Purpose:Hypopharyngeal carcinoma is usually diagnosed as an advanced disease after an asymptomatic beginning, and it is related to a high frequency of lymph node metastases. An eventual negative outcome may occur not only because of possible locoregional failures but also for frequent distant metastases. Thus, the efficacy of induction chemotherapy followed by radiation therapy, with regards to the response, survival rate and complications for locally advanced hypopharyngeal carcinoma patients, was examined. Methods and Materials:Since July 1998 to February 2001, 18 patients having locally advanced hypopharyngeal carcinoma were treated with induction chemotherapy followed by radiation therapy, and the results were retrospectively analyzed. The regimen of the induction chemotherapy was the 5-flurouracil(5-FU, 1,000mg/$m^2$ daily for 5 consecutive days) and cisplatin(100mg/$m^2$ on day 1) combination at 3-week intervals for 2 cycles. The total radiation dose for the primary tumor and metastatic lymph nodes was 68.4-72.0Gy(median:70.2Gy) Results:The 3-year overall survival rate and disease free survival rate were 31.3% and 22.2%, respectively. In 6 patients(33.3%), preservation of the larynx for over 3 years was possible. After the induction chemotherapy and radiotherapy, a complete response was noted in 14 patients(77.8%), and a partial response in 4 patients (22.2%), with an overall response rate of 100%. Conclusion:Induction chemotherapy followed by radiation therapy is an effective treatment and larynx preservation rate was 33% in patients with locally advanced hypopharyngeal carcinoma in our report.

The Results of Definitive Radiation Therapy and The Analysis of Prognostic Factors for Non-Small Cell Lung Cancer (비소세포성 폐암에서 근치적 방사선치료 성적과 예후인자 분석)

  • Chang, Seung-Hee;Lee, Kyung-Ja;Lee, Soon-Nam
    • Radiation Oncology Journal
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    • v.16 no.4
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    • pp.409-423
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    • 1998
  • Purpose : This retrospective study was tried to evaluate the clinical characteristics of patients, patterns of failure, survival rates, prognostic factors affecting survival, and treatment related toxicities when non-small cell lung cancer patients was treated by definitive radiotherapy alone or combined with chemotherapy. Materials and Methods : We evaluated the treatment results of 70 patients who were treated by definitive radiation therapy for non-small cell lung cancer at the Department of Radiation Oncology, Ewha Womans University Hospital, between March 1982 and April 1996. The number of patients of each stage was 2 in stage I, 6 in stage II, 30 in stage III-A, 29 in stage III-B, 3 in stage IV. Radiation therapy was administered by 6 MV linear accelerator and daily dose was 1.8-2.0 Gy and total radiation dose was ranged from 50.4 Gy to 72.0 Gy with median dose 59.4 Gy. Thirty four patients was treated with combined therapy with neoadjuvant or concurrent chemotherapy and radiotherapy, and most of them were administered with the multi-drug combined chemotherapy including etoposide and cisplatin. The survival rate was calculated with the Kaplan-Meier methods. Results : The overall 1-year, 2-year, and 3-year survival rates were 63$\%$, 29$\%$, and 26$\%$, respectively. The median survival time of all patients was 17 months. The disease-free survival rate for 1-year and 2-year were 23$\%$ and 16$\%$, respectively. The overall 1-year survival rates according to the stage was 100$\%$ for stage I, 80$\%$ for stage II, 61$\%$ for stage III, and 50$\%$ for stage IV. The overall 1-year 2-year, and 3-year survival rates for stage III patients only were 61$\%$, 23$\%$, and 20$\%$, respectively. The median survival time of stage III patients only was 15 months. The complete response rates by radiation therapy was 10$\%$ and partial response rate was 50$\%$. Thirty patients (43$\%$) among 70 patients assessed local control at initial 3 months follow-up duration. Twenty four (80$\%$) of these 30 Patients was possible to evaluate the pattern of failure after achievement of local control. And then, treatment failure occured in 14 patients (58$\%$): local relapse in 6 patients (43$\%$), distant metastasis in 6 patients (43$\%$) and local relapse with distant metastasis in 2 patients (14$\%$). Therefore, 10 patients (23$\%$) were controlled of disease of primary site with or without distant metastases. Twenty three patients (46$\%$) among 50 patients who were possible to follow-up had distant metastasis. The overall 1-year survival rate according to the treatment modalities was 59$\%$ in radiotherapy alone and 66$\%$ in chemoirradiation group. The overall 1-year survival rates for stage III patients only was 51$\%$ in radiotherapy alone and 68$\%$ in chemoirradiation group which was significant different. The significant prognostic factors affecting survival rate were the stage and the achievement of local control for all patients at univariate- analysis. Use of neoadjuvant or concurrent chemotherapy, use of chemotherapy and the achievement of local control for stage III patients only were also prognostic factors. The stage, pretreatment performance status, use of neoadjuvant or concurrent chemotherapy, total radiation dose and the achievement of local control were significant at multivariate analysis. The treatment-related toxicities were esophagitis, radiation pneunonitis, hematologic toxicity and dermatitis, which were spontaneously improved, but 2 patients were died with radiation pneumonitis. Conclusion : The conventional radiation therapy was not sufficient therapy for achievement of long-term survival in locally advanced non-small cell lung cancer. Therefore, aggressive treatment including the addition of appropriate chemotherapeutic drug to decrease distant metastasis and preoperative radiotherapy combined with surgery, hyperfractionation radiotherapy or 3-D conformal radiation therapy for increase local control are needed.

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A Study on the Evaluation of 3D Dose Distribution using Normoxic Polymer Gel (정상산소 중합체 겔 선량계를 이용한 3차원 방사선량 평가에 관한 연구)

  • Chung, Se-Young;Kim, Young-Bum;Kwon, Young-Ho;Lee, Suk
    • The Journal of Korean Society for Radiation Therapy
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    • v.19 no.1
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    • pp.7-17
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    • 2007
  • Purpose: As increasing complexity of modern radiotherapy technique, more developing dosimetry is required. Polymer gel dosimeters offer a wide range of potential applications with high resolution and assured quality in the thee-dimensional verification of complex dose distribution such as intensity-modulated radiotherapy (IMRT). The purpose of this study is to find the most sensitive and suitable gel as a dosimeter by varying its composition ratio and its condition such as temperature during manufacturing. Materials and Methods: Each polymer gel with various ratio of composition was irradiated with the same amount of photon beam accordingly. Various polymer gels were analyzed and compared using a dedicated software written in visual C++ which converts TE images to R2 map images. Their sensitivities to the photon beam depending on their composition ratio were investigated. Results: There is no dependence on beam energy nor dose rate, and calibration curve is linear. Conclusion: The polymer gel dosimeter developed by using anti-oxidant in this study proved to be suitable for dosimetry.

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Novel Nonsense Variants c.58C>T (p.Q20X) and c.256G>T (p.E85X) in the CHEK2 Gene Identified dentified in Breast Cancer Patients from Balochistan

  • Baloch, Abdul Hameed;Khosa, Ahmad Nawaz;Bangulzai, Nasrullah;Shuja, Jamila;Naseeb, Hafiz Khush;Jan, Mohammad;Marghazani, Illahi Bakhsh;Kakar, Masood-ul-Haq;Baloch, Dost Mohammad;Cheema, Abdul Majeed;Ahmad, Jamil
    • Asian Pacific Journal of Cancer Prevention
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    • v.17 no.3
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    • pp.1089-1092
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    • 2016
  • Breast cancer is the most commonly occurring and leading cause of cancer deaths among women globally. Hereditary cases account 5-10% of all the cases and CHEK2 is considered as a moderate penetrance breast cancer risk gene. CHEK2 plays a crucial role in response to DNA damage to promote cell cycle arrest and repair DNA damage or induce apoptosis. Our objective in the current study was to analyze mutations in the CHEK2 gene related to breast cancer in Balochistan. A total of 271 individuals including breast cancer patients and normal subjects were enrolled. All 14 exons of CHEK2 were amplified and sequenced. The majority of the patients (>95%) had invasive ductal carcinomas (IDCs), 52.1% were diagnosed with tumor grade III and 56.1% and 27.5% were diagnosed with advance stages III and IV. Two novel nonsense variants i.e. c.58C>T (P.Q20X) and c.256G>T (p.E85X) at exon 1 and 2 in two breast cancer patients were identified in the current study. Both the variants identified were novel and have not been reported elsewhere.