• Radiation Oncology Journal
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• v.16 no.2
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• pp.177-184
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• 1998

Purpose : Radiotherapy has been the mainstay of the treatment of brain metastases. We evaluated the response rate, survival and prognostic factors of patients with brain metastases treated with radiotherapy for palliative purpose. Materials and Methods : From January 1994 through April 1997, in all 42 patients, a retrospective analysis was undertaken. Of these, 33 patients received whole brain irradiation with 30Gy in 10 daily fractions with or without a boost of 10Gy in 5 daily fractions to the site of solitary lesion. Nine patients failed to complete the planned treatment Results : Of 33 patients who finished radiotherapy, complete and partial response were observed in $4(12\%)$ patients and $22(67\%)$ ones, respectively. Overall response rate was $79\%$ and median survival was 4 months. In univariate analysis, prognostic factors affecting survival were initial neurologic function class(p=0.0136), extracranial tumor activity(p=0.042), and response after radiotherapy(p=0.001). Conclusion : We confirmed that whole brain irradiation is the effective means for treating the patient with brain metastases. initial neurologic function class, extracranial tumor activity, and response alter radiotherapy were identified as prognostic factors affecting survival.

• Radiation Oncology Journal
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• v.1 no.1
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• pp.69-77
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• 1983

20 cases of midline pineal tumors and 3 suprasellar germinomas received radiation therapy at Yonsei University Medical College, Severance hospital from 1971 to 1982 were reviewed. 12 cases were pathologically proved; 10 germinomas, 1 pineoblastoma, and 1 pineocytoma. 11 cases received radiotherapy without biopsy confirmation. Although treatment fields varied from small field to whole brain irradiation, but not to the spinal cord, most patients received 4000-5000 rads irradiation to the primary tumor site. 17 patients are alive without evidence of disease and 5 year actuarial NED survival is 73.2%. 9 of 10 biopsy proved germinomas and all 6 presumed germinomas are alive and well. Optimum radiation dose, adequate irradiation field, tumor response to radiation observed in serial CT scan and role of radiation therapy in the management of pineal tumors are also discussed.

• Journal of Korean Neurosurgical Society
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• v.65 no.6
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• pp.861-867
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• 2022

Objective : High-dose radiation is well known to induce and modulate the immune system. This study was performed to evaluate the correlation between clinical outcomes and changes in natural killer cell activity (NKA) after Gamma Knife Radiosurgery (GKS) in patients with brain cancer. Methods : We performed an open-label, prospective, cross-sectional study of 38 patients who were treated with GKS for brain tumors, including metastatic and benign brain tumors. All of the patients underwent GKS, and blood samples were collected before and after GKS. NKA was measured using an enzyme-linked immunosorbent assay kit, to measure interferon-gamma (IFNγ) secreted by ex vivo-stimulated NK cells from whole blood. We explored the correlations between NK cell-produced IFNγ (NKA-IFNγ) levels and clinical parameters of patients who were treated with GKS for brain tumors. Results : NKA-IFNγ levels were decreased in metastatic brain tumor patients compared to those with benign brain tumors (p<0.0001). All the patients who used steroid treatment to reduce brain swelling after GKS had an NKA-IFNγ level of zero except one patient. High NKA-IFNγ levels were not associated with a rapid decrease in brain metastasis and did not increase after GKS. Conclusion : The activity of NK cells in metastatic brain tumors decreased more than that in benign brain tumors after GKS.

• Radiation Oncology Journal
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• v.6 no.2
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• pp.177-182
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• 1988

A retrospective analysis was peformed on 23 patients with pineal region tumors treated with radiation from 1979 through 1985 at the Department of Therapeutic Radiology, Seoul National University Hospital. Histologic confirmation was done in only one case by surgical removal, and in the remaining 22 patients, the diagnosis was based on clinical and radiological findings. The radiation volume was the primary tumor site in 1 case, whole brain in 14 cases, and the whole craniospinal axis En 8 cases. The overall 5 year survival was $71.5\%$. The 5 year survival was $69.3\%$ for whole brain treated group and $73.3\%$ for craniospinal axis treated group. The survival for the two groups did not differ significantly. In two cases sites of recurrence were detected, one in supratentorial area, and the other in the lung. The results from this retrospective analysis and the review of other reports indicate that routine use of prophylactic spinal irradiation is not warranted in pineal region tumor, and the craniospinal irradiation is recommended in cases with high risk for subarachnoid seeding such as positive CSF cytology, surgical removal or biopsy.

• Radiation Oncology Journal
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• v.3 no.2
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• pp.163-168
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• 1985

Intraocular melanoma is the most common primary occular malignancy in adult above the age of 20. Before treatment of intraocular melanoma, it is essential to do complete work-ups including LFT (LDH, SGPT), chest X-ray, whole body bone scan. Also, liver-spleen and brain scan will be done if clinically indicated. Though, malignant melanoma is radioresistant, however, show rapid tumor shrinkage after irradiation with total tumor dose of 7,000 to 8,000 rads in 7-8 weeks.

• Journal of radiological science and technology
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• v.34 no.1
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• pp.59-64
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• 2011

We investigated the radiation exposure caused by DIPS, which is used to identify accurate repositioning and tumor location in pediatric cancer patients proton therapy. To compare and analyze DIPS condition, 50 pediatric cancer patients who underwent proton therapy were selected in Ilsan K cancer-specialized hospital from March 2007 to October 2009. For DIP exposure, 0.09~1.57 mGy is measured in AP and lateral directions and 23.55 mGy is measured in CSI patients. In whole brain patient, the amount of a day DIP exposure dose was 1.13 mGy. During treatment period, who exposed the biggest DIP dose are whole brain patients, 632.71 mGy is exposed. It is 1.13% of prescribed dose, represented dose is adequate because it is not exceeded 2% of recommended dose. Even though the exposed dose is not exceeded more than 2% of prescribed in DIP exposure, we should recognize the radiation damage and genetic influences to pediatric cancer patients, who is much sensitive to radiation and has longer mean residual life time. Therefore, DIPS guideline for pediatric cancer patients should be indicated to minimize the radiation exposure.

• Journal of Korean Neurosurgical Society
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• v.50 no.2
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• pp.99-102
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• 2011

Objective : The purpose of this retrospective study was to evaluate the outcome of gamma knife radiosurgery (GKRS) and/or whole brain radiation therapy (WBRT) for the treatment of small cell lung carcinoma (SCLC) metastasis to the brain. Methods : From 2000 to 2010, 50 patients underwent GKRS for metastatic brain lesions originating from SCLC. Among these patients, 11 received prophylactic cranial irradiation (PCI) before the development of metastatic lesions (PCI group), and GKRS was performed as an initial treatment for newly diagnosed lesions in 12 patients who had not received PCI (primary GKRS group). In addition, GKRS was performed as a salvage treatment for progressive lesions after WBRT in 27 patients (salvage GKRS group). The medical records and imaging data of all patients were retrospectively analyzed. Results : The overall survival of the 50 patients was 20.8 months (range 1-53) after the diagnosis of primary tumor and 12.0 months (range 1-47) after the development of cerebral metastasis. Median survival after GKRS was 4.8 months (range 1-15) in the PCI group, 4.6 months (range 0-18) in the primary GKRS group, and 7.6 months (range 0-33) in the salvage GKRS group. Further treatment for progressive lesions after GKRS was necessary in 15 patients, after a mean interval of 3.8 months. Causes of death were systemic organ failure in 15 patients, deterioration of neurological state in 13 patients, and unknown or combined causes in 16 patients. The local control rate of the lesions treated with GKRS was 76.4% (decreased in 13 patients and stable in 16 patients at the final imaging follow-up (mean 5.60 months). Conclusion : GKRS is an effective local treatment for brain metastasis from SCLC both as an initial treatment for newly diagnosed lesions after PCI and as a salvage treatment for recurrent or progressive lesions. However, the survival benefit is not significant because most patients die of systemic multi-organ failure with a short life expectancy.

• The Journal of Korean Society for Radiation Therapy
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• v.31 no.2
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• pp.33-41
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• 2019

Purpose: The purpose of this study is to improve the reduction of coverage of PTVs adjacent to organ at risk (OAR) by setting up overlapping Planning Target Volume (PTV) during Volumetric Modulated Arc Therapy(VMAT). Materials and Methods: In patients who received Whole Brain, Gall Bladder and Rectum radiation therapy, We compared the cover change, maximum dose, Homogenicity Index and Conformity Index of PTV and also compared the maximum dose and average dose change of Organ At Risk by organizing treatment plans that are not applied overlaped PTV and treatment plans that are applied overlaped PTV in areas where coverage is insufficient. Results: overage of treatment plans with overlapping PTVs was increased in all patients, and overall coverage was also increased in each of the four patients. The maximum dose for PTV was increased in five patients, and the Homogenicity Index and Conformity Index for all patients did not differ much. The maximum dose of the lens was increased by 1.12 times, and the maximum dose was decreased in two patients for brain stem. The mean dose of the eyeball was increased by a maximum of 1.15 times, and there was no significant difference between both parotid gland. In case of gallbladder cancer patients, the mean dose in the liver and colon was decreased, and the mean dose in the duodenum was increased. In the case of rectal cancer patients, the mean dose was reduced for both femur and bladder set as OARs. The overall MU was shown to be similar in four patients, excluding one. Conclusion: If the critical dose of OAR is considered and used properly, I think it is a useful way to improve coverage of PTV.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.301-309
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• 2015

Purpose: To identify prognostic factors for disease progression and survival of patients with extracranial oligometastatic breast cancer (EOMBC), and to investigate the role of radiation therapy (RT) for metastatic lesions. Materials and Methods: We retrospectively reviewed the medical records of 50 patients who had been diagnosed with EOMBC following standard treatment for primary breast cancer initially, and received RT for metastatic lesions, with or without other systemic therapy between January 2004 and December 2008. EOMBC was defined as breast cancer with five or less metastases involving any organs except the brain. All patients had bone metastasis (BM) and seven patients had pulmonary, hepatic, or lymph node metastasis. Median RT dose applied to metastatic lesions was 30 Gy (range, 20 to 60 Gy). Results: The 5-year tumor local control (LC) and 3-year distant progression-free survival (DPFS) rate were 66.1% and 36.8%, respectively. High RT dose (${\geq}50Gy_{10}$) was significantly associated with improved LC. The 5-year overall survival (OS) rate was 49%. Positive hormone receptor status, pathologic nodal stage of primary cancer, solitary BM, and whole-lesion RT (WLRT), defined as RT whose field encompassed entire extent of disease, were associated with better survival. On analysis for subgroup of solitary BM, high RT dose was significantly associated with improved LC and DPFS, shorter metastasis-to-RT interval (${\leq}1month$) with improved DPFS, and WLRT with improved DPFS and OS, respectively. Conclusion: High-dose RT in solitary BM status and WLRT have the potential to improve the progression-free survival and OS of patients with EOMBC.

• Journal of Sasang Constitutional Medicine
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• v.26 no.4
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• pp.400-408
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• 2014

Objectives The aim of this study was to report the improvement of delirium and performance status in the small-cell lung cancer patient who had multiple brain metastases and pericardial effusion after Sasang constitutional treatment. Methods We retrospectively reviewed the medical records, medical laboratory and image scans of 71-year-old male patient diagnosed as small-cell lung cancer. Results The small-cell lung cancer with multiple brain metastases patient sometimes talked deliriously even after the whole brain radiation therapy. During the hospitalization period, he showed delirium. We treated him with Gihwangbaekho-tang and Dojeokgangki-tang as a main therapy. After treatment, he didn't show delirium and performance status was improved. Conclusions A small-cell lung cancer with multiple brain metastases patient showed the improvement of symptoms (delirium, poor performance status, constipation and poor oral intake) with the treatment of Gihwangbaekho-tang, Yanggyuksanhwa-tang and Dojeokgangki-tang.