PURPOSE: This study was performed to determine the optimal treatment volume of patients treating with radiation therapy for intracranial germ cell tumor. MATERIALS AND METHODS: From 1993 to 1998, 19 patients with intracranial germ cell tumors treated by gamma knife radiosurgery were analyzed. The location of tumor was as follows; 9 cases on pineal region, 1 case on suprasellar region, and 9 cases of multiple lesion. 7 patients were pathologically verified; 5 cases of germ cell tumor and 2 cases of non germinomatous germ cell tumor. Tumor volume was ranged from 2.4 cm3 to 74 cm3. Irradiation dose was 10 Gy to 20 Gy with 50% isodose curve. Follow up period was 10 months to 54 months. RESULTS: Recurrences were observed in 14 cases among 19 (74%) patients. Complete remission and partial remission were achieved in 2 (11%) and 10 (53%) respectively. No response was observed in 7 (36 %). 2 cases were recurred within original tumor bed. 6 cases were recurred beyond but contiguous with tumor bed. Ventricular relapses separated from pretreatment tumor bed were 3. Spinal recurrences were 4. Among 8 recurred cases of which tumor volume is smaller than 20 cm3, 2 were recurred within original tumor bed, 4 were recurred beyond but contiguous with tumor bed, and 1 spinal recurrence. Meanwhile, 6 cases of which tumor volume larger than 20 cm3, 1 case was recurred beyond but contiguous with tumor bed, 2 ventricular recurrences separated with original tumor bed, and 3 spinal recurrences. 5 cases which did not show any recurrence sign showed characteristics of single lesion, tumor volume smaller than 20 cm3 and normal tumor marker. All of 4 cases of spinal recurrences happened in the case having ventricular invasion or lesion. Among 9 cases having multiple lesion, only 3 cases recurred within original tumor bed or around tumor bed, the other 6 cases recurred separated from pretreatment tumor bed. CONCLUSION: Gamma knife radiosurgery is not recommended for the treatment of intracranial germ cell tumor. It is because of small treatment volume and inadequate radiation dose that are characteristics of gamma knife radiosurgery. Tumor volume, ventricular invasion or ventricular lesion in multiple lesion are important factors to be considered for the wide field radiation therapy. Tumor volume smaller than 20 cm3, single lesion, no ventricular lesion or invasion, and normal tumor marker are ideal indications for small involved field radiation therapy. Prophylactic spinal irradiation seems to be necessary when there is ventricular lesion, ventricular invasion, and multiple lesions. When the tumor volume is larger than 20 cm3, multiple lesions, abnormal tumor marker, and whole ventricular irradiation or partial brain irradiation would be possible and neoadjuvant chemotherapy would be most beneficial in these group.
Brain ; Drug Therapy ; Follow-Up Studies ; Germ Cells* ; Humans ; Neoplasms, Germ Cell and Embryonal* ; Radiosurgery* ; Recurrence ; Tumor Burden

From December 1984 to February 1990, 16 patients with tumors of pineal and suprasellar location were treated with radiation therapy. Tissue diagnoses were obtained before radiation therapy in 5 patients and 11 were irradiated without histologic confirmation. Initial treatments for these patients were craniospinal plus boost primary irradiation(six), whole brain plus boost primary irradiation(nine), primary tumor site irradiation(one). The 5 year actuarial survival rate is 71%. Three cases with elevated beta-human chorionic gonadotropin (HCG) responded favorably to radiation, but pineal tumors with elevated alpha-fetoprotein(AFP) did not respond well. Spinal metastasis developed in 2 cases (2/15) with elevated AFP : one received prophylactic spinal irradiation, another did not. Our studies suggest that more aggressive treatment would be necessary in patient with elevated AFP and in this patient, radiation therapy may be initiate without pathologic confirmation. From the result of our study, routine use of prophylactic spinal irrdiation for all patients with pineal region tumor is not indicated and use of prophylactic spinal irrdiation is considered for the patients with positive craniospinal fluid cytology, meningeal seeding, disease extension along the ventricular wall and biopsy proven germinoma
Biopsy ; Brain ; Chorionic Gonadotropin ; Diagnosis ; Germinoma ; Humans ; Neoplasm Metastasis ; Pinealoma* ; Radiotherapy* ; Survival Rate ; Biomarkers, Tumor

PURPOSE: We investigated the temporal alterations of apoptosis and mitotic death followingirradiation in the rat's small intestinal crypts. MATERIALS AND METHODS: Male Sprague-Dawley rats were irradiated 2 Gy by 6 MV linear accelerator and sacrified at 2, 4, 8, 24, 48 hours after irradiation. The mean numbers of the apoptotic cells and mitotic cells per their small intestinal crypts were measured in the unirradiated control and irradiated groups. To compare with H & E staining, ISEL (In Situ End Labelling) were performed in the group having the highest apoptotic count. RESULTS: The mean number of the apoptosis per crypt in the control group was 0.14 and those at 2, 4, 8, 24, 48 hours after irradiation were 1.43, 3.19, 1.15, 0.26, 0.17, respectively. So the apoptosis development was increased upto 4 hours and then normalized around 24 hours following irradiation. The mean number of the mitotic cells per crypt in the control group was 1.29 and those at 2, 4, 8, 24, 48 hours after irradiation were 0.56, 0.47, 0.23, 0.65, 1.19, respectively. The mitotic cell counts following irradiation was decreased to 8 hours and recovered to the normal level about 48 hours. So the increment of apoptotic cell count was occurred earlier and more remarkable than the decrement of mitotic cell count after irradiation. According to the staining time, false positivity was found in the ISEL staining. CONCLUSIONS: The cell death in the small intestinal crypt developed by acute radiation damage was usually decreased to the normal level within 24~48 hours after irradiation and the apoptosis was thought to be more important process than the mitotic death.
Animals ; Apoptosis* ; Cell Count ; Cell Death ; Humans ; Intestine, Small ; Male ; Mitosis ; Particle Accelerators ; Rats* ; Rats, Sprague-Dawley

PURPOSE: Pathologic stage is the most accurate prognostic factor of renal cell carcinoma. We evaluated whether perirenal fat infiltration is a significant factor in tumors 7 cm or less in size. MATERIALS AND METHODS: We retrospectively reviewed the record of 164 cases of tumors 7 cm or less in size. We divided the patients into two groups according to the presence of perirenal fat infiltration (group A, pT1; group B, pT3a). We evaluated relationships, recurrence-free survival and disease-specific survival according to clinicopathologic parameters. Statistical differences were calculated by log-rank test. RESULTS: A total 131 patients were included in group A, with a mean age of 55.8 years, average tumor size was 4.2 cm, and a mean follow-up period of 43 months. Group B included 33 patients, with a mean age of 55.9 years, an average tumor size of 4.1 cm, and a mean follow-up period of 38 months. There was no significant difference in disease-specific survival; however, recurrence-free survival showed significantly different between two groups (group A: 95.5%, group B: 84.4%). CONCLUSION: In this study, perirenal fat infiltration proved to be an independent prognostic factor for predicting disease-free survival in patients with tumors of 7 cm or less in size. Therefore, as this study showed, the presence of perirenal fat infiltration requires stricter follow-up planning, even in small renal cell carcinoma.
Adipose Tissue ; Carcinoma, Renal Cell* ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Neoplasm Invasiveness ; Prognosis ; Retrospective Studies

Abdominal oblique muscle injuries are relatively common in professional baseball players and can result in substantial loss of playing time. It is usually caused by a sudden movement of the torso in sports involving repetitive activity requiring trunk rotation and it tend to occur on the contralateral side of the dominant arm. We report a unique case of sequentially occurred bilateral abdominal internal oblique muscle rupture in a right-handed professional baseball batter over two seasons. Each internal oblique rupture had a different mechanism of the injury, the non-dominant side occurred during bat swing and the dominant side during bent leg sliding. After rest and rehabilitation, each injury was recovered to play in about 1 month.

The first step in the commissioning procedure of a treatment planning system is always verification of the basic beam data. In this work, we have measured PDD curves and beam profiles between 1x1 cm2 and 40x40 cm2. In an attempt, Pinnacle 7.4f detect discrepancies between predicted dose distribution and delivered dose distribution. The discrepancies between measurement data and caculation data was found. The delivered dose was underestimated in field but overestimated out of field. The Dmax depth of 1x1 cm2 was reduced about 2 mm. For the larger field size (> or = 4x4 cm2), the beam profile and PDD curve showed good agreement between measurement data and calculation data.

PURPOSE: To evaluate the prognostic factors for disease-free survival and long-term results of radiotherapy for pituitary adenoma. METHODS AND MATERIALS: The study involved a retrospective review of outcome in a series of 27 patients with pituitary adenoma, between 1984 and 1995 at Paik hospital. The study included 20 patients treated with surgery and postoperative radiotherapy and 7 with radiotherapy alone. The patients were followed for 12-146 months (median : 97 months). Seventeen were men and 10 were women. The numbers of functioning and non-functioning pituitary adenoma were 22 and 5 respectively and those of microadenoma and macroadenoma were 4 and 23 respectively. The radiation doses of 5040-5580cGy (median : 5040cGy) were deliverd over 5-7 weeks, using 4MV LINAC. The prognostic factors were analyzed by log-rank test. RESULTS: For radiation therapy alone, the 5YSR was 100% and progression free survival rate was 85.8%. The tumor was controlled in 6/7 (85.8%). For surgery and postoperative radiotherapy, the 5YSR, progression free survival rate and local control rate were 95%, 84.8%, and 89.5% respectively. The parameters of tumor size, hormone secretion, radiation dose, radiotherapy field size were evaluated in a uni- and multivariate analysis and all the factors were not statistically significant (P > 0.05). Eleven of 12 (92%) with visual field defect experienced normalization or improvement, and 5 for 7 evaluable patients with hyperprolactinoma achived normalization in 4 and decrement in 5 patients. Only 2 patients developed mild degree of panhypopituitarism. CONCLUSION: The radiotherapy appears to be effective in controlling clinical symptoms and signs resulting from pituitary adenoma. Local control rate with radiotherapy alone or with surgery and postoperative radiotherapy was comparable. There was a trend toward high recurrence rate in patients with nonfunctioning or prolactin secreting tumor and larger radiation field sizes.
Disease-Free Survival ; Female ; Humans ; Male ; Multivariate Analysis ; Pituitary Neoplasms* ; Prolactin ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Visual Fields

PURPOSE: To investigate the pathways of radiation induced apoptosis and the effect of cysteamine (beta-mercaptoethylamine), as a radioprotector, on it. MATERIALS AND METHODS: HL-60 cells were assigned to control, irradiated, and cysteamine (1 mM, 10mM) pretreated groups, Irradiation was given in a single fraction of 10 Gy (6 MV x-ray) and cysteamine was administered 1 hour before irradiation. The activities of caspase-8 were measured in control and irradiated group to evaluate its relation to the radiation induced apoptosis. To evaluate the role of cysteamine in radiation induced apoptosis, the number of viable cells, the expression and activity of caspase-3, and the expression of poly (ADP-ribose) polymerase (PARP) were measured and compared after irradiation the HL-60 cells with cysteamine pretreatment or not. RESULTS: The intracellular caspase-8 activity, known to be related to the death receptor induced apoptosis, was not affected by irradiation (p>0.05). The number of viable cells began to decrease from 6 hours after irradiation (p>0.05), but the number of viable cells in 1 mM cysteamine pretreated group was not decreased afger irradiation and was similar to those in the control group. In caspase-3 analyses, known as apoptosis executioner, its expression was not different but its activity was increased by irradiation (p>0.05). However, this increase of activity was suppressed by the pretreatment of 1mM crysteamine. The cleavage of PARP, thought to be resulted from caspase-3 activation, occurred after irradiation, which was attenuated by the pretreatment of 1mM cysteamine. CONCLUSION: these results show that radiation induced apoptotic process is somewhat different from death receptor induced one and the pretreatment of 1 mM cysteamine has a tendency to decrease the radiation-induced apoptosis in HL-60 cells.
Apoptosis* ; Caspase 3 ; Caspase 8 ; Cysteamine* ; HL-60 Cells ; Humans

PURPOSE: Since the mid cranial fossa is composed of various thickness of bone, the tissue inhomogeneity caused by bone would produce dose attenuation in cobalt-60 gamma knife irradiation. The correction factor for bone attenuation of cobalt-60 which is used for gamma knife source is -3.5%. More importantly, nearly all the radiosurgery treatment planning systems assume a treatment volume of unit density; any perturbation due to tissue inhomogeneity is neglected. This study was performed to confirm the bone attenuation in mid cranial fossa using gamma knife. MATERIALS AND METHODS: Computed tomography was performed after Leksell stereotactic frame had been fixed to the Alderson Rando phantom (human phantom) skull area. Kodak X-omat V film was inserted into two sites of pituitary adenoma point and acoustic neurinoma point, and irradiated by gamma knife with 14mm and 18mm collimator. An automatic scanning densitometer with a 1mm aperture is used to measure the dose profile along the x and y axis. RESULTS: Isodose curve constriction in mid cranial fossa is observed with various ranges. Pituitary tumor point is greater than acoustic neurinoma point (0.2-3.0 mm vs. 0.1-1.3 mm) and generally 14 mm collimator is greater than 18mm collimator (0.4-3.0 mm vs. 0.2-2.2 mm). Even though the isodose constriction is found, constriction of 50% isodose curve which is used for treatment reference line does not exceed 1 mm. This range is too small to influence the treatment planning and treatment results. CONCLUSION: Radiosurgery planning system of gamma knife does not show significant error to be corrected without consideration of bone attenuation.
Axis, Cervical Vertebra ; Constriction ; Film Dosimetry* ; Neuroma, Acoustic ; Pituitary Neoplasms ; Radiosurgery* ; Skull

PURPOSE: This study was performed to analyze the efficacy of induction chemotherapy followed by radiation therapy in locally advanced non-small cell lung cancer. MATERIALS AND METHODS: Eighty patients with locally advanced non-small cell lung cancer treated from 1989 to 1995 at Pusan Paik hospital were analyzed retrospectively. Twenty-one patients were treated with induction chemotherapy followed by radiation therapy and Fifty-nine patients were treated with radiation therapy alone. Chemotherapy regimen consisted of cisplatin-based combination (2 or 3 drugs). All patients were treated by Co-60 or 6 MV linear accelerators. Radiation dose ranged from 50 Gy to 80 Gy (median, 64.8 Gy). We evaluated response rate, survival rate, and pattern of failure in both treatment groups. RESULTS: Overall response rate in induction chemotherapy group and radiotherapy alone group were 48% and 45%, respectively. Of the 80 patients, 46 patients were evaluable for pattern of failure. Initial failure pattern in induction chemotherapy group was as follows: 8 (67%) at locoregional, 4 (33) in distant metastasis. Radiation alone group was 21 (71%) and 5 (29%), respectively. Results showed no difference of distant failure between induction chemotherapy group and radiation alone group. The 1 and 2 year survival rate in induction chemotherapy group were 43% and 14%, respectively and in radiotherapy alone group, 31% and 7%, respectively (p=0.135). CONCLUSION: In stage lll non-small cell lung cancer, induction chemotherapy and radiation therapy showed increased tendency in survival with no statistical significance. Induction chemotherapy seems to have no effect of decreasing distant failure and no survival advantage compared with radiotherapy alone.
Busan ; Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Humans ; Induction Chemotherapy* ; Neoplasm Metastasis ; Particle Accelerators ; Radiotherapy ; Retrospective Studies ; Survival Rate