In spite of remarkable improvement of surgical skills and anesthesia, local failure still occurred in 36-45% of locally advanced colorectal cancer after curative resection with or without pre-or post-operative irradiation. Intraoperative radiation therapy (IORT) is the ideal modality which respectable lesions are removed surgically and the remaining cancer nests are sterilized by irradiation during a surgical procedure. Therefore, the excellent local control without the damage of the adjacent normal tissues can be achieved. In IORT, judicious set up of the treatment cone on the treatment surface of the patient is required for accurate and homogenous dose distribution within treatment field, especially on the slopping surface of sacrum and pelvic sidewall which are the common sites of the local recurrence in rectal cancer. For this purpose, adequate coordination of gantry rotation and table tilting are essential. Adjusting gantry rotation is not difficult but tilting of the table is impossible inconventional treatment couch. Department of Therapeutic Radiology in Yeungnam University Medical Center developed the IORT table for colorectal cancer which is easy to set up and detach on head-down is about 30 degree which is efficient and easy-to-use, not only for IORT but also for colorectal surgery. So far, authors performed IORT with newly developed treatment table in 2 patients with rectal cancer and we found that this newly developed table could contribute in improving the dose distribution of IORT and surgical procedure for colorectal cancer.
Academic Medical Centers ; Anesthesia, Local ; Colorectal Neoplasms* ; Colorectal Surgery ; Humans ; Radiation Oncology ; Rectal Neoplasms ; Recurrence ; Sacrum

The purpose of this paper is to develop an efficient method for the quick determination of multiple isocenters plans to provide optimal dose distribution in stereotactic radiosurgery. A Spherical dose model was developed through the use of fit to the exact dose data calculated in a 18cm diameter of spherical head phantom. It computes dose quickly for each spherical part and is useful to estimate dose distribution for multiple isocenter. An automatic computer search algorithm was developed using the relationship between the isocenter move and the change of dose shape, and adapted with a spherical dose model to determine isocenter separation and collimator sizes quickly and automatically. A spherical dose model shows a comparable isodose distribution with exact dose data and permits rapid calculation of 3-D isodoses. The computer search can provide reasonable isocenter settings more quickly than trial and error types of plans, while producing steep dose gradient around target boundary. A spherical dose model can be used for the quick determination of the multiple isocenter plans with a computer automatic search. Our guideline is useful to determine the initial multiple isocenter plans.
Head ; Radiosurgery*

Among the 63 patients with histopathologically proven primary squamous cell anal cancer who were managed in Presbyterian Medical Center and Yonsei University Cancer from Jan. 1971 to Dec. 1991, 34 patients, who were managed with surgery alone (abdominoperineal resection) or post-operative radiotherapy and concurrent chemoradiotherapy were analyzed. With mean follow up time of 81.3 months, 30 patients (88%) were followed up from 17 to 243 months. In methods, 10 patients were treated with surgery alone. 9 patients were treated with combined surgery and postoperative radiotherapy (59~60 Gy in 28~30 fractions). 15 patients were treated with concurrent chemoradiotherapy. Chemotherapy (Mitomycin C 15 mg/squ, bolus injection day 1;5-FU, 750 mg/squ, 24hr infusion, day 1 to 5) and radiotherapy started the same day. A dose of 30 Gy was given to the tumor and to the pelvis including inguinal nodes, in 15 fractions. After 2 weeks a boost of radiotherapy (20 Gy) to the ano-perineal area and second cycle of chemotherapy completed the treatment. The overall 50year survival rate was 56.2%. concurrent chemoradiotherapy group was 70% and surgery alone group was 16.7%. According to the cox proportional harzard model, there was significant different between survival with concurrent chemoradiotherapy and surgery alone (p=0.0129), but post-operative radiotherapy was 64.8%, which was not stastically significant (p=0.1412). In concurrent chemoradiotherapy group, the anal function preservation rate was 87% and the severe complication rate (grade 3 stenosis and incontinence) was 13.3%. In conclusion, we conclude that the concurrent chemoradiotherapy may be effective treatment modality in patients with anal cancer
Anus Neoplasms* ; Chemoradiotherapy* ; Constriction, Pathologic ; Drug Therapy ; Follow-Up Studies ; Humans ; Pelvis ; Protestantism ; Radiotherapy ; Survival Rate

PURPOSE: Despite apparently complete resection of cancer of the rectum, local recurrence rate was high. Radiation therapy has been used either alone or in combination with chemotherapy as an adjunct to surgery to reduce the risk of recurrence. This study was designed to evaluate the prognostic factors, survival rate and local recurrence rate of the rectal cancer who had received postoperative radiation therapy by retrospective analysis. METHOD: From 1982 to 1990, 63 patients with cancer of the rectum surgically staged as B2 or C disease received postoperative adjuvant radiation therapy after curative resection of tumor for cure. Postoperative radiation therapy was given to the whole pelvis (mean dose: 5040 cGy in 5-6weeks) and perineum was included in irradiated field in case of abdominoperineal resection. RESULTS: Three-year actuarial survival rate was 73.2% overall, 87.7% in stage B2+3 and 62.9% in stage C2+3. Three-year disease-free survival rate was 69.5% overall, 87.7% in stage B2+3 and 56.8% in stage C2+3. Three-year disease-free survival rate in anterior resection was 77.8% and 44.4% in abdominoperineal resection. The local recurrence rate was 15.9% and distant failure rate was 20.6%. Severe late complication was small bowel obstruction in 6 patients and surgery was required in 4 patients (6.3%). The prognostic factors were stage (p=0.0221) and method of surgery(p=0.0414) (anterior resection vs abdominoperineal resection). CONCLUSION: This study provides evidence supporting the use of postoperative radiation therapy for reducing the local recurrence rate in patients who have had curative resection of rectal cancer with involvement of perirectal fat or regional nodes or both (stage B2 and C).
Disease-Free Survival ; Drug Therapy ; Humans ; Pelvis ; Perineum ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: The aim of this study is to analyze the clinical results of thermo-irradiation treatment for surgically unresectable advanced hepatoma with or without hepatic arterial chemo-embolization (HACE), chemotherapy (CT) and interferon (IFN) therapy. MATERIALS AND METHODS: Between February 1990 and December 1992, 45 patients with surgically unresectable advanced hepatomas were treated by thermo-irradiation with or without hepatic arterial chemo-embolization and other treatment modalities. Among them, We analyzed retrospectively 25 patients who received more than three times of hyperthermias. Mean age was 50 years (range: 18-71 years) and male to female ratio was 20:5. In the study, treatment was administered as follows: 3 patients received radiation therapy (RT) and hyperthermia (HT). 3 received RT+HT+CT. 3 received RT+HT+HACE. 1 received RT+HT+CT+HACE. 2 received RT+HT+CT+IFN. 10 received RT+HT+HACE+IFN. 3 received RT+HT+CT+HACE+IFN. Radiation therapy was done by a 6 MV linear accelerator. Patients were treated with daily fractions of 180 cGy to doses of 11 Gy-50Gy (median 30Gy). Local hyperthermia was done by HEH-500C(Omron Com Japan), 30-45 min/session, 2 session/wk and the number of HT sessions ranged from 3 to 17 (median 7 times). 15 patients of 25 were followed by abdominal CT scan or abdominal ultra-sonogram. The following factor were analyzed : Age, histologic grade, sex, number of hyperthermia, total RT does, hepatic arterial chemo-embolization. RESULTS: Of 25 patients. There were observed tumor regression (partial response and minimal response) in 6 (24%), no response in 8 (32%), progression in 1 (4%) and not evaluable ones in 10 (40%) radiographically. The over all 1-year survival was 25% with a mean survival of 33 weeks. The treatment modes of partial and minimal responsive patients (PR+MR) were as follows: Two were treated with RT+HT+HACE, 2 were done with RT+HT+HACE+IFN Remaining 2 were treated with RT+HT+CT+HACE+IFN. The significant factor affecting the survival rate were RT dose (more than 25Gy), HACE, number of HT (above 6 times), responsiveness after treatment (PR+MR). Age, sex, histologic differentiation, chemotherapy, interferon therapy were not statistically significant factors affecting the survival rate. Conclusion : Although follow-up duration was short, the thermo-irradiation with/without hepatic arterial chemo-embolization was well tolerated and there were no serious complications. In future, it is considered the longer follow up and prospective, well controlled trails should be followed to evaluate the efficacies of survival advantage.
Carcinoma, Hepatocellular* ; Drug Therapy ; Female ; Fever ; Follow-Up Studies ; Humans ; Hyperthermia, Induced ; Interferons ; Male ; Particle Accelerators ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Tomography, X-Ray Computed

From December 1989 to February 1993, 108 patients with Non-Small Cell Lung Cancers(NSCLC) were studied retrospectively to evaluate radiotherapeutic significance of serum levels of NSE. We considered elevated serum neuron specific pathologic evaluation revealed 86 squamous cell carcinomas, 11 adenocarcinomas, 3 large cell carcinomas, 3 mucoepidermoid carcinomas, and 5 unknown pathology. Eight patients had stageI, 40 stage III A, and 60 stageIII B. S-NSE level greater than 15 ng/ml was considered as elevated, and below this considered as normal. All patients received radiotherapy as primary treatment modality. The responders to radiotherapy had significantly higher mean S-NSE level than on-responders (28.5 ng/ml vs 20 ng/ml, p=0.01). Overall 2-year survival rate (YSR) was 23.6%. According to radiotherapy response, 2 YSR for patients with CR, PR, and NR were 39.2%, 28.6%, and 6.2% respectively (p=0.001). 2 YSR for patients with elevated and normal S-NSE were 14.6% and 31.7%(p=0.02). The patients with NR showed no difference in survival according to S-NSE level. When we considered all patients, S-NSE level showed no significant impact on response. But for squamous cell cardinomas alone, patients with elevated S-NSE had more patients with higher nodal stage. Based on our and other data, NSCLSC with neuroendocrine features have different response to treatment and clinical behavior compared to other NSCLSC. Thus, this subgroup may need different treatment modality, and S-NSE level may have prognostic significance.
Adenocarcinoma ; Carcinoma, Large Cell ; Carcinoma, Mucoepidermoid ; Carcinoma, Squamous Cell ; Humans ; Lung Neoplasms* ; Lung* ; Neurons ; Pathology ; Phosphopyruvate Hydratase ; Radiotherapy ; Retrospective Studies ; Survival Rate

Kimura's disease is a rare disorder which predominantly involves the head and neck region can cause eosinophilia in peripheral blood. It has beeb treated with steroids, surgical excision, irradiation, cryotherapy, and laser. The sessions have a tendency to recur after steroid and surgery. We reviewed 2 patients with Kimura's disease who recurred, because they were resistant steroid therapy and surgery, and treated successfully conventional radiation therapy.
Cryotherapy ; Eosinophilia ; Head ; Humans ; Neck ; Radiotherapy* ; Steroids

Seventy-five patients with tumors of the head and neck treated with either radiation therapy alone or combined with surgery or chemotherapy were studied prospectively to evaluate the effects of radiation therapy to the neck on thyroid gland between September 1986 and October 1992. All patients were serially monitored for thyroid function tests before and after radiation therapy. Radiation dose to the thyroid gland ranged from 35 to 60 Gy with a median dose of 50 Gy. Median follow-up time was 30 months with a range of 11 to 85 months. The incidence of thyroid dysfunction was 40%; forty-five patients (60%) euthyroid, 2 patients (3%) clinical hypothyroidism, 27 patients (36%) subclinical hypothyroidism and 1 patient (1%) hyperthyroidism. No thyroid nodules or thyroid cancer were detected in any patients. Thyroid dysfunction appeared earlier in patients who underwent surgery than in those patients treated with radiation therapy alone or combination of chemotherapy and radiation therapy (p=0.0013). By multivariate analysis, risk factors that significantly influenced a higher incidence of thyroid dysfunction were female sex (p=0.0293) and combination of total larygectomy and radiation therapy (p=0.0045). In conclusion, evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests are recommended to detect thyroid dysfunction in time and thyroid hormone replacement therapy is recommended whenever thyroid dysfunction develops.
Drug Therapy ; Female ; Follow-Up Studies ; Head* ; Hormone Replacement Therapy ; Humans ; Hyperthyroidism ; Hypothyroidism ; Incidence ; Multivariate Analysis ; Neck* ; Prospective Studies ; Risk Factors ; Thyroid Function Tests ; Thyroid Gland* ; Thyroid Neoplasms ; Thyroid Nodule

Seventy-nine patients with carcinoma of maxillary antrum treated at the department of therapeutic radiology, Kosin Medical Center, between June 1980 and December 1986 were analyzed retrospectively for survival rate and treatment failure. Forty-three patients were treated with radiotherapy alone and thirty-six patients were treated with combination of surgery and radiotherapy. The overall 5 year survival rate was 32%, patients that were treated with radiotherapy alone had a 5-year survival rate of 23%, and patients who were treated with combination of surgery and radiotherapy had a 5-year survival rate of 42%. 54 patients(68.4%) failed to be cured. Among these 54 patients, 37 patients(68.5%) had only locoregional failure, 16 patients(29.6%) had locoregional failure and distant metastases and 1 patient had only distant metastasis. From above study combination of surgery and radiotherapy might be a better treatment modality for carcinoma of the maxillary antrum.
Humans ; Maxillary Sinus* ; Neoplasm Metastasis ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Treatment Failure

A retrospective analysis was performed on 55 patients with malignant parotid tumor who were treated with radiation therapy between March, 1979 and July, 1989. Of these patients, 8 patients received radiation therapy(RT) alone and 47 patients were treated with combined operation and radiation therapy(OP+RT). The follow-up period of the survivors ranged form 1 to 129 months with a median of 48 months. The common histologic types were mucoepidermoid carcinoma (25 cases), malignant mixed tumor(12 cases), adenoid cystic carcinoma(6 cases). The 5 and 10 year local control rate were 69.8% and 65.7% in all patients. In OP+RT group, prognostic factors related to local control were histologic grade, tumor size, lymph node metastasis. Resection of facial nerve did not affect the local control rate significantly(p=0.129). Distant metastasis developed in 23.6% of patients, mostly to the lung. Actuarial overall survival rate was 72.2% at 10 years and formed plateau after 5 years. Disease-free (NED) survival rate was 49.4% at 10 years and was better achieved in OP+RT group and low grade lesions. Based on our result, a well planned postoperative RT following parotidectomy is highly efficacious in controlling malignant tumors of the parotid gland and preservation of facial nerve.
Adenoids ; Carcinoma, Mucoepidermoid ; Facial Nerve ; Follow-Up Studies ; Humans ; Lung ; Lymph Nodes ; Neoplasm Metastasis ; Parotid Gland* ; Retrospective Studies ; Survival Rate ; Survivors