PURPOSE: To evaluate the effectiveness and safety of postoperative radiotherapy for the treatment of keloid scars administered immediately after Cesarean section. MATERIALS AND METHODS: A total of 26 postpartum patients with confirmed keloids resulting from previous Cesarean sections received either 12 or 15 Gy radiotherapy. The radiotherapy was divided into three 6 MeV electron beam fractions administered during the postpartum period immediately following the final Cesarean section. To evaluate ovarian safety, designated doses of radiation were estimated at the calculated depth of the ovaries using a solid plate phantom and an ionization chamber with the same lead cutout as was used for the treatment of Cesarean section operative scars and a tissue equivalent bolus. RESULTS: In total, the control rate was 77% (20 patients), while six (23%) developed focally elevated keloids (ranging from 0.5 to 2 cm in length) in the middle of the primary abdominal scar. Five patients experienced mild hyperpigmentation. Nonetheless, most patients (96%) were satisfied with the treatment results. The estimated percentage of the applied radiation doses that reached the calculated depth of the ovaries ranged from 0.0033% to 0.0062%. CONCLUSION: When administered during the immediate postpartum period, postoperative electron beam radiotherapy for repeated Cesarean section scars is generally safe and produces good cosmetic results with minimal toxicity.
Cesarean Section ; Cicatrix ; Cosmetics ; Electrons ; Female ; Humans ; Hyperpigmentation ; Keloid ; Ovary ; Postpartum Period ; Pregnancy

Chestnut honey contains various components such as phenolic compounds and alkaloids that exhibit antioxidant and anti-inflammatory activities. However, the composition and activity of chestnut honey significantly differ depending on its region of origin. In this study, the antioxidant activity of chestnut honey obtained from nine regions in Korea was evaluated by ABTS free radical scavenging assay. In addition, the phenolic acid content of each honey sample was analyzed using high-performance liquid chromatography (HPLC) and an ultraviolet (UV) detector. The antioxidant activity increased with the increasing concentration of chestnut honey samples. The major phenolic compounds in chestnut honey were observed to be gallic, p-coumaric, and ferulic acid. Altogether, the quantitative analysis of phenolic acids and evaluation of antioxidant activity in chestnut honey from different regions will contribute to establishing regional chestnut honey profiling in Korea and may provide preliminary data for collecting honey with various biological activities.

One of the most important task in commissioning intensity modulated radiotherapy (IMRT) into a clinic is the characterization of dosimetry performance under small monitor unit delivery conditions. In this study, method of evaluating dose monitor linearity, beam flatness and symmetry, and MLC positioning accuracy using a diode array is investigated. Siemens Primus linear accelerator (LA) with 6 and 10 MV x-rays was used to deliver radiation and the characteristics were measured using a multi array diodes. Monitor unit stabilities were measured for both x-ray energies. The dose linearity errors for the 6 MV x-ray were 2.1, 3.4, 6.9, 8.6, and 15.4 % when 20 MU, 10 MU, 5 MU, 4 MU, and 2 MU was delivered, respectively. Greater errors were observed for 10 MV x-rays with a maximum of 22% when 2 MU was delivered. These errors were corrected by adjusting D1_C0 values and reduced to less than 2% in all cases. The beam flatness and symmetry were appropriate without any correction. The picket fence test performed using diode array and film measurement showed similar results. The use of diode array is a convenient method in characterizing beam stability, symmetry and flatness, and positioning accuracy of MLC for IMRT commissioning. In addition, adjustment of D1-C0 value must be performed when a Siemens LA is used for IMRT because factory value usually gives unacceptable beam stability error when the MU/segment is smaller than 20.
Organothiophosphorus Compounds ; Particle Accelerators

PURPOSE: Whole breast irradiation (WBI) after breast conserving surgery (BCS) is the standard treatment modality for controlling ipsilateral local recurrence of breast cancer. However, the WBI needs 5 to 6 weeks of the treatment period. Partial breast irradiation (PBI) has recently appeared as an alternative treatment to WBI in selected early breast cancer patients. This study was performed to evaluate the feasibility of PBI alone after BCS. METHODS: The brachy-catheters were inserted at the lumpectomy site after BCS. Six to nine days after the operation, the patients underwent fractionated PBI twice in a day with median dose of 3 Gy. The median value of the total dose was 3,120 cGy (28 to 34 Gy) given over 5 days. Forty-one patients who were proven as having a tumor-free margin by pathologic report were included in this study. Thirty-five patients had axillary lymph node-negative disease and thirty- six patients underwent concurrent adjuvant CMF chemotherapy. Follow-up ultrasono graphy was performed one month after the completion of PBI. RESULTS: The median post-operative hospital stay was 15 days (range: 12-17 days). Twenty-eight patients had seromas smaller than 1 cm in size and the 13 patients appeared to have 1~3 cm sized seromas on the follow-up ultrasonography. Long lasting (> 3 months) seromas were observed in 7 patients. None of the patients complained of tenderness or discomfort of the operation site and complications such as skin desquamation, pigmentation and wound contracture were not observed. Fat necrosis was observed in 1 patient. There was no case of local recurrence at the median follow-up period of 19 months (range: 15-41 months). CONCLUSION: PBI for early breast cancer using interstitial brachytherapy was a safe and effective alternative to WBI with excellent cosmetic results after BCS. The results of the current study prompts a multi-center clinical trial of PBI as an alternative to the WBI in early breast cancer to validate its feasibility in a selected patient population.
Brachytherapy ; Breast Neoplasms ; Breast* ; Contracture ; Drug Therapy ; Fat Necrosis ; Follow-Up Studies ; Humans ; Length of Stay ; Mastectomy, Segmental* ; Pigmentation ; Recurrence ; Seroma ; Skin ; Ultrasonography ; Wounds and Injuries

PURPOSE: To investigate the clinical usefulness of a follow-up examination using serum squamous cell carcinoma antigen (SCC) for the early detection of recurrence in patients treated for cervical squamous cell carcinoma. MATERIALS AND METHODS: 20 patients who were treated for recurrent cervical squamous cell carcinoma between 1997 and 1998, who had experienced a complete remission after radiotherapy and who underwent an SCC test around the time when recurrence was detected, were included in this study. The levels of SCC were measured from the serum of the patients by immunoassay and values less than 2 ng/mL were regarded as normal. The sensitivity of the SCC test for use in the detection of recurrence, the association between the SCC values and the recurrence patterns and the tumor size and stage, and the temporal relation between the SCC increment and recurrence detection were evaluated. RESULTS: The SCC values were above normal in 17 out of 20 patients, so the sensitivity of the SCC test for the detection of recurrence was 85%, and the mean and median of the SCC values were 15.2 and 9.5 ng/mL, respectively. No differences were observed in the SCC values according to the recurrence sites. For 11 patients, the SCC values were measured over a period of 6 months before recurrence was detected, and the mean and median values were 13.6 and 3.6 ng/mL, respectively. The SCC values of 7 patients were higher than the normal range, and the SCC values of the other 4 patients were normal but 3 among them were above 1.5 ng/mL. At the time of diagnosis, the SCC valuess were measured for 16 of the 20 recurrent patients, and the SCC values of the patients with a bulky tumor (> or =4 cm) or who were in stage IIb or III were higher than those of the patients with a non-bulky tumor or who were in stage Ib or IIa. CONCLUSION: The SCC test is thought to be useful for the early detection of recurrence during the follow up period in patients treated for cervical squamous cell carcinoma. When an effective salvage treatment is developed in the future, the benefit of this follow-up SCC test will be increased.
Carcinoma, Squamous Cell* ; Cervix Uteri* ; Diagnosis ; Female ; Follow-Up Studies* ; Humans ; Immunoassay ; Radiotherapy ; Recurrence ; Reference Values ; Uterine Cervical Neoplasms

PURPOSE: The optimal sequence of chemotherapy (CT) and radiotherapy (RT) remains uncertain although both can reduce breast cancer recurrence after breast-conserving surgery (BCS). The current study was performed to evaluate whether concurrent RT with CT increases chemotherapy-associated toxicities. METHODS: Two hundred and thirty-eight patients with stage I and II breast cancers were prospectively allocated concurrent CT and RT (N=133) or sequential CT and RT (N= 105) after BCS. In the sequential group, the RT was started after completion of 3 cycles of CT with an additional 3 cycles of CT delivered after the RT. All patients underwent intravenous CMF chemotherapy composed of cyclophosphamide (500 mg/m2), methotrexate (50 mg/m2) and 5-FU (500 mg/ m2), every 3 weeks for 6 cycles following surgery. RESULTS: There were no significant differences between the two groups with regard to the grade 3 or 4 hematologic toxicities during chemotherapy or in abnormal liver enzyme elevation. Radiation related adverse effects, such as moist desquamation and pneumonitis symptom, were no different between the two groups. During the median 42 month follow-up period, range 16- to 60 months, 18 (13.5%) and 20 (19.1%) patients in the concurrent and sequential groups had systemic recurrences of breast cancer. The disease-free survival and local recurrence rates were no different between the two groups. CONCLUSION: Concurrent CT and RT were not associated with an increased toxicity and reasonable cosmetic results were achieved in this current study. The current study indicates that concurrent RT with CT after BCS is a feasible treatment modality, with the advantage of a shortening treatment time.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant* ; Cyclophosphamide ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Liver ; Mastectomy, Segmental* ; Methotrexate ; Pneumonia ; Prospective Studies ; Radiotherapy* ; Recurrence

OBJECTIVE: To investigate the role of radiotherapy (RT) in patients who underwent hysterectomy for uterine carcinosarcoma (UCS). METHODS: Patients with the International Federation of Gynecology and Obstetrics stage I–IVa UCS who were treated between 1990 and 2012 were identified retrospectively in a multi-institutional database. Of 235 identified patients, 97 (41.3%) received adjuvant RT. Twenty-two patients with a history of previous pelvic RT were analyzed separately. Survival outcomes were assessed using the Kaplan-Meier method and Cox proportional hazards model. RESULTS: Patients with a previous history of pelvic RT had poor survival outcomes, and 72.6% of these patients experienced locoregional recurrence; however, none received RT after a diagnosis of UCS. Univariate analyses revealed that pelvic lymphadenectomy (PLND) and para-aortic lymph node sampling were significant factors for locoregional recurrence-free survival (LRRFS) and disease-free survival (DFS). Among patients without previous pelvic RT, the percentage of locoregional failure was lower for those who received adjuvant RT than for those who did not (28.5% vs. 17.5%, p=0.107). Multivariate analysis revealed significant correlations between PLND and LRRFS, distant metastasis-free survival, and DFS. In subgroup analyses, RT significantly improved the 5-year LRRFS rate of patients who did not undergo PLND (52.7% vs. 18.7% for non-RT, p<0.001). CONCLUSION: Adjuvant RT decreased the risk of locoregional recurrence after hysterectomy for UCS, particularly in patients without surgical nodal staging. Given the poorer locoregional outcomes of patients previously subjected to pelvic RT, meticulous re-administration of RT might improve locoregional control while leading to less toxicity in these patients.
Adult ; Aged ; Aged, 80 and over ; Carcinosarcoma/mortality/*radiotherapy/surgery ; Chemotherapy, Adjuvant ; Female ; Humans ; *Hysterectomy ; Kaplan-Meier Estimate ; Lymph Node Excision ; Lymphatic Metastasis ; Middle Aged ; Neoplasm Recurrence, Local/prevention & control ; Proportional Hazards Models ; *Radiotherapy, Adjuvant/adverse effects ; Retrospective Studies ; Survival Rate ; Uterine Neoplasms/mortality/*radiotherapy/surgery

OBJECTIVE: The aim of the present study was to acquire information on brachytherapy resources in Korea through a national survey of radiation oncologists. METHODS: Between October 2014 and January 2015, a questionnaire on the current status of brachytherapy was distributed to all 86 radiation oncology departments in Korea. The questionnaire was divided into sections querying general information on human resources, brachytherapy equipment, and suggestions for future directions of brachytherapy policy in Korea. RESULTS: The response rate of the survey was 88.3%. The average number of radiation oncologists per center was 2.3. At the time of survey, 28 centers (36.8%) provided brachytherapy to patients. Among the 28 brachytherapy centers, 15 (53.5%) were located in in the capital Seoul and its surrounding metropolitan areas. All brachytherapy centers had a high-dose rate system using (192)Ir (26 centers) or (60)Co (two centers). Among the 26 centers using (192)Ir sources, 11 treated fewer than 40 patients per year. In the two centers using (60)Co sources, the number of patients per year was 16 and 120, respectively. The most frequently cited difficulties in performing brachytherapy were cost related. A total of 21 centers had a plan to sustain the current brachytherapy system, and four centers noted plans to upgrade their brachytherapy system. Two centers stated that they were considering discontinuation of brachytherapy due to cost burdens of radioisotope source replacement. CONCLUSION: The present study illustrated the current status of brachytherapy in Korea. Financial difficulties were the major barriers to the practice of brachytherapy.
*Brachytherapy/economics ; Humans ; Neoplasms/*radiotherapy ; *Oncologists ; Republic of Korea ; Surveys and Questionnaires

OBJECTIVE: The aim of the present study was to acquire information on brachytherapy resources in Korea through a national survey of radiation oncologists. METHODS: Between October 2014 and January 2015, a questionnaire on the current status of brachytherapy was distributed to all 86 radiation oncology departments in Korea. The questionnaire was divided into sections querying general information on human resources, brachytherapy equipment, and suggestions for future directions of brachytherapy policy in Korea. RESULTS: The response rate of the survey was 88.3%. The average number of radiation oncologists per center was 2.3. At the time of survey, 28 centers (36.8%) provided brachytherapy to patients. Among the 28 brachytherapy centers, 15 (53.5%) were located in in the capital Seoul and its surrounding metropolitan areas. All brachytherapy centers had a high-dose rate system using (192)Ir (26 centers) or (60)Co (two centers). Among the 26 centers using (192)Ir sources, 11 treated fewer than 40 patients per year. In the two centers using (60)Co sources, the number of patients per year was 16 and 120, respectively. The most frequently cited difficulties in performing brachytherapy were cost related. A total of 21 centers had a plan to sustain the current brachytherapy system, and four centers noted plans to upgrade their brachytherapy system. Two centers stated that they were considering discontinuation of brachytherapy due to cost burdens of radioisotope source replacement. CONCLUSION: The present study illustrated the current status of brachytherapy in Korea. Financial difficulties were the major barriers to the practice of brachytherapy.
*Brachytherapy/economics ; Humans ; Neoplasms/*radiotherapy ; *Oncologists ; Republic of Korea ; Surveys and Questionnaires

We have taken surveys about total 72 departments of radiation oncology which is performing the treatment with linear accelerator and brachytherapy unit in Korea. The survey was included the research about the linear accelerator, brachytherapy, Also, we surveyed the various performance (QA period, manpower, time) of quality control for understanding of efficiency. The survey results show that the QA test of daily and weekly are almost same comparing to USA and Europe but the QA performance of monthly and yearly in Korea are 15.5 which is less than USA and Europe recommended QA item number of 17 to 21. The manpower and QA time in Korea also lower than 50% of USA and Europe recommended because the manpower and QA time limitation in Korea. It will be expected that the manual of quality management in each clinic could be appropriately established when combining the present results with previously published AAPM TG-40 and other protocols.
Brachytherapy ; Europe ; Korea ; Particle Accelerators ; Quality Control ; Radiation Oncology