PURPOSE: To investigate whether changes in plasma concentrations of transforming growth factor-beta1 (TGF-beta1), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. METHODS AND MATERIALS: Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-beta1, TNF-alpha and IL-6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. RESULTS: Thirteen patients eventually developed signs and symptoms of clinical pneumonitis while four patients did not. TGF-beta1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF-alpha and IL-6 were also elevated in the group of patients who developed pneumonitis but the pattern was not characteristic. CONCLUSIONS: Changes in plasma TGFbeta-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF-alpha and IL-6 shows no meaningful changes in association with radiation pneumonitis.
Cytokines* ; Enzyme-Linked Immunosorbent Assay ; Follow-Up Studies ; Humans ; Interleukin-6 ; Lung Neoplasms* ; Lung* ; Plasma* ; Pneumonia* ; Prospective Studies ; Radiation Pneumonitis ; Radiotherapy ; Transforming Growth Factor beta1 ; Tumor Necrosis Factor-alpha

The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.
Carboplatin ; Deglutition ; Drug Therapy* ; Leiomyosarcoma* ; Lymphatic Diseases* ; Neck ; Neoplasm Metastasis ; Paclitaxel ; Radiotherapy* ; Spinal Canal ; Spinal Cord Compression ; Spine

PURPOSE: The aim of this study is to analysis of survival and recurrence rates of the uterine cervical carcinoma patients whom received the radiation therapy respectively. The prognostic factors, such as Papanicolaou (Pap) smear, carcinoembriogenic antigen (CEA) and squamous cell carcinoma (SCC) antigen has been studied. METHODS AND MATERIALS: From January 1981 to December 1998, eight-hundred twenty-seven uterine cervical cancer patients were treated with radiation therapy. All of the patients were divided into two groups : the radiation therapy only (521 patients) group and the postoperative radiation therapy (326 patients) group. The age, treatment modality, clinical stage, histopathology, recurrence, follow-up Pap smears, CEA and SCC antigen were used as parameters for the evaluation. The prognostic factors such as survival and recurrence rates were performed with the Kaplan-Meier method and the Cox hazard model, respectively. Median follow-up was 38.6 months. RESULTS: On the radiation therapy only group, 314 patients (60%) achieved complete response (CR), 47 patients (9%) showed local recurrence (LR), 78 patients (15%) developed distant metastasis (DM). On the postoperative radiation therapy group, showed 276 patients (85%) CR, 8 patients (2%) LR, 37 patients (11%) DM. The 5-year survival and recurrence rates was evaluated for all parameters. The statistically significant factors for the survival rate in univariate analysis were clinical stage (p=0.0001), treatment modality ( p=0.0010), recurrence ( p=0.0001), Pap smear ( p=0.0329), CEA ( p=0.0001) and SCC antigen ( p= 0.0001). CONCLUSION: This study indicated that after treatment, the follow-up studies of Pap smear, CEA and SCC antigen were significant parameter and prediction factors for the survival and recurrence of the uterine cervical carcinoma.
Carcinoma, Squamous Cell ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Proportional Hazards Models ; Recurrence ; Survival Rate ; Uterine Cervical Neoplasms*

PURPOSE: We conducted a prospective non-randomized clinical study to evaluate the efficacy and toxicity of the preoperative concurrent chemoradiotherapy for locally advanced unresectable rectal cancer. MATERIALS AND METHODS: Between January 1995 and June 1998, 37 consecutive patients with locally unresectable advanced rectal cancer were entered into the study. With 3- or 4- fields techniuqe, a total of 45 Gy radiation was delivered on whole pelvis, followed by 5.4 Gy boost to the primary tumor in some cases. Chemotherapy was done at the first and fifth week of radiation with bolus i.v. 5-Fluorouracil (FU) 370~450 mg/m2, days 1~5, plus Leucovorin 20 mg/m2, days 1~5. Of 37 patients, 6 patients did not receive all planned treatment course (refusal in 4, disease progression in 1, metastasis to lung in 1). Surgical resection was undergone 4~6 weeks after preoperative concurrent chemoradiotherapy. RESULTS: Complete resection rate with negative margins was 94% (29/31). Complete response was seen in 7 patients (23%) clinically and 2 patients (6%) pathologically. Down staging of tumor occured in 21 patients (68%). Treatment related toxicity was minimal except grade III & IV leukopenia in 2 patients, respectively. CONCLUSION: Preoperative concurrent chemoradiotherapy in locally advanced rectal cancer was effective in inducing down staging and complete resection rate. Treatment related toxicity was minimal. Further follow up is on-going to determine long term survival following this treatment.
Chemoradiotherapy* ; Disease Progression ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Leukopenia ; Lung ; Neoplasm Metastasis ; Pelvis ; Prospective Studies ; Radiation Dosage ; Rectal Neoplasms*

PURPOSE: Although It has been known that the tolerance of the liver to external beam irradiation depends on the irradiated volume and dose, few data exist which quantify this dependence. However, recently, with the development of three dimensional (3-D) treatment planning, have the tools to quantify the relationships between dose, volume, and normal tissue complications become available. The objective of this study is to investigate the relationships between normal tissue complication probability (NTCP) and the risk of radiation hepatitis for patients who received variant dose partial liver irradiation. MATERIALS AND METHOD: From March 1992 to December 1994, 10 patients with hepatoma and 10 patients with bile duct cancer were included in this study. Eighteen patients had normal hepatic function, but 2 patients (prothrombin time 73%, 68%) had mild liver cirrhosis before irradiation. Radiation therapy was delivered with 10MV linear accelerator, 180~200 cGy fraction per day. The total dose ranged from 3,960 cGy to 6,000 cGy (median dose 5,040 cGy). The normal tissue complication probability was calculated by using Lyman's model. Radiation hepatitis was defined as the development of anicteric elevation of alkaline phosphatase of at least two fold and non-malignant ascites in the absence of documented progressive. RESULTS: The calculated NTCP ranged from 0.001 to 0.840 (median 0.05). Three of the 20 patients developed radiation hepatitis. The NTCP of the patients with radiation hepatitis were 0.390, 0.528, 0.844 (median : 0.58+/-0.23), but that of the patients without radiation hepatitis ranged from 0.001 to 0.308 (median : 0.09+/-0.09). When the NTCP was calculated by using the volume factor of 0.32, a radiation hepatitis was observed only in patients with the NTCP value more than 0.39. By contrast, clinical results of evolving radiation hepatitis were not well correlated with NTCP value calculated when the volume factor of 0.69 was applied. On the basis of these observations, the volume factor of 0.32 was more correlated to predict a radiation hepatitis. CONCLUSION: The risk of radiation hepatitis was increased above the cut-off value. Therefore the NTCP seems to be used for predicting the radiation hepatitis.
Alkaline Phosphatase ; Ascites ; Bile Duct Neoplasms ; Carcinoma, Hepatocellular ; Hepatitis* ; Humans ; Liver ; Liver Cirrhosis ; Particle Accelerators

PURPOSE: For early stage non-small-cell lung cancer, surgical resection is the treatment of choice. But when the patients are not able to tolerate it because of medical problem and when refuse surgery, radiation therapy is considered an acceptable alternative. We report on the treatment results and the effect of achieving local control of primary tumors on survival end points, and analyze factors that may influence survival and local control. MATERIALS AND METHOD: We reviewed the medical records of 32 patients with medically inoperable non-small cell lung cancer treated at our institution from June, 1987 through June, 1997. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidate for surgical resection because of either patients refusal (4), old age (2), lung problem (21), chest wall invasion (3) and heart problems (3). In 8 patients, there were more than 2 problems. The median age of the patients was 68 years (ranging from 60 to 86 years). Histologic cell type included squamous (24), adenocarcinoma (6) and unclassified squamous cell (2). The clinical stages of the patients were T1 in 5, T2 in 25, T3 in 2 patients. Initial tumor size was < or =3.0 cm in 11, between 3.0 cm and 5.0 cm in 13 and more than 5.0 cm in 8 patients. All patients had taken chest x-rays, chest CT, abdomen USG and bone scan. Radiotherapy was delivered using 6 MV or 10 MV linear accelerators. The doses of primary tumor were the ranging from 54.0 Gy to 68.8 Gy (median; 61.2 Gy). The duration of treatment was from 37 days through 64 days (median; 48.5 days) and there was no treatment interruption except 1 patient due to poor general status. In 12 patients, concomitant boost technique was used. There were no neoadjuvant or adjuvant treatments such as surgery or chemotherapy. The period of follow-up was ranging from 2 months through 93 months (median; 23 months). Survival was measured from the date radiation therapy was initiated. RESULTS: The overall survival rate was 44.6% at 2 years and 24.5% at 5 years, with the median survival time of 23 months. Of the 25 deaths, 7 patients died of intercurrent illness, and cause-specific survival rate was 61.0% at 2 years and 33.5% at 5 years. The disease-free survival rate was 38.9% at 2 years and 28.3 % at 5 years. The local-relapse-free survival rate was 35.1%, 28.1%, respectively. On univariate analysis, tumor size was significant variable of overall survival ( p=0.0015, 95% C.I.; 1.4814-5.2815), disease-free survival ( p=0.0022, 95% C.I.; 1.4707-5.7780) and local-relapse-free survival ( p=0.0048, 95% C.I.; 1.2910- 4.1197). T stage was significant variable of overall survival ( p=0.0395, 95% C.I.; 1.1084-65.9112) and had borderline significance on disease-free survival ( p=0.0649, 95% C.I.; 0.8888-50.7123) and local-relapse-free survival ( p= 0.0582, 95% C.I.; 0.9342-52.7755). On multivariate analysis, tumor size had borderline significance on overall survival ( p=0.6919, 955 C.I.; 0.9610-5.1277) and local-relapse-free survival ( p=0.0585, 95% C.I.; 0.9720- 4.9657). Tumor size was also significant variable of disease-free survival ( p=0.0317, 95% C.I.; 1.1028-8.4968). CONCLUSION: Radical radiotherapy is an effective treatment for small (T1 or < or =3 cm) tumors and can be offered as alternative to surgery in elderly or infirmed patients. But when the size of tumor is larger than 5 cm, there were few long-term survivors treated with radiotherapy alone. The use of hyperfractionated radiotherapy, endobronchial boost, radisensitizer and conformal or IMRT should be consider to improve the local control rate and disease-specific survival rate.
Abdomen ; Adenocarcinoma ; Aged ; Carcinoma, Non-Small-Cell Lung* ; Diagnosis ; Disease-Free Survival ; Disulfiram ; Drug Therapy ; Follow-Up Studies ; Heart ; Humans ; Lung ; Lung Neoplasms ; Medical Records ; Multivariate Analysis ; Particle Accelerators ; Radiotherapy* ; Survival Rate ; Survivors ; Thoracic Wall ; Thorax ; Tomography, X-Ray Computed

PURPOSE: To evaluate efficacy and complication of stereotactic radiosurgery using stereotactic body frame. METHODS AND MATERIALS: From December 1997 to June 1999, 11 patients with primary and metastatic tumors were treated with stereotactic radiosurgery using stereotactic body frame(Precision Therapy(TM)). Three patients were treated with primary hepatoma and seven with metastatic tumor from liver, lung, breast, trachea and one with arteriovenous malformation on neck. We used vacuum pillow for immobilization and made skin marker on sternum and tibia area with chest marker and leg marker. Diaphragm control was used for reducing movement by respiration. CT-simulation and treatment planning were performed. Set-up error was checked by CT-Simulator before each treatment. Dose were calculated on the 80~90% isodose of isocenter dose and given consecutive 3 fractions for total dose of 30 Gy (10 Gy/fraction). RESULTS: Median follow-up was 12 months. One patient (9%) showed complete response and four patients (36%) showed partial response and others showed stable disease. Planning target volumes (PTV) ranged from 3 to 111 cc (mean 18.4 cc). Set-up error was within 5 mm in all directions (X, Y, Z axis). There was no complication in all patients. CONCLUSION: In primary and metastatic tumors, stereotactic radiosurgery using stereotactic body frame is very safe, accurate and effective treatment modality.
Arteriovenous Malformations ; Breast ; Carcinoma, Hepatocellular ; Diaphragm ; Follow-Up Studies ; Humans ; Immobilization ; Leg ; Liver ; Lung ; Neck ; Radiosurgery* ; Respiration ; Skin ; Sternum ; Thorax ; Tibia ; Trachea ; Vacuum

PURPOSE: To see the relationship between the response to chemotherapy and the final outcome of neoadjuvant chemotherapy and radiotherapy in patients with locally advanced hypopharyngeal cancer. METHODS AND MATERIALS: A retrospective analysis was done for thirty-two patients with locally advanced hypopharyngeal cancer treated in the Seoul National University Hospital with neoadjuvant chemotherapy and radiotherapy from August 1979 to July 1997. The patients were treated with Co-60 teletherapy unit or 4MV or 6MV photon beam produced by linear accelerator. Daily fractionation was 1.75 to 2 Gy, delivered five times a week. Total dose ranged from 60.8 Gy to 73.8 Gy. Twenty-nine patients received continuous infusion of cisplatin and 5-FU. Other patients were treated with cisplatin combined with bleomycin or vinblastin. Twenty-four (75%) patients received all three prescribed cycles of chemotherapy delivered three weeks apart. Six patients received two cycles, and two patients received only one cycle. RESULTS: The overall 2-year and 5-year survival rates are 65.6% and 43.0%, respectively. 5-year local control rate is 34%. Organ preservation for more than five years is achieved in 12 patients (38%). After neoadjuvant chemotherapy, 24 patients achieved more than partial remission (PR); the response rate was 75% (24/32). Five patients had complete remission (CR), 19 patients PR, and 8 patients no response (NR). Among the 19 patients who had PR to chemotherapy, 8 patients achieved CR after radiotherapy. Among the 8 non-responders to chemotherapy, 2 patients achieved CR, and 6 patients achieved PR after radiotherapy. There was no non-responder after radiotherapy. The overall survival rates were 60% for CR to chemotherapy group, 35.1% for PR to chemotherapy group, and 50% for NR to chemotherapy group, respectively ( p=0.93). There were significant difference in five-year overall survival rates between the patients with CR and PR after neoadjuvant chemotherapy and radiotherapy (73.3% vs. 14.7%, p< 0.01). The prognostic factor affecting overall survival was the response to overall treatment (CR vs. PR, p<0.01). CONCLUSION: In this study, there were only five patients who achieved CR after neoadjuvant chemotherapy. Therefore the difference of overall survival rates between CR and PR to chemotherapy group was not statistically significant. Only the response to chemo-radiotherapy was the most important prognostic factor. There needs to be more effort to improve CR rate of neoadjuvant chemotherapy and consideration for future use of concurrent chemoradiotherapy.
Bleomycin ; Chemoradiotherapy ; Cisplatin ; Drug Therapy* ; Fluorouracil ; Humans ; Hypopharyngeal Neoplasms* ; Organ Preservation ; Particle Accelerators ; Radiotherapy* ; Retrospective Studies ; Seoul ; Survival Rate

BACKGROUND: First of all, this study was performed to assess the result of curative radiotherapy and to evaluate different possible prognostic factors for squamous cell carcinoma of the supraglottic larynx treated at the Pusan National University Hospital. The second goal of this study was by comparing our data with those of other study groups, to determine the better treatment policy of supraglottic cancer in future. METHODS AND MATERIALS: Thirty-two patients with squamous cell carcinoma of the supraglottic larynx were treated with radiotherapy at Pusan National University Hospital, from August 1985 to December 1996. Minimum follow-up period was 29 months. Twenty-seven patients (84.4%) were followed up over 5 years. Radiotherapy was delivered with 6 MV photons to the primary laryngeal tumor and regional lymphatics with shrinking field technique. All patients received radiotherapy under conventional fractionated schedule (once a day). Median total tumor dose was 70.2 Gy (range, 55.8 to 75.6 Gy) on primary or gross tumor lesion. Thirteen patients had induction chemotherapy with cisplatin and 5-fluorouracil (1-3 cycles). Patient distribution, according to the different stages, were as follows: stage I, 5/32 (15.6%); stage II, 10/32 (31.3%); stage III, 8/32 (25%); stage IV, 9/32 (28.1%). RESULTS: The 5-year overall survival rate of the whole series (32 patients) was 51.7%. The overall survival rate at 5-years was 80% in stage I, 66.7% in stage II, 42.9% in stage III, 25% in stage IV ( p= 0.0958). The 5-year local control rates after radiotherapy were as follows: stage I, 100%; stage II, 60%; stage III, 62.5%; stage IV, 44.4% ( p=0.233). Overall vocal preservation rates was 65.6%, 100% in stage I, 70% in stage II, 62.5% in stage III, 44.4% in stage IV ( p=0.210). There was no statistical significance in survival and local control rate between neoadjuvant chemotherapy followed by radiotherapy group and radiotherapy alone group. Severe laryngeal edema was found in 2 cases after radiotherapy, emergent tracheostomy was done. Four patients were died from distant metastsis, : three in lung, one in brain. Double primary tumor was found in 2 cases, one in lung (metachronous), another in thyroid (synchronous). Ulcerative lesions were revealed as unfavorable prognostic factor ( p=0.0215), and radiation dose (more or less than 70.2 Gy) was an important factor on survival ( p=0.0302). CONCLUSIONS: The role of radiotherapy in the treatment of supraglottic carcinoma is to improve the survival and to preserve the laryngeal function. Based on our data and other studies, early and moderately advanced supraglottic carcinomas could be successfully treated with either conservative surgery or radiotherapy alone. Both modalities showed similar results in survival and vocal preservation. For the advanced cases, radiotherapy alone is inadequate for curative aim and surgery combined with radiotherapy should be done in operable patients. When patients refuse operation or want to preserve vocal function, or for the patients with inoperable medical conditions, combined chemoradiotherapy (concurrent) or altered fractionated radiotherapy with or without radiosensitizer should be taken into consideration in future.
Appointments and Schedules ; Brain ; Busan ; Carcinoma, Squamous Cell* ; Chemoradiotherapy ; Cisplatin ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Induction Chemotherapy ; Laryngeal Edema ; Larynx* ; Lung ; Photons ; Radiotherapy* ; Survival Rate ; Thyroid Gland ; Tracheostomy ; Ulcer

PURPOSE: This study was performed to find out the prognostic factors affecting local control in early glottic cancer treated with radiation therapy alone. MATERIALS AND METHODS: We analysed 37 patients of histologically confirmed early glottic cancer treated at Chonnam National University Hospital between July 1986 and December 1995, retrospectively. Age of patients ranged from 30 to 73 years (median; 59 years). Thirty-five (95%) patients were male. Histological type was all squamous cell carcinoma. According to the staging system of 1997 American Joint Committee on Cancer, 37 patients were restaged as follows: T1a; 27 (73%), T1b; 3 (8%), T2; 7 (19%). Radiation therapy was done using 6 MV X-ray of linear accelerator. The range of total radiation dose delivered to the glottic lesion was between 5,040 cGy and 7,020 cGy (median; 6,600 cGy). Median follow-up period was 80 months. Local control rates were calculated by Kaplan-Meier method. Generalized Wilcoxon test was used to evaluate the difference of control rates between comparable groups. Multivariate analysis using Cox proportional hazard model was done to find out prognostic factors affecting local control. RESULTS: 5 year survival rate of 37 patients was 89%. Local control rate of 37 patients was 74% in 5 years. We included age, T-stage, anterior commissure involvement, fraction size, total radiation dose, treatment time of radiotherapy as potential prognostic factors in univariate and multivariate analysis. As a result, treatment time had statistical significance in local control rate in both univariate ( p=0.026) and multivariate ( p=0.017) analysis. Complication was not recorded except one patient with hypothyroidism. CONCLUSION: This study revealed that overall treatment time of radiation was a significant factor affecting local control rate.
Carcinoma, Squamous Cell ; Follow-Up Studies ; Humans ; Hypothyroidism ; Jeollanam-do ; Joints ; Male ; Multivariate Analysis ; Particle Accelerators ; Proportional Hazards Models ; Radiotherapy ; Retrospective Studies ; Survival Rate