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The Comparison of DVH between Multiple arc FSRT and Conformal FSRT.

Ki Hwan KIM ; Jun Sang KIM ; Ji Young JANG ; Jae Sung KIM ; Seong Ho KIM ; Chang Joon SONG ; Min Kyu PARK ; Moon June CHO

The Journal of the Korean Society for Therapeutic Radiology and Oncology.1999;17(3):261-267.

PURPOSE: .In FSRT (Fractionated stereotactic radiotherapy) planning, we studied the usefulness between multiple arc FSRT and conformal FSRT by comparing tumor shape and DVH(dose volume histogram). MATERIALS AND METHDS: In Chungnam Univ. hospital, we had treated the sixteen patients with FSRT from Aug. 1997 to Dec. 1998. In choosing multiple arc FSRT or conformal FSRT, we had considered multiple arc FSRT if tumor shape was similar to sphere or the value of IF was less than 1.25, conformal FSRT if tumor shape was very irregular or IF was more than 1.3. For evaluation of treatment planning, we had considered the appropriate DVH for tumor volume and for critical organs. RESULT: The errors between reference point and the coordinates point on AP, Lat radiography were less than 1 mm before treatment. We had planned 3~5 arcs for multiple arc FSRT, 5~6pots for conformal FSRT. The mean dose distribution of tumor volume of cumulative DVH between multiple arc FSRT and conformal FSRT was 90.6, 86%, respectively. The dose of critical organs irradiated was less than 5% maximum dose of cumulative DVH. CONCLUSION: We had obtained the similar value between multiple arc FSRT and conformal FSRT, so that we had appropriate treatment planning of FSRT for multiple arc FSRT and conformal FSRT according to tumor shape and size.
Chungcheongnam-do ; Humans ; Radiography ; Tumor Burden

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Photon Energy Dependence of the Sensitivity of LiF TLDs Loaded with Thin Material.

Byongim J MIN ; Sookil KIM ; John J K LOH ; Young Kap CHO

The Journal of the Korean Society for Therapeutic Radiology and Oncology.1999;17(3):256-260.

PURPOSE: An investigation has been carried out on the factors which affect the response reading of thermoluminescent dosimeters (TLD-100) loaded with thin material in high energy photon. The aim of the study was to assess the energy response of TLD-100 to the therapeutic ranges of photon beam. MATERIALS AND METHODS: In this technique, TLD-100 (abbreviated as TLD) chips and three different thin material (Tin, Gold, and Tissue equivalent plastic plate) which mounted on the TLD chip were used in the clinical photon beam. The thickness of each metal plates was 0.1 mm and TE plastic plate was 1 mm thick. These compared with the photon energy dependence of the sensitivities of TLD (normal chip), TLD loaded with Tin or Gold plate, for the photon energy range 6 MV to 15 MV, which was of interest in radiotherapy. RESULTS: The enhancement of surface dose in the TLD with metal plate was clearly detected. The TLD chips with a Gold plate was found to larger response by a factor of 1.83 in 10 MV photon beam with respect to normal chip. The sensitivity of TLD loaded with Tin was less than that for normal TLD and TLD loaded with Gold. The relative sensitivity of TLD loaded with metal has little energy dependence. CONCLUSION: The good stability and linearity with respect to monitor units of TLD loaded with metal were demonstrated by relative measurements in high energy photon (6~15 MV) beams. The TLD laminated with metals embedded system in solid water phantom is a suitable detector for relative dose measurements in a small beam size and surface dose.
Metals ; Plastics ; Radiotherapy ; Tin ; Water

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Basic Dose Response of Fluorescent Screen-based Potal Imaging Device.

Inhwan J YEO ; Yonas YOHANNES ; Yunping ZHU

The Journal of the Korean Society for Therapeutic Radiology and Oncology.1999;17(3):249-255.

PURPOSE: The purpose of this study is to investigate fundamental aspects of the dose response of fluorescent screen-based electronic portal imaging devices (EPIDs). MATERIALS AND METHODS: We acquired scanned signal across portal planes as we varied the radiation that entered the EPID by changing the thickness and anatomy of the phantom as well as the air gap between the phantom and the EPID. In addition, we simulated the relative contribution of the scintillation light signal in the EPID system RESULTS: We have shown that the dose profile across portal planes is a function of the air gap and phantom thickness. We have also found that depending on the density change within the phantom geometry, errors associated with dose response based on the EPID scan can be as high as 7%. We also found that scintillation light scattering within the EPID system is an important source of error. CONCLUSION: This study revealed and demonstrated fundamental characteristics of dose response of EPID, as relative to that of ion chambers. This study showed that EPID based on fluorescent screen cannot be an accurate dosimetry system

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Histomorphologic Change of Radiation Pneumonitis in Rat Lungs : Captopril Reduces Rat Lung Injury Induced by Irradiation.

Jin Hee KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.1999;17(3):238-248.

PURPOSE: To assess the histomorphologic changes in the rat lung injury induced by radiation, to determine whether captopril reduces the rat lung injury and to evaluate change in TNF-alpha and TGF-beta in rat lung damage by radiation and captopril. METHODS AND MATERIAL: Right lungs in male Sprague-Dawley rats were divided irradiation alone (10, 20, 30 Gy) or radiation (same dose with radiation alone group) with captopril (500 mg/L). Radiation alone group were sacrificed at twelve hours and eleven weeks after radiation and radiation with captopril group (captopril group) were sacrificed at eleven weeks after radiation with captopril. We examined the light microscope and electron microscopic features in the groups. RESULTS: In radiation alone group, there were patch parenchymal collapse and consolidation at twelve hours after radiation. The increase of radiation dose shows more prominent the severity and broader the affected areas. Eleven weeks after radiation, the severity and areas of fibrosis had increased in proportion to radiation dose given in the radiation alone group. There was notable decrease of lung fibrosis in captopril group than in radiation alone group. The number of mast cells rapidly increased with increase of radiation dose in radiation alone group and the degree of increase of mast cell number and severity of collagen accumulation more decreased in captopril group than in radiation alone group. In radiation alone group, expression of TNF-alpha and TGF-beta increased according to increase of radiation dose at twelve hours after radiation in both group. At eleven weeks after radiation, expression of TGF-beta increased according to increase of radiation dose in radiation group but somewhat decreased in captopril group. In the captopril group the collagen deposition increased but less dense than those of radiation alone group. The severity of perivascular thickening, capillary change, the number and degranulation of mast cells more decreased in the captopril group than in the radiation alone group. CONCLUSION: It is concluded that the effect of captopril in the rat lungs after radiation was considered to be due to its effect on inhibition of mast cells and reduction of collagen deposition, and captopril may be protect in lung damage after radiation. We observed expression of TNF-alpha and TGF-beta increased at the early phase after radiation and expression of TGF-beta increased in proportion to increase of radiation dose at the chronic phase after radiation. This results will contribute to future investigation in reduction mechanism of captopril in lung damage after radiation.
Animals ; Capillaries ; Captopril* ; Collagen ; Fibrosis ; Humans ; Lung Injury* ; Lung* ; Male ; Mast Cells ; Radiation Pneumonitis* ; Rats* ; Rats, Sprague-Dawley ; Transforming Growth Factor beta ; Tumor Necrosis Factor-alpha

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Modification of Late Radiation Response of Rat Salivary Glands by Pentoxifylline and Diltiazem.

Hyun Suk SUH ; Kwang Mo YANG ; Yun Kyung KANG

The Journal of the Korean Society for Therapeutic Radiology and Oncology.1999;17(3):230-237.

PURPOSE: To elucidate the effects of pentoxifylline and diltiazem on the late response of the salivary glands of the rat after irradiation. MATERIALS AND METHODS: Sixteen Sprague-Dawley rats were divided into 4 groups : (a) irradiation alone (b) irradiation with pentixifylline (PTX) (c) irradiation with diltiazem (DTZ) (d) irradiation with both PTX and DTZ. Irradiation was given in a single fraction of 16 Gy using 4 MV photon energy through an anterior port encompassing the left side of the salivary gland leaving the right side of salivary gland as a contol. PTX, 20 mg/kg and/or DTZ, 50 mg/kg were infused intraperitoneally before irradiation. Two rats from each group were sacrificed on the 10th week and the rest was sacrificed on the 16th week after irradiation. Histopathologic examinations were undertaken for each section and the proportion of vacuolated cells out of the total number of cells under light microscopic fields was calculated. The statistical significance in the difference of the proportion of the vacuolated cells among the experimental groups was evaluated by a x2-test. RESULTS: Irradiated salivary glands of the 10th week group revealed markedly increased number of vacuolated cells compared to those of unirradiated control. The proportion of vacuolated cells was significantly reduced in both the PTX group (p value=0.001) and the combined PTX and DTX group compared to those of irradiation alone group. The DTZ alone group did not reveal the significant reduction of vacuolated cells compared to those of irradiation alone group (p value, >0.05). The 16th week groups revealed similar findings to those of the 10th week group, but the degree of chronic inflammatory cell infiltrates and interstitial fibrosis was increased and the number of acinar cells was reduced compared to those of the 10th week group. CONCLUSIONS: PTX significantly reduced the late radiation response of salivary glands, but DTZ did not reduce the same degree as PTX did. Taking the positive results of this study into consideration, it seems reasonable to apply PTX into the clinical trial for the head and neck irradiation to reduce the late radiation sequelae of salivary glands in the near future. At the same time the further experiment to clarify the subcellular mechanisms involved in PTX should be preceded.
Acinar Cells ; Animals ; Diltiazem* ; Fibrosis ; Head ; Neck ; Pentoxifylline* ; Rats* ; Rats, Sprague-Dawley ; Salivary Glands*

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Expression of c-jun by X-ray According to Cell Growth State in CaSki Cell Line.

Seong Sun JANG ; Woo Yoon PARK

The Journal of the Korean Society for Therapeutic Radiology and Oncology.1999;17(3):223-229.

PURPOSE: The expression pattern of c-jun by ionizing radiation according to cell growth state (exponential growth phase vs. stationary phase) and its relationship with cell cycle redistribution were investigated. MATERIALS AND METHODS: The exponential growth phase (day 4) and stationary phase (day 9) cells were determined from cell growth curve according to the elapse of days in CaSki. The cells were irradiated using 6 MV X-ray with a dose of 2 Gy at a fixed dose rate of 3 Gy/min. Northern blot analysis was performed with total cellular RNA and cell cycle distribution was analyzed using flow cytometry according to time-course after irradiation. RESULTS: The maximum expression of c-jun occurred 1 hour after irradiation in both exponential growth and stationary phase cells. After then c-jun expression was elevated upto 6 hours in exponential growth phase cells, but the level decreased in stationary phase cells. Movements of cells from G0-G1 to S, G2-M phase after irradiation were higher in exponential growth phase than stationary phase. CONCLUSION: c-jun may be involved in the regulation of cellular proliferation according to the growth states after irradiation.
Blotting, Northern ; Cell Cycle ; Cell Line* ; Cell Proliferation ; Flow Cytometry ; Radiation, Ionizing ; RNA

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Radiotherapy Results for Recurrent Uterine Cervical Cancer after Surgery.

Mi Ryeong RYU ; Chul Seung KAY ; Ki Moon KANG ; Yeon Shil KIM ; Su Mi CHUNG ; Sung Eun NAMKOONG ; Sei Chul YOON

The Journal of the Korean Society for Therapeutic Radiology and Oncology.1999;17(3):217-222.

PURPOSE: To evaluate prognostic factors and survival rates of the patients who received radiation therapy for locally recurrent uterine cervical cancer after curative surgery. MATERIALS AND METHODS: Between October 1983 and July 1996, fifty three patients who received radiation therapy for locally recurrent cervical cancer after curative surgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea were analysed retrospectively. Age at diagnosis ranged from 33 to 69 years (median 53 years). Pathological analysis showed that forty five (84.9%) patients had squamous cell carcinoma, seven (13.2%) patients had adenocarcinoma, and one (1.9%) patient had adenosquamous cell carcinoma. The interval between hysterectomy and tumor recurrence ranged from 2 months to 25 years (mean 34.4 months). The recurrent sites were vaginal stump in 41 patients (77.4%) and pelvic side wall in 12 patients (22.6%). Recurrent tumor size was devided into two groups : less than 3 cm in 43 patients (81.1%) and more than 3 cm in 10 patients (18.9%). External beam irradiation of whole pelvis was done first up to 46.8 Gy to 50.4 Gy in 5 weeks to 6 weeks, followed by either external beam boost to the recurrent site in 18 patients (34%) or intracavitary irradiation in 24 patients (45.3%). Total dose of radiation ranged from 46.8 Gy to 111 Gy (median 70.2 Gy). Follow up period ranged from 2 to 153 months with a median of 35 months. RESULTS: Overall response rate was 66% (35/53). Among them, six patients (17.1%) relapsed between 7 months and 116 months after radiation therapy (mean 47.7 months). Therefore overall recurrence rate was 45.3%. Overall five-year actuarial survival rate was 78.9% and distant failure rate was 10% (5/50). The significant prognostic factors affecting survival rate were interval between primary surgery and tumor recurrence (p=0.0055), recurrent tumor size (p=0.0039), and initial response to radiation therapy (p=0.0428). Complications were observed in 10 (20%) patients, which included mild to moderate lower gastrointestinal, genitourinary, or skin manifestations. One patient died of pulmonary embolism just after intracavitary irradiation. CONCLUSION: Radiation therapy is the effective treatment for the patients with locally recurrent cervical cancer after curative surgery. These results suggest that interval between primary surgery and tumor recurrence, recurrrent tumor size, and initial response to radiation therapy were significant prognostic factors for recurrent cervical cancer.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Diagnosis ; Follow-Up Studies ; Humans ; Hysterectomy ; Korea ; Pelvis ; Pulmonary Embolism ; Radiation Oncology ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Skin Manifestations ; Survival Rate ; Uterine Cervical Neoplasms*

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The Results of Postoperative Radiotherapy for Early Stage Endometrial Carcinoma.

Min Kyu KANG ; Seung Jae HUH ; Won PARK ; Jeong Won LEE ; Byoung Gie KIM ; Duk Soo BAE ; Je Ho LEE ; Ki Heon LEE ; Kyung Taek LIM ; Tae Jin KIM ; Seok Ju SEONG ; Chong Taik PARK ; Jeong Eun LEE ; Young Je PARK ; Heerim NAM ; Dongryul OH ; Do Hoon LIM ; Yong Chan AHN

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(2):116-122.

PURPOSE: To determine treatment policy for early stage endometrial carcinoma, we analyzed the results of postoperative radiotherapy. MATERIALS AND METHODS: From Oct. 1994 to Aug. 2002, 42 patients with FIGO stage I endometrial carcinoma received postoperative radiotherapy. All patients received curative surgery and pelvic lymph node dissection was done in 26 patients. Based on the FIGO staging system, 3 were at stage IA, 21 were at stage IB and 18 were at stage IC. Histologically, there were 14 grade 1, 16 grade 2, and 12 grade 3. Nineteen patients received intracavitary brachytherapy and 23 patients did whole pelvic radiotherapy. The median period of follow-up was 41 months (22 to 100 months). RESULTS: Five-year overall survival, disease-free survival, local control, and regional control rates of all patients were 86.0%, 87.9%, 100%, and 97.5%, respectively. All failures were distant metastases in 5 patients and two patients had simultaneous regional recurrences. There was no intrapelvic failure in patients who received intracavitary radiotherapy. Grade 3 chronic complications were found in 1 patient (4.3%), who received whole pelvic radiotherapy. CONCLUSION: We achieved high rates of loco-regional control and survival by curative surgery and postoperative radiotherapy. However, we need to select the type of radiotherapy based on the risk factors for recurrence to reduce the treatment-related complication.
Brachytherapy ; Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Lymph Node Excision ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Risk Factors

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Prognostic Factors Influencing the Result of Postoperative Radiotherapy in Endometrial Carcinoma.

Yong Kan KI ; Byung Hyun KWON ; Won Taek KIM ; Ji Ho NAM ; Man Su YUN ; Hyung Sik LEE ; Dong Won KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(2):110-115.

PURPOSE: This study was performed to determine the prognostic factors influencing relapse pattern, overall and disease-free survival in patients treated with postoperative radiotherapy for endometrial carcinoma. MATERIALS AND METHODS: The records of 54 patients with endometrial adenocarcinoma treated postoperative radiotherapy at Pusan National University Hospital between April 1992 and May 2003 were reviewed retrospectively. Median age of the patients was 55 (range 35~76). The distribution by surgical FIGO stages were 63.0% for 0Stage I, 14.8% for Stage II, 22.2% for Stage III. All patients received postoperative external radiotherapy up to 41.4~54 Gy (median: 50.4 Gy). Additional intravaginal brachytherapy was applied to 20 patients (37.0% of all). Median follow-up time was 35 months (5~115 months). Significant factors of this study: histologic grade, lymphovascular space invasion and myometrial invasion depth were scored (GLM score) and analyzed. Survival analysis was performed using Kaplan-Meier method. The log-rank test was used for univariate analysis and the Cox regression model for multivariate analysis. RESULTS: 5-year overall and disease-free survival rates were 87.7% and 87.1%, respectively. Prognostic factors related with overall and disease-free survival were histologic grade, lymphovascular space invasion and myometrial invasion according to the univariate analysis. According to the multivariate analysis, lymphovascular space invasion was associated with decreased disease-free survival. GLM score was a meaningful factor affecting overall and disease-free survival (p=0.0090, p=0.0073, respectively) and distant recurrence (p=0.0132), which was the sum of points of histologic grade, lymphovascular space invasion and myometrial invasion. Total failure rate was 11% with 6 patients. Relapse sites were 2 para-aortic lymph nodes, 2 lungs, a supraclavicular lymph node and a vagina. CONCLUSION: The prognosis in patients with endometrial carcinoma treated by postoperative radiotherapy was closely related with surgical histopathology. If further explorations confirm the system of prognostic factors in endometrial carcinoma, it will help us to predict the progression pattern and to manage.
Adenocarcinoma ; Brachytherapy ; Busan ; Disease-Free Survival ; Endometrial Neoplasms* ; Female ; Follow-Up Studies ; Humans ; Lung ; Lymph Nodes ; Multivariate Analysis ; Prognosis ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Vagina

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Salvage Treatment for Locally Recurrent Rectal Cancer.

Jae Myoung NOH ; Won PARK ; Yong Chan AHN ; Sang Min YOON ; Seung Jae HUH ; Do Hoon LIM ; Ho Kyung CHUN ; Woo Yong LEE ; Seong Hyeon YUN ; Won Ki KANG ; Young Suk PARK ; Joon Oh PARK

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(2):103-109.

PURPOSE: To evaluate the treatment outcome according to the salvage treatment modalities and identify the prognostic factors influencing the survival. MATERIALS AND METHODS: Forty-five patients with locally recurrent rectal cancer treated between 1994 to 2003 were reviewed retrospectively. Median time from initial surgery to local recurrence was 16months. Of the patients, 25 (56%) recurred at presacral and perirectal space. Among the 18 (40%) patients who received salvage surgery, 14 patients were treated with postoperative chemoradiotherapy. Among 27 (60%) patients who didn't receive salvage surgery, 16 were treated with chemoradiotherapy and 11 were treated with radiotherapy alone. Radiotherapy was given with total dose ranging from 37.5 to 64.8 Gy. RESULTS: Five-year locoregional progression-free survival rate and overall survival rate of all patients were 49.5% and 34.3%, respectively. The 5-year locoregional progression-free survival rate and overall survival rate of patients undergoing salvage surgery were 77.0% and 52.1% compared with 36.0% and 37.9% for patients treated with chemoradiotherapy and 0% and 0% for patients treated with radiotherapy alone, respectively. The 5-year locoregional progression free survival and overall survival of patients who recurred earlier than 24 months were higher (67.5% and 59.1%) than the other patients (39.5% and 24.9%). Among the 27 patients who didn't receive salvage surgery, there was no significant difference for locoregional progression free survival and overall survival between re-irradiated patients and radiation-naive patients. CONCLUSION: Surgical resection is preferred to treatment for locally recurrent rectal cancer. If salvage surgery is not possible, chemoradiotherapy may achieve higher locoregional progression free survival and overall survival than radiotherapy alone.
Chemoradiotherapy ; Disease-Free Survival ; Humans ; Radiotherapy ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome

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