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Development of a Dose Calibration Program for Various Dosimetry Protocols in High Energy Photon Beams .

Dong Oh SHIN ; Sung Yong PARK ; Young Hoon JI ; Chang Geon LEE ; Tae Suk SUH ; Soo IL KWON ; Hee Kyung AHN ; Jin Oh KANG ; Seong Eon HONG

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):381-390.

PURPOSE: To develop a dose calibration program for the IAEA TRS-277 and AAPM TG-21, based on the air kerma calibration factor (or the cavity-gas calibration factor), as well as for the IAEA TRS-398 and the AAPM TG-51, based on the absorbed dose to water calibration factor, so as to avoid the unwanted error associated with these calculation procedures. MATERIALS AND METHODS: Currently, the most widely used dosimetry protocols of high energy photon beams are the air kerma calibration factor based on the IAEA TRS-277 and the AAPM TG-21. However, this has somewhat complex formalism and limitations for the improvement of the accuracy due to uncertainties of the physical quantities. Recently, the IAEA and the AAPM published the absorbed dose to water calibration factor based, on the IAEA TRS-398 and the AAPM TG-51. The formalism and physical parameters were strictly applied to these four dose calibration programs. The tables and graphs of physical data and the information for ion chambers were numericalized for their incorporation into a database. These programs were developed user to be friendly, with the Visual C++ language for their ease of use in a Windows environment according to the recommendation of each protocols. RESULTS: The dose calibration programs for the high energy photon beams, developed for the four protocols, allow the input of informations about a dosimetry system, the characteristics of the beam quality, the measurement conditions and dosimetry results, to enable the minimization of any inter-user variations and errors, during the calculation procedure. Also, it was possible to compare the absorbed dose to water data of the four different protocols at a single reference points. CONCLUSION: Since this program expressed information in numerical and data-based forms for the physical parameter tables, graphs and of the ion chambers, the error associated with the procedures and different user could be solved. It was possible to analyze and compare the major difference for each dosimetry protocol, since the program was designed to be user friendly and to accurately calculate the correction factors and absorbed dose. It is expected that accurate dose calculations in high energy photon beams can be made by the users for selecting and performing the appropriate dosimetry protocol.
Calibration* ; Water

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One Click Film (OCF) Dosimetry System for Routine QA.

So Young KIM ; Byong Yong YI ; Kwan Sik JOO ; Jong Hoon KIM ; Seung Do AHN ; Sang Wook LEE ; Eun Kyoung CHOI

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):375-380.

PURPOSE: To develop a practical film dosimetry system for routine Quality Assurance (QA). MATERIALS AND METHODS: An One Click Film (OCF) Dosimetry system was designed to perform swift routine QA with functions including automatic fog value elimination, angle adjustment, automatic symmetry calculation, and realtime profile generation with the ability to display realtime three-dimensional dose distributions. RESULTS: The most frequently used functions for routine QA, such as the elimination of the fog value, conversion into an H&D curve, symmetry, and isodose distribution, can be achieved with only one click. CONCLUSION: Reliable results were achieved with the OCF dosimetry with simpler steps than other commercially available film dosimetry systems for routine QA. More research on the refined user interface will make this system be clinically useful.
Film Dosimetry ; Weather

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A Novel Chenodeoxycholic Derivative HS-1200 Induces Apoptosis in Human HT-29 Colon Cancer Cells.

Sin Geun OH ; Kwang Mo YANG ; Won Joo HUR ; Young Hyun YOO ; Hong Suk SUH ; Hyung Sik LEE

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):367-374.

PURPOSE: To investigate the growth inhibitory effects, and the underlying mechanism of human colon cancer cell (HT-29) death, induced by a new synthetic bile acid derivative (HS-1200). MATERIALS AND METHODS: Human colon cancer cells (HT-29), in exponential growth phase, were treated with various concentrations of a new synthetic bile acid derivative (HS-1200). The growth inhibitory effects on HT-29 cells were examined using a trypan blue exclusion assay. The extent of apoptosis was determined using agarose gel electrophoresis, TUNEL assays and Hoechst staining. The apoptotic cell death was also confirmed by Western blotting of PARP, caspase-3 and DNA fragmentation factor (DFF) analysis. To investigate the involvement of mitochondria, we employed immunofluorescent staining of cytochrome c and mitochondrial membrane potential analyses. RESULTS: The dose required for the half maximal inhibition (IC50) of the HT-29 cell growth was 100~150 micro M of HS-1200. Several changes, associated with the apoptosis of the HT-29 cells, were reveal by the agarose gel eletrophoresis, TUNEL assays and Hoechst staining, following their treatment with 100 micro M of HS-1200. HS-1200 treatment also induced caspase-3, PARP and DFF degradations, and the western blotting showed the processed caspase-3 p20, PARP p85 and DFF p30 and p11 cleaved products. Mitochondrial events were also demonstrated. The cytochrome c staining indicated that cytochrome c had been released from the mitochondria in the HS-1200 treated cells. The mitochondrial membrane potential (deltaxm) was also prominently decreased in the HS-1200 treated cells. CONCLUSION: These findings suggest that the HS-1200 - induced apoptosis of human colon cancer cells (HT-29) is mediated via caspase and mitochondrial pathways.
Apoptosis* ; Bile ; Bile Acids and Salts ; Blotting, Western ; Caspase 3 ; Cell Death ; Colon* ; Colonic Neoplasms* ; Cytochromes c ; DNA Fragmentation ; Electrophoresis, Agar Gel ; HT29 Cells ; Humans* ; In Situ Nick-End Labeling ; Membrane Potential, Mitochondrial ; Mitochondria ; Sepharose ; Trypan Blue

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Analyses of the Studies on Cancer-Related Quality of Life Published in Korea.

Eun Hyun LEE ; Hee Boong PARK ; Myung Wook KIM ; Sunghee KANG ; Hye Jin LEE ; Won Hee LEE ; Mison CHUN

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):359-366.

PURPOSE: The purpose of the present study was to analyze and evaluate prior studies published in Korea on the cancer-related quality of life, in order to make recommendations for further research. MATERIALS AND METHODS: A total of 31 studies were selected from three different databases. The selected studies were analyzed according to 11 criteria, such as site of cancer, domain, independent variable, research design, self/proxy rating, single/battery instrument, translation/back translation, reliability, validity, scoring, and findings. RESULTS: Of the 31 studies, approximately half of them were conducted using a mixed cancer group of patients. Many of the studies asserted that the concept of quality of life had a multidimensional attribute. Approximately 30% were longitudinal design studies giving information about the changes in quality of life. In all studies, except one, patients directly rated their level of quality of life. With respect to the questionnaires used for measuring the quality of life, most studies did not consider whether or not their reliability and validity had been established. In addition, when using questionnaires developed in other languages, no studies employed a translation/ back-translation technique. All studies used sum or total scoring methods when calculating the level of quality of life. The types of variables tested for their influence on quality of life were quite limited. CONCLUSION: It is recommended that longitudinal design studies be performed, using methods of data collection whose validity and reliability has been confirmed, and that studies be conducted to identify new variables having an influence on the quality of life.
Data Collection ; Humans ; Korea* ; Quality of Life* ; Surveys and Questionnaires ; Reproducibility of Results ; Research Design

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The Clinical Significance of Follow Up SCC Levels in Patients with Recurrent Squamous Cell Carcinoma of the Cervix.

Young Min CHOI ; Sung Kwang PARK ; Heung Lae CHO ; Kyoung Bok LEE ; Ki Tae KIM ; Juree KIM ; Seung Chang SOHN

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):353-358.

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

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Rectal Bleeding and Its Management after Irradiation for Cervix Cancer.

Mison CHUN ; Seunghee KANG ; Hoon Jong KIL ; Young Taek OH ; Jeong Hye SOHN ; Hye Young JUNG ; Hee Suk RYU ; Kwang Jae LEE

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):343-352.

PURPOSE: Radiotherapy is the main treatment modality for uterine cervix cancer. Since the rectum is in the radiation target volume, rectal bleeding is a common late side effect. This study evaluates the risk factors of radiation induced rectal bleeding and discusses its optimal management. MATERIALS AND METHODS: A total of 213 patients who completed external beam radiation therapy (EBRT) and intracavitary radiation (ICR) between September 1994 and December 1999 were included in this study. No patient had undergone concurrent chemo-radiotherapy. Ninety patients received radiotherapy according to a modified hyperfractionated schedule. A midline block was placed at a pelvic dose of between 30.6 Gy to 39.6 Gy. The total parametrial dose from the EBRT was 51 to 59 Gy depending on the extent of their disease. The point A dose from the HDR brachytherapy was 28 Gy to 30 Gy (4 Gyx7, or 5 Gyx6). The rectal point dose was calculated either by the ICRU 38 guideline, or by anterior rectal wall point seen on radiographs, with barium contrast. Rectal bleeding was scored by the LENT/SOMA criteria. For the management of rectal bleeding, we opted for observation, sucralfate enema or coagulation based on the frequency or amount of bleeding. The median follow-up period was 39 months (12~86 months). RESULTS: The incidence of rectal bleeding was 12.7% (27/213); graded as 1 in 9 patients, grade 2 in 16 and grade 3 in 2. The overall moderate and severe rectal complication rate was 8.5%. Most complications (92.6%) developed within 2 years following completion of radiotherapy (median 16 months). No patient progressed to rectal fistula or obstruction during the follow-up period. In the univariate analysis, three factors correlated with a high incidence of bleeding : an icruCRBED greater than 100 Gy (19.7% vs. 4.2%), an EBRT dose to the parametrium over 55 Gy (22.1% vs. 5.1%) and higher stages of III and IV (31.8% vs. 10.5%). In the multivariate analysis, the icruCRBED was the only significant factor (p>0.0432). The total parametrial dose from the EBRT had borderline significance (p=0.0546). Grade 1 bleeding was controlled without further management (3 patients), or with sucralfate enema 1 to 2 months after treatment. For grade 2 bleeding, sucralfate enema for 1 to 2 months reduced the frequency or amount of bleeding but for residual bleeding, additional coagulation was performed, where immediate cessation of bleeding was achieved (symptom duration of 3 to 10 months). Grade 3 bleeding lasted for 1 year even with multiple transfusions and coagulations. CONCLUSION: Moderate and severe rectal bleeding occurred in 8.5% of patients, which is comparable with other reports. The most significant risk factor for rectal bleeding was the accumulated dose to the rectum (icruCRBED), which corrected with consideration to biological equivalence. Prompt management of rectal bleeding, with a combination of sucralfate enema and coagulation, reduced the duration of the symptom, and minimized the anxiety/discomfort of patients.
Appointments and Schedules ; Barium ; Brachytherapy ; Cervix Uteri* ; Enema ; Female ; Follow-Up Studies ; Hemorrhage* ; Humans ; Incidence ; Multivariate Analysis ; Radiotherapy ; Rectal Fistula ; Rectum ; Risk Factors ; Sucralfate ; Uterine Cervical Neoplasms*

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Postoperative Adjuvant Chemotherapy and Chemoradiation for Rectal Cancer.

Kang Kyoo LEE ; Kyung Ran PARK ; Ik Jae LEE ; Ik Yong KIM ; Kwang Yong SIM ; Dae Sung KIM ; Jong Young LEE

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):334-342.

PURPOSE: The aim of this study was to determine if postoperative adjuvant chemotherapy (CT) alone and concurrent chemoradiation (CCRT), following radical surgery, improved the disease free survival (DFS) and overall survival (OS) in rectal cancer AJCC stage II and III patients. MATERIALS AND METHODS: A total of 144 patients with AJCC stage II and III rectal cancer who had had radical surgery between 1989 and 1999 were included in the study. Of these patients, 72 had been treated with postoperative CT, and the other 72 with postoperative CCRT. The chemotherapy regimen consisted of oral UFT on a daily basis for 1~12 months (median 12 months) or 5-FU (500 mg/m2 for 5 days) intravenous (IV) chemotherapy with 4 week intervals for 1~18 cycles (median 6 cycles). Radiation of 4,500 cGy was delivered to the surgical bed and regional pelvic lymph nodes area, followed by 540~1,440 cGy (median 540 cGy) boost to the surgical bed. The follow-up period ranged from 20 to 150 months, with a median of 44 months. RESULTS: The 5-year OS was 60.9% and 68.9% (p=0.0915), and the 5-year DFS was 56.1% and 63.8% (p=0.3510) for postoperative CT and postoperative CCRT, respectively. In the stage II patients, the 5-year OS was 71.1% and 92.2%, and the 5-year DFS was 57.3% and 85.4% for postoperative CT and CCRT, respectively. The OS was significantly improved (p=0.0379) but the DFS was not with postoperative CCRT compared to the postoperative CT (p=0.1482). In the stage III patients, the 5-year OS was 52.0% and 55.0%, and the 5-year DFS was 47.8% and 49.8% for postoperative CT and postoperative CCRT. There were no statistically significant differences between postoperative CT and CCRT (p=0.4280 and p=0.7891) in OS and DFS. The locoregional relapses were 16.7% and 12.5% for postoperative CT and CCRT, respectively. The distant relapses were 25.0% and 26.4% for postoperative CT and CCRT, respectively. CONCLUSION: These results showed that postoperative CCRT compared with CT alone improved OS in stage II patients. Although there was no statistical significance, the addition of postoperative RT to CT reduced locoregional relapses compared to CT alone.
Chemotherapy, Adjuvant* ; Disease-Free Survival ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Rectal Neoplasms* ; Recurrence

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Concurrent Chemoradiation for Unresectable Pancreatic Cancer.

Yong Bae KIM ; Jinsil SEONG ; Si Young SONG ; Seung Woo PARK ; Chang Ok SUH

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):328-333.

PURPOSE: To analyze the treatment results of concurrent chemoradiation with oral 5-FU plus Gemcitabine or Paclitaxel for unresectable pancreatic cancer. MATERIALS & METHODS: The patients, who were diagnosed by imaging modalities or by explo-laparotomy, were treated with concurrent chemoradiation. Radiotherapy was delivered to primary tumor and regional lymph nodes, and the total dose was 45 Gy. Patients received Gemcitabine 1,000 mg/m2 or Paclitaxel 50 mg/m2 weekly and oral 5-FU daily. The total number of cycles of chemotherapy ranged from 1 to 39 (median, 11 cycles). The follow-up period ranged from 6 to 36 months. Survival was analyzed using the Kaplan-Meier method. RESULTS: Fifty-four patients between Jan. 1999 to Nov. 2001 were included in this study. Forty-two patients who completed the planned treatment were included in this analysis. The patients' age ranged from 37 to 73 years (median, 60 years) and the male to female ratio was 30:12. Treatment was interrupted for 12 patients due to; disease progression for 6 (50%), poor performance status for 4 (33.3%), intercurrent disease for 1 (8.3%), and refusal for 1 (8.3%). Response evaluation was possible for 40 patients. One patient gained complete remission and 24 patients gained partial remission, hence the response rate was 59%. The survival rates were 46.7% and 17.0% at 1 year and 2 years, respectively with a median survival time of 12 months. Patients treated with Paclitaxel showed superior outcomes compared to those patients treated with Gemcitabine, in terms of both response rate and survival rate although this difference was not statistically significant. Grade III or IV hematologic toxicity was shown in 8 patients (19%), while grade III or IV non-hematologic toxicity was shown in 5 patients (12%). CONCLUSION: Concurrent chemoradiation with oral 5-FU and Gemcitabine or Paclitaxel improves both the response rate and survival rate in patients with unresectable pancreatic cancer. A prospective study should be investigated in order to improve both the patient selection and the treatment outcome as well as to reduce the toxicity.
Disease Progression ; Disulfiram ; Drug Therapy ; Female ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Male ; Paclitaxel ; Pancreatic Neoplasms* ; Patient Selection ; Radiotherapy ; Survival Rate ; Treatment Outcome

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Radiation Therapy Alone for Early Stage Non-small Cell Carcinoma of the Lung.

Ha Chung CHUN ; Myung Za LEE

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):323-327.

PURPOSE: To evaluate the outcome of early stage non-small cell lung cancer patients who were treated with radiation therapy alone and define the optimal radiotherapeutic regimen for these patients. MATERIALS AND METHODS: A retrospective review was performed on patients with sage I or II non-small cell carcinoma of the lung that were treated at our institution between June, 1987 and May, 2000. A total of 21 patients treated definitively with radiation therapy alone were included in this study. The age of the patients ranged from 53 to 81 years with a median of 66 years. All the patients were male. The medical reasons for inoperability were lack of pulmonary reserve, cardiovascular disease, poor performance status, old age, and patient refusal in the decreasing order. Pathological evidence was not adequate to characterize the non-small cell subtype in two patients. Of the remaining 19 patients, 16 had squamous cell carcinoma and 3 had adenocarcinoma. Treatment was given with conventional fractionation, once a day, five times a week. The doses to the primary site ranged from 56 Gy to 69 Gy. No patients were lost to follow-up. RESULTS: The overall survival rates for the entire group at 2, 3 and 5 years were 41, 30 and 21%, respectively. The cause specific survivals at 2, 3 and 5 years were 55, 36 and 25%, respectively. An intercurrent disease was the cause of death in two patients. The cumulative local failure rate at 5 years was 43%. Nine of the 21 patients had treatment failures after the curative radiotherapy was attempted. Local recurrences as the first site of failure were documented in 7 patients. Therefore, local failure alone represented 78% of the total failures. Those patients whose tumor sizes were less than 4 cm had a significantly better 5 year disease free survival than those with tumors greater than 4 cm (0% vs 36%). Those patients with a Karnofsky performance status less than 70 did not differ significantly with respect to actuarial survival when compared to those with a status greater than 70 (25% vs 26%, p>0.05). CONCLUSION: Radiation therapy alone is an effective and safe treatment for early stage non-small cell lung cancer patients who are medically inoperable or refuse surgery. Also we believe that a higher radiation dose to the primary site could improve the local control rate, and ultimately the overall survival rate.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Carcinoma, Squamous Cell ; Cardiovascular Diseases ; Cause of Death ; Disease-Free Survival ; Disulfiram ; Humans ; Karnofsky Performance Status ; Lost to Follow-Up ; Lung* ; Male ; Radiotherapy ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Failure

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The Role of Postoperative Adjuvant Radiotherapy in Resected Esophageal Cancer.

Chang Geol LEE ; Choong Bae KIM ; Kyung Young CHUNG ; Doo Yun LEE ; Jinsil SEONG ; Gwi Eon KIM ; Chang Ok SUH

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(4):316-322.

OBJECTIVE: A retrospective study was performed to evaluate whether postoperative adjuvant radiotherapy can improve survival and decrease recurrence as compared with surgery alone in resected esophageal cancer. MATERIALS AND METHODS: From Jan. 1985 to Dec. 1993, among 94 esophageal cancer patients treated with surgery, fifty-one patients were included in this study. Transthoracic esophagectomy was performed in 35 patients and transhiatal esophagectomy in 16. Postoperative adjuvant radiotherapy was performed 4 weeks after surgery in 26 among 38 patients in stage II and III. A total dose of 30~60 Gy in 1.8 Gy daily fraction, median 54 Gy over 6 weeks, was delivered in the mediastinum+both supraclavicular lymph nodes or celiac lymph nodes according to the tumor location. Forty-seven patients(92%) had squamous histology. The median follow-up period was 38 months. RESULTS: The overall 2-year and 5-year survival and median survival were 56.4%, 36.8% and 45 months. Two-year and 5-year survival and median survival by stage were 92%, 60.3% for stage I, 63%, 42% and 51 months for stage II and 34%, 23% and 19 months for stage III (p=0.04). For stage II and III patients, 5-year survival and median survival were 22.8%, 45 months for the surgery alone group and 37.8%, 22 months for the postoperative RT group (p=0.89). For stage III patients, 2-year survival and median survival were 0%, 11 months for the surgery alone group and 36.5%, 20 months for the postoperative RT group (p=0.14). Local and distant failure rates for stage II and III were 50%, 16% for the surgery alone and 39%, 31% for the postoperative RT group. For N1 patients, local failure rate was 71% for the surgery alone group and 37% for the postoperative RT group (p=0.19). Among 10 local failures in the postoperative RT group, in-field failures were 2, marginal failures 1, out-field 5 and anastomotic site failures2. CONCLUSION: There were no statistically significant differences in either the overall survival or the patterns of failure between the surgery alone group and the postoperative RT group for resected stage II and III esophageal cancer. But this study showed a tendency of survival improvement and decrease in local failure when postoperative RT was performed for stage III or N1 though statistically not significant. To decrease local failure, a more generous radiation field encompassing the supraclavicular, mediastinal, and celiac lymph nodes and anastomotic site in postoperative adjuvant treatment should be considered.
Esophageal Neoplasms* ; Esophagectomy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Radiotherapy ; Radiotherapy, Adjuvant* ; Recurrence ; Retrospective Studies

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