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Analysis of the Movement of Surgical Clips Implanted in Tumor Bed during Normal Breathing for Breast Cancer Patients.

Rena LEE ; Eunah CHUNG ; HyunSuk SUH ; Kyung ja LEE ; Jihye LEE

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(3):192-200.

PURPOSE: To evaluate the movement of surgical clips implanted in breast tumor bed during normal breathing. MATERIALS AND METHODS: Seven patients receiving breast post-operative radiotherapy were selected for this study. Each patient was simulated in a common treatment position. Fluoroscopic images were recorded every 0.033 s, 30 frames per 1 second, for 10 seconds in anterior to posterior (AP), lateral, and tangential direction except one patient's images which were recorded as a rate of 15 frames per second. The movement of surgical clips was recorded and measured, thereby calculated maximal displacement of each clip in AP, lateral, tangential, and superior to inferior (SI) direction. For the comparison, we also measured the movement of diaphragm in SI direction. RESULTS: From AP direction's images, average movement of surgical clips in lateral and SI direction was 0.8+/-0.5 mm and 0.9+/-0.2 mm and maximal movement was 1.9 mm and 1.2 mm. Surgical clips in lateral direction's images were averagely moved 1.3+/-0.7 mm and 1.3+/-0.5 mm in AP and SI direction with 2.6 mm and 2.6 mm maximal movement in each direction. In tangential direction's images, average movement of surgical clips and maximal movement was 1.2+/-0.5 mm and 2.4 mm in tangential direction and 0.9+/-0.4 mm and 1.7 mm in SI direction. Diaphragm was averagely moved 14.0+/-2.4 mm and 18.8 mm maximally in SI direction. CONCLUSION: The movement of clips caused by breathing was not as significant as the movement of diaphragm. And all surgical clip movements were within 3 mm in all directions. These results suggest that for breast radiotherapy, it may not necessary to use breath-holding technique or devices to control breath.
Breast Neoplasms* ; Breast* ; Diaphragm ; Humans ; Radiotherapy ; Respiration* ; Surgical Instruments*

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The Development of Quality Assurance Program for CyberKnife.

Jisun JANG ; Dong Han LEE ; Young Nam KANG ; Dong Oh SHIN ; Moon Chan KIM ; Sei Chul YOON ; Ihl Bohng CHOI ; Mi Sook KIM ; Chul Koo CHO ; Seong Yul YOO ; Soo Il KWON

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(3):185-191.

PURPOSE: Standardization quality assurance (QA) program of CyberKnife for suitable circumstances in Korea has not been established. In this research, we investigated the development of QA program for CyberKnife and evaluation of the feasibility under applications. MATERIALS AND METHODS: Considering the feature of constitution for systems and the therapeutic methodology of CyberKnife, the list of quality control (QC) was established and divided dependent on the each period of operations. And then all these developed QC lists were categorized into three groups such as basic QC, delivery specific QC, and patient specific QC based on the each purpose of QA. In order to verify the validity of the established QA program, this QC lists was applied to two CyberKnife centers. The acceptable tolerance was based on the undertaking inspection list from the CyberKnife manufacturer and the QC results during last three years of two CyberKnife centers in Korea. The acquired measurement results were evaluated for the analysis of the current QA status and the verification of the propriety for the developed QA program. RESULTS: The current QA status of two CyberKnife centers was evaluated from the accuracy of all measurements in relation with application of the established QA program. Each measurement result was verified having a good agreement within the acceptable tolerance limit of the developed QA program. CONCLUSION: It is considered that the developed QA program in this research could be established the standardization of QC methods for CyberKnife and confirmed the accuracy and stability for the image-guided stereotactic radiotherapy.
Constitution and Bylaws ; Humans ; Korea ; Mortuary Practice ; Quality Control ; Radiotherapy

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Effects of Recombinant Human Epidermal Growth Factor on the Proliferation and Radiation Survival of Human Fibroblast Cell Lines in Vitro.

Hyun Sook KIM ; Ki Mun KANG ; Sang wook LEE ; Jae Boem NA ; Gyu Young CHAI

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(3):179-184.

PURPOSE: To explore the effect of recombinant human EGF on the proliferation and survival of human fibroblast cell lines following irradiation. MATERIALS AND METHODS: Fibroblast was originated human skin and primary cultured. The trypan blue stain assay and MTT assay were used to study the proliferative effects of EGF on human fibroblast cell lines in vitro. An incubation of fibroblasts with rhEGF for 24 hours immediately after irradiation was counted everyday. Cell cycle distributions were analyzed by FACS analysis. RESULTS: Number of fibroblast was significantly more increased rhEGF (1.0 nM, 10 nM, 100 nM, 1,000 nM) treated cell than control after 8 Gy irradiation. Most effective dose of rhEGF was at 160 nM. These survival differences were maintained at 1 week later. Proportion of S phase was significantly increased on rhEGF treated cells. CONCLUSION: rhEGF cause increased fibroblast proliferation following irradiation. We expect that rhEGF was effective for radiation induced wound healing.
Cell Cycle ; Cell Line* ; Epidermal Growth Factor* ; Fibroblasts* ; Humans* ; S Phase ; Skin ; Trypan Blue ; Wound Healing

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Preliminary Results of Concurrent Chemotherapy and Radiation Therapy using High-dose-rate Brachytherapy for Cervical Cancer.

Kyung Ja LEE ; Jihye LEE ; Rena LEE ; Hyunsuk SUH

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(3):171-178.

PURPOSE: To determine the efficacy and safety of concurrent chemotherapy and radiation therapy with high-dose-rate brachytherapy for cervical cancer. MATERIALS AND METHODS: From January 2001 to December 2002, 30 patients with cervical cancer were treated with concurrent chemotherapy (cisplatin and 5-FU) and definitive radiation therapy. The median age was 58 (range 34~74) year old. The pathology of the biopsy sections was squamous cell carcinoma in 29 patients and one was adenocarcinoma. The distribution to FIGO staging system was as follows: stage IB, 7 (23%); IIA, 3 (10%); IIB, 12 (40%); IIIA, 3 (10%); IIIB, 5 (17%). All patients received pelvic external beam irradiation (EBRT) to a total dose of 45~50.4 Gy (median: 50.4 Gy) over 5~5.5 weeks. Ir-192 HDR intracavitary brachytherapy (ICBT) was given after a total dose of 41.4 Gy. HDR-ICBT was performed twice a week, with a fraction point A dose of 4 Gy and median dose to point A was 28 Gy (range: 16~32 Gy) in 7 fractions. The median cumulative biologic effective dose (BED) at point A (EBRT+ICBT) was 88 Gy10 (range: 77~94 Gy10). The median cumulative BED at ICRU 38 reference point (EBRT+ICBT) was 131 Gy3 (range: 122~140 Gy3) at point A, 109 Gy3 (range: 88~125 Gy3) at the rectum and 111 Gy3 (range: 91~123 Gy3) at the urinary bladder. Cisplatin (60 mg/m2) and 5-FU (1,000 mg/m2) was administered intravenously at 3 weeks interval from the first day of radiation for median 5 (range: 2~6) cycles. The assessment was performed at 1 month after completion of radiation therapy by clinical examination and CT scan. The median follow-up time was 36 months (range: 8~50 months). RESULTS: The complete response rate after concurrent chemoradiation therapy was 93.3%. The 3-yr actuarial pelvic control rate was 87% and 3-yr actuarial overall survival and disease-free survival rate was 93% and 87%, respectively. The local failure rate was 13% and distant metastatic rate was 3.3%. The crude rate of minor hematologic complications (RTOG grade 1-2) occurred in 3 patients (10%) and one patient had suffered from severe leukopenia (RTOG grade 4) during concurrent treatment. Acute minor enterocolitis (RTOG grade 1-2) occurred in 11 patients (37%) and one patient (3%) was suffered from colon perforation during radiation therapy. Late colitis of RTOG grade 1 occurred in 5 patients (15%). Acute cystitis of RTOG grade 1 occurred in 12 patients (40%) and late cystitis of RTOG grade 2 occurred in one patient (3%). No treatment related death was seen. CONCLUSION: The results of this study suggest that the concurrent chemoradiation therapy with HDR brachytherapy could be accepted as an effective and safe treatment for cervical cancer.
Adenocarcinoma ; Biopsy ; Brachytherapy* ; Carcinoma, Squamous Cell ; Cisplatin ; Colitis ; Colon ; Cystitis ; Disease-Free Survival ; Drug Therapy* ; Enterocolitis ; Fluorouracil ; Follow-Up Studies ; Humans ; Leukopenia ; Pathology ; Rectum ; Tomography, X-Ray Computed ; Urinary Bladder ; Uterine Cervical Neoplasms*

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Postoperative Radiation Therapy in the Management of Early Cervical Cancer.

Jae Chul KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(3):164-170.

PURPOSE: This study identified the result of postoperative radiation therapy and the prognostic factors to affect survival rates in cervical cancer patients. MATERIALS AND METHODS: One hundred and thirty three patients with cervical cancer who were treated with postoperative radiation therapy following surgery at our institution between June 1985 and November 2002 were retrospectively analyzed. One hundred and thirteen patients had stage IB disease, and 20 patients had stage IIA disease. Histological examination revealed 118 squamous cell carcinoma patients and 15 adenocarcinoma patients. Sixty seven patients were noted to have stromal invasion greater than 10 mm, and 45 patients were noted to have stromal invasion 10 mm or less. Positive lymphovascular invasion was found in 24 patients, and positive pelvic lymph nodes were noted in 39 patients. Positive vaginal resection margin was documented in 8 patients. All of the patients were treated with external beam radiation therapy to encompass whole pelvis and primary surgical tumor bed. Intracavitary radiation therapy was added to 19 patients who had positive or close surgical margins. RESULTS: Actuarial overall and disease-free survival rates for entire group of the patients were 88% and 84% at 5 years, respectively. Five-year disease-free survival rates for patients with stromal invasion greater than 10 mm and 10 mm or less were 76% and 97%, respectively (p<0.05). Also there was a significantly lower survival in patients with positive pelvic lymph nodes compared with patients with negative pelvic lymph nodes (p<0.05). However, lymphovascular invasion, positive vaginal resection margins were not statistically significant prognostic factors. Addition of neoadjuvant chemotherapy or type of surgery did not affect disease-free survival. CONCLUSION: Postoperative radiation therapy appears to achieve satisfactory local control with limited morbidity in cervical cancer patients with high pathologic risk factors. Distant metastasis was a dominant failure pattern to affect survival in cervical cancer patients after radical surgery and radiation and more effective systemic treatment should be investigated in these high-risk patients.
Adenocarcinoma ; Carcinoma, Squamous Cell ; Disease-Free Survival ; Drug Therapy ; Humans ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Pelvis ; Retrospective Studies ; Risk Factors ; Survival Rate ; Uterine Cervical Neoplasms*

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Postoperative Adjuvant Chemoradiotherapy in Rectal Cancer.

Sei Kyung CHANG ; Jong Woo KIM ; Doyeun OH ; So Young CHONG ; Hyun Soo SHIN

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2006;24(3):157-163.

PURPOSE: To evaluate the role of postoperative adjuvant chemoradiotherapy in rectal cancer, we retrospectively analyzed the treatment outcome of patients with rectal cancer taken curative surgical resection and postoperative adjuvant chemoradiotherapy. MATERIALS AND METHODS: A total 46 patients with AJCC stage II and III carcinoma of rectum were treated with curative surgical resection and postoperative adjuvant chemoradiotherapy. T3 and T4 stage were 38 and 8 patients, respectively. N0, N1, and N2 stage were 12, 16, 18 patients, respectively. Forty patients received bolus infusions of 5-fluorouracil (500 mg/m2/day) with leucovorin (20 mg/m2/day), every 4 weeks interval for 6 cycles. Oral Uracil/Tegafur on a daily basis for 6~12 months was given in 6 patients. Radiotherapy with 45 Gy was delivered to the surgical bed and regional pelvic lymph node area, followed by 5.4~9 Gy boost to the surgical bed. The follow up period ranged from 8 to 75 months with a median 35 months. RESULTS: Treatment failure occurred in 17 patients (37%). Locoregional failure occurred in 4 patients (8.7%) and distant failure in 16 patients (34.8%). There was no local failure only. Five year actuarial overall survival (OS) was 51.5% and relapse free survival (RFS) was 58.7%. The OS and RFS were 100%, 100% in stage N0 patients, 53.7%, 47.6% in N1 patients, and 0%, 41.2% in N2 patients (p=0.012, p=0.009). The RFS was 55%, 78.5%, and 31.2% in upper, middle, and lower rectal cancer patients, respectively (p=0.006). Multivariate analysis showed that N stage (p=0.012) was significant prognostic factor for OS and that N stage (p=0.001) and location of tumor (p=0.006) were for RFS. Bowel complications requiring surgery occurred in 3 patients. CONCLUSION: Postoperative adjuvant chemoradiotherapy was an effective modality for locoregional control of rectal cancer. But further investigations for reducing the distant failure rate are necessary because distant failure rate is still high.
Chemoradiotherapy ; Chemoradiotherapy, Adjuvant* ; Fluorouracil ; Follow-Up Studies ; Humans ; Leucovorin ; Lymph Nodes ; Multivariate Analysis ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Recurrence ; Retrospective Studies ; Treatment Failure ; Treatment Outcome

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Quality Assurance of Patients for Intensity Modulated Radiation Therapy.

Sang Min YOON ; Byong Yong YI ; Eun Kyung CHOI ; Jong Hoon KIM ; Seung Do AHN ; Sang Wook LEE

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(1):81-90.

PURPOSE: To establish and verify the proper and the practical IMRT (Intensity-modulated radiation therapy) patient QA (Quality Assurance). MATERIALS AND METHODS: An IMRT QA which consists of 3 steps and 16 items were designed and examined the validity of the program by applying to 9 patients, 12 IMRT cases of various sites. The three step QA program consists of RTP related QA, treatment information flow QA, and a treatment delivery QA procedure. The evaluation of organ constraints, the validity of the point dose, and the dose distribution are major issues in the RTP related QA procedure. The leaf sequence file generation, the evaluation of the MLC control file, the comparison of the dry run film, and the IMRT field simulate image were included in the treatment information flow procedure QA. The patient setup QA, the verification of the IMRT treatment fields to the patients, and the examination of the data in the Record & Verify system make up the treatment delivery QA procedure. RESULTS: The point dose measurement results of 10 cases showed good agreement with the RTP calculation within 3%. One case showed more than a 3% difference and the other case showed more than 5%, which was out side the tolerance level. We could not find any differences of more than 2 mm between the RTP leaf sequence and the dry run film. Film dosimetry and the dose distribution from the phantom plan showed the same tendency, but quantitative analysis was not possible because of the film dosimetry nature. No error had been found from the MLC control file and one mis-registration case was found before treatment. CONCLUSION: This study shows the usefulness and the necessity of the IMRT patient QA program. The whole procedure of this program should be performed, especially by institutions that have just started to accumulate experience. But, the program is too complex and time consuming. Therefore, we propose practical and essential QA items for institutions in which the IMRT is performed as a routine procedure.
Film Dosimetry ; Humans

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Apoptosis and Proliferative Activity of Non-Hodgkin's Lymphoma: Correlation with Bcl-2 and P53 Protein Expression.

Yoon Kyeong OH ; Mi Ja LEE ; Ho Jong JEON

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(1):73-80.

PURPOSE: Tumor growth in a given neoplasm is the net result of cell proliferation and cell loss, and apoptosis is the most significant component of continuous cell loss in most tumors. In this study, we examined non-Hodgkin's lymphoma (NHL, n=67) immunohistochemically for the presence of Bcl-2 oncoprotein and P53 protein and compared apoptotic indices (AIs) and Ki-67 proliferative indices (percentages of Ki-67 positive cells). MATERIALS AND METHODS: 67 patients with NHL were evaluated : 3 low-grade and 64 intermediate-grade. The phenotype was determined in 65 cases : 47 (70%) were B cell type and 18 (27%) were T cell type. AIs and Ki-67 proliferative indices were determined immunohistochemically and the overexpression of P53 and Bcl-2 protein were also evalutated. RESULTS: The overexpressions of Bcl-2 protein and P53 protein were found in 40% (26/65) and 31% (20/ 65). The AI ranged from 0% to 15% (mean 2.16, median 1.2). Cellular Bcl-2, which counteracts apoptosis, was significantly ( p=0.005) associated with AIs. Ki-67 proliferative indices ranged from 1% to 91% (mean 55.4), and P53 was significantly ( p=0.000) associated with Ki-67 proliferative indices. A positive correlation between AIs and Ki-67 proliferative indices was revealed ( p=0.012) in Bcl-2 positive patients. CONCLUSION: In NHL, we observed a correlation between AIs and Bcl-2 expression, between Ki-67 proliferative indices and P53 expression, and between AIs and Ki-67 proliferative indices in Bcl-2 positive patients. Our results suggest that cell apoptosis may be inseparable from cell proliferation during tumor growth.
Apoptosis* ; Cell Proliferation ; Humans ; Lymphoma, Non-Hodgkin* ; Phenotype

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Application of Intensity Modulated Radiation Therapy (IMRT) in Prostate Cancer.

Suk Won PARK ; Do Hoon OH ; Hoon Sik BAE ; Byung Chul CHO ; Jae Hong PARK ; Seung Hee HAN

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(1):68-72.

This study was done to implement intensity-modulated radiation therapy (IMRT) for the treatment of primary prostate cancer and to compare this technique with conventional treatment methods. A 72-year- old male patient with prostate cancer stage T2a was treated with IMRT delivered with dynamic multi-leaf collimation. Treatment was designed using an inverse planning algorithm, which accepts dose and dose- volume constraints for targets and normal structures. The IMRT plan was compared with a three-dimensional (3D) plan using the same 6 fields technique. Lower normal tissue doses and improved target coverage were achieved using IMRT at current dose levels, and facilitate dose escalation to further enhance locoregional control and organ movement during radiotherapy is an important issue of IMRT in prostate cancer.
Humans ; Male ; Prostate* ; Prostatic Neoplasms* ; Radiotherapy

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Treatment Results in Anal Cancer: Non-operative Treatment Versus Operative Treatment.

Eui Kyu CHIE ; Sung Whan HA ; Jae Gahb PARK ; Yung Jue BANG ; Dae Seog HEO ; Noe Kyeong KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2002;20(1):62-67.

PURPOSE: This study was undertaken to analyze the efficacy and sphincter preservation rate of platinum based neoadjuvant chemotherapy plus radiotherapy versus abdominoperineal resection and postoperative radiotherapy for anal cancer. MATERIALS AND METHODS: Data of forty-two patients with anal cancer were retrospectively analyzed. Among thirty-eight patients with epidermoid histology, four patients received radiotherapy, and nineteen patients received abdominoperineal resection and adjuvant radiotherapy with or without chemotherapy (APR+RT+/-CT), and fifteen patients received neoadjuvant chemotherapy and radiotherapy (CRT). The CRT regimen was composed of three cycles of 5-fluorouracil (1,000 mg/m2 bolus on D1-5) and cisplatin (60 mg/m2 bolus on D1) followed by 50.4 Gy to the tumor bed and regional lymphatics over 5.5 weeks. Both inguinal lymphatics were treated with an identical dose schedule. Residual disease was treated with an additional three cycles of identical adjuvant chemotherapy. An identical dose schedule was used for post-operative radiotherapy. Median follow-up period was eighty-five months. RESULTS: Overall five-year survival rates were 80.3%, 88.9 and 79.4% for entire patients, APR+RT+/-CT group, and the CRT group, respectively. No significant difference was found between the two groups (p= 0.49). Anus preservation rate for the CRT group was 86.7%. Age (p=0.0164) and performance status (p= 0.0007) were found to be significant prognostic factors by univariate analysis. Age (p=0.0426), performance status (p=0.0068), and inguinal lymph node metastasis (p=0.0093) were statistically significant prognostic factors by multivariate analysis. No case of RTOG grade 3 complication or higher was reported. CONCLUSION: This and other recent studies have shown that combined chemotherapy plus radiotherapy for anal cancer results in a high rate of anal sphincter preservation as well as local control and survival. Furthermore, neoadjuvant use of chemotherapy with a cisplatin based regimen rather than a concurrent regimen may lead to a decrease in complications.
Anal Canal ; Anus Neoplasms* ; Appointments and Schedules ; Chemoradiotherapy ; Chemotherapy, Adjuvant ; Cisplatin ; Drug Therapy ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Multivariate Analysis ; Neoplasm Metastasis ; Platinum ; Radiotherapy ; Radiotherapy, Adjuvant ; Retrospective Studies ; Survival Rate

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