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A Case Report of Intraocular Metastasis Treated with Radiotherapy.

Ok Bae KIM ; Sang Jun BYUN ; Kwang Soo KIM ; Ho Jun LEE ; Jin Hee KIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):169-172. doi:10.3857/jkstro.2009.27.3.169

Intraocular metastasis is the most common malignancy of the eye. The frequency of intraocular metastasis in all the patients dying of cancer is about 12% and ocular metastases will be detected more frequently in the future because the patients with malignant tumor are now living longer. Intraocular metastasis can cause a serious clinical problem such as blindness. The early recognition and treatment of intraocular metastasis are very important clinical oncologic issues to maintain vision and to maximize the quality of life. However, significance of intraocular metastasis is still under-evaluated for practicing oncologists. External beam radiotherapy is a safe, effective palliative treatment in terms of preserving both the vision and the eye globe.
Blindness ; Eye ; Humans ; Neoplasm Metastasis ; Palliative Care ; Quality of Life ; Vision, Ocular

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Comparison of Stereotactic Radiosurgery and Whole Brain Radiotherapy in Patients with Four or More Brain Metastases.

Cheoljin KIM ; Miyoung BAEK ; Sungkwang PARK ; Kijung AHN ; Heunglae CHO

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):163-168. doi:10.3857/jkstro.2009.27.3.163

PURPOSE: This study was a retrospective evaluation of the efficacy of stereotactic radiosurgery (SRS) in patients with >4 metastases to the brain. MATERIALS AND METHODS: Between January 2004 and December 2006, 68 patients with > or = 4 multiple brain metastases were included and reviewed retrospectively. Twenty-nine patients received SRS and 39 patients received whole brain radiotherapy (WBRT). Patients with small cell lung cancers and melanomas were excluded. The primary lesions were non-small cell lung cancer (69.0%) and breast cancer (13.8%) in the SRS group and non-small cell lung cancer (64.1%), breast cancer (15.4%), colorectal cancer (12.8%), esophageal cancer (5.1%) in the WBRT group. SRS involved gamma-knife radiosurgery and delivered 10~20 Gy (median, 16 Gy) in a single fraction with a 50% marginal dose. WBRT was delivered daily in 3 Gy fractions, for a total of 30 Gy. After completion of treatment, a follow-up brain MRI or a contrast-enhanced brain CT was reviewed. The overall survival and intracranial progression-free survival were compared in each group. RESULTS: The median follow-up period was 5 months (range, 2~19 months) in the SRS group and 6 months (range, 4~23 months) in the WBRT group. The mean number of metastatic lesions in the SRS and WBRT groups was 6 and 5, respectively. The intracranial progression-free survival and overall survival in the SRS group was 5.1 and 5.6 months, respectively, in comparison to 6.1 and 7.2 months, respectively, in the WBRT group. CONCLUSION: SRS was less effective than WBRT in the treatment of patients with >4 metastases to the brain.
Brain ; Breast Neoplasms ; Carcinoma, Non-Small-Cell Lung ; Colorectal Neoplasms ; Disease-Free Survival ; Esophageal Neoplasms ; Follow-Up Studies ; Humans ; Lung Neoplasms ; Melanoma ; Neoplasm Metastasis ; Radiosurgery ; Retrospective Studies

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Long-term Results of Breast-conserving Surgery and Radiation Therapy in Early Breast Cancer.

Jin Hee KIM ; Sang Jun BYUN

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):153-162. doi:10.3857/jkstro.2009.27.3.153

PURPOSE: To evaluate the long-term results after breast-conserving surgery and radiation therapy in early breast cancer in terms of failure, survival, and cosmesis. MATERIALS AND METHODS: One hundred fifty-four patients with stage I and II breast cancer were treated with conservative surgery plus radiotherapy between January 1992 and December 2002 at the Keimyung University Dongsan Medical Center. According to TNM stage, 93 patients were stage I, 50 were IIa, and 11 were IIb. The affected breasts were irradiated with 6 MV photons to 50.4 Gy in 28 fractions over 5.5 weeks with a boost irradiation dose of 10~16 Gy to the excision site. Chemotherapy was administered in 75 patients and hormonal therapy in 92 patients with tamoxifen. Follow-up periods were 13~179 months, with a median of 92.5 months. RESULTS: The 5- and 10-year overall survival rates were 97.3% and 94.5%, respectively. The 5- and 10-year disease-free survival (5YDFS and 10YDFS, respectively) rates were 92.5% and 88.9%, respectively; the ultimate 5YDFS and 10YDFS rates after salvage treatment were 93.9% and 90.2%, respectively. Based on multivariate analysis, only the interval between surgery and radiation therapy (< or = 6 weeks vs. >6 weeks, p=0.017) was a statistically significant prognostic factor for DFS. The major type of treatment failure was distant failure (78.5%) and the most common distant metastatic site was the lungs. The cosmetic results were good-to-excellent in 96 patients (80.7%). CONCLUSION: Conservative surgery and radiation for early stage invasive breast cancer yielded excellent survival and cosmetic results. Radiation therapy should be started as soon as possible after breast-conserving surgery in patients with early breast cancer, ideally within 6 weeks.
Breast ; Breast Neoplasms ; Cosmetics ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Lung ; Mastectomy, Segmental ; Multivariate Analysis ; Photons ; Survival Rate ; Tamoxifen ; Treatment Failure

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The Results of Radiotherapy in Locally Advanced, Unresectable Pancreatic Cancer.

Hyun Soo JANG ; Seung Hee KANG ; Sang Won KIM ; Mison CHUN ; Sun Mi JO ; Jun Chul LIM ; Young Taek OH ; Seok Yun KANG

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):145-152. doi:10.3857/jkstro.2009.27.3.145

PURPOSE: We retrospectively studied the outcomes and prognostic factors of patients with locally advanced, unresectable pancreatic cancer who were treated with concurrent chemoradiotherapy (CCRT) or radiotherapy only. MATERIALS AND METHODS: Fifty-one patients with locally advanced, unresectable pancreatic cancer (stage IIA~III) who recevied radiotherapy (> or =30 Gy) between January 1994 and August 2008 were reviewed retrospectively. The median radiation dose was 39 Gy. Chemotherapy consisted of gemcitabine, cisplatin, or 5-FU alone or in various combinations, and was administered concurrently with radiotherapy in 38 patients. RESULTS: The follow-up period ranged from 2~40 months (median, 8 months). The median survival, and the 1- and 2-year overall survival (OS) rates were 7 months, 15.7%, and 5.9%, respectively. Based on univariate analysis, the baseline CA19-9, performance status, and chemotherapy regimen were significant prognostic factors. The median survival was 8 months for CCRT, and 6 months for radiotherapy alone. The patients treated with gemcitabine-containing regimens had longer survival (median, 10 months) than the patients treated with radiotherapy alone (p=0.027). Twenty-three patients were available to evaluate the patterns of failure. Distant metastases (DM) occured in 18 patients and regional recurrences were demonstrated in 4 patients. Local progression developed in 14 patients. We analyzed the association between the time-to-DM and the baseline CA19-9 levels for 18 evaluable patients. The median time-to-DM was 20 months for patients with normal baseline CA19-9 levels and 2 months for patients with baseline CA19-9 levels > or =200 U/ml. CONCLUSION: CCRT with gemcitabine-based regimens was effective in improving OS in patients with locally advanced, unresectable pancreatic cancer. We suggest that the baseline CA19-9 level is valuable in determining the treatment strategy for patients with locally advanced, unresectable pancreatic cancer.
Chemoradiotherapy ; Cisplatin ; Deoxycytidine ; Fluorouracil ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Pancreatic Neoplasms ; Recurrence ; Retrospective Studies

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Survival Analysis of Patients with Brain Metastsis by Weighting According to the Primary Tumor Oncotype.

Hee Keun GWAK ; Woo Chul KIM ; Hun Jung KIM ; Jung Hoon PARK ; Chang Hoon SONG

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):140-144. doi:10.3857/jkstro.2009.27.3.140

PURPOSE: This study was performed to retrospectively analyze patient survival by weighting according to the primary tumor oncotype in 160 patients with brain metastasis and who underwent whole brain radiotherapy. MATERIALS AND METHODS: A total of 160 metastatic brain cancer patients who were treated with whole brain radiotherapy of 30 Gy between 2002 and 2008 were retrospectively analyzed. The primary tumor oncotype of 20 patients was breast cancer, and that of 103 patients was lung cancer. Except for 18 patients with leptomeningeal seeding, a total of 142 patients were analyzed according to the prognostic factors and the Recursive Partitioning Analysis (RPA) class. Weighted Partitioning Analysis (WPA), with the weighting being done according to the primary tumor oncotype, was performed and the results were correlated with survival and then compared with the RPA Class. RESULTS: The median survival of the patients in RPA Class I (8 patients) was 20.0 months, that for Class II (76 patients) was 10.0 months and that for Class III (58 patients) was 3.0 months (p<0.003). The median survival of patients in WPA Class I (3 patients) was 36 months, that for the patients in Class II (9 patients) was 23.7 months, that for the patients in Class III (70 patients) was 10.9 months and that for the patients in Class IV (60 patients) was 8.6 months (p<0.001). The WPA Class might have more accuracy in assessing survival, and it may be superior to the RPA Class for assessing survival. CONCLUSION: A new prognostic index, the WPA Class, has more prognostic value than the RPA Class for the treatment of patients with metastatic brain cancer. This WPA Class may be useful to guide the appropriate treatment of metastatic brain lesions.
Brain ; Brain Neoplasms ; Breast Neoplasms ; Humans ; Lung Neoplasms ; Neoplasm Metastasis ; Retrospective Studies ; Seeds ; Survival Analysis*

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Retrospective Analysis of Chemoradiotherapy for Limited-Stage Small-Cell Lung Cancer.

Jong Hoon LEE ; Sung Hwan KIM ; Su Zy KIM ; Joo Hwan LEE ; Hoon Kyo KIM ; Byoung Yong SHIM

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):133-139. doi:10.3857/jkstro.2009.27.3.133

PURPOSE: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). MATERIALS AND METHODS: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. RESULTS: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). CONCLUSION: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.
Arm ; Chemoradiotherapy ; Cisplatin ; Disease-Free Survival ; Esophagitis ; Etoposide ; Humans ; Leukopenia ; Lung ; Lung Neoplasms ; Retrospective Studies

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Division of the N2 Stage According to the Multiplicity of the Involved Nodal Stations May be Necessary in the N2-NSCLC Patients Who are Treated with Postoperative Radiotherapy.

Hong In YOON ; Yong Bae KIM ; Chang Geol LEE ; Ik Jae LEE ; Songyih KIM ; Jun Won KIM ; Joo Hang KIM ; Byung Chul CHO ; Jin Gu LEE ; Kyung Young CHUNG

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):126-132. doi:10.3857/jkstro.2009.27.3.126

PURPOSE: We wanted to evaluate the prognostic factors for the pathologic N2 non-small cell lung cancer (NSCLC) patients who were treated by postoperative radiotherapy. MATERIALS AND METHODS: We retrospectively reviewed 112 pN2 NSCLC patients who underwent surgery and postoperative radiotherapy (PORT) From January 1999 to February 2008. Seventy-five (67%) patients received segmentectomy or lobectomy and 37 (33%) patients received pneumonectomy. The resection margin was negative in 94 patients, and it was positive or close in 18 patients. Chemotherapy was administered to 103 (92%) patients. Nine (8%) patients received PORT alone. The median radiation dose was 54 Gy (range, 45 to 66), and the fraction size was 1.8~2 Gy. RESULTS: The 2-year overall survival (OS) rate was 60.2% and the disease free survival (DFS) rate was 44.7% for all the patients. Univariate analysis showed that the patients with multiple-station N2 disease had significantly reduced OS and DFS (p=0.047, p=0.007) and the patients with an advanced T stage (> or =T3) had significantly reduced OS and DFS (p<0.001, p=0.025). A large tumor size (> or =5 cm) and positive lymphovascular invasion reduced the OS (p=0.035, 0.034). Using multivariate analysis, we found that multiple-station N2 disease and an advanced T stage (> or =T3) significantly reduced the OS and DFS. Seventy one patients (63.4%) had recurrence of disease. The patterns of failure were loco-regional in 23 (20.5%) patients, distant failure in 62 (55.4%) and combined loco-regional and distant failure in 14 (12.5%) patients. CONCLUSION: Multiple involvement of mediastinal nodal stations for the pN2 NSCLC patients with PORT was a poor prognostic factor in this study. A prospective study is necessary to evaluate the N2 subclassification and to optimize the adjuvant treatment.
Carcinoma, Non-Small-Cell Lung ; Disease-Free Survival ; Humans ; Mastectomy, Segmental ; Multivariate Analysis ; Pneumonectomy ; Recurrence ; Retrospective Studies

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The Preliminary Results of Intensity-Modulated Radiotherapy for Tonsillar Cancer.

Geumju PARK ; Sang Wook LEE ; Eun Kyung CHOI ; Jong Hoon KIM ; Si Yeol SONG ; Sang Min YOUN ; Sung Ho PARK ; Dong Wook PARK ; Seung Do AHN

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):120-125. doi:10.3857/jkstro.2009.27.3.120

PURPOSE: We wanted to present the preliminary results of intensity-modulated radiotherapy (IMRT) for the treatment of tonsillar cancer. MATERIALS AND METHODS: We retrospectively analyzed 12 patients who underwent IMRT for tonsillar cancer at Asan Medical Center between November 2002 and February 2007. Seven patients (58%) received definitive treatment, and five (42%) were treated in the postoperative setting. Among the definitively treated patients, 6 patients received cisplatin-based chemotherapy regimens. Simultaneous modulated accelerated radiation therapy (SMART) was used in nine patients. The prescribed dose was 72 Gy at 2.4 Gy/fraction for the definitively treated cases and 61.6 Gy at 2.2 Gy/fraction for the postoperative cases. The median follow-up period was 34 months. RESULTS: All twelve patients completed treatment without interruption, and eleven showed a complete response. One patient had persistent loco-regional disease after treatment. The three-year estimates of loco-regional control, disease-free survival and overall survival were 91.7%, 91.7%, and 100%. The worst acute mucositis was Grade 1 in four patients, Grade 2 in five patients, Grade 3 in two patients and Grade 4 in one patient. Grade 3 xerostomia was observed in six patients. CONCLUSION: Intensity-modulated radiotherapy was shown to be a safe and effective treatment modality for tonsillar cancer. Further studies with a larger number of patients and a longer follow-up period are needed to evaluate the ultimate tumor control and late toxicity of IMRT for treating tonsillar cancer.
Disease-Free Survival ; Follow-Up Studies ; Humans ; Mucositis ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Tonsillar Neoplasms ; Xerostomia

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The Usefulness of 18F-FDG PET/CT for Predicting the Response of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiation Therapy.

Jin Kyu KANG ; Mi Sook KIM ; Chul Won CHOI ; Su Young JEONG ; Seong Yul YOO ; Chul Koo CHO ; Kwang Mo YANG ; Hyung Jun YOO ; Gi Jeong CHEON ; Young Joo SHIN ; Young Seok SEO

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2009;27(3):111-119. doi:10.3857/jkstro.2009.27.3.111

PURPOSE: This study aimed at assessing the value of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) for predicting the response of locally advanced rectal cancer to neoadjuvant CRT. MATERIALS AND METHODS: Between August 2006 and January 2008, we prospectively enrolled 20 patients with locally advanced rectal cancer and who were treated with neoadjuvant CRT at the Korea Institute of Radiological and Medical Sciences. The treatment consisted of radiation therapy and chemotherapy, and this was followed by curative resection 6 weeks later. All the patients underwent 18F-FDG PET/CT both before CRT and 6 weeks after completing CRT. The measurements of the FDG uptake (SUV(max)), the absolute difference (DeltaSUV(max)) and the percent SUV(max) difference (response index, RI(SUV)) between the pre- and post-CRT 18F-FDG PET/CT scans were assessed. The measurements of the metabolic volume, the absolute difference (Delta metabolic volume) and the percent metabolic volume difference (response index, RI(metabolic volume)) were also assessed. RESULTS: Of the 20 patients who underwent surgery, 11 patients (55%) were classified as responders according to Dworak's classification. The post-CRT SUV(max) was significantly lower than the pre-CRT SUV(max). However, there were no significant differences in the SUV(max) and the metabolic volume reduction between the responders and non-responders. We used a minimum SUV(max) reduction of 67% as the cut-off value for defining a response, with a sensitivity of 45.5%, a specificity of 88.9%, a positive predictive value of 77% and a negative predictive value of 53.8%. CONCLUSION: Although there were no statistically significant results in this study, other studies have revealed that 18F-FDG PET/CT has the potential to assess the tumor response to neoadjuvant CRT in patients with locally advanced rectal cancer.
Fluorodeoxyglucose F18 ; Humans ; Korea ; Positron-Emission Tomography ; Prospective Studies ; Rectal Neoplasms ; Sensitivity and Specificity

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Radiation Oncology Digital Image Chart and Digital Radiotherapy Record System at Samsung Medical Center.

Seung Jae HUH ; Yong Chan AHN ; Do Hoon LIM ; Chung Keun CHO ; Dae Yong KIM ; Inhwan Jason YEO ; Moon Kyung KIM ; Seung Hee CHANG ; Suk Won PARK

The Journal of the Korean Society for Therapeutic Radiology and Oncology.2000;18(1):67-72.

BACKGROUND: The authors have developed a Digital image chart(DIC) and digital Radiotherapy Record System (DRRS). We have evaluated the DIC and DRRS for reliability, usefulness, ease of use, and efficiency. METHOD AND MATERIALS: The basic design o f the DIC and DRRS was to build an digital image database of radiation therapy patient records for a more efficient and timely flow of critical image in formation throughout the department. This system is a subunit of comprehensive radiation oncology managemert system (C-ROMS) and composed of a picture archiving and communication system (PACS), radiotherapy information database, and a radiotherapy imaging database. The DIC and DRRS were programmed using Delphi under a Windows 95 environment and is capable of displaying the digital images of patients identification photos, simulation films, radiotherapy setup, diagnostic radiology image... Gross lesion photos, and radiotherapy planning isodose charts with beam arrangements. Twenty-three clients in the department are connected by Ethernet (10 Mbps) to the central image server (Sun Ultra-sparc 1 workstation). RESULTS: From the introduction of this system in February 1998 through December 1999, we have accumulated a total of 15,732 individual images for 2,556 patients. We can organize radiation therapy in; paperless environment in 120 patients with breast cancer. Using this system, we have succeeded in the prompt, accurate, and simultaneous access to patient care information from multiple locations throughout the department. This coordination has resulted in improved operational efficiency within the department. CONCLUSION: The authors believe that the DIC and DRRS has contributed to the improvement of radiation oncology department efficacy as well as to time and resource savings by providing necessary visual information throughout the department conveniently and simultaneously. As a result, we can also achieve the paperless and filmless practice of radiation oncology with this system.
Breast Neoplasms ; Dacarbazine ; Hospital Information Systems ; Humans ; Income ; Patient Care ; Radiation Oncology* ; Radiotherapy*

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