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Skin Dose Distrubution with Spoiler of 6 MV X-ray for head and Neck Tumor.

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):339-345.

PURPOSE: This study was performed for adequate irradating tumor area when 6 MV linear accerelator photon was used to treat the head and neck tumor. The skin surface dose and maximum build-up ragion was measured by using a spoiler which was located between skin surface and collimator. METHODS: A spoiler was made of tissue equivalent materials and the skin surface dose and maximum build-up region was measured varing with field size, thickness of spoiler and interval between skin and collimator. The results of skin surface dose and maximum build-up dose was represented as a build-up ratio and it was compared with dose distribution by using a bolus. RESULTS: The skin surface dose was increased with appling spoiler and decreased by distance of the skin-spoiler separation. The maxium build-up region was 1.5 cm below the skin surface and it was markedly decreased near the skin surface. By using a 1.0-cm thickness spoiler, Dmax moved to 5, 10.2, 12.3, 13.9 and 14.8 mm from the skin surface by separation of the spoiler from the skin 0, 5, 10, 15, 20 cm, respectively. CONCLUSION: The skin surface dose was increased and maximum build-up region was moved to the surface by using a spoiler. Therefore spoiler was useful in treating by high energy photon in the head and neck tumor.
Head* ; Neck* ; Skin*

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The Sosimetric Effects on Scallop Penumbra from Multi-leaf Collimator by Daily Patient Setup Error in Radiation Therapy with Photon.

Byong Yong YI

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):333-338.

PURPOSE: To evaluate the clinical implications of scallp penumbra width that comes from multileaf collimator(MLC) effect by the daily routine patient setup error. MATERIALS AND METHODS: The angles of 0degree, 15degree, 30degree, 45degree, 60degree and 75degree inclined-radiation blocked fields were generated using the both conventional cerrobend block and the MLC. Film dosimetry in the phantom were performed to measure penumbral widths of differences between the dose distributions from the cerrobend block and those of respect the MLC. The patient setup error effect on scallop penumbra was simulated with respect to the table of setup error distribution. Same Procedures are repeated for the cerrobend block generated field. RESULTS: There are penumbral widths of to 3mm difference between the dose distributions from two kinds of field shaping tools, the conventional block and the MLC with 4mm setup error model and resolution of 1cm leaf at the isocenter. CONCLUSION: We need not additive margin for MLC, if planning target bolume is selected according to the recommendation of ICRU 50. For particular cases, we can include the target volume with less than 3mm additive margin.
Film Dosimetry ; Humans ; Pectinidae*

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Dosimetric Characteristics of Dynamic Wedge Techinique.

Ki Chang KEUM ; Seong Sil CHU ; Gwi Eon KIM ; Young Taek OH

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):323-332.

PURPOSE: The wedge filter is the most commonly used beam modifying device during radiation therapy. Recently dynamic wedge technique is available through the computer controlled asymmetric collimator, independent jaw. But dosimetric characteristics of dynamic wedge technique is not well know. Therefore we evluate dosimetric characteristics of dynamic wedge compared to conventional fixed wedge. MATERIALS AND METHODS: We evaluated dosimetric characteristics of dynamic wedge and fixed wedge by ion chamber, film dosimetry and TLD in phantoms such as water, polystyrene and average breast phantom. Six MV x-ray was used in 15X15 cm field with 15,30 and 45 degree wedge of dynamic/fixed wedge system. Dosimetric characteristics are interpreted by wellhofer Dosimetrie system WP700/WP700i and contralateral breast dose(CBD) with tangential technique was confirmed by TLD. RESULTS: 1) Percent depth dose through the dynamic wedge technique in tissue equivalent phantom was similar to open field irradiation and there was no beam hardening effect compared to fixed wedge technique. 2) Isodose line composing wedge angle of dynamic wedge is more straight than hard wedge. And dynamic wedge technique was able to make any wedge angle on any depth and field size. 3) The contralateral breast dose in primary breast irradiation was reduced by dynamic wedge technique compared to fixed wedge. When the dynamic wedge technique was applied, the scatter dose was similar to that of open field irradiation. CONCLUSION: The dynamic wedge technique was superior to fixed wedge technique in dosimetric characteristics and may be more useful in the future.
Breast ; Film Dosimetry ; Jaw ; Polystyrenes ; Water

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Radiotherapy Results of Carcinoma of Cervix with positive Resection Margin.

Won Dong KIM ; Charn Il PARK ; Dae Yong KIM ; Il Han KIM ; Sung Whan HA ; Seung Jae HUH ; Yong Chan AHN ; Hong Gyun WU

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):317-322.

PURPOSE: Patients with cervical cancer who have positive resection margins after radical hysterectomy are at increased risk for local recurrence. The results of postoperative pelvic radiotherapy for cervix cancer with positive resection margins were analyzed to evaluated the role of radiotherapy. MATERIALS AND METHODS: Between 1979 and 1992, 60 patients of cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy because of positive vaginal(48 patients) or parametrial resection margins(12 patients). Patients were treated with external beam radiation therapy(EBRT) alone (12 patients) or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median follow-up period was 5 months. RESULTS: The 5-year actuarial disease free and overall survival rates for all patients were 75.2%, 84.1%, respectively. The overall recurrence rate was 23%(14/60). In 48 patients with positive vaginal resection margins, the pelvic recurrence was 8%(4/48). Distant metastasis was 15%(7/48). Of the 43 patients with positive vaginal resection margins treated with EBRT and VOI, recurrence rate was 21%(9/43), while recurrence rate was 40%(2/5) in the EBRT only treated group. In 12 patients with positive parametrial margins, three patients (25%) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of 32%(19/60) and grade III complications occurred in three patients (5%). CONCLUSION: Postoperative radiotherapy can produce excellent pelvic control rates in patients with positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and BOI is recommended.
Cervix Uteri* ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Nodes ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Survival Rate ; Uterine Cervical Neoplasms

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Analysis of prognostic factors in patients with Carcinoma of Uterine Cervix.

Mi Sook KIM ; Chul Koo CHO ; Seong Yul YOO ; Hyong Geun YUN ; Jae Won SHIM ; Jae Yong KIM

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):307-316.

PURPOSE: The authors conducted a retrospective analysis of patients with the carcinoma of uterine cervix treated with curative radiation therapy to evaluated the prognostic factors that would affect the results of the therapy and to get the critical ideas in determining more aggressive treatment schedule. METHODS AND MATERIALS: From January 1987 to December 1988, Four hundreds and sixty patients with uterine cervical carcinomas treated with radiotherapy at KCCH were registered to this retrospective study. One hundred and three patients were treated with external radiation therapy alone, and 357 patients were treated with external radiation followed by low dose rate intracavitary radiation therapy. He follow-up rate was 88% and median follow-up duration was 48 months. RESULTS: The overall 5 year survival rate of the patients was 67.7%, and when classified by FIGO stages, 5 year survival rates were 81.2%, 76.3%, 73.1%, 50%, 52.3%, 11.5% for stages Ib, IIa, IIb, IIIa, IIIb, IVa respectively. Tumor size(p=0.0002), endocervical growth pattern(p=0.003), lymph node invasion(p=0.0001), mean hemoglobin level(p=0.0001), and pathologic cell type(p=0.0001) were significant prognostic factors and decrease in survival for young age patient group was marginally important(p=0.03). CONCLUSION: Significant prognostic factors I the radiation therapy of the uterine cervical carcinoma were tumor size, growth pattern of tumor, lymph node invasion, pathologic cell type, hemoglobin level of patients during treatment and lower survival rate in young age group was obvious, too. Patients with large size tumor(> or =4cm), especially combined with endocervical growth patterns or advanced stages(III or more) need more aggressive treatment to improve the outcome of treatment. And positive feature of lymph node invasion affected the result of therapy, so improvement in the diagnostic and therapeutic trial is essential.
Appointments and Schedules ; Cervix Uteri* ; Female ; Follow-Up Studies ; Humans ; Lymph Nodes ; Radiotherapy ; Retrospective Studies ; Survival Rate

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Short-term Results of Endobronchial Brachytherapy for Malignant Airway Obstructions.

Man Pyo CHUNG ; O Jung KWON ; Dong Rak CHOI ; Seung Jae HUH ; Do Hoon LIM ; Moon Kyung KIM ; Dne Yong KIM ; Ho Joong KIM ; Yong Chang AHN

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):299-306.

PURPOSE: Respiratory symptoms related with malignant airway disease have been the main causes of lowered quality of life and also sometimes may be life-threatening if not properly amanged. He authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit. MATERIALS AND METHODS: Twenty-five patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center. Twenty-one(84%) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patients were planned and total of 70 procedures were completed. RESULTS: Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were 88%(22/25), 96%(22/23)m 100%(15/15), and 100%(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG Performance scores were improved in 56% of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range : 1~17 months), while that of ten survivors was 9 months (range:5~19 months). There were five patients with controlled intrathoracic disease, who have survived over one year. All deaths were associated with uncontrolled local and/or distant disease. Four patients died of massive fatal hemoptysis, three of who received emergency endobrronchial laser evaporation therapy before the start of endobronchial brachytherapy. CONCLUSION: Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.
Airway Obstruction* ; Brachytherapy* ; Carcinoma, Non-Small-Cell Lung ; Cough ; Dyspnea ; Emergencies ; Esophageal Neoplasms ; Hemoptysis ; Humans ; Palliative Care ; Pneumonia ; Quality of Life ; Radiation Oncology ; Recurrence ; Survivors

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Radiotherapy Results of Midline Malignant Reticulosis (MMR).

Jae Cheol KIM ; Sang Mo YUN

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):291-298.

PURPOSE: This study was performed to evaluate survival, failure patterns, and prognositc factors of MMR patients after radiation therapy. We also discussed the need for chemotherapy. MATERIALS AND METHODS: A retrospective analysis was done for 23 patients with MMR who were treated with radiation therapy form June 1985 to November 1992. There were 19 male and 4 female patients. The patients' age ranged from 17 to 71 years(median 39 years). Systemic symptoms including fever, weight loss, or malaise were found in 30% of the patients. He nasal cavity was most frequently involved. No patients had nodal involvement at diagnosis. There were 2 patients with distant metastasis at presentation. Radiation therapy was delivered five times a week, 1.8 Gy daily, total 45~54 Gy(median 50.4 Gy) using 6 MV X-ray. No patients received chemotherapy as initial treatment. RESULTS: Overall 5-year and 10-yar survival rates were 52.4% and 44.1%, respectively. Seventy percent(12/17) of the patients achieved complete response to radiotherapy., and 29.4%(5/17) achieved partial response. The patients with complete response showed a better 5-year survival rate than those with partial response (66.9% vs. 20%, p-0.004). Symptom duration before diagnosis, the presence of systemic symptom, ad the number of primary sites had no influence on survival. The patterns of failure were as flows: local failure(1), failure in adjacent site(1), local and distant failure(1), distant metastasis(2), and conversion to malignant lymphoma(1). W could not find factors associated with the patterns of failure. CONCLUSION: The most important factor associated with survival was the response to radiotherapy. Seventeen percent of the patients had distant metastasis, and the salvage after distant metastasis was not successful. However, about 50% of the patients could achieve long-term survival with local radiation therapy alone. Therefore, chemotherapy of MMR should be done after a prospective randomized study for the factors associated with distant metastasis.
Diagnosis ; Drug Therapy ; Female ; Fever ; Humans ; Male ; Nasal Cavity ; Neoplasm Metastasis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Weight Loss

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The Effect of Pentoxifylline on Radiation-Induced Cardiac Injury in ICR Mice.

Yun Kyung KANG ; Kwang Mo YANG ; Seung Hee KANG ; Hung Suk SUH

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):281-290.

PURPOSE: Chest irradiation leads to a significant cardiac injury in a number of patients. To prevent, or to reduce the risk of radiation-induced cardiac injury, pentosifylline(PTX), a haemorrheologic agent that improves the blood flow through small blood capillaries has been employed. MATERIALS AND METHODS: One hundred and eighty ICR mice were divided into three study groups : control, radiation alone, and radiation-pentoxifylline. Each group was subdivided into 12 subgroups: 1,3,6 and 10 days and 2, 3, 4, 6, 8, 12, 16 and 20 weeks y observation period after irradiation. The total 15 Gy of radiation was delivered in a single fraction ghrough anterior mediastinal port. Pentoxifylline was injected subcutaneously daily 50mg/k to the back of the mice from the first day of irradiation throughout the observation period. The mice of each group after a certain observation period were sacrificed and sectioned for histopathologic examination of the heart. RESULTS: he findings of acute radiation-induced carditis i.e., heterohpilic infiltration and vacuolization and ballooning of endotherlial cells were onserved upto weeks and reduced sharply afterwards. The late radiation effects including pericarditis with mononuclear cell infiltration, pericardial fibrosis, endothelial cell changes, myocardial degenerationa dn fibrosis present from 4 weeks onwards after irradiation but with various degree of severity. The overall process of pathologic changes of radiation-pentoxify-acute stage was relatively short and the severity of late cardiac toxicity was much lesser compared with those of radiation alone group. CONCLUSION: Pentoxifyllline can effectively reduce the late radiation-induced cardiac injury and resolve the acute effects relatively rapidly.
Animals ; Capillaries ; Endothelial Cells ; Fibrosis ; Heart ; Humans ; Mice ; Mice, Inbred ICR* ; Myocarditis ; Pentoxifylline* ; Pericarditis ; Radiation Effects ; Thorax

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Expression of Jun and p53 Genes from the Brain of Rats Irradiated with 60Co gamma-ray.

Yong Sung LEE ; Myung Za LEE ; Ha Chung CHUN ; Chong Kyu WOO ; Jai Kyung KOH ; Yong Seok KIM

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):265-280.

Damage produced by radiation elicits a complex response in mammalian cells. Including growth rate changes and the induction of a variety of genes associated with growth control and apoptosis.At doses of 10,000 cGy or greater, the exposed indivisual was killed in a matter of minutes to a couple of days. With symptoms consistent with pathology of the central nervous system(CNS) including degenerative changes. The nature of the damege in irradiated cells underlies the unique hazads of ionizing radiation. Radiation injury CNS is a rare event in clinical medicine, but it is catastrophic for the patient in whom it occurs. The incidience of cerebral necrosis has been reportes as high as 16% for doses greater than 6,000 cGy.In this study, the effect of radiation on brain tissues was studied in vivo. Jun and p53 genes in the rat brain were induced by whole body irradiation of rat with 60Co in doses between 1 Gy and analyzed for expression analyses were done using 1.8 Kb & 0.8 Kb-pGEM-2-JUN/Eco RI/Pst I fragments, 2.0 Kb-php53B/Bam HI fragment and 1.1 Kb-pBluescript SK-ACTIN/Eco RI fragment as the digoxigenin or [alpha32P]dCTPlabeled probes for Jun, p53 and beta-actin genes, respectively.Jun gene seemed to be expressed near the threshold levels in 1 hour after irradiation of 60Co in dose less than 1 Gy and was expressed in maximum at 1 hour after irradiation of 60Co in dose of 30 Gy. Jun was expressed increasingly with time until 5 or 6 hours after irradiation of 60Co in dose of 1 Gy and 10 Gy . After irradition of 60Co in dose between 20 Gy and 100Gy, the expression of Jun was however increased to peak in 2 hours and decreased thereafter.P53 gene in this study also seemed to be expressed near the threshold levels in 1 hours after irradiation of 60Co in less than 1 Gy and was expressed in maximum and 6 hours after irradiation of 60Co in dose of 1 Gy. P53 was expressed increasingly with time until 5 or 6 hours after irradition of 60Co in dose between 1 Gy and 40 Gy. After irradition of 60Co in dose of 50 Gy and 100Gy. The expression of p53 was however increased in peak in 2 hours and decreased thereafter. The expression of Jun and p53 genes was not correlative in the brain tissue from rats.It seemed to be very important for the establishment of the optimum conditions for the animal studies relevant to the response of genes inducible on DNA damage to ionizing radiation in mammalian cells. But there are many limitations to the animal studies such as the ununiform patterns of gene expression from the tissue because of its complex compositions. It is necessary to overcome the limitations for development of in situ Northern analysis.
Actins ; Animals ; Brain* ; Clinical Medicine ; Digoxigenin ; DNA Damage ; Gamma Rays ; Gene Expression ; Genes, p53* ; Humans ; Necrosis ; Pathology ; Radiation Injuries ; Radiation, Ionizing ; Rats* ; Whole-Body Irradiation

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Effects of the Paciltaxel and Radiation in the Mucosa of the Small Bowel of Rat.

Kyung Ja LEE

Journal of the Korean Society for Therapeutic Radiology.1996;14(4):255-264.

PURPOSE: Paclitaxel is a chemotherapeutic agent with potent microtublue stablelizing activity that arrests cell cycle in G2-M. Because G2-M is the most radiosensitive phase of the cell cycle. Paclitaxel has potential as a cell cycle- specic radio sensitizer. This study was design to investigate the ablity of paclitaxel to increase the radiotoxicity in normal small bowl mucosa of the rat. METHODS AND MATERIALS: A single intraperitoneal infusion of paciltaxel(10mg/kg). And a single irradiation(8 Gy, x-ray) to the whole abdomen and combination of radiation(8 Gy, x-ray) 24 hours after paclitaxel infusion in the rats were done. The changes of jejunal mucosa. And kinetics of mitotic arrest and apoptosis in the jejunal crypt were defined at 6 hours – 5 days after each treatment histologically. RESULTS: Paclitaxel blocked jejunal crypt cell in mitosis and induced minmal apoptosis. Mitotic arrest by paclitaxel was peaked at 6 hours after infusion and returned to normal by 24 hours. Radiation induced apoptosis and peaked at 6 hours and returned to normal by 24 hours. Combination of paclitaxel and radiation blocked crypt cell in mitosis at 3 days and induced apoptosis slightly at 6 hours and 24 hours and returned to normal by 3 days. The incidence of apopsis in combined group at 6hours was slightly higher than normal control buy significantly lower than radiation alone group. The major changes of jejunal mucosa were nuclear vesicle and atypia which were appered at 6 hours – 3 days and returned to normal by 5 days. The degree of mucosal changes are no different in 3groups except for absence of inflmatory reaction in radiation group. CONCLUSION: Mitotic arrest by paclitaxel was peaked at 6hours and returned to normal by 24 hours and paclitaxel induced minimal apoptosis. Radiation induced apoptosis. Peaked at 6 hours and returned to normal by 24 hours. Radiation induced apoptosis was less in combined group which suggested that paclitaxel have a radioprotective effech when radiation was given 24 hours after paclitaxel infusion.
Abdomen ; Animals ; Apoptosis ; Cell Cycle ; Incidence ; Infusions, Parenteral ; Kinetics ; Mitosis ; Mucous Membrane* ; Paclitaxel ; Rats*

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