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Variable uterine uptake of FDG in adenomyosis during concurrent chemoradiation therapy for cervical cancer.

Jeong Il YU ; Seung Jae HUH ; Young Il KIM ; Tae Joong KIM ; Byung Kwan PARK

Radiation Oncology Journal.2011;29(3):214-217. doi:10.3857/roj.2011.29.3.214

To avoid improper tumor volume contouring in radiation therapy (RT) and other invasive procedures, we report a case of uterine adenomyosis showing increased 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography (PET)/computed tomography (CT) mimicking malignant tumor in a 44-year-old woman during concurrent chemoradiation therapy (CCRT) for uterine cervical cancer. The adenomyosis was not associated with her menstrual cycle or with normal endometrium uptake, and it resolved one month after completion of RT. This case indicates that uterine adenomyosis in a premenopausal woman may show false positive uptake of 18FDG-PET/CT associated with CCRT.
Adenomyosis ; Adult ; Endometrium ; Female ; Humans ; Menstrual Cycle ; Positron-Emission Tomography ; Tumor Burden ; Uterine Cervical Neoplasms

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Analysis of changes in dose distribution due to respiration during IMRT.

Jung Suk SHIN ; Eunhyuk SHIN ; Youngyih HAN ; Sang Gyu JU ; Jin Sung KIM ; Sung Hwan AHN ; Tae Gyu KIM ; Bae Kwon JEONG ; Hee Chul PARK ; Young Chan AHN ; Doo Ho CHOI

Radiation Oncology Journal.2011;29(3):206-213. doi:10.3857/roj.2011.29.3.206

PURPOSE: Intensity modulated radiation therapy (IMRT) is a high precision therapy technique that can achieve a conformal dose distribution on a given target. However, organ motion induced by respiration can result in significant dosimetric error. Therefore, this study explores the dosimetric error that result from various patterns of respiration. MATERIALS AND METHODS: Experiments were designed to deliver a treatment plan made for a real patient to an in-house developed motion phantom. The motion pattern; the amplitude and period as well as inhale-exhale period, could be controlled by in-house developed software. Dose distribution was measured using EDR2 film and analysis was performed by RIT113 software. Three respiratory patterns were generated for the purpose of this study; first the 'even inhale-exhale pattern', second the slightly long exhale pattern (0.35 seconds longer than inhale period) named 'general signal pattern', and third a 'long exhale pattern' (0.7 seconds longer than inhale period). One dimensional dose profile comparisons and gamma index analysis on 2 dimensions were performed RESULTS: In one-dimensional dose profile comparisons, 5% in the target and 30% dose difference at the boundary were observed in the long exhale pattern. The center of high dose region in the profile was shifted 1 mm to inhale (caudal) direction for the 'even inhale-exhale pattern', 2 mm and 5 mm shifts to exhale (cranial) direction were observed for 'slightly long exhale pattern' and 'long exhale pattern', respectively. The areas of gamma index >1 were 11.88%, 15.11%, and 24.33% for 'even inhale-exhale pattern', 'general pattern', and 'long exhale pattern', respectively. The long exhale pattern showed largest errors. CONCLUSION: To reduce the dosimetric error due to respiratory motions, controlling patient's breathing to be closer to even inhaleexhale period is helpful with minimizing the motion amplitude.
Humans ; Respiration

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A comparison of preplan MRI and preplan CT-based prostate volume with intraoperative ultrasound-based prostate volume in real-time permanent brachytherapy.

Hyeli PARK ; Ja Young KIM ; Bo Mi LEE ; Sei Kyung CHANG ; Seung Young KO ; Sung Jun KIM ; Dong Soo PARK ; Hyun Soo SHIN

Radiation Oncology Journal.2011;29(3):199-205. doi:10.3857/roj.2011.29.3.199

PURPOSE: The present study compared the difference between intraoperative transrectal ultrasound (iTRUS)-based prostate volume and preplan computed tomography (CT), preplan magnetic resonance imaging (MRI)-based prostate volume to estimate the number of seeds needed for appropriate dose coverage in permanent brachytherapy for prostate cancer. MATERIALS AND METHODS: Between March 2007 and March 2011, among 112 patients who underwent permanent brachytherapy with 125I, 60 image scans of 56 patients who underwent preplan CT (pCT) or preplan MRI (pMRI) within 2 months before brachytherapy were retrospectively reviewed. Twenty-four cases among 30 cases with pCT and 26 cases among 30 cases with pMRI received neoadjuvant hormone therapy (NHT). In 34 cases, NHT started after acquisition of preplan image. The median duration of NHT after preplan image acquisition was 17 and 21 days for cases with pCT and pMRI, respectively. The prostate volume calculated by different modalities was compared. And retrospective planning with iTRUS image was performed to estimate the number of 125I seed required to obtain recommended dose distribution according to prostate volume. RESULTS: The mean difference in prostate volume was 9.05 mL between the pCT and iTRUS and 6.84 mL between the pMRI and iTRUS. The prostate volume was roughly overestimated by 1.36 times with pCT and by 1.33 times with pMRI. For 34 cases which received NHT after image acquisition, the prostate volume was roughly overestimated by 1.45 times with pCT and by 1.37 times with pMRI. A statistically significant difference was found between preplan image-based volume and iTRUS-based volume (p < 0.001). The median number of wasted seeds is approximately 13, when the pCT or pMRI volume was accepted without modification to assess the required number of seeds for brachytherapy. CONCLUSION: pCT-based volume and pMRI-based volume tended to overestimate prostate volume in comparison to iTRUS-based volume. To reduce wasted seeds and cost of the brachytherapy, we should take the volume discrepancy into account when we estimate the number of 125I seeds for permanent brachytherapy.
Brachytherapy ; Humans ; Magnetic Resonance Imaging ; Prostate ; Prostatic Neoplasms ; Retrospective Studies ; Seeds

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The role of squamous cell carcinoma antigen as a prognostic and predictive factor in carcinoma of uterine cervix.

Bae Kwon JEONG ; Doo Ho CHOI ; Seung Jae HUH ; Won PARK ; Duk Soo BAE ; Byoung Gie KIM

Radiation Oncology Journal.2011;29(3):191-198. doi:10.3857/roj.2011.29.3.191

PURPOSE: Although the role of squamous cell carcinoma antigen (SCC-Ag) as a predictive and prognostic factor for uterine cervical cancer has been identified in previous studies, 1) the effective patient group of screening for recurrence with SCC-Ag, 2) the relationship between SCC-Ag and recurrence site, and 3) the relationship between the change of SCC-Ag and treatment outcome or recurrence have not been described. MATERIALS AND METHODS: The study included 506 patients with histologically proven uterine cervical cancer between January 1994 and December 2010. We determining the serum SCC-Ag level before treatment and after treatment, and conducted a retrospective review of the patients' records. We evaluated the sensitivity and specificity of SCC-Ag for the detection of tumor recurrence by comparing biochemical recurrence with clinical recurrence. RESULTS: The pretreatment SCC-Ag level and the proportion of patients over 1.5 ng/mL were higher in poor prognostic patient group. In the univariate and multivariate analysis, pretreatment SCC-Ag showed a statistically significant correlation with tumor size, International Federation of Gynecology and Obstetrics (FIGO) stage, pathology. In patients with biochemical recurrence vs. those without, 5-year DFS and OS were 27.6 vs. 92.7% (p < or = 0.001) and 53.7 vs. 92.5% (p < or = 0.001), respectively. CONCLUSION: Our study reconfirmed the known function of pretreatment SCC-Ag, but could not confirm the function of biochemical response as a predictive factor for treatment and as a prognostic factor. There was no statistically significant relationship between SCC-Ag level and recurrence site. We confirmed the role of SCC-Ag as a follow-up tool for recurrence of disease and which patient groups SCC-Ag was more useful for.
Antigens, Neoplasm ; Carcinoma, Squamous Cell ; Cervix Uteri ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Mass Screening ; Multivariate Analysis ; Obstetrics ; Recurrence ; Retrospective Studies ; Sensitivity and Specificity ; Serpins ; Treatment Outcome ; Uterine Cervical Neoplasms

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Factors predicting radiation pneumonitis in locally advanced non-small cell lung cancer.

Myungsoo KIM ; Jihae LEE ; Boram HA ; Rena LEE ; Kyung Ja LEE ; Hyun Suk SUH

Radiation Oncology Journal.2011;29(3):181-190. doi:10.3857/roj.2011.29.3.181

PURPOSE: Thoracic radiotherapy is a major treatment modality of stage III non-small cell lung cancer. The normal lung tissue is sensitive to radiation and radiation pneumonitis is the most important dose-limiting complication of thoracic radiation therapy. This study was performed to identify the clinical and dosimetric parameters related to the risk of radiation pneumonitis after definitive radiotherapy in stage III non-small cell cancer patients. MATERIALS AND METHODS: The medical records were reviewed for 49 patients who completed definitive radiation therapy for locally advanced non-small cell lung cancer from August 2000 to February 2010. Radiation therapy was delivered with the daily dose of 1.8 Gy to 2.0 Gy and the total radiation dose ranged from 50.0 Gy to 70.2 Gy (median, 61.2 Gy). Elective nodal irradiation was delivered at a dose of 45.0 Gy to 50.0 Gy. Seven patients (14.3%) were treated with radiation therapy alone and forty two patients (85.7%) were treated with chemotherapy either sequentially or concurrently. RESULTS: Twenty-five cases (51.0%) out of 49 cases experienced radiation pneumonitis. According to the radiation pneumonitis grade, 10 (20.4%) were grade 1, 9 (18.4%) were grade 2, 4 (8.2%) were grade 3, and 2 (4.1%) were grade 4. In the univariate analyses, no clinical factors including age, sex, performance status, smoking history, underlying lung disease, tumor location, total radiation dose and chemotherapy were associated with grade > or =2 radiation pneumonitis. In the subgroup analysis of the chemotherapy group, concurrent rather than sequential chemotherapy was significantly related to grade > or =2 radiation pneumonitis comparing sequential chemotherapy. In the univariate analysis with dosimetric factors, mean lung dose (MLD), V20, V30, V40, MLDipsi, V20ipsi, V30ipsi, and V40ipsi were associated with grade > or =2 radiation pneumonitis. In addition, multivariate analysis showed that MLD and V30 were independent predicting factors for grade > or =2 radiation pneumonitis. CONCLUSION: Concurrent chemotherapy, MLD and V30 were statistically significant predictors of grade > or =2 radiation pneumonitis in patients with stage III non-small cell lung cancer undergoing definitive radiotherapy. The cutoff values for MLD and V30 were 16 Gy and 18%, respectively.
Carcinoma, Non-Small-Cell Lung ; Humans ; Lung ; Lung Diseases ; Medical Records ; Multivariate Analysis ; Radiation Pneumonitis ; Smoke ; Smoking

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Radiotherapy for gastric mucosa-associated lymphoid tissue lymphoma: dosimetric comparison and risk assessment of solid secondary cancer.

Sun Hyun BAE ; Dong Wook KIM ; Mi Sook KIM ; Myung Hee SHIN ; Hee Chul PARK ; Do Hoon LIM

Radiation Oncology Journal.2017;35(1):78-89. doi:10.3857/roj.2016.01942

PURPOSE: To determine the optimal radiotherapy technique for gastric mucosa-associated lymphoid tissue lymphoma (MALToma), we compared the dosimetric parameters and the risk of solid secondary cancer from scattered doses among anterior-posterior/posterior-anterior parallel-opposed fields (AP/PA), anterior, posterior, right, and left lateral fields (4_field), 3-dimensional conformal radiotherapy (3D-CRT) using noncoplanar beams, and intensity-modulated radiotherapy composed of 7 coplanar beams (IMRT_co) and 7 coplanar and noncoplanar beams (IMRT_non). MATERIALS AND METHODS: We retrospectively generated 5 planning techniques for 5 patients with gastric MALToma. Homogeneity index (HI), conformity index (CI), and mean doses of the kidney and liver were calculated from the dose-volume histograms. Applied the Biological Effects of Ionizing Radiation VII report to scattered doses, the lifetime attributable risk (LAR) was calculated to estimate the risk of solid secondary cancer. RESULTS: The best value of CI was obtained with IMRT, although the HI varied among patients. The mean kidney dose was the highest with AP/PA, followed by 4_field, 3D-CRT, IMRT_co, and IMRT_non. On the other hand, the mean liver dose was the highest with 4_field and the lowest with AP/PA. Compared with 4_field, the LAR for 3D-CRT decreased except the lungs, and the LAR for IMRT_co and IMRT_non increased except the lungs. However, the absolute differences were much lower than <1%. CONCLUSION: Tailored RT techniques seem to be beneficial because it could achieve adjacent organ sparing with very small and clinically irrelevant increase of secondary solid cancer risk compared to the conventional techniques.
Hand ; Humans ; Kidney ; Liver ; Lung ; Lymphoma, B-Cell, Marginal Zone* ; Planning Techniques ; Radiation, Ionizing ; Radiotherapy* ; Radiotherapy, Conformal ; Radiotherapy, Intensity-Modulated ; Retrospective Studies ; Risk Assessment* ; Stomach

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Radiotherapy for locally recurrent rectal cancer treated with surgery alone as the initial treatment.

Hidekazu TANAKA ; Takahiro YAMAGUCHI ; Kae HACHIYA ; Sunaho OKADA ; Masashi KITAHARA ; Katsuya MATSUYAMA ; Masayuki MATSUO

Radiation Oncology Journal.2017;35(1):71-77. doi:10.3857/roj.2016.02005

PURPOSE: Although the technical developments of radiotherapy have been remarkable, there are currently few reports on the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as initial treatment in this three-dimensional conformal radiotherapy era. Thus, we retrospectively evaluated the treatment results of radiotherapy for local recurrence of rectal cancer treated with surgery alone as the initial treatment. MATERIALS AND METHODS: Thirty-two patients who underwent radiotherapy were enrolled in this study. The dose per fraction was 2.0–3.5 Gy. Because the treatment schedule was variable, the biological effective dose (BED) was calculated. RESULTS: Local control (LC) and overall survival (OS) rates from the completion of radiotherapy were calculated. The 1-, 2-, 3-, 4-, and 5-year LC rates were 51.5%, 24.5%, 19.6%, 19.6%, and 13.1%, respectively. LC rates were significantly higher for the high BED group (≥75 Gy10) than for the lower BED group (<75 Gy10). All patients who reported pain achieved pain relief. The duration of pain relief was significantly higher for the high BED group than for the lower BED group. The 1-, 2-, 3-, 4-, and 5-year OS rates were 82.6%, 56.5%, 45.2%, 38.7%, and 23.2%, respectively. There was a trend toward higher OS rates in with higher BED group compared to lower BED group. CONCLUSION: For patients with unresectable locally recurrent rectal cancer treated with surgery alone, radiotherapy is effective treatment. The prescribed BED should be more than 75 Gy10, if the dose to the organ at risk is within acceptable levels.
Appointments and Schedules ; Humans ; Radiotherapy* ; Radiotherapy, Conformal ; Rectal Neoplasms* ; Recurrence ; Retrospective Studies

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The role of surgical clips in the evaluation of interfractional uncertainty for treatment of hepatobiliary and pancreatic cancer with postoperative radiotherapy.

Jin Suk BAE ; Dong Hyun KIM ; Won Taek KIM ; Yong Ho KIM ; Dahl PARK ; Yong Kan KI

Radiation Oncology Journal.2017;35(1):65-70. doi:10.3857/roj.2016.02019

PURPOSE: To evaluate the utility of implanted surgical clips for detecting interfractional errors in the treatment of hepatobiliary and pancreatic cancer with postoperative radiotherapy (PORT). METHODS AND MATERIALS: Twenty patients had been treated with PORT for locally advanced hepatobiliary or pancreatic cancer, from November 2014 to April 2016. Patients underwent computed tomography simulation and were treated in expiratory breathing phase. During treatment, orthogonal kilovoltage (kV) imaging was taken twice a week, and isocenter shifts were made to match bony anatomy. The difference in position of clips between kV images and digitally reconstructed radiographs was determined. Clips were consist of 3 proximal clips (clip_p, ≤2 cm) and 3 distal clips (clip_d, >2 cm), which were classified according to distance from treatment center. The interfractional displacements of clips were measured in the superior-inferior (SI), anterior-posterior (AP), and right-left (RL) directions. RESULTS: The translocation of clip was well correlated with diaphragm movement in 90.4% (190/210) of all images. The clip position errors greater than 5 mm were observed in 26.0% in SI, 1.8% in AP, and 5.4% in RL directions, respectively. Moreover, the clip position errors greater than 10 mm were observed in 1.9% in SI, 0.2% in AP, and 0.2% in RL directions, despite respiratory control. CONCLUSION: Quantitative analysis of surgical clip displacement reflect respiratory motion, setup errors and postoperative change of intraabdominal organ position. Furthermore, position of clips is distinguished easily in verification images. The identification of the surgical clip position may lead to a significant improvement in the accuracy of upper abdominal radiation therapy.
Diaphragm ; Humans ; Pancreatic Neoplasms* ; Radiotherapy* ; Respiration ; Surgical Instruments* ; Uncertainty*

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Long-term outcomes after salvage radiotherapy for postoperative locoregionally recurrent non-small-cell lung cancer.

Eunji KIM ; Changhoon SONG ; Mi Young KIM ; Jae Sung KIM

Radiation Oncology Journal.2017;35(1):55-64. doi:10.3857/roj.2016.01928

PURPOSE: The outcomes and toxicities of locoregionally recurrent non-small-cell lung cancer (NSCLC) patients treated with curative radiotherapy were evaluated in the modern era. MATERIALS AND METHODS: Fifty-seven patients receiving radical radiotherapy for locoregionally recurrent NSCLC without distant metastasis after surgery from 2004 to 2014 were reviewed. Forty-two patients were treated with concurrent chemoradiotherapy (CCRT), and 15 patients with radiotherapy alone. The median radiation dose was 66 Gy (range, 45 to 70 Gy). Lung function change after radiotherapy was evaluated by comparing pulmonary function tests before and at 1, 6, and 12 months after radiotherapy. RESULTS: Median follow-up was 53.6 months (range, 12.0 to 107.5 months) among the survivors. The median overall survival (OS) and progression-free survival (PFS) were 54.8 months (range, 3.0 to 116.9 months) and 12.2 months (range, 0.8 to 100.2 months), respectively. Multivariate analyses revealed that single locoregional recurrence focus and use of concurrent chemotherapy were significant prognostic factors for OS (p = 0.048 and p = 0.001, respectively) and PFS (p = 0.002 and p = 0.026, respectively). There was no significant change in predicted forced expiratory volume in one second after radiotherapy. Although diffusing lung capacity for carbon monoxide decreased significantly at 1 month after radiotherapy (p < 0.001), it recovered to pretreatment levels within 12 months. Acute grade 3 radiation pneumonitis and esophagitis were observed in 3 and 2 patients, respectively. There was no chronic complication observed in all patients. CONCLUSION: Salvage radiotherapy showed good survival outcomes without severe complications in postoperative locoregionally recurrent NSCLC patients. A single locoregional recurrent focus and the use of CCRT chemotherapy were associated with improved survival. CCRT should be considered as a salvage treatment in patients with good prognostic factors.
Carbon Monoxide ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy ; Esophagitis ; Follow-Up Studies ; Forced Expiratory Volume ; Humans ; Lung Neoplasms* ; Lung Volume Measurements ; Lung* ; Multivariate Analysis ; Neoplasm Metastasis ; Radiation Pneumonitis ; Radiotherapy* ; Recurrence ; Respiratory Function Tests ; Salvage Therapy ; Survivors

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Adverse effect of excess body weight on survival in cervical cancer patients after surgery and radiotherapy.

Yunseon CHOI ; Ki Jung AHN ; Sung Kwang PARK ; Heunglae CHO ; Ji Young LEE

Radiation Oncology Journal.2017;35(1):48-54. doi:10.3857/roj.2016.01977

PURPOSE: This study aimed to assess the effects of body mass index (BMI) on survival in cervical cancer patients who had undergone surgery and radiotherapy (RT). MATERIALS AND METHODS: We retrospectively reviewed the medical records of 70 cervical cancer patients who underwent surgery and RT from 2007 to 2012. Among them, 40 patients (57.1%) had pelvic lymph node metastases at the time of diagnosis. Sixty-seven patients (95.7%) had received chemotherapy. All patients had undergone surgery and postoperative RT. Median BMI of patients was 22.8 kg/m² (range, 17.7 to 35.9 kg/m²). RESULTS: The median duration of follow-up was 52.3 months (range, 16 to 107 months). Twenty-four patients (34.3%) showed recurrence. Local failure, regional lymph nodal failure, and distant failure occurred in 4 (5.7%), 6 (8.6%), and 17 (24.3%) patients, respectively. The 5-year actuarial pelvic control rate was 83.4%. The 5-year cancer-specific survival (CSS) and disease-free survival (DFS) rates were 85.1% and 65.0%, respectively. The presence of pelvic lymph node metastases (n = 30) and being overweight or obese (n = 34, BMI ≥ 23 kg/m²) were poor prognostic factors for CSS (p = 0.003 and p = 0.045, respectively). Of these, pelvic lymph node metastasis was an independent prognostic factor (p = 0.030) for CSS. CONCLUSION: Overweight or obese cervical cancer patients showed poorer survival outcomes than normal weight or underweight patients. Weight control seems to be important in cervical cancer patients to improve clinical outcomes.
Body Mass Index ; Body Weight* ; Diagnosis ; Disease-Free Survival ; Drug Therapy ; Follow-Up Studies ; Humans ; Lymph Nodes ; Medical Records ; Neoplasm Metastasis ; Obesity ; Overweight ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Thinness ; Uterine Cervical Neoplasms*

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