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Concurrent chemoradiotherapy for elderly patients with stage III non-small cell lung cancer.

Ki Mun KANG ; Bae Kwon JEONG ; In Bong HA ; Gyu Young CHAI ; Gyeong Won LEE ; Hoon Gu KIM ; Jung Hoon KANG ; Won Seob LEE ; Myoung Hee KANG

Radiation Oncology Journal.2012;30(3):140-145.

PURPOSE: Combined chemoradiotherapy is standard management for locally advanced non-small cell lung cancer (LA-NSCLC), but standard treatment for elderly patients with LA-NSCLC has not been confirmed yet. We evaluated the feasibility and efficacy of concurrent chemoradiotherapy (CCRT) for elderly patients with LA-NSCLC. MATERIALS AND METHODS: Among patients older than 65 years with LA-NSCLC, 36 patients, who underwent CCRT were retrospectively analyzed. Chemotherapy was administered 3-5 times with 4 weeks interval during radiotherapy. Thoracic radiotherapy was delivered to the primary mass and regional lymph nodes. Total dose of 54-59.4 Gy (median, 59.4 Gy) in daily 1.8 Gy fractions and 5 fractions per week. RESULTS: Regarding the response to treatment, complete response, partial response, and no response were shown in 16.7%, 66.7%, and 13.9%, respectively. The 1- and 2-year overall survival (OS) rates were 58.2% and 31.2%, respectively, and the median survival was 15 months. The 1- and 2-year progression-free survivals (PFS) were 41.2% and 19.5%, respectively, and the median PFS was 10 months. Regarding to the toxicity developed after CCRT, pneumonitis and esophagitis with grade 3 or higher were observed in 13.9% (5 patients) and 11.1% (4 patients), respectively. Treatment-related death was not observed. CONCLUSION: The treatment-related toxicity as esophagitis and pneumonitis were noticeably lower when was compared with the previously reported results, and the survival rate was higher than radiotherapy alone. The results indicate that CCRT is an effective in terms of survival and treatment related toxicity for elderly patients over 65 years old with LA-NSCLC.
Aged ; Carcinoma, Non-Small-Cell Lung ; Chemoradiotherapy ; Disease-Free Survival ; Esophagitis ; Humans ; Lymph Nodes ; Pneumonia ; Retrospective Studies ; Survival Rate

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Nutritional status of patients treated with radiotherapy as determined by subjective global assessment.

Woong Sub KOOM ; Seung Do AHN ; Si Yeol SONG ; Chang Geol LEE ; Sung Ho MOON ; Eui Kyu CHIE ; Hong Seok JANG ; Young Taek OH ; Ho Sun LEE ; Ki Chang KEUM

Radiation Oncology Journal.2012;30(3):132-139.

PURPOSE: The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. MATERIALS AND METHODS: A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). RESULTS: The mean age of patients in this study was 59.4 +/- 11.9 years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss > or =5% (OR, 2.299). CONCLUSION: SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.
Animals ; Ankle ; Ascites ; Edema ; Female ; Head ; Humans ; Korea ; Lung ; Male ; Malnutrition ; Muscles ; Neck ; Nutrition Assessment ; Nutritional Status ; Prevalence ; Prospective Studies ; Radiation Oncology ; Subcutaneous Fat ; Weight Loss

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Treatment outcome in patients with triple negative early stage breast cancers compared with other molecular subtypes.

Ja Young KIM ; Sei Kyung CHANG ; Heily PARK ; Bo Mi LEE ; Hyun Soo SHIN

Radiation Oncology Journal.2012;30(3):124-131.

PURPOSE: To determine whether triple negative (TN) early stage breast cancers have poorer survival rates compared with other molecular types. MATERIALS AND METHODS: Between August 2000 and July 2006, patients diagnosed with stage I, II early stage breast cancers, in whom all three markers (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor [HER]-2) were available and treated with modified radical mastectomy or breast conserving surgery followed by radiotherapy, were retrospectively reviewed. RESULTS: Of 446 patients, 94 (21.1%) were classified as TN, 57 (12.8%) as HER-2 type, and 295 (66.1%) as luminal. TN was more frequently associated with young patients younger than 35 years old (p = 0.002), higher histologic grade (p < 0.0001), and nuclear (p < 0.0001). The median follow-up period was 78 months (range, 4 to 130 months). There were 9 local relapses (2.0%), 15 nodal (3.4%), 40 distant metastases (9.0%), and 33 deaths (7.4%) for all patients. The rates of 5-year OS, DFS, LFS, and DMFS for all patients were 95.5%, 89.9%, 95.4%, and 91.7%, respectively. There were no significant differences in OS, DFS, LFS, and DMFS between triple negative and other subtypes (p > 0.05). CONCLUSION: We found that patients with TN early stage breast cancers had no difference in survival rates compared with other molecular subtypes. Prospective study in homogeneous treatment group will need for a prognosis of TN early stage breast cancer.
Breast ; Breast Neoplasms ; Disease-Free Survival ; Follow-Up Studies ; Humans ; Mastectomy, Modified Radical ; Mastectomy, Segmental ; Neoplasm Metastasis ; Phenobarbital ; Prognosis ; Receptor, Epidermal Growth Factor ; Receptors, Progesterone ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome

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Negative impact of pretreatment anemia on local control after neoadjuvant chemoradiotherapy and surgery for rectal cancer.

Hyebin LEE ; Hee Chul PARK ; Won PARK ; Doo Ho CHOI ; Young Il KIM ; Young Suk PARK ; Joon Oh PARK ; Ho Kyung CHUN ; Woo Yong LEE ; Hee Cheol KIM ; Seong Hyeon YUN ; Yong Beom CHO ; Yoon Ah PARK

Radiation Oncology Journal.2012;30(3):117-123.

PURPOSE: Although anemia is considered to be a contributor to intra-tumoral hypoxia and tumor resistance to ionizing radiation in cancer patients, the impact of pretreatment anemia on local control after neoadjuvant concurrent chemoradiotherapy (NACRT) and surgery for rectal cancer remains unclear. MATERIALS AND METHODS: We reviewed the records of 247 patients with locally advanced rectal cancer who were treated with NACRT followed by curative-intent surgery. RESULTS: The patients with anemia before NACRT (36.0%, 89/247) achieved less pathologic complete response (pCR) than those without anemia (p = 0.012). The patients with pretreatment anemia had worse 3-year local control than those without pretreatment anemia (86.0% vs. 95.7%, p = 0.005). Multivariate analysis showed that pretreatment anemia (p = 0.035), pathologic tumor and nodal stage (p = 0.020 and 0.032, respectively) were independently significant factors for local control. CONCLUSION: Pretreatment anemia had negative impacts on pCR and local control among patients who underwent NACRT and surgery for rectal cancer. Strategies maintaining hemoglobin level within normal range could potentially be used to improve local control in rectal cancer patients.
Anemia ; Anoxia ; Chemoradiotherapy ; Hemoglobins ; Humans ; Multivariate Analysis ; Neoadjuvant Therapy ; Polymerase Chain Reaction ; Radiation, Ionizing ; Rectal Neoplasms ; Reference Values

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Postoperative radiotherapy for endometrial cancer.

Eun Cheol CHOI ; Jin Hee KIM ; Ok Bae KIM ; Sang Jun BYUN ; Seung Gyu PARK ; Sang Hoon KWON

Radiation Oncology Journal.2012;30(3):108-116.

PURPOSE: To investigate the prognostic factors and effectiveness of postoperative radiotherapy alone for endometrial carcinoma. MATERIALS AND METHODS: Sixty four patients with stage I-III endometrial cancer (EC) treated with postoperative radiotherapy alone between January 1989 and December 2008 at the Keimyung University Dongsan Medical Center were chosen for the present study. Typically, total hysterectomy, salpingo-oophorectomy and lymphadenectomy were performed on the patient's pelvis. Total dose from 50.4 Gy to 63 Gy was irradiated at pelvis or extended field. Thirteen patients were treated with Co-60 or Ir-192 intracavitary radiotherapy. Follow-up periods were from 7 to 270 months, with a median of 56 months. RESULTS: Five year overall survival (OS) rate was 58.7%, respectively. Five year disease-free survival (DFS) rate was 59.2%, respectively. In univariate analysis for OS and DFS, stage, menopausal age, type of operation, serosal invasion, and lymph node involvement were found to be statistically significant. Histologic type was marginally significant. In multivariate analysis for OS and DFS, stage, types of operation, histologic type were also found to be statistically significant. Treatment failure occurred in 14 patients. The main pattern of failure was found to be distant metastasis. Time to distant metastasis was from 3 to 86 months (median, 12 months). There were no grade 3 or 4 complications. CONCLUSION: Stage, types of operation, and histologic type could be the predictive prognostic factors in patients. We contemplated postoperative radiation as effective and safe treatment method for EC. Additional treatment would be needed to reduce distant metastasis.
Disease-Free Survival ; Endometrial Neoplasms ; Female ; Follow-Up Studies ; Humans ; Hysterectomy ; Lymph Node Excision ; Lymph Nodes ; Menopause ; Multivariate Analysis ; Neoplasm Metastasis ; Pelvis ; Postoperative Care ; Prognosis ; Radiotherapy, Adjuvant ; Treatment Failure

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Clinical predictive factors of pathologic tumor response after preoperative chemoradiotherapy in rectal cancer.

Chi Hwan CHOI ; Won Dong KIM ; Sang Jeon LEE ; Woo Yoon PARK

Radiation Oncology Journal.2012;30(3):99-107.

PURPOSE: The aim of this study was to identify clinical predictive factors for tumor response after preoperative chemoradiotherapy (CRT) in rectal cancer. MATERIALS AND METHODS: The study involved 51 patients who underwent preoperative CRT followed by surgery between January 2005 and February 2012. Radiotherapy was delivered to the whole pelvis at a dose of 45 Gy in 25 fractions, followed by a boost of 5.4 Gy in 3 fractions to the primary tumor with 5 fractions per week. Three different chemotherapy regimens were used (5-fluorouracil and leucovorin, capecitabine, or tegafur/uracil). Tumor responses to preoperative CRT were assessed in terms of tumor downstaging and pathologic complete response (ypCR). Statistical analyses were performed to identify clinical factors associated with pathologic tumor response. RESULTS: Tumor downstaging was observed in 28 patients (54.9%), whereas ypCR was observed in 6 patients (11.8%). Multivariate analysis found that predictors of downstaging was pretreatment relative lymphocyte count (p = 0.023) and that none of clinical factors was significantly associated with ypCR. CONCLUSION: Pretreatment relative lymphocyte count (%) has a significant impact on the pathologic tumor response (tumor downstaging) after preoperative CRT for locally advanced rectal cancer. Enhancement of lymphocyte-mediated immune reactions may improve the effect of preoperative CRT for rectal cancer.
Chemoradiotherapy ; Deoxycytidine ; Fluorouracil ; Humans ; Leucovorin ; Lymphocyte Count ; Multivariate Analysis ; Pelvis ; Rectal Neoplasms ; Capecitabine

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Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation.

Shin Hyung PARK ; Jae Chul KIM ; Jeong Eun LEE ; In Kyu PARK

Radiation Oncology Journal.2015;33(1):50-56. doi:10.3857/roj.2015.33.1.50

PURPOSE: To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. MATERIALS AND METHODS: Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. RESULTS: The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. CONCLUSION: The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.
Axilla ; Body Mass Index ; Breast Neoplasms ; Breast* ; Electrons ; Female ; Humans ; Lymph Nodes* ; Mastectomy, Segmental ; Radiotherapy ; Tomography, X-Ray Computed

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New methods for optical distance indicator and gantry angle quality control tests in medical linear accelerators: image processing by using a 3D phantom.

Mahdi Heravian SHANDIZ ; Ghorban Safaeian LAYEN ; Kazem ANVARI ; Mohammadmahdi KHALILZADEH

Radiation Oncology Journal.2015;33(1):42-49. doi:10.3857/roj.2015.33.1.42

PURPOSE: In order to keep the acceptable level of the radiation oncology linear accelerators, it is necessary to apply a reliable quality assurance (QA) program. MATERIALS AND METHODS: The QA protocols, published by authoritative organizations, such as the American Association of Physicists in Medicine (AAPM), determine the quality control (QC) tests which should be performed on the medical linear accelerators and the threshold levels for each test. The purpose of this study is to increase the accuracy and precision of the selected QC tests in order to increase the quality of treatment and also increase the speed of the tests to convince the crowded centers to start a reliable QA program. A new method has been developed for two of the QC tests; optical distance indicator (ODI) QC test as a daily test and gantry angle QC test as a monthly test. This method uses an image processing approach utilizing the snapshots taken by the CCD camera to measure the source to surface distance (SSD) and gantry angle. RESULTS: The new method of ODI QC test has an accuracy of 99.95% with a standard deviation of 0.061 cm and the new method for gantry angle QC has a precision of 0.43degrees. The automated proposed method which is used for both ODI and gantry angle QC tests, contains highly accurate and precise results which are objective and the human-caused errors have no effect on the results. CONCLUSION: The results show that they are in the acceptable range for both of the QC tests, according to AAPM task group 142.
Particle Accelerators* ; Quality Control* ; Radiation Oncology

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Post-treatment intracranial hemorrhage of brain metastases from hepatocellular carcinoma.

Kyung Su KIM ; Kyubo KIM ; Eui Kyu CHIE ; Yoon Jun KIM ; Jung Hwan YOON ; Hyo Suk LEE ; Sung W HA

Radiation Oncology Journal.2015;33(1):36-41. doi:10.3857/roj.2015.33.1.36

PURPOSE: To evaluate the incidence and risk factors of post-treatment intracranial hemorrhage of brain metastases from hepatocellular carcinoma (HCC). MATERIALS AND METHODS: Medical records of 81 patients who have been diagnosed of brain metastases from HCC and underwent surgery, radiosurgery and/or whole brain radiotherapy (WBRT) between January 2000 and December 2013 were retrospectively reviewed. RESULTS: Intracranial hemorrhage was present in 64 patients (79%) at the time of diagnosis. Median value of alpha-fetoprotein (AFP) level was 1,700 ng/mL. The Eastern Cooperative Oncology Group (ECOG) performance status for 20 patients was greater than 2. Fifty-seven patients underwent WBRT and the others were treated with surgery and/or radiosurgery without WBRT. During follow-up, 12 events of intracranial hemorrhage after treatment were identified. Three-month post-treatment hemorrhage rate was 16.1%. Multivariate analyses revealed that ECOG performance status, AFP, and WBRT were associated with post-treatment hemorrhage (p = 0.013, 0.013, and 0.003, respectively). Kaplan-Meier analysis showed that 3-month post-treatment hemorrhage rate of new lesion was higher in patients treated without WBRT, although statistical significance was not reached. (18.6% vs. 4.6%; p = 0.104). Ten of 12 patients with post-treatment hemorrhage died with neurologic cause. CONCLUSION: WBRT should be considered to prevent post-treatment hemorrhage in the treatment of brain metastases from HCC.
alpha-Fetoproteins ; Brain* ; Carcinoma, Hepatocellular* ; Diagnosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Incidence ; Intracranial Hemorrhages* ; Kaplan-Meier Estimate ; Medical Records ; Multivariate Analysis ; Neoplasm Metastasis* ; Radiosurgery ; Radiotherapy ; Retrospective Studies ; Risk Factors

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Outcome analysis in patients with uterine sarcoma.

Tosol YU ; Hak Jae KIM ; Hong Gyun WU ; Sung Whan HA ; Yong Sang SONG ; Noh Hyun PARK ; Jae Won KIM

Radiation Oncology Journal.2015;33(1):29-35. doi:10.3857/roj.2015.33.1.29

PURPOSE: To analyze the prognostic factors for survivals and to evaluate the impact of postoperative whole pelvic radiotherapy (WPRT) on pelvic failure in patients with uterine sarcoma treated with radical surgery. MATERIALS AND METHODS: We retrospectively analyzed 75 patients with uterine sarcoma who underwent radical surgery with (n = 22) or without (n = 53) radiotherapy between 1990 and 2010. There were 23 and 52 patients with carcinosarcoma and non-carcinosarcoma (leiomyosarcoma, 22; endometrial stromal sarcoma, 25; others, 5), respectively. The median follow-up period was 64 months (range, 17 to 269 months). RESULTS: The 5-year overall survival (OS) and pelvic failure-free survival (PFFS) of total patients was 64.2% and 83.4%, respectively. Multivariate analysis revealed that mitotic count (p = 0.006) was a significant predictor of OS. However, factors were not found to be associated with PFFS. On analyzing each of the histologic subtypes separately, postoperative WPRT significantly reduced pelvic failure in patients with carcinosarcoma (10.0% vs. 53.7%; p = 0.046), but not in patients with non-carcinosarcoma (12.5% vs. 9.9%; p = 0.866). Among the patients with carcinosarcoma, 4 patients (17%) had recurrence within the pelvis and 3 patients (13%) had recurrence in other sites as an initial failure, whereas among the patients with non-carcinosarcoma, 3 patients (6%) experienced pelvic failure and 13 patients (25%) experienced distant failure. CONCLUSION: The most significant predictor of OS was mitotic count. Based on the improved PFFS after postoperative WPRT only in patients with carcinosarcoma and the difference in patterns of failure between histologic subtypes, optimal adjuvant treatment options should be offered to patients based on the risk of recurrence patterns.
Carcinosarcoma ; Follow-Up Studies ; Humans ; Multivariate Analysis ; Pelvis ; Radiotherapy ; Radiotherapy, Adjuvant ; Recurrence ; Retrospective Studies ; Sarcoma* ; Sarcoma, Endometrial Stromal ; Uterus

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