1.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 4: Liver and locally recurrent rectal cancer
Hwa Kyung BYUN ; Gyu Sang YOO ; Soo-Yoon SUNG ; Jin-Ho SONG ; Byoung Hyuck KIM ; Yoo-Kang KWAK ; Yeon Joo KIM ; Yeon-Sil KIM ; Kyung Su KIM
Radiation Oncology Journal 2024;42(4):247-256
In this paper, we review the use of hypofractionated radiotherapy for gastrointestinal malignancies, focusing on primary and metastatic liver cancer, and recurrent rectal cancer. Technological advancements in radiotherapy have facilitated the direct delivery of high-dose radiation to tumors, while limiting normal tissue exposure, supporting the use of hypofractionation. Hypofractionated radiotherapy is particularly effective for primary and metastatic liver cancer where high-dose irradiation is crucial to achieve effective local control. For recurrent rectal cancer, the use of stereotactic body radiotherapy offers a promising approach for re-irradiation, balancing efficacy and safety in patients who have been administered previous pelvic radiotherapy and in whom salvage surgery is not applicable. Nevertheless, the potential for radiation-induced liver disease and gastrointestinal complications presents challenges when applying hypofractionation to gastrointestinal organs. Given the lack of universal consensus on hypofractionation regimens and the dose constraints for primary and metastatic liver cancer, as well as for recurrent rectal cancer, this review aims to facilitate clinical decision-making by pointing to potential regimens and dose constraints, underpinned by a comprehensive review of existing clinical studies and guidelines.
2.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 3. Genitourinary and gynecological cancers
Gyu Sang YOO ; Soo-Yoon SUNG ; Jin Ho SONG ; Byoung Hyuck KIM ; Yoo-Kang KWAK ; Kyung Su KIM ; Hwa Kyung BYUN ; Yeon-Sil KIM ; Yeon Joo KIM
Radiation Oncology Journal 2024;42(3):171-180
Hypofractionated radiotherapy (RT) has become a trend in the modern era, as advances in RT techniques, including intensity-modulated RT and image-guided RT, enable the precise and safe delivery of high-dose radiation. Hypofractionated RT offers convenience and can reduce the financial burden on patients by decreasing the number of fractions. Furthermore, hypofractionated RT is potentially more beneficial for tumors with a low α/β ratio compared with conventional fractionation RT. Therefore, hypofractionated RT has been investigated for various primary cancers and has gained status as a standard treatment recommended in the guidelines. In genitourinary (GU) cancer, especially prostate cancer, the efficacy, and safety of various hypofractionated dose schemes have been evaluated in numerous prospective clinical studies, establishing the standard hypofractionated RT regimen. Hypofractionated RT has also been explored for gynecological (GY) cancer, yielding relevant evidence in recent years. In this review, we aimed to summarize the representative evidence and current trends in clinical studies on hypofractionated RT for GU and GY cancers addressing several key questions. In addition, the objective is to offer suggestions for the available dose regimens for hypofractionated RT by reviewing protocols from previous clinical studies.
3.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 4: Liver and locally recurrent rectal cancer
Hwa Kyung BYUN ; Gyu Sang YOO ; Soo-Yoon SUNG ; Jin-Ho SONG ; Byoung Hyuck KIM ; Yoo-Kang KWAK ; Yeon Joo KIM ; Yeon-Sil KIM ; Kyung Su KIM
Radiation Oncology Journal 2024;42(4):247-256
In this paper, we review the use of hypofractionated radiotherapy for gastrointestinal malignancies, focusing on primary and metastatic liver cancer, and recurrent rectal cancer. Technological advancements in radiotherapy have facilitated the direct delivery of high-dose radiation to tumors, while limiting normal tissue exposure, supporting the use of hypofractionation. Hypofractionated radiotherapy is particularly effective for primary and metastatic liver cancer where high-dose irradiation is crucial to achieve effective local control. For recurrent rectal cancer, the use of stereotactic body radiotherapy offers a promising approach for re-irradiation, balancing efficacy and safety in patients who have been administered previous pelvic radiotherapy and in whom salvage surgery is not applicable. Nevertheless, the potential for radiation-induced liver disease and gastrointestinal complications presents challenges when applying hypofractionation to gastrointestinal organs. Given the lack of universal consensus on hypofractionation regimens and the dose constraints for primary and metastatic liver cancer, as well as for recurrent rectal cancer, this review aims to facilitate clinical decision-making by pointing to potential regimens and dose constraints, underpinned by a comprehensive review of existing clinical studies and guidelines.
4.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 3. Genitourinary and gynecological cancers
Gyu Sang YOO ; Soo-Yoon SUNG ; Jin Ho SONG ; Byoung Hyuck KIM ; Yoo-Kang KWAK ; Kyung Su KIM ; Hwa Kyung BYUN ; Yeon-Sil KIM ; Yeon Joo KIM
Radiation Oncology Journal 2024;42(3):171-180
Hypofractionated radiotherapy (RT) has become a trend in the modern era, as advances in RT techniques, including intensity-modulated RT and image-guided RT, enable the precise and safe delivery of high-dose radiation. Hypofractionated RT offers convenience and can reduce the financial burden on patients by decreasing the number of fractions. Furthermore, hypofractionated RT is potentially more beneficial for tumors with a low α/β ratio compared with conventional fractionation RT. Therefore, hypofractionated RT has been investigated for various primary cancers and has gained status as a standard treatment recommended in the guidelines. In genitourinary (GU) cancer, especially prostate cancer, the efficacy, and safety of various hypofractionated dose schemes have been evaluated in numerous prospective clinical studies, establishing the standard hypofractionated RT regimen. Hypofractionated RT has also been explored for gynecological (GY) cancer, yielding relevant evidence in recent years. In this review, we aimed to summarize the representative evidence and current trends in clinical studies on hypofractionated RT for GU and GY cancers addressing several key questions. In addition, the objective is to offer suggestions for the available dose regimens for hypofractionated RT by reviewing protocols from previous clinical studies.
5.Efficacy and Safety of Intramuscular Injections of Vitamin D3 B.O.N. on Serum Vitamin D Levels in Adults with Vitamin D Deficiency: A Prospective, Single-Center, Open-Label Study
David Samuel KWAK ; Hwa Yeon SUN ; Byung Wook YOO
Korean Journal of Health Promotion 2024;24(1):2-10
Background:
Vitamin D deficiency is a common challenge its consequences are studied to be related to diversity of other health concerns. The efficacy and safety in longevity of vitamin D3 B.O.N. 200,000 IU Intramuscular Injection were examined through investigator-initiated clinical trial.
Methods:
One-hundred and eight subjects between ages of 19 and 65 who showed vitamin D deficiency (serum 25(OH)D<20 ng/mL) were initially injected once and were checked every 3 months for the next 12 months for serum 25(OH)D and 1,25(OH)2D levels for the drug’s efficacy, and for other safety observations. The percentage of participants maintaining within the normal serum 25(OH)D range were analyzed. Participants who reduced in the serum level below 30 ng/mL during the regular visits were given additional injections.
Results:
All the subjects showed similar patterns of statistically significant improvements at all times. The percentage of participants remaining in the normal range was higher in the better compliance group. No serious adverse events or severe adverse reactions occurred.
Conclusions
Treatment of the vitamin D-deficient subjects with the injection of 200,000 IU vitamin D3 B.O.N. Intramuscular Injection induced a statistically significant increase in blood vitamin D concentration for 12 months demonstrating the clinical efficacy of the intervention. The higher percentage of the better compliance group being within normal ranges strengthens the evidence of the efficacy. No new adverse events or severe adverse events were associated with the injection, demonstrating its safety. Further studies to facilitate development of appropriate guidelines for interventions using vitamin D3 intramuscular injections will be desirable.
6.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 2. Lung (non-small cell lung cancer)
Yoo-Kang KWAK ; Kyung Su KIM ; Gyu Sang YOO ; Hwa Kyung BYUN ; Yeon Joo KIM ; Yeon-Sil KIM ; Soo-Yoon SUNG ; Jin Ho SONG ; Byoung Hyuck KIM
Radiation Oncology Journal 2024;42(2):104-115
Several recent studies have investigated the use of hypofractionated radiotherapy (HFRT) for various cancers. However, HFRT for non-small cell lung cancer (NSCLC) with or without concurrent chemotherapy is not yet widely used because of concerns about serious side effects and the lack of evidence for improved treatment results. Investigations of HFRT with concurrent chemotherapy in NSCLC have usually been performed in single-arm studies and with a small number of patients, so there are not yet sufficient data. Therefore, the Korean Society for Radiation Oncology Practice Guidelines Committee planned this review article to summarize the evidence on HFRT so far and provide it to radiation oncology clinicians. In summary, HFRT has demonstrated promising results, and the reviewed data support its feasibility and comparable efficacy for the treatment of locally advanced NSCLC. The incidence and severity of esophageal toxicity have been identified as major concerns, particularly when treating large fraction sizes. Strategies, such as esophagus-sparing techniques, image guidance, and dose constraints, may help mitigate this problem and improve treatment tolerability. Continued research and clinical trials are essential to refine treatment strategies, identify optimal patient selection criteria, and enhance therapeutic outcomes.
7.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 1. Brain and head and neck
Soo-Yoon SUNG ; Jin Ho SONG ; Byoung Hyuck KIM ; Yoo-Kang KWAK ; Kyung Su KIM ; Gyu Sang YOO ; Hwa Kyung BYUN ; Yeon Joo KIM ; Yeon-Sil KIM
Radiation Oncology Journal 2024;42(1):17-31
Advances in radiotherapy (RT) techniques, including intensity-modulated RT and image-guided RT, have allowed hypofractionation, increasing the fraction size over the conventional dose of 1.8–2.0 Gy. Hypofractionation offers advantages such as shorter treatment times, improved compliance, and under specific conditions, particularly in tumors with a low α/β ratio, higher efficacy. It was initially explored for use in RT for prostate cancer and adjuvant RT for breast cancer, and its application has been extended to various other malignancies. Hypofractionated RT (HFRT) may also be effective in patients who are unable to undergo conventional treatment owing to poor performance status, comorbidities, or old age. The treatment of brain tumors with HFRT is relatively common because brain stereotactic radiosurgery has been performed for over two decades. However, re-irradiation of recurrent lesions and treatment of elderly or frail patients are areas under investigation. HFRT for head and neck cancer has not been widely used because of concerns regarding late toxicity. Thus, we aimed to provide a comprehensive summary of the current evidence for HFRT for brain tumors and head and neck cancer and to offer practical recommendations to clinicians faced with the challenge of choosing new treatment options.
8.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 4: Liver and locally recurrent rectal cancer
Hwa Kyung BYUN ; Gyu Sang YOO ; Soo-Yoon SUNG ; Jin-Ho SONG ; Byoung Hyuck KIM ; Yoo-Kang KWAK ; Yeon Joo KIM ; Yeon-Sil KIM ; Kyung Su KIM
Radiation Oncology Journal 2024;42(4):247-256
In this paper, we review the use of hypofractionated radiotherapy for gastrointestinal malignancies, focusing on primary and metastatic liver cancer, and recurrent rectal cancer. Technological advancements in radiotherapy have facilitated the direct delivery of high-dose radiation to tumors, while limiting normal tissue exposure, supporting the use of hypofractionation. Hypofractionated radiotherapy is particularly effective for primary and metastatic liver cancer where high-dose irradiation is crucial to achieve effective local control. For recurrent rectal cancer, the use of stereotactic body radiotherapy offers a promising approach for re-irradiation, balancing efficacy and safety in patients who have been administered previous pelvic radiotherapy and in whom salvage surgery is not applicable. Nevertheless, the potential for radiation-induced liver disease and gastrointestinal complications presents challenges when applying hypofractionation to gastrointestinal organs. Given the lack of universal consensus on hypofractionation regimens and the dose constraints for primary and metastatic liver cancer, as well as for recurrent rectal cancer, this review aims to facilitate clinical decision-making by pointing to potential regimens and dose constraints, underpinned by a comprehensive review of existing clinical studies and guidelines.
9.Evidence-based clinical recommendations for hypofractionated radiotherapy: exploring efficacy and safety - Part 3. Genitourinary and gynecological cancers
Gyu Sang YOO ; Soo-Yoon SUNG ; Jin Ho SONG ; Byoung Hyuck KIM ; Yoo-Kang KWAK ; Kyung Su KIM ; Hwa Kyung BYUN ; Yeon-Sil KIM ; Yeon Joo KIM
Radiation Oncology Journal 2024;42(3):171-180
Hypofractionated radiotherapy (RT) has become a trend in the modern era, as advances in RT techniques, including intensity-modulated RT and image-guided RT, enable the precise and safe delivery of high-dose radiation. Hypofractionated RT offers convenience and can reduce the financial burden on patients by decreasing the number of fractions. Furthermore, hypofractionated RT is potentially more beneficial for tumors with a low α/β ratio compared with conventional fractionation RT. Therefore, hypofractionated RT has been investigated for various primary cancers and has gained status as a standard treatment recommended in the guidelines. In genitourinary (GU) cancer, especially prostate cancer, the efficacy, and safety of various hypofractionated dose schemes have been evaluated in numerous prospective clinical studies, establishing the standard hypofractionated RT regimen. Hypofractionated RT has also been explored for gynecological (GY) cancer, yielding relevant evidence in recent years. In this review, we aimed to summarize the representative evidence and current trends in clinical studies on hypofractionated RT for GU and GY cancers addressing several key questions. In addition, the objective is to offer suggestions for the available dose regimens for hypofractionated RT by reviewing protocols from previous clinical studies.
10.The Korean Academy of Asthma Allergy and Clinical Immunology guidelines for sublingual immunotherapy
Gwanghui RYU ; Hye Mi JEE ; Hwa Young LEE ; Sung-Yoon KANG ; Kyunghoon KIM ; Ju Hee KIM ; Kyung Hee PARK ; So-Young PARK ; Myong Soon SUNG ; Youngsoo LEE ; Eun-Ae YANG ; Jin-Young MIN ; Eun Kyo HA ; Sang Min LEE ; Yong Won LEE ; Eun Hee CHUNG ; Sun Hee CHOI ; Young-Il KOH ; Seon Tae KIM ; Dong-Ho NAHM ; Jung Won PARK ; Jung Yeon SHIM ; Young Min AN ; Man Yong HAN ; Jeong-Hee CHOI ; Yoo Seob SHIN ; Doo Hee HAN ;
Allergy, Asthma & Respiratory Disease 2024;12(3):125-133
Allergen immunotherapy (AIT) has been used for over a century and has been demonstrated to be effective in treating patients with various allergic diseases. AIT allergens can be administered through various routes, including subcutaneous, sublingual, intralymphatic, oral, or epicutaneous routes. Sublingual immunotherapy (SLIT) has recently gained clinical interest, and it is considered an alternative treatment for allergic rhinitis (AR) and asthma. This review provides an overview of the current evidence-based studies that address the use of SLIT for treating AR, including (1) mechanisms of action, (2) appropriate patient selection for SLIT, (3) the current available SLIT products in Korea, and (4) updated information on its efficacy and safety. Finally, this guideline aims to provide the clinician with practical considerations for SLIT.

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