Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. Materials and Methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. Conclusion Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.

Purpose: The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. Materials and Methods: We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. Results: Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. Conclusion Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.

PURPOSE: To measure the hypermethylation of four genes in primary tumors and paired plasma samples to determine the feasibility of gene promoter hypermethylation markers for detecting breast cancer in the plasma. MATERIALS AND METHODS: DNA was extracted from the tumor tissues and peripheral blood plasma of 34 patients with invasive breast cancer, and the samples examined for aberrant hypermethylation in cyclin D2, retinoic acid receptor beta (RARbeta), twist and high in normal-1 (HIN-1) genes using methylation-specific PCR (MSP), and the results correlated with the clinicopathological parameters. RESULTS: Promoter hypermethylation was detected at high frequency in the primary tumors for cyclin D2 (53%), RARbeta (56%), twist (41%) and HIN-1 (77%). Thirty-three of the 34 (97%) primary tumors displayed promoter hypermethylation in at least one of the genes examined. The corresponding plasma samples showed hyperme thylation of the same genes, although at lower frequencies (6% for cyclin D2, 16% for RARbeta, 36% for twist, and 54% for HIN-1). Overall, 22 of the 33 (67%) primary tumors with hypermethylation of at least one of the four genes also had abnormally hypermethylated DNA in their matched plasma samples. No significant relationship was recognized between any of the clinical or pathological parameters (tumor size, axillary lymph node metastasis, stage, or Ki-67 labeling index) with the frequency of hypermethylated DNA in the primary tumor or plasma. CONCLUSION: The detection of aberrant promoter hypermethylation of cancer-related genes in the plasma may be a useful tool for the detection of breast cancer.
Breast Neoplasms* ; Breast* ; Cyclin D2 ; DNA ; Humans ; Lymph Nodes ; Methylation ; Neoplasm Metastasis ; Plasma* ; Polymerase Chain Reaction ; Receptors, Retinoic Acid

BACKGROUND: Electromagnetic fields (EMF) are ubiquitous in modern society including medical field. As the technology of medical instruments and telecommunications has developed rapidly, it has influenced on our lives in many ways. Modern medical practice requires high quality medical equipments, which have a great deal of electromagnetic interference and susceptibility. The purpose of this study were to evaluate electromagnetic condition under usual clinical condition and to suggest a practical guideline in general hospital. MATERIALS AND METHODS: The actual state of the electromagnetic interference in the medical field was studied under usual clinical conditions including operating rooms, intensive care units, magnetic resonance imaging unit, and hyperthermia unit. RESULTS: There was considerable noise as a result of electromagnetic fields from medical equipments including electrosurgical units and hyperthermia unit, and cellular phones, which could induce serious functional derangements of functioning medical devices. CONCLUSION: It will be necessary to evaluate the individual electromagnetic situations under various medical conditions and to define a limited zone for cellular phone as well as reposition medical equipments to secure a safer medical practice and to minimize electromagnetic interference.
Cellular Phone ; Electromagnetic Fields* ; Fever ; Hospitals, General* ; Intensive Care Units ; Magnetic Resonance Imaging ; Magnets* ; Noise ; Operating Rooms ; Telecommunications

BACKGROUND: Brain metastasis is a common complication in cancer patients. We evaluated the clinical characteristics, treatment outcome and prognostic factors for patients with metastatic brain tumor. METHODS: The records of 97 patients with metastatic brain tumor during the period from January 1991 to November 1997 were reviewed retrospectively. RESULTS: The most common primary tumor is lung cancer (61 cases, 63%) followed by metastatic cancer unknown primary site (15 cases, 16%), gastrointestinal cancer (13 cases, 13%), breast cancer (6 cases, 6%) and renal cancer (2 cases, 2%). There were 44 patients with a single brain metastasis and 53 patients with multiple brain metastases. The median survival was 3.0 months and one-year survival rate was 8% irrespective of treatment. Favorable prognostic factors which affect survival were ambulatory status (p<0.01) and functional neurologic class 1, 2 (p<0.01). Median survival was 3.7 months for patients with steroid therapy and 1.1 months with no therapy (p<0.01). Median survival was 4.8 months for patients with steroid therapy plus whole brain radiotherapy (WBRT) and 2.2 months with steroid therapy alone (p<0.01). Additional chemotherapy did not appear to affect the survival. The patients treated with surgery had median survival time of 8.8 months compared with 2.5 months for patients treated with steroid therapy plus WBRT (p<0.05). CONCLUSION: In present study, we confirmed that whole brain irradiation and corticosteroid administration are effective palliative treatment for patients with metastatic brain tumor. Initial performance status and neurological function were identified as important prognostic factors. Although confounded by the limitations of retrospective study, more aggressive treatments including surgery and chemotherapy could be regarded to have a significant role to achieve better treatment outcome in some selected cases.
Brain Neoplasms ; Brain* ; Breast Neoplasms ; Drug Therapy ; Gastrointestinal Neoplasms ; Humans ; Kidney Neoplasms ; Lung Neoplasms ; Neoplasm Metastasis* ; Palliative Care ; Prognosis* ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome

PURPOSE: This study was conducted to assess the effects of x-irradiation on the expression of the novel glutathione S-transferase K1 gene. MATERIALS AND METHODS: Human glutathione S-transferase K1 (hGSTK1) DNA was purified and ligated to a pcDNA3.1/Myc-His(+) vector for the overexpression of hGSTK1 gene. MCF-7 cells were transfected with or without the recombinant hGSTK1 gene, and irradiated with 6 MV x-ray. After incubation of 14 days, cell survival was measured and compared. The expression of hGSTK1 and the effect of x- irradiation on hGSTK1 expression were also estimated in MCF-7 cells transfected with or without the hGSTK1 gene by RT-PCR. RESULTS: Following 2 to 12 Gy of x-irradiation, the cell survivals were higher in the MCF-7 cells transfected with the hGSTK1 gene than in those without transfection. Despite the higher cell survival in the hGSTK1-transfected cells, RT-PCR for hGSTK1 mRNA revealed no significant differences according to radiation dose, fractionation, and time after irradiation. CONCLUSION: The MCF-7 cells transfected with the hGSTK1 gene showed higher cell survival than those without transfection of the gene. The hGSTK1 gene might be associated with the radiosensitivity of MCF-7 cell line and further analysis should be needed.
Cell Survival ; DNA ; Glutathione Transferase* ; Glutathione* ; Humans ; MCF-7 Cells* ; Radiation Tolerance ; RNA, Messenger ; Transfection

BACKGROUND: The purpose of this study was to evaluated the usefulness of diffusion-weighted magnatic resonance imaging for monitoring the response to radiation therapy in metastatic bone marrow of the spines. MATERIALS AND METHOD: Twenty-one patients with metastatic bone marrow of the spine were examined with MRI. Diffusion-weighted and spin-echo MRI were performed in 10 patients before and after radiation therapy with or without systematic chemotherapy, and performed in 11 patiemts after radiation therapy alone. Follow up spin-echo and diffusion-weighted MRI were obtained at 1 to 6 months after radiation therapy according to patients' condition. The diffusion-weighted imaging sequence was based on reversed fast imaging with steady-state precession(PSIF). Signal intensity changes of the metastatic bone marrows before and after radiation therapy on conventional spin-echo sequence MRI and diffusion-weighted MRI were evaluated. Bone marrow contrast ratios and signal-to-noise ratio before and after radiation therapy of diffusion-weighted MRI were analyzed. RESULTS: All metastatic bone marrow of the spinal bodies were hyperintense to normal bone marrow of the spinal bodies on pretreatment diffusion-weighted MRI and positive bone marrow contrast ratio(p<0.001). and hypointense to normal spinal bodies on posttreatment diffusion-weighted MRI and negative bone marrow contrast ratio(p<0.001). The signal to noise ratio after treatment decreased comparing with those of pretreatment. Decreased signal intensity of the metastatic bone marrows on diffusion-weighted MRI began to be observed at average more than one month after the initiation of the radiation therapy. CONCLUSION: tThese results suggest that diffusion-weighted MRI would be an excellent method for monitoring the response to therapy of metastatic bone marrow of the spinal bodies. However, must be investigated in a larger series of patients with longer follow up period.
Bone Marrow ; Drug Therapy ; Follow-Up Studies ; Humans ; Magnetic Resonance Imaging* ; Signal-To-Noise Ratio ; Spine*

BACKGROUND: Non-Hodgkin's lymphoma presenting in the eye is a rare disorder. The aim of this study was to evaluate the clinical features, treatment outcome and complications of patients with non-Hodgkin's lymphoma of the eye. METHODS: We designed retrospective, observational case study. The participants included 22 consecutive patients with non-Hodgkin's lymphoma of the orbit and ocular adnexa treated at the Yeungnam University Hospital between 1992 and 2001. RESULTS: There were 16 males (73%) and 6 females (27%). The median age at ocular presentation was 47. The most common presenting complaint was slowly growing mass at the eye. Histopathologic studies revealed extranodal marginal zone B-cell lymphoma, MALT type in 19 cases (86%), B-cell small lymphocytic lymphoma in one case, diffuse large B-cell lymphoma in one case, and lymphoplasmacytoid lymphoma/immunocytoma in one case. The stages of lymphomas were IA(E) in 17 cases (82%), IIA(E) in 2 cases (9%), IIIA(E) in 2 cases (9%). Radiotherapy alone was employed in 17 cases, chemoradiotherapy was done in 3 cases, chemotherapy alone was administered in one case. Nineteen out of 21 cases (90%) achieved a complete remission, and 5 year survival rate was approximately 90%. Subgroup analysis of the patients with lymphomas in stage IA(E) revealed that complete response rate was 100% and 5 year survival rate was 100% CONCLUSION: Radiotherapy alone can produce durable remission in the majority of the patients with localized extranodal marginal zone B-cell lymphoma, MALT type. However, combination chemotherapy or chemoradiotherapy should be considered in the patients with aggressive lymphomas or indolent lymphomas with systemic manifestation.
B-Lymphocytes ; Chemoradiotherapy ; Drug Therapy ; Drug Therapy, Combination ; Female ; Humans ; Leukemia, Lymphocytic, Chronic, B-Cell ; Lymphoma ; Lymphoma, B-Cell ; Lymphoma, B-Cell, Marginal Zone ; Lymphoma, Non-Hodgkin* ; Male ; Orbit* ; Radiotherapy ; Retrospective Studies ; Survival Rate ; Treatment Outcome

Centrosomes maintain genomic stability by establishing the bipolar spindles during cell division and, execute accurate segregation of chromosomes during mitosis. In this study, we have demonstrated that there are three forms of STK-15 gene in breast cancer cell lines. Alternative splice positions are located in 5'-untranslated region of STK15 gene. The results of in vitro translation experiments revealed that the alternative splicing in the 5'-untranslated region of STK15 had no effect on protein translation. The differential expression patterns of these alternatively spliced STK15 in breast cell lines and primary tumors therefore suggest that STK15 gene transcription may be differentially regulated or stabilized in these cells.
*5' Untranslated Regions ; *Alternative Splicing ; Base Sequence ; Breast Neoplasms/enzymology/*genetics ; Centrosome/*enzymology ; Female ; Human ; Molecular Sequence Data ; Protein-Serine-Threonine Kinases/*genetics ; Tumor Cells, Cultured

PURPOSE: This study was aimed to develop a new vaginal applicator(Shin's Applicator) for 2-channel high-dose rate vaginal brachytherapy to evaluate uniformity of surface dose, and to present 3-dimensional dose distribution of the applicator. METHODS: Shin's Applicator was inexpensively constructed using human soft tissue equivalent acrylic bar. We evaluated dose uniformity along the applicator surface using film densitometer and performed vaginal intracavitary brachytherapy after insertion of the applicator using HDR brachytherapy planning software and brachytherapy unit(Ralstron-20B). RESULTS: Shin's Applicator allows improved dose distribution than the existing 1-channel cylinder and achieves diminished urinary bladder and rectal dose by 20%. CONCLUSIONS: From the above results, it can be concluded that Shin's Applicator may be an improved form of a vaginal applicator. Furthermore, it can be suggested that this applicator has an advantage, for it prevents vaginal stenosis after radiation therapy and can be used as a disposable vaginal dilator. Further follow up examination with radiological study may be helpful to evaluate the therapeutic efficacy of this applicator.
Brachytherapy* ; Constriction, Pathologic ; Humans ; Urinary Bladder