Laparoscopic Excision of a Congenital Seminal Vesicle Cyst and Coexisting Ipsilateral Renal Agenesis / 대한남성과학회지

Seminal vesicle cyst (SVC) with ipsilateral renal agenesis is a rare congenital anomaly. When the patient is symptomatic, surgical treatment may be necessary. The open surgical approach, traditionally considered the definite form of treatment, has been associated with a high rate of morbidity. The laparoscopic approach for the management of SVCs has recently been described. A 18-year-old man presented with a 2-year history of dysuria and perineal pain. The diagnostic evaluation revealed a 45x35x48 mm sized left seminal vesicle cyst. In addition, he had a solitary, right, functioning kidney, with left renal agenesis. Transperitoneal laparoscopic excision of the cyst was performed successfully. The patient was discharged from the hospital on the fourth postoperative day and did not present with any complaints or complications.

The Clinical Value of Performing an MRI before Prostate Biopsy

PURPOSE: Prostate cancer foci have a characteristic feature in magnetic resonance imaging (MRI). We aimed to assess the clinical value of MRI before prostate biopsy in prostate cancer detection. MATERIALS AND METHODS: From March 2009 to June 2010, 154 patients were enrolled in this study. A total of 51 patients with a clinical suspicion of prostate cancer underwent prostate MRI by a 3T scanner before transrectal ultrasound (TRUS)-guided biopsies. A total of 103 patients with a clinical suspicion of prostate cancer underwent prostate MRI after biopsies. The sensitivity, specificity, and positive predictive value (PPV) were evaluated. In addition, tumor location of pathologic findings and ADC mapping on MRI were matched and compared. RESULTS: The sensitivity of MRI before and after biopsy was 84.8% and 92.4%, respectively. The PPV of MRI before and after biopsy was 75.7% and 92.4%, respectively. The MRI location match percentage before and after biopsy was 89.3% and 94.1%, respectively. CONCLUSIONS: Compared with other previous reports, our results show that the prostate cancer detection sensitivity of MRI is on the rise. Furthermore, MRI before prostate biopsy can provide more information by which to identify prostate cancer during prostate biopsy and thus reduce the false-negative rate.

The Clinical Value of Performing an MRI before Prostate Biopsy

PURPOSE: Prostate cancer foci have a characteristic feature in magnetic resonance imaging (MRI). We aimed to assess the clinical value of MRI before prostate biopsy in prostate cancer detection. MATERIALS AND METHODS: From March 2009 to June 2010, 154 patients were enrolled in this study. A total of 51 patients with a clinical suspicion of prostate cancer underwent prostate MRI by a 3T scanner before transrectal ultrasound (TRUS)-guided biopsies. A total of 103 patients with a clinical suspicion of prostate cancer underwent prostate MRI after biopsies. The sensitivity, specificity, and positive predictive value (PPV) were evaluated. In addition, tumor location of pathologic findings and ADC mapping on MRI were matched and compared. RESULTS: The sensitivity of MRI before and after biopsy was 84.8% and 92.4%, respectively. The PPV of MRI before and after biopsy was 75.7% and 92.4%, respectively. The MRI location match percentage before and after biopsy was 89.3% and 94.1%, respectively. CONCLUSIONS: Compared with other previous reports, our results show that the prostate cancer detection sensitivity of MRI is on the rise. Furthermore, MRI before prostate biopsy can provide more information by which to identify prostate cancer during prostate biopsy and thus reduce the false-negative rate.

Involvement of protein kinase C pathway in UVC-stimulated phospholipase D2 activity in Vero 76 cells

Phospholipase D (PLD) activity is known to be related to oxidant-induced cellular signaling and membrane disturbance. Previously, an induction of PLD activity in various cell lines by X-ray irradiation was observed. In this study, we examined the effect of UVC radiation on the PLD activity in Vero 76 cells. At a dose of 10 kJ/m2 of UVC irradiation, the PLD activity was stimulated approximately 10-fold over the basal activity. This UVC-induced PLD activity was found to be dependent on the presence of extracellular calcium and was inhibited by catalase as well as amifostine-an intracellular thiol antioxidant. Pretreatments with Ro32-0432-a selective inhibitor of protein kinase C (PKC)-and downregulation of PKC by preincubation of phorbol 12-myristate 13-acetate significantly inhibited the UVC-induced PLD activity. UVC-stimulated PLD activity was observed only in murine PLD2 (mPLD2)-transfected Vero 76 cells and not in human PLD1 (hPLD1)-transfected cells. Transient incorporation of PKC with mPLD2 and the phosphorylation of mPLD2 by a and b forms of PKC by UVC irradiation were observed. These results suggest that the UVC-stimulated PLD activity in Vero 76 cells is mediated through transient phosphorylation of PLD2 by the translocation of PKC to PLD2.

Use of the Rectal Retractor to Reduce the Rectal Dose in High Dose Rate Intracavitary Brachytherapy for a Carcinoma of the Uterine Cervix

Commercially available rectal retractors can be used in high dose rate intracavitary brachytherapy (HDR ICR) as one of the methods for reducing the rectal dose in radiotherapy for a uterine cervical cancer. However, the extent of the rectal protection achieved using these rectal retractors has not been reported. The aim of the study was to examine the effect of a rectal retractor on reducing the rectal dose in HDR ICR. Thirty patients were treated with HDR ICR using rectal retractors. Tandem and ovoids were applied in 15 patients and ovoids only were used in the other 15 patients. During the simulation, the rectum was filled with barium, and anteroposterior and lateral radiographs were then taken with and without the rectal retractor. Along the anterior rectal wall outlined, 4 to 8 points (median 6) were chosen to calculate the dose for each patient including the rectal point (RP), which is an author-defined rectal point modified from the definition of the rectal reference point in the ICRU report 38. The length of the measured rectum was 3-7 cm (median 5 cm). The bladder point (BP) dose was measured as recommended by the ICRU. The prescription doses to point A varied from 3.5 to 5 Gy (median 4 Gy). Paired comparisons were made on the individual patients by calculating the normalized mean doses of the RP, the maximal point (MP), and the longitudinal average (LA) with and without the rectal retractor. The doses to the bladder points (BP) were also calculated in parallel to the rectal points. The anterior rectal walls were displaced posteriorly after inserting the rectal retractor. In the tandem and ovoids group, the number of patients with a reduced dose in the RP, MP and LA were 14 (93.3%), 12 (80.0%) and 13 (86.7%), respectively. In the ovoids only group, the corresponding figures were 14 (93.3%), 14 (93.3%) and 14 (93.3%). In the tandem and ovoids group, the reduced dose in the RP, MP, and LA dose were 0.52 Gy (13.0%), 0.50 Gy (12.5%), and 0.39 Gy (9.8%), respectively (p 0.05). The mean RP, MP, and LA dose reduction rates of the patient subgroup where the RP dose was 70%. The effect of the rectal dose reduction was significant only in the subgroup of patients who received > 70% of the prescription dose (p < 0.05). The use of the rectal retractor was a simple and an effective method for reducing the rectal dose. It was also considered to be a highly reproducible method, which can replace the time-consuming vaginal gauze packing in HDR-ICR.

Development of Respiration Gating RT Technique using Moving Phantom and Ultrasound Sensor: a feasibility study / 대한방사선종양학회지

PURPOSE: In radiotherapy of tumors in liver, enough planning target volume (PTV) margins are necessary to compensate breathing-related movement of tumor volumes. To overcome the problems, this study aims to obtain patients' body movements by using a moving phantom and an ultrasonic sensor, and to develop respiration gating techniques that can adjust patients' beds by using reversed values of the data obtained. MATERIALS AND METHODS: The phantom made to measure patients' body movements is composed of a microprocessor (BS II, 20 MHz, 8K Byte), a sensor (Ultra-Sonic, range 3~3 m), host computer (RS232C) and stepping motor (torque 2.3 Kg) etc., and the program to control and operate it was developed. The program allows the phantom to move within the maximum range of 2 cm, its movements and corrections to take place in order, and x, y and z to move successively. After the moving phantom was adjusted by entering random movement data (three dimensional data form with distance of 2 cm), and the phantom movements were acquired using the ultra sonic sensor, the two data were compared and analyzed. And then, after the movements by respiration were acquired by using guinea pigs, the real-time respiration gating techniques were drawn by operating the phantom with the reversed values of the data. RESULTS: The result of analyzing the acquisition-correction delay time for the three types of data values and about each value separately shows that the data values coincided with one another within 1% and that the acquisition-correction delay time was obtained real-time (2.34x10-4 sec). CONCLUSION: This study successfully confirms the clinic application possibility of respiration gating techniques by using a moving phantom and an ultrasonic sensor. With ongoing development of additional analysis system, which can be used in real-time set-up reproducibility analysis, it may be beneficially used in radiotherapy of moving tumors.

Gene Expression Profiles in Cervical Cancer with Radiation Therapy Alone and Chemo-radiation Therapy / 대한방사선종양학회지

PURPOSE: To analyze the gene expression profiles of uterine cervical cancer, and its variation after radiation therapy, with or without concurrent chemotherapy, using a cDNA microarray. MATERIALS AND METHODS: Sixteen patients, 8 with squamous cell carcinomas of the uterine cervix, who were treated with radiation alone, and the other 8 treated with concurrent chemo-radiation, were included in the study. Before the starting of the treatment, tumor biopsies were carried out, and the second time biopsies were performed after a radiation dose of 16.2~27 Gy. Three normal cervix tissues were used as a control group. The microarray experiments were performed with 5 groups of the total RNAs extracted individually and then admixed as control, pre-radiation therapy alone, during-radiation therapy alone, pre-chemoradiation therapy, and during-chemoradiation therapy. The 33P-labeled cDNAs were synthesized from the total RNAs of each group, by reverse transcription, and then they were hybridized to the cDNA microarray membrane. The gene expression of each microarrays was captured by the intensity of each spot produced by the radioactive isotopes. The pixels per spot were counted with an Arrayguage(R), and were exported to Microsoft Excel(R). The data were normalized by the Z transformation, and the comparisons were performed on the Z-ratio values calculated. RESULTS: The expressions of 15 genes, including integrin linked kinase (ILK), CDC28 protein kinase 2, Spry 2, and ERK 3, were increased with the Z-ratio values of over 2.0 for the cervix cancer tissues compared to those for the normal controls. Those genes were involved in cell growth and proliferation, cell cycle control, or signal transduction. The expressions of the other 6 genes, including G protein coupled receptor kinase 6, were decreased with the Z-ratio values of below -2.0. After the radiation therapy, most of the genes, with a previously increase expressions, represented the decreased expression profiles, and the genes, with the Z-ratio values of over 2.0, were cyclic nucleotide gated channel and 3 Expressed sequence tags (EST). In the concurrent chemo-radiation group, the genes involved in cell growth and proliferation, cell cycle control, and signal transduction were shown to have increased expressions compared to the radiation therapy alone group. The expressions of genes involved in angiogenesis (angiopoietin-2), immune reactions (formyl peptide receptor-like 1), and DNA repair (cAMP phosphodiesterase) were increased, however, the expression of gene involved in apoptosis (death associated protein kinase) was decreased. CONCLUSION: The different kinds of genes involved in the development and progression of cervical cancer were identified with the cDNA microarray, and the proposed theory is that the proliferation signal starts with ILK, and is amplified with Spry 2 and MAPK signaling, and the cellular mitoses are increased with the increased expression of Cdc 2 and cell division kinases. After the radiation therapy, the expression profiles demonstrated the evidence of the decreased cancer cell proliferation. There was no significant difference in the morphological findings of cell death between the radiation therapy alone and the chemo-radiation groups in the second time biopsy specimen, however, the gene expression profiles were markedly different, and the mechanism at the molecular level needs further study.

High-Dose-Rate Intraluminal Brachytherapy for Biliary Obstruction by Secondary Malignant Biliary Tumors / 대한방사선종양학회지

PURPOSE: To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic biliary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor. METHODS AND MATERIALS: A retrospective study was performed on 24 patients having undergone HDR- ILB, with PTBD catheter insertion, between December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-ILB, while six were treated with HDR-ILB only. The total external beam, and brachytherapy radiations dose were 30~61.2 and 9~30 Gy, with median doses of 50 and 15 Gy, respectively. RESULTS: Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8% (5 patients), respectively. The median survivals for stomach and gallbladder cancers were 7.8 and 10.2 months, respectively. According to the univariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (p=0.0200), with all the patients surviving more than one year had been irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangitis due to the radiation therapy. CONCLUSION: An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of those patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-ILB, which is a prognostic factor. In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and it could be regarded as a safe treatment.

External Beam Irradiation for Squamous Cell Carcinoma of the Maxillary Sinus / 대한방사선종양학회지

PURPOSE: Maxillary sinus cancers are usually locally advanced, and involve the structures around sinus, but the regional lymphatic spread is uncommon. Therefore, the local control of these cancers is important for their cure. We reviewed our experience of 55 patients with squamous cell carcinomas of the maxillary sinus, treated with radiation therapy, and looked for the role of radiation therapy in maxillary sinus cancers. MATERIALS AND METHODS: Between November 1982 and October 1999, 55 patients with squamous cell carcinomas of the maxillary sinus underwent either radiation therapy only, or combined with surgery or with concurrent chemoradiation therapy. All patients were restaged according to the 1997 AJCC staging systems. The T classifications of the tumors of the patients were as follows:1.8% (1/55) for T2, 81.8% (45/55) for T3 and 16.4% (9/55) for T4. Thirteen patients were diagnosed with lymph node involvement. With the surgical procedures, 12 patients were managed by biopsy only, 21 were resected by FESS (functional endoscopic sinus surgery) and 22 by partial/medial/total maxillectomies. The details of the treatments were as follows:8 patients were treated with radiation therapy only, 17 with a combination of FESS and radiation therapy, 22 with a combination of a maxillectomy and radiation therapy, 4 with a combination of preoperative radiation therapy and surgery, and 4 with concurrent chemoradiation therapy. The mean follow-up for all patients was 25 months, ranging from 2.8 to 125 months. RESULTS: The 4-year local control and survival rates for all patients were 45.5 and 33.3%, respectively. The 4-year local control and survival rates, due to the extent of surgery, were as follows:32.1, and 21.4 % for biopsy; 41.9, and 31.7% for FESS; and 56.8, and 52.7% for maxillectomy, respectively. Twenty-nine (52.7%) patients were not cured, and of these 29 patients, 23 (79.3%) patients had a local recurrence following treatment. CONCLUSION: This study has shown that the major failure sites following treatment to be the local regions, and that the completeness of surgery was important for improving the local control and survival of patients with squamous cell carcinoma of the maxillary sinus.

Endobronchial Brachytherapy of Advanced Non-small Cell Lung Carcinoma

PURPOSE: To evaluate the effect of high-dose-rate endobronchial brachytherapy for symptomatic relief, tumor response and overall survival of advanced non-small cell lung carcinoma (NSCLC). MATERIALS AND METHODS: Between July 1992 and July 2001, 37 patients with advanced NSCLC were analysed retrospectively. Group A patients (palliative aim, n=25) were treated using brachytherapy alone due to relapse after external beam radiation therapy (EBRT). Group B patients (curative aim, n=12) were treated using brachytherapy alone or combined EBRT due to untreated inoperable NSCLC or positive resection margin after radical resection. The dose per fraction was 3~6 Gy at a radius of 1cm from the center of the source and each patient received 2~3 fractions. The total dose of brachytherapy was 9~18 Gy (median 15 Gy). Each fraction separated by 1 week interval. RESULTS: Symptomatic relief was obtained for cough (58.3% & 72.7%), dyspnea (56.3% & 75%) and hemoptysis (86.7% & 100%) in group A and B, respectively. The tumor improvement on bronchoscopy was obtained for complete response (28% & 60%) and partial response (64% & 40%) in group A and B, respectively. Median overall survival was 7 and 17.2 months for Group A and B, respectively. In group A, mediastinal node metastasis (p=0.039) and Karnofsky performance scale (p=0.062) was independent prognostic factor by univariate analysis. After radical therapy, 7 symptomatic radiation pneumonitis, 4 hemoptysis and 1 pneumothorax were observed. CONCLUSION: Endobronchial brachytherapy was effective for symptomatic relief of hemoptysis. In curative aim, we think that survival improvement may be expected in some selected patients

High-Dose-Rate Brachytherapy for Uterine Cervical Cancer : The Results of Different Fractionation Regimen / 대한방사선종양학회지

PURPOSE: Although high-dose-rate (HDR) brachytherapy regimens have been practiced with a variety of modalities and various degrees of success, few studies on the subject have been conducted. The purpose of this study was to compare the results of local control and late complication rate according to different HDR brachytherapy fractionation regimens in uterine cervical cancer patients. METHODS AND MATERIALS: From November 1992 to March 1998, 224 patients with uterine cervical cancer were treated with external beam irradiation and HDR brachytherapy. In external pelvic radiation therapy, the radiation dose was 45~54 Gy (median dose 54 Gy) with daily fraction size 1.8 Gy, five times per week. In HDR brachytherapy, 122 patients (Group A) were treated with three times weekly with 3 Gy to line-A (isodose line of 2 cm radius from source) and 102 patients (Group B) underwent the HDR brachytherapy twice weekly with 4 or 4.5 Gy to line-A after external beam irradiation. Iridium-192 was used as the source of HDR brachytherapy. Late complication was assessed from grade 1 to 5 using the RTOG morbidity grading system. RESULTS: The local control rate (LCR) at 5 years was 80% in group A and 84% in group B (p=0.4523). In the patients treated with radiation therapy alone, LCR at 5 years was 60.9% in group A and 76.9% in group B (p=0.2557). In post-operative radiation therapy patients, LCR at 5 years was 92.6% in group A and 91.6% in group B (p=0.8867). The incidence of late complication was 18% (22 patients) and 29.4% (30 patients), of bladder complication was 9.8% (12 patients) and 14.7% (15 patients), and of rectal complication was 9.8% (12 patients) and 21.6% (22 patients), in group A and B, respectively. Lower fraction sized HDR brachytherapy was associated with decrease in late complication (p=0.0405) (rectal complication, p=0.0147; bladder complication, p=0.115). The same result was observed in postoperative radiation therapy patients (p=0.0860) and radiation only treated patients (p=0.0370). CONCLUSION: For radiation only treated patients, a greater number of itemized studies on the proper fraction size of HDR brachytherapy, with consideration for stages and prognostic factors, are required. In postoperative radiation therapy, the fraction size of HDR brachytherapy did not have much effect on local control, yet the incidence of late complication increased with the elevation in fraction size. We suggest that HDR brachytherapy three times weekly with 3 Gy could be an alternative method of therapy.

Concurrent Chemoradiation Therapy with Cisplatin and Oral Etoposide for Locally Advanced Non-small Cell Lung Cancer / 대한암학회지

PURPOSE: Prognosis of locally advanced inoperable non-small cell lung cancer (NSCLC) treated with radiation therapy alone has been disappointing. In recent years, concurrent chemoradiation therapy has potential of improving both local and metastatic disease-free survival. This phase II study was undertaken to determine the feasibility, toxicity, response rate, local control rate, and survival duration of locally advanced NSCL patients treated with concurrent chemoradiation using cisplatin and oral etoposide. MATERIAL AND METHODS: Forty-seven patients were enrolled and forty-one patients were evaluable. Chemotheray consisted of cisplatin 50 mg/m2/IV on days 1 and 8 and oral etoposide 100 mg/day on days 1 to 5 and 8 to 12 which was repeated, every 4 weeks for two cycles during radiation therapy. Radiation therapy was administered to a total dose of 6300 cGY. RESULTS: Among 41 evaluable patients, six patients achieved complete response, and twenty had partial response, for an overall response rate of 63.4% (95% confidence interval; 48.4% to 75.4%). Stable disease was reported in 10 patients (24.4%) and another 5 (12.2%) showed disease pro gression. Overall survival rate was 76% at 1 year, 34% at 2 years. Median survival duration was 17 months (range; 3 to 41 ). Eighty-three percents of patients had radiation pneumonitis but only one patients needed medical treatment. CONCLUSION: Concurrent chemoradiation therapy with cisplatin and oral etoposide at this level is a well tolerated and feasible.

An Analysis of Prognostic Factors in the Uterine Cervical Cancer Patients / 대한방사선종양학회지

PURPOSE: The aim of this study is to analysis of survival and recurrence rates of the uterine cervical carcinoma patients whom received the radiation therapy respectively. The prognostic factors, such as Papanicolaou (Pap) smear, carcinoembriogenic antigen (CEA) and squamous cell carcinoma (SCC) antigen has been studied. METHODS AND MATERIALS: From January 1981 to December 1998, eight-hundred twenty-seven uterine cervical cancer patients were treated with radiation therapy. All of the patients were divided into two groups : the radiation therapy only (521 patients) group and the postoperative radiation therapy (326 patients) group. The age, treatment modality, clinical stage, histopathology, recurrence, follow-up Pap smears, CEA and SCC antigen were used as parameters for the evaluation. The prognostic factors such as survival and recurrence rates were performed with the Kaplan-Meier method and the Cox hazard model, respectively. Median follow-up was 38.6 months. RESULTS: On the radiation therapy only group, 314 patients (60%) achieved complete response (CR), 47 patients (9%) showed local recurrence (LR), 78 patients (15%) developed distant metastasis (DM). On the postoperative radiation therapy group, showed 276 patients (85%) CR, 8 patients (2%) LR, 37 patients (11%) DM. The 5-year survival and recurrence rates was evaluated for all parameters. The statistically significant factors for the survival rate in univariate analysis were clinical stage (p=0.0001), treatment modality ( p=0.0010), recurrence ( p=0.0001), Pap smear ( p=0.0329), CEA ( p=0.0001) and SCC antigen ( p= 0.0001). CONCLUSION: This study indicated that after treatment, the follow-up studies of Pap smear, CEA and SCC antigen were significant parameter and prediction factors for the survival and recurrence of the uterine cervical carcinoma.

Intraoperative radiation therapy as an adjunctive therapy for huge and highly vascular parasagittal meningiomas

This case presents a 34-year-old man who had a huge parasagittal meningioma. Initial treatment consisted of preoperative external carotid artery embolization and partial tumor resection. During the resection, we found that the tumor invaded the adjacent calvarium, and due to massive hemorrhage, total removal of the tumor was impossible. The patient was treated with intraoperative radiation therapy (IORT) (25 Gy via 16 MeV) as an adjunctive therapy. Eight months after IORT, we were able to remove the tumor completely without surgical difficulties. IORT can be considered an useful adjunctive therapy for the superficially located, huge, and highly vascular meningioma.

The Role of Postoperative External Irradiation for the Incompletely Resected Meningiomas / 대한방사선종양학회지

PURPOSE: The aim of this study is to look for the possible efficacy of postoperative external irradiation for incompletely resected meningiomas. METHODS AND MATERIALS: From August 1981 to January 1997, forty-four patients with intracranial meningioma were treated by postoperative external irradiation. Of the 44 meningiomas, 18 transitional, 13 meningotheliomatous, 6 hemangiopericytic, 4 atypical, 2 fibroblastic and 1 malignant meningioma were identified. We classified all patients into two groups by the histology. The benign group was consisted of the meningotheliomatous, transitional and fibroblastic types. The malignant group was consisted of the atypical, hemangiopericytic and malignat types. In the means of surgery, 37 patients were resected incompletely and 7 patients were managed by biopsy only. After surgery, all patients were received postoperative external irradiation. Radiotherapy was deliverd using Co-60 or 4 MV photon beam to a total dose of 50 to 66 Gy (mean dose : 57.4 Gy) with a 1.8 to 2 Gy per fraction. The median follow-up was 48 months (range : 21~101 months). Multivariate analysis of the influence by age, sex, location, histology and radiation dose on local control has been done using Cox's proportional hazard model. RESULTS: 5-year local control rate was 93.8% for the benign histology and 51.8% for the malignant histology (p=0.0110) and overall local control rate at 5 years was 87.4%. The analysis of the prognostic factors, such as age, sex, location, and radiation dose were not significant except for the histology. CONCLUSION: Adjuvant postoperative external irradiation appears to be significantly improved local control in the patients with incompletely resected meningiomas.

The Role of External Irradiation for the Locally Advanced Papillary Thyroid Cancers / 대한방사선종양학회지

PURPOSE: The aim of this study is to look for the possible efficacy of external irradiation for locally advanced papillary thyroid cancers (stage pT4 or N1). METHODS AND MATERIALS: From August 1981 through September 1997, 91 Patients with locally advanced papillary thyroid cancers (stage pT4 or N1) have been treated with external irradiation and followed up at our clinic. All of the patients have been treated with surgical resection. After surgery, 23 patients received postoperative external irradiation with or without ablative radioiodine therapy, whereas the other 68 patients were treated with ablative radioiodine therapy alone. Distributions of sex, age, and stage were comparable in both irradiated and nonirradiated groups. Multivariate analysis of the influence by age, sex, stage, ablative radioiodine therapy and external irradiation on local control were performed by using Cox's proportional hazard model. RESULTS: Overall survival rates at 7 years were of no significant difference in both groups. There were 98.1% for no RT group and 90% for RT group (p=0.506).5-year local control rates were significantly different, these were 95.2% for RT group and 67.5% for no RT group (p=0.0408). An analysis of the prognostic factors, age, sex, stage, and RAI were not significant variables, except for the external irradiation. CONCLUSION: Adjuvant postoperative external irradiation did not affect overall survival, but significantly improved local control in the patients with locally advanced papillary thyroid cancers (stage pT4 or lymph node involvement).

Intraoperative Radiation Therapy(IORT) for the Treatment of Brain Tumors

Intraoperative Radiation Therapy(IORT) delivers a high single dose of radiation to a localized volume encompassing the tumor tissue as well as a minimal amount to the surrounding brain. The aims of the study are to evaluate the feasibility of IORT for the treatment of brain tumors, its effect on survival, and possible complications. Nineteen brain tumor patients underwent wide resection of the tumor followed by IORT at the first surgery or at the second salvage surgery. IORT was given for primary tumors in two patients, but was used for treating recurrent tumors in the other 17 patients. IORT doses of 15-25Gy was delivered depending on the tumor volume and previous radiation therapy. The mean follow-up after IORT was 11.5 months(range: 1-40 months). There were several complications after IORT; 1 radiation necrosis, 1 hydrocephalus,and 3 wound infections. For Glioblastomas cases, the median survival time after initial diagnosis was 14 months(SD, 6.4mo; range 10-28mo). An Unresectable huge highly vascularized meningioma was removed successfully after IORT. Based on our limited experiences, IORT may be considered as an adjuvant therapeutic modality, especially for malignant brain tumors and large rich vascularized meningioma.

Effects of REtinoic Acid and Radiation on the Growth of Cell Lines of Human Head and Neck Squamous Cell Carcinoma / 대한암학회지

PURPOSE: Mammalian tumor cells differ in their response to ionizing radiation to a degree that some patients are readily curable with conventional doses of radiation, while others are rarely controlled. In experimental systems, it is possible to demonstrate differences between cell lines both in intrinsic radiosensitivity and in the apparent capacity to repair damage. Retinoic acid is a substance that has previously been reported to increase radiosensitivity, but at concentrations likely to have cytostatic effects or induce cellular differentiation. We chose several head and neck cancer cell lines to investigate radiation sensitivity and synergism in combination with retinoic acid. Material and Methods: Seventeen head and neck cancer cell lines (MDA886, P1, P13, A-431, PCI-50, UMSCC-10A, UMSCC-10B, UMSCC-11A, UMSCC-11B, UMSCC-17A, UMSCC-17B, UMSCC-19, UMSCC-22B, UMSCC-30, UMSCC-38, 1YA, 1YB) are irradiated with variable dose of radiation (1 Gy, 5 Gy, 9 Gy) for determination of radiosensitivity of each cell lines. The less radiosensitive cell lines are treated with retinoic acid for evaluation of the effects of retinoic acid on cellular X-ray sensitivity and recovery from X ray-induced potentially lethal damage. RESULTS: Lowest growth inhibition rates are seen UMSCC-11A and 1YA cell lines in 1 Gy, so that we treated with retinoic acid such cell lines. We obtained the following RESULTS: 1) two cell lines appear not inhibitory effect on recovery from X-ray induced potentially lethal damage but growth inhibition synergism when irradiated with retinoic acid in 1 Gy of radiation dose. 2) two cell lines were little effect on radiosensitivity and inhibitory effect on recovery from X-ray damage in 0.5 Gy radiation dose. CONCLUSION: We found that direct radiosensitizing effects of retinoic acid on 1 Gy of radiation dose may act synergistically for cell growth inhibition in vitro study(three cell lines: UMSCC-11A, 1YA, UMSCC-11B). Further in vitro and in vivo experiments are now necessary to evaluate retinoic acid as radiosensitizer for head and neck cancer radiation therapy.

Nodal Status of the Head and Neck Cancer Patients / 대한치료방사선과학회지

PURPOSE: It is well known that the risk of lymph nodes metastases to head and neck cancers are influenced by the location and size of the primary tumor, as well as the degree and types of histological differentiation. However, data on the statistical analyses of lymph node metastases from the head and neck cancers among Korean population are not available at present. In order to obtain current status of such data, we have analyzed cancer patients at the department of radiation oncology, Korea university hospital for radiation treatment. MATERIALS AND METHODS: We have evaluated nine-hundred and ninetyseven (997) head and neck cancer patients who visited to the Department of radiation oncology, between November 1981 to December 1995. After careful physical examinations and CAT scan, patients were divided into two groups, those with positive lymph node metastases and with negative lymph node metastases. The nodal status were classified according to the TNM system of American Joint Committee on Cancer (AJCC) RESULTS: Four-hundred and sixteen patients out of the 997 patients were lymph node positive (42%) and 581 patients were lymph node negative (58%) when they were first presented at the department of radiation oncology. According to the AJCC classification, the distribution of positive lymph node is as follow:N1:106 (25.5%), N2a:100 (24%), N2b:68 (16.4%), N2c: 69 (16.6%), N3:73 (15%), respectively. The frequency of lymph node metastases according to the primary sites is as follow : larynx : 283 (28.5%), paranasal sinuses:182 (18%), oropharynx:144 (14.5%), nasopharynx:122 (12%), oral cavity:92 (9%), hypopharynx:71 (7%), salivary gland:58 (6%), unknown primary:31(3%), skin:14(2%). The most frequent primary site for the positive lymph node metastases was nasopharynx (71%) followed by hypopharynx (69%), oropharynx (64%), oral cavity (39%). The most commonhistologic type was squamous cell carcinoma (652/997: 65.4%), followed by malignant lymphoma (109/997:11%). CONCLUSION: Statistical results of lymph node metastases from head and neck cancer at our department were very similar to those obtained from other countries. It is concluded that the location of primary cancer influences sites of metastases on head and neck, and stage of the primary cancer also influences the development of metastatic lesions. Since the present study is limited on the data collected from one institute, further statistical analyses on Korean cancer patients are warrented.

Alteration of Phospholipase D Activity in the Rat Tissues by Irradiation / 대한치료방사선과학회지

PURPOSE: Phospholipase D (PLD) catalyzes the hydrolysis of phosphatidyl choline to phosphatidic acid (PA) and choline. Recently, PLD has been drawing much attentions and considered to be associated with cancer process since it is involved in cellular signal transduction. In this experiment, oleate-PLD activities were measured in various tissues of the living rats after whole body irradiation. MATERIAL AND METHODS: The reaction mixture for the PLD assay contained 0.1microCi 1,2-di[1-14C]palmitoyl phosphatidylcholine, 0.5mM phosphatidylcholine, 5mM sodium oleate, 0.2% taurodeoxycholate, 50mM HEPES buffer (pH 6.5), 10mM CaCl2, and 25mM KF. phosphatidic acid, the reaction product, was separated by TLC and its radioactivity was measured with a scintillation counter. The whole body irradiation was given to the female Wistar rats via Cobalt 60 Teletherapy with field size of 10cm x 10cm and an exposure of 2.7Gy per minute to the total doses of 10Gy and 25Gy. RESULTS: Among the tissues examined, PLD activity in lung was the highest one and was followed by kidney, skeletal muscle, brain, spleen, bone marrow, thymus, and liver. Upon irradiation, alteration of PLD activity was observed in thymus, spleen, lung, and bone marrow. Especially PLD activities of the spleen and thymus revealed the highest sensitivity toward gamma-ray with more than two times amplification in their activities. In contrast, the PLD activity of bone marrow appears to be reduced to nearly 30%. Irradiation effect was hardly detected in liver which showed the lowest PLD activity. CONCLUSION: The PLD activities affected most sensitively by the whole-body irradiation seem to be associated with organs involved in immunity and hematopoiesis. This observation strongly indicates that the PLD is closely related to the physiological function of these organs. Furthermore, radiation stress could offer an important means to explore the phenomena covering from cell proliferation to cell death on these organs.