The Anatomic Figure of Saphenofemoral Junction in Primary Varicose Vein

PURPOSE: The purpose of this study is to measure the diameter of saphenofemoral junction (SFJ) by using duplex scan and to assess the different anatomic characteristics of SFJ according to the clinical manifestation. METHODS: 100 Limbs of 77 patients with varicose veins due to greater saphenous vein (GSV) were assessed prospectively about sex, symptom, disease duration, morphology of varicose vein. The diameter of GSV (GSVD), SFJ, femoral vein (FVD) and the ratio of each value-GSV/FV (GFDR) and SFJ/FV (JFDR)-were measured by color-flow duplex scanning. Findings were compared with clinically normal 20 control limbs. RESULTS: The mean value of GSVD, FVD, SFJ, GFDR, JFDR in patients group were different from that of control group with statistical significance except FVD. There were statistically significant differences in the mean value of GSVD, FVD, GFDR, JFDR between men and women. The mean value of GSVD, FVD, SFJ, GFDR, JFDR between symptomatic and asymptomatic group were not different statistically. The result of comparison according to the disease duration showed statistically significant difference, which the more duration of disease were longer, the more the mean value of SFJ were increased. In comparison of the findings according to the morphologic classification, there were no statistically significant differences in the mean value of GSVD, FVD, SFJ, GFDR, JFDR. CONCLUSION: Dilatation of SFJ may be related to the cause of varicose veins from the result that the mean value of SFJ was more increased in patients group than control group.

Acute Arterial Thrombosis in Leg Associated with Hyperhomocysteinemia

Herein, two cases of acute arterial thrombosis associated with hyperhomocysteinemia are reported. A 34-year old male patient without heart disease, was brought to hospital with an acute ischemic limb due to thromboses of both superficial femoral arteries, where no atherosclerotic lesions were found. Subsequent investigation revealed that the patient had hyperhomocysteinemia, with a low folic acid level. Catheter directed thrombolysis was attempted, but failed, so bypass surgery was performed. After revascularization, anticoagulation therapy and folate supplementation were initiated. His plasma homocysteine level returned to normal, and there has been no recurrence during the 48 month follow up periods. The other case was a 51-year man with an acute left ilio-femoro-popliteal artery occlusion, who had also shown hyperhomocysteinemia, with a low folic acid level. There was nothing abnormal from his medical records, and showed normal findings in his transesophageal echocardiogram. In a serologic hypercoagulability test, everything was normal, with the exception of an increased homocysteine level. After a successful thrombectomy with a Fogarty catheter, folate supplementation was administered until his homocysteine level returned to normal. In both patients, the heterozygous mutation of 5, 10-methylenetetrahydrofolate reductase (MTHFR), C677T (alanine to valine substitution), was detected.

Clinical Results of Lower Extremity Trauma Accompanied with Popliteal Artery Injury

PURPOSE: Although popliteal artery injuries are uncommon, the consequent lack of management protocols may contribute to the high level of outcome morbidity. METHOD: We retrospectively reviewed the records of popliteal artery trauma treated at our institution in the past 5 years. RESULT: In 15 patients [male 13, female 2, median age 45.9 (15-73)] there were 13 cases of blunt trauma, mainly motorcycle accident. Most patients presented with severe signs of ischemia when they arrived at the emergency unit. Most commonly skeletal injury was accompanied (fracture 13, nerve injury 7). Some delays occurred between injury and treatment in every cases. Bypass using the contralateral long saphenous vein was the predominant procedure for arterial injury. Our limb salvage rate was 66.7% (10/15), but all patients needed more than two additive operations, and finally had persistent neurologic disability. CONCLUSION: Popliteal artery injury, especially in Korean urban society, was mainly caused by blunt trauma from traffic accidents and the results remain challenging.

Multi Detector Row Computed Tomography Angiogram as the Sole Preoperative Imaging for Infrainguinal Arterial Surgery

PURPOSE: To assess the suitability of multidetector row CT angiogram (MDCTA) as the sole preoperative imaging for infrainguinal arterial surgery. METHOD: From March 2002 to September 2003, 75 patients (24 claudicants, 41 limb-threatening ischemia) were studied with MDCTA preoperatively. We compared the surgical inflow and outflow site changes between preoperative planning based on MDCTA and the results of final operation. MDCTA was interpreted by the same vascular surgeon, and arterial segments from the renal artery to foot were reviewed. Surgery plans were formulated based on arterial anatomic and hemodynamic characteristics. Additional diagnostic value and test related complications were also studied. RESULT: Twenty- one patients had conventional angiogram after MDCTA scan - 9 for interventional treatment at inflow site and 12 patients for complement of MDCTA, although the operation plan was not changed. The agreement between preoperative plan based on MDCTA and final operation was 100% even in critical limb ischemia. In 11 patients tortuous calcified iliac artery was ambiguous in routine image but it could be solved using the other specific functional option of MDCTA. There were no serious complications related to the test. CONCLUSION: These findings suggest that MDCTA is an adequate preoperative imaging study of infrainguinal arterial surgery and that it may be substituted for conventional angiogram without any serious complication. The particular functional options of MDCTA help resolve its defect.

Pulmonary Embolism Related with Catheter Directed Thrombolysis in Acute Deep Vein Thrombosis

PURPOSE: Catheter directed thrombolytic dissolution (CDT) of deep vein thrombus (DVT) is in widespread use, yet the complications especially pulmonary embolism (PE), associated with the procedure remains ill defined. To assess the incidence of PE we reviewed the clinical course of acute DVT patients treated by CDT. METHOD: From January 2000 to September 2003, 25 patients were treated by CDT. To define the new development of PE, patients had a technetium 99m lung scan before and just after CDT-, and clinical symptoms were recorded. All patients underwent ascending venogram and CT scan initially to define DVT extension. CDT with urokinase was done by a the same intervention radiologist. RESULT: Proximal thrombus extension level was the femoral vein in 8 patients, iliac vein in 12-, and inferior vena cava (IVC) in 5. Complete thrombolysis was achieved in 16 patients, partial lysis in 2 and no lysis in 7. PE was detected in 7 patients with initial lung scan whose thrombus proximal level was IVC 2, iliac vein 4, femoral vein 1 in each, and no changes in lung scan after CDT. In 17 patients with normal findings at intial lung scan, there were also no changes after CDT. One patient with normal lung scan showed high probable scan defects in lung scan after CDT. Because he also complained of sudden onset dyspnea with cough, we diagnosed him as newly developed, PE-related CDT. CONCLUSION: Only one (4%) case of PE was developed in our study. No prediction factor of PE such as CDT results, or thrombus proximal extent could be defined. These findings suggest that routine usage of temporary IVC filter is unnecessary during CDT.

The Effect of Photodynamic Therapy on Colon Cancer Cell Line

PURPOSE: Photodynamic therapy (PDT) is a relatively new technology for an alternative modality in the treatment of colorectal cancers. This study was conducted to identify the appropriate dosage and energy level for the photosensitizer as well as effect of PDT on colon cancer cells. METHODS: Colon cancer cell line, COLO 205 (American Type Culture Collection, ATCC) was obtained from Korea Cell Line Bank (KCLB, Seoul, Korea). Cells were cultured on RPMI 1640 medium with 10% fetal calf serum, penicillin, and gentamicin. Cells were incubated at 37 C in a 5% CO2 air environment. Photosense (sulphonated aluminum phthalocyanine, AlPcS4, NIOPIK, State Research Center, Moscow, Russia) was used for the photosensitizer and Fireplace video-3 (Biospec, General Physics Institute, Moscow, Russia, 500 mW/cm2, 670 nm) was used for the light source. 1 104 cells were incubated in 96 well plates with different concentrations of aluminum phthalocyanine: 0.1, 0.3, 0.5 and 1micrometer for 24 hours then photoirradiation was performed at either 24 or 48 J/cm2. The time variations of the viabilities of cells of the four study groups and were measured by using MTT assay according to time were compared to those of the three control groups: control (no treatment), control (AlPcS4, no light), control (light, no AlPcS4), and the study groups (PDT) at one hour, 24 hours, 48 hours and 72 hours after PDT. RESULTS: At, one hour after PDT, the viability of the cells was not changed in the control groups. Viabilities of 117, 40, 35, and 23% in the 24 J group and 76, 31, 52, and 48% in 48 J group were observed, respectively in order of increasing concentration with the value of 87~103% for the control group. 24 hours later, viability of control groups were not changed, By 24 hour after PDT, the viabilities of the control groups had not changed, but those of the 24 J/cm2 and 48 J/cm2 PDT study groups had decreased significantly to 62, 17, 16, and 18% and 24, 15, 13, and 13%, respectively (P=0.00). By 48 hours viability of the 24 J/cm2 and 48 J/cm2 PDT study groups were also significantly decreased being 103, 26, 13, and 13% and 50, 8, 8, and 9%, respectively (P=0.00). By 72 hours, viabilities were 84, 21, 21, and 30 % and 33, 20, 33, and 15%, respectively (P=0.00). CONCLUSIONS: The PDT groups showed a marked cytotoxic effect compared to the control groups, and the effect appeared just after PDT and peaked in 48 hours. The minimum required concentration of the photosensitizer for effective cytotoxicity was at 0.3 micrometer either 24 or 48 J/cm2.

Detection of Peripheral Blood Telomerase Activity from Gastric Cancer Patients

PURPOSE: Telomerase activity is generally absent in primary cell cultures and normal tissues. Telomerase is known to be induced upon immortalization or malignant transformation of human cells. Telomerase activity can be increased in immature lymphocytes and activated lymphocytes, but it is not detected in the peripheral blood of normal persons. The authors analyzed peripheral blood telomerase from patients of gastric cancer to evaluate the possibility of using it for diagnosis and as a prognostic factor. MATENRIALS AND METHODS: We obtained blood samples from 11 inflammatory patients and 64 gastric cancer patients. The telomerase activity was measured using the [PCR-ELISA] method. The results were correlated with the T, N, M stage, cell differentiation, vascular, neural, and lymphatic invasion, tumor size, and tumor location. RESULTS: In the 11 inflammatory patients, telomerase activity was not detected while in the gastric cancer patients, a positive rate of 28.1% was noted. The peripheral telomerase activity was not related with tumor size, tumor site, lymphatic and vascular invasion, stage, or histologic differentiation. CONCLUSION: The peripheral blood telomerase activity for patients of gastric cancer can be utilized as a marker for the diagnosis of not only advanced gastric cancer, but also relatively early stage gastric cancer, but not as a prognostic factor.

Endovascular Management of Iliac Vein Compression Syndrome Associated with Thrombosis

PURPOSE: We report our early experience, and the feasibility, of an endovascular technique for treating iliac vein compression syndrome, which is known to be caused by a chronic pulsating irritation of the iliac artery. METHODS: Five patients presented with acute deep vein thromboses in their left legs, diagnosed by computed tomography (CT), and treated with a catheter-directed thrombolysis. The residual stenosis was treated by angioplasty, followed by stent placement. The results were evaluated, followed with duplex ultrasound. RESULTS: The CT scan of the left iliac vein was compressed by the right iliac artery, with the thrombosis shown distal of the venous segment of the crossover point in all five cases. Success with the endovascular technique was achieved in all 5 patients. In the follow up, the duplex scan stent site and patency were examined. During the follow up period all the stents were patent, and no thrombosis recurred. CONCLUSION: A CT scan is helpful in diagnosing iliac vein compression syndrome, with a thrombosis. The endovascular approach for its treatment should be considered affirmative due to its safety and simplicity.

Clinical Significance of Detection of Carcinoembryonic Antigen in Peritoneal Fluid by Reverse Transcription-Polymerase Chain Reaction in Patients with Gastric Cancer

PURPOSE: Free cancer cells in the peritoneal cavity exfoliated from a tumor are considered to be responsible for peritoneal dissemination in gastric cancer. To detect free cancer cells, a carcinoembryonic antigen (CEA) was introduced to the marker of gastric cancer. The clinical significance of detecting the carcinoembryonic antigen (CEA) mRNA in the peritoneal fluid was evaluated by RT-PCR in patients with gastric cancer. METHODS: In 50 patients with gastric cancer who received a gastrectomy, the peritoneal washing fluids were obtained and the CEA mRNA was detected by RT-PCR and a cytological examination was taken, simultaneously. The results were correlated with the stage and the recurrence of peritoneal seeding. RESULTS: Positive values of CEA mRNA from the peritoneal washing fluids were observed in 24% (12/50) of patients with gastric cancer but of 4% (2/50) showed peritoneal cytology. There were 8 cases of peritoneal seeding in the follow-up and 6 cases of them presented positive CEA mRNA values (50%, 6/12). According to the stage, positive CEA mRNA values from the peritoneal washing fluids were found in 9% (2/21) in stage I, 20% (2/10) in stage II, 33% (5/15) in stage III and 75% (3/4) in stage IV (P=0.030). In the T classification, positive CEA mRNA values were found in 13% (2/15) in T1, 10% (1/10) in T2, 30% (7/23) in T3 and 100% (2/2) in T4 (P=0.031). In the N classification, positive CEA mRNA values were found in 15% (4/26) in N0, 20% (3/15) in N1, 40% (2/5) in N2 and 75% (3/4) in N3 (P=0.055). CONCLUSION: These results suggest that the detection of CEA mRNA by RT-PCR in peritoneal fluid of gastric cancer patients was more sensitive than the peritoneal cytology, and may have a role in selecting patients with a poor prognosis who may benefit from adjuvant therapy.

A Study for Pressure-Flow Relationship and Oxygenation in the Denervated Canine Liver / 대한마취과학회지

BACKGROUND: Various pressor agents are used to raise systemic vascular resistance (SVR) during liver transplantation. The aim of this study was to investigate the effect of liver denervation on hepatic hemodynamic responses to vasopressors. METHODS: This study was conducted in eight anesthetized dogs randomly assigned in to 4 groups [epinephrine-Low dose (L): 0.05 microgram/kg/min, epinephrine-High dose (H): 0.5 microgram/kg/min, ephedrine (D): 0.2 mg/kg, phenylephrine (P): 80 microgram/min]. One hour after surgical denervation of the liver, cardiac output, blood gases and hepatic blood flow were measured before and after administration of vasopressors with an electromagnetic flow meter. Oxygen consumption rate (hepatic artery plus portal vein oxygen delivery-hepatic vein oxygen delivery) was calculated. The Wilcoxon signed rank test and Kruskal-Wallis test were used for statistical analysis; The level of significance was assumed at the P < 0.05 level. Results are expressed as mean +/- SE. RESULTS: The resulting hemodynamic values were not significantly different between groups except for hepatic vascular resistance in the P group. Hepatic blood flow decreased significantly in the P and H groups, whereas it increased significantly in the L group. Hepatic oxygen consumption and Base Excess in hepatic venous blood after vasopressors were not significantly different between groups. These results mean there were no significant differences in hepatic oxygenation between groups. CONCLUSIONS: Various pressor agents can be used to raise SVR without jeopardizing hepatic oxygenation. However, phenylephrine and high dose of epinephrine are not recommended after liver transplantation because decreased hepatic blood flow might affect the intracellular oxygen environment adversely.

Comparison between a Pylorus-Preserving Pancreatoduodenectomy and a Classical Pancreatoduodenectomy Nutritional status and quality of life

BACKGROUND: This study was performed to prove whether a pylorus-preserving pancreatoduodenectomy (PPPD), now widely used in the treatment of not only positive tumors but also negative tumors, is advantageous for recovering the nutritional status and the quality of life of patients with pancreatic cancer and periampullary regions compared with a classical pancreatoduodenectomy (PD). METHODS: A retrospective study of the nutritional status and the quality of life of 200 patients who had undergone a PPPD (n=92) and a PD (n=118) from January 1993 to July 1998 was performed. The nutritional status was measured by using Broca's index, cholesterol, total protein, and albumin. The quality of life was assessed by one question on how the patients felt about their quality of life. RESULTS: The PD was preferred in advanced stages and had a higher recurrence rate. The PPPD had a shorter operative time, less transfused blood, a longer duration of nasogastric tube drainage, and a shorter postoperative hospital stay. In the PPPD, the nutritional status was improved compared with that in the PD. There were no significant differences in operative mortality or morbidity, gastrointestinal symptoms, and the quality of life between patients having a PPPD and a PD. CONCLUSIONS: This study suggests that there are no differences in postoperative subjective symptoms and the quality of life between patients having a PPPD and those having a PD. However, preserving the pylorus allows a better recovery of nutritional status than a pylorus resection dose. The PPPD hasa survival rate similar to that of the PD. Therefore, the PPPD can be recommended for the procedure in the surgical treatment of diseases of the periampullary regions.

Right Hepatic Lobectomy in the Treatment of Right-sided Hepatolithiasis

BACKGROUND: Right-sided hepatolithiasis has been diagnosed in 14-25% of all hepatolithiasis cases and right hepatic resection contributes only 5-9% of all hepatic resections for hepatolithiasis. Outcomes of otherwise treatment modalities were unsatisfactory resulting high incidence of remnant stone and high recurrence rate. General indications for hepatic resection in hepatolithiasis include localized intrahepatic calculi with irreversible biliary strictures, atrophied segment or lobe of the liver, multiple cholangitis abscess and possible presence of cholangiocarcinoma. PURPOSE: In this study, we presented the outcome of right hepatic lobectomy in right-sided hepatolithiasis patients, especially focused on the rationale and indications of this procedure. METHODS: We reviewed 15 cases undergone right lobectomy for right-sided hepatolithiasis from January 1995 to June 1997 with median follow-up of 23 months. RESULTS: Mean age of the patients was 49 years old. Clinical manifestations included signs of cholangitis in 7 (47%), abdominal pain in 5 (33%), jaundice in 1 (7%) and nonspecific symptoms in 2 (13%) cases. Criteria for indications of right lobectomy were overt biliary strictures in 9 (60%), marked atrophy of the right lobe in 7 (47%), multiple cholangitis abscess in 6 (40%) and suspected cholangiocarcinoma in 2 (13%) cases. Mean indocyanine green retention rate at 15 minutes was 7.6 4.5% and mean weight of resected specimen was 352 185 gm. Operative stone clearance rate was 100% for 14 isolated right-sided hepatolithiasis cases and choledochoscopic stone removal was followed for 1 both-sided case. Overall stone clearance rate was also 100%. Rate of stone recurrence was 0% at median follow-up of 23 months. Operative complications occurred in 4 cases without hepatic function-associated complication or operative mortality. CONCLUSIONS: Right hepatic lobectomy is indicated in patients who have localized right-sidedhepatolithiasis with irreversible biliary strictures involving the right hepatic duct, an atrophied right lobe of the liver, multiple cholangitis abscesses, or possible presence of cholangiocarcinoma.

Right Hepatic Lobectomy for Adult Living Donor Liver Transplantation Safety, anatomical points, and technical points

BACKGROUND: Living related liver transplantation (LRLT) has gained acceptance as treatment modality for children with end-stage liver disease. The left lobe used in LRLT doesn't provide adequate parenchymal mass for its application to adults. We have used right lobe for LRLT in adults. Some criticism has been aroused becuase of the potential significant risk to the donors. METHODS: We analyzed the surgical risk and the stress to 20 donors in a right lobectomy for LRLT. We also analyzed anatomical points for safe harvest, and we describe techincal points based on anatomical variations. RESULTS: There were no deaths, and 6 major complications (3 bleeding, 1 perihepatic fluid collection, 1 pleural effusion, and 1 bile peritonitis after removal of the T-tube) occurred in 6 patients. Liver function was normalized within 2 weeks. There were anatomical variations in the hepatic vein, the portal vein, and the bile duct, especially the right inferior hepatic vein (55%), trifurcation of the portal vein (10%), low inserion of the right posterior bile duct into the common hepatic duct (10%), and separate insertion of the right anterior bile duct and right posterior bile duct into the hepatic duct (10%). We made a vena cava patch for the right inferior hepatic vein. In cases of the low insertion of the right posterior hepatic duct into the common hepatic duct, the cholecystectomy should be done carefully so as not to injure the right posterior hepatic duct. We ligated and divided the right posterior bile duct before dissection of the hepatic artery and the portal vein. In cases of trifurcation of the portal vein, closure of the left portal vein should be done to prevent the narrowing of the left portal vein lumen. CONCLUSIONS: Our results suggest that a right lobectomy for LRLT is safe for donors. However, anatomical variations in the bile duct, the hepatic vein, and the portal vein should be kept in mind to ensure a safe and successful operation.

Anterior Segment Congestion of a Right Liver Lobe Graft in Living Donor Liver Transplantation and its Strategy to Prevent Congestion / 대한이식학회지

PURPOSE: A left lobe graft from a small donor will not meet the metabolic demands of a larger recipient in adult-to-adult living donor liver transplantation (LDLT). One solution to this problem is to use a right lobe graft. However, the necessity of the middle hepatic vein (MHV) drainage from the anterior segment of a right lobe graft was not yet clearly described in the literatures. METHODS: From July 1997 to February 1998, five right lobe grafts without having a MHV drainage were implanted in 5 recipients with 2 HBV-cirrhosis, 2 fulminant hepatic failure and 1 secondary biliary cirrhosis. The graft weight ranged from 650 gm to 1000 gm, and their volume ranged from 48% to 83% of the ideal liver mass of the recipients. RESULTS: Two grafts showed severe congestion of the anterior segment immediately after reperfusion, followed by prolonged massive ascites and severe liver dysfunction in each patient postoperatively. Eventually, one patient died of sepsis on posttransplant 20th day demonstrating progressive hepatic dysfunction. CONCLUSION: A right lobe graft without having MHV drainage might result in severe congestion of the anterior segment, which was able to lead to the patient's death in an extreme situation. Preservation of the anterior segment venous drainage in the right lobe graft is possible by two harvesting method: an extended right lobe (ERL) graft in which MHV is included in the graft and a modified right lobe (MRL) graft in which venous tributaries of the anterior sement were reconstructed via interposition vein grafts into the recipient's hepatic venous system. Theoretically, in a view point of donor safety, a MRL graft is more advantageous than an ERL graft because MHV is left in the donor liver. Here, we report our experiences of 27 MRL grafts in adult-to-adult LDLTs.

Physical Characteristics Comparison of Virtual Wedge Device With Physical Wedge / 대한방사선종양학회지

PURPOSE: We have compared the characteristics of Siemens virtual wedge device with physical wedges for clinical application. MATERIALS AND METHODS: We investigated the characteristics and physical wedges for various wedge angles (15,30,45,and 60 degrees)using 6- and 15MV photon beams. Wedge factors were measured in water using an ion chamber for various field sizes and depths. In case of virtual wedge device, as upper jaw moves during irradiation, wedge angles were estimated by accumulated doses. These measurements were performed at off-axis points perpendicular to beam central axis in water for a 15Cm x20Cm radiation field size at the depth of 10Cm. Surface doses without and with virtual or physical wedges were measured using a parallel plate ion chamber at surface. Field size was15Cmx20Cm and a polystyrene phantom was used. RESULT: For various field sizes, virtual and physical wedge factors were changed by maximum 2.1%and 3.9%, respectively. For various depths, virtual and physical wedge factors were changed by maximum 1.9% and 2.9%, respectively. No major difference was found between the virtual and physical wedge angles and the difference was within 0.5 degrees. Surface dose with physical wedge was reduced by maximum 20% (x-ray beam : 6 MV, Wedge angle: 45 degrees, SSD; 80 Cm) relative to one with virtual wedge or without wedge. CONCLUSION: comparison of the characteristics of Siemens virtual wedge device with physical wedges was performed.Depth dependence of virtual wedge factor was smaller than of physical wedge factor. Virtual and physical wedge factors were nearly independent of field size. The accuracy of virtual and physical wedge angles was excellent. Surface dose was found to be reduced using physical wedge.

Fractionated Stereotactic Radiation Therapy for Intracranial Malignant Tumor: Preliminary Results of Clinical Application / 대한암학회지

PURPOSE: Fractionated stereotactic radiation therapy(FSRT) is a new modality that combines the accurate focal dose delivery of stereotactic radiosurgery with the biological advantages of conventional radiotherapy. We report our early experience using FSRT for intracranial malignant tumor. MATERIALS AND METHODS: Between October 1995 and December 1996, 16 patients(9 males and 7 females aged between 10~64 years) with central nerve system malignancy were treated using FSRT. Sixteen patients had the following diagnosis: 6 high-grade gliomas, 1 pineoblastoma, 4 germinomas, 2 medulloblastomas, and 3 solitary brain metastases. Using the Gill-Thomas-Cosman relocatable head frame and multiple non-coplanar therapy, the daily dose of 2 Gy(3 Gy in metastasis) was irradiated at 85~100% isodose surface. RESULTS: Although the follow-up period is relatively short(range; 2~18 months), post- treatment clinical courses in 16 patients have been consistent with changes similar to those found after conventional radiation therapy. No significant adverse effects were observed in our neurological and radiological studies. Four out of 5 patients with high grade glioma died from progressive disease, surviving from 7 to 17 months(median 14 months), but patients with pineoblastoma, germinoma and medulloblastoma showed no evidence of recurrence. All patients with metastasis obtained a neurologic response, but two among them died with extracranial progression and one die from multiple intracranial metastasis.In overall patient setup with scalp measurements, reproducibility was found to have mean of 1.1+/-0.6 mm from the baseline reading. CONCLUSION: FSRT and relocatable stereotactic head frames were well tolerated with minimal transient acute side effects. Subacute or late complications were not observed, because the follow-up period was short. We expect that FSRT might be a good indication for; recurrent disease with previous radiation therapy history, tumors of relatively large volume, lesions adjacent to radiosensitive organs, and as a boost, following conventional radiation therapy.

Fractionated Stereotactic Radiation Therapy for Intracranial Benign Tumor: Preliminary Results of Clinical Application / 대한방사선종양학회지

PURPOSE: With the development of stereotactic immobilization systems capable of reliable serial repositioning, fractionated stereotactic radiation therapy (FSRT) offers the potential for an improved treatment outcome by excellent dose delivery, and dose distribution characteristics with the favorable radiobiological properties of fractionated irradiation. We describe our initial experience using FSRT for the treatment of intracranial benign tumor. MATERIALS AND METHODS: Between August 1995 and December 1996, 15 patients (7 males and 8 females aged 6-70 years) were treated with FSRT. The patients had the following diagnosis : pituitary adenoma (10) including one patient who previously had received radiotherapy, craniopharyngioma (2), acoustic neurinoma (1), meningioma (2). Using the Gill-Thomas-Cosman relocatable head frame and multiple non-coplanar therapy, the daily dose of 2Gy was irradiated at 90% to 100% isodose surface of the isocenter. The collimator sizes ranged from 26mm to 70mm. RESULTS: In all patients except one follow-up lost, disease was well- controlled. Acute complication was negligible and no patient experienced cranial nerve neuropathies and radiation necrosis. In overall patient setup with scalp measurements, reproducibility was found to have mean of 1.1+/-0.6mm from the baseline reading. CONCLUSION: Relocatable stereotactic system for FSRT is highly reproducible and comfortable. Although the follow-up period was relatively short, FSRT is considered to be a safe and effective radiation technique as the treatment of intracranial tumor. But the fractionation schedule (fraction size, overall treatment time and total dose) still remains to be solved by further clinical trials.

Excellent Local Tumor Response after Fractionated Stereotactic Radiation Therapy for Locally Recurrent Nasopharynx Cancer / 대한치료방사선과학회지

PURPOSE: This study is to report experience with Fractionated Stereotactic Radiation Therapy (FSRT) for locally recurrent nasopharynx cancer after curative conventional radiation therapy. MATERIALS AND METHODS: Three patients with locally recurrent and symptomatic nasopharynx cancer were given FSRT as reirradiation method between the period of September of 1995 and August of 1996. For two patients, application of FSRT is their third radiation therapy directed to the nasopharynx. Two patients were given low dose chemotherapy as radiation sensitizer concurrently with FSRT. Authors used 3-dimensional coordinate system by individually made, relocatable Gill-Thomas-Cosman (GTC) stereotactic frame and multiple non-coplanar arc therapy dose planning was done using XKnife-3. Total of 45 Gy/18 fractions or 50 Gy/20 fractions were given. RESULTS: Authors observed satisfactory symptomatic improvement and remarkable objective tumor size decrease by follow-up MR images taken 1 month post-FSRT in all three patients, while no neurologic side effect attributable to reirradiation was noticed. Two died at 7 and 9 months with loco-regional and distant seeding outside FSRT field, while one patient is living for 4 month. CONCLUSION: Authors experienced satisfactory therapeutic effectiveness and safety of FSRT as reirradiation method for locally recurrent nasopharynx cancer. Development of more effective systemic chemotherapeutic regimen is desired for distant metastasis.

Minimization of Small Bowel Volume within Treatment Fields Using Customized Small Bowel Displacement System (SBDS) / 대한치료방사선과학회지

PURPOSE: Authors designed a customized Small Bowel Displacement System (SBDS) to displace the small bowel from the pelvic radiation fields and minimize treatment-related bowel morbidities. METHODS AND MATERIALS: From August 1995 to May 1996, 55 consecutive patients who received pelvic radiation therapy with the SBDS were included in this study. The SBDS consists of a customized styrofoam compression device which can displace the small bowel from the radiation fields and an individualized immobilization abdominal board for easy daily setup in prone position. After opacifying the small bowel with Barium , the patients were laid prone and posterior-anterior (PA) and lateral (LAT) simulation films were taken with and without the SBDS. The areas of the small bowel included in the radiation fields with and without the SBDS were compared. RESULTS: Using the SBDS, the mean small bowel area was reduced by 59% on PA and 51% on LAT films (P=0.0001). In six patients (6/55, 11%), it was possible that no small bowel was included within the treatment fields. The mean upward displacement of the most caudal small bowel was 4.8 cm using the SBDS. Only 15% (8/55) of patients treated with the SBDS manifested diarrhea requiring medication. CONCLUSION: The SBDS is a novel method that can be used to displace the small bowel away from the treatment portal effectively and reduce the radiation therapy morbidities. Compliance with setup is excellent when the SBDS is used.

Short-term Results of Endobronchial Brachytherapy for Malignant Airway Obstructions / 대한치료방사선과학회지

PURPOSE: Respiratory symptoms related with malignant airway disease have been the main causes of lowered quality of life and also sometimes may be life-threatening if not properly amanged. He authors report the short-term experiences of endobronchial brachytherapy for symptomatic malignant airway obstruction using high dose rate after-loading brachytherapy unit. MATERIALS AND METHODS: Twenty-five patients with symptomatic malignant airway obstruction were treated with endobronchial brachytherapy between the period of December 1994 and March 1996 at Department of Radiation Oncology of Samsung Medical Center. Twenty-one(84%) were patients with non-small cell lung cancer, three with tracheal malignancies, and one with recurrence of esophageal cancer. Twenty patients were given elective external beam radiation therapy, while six were given endobronchial laser evaporation therapy on emergency bases in addition to endobronchial brachytherapy. Three procedures for each patients were planned and total of 70 procedures were completed. RESULTS: Improvement rates of major respiratory symptoms after endobronchial brachytherapy procedures were 88%(22/25), 96%(22/23)m 100%(15/15), and 100%(9/9) for cough, dyspnea, hemoptysis and obstructive pneumonia, respectively. ECOG Performance scores were improved in 56% of total patients group, while there was no case with worsened ECOG score. Fifteen patients died and the median interval from the start of treatment to death was 4 months (range : 1~17 months), while that of ten survivors was 9 months (range:5~19 months). There were five patients with controlled intrathoracic disease, who have survived over one year. All deaths were associated with uncontrolled local and/or distant disease. Four patients died of massive fatal hemoptysis, three of who received emergency endobrronchial laser evaporation therapy before the start of endobronchial brachytherapy. CONCLUSION: Endobronchial brachytherapy has been confirmed as an excellent palliative treatment modality improving respiratory symptoms as well as patients' general performance status. Based on the current observations, use of endobronchial brachytherapy in curative setting as a boost technique may be warranted.