Survey of the Patterns of Using Stereotactic Ablative Radiotherapy for Early-Stage Non-small Cell Lung Cancer in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Stereotactic ablative radiotherapy (SABR) is an effective emerging technique for early-stage non-small cell lung cancer (NSCLC). We investigated the current practice of SABR for early-stage NSCLC in Korea. MATERIALS AND METHODS: We conducted a nationwide survey of SABR for NSCLC by sending e-mails to all board-certified members of the Korean Society for Radiation Oncology. The survey included 23 questions focusing on the technical aspects of SABR and 18 questions seeking the participants' opinions on specific clinical scenarios in the use of SABR for early-stage NSCLC. Overall, 79 radiation oncologists at 61/85 specialist hospitals in Korea (71.8%) responded to the survey. RESULTS: SABR was used at 33 institutions (54%) to treat NSCLC. Regarding technical aspects, the most common planning methods were the rotational intensity-modulated technique (59%) and the static intensity-modulated technique (49%). Respiratory motion was managed by gating (54%) or abdominal compression (51%), and 86% of the planning scans were obtained using 4-dimensional computed tomography. In the clinical scenarios, the most commonly chosen fractionation schedule for peripherally located T1 NSCLC was 60 Gy in four fractions. For centrally located tumors and T2 NSCLC, the oncologists tended to avoid SABR for radiotherapy, and extended the fractionation schedule. CONCLUSION: The results of our survey indicated that SABR is increasingly being used to treat NSCLC in Korea. However, there were wide variations in the technical protocols and fractionation schedules of SABR for early-stage NSCLC among institutions. Standardization of SABR is necessary before implementing nationwide, multicenter, randomized studies.

Multiple Myeloma with Biclonal Gammopathy Accompanied by Prostate Cancer / 대한진단검사의학회지

We report a rare case of multiple myeloma with biclonal gammopathy (IgG kappa and IgA lambda type) in a 58-year-old man with prostate cancer who presented with lower back pain. Through computed tomography (CT) imaging, an osteolytic lesion at the L3 vertebra and an enhancing lesion of the prostate gland with multiple lymphadenopathies were found. In the whole body positron emission tomography-computed tomography (PET-CT), an additional osteoblastic bone lesion was found in the left ischial bone. A prostate biopsy was performed, and adenocarcinoma was confirmed. Decompression surgery of the L3 vertebra was conducted, and the pathologic result indicated that the lesion was a plasma cell neoplasm. Immunofixation electrophoresis showed the presence of biclonal gammopathy (IgG kappa and IgA lambda). Bone marrow plasma cells (CD138 positive cells) comprised 7.2% of nucleated cells and showed kappa positivity. We started radiation therapy for the L3 vertebra lesion, with a total dose of 3,940 cGy, and androgen deprivation therapy as treatment for the prostate cancer.

Quality Assurance of Intensity Modulated Radiation Therapy: Site-Specific Results of Eulji University Hospital / 대한방사선종양학회지

PURPOSE: To analyze our quality assurance (QA) data for intensity modulated radiation therapy (IMRT) according to treatment site and to possibly improve QA for IMRT in Hospital. MATERIALS AND METHODS: We performed QA on 50 patients (head and neck, 28 patients; Breast, 14 patients; Pelvis, 8 patients) for IMRT. The calculated dose from RTP was compared with the measured value film, gamma index, and ionization chamber for dose measurement in each case. RESULTS: The point dose measurement results in 45 of 50 patients showed good agreement with the calculation dose (+/-3%). The largest error measured thus far has been 3.60%, with a mean of only -0.17% (SD, 2.25%). Each treatment site showed an error rate of -0.13% (SD, 1.93%) for head and neck cases, -0.26% (SD, 2.79%) for breast cases, and -0.24% (SD, 2.44%) for pelvis cases. The gamma index verified with the error rate of head and neck cases (6%), breast (10%), and pelvis (6%), which corresponded to a tolerance of 3 mm (3% for the head and neck, 2%, for the breast 1% for the pelvis, and 0% in the region where the isodose curve was greater than 90%. CONCLUSION: We recognize the cause of errors for each treatment site of IMRT QA and so we maximize our efforts to reduce error and increase accuracy.

A Comprehensive Dosimetric Analysis of Inverse Planned Intensity Modulated Radiation Therapy and Multistatic Fields Technique for Left Breast Radiotherapy / 대한방사선종양학회지

PURPOSE: This aim of this study is to analyze the dosimetric difference between intensity-modulated radiation therapy (IMRT) using 3 or 5 beams and MSF in the radiotherapy of the left breast. MATERIALS AND METHODS: We performed a comparative analysis of two radiotherapy modalities that can achieve improved dose homogeneity. First is the multistatic fields technique that simultaneously uses both major and minor irradiation fields. The other is IMRT, which employs 3 or 5 beams using a fixed multileaf collimator. We designed treatment plans for 16 early left breast cancer patients who had taken breast conservation surgery and radiotherapy, and analyzed them from a dosimetric standpoint. RESULTS: For the mean values of V95 and dose homogeneity index, no statistically significant difference was observed among the three therapies. Extreme hot spots receiving over 110% of the prescribed dose were not found in any of the three methods. A Tukey test performed on IMRT showed a significantly larger increase in exposure dose to the ipsilateral lung and heart than multistatic fields technique (MSF) in the low-dose area, but in the high-dose area, MSF showed a slight increase. CONCLUSION: In order to improve dose homogeneity, the application of MSF, which can be easily planned and applied more widely, is considered an optimal alternative to IMRT for radiotherapy of early left breast cancer.

A Case of Synchronous Double Primary Cancer of the Penis and Urinary Bladder / Journal of the Korean Cancer Association, 대한암학회지

Multiple primary cancers are the occurrence of more than two cancers of different origin in an individual. Penile cancer is a rare disease, and finding it combined with other cancers is even rarer. A 64-year-old man with a painful penile mass was referred to us from a primary urological clinic. We performed a biopsy of the penile mass and the histology revealed a well-differentiated squamous cell carcinoma. Abdominal computed tomography showed a localized bladder tumor with inguinal lymphadenopathy. The patient underwent a partial penectomy, transurethral resection of the bladder tumor and inguinal lymph node dissection. The histology of the bladder tumor was high-grade papillary carcinoma, and that of the lymph node was squamous cell carcinoma. The penile and bladder tumors were in stage II (T1N1M0) and stage I (T1N0M0), respectively. We successfully treated the patient with adjuvant radiotherapy and systemic chemotherapy.

The Modulation of Radiosensitivity by Combined Treatment of Selective COX-2 Inhibitor, NS 398 and EGF Receptor Blocker AG 1478 in HeLa Cell Line / 대한방사선종양학회지

PURPOSE: Selective inhibition of multiple molecular targets may improve the antitumor activity of radiation. Two specific inhibitors of selective cyclooxygenase-2 (COX-2) and epidermal growth factor receptor (EGFR) were combined with radiation on the HeLa cell line. To investigate cooperative mechanism with selective COX-2 inhibitor and EGFR blocker, in vitro experiments were done. MATERIASL AND METHODS: Antitumor effect was obtained by growth inhibition and apoptosis analysis by annexin V-Flous method. Radiation modulation effects were determined by the clonogenic cell survival assay. Surviving fractions at 2 Gy (SF2) and dose enhancement ratio at a surviving fraction of 0.25 were evaluated. To investigate the mechanism of the modulation of radiosensitivity, the cell cycle analyses were done by flow cytometry. The bcl-2 and bax expressions were analyzed by western blot. RESULTS: A cooperative effect were observed on the apoptosis of the HeLa cell line when combination of the two drugs, AG 1478 and NS 398 with radiation at the lowest doses, apoptosis of 22.70% compare with combination of the one drug with radiation, apoptosis of 8.49 %. In cell cycle analysis, accumulation of cell on G0/G1 phase and decrement of S phase fraction was observed from 24 hours to 72 hours after treatment with radiation, AG 1478 and NS 398. The combination of NS 398 and AG 1478 enhanced radiosensitivity in a concentration-dependent manner in HeLa cells with dose enhancement ratios of 3.00 and SF2 of 0.12 but the combination of one drug with radiation was not enhanced radiosensitivity with dose enhancement ratios of 1.12 and SF2 of 0.68 (p=0.005). The expression levels of bcl-2 and bax were reduced when combined with AG 1478 and NS 398. CONCLUSION: Our results indicate that the selective COX-2 inhibitor and EGFR blocker combined with radiation have potential additive or cooperative effects on radiation treatment and may act through various mechanisms including direct inhibition of tumor cell proliferation, suppression of tumor cell cycle progression and inhibition of anti-apoptotic proteins.

Signal Transduction Factors on the Modulation of Radiosusceptibility in K562 Cells / 대한방사선종양학회지

PURPOSE: The human chronic myelogenous leukemia cell line, K562, expresses the chimeric bcr-abl oncoprotein, whose deregulated protein tyrosine kinase activity antagonizes the induction of apoptosis via DNA damaging agents. Previous experiments have shown that nanomolar concentrations of herbimycin A (HMA) coupled with X-irradiation have a synergistic effect in inducing apoptosis in the Ph-positive K562 leukemia cell line, but genistein, a PTK inhibitor, is non selective for the radiation-induced apoptosis of p210bcr/abl protected K562 cells. In these experiments, the cytoplasmic signal transduction pathways, the induction of a number of transcription factors and the differential gene expression in this model were investigated. MATERIALS AND METHODS: K562 cells in the exponential growth phase were used in this study. The cells were irradiated with 0.5-12 Gy, using a 6 MeV Linac (Clinac 1800, Varian, USA). Immediately after irradiation, the cells were treated with 0.25 microM of HMA and 25 microM of genistein, and the expressions and the activities of abl kinase, MAPK family, NF-kB, c-fos, c-myc, and thymidine kinase1 (TK1) were examined. The differential gene expressions induced by PTK inhibitors were also investigated. RESULTS: The modulating effects of herbimycin A and genistein on the radiosensitivity of K562 cells were not related to the bcr-abl kinase activity. The signaling responses through the MAPK family of proteins, were not involved either. In association with the radiation-induced apoptosis, which is accelerated by HMA, the expression of c-myc was increased. The combined treatment of genistein, with irradiation, enhanced NF-kB activity and the TK1 expression and activity. CONCLUSION: The effects of HMA and genistein on the radiosensitivity of the K562 cells were not related to the bcr-abl kinase activity. In this study, another signaling pathway, besides the MAPK family responses to radiation to K562 cells, was found. Further evaluation using this model will provide valuable information for the optional radiosensitization or radioprotection.

Regulatory Mechanism of Radiation-induced Cancer Cell Death by the Change of Cell Cycle / 대한방사선종양학회지

PURPOSE: In our previous study, we have shown the main cell death pattern induced by irradiation or protein tyrosine kinase (PTK) inhibitors in K562 human myelogenous leukemic cell line. Death of the cells treated with irradiation alone was characterized by mitotic catastrophe and typical radiation-induced apoptosis was accelerated by herbimycin A (HMA). Both types of cell death were inhibited by genistein. In this study, we investigated the effects of HMA and genistein on cell cycle regulation and its correlation with the alterations of radiation-induced cell death. MATERIALS AND METHODS: K562 cells in exponential growth phase were used for this study. The cells were irradiated with 10 Gy using 6 MeV Linac (200-300 cGy/min). Immediately after irradiation, cells were treated with 250 nM of HMA or 25 microM of genistein. The distributions of cell cycle, the expressions of cell cycle-related protein, the activities of cyclin-dependent kinase, and the yield of senescence and differentiation were analyzed. RESULTS: X-irradiated cells were arrested in the G2 phase of the cell cycle but unlike the p53-positive cells, they were not able to sustain the cell cycle arrest. An accumulation of cells in G2 phase of first cell-cycle post-treatment and an increase of cyclin B1 were correlated with spontaneous, premature, chromosome condensation and mitotic catastrophe. HMA induced rapid G2 checkpoint abrogation and concomitant p53-independent G1 accumulation. HMA-induced cell cycle modifications correlated with the increase of cdc2 kinase activity, the decrease of the expressions of cyclins E and A and of CDK2 kinase activity, and the enhancement of radiation-induced apoptosis. Genistein maintained cells that were arrested in the G2-phase, decreased the expressions of cyclin B1 and cdc25C and cdc2 kinase activity, increased the expression of p16, and sustained senescence and megakaryocytic differentiation. CONCLUSION: The effects of HMA and genistein on the radiation-induced cell death of K562 cells were closely related to the cell cycle regulatory activities. In this study, we present a unique and reproducible model in which for investigating the mechanisms of various, radiation-induced, cancer cell death patterns. Further evaluation by using this model will provide a potent target for a new strategy of radiotherapy.

A study for time sequential expression of IL-1 alphaand IL-6 after irradiation on rat lung / 대한내과학회지

BACKGROUND: One of the limitation during the irradiation of malignant tumor is hazard to normal tissue although it is important and effective tool for treating malignant tumor. We studied the role of interleukin-1 alpha (IL-1alpha) and interleukin-6 (IL-6) in the radiation-induced lung injury especially on fibrosis. METHODS: We irradiated right-side lungs of thirty Sprague-Dawley rats with single fraction of 20 Gy and then sacrificed the animals until 20th week at intervals of two weeks. Both irradiated and unirradiated lung tissues were stained hematoxilin and eosin, Masson trichrome, reticulin and immunohistochemical staining for IL-1alpha and IL-6. The degree of the staining for IL-1alpha and IL-6 were examined semiquantitatively. RESULTS: Two weeks after irradiation interstitial edema and capillary congestion appeared, followed by increase of the monocytes infiltration and proteinaceous material during 4th and 8th week. After eight weeks of irradiation, collagen and reticulin fibers were detected along alveolar wall. 12th to 20th week, fibrosis in interstitium, decreased number of alveoli and thickening of bronchial wall were observed. The degree of immunohistochemical staining for IL-1alpha and IL-6 was increased rapidly during the first three week and then decreased slowly, but remain incresed until 20th week. CONCLUSION: Our Study demonstrate the early and persistent elevation of cytokines IL-1alpha and IL-6 by immunohistochemical stain in rat lung following pulmonary irradiation. We think cytokines are produced immediately after irradiation, make collagen genes turn on and perisist until the expression of late effects become apparent pathologically and clinically.

Combined Modality Therapy with Selective Bladder Preservation for Muscle Invading Bladder Cancer / 대한방사선종양학회지

PURPOSE: To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. METHOD AND MATERIALS: From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by 39.6~45 Gy pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. RESULT: The patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients (81%) successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients (58%) were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were 80% and 14%, respectively (p=0.001). CONCLUSION: In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

The Measurements of Plasma Cytokines in Radiation-induced Pneumonitis in Lung Cancer Patients / 대한방사선종양학회지

PURPOSE: To investigate whether changes in plasma concentrations of transforming growth factor-beta1 (TGF-beta1), tumor necrosis factor-alpha (TNF-alpha) and interleukin-6 (IL-6) could be used to identify the development of radiation-induced pneumonitis in the lung cancer patients. METHODS AND MATERIALS: Seventeen patients with lung cancer (11 NSCLC, 6 SCLC) were enrolled in a prospective study designed to evaluate clinical and molecular biologic correlation of radiation-induced pneumonitis. The study began in May 1998 and completed in July 1999. All patients were treated with radiotherapy with curative intent : 1.8 Gy per day, 5 fractions per week. Serial measurements of plasma TGF-beta1, TNF-alpha and IL-6 were obtained in all patients before, weekly during radiotherapy and at each follow-up visits after completion of treatment. These measurements were quantified using enzyme linked immunosorbent assay (ELISA). All patients were evaluated for signs and symptoms of pneumonitis at each follow-up visit after completion of radiotherapy. High resolution CT (HRCT) scans were obtained when signs and symptoms of pneumonitis were developed after completion of radiotherapy. RESULTS: Thirteen patients eventually developed signs and symptoms of clinical pneumonitis while four patients did not. TGF-beta1 levels were elevated in all 13 patients with pneumonitis, which showed characteristic pattern of elevation (38.45 ng/ml at pretreatment, 13.66 ng/ml during radiotherapy, then 60.63 ng/ml at 2-4 weeks after completion of radiotherapy). The levels of TNF-alpha and IL-6 were also elevated in the group of patients who developed pneumonitis but the pattern was not characteristic. CONCLUSIONS: Changes in plasma TGFbeta-1 levels before, during and after radiotherapy appears to be a useful means by which to identify patients at risk for the development of symptomatic pneumonitis. Other cytokines like TNF-alpha and IL-6 shows no meaningful changes in association with radiation pneumonitis.

Combined Effect of Radiation and Tyrphostin AG 1478 in Human Cervical Cancer Cell Lines / 대한산부인과학회잡지

OBJECTIVE: We studied the possibility that addition of Tyrphostin AG 1478 which is selective epidermal growth factor inhibitor, would enhance the effect of radiation on human cervical cancer cell lines, HeLa and CaSki. METHODS: Tyrphostin was added to the cells which were irradiated. The ratio of dead cells was estimated by trypan blue dye examination, and survived cell fractions were estimated by clonogenic assays. The presence and degree of apoptosis were examined by DNA electrophoresis and nuclear dye using propium iodide. RESULTS: The growth was completely inhibited in both cell lines, but the addition of tyrphostin resulted in different effects on the radiation induced cell death and apoptosis in each cell line. However, the percentage of dead cells and apoptotic cells was decreased in HeLa cell line compared with CaSki cell line. The ultimate survived cell fractions determined by clonogenic assays were decreased in both cell lines and the size of colony was also decreased. CONCLUSION: These data suggest that the addition of Tyrphostin is able to increase the radiotherapeutic effects on human cervical cancer cells, and this synergistic effect may result from effective blocking of radiation-induced accelerated repopulation of cancer cells by tyrphostin.

The Results of Hyperfractionated Radiotherapy on Locally Advanced Non-Small Cell Lung Cancer / 대한방사선종양학회지

PURPOSE: The effect of hyperfractionated radiotherapy on locally advanced non-small lung cancer was studied by a retrospective analysis. MATERIALS AND METHODS: We analyzed sixty one patients of biopsy-confirmed, IIIA and IIIB non-small cell lung cancer. Using the ECOG performance scale, all the patients were scored less than 2. They were treated by curative hyperfractionated radiotherapy alone from Oct. 1992 to Oct. 1995 at the Department of Radiation Oncology. All the patients received 120cGy b.i.d with more than 6 hours interval between each fraction. The total dose of radiation was reached up to 6400-7080 cGy with a mean dose of 6934 cGy. The results were analyzed retrospectively. RESULTS: The overall survival rate was 53.1% in 1 year, 9.9% in 2 years with a median survival time (MST) of 13.9 months. The progression free survival (PFS) rate was 37.0% in 1 year, 8.9% in 2 years. Twenty two patients were classified as complete responders to this treatment and their MST was 19.5 months. When this was compared with that of partial responders (MST: 11.7months), it was statistically significant (p=0.0003). Twenty nine patients of stage IIIA showed a better overall survival rate (1yr 63.3%, 2yr 16.8%) than IIIB patients (1yr 43.3%, 2yr 3.6%), which was also statistically signifcant (p=0.003). Patients with adenocarcinoma showed a better survival rate (1yr 64.3%, 2yr 21.4%) than that of squamous cell counterpart (1yr 49.4%, 2yr 7.4%), although this was not significant statistically (p=0.61). Two patients developed fatal radiation-induced pneumonia right after the completion of the treatment which progressed rapidly and they all died within 2 months. One patient developed radiation-induced fibrosis after 13 months. He refused further treatment and died soon after the development of fibrosis. CONCLUSION: Among locally advanced NSCLC, hyperfractionated radiotherapy was effective on stage IIIA patients by increasing MST with acceptable toxicities. Acute radiation-induced pneumonia should be carefully monitored and must be avoided during or after this treatment.

Effect of Pelvic Irradiation on the Bone Mineral Content of Lumbar Spine in Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate the loss of bone mineral contents(BMC) in lumbar spine within the radiation field for cervical cancer treatment, BMC in the irradiated patient group was compared with that of a normal control group. METHOD AND MATERIALS: Measurements of BMC in the trabecular bone in lumbar spines(L3-L5) were performed in the both patient and normal control groups. Investigators used dual-energy quantitative computerized tomography(DEQCT) using photon energy of 120 and 80kVp. The numbers of patient and control groups were 43 in each with age distribution of fifth to seventh decade of women. The numbers of control group were 22 in fifth, 10 in sixth, and 11 in seventh decade, those of patient group were 14 in fifth, 14 in sixth, and 15 in seventh decade of women. The radiation field was extended to L5 spine for pelvic irrdiation with 45-54Gy of external radiation dose and 30Gy of high dose rate brachytherapy in cervical cancer. RESULTS: The BMC is decreased as increasing age in both control and patient groups. BMC in lumbar spine of patient group was decreased by about 13% to 40% maximally. The BMC of L3 and L4 a region that is out of a radiation field for the patient group demonstrated 119.5+/-30.6, 117.0+/-31.7 for fifth, 83.3+/-37.8, 88.3+/-46.8 for sixth and 61.5+/-18.3, 56.2+/-26.6mg/cc for seventh. Contrasted by the normal control group has shown 148.0 +/-19.9, 153.2+/-23.2 for fifth, 96.1+/-30.2, 105.6+/-26.5 for sixth and 73.9+/-27.9, 77.2+/-27.2mg/cc for seventh decade, respectively. The BMC of patient group was decreased as near the radiation field, while the lower lumbar spine has shown more large amounts of BMC in the normal control group. In particular, the BMC of L5 within the radiation field was significantly decresed to 33%, 31%, 40% compared with the control group of the fifth, sixth and seventh decades, respectively. CONCLUSION: The pelvic irradiation in cervical cancer has much effected on the loss of bone mineral content of lumbar spine within the radiation field, as the lower lumbar spine has shown a smaller BMC in patient group with pelvic irradiation in contrast to that of the normal control groups.

Hydroxyurea with Radiation Therapy of the Carcinoma of the Cervix IIA, IIB / 대한치료방사선과학회지

PURPOSE: To evaluate the efficacy of hydroxyurea with radiation in carcinoma of the cervix, huge exophytic or endophytic stage IIa and Iib. MATERIALS AND METHODS: Sixty four patients with carcinoma of the cervix stage IIA(29 patients) with exophytic(> or =3cm in diameter) or huge endophytic mass and IIB(35 patients) treated with radiation and hydroxyurea at the Department of Radiation Oncology, Dongsan Hospital, Keimyung University, School of Medicine from Aug, 1989 to May, 1991. The maximum and mean follow up durations were 68 and 57 months respectively. The radiation therapy consisted of external irradiation to the whole pelvis(3600-5400cGy) shield (4X10 cm), and combined with intracavitary irradiation (3000-3500cGy to point A). Hydroxyurea was to be taken in a single oral dose of 1.0gm/day during radiation therapy. RESULTS: The control rate was 89.1%. The actuarial overall five year survival rate was 78.8% for stage IIA and 72.8% for stage IIB. The overall recurrence rate was 25%(16/64). Twenty-three percent of the patients developed or greater thrombocytopenia. Grade 3 or greater GI, GU complication and anemia were not noted. There was no treatment related death noted. CONCLUSION: We considered that hydroxyurea and radiation therapy may improve survival rate in huge exophytic and endophytic stage IIa cervical carcinoma with acceptible morbidity.