Preliminary application of MR-Linac in breast cancer radiotherapy in a single academic center / 中华放射肿瘤学杂志

Objective:To describe a prospective study of pre-operative tumor-bed boost performed at the 1.5 T MR-Linac in combination with adjuvant whole breast irradiation, and a first case, with an accentuation on clinical feasibility and safety.Methods:A phase II, single arm study recruiting early stage patients follows a paradigm that first boosts the tumor bed and then undergoes breast conservative surgery in 2 weeks, and last irradiates the whole breast in 6 weeks. The primary endpoint is ≥ grade 2 acute breast toxicity. A 43 years old patient affected by a breast carcinoma, not special type of the right-sided lateral quadrant, staged cT 2N 0M 0, was planned and treated. The dose, 8 Gy for one time, was calculated by Monaco on CT simulation images. Both the air electron stream effect (ESE) and the electron return effect (ERE) at the presence of 1.5 T magnetic field were evaluated. During the pre-treatment evaluation, we carried out adaptation-to-position adjustment. Results:The normal organ dosimetry is within toleration. The Dmax to the skin, the chin and the right upper arm was 8.44 Gy, 28.5 cGy and 17.8 cGy, respectively. There was no increased toxicity from ERE and ESE, and the treatment was well tolerated without > grade 1 acute toxicity. The patient received breast conservative surgery on day 7 without delayed wound healing.Conclusions:This is the first case successfully treated within a clinical trial by pre-operative tumor-bed boost under 1.5 T MR-Linac in our institution. More participants are needed to validate and optimize the paradigm.

Research progress in the preoperative radiotherapy and immunotherapy for primary liver cancer / 中华放射医学与防护杂志

Liver cancer is one of the most common cancers in China. In recent years, liver cancer tends to be treated with comprehensive therapies, including surgery, ablation, interventional embolization, radiotherapy, chemotherapy, targeted therapy, immunotherapy, and liver transplantation. At present, the low surgical resectionrate is one of the main factors affecting the prognosis of liver cancer patients. Preoperative neoadjuvant therapy or conversion therapy for liver cancer can maximize the rate of surgical resection and improve the prognosis. With the rapid development of radiotherapy and immunotherapy in the comprehensive treatment of liver cancer, it has been gradually confirmed that the unique effects of preoperative radiotherapy and immune therapy for liver cancer can improve the prognosis of the patients. Therefore, this paper reviewed the research progress in the preoperative radiotherapy and immunotherapy for liver cancer by searching relevant literature and reports at home and abroad.

Sequential simulation computed tomography allows assessment of internal rectal movements during preoperative chemoradiotherapy in rectal cancer

Purposes: The purpose of this study was to assess the internal rectal movement and to determine the factors related to extensive internal rectal movement using sequential simulation computed tomography (CT) images. Materials and Methods: From 2010 to 2015, 96 patients receiving long-course preoperative chemoradiotherapy were included in our retrospective study. The initial simulation CT (Isim-CT) and follow-up simulation CT (Fsim-CT) for a boost were registered according to the isocenters and bony structure. The rectums on Isim-CT and Fsim-CT were compared on four different axial planes as follows: (1) lower pubis symphysis (AXVERYLOW), (2) upper pubis symphysis (AXLOW), (3) superior rectum (AXHIGH), and (4) middle of AXLOW and AXHIGH (AXMID). The involved rectum in the planning target volume was evaluated. The maximal radial distances (MRD), the necessary radius from the end of Isim-CT rectum to cover entire Fsim-CT rectum, and the common area rate (CAR) of the rectum (CAR, (Isim-CT∩Fsim-CT)/(Isim-CT)) were measured. Linear regression tests for the MRDs and logistic regression tests for the CARs were conducted. Results: The mean ± standard deviation (mm) of MRDs and CAR <80% for AXVERYLOW, AXLOW, AXMID, and AXHIGH were 2.3 ± 2.5 and 8.9%, 3.0 ± 3.7 and 17.4%, 4.0 ± 5.2 and 27.1%, and 4.1 ± 5.2 and 25%, respectively. For MRDs and CARs, a higher axial level (AXVERYLOW/AXMID-HIGH, P = 0.018 and P = 0.034, respectively), larger bladder volume (P = 0.054 and P = 0.017, respectively), smaller bowel gas extent (small/marked, P = 0.014 and P = 0.001, respectively), and increased bowel gas change (decrease/increase, both P < 0.001) in rectum were associated with extensive internal rectal movement in multivariate analyses. Conclusions: As a result of following internal rectal movement through sequential simulation CT, the rectum above the pubis symphysis needs a larger margin, and bladder volume and bowel gas should be closely observed.

Patterns of Rectal Cancer Radiotherapy Adopting Evidence-Based Medicine: An Analysis of the National Database from 2005 to 2016 / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Not many studies have evaluated the adoption and dissemination of evidence-based medicine in rectal cancer radiotherapy (RT). We aimed to analyze the differences by institutional characteristics and geography in adopting evidence-based care for rectal cancer RT and factors affecting the adoption in Korea. MATERIALS AND METHODS: Korean National Health Insurance Service claims database was used. All rectal cancer patients treated with radical surgery and adjuvant RT at the same institution in 2005-2016 were included in this study. RT within 3 months before and after surgery was regarded as preoperative and postoperative RT, respectively. RESULTS: A total of 16,827 patients treated in 83 institutions were included in the analysis. The use of preoperative RT has substantially increased over time, from 40.6% in 2005 to 84.2% in 2016 all over the nation. The proportion of preoperative RT (54.8%) exceeded that of postoperative RT (45.2%) in 2006. However, a wide range of institutional and regional variation was observed. Compared to high-volume institutions, low-volume institutions showed late adoption and variable dissemination patterns of preoperative RT. Busan–Ulsan–Gyeongsangnam-do and Gangwon-do showed slower adoption and less use of preoperative RT than other region. CONCLUSION: We demonstrated gradual and steady increase in adoption of preoperative RT in rectal cancer treatment nationally from 2005 to 2016. Institutional variations between high- and low-volume institutions were observed.

Motion of gastroesophageal junction adenocarcinoma during preoperative radiotherapy / 中华放射肿瘤学杂志

Objective To evaluate the range of motion of gastroesophageal junction (GEJ) adenocarcinoma during preoperative radiotherapy.Methods Fourteen consecutive patients who received preoperative chemoradiotherapy for GEJ adenocarcinoma were included in this study.Fiducial markers were placed on the upper and lower edges of and around the primary tumor under a gastroscope.Eight patients underwent four-dimensional computed tomography to obtain 98 intrafractional images containing 8 fiducial markers at the GEJ.Twelve patients underwent cone-beam computed tomography at the 1 st to 5th,7th,12th,17th,and 22nd courses of radiotherapy to obtain 90 interfractional images.The paired t test was used for difference analysis.Results The intrafractional tumor displacements in left-right (LR),ventro-dorsal (VD),and cranio-caudal (CC) directions were 0.92±0.95 mm,2.27±2.73 mm,and 9.95±5.48 mm,respectively;the motion in CC direction was larger than that in LR or VD direction (P=0.000 or P=0.000);the motion in VD direction was larger than that in LR direction (P=0.000).The interfractional tumor displacements in LR,VD,and CC were 6.56±4.19 mm,5.69±3.29 mm,and 6.49±4.37 mm,respectively;the motion in LR or CC direction was larger than that in VD direction (P=0.031 or P=0.044);there was no significant difference between the motions in LR and CC directions (P=0.956).In order to ensure 95% of prescribed dose to at least 90% of the tumor volume,the margins from GEJ lesion in LR,VD,and CC directions were 19.4 mm,14.6 mm,and 27.2 mm,respectively,which could cover both intrafractional and interfractional tumor displacements during preoperative radiotherapy.Conclusions GEJ tumor has a wide range of movement in preoperative intra-and inter-fractional radiotherapy.This should be considered for precise radiotherapy,and a new method should be selected to limit tumor movement.

An evaluation of Mandard tumor regression grade system in patients with locally advanced rectal cancer treated with preoperative radiotherapy / 中华放射医学与防护杂志

Objective To explore the clinical and imaging factors influencing the patients' prognosis after preoperative radiotherapy for local advanced rectal cancer.Methods We retrospectively analyzed 106 locally advanced rectal cancer patients from June 2004 to September 2015 in our institution.All patients underwent preoperative radiotherapy.According to the Mandard score,patients were divided into 5 groups (TRG1-5).All patients were divided into two groups according to the TRG,which including good responder (TRG1 + 2) and poor responder (TRG3 + 4 + 5) groups.All of the tumor ADC values of post-RT were measured by Diffusion-weighted MRI technology,and the relationship between tumor ADC values of post-RT and TRG was analyzed.Results In univariate analysis,age,chemotherapy,pT,pN,differentiation degree,vascular invasion and TRG were significantly associated with overall survival (x2 =3.945-8.110,P ＜ 0.05).Multivariate analysis indicated that differentiation degree and TRG were the independent prognostic factors for OS (x2 =5.221,6.563,P ＜ 0.05).No significant difference was found between long-course and short-course radiotherapy group (P ＞ 0.05) in OS.The good responder group had a favorable survival in 5-year OS compared to the poor responder group (x2 =8.110,P ＜ 0.05).Preoperative radiotherapy,preoperative chemotherapy,pathological type,differentiation degree and gross type,vascular tumor thrombus and tumor ADC values of post-RT were significantly associated with TRG (x2 =4.189-18.139,P ＜ 0.05).The best critical point of tumor ADC values of post-RT was 1.7 x 10-3 mm2/s by using ROC curve.The accuracy of tumor ADC values of post-RT in predicting TRG1 + 2 was 70％.Conclusions The TRG can predict the efficacy of preoperative radiotherapy in patients with locally advanced rectal cancer based on the Mandard score.There was no significant difference in OS between long-course radiotherapy group and short-course radiotherapy group.The tumor ADC values of post-RT might become a potential factor to predict TRG in patients with locally advanced rectal cancer after preoperative radiotherapy.

Dosimetric comparison of volumetric modulated arc therapy for rectal cancer using flattening filter-free and flattening filter modes / 肿瘤研究与临床

Objective To compare the dosimetric differences of volumetric modulated arc therapy (VMAT) for preoperative radiotherapy of rectal cancer using 6MV X-ray flattening filter-free (FFF) and flattening filter (FF) modes.Methods FF-VMAT and FFF-VMAT plans were designed for 15 rectal cancer patients with preoperative radiotherapy by planning treatment system (Eclipse 10.0),respectively.Prescription dose of PTV was 50 Gy in 25 fractions.When the plans were normalized to 50 Gy to 95 ％ of PTV,the dose volume histogram (DVH),target and risk organ doses,conformity indexes (CI),homogeneity indexes (HI),low dose volume of normal tissue (B-P),monitor units (MU) and treatment time (TT) were compared between the two kinds of plans.Results FF-VMAT provided the lower Dmean,V105,HI (P ＜ 0.05),and higher CI (P ＜ 0.05) compared with FFF-VMAT.Small intestine (D5),Bladder (D5,Dmean V40,V50),L-femoral head (V40),R-femoral head (Dmean) were lower in FF-VMAT than those in FFF-VMAT (P ＜ 0.05).FF-VMAT had higher B-P (V5) compared with FFF-VMAT (P ＜ 0.05).FF-VMAT reduced the monitor units (MU) by 21％ (382±53 vs 483±26,P ＜ 0.05),as well as the treatment time (TT) in FF-VMAT was no significant difference compared with that in FFF-VMAT [(148±4) s vs (146±3) s,P ＞ 0.05)].Conclusions The qualities of FF-VMAT and FFF-VMAT plans were comparable and both clinically acceptable.When comparing two plans,FF-VMAT showed better target coverage and some of OARs sparing.The MUs of FFF-VMAT were higher than those of FF-VMAT,yet were not delivered within the same time.

Morphologic change of rectosigmoid colon using belly board and distended bladder protocol

PURPOSE: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. MATERIALS AND METHODS: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. RESULTS: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). CONCLUSION: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.

Morphologic change of rectosigmoid colon using belly board and distended bladder protocol

PURPOSE: This study investigates morphologic change of the rectosigmoid colon using a belly board in prone position and distended bladder in patients with rectal cancer. We evaluate the possibility of excluding the proximal margin of anastomosis from the radiation field by straightening the rectosigmoid colon. MATERIALS AND METHODS: Nineteen patients who received preoperative radiotherapy between 2006 and 2009 underwent simulation in a prone position (group A). These patients were compared to 19 patients treated using a belly board in prone position and a distended bladder protocol (group B). Rectosigmoid colon in the pelvic cavity was delineated on planning computed tomography (CT) images. A total dose of 45 Gy was planned for the whole pelvic field with superior margin of the sacral promontory. The volume and redundancy of rectosigmoid colon was assessed. RESULTS: Patients in group B had straighter rectosigmoid colons than those in group A (no redundancy; group A vs. group B, 10% vs. 42%; p = 0.03). The volume of rectosigmoid colon in the radiation field was significantly larger in group A (56.7 vs. 49.1 mL; p = 0.009). In dose volume histogram analysis, the mean irradiated volume was lower in patients in group B (V45 27.2 vs. 18.2 mL; p = 0.004). In Pearson correlation coefficient analysis, the in-field volume of rectosigmoid colon was significantly correlated with the bladder volume (R = 0.86, p = 0.003). CONCLUSION: Use of a belly board and distended bladder protocol could contribute to exclusion of the proximal margin of anastomosis from the radiation field.

Analysis of survival prediction value using modification 7th UICC esophageal cancer staging system for esophageal squamous cell carcinoma with preoperative radiotherapy / 中华放射肿瘤学杂志

ObjectiveTo evaluate the value of the international union against cancer (UICC)stage,pathologic complete response (pCR),and the estimated treatment response as various means for prognostic stratifying patients after surgery in patients with squamous cell carcinoma of the esophagus who received preoperative radiotherapy (RT).MethodsA retrospective review was performed on 311 patients with esophageal squamous cell carcinoma who received RT before the esophagectomy. Data collected included the demographics,the RT details,the pathologic findings,and the survival.Prognostic survival was analyzed by Kaplan-Meier method and Logrank test.ResultsThe follow-up rate was 96.5％,89 and 43 patients,respectively were followed up more than 5 and 10 years.In univariate analysis,residual disease and the number of positive lymph node were predictors of the overall survival ( T-pCR,x2 =11.53,P =0.001 ;0,1 -3,≥4,x2=42.13,P=0.000,respectively).Further study found the 7th stage system of UICC cannot (can or cannot) entirely predict the prognosis of this group of patients.If categorizing the stages of their lymph nodes into three groups:N0(0),N1 (1-3) and N2(≥4)),and the modified UICC system can accurately distinguish ypStage Ⅰ with ypStage Ⅱ ( T0.3 N 1 M0 + T3 N0 M0 ) ( x2 =11.15,P =0.001 ) and ypStage Ⅱ with ypStage Ⅲ ( T4 N0-1 M0 and T0-3 N2 M0 ) ( x2 =23.39,P =0.000 ).ConclusionsThe pathologic post-radiotherapy T stage and the number of positive lymph node are predictors for esophageal squamous cell carcinoma receiving preoperative radiotherapy.The modified UICC stage system can be a better survival predictor than the 7th UICC stage system.

Dosimetric analysis of preoperative three-dimensional conformal and preoperative intensity modulated radiotherapy for rectal cancer / 中华放射医学与防护杂志

Objective To compare the dose distribution of the three-dimensional conformal radiotherapy(3D-CRT)and 5-field or 7-field intensity modulated radiation therapy(IMRT), and to explore the value of IMRT in preoperative radiotherapy for rectal cancer.Methods Ten rectal cancer patients treated with preoperative combination radiotherapy and chemotherapy were enrolled in this study. 3D-CRT plan and the 5.field or 7-field IMRT plans were performed for each patient.The conformal index (CI),heterogeneity index(HI)of the planning target volume(PTV)and the dose of normal organs of 3D-CRT plan(3D-CRTp)and the 5-field or 7-field IMRT plans(IMRT5fp or IMRT7fp)were analyzed with the dose-volume histogram.Results The CI values of PTV were 0.91,0.87 and 0.78 in IMRT7fpIMRT5fp and 3D- CRT but with IMRT7fp>IMRT5fp>3D-CRTp(t=-5.69、-8.91,P<0.01),respectively.The HI values of PrV were 1.09,1.08 and 1.05 in IMRT5fp,IMRT7fp and 3D- CRTp but with IMRT5fp >IMRT7fp>3D- CRTp(t=3.41、-6.89,P<0.01),respectively.The ratio of dose volume were 0.08,0.10 and 0.19(t=2.79、3.52,P<0.05)in IMRT7fp,IMRT5fp and 3D- CRTp on the small intestine V50,with 0.07,0.10 and 0.19(t=2.58、3.40,P<0.05)in IMRT7fp,IMRT5fp and 3D-CRTp on the bladder V50 and 0.01,0.01 and 0.05(t=3.00、3.17,P<0.01)in IMRT7fp,IMRT5fp and 3D- CRTp on the fomoral head V45.The ratio of dose volume were 0.31 and 0.38(t=3.91,P<0.01)in IMRT7fp and IMRT5fp on the bone marrow V50,with 0.07 and 0.10 in IMRT7fp and IMRT5fp on bladder V45.Conclusions IMRT plan is superior to 3 D- CRT plan in dose conformal degrees of PTV with preoperative radiotherapy of rectal cancer and can significantly protect the normal tissues.The 7-field IMRT plan might be the optimal plan for dose conformal degree and dose uniformity compared with 5-field IMRT.

Tumor-infiltrating lymphocytes predict efficacy of preoperative radiotherapy for rectal cancer / 中华放射肿瘤学杂志

Objective To evaluate the effect of tumor infiltrating lymphocyte(TIL) on prognosis of rectal cancer treated with preoperative radiotherapy. Methods From Jan. 1999 to Oct. 2007,107 patients with rectal cancer were treated with preoperative radiotherapy of 30 Gy/10f/12 days. The relationships a-mong TIL,pathologic regression and prognosis were analyzed. Results Before radiotherapy,TIL in rectal cancer was 75 patients (70.1%) in grade 1,16 (15.0%) in grade 2 and 16 (15.0%) in grade 3; While after radiotherapy,it changed to 19 (17.7 %) in grade 1,43 (40.2%) in grade 2,35 (32.7 %) in grade 3 and 10 (9.3%) in grade 4. After radiotherapy,pathologic regression was 36 (33.6%) in grade 1,57 (53.3%) in grade 2 and 14 (13.1%) in grade 3. Univariate analysis showed that TIL both before and after radiotherapy was the significant prognostic factor for local pathologic regression (X2= 36.80, P < 0.01; X<'2>= 14.00, P<0.01). Kaplan Meier survival analysis showed that TIL and pathologic regression after radiother-apy were significant associated with the survival(X2=24.00, P < 0.01; X2=12.17, P<0.01 ). Logistic re-gression showed that TIL after radiotherapy had a significant effect on local pathologic regression(X2=8.05, P<0.01). Conclusions For rectal cancer treated with preoperative radiotherapy,TIL before and after ra-diotherapy is significantly related with local pathologic regression, and TIL after radiotherapy is a prognostic factor.

Effects of Preoperative Radiotherapy for T2, T3 Distal Rectal Cancer / 대한방사선종양학회지

PURPOSE: Preoperative radiotherapy has been used to induce tumor regression and allow complete resection of rectal cancer with a sphincter preservation surgery. This study was performed to determine the effectiveness of preoperative radiotherapy for T2, T3 distal rectal carcinoma. MATERIALS AND METHODS: From November 1995 to June 1997, fifteen patients with invasive distal rectal cancer were treated with preoperative radiotherapy followed by sphincter preservation surgery. Classification by preoperative T stage consisted of 7 T2 and 8 T3 tumors. Radiation therapy was delivered with 6 MV and 15 MV linear accelerator, at 1.8 Gy fractions for 5 days per week. Total radiation doses were 45 Gy to 50.4 Gy (median : 50.4 Gy). Sphincter preservation surgery was performed 4~6 weeks after the completion of radiotherapy. Median follow-up was 22 months (range : 16~37 months). RESULTS: One patient (6.7%) had a complete pathologic response. Comparing the stage at the diagnostic workup with the pathologic stage, tumor downstaging of T stages occurred in 11 of 15 patients (73.3%) and N1 stages occurred in 2 of 5 patients (40%). No patient developed progressive disease undergoing treatment. Two patients suffered local recurrence at 7 and 20 months, and one a distant metastasis at 30 months. No grade 3 or 4 toxicity was observed. CONCLUSION: Our experience suggests that preoperative radiotherapy followed by sphincter preservation surgery is well tolerated, and can significantly reduce the tumor burden for T2, T3 distal rectal cancer.

Intraoperative Detection of Liver Metastasis after Preoperative Radiotherapy in Rectal Cancer

PURPOSE: Preoperatvie radiotherapy has many theoretical advantages in contrast to postoperative one such as preventing dissemination of cancer cells during surgery and increasing resectability rate by down-staging, thus more feasibility of preserving anus and improving survival. But there are several adverse effects, too. Distant metastasis can be detected after preoperative radiotherapy. Postoperative complication rate is high. Pathologic stage is changed after preoperative radiationtherapy so that there is difficulty in prediction of prognosis. We reviewed distant metastasis after preoperative radiotherapy and evaluated detection rate of metastasis with computed tomography in rectal cancer. METHODS: Fifty patients with histologically proven rectal cancer and locally advanced lesions, as determined by physical examination and with no distant metastasis on preoperative computed tomography, entered the trial from 1990 to 1999. Surgery followed 2 to 6 weeks after completion of hyperthermia-chemoradiotherapy (HTCRT). Preoperative stages were determined with computed tomography. Postoperatve stage were determined by pathologic study. RESULTS: Thirty cases were male. Twenty cases were female. Distance from anal verge to tumor were under 7 cm of 36 cases, over of 14 cases. The median tumor size was 3.3 cm in diameter. The conservation rate of anal sphincter function were 48.0%. In preoperative staging with computed tomography, the number of stage I, II, and III were 4, 11 and 35 cases. none were stage IV. The overall resectability rate was 90.0% (45 of 50 patients). In postoperative staging with pathologic study, the number of stage 0, I, II, and III were 4, 5, 19, and 13 cases. stage IV were 9 cases. Anastomotic leakage were noticed in 2 cases. In stage IV cases, liver metastases were noticed in all cases. CONCLUSIONS: The preoperative radiotherapy was applied to the 50 patients with rectal cancer. The liver metastases which were detected after preoperative radiotherapy were 9 cases. The false negative value of computed tomography for liver metastasis in rectal cancer was 18.0%. We need more sensitive study for detecting liver metastasis of rectal cancer, especially in scheduled preoperative radiotherapy.

Advances on esophageal carcinoma radiotherapy in China / 中国癌症杂志

Carcinoma of the esophagus is one of the most common cancer in China. Because the early diagnosis is delayed, 80% patients have the locally extensive or distant metastasis at the time of diagnosis, and radiotherapy is one of the most important modalities in esophageal carcinoma management. In this paper , a brief introduction about the advances on esophageal carcinoma radiotherapy in China will be done ,such as radiotherapy alone, radiotherapy combined with surgery,chemotheropy or intraluminal hyperthermia.

Neoadjuvant chemotherapy and preoperative radiation for stage Ⅰb-Ⅱb cervical cancer / 中国癌症杂志

Purpose:To evaluate the effect of preoperativ e chemotherapy or brachtherapy and radical hysterectomy on stage Ⅰb-Ⅱb locally advanced cervical cancer with high risk factors. Methods:preoperative chemotherapy or radiotherapy followed by r adical hysterectomy compared to radical hysterectomy alone in stage Ⅰb-Ⅱb cer vical cancer with higher risk factors(bulky,lower grade,small cell cancer or ade nocarcinoma). Results:①Pelvic lymphnode metastases rate was significantly decreased in the neoadjuvant chemotherapy arm compared with surgery alone(P 0.05). Conclusions:Preoperative chemotherapy followed by surgery is e ffective and superior to surgery alone in stage Ⅰb-Ⅱb cervical cancer with high risk factors.It might be able to reduce tumor volume and eliminate effectiv ely disease in lymphnodes and possibly micrometastases.It may be beneficial in improving quality of life of patients by decreasing the need for postoperative r adiotherapy. Response to chemotherapy may be a prognostic factor.Preoperative br achytherapy showed no significant advantage in eliminating lymphnodes matastases as compared to surgery alone.

Preoperative Radiotherapy of Maxillary Sinus Cancer / 대한방사선종양학회지

PURPOSE: This study was to evaluate the effectiveness of preoperative radiotherapy in maxillary sinus cancer. MATERIALS AND METHODS: A retrospective analysis was done for 42 patients with maxillary sinus cancer who were treated with radiation with or without surgery from April 1986 to September 1996. There were 27 male and 15 female patients. Patients' age ranged from 24 to 75 years (median 56 years). Stage distribution showed 2 in T2, 19 in T3, and 21 in T4 lesions. The histologic type was squamous cell carcinoma in 38, undifferentiated carcinoma in 1, transitional cell carcinoma in 1, and adenoid cystic carcinoma in 2 patients. All patients were treated with radiation initially with a dosage range of 50.4-70.2 Gy (median 70.2 Gy) before further evaluation of remnant disease. Eleven patients were given induction chemotherapy (2 cycles of 5-fluorouracil and cisplatin) concurrently with radiotherapy. Six to eight weeks after radiotherapy with or without chemotherapy, computerized tomography (CT) of paranasal sinus was taken to evaluate remnant disease. If the CT finding showed remnant disease, a Caldwell-Luc procedure was done to get the specimen of suspicious lesions. A radical maxillectomy was done if the specimen was proven to contain malignancy. In contrast periodic follow-up examination was done without any radical surgery if the tissue showed only granulation tissue. Follow-up period ranged from 3 to 92 months with a median 16 months. RESULTS: Nine (21.4%) patients showed complete response (CR) and 33 patients (78.6%) showed persistent disease (PER) to initial radiotherapy. Among the 9 CR patients, 7 patients had no evidence of disease (NED), 1 patient had local failure, and 1 patient had regional failure. Among 33 PER patients, salvage total maxillectomy was done in 10 patients, and the surgery was not feasible or refused in 23 patients. Following the salvage radical surgery, 2 patients were NED and 8 patients were PER status. Overall and disease- free survival rate at 5 years was 23.1% and 16.7%, respectively. The only factors associated with the overall survival rate was the response to radiotherapy (p<0.01). CONCLUSION: The only factors associated with the overall survival rate was the response to radiotherapy. We could omit a radical mutilating surgery by preoperative irradiation in 7 of 42 patients (21.4%) so as to preserve their facial integrity.

Treatment Results of Preoperative Radiotherapy Alone vs. Preoperative Radiotherapy and Chemotherapy in Locally Advanced Rectal Cancer / 대한치료방사선과학회지

PURPOSE: To assess the efficacy and toxicity of the preoperative radiotherapy with or without chemotherapy in locally advanced rectal cancer. METHODS: Forty three Patients (clinically diagnosed stages above or equal to Astler-Coller stage B2 without distant metastasis) were assigned to preoperative radiotherapy alone arm (n=16) or combined preoperative radiotherapy and chemotherapy arm (n=27). Preoperative radiotherapy of 4500 cGy to whole pelvis +/- 540 cGy boost to primary site and concurrent chemotherapy of 2 cycles of 5-FU (500 mg/m2) and leucovorin (20 mg/m2) were used. Fifteen patients of preoperative radiotherapy alone arm and 19 of combined arm received surgical resection after preoperative treatment. RESULTS: During the preoperative treatment, no significant complication was developed in both groups. Pathologic results were as follows; complete remission 1, B1 1, B2 6, C1 2, C2 5 in preoperative radiotherapy alone arm and complete remission 2, B1 8, B2 4, C2 3 D2 in combined arm. Postoperative complications were delayed perineal would healing in three patients, intestinal obstruction in three patients (one managed by conservative medical treatment, two by surgical treatment). CONCLUSION: The combined preoperative radiotherapy and chemotherapy arm was more effective in pathological response and lymph node negativity rate that the preoperative radiotherapy alone arm. Both the preoperative radiotherapy alone arm and the combined arm were generally well tolerated and did not result in an increased postoperative morbidity.

Comparative Analysis between preoperative Radiatherapy and postoperative Radiotherapy in Clinical Stage I and II Endometrial Carcinoma / 대한치료방사선과학회지

PURPOSE: To obtain the optical treatment method in patients with endometrial carcinoma(clinical stage FIGO I, II) by comparative analysis between preoperative radiotherapy(pre-op R) and postoperative radiotherapy(post-op RT). MATERIALS AND METHODS: A retrospctive review of 62 endometrial carcinoma patients referred to the Yonsei Cancer Center for radiotherapy between 1985 and 1991 was undertaken. Of 62 patients, 19 patients(Stage I; 12 patients, Stage II; 7 patients) received pre-op RT before TAH(Total Abdominal Hysterectomy) and BSO(Bilateral Salphingoophorectomy) (Group 1) and 43 patients( Stage 1; 32 patients, Stage 2; 11 patients) received post-op RT after TAH and BSO (Group 2). Pre-op irradiation was given 4-6 weeks prior to surgery and post-op RT was administered on 4-5 weeks following surgery. All patients exept 1 patient(Group2; ICR alone) received external irradiation. Seventy percent(13/19) of pre-op RT group and 54 percent(23/42) of post-op RT group received external pelvic irradiation and intracavitary radiation therapy(ICR). External radiation dose was 39.6-55Gy(median 45Gy) in 5-6week through opposed AP/PA fields or 4-field box technique treating daily, five days per week, 180cGy per fraction. ICR doses were prescreibed to point A(20-39.6 Gy, median 39Gy) in Group 1 and 0.5cm depth from vaginal surface (18-30 Gy, median 21Gy) in Group2. RESULTS: The overall 5year survival rate was 95%. No survival difference between pre-op and post-op RT group.(89.3% vs 97.7%, p>0.1) There was no survival difference by stage, grade and histology between two groups. The survival rate was not affected by presence of residual tumor of surgical specimen after pre-op RT in Group 1(p>0.1), but affected by presence of lymph node metastasis in post-op RT group(p<0.5). The complication rate of pre-op RT group was higher than post-op RT.(16% vs 5%) CONCLUSION: Post-op radiotherapy offers the advantages of accurate surgical-pathological staging and low complication rate.

The Effect of Radiation Therapy on the Healing Ability of Subsequent Surgical Wounds / 대한치료방사선과학회지

This study was undertaken to find the effect of radiation therapy on the healing ability of surgical wounds and on this basis, to find the proper time interval between the radiation therapy and surgery. Two hundred and fifty-two mice were used and a single dose of 2000 cGy was given in each instances to the hind limb of mice. Incisional wounds were produced after varying intervals in the previously irradiated areas and then they were followed up at regular intervals by the measurement of tensile strength. The wounds which received surgery immediately, 1 or 2 weeks after irradiation revealed marked delay and the wounds which received surgery 12.16 or 20 weeks after irradiation demonstrated slight delay in wound healing in terms of tensile strength measurement. But the wounds which received irradiation 4 or 8 weeks before surgery did not differ much in the wound healing process from that of the control group. Histopathologic studies of the wounds demonstrated epithelization in most instances as quickly as in the control wounds. The appearance of fibroblasts and collagen fibers has delayed momently and appeared to have close correlation with the tensile strength healing curves.