The Three Dimensional Conformal Radiotherapy for Hyperkeratotic Plantar Mycosis Fungoides

The localized early-stage of Mycosis fungoides (MF) (stage IA-IIA) is usually treated with topical agents, such as nitrogen mustard, steroids, and phototherapy (UVB/PUVA) as first line therapy; response to these initial treatments is usually good. However, hyperkeratotic plantar lesions are clinically rare and have decreased responsiveness to topical agents. For such cases, physicians may consider local radiotherapy. Here, a case of an 18-year-old Korean woman who was treated with three-dimensional conformal radiotherapy (3D-CRT) for hyperkeratotic plantar lesions that were refractory to UVA-1, methotrexate, and topical steroids is reported. Complete remission was attained after radiotherapy. During the one-year follow-up period, there has been no evidence of disease recurrence and no chronic complications have been observed.

An Analysis of the Incidence and Related Factors for Radiation Dermatitis in Breast Cancer Patients Who Received Radiation Therapy / 대한방사선종양학회지

PURPOSE: We analyzed the incidence and related factors of radiation dermatitis; at first, to recognize whether a decrease in radiation dermatitis is possible or not in breast cancer patients who received radiation therapy. MATERIALS AND METHODS: Of 338 patients, 284 with invasive breast cancer who received breast conservation surgery with radiotherapy at Chonbuk National University Hospital from January 2007 to June 2009 were evaluated. Patients who also underwent bolus, previous contralateral breast irradiation and irradiation on both breasts were excluded. For patients who appeared to have greater than moderate radiation dermatitis, the incidence and relating factors for radiation dermatitis were analyzed retrospectively. RESULTS: A total of 207 and 77 patients appeared to have RTOG grade 0/1 or above RTOG grade 2 radiation dermatitis, respectively. The factors found to be statistically significant for the 77 patients who appeared to have greater than moderate radiation dermatitis include the presence of lymphocele due to the stasis of lymph and lymph edema which affect the healing disturbance of radiation dermatitis (p=0.003, p=0.001). Moreover, an allergic reaction to plaster due to the immune cells of skin and the activation of cytokine and concomitant hormonal therapy were also statistically significant factors (p=0.001, p=0.025). CONCLUSION: Most of the breast cancer patients who received radiation therapy appeared to have a greater than mild case of radiation dermatitis. Lymphocele, lymphedema, an allergy to plaster and concomitant hormonal therapy which affect radiation dermatitis were found to be significant factors. Consequently, we should eliminate lymphocele prior to radiation treatment for patients who appear to have an allergic reaction to plaster. We should also instruct patients of methods to maintain skin moisture if they appear to have a greater than moderate case of radiation dermatitis.

Lymph Node Failure Pattern and Treatment Results of Esophageal Cancer Patients Treated with Definitive Radiotherapy / 대한방사선종양학회지

PURPOSE: We evaluated the failure pattern of the celiac axis, gastric lymph node, and treatment outcome in the upper and mid-esophageal region of cancer patients treated by definitive radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, retrospectively. MATERIALS AND METHODS: The study constituted the evaluation 108 patients with locally advanced esophageal cancer receiving radiotherapy or a combination of radiotherapy and chemotherapy at Chonbuk National University Hospital from January 1986 to December 2006. In total, 82 patients treated by planned radiotherapy, except when treating the celiac axis and gastric lymph node for treatment volume, were analysed retrospectively. The study population consisted of 78 men and 2 women (mean age of 63.2 years). In addition, 51 patients received radiotherapy alone, whereas 31 patients received a combination of radiation therapy and chemotherapy. The primary cancer sites were located in the upper portion (17 patients), and mid portion (65 patients), respectively. Further, the patients were in various clinical stages including T1N0-1M0 (7 patients), T2N0-1M0 (18 patients), T3N0-1M0 (44 patients) and T4N0-1M0 (13 patients). The mean follow up period was 15 months. RESULTS: The various treatment outcomes included complete response (48 patients), partial response (31 patients) and no response (3 patients). The failure patterns of the lymph node were comprised of the regional lymph node (23 patients) and the distance lymph node which included celiac axis and gastric lymph node (13 patients). However, metastasis was not observed in the regional and distant lymph node in 10 patients, whereas 36 patients were not evaluated. Furthermore, of the 13 patients who developed celiac axis and gastric lymph node metastases, 3 were in stage T1N0-1M0 and 10 were in stage T2-4N0-1M0. A complete response appeared in 12 patients, whereas a partial response appeared in 1 patient. The mean survival time of the patients who appeared for regional and distant lymph node metastasis was 14.4 and 7.0 months, respectively. CONCLUSION: In locally advanced esophageal cancer patients, who were treated by definitive radiotherapy without celiac axis and gastric lymph node irradiation, the distant lymph node metastasis rate was high and the overall survival rate was lower compared to the regional lymph node metastasis. The incidence of regional and distant lymph node metastasis was high in patients who appeared beyond clinical stage T2 and received radiotherapy alone.

Immune Cell Activation and Co-X-irradiation Effect of Eleutherococcus senticosus Maxim Root / 대한방사선종양학회지

PURPOSE: This study was performed to investigate the effects of immune cell activation and the antitumor effect for the combination of treatment with X-irradiation and Eleutherococcus senticosus Maxim Root (ESMR) on mouse tumor cells. MATERIALS AND METHODS: ESMR (250g) was extracted with 80% methanol, concentrated under decompression and lyophilized. To determine whether ESMR is able to activate the immune cells or not, the proliferation of splenocytes in vitro and the number of B cells and T cells in splenic lymphocytes in ESMR-pretreated mice were evaluated. X-irradiation was given to the mouse fibrosarcoma tumor cells (FSa II) by 250 kv X-irradiation machine. The cytotoxicity of ESMR was evaluated from its ability to reduce the clonogenecity of FSa II cells. In X-irradiation alone group, each 2, 4, 6 and 8 Gy was given to FSa II cells. In X-irradiation with ESMR group, 0.2 mg/ml of ESMR was exposed to FSa II cells for 1 hour before X-irradiation. RESULTS: The proliferation of cultured mouse splenocytes and thymocytes were enhanced by the addition of ESMR in vitro. The number of B cells and T cells in mouse splenic lymphocytes was significantly increased in ESMR pretreated mice in vivo. In FSa II cells that received a combination of 0.2 mg/ml of ESMR with X-irradiation exposure, the survival fraction with a dose of 2, 4 and 6 Gy was 0.39+/-0.005, 0.22+/-0.005 and 0.06+/-0.007, respectively. For FSa II cells treated with X-irradiation alone, the survival fraction with a dose of 2, 4 and 6 Gy was 0.76+/-0.02, 0.47+/-0.008 and 0.37+/-0.01. The difference in the survival fraction of the mouse FSa II cells treated with and without ESMR was statistically significant (p<0.05). CONCLUSION: Treatment with ESMR increased cell viability of mouse splenocytes in vitro and especially the subpopulation of B cells and T cells in splenocytes in ESMR-pretreated mice. However, treatment with ESMR did not increase the level of Th and Tc subpopulations in the thymocytes. Treatment with the combination of ESMR and X-irradiation was more cytotoxic to mouse tumor cells than treatment with X-irradiation alone; this finding was statistically significant.

Treatment Outcome of Locally Advanced Non-small Cell Lung Cancer / 대한방사선종양학회지

PURPOSE: We evaluated retrospectively the outcome of locally advanced non-small cell lung cancer patients treated with definitive radiotherapy to find out prognostic factros affecting survival. MATERIALS AND METHODS: 216 cases of stage IIIB non-small cell lung cancer were with treated radiotherapy at our Hospital between 1991 to 2002 and reviewed retrospectively. Cases were classified by mode of treatment and response to treatment. Patients showing complete response or partial response to treatment were included in the "response group", while those showing stable or progressive cancer were included in the "non-response group". RESULTS: 30 patients completed the planned radiotherapy treatments and 39 patients completed combined treatments or chemoradiotherapy. Median survival was 4.6 months for patients treated with radiotherapy and 9.9 months for those undergoing combined radiotherapy and chemotherapy. Survival rates for the first year were 13.3% with radiotherapy and 35.9% with chemoradiotherapy. In the second year, 3.3% of the radiotherapy patients survived and 20.5% of the patients receiving chemoradiotherapy survived. By the third year, 15.4% of the patients receiving the combined treatments survived. None of the patients treated with radiotherapy alone lived to the third year, however. Overall survival was significantly different between the radiotherapy patients and the combined chemoradiotherapy patients (p<0.001). In the response group, median survival was 7.2 months with radiotherapy and 16.5 months with combined therapy. In the non-response group, median survival was 4.4 months with radiotherapy and 6.7 months with combined treatments. Severe acute complications (grade 3) occurred in 2 cases using radiotherapy, and in 7 cases using combined therapy. CONCLUSION: When the patients with stage IIIB non-small cell lung cancer received chemoradiotherapy, treatment response rate and overall survival was greater than with radiation alone.

Investigation of Study Items for the Patterns of Care Study in the Radiotherapy of Laryngeal Cancer: Preliminary Results / 대한방사선종양학회지

PURPOSE: In order to develop the national guide-lines for the standardization of radiotherapy we are planning to establish a web-based, on-line data-base system for laryngeal cancer. As a first step this study was performed to accumulate the basic clinical information of laryngeal cancer and to determine the items needed for the data-base system. MATERIALS AND METHODS: We analyzed the clinical data of patients who were treated under the diagnosis of laryngeal cancer from January 1998 through December 1999 in the South-west area of Korea. Eligibility criteria of the patients are as follows: 18 years or older, currently diagnosed with primary epithelial carcinoma of larynx, and no history of previous treatments for another cancers and the other laryngeal diseases. The items were developed and filled out by radiation oncologist who are members of Korean Southwest Radiation Oncology Group. SPSS v10.0 software was used for statistical analysis. RESULTS: Data of forty-five patients were collected. Age distribution of patients ranged from 28 to 88 years (median, 61). Laryngeal cancer occurred predominantly in males (10:1 sex ratio). Twenty-eight patients (62%) had primary cancers in the glottis and 17 (38%) in the supraglottis. Most of them were diagnosed pathologically as squamous cell carcinoma (44/45, 98%). Twenty-four of 28 glottic cancer patients (86%) had AJCC (American Joint Committee on Cancer) stage I/II, but 50% (8/16) had in supraglottic cancer patients (p=0.02). Most patients (89%) had the symptom of hoarseness. Indirect laryngoscopy was done in all patients and direct laryngoscopy was performed in 43 (98%) patients. Twenty-one of 28 (75%) glottic cancer cases and 6 of 17 (35%) supraglottic cancer cases were treated with radiation alone, respectively. The combined treatment of surgery and radiation was used in 5 (18%) glottic and 8 (47%) supraglottic patients. Chemotherapy and radiation was used in 2 (7%) glottic and 3 (18%) supraglottic patients. There was no statistically significant difference in the use of combined modality treatments between glottic and supraglottic cancers (p=0.20). In all patients, 6 MV X-ray was used with conventional fractionation. The fraction size was 2 Gy in 80% of glottic cancer patients compared with 1.8 Gy in 59% of the patients with supraglottic cancers. The mean total dose delivered to primary lesions were 65.98 Gy and 70.15 Gy in glottic and supraglottic patients treated, respectively, with radiation alone. Based on the collected data, 12 modules with 90 items were developed for the study of the patterns of care in laryngeal cancer. CONCLUSION: The study items for laryngeal cancer were developed. In the near future, a web system will be established based on the items investigated, and then a nation-wide analysis on laryngeal cancer will be processed for the standardization and optimization of radiotherapy.

Cytotoxic Effect of X-irradiation of Mouse Tumor Cells in the Presence of Korean Ginseng Extract / 대한방사선종양학회지

PURPOSE: We already reported the results that aqueous extract of Korean ginseng roots showed a marked cytotoxicity. In this study, we investigated whether combined ginseng product with X-irradiation increase the cytotoxicity of tumor cells than X-irradiation or not. MATERIALS AND METHODS: Fifty gram of Korean ginseng powder mixed with 1 L of distilled water was extracted with reflux flask under condition of 100 degrees C for 5 hrs. This aquaous ginseng extract was filtered, centrifuged and then was freezed under condition of -90degrees C for 16-18 hrs. The freezing extract was dried with freeze drier, and then diluted. X-irradiation was given to tumor cells by 6 MeV linear accelerator. The cytotoxicity of ginseng in vitro was evaluated from its ability to reduce the clonogenecity of fibrosarcoma (FSa II) cells. In X-irradiation alone group, each 2, 4, 6 and 8 Gy was given to tumor cells. In X-irradiation with ginseng group, 0.2 mg/mL of ginseng extract was exposed to tumor cells for 1 hour before X-irradiation. RESULTS: The yield for 50 g of ginseng extract which was treated with freezing drier was 3.13 g (6.3%). Cytotoxicity in vitro was measured as survival fraction which was judged from the curve, at ginseng concentration of 0.001, 0.01, 0.1 and 1 mg/mL were 0.89+/-0.04, 0.86+/-0.06, 0.73+/-0.01 and 0.09+/-0.02, respectively. Survival fraction at X-irradiation alone of 2, 4, 6 and 8 Gy were 0.81+/-0.07, 0.42+/-0.08, 0.15+/-0.02, 0.03+/-0.01, respectively. But, survival fraction in combined group of X-irradiation and ginseng (0.2mg/mL) at each same radiation dose were 0.28+/-0.01, 0.18+/-0.03, 0.08+/-0.02, 0.006+/-0.002, respectively ( p<0.05). CONCLUSION: The yield for ginseng extract which was treated with freezing drier was 6.3%. Cytotoxicity of Fsa II in combined ginseng with X-irradiation group was increased than that of X-irradition alone group, and its enhancing effect seemed to be added.

Anti-tumor Effect of Combined Betacarotene with X-irradiation in the Mouse Fibrosarcoma : Cytotoxicity and Tumor Growth Delay / 대한방사선종양학회지

PURPOSE: To investigate whether combined beta-carotene with X-irradiation has more enhanced radition response than X-irradiation or not, we performed a experiment about in vitro cytotoxicity of beta-carotene and/or X-irradiation in the fibrosarcoma cells, tumor growth delay of combined beta-caroten with/or X-irradiation in the mouse fibrosarcoma. MATERIALS AND METHODS: 2% emulsion of beta-carotene was serially diluted and used. X-irradiation was given by 6 MeV linear accelerator. The cytotoxicity of beta-carotene in vitro was evaluated from clonogenic assay. To compare the cytotoxicity between combined beta-carotene with X-irradiation and X-irradiation group, 2 mg/ml of beta-carotene was contacted to fibrosarcoma (FSaII) cells for 1 hour before X-irradiation. For the tumor growth delay, single 20 Gy was given to FSaII tumor bearing C3H/N mice whic was classified as beta-crotene with X-irradiation group (n=6) and X-irradiation alone group (n=5). 0.2 ml of 20 mg/kg of beta-carotene were i.p. injected to mice 30 minute before X-irradiation in the beta-crotene with X-irradiation group. The tumor growth delay defined as the time which reach to 1,000 mm3 of tumor volume. RESULT: (1) Cytotoxicity in vitro; 1) survival fraction at beta-carotene concentration of 0.002, 0.02, 0.2 and 2 mg/ml were 0.69+/-0.07, 0.59+/-0.08, 0.08+/-0.008 and 0.02+/-0.006, respectively. 2) each survival fraction at 2, 4, 6 and 8 Gy in the 2 mg/ml of beta-carotene + X-irradiation group were 0.13+/-0.05, 0.03+/-0.005, 0.01+/-0.002 and 0.009+/-0.0008, respectively. But each survival fraction at same irradiation dose in the X- irradiation group were 0.66+/-0.05, 0.40+/-0.04, 0.11+/-0.01 and 0.03+/-0.006, respectively( p0.05). CONCLUSION: The contact of beta-caroten to FSaII cells showed mild cytotoxicity which was increased according to concentration. The cytotoxicity of combined beta-carotene with X-irradiation more increased than that of X-irradiation, additionaly. And there was significant difference of cytotoxicity between two groups. But there were no significant difference of the growth delay of fibrosarcoma between two groups.

The Results of Curative Radiotherapy for the Uterine Cervical Cancer / 대한치료방사선과학회지

PURPOSE: To evaluate 5-year survival rate, patterns of failure and complications of cervical cancer treatment, fifty nine patients treated by curative cancer were analyzed retrospectively. METHODS AND MATERIALS : From March 1986 to May 1990, fifty nine patients with histologically proven uterine cervical cancer were analyzed. According to FIGO stage, there were 2 patients (3.4%) in stage Ib, 2 patients (3.4%) in stage IIa, 31 patients (52.5%) in stage IIb, 15 patients (25.4%) in stage IIIb, 9 patients (15.3%) in stage IV, External RT was per formed by 6 MVLINAC with daily 1.8 Gy, 5 times per week and followed by ICR, A point dose of ICR was calculated to 30-43.66 Gy (median : 34.6Gy). These techniques delivered total A point dose of 80.4 to 109.8 Gy (median : 85Gy). Patients had been followed up from 2 to 110 months (median : 61 months) RESULTS: The overall 5-year survival rate & disease free survival rate were 55.9% and 55.0 % respectively. According to FIGO stage, the 5-year survival rate for less than Iia, IIb, IIIb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage IIb and below versus stage llla and above revealed 74.8%, 29.2% respectively (p<0.005). According to FIGO stage, the 5-year survival rate for less than lla, llb, lllb, IV were 75.0%, 74.8%, 26.7%, 33.3%, respectively. In univariate analysis, the 5-year survival rate for stage llb and below versus stage llla and aboce revealed 74.8%, 29.2% respectively (p<0.005). According to the hemoglobin level during RT, the 5-year survival rate of was 73.3% for patients with Hg 10 gm/dL or higher, in contrast to 0% for those with lower than 10 gm/dL (p<0.005). In 18 patients with nonbulky tumor (<5 cm), the 5-year survival rates were 71.8%. The 5-year survival rates for 18 patients with 5 cm or greater in tumor diameter were 22.2% (p<0.005). The 5-year survival rate for patient age of above 50 years and below were 65.3%, 34.2% respectively (p<0.05). ECOG performance status, pathologic finding, total dose, total treatment time were not statistically significant factors. The significant prognostic factors affecting overall 5-year survival rate by multicariate analysis showed the hemoglobin level during RT (p=0.0001), tumor size (p=0.0390), FIGO stage (p=0.0468) Total recurrence rate was 23.7%; local failure 15.2% (9/59), distant metastasis 6.8% (4/59), local and distant metastasis 1.7% (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59). The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively : 10 patients(17.0%) were grade 2, 3 patients (5.1%) were grade 3 and one patient (1.7%) (1/59). According to the RTOG/EORTC Soma Scales, the late complication rate was 23.8% (14/59). The late complication rate of colorectum and genitourinary tract were 15.3% (9/59), 8.5% (5/59), respectively : 10 patients (17.0%) were grade 2,3 patients (5.1%) were grade 3 and one patient(1.7%) was grade 4. The late complications were radiation proctitis, rectal bleedint, radiation colitis, diarrhea and radiation cystitis in decreasing order. CONCLUSION: For improvement of therapeutic results, prospective randomized trials are recommended to discover new prognostic factors and more aggressive radiation therapeutic methods are needed for poor prognostic patients. The adjuvant chemotherapy or radiation-sensitizing agents must be considered to inhibit regional and distant metastasis.

Antitumor effect of Ganoderma lucidum: Cytotoxicity and Tumor Growth Delay(1) / 대한치료방사선과학회지

PURPOSE: To investigate the effect of aqueous extract of Ganoderma lucidum(G.I.) on the survival of tumor cells in vitro and on the growth of tumors in vivo. MATERIALS AND METHODS: Dried G.I. was made into powder, extracted with distilled water, filtered and diluted from a maximum concentration of 100 mg/ml in sequence. The cytotoxicity of G.O. in vitro was evaluated from its ability to reduce the clonogenicity of SCK tumor cells. For the tumor growth delay study, about 2' 105 of SCK tumor cells were subcutaneously inoculated in the legs of A/J mice. The first experimental group of mice were injected i.p. with 0.2ml of 250 mg/kg of G/I. From the first day after tumor inoculation for 10 days. The second experimental group of mice were injected i.p. with 0.2ml of 250 mg/kg of G.I. either once a day for 10 days or twice a day for 5 days beginning from the 7th day after tumor inoculation. RESULTS: 1. Cytotoxicity in vitro; survival fraction, as judged from the curve, at G.I. concentration of 0.5,1,5,10,25,50 and 100 mg/ml were 1.0, 0.74+/-0.03, 0.18+/-0.03, 0.15+/-0.02, 0.006+/-0.002, 0.015 and 0.0015, respectively. 2. Tumor growth delay in vivo; a) the time required for the mean tumor volume to grow to 1,000mm3 was 11 days in the control group and 14 days in the experimental group. b) the time required for tumor volume to increase 4 times was 11 days in the control group while it was 10.5 and 12 days in the groups injected with G.I. once a day and twice a day from the 7th day after tumor inoculation respectively. CONCLUSION: Aqueous extracts of G.I. showed a marked cytotoxicity on the SCK mammary cells in vitro. Tumor growth delay was statistically significant when G.I. injection was started soon after tumor inoculation, but it was not significant when injection was started after the tumors were firmly established.

The Radiation Effect on Peripheral Blood Cell / 대한치료방사선과학회지

To evaluate radiation effect on the hematopoietic system, we analyzed 44 patients who were treated with conventionally fractionated radiation therapy (RT) at Chonbuk National University Hospital. According to the treatment sites, we classified them into three groups: group I as head and neck, group II as thorax, and group III as pelvis. White blood cell, lymphocyte, platelet and hemoglobin were checked before and during RT The results were as follow; 1. White blood cell (WBC) and lymphocyte count were declined from the first week of RT to the third week, and then slightly recovered after the third or fourth week. There was prominent decrease in lymphocyte counts than WBC. 2. Platelet counts were declined until the second week of the RT, showed slight recovery at fourth week in all groups. Hemoglobin values were slightly decreased in the first week and then recovered the level of pretreatment value, gradually. 3. Lymphocyte count were declined significantly on group III(p<0.01), WBC and platelet counts were decreased on group II but statistically not significant.

Radiation Therapy (RT) of Midline Granuloma / 대한치료방사선과학회지

Seven patients having midline granuloma received local irradiation from March 1983 to June 1986. Clinically, all of the 7 patients had pansinusitis with necrotic destruction of the involved sites and one case revealed colonic lesion. Each of the patients received a tumor dose of 4,000 ~ 5,000 cGy/5~6wks to the upper aerodingestive tract using a 6-MV linear accelerator. Complete and partial remission occurred in 3 patients each, and in one case, the disease progressed despite of the irradiation.

An Experimental Dosimetry of Irregularly Shaped Fields Using Therapeutic Planning Computer / 대한치료방사선과학회지

The authors have intended to measure intrinsic dose distribution by Farmer dosimeter in irregularly shaped fields such as L.M. and T shape models in order to determine dose in homogeneity in those models. We made 2 off-xis points in each model and measured the depth dose at 1.5, 5 and 9cm below surface. The results showed 1~3% dose discrepancy between 2 points. We also measured the depth dose by geometric approximation and computer calculation in those models, and came to the conclusion that computer calculation using Clarkson's principle is simpler and the measurements are closer to the ideal data obtained by the experiment in three models of irregularly shaped fields than those of geometric approximation method.