A Retrospective Study of the Radiotherapy Care Patterns for Patients with Laryngeal Cancer and Comparison of Different Korean Hospitals Treated from 1998 through 1999 / 대한방사선종양학회지

PURPOSE: To investigate the care patterns for radiation therapy and to determine inter-hospital differences for patients with laryngeal carcinoma in Korea. MATERIALS AND METHODS: A total of 237 cases of laryngeal carcinoma (glottis, 144; supraglottis, 93) assembled from 23 hospitals, who underwent irradiation in the year of 1998 and 1999, were retrospectively analyzed to investigate inter-hospital differences with respect to radiotherapy treatment. We grouped the 23 hospitals based on the number of new patients annually irradiated in 1998; and designated them as group A (> or =900 patients), group B (> or =400 patients and <900 patients), and group C (<400 patients). RESULTS: The median age of the 237 patients was 62 years (range, 25 to 88 years), of which 216 were male and 21 were female. The clinical stages were distributed as follows: for glottis cancer, I; 61.8%, II; 21.5%, III; 4.2%, IVa; 11.1%, IVb; 1.4%, and in supraglottic cancer, I; 4.3%, II; 19.4%, III; 28.0%, IVa; 43.0%, IVb; 5.4%, respectively. Some differences were observed among the 3 groups with respect to the dose calculation method, radiation energy, field arrangement, and use of an immobilization device. No significant difference among 3 hospital groups was observed with respect to treatment modality, irradiation volume, and median total dose delivered to the primary site. CONCLUSION: This study revealed that radiotherapy process and patterns of care are relatively uniform in laryngeal cancer patients in Korean hospitals, and we hope this nationwide data can be used as a basis for the standardization of radiotherapy for the treatment of laryngeal cancer.

Survival and Compliance with the Use of Radiation Therapy for Anaplastic Thyroid Carcinoma / 대한방사선종양학회지

PURPOSE: The purpose of this study was to evaluate the impact of the use of external radiation therapy (ERT) in terms of survival and compliance in patients with anaplastic thyroid carcinoma. MATERIALS AND METHODS: The medical records of 17 patients with anaplastic thyroid carcinoma treated with ERT between 1993 and 2002 were retrospectively reviewed. ERT was administered after surgery in 14 patients and after a biopsy in three patients. Among the 14 patients who had undergone surgery, nine underwent a curative resection and five underwent a palliative resection. Six patients had associated well-differentiated thyroid carcinomas and 14 patients were diagnosed with a tumor size exceeding 5 cm. The radiation dose ranged from 6~70 Gy (median dose, 37.5 Gy). Eleven patients completed the planned course of ERT, whereas six patients did not. The follow-up period ranged from 1~104 months (median, 5 months; mean, 20 months). RESULTS: Five patients started the ERT without the presence of a gross mass and all of the patients completed ERT without a re-growth of tumor. Twelve patients (four patients after a curative resection, five patients after a palliative resection and three patients after a biopsy) started ERT with a gross mass present and only six patients were able to complete the planned course of ERT. Among the six patients who completed ERT, two patients showed a marked regression of the tumor mass, whereas two patients showed slight regression and two patients showed no response. The median survival was five months (range, 1~104 months) and the mean survival was 21 months. The overall survival was 41% at 1-year, 24% at 2-years and 12% at 5-years. Significant prognostic factors included the number of primary tumors present, tumor size, whether surgery was performed and completion of ERT as planned. Long-term survivors showed a tendency of having smaller sized initial tumors and smaller sized pre-ERT tumors than the short-term survivors. CONCLUSION: This study suggests that patients with a small initial tumor (5 cm) and did not undergo surgery before ERT or that rapid re-growth of the mass was observed at the surgical site are likely to have a short survival time, along with the interruption of ERT. In these cases, the role of ERT is very limited and the omission of ERT could be considered.

Meningeal Hemangiopericytoma Treated with Surgery and Radiation Therapy: Case Report / 대한방사선종양학회지

Meningeal hemangiopericytoma (HPC) is an uncommon dura-based tumor and can recur not only locally but also distantly in the neural axis or extraneural sites. We report our experience of radiation therapy, one preoperative and one elective postoperative, in two patients with meningeal HPC and reviewed the role of radiation therapy. A 41-year-old man (Case 1) presented with a 3-month history of headache and right hemiparesis. The mass was nearly unresectable at the first and second operation and diagnosed as meningeal HPC. Preoperative radiation therapy was given with a total dose of 55.8 Gy/31 fractions to the large residual mass of left frontoparietal area. Follow-up computerized tomography (CT) showed marked regression of tumor after radiation therapy. The third operation was performed to remove the residual tumor at 6 months after the radiation therapy and a 2 x 2 cm sized tumor was encountered. The mass was totally removed. The serial follow-up CT showed no evidence of recurrence and he is alive without distant metastasis for 4 years and 10 months after the first operation. A 45-year-old woman (Case 2) presented with suddenly developed headache and visual impairment. Tumor mass occupying right frontal lobe was removed with the preoperative diagnosis of meningioma. It was totally removed with attached sagittal sinus and diagnosed as meningeal HPC. Elective postoperative radiation therapy was performed to reduce local recurrence with a total dose of 54 Gy/30 fractions to the involved area of right frontal lobe. She is alive for 5 years maintaining normal activity without local recurrence and distant metastasis.

Streptococcal Toxic Shock Syndrome Occurred during Postoperative Radiotherapy in a Cancer Patient with Preexisting Lymphedema and Chronic Illness: Case Report / 대한방사선종양학회지

A case is reported of a man with malignant fibrous histiocytoma (MFH) in right thigh who developed streptococcal toxic shock syndrome (STSS) during postoperative radiotherapy. Before radiotherapy, a patient complained wax and wane lymphedema following wide excision of tumor mass which was confirmed as MFH. He took some nonsteroidal antiinflammatory drug (NSAID) for about one month. He suffered preexisting hepatitis C virus (HCV) infection, diabetes and well-controlled hypertension. The patient received conventional radiotherapy to right thigh with a total dose of 32.4 Gy at 1.8 Gy per day. At last radiotherapy fraction, cutaneous erythematous inflammation was suddenly developed at his affected thigh. At that time, he also complained of oliguria, fever and chills. The patient was consulted to internal medicine for adequate evaluation and management. The patient was diagnosed as suggested septic shock and admitted without delay. At admission, he showed hypotension, oliguria, constipation, abnormal renal and liver function. As a result of blood culture, Streptococcus pyogenes was detected. The patient was diagnosed to STSS. He was treated with adequate intravenous antibiotics and fluid support. STSS is one of oncologic emergencies and requires immediate medical intervention to prevent loss of life. In this patient, underlying HCV infection, postoperative lymphedema, prolonged NSAID medication, and radiotherapy may have been multiple precipitating factors of STSS.

Clinical Experience of Patients with Ductal Carcinoma In Situ of the Breast Treated with Breast-Conserving Surgery plus Radiotherapy: A Preliminary Report / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Breast-conserving therapy (BCT) is a practical alternative to mastectomy for treating ductal carcinoma in situ (DCIS). We reviewed our experience for treating patients with DCIS of the breast to evaluate the outcome after performing breast-conserving surgery plus radiotherapy (BCS-RT). MATERIALS AND METHODS: Between January 1983 and December 2002, 25 patients with clinically or mammographically detected DCIS were treated by BCS-RT. One patient was diagnosed with bilateral DCIS. Thirteen cases (50%) had symptomatic lesions at presentation. All 26 cases of 25 patients underwent BCS such as lumpectomy, partial mastectomy or quadrantectomy. All of them received whole breast irradiation to a median dose of 50.4 Gy. Twenty-four cases (92.3%) received a boost to the tumor bed for a median total dose of 59.4 Gy. The median follow up period was 67 months (range: 38 to 149 months). RESULTS: Two cases (7.7%) experienced ipsilateral breast tumor recurrence (IBTR) after BCS-RT. The histology results at the time of IBTR showed invasive ductal carcinoma (IDC), and the median time to IBTR was 25.5 months. On the univariate analysis, there were no significant factors associated with IBTR in the DCIS patients. The three-year local recurrence free survival rate was 96.0% and the overall survival rate was 96.3%. CONCLUSION: After the treatment for DCIS, the IBTR rate in our study was similar to other previous studies. Considering that we included patients who had many symptomatic lesions, close or positive margins and less that complete early data, our result is comparable to the previous studies. We could not find the prognostic significant factors associated with IBTR after BCS-RT. A longer follow up period with more patients would be required to evaluate the role of any predictive factors and to confirm these short-term results.

Radiation-Induced Apoptosis of Lymphocytes in Peripheral Blood / 대한방사선종양학회지

PURPOSE: This study quantitatively evaluated the apoptosis in human peripheral blood lymphocytes using flow cytometry, and investigated the possibility of using this method, with a small amount of blood, and the time and dose dependence of radiation-induced apoptosis. MATERIALS AND METHODS: Peripheral blood lymphocytes were isolated from the heparinized venous blood of 11 healthy volunteers, 8 men and 3 women, with each 10 ml of blood being divided into 15 samples. The blood lymphocytes were irradiated using a linear accelerator at a dose rate of 2.4 Gy/min, to deliver doses of 0.5, 1, 2 and 5 Gy. The control samples, and irradiated cells, were maintained in culture medium for 24, 48 and 72 hours following the irradiation. The number of apoptotic cells after the in vitro X-irradiation was measured by flow cytometry after incubation periods of 24, 48 and 72 hours. We also observed the apoptotic cells using a DNA fragmentation assay and electron microscopy. RESULTS: The rate of spontaneous apoptosis increased in relation to the time interval following irradiation (1.761+/-0.161, 3.563+/-0.564, 11.098+/-2.849, at 24, 48, and 72 hours). The apoptotic cells also increased in the samples irradiated with 0.5, 1, 2 and 5 Gy, in a radiation dose and time interval after irradiation manner, with the apoptosis being too great at 72 hours after irradiation. The dose-response curves were characterized by an initial steep increase in the number of apoptotic cells for irradiation doses below 2 Gy, with a flattening of the curves as the dose approached towards 5 Gy. CONCLUSION: The flow cytometric assay technique yielded adequate data, and required less than 1 mL of blood. The time and dose dependence of the radiation-induced apoptosis, was also shown. It is suggested that the adequate time interval required for the evaluation of apoptosis would be 24 to 48 hours after blood sampling.

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.

Results of Curative Radiotherapy Alone in Patients with Uterine Cervical Carcinomas / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To evaluate the role of curative radiotherapy alone in the treatment of uterine cervical carcinomas, by a retrospective analysis with respects to survival and pelvic control, and to find any risk factors of failure MATERIALS AND METHODS: Between Jan. 1990 and Dec. 1995, a total of 187 patients, diagnosed with uterine cervical carcinomas in FIGO stages greater than IA, were treated by curative radiotherapy alone with no chemotherapy. The ages of the patients ranged from 26 to 80 years, with a median of 60 years. The number of patients diagnosed with squamous cell carcinomas were 183 (97.9%). The number of patients with FIGO stage IB1, IB2, IIA, IIB, IIIA, IIIB and IVA were 61 (32.6%), 7 (3.7%), 43 (23.0%), 62 (33.3%), 3 (1.6%), 7 (3.7%) and 4 (2.1%), respectively. External radiotherapy was performed with 6 MV or 10 MV X-rays, with a dose range of 19.8 Gy~ 50.4 Gy (median; 30.6), to whole pelvis. Intracavitary radiation (ICR) was then performed using a high-dose rate remote controlled afterloader with radioisotopes of Co-60 and Cs-137. The fraction size of the ICR was 5 Gy twice a week, and was delivered up to total doses of 10 Gy~ 55 Gy (median; 40). After the ICR, additional pelvic external radiotherapy with midline shielding width of 4 cm was performed with the dose range of 0~30.6 Gy (median; 19.8), and the resultant total doses of A points ranged between 49.8 Gy and 86.0 Gy (median; 70.6). RESULTS: The five-year overall survival rates of FIGO IB1, IB2, IIA, IIB, III and IVA were 88.3%, 83.3%, 86.1%, 65.2%, 60.0% and 50.0%, respectively (p=0.005). The pelvic control rates of each stage were 90.1%, 85.7%, 86.1%, 69.4%, 68.6% and 50.0%, respectively (p=0.03). From the multivariate analysis, the radiation response and tumor diameter were found to be significant factors affecting the overall survival. The significant factors influencing pelvic control were the radiation response and pre-treatment hemoglobin level. CONCLUSION: The radiation response and tumor diameter were significant factors affecting survival, so patients with tumor diameters greater than 4 cm should be considered for a combined modality, such as concurrent chemoradiotherapy.

Radiotherapy in Supraglottic Carcinoma: With Respect to Locoregional Control and Survival / 대한방사선종양학회지

PURPOSE: A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. MATERIALS AND METHODS: From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage I, II, III, IVA, IVB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2~79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0~93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage I and IVB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0~68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0~59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (+-lymph node dissection), three had a supraglottic horizontal laryngectomy (+-lymph node dissection), and one had a primary excision alone. RESULTS: The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage I+I, III+V were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+T) vs radiotherapy alone (RT) in stage II, III, IVA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (P<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage I, II, III, IVA, IVB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+T vs RT in stage II, III, IVA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (P<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (P<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. CONCLUSION: In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted.

Lymphopenia after Mediastinal Irradiation in Lung Cancer / 대한방사선종양학회지

PURPOSE: This study was undertaken to retrospectively evaluate white blood cell kinetics, especially lymphocyte depression after different treatments, and to find the correlation between immunosuppression and large blood volume and dynamic blood flow within the mediastinal radiotherapy (RT) field in lung cancer. MATERIALS AND METHODS: Thirty-four patients with lung cancer were retrospectively evaluated; 10 patients had only radiotherapy (RT group), 8 had chemotherapy (CT group) and 16 had chemotherapy and radiotherapy (RT/CT group). The mean follow-up periods of the RT-including groups (RT group and RT/CT group) and the RT-excluding group (CT group) were 6 and 8 months, respectively. Complete blood cell counts including lymphocyte percentage (%) were checked weekly during RT but less frequently during CT and after RT. RESULTS: Changes in total white blood cell counts were not significantly different among the three groups. The lymphocyte count and lymphocyte % were much lower in the RT-including groups than in the RT- excluding group. The difference between pre-treatment and final lymphocyte count and the difference between pre-treatment and final lymphocyte % were significant (p=0.044 and p=0.037) between the RT- including groups and the RT-excluding group. CONCLUSION: Lymphopenia was more marked after treatment containing RT than CT only. Lymphopenia may be one cause of a compromised immune system after mediastinal irradiation in lung cancer. We suggest cautiously that previous studies showing evidence of lymphocyte apoptosis after low-dose irradiation and large blood volume and dynamic blood flow within the RT fields could be somewhat related to lymphopenia after mediastinal irradiation.

Apoptosis and Proliferative Activity of Non-Hodgkin's Lymphoma: Correlation with Bcl-2 and P53 Protein Expression / 대한방사선종양학회지

PURPOSE: Tumor growth in a given neoplasm is the net result of cell proliferation and cell loss, and apoptosis is the most significant component of continuous cell loss in most tumors. In this study, we examined non-Hodgkin's lymphoma (NHL, n=67) immunohistochemically for the presence of Bcl-2 oncoprotein and P53 protein and compared apoptotic indices (AIs) and Ki-67 proliferative indices (percentages of Ki-67 positive cells). MATERIALS AND METHODS: 67 patients with NHL were evaluated : 3 low-grade and 64 intermediate-grade. The phenotype was determined in 65 cases : 47 (70%) were B cell type and 18 (27%) were T cell type. AIs and Ki-67 proliferative indices were determined immunohistochemically and the overexpression of P53 and Bcl-2 protein were also evalutated. RESULTS: The overexpressions of Bcl-2 protein and P53 protein were found in 40% (26/65) and 31% (20/ 65). The AI ranged from 0% to 15% (mean 2.16, median 1.2). Cellular Bcl-2, which counteracts apoptosis, was significantly ( p=0.005) associated with AIs. Ki-67 proliferative indices ranged from 1% to 91% (mean 55.4), and P53 was significantly ( p=0.000) associated with Ki-67 proliferative indices. A positive correlation between AIs and Ki-67 proliferative indices was revealed ( p=0.012) in Bcl-2 positive patients. CONCLUSION: In NHL, we observed a correlation between AIs and Bcl-2 expression, between Ki-67 proliferative indices and P53 expression, and between AIs and Ki-67 proliferative indices in Bcl-2 positive patients. Our results suggest that cell apoptosis may be inseparable from cell proliferation during tumor growth.

Intramedullary Spinal Cord Metastasis: A Report of Two Cases and a Review of the Literature / 대한방사선종양학회지

Intramedullary spinal cord metastases (ISCM) account for only 3.4% of symptomatic metastases to the spinal cord. The survival of patients with ISCM is characteristically short, often no longer than 2 months, due to a rapid neurologic deterioration and the presence of widespread metastases, including metastases to the brain. We report two cases of ISCM arising from primary sphenoid sinus carcinoma and primary lung cancer along with a review of the literature. The case of ISCM from the primary sphenoid sinus is the third case of secondary syringomyelia due to ISCM in the world literature, and ISCM from the primary lung cancer is the first case reported in Korea. One case showed a slow progression of symptoms and a longer survival (26 months after the radiotherapy to the spine), and the other showed a rapid deterioration of symptoms with a shorter survival. More effective palliation can be achieved if the disease is diagnosed at an early stage when the neurologic deficits are still reversible.

Expression of c-erbB-2, c-myc, c-fos, bcl-2, p53, PCNA, and TGF-alpha in Transitional Cell Carcinoma of the Urinary Bladder

Most of malignant tumors in the urinary bladder is transitional cell carcinoma (TCC) deriving from the urothelium. Clinical stage and histopathologic grading of the TCC of the urinary bladder is important in the determination of the patient's prognosis. To investigate the correlation between the prognostic factors and the expression of the various oncoproteins and growth factors in each grade of the TCC, immunohistochemical stains for c-erbB2, c-myc, c-fos, bcl-2, p53, proliferating cell nuclear antigen (PCNA), and transforming growth factor-alpha (TGF-alpha) were performed in the formalin fixed paraffin embedded tissues of the TCC (Grade I; 15 cases, Grade II; 20 cases, Grade III; 15 cases) of the urinary bladder. The immunoexpression rate of c-erbB2 was immunoexpression 78.0% in the grade I, 85.0% in the grade II, and 95.0% in the grade III TCC. The immunoexpression rate of c-myc, c-fos and bcl-2 was below 5% in each grades of TCC. The p53 immunoexpression was identified in 11.5%, 24.3% and 30.6% of the grade I, II, and III TCC, respectively. The PCNA and TGF-alpha expression was 53.0% and 27.6% in the grade I, 77.3% and 32.7% in the grade II, and 78.2% and 37.3% in the grade III TCC, respectively. These results suggest that the expressions of c-myc, c-fos, bcl-2, and TGF-alpha are similar in each grade of the TCC and the positivity of c-erbB2, p53, and PCNA shows an increasing tendency for the higher grade TCC of the urinary bladder. Therefore, c-erbB2, p53, and PCNA are clinically useful predictors of the patient's prognosis.

Metastatic Cervical Lymphadenopathy from Uterine Leiomyosarcoma with Good Local Response to Radiotherapy and Chemotherapy / 대한방사선종양학회지

The metastasis of uterine leiomyosarcoma to the neck node has not been reported previously and the radiotherapy has been rarely used for the metastatic lesion of the other sites. We report a case of neck metastasis from a uterine leiomyosarcoma, which developed 10 months after surgery and postoperative pelvic radiotherapy. It also involved the parapharyngeal space, adjacent spine, and spinal canal. The metastatic neck mass was inoperable, and was treated by neck radiotherapy (6,000 cGy) and chemotherapy including taxol and carboplatin. The mass has regressed progressively to a nearly impalpable state. She has never developed spinal cord compression syndrome, and has maintained good swallowing for eight months since the neck radiotherapy and chemotherapy. Since the extensive metastatic neck mass showed good local response to high dose radiotherapy and chemotherapy, both treatments may be considered for an unresectable metastatic leiomyosarcoma.

Spontaneous Apoptosis and Metastasis in Squamous Cell Carcinoma of the Lung / 대한방사선종양학회지

PURPOSE: To evaluate whether spontaneous apoptosis has prognostic value among patients with squamous cell carcinoma of lung. MATERIALS AND METHODS: Material from 19 patients who received thoracic irradiation between 1990 and 1994 was analyzed. Their stages were II (1), IIIa (8), IIIb (5), and IV (5). Patients were observed from 5 to 67 months (median : 17 months). The spontaneous apoptosis index (AI) and p53 mutation were measured by immunohistochemical stains. RESULTS: AI was found to range from 0 to 1% (median 0.4%). Patients with low AI (AI< or =median) had a much higher distant metastasis rate at diagnosis than patients with high AI. By analysis of prognostic factors for survival, M stage was significant in univariate analysis. AI, chemotherapy, M stage, T stage, and stage were significant in multivariate analysis. The correlation between the AI and p53 mutation was not seen. CONCLUSION: AI was related with distant metastasis at diagnosis and not with p53 mutation. Also low AI group tended to have shorter survival time than high AI group.

A Study on the Knowledge and Attitudes Towards Radiation Therapy and Cancer / 대한방사선종양학회지

PURPOSE: To get the data for public information and education of medical students about radiation therapy (RT). MATERIALS AND METHODS: We evaluated the knowledge and attitudes towards the RT and cancer in the third grade medical students who did not receive a lecture before starting the poly-clinic education about radiation oncology in our medical school. We obtained a total of 142 answers from the students that completed the questionnaire. RESULTS: More than half of the third grade medical students answered 1 question correctly and 5 questions incorrectly among 6 questions about knowledge of RT. Incorrect answers were done about the frequency of RT, hair loss, the period of RT, re-RT, cost of RT. Fifty-six percent of students didn't wish to prolong the survival time from 1 year to 3 years with long courses of chemotherapy and RT. They had bad images about cancer of colorectum, lung, esophagus, liver, breast, cervix which consist of 56.3% of patients receiving RT. CONCLUSION: Public information about the basic points of RT should be considered. Also the students showed the pessimism about the anticancer treatments such as chemotherapy and RT, so the exact results and positive aspects of anticancer treatment should be educated more. Especially it is needed to inform the students and the public the positive aspects of RT in some cancers (colorectal, lung, esophageal, hepatic, breast, cervix cancers) which the students had bad images about.

Intracranial Extension of Adenoid Cystic Carcinoma of the Palate / 대한방사선종양학회지

Intracranial involvement by adenoid cystic carcinoma (ACC) is very rare and there is no report of intracranial extension from the palate ACC in Korea. Intracranial involvement can occur in one of three ways : direct extension, perineural spread, and hematogenous spread. A case report of a 35-year-old woman with intracranial ACC is presented. Initially she had ACC of the right palate and was treated by surgery and postoperative radiation therapy. Three years and 10 months later, the paresthesia in the distribution of ophthalmic and maxillary branch of right trigeminal nerve developed without evidence of recurrence in CT scan. Ptos and total ophthalmoplegia developed sequentially and the second operation was performed. It was suggested that the tumor was spread perineurally along the trigeminal nerve into the Gasserian ganglion and then cavernous sinus and orbit. Seven years and 6 months after the first operation, direct intracranial extension into the right temporal lobe developed via sphenoid bone, sphenoid sinus and temporal bone and the third operation was done. And then lung metastasis was diagnosed. She is alive for 9 years 5 months after first operation.

Effect of Ionizing Radiation on the Host Resistance Against Listeria Monocytogenes Infection and the Cytokine Production in Mice / 대한치료방사선과학회지

PURPOSE: To evaluate the qualitative immunologic changes by ionizing radiation, we studied the altered capacities of the macrophages and lymphocytes to produce cytokines in conjunction with resistance to Listeria monocytogenes (LM) infection in mice. MATERIALS AND METHODS: BALB/c mice and Listeria monocytogenes were used. The mice were infected intraperitoneally with 105LM at 1 day after irradiation (300cGy) and sacrificed at 1, 3, 5 days after infection, and then the numbers of viable LM per spleen in the irradiated and control group were counted. Tumor necrosis factor-alpha (TNF-alpha), interferon-gamma (IFN-gamma), interleukin-2 (IL-2), and nitric oxide (NO) were assessed after irradiation. RESULTS: Under gamma-ray irradiation with a dose range of 100-850cGy, the number of total splenocytes decreased markedly in a dose-dependent manner, while peritoneal macrophages did so slightly. Cultured peritoneal macrophages produced more TNF-alpha in the presence of lipopolysaccharide (LPS) during the 24 hours after in vitro irradiation, but their capacity of TNF-alpha production showed a decreased tendency at 5 days after in vivo total body irradiation. With 100cGy and 300cGy irradiation, cultured peritoneal macrophages produced more NO in the presence of LPS during the 24 hours after in vitro irradiation than without irradiation. Activated splenocytes from irradiated mice (300cGy) exhibited a decreased capacity to produce IL-2 and IFN-gamma with Concavalin-A stimulation at 3 days after irradiation. When BALB/c mice were irradiated to the total body with a dose of 300cGy, they showed enhanced resistance during early innate phase, but a significant inhibition of resistance to LM was found in the late innate and acquired T-cell dependent phases. CONCLUSION: These results suggest that increased early innate and decreased late innate and acquired immunity to LM infection by ionizing radiation (300cGy) may be related to the biphasic altered capacity of the macrophages to produce TNF-alpha and the decreased capacities of the lymphocytes to produce IL-2 and IFN-gamma in addition to a marked decrease in the total number of cells.

Characteristics of the Immortalized Human B-cells by Epstein-Barr Virus

Human lymphoblastoid B-cell lines immortalized by Epstein-Barr virus (EBV) were established from peripheral blood of patients with acute myeloblastic and chronic lymphocytic leukemia and chronic fatigue syndrome. The sera of patients with acute myeloblastic and chronic lymphocytic leukemia did not show antibodies to Epstein-Barr viral capsid antigen (VCA), but serum of a patient with chronic fatigue syndrome disclosed antibodies to VCA (IgG, IgM), and EBNA was demonstrated in peripheral blood mononuclear cells by polymerase chain reaction. The established cell lines were mature B-cell phenotypes with polyclonal proliferation in early passage and no evidence for commitment to other lineages. The immortalized cells by EBV were designated as CSUP-1 and CSUP-2 (from acute myeloblastic leukemia, FAB classification M2 and M1), CSUP-3 (from chronic lymphocytic leukemia) and CSUP-4 (from a patient with chronic fatigue syndrome). The CSUP-1, 2, 3, and 4 grew in suspension forming clumps with a doubling time of 38 to 49 hours. Colony formation was not recognized in plate. By light and electron microscopic examination, the immortalized cells showed features of lymphoblastoid to plasmacytoid lymphocytes, and multinucleated giant cells. The lymphoblastoid cells showed scanty cytoplasm with poorly developed organelles. Immunophenotypic analyses of CUSP-1, 2, 3, and 4 with monoclonal antibodies by flow cytometry showed B-cell phenotype with polyclonal proliferation in early passage. Epstein-Barr virus nuclear antigen was confirmed in the extracted DNAs from immortalized cells by polymerase chain reaction. DNA analysis showed a normodiploid stemline with a DNA index of 1.12. The established cells were strongly reactive for CD10, CD30 (Ki-1) in early passage, and bcl-2 and c-myc onco-protein in early and late passage. Karyotypic analysis of CSUP-1, 2, 3 and 4 showed 46, XY or 46, XX. No tumorigenesis in heterotransplanted SCID mouse was recognized. This immortalized cells by EBV should be a valuable cell lines to study the pathogenesis of EBV-related malignant lymphoma.

Sphenoid Sinus Carcinoma with Intramedullary Spinal Cord Metastasis and Syringomyelia: Report of A Case / 대한치료방사선과학회지

PURPOSE: Primary sphenoid carcinoma is rare. It accounts for 0.3% of all primary paranasal sinus malignancies. Because of the rarity of sphenoid carcinoma, large series of patients with outcome and survival statistics are currently unavailable. So we followed up the 1 case of sphenoid sinus carcinoma treated in our hospital and reported the course of the disease. METHODS AND MATERIALS : In a review of case reports and small series of patients, 2-year survival was 7%. Our case is alive at 29 months after diagnosis of sphenoid sinus carcinoma. Intramedullary spinal cord metastasis (ISCM) is an unusual complication of cancer. In our case rapidly progressive paraparesis and urinary retention developed at 25 months after diagnosis of sphenoid sinus carcinoma. MRI of the thoracic spines showed the intramedullary spinal cord tumor mass at T3 and T4 level with accompanying syringomyelia.Here we report a case of ISCM associated with syringomyelia which has developed after primary sphenoid sinus carcinoma with a review of literature about the clinical behavior and treatment of this lesion.