비인강암의 방사선치료 성적

조문준(Moon-June Cho),장지영(Ji-Young Jang),김준상(Jun-Sang Kim),김병국(Byung-Kook Kim),송창준(Chang-Joon Song),김재성(Jae-Sung Kim) 대한방사선종양학회 2001 Radiation Oncology Journal Vol.19 No.1

목 적 :비인강암 환자의 방사선치료 성적을 후향적으로 분석하여 방사선치료의 효과와 예후인자를 분석하고자 하였다. 대상 및 방법 : 1989년 9월부터 1996년 10월까지 비인강암으로 진단받고 방사선치료를 받은 19명을 대상으로 하였다. 병기별로 보면 I 병기가 2명, II 병기가 6명, III 병기가 2명, IV 병기가 9명이었다. 병리조직학적으로 편평세포암이 5명, 미분화세포암이 14명이었다. 14명은 방사선치료만을 받았다. 5명은 항암제치료를 받았다. 추적 기간은 5개월에서 115개월이였으며 중앙값은 33개월이었다. 모든 환자에게서 추적이 가능하였다. 결 과 :방사선치료 후 15명(79%)에서 완전관해를 보였고 2명(10.5%)에서 부분관해를 보였으며 2명(10.5%)에서는 무반응을 보였다. 치료실패 양상은 국소 실패가 6명이었으며 원격전이가 4명에서 나타났다. 원격전이는 뼈, 간, 폐 등에서 관찰되었다. 전체 환자의 5년 생존율은 47.4%이었고 5년 무병 생존율은 48.1%였다. 병기, T 병기, N 병기, 뇌신경침윤 여부, 병리학적 유형, 활동지수, 반응도, 방사선량, 항암제 치료여부 등에 의한 생존율의 의미 있는 통계적 차이는 없었다. 결 론 :전체 환자의 5년 생존율은 47.4%이었고 5년 무병 생존율은 48.1%이었다. 치료 효과를 증가시키기 위하여 방사선치료 방법의 개선 및 항암제치료 방법에 대한 연구가 필요할 것으로 사료된다. Purpose :This is a retrospective study to evaluate the results of radiation therapy in nasopharyngeal carcinoma. Materials and Methods : From September 1989 to October 1996, 19 patients with nasopharyngeal ca rcinoma completed planned radiation therapy course. Stages were I in 2 patients, II in 6, III in 2 IV in 9 patients, respectively. Pathology was squamous cell carcinoma in 5 patients, undifferentiated cell carcinoma in 14 patients. Fourteen patients were treated with radiation therapy only. Five patients received chemotherapy. The follow- up period ranged from 5 months to 115 months with a median of 33 months. Follow- up was possible in all patients. Results : Responses to radiation therapy were complete response in 15 patients, partial response in 2, and no response in 2, respectively. Patterns of failure were as follows : locoregional recurrence in 6 patients and distant metastasis in 4 patients. The sites of distant metastasis were bone, liver and lung. Five year survival rate was 47.8% and five year disease free survival rate was 48.1%. Stage, T- stage, Nstage, central nervous system involvement, pathology type, performance status, response, radiation dose, chemotherapy were not significant prognostic factors. Conclusion :5- year survival rate was 47.8% and 5-yea r disease free survival rate was 48.1%. The advances in radiation therapy techniques and chemotherapy are needed.

방사선치료 조사영역 내에 발생한 설암 환자에서 입체조형방사선치료 경험

조문준(Moon June Cho),김기환(Ki Hwan Kim),김병국(Byung Kook Kim),송창준(Chang Joon Song),김준상(Jun Sang Kim),김재성(Jae Sung Kim),장지영(Ji Young Jang) 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.1

Objectives: We report an interim result of conformal radiotherapy in a patient with early stage cancer at the base of the tongue, which developed in a previously irradiated area. Materials and Methods: A 64-year-old male patient was diagnosed with T4N0M0 supraglottic cancer. He received 72Gy of radiation therapy from 21 November 1988 to 24 February 1989. He had local failure and underwent a salvage total laryngectomy on 28 August 1989. Subsequently, he did well. In early 1999, he suffered from throat pain. He had a 2.5cm ulcerative mass at the base of his tongue, in the area that had been irradiated previously. Biopsy showed squamous cell carcinoma. After workup, he was diagnosed with base of tongue cancer with T2N0M0. Surgery was not feasible because the morbidity was not acceptable. Since it was difficult to re-irradiate the area with a curable dose using conventional 2D radiation therapy with an acceptable morbidity, we decided to try conformal radiotherapy. We used 7 static beam ports with field sizes from 7x6.4to8x8cm 2, using 6 and 10MV photons. The fractionation regimen was 1.8Gy, 5 times per week. He received 64.8Gy in 36 fractions from 9 April 1999 to 1 June 1999. Results: In the 21 months since radiotherapy, the patient has not experienced any acute or chronic complications, such as xerostomia. He experienced relief of pain shortly after the start of radiotherapy, showed a complete response, and is still doing well. Conclusion: Conformal radiotherapy can be used to treat cancer that develops within a previously irradiated field, with curative intent.

비인강암환자에서 시행한 3차원 입체조형 방사선치료의 조기 임상결과

장지영(Ji Young Jang),조문준(Moon June Cho),김기환(Ki Hwan Kim),송창준(Chang Joon Song),김병국(Byoung Kook Kim),김준상(Jun sang Kim),김재성(Jae sung Kim) 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.2

Objectives: To improve local control and reduce toxicity, 3-D conformal radiotherapy was used as a boost the primary tumor site following fractionated radiotherapy in patients with nasopharyngeal carcinoma. Materials and Methods: Eight patients with previously untreated nasopharyngeal carcinomas were treated with 3-D conformal radiotherapy following fractionated radiotherapy from September 1998 to April 2000. All patients had biopsy confirmation of disease before radiation therapy. Stages were II in 1, III in 5, and IV in 2. Two patients received cisplatin based chemotherapy in addition to radiation therapy; induction chemotherapy in 1, concurrent chemoradiation in 1. 3-D conformal radiotherapy delivered using 6MV Linac as a boost(range 25.2-28.8Gy, median 25.7Gy) following conventionally fractionated radiotherapy(range 50.4Gy). Average total dose ranged from 75.6-79.2Gy(median 76Gy). Follow-up time was 4-21 months(median 9.6 months). Results: Seven of 8 patients were evaluated radiologically within 3 months after completion of radiation therapy. All 7 patients were seen complete remission. One of 7 patients had distant metastasis after 5 months and local failure after 7 months. The tree interval of local recurrence was ranged from 4 - 21 months(median 10.2 months). One patient without radiological evaluation got complete remission clinically. Treatment related toxicity was grade 1-3 xerostomia, dysphagia, and mucositis. During 3-D conformal radiotherapy, there was no aggravation of any toxicity. Conclusion: Although the number of patients was small and follow-up period was short, 3-D conformal radiotherapy following conventional radiotherapy improved tumor control and dose escalation without increased toxicity. Survival and late toxicity should be evaluated through long term follow-up. In addition, it is necessary to confirm the benefits of 3-D conformal radiotherapy in nasopharyngeal carcinoma with randomized trial.

Multiple arc FSRT와 Conformal FSRT의 DVH 비교

김기환,김준상,장지영,김재성,김성호,송창준,박민규,존문준,Kim Ki-Hwan,Kim Jun-Sang,Jang JiYoung,Kim Jae-Sung,Kim Seong-Ho,Song Chang-Joon,Park Min-Kyu,Cho Moon-June 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.3

목적 : Multiple arc FSRT (fractionated stereotactic radiotherapy)와 conformal FSRT의 치료계획에 있어서 종양의 모양과 DVH (dose volume histogram)를 비교하여 두 기법간의 유용성에 대하여 논하고자 한다. 대상 및 방법 : 16명의 뇌종양 환자들을 대상으로 1997년 8월부터 1998년 12월까지 충남대학교병원 치료방사선과에서 112회의 FSRT를 실시하였다. 치료 전 모의치료에서 얻은 AP(Anterior-posterior), Lateral 필름상의 금속표지자의 좌표값을 ISOLOC프로그램에 입력하여 얻은 기준점과의 오차를 확인한 후 치료계획을 하였다. 치료계획은 종양용적과 종양표면적를 계산한 후 if (Irregular factor)를 고려하여 multiple arc FSRT 혹은 conformal FSRT를 선택하였다. Multiple arc FSRT는 종양의 IF값이 1-1.2인 경우에 고려하였고, conformal FSRT는 IF값이 1.3 이상인 경우에 고려한 후 종양용적에 대하여 처방선량 이상의 선량에 대한 DVH곡선에 의한 면적이 최소이면서 처방선량 이하의 선량에 대한 DVH곡선에 의한 면적이 최대가 되도록 하는 치료계획을 선택하여 평가하였다. 결과 : 치료전 모의치료에서 시행한 금속표지자의 좌표값을 ISOLOC프로그램에 입력하여 얻은 기준점과의 오차는 1 mm 이내였다. Huitlple arc FSRT는 누적DVH상에서 처방선량의 90, 91, 92, $93\%$에서 전체 종양용적을 포함하고 있었으며 평균값은 $90.6\%$이었고, conformal FSRT 는 누적DVH상에서 처방선량의 81, 85, 86, 87, $91\%$에서 전체 종양용적을 포함하고 있었으며 평균값은 $8\%$이었다. 두 방식 모두 결정장기들에는 최대선량의 $5\%$이하의 적은 선량이 조사되었다. 결론 : Multiple arc FSRT와 conformal FSRT를 IF를 기준으로 치료 계획하여 구형의 종양에 multiple arc FSRT를 시행하였으며, 불규칙한 모양의 종양에는 conformal FSRT를 시행하여 종양의 모양에 관계없이 적절한 FSRT치료계획을 수립할 수 있었다. Purpose : In FSRT (Fractionated stereotactic radiotherapy) planning, we studied the usefulness between multiple arc FSRT and conformal FSRT by comparing tumor shape and DVH (dose volume histogram). Materials and Methods In Chungnam Univ. hospital, we had treated the sixteen patients with FSRT from Aug. 1997 to Dec. 1998. In choosing multiple arc FSRT or conformal FSRT, we had considered If (irregular factor) after calculating tumor volume and surface area. We had considered multiple arc FSRT if tumor shape was similar to sphere or the value of If was less than 1.25, conformal FSRT if tumor shape was very irregular or If was more than 1.3. For evaluation of treatment planning, we had considered the appropriate DVH for tumor volume and for critical organs. Results : The errors between reference point and the coordinates point on AP, Lat radiography were less than 1 mm before treatment. We had planned $3\~$5 arcs for multiple arc FSRT, $5\~6$ports for conformal FSRT. The mean dose distribution of tumor volume of cumulative DVH between multiple arc FSRT and conformal FSRT was 90.6, 85%, respectively. The dose of critical organs irradiated was less than $5\%$ maximum dose of cumulative DVH. Conclusion : We had obtained the similar value between multiple arc FSRT and conformal FSRT, so that we had appropriate treatment planning of FSRT for multiple arc FSRT and conformal FSRT according to tumor shape and size.

뇌의 자기공명(MR) 영상에서 백질과 회백질의 추출

유현경(Hyun-Kyung Yoo),박종원(Jong-Won Park),송창준(Chang-June Song) 한국정보과학회 1999 한국정보과학회 학술발표논문집 Vol.26 No.2Ⅱ

본 논문에서는 뇌의 자기공명(이하 MR로 줄임) 영상에서 양측 대뇌반구의 뇌백질과 뇌회백질의 추출에 관하여 연구하였다. MR 영상은 특정 장기에서 일정한 gray level 값을 유지하는 전산화단층촬영(이하 CT로 줄임) 영상과는 달리 사람마다 gray level 값이 다르며 한 사람에 대해서도 각 슬라이스에 따라 gray level 값이 다르므로 각 슬라이스별로 조직의 특성을 파악하여 백질과 회백질의 추출에 이용하였다. 먼저 뇌를 둘러싸고 있는 두피, 근육, 두개골과 함께 안구를 제거한 후 두개강 내에 위치한 뇌간과 소뇌의 특성을 차례로 인식하여 대뇌반구로부터 분리한 후 제거하였다. 또한 추출된 대뇌의 영상으로부터 백질과 회백질의 체적을 구하고, 뇌신경계 진단방사선과 전문의의 manual 작업과 비교하여 본 논문에서 제시한 방법의 정확도를 검증하였다.

혈액투석 중인 만성 신부전 환자에서 발생한 Reversible Posterior Leukoencephalopathy Syndrome

구영선(Young Sun Koo),김도희(Do Hee Kim),장윤경(Yoon Kyung Chang),양종오(Jong Oh Yang),강민규(Min Gyu Kang),황평주(Pyeong Joo Hwang),송창준(Chang June Song),이강욱(Kang Wook Lee),신영태(Young Tai Shin) 대한신장학회 2001 Kidney Research and Clinical Practice Vol.20 No.1

A Reversible Posterior Leukoencephalopathy Syndrome(RPLS) consists of neurologic symptoms and signs - headache, consciousness change, seizure, visual impairment - and brain imaging finding showing brain(espicially white matter) edema usually involving the posteior parietal-temporal-occipital areas. The causes are thought to be hypertensive encephalopathy, preeclampsia or eclampsia, renal failure with fluid overload and immunosuppressive agents such as cyclosporin A or FK506. RPLS may usually reversible if treated early by decreasing blood pressure and discontinuing offending drugs. A 23-year- old man had been hemodialyzed with chronic renal failure for two years. His blood pressure elevated to 240/150mmHg 3 days before admission and he complained of severe headache, vomiting, and total visual loss at the day of admission. Brain T2-weighted MRI imaging showed increased signal intensity involving the both parietal, posterior temporal, and occipital lobes. After antihypertensive and dexamethason treatment, a follow-up brain MRI performed on 7 days after admission showed nearly normalized findings and all symptoms including visual loss were recovered completely in one week.

Multiple are FSRT 와 Conformal FSRT의 DVH 비교

김기환(Ki-Hwan Kim),김준상(Jun-Sang Kim),장지영(Ji-Young Jang),김재성(Jae-Sung Kim),김성호(Seong-Ho Kim),송창준(Chang-Joon Song),박민규(Min-Kyu Park),조문준(Moon-June Cho) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.3

목 적: Multiple are FSRT(fractionated stereotaerapy radiotherapy)와 conformal FSRT 의 계획에 있어서 종양의 모양과 DVH(dose volume histogram)를 비교하여 두 기법간의 유용성을 대하여 논하고자 한다 대 상 및 방법: 16명의 뇌종양 환자들을 대상으로 1997년 8월부터 1998년 12월까지 충남대학교의 치료방사선과에서 12회의 FSRT를 실시하였다.치료전 모의치료에서 얻은 AP(Anterior-posterior), lateral 필름상의 금속표지자의 좌표값을 ISOLOC프로그램에 입력하여 얻은 기준점과의 오차를 확인한 후 치료계획을 하였다. 치료계획은 종양용적과 종양표면적를 계산한후 IF (irregular factor)를 고려하여 multiple arc FSRT 혹은 conformal FSRT를 선택하였다. Multiple are FSRT 는 종양의 IF값이 1-1.2인 경우에 고려하였고, Conformal FSRT 는 IF값이 1.3이상인 경우에 고려한 후 종양용적에 대하여 처방선량 이상의 선량에 대한 DVH곡선에 의한 면적이 최소이면서 처방선량 이하의 선량에 대한 DVH곡선에 의한 면적이 최대가 되도록 하는 치료계획을 선택하여 평가하였다. 결 과: 치료전 모의치료에서 시행한 금속표지자의 좌표값을 ISOLOC프로그램에 입력하여 얻은 기준점과의 오차는 1mm이내였다. Multiple are FSRT는 누적 DVH상에서 처방선량의 90,91,92,93%에서 전체 종양용적을 포함하고 있었으며 평균값은 90.6%이였고, conformal FSRT는 누적 DVH상에서 처방선량의 81,85,87,91%에서 전체 종양용적을 포함하고 있었으며 평균값은 86%이었다. 두 방식 모두 결정장기들에는 최대선량의 5%이하의 적은 선량이 조사되었다. 결 론: Multiple are FSRT 와 conformal FSRT 를 IF를 기준으로 치료 계획하여 구형의 종양에 Multiple are FSRT를 시행하였으며, 불규칙한 모양의 종양에는 conformal FSRT를 시행하여 종양의 모양에 관계없이 적절한 FSRT치료계획을 수립할 수 있었다. Purpose:.In FSRT (Fractionated stereotactic radiotherapy) planning, we studied the usefulness between multiple arc FSRT and conformal FSRT by comparing tumor shape and DVH(dose volume histogram). Materials and Methods: In Chungnam Univ. hospital, we had treated the sixteen patients with FSRT from Aug. 1997 to Dec. 1998. In choosing multiple arc FSRT or conformal FSRT, we had considered multiple arc FSRT if tumor shape was similar to sphere or the value of IF was less than 1.25, conformal FSRT if tumor shape was very irregular or IF was more than 1.3. For evaluation of treatment planning, we had considered the appropriate DVH for tumor volume and for critical organs. Result: The errors between reference point and the coordinates point on AP, Lat radiography were less than 1 mm before treatment. We had planned 3~5 arcs for multiple arc FSRT, 5~6pots for conformal FSRT. The mean dose distribution of tumor volume of cumulative DVH between multiple arc FSRT and conformal FSRT was 90.6, 86%, respectively. The dose of critical organs irradiated was less than 5% maximum dose of cumulative DVH. Conclusion: We had obtained the similar value between multiple arc FSRT and conformal FSRT, so that we had appropriate treatment planning of FSRT for multiple arc FSRT and conformal FSRT according to tumor shape and size.

결핵성 경부임파선염의 전산화 단층촬영 소견

송창준,정연수,최창락,윤완규,조준식 충남대학교 의과대학 지역사회의학연구소 1995 충남의대잡지 Vol.22 No.2

Purpose : To evaluate the computed tomography (CT) findings of the cervical tuberculous lymphadenitis Methods and materials : The CT features in 10 patients of tuberculous lymphadenitis were retrospectively reviewed. We characterized the morphologic appearances of lymphadenopathy on post-contrast CT scan and comparatively evaluated the densities of central necrotic portion and peripheral solid portion of necrotic nodes on pre-contrast CT scan. All examines were performed on a General Electric Hispeed Advantage RP System. Ten millimeter and five millimeter contiguous sections from skull base to thoracic inlet were obtained for the pre-contrast and post-contrast images respectively. Results : Most patients were young adults. A painless neck mass was the most common chief complaint and the duration of the symptoms was about 5 months. The average number of diseased lymph nodes was 3.7. Unilateral involvement was 4 times as common as bilateral location. Central necrotic lymphadenopathy was 78.3% of 37 enlarged lymph nodes and the density of the nerotic portion was isodense to the density of the peripheral wall on pre-contrast images in 71.4% of necrotic lymph nodes. The most common morphologic features of cervical tuberculous lymphadenitis was the type of a multichambered or conglomerated necrotic lymphadenopathy with a peripheral irregular enhancement. Conclusion : The tuberculous cervical lymphadenitis was highly suggestive when the diseased lymph nodes show the central necrosis, the morphologic features of multichambered or conglomerated necrotic lymphadenopathy with a strong peripheral irregular contrast enhancement, and necrotic materails isodense to peripheral solid portion on pre-contrast CT scan in young adult patients who complain of a painless neck mass.

요추간판팽윤증 환자에서 전산화단층촬영술과 척수강조영술의 역할

송창준 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Computed tomography is beginning to play a major role in the diagnosis of lesions of the spine. Many physicians, reluctant to subject their patients to myelography, are beginning to rely on computed tomography as the primary method for the evaluation of lumbar spinal stenosis and diseases of the lumbar intervertebral discs. But, as availability of computed tomography is increased, the possible role of the computed tomography, in interpreting the degree of thecal sac compression based on narrowing of the spinal canal, in predicting pathologic focus consistent with radiculopathy and in confindently confirming diffuse bulging disc to the cause of the radiculopathy has been debated in reports of the literature. The purpose of this study was to determine the reliability of computed tomographic measurements and to correlate such measurements with the myelographic findings in patients with diffuse bulging of lumbar intervertebral discs. The computed tomographic scans and myelograms, which had been simultaneously performed, of twenty-six patients with diffuse bulging discs were retrospectively reviewed. In 5 cases of 12 cases(41.6%) which anterior-posterior(AP) diameter of the spinal canal on crosssectional image obtained by computed tomography was less than 1.2 cm, degree of the thecal sac compression on lateral myelogram was less than 20%. In 8 cases of 16 cases(50%) which showed 20% to 40% thecal sac compression on myelogram, AP diameters of the spinal canal were more than 1.4 cm. Cutoff of nerve root sleeves were observed in 5 cases which spinal canal AP diameter was more than 1.2 cm, and evidence of nerve root compression was not observed in 8 cases of 24 cases(33%) which AP diameter was less than 1.2 cm. In conclusion, from this comparative review, measurements of computed tomography in diffuse bulging of the lumbar intervertebral discs are not reliable and lumbar myelography is to be considered as an adjunctive modality in the cases requiring active treatment such as surgical management.

미만성 축삭손상의 자기공명 영상소견

송창준 충남대학교 의과대학 지역사회의학연구소 1994 충남의대잡지 Vol.21 No.2

Purpose : To assess how accurately magnetic resonance image can demonstrate the diffuse axonal shearing injury which is believed to be developed after head trauma by the mechanism to which Holbourn suggested, to analysis the MR findings of shearing injuries, and to do comparative study of MR and CT. Materials and method : Twelve patients studied to evaluate the sequelae of head trauma who underwent MR and had diffuse shear injuries on magnetic resonance images were included in the series. Patients who have a possibility of cerebral infarction, have a widened Virchow-Robin space due to cerebral atrophy, and have a possibility of fat embolism from the clinical course were excluded from the study. The author evaluated MR findings with the special attention to the prevalant location, size, shape and presence of hemorrhage, and tried to define the respective roles of MR and CT. Results : The locations of the lesions were Gray-white matter junction of lobar white matter, corpus callosum, subcortical gray matter, internal capsule, brainstem, and cerebellum. Non-hemorrhagic lesions were snore common than hemorrhagic lesions, especially in the gray-white matter junction. Size and shape of the lesions in the gray-white matter junction and of the lesions in the rest were punctate and small granular, and oval or round shaped lesions, respectively. MR was found to be equal or superior to CT in all the cases. Conclusion : MMR is extremely valuable in the assessment of patients with head trauma and recommend it as the primary imaging method in all patients with minor head trauma as well as in those with moderate to severe injuries in the subacute, chronic, or remote, though CT still remains as an important imaging modality for the acutely injured patients with significant neurologic impairment because of the limitations of MR in the identification of subarachnoid hemorrhage, acute parenchymal hemorrhage and skull fracture.