Long-term toxicities after allogeneic hematopoietic stem cell transplantation with or without total body irradiation: a population-based study in Korea

Jeanny Kwon(Jeanny Kwon),Byoung Hyuck Kim(Byoung Hyuck Kim) 대한방사선종양학회 2024 Radiation Oncology Journal Vol.42 No.1

Purpose: To compare long-term toxicity incidences, including secondary cancer (SC) with or without total body irradiation (TBI), in Asian patients receiving allogeneic hematopoietic stem cell transplantation (HSCT) using a nationwide database. Materials and Methods: We identified 4,554 patients receiving HSCT for leukemic disease from 2009 to 2016 using the healthcare bigdata system of Korea. Incidence rate ratios (IRRs) for SC, cataracts, hypothyroidism, chronic kidney disease (CKD), myocardial infarction, or strokes were compared, and standardized incidence ratios (SIR) of SC was also estimated. Results: TBI was conducted on 1,409 patients (30.9%). No overall survival differences based on TBI were observed. With a median follow-up duration of 58.2 months, 143 patients were diagnosed with subsequent SC (3.4%). Incidence rates per 1,000 person-year were 6.56 (95% confidence interval [CI], 4.8–8.8) and 7.23 (95% CI, 5.9–8.8) in the TBI and no-TBI groups, respectively (p = 0.594). Also, the SIR (95% CI) was not significantly increased by TBI (1.32 [0.86–1.94] vs. 1.39 [1.08–1.77] in the no-TBI group). In the young age group (0–19 years), SIRs were increased in both groups regardless of TBI (8.60 vs. 11.96). The IRRs of cataracts (1.60; 95% CI, 1.3–2.0), CKD (1.85; 95% CI, 1.3–2.6), and hypothyroidism (1.50; 95% CI, 1.1–2.1) were significantly increased after TBI. However, there were no significant differences in the occurrence of myocardial infarction and stroke according to TBI. Conclusion: Our results suggest that modern TBI may not additionally increase the risk of SC after allogeneic HSCT, although increased risks of other diseases were noted. Physicians should carefully consider individualized risks and benefits of TBI, with a particular focus by age group.

Role of adjuvant postoperative external beam radiotherapy for well differentiated thyroid cancer

Jeanny Kwon,Hong-Gyun Wu,Yeo-Kyu Youn,Kyu Eun Lee,Kwang Hyun Kim,Do Joon Park 대한방사선종양학회 2013 Radiation Oncology Journal Vol.31 No.3

Purpose: To analyze the outcome of adjuvant postoperative external beam radiotherapy (EBRT) in well-differentiated thyroid cancer (WDTC). Materials and Methods: We identified 84 patients treated with EBRT for WDTC from February 1981 to December 2010. Among them, we analyzed 39 patients who received EBRT after initial radical surgery. Twenty-four females and 15 males were included. The median age was 49 years (range, 16 to 72 years). There were 34 papillary thyroid carcinomas and 5 follicular thyroid carcinomas. Most patients showed pathologic T3/T4 stage (54%/26%). Ten patients (25.6%) had gross residual tumors. Five patients (12.8%) had tumor cells at the margin. The median EBRT dose and fraction size were 62.6 Gy and 1.8 to 2.0 Gy, respectively. Results: The median follow-up was 73 months (range, 21 to 372 months). The five-year overall survival (OS) and locoregional recurrence free survival (LRFS) were 97.4% and 86.9%, respectively. Locoregional failures occurred in 5 and all failure sites were the neck node area. In univariate analysis, OS was significantly influenced by invasion of the trachea (p = 0.016) or esophagus (p = 0.006). LRFS was significantly decreased by male (p = 0.020), gross residuum after resection (p = 0.002), close or positive tumor at surgical margin involvement (p = 0.044), and tracheal invasion (p = 0.040). No significant prognostic factor was identified in the multivariate analysis. No patient experienced the Radiation Therapy Oncology Group grade 3 or more toxicity. Conclusion: Our locoregional control rate of 87.2% is comparable to historical controls with surgery alone, even though our study had a large proportion of advanced stage. Adjuvant EBRT may an effective and safe treatment option in patients with WDTC.

Role of adjuvant postoperative external beam radiotherapy for well differentiated thyroid cancer

Kwon, Jeanny,Wu, Hong-Gyun,Youn, Yeo-Kyu,Lee, Kyu Eun,Kim, Kwang Hyun,Park, Do Joon The Korean Society for Radiation Oncology 2013 Radiation Oncology Journal Vol.31 No.3

Purpose: To analyze the outcome of adjuvant postoperative external beam radiotherapy (EBRT) in well-differentiated thyroid cancer (WDTC). Materials and Methods: We identified 84 patients treated with EBRT for WDTC from February 1981 to December 2010. Among them, we analyzed 39 patients who received EBRT after initial radical surgery. Twenty-four females and 15 males were included. The median age was 49 years (range, 16 to 72 years). There were 34 papillary thyroid carcinomas and 5 follicular thyroid carcinomas. Most patients showed pathologic T3/T4 stage (54%/26%). Ten patients (25.6%) had gross residual tumors. Five patients (12.8%) had tumor cells at the margin. The median EBRT dose and fraction size were 62.6 Gy and 1.8 to 2.0 Gy, respectively. Results: The median follow-up was 73 months (range, 21 to 372 months). The five-year overall survival (OS) and locoregional recurrence free survival (LRFS) were 97.4% and 86.9%, respectively. Locoregional failures occurred in 5 and all failure sites were the neck node area. In univariate analysis, OS was significantly influenced by invasion of the trachea (p = 0.016) or esophagus (p = 0.006). LRFS was significantly decreased by male (p = 0.020), gross residuum after resection (p = 0.002), close or positive tumor at surgical margin involvement (p = 0.044), and tracheal invasion (p = 0.040). No significant prognostic factor was identified in the multivariate analysis. No patient experienced the Radiation Therapy Oncology Group grade 3 or more toxicity. Conclusion: Our locoregional control rate of 87.2% is comparable to historical controls with surgery alone, even though our study had a large proportion of advanced stage. Adjuvant EBRT may an effective and safe treatment option in patients with WDTC.

Korean Association for Clinical Oncology : Slide Session ; P-57 : Others ; Prognostic Value of Log Odds of Positive Lymph Nodes After Radical Surgery Followed by Adjuvant Treatment in Cervical Cancer

( Jeanny Kwon ),( Keun Yong Eom ),( In Ah Kim ),( Jae Sung Kim ),( Young Beom Kim ),( Jae Hong No ),( Ki Dong Kim ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1

Purpose:To compare prognostic value of various methods assessing lymph node (LN) status [location or number of positive LNs, LN ratio (LNR), and log odds of positive LNs (LODDs)] in cervical cancer treated with radical surgery and adjuvant treatment. Materials and Methods: Between 2004 and 2012, we retrospectively analyzed 66 patients who underwent radical hysterectomy and pelvic node dissection followed by adjuvant treatment (radiotherapy, 16; chemoradiotherapy, 50 patients). Patients had fiGO stage IA2-IIB and positive LN was found in 58%. LN groups were classifi ed into upper (common iliac or higher) and lower LNs (below common iliac). LNR was calculated as a ratio of number of pathologic LNs over number of harvested LNs. LODDs was log of odds ratio between positive LNs and negative LNs. Radiotherapy was delivered to whole pelvis with median 50.4 Gy/28 Fx ± para-aortic region. In case of chemoradiation, platinum-based chemotherapy was used mainly (96%). The median follow-up duration was 60 months. Results: Estimated 5-year disease-free survival (DFS) and overall survival (OS) was 78.3% and 87.7%. Treatment failure occurred in 13 patients and distant failure was dominant pattern (12 patients). In univariate analysis, DFS was signifi cantly decreased in patients with PNI (p<0.001), =2 LN metastases (p=0.016), LNR =10% (p=0.001), upper LN metastasis (p=0.001) and =-1.05 LODDs (p<0.001). Multivariate analysis revealed that PNI (p=0.046) and =-1.05 LODDs (p=0.012) were independent prognostic factors for DFS. Of 22 patients with LODDs =-1.05, 9 patients (40.9%) experienced distant failure.As for OS, LODDs was the only signifi cant prognostic factor as well (p=0.012). Conclusion: LODDs =-1.05 was strong prognostic factor for DFS and OS after radical surgery and adjuvant treatment. In patients with LODDs =-1.05, it may need to reinforce chemotherapy considering high rate of distant failure.

Impact of Multimodality Approach for Patients with Leptomeningeal Metastases from Solid Tumors

Jeanny Kwon,지의규,김규보,김학재,우홍균,김일한,오도연,이세훈,김동완,임석아,김태유,허대석,방영주,하성환 대한의학회 2014 Journal of Korean medical science Vol.29 No.8

The purpose of this study was to evaluate treatment patterns, outcome andprognosticators for patients with leptomeningeal metastases from solid tumor. Medicalrecords of 80 patients from January 1, 2004 to May 31, 2011 were retrospectivelyreviewed. Most frequent site of origin was the lung (59%) followed by the breast (25%). Most patients were treated with intrathecal chemotherapy (90%) and/or whole brainradiotherapy (67.5%). Systemic therapy was offered to 27 patients (33.8%). Percentage ofpatients treated with single, dual, and triple modality were 32.5%, 43.8%, and 23.8%,respectively. Median survival was 2.7 months and 1 yr survival rate was 11.3%. Multivariate analysis showed that negative cerebrospinal fluid cytology, fewerchemotherapy regimen prior to leptomeningeal metastases, whole brain radiotherapy,systemic therapy, and combined modality treatment (median survival; single 1.4 vs. dual2.8 vs. triple 8.3 months, P < 0.001) had statistical significance on survival. Subgroupanalysis of non-small cell lung cancer (NSCLC) patients showed that targeted therapy hadsignificant independent impact on survival (median survival; 10.5 vs. 3.0 months,P = 0.008). Unlike previous reports, survival of patients with NSCLC primary wascomparable to breast primary. Furthermore, combined modality treatment for all patientsand additionally targeted therapy for NSCLC patients should be considered in the treatmentof leptomeningeal metastases from solid tumor.

Objective Measurement of Cosmetic Outcomes of Breast Conserving Therapy Using BCCT.core

유도솔,엄근용,장나영,김경수,Tae Ryool Koo,Jeanny Kwon,김병혁,강은영,김성원,김재성,김인아 대한암학회 2016 Cancer Research and Treatment Vol.48 No.2

Purpose The purpose of this study is to evaluate objective cosmetic outcomes and factors related to breast-conserving therapy (BCT) using the BCCT.core software. Materials and Methods Fifty-one patients who received BCT with informed consent were evaluated using the BCCT.core software. Patients were divided into two groups based on the BCCT score: excellent or good (n=42) vs. fair or poor (n=9). Analysis of clinical factors was performed to determine factors affecting cosmetic outcomes. Results The objective cosmetic outcome of BCT measured using the BCCT.core software was excellent in 10% of patients, good in 72%, and fair in 18%. None of the patients were classified as poor outcome. Tumor characteristics, systemic adjuvant therapy (chemotherapy and hormonal therapy), and radiation dose or energy of electron boost did not show correlation with the score measured by the BCCT.core program (p > 0.05). In univariate analysis, maximum dose within the breast (Dmax), width of tangential field, and excised tumor volume were smaller in patients with excellent or good by the BCCT.core compared to those with fair or poor (Dmax, 110.2±1.5% vs. 111.6±1.7%, p=0.019; width of tangential field, 8.0±1.1 cm vs. 8.6±0.7 cm, p=0.034; excised tumor volume, 64.0±35.8 cm3 vs. 95.3±54.4 cm3, p=0.067). In multivariate analysis, only Dmax was a significant factor for breast cosmetic outcome with a risk ratio of 1.697 (95% confidence interval, 1.006 to 2.863; p=0.047). Conclusion Objective measurement of cosmetic outcome of BCT using the BCCT.core software was feasible. The cosmetic outcome of BCT may be affected by the maximum dose within the breast.

대학시설 내 지체장애인의 생활행태기반 공간적 개선요구에 관한 연구

이연숙(Lee, Yeunsook),임진이(Lim, Jeanny),임채숙(Lim, Chaesuk),권현주(Kwon, Hyunjoo) 한국생태환경건축학회 2007 한국생태환경건축학회 논문집 Vol.7 No.3

두경부암 환자에서 근치적 방사선치료 후 12주 시행한 양전자방출촬영의 임상적 중요성에 대한 연구

김영일(Young-il Kim),김준상(Jun-sang Kim),권진이(Jeanny Kwon),김섭(Sup Kim),서영덕(Youngduk Seo),구본석(Bon-seok Koo),장재원(Jae-won Chang),조문준(Moon-June Cho) 대한두경부종양학회 2021 대한두경부 종양학회지 Vol.37 No.1

Background/Objectives: To evaluate clinical significance of FDG PET-CT for detection of residual cancer cells after curative radiation therapy or chemoradiotherapy for patients with squamous cell carcinoma (SCC) of Head and Neck Materials & Methods: A retrospective analysis of patients with SCC of Head and neck with curative radiotherapy or chemoradiotherpy between June 2011 and Jan. 2019 was performed. Sixty patients were treated with Intensity-modulated radiotherapy (IMRT). The Metabolic responses were evaluated on the post-treatment FDG PET-CT at 12 weeks after curative radiotherapy completion. Results: Median follow up was 51.5 months (3-102). The overall survival (OS), disease free survival (DFS), local control rate (LCR), and Distant metastasis free survival (DMFS) at 5 years were 80.5%, 80.1%, 87.7% and 89.1%. Metabolic CR was found in 43 (71.7%) and partial metabolic response (PR) was noted in 17 (14.6%). Metabolic CR was significantly correlated with OS, DFS, LCR, and DMFS. On multivariate analysis, Metabolic CR remained significant for DFS and LCR. Conclusion: Metabolic CR on post-radiotherapy FDG PET-CT is highly predictive of increased DFS and LCR in patients with head and neck cancer.

The Benefit of Post-Mastectomy Radiotherapy in ypN0 Patients after Neoadjuvant Chemotherapy According to Molecular Subtypes

조원경,박원,최두호,김용배,김진호,김수산,김규보,김진희,안성자,이선영,이정심,김상원,Jeanny Kwon,안기정 한국유방암학회 2019 Journal of breast cancer Vol.22 No.2

Purpose: The benefit of post-mastectomy radiation therapy (PMRT) in patients with breast cancer who achieve ypN0 following neoadjuvant chemotherapy (NAC) has not yet been established. This study aimed to identify the role of PMRT in patients who achieve ypN0 according to molecular subtype. Methods: We identified patients initially suspected with axillary disease who achieved ypN0 following NAC. From 13 institutions of the Korean Radiation Oncology Group between 2005 and 2011, a total of 189 patients were included in the analysis. Effects of PMRT on loco-regional control (LRC), disease-free survival (DFS), and overall survival (OS) were evaluated for different molecular subtypes. Results: In all patients, the prognostic effect of PMRT on LRC, DFS, or OS was not significant. Subgroups analysis showed that the effect of PMRT on LRC was different according to molecular subtype (p for interaction = 0.019). PMRT was associated with greater LRC in the luminal subtype (p = 0.046), but not in other subtypes. Conclusion: In patients who achieve ypN0 following NAC and mastectomy, PMRT shows no additional survival benefits for any molecular subtype.