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수모세포종의 방사선치료 후 전두엽하방 재발된 환자에서 원인 분석 및 구제 치료

Other Titles
 Analysis of the Causes of Subfrontal Recurrence in Medulloblastoma and Its Salvage Treatment 
Authors
 정경근  ;  조재호  ;  서창옥  ;  최중언  ;  김동석  ;  김태곤  ;  박진호  ;  심수정  ;  김경주  ;  이창걸  ;  금웅섭 
Citation
 Journal of the Korean Society for Therapeutic Radiology and Oncology, Vol.22(3) : 165-176, 2004 
Journal Title
Journal of the Korean Society for Therapeutic Radiology and Oncology(대한방사선종양학회지)
ISSN
 1229-8719 
Issue Date
2004
Keywords
Medulloblastoma ; Subfrontal recurrence ; Intensity modulated radiotherapy
Abstract
Purpose: Firstly, to analyze facto in terms of radiation treatment that might potentially cause subfrontal relapse in two patients who had been treated by craniospinal irradiation (CSI) for medulloblastoma, Secondly, to explore an effective salvage treatment for these relapses. Materials and Methods: Two patients who had high-risk disease (T3bMl, T3bM3) were treated with combined chemoradiotherapy CT-simulation based radiation-treatment planning (RTP) was peformed. One patient who experienced relapse at 16 months after CSI was treated with salvage surgery followed by a 30.6 Gy IMRT (intensity modulated radiotherapy). The other patient whose tumor relapsed at 12 months after CSI was treated by surgery alone for the recurrence. To investigate factors that might potentially cause subfrontal relapse, we evaluated thoroughly the charts and treatment planning process including portal films, and tried to find out a method to give help for placing blocks appropriately between subfrotal-cribrifrom plate region and both eyes. To salvage subfrontal relapse in a patient, re-irradiation was planned after subtotal tumor removal. We have decided to treat this patient with IMRT because of the proximity of critical normal tissues and large burden of re-irradiation. With seven beam directions, the prescribed mean dose to PTV was 30.6 Gy (1.8 Gy fraction) and the doses to the optic nerves and eyes were limited to 25 Gy and 10 Gy, respectively. Results: Review of radiotherapy Portals clearly indicated that the subfrontal-cribriform plate region was excluded from the therapy beam by eye blocks in both cases, resulting in cold spot within the target volume, When the whole brain was rendered in 3-D after organ drawing in each slice, it was easier to judge appropriateness of the blocks in port film. IMRT planning showed excellent dose distributions (Mean doses to PTV, right and left optic nerves, right and left eyes: 31.1 Gy, 14.7 Gy, 13.9 Gy, 6.9 Gy, and 5.5 Gy, respectively. Maximum dose to PTV: 36 Gy). The patient who received IMRT is still alive with no evidence of recurrence and any neurologic complications for 1 year. Conclusion: To prevent recurrence of medulloblastoma in subfrontal-cribriform plate region, we need to pay close attention to the placement of eye blocks during the treatment. Once subfrontal recurrence has happened, IMRT may be a good choice for re-irradiation as a salvage treatment to maximize the differences of dose distributions between the normal tissues and target volume.
Files in This Item:
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Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Radiation Oncology (방사선종양학교실) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Neurosurgery (신경외과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Kyoung Ju(김경주)
Kim, Dong Seok(김동석)
Kim, Tae Gon(김태곤)
Bak, Jino(박진호)
Suh, Chang Ok(서창옥)
Shim, Su Jung(심수정)
Lee, Chang Geol(이창걸) ORCID logo https://orcid.org/0000-0002-8702-881X
Jeong, Kyoung Keun(정경근)
Cho, Jae Ho(조재호) ORCID logo https://orcid.org/0000-0001-9966-5157
Choi, Joong Uhn(최중언)
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/112071
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