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Results of Curative Radiotherapy Alone in Patients with Uterine Cervical Carcinomas
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Taek Keun Nam, Byung Sik Nah, Sung Ja Ahn, Woong Ki Chung, Ho Seon Choi, Yoon Kyeong Oh
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Cancer Res Treat. 2002;34(5):365-371. Published online October 31, 2002
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DOI: https://doi.org/10.4143/crt.2002.34.5.365
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 Abstract
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- 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.
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Significance of p53 Immunoreactivity in Squamous Cell Carcinoma of the Cervix Treated with Radiotherapy Alone
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Sung Ja Ahn, Ho Sun Choi, Chan Choi, Byung Sik Nah, Woong Ki Chung, Taek Keun Nam
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J Korean Cancer Assoc. 2001;33(2):106-112.
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Abstract
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- PURPOSE
We undertook this study to evaluate the significance of p53 immunoreactivity in squamous cell carcinoma of the cervix, treated with radiotherapy alone.
MATERIALS AND METHODS
Immunohistochemical staining of p53 proteins were performed in eighty patients with squamous cell carcinoma of the cervix, and who completed curative radiotherapy between Jan. 1996 and Apr. 1998 at the Department of Therapeutic Radiology, Chonnam National University Hospital. External- beam radiotherapy was combined with intracavitary brachytherapy. Results were analyzed for the end points of pelvic tumor control and distant failure rates. The follow-up time ranged from 7 to 58 months with a median of 40 months.
RESULTS
p53 positive and negative groups involved 45 and 35 patients, respectively, and the positive p53 immunoreactivity rate was 56% (45/80). p53 immunoreactivity showed no significant correlation with age, tumor size, serum tumor marker (SCC), or HPV18 expression, while there was a statistically marginally significant correlation with HPV16 expression. The pelvic tumor control rate of the p53 positive group was 87% and that of p53 negative group was 83% (0.05). The other parameters influencing negatively to the pelvic tumor control and with statistical significance were tumor ulceration and barrel type. Multivariate analysis also showed that p53 immunoreactivity had no prognostic value for pelvic tumor control of the disease, and that the statistically significant factor was tumor ulceration. The treatment failure rate of the p53 positive group was 23% and that of the negative group was 26% (p>0.05).
CONCLUSION
p53 immunoreactivity in the cervix cancer stage IB, II patients seems to have no value as a predictor of tumor behavior after curative radiotherapy.
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Radiation-induced Apoptotic Signaling Pathway in HL - 60 Cells
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Sung Ja Ahn, Rae Kil Park, Sang Rock Lee, Woong Ki Chung, Byung Sik Nah, Taek Keun Nam, Hun Taeg Chung, Sun Rock Moon, Heoung Keun Kang, Seung Jin Park
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J Korean Cancer Assoc. 2000;32(1):156-167.
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Abstract
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- PURPOSE
The mechanical insights of death of cancer cells by ionizing radiation are not yet clearly defined. Recent evidences have demonstrated that radiation therapy may induce cell death via activation of signaling pathway for apoptosis in target cells. This study was designed whether ionizing radiation may activate the signaling cascades of apoptosis including caspase family cystein proteases, mitogen-activated protein (MAP) kinases, and transcriptional activation factors in target cells eventually leading to death.
MATERIALS AND METHODS
HL-60 cell line in the log phase was used in this study and the culture media was RPMI 1640. The irradiation was done using the linear accelarator and the radiation does was 10 Gy, 20 Gy, and 30 Gy, respectively. The cell viability was tested by MTT assay and apoptosis was identified by the DNA fragmentation assay.
JNK1 (cJun N-terminal kinase) and ERK (extracellular-signal regulated protein kinase) activity was analyzed by the in vitro Ig complex kinase assay. NF- kB (Nuclear Factor- kB) and AP-1 (activator protein-1) activity was assayed by the electrophoretic mobility sbift assay.
RESULTS
Ionizing radiation decreased the viability of HL-60 cells in a time and dose dependent manner. Ionizing radiation-induced cell death of HL-60 cells may be an apo- ptotic death which was evidenced as apoptotic characteristic ladder pattern fragmentation of DNA over 20 Gy at 4 hours. Ionizing radiation specifically induced the activation of CPP32-like cystein protease rather than ICE-like protease of HL-60 cells in a time and dose dependent manner.
The activation of CPP32-like cystein protease was also evidenced by the digestion of poly (ADP-ribose) polymerase with 30 Gy ionizing irradiation at 2 hours. The activity of JNK1 was transiently increased up to 3.6 fold by 30 Gy ionizing radiation at 2 hours.
Ionizing radiation also rapidly activated the transcriptional activation factors including AP-1 and NF- kB at 10 or 30 min.
CONCLUSION
These data suggested that ionizing radiation-induced apoptosis was mediated by the activation of CPP32-like cystein protease, JNK1, and transcriptional activation factors
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Irradiation alone in Stage IB , IIA and IIB Cervix Cancer: 2 Correlation between Treatment Factors and Pelvic Tumor Control
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Sung Ja Ahn, Woong Ki Chung, Byung Sik Nah, Taek Keun Nam, Ho Sun Choi, Ji Soo Byun
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J Korean Cancer Assoc. 1998;30(2):321-328.
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Abstract
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- No abstract available.
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Study on the Immunomodulatory Effect of Thymulin in the Patients under Radiotherapy
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Sung Ja Ahn, Woong Ki Chung, Byung Sik Nah, Taek Keun Nam, l Gyoon Cho, Sang Woo Juhng
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J Korean Cancer Assoc. 1995;27(5):790-797.
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Abstract
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- In order to evaluate the effect of Thymulin, which is a thymic extract and known as one of the immunomodulating agents, 20 patients were prescribed the drug, orally one capsule(80 mR) twice a day during the radiation therapy(Thymulin group) and 28 patients were treated with radiotherapy only(RT grouP) randomly. The treatment field was medias- tinum in 29 patients and pelvis in 19, respectively. Age ranged from 36 to 73 years (mean and median; 57) and the male to female ratio was 1.3(27: 21). We evaluated the CBC with D/C, the blood chemistry, the lymphocyte subsets, and serum immunoglobulin level as parameters of the patient's immunological status. Drug intolerance was not observed in any patients. In the Thymulin group, the postirradiation decrease of white blood cell(WBC), lymphocyte, neutrophil, and basophil count was less than that of the RT group, and there was a statistical significance in the difference of the absolute lymphocyte count between two groups. In the peripheral bload lymphocyte subset study, the absolute number of CD4(helper T cell) and CD19(B cel1) were less reduced in the Thymulin group with statistical significance and the change of the other parameters was also less than that of the RT group. In the serum immunoglobulin level, the gostirradiation decrease was less in the Thymulin group and there was a marginal statistical significance in the difference of Ig A between two groups. From the above data, we can reach the conclusion that the combination of Thymulin may reduce the harmful effect of radiation therapy on immunity in cancer patients.
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KCA
