Hypofractionated radiotherapy (HRT) is now commonly used for pulmonary malignancies, since a tumoricidal dose can be accurately delivered to the target without a consequential dose to adjacent normal tissues. However, radiation pneumonitis (RP) is still a major problem after HRT. To determine the significant parameters associated with developing RP, we retrospectively investigated data from patients with lung metastases treated with HRT using helical tomotherapy. A total of 45 patients were included in the study and the median age was 53 years old. The median prescriptive doses were 50 Gy to the internal target volume and 40 Gy to the planning target volume in 10 fractions over 2 weeks. RP was diagnosed by chest X-ray or computed tomography after HRT, and its severity was determined by CTCAE version 4.0. The incidence of symptomatic RP was 26.6%. Univariate analysis indicated that mean lung doses, V5, V10, V15, V20 and V25 were associated with the development of symptomatic RP (P < 0.05). However, multivariate analysis indicated that only V5 was associated with the development of symptomatic RP (P = 0.019). From the ROC curve, V5 was the most powerful predictor of symptomatic RP, and its AUC (area under curve) was 0.780 (P = 0.004). In addition, the threshold value of V5 for the development of symptomatic RP was 65%. A large distribution of low-dose radiation resulted in a higher risk of lung toxicity. So, to prevent symptomatic RP, it is recommended that the V5 be limited to <65%, in addition to considering conventional dosimetric factors. However, further clinical study must be undertaken in order to confirm this result.

BackgroundWe attempted to analyze the effects of an increase in the Child-Pugh (CP) score on the overall survival of patients with unresectable hepatocellular carcinoma (HCC) after radiotherapy (RT).MethodsFrom March 2006 to February 2012, 103 patients received RT using the TomoTherapy Hi-Art at Incheon St. Mary’s Hospital and Seoul St. Mary’s Hospital. The dose per fraction was 1.8–5 Gy, and the total dose was 40–60 Gy (median, 50 Gy). We considered an increase of at least 2 points in the CP score within 3 months after RT to be clinically important radiation-induced hepatic toxicity and analyzed the effects of an increased CP score on overall survival.ResultsThe median follow-up duration was 11.6 months (range, 3.5–85.3 months). The median survival time was 11.6 months. In multivariate analysis, planning target volume and an increase in the CP score after RT were found to be a statistically significant factors (p = 0.010 and 0.015, respectively). In a comparison of cases with and without an increase in the CP score, there was an 11.0-month difference in the median survival time (6.9 vs. 17.9 months), and the relative risk of mortality was 1.8.ConclusionAn increase of at least 2 points in the CP score within 3 months of RT completion is an important on-treatment factor that affects overall survival. To minimize such increases, careful patient selection and a more sophisticated radiation treatment plan are imperative.

Th e results were as lollow 1. The most preva lent age group were 5th to 7th decades. male to lemale ratio was 4.9' 1 2. Classilication with incidence 01 computed tomographic appearance 01 the hepatocellular carcinoma were solitary type 28 cases (48%), multinodular type 24 cases (40%), and diffuse type 7 cases (1 2%), Association w ith liver cirrhosis was noted in 22 cases (38%) Inhomogenous internal cons istency 01 hepatocelluar carci noma d ue to central nec rosis were 35 cases (60%)Portal vein invasion by hepatocellular ca rc in o 때 was noted in 15 cases (25%), and parti cul arl y most common in d iffuse type 4 cases (55%) 4. On precontrast scan, all hepatocellu lar ca rcinoma were seerl as area 01 low density except lor 3 cases (0.5%) 01 near isodensity which turned o ut to be remarkable low density o n postcontrast scan.5. In so litary type, posterior segment 01 ri ght lobe was most common site 01 involvment 12 cases (43%). In diffuse type, bilobar involvment was most common, 6 cases (85%) 1 . 서

Th e authors ana lyzed ultrasonographic findings of 112 cases of trophoblastic diseases wh ich we re confirm ed by D&E o r hysterectomy at Wallace Memorial Baptist Hospital from September 1980 to December 1984The res 비 ts were as follows;1. Of all 112 cases, hydatid ifo rm moles were 99 cases, invasive moles were 3 cases and chorioca rcinomas we re 10 cases 2. 81 cases (72%) occurred in 3rd decades 3. Th e .size of uterus was large for gestational weeks in 65 cases (56%) and smaller in 13 cases (13%) 4. Th e contour of uterus was globular in 59 cases (53%), diffuse in 49 cases (4 4%) and nodular in 4 cases (3%) 5. The internal echopatterns of uterus revealed numero us small vesic ular snowstorm patterns in all cascs, and revea led internal degeneration in 67 cases (60%) 6. Uterine walls in 89 cases (79%) were well delineated but uterine walls in 23 cases (21 %) were poor delineated 7. M ultiseptated ovarian theca lutein cysts we re seen in 36 cases (32%) 8. Invasive t rophoblastic diseases (invasive moles 3 cases and choriocarcinomas 10 cases) revealed sim ili ar ultrasonographic findings with H.mole, but more irregular internal echoes and irregular echoes in uterine wal l 9. Diagnostic acc uracy was diagnostic in 98 cases (88%), nonspecific in 11 cases (10%) and error in 3 cascs (2%)