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Article: The Role of Modern Radiotherapy Technology in the Treatment of Esophageal Cancer.

Moon, Sung Ho / Suh, Yang-Gun

The Korean journal of thoracic and cardiovascular surgery

2020 Volume 53, Issue 4, Page(s) 184–190

Abstract: Radiation therapy (RT) has improved patient outcomes, but treatment-related complication rates remain high. In the conventional 2-dimensional and 3-dimensional conformal RT (3D-CRT) era, there was little room for toxicity reduction because of the need to ...

Abstract	Radiation therapy (RT) has improved patient outcomes, but treatment-related complication rates remain high. In the conventional 2-dimensional and 3-dimensional conformal RT (3D-CRT) era, there was little room for toxicity reduction because of the need to balance the estimated toxicity to organs at risk (OARs), derived from dose-volume histogram data for organs including the lung, heart, spinal cord, and liver, with the planning target volume (PTV) dose. Intensity-modulated RT (IMRT) is an advanced form of conformal RT that utilizes computer-controlled linear accelerators to deliver precise radiation doses to the PTV. The dosimetric advantages of IMRT enable better sparing of normal tissues and OARs than is possible with 3D-CRT. A major breakthrough in the treatment of esophageal cancer (EC), whether early or locally advanced, is the use of proton beam therapy (PBT). Protons deposit their highest dose of radiation at the tumor, while leaving none behind; the resulting effective dose reduction to healthy tissues and OARs considerably reduces acute and delayed RT-related toxicity. In recent studies, PBT has been found to alleviate severe lymphopenia resulting from combined chemo-radiation, opening up the possibility of reducing immune suppression, which might be associated with a poor prognosis in cases of locally advanced EC.
Language	English
Publishing date	2020-03-24
Publishing country	Korea (South)
Document type	Journal Article
ISSN	2233-601X
ISSN	2233-601X
DOI	10.5090/kjtcs.2020.53.4.184
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Article: Local ablative radiotherapy for oligometastatic non-small cell lung cancer.

Suh, Yang-Gun / Cho, Jaeho

Radiation oncology journal

2019 Volume 37, Issue 3, Page(s) 149–155

Abstract: In metastatic non-small cell lung cancer (NSCLC), the role of radiotherapy (RT) has been limited to palliation to alleviate the symptoms. However, with the development of advanced RT techniques, recent advances in immuno-oncology therapy targeting ... ...

Abstract	In metastatic non-small cell lung cancer (NSCLC), the role of radiotherapy (RT) has been limited to palliation to alleviate the symptoms. However, with the development of advanced RT techniques, recent advances in immuno-oncology therapy targeting programmed death 1 (PD-1) and programmed death ligand 1 (PD-L1) and targeted agents for epidermal growth factor receptor (EGFR) mutation or anaplastic lymphoma kinase (ALK) translocation allowed new roles of RT in these patients. Within this metastatic population, there is a subset of patients with a limited number of sites of metastatic disease, termed as oligometastasis that can achieve long-term survival from aggressive local management. There is no consensus on the definition of oligometastasis; however, most clinical trials define oligometastasis as having 3 to 5 metastatic lesions. Recent phase II randomized clinical trials have shown that ablative RT, including stereotactic ablative body radiotherapy (SABR) and hypofractionated RT, to primary and metastatic sites improved progression-free survival (PFS) and overall survival (OS) in patients with oligometastatic NSCLC. The PEMBRO-RT study, a randomized phase II study comparing SABR prior to pembrolizumab therapy and pembrolizumab therapy alone, revealed that the addition of SABR improved the overall response, PFS, and OS in patients with advanced NSCLC. The efficacy of RT in oligometastatic lung cancer has only been studied in phase II studies; therefore, large-scale phase III studies are needed to confirm the benefit of local ablative RT in patients with oligometastatic NSCLC. Local intensified RT to primary and metastatic lesions is expected to become an important treatment paradigm in the near future in patients with metastatic lung cancer.
Language	English
Publishing date	2019-09-30
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2712565-8
ISSN	2234-3156 ; 2234-1900
ISSN (online)	2234-3156
ISSN	2234-1900
DOI	10.3857/roj.2019.00514
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Article ; Online: Patterns of Proton Beam Therapy Use in Clinical Practice between 2007 and 2019 in Korea.

Lee, Sung Uk / Yang, Kyungmi / Moon, Sung Ho / Suh, Yang-Gun / Yoo, Gyu Sang

Cancer research and treatment

2021 Volume 53, Issue 4, Page(s) 935–943

Abstract: Purpose: Proton beam therapy (PBT) is a state-of-the-art technology employed in radiotherapy (RT) for cancer patients. This study characterized how PBT has been used in clinical practice in Korea.: Materials and methods: Patients who received any ... ...

Abstract	Purpose: Proton beam therapy (PBT) is a state-of-the-art technology employed in radiotherapy (RT) for cancer patients. This study characterized how PBT has been used in clinical practice in Korea. Materials and methods: Patients who received any type of RT between 2007 and 2019 were identified from the radiation oncology registry of the two PBT facilities operating in Korea (National Cancer Center and Samsung Medical Center). The chi-square test was used to identify patient- and treatment-related characteristics associated with the receipt of PBT. Results: A total of 54,035 patients had been treated with some form of RT in the two institutions, of whom 5,398 received PBT (10.0%). The number of patients who receive PBT has gradually increased since PBT first started, from 162 patients in 2007 to 1,304 patients in 2019. Among all types of cancer, PBT use in liver cancer has been steadily increasing from 20% in 2008-2009 to 32% in 2018-2019. In contrast, that in prostate cancer has been continuously decreasing from 20% in 2008-2009 to < 10% in 2018-2019. Male sex, very young or old age, stage I-II disease, residency in non-capital areas, a definitive setting, a curative treatment aim, enrollment in a clinical trial, re-irradiation and insurance coverage were significantly associated with the receipt of PBT (all p < 0.05). Conclusion: Since PBT started in Korea, the number of patients receiving PBT has increased to more than 1,000 per year and treatment indications have expanded. Liver cancer is the most common primary tumor among all PBT cases in Korea.
MeSH term(s)	Adult ; Aged ; Female ; Follow-Up Studies ; Humans ; Insurance Coverage ; Male ; Middle Aged ; Neoplasms/epidemiology ; Neoplasms/pathology ; Neoplasms/radiotherapy ; Prognosis ; Proton Therapy/methods ; Proton Therapy/statistics & numerical data ; Registries/statistics & numerical data ; Republic of Korea/epidemiology ; Retrospective Studies ; Time Factors ; Young Adult
Language	English
Publishing date	2021-05-17
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2133613-1
ISSN	2005-9256 ; 1598-2998
ISSN (online)	2005-9256
ISSN	1598-2998
DOI	10.4143/crt.2021.409
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Article: Proton Beam Therapy versus Photon Radiotherapy for Stage I Non-Small Cell Lung Cancer.

Suh, Yang-Gun / Noh, Jae Myoung / Lee, Doo Yeul / Kim, Tae Hyun / Bayasgalan, Unurjargal / Pyo, Hongryull / Moon, Sung Ho

Cancers

2022 Volume 14, Issue 15

Abstract: Proton beam therapy (PBT) and photon radiotherapy for stage I non-small cell lung cancer (NSCLC) were compared in terms of clinical outcomes and dosimetry. Data were obtained from patients who underwent PBT or photon radiotherapy at two institutions-the ... ...

Abstract	Proton beam therapy (PBT) and photon radiotherapy for stage I non-small cell lung cancer (NSCLC) were compared in terms of clinical outcomes and dosimetry. Data were obtained from patients who underwent PBT or photon radiotherapy at two institutions-the only two facilities where PBT is available in the Republic of Korea. Multivariate Cox proportional hazards models and propensity score-matched analyses were used to compare local progression-free survival (PFS) and overall survival (OS). Survival and radiation exposure to the lungs were compared in the matched population. Of 289 patients included in the analyses, 112 and 177 underwent PBT and photon radiotherapy, respectively. With a median follow-up duration of 27 months, the 2-year local PFS and OS rates were 94.0% and 83.0%, respectively. In the multivariate analysis, a biologically effective dose (BED
Language	English
Publishing date	2022-07-26
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers14153627
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Article ; Online: Role of Local Treatment for Oligometastasis: A Comparability-Based Meta-Analysis.

Rim, Chai Hong / Cho, Won Kyung / Lee, Jong Hoon / Kim, Young Seok / Suh, Yang-Gun / Kim, Kyung Hwan / Chie, Eui Kyu / Ahn, Yong Chan

Cancer research and treatment

2022 Volume 54, Issue 4, Page(s) 953–969

Abstract: Purpose: We intend to investigate the oncological efficacy and feasibility of local consolidative therapy (LCT) through a meta-analysis method.: Materials and methods: Four databases including PubMed, MEDLINE, Embase, and Cochrane library were ... ...

Abstract	Purpose: We intend to investigate the oncological efficacy and feasibility of local consolidative therapy (LCT) through a meta-analysis method. Materials and methods: Four databases including PubMed, MEDLINE, Embase, and Cochrane library were searched. Target studies are controlled trials comparing outcomes of LCT versus a control group. Primary endpoints are overall survival (OS) and progression-free survival (PFS). Results: A total of 54 studies involving 7,242 patients were included. Pooled analyses showed that the LCT arm could achieve improved OS with pooled odds ratio of 2.896 (95% confidence interval [CI], 2.377 to 3.528; p < 0.001). Regarding PFS, pooled analyses showed pooled odds ratio of 3.045 (95% CI, 2.356 to 3.937; p < 0.001) in favor of the LCT arm. In the subgroup analyses including the studies with reliable comparability (e.g. randomized studies or intentionally matched studies without significant favorable prognosticator in LCT arms), pooled odds ratio was 2.548 (95% CI, 1.808 to 3.591; p < 0.001) favoring the LCT arm regarding OS. Regarding PFS, pooled OR was 2.656 (95% CI, 1.713 to 4.120; p < 0.001) which also favored the LCT arm. Subgroup analyses limited to the randomized controlled trials (RCT) were also performed and pooled odds ratios on OS and PFS were 1.535 (95% CI, 1.082 to 2.177; p=0.016) and 1.668 (95% CI, 1.187 to 2.344; p=0.003). The rates of grade ≥ 3 complications related to LCT was mostly low (< 10%) and not significantly higher compared to the control arm. Conclusion: Pooled analyses results of all included studies, selected studies with reliable comparability, and RCT's demonstrated the survival benefit of LCT. These consistent results suggest that LCT was beneficial to the patients with oligometastasis.
MeSH term(s)	Humans ; Lymphoma, Follicular ; Progression-Free Survival
Language	English
Publishing date	2022-08-16
Publishing country	Korea (South)
Document type	Journal Article ; Meta-Analysis
ZDB-ID	2133613-1
ISSN	2005-9256 ; 1598-2998
ISSN (online)	2005-9256
ISSN	1598-2998
DOI	10.4143/crt.2022.329
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Article: Treatment Outcomes of Proton Beam Therapy for Esophageal Squamous Cell Carcinoma at a Single Institute.

Oh, Eun Sang / Moon, Sung Ho / Lee, Youngjoo / Ahn, Beung-Chul / Lee, Jong Yeul / Suh, Yang-Gun / Chung, Joo-Hyun / Kim, Moon Soo / Lee, Jong Mog / Choi, Jin-Ho / Kim, Tae Hyun

Cancers

2023 Volume 15, Issue 23

Abstract: Recently, proton beam therapy (PBT) has gathered attention for improving outcomes and reducing toxicities in various cancers; however, the evidence for esophageal squamous cell carcinoma (ESCC) is lacking. Our study retrospectively evaluated the outcomes ...

Abstract	Recently, proton beam therapy (PBT) has gathered attention for improving outcomes and reducing toxicities in various cancers; however, the evidence for esophageal squamous cell carcinoma (ESCC) is lacking. Our study retrospectively evaluated the outcomes of PBT for ESCC patients at a single institute. The patients treated with PBT between November 2015 and February 2022 were included in the study, excluding those with distant metastases or those that had undertaken prior treatment for esophageal cancer (EC). The 3 year overall survival (OS) and progression-free survival (PFS) rates were calculated based on stage grouping. The patterns of failure, salvage treatment outcomes, and toxicity profiles were analyzed. The median follow-up was 35.1 months, and 132 patients were analyzed. The 3 year OS and PFS rates for the stages I, II, and III disease cases were 81.0%, 62.9%, and 51.3%; and 70.6%, 71.8%, and 39.8%, respectively. Nineteen patients presented isolated local progression, ten patients underwent appropriate salvage procedures, and nine were successfully salvaged. One patient with isolated regional progression was also salvaged. No cases of grade ≥ 4 lymphopenia were observed. One patient had grade 4 pericardial effusion and esophageal fistula. For the patients with ESCC, PBT is an effective treatment in terms of the survival outcomes and toxicities.
Language	English
Publishing date	2023-11-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15235524
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Article ; Online: Differential Perspectives by Specialty on Oligometastatic Colorectal Cancer: A Korean Oligometastasis Working Group's Comparative Survey Study.

Cho, Won Kyung / Yoo, Gyu Sang / Rim, Chai Hong / Jeong, Jae-Uk / Chie, Eui Kyu / Ahn, Yong Chan / Cho, Hyeon-Min / Um, Jun Won / Suh, Yang-Gun / Chang, Ah Ram / Lee, Jong Hoon

Cancer research and treatment

2023 Volume 55, Issue 4, Page(s) 1281–1290

Abstract: Purpose: Despite numerous studies on the optimal treatments for oligometastatic disease (OMD), there is no established interdisciplinary consensus on its diagnosis or classification. This survey-based study aimed to analyze the differential opinions of ... ...

Abstract	Purpose: Despite numerous studies on the optimal treatments for oligometastatic disease (OMD), there is no established interdisciplinary consensus on its diagnosis or classification. This survey-based study aimed to analyze the differential opinions of colorectal surgeons and radiation oncologists regarding the definition and treatment of OMD from the colorectal primary. Materials and methods: A total of 141 participants were included in this study, consisting of 63 radiation oncologists (44.7%) and 78 colorectal surgeons (55.3%). The survey consisted of 19 questions related to OMD, and the responses were analyzed using the chi-square test to determine statistical differences between the specialties. Results: The radiation oncologists chose "bone" more frequently compared to the colorectal surgeons (19.2% vs. 36.5%, p=0.022), while colorectal surgeons favored "peritoneal seeding" (26.9% vs. 9.5%, p=0.009). Regarding the number of metastatic tumors, 48.3% of colorectal surgeons responded that "irrelevant, if all metastatic lesions are amendable to local therapy", while only 21.8% of radiation oncologist chose same answer. When asked about molecular diagnosis, most surgeons (74.8%) said it was important, but only 35.8% of radiation oncologists agreed. Conclusion: This study demonstrates that although radiation oncologists and colorectal surgeons agreed on a majority of aspects such as diagnostic imaging, biomarker, systemic therapy, and optimal timing of OMD, they also had quite different perspectives on several aspects of OMD. Understanding these differences is crucial to achieving multidisciplinary consensus on the definition and optimal management of OMD.
MeSH term(s)	Humans ; Surveys and Questionnaires ; Consensus ; Biomarkers ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/therapy ; Colorectal Neoplasms/pathology ; Republic of Korea
Chemical Substances	Biomarkers
Language	English
Publishing date	2023-06-07
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2133613-1
ISSN	2005-9256 ; 1598-2998
ISSN (online)	2005-9256
ISSN	1598-2998
DOI	10.4143/crt.2023.479
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Article ; Online: Radiation Oncologists' Perspectives on Oligometastatic Disease: A Korean Survey Study.

Rim, Chai Hong / Cho, Won Kyung / Lee, Jong Hoon / Kim, Young Seok / Suh, Yang-Gun / Kim, Kyung Hwan / Chang, Ah Ram / Chie, Eui Kyu / Ahn, Yong Chan

Cancer research and treatment

2023 Volume 56, Issue 2, Page(s) 414–421

Abstract: Purpose: Perspectives of radiation oncologists on oligometastatic disease was investigated using multi-layered survey.: Materials and methods: Online survey on the oligometastatic disease was distributed to the board-certified regular members of the ... ...

Abstract	Purpose: Perspectives of radiation oncologists on oligometastatic disease was investigated using multi-layered survey. Materials and methods: Online survey on the oligometastatic disease was distributed to the board-certified regular members of the Korean Society for Radiation Oncology. The questionnaire consisted of four domains: five questions on demographics; five on the definition of oligometastatic disease; four on the role of local therapy; and three on the oligometastatic disease classification, respectively. Results: A total of 135 radiation oncologists participated in the survey. The median length of practice after board certification was 22.5 years (range, 1 to 44 years), and the vast majority (94.1%) answered affirmatively to the clinical experience in oligometastatic disease management. Nearly two-thirds of the respondents considered the number of involved organs as an independent factor in defining oligometastasis. Most frequently perceived upper limit on the numerical definition of oligometastasis was 5 (64.2%), followed by 3 (26.0%), respectively. Peritoneal and brain metastasis were nominated as the sites to be excluded from oligometastastic disease by 56.3% and 12.6% of the participants, respectively. Vast majority (82.1%) agreed on the role of local treatment in the management of oligometastatic disease. Majority (72%) of the participants acknowledged the European Society for Radiotherapy and Oncology (ESTRO)-European Organisation for Research and Treatment of Cancer (EORTC) classification of oligometastatic disease, however, only 43.3% answered that they applied this classification in their clinical practice. Underlying reasons against the clinical use were 'too complicated' (66.0%), followed by 'insufficient supporting evidence' (30.0%), respectively. Conclusion: While most radiation oncologists supported the role of local therapy in oligometastatic disease, there were several inconsistencies in defining and categorizing oligometastatic disease. Continued education and training on oligometastatic disease would be also required to build consensus among participating caregivers.
MeSH term(s)	Humans ; Radiation Oncologists ; Surveys and Questionnaires ; Radiation Oncology ; Brain Neoplasms ; Republic of Korea/epidemiology
Language	English
Publishing date	2023-11-22
Publishing country	Korea (South)
Document type	Journal Article
ZDB-ID	2133613-1
ISSN	2005-9256 ; 1598-2998
ISSN (online)	2005-9256
ISSN	1598-2998
DOI	10.4143/crt.2023.876
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Article ; Online: Toxicity of Proton Therapy versus Photon Therapy on Salvage Re-Irradiation for Non-Small Cell Lung Cancer

Kyungmi Yang / Yang-Gun Suh / Hyunju Shin / Hongryull Pyo / Sung Ho Moon / Yong Chan Ahn / Dongryul Oh / Eunah Chung / Kwanghyun Jo / Jae Myoung Noh

Life, Vol 12, Iss 292, p

2022 Volume 292

Abstract: This study evaluated the toxicity associated with radiation techniques on curative re-irradiation (re-RT) in patients with thoracic recurrence of non-small cell lung cancer (NSCLC). From 2011 to 2019, we retrospectively reviewed the data of 63 patients ... ...

Abstract	This study evaluated the toxicity associated with radiation techniques on curative re-irradiation (re-RT) in patients with thoracic recurrence of non-small cell lung cancer (NSCLC). From 2011 to 2019, we retrospectively reviewed the data of 63 patients with salvage re-RT for in-field or marginal recurrence of NSCLC at two independent institutions. Re-RT techniques using X-ray beams and proton beam therapy (PBT) were also included. Re-RT had a 2-year overall survival (OS) and local progression-free survival of 48.0% and 52.0%, respectively. Fifteen patients experienced grade 3 or higher toxicity after re-RT. The complication rates were 18.2% (4/22) and 26.8% (11/41) in PBT patients and X-ray patients, respectively. Airway or esophageal fistulas occurred in seven patients (11.1%). Fistulas or severe airway obstruction occurred in patients with tumors adjacent to the proximal bronchial tree and esophagus, who underwent hypofractionated radiotherapy (RT) or concurrent chemotherapy, and with a higher dose exposure to the esophagus. In conclusion, salvage re-RT was feasible even in patients with local recurrence within the previous RT field. PBT showed similar survival outcomes and toxicity to those of other techniques. However, thoracic re-RT should be performed carefully considering tumor location and RT regimens such as the fraction size and concurrent chemotherapy.
Keywords	lung cancer ; non-small cell lung cancer ; radiotherapy ; re-irradiation ; locoregional recurrence ; proton beam therapy ; Science ; Q
Subject code	610 ; 616
Language	English
Publishing date	2022-02-01T00:00:00Z
Publisher	MDPI AG
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Dosimetric Comparisons between Proton Beam Therapy and Modern Photon Radiation Techniques for Stage I Non-Small Cell Lung Cancer According to Tumor Location.

Bayasgalan, Unurjargal / Moon, Sung Ho / Kim, Tae Hyun / Kim, Tae Yoon / Lee, Seung Hyun / Suh, Yang-Gun

Cancers

2021 Volume 13, Issue 24

Abstract: Herein, we investigated the dosimetric benefits for proton beam therapy (PBT) over modern photon radiation techniques according to tumor location (central, peripheral, and close to the chest wall) for stage I non-small cell lung cancer (NSCLC) patients. ... ...

Abstract	Herein, we investigated the dosimetric benefits for proton beam therapy (PBT) over modern photon radiation techniques according to tumor location (central, peripheral, and close to the chest wall) for stage I non-small cell lung cancer (NSCLC) patients. A total of 42 patients with stage I NSCLC were treated with PBT with a total dose of 50-70 Gy in four or 10 fractions considering the risk of treatment-related toxicities. Simulation plans for three-dimensional conformal radiation therapy (3D-CRT), static-field intensity-modulated radiotherapy (IMRT), and volumetric-modulated arc therapy (VMAT) were retrospectively generated using the same treatment volumes as implemented in the PBT plans for these patients. Dosimetric improvements were observed with PBT as compared with all the photon-based radiation techniques with regards to the mean lung dose, lung V5 and V10, mean heart dose, and heart V5 and V10 in all locations. Moreover, lower radiation exposure to the chest wall was observed within PBT for peripherally located and close to the chest wall tumors. All radiotherapy modalities achieved clinically satisfactory treatment plans in the current study. Notably, the usage of PBT resulted in significant dosimetric improvements in the lung and heart over photon-based techniques at all tumor locations, including the periphery, for stage I NSCLC.
Language	English
Publishing date	2021-12-17
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers13246356
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