Park J.,Proton Therapy |
Park Y.,Soonchunhyang University |
Lee S.U.,Proton Therapy |
Kim T.,Proton Therapy |
And 3 more authors.
Background: We performed dosimetric comparisons between proton beam therapy and intensity modulated radiotherapy (IMRT) of intracranial germ cell tumors (ICGCTs) arising in various locations of the brain. Materials: IMRT, passively scattered proton therapy (PSPT), and spot scanning proton therapy (SSPT) plans were performed for four different target volumes: the whole ventricle (WV), pineal gland (PG), suprasellar (SS), and basal ganglia (BG). Five consecutive clinical cases were selected from the patients treated between 2011 and 2014 for each target volume. Total 20 cases from the 17 patients were included in the analyses with three overlap cases which were used in plan comparison both for the whole ventricle and boost targets. The conformity index, homogeneity index, gradient index, plan quality index (PQI), and doses applied to the normal substructures of the brain were calculated for each treatment plan. Results: The PQI was significantly superior for PSPT and SSPT than IMRT for ICGCTs in all locations (median; WV: 2.89 and 2.37 vs 4.06, PG: 3.38 and 2.70 vs 4.39, SS: 3.92 and 2.49 vs 4.46, BG: 3.01 and 2.49 vs 4.45). PSPT and SSPT significantly reduced the mean dose, and the 10 and 15 Gy dose volumes applied to the normal brain compared with IMRT (p ≤ 0.05). PSPT and SSPT saved significantly greater volumes of the temporal lobes and hippocampi (p < 0.05) in the SS and PG targets than IMRT. For tumors arising in the BG, PSPT and SSPT also saved greater volumes of the contralateral temporal lobes. Conclusions: PSPT and SSPT provide superior target volume coverage and saved more normal tissue compared with IMRT for ICGCTs in various locations. Future studies should assess whether the extent of normal tissue saved has clinical benefits in children with ICGCTs. © Park et al. 2015. Source
Yoo H.-J.,University of Ulsan |
Ra Y.-S.,University of Ulsan |
Park H.-J.,Center for Pediatric Cancer |
Lai J.-S.,Northwestern University |
And 3 more authors.
BACKGROUND: This study investigated the agreement between self-reports from pediatric brain tumor patients and proxy reports from their parents regarding the patients' quality of life (QOL), as assessed using a brain tumor-specific QOL assessment tool, the Pediatric Functional Assessment of Cancer Therapy-Childhood Brain Tumor Survivors (pedsFACT-BrS) questionnaire. The authors expected moderate correlation and similar mean scores between patient and parent reports. METHODS: The pedsFACT-BrS for those aged 7 to 18 years was completed by 351 brain tumor patients (166 children and 185 adolescents), and the parent proxy reports were completed by 351 mother proxies and 37 father proxies. Statistical analyses, including the Pearson product-moment correlation coefficient, intraclass correlation, and comparison of group means, were used to compare the 33 items shared by all 4 versions of the pedsFACT-BrS. RESULTS: The correlation between reports completed by pediatric patients and their parent proxies was significant (P = .59-.84), whereas that between the reports of adolescent patients and their parent proxies was slightly weaker (P = .47-.78). The patient and parent proxy reports showed moderate-to-good agreement and yielded similar mean scores in both the child and adolescent brain tumor patient groups; the sole exception was a difference in emotional well-being scores. CONCLUSIONS: The results indicate that proper use of the pedsFACT-BrS for patients and their parent proxies can provide clinicians with valid information about the overall QOL of child and adolescent brain tumor patients, including both their general health and their brain tumor-specific well-being. © 2010 American Cancer Society. Source
Choi E.K.,Duksung Womens University |
Yoon S.J.,Yonsei University |
Kim J.-H.,National Cancer Center |
Park H.J.,Center for Pediatric Cancer |
And 3 more authors.
Objective This study's objectives were to examine the effects of depression on the distress of caregivers of children with brain tumors and to identify the factors moderating depression and caregiver distress. Methods Participants were 82 caregivers of children with brain tumors undergoing treatment in the National Cancer Center of South Korea. The depression subscale of the Symptom Checklist 90-Revised (SCL-90-R) and the Burden of a Primary Caregiver (BPC) Scale were used to measure participants' depression and caregiver distress, respectively. The Korean version of the Parenting Sense of Competence (K-PSOC) Scale, Family Environmental Scale-Revised (K-FES-R), and the DUKE-UNC Functional Social Support Questionnaire-S (DUKE-UNC-FSSQ) were used to assess parental efficacy, family relationships, and perceived social support, respectively. Results Younger patient age, lower family income, and caregivers' greater number of years of education significantly predicted caregiver distress. Caregivers with depression experienced significantly more distress than those without depression. The interaction of depression with parenting efficacy and social support affected caregiver distress. For highly depressed caregivers, parental efficacy, social support, and family relationships played weaker roles as protective factors against caregiver distress. High parental efficacy and social support were protective factors against distress in caregivers without depression. Conclusions A multi-dimensional assessment of the psychosocial factors that may affect caregivers of children with brain tumors should precede interventions for distress management. Interventions tailored to individuals' psychosocial factors are needed. Copyright © 2015 John Wiley & Sons, Ltd. Source
Yoo H.,University of Ulsan |
Kim D.-S.,Yonsei University |
Shin H.-Y.,Seoul National University |
Lai J.-S.,Northwestern University |
And 5 more authors.
Journal of Pain and Symptom Management
We evaluated the reliability and validity of the Pediatric Functional Assessment of Cancer Therapy-Childhood Brain Tumor Survivor Questionnaire (pedsFACT-BrS, Version 2). This was specifically directed to patients aged 13 years and older (adolescents). The pedsFACT-BrS was translated and cross-culturally adapted into Korean, following standard Functional Assessment of Chronic Illness Therapy methodology. The psychometric properties of the pedsFACT-BrS in adolescents were evaluated in 161 brain tumor (BT) patients (mean age = 15.53 years). Pretesting was performed in 30 patients, and the results indicated good symptom coverage and overall comprehensibility. In validating the pedsFACT-BrS for adolescents, we found high internal consistency, with Cronbach's α coefficients ranging from 0.76 to 0.91. The pedsFACT-BrS for adolescents also demonstrated good convergent and divergent validities when correlated with the Revised Children's Manifest Anxiety Scale and the Kovacs' Children's Depression Inventory. The pedsFACT-BrS for adolescents showed good clinical validity and effectively differentiated between clinically distinct patient groups according to Karnofsky score, type of treatment, and treatment on/off status. This reliable and valid instrument can now be used to properly evaluate the quality of life of Korean adolescent BT patients. © 2010 U.S. Cancer Pain Relief Committee. Published by Elsevier Inc. All rights reserved. Source
Yoo K.H.,Sungkyunkwan University |
Lee S.H.,Sungkyunkwan University |
Sung K.W.,Sungkyunkwan University |
Koo H.H.,Sungkyunkwan University |
And 25 more authors.
American Journal of Hematology
We report the outcome of 236 pediatric umbilical cord blood transplantations (UCBT) performed in Korea. Given that the sources of the grafts were mostly unrelated donors (n = 226; 95.8%), only the results of unrelated UCBT were included for all statistics. The most frequent primary disease was acute leukemia (n = 167). In total, 91.7% of recipients were seropositive for cytomegalovirus (CMV). The median doses of nucleated cells and CD34+ cells were 4.84 × 107/kg and 2.00 × 105/kg, respectively. The median times to neutrophil (>0.5 × 109/L) and platelet recovery (>20 × 109/L) were 18 and 45 days, respectively. Grade 2-4 acute graft-versus-host-disease (GVHD) and chronic GVHD developed in 41.1 and 36.1% of cases, respectively. Forty-five patients developed CMV disease. The 5-year overall and event-free survival were 47.5 and 36.9%, respectively. Multivariate analysis revealed that adverse factors for survival of the whole cohort were total body irradiation-based conditioning (P = 0.007), salvage transplant (P = 0.001), failure to achieve early complete chimerism (P < 0.0005), and CMV disease (P = 0.001). The outcomes of the single- and double-unit UCBT (n = 64) were similar, while double-unit recipients were heavier (P < 0.0005) and older (P < 0.0005). We conclude that double-unit UCBT is a reasonable option for older or heavier children and that the thorough surveillance of CMV infection and the development of an effective CMV therapeutic strategy may be especially important for Korean children, whose CMV seroprevalence exceeds 90%. © 2010 Wiley-Liss, Inc. Source