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Off Pump Total Arterial Myocardial Revascularization (동맥 도관만을 이용하여 체외심폐순환 없이 시행한 관상동맥우회술)

  • Youn Young Nam;Lee Kyo Joon;Lee Gy Jong;Joo Hyun Chul;Lim Sang Hyun;Kim Seung Ho;Kwak Young Lan;Yoo Kyung Jong
    • Journal of Chest Surgery
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    • v.38 no.5 s.250
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    • pp.349-356
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    • 2005
  • Background: Arterial conduits using in coronary artery bypass grafting (CABG) have been known a great long term patency rates, and improved short and long term clinical outcomes. It has been reported that Off pump CABG has better clinical results than CABG using cardiopulmonary bypass. To evaluate the advantage of arterial conduits over venous conduits and to avoid the adverse effects of cardiopulmonary bypass, we performed total arterial Off pump CABG. Material and Method: From January 2001 to October 2004, Off pump CABG using only arterial conduits was performed on 325 patients with a mean age of $59.3\pm11.9$ years ($36\~83$). Mean ejection fraction was $55.4\pm14.0\%\;(15\~86).$ Angiography showed left main disease or triple-vessel disease in $81.9\%$ of the patients. Indications of using arterial conduits was stenosis $\ge50\%$ of left anterior descending artery, stenosis $\ge80\%$ of branches of left circumflex artery, and stenosis $\ge90\%$ of right coronary artery and its branches. Multi-slice computed tomography was performed on 194 patients to evaluate the short term patency rates. Result: A total of 928 distal anastomoses were performed and the average anastomoses per a patient were $2.86\pm0.78$. There was 1 operative mortality. Postoperative complications were mediastinitis in 6 patients ($1.8\%$), renal failure in 4 patients ($1.2\%$), perioperative myocardial infarction in 3 patients ($0.9\%$), reoperation for bleeding in 3 patients ($0.9\%$). There was no postoperative stroke. Patency rate of arterial conduits was $99.3\%$ (581/585). There were 4 stenoses or competitive flows in 2 radial arteries and 2 right internal mammary arteries. Conclusion: Total arterial Off pump CABG appears to be safe, showing a low surgical mortality and morbidity and excellent short term patency rates of arterial conduits.

Studies on the Nutritional Effects of Locally Produced Dried Formula Milk and Fermented Milk -2. Effect of Feeding Dried Formula Milk and Fermented Milk on the Growing Performance, Protein Utilizability and Intestinal Microbial Changes of Albino Rats (국산(國産) 조제분유(調製粉乳)와 발효유(醱酵乳)의 영양효과(營養效果)에 관한 연구(硏究) - 2. 유제품(乳製品)이 성장기(成長期) 흰쥐에 미치는 영양효과(營養效果) 및 장내미생물(腸內微生物)의 변화(變化)에 관한 연구(硏究) -)

  • Paik, Jeong-J.;Han, In-K.
    • Journal of Nutrition and Health
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    • v.9 no.1
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    • pp.92-98
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    • 1976
  • The present studies were carried out to observe the nutritional effects of three kinds of locally produced dried infantile formula milk (DFM) and one fermented milk (FM). A feeding trial with 60 male growing albino rats weighing $60{\sim}70$ grams was conducted during 6 weeks to compare the nutritive values and protein qualities of three DFM and a FM. The diet treatments consisted of 100% control diet, 70% control diet plus 30% DFM-A, 70% control diet plus 30% DFM-B, 70% control diet plus 30% DFM-C, 100% control diet with FM and 70% control diet plus 30% DFM-B with FM. The items investigated were body weight gain, feed intake, feed efficiency ratio (FER), various organ weights, protein efficiency ratio (PER), digestibility of nutrients, biological value, utilizability of protein and intestinal microbial changes of albino rats. The results obtained are summarized as follows; 1. Although there was no statistical significance, rats fed diets containing DFMs and FM gained faster than the rats fed control diet. The best growth rate was obtained with the DFM-A and DFM-C groups. In spite of the lower protein contents of the three DFM diets than the control diet, the growth rate of albino rats fed the DFM diets was somewhat improved than rats fed control diet. 2. No statistical significance was found in feed consumption but the trend was that the feed intake of control group was higher than those of the DFM diet group. 3. Feed efficiency was inproved significantly (p<0.01) by feeding DFMs as compared with control diet. DFM-A group showed the best FER, although no statistical significance was found. 4. Rats fed the DFM diets showed significantly (p<0.01) higher PER as compared with those of the control group. But no difference was found anions DFM groups. The significant improvement (p<0.01) of PER due also to the feeding of FM was seemed to be brought about by the beneficial effect of FM. 5. The present data revealed that feeding DFM and FM didn't affect the weights of various organs of rats. 6. The protein digestibility of experimental diets was similar to each other. Although no statistical significance was found among treatments, the DFMs and FM surely tended to improve the biological value and utilizability of protein. 7. Microbial study indicated that among intestinal flora FM fed group, there were more Lactic acid bacteria than E. coli. From the experimental results described above, it may be concluded that the nutritive effects of three kinds of locally produced DFMs are much alike and the growth rate of growing albino rats can be improved by feeding either DFM or FM due to their beneficial effects on the feed efficiency and protein utilization.

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The meaning based on Yin-Yang and Five Elements Principle in Semantic Landscape Composition of 'the Forty Eight Poems of Soswaewon' ('소쇄원(瀟灑園) 48영'의 의미경관 구성에 있어서 음양오행론적(陰陽五行論的) 의미(意味))

  • Jang, Il-Young;Shin, Sang-Sup
    • Journal of the Korean Institute of Traditional Landscape Architecture
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    • v.31 no.2
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    • pp.43-57
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    • 2013
  • The purpose of this study is to identify potential semantic landscape makeup of "the Forty Eight Poems of Soswaewon" according to Yin-Yang and Five Elements Principle(陰陽五行論). that speculation system between human's nature and cosmical universal order. Existing academic discussions made so far concerning this topic can be summed up as follows: 1. Among Yin-Yang-based landscape makeups of the Forty Eight Poems of Soswaewon, poetic writings for embodiment of interactions between nature and human behaviors focused on depicting dynamic aspects of a poetic narrator when he appreciates or explores hills and streams as of to live free from worldly cares. Primarily, many of those writings were created on the east and south primarily through assignment of yang. On the other hand, poetic writings for embodiment of nature and seasonal scenery - as static landscape makeup of yin - were often created on or near the north and west for many times. Those writings focusing on embodiment of nature and artificial scenery as a work are divided into two categories: One category refers to author Kim In-hu's expression of semantic landscape from seasonal scenery in nature. The other refers to his depiction of realistic garden images as they are. In the Forty Eight Poems of Soswaewon, the poetic writings show that author Kim focused on embodying seasonal scenery rather than expressing human behaviors. In addition, both Poem No. 1 and Poem No. 48(last poem; titled 'Jangwon Jeyeong') were created in a same place, which author Kim sought to understand the place as a space of beginning and end where yin and yang - i.e. the principle of natural cycle - are inherent. 2. According to construction about landscape in the Forty Eight Poems of Soswaewon on the basis of Ohaeng-ron (five natural element principle), it was found that tree(木) and fire(火) are typical examples of a world combined by emanation. First, many of poetic writings depicting the sentiments of tree focused on embodying seasonal scenery and were located in the place of Ogogmun(五曲門) area in the east, from overall perspective of Soswaewon. The content of these poems shows generation and curve / straightness in flexibility and simplicity. Many of poems depicting the sentiments of fire(火) focused on embodying human behaviors, and they were created in Aeyangdan area on the south of Soswaewon over which sun rises at noon. These poems are all on a status of side movement that is characterized by emanation and ascension which belong to attributes of yang. 3. With regard to Ohaeng-ron's interpretation about landscape in the Forty Eight Poems of Soswaewon, it was found that metal(金) and water(水) are typical examples of world combined by convergence. First, it was found that all of poems depicting sentiments of metal focused on embodying seasonal scenery, and were created in a bamboo grove area on the west from overall perspective of Soswaewon. They represent scenery of autumn among 4 seasons to symbolize faithfulness vested in a man of virtue(seonbi) with integrity and righteousness. Poems depicting sentiments of water were created in vicinity of Jewoldang on the north, possibly topmost of Soswaewon. They were divided into two categories: One category refers to poems embodying actions of welcoming the first full moon deep in the night after sunset, and the other refers to poems embodying natural scenery of snowscape. All of those poems focused on expressing any atmosphere of turning into yin via convergence. 4. With regard to Ohaeng-ron's interpretation of landscape in the Forty Eight Poems of Soswaewon, it was found that poems depicting sentiments of earth(土), a complex body of convergence and emanation, were created in vicinity of mountain stream around Gwangpunggak which is located in the center of Soswaewon. These poems focused on carrying actions of author Kim by way of natural phenomena and artificial scenery.

Malacological Studies on Parafossarulus manchouricus(Gastropoda: Prosobranchia) in Korea (한국산(韓國産) 왜우렁(Parafossarulus manchouricus)의 패류학적(貝類學的) 연구(硏究))

  • Chung, Pyung-Rim
    • The Korean Journal of Malacology
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    • v.1 no.1
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    • pp.24-50
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    • 1985
  • Five different populations of Parafossarulus manchouricus (Chongpyung, Chinju and Kunsan, Korea; and Japan and Taiwan), a population of Bitbynia (Gabbia) misella (Gongju, Korea) and two different populations of Bithynta tentaculata (Michigan, U.S.A. and Bodensee, Germany) were compared in regard to eff-laying characteristics, morphology, chromosome cytology, natural infections of parasites and ecology of habitats. A satisfactory culture method was devised for laboratory rearing of the snails. Tropical fish food (Terra SML) and powdered green leaves (Ceralife) were used as the main food sources for the snails. Benthic diatoms such as Navicula and Gomphonema from the periphyton were also essential for satisfactory growth, especially for the baby snails. The aquaria were stabilized with small stones from a local stream. Young P. manchouricus snails grew to adult size in about 54 days after hatching. They laid eggs 150-156 days after hatching. The whole cycle (birth to egg-laying) took approximately 5 months. The three species of bithyniid snails are iteroparous and lay eggs once a year. There were no major morphological differences in the shells of genera or subgenera studied here. They did exhibit the following rather minor differences. The shell of Parafossarulus has spirally raised ridges, and its apex is usually eroded; the other two genera lack these characteristics. The shell of B. (Gabbia) misella is small, nor exceeding 7.5 mm in length, while the shells of the other two species are larger, being more than 10 mm in length. Scanning electron microscopy (SEM) of the protoconch of P. manchouricus reveals nearly smooth sculpture with small, low, spiral wrinkles. This sculpture is quite different from that of the Hydrobiidae, a family to which the bithyniids are frequently assigned. Scanning electron microscopy of the radulae of the three bithyniid species showed that their radular morphologies are very similar, but there are some small differences, which may be species-specific. There were some statistical differences in shell heights between the Korean and the other populations of P. manchouricus, and between this species and the other two bithyniids as well. The shell differences between the several populations of Korean P. manchouricus may be related to environment. Edtails of the chromosome cycle of these bithyniid snails are similar to those reported for other snails. No specific differences were observed in the chromosome cycle between the various species and populations of snails employed in this study. Reporred for the first time in molluscs are two darkly stained "nucleolar organizers" during pachyterne stages of meiosis. Two different chromosome numbers were observed in the three bithyniid species: n=17 in B. tentaculata and P. manchouricus, and n=18 in B. (G.) misella. no sex chromosomes or supernumerary chromosomes were seen. There were no morphological differences in karyotypes of three Korean strains of P. manchouricus. The infection rates of cercariae of Clonorchis sinensis in Chinju and Kunsan strains of P. manchouricus were 0.14% and 1.25%, respectively. However, Clonorchis cercariae were found in Chongpyung strain of P. manchouriceu and Gongju strain of B. (G.) misella. The habitats of P. manchouricus around Jinyang Lake were relatively clean without any heavy pollution of aquatic microorganisms and organic materials during the period of this study. The levels of dissolved oxygen (D.O.) and biochemical oxygen demand (B.O.D.) of the water specimens sampled from the study areas ranged from 6.0 to 9.6 ppm and from 0.4 to 1.6 ppm, respectively. Eight metalic constituents from the water samples were also assayed, and all metalic ions detercted were remarkably low below the legal criteria. However, calcium ion in the water samples from the habitats of P. manchouricus was considerably higher than others.

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Effect of Pelvic Irradiation on the Bone Mineral Content of Lumbar Spine in Cervical Cancer (자궁경부암 환자에서 방사선 치료가 골무기물 함량에 미치는 영향)

  • Youn Seon Min;Choi Tae Jin;Koo Eun Sil;Kim Ok Bae;Lee Seung Moon;Suh Soo Jhi
    • Radiation Oncology Journal
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    • v.15 no.2
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    • pp.145-151
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    • 1997
  • Purpose : To evaluate the loss of bone mineral contents(BMC) in lumbar spine within the radiation field for cervical cancer treatment, BMC in the irradiated patient group was compared with that of a normal control group. Method and materials : Measurements of BMC in the trabecular bone in lumbar spines(L3-L5) were performed in the both patient and normal control groups. Investigators used dual-energy quantitative computerized tomography(DEQCT) using Photon energy of 120 and 80kVp, The numbers of Patient and control groups were 43 in each with age distribution of fifth to seventh decade of women. The numbers of control group were 22 in fifth, 10 in sixth and 11 in seventh decade, those of patient group were 14 in filth, 14 in sixth, and 15 in seventh decade of women. The radiation field was extended to L5 spine for Pelvic irrdiation with 45-54Gy of external radiation dose and 30Gy of high dose rate brachytherapy in cervical cancer, Results : The BMC is decreased as increasing age in both control and patient groups. BMC in lumbar spine of patient group was decreased by about $13\%\;to\;40\%$ maximally. The BMC of L3 and L4 a region that is out of a radiation field for the Patient group demonstrated $119.5\pm30.6,\;117.0\pm31.7\;for\;fifth,\;83.3\pm37.8,\;88.3\pm46.8\;for\;sixth\;and\;61.5\pm18.3,\;56.2\pm26.6mg/cc$ for seventh, Contrasted by the normal control group has shown $148.0\pm19.9,\;153.2\pm23.2\;for\;fifth,\;96.1\pm30.2,\;105.6\pm26.5\;for\;sixth\;and\;73.9\pm27.9,\;77.2\pm27.2mg/cc$ for seventh decade, respectively The BMG of patient group was decreased as near the radiation field, while the lower lumbar spine has shown more large amounts of BMC in the normal control group. In Particular, the BMC of L5 within the radiation field was significantly decresed to $33\%,\;31\%,\;40\%$ compared with the control group of the fifth, sixth and seventh decades, respectively. Conclusion : The pelvic irradiation in cervical cancer has much effected on the loss of bone mineral content of lumbar spine within the radiation field, as the lower lumbar spine has shown a smaller BMC in Patient group with Pelvic irradiation in contrast to that of the normal control groups.

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The Results of Postoperative Radiation Therapy for Perihilar Cholangiocarcinoma (간문부 담도암에서 수술 후 방사선 치료의 결과)

  • Lee, Yu-Sun;Park, Jae-Won;Park, Jin-Hong;Choi, Eun-Kyung;Ahn, Seung-Do;Lee, Sang-Wook;Song, Si-Yeol;Lee, Sung-Gyu;Hwang, Shin;Lee, Young-Joo;Park, Kwang-Min;Kim, Ki-Hun;Ahn, Chul-Soo;Moon, Deok-Bog;Chang, Heung-Moon;Ryu, Min-Hee;Kim, Tae-Won;Lee, Jae-Lyun;Kim, Jong-Hoon
    • Radiation Oncology Journal
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    • v.27 no.4
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    • pp.181-188
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    • 2009
  • Purpose: The aim of this study was to evaluate the results of postoperative radiotherapy in a case of perihilar cholagiocarcinoma by analyzing overall survival rate, patterns of failure, prognostic factors for overall survival, and toxicity. Materials and Methods: Between January 1998 and March 2008, 38 patients with perihilar cholangiocarcinoma underwent a surgical resection and adjuvant radiotherapy. The median patient age was 59 years (range, 28 to 72 years), which included 23 men and 15 women. The extent of surgery was complete resection in 9 patients, microscopically positive margins in 25 patients, and a subtotal resection in 4 patients. The tumor bed and regional lymphatics initially received 45 Gy or 50 Gy, but was subsequently boosted to a total dose of 59.4 Gy or 60 Gy in incompletely resected patients. The median radiotherapy dose was 59.4 Gy. Concurrent chemotherapy was administered in 30 patients. The median follow-up period was 14 months (range, 6 to 45 months). Results: The 3-year overall survival and 3-year progression free survival rates were 30% and 8%, respectively. The median survival time was 28 months. A multivariate analysis showed that differentiation was the only significant factor for overall survival. The 3-year overall survival was 34% in R0 patients and 20% in R1 patients. No statistically significant differences in survival were found between the 2 groups (p=0.3067). The first site of failure was local in 18 patients (47%). No patient experienced grade 3 or higher acute toxicity and duodenal bleeding developed in 2 patients. Conclusion: Our results suggest that adjuvant RT might be a significant factor in patients with a positive margin following a radical resection. However, there was still a high locoregional recurrence rate following surgery and postoperative radiotherapy. Further study is necessary to enhance the effect of the adjuvant radiotherapy.

Effect of Eddy on the Cycle of 210Po and 234 in the central Region of Korean East Sea (동해 중부해역에서 210Po과 234Th의 순환에 대한 소용돌이의 영향)

  • YANG, HAN SOEB;KIM, SOUNG SOO;LEE, JAE CHUL
    • 한국해양학회지
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    • v.30 no.4
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    • pp.279-287
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    • 1995
  • The vertical profiles of natural 210Pb, 210Po and 234Th activities were measured for the upper 100 m of water column at three stations in the middle region of the Korean East Sea during May 1992. And the distribution of these radionuclides was discussed associated with the formation of warm eddy or water mass. The main thermocline was maintained between the depth of 50 and 100 m at the southern station (Sta. A1), and between the depth of 10 to 50 m at the coastal station of Sockcho (Sta. B10). Contrastingly, a main thermocline at Sta. A10, which locates near the center of warm eddy, was observed below 230 m depth. Between 50 and 220 m depth of Sta. A10 is there a relatively homogeneous water mass of 10.1${\pm}$0.5$^{\circ}C$, which is significantly higher in temperature and lower in nutrient than the other two stations. It seems to be due to sinking of the warm surface water in which nutrients were completely consumed. Both 210Pb and 210Po show the highest concentration at Sta. A1 and the lowest at Sta. B10 among the three stations. Also, the 210Pb activity is generally higher in the upper layer than in the lower layer, while 210Po activity represents the reversed pattern at all three stations. At Sta. A1 and Sta. B10, the activities of 210Po relative to its parent 210Pb were deficient in the water column above the main thermocline, but were excess below the thermocline. However, the station near the center of warm eddy(Sta. A10), shows no excess of 210Po in the depths below 50 m, although its defficiency is found in the upper layer like the other stations. At Sta. A1 and b10. 234Th activities are slightly lower in the surface mixed layer than in the deeper region However, at Sta. A10, 234Th activity in the upper 30 m is higher than below 50 m or in the same depth of the other stations, probably because of the high concentration of particulate matter. The residence time of 210Po in the surface mixed layer at Sta. A10 is 0.4 year, much shorter than at the other two stations(about one year). Above 100 m depth, the residence times of 234Th range from 18 to 30 other two stations(about on year). Above 100 m depth, the residence times of 234Th range from 18 to 30 days at all stations, without significant regional variation. The percentages of recycled 210Po within the thermocline are 39% and 92% at Sta. A1 and Sta. B10, respectively. Much higher value at Sta. B10 may be due to a thin thickness of the mixed layer as well as the slower recycling rate of 210Po in the main thermocline.

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Estimation of Availability of Whole Crop Barley and Rye Silage TMR in the Cattle (청보리 및 호밀 Silage를 이용한 거세한우 비육중기용 TMR의 소 체내 이용성 조사)

  • Qin, Wei-Ze;Jin, Guang Lin;Kim, Jong-Kyu;Oh, Young-Kyoon;Lee, Sang-Cheol;Song, Man-Kang
    • Journal of The Korean Society of Grassland and Forage Science
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    • v.30 no.4
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    • pp.343-354
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    • 2010
  • The present study was conducted to examine the fermentation characteristics and effective degradability (ED) in the rumen, and whole tract digestibility of whole crop silage based TMR in comparison with conventional separate feeding of concentrate and roughage. Three ruminally fistulated non-lactating Holstein cattle were used in a 3 $\times$ 3 Latin square design. The cattle were fed 8kg of whole crop barley silage based TMR (BS-TMR) or 8kg (DM basis) of whole crop rye silage based TMR (RS-TMR) twice (08:00 and 18:00) daily in an equal amount. The cattle were also fed concentrate (5.6kg) and rice straw (1.4kg) seperately (DM basis, Control) twice daily in an equal amount. The both silages were included in TMR at 20% level (as fed basis). pH in the rumen fluid was not influenced by the diets but was slightly higher from TMR than from control. No difference was found in ammonia-N concentration between diets. Total VFA concentration was relatively increased in the cattle fed RS-TMR to the other diets up to 6h post feeding. The proportion of acetate was increased in the TMR feeding at right before feeding (0 h, p<0.005) and 9 h (p<0.048) post feeding compared with control. Propionate proportion was increased (p<0.046) in both TMRs while butyrate proportion was increased (p<0.029) at 1h post feeding compared to other diets. Effective degradability (ED) of DM and CP of RS-TMR was relatively increased to other diets, and EDNDF of both TMRs was higher than that of control diet due to the increased parameters b (p<0.039) and c (p<0.006) in TMR treatments. Whole track digestibility of most components in the TMRs was slightly increased compared to that in control diet, and RS-TMR had a tendency to be increased whole track digestibility except for NDF compared to BS-TMR. Based on the results observed from the present study, nutrient availability of whole crop silage based TMR looked slightly better than conventional separate feeding of concentrate and rice straw, mainly due to the improved stabilization of fermentation in the rumen and increased NDF digestibility of whole crop silage in TMR.

Analysis of the Causes of Subfrontal Recurrence in Medulloblastoma and Its Salvage Treatment (수모세포종의 방사선치료 후 전두엽하방 재발된 환자에서 원인 분석 및 구제 치료)

  • Cho Jae Ho;Koom Woong Sub;Lee Chang Geol;Kim Kyoung Ju;Shim Su Jung;Bak Jino;Jeong Kyoungkeun;Kim Tae_Gon;Kim Dong Seok;Choi oong-Uhn;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.22 no.3
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    • pp.165-176
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    • 2004
  • 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.

Bladder Preserving Treatment in Patients with Muscle Invasive Bladder Cancer (근침윤성 방광암 환자의 방광 보존적 치료 결과)

  • Yu, Jeong-Il;Oh, Dong-Ryol;Huh, Seung-Jae;Choi, Han-Yong;Lee, Hyon-Moo;Jeon, Seong-Soo;Yim, Ho-Young;Kim, Won-Suk;Lim, Do-Hoon;Ahn, Yong-Chan;Park, Won
    • Radiation Oncology Journal
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    • v.25 no.2
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    • pp.70-78
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    • 2007
  • [ $\underline{Purpose}$ ]: This study analyzed the tumor response, overall survival, progression free survival and related prognostic factors in patients with muscle invasive bladder cancer subjected to bladder preserving treatment. $\underline{Materials\;and\;Methods}$: Between August 1995 and June 2004, 37 patients with muscle invasive (transitional cell carcinoma, clinically stage T2-4) bladder cancer were enrolled for the treatment protocol of bladder preservation. There were 33 males and 4 females, and the median age was 67 years (range $38{\sim}86\;years$). Transurethral resection of the bladder (TURB) was performed in 17 patients who underwent complete resection. The median radiation dose administered was 64.8 Gy (range $55.8{\sim}67\;Gy$). The survival rate was calculated by the Kaplan-Meier method. $\underline{Results}$: An evaluation of the response rate was determined by abdomen-pelvic CT and cystoscopy at three months after radiotherapy. A complete response was seen in 17 patients (46%). The survival rate at three years was 54.7%, with 54 months of median survival (range $3{\sim}91$ months). During the study, 17 patients died and 13 patients had died from bladder cancer. The progression free survival rate at three years was 37.2%. There were 24 patients (64.9%) who had disease recurrence: 16 patients (43.2%) had local recurrence, 6 patients (16.2%) had a distant recurrence, and 2 patients (5.4%) had both a local and distant recurrence. The survival rate (p=0.0009) and progression free survival rates (p=0.001) were statistically significant when compared to the response rate after radiotherapy. $\underline{Conclusion}$: The availability of complete TURB and appropriate chemoradiotherapy were important predictors for bladder preservation and survival.