• Radiation Oncology Journal
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• v.28 no.4
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• pp.205-210
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• 2010

Purpose: To evaluate the predictive factors for treatment response and prognostic factors affecting survival outcomes after concurrent chemoradiotherapy (CCRT) for patients with anal squamous cell carcinoma. Materials and Methods: Medical records of forty two patients with histologically confirmed analsquamous cell carcinoma, who had complete CCRT between 1993 and 2008, were reviewed retrospectively. Median age was 61.5 years (39~89 years), and median radiotherapy (RT) dose was 50.4 Gy (30.0~64.0 Gy). A total of 36 patients had equal to or less than T2 stage (85.7%). Fourteen patients (33.3%) showed regional nodal metastasis, 36 patients (85.7%) were treated with 5-fluorouracil (5-FU) plus mitomycin, and the remaining patients were treated by 5-FU plus cisplatinum. Results: The median follow-up time was 62 months (2~202 months). The 5-year overall survival, loco regional relapse-free survival, disease-free survival, and colostomy-free survival rates were 86.0%, 71.7%, 71.7%, 78.2%, respectively. Regarding overall survival, the Eastern Cooperative Oncology Group (ECOG) performance status and complete response were found to be significant prognostic factors on univariate analysis. For multivariate analysis, only the ECOG performance status was significant. No significant factor was found for locoregional relapse-free survival or disease-free survival and similarly for treatment response, no significant factor was determined on logistic regression analysis. There were 7 patients who had local or regional recurrences and one patient with distant metastasis. The only evaluable toxicity in all patients was radiation dermatitis of perianal skin (grade 3), which developed in 4 patients (9.5%) and grade 2 in 22 patients (52.4%). Conclusion: This study revealed that patients with a performance score of ECOG 0-1 survived significantly longer than those with a poorer score. Finally, there was no significant predicting factors tested for treatment response.

• The Journal of Korean Society for Radiation Therapy
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• v.21 no.1
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• pp.17-23
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• 2009

Purpose: In treating head and neck cancer, it is very important to irradiate uniform dose on the junction of the bilateral irradiation field of the upper head and neck and the anterior irradiation field of the lower neck. In order to improve dose distribution on the junction, this study attempted to correct non uniform dose resulting from under dose and over dose using the field-in-field technique in treating the anterior irradiation field of the lower neck and to apply the technique to the treatment of head and neck cancer through comparison with conventional treatment. Materials and Methods: In order to examine dose difference between the entry point and the exit point where beam diffusion happens in bilateral irradiation on the upper head and neck, we used an anthropomorphic phantom. Computer Tomography was applied to the anthropomorphic phantom, the dose of interest points was compared in radiation treatment planning, and it was corrected by calculating the dose ratio at the junction of the lower neck. Dose distribution on the junction of the irradiated field was determined by placing low-sensitivity film on the junction of the lower neck and measuring dose distribution on the conventional bilateral irradiation of the upper head and neck and on the anterior irradiation of the lower neck. In addition, using the field-in-field technique, which takes into account beam diffusion resulting from the bilateral irradiation of the upper head and neck, we measured difference in dose distribution on the junction in the anterior irradiation of the lower neck. In order to examine the dose at interest points on the junction, we compared and analyzed the change of dose at the interest points on the anthropomorphic phantom using a thermoluminescence dosimeter. Results: In case of dose sum with the bilateral irradiation of the upper head and neck when the field-in-field technique is applied to the junction of the lower neck in radiation treatment planning, The dose of under dose areas increased by 4.7~8.65%. The dose of over dose areas also decreased by 2.75~10.45%. Moreover, in the measurement using low-sensitivity film, the dose of under dose areas increased by 11.3%, and that of over dose areas decreased by 5.3%. In the measurement of interest point dose using a thermoluminescence dosimeter, the application of the field-in-field technique corrected under dose by minimum 7.5% and maximum 17.6%. Thus, with the technique, we could improve non.uniform dose distribution. Conclusion: By applying the field-in-field technique, which takes into account beam divergence in radiation treatment planning, we could reduce cold spots and hot spots through the correction of dose on the junction and, in particular, we could correct under dose at the entry point resulting from beam divergence. This study suggests that the clinical application of the field-in-field technique may reduce the risk of lymph node metastasis caused by under dose on the cervical lymph node.

• Journal of Gastric Cancer
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• v.6 no.4
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• pp.270-276
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• 2006

Purpose: The prognosis of Borrmann type IV gastric cancer is poorer than that of the other gastric carcinomas. We compared the clinicopathological features of Borrmann type IV gastric cancer with those of other types of cancer and analyzed the significance of a Borrmann type IV carcinoma as a prognostic factor Materials and Methods: We retrospectively reviewed the clinicopathologic features, TNM stage and survival rates of 4,389 gastric cancer patients who received surgical management at Samsung Medical Center between January 1995 and December 2004. Results: Patients with a Borrmann type IV gastric carcinoma had a more advanced stage than patients with other types of gastric carcinomas at the initial diagnosis, and the curative resection rate was lower. The 5-year survival rate of patients with Borrmann type IV cancer was 20.7%, and that of patients with other types of cancer was 50.3%. The 5-year survival rate of patients with Borrmann type IV gastric carcinomas was significantly lower than that of patients with other types of gastric carcinomas at the same TNM stage. In univariate and multivariate analyses, the depth of invasion, the nodal state, distant metastasis, the TNM stage, curability and the presence of a Borrmann type IV carcinoma were independent prognostic factors in cases of gastric cancer. Conclusion: Compared to the other types of gastric carcinomas, a Borrmann type IV carcinoma has unique clinicopathological features. The prognosis should be predicated considering the differences between Borrmann type IV qastric carcinomas and other types of gastric carcinomas, and multimodal and intensive therapies are needed in patients with a Borrmann type IV gastric carcinoma.

• Journal of Korean Orthopaedic Sports Medicine
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• v.1 no.1
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• pp.71-74
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• 2002

Purpose : To evaluate the clinical and radiological characteristics of osteochondral ridges of talus and ankle. Materials and Methods : We have analyzed their clinical symptoms and signs, radiologic and CT findings and post-operative results in 17 ankle joints of 14 patients (bilateral in 3), followed them for average 13 months after surgical excision. Results : No definite trauma, but mostly in male after middle age. Their chief complaints are pain on ankle, especially in dorsiflexion or squatting position, and symptom durations are very long, more than average 15 months. Definite diagnosis was made by lateral radiograms of ankle joint. Osteochondral ridges are common in talar neck (10 cases), tibia (4 cases) and both side (3 cases). After excision of osteophytes, all patients gained normal ankle without pain and any limited motion. Conclusions : Anterior impingement syndromes are common in middle aged male, but no definite correlation with sports. Plantar and dorsiflexed lateral radiographs are helpful in definite diagnosis for impingement, and surgical excision is best for treatment.

• Journal of Technology Innovation
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• v.2 no.1
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• pp.1-57
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• 1994

본 고는 지속적 개발 론에 입각한 적극적인 에너지수요 관리정책을 추진한다는 전제하에 2001년과 2006년의 우리 나라 가정부문 전력수요를 전망하고자 한다. 본 고는 지속적 개발 시나리오를 추정함에 있어서 기존의 계량모형보다 일종의 공학적 모형인 공정분석(process analysis)을 선호한다. 계량모형이 주로 과거 수요의 소득 및 가격 탄성 치를 바탕으로 미래의 수요를 예측하는데 비하여 공정분석모형은 기술발전에 따른 미래의 효율변화(향상)를 비교적 잘 반영할 수 있기 때문이다. 본 고는 덴마크공과대학교 Norgard 교수팀이 개발한 모형을 도입하여 분석모형(수식 (6))을 전력수요 = 기기 수 $\times$ 전력서비스$\times$ 전력집약도와 같이 설정하고 이를 사용하여 냉장고, 텔레비전, 조명 기기, 난방기기 등과 같은 전력사용 기기 별로 2001년과 2006년이 전력수요를 전망하였다. 본 고는 전력수요를 전력사용 기기의 사용용량(300리터 용량의 냉장고 등)과 사용시간을 나타내는 전력서비스와 전력 서비스당 필요 전력사용량을 나타내는 전력집약도로 나누어 구분하고 있는 모형을 이용함으로써 소득향상효과와 함께 기술발전에 따른 효율개선효과를 분석할 수 있다. 1) 생활수준 향상에 따라 전력서비스는 지금과 같이 증가한다, 2) 현실적으로 가능한 범위 내에서 전력사용 기기에 대한 최저 에너지 효율 제를 실시한다, 3) 현재 사용중인 기기 들은 원칙적으로 수명이 다한 후 고효율 기기 들로 자연 교체한다, 4) 최저 에너지 효율 제를 제외한 다른 제도 및 정책개선, 사용자의 에너지소비형태 개선에 따른 절전 잠재 량을 고려하지 않는다 등의 가정 하에 전력수요를 추정한 결과 1992년에 796 GWh(100)이었던 우리 나라 가정부문 전력수요는 2001년과 2006년에 29,237 GWh(134)와 33,118 GWh(152)로 각각 34%와 52%증가할 것으로 나타났다. 이 경우 1992년부터 2006년까지 가정용 전력수요 증가율은 연평균 3%로 추정된다. 기기의 서비스(가구수$\times$기기의 보급 율$\times$기기의 전력서비스)가 소득향상에 따라 증가하는데도 불구하고 전력수요의 증가율이 GDP(같은 기간 동안 연평균 증가율 5.7%)보다 매우 낮은 것은 기기의 대형화와 기기의 보급을 증가에 따른 전력의 추가수요가 기기의 에너지효율 개선으로 대부분 상쇄될 것이기 때문이다. 향후 10년 내에 기기에 따라 전력사용량을 25%~50%정도까지 줄일 수 있을 것으로 분석된다. 기술발전에 따른 기기의 에너지효율 개선효과는 본 고의 2006년도 가정용 전력수요의 전망치 33,118 GWh가 기존방식에 의한 한전의 전망치 61,155 GWh의 54%수준밖에 되지 않는데 서도 잘 나타나고 있다. 한편 본 고는 경제성장과 환경보존을 동시에 달성할 수 있는 지속적 개발의 실천방안으로서 에너지 수요관리를 논하고자 한다. 고효율 기기의 개발과 조기도입을 촉진시키는 에너지 수요관리 통하여 우리는 에너지효율을 대폭 개선시키며 대기오염 배출량도 대폭 줄일 수 있다. 본 고는 에너지 공급관리(공급확충)위주에서 에너지 수요관리위주로서의 에너지정책 전환은 불가피하다고 판단한다. 에너지 공급시스템보다 에너지 수요시스템위주로 전체 에너지시스템을 획기적으로 개선시키기 위해서는 최저 에너지효율제의 광범위한 실시와 함께 고효율 기기의 개발과 보급에 필요한 유인책의 도입, 고효율 기기와 에너지의 효율적 이용에 대한 정보 등이 필요시 되고 있다. 우리 나라의 경우 현재의 산업구조와 기술수준을 고려하여 에너지 효율의 기준을 미국보다 다소 낮게 설정한다면 최저 에너지효율제의 도입이 문제가 되지 않을 것으로 판단된다. 본 고는 고효율 기기의 개발과 조기도입을 지원하기 위한 가칭 대기환경보존 및 에너지 수요관리기금의 창설을 제안한다. 전력부문의 경우 기금은 1. 탄소세, 2. 전력소비에 대한 수요 관리 세의 도입 혹은 3. 한국전력공사 전력판매수입의 일정 분으로 조성될 수 있을 것으로 본다. 예를 들어 선진국들이 탄소세를 예정대로 도입한다는 전제하에 우리 나라가 2000년을 기준으로 탄소 톤당 8달러(석유 배럴 당 85센트)의 탄소세를 도입한다면 연간 7억 2,000만 달러(약5,760억 원)규모의 기금을 조성할 수 있다. 이 중 연간 2,000억 원 정도를 고효율 기기의 개발과 조기도입에 지원한다면 우리 나라 에너지 시스템 효율은 대폭 개선될 수 있을 것으로 예상된다.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.224-229
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• 2001

Purpose : The aim of this study is to analyze the treatment failure patterns and the risk factors for locoregional or distant failure of uterine cervical carcinoma treated with radiation therapy. Materials and methods . A retrospective analysis was undertaken of 154 patients treated with curative radiation therapy in Gyeongsang National University Hospital from April 1989 through December 1997. According to FIGO classification, 12 patients were stage IB, 24 were IIA, 98 were IIB, 1 were IIIA, 17 were IIIB, 2 were IVA. Results : Overall treatment failure rate was $42.1\%$ (65/154), and that of complete responder was $31.5\%$ (41/130). Among 65 failures, 25 failed locoregionally, another 25 failed distantly, and 15 failed locoregionally and distantly. Multivariate analysis confirmed tumor size (>4 cm) as risk factor for locoregional failure, and tumor size (>4 cm), pelvic lymph node involvement as risk factors for distant failure. Conclusion : On the basis of results of our study and recent published data of prospective randomized study for locally advanced uterine cervical carcinoma, we concluded that uterine cervical carcinoma with size more than 4 cm or pelvic lymph node involvement should be treated with concurrent chemoradiation.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.335-344
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• 2001

Purpose : The aim of this study was to clarify the role of VEGF expression as an independent prognostic factor and to identify the patients at high risk for poor prognosis in stage IB cervical cancer. Materials and methods : A total of 118 patients with stage IB cervical cancer who had radical hysterectomy and pelvic lymph node dissection were included in the study. All known high risk factors of the patients were pathologically confirmed from the surgical specimen. Of the 118 patients, n patients were treated with postoperative radiotherapy and/or chemotherapy. VEGF expression was examined using immunohistochemistry in formalin-fixed, paraffin-embedded specimens of post-hysterectomy surgical materials. A semiquantitative analysis was made using a scoring system of 0, +, ++, and +++ for increasing intensity of stain. We classified the patients with scores from 0 to ++ as low VEGF expression and the patients with a score of +++ as high VEGF expression. Results : Of the 118 patients, 35 patients $(29.7\%)$ showed high VEGF expression. Strong correlations were found between the high VEGF expression and both deep stromal invasion (p=0.01) and the positive pelvic node (p=0.03). The 5-year overall and disease-free survival rates for all 118 patients were $95.5\%\;and\;93.8\%$. The 5-year overall (p=0.03) and disease-free survival (p<0.001) rates were $98.5\%\;and\;100%$ for low VEGF expression (0, +, and ++) and $85.5\%\;and\;79.7\%$ for high VEGF expression, respectively. Pelvic and distant failures for low versus high VEGF expression were $1.2\%$ versus $17.1\%$, (p=0.001) and $0\%$ versus $14.3\%$ (p<0.001), respectively. In a Cox multivariate analysis of survival, the high VEGF expression (p=0.02) and the bulky mass (p=0.02) were significant prognostic factors for overall survival. The high VEGF expression (p=0.002), and bulky mass (p=0.01) demonstrated as significant prognostic indicators for disease free survival. Conclusion : These results showed that VEGF expression was a highly significant predictor for pelvic and distant failure and the most significant prognostic factor of overall and disease free survival for the patients with stage IB cervix cancer treated with radical surgery. We strongly suggest that the immune-histochemistry for VEGF expression be performed in a routine clinical setting in order to identify the patients at high risk for poor prognosis in early stage cervical cancer. Furthermore, postoperative and/or chemotherapy did not reduce the pelvic failure and distant metastasis. To improve the cure rate for the patients with high VEGF expression in stage IB cervical cancer, antiangiogenic therapy including anti-VEGF Ab may be new treatment option.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.349-356
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• 1997

Purpose : To evaluate the efficacy of hyperfractionated radiation therapy in carcinoma of the cervix, especially on huge exophytic and endophytic stage Ib, IIa and IIb Materials and Materials : Fourty one patients with carcinoma of the cervix treated with hyperfractionated radiation therapy at the Department of Therapeutic Radiology, Dongsan Hospital, Keimyung University. School of Medicine from Jul, 1991 to Apr, 1994. According to FIGO s1aging system, therewere stage Ib (3 patients) IIa (6 patients) with exophytic ($\geq$5cm in dinmeter) and huge endophytic mass. and IIb (32 patients) with median age of 55 yeavs old. Radiation therapy consisted of hyperfractionated external irradition to the whole pelvis (120cGy/fraction, 2 fraction/day (minimum interval of 6 hours), 3600-5520cGy) and boost parametrial doses (for a total of 4480-6480cGy) with midline shield $(4\times10cm)$, and combined with intracavitary irradiation (up to 7480-8520cGy in Ib, IIa and 8480-9980cGy in IIb to point A). The maximum and mean follow up durations were 70 and 47 months respectively . Results : Five year local control rate was $78\%$ and the actuarial overall five year survival rate was $66.1\%$ for all patients, $44.4\%$ for stage Ib, IIa and $71.4\%$ for stage IIb. In bulky IIb (above 5cm in tumor size, 11 patients) five year local control rate and five rear survival rate was $88.9\%,\;73\%$ respectively Pelvic lymph node status (negative : $74\%,\;positive:25\%$, p=0.0015) was significant Prognostic factor affecting to five rear survival rate. There was marginally significant survival difference by total dose to A point ($>84Gy\;:\;70\%,\;>84Gy\;:\;42.8\%$, p=0.1). We consider that the difference of total dose to A point by stage (mean Ib,IIa : 79Gy. IIb 89Gy P=0.001) is one of the causes in worse local control and survival of Ib,IIa than IIb The overall recurrence rate was $39\%$ (16/41). The rates of local failure alone. distant failure alone. and combined local and distant failure were $9.7\%,\;19.5\%,\;and\;9.7\%$, respectively. Two Patients developed leukopenia ($\geq$ grade 3) and Three patients develoued grade 3 gastrointestinal complication. Above grade 3 complication was not noted. There was no treatment related death noted. Conclusion : We thought that it may be necessary to increase A point dose to more than 85Gy in hyperfractionated radiotherapy of huge exophytic and endophvtic stage Ib,IIa. We considered that hyperfractionated radiation therapy may be tolerable in huge exophytic and endophytic stage IIb cervical carcinoma with acceptable morbidity and possible survival gain but this was results in small patient group and will be confirmed by long term follow up in many patients.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.216-223
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• 2001

Purpose : We evaluated retrospectively the outcomes of inoperable squamous cell lung cancer patients treated with radiotherapy to find out prognostic factors affecting survival. Materials and methods : Four hundred and eleven patients diagnosed as squamous cell lung cancer between November 1988 and December 1997 were the basis of this analyses. The planned dose to the gross tumor volume was ranged from 30 to 70.2 Gy. Chemotherapy was combined in 72 patients $(17.5\%)$ with the variable schedule and drug combination regimens. Follow-up period ranged from 1 to 113 months with the median of 8 months and survival status was identified in 381 patients $(92.7\%)$. Overall survival rate was calculated using the Kaplan-Meier method. Results : Age ranged from 23 years to 83 years with the median 63 years. The male to female ratio was about 16:1. For all 411 patients, the median overall survival was 8 months and the 1-year survival rate (YSR), 2-YSR, and 5-YSR were $35.6\%,\;12.6\%,\;and\;3.7\%$, respectively. The median and 5-YSR were 29 months and $33.3\%$ for Stage IA, 13 months and $6.3\%$ for Stage IIIA, and 9 months and $3.4\%$ for Stage IIIB, respectively(p=0.00). The median survival by treatment aim was 11 months in radical intent group and 5 months in palliative, respectively (p=0.00). Of 344 patients treated with radical intent, median survival of patients (N=247) who received planned radiotherapy completely was 12 months while that of patients (N=97) who did not was 5 months (p=0.0006). In the analyses of the various prognostic factors affecting to the survival outcomes in 247 patients who completed the planned radiotherapy, tumor location, supraclavicular LAP, SVC syndrome, pleural effusion, total lung atelectasis and hoarseness were statistically significant prognostic factors both in the univariate and multivariate analyses while the addition of chemotherapy was statistically significant only in multivariate analyses. The acute radiation esophagitis requiring analgesics was appeared in 49 patients $(11.9\%)$ and severe radiation esophagitis requiring hospitalization was shown in 2 patients $(0.5\%)$. The radiation pneumonitis requiring steroid medication was shown in 62 patients $(15.1\%)$ and severe pneumonitis requiring hospitalization was occurred in 2 patients $(0.5\%)$. During follow-up, 114 patients $(27.7\%)$ had progression of local disease with 10 months of median time to recur (range : $1\~87\;months$) and 49 patients $(11.9\%)$ had distant failure with 7 months of median value (range : $1\~52\;months$). Second malignancy before or after the diagnosis of lung cancer was appeared in 11 patients Conclusion : The conventional radiotherapy in the patients with locally advanced squamous cell lung cancer has given small survival advantage over supportive care and it is very important to select the patient group who can obtain the maximal benefit and to select the radiotherapy technique that would not compromise the life quality in these patients.