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A Study on the Timing and Method of the Final Price of Air Ticket in Computerised Booking System (인터넷 항공권 예약시스템에서의 '최종가격' 표시시기와 방법 - 2015년 1월 15일 EU사법재판소 C-573/13 판결을 중심으로 -)

  • Sur, Ji-Min
    • The Korean Journal of Air & Space Law and Policy
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    • v.32 no.1
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    • pp.327-353
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    • 2017
  • The issue submitted to the Court of Justice on the merits of case C---573/13 originated from a claim brought in the context of a dispute between Air Berlin and the German Federal Union of Consumer Organisations and Associations. The challenge concerned the way in which air fares were displayed in Air Berlin's computerised booking system. The system was organised in such a way that, after selecting a date and a departure airport, one would find all possible flight connections in a summary table. However, the final price of the ticket was displayed only for the clicked connection, and not for all connections, thus preventing customers from being able to compare such price with the prices of other connections. The German Federal Union took the view that this practice did not meet the requirements laid down by Article 23 of Regulation (EC) No. 1008/2008, which requires transparency in the prices set for air services. This led the German State to bring an injunctive action to cause Air Berlin to discontinue said practice. The claim was upheld at both the application and appeal stage of the relevant proceedings. Subsequently, Air Berlin submitted the matter to the German Federal High Court, which decided to stay the proceedings and ask for a preliminary ruling from the Court of Justice as to 1. whether Article 23 of Regulation (EC) No. 1008/2008 must be interpreted as meaning that, during the computerised booking process, the final price to be paid must be indicated at all times when prices of air services are shown, including when they are shown for the first time; and 2. whether, during the computerised booking process, the final price must be indicated only for the air service specifically selected by the customer or for each air service shown. In a nutshell, the Court, by the here---discussed judgment determined that Article 23 of Regulation (EC) No. 1008/2008 must be interpreted as meaning that, in the context of a computerised air ticket booking system, the final price to be paid must be indicated not only for the air service specifically selected by the customer, but also for each air service in respect of which the fare is shown. Clearly the above judgment will place air companies under an obligation to update and adjust (when needed) their computerised ticket booking and payment systems, in consideration of the primary need for consumers to be aware at all times of the actual price payable for a ticket and be able to compare the price of the service selected with the prices for other air services in respect of which the fare is shown.

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The 1998, 1999 Patterns of Care Study for Breast Irradiation after Mastectomy in Korea (1998, 1999년도 우리나라에서 시행된 근치적 유방 전절제술 후 방사선치료 현황 조사)

  • Keum,, Ki-Chang;Shim, Su-Jung;Lee, Ik-Jae;Park, Won;Lee, Sang-Wook;Shin, Hyun-Soo;Chung, Eun-Ji;Chie, Eui-Kyu;Kim, Il-Han;Oh, Do-Hoon;Ha, Sung-Whan;Lee, Hyung-Sik;Ahn, Sung-Ja
    • Radiation Oncology Journal
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    • v.25 no.1
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    • pp.7-15
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    • 2007
  • [ $\underline{Purpose}$ ]: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. $\underline{Materials\;and\;Methods}$: A web- based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. $\underline{Results}$: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was $45{\sim}59.4\;Gy$ (median 50.4 Gy), to the SCL was $45{\sim}59.4\;Gy$ (median 50.4 Gy), and to the PAB was $4.8{\sim}38.8\;Gy$, (median 9 Gy) $\underline{Conclusion}$: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.

Modified Thoracoscopic Bullectomy (흉강경하 기낭절제술의 변형 술식)

  • Park, Chan-Beom;Cho, Min-Seob;Sa, Young-Jo;Lee, Jong-Ho;Jin, Ung;Kwon, Jong-Bum;Cho, Deog-Gon;Park, Kuhn;Cho, Kyu-Do;Kim, Chi-Kyeong
    • Journal of Chest Surgery
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    • v.36 no.12
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    • pp.937-942
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    • 2003
  • Morbidity, the use of analgesics, the amount of postoperative drainage and the postoperative hospital stay were reduced in VATS for pneumothorax. However, some authors preferred minithoracotomy to VATS because the rate of recurrence after VATS were between 5% and 10%. Therefore, we present a modified thoracoscopic bullectomy (MTB) which we believe has the advantages of conventional VATS and minithoracotomy. Material and Method: Sixty-six patients who received the operation from January 2002 to December 2002 were divided into 3 groups. Twenty-six patients were treated by axillary minithoracotomy and thirteen by conventional VATS and 18 by modified thoracoscopic bullectomy, The mean age was 21.9 years (range, 16∼35 years) for minithoracotomy group, 20.6 years (range, 17∼28 years) for conventional VATS group and 22.6 years (range, 16∼39 years) for MTB group. The mean follow-ups were 11.4 months for minithoracotomy group, 9.5 months for conventional VATS group and 4.7 months for MTB group. Result: The mean duration of operation was 55.79$\pm$23.35 minutes in MTB and 44.23$\pm$19.24 minutes in conventional VATS (p=0.333). The number of staplers being used was 1.63 $\pm$0.76 in MTB, 1.41$\pm$0.64 in minithoracotomy (p=0.663), and 2.92$\pm$1.19 in conventional VATS (p<0.001). The duration of indwelling chest tube was 1.63$\pm$0.76 day in MTB, 4.07$\pm$ 1.41 day in minithoracotomy (p<0.001) and 4.46$\pm$2.33day in conventional VATS (p<0.001). Hospital length of stay was 3.26$\pm$0.81 day in MTB, 6.04$\pm$2.21 day in minithoracotomy (p<0.001) and 6.69$\pm$3.33 day in conventional VATS (p<0.001). The number of postoperative complication and recurrence were 2 in minithoracotomy (7.4%), 5 in conventional VATS (38.5%) and 1 in MTB (5.6%). Conclusion: Modified thoracoscopic bullectomy is an effective procedure in the treatment of spontaneous pneumothorax.

Effect of Temperature During Grain Filling Stage on Grain Quality and Taste of Cooked Rice in Mid-late Maturing Rice Varieties (등숙기 온도변이가 중만생종 벼의 쌀 품질과 식미치에 미치는 영향)

  • Choi, Kyung-Jin;Park, Tae-Shik;Lee, Choon-Ki;Kim, Jung-Tae;Kim, Jun-Hwan;Ha, Ki-Yong;Yang, Woon-Ho;Lee, Chung-Keun;Kwak, Kang-Su;Park, Hong-Kyu;Nam, Jeong-Kwon;Kim, Jeong-Il;Han, Gwi-Jung;Cho, Yong-Sik;Park, Young-Hee;Han, Sang-Wook;Kim, Jae-Rok;Lee, Sang-Young;Choi, Hyun-Gu;Cho, Seung-Hyun;Park, Heung-Gyu;Ahn, Duok-Jong;Joung, Wan-Kyu;Han, Sang-Ik;Kim, Sang-Yeol;Jang, Ki-Chang;Oh, Seong-Hwan;Seo, Woo-Duck;Ra, Ji-Eun;Kim, Jun-Young;Kang, Hang-Won
    • KOREAN JOURNAL OF CROP SCIENCE
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    • v.56 no.4
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    • pp.404-412
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    • 2011
  • This experiment was conducted to clarify the effect of the temperature for grain filling duration on quality and taste of cooked rice cultivated in different region in Korea. In 2006 and 2007, 4 mid-late maturing group of rice varieties (Nampyeongbyeo, Ilpumbyeo, Junambyeo and Dongjin 1) were cultivated in 28 experimental plots of 27 different regions located in 8 provinces. The taste of cooked rice were positively correlated with 1,000 grain weight but negatively correlated with protein content of brown rice. Mean temperature for 30 days from heading was more closely correlated with grain filling and tastes of cooked rice than those for 40 days. Though, the optimum mean temperature for the best taste of cooked rice for 30 days after heading was 22.1 to $23.1^{\circ}C$ depending on varieties, in general, 1,000 grain weight and cooked rice taste were the highest in the mean temperature of $22.2^{\circ}C$ for 30 days from heading. But grains were poorly ripened in case of the mean temperature lower than $21.0^{\circ}C$ for 30 days after heading. Therefore, for the better taste of cooked rice in Korea, the developing new rice varieties and cultivation method should be focused to adjust the mean temperature within $22-23^{\circ}C$ during the period of 30 days after heading.

The Benefit of Individualized Custom Bolus in the Postmastectomy Radiation Therapy : Numerical Analysis with 3-D Treatment Planning (유방전절제술 후 방사선치료를 위한 조직보상체 개발 및 3차원 치료계획을 통한 유용성 분석)

  • Cho Jae Ho;Cho Kwang Hwan;Keum Kichang;Han Yongyih;Kim Yong Bae;Chu Sung Sil;Suh Chang Ok
    • Radiation Oncology Journal
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    • v.21 no.1
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    • pp.82-93
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    • 2003
  • Purpose : To reduce the Irradiation dose to the lungs and heart in the case of chest wail irradiation using an oppositional electron beam, we used an Individualized custom bolus, which was precisely designed to compensate for the differences In chest wall thickness. The benefits were evaluated by comparing the normal tissue complication probablilties (NTCPS) and dose statistics both with and without boluses. Materials and Methods : Boluses were made, and their effects evaluated in ten patients treated using the reverse hockey-stick technique. The electron beam energy was determined so as to administer 80% of the irradiation prescription dose to the deepest lung-chest wall border, which was usually located at the internal mammary lymph node chain. An individualized custom bolus was prepared to compensate for a chest wall thinner than the prescription depth by meticulously measuring the chest wall thickness at 1 emf intervals on the planning CT Images. A second planning CT was obtained overlying the individuailzed custom bolus for each patient's chest wall. 3-D treatment planning was peformed using ADAC-Pinnacle$^{3}$ for all patients with and without bolus. NTCPS based on 'the Lyman-Kutcher' model were analyzed and the mean, maximum, minimum doses, V$_{50}$ and V$_{95}$ for 4he heari and lungs were computed. Results .The average NTCPS in the ipsliateral lung showed a statistically significant reduction (p<0.01), from 80.2${\pm}$3.43% to 47.7${\pm}$4.61%, with the use of the individualized custom boluses. The mean lung irradiation dose to the ipsilateral iung was also significantly reduced by about 430 cGy, Trom 2757 cGy to 2,327 cGy (p<0.01). The V$_{50}$ and V$_{95}$ in the ipsilateral lung markedly decreased from the averages of 54.5 and 17.4% to 45.3 and 11.0%, respectively. The V$_{50}$ and V$_{95}$ In the heart also decreased from the averages of 16.8 and 6.1% to 9.8% and 2.2%, respectively. The NTCP In the contralateral lung and the heart were 0%, even for the cases with no bolus because of the small effective mean radiation volume values of 4.4 and 7.1%, respectively Conclusion : The use of an Individualized custom bolus in the radiotherapy of postrnastectorny chest wall reduced the NTCP of the ipsilateral lung by about 24.5 to 40.5%, which can improve the complication free cure probability of breast cancer patients.

Trends of Antimicrobial Susceptibility Test for Bacterias Isolated from Blood, Urine, Stool, and Cerebrospinal Fluid(1997~2001) (혈액 및 일반 세균배양에서 검출된 균종과 항균제 감수성 추이(1997~2001))

  • Hong, Mi Ae;Oh, Kyung Chang;Ahn, Seng In;Kim, Bong Rim;Kim, Yun Ho;Kim, Sung Seop;Chang, Jin Keun;Jeun, Kyoung So;Cha, Sung Ho
    • Pediatric Infection and Vaccine
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    • v.10 no.2
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    • pp.167-177
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    • 2003
  • Purpose : To know the trends of antimicrobial susceptibility is critical for antimicrobial treatment. We studied the organisms isolated from blood, urine, stool, and cerebrospinal fluid from 1997 to 2001 to reveal the trends of their antimicrobial susceptibility. Methods : We conducted a retrospective study with isolates obtained from 0~18 year old outpatients and inpatients from 1997 to 2001 at Department of Pediatrics, Hanil general hospital. We gathered the data through the laboratory test files and the origin of microorganisms cultured from blood, urine, stool and cerebrospinal fluid and their antimicrobial susceptibility. Results : Microorganisms were isolated from 226(3.3%) out of 6,974 blood cultures, 365 (8.0%) out of 4,549 urine cultures, 50(1.9%) out of 2,593 stool cultures and 9(1.4%) in 655 cerebrospinal fluid cultures. The most frequently isolated organisms from blood cultures was Staphylococcus epidermidis(33.5%) which was followed by Staphylococcus aureus(19.7%), Escherichia coli(13.8%), and Burkholderia cepacia(9.0%). Among the urine cultures, E. coli was the most common(74.7%) which was followed by Group D Enterococcus(11.3%), Klebsiella pneumoniae(7.1%) and Proteus mirabilis(2.5%). The positive stool cultures all yield Salmonella species. Group D Salmonella was obtained most frequently. Among the positive cerebrospinal fluid cultures, Group B Streptococcus was isolated most frequently. Among the 40 cases of S. aureus in blood cultures, 27 cases were methicillin-resistant. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of E. coli isolated from blood cultures were 80%, 100% and 60% in 1997 and 60%, 80% and 60% in 2001. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of K. pnumoniae isolated from urine cultures. were 80%, 100% and 80% in 1997 and 50%, 83% and 50% in 2001 Enterococcus was isolated from 6.7% to 15.8% and vancomycin-resistant Enterococcus was observed in 17% of Group D Enterococcus isolated from urine cultures. The rates of susceptibility for amikacin, ceftizoxime and ceftriaxone of Group D Salmonella were 96%, 96% and 92% during the study period. Conclusion : Among the blood cultures S. epidermidis, S. aureus, E. coli and B. cepacia were isolated in order of frequency and among the urine cultures E. coli, Group D Enterococcus, K. pneumoniae and P. mirabilis were isolated in order of frequency. During the study period there was no big difference in major organisms isolated from blood and urine. The methicillin-resistant S. aureus was observed in 67% of S. aureus isolated from blood cultures but vancomycin-reistant S. aureus or vancomycin intermediate resistant S. aureus was not observed. The rates of susceptibility to amikacin and the third generation cephalosporin of E. coli isolated from blood cultures and K. pneumoniae from urine cultures have decreased. The isolation rates of Group D Enterococcus and vancomycin resistant Enterococcus have increased.

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A Comparative Study on Awareness of Middle School Students, School Parents, and Human Resources Directors in Industrial Institutions about Admission into Specialized High Schools and Career after Graduating from Specialized High Schools (특성화고 진학 및 졸업 후 진로에 대한 중학생, 학부모, 산업체 인사 담당자의 인식 비교 연구)

  • Lee, Byung-Wook;Ahn, Jae-Yeong;Lee, Chan-Joo;Lee, Sang-Hyun
    • 대한공업교육학회지
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    • v.38 no.2
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    • pp.48-67
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    • 2013
  • This study tried to suggest implications about operation direction of specialized high schools (SHS) by researching awareness of middle school students (MSS), school parents (SP), human resources directors in industrial institutions (HRDII) who will be the main users of SHS education, about entering SHS and career after graduating from SHS. Seniors of middle school, SP and HRDII in Asan, Chungnam were the subject of this survey research. The summary of the result of this study is as follow: First, MSS and SP usually hoped to enter general high schools rather than vocational education schools such as SHS, meister high schools, and MSS considered school records and SP considered aptitude and talent for the factors to choose high school. Second, MSS, SP, and HRDII recognized purposes of SHS as improvement of talent and aptitude, and getting a job. As for positive images of SHS, they recognized it as applying talent and aptitude to life early, getting good jobs easily, fast independence after graduation, and learning excellent technologies, and as for negative images of SHS, they recognized it as social prejudices and discrimination, students with bad school records enter them, disadvantages about promotion and wages, and being unfavorable for entering universities. They also recognized education of SHS as being effective for improvement of basic and executive ability and key competency, development of creative human resources, and improvement of right personality and courteous manners. Third, many MSS and SP showed intention to enter SHS if it is established in Asan. They wished to enter SHS because they would like to apply their aptitude and talent to life early, learn excellent skill, and hope for early employment, on the other hand, they did not wish to enter SHS because it was not suited for their aptitude and talent, awareness about SHS is low, it is unfavorable to enter universities, and there were social prejudices and discrimination. They also similarly hoped for getting jobs and entering universities after graduating from SHS. And the reason they wanted to get a job was usually because they want to be successful by advancing into society early, or because it is still hard to get a job even after graduate from the university, on the other hand, the reason they want to enter university is because is usually in-depth education about major and social discrimination about level of education. The ability to perform duties forms the greatest part of the employment standard that MSS, SP, and HRDII aware. MSS and SP usually hoped for industrial, home economics and housework and commercial majors in SHS, and considered aptitude and talent, the promising future, and being favorable for employment for choosing major. The reason HRDII hire SHS student was to develop student into talent of industrial institution, ability of student, and need for manpower with high school graduation level, and there were also partial answer that they can hire SHS student if they have ability to perform duties. The proposals about operation direction of SHS according to the results above are as follow: SHS should diversify major and curriculum to meet various requirements of student and parents, establish SHS admission system based on career guidance, and improve student's ability to perform duties by establishing work-based learning. The Government should organize work-to-school policy to enable practical career development of students from SHS, and promote relevant policy to reinforcing SHS education rather than quantitative evaluation such as employment rate, and cooperative support from each government departments is required to make manpower with skill related to SHS to get proper evaluation and treatment.

The Impact of e-Store Personality on e-Store Loyalty-Focus on the Mediating Role of Identification, Trust, and Engagement (온라인에서 점포 개성이 점포 충성도에 미치는 영향-동일시, 신뢰, 인게이지먼트의 매개 역할을 중심으로)

  • Park, Hyo-Hyun;Jung, Gang-Ok;Lee, Seung-Chang
    • Journal of Distribution Research
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    • v.16 no.2
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    • pp.57-94
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    • 2011
  • Nowadays, it is common that most consumers are purchasing goods in e-stores. The e-stores eager to attract, revisit, retain, and finally convert them into loyal customers. The e-store marketers have planned and executed numerous marketing efforts. As one of the marketing activities, e-store managers attempt to build web sites that meet customers' functional and psychological needs. A wide array of studies has been done to identify factors that could affect customers' response of web sites. Majority of studies were conducted to verify technology-related and functional variables of the website which facilitate transactions and enhance customer responses such as purchase intention and website loyalty. However, there has been little research on the external cues of website and psychological variables of consumer that could have positive influences on customer response. The purpose of this study is to investigate the influence of e-store personality on e-store loyalty through mediating variables such as e-store identification, e-store trust, and e-store engagement. The authors of this study develop the model and set up the six main hypotheses and a set of sub-hypotheses based on a literature review, shown in

    . This model is composed of four paths such as dimensions of e-store personality${\rightarrow}$e-store identification, e-store identification${\rightarrow}$e-store loyalty, e-store identification ${\rightarrow}$e-store trust${\rightarrow}$e-store loyalty, and e-store identification${\rightarrow}$e-store engagement${\rightarrow}$e-store loyalty. II. Research Method Ladies under 30s were the respondents of this survey. Data were collected from January 20th to February 26th in 2010. A total of 200 questionnaires were distributed and 169 respondents were analysed finally to test hypotheses because 31 questionnaires had incorrect or missing responses. SPSS 12.0 and LISREL 7.0 program were used to test frequency, reliability, factor, and structural equation modeling analysis. III. Result and Conclusion According to results from factor analysis, eigen value was over 1.0 and items which were below 0.6 were deleted. Consequently, 9 factors(% of total variance is 72.011%) were searched. All Cronbach's ${\alpha}$ values are over the recommended level(${\alpha}$ > 0.7). The overall fit indices are acceptable such as ${\chi}^2$=2028.36(p=0.00), GFI=0.87, AGFI=0.82, CFI=0.81, IFI=0.92, RMR=0.075. All factor loadings were over the recommended level. As the result of discriminant validity check with chi-square difference test between paired constructs, each construct has good discriminant validity. The overall fit indices of final model are acceptable such as ${\chi}^2$=340.73(df=36, p=0.00), GFI=0.92, AGFI=0.81, CFI=0.91, IFI=0.91, RMR=0.085. As test results, 5 out of 6 hypotheses are supported because there are statistically significant casual relationships in structural equation model, shown in . First of all, hypothesis 1 is partially supported because sub-hypothesis 1-1 and 1-2 are supported, whereas sub-hypothesis 1-3, 1-4, and 1-5 are rejected. Specifically, it reveals that warmth and sophistication dimensions in e-store personality have positive influence on e-store identification, however, activity, progressiveness, and strictness does not have any significant relationship on e-store identification. Secondly, hypothesis 2 was supported. Therefore, it can be said that e-store identification has a positive impact on e-store trust. Thirdly, hypothesis 3 is also supported. Hence, there is a positive relationship between e-store identification and e-store engagement. Fourthly, hypothesis 4 is supported too. e-store identification has a positive influence on e-store loyalty. Fifthly, hypothesis 5 is also accepted. This indicates that e-store trust is a precedent variable which positively affects e-store loyalty. Lastly, it reveals that e-store engagement has a positive impact on e-store loyalty. Therefore, hypothesis 6 is supported. The findings of the study imply that some dimensions of e-store personality have a positive influence on e-store identification, and that e-store identification has direct and indirect influence on e-store loyalty through e-store trust and e-store engagement positively. These results also suggest that the e-store identification in e-store personality is a precedent variable which positively affects e-store loyalty directly and indirectly through e-store trust and engagement as a mediating variable. Therefore, e-store marketers need to implement website strategy based on e-store personality, e-store identification, e-store trust, and e-store engagement to meet customers' psychological needs and enhance e-store loyalty. Finally, the limitations and future study directions based on this study are discussed.

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  • Late Rectal Complication in Patients treated with High Dose Rate Brachytherapy for Stage IIB Carcinoma of the Cervix (FIGO병기 IIB 자궁경부암에서 고선량 강내 방사선치료후의 후기 직장 합병증)

    • Chung, Eun-Ji;Kim, Gwi-Eon;Suh, Chang-Ok;Keum, Ki-Chang;Kim, Woo-Cheol
      • Radiation Oncology Journal
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      • v.14 no.1
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      • pp.41-52
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      • 1996
    • Purpose : This paper reports a dosimetric study of 88 patients treated with a combination of external radiotherapy and high dose rate ICR for FIGO stage IIB carcinoma of the cervix. The purpose is to investigate the correlation between the radiation doses to the rectum, external radiation dose to the whole pelvis, ICR reference volume, TDF BED and the incidence of late rectal complications, retrospectively. Materials and Methods : From November 1989 through December 1992, 88 patients with stage IIB cervical carcinoma received radical radiotherapy at Department of Radiation Oncology in Yonsei University Hospital. Radiotherapy consisted of 44-54 Gy(median 49 Gy) external beam irradiation plus high dose rate intracavitary brachytherapy with 5 Gy per fraction twice a week to a total dose of 30 Gy on point A. The maximum dose to the rectum by contrast(r, R) and reference rectal dose by ICRU 38(dr, DR) were calculated. The ICR reference volume was calculated by Gamma Dot 3.11 HDR planning system, retrospectively The time-dose factor(TDF) and the biologically effective dose (BED) were calculated. Results : Twenty seven($30.7\%$) of the 88 patients developed late rectal complications:12 patients($13.6\%$) for grade 1, 12 patients($13.6\%$) for grade 2 and 3 patients($3.4\%$) for grade 3. We found a significant correlation between the external whole pelvis irradiation dose and grade 2, 3 rectal complication. The mean dose to the whole pelvis for the group of patients with grade 2, 3 complication was Higher, $4093.3\pm453.1$ cGy, than that for the patients without complication, $3873.8\pm415.6$ (0.05$7163.0\pm838.5$ cGy, than that for the Patients without rectal complication, $0772.7\pm884.0$ (p<0.05). There was no correlation of the rate of grade 2, 3 rectal complication with the iCR rectal doses(r, dr), ICR reference volume, TDF and BED. Conclusion : This investigation has revealed a significant correlation between the dose calculated at the rectal dose by ICRU 38(DR) or the most anterior rectal dose by contrast(R) dose to the whole pelvis and the incidence of grade 2, 3 late rectal complications in patients with stage IIB cervical cancer undergoing external beam radiotherapy and HOR ICR. Thus these rectal reference points doses and whole pelvis dose appear to be useful Prognostic indicators of late rectal complication in high dose rate ICR treatment in cervical carcinoma.

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    Parotid Gland Sparing Radiotherapy Technique Using 3-D Conformal Radiotherapy for Nasopharyngeal CarcinomB (비인강암에서 방사선 구강 건조증 발생 감소를 위한 3차원 입체조형치료)

    • Lim Jihoon;Kim Gwi Eon;Keum Ki Chang;Suh Chang Ok;Lee Sang-wook;Park Hee Chul;Cho Jae Ho;Lee Sang Hoon;Chang Sei Kyung;Loh Juhn Kyu
      • Radiation Oncology Journal
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      • v.18 no.1
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      • pp.1-10
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      • 2000
    • Purpose : Although using the high energy Photon beam with conventional Parallel-opposed beams radiotherapy for nasopharyngeal carcinoma, radiation-induced xerostomia is a troublesome problem for patients. We conducted this study to explore a new parotid gland sparing technique in 3-D conformal radiotherapy (3-D CRT) in an effort to prevent the radiation-induced xerostomia. Materials and Methods : We peformed three different planning for four clinically node-negative nasopharyngeal cancer patients with different location of tumor(intracranial extension, nasal cavity extension, oropharyngeal extension, parapharyngeal extension), and intercompared the plans. Total prescription dose was 70.2 Gy to the isocenter. For plan-A, 2-D parallel opposing fields, a conventional radiotherapy technique, were employed. For plan-B, 2-D parallel opposing fields were used up until 54 Gy and afterwards 3-D non-coplanar beams were used. For plan-C, the new technique, 54 Gy was delivered by 3-D conformal 3-port beams (AP and both lateral ports with wedge compensator; shielding both superficial lobes of parotid glands at the AP beam using BEV) from the beginning of the treatment and early spinal cord block (at 36 Gy) was peformed. And bilateral posterior necks were treated with electron after 36 Gy. After 54 Gy, non-coplanar beams were used for cone-down plan. We intercompared dose statistics (Dmax, Dmin, Dmean, D95, DO5, V95, VOS, Volume receiving 46 Gy) and dose volume histograms (DVH) of tumor and normal tissues and NTCP values of parotid glands for the above three plans. Results : For all patients, the new technique (plan-C) was comparable or superior to the other plans in target volume isodose distribution and dose statistics and it has more homogenous target volume coverage. The new technique was most superior to the other plans in parotid glands sparing (volume receiving 46 Gy: 100, 98, 69$\%$ for each plan-A, B and C). And it showed the lowest NTCP value of parotid glands in all patients (range of NTCP; 96$\~$100$\%$, 79$\~$99$\%$, 51$\~$72$\%$ for each plan-A, B and C). Conclusion : We conclude that the new technique employing 3-D conformal radiotherapy at the beginning of radiotherapy and cone down using non-coplanar beams with early spinal cord block is highly recommended to spare parotid glands for node-negative nasopharygeal cancer patients.

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