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Studies on the Estimation of Growth Pattern Cut-up Parts in Four Broiler Strain in Growing Body Weight (육용계에 있어서 계통간 산육능력 및 체중증가에 따른 각 부위별 증가양상 추정에 관한 연구)

  • 양봉국;조병욱
    • Korean Journal of Poultry Science
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    • v.17 no.3
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    • pp.141-156
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    • 1990
  • The experiments were conducted to investigate the possibility of improving the effectiveness of the existing method to estimate the edible meat weight in the live broiler chicken. A total of 360 birds, five male and female chicks from each line were sacrificed at Trial 1 (body weight 900-1, 000g), Trial 2 (body weight 1.200-1, 400g), Trial 3(body weight 1, 600-1, 700), and Trial 4(body weight 2, 000g) in order to measure the body weight, edible meat weight of breast, thigh and drumsticks, and various components of body weight. Each line was reared at the Poultry Breeding Farm, Seoul National University from the second of july, 1987 to the thirteenth of September, 1987. The results obtained from this study were summarized as follows : 1. The average body weights of each line( H. T, M, A) were $2150.5\pm$34.9, $2133.0\pm$26.2, $1960.0\pm$23.1, and $2319.3\pm$27.9, respectively. at 7 weeks of age. The feed to body weight eain ratio for each line chicks was 2.55, 2.13, 2.08, and 2.03, respectively, for 0 to 7 weeks of age. The viability of each line was 99.7. 99.7, 100.0, and 100.0%, respectively, for 0 to 7 weeks of age.01 was noticed that A Line chicks grow significantly heavier than did T, H, M line chic ks from 0 to 7 weeks of age. The regression coefficients of growth curves from each line chicks were bA=1.015, bH=0.265, bM=0.950 and bT=0.242, respectively. 2. Among the body weight components, the feather. abdominal fat, breast, and thigh and drumsticks increased in their weight percentage as the birds grew older, while neck. head, giblets and inedible viscera decreased. No difference wat apparent in shank, wings and hack. 3. The weight percentages of breast in edible part for each line thicks were 19.2, 19.0, 19.9 and 19.0% at Trial 4, respectively. The weight percentages of thigh and drumsticks in edible part for each line chicks were 23.1, 23.3, 22.8, and 23.0% at Trial 4. respective1y. 4. The values for the percentage meat yield from breast were 77.2. 78.9 73.5 and 74.8% at Trial 4 in H, T, M and A Line chicks. respectively. For thigh and drumstick, the values of 80.3, 78.4. 79.7 and 80.2% were obtained. These data indicate that the percentage meat yield increase as the birds grow older. 5. The correlation coefficients between body weight and blood. head, shanks. breast. thigh-drumstick were high. The degree if correlation between abdominal fat(%) and percentage of edible meat were extremely low at all times, but those between abdominal fat (%) and inedible viscera were significantly high.

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Clinical Outcomes of Corrective Surgical Treatment for Esophageal Cancer (식도암의 외과적 근치 절제술에 대한 임상적 고찰)

  • Ryu Se Min;Jo Won Min;Mok Young Jae;Kim Hyun Koo;Cho Yang Hyun;Sohn Young-sang;Kim Hark Jei;Choi Young Ho
    • Journal of Chest Surgery
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    • v.38 no.2 s.247
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    • pp.157-163
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    • 2005
  • Background: Clinical outcomes of esophageal cancer have not been satisfactory in spite of the development of surgical skills and protocols of adjuvant therapy. We analyzed the results of corrective surgical patients for esophageal cancer from January 1992 to July 2002. Material and Method: Among 129 patients with esophageal cancer, this study was performed in 68 patients who received corrective surgery. The ratio of sex was 59 : 9 (male : female) and mean age was $61.07\pm7.36$ years old. Chief complaints of this patients were dysphagia, epigastric pain and weight loss, etc. The locations of esophageal cancer were 4 in upper esophagus, 36 in middle, 20 in lower, 8 in esophagogastric junction. 60 patients had squamous cell cancer and 7 had adenocarcinoma, and 1 had malignant melanoma. Five patients had neoadjuvant chemotherapy. Result: The postoperative stage I, IIA, IIB, III, IV patients were 7, 25, 12, 17 and 7, respectively. The conduit for replacement of esophagus were stomach (62 patients) and colon (6 patients). The neck anastomosis was performed in 28 patients and intrathoracic anastomosis in 40 patients. The technique of anastomosis were hand sewing method (44 patients) and stapling method (24 patients). One of the early complications was anastomosis leakage (3 patients) which had only radiologic leakage that recovered spontaneously. The anastomosis technique had no correlation with postoperative leakage, which stapling method (2 patients) and hand sewing method (1 patient). There were 3 respiratory failures, 6 pneumonia, 1 fulminant hepatitis, 1 bleeding and 1 sepsis. The 2 early postoperative deaths were fulminant hepatitis and sepsis. Among 68 patients, 23 patients had postoperative adjuvant therapy and 55 paitents were followed up. The follow up period was $23.73\pm22.18$ months ($1\~76$ month). There were 5 patients in stage I, 21 in stage 2A, 9 in stage IIB, 15 in stage III and 5 in stage IV. The 1, 3, 5 year survival rates of the patients who could be followed up completely was $58.43\pm6.5\%,\;35.48\pm7.5\%\;and\;18.81\pm7.7\%$, respectively. Statistical analysis showed that long-term survival difference was associated with a stage, T stage, and N stage (p<0.05) but not associated with histology, sex, anastomosis location, tumor location, and pre and postoperative adjuvant therapy. Conclusion: The early diagnosis, aggressive operative resection, and adequate postoperative treatment may have contributed to the observed increase in survival for esophageal cancer patients.

Mid-term results of IntracardiacLateral Tunnel Fontan Procedure in the Treatment of Patients with a Functional Single Ventricle (기능적 단심실 환자에 대한 심장내 외측통로 폰탄술식의 중기 수술성적)

  • 이정렬;김용진;노준량
    • Journal of Chest Surgery
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    • v.31 no.5
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    • pp.472-480
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    • 1998
  • We reviewed the surgical results of intracardiac lateral tunnel Fontan procedure for the repair of functional single ventricles. Between 1990 and 1996, 104 patients underwent total cavopulmonary anastomosis. Patients' age and body weight averaged 35.9(range 10 to 173) months and 12.8(range 6.5 to 37.8) kg. Preoperative diagnoses included 18 tricuspid atresias and 53 double inlet ventricles with univentricular atrioventricular connection and 33 other complex lesions. Previous palliative operations were performed in 50 of these patients, including 37 systemic to pulmonary artery shunts, 13 pulmonary artery bandings, 15 surgical atrial septectomies, 2 arterial switch procedures, 2 resections of subaortic conus, 2 repairs of total anomalous pulmonary venous connection and 1 Damus-Stansel-Kaye procedure. In 19 patients bidirectional cavopulmonary shunt operation was performed before the Fontan procedure and in 1 patient a Kawashima procedure was required. Preoperative hemodynamics revealed a mean pulmonary artery pressure of 14.6(range 5 to 28) mmHg, a mean pulmonary vascular resistance of 2.2(range 0.4 to 6.9) wood-unit, a mean pulmonary to systemic flow ratio of 0.9(range 0.3 to 3.0), a mean ventricular end-diastolic pressure of 9.0 (range 3.0 to 21.0) mmHg, and a mean arterial oxygen saturation of 76.0(range 45.6 to 88.0)%. The operative procedure consisted of a longitudinal right atriotomy 2cm lateral to the terminal crest up to the right atrial auricle, followed by the creation of a lateral tunnel connecting the orifices of either the superior caval vein or the right atrial auricle to the inferior caval vein, using a Gore-Tex vascular graft with or without a fenestration. Concomitant procedures at the time of Fontan procedure included 22 pulmonary artery angioplasties, 21 atrial septectomies, 4 atrioventricular valve replacements or repairs, 4 corrections of anomalous pulmonary venous connection, and 3 permanent pacemaker implantations. In 31, a fenestration was created, and in 1 an adjustable communication was made in the lateral tunnel pathway. One lateral tunnel conversion was performed in a patient with recurrent intractable tachyarrhythmia 4 years after the initial atriopulmonary connection. Post-extubation hemodynamic data revealed a mean pulmonary artery pressure of 12.7(range 8 to 21) mmHg, a mean ventricular end-diastolic pressure of 7.6(range 4 to 12) mmHg, and a mean room-air arterial oxygen saturation of 89.9(range 68 to 100) %. The follow-up duration was, on average, 27(range 1 to 85) months. Post-Fontan complications included 11 prolonged pleural effusions, 8 arrhythmias, 9 chylothoraces, 5 of damage to the central nervous system, 5 infectious complications, and 4 of acute renal failure. Seven early(6.7%) and 5 late(4.8%) deaths occured. These results proved that the lateral tunnel Fontan procedure provided excellent hemodynamic improvements with acceptable mortality and morbidity for hearts with various types of functional single ventricle.

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Changes in Immunogenicity of Preserved Aortic Allograft (보존된 동종동맥편 조직의 면역성 변화에 관한 연구)

  • 전예지;박영훈;강영선;최희숙;임창영
    • Journal of Chest Surgery
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    • v.29 no.11
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    • pp.1173-1181
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    • 1996
  • The causes of degenerative changes in allograft cardiac valves are not well known to this day. Today's preserved allografts possess highly viable endothelial cells and degeneration of allografts can be facilitated by immune reaction which may be mediated by these viable cells. To test the antigenicity of endothelial cells, pieces from aortic wall were obtained from fresh and cryo-preserved rat allograft. Timings of sampling were prior to sterilization, after sterilization, after 1, 2, 7, 14 days of fresh preservation and cryopreservation. Endothelial cells were tested by immunohistochemical methods using monoclonal antibodies to MHC class I(MRC OX-18), class II(MRC OX-6) and ICAM-1 antigens. After transplantation of each group of aortic allograft at the subcutaneous layers of rats, population of CD4$^{+}$ T cell and CD8$^{+}$ T cell were analyzed with monoclonal antibodies after 1, 2, 3, 4, 6 and 8 weeks. MHC class I expression was 23.95% before preservation and increased to 35.53~48.08% after preservation(p=0.0183). MHC Class II expression was 9.72% before preservation and 10.13~13.39% after preservation(P=0.1599). ICAM-1 expression was 15.02% before preservation and increased to 19.85~35.33% after preservation(P=0.001). The proportion of CD4$^{+}$ T-cell was 42.13% before transplantation. And this was 49.23~36.8% after transplantation in No treat group (p=0.955), decreased to 29.56~32.80% in other group(p=0.0001~0.008). In all the groups, the proportion of CD8$^{+}$ T-cell increased from 25.57% before transplantation to 42.32~58.92% after transplantation(p=0.000l~0.0002). The CD4$^{+}$/CD8$^{+}$ ratio decreased from 1.22~2.28 at first week to 0.47~0.95 at eighth week(p=0.0001). The results revealed that the expression of MHC class I and ICAM-1 in aortic allograft endothelium were increased but that of MHC class II were not changed, despite the different method of preservation. During 8 weeks after transplantation of aortic allograft, the subpopulations of CD4$^{+}$ T cell were not changed or only slightly decreased but those of CD8$^{+}$ T cell were progressively increased.ely increased.

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The Recent Outcomes after Repair of Tetralogy of Fallot Associated with Pulmonary Atresia and Major Aortopulmonary Collateral Arteries (폐동맥폐쇄와 주대동맥폐동맥부행혈관을 동반한 활로씨사징증 교정의 최근 결과)

  • Kim Jin-Hyun;Kim Woong-Han;Kim Dong-Jung;Jung Eui-Suk;Jeon Jae-Hyun;Min Sun-Kyung;Hong Jang-Mee;Lee Jeong-Ryul;Rho Joon-Ryuang;Kim Yong-Jin
    • Journal of Chest Surgery
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    • v.39 no.4 s.261
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    • pp.269-274
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    • 2006
  • Background: Tetralogy of Fallot (TOF) with pulmonary atresia and major aortopulmonary collateral arteries (MAPCAS) is complex lesion with marked heterogeneity of pulmonary blood supply and arborization anomalies. Patients with TOF with PA and MAPCAS have traditionally required multiple staged unifocalization of pulmonary blood supply before undergoing complete repair. In this report, we describe recent change of strategy and the results in our institution. Material and Method: We established surgical stratagies: early correction, central mediastinal approach, initial RV-PA conduit interposition, and aggressive intervention. Between July 1998 and August 2004, 23 patients were surgically treated at our institution. We divided them into 3 groups by initial operation method; group I: one stage total correction, group II: RV-PA conduit and unifocalization, group III: RV-PA conduit interposition only. Result: Mean ages at initial operation in each group were $13.9{\pm}16.0$ months (group 1), $10.4{\pm}15.6$ months (group II), and $7.9{\pm}7.7$ months (group III). True pulmonary arteries were not present in f patient and the pulmonary arteries were confluent in 22 patients. The balloon angioplasty was done in average 1.3 times (range: $1{\sim}6$). There were 4 early deaths relating initial operation, and 1 late death due to incracranial hemorrhage after definitive repair. The operative mortalities of initial procedures in each group were 25.0% (1/4: group I), 20.0% (2/10: group II), and 12.2% (1/9: group III). The causes of operative mortality were hypoxia (2), low cardiac output (1) and sudden cardiac arrest (1). Definitive repair rates in each group were 75% (3/4) in group I, 20% (2/10, fenestration: 2) in group II, and 55.0% (5/9, fenestration: 1) in group III. Conclusion: In patients of TOF with PA and MAPCAS, RV-PA connection as a initial procedure could be performed with relatively low risk, and high rate of definitive repair can be obtained in the help of balloon pulmonary angioplasty. One stage RV-PA connection and unifocalization appeared to be successful in selected patients.

Influence of Change of Atmospheric Pressure and Temperature on the Occurrence of Spontaneous Pneumothorax (기압과 기온변화가 자발성 기흉 발생에 미치는 영향)

  • Lee, Gun;Lim, Chang-Young;Lee, Hyeon-Jae
    • Journal of Chest Surgery
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    • v.40 no.2 s.271
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    • pp.122-127
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    • 2007
  • Background: Spontaneous pneumothorax is a common respiratory condition and has been postulated that it develops because of rupture of subpleural blebs. Although the morphology and ultrastructure of causative lesions are well known, the reason for rupture of sbupleural blebs is not absolutely clear. Broad consensus concerning the role of meteorological factors in spontaneous pneumothorax dose not exist. The aim of the study was to examine the influence of change of atmospheric pressure and temperature on the occurrence of spontaneous pneumothorax. Material and Method: One hundred twenty eight consecutive spontaneous pnemothorax events that occurred between January 2003 and December 2004 were selected. Changes of meteorological factors of particular days from the day before for 5 consecutive days were calculated and compared between the days with pneumothorax occurrence (SP days) and the days without pneumothorax occurrence (Non SP days). The correation between change of pressure and temperature and the occurrence of SP was evaluated. Result: SP occurred on 117 days (16.0%) in the 2-year period. Although there was no significant differences in change of pressure factors prior 4 days of SP occurrence compare to the 4 days prior Non SP day, change of mean pressure was higher (+0.934 vs. -0.191hPa, RR 1.042, Cl $1.003{\sim}1.082$, p=0.033), and change of maximum pressure fall was lower (3.280 vs. 4.791 hPa, RR 1.051, Cl $1.013{\sim}l.090$, p=0.009) on the 4 days prior SP day. There were significant differences in change of temperature factors prior 2 days and the day of SP, Changes of mean temperature (-0.576 vs.+$0.099^{\circ}C$, RR 0.886, 95% Cl $0.817{\sim}0.962$, p=0.004) and maximum temperature rise (7.231 vs. $8.079^{\circ}C$, RR 0.943 Cl $0.896{\sim}0.993$, p=0.027) were lower on the 2 days prior SP. But changes of mean temperature (0.533 vs. $-0.103^{\circ}C$, RR 1.141, Cl $1.038{\sim}l.255$, p=0.006) and maximum temperature rise (9.209 vs. $7.754^{\circ}C$, RR 1.123, Cl $1.061{\sim}1.190$, p=0.006) and maximum temperature rise (9.209 vs. $7.754^{\circ}C$ RR 1.123, Cl $1.061{\sim}l.190$, p=0.000) were higher on the SP days. Conclusion: Charge of atmospheric pressure and temperature seems to influence the chance of occurrence of SP. Meteorological phenomena that pressure rise 4 day prior to SP and following temperature fall and rise might explain the occurrence of SP. Further studies should be continued in the future.

Application of OECD Agricultural Water Use Indicator in Korea (우리나라에 적합한 OECD 농업용수 사용지표의 설정)

  • Hur, Seung-Oh;Jung, Kang-Ho;Ha, Sang-Keun;Song, Kwan-Cheol;Eom, Ki-Cheol
    • Korean Journal of Soil Science and Fertilizer
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    • v.39 no.5
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    • pp.321-327
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    • 2006
  • In Korea, there is a growing competitive for water resources between industrial, domestic and agricultural consumer, and the environment as many other OECD countries. The demand on water use is also affecting aquatic ecosystems particularly where withdrawals are in excess of minimum environmental needs for rivers, lakes and wetland habits. OECD developed three indicators related to water use by the agriculture in above contexts : the first is a water use intensity indicator, which is expressed as the quantity or share of agricultural water use in total national water utilization; the second is a water stress indicator, which is expressed as the proportion of rivers (in length) subject to diversion or regulation for irrigation without reserving a minimum of limiting reference flow; and the third is a water use efficiency indicator designated as the technical and the economic efficiency. These indicators have different meanings in the aspect of water resource conservation and sustainable water use. So, it will be more significant that the indicators should reflect the intrinsic meanings of them. The problem is that the aspect of an overall water flow in the agro-ecosystem and recycling of water use not considered in the assessment of agricultural water use needed for calculation of these water use indicators. Namely, regional or meteorological characteristics and site-specific farming practices were not considered in the calculation of these indicators. In this paper, we tried to calculate water use indicators suggested in OECD and to modify some other indicators considering our situation because water use pattern and water cycling in Korea where paddy rice farming is dominant in the monsoon region are quite different from those of semi-arid regions. In the calculation of water use intensity, we excluded the amount of water restored through the ground from the total agricultural water use because a large amount of water supplied to the farm was discharged into the stream or the ground water. The resultant water use intensity was 22.9% in 2001. As for water stress indicator, Korea has not defined nor monitored reference levels of minimum flow rate for rivers subject to diversion of water for irrigation. So, we calculated the water stress indicator in a different way from OECD method. The water stress indicator was calculated using data on the degree of water storage in agricultural water reservoirs because 87% of water for irrigation was taken from the agricultural water reservoirs. Water use technical efficiency was calculated as the reverse of the ratio of irrigation water to a standard water requirement of the paddy rice. The efficiency in 2001 was better than in 1990 and 1998. As for the economic efficiency for water use, we think that there are a lot of things to be taken into considerations to make a useful indicator to reflect socio-economic values of agricultural products resulted from the water use. Conclusively, site-specific, regional or meteorogical characteristics as in Korea were not considered in the calculation of water use indicators by methods suggested in OECD(Volume 3, 2001). So, it is needed to develop a new indicators for the indicators to be more widely applicable in the world.

Postoperstive Chemoradiotherapy in Locally Advanced Rectal Cancer (국소 진행된 직장암에서 수술 후 화학방사선요법)

  • Chai, Gyu-Young;Kang, Ki-Mun;Choi, Sang-Gyeong
    • Radiation Oncology Journal
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    • v.20 no.3
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    • pp.221-227
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    • 2002
  • Purpose : To evaluate the role of postoperative chemoradiotherapy in locally advanced rectal cancer, we retrospectively analyzed the treatment results of patients treated by curative surgical resection and postoperative chemoradiotherapy. Materials and Methods : From April 1989 through December 1998, 119 patients were treated with curative surgery and postoperative chemoradiotherapy for rectal carcinoma in Gyeongsang National University Hospital. Patient age ranged from 32 to 73 years, with a median age of 56 years. Low anterior resection was peformed in 59 patients, and abdominoperineal resection in 60. Forty-three patients were AJCC stage II and 76 were stage III. Radiation was delivered with 6 MV X rays using either AP-PA two fields, AP-PA both lateral four fields, or PA both lateral three fields. Total radiation dose ranged from 40 Gy to 56 Gy. In 73 patients, bolus infusions of 5-FU $(400\;mg/m^2)$ were given during the first and fourth weeks of radiotherapy. After completion of radiotherapy, an additional four to six cycles of 5-FU were given. Oral 5-FU (Furtulone) was given for nine months in 46 patients. Results : Forty $(33.7\%)$ of the 119 patients showed treatment failure. Local failure occurred in 16 $(13.5\%)$ patients, 1 $(2.3\%)$ of 43 stage II patients and 15 $(19.7\%)$ of 76 stage III patients. Distant failure occurred in 31 $(26.1\%)$ patients, among whom 5 $(11.6\%)$ were stage II and 26 $(34.2\%)$ were stage III. Five-year actuarial survival was $56.2\%$ overall, $71.1\%$ in stage II patients and $49.1\%$ in stage III patients (p=0.0008). Five-year disease free survival was $53.3\%$ overall, $68.1\%$ in stage II and $45.8\%$ in stage III (p=0.0006). Multivariate analysis showed that T stage and N stage were significant prognostic factors for five year survival, and that T stage, N stage, and preoperative CEA value were significant prognostic factors for five year disease free survival. Bowel complication occurred in 22 patients, and was treated surgically in 15 $(12.6\%)$, and conservatively in 7 $(5.9\%)$. Conclusion : Postoperative chemoradiotherapy was confirmed to be an effective modality for local control of rectal cancer, but the distant failure rate remained high. More effective modalities should be investigated to lower the distant failure rate.

Interlaboratory Comparison of Blood Lead Determination in Some Occupational Health Laboratories in Korea (일부 산업보건기관들의 혈중연 분석치 비교)

  • Ahn, Kyu Dong;Lee, Byung Kook
    • Journal of Korean Society of Occupational and Environmental Hygiene
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    • v.5 no.1
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    • pp.8-15
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    • 1995
  • The reliable measurement of metal in biological media in human body is one of critical indicators for the proper evaluation of its toxic effect on human health. Recently in Korea the necessity of quality assurance of measurement in occupational health and occupational hygiene fields brought out regulatory quality control program. Lead is often used as a standard metal for the program in both fields of occupational health and hygiene. During last 20 years lead poisoning was prevalent in Korea and still is one of main heavy metal poisoning and the capability of the measurement of blood lead is one of prerequisites for institute of specialized occupational health in Korea. Furthermore blood lead is most important indicator to evaluate lead burden of human exposure to lead and the reliable and accurate analysis is most needed whenever possible. To evaluate the extent of the interlaboratory differences of blood lead measurement in several well-known institute specialized in occupational health in Korea, authors prepared 68 blood samples from two storage battery industries and all samples were divided into samples with 2 ml. One set of 68 samples were analyzed by authors's laboratory(Soonchunhyang University Institute of Industrial Medicine: SIIM) and 40 samples of other set were analyzed by C University Institute of Industrial Medicine(CIIM) and the rest 28 samples of other set were analyzed by Japanese institute(K Occupational Health Center:KOHC). Authors also prepared test bovine samples which were obtained from Japanese Federation of Occupational Health Organization (JFOHO) for quality control. Authors selected 2 other well-known occupational health laboratories and one laboratory specialized for instrumental analysis. A total of 6 laboratories joined the interlaboratory comparison of blood lead measurement and the results obtained were as follows: 1. There was no significant difference in average blood lead between SIIM and CIIM in different group of blood lead concentration, and the relative standard deviation of two laboratories was less than 3.0%. On the other hand, there was also no significant difference of average blood lead between SIIM and KOHC with relative standard deviation of 6.84% as maximum. 2. Taking less than 15% difference of mean or less than 6 ug/dl difference in below 40 ug/dl in whole blood as a criteria of agreement of measurement between two laboratories, agreement rates were 87.5%(35/40) and 78.6%(22/28) between SIIM and CIIM, SIIM and KOHC respectively. 3. The correlation of blood lead between SIIM and CIIM was 0.975 (p=0.0001) and the regression equation was SIIM = 2.19 + 0.9243 ClIM, whereas the correlation between SUM and KOHC was O.965(p=0.0001) with the equation of SIIM = 1.91 + 0.9794 KOHC. 4. Taking the reference value as a dependent variable and each of 6 laboratories's measurement value as a independent variable, the determination coefficient($R^2$) of simple regression equations of blood lead measurement for bovine test samples were very high($R^2>0.99$), and the regression coefficient(${\beta}$) was between 0.972 and 1.15 which indicated fairly good agreement of measurement results.

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High-Dose-Rate Brachytherapy for Uterine Cervical Cancer : The Results of Different Fractionation Regimen (자궁경부암의 고선량률 근접치료 : 분할선량에 따른 결과 비교)

  • Yoon, Won-Sup;Kim, Tae-Hyun;Yang, Dae-Sik;Choi, Myung-Sun;Kim, Chul-Yong
    • Radiation Oncology Journal
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    • v.20 no.3
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    • pp.228-236
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    • 2002
  • Purpose : Although high-dose-rate (HDR) brachytherapy regimens have been practiced with a variety of modalities and various degrees of success, few studies on the subject have been conducted. The purpose of this study was to compare the results of local control and late complication rate according to different HDR brachytherapy fractionation regimens in uterine cervical cancer patients. Methods and Materials : From November 1992 to March 1998, 224 patients with uterine conical cancer were treated with external beam irradiation and HDR brachytherapy. In external pelvic radiation therapy, the radiation dose was $45\~54\;Gy$ (median dose 54 Gy) with daily fraction size 1.8 Gy, five times per week. In HDR brachytherapy, 122 patients (Group A) were treated with three times weekly with 3 Gy to line-A (isodose line of 2 cm radius from source) and 102 patients (Group B) underwent the HDR brachytherapy twice weekly with 4 or 4.5 Gy to line-A after external beam irradiation. Iridium-192 was used as the source of HDR brachytherapy. Late complication was assessed from grade 1 to 5 using the RTOG morbidity grading system. Results : The local control rate (LCR) at 5 years was $80\%$ in group A and $84\%$ in group B (p=0.4523). In the patients treated with radiation therapy alone, LCR at 5 years was $60.9\%$ in group A and $76.9\%$ in group B (p=0.2557). In post-operative radiation therapy patients, LCR at 5 years was $92.6\%$ In group A and $91.6\%$ in group B (p=0.8867). The incidence of late complication was $18\%$ (22 patients) and $29.4\%$ (30 patients), of bladder complication was $9.8\%$ (12 patients) and $14.7\%$ (15 patients), and of rectal complication was $9.8\%$ (12 patients) and $21.6\%$ (22 patients), in group A and B, respectively. Lower fraction sized HDR brachytherapy was associated with decrease in late complication (p=0.0405) (rectal complication, p=0.0147; bladder complication, p=0.115). The same result was observed in postoperative radiation therapy patients (p=0.0860) and radiation only treated patients (0=0.0370). Conclusion : For radiation only treated patients, a greater number of itemized studies on the proper fraction size of HDR brachytherapy, with consideration for stages and prognostic factors, are required. In postoperative radiation therapy, the fraction size of HDR brachytherapy did not have much effect on local control, yet the incidence of late complication increased with the elevation in fraction size. We suggest that HDR brachytherapy three times weekly with 3 Gy could be an alternative method of therapy.