• Radiation Oncology Journal
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• v.23 no.3
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• pp.143-156
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• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

• KOREAN JOURNAL OF CROP SCIENCE
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• v.3
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• pp.1-40
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• 1965

To measure variations in some of the important agronomic characteristics of rice varieties under shifting of seedling dates, this study has been carried out at the Paddy Crop Division of Crop Experiment Station(then Agricultural Experiment Station) in Suwon for the period of three years 1958 to 1960. The varieties used in this study were Kwansan, Suwon ＃82, Mojo, Paltal and Chokwang, which have the different agronomic characteristics such as earliness and plant type. Seeds of each variety were sown at 14 different dates in 10-day interval starting on March 2. The seedlings were grown on seed bed for 30, 40, 50, 60, 70 and 80 days, respectively. The results of this study are as follows: A. Heading dates. 1. As the seeding date was delayed, the heading dates was almost proportionally delayed. The degree of delay was higher in early varieties and lower in late varieties and the longer the seedling stage, the more delayed the heading date. 2. Number of days to heading was proportionally lessened as seeding was delayed in all the varieties but the magnitude varied depending upon variety. In other words, the required period for heading in case of late planting was much shortened in late variety compared with early one. Within a variety, the number of days to heading was less shortened as the seedling stage was prolonged. Early variety reached earlier than late variety to the marginal date for the maximum shortening of days to heading and the longer the seeding stage, the limitted date came earlier. There was a certain limit in seeding date for shortening of days to heading as seeding was delayed, and days to heading were rather prolonged due to cold weather when seeded later than that date. 3. In linear regression equation, Y=a+bx obtained from the seeding dates and the number of days to heading, the coefficient b(shortening rate of days to heading) was closely correlated with the average number of days to heading. That is, the period from seeding to heading was more shortened in late variety than early one as seeding was delayed. 4. To the extent that the seedling stage is not so long and there is a linear relationship between delay of seeding and shortening of days to heading, it might be possible to predict heading date of a rice variety to be sown any date by using the linear regression obtained from variation of heading dates under the various seeding dates of the same variety. 5. It was found out that there was a close correlation between the numbers of days to heading in ordinary culture and the other ones. When a rice variety was planted during the period from the late part of March to the middle of June and the seedling ages were within 30 to 50 days, it could be possible to estimate heading date of the variety under late or early culture with the related data of ordinary culture. B. Maturing date. 6. Within (he marginal date for maturation of rice variety, maturing date was proportionally delayed as heading was delayed. Of course, the degree of delay depended upon varieties and seedling ages. The average air temperature (Y) during the ripening period of rice variety was getting lower as the heading date. (X) was delayed. Though there was a difference among varieties, in general, a linear regression equation(y=25.53-0.182X) could be obtained as far as heading date were within August 1 to September 13. 7. Depending upon earliness of a rice variety, the average air temperature during the ripening period were greatly different. Early variety underwent under 28$^{\circ}C$ in maximum while late variety matured under as low as 22$^{\circ}C$. 8. There was a highly significant correlation between the average air temperature (X) during the ripening period, and number of day (Y) for the maturation. And the relationship could be expressed as y=82.30-1.55X. When the average air temperature during the period was within the range of 18$^{\circ}C$ to 28$^{\circ}C$, the ripening period was shortened by 1.55 days with increase of 1$^{\circ}C$. Considering varieties, Kwansan was the highest in shortening the maturing period by 2.24 days and Suwon ＃82 was the lowest showing 0.78 days. It is certain that ripening of rice variety is accelerated at Suwon as the average air temperature increases within the range of 18$^{\circ}C$ to 28$^{\circ}C$. 9. Between number of days to heading (X) related to seeding dates and the accumulated average air temperature (Y) during the ripening period, a positive correlation was obtained. However, there was a little difference in the accumulated average air temperature during the ripening period even seeding dates were shifted to a certain extent. C. Culm- and ear-lengths. 10. In general all the varieties didn't show much variation in their culm-lengths in case of relatively early seeding but they trended to decrease the lengths as seeding was delayed. The magnitude of decreasing varied from young seedlings to old ones. Young seedlings which were seeded during May 21 to June 10 didn't decrease their culm-lengths, while seedlings old as 80 days decreased the length though under ordinary culture. 11. Variation in ear-length of rice varieties show the same trend as the culm-length subjected to the different seeding dates. When rice seedlings aged from 30 to 40 days, the ear-length remained constant but rice plants older than 40 days obviously decreased their ear-lengths. D. Number of panicles per hill. 12. The number of panicles per hill decreased up to a certain dates as seeding was delayed and then again increased the panicles due to the development of numerous tillers at the upper internodes. The seeding date to reach to the least number of panicles of rice variety depended upon the seedling ages. Thirty- to 40-day seedlings which were seeded during May 31 to June 10 developed the lowest number of panicles and 70- to 80-day seedlings sown for the period from April 11 to April 21 reached already to the minimum number of panicles. E. Number of rachillae. 13. To a certain seeding date, the number of rachillae didn't show any variation due to delay of seeding but it decreased remarkably when seeded later than the marginal date. 14. Variation in number of rachillae depended upon seedling ages. For example, 30- to 40-day old seedlings which, were originally seeded after May 31 started to decrease the rachillae. On the other hand, 80-day old seedlings which, were seeded on May 1 showed a tendency to decrease rachillae and the rice plant sown on May 31 could develop narrowly 3 or 4 panicles. F. Defective grain and 1.000-grain weights. 15. Under delay of the seeding dates, weight of the defective grains gradually increased till a certain date and then suddenly increased. These relationships could be expressed with two different linear regressions. 16. If it was assumed that the marginal date for ripening was the cross point of these two lines, the date seemed. closely related with seedling ages. The date was June 10- in 30- to 40-day old seedlings but that of 70- to 80-day old seedlings was May 1. Accordingly, the marginal date for ripening was getting earlier as the seedling stage was prolonged. 17. The 1.000-grain weight in ordinary culture was the heaviest and it decreased in both early and late cultures. G. Straw and rough rice weights. 18. Regardless of earliness of variety, rice plants under early culture which were seeded before March 22 or April 1 did not show much variation in straw weight due to seedling ages but in ordinary culture it gradually decreased and the degree was became greater in late culture. 19. Relationship between seeding dates (X) and grain weight related to varieties and seedling ages, could be expressed as a parabola analogous to a line (Y=77.28-7.44X$_1$-1.00lX$_2$). That is, grain yield didn't vary in early culture but it started to decrease when seeded later than a certain date, as seeding was delayed. The variation was much greater in cases of late planting and prolongation of seedling age. 20. Generally speaking, the relationship between grain yield (Y) and number of days to heading (X) was described with linear regression. However, the early varieties were the highest yielders within the range of 60 to 110, days to heading but the late variety greatly decreased its yield since it grows normally only under late culture. The grain yield, on the whole, didn't increase as number of days to heading exceeded more than 140 days.