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Comparative Analysis of Patterns of Care Study of Radiotherapy for Esophageal Cancer among Three Countries: South Korea, Japan and the United States (한국, 미국, 일본의 식도암 방사선 치료에 대한 PCS($1998{\sim}1999$) 결과의 비교 분석)

  • Hur, Won-Joo;Choi, Young-Min;Kim, Jeung-Kee;Lee, Hyung-Sik;Choi, Seok-Reyol;Kim, Il-Han
    • Radiation Oncology Journal
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    • v.26 no.2
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    • pp.83-90
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    • 2008
  • Purpose: For the first time, a nationwide survey of the Patterns of Care Study(PCS) for the various radiotherapy treatments of esophageal cancer was carried out in South Korea. In order to observe the different parameters, as well as offer a solid cooperative system, we compared the Korean results with those observed in the United States(US) and Japan. Materials and Methods: Two hundreds forty-six esophageal cancer patients from 21 institutions were enrolled in the South Korean study. The patients received radiation theraphy(RT) from 1998 to 1999. In order to compare these results with those from the United States, a published study by Suntharalingam, which included 414 patients[treated by Radiotherapy(RT)] from 59 institutions between 1996 and 1999 was chosen. In order to compare the South Korean with the Japanese data, we choose two different studies. The results published by Gomi were selected as the surgery group, in which 220 esophageal cancer patients were analyzed from 76 facilities. The patients underwent surgery and received RT with or without chemotherapy between 1998 and 2001. The non-surgery group originated from a study by Murakami, in which 385 patients were treated either by RT alone or RT with chemotherapy, but no surgery, between 1999 and 2001. Results: The median age of enrolled patients was highest in the Japanese non-surgery group(71 years old). The gender ratio was approximately 9:1(male:female) in both the Korean and Japanese studies, whereas females made up 23.1% of the study population in the US study. Adenocarcinoma outnumbered squamous cell carcinoma in the US study, whereas squamous cell carcinoma was more prevalent both the Korean and Japanese studies(Korea 96.3%, Japan 98%). An esophagogram, endoscopy, and chest CT scan were the main modalities of diagnostic evaluation used in all three countries. The US and Japan used the abdominal CT scan more frequently than the abdominal ultrasonography. Radiotherapy alone treatment was most rarely used in the US study(9.5%), compared to the Korean(23.2%) and Japanese(39%) studies. The combination of the three modalities(Surgery+RT+Chemotherapy) was performed least often in Korea(11.8%) compared to the Japanese(49.5%) and US(32.8%) studies. Chemotherapy(89%) and chemotherapy with concurrent chemoradiotherapy(97%) was most frequently used in the US study. Fluorouracil(5-FU) and Cisplatin were the most preferred drug treatments used in all three countries. The median radiation dose was 50.4 Gy in the US study, as compared to 55.8 Gy in the Korean study regardless of whether an operation was performed. However, in Japan, different median doses were delivered for the surgery(48 Gy) and non-surgery groups(60 Gy). Conclusion: Although some aspects of the evaluation of esophageal cancer and its various treatment modalities were heterogeneous among the three countries surveyed, we found no remarkable differences in the RT dose or technique, which includes the number of portals and energy beams.

THE EFFECT OF IRRADIATION MODES ON POLYMERIZATION AND MICROLEAKAGE OF COMPOSITE RESIN (광조사 방식이 복합레진의 중합과 누출에 미치는 영향)

  • Park, Jong-Jin;Park, Jeong-Won;Park, Sung-Ho;Park, Ju-Myong;Kwon, Tae-Kyung;Kim, Sung-Kyo
    • Restorative Dentistry and Endodontics
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    • v.27 no.2
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    • pp.158-174
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    • 2002
  • The aim of this study was to investigate the effect of light irradiation modes on polymerization shrinkage, degree of cure and microleakage of a composite resin. VIP$^{TM}$ (Bisco Dental Products, Schaumburg, IL, USA) and Optilux 501$^{TM}$ (Demetron/Kerr, Danbury, CT, USA) were used for curing Filtek$^{TM}$ Z-250 (3M Dental Products, St. Paul., MN, USA) composite resin using following irradiation modes: VIP$^{TM}$ (Bisco) 200mW/$\textrm{cm}^2$ (V2), 400mW/$\textrm{cm}^2$ (V4), 600mW/$\textrm{cm}^2$ (V6), Pulse-delay (200 mW/$\textrm{cm}^2$ 3 seconds, 5 minutes wait, 600mW/$\textrm{cm}^2$ 30seconds, VPD) and Optilux 501$^{TM}$ (Demetron/Kerr) C-mode (OC), R-mode (OR). Linear polymerization shrinkage of the composite specimens were measured using Linometer (R&B, Daejeon, Korea) for 90 seconds for V2, V4, V6, OC, OR groups and for up to 363 seconds for VPD group (n=10, each). Degree of conversion was measured using FTIR spectrometer (IFS 120 HR, Bruker Karlsruhe, Germany) at the bottom surface of 2 mm thick composite specimens V2, Y4, V6, OC groups were measured separately at five irradiation times (5, 10, 20, 40, 60 seconds) and OR, VPD groups were measured in the above mentioned irradiation modes (n=5 each). Microhardness was measured using Digital microhardness tester (FM7, Future-Tech Co., Tokyo, Japan) at the top and bottom surfaces of 2mm thick composite specimens after exposure to the same irradiation modes as the test of degree of conversion(n=3, each). For the microleakage test, class V cavities were prepared on the distal surface of the ninety extracted human third molars. The cavities were restored with one of the following irradiation modes : V2/60 seconds, V4/40 seconds, V6/30 seconds, VPD , OC and OR. Microleakage was assessed by dye penetration along enamel and dentin margins of cavities. Mean polymerization shrinkage, mean degree of conversion and mean microhardness values for all groups at each time were analyzed using one-way ANOVA and Duncan's multiple range test, and using chi-square test far microleakage values. The results were as follows : . Polymerization shrinkage was increased with higher light intensity in groups using VIP$^{TM}$ (Bisco) : the highest with 600mW/$\textrm{cm}^2$, followed by Pulse-delay, 400mW/$\textrm{cm}^2$ and 200mW/$\textrm{cm}^2$ groups, The degree of polymerization shrinkage was higher with Continuous mode than with Ramp mode in groups using Optilux 501$^{TM}$ (Demetron/Kerr). . Degree of conversion and microhardness values were higher with higher light intensity. The final degree of conversion was in the range of 44.7 to 54.98% and the final microhardness value in the range of 34.10 to 56.30. . Microleakage was greater in dentin margin than in enamel margin. Higher light intensity showed more microleakage in dentin margin in groups using VIP$^{TM}$ (Bisco). The microleakage was the lowest with Continuous mode in enamel margin and with Ramp mode in dentin margin when Optilux 501$^{TM}$ (Demetron/Kerr) was used.

Survey of Caffeine levels in the Favorite Diets of Children (어린이 기호식품 중 카페인 함량에 대한 조사)

  • Lee, E-Na;Kim, Hee-Jin;Im, Ji-Young;Kim, Jeoung-A;Park, Hye-Young;Ryu, Ju-Young;Ko, Kwang-Rack;Kim, Hyung-Sik
    • Journal of Food Hygiene and Safety
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    • v.22 no.3
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    • pp.173-178
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    • 2007
  • Children may respond differently to the caffeine from adults because they have different physiologic makeup and are functionally immature in terms of hepatic and renal function; this leads to the slower clearance of caffeine in early life. Therefore, children are often assumed to be more susceptible to caffeine effects. Alarge number of food supplements may interfere with these processes, and therefore caffeine exposure may have more serious consequences for children than for adults, irrespective of sensitivity. However, there has never been a national dietary survey on caffeine intakes in children. The purpose of our study was to identify caffeine intakes and beverage sources of caffeine in a representative sample of children in Busan, Korea. Caffeine intakes were based only on beverages included in the Continuing Surveys of Food Intakes by individuals. The caffeine content of the beverages ranged from 2.8 to 65.2mg/100ml for cola, soft drinks, and teas. Caffeine was not completely absent from caffeine-free colas, juice, and milk. In this study, cola-type beverages were an important dietary source of caffeine in the children. Daily caffeine intake for children was estimated to range from 12.5 to 250 mg/day. In general, the acceptable daily intake (ADI) of caffeine should cover the entire population including children. Therefore, special considerations should be needed regarding the consumption of soft drinks containing caffeine to children below the 12 years of age.

Clinical observation for the Geriatric C.V.A. (노인(老人) 뇌졸중(腦卒中)에 대(對)한 임상적(臨床的) 고찰(考察))

  • Seo, Un-Kyo;Jeong, Ji-Cheon;Lee, Won-Chul
    • The Journal of Internal Korean Medicine
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    • v.14 no.2
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    • pp.50-70
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    • 1993
  • Clinical observation was done on 92 cases of Occlusive CVD, Cerebral hemorrhage (Subarachnoid hemorrhage) which were confirmed by Brain CT scan and observed for over 4 weeks, among the 121 cases which were more than 65 years of age. they admitted to the Dept. of Internal Medicine, Oriental Medical Hospital in Dong Guk Univ. from July 1992 to June 1993. The result were as follows; 1. In this study, Occlusive CVD was 74 cases, Cerebral hemorrhage (Subarachnoid hemorrhage was 2 cases) was 18 cases. 2. The ratio of male to female was 1.09:1. The age distribution showed the large number in the 65-69 year group(52.2%), 7th decade was 44.5% over 8th decade was 3.3% in ratio. 3. The site of Occlusive CVD was most common at MCA. the site of Cb-hemorrhage was most common at Basal ganglia. 4. The most common preceding disease was hypertension(47.8%) and the next were diabetes mellitus(14.1%), heart desease(14.1%). 5. Recurrence rate was 33.7% and 2nd attack was 20.7%, 3rd attack was 8.7%, 4th attack was 4.3% 6. Predisposing factors in Occlusive CVD were initiated usually during resting and sleeping, and that in Cb-hemorrhage were represented chiefly exercising(66.6%). 7. The smoker was 52.2%, the drinker was 32.6% in whole group. the drinker was 61.1% by the Cb-hemorrhage. 8. The ratio of the season distribution was as follow, fall 35.8%, winter 29.3%, spring 19.6%, summer 15.3%, that of the month distribution was november 15.2%. 9. Duration from on set in Occlusive CVD, 60.8% was within 5 days, that in Cb-hemorrhage, 77.8% was within 5 days. 10. Level of consciousness on attack was clear 42.2%, lethargy and mental change(dull, stupid etc.) 41.3%. The common symptoms were motor disturbance(90.2%), verbal disturbance(65.2%), headache(43.5%). 11. The physical theraphy of Occlusive CVD has been performed 75.7% in whole group and the average beginning time was 6.4 days, and that of Cb-hemorrhage has been performed 61.1% in whole group and the average beginning time was 13 days. 12. Duration of hospitalization was noted 11-20 days was 31.5%, over 21 days was 46.8%, and the average admission was 22.7 day(Occlusive CVD), 32days (Cb-hemorrhage). 13. The main complication were observed in the studies; urinary tract infection and pneumonia were noted in 6.5%, bed sore in 5.4%. 14. The ratio of systolic blood pressures in admission and discharge decreased from 58.7% to 28.3% in over 160 mmHg, that of diastolic blood pressures in admission and discharge decreased from 72.8% to 51.1% in over 90 mmHg. In 31(33.7%) of the 92 cases it showed the glucose levels of more than normal. 15. The patients have done family history of hypertension and C.V.A were 32.6% of all 16. Occlusive CVD In 83.8% and Cb-hernorrhage in 72.2% were improved 17. The herb medications were various Sunghyanggeonggisan, Sopungtang, CHunmagudeungeum were used most frequently and Gamidaebotang, Boyangwhanotang, Gagamyunjotang, Mangeumtang etc. were used as discharge.

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Evaluation of X-ray System for Nondestructive Testing on Radioactive Waste Drums (방사성폐기물 드럼 비파괴 검사를 위한 X-ray 장비 평가)

  • Park, Jong-Kil;Maeng, Seong-Jun;Lee, Yeon-Ee;Hwang, Tae-Won
    • Journal of Nuclear Fuel Cycle and Waste Technology(JNFCWT)
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    • v.6 no.3
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    • pp.189-203
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    • 2008
  • The physical and chemical properties of radioactive waste drums, which have been temporarily stored on site, should be characterized before their shipment to a disposal facility in order to prove that the properties meet the acceptance guideline. The investigation of NDT(Nondestructive Test) method was figured out that the contents in drum, the quantitative analysis of free standing water and void fraction can be examined with X-ray NDT techniques. This paper describes the characteristics of X-ray NDT such as its principles, the considerations for selection of X-ray system, etc. And then, the waste drum characteristics such as drum type and dimension, contents in drum, etc. were examined, which are necessary to estimate the optimal X-ray energy for NDT of a drum. The estimation results were that: $(R)\acute{A}$ the proper X-ray energy is under 3 MeV to test the drums of 320 ${\beta}\S$ and less; $(R)\ddot{E}$ both X-ray systems of 450 keV and/or 3 MeV might be needed considering the economical efficiency and the realization. The number of drums that can be tested with 450 keV and 3 MeV X-ray system was figured out as 42,327 and 18,105 drums (based on storage of 2006. 12), respectively. Four testing scenarios were derived considering equipment procurement method, outsourcing or not, etc. The economical and feasibility assessment for the scenarios was resulted in that an optimal scenario is dependent on the acceptance guide line, the waste generator's policy on the waste treatment and the delivery to a disposal facility, etc. For example, it might be desirable that a waste generator purchases two 450 keV mobile system to examine the drums containing low density waste, and that outsourcing examination for the high density drums, if all NDT items such as quantitative analysis for 'free standing water' and 'void fraction', and confirmation of contents in drum have to be characterized. However, one 450 keV mobile system seems to be required to test only the contents in 13,000 drums per year.

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The Efficacy of Proximal Esophageal 24-hour pH Monitoring in Infants with Chronic Cough (만성기침을 동반한 영아에서 상부 식도 24시간 pH 검사의 유용성)

  • Kim, Yun Hee;Kim, Ja Kyoung;Kim, Jung Hee;Lim, Dae Hyun;Son, Byong Kwan
    • Clinical and Experimental Pediatrics
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    • v.46 no.12
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    • pp.1242-1247
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    • 2003
  • Purpose : Gastroesophageal reflux disease(GERD) is known as one of the most common causes of chronic cough, especially in children. The purpose of this study is to evaluate the efficacy of parameters from proximal esophageal 24-hr pH monitoring through its comparison with those of distal esophageal 24-hr pH monitoring that we generally use for diagnosis of GERD. Methods : We performed chest CT scans to find out the cause of chronic cough in infants with no clinical manifestation suggesting GERD. Then, in case that they had air space consolidation in posterior segment of both upper lobes and superior segment of both lower lobes(dependent position), we performed proximal and distal esophageal 24-hr pH monitoring. Results : The proximal and distal pH monitoring were performed in 17 infants(male 12; female five). The patients with positive pathologic reflux in proximal esophagus were 15 of 17(88.2%) and in distal esophagus were four of 17(23.5%). Reflux index and the total number of reflux episodes were statistically significantly lower in the proximal than in the distal esophagus(P<0.05). There was no correlation between each parameters of proximal and distal esophageal 24-hr pH monitoring. Conclusion : This study suggests that proximal esophageal 24-hr pH monitoring can be used as a very useful diagnostic tool in infants with chronic cough in which there are suspicions that it resulted from aspiration due to GERD.

Effect of the Number and Location of Implants on the Stress Distribution in Three-unit Fixed Partial Denture: A Three-Dimensional Finite Element Analysis (임플란트 고정성 보철물에서 수와 식립위치 변화에 따른 골과 임플란트에서의 응력분포에 관한 3차원 유한요소법적 연구)

  • Lee, Woo-Hyun;Lim, Jong-Hwa;Cho, In-Ho
    • Journal of Dental Rehabilitation and Applied Science
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    • v.26 no.3
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    • pp.221-239
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    • 2010
  • Bone loss may occur depending on the loading conditions. careful treatment planning and prosthetic procedures are very important factors for the proper distribution of stress. Evaluate the stress distributions according to numbers and location of implants in three-unit fixed partial dentures. A mandible missing the right second premolar, first molar and second molar was modeled. Using the CT data. we modeled a mandible with a width of 15mm, a height of 20mm and a length of 30mm, 2mm-thickness cortical bone covering cancellous bone mallow. An internal type implant and A solid type abutment was used. A model with 3 implants placed in a straight line, offset 1.5 mm buccally, offset 1.5 mm lingually and another model with 3 implants offset in the opposite way were prepared. And models with 2 implants were both end support models, a mesial cantilever model and a distal cantilever model. Three types of loading was applied; a case where 155 N was applied solely on the second premolar, a case where 206 N was applied solely on the second molar and a case where 155 N was applied on the first premolar and 206 N was applied on the first and second molar. For all the cases, inclined loads of 30 degrees were applied on the buccal cusps and vertical loads were applied on the central fossas of the teeth. Finite element analysis was carried out for each case to find out the stress distribution on bones and implants. This study has shown that prostheses with more implants caused lower stress on bones and implants, no matter what kind of load was applied. Furthermore, it was found out that inclined loads applied on implants had worse effects than vertical loads. Therefore, it is believed that these results should be considered when placing implants in the future.

How to Reflect Sustainable Development, exemplified by the Equator Principles, in Overseas Investment (해외투자(海外投資)와 지속가능발전 원칙 - 프로젝트 파이낸스의 적도원칙(赤道原則)을 중심으로 -)

  • Park, Whon-Il
    • THE INTERNATIONAL COMMERCE & LAW REVIEW
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    • v.31
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    • pp.27-56
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    • 2006
  • Today's financial institutions usually take environmental issues seriously into consideration as they could not evade lender liability in an increasing number of cases. On the international scene, a brand-new concept of the "Equator Principles" in the New Millenium has driven more and more international banks to adopt these Principles in project financing. Sustainable development has been a key word in understanding new trends of the governments, financial institutions, corporations and civic groups in the 21st century. The Equator Principles are a set of voluntary environmental and social guidelines for sustainable finance. These Principles commit bank officers to avoid financial support to projects that fail to meet these guidelines. The Principles were conceived in 2002 on an initiative of the International Finance Corporation(IFC), and launched in June 2003. Since then, dozens of major banks, accounting for up to 80 percent of project loan market, have adopted the Principles. Accordingly, the Principles have become the de facto standard for all banks and investors on how to deal with potential social and environmental issues of projects to be financed. Compliance with the Equator Principles facilitates for endorsing banks to participate in the syndicated loan and help them to manage the risks associated with large-scale projects. The Equator Principles call for financial institutions to provide loans to projects under the following circumstances: - The risk of the project is categorized in accordance with internal guidelines based upon the environmental and social screening criteria of the IFC. - For Category A and B projects, borrowers or sponsors are required to conduct a Social and Environmental Assessment, the preparation of which must meet certain requirements and satisfactorily address key social and environmental issues. - The Social and Environmental Assessment report should address baseline social and environmental conditions, requirements under host country laws and regulations, sustainable development, and, as appropriate, IFC's Environmental, Health and Safety Guidelines, etc. - Based on the Social and Environmental Assessment, Equator banks then make agreements with borrowers on how they mitigate, monitor and manage the risks through a Social and Environmental Management System. Compliance with the plan is included in the covenant clause of loan agreements. If the borrower doesn't comply with the agreed terms, the bank will take corrective actions. The Equator Principles are not a mere declaration of cautious banks but a full commitment of lenders. A violation of the Principles in the process of project financing, which led to an unexpected damage to the affected community, would not give rise to any specific legal remedies other than ordinary lawsuits. So it is more effective for banks to ensure consistent implementation of the Principles and to have them take responsible measures to solve social and environmental issues. Public interests have recently mounted up with respect to environmental issues on the occasion of the Supreme Court's decision (2006Du330) on the fiercely debated reclamation project at Saemangeum. The majority Justices said that the expected environmental damages like probable pollution of water and soil were not believed so serious and that the Administration should continue to implement the project seeking ways to make it more environment friendly. In this case, though the Category A Saemangeum Project was carried out by a government agency, the Supreme Court behaved itself as a signal giver to approve or stop the environment-related project like an Equator bank in project financing. At present, there is no Equator bank in Korea in contrast to three big banks in Japan. Also Korean contractors, which are aggressively bidding for Category A-type projects in South East Asia and Mideast, might find themselves in a disadvantageous position because they are generally ignorant of the environmental assessment associated with project financing. In this regard, Korean banks and overseas project contractors should care for the revised Equator Principles and the latest developments in project financing more seriously. It's because its scope has expanded to the capital cost of US$10 million or more across all industry sectors regardless of developing countries or not. It should be noted that, for a Korean bank, being an Equator bank is more or less burdensome in a short-term period, but it must be conducive to minimizing risks and building up good reputation in the long run.

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The Effect of Antifibrinolytic Therapy in Prevention of Rebleeding before Early Aneurysm Surgery (뇌동맥류의 조기수술 전 재출혈 방지를 위한 항섬유소용해제 투여의 효과)

  • Lee, Chang Young;Yim, Man Bin;Lee, Jang Chull;Son, Eun Ik;Kim, Dong Won;Kim, In Hong
    • Journal of Korean Neurosurgical Society
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    • v.30 no.9
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    • pp.1065-1071
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    • 2001
  • Object : This study was conducted to evaluate whether short-term intravenous infusion of tranexamic acid (AMCA) was able to improve the management outcome by preventing rebleeding without increasing vasospasm and hydrocephalus associated with the long-term administration of this agent in the patients with aneurysmal subarachnoid hemorrhage(SAH) who were planned for the early surgery. Methods : During the period from June, 1996 to May, 1998, 137 patients admitted within 3 days of their SAH and planned for early surgical intervention were subject to study population. Of these, 60 patients who had been treated with AMCA were classified as AMCA treated group and 77 patients without AMCA treatment as AMCA untreated group. Initially, prognostic factors for rebleeding, vasospasm, hydrocephalus and outcome following SAH including age, sex, clinical grade, CT grade, site of ruptured aneurysms, admission day after SAH, surgery day after SAH, number of aneurysms and hypertension history, were analyzed and compared between AMCA treated group and untreated group. Secondly, the incidence of rebleeding, symptomatic vasospasm and hydrocephalus were compared between the two groups. Also, the management outcome of the patients was compared between the two groups. Results : There were no significant differences in prognostic factors between the two groups. The rebleeding rate was 0% in the AMCA treated group whereas the rate was 7.8% in the untreated group. This difference was statistically significant. The incidences of symptomatic vasospasm and hydrocephalus were found not to be significantly different between the two groups. Of the treated group, 31.7% of patients developed hydrocephalus compared to 32.5% of those at the untreated group. Fourteen(23.3%) patients in treated group developed symptomatic vasospasm and 6 of them(10%) suffered stroke whereas incidences of these in untreated group were 25.9% and 11.7%, respectively. The AMCA treated group showed more favorable outcome than that of untreated group. There was no case of death by rebleeding in the AMCA treated group while one of the main causes of death in the untreated group was rebleeding. Conclusion : Short-term high-dose AMCA administration is considered beneficial in improving outcome and diminishing the risk of rebleeding in the patients who suffer from an aneurysmal SAH prior to early surgical intervention.

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Comparison of Stereotactic Radiosurgery and Whole Brain Radiotherapy in Patients with Four or More Brain Metastases (4개 이상의 다발성 전이성 뇌종양의 정위적 방사선수술과 전뇌 방사선조사의 비교)

  • Kim, Cheol-Jin;Baek, Mi-Young;Park, Sung-Kwang;Ahn, Ki-Jung;Cho, Heung-Lae
    • Radiation Oncology Journal
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    • v.27 no.3
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    • pp.163-168
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    • 2009
  • Purpose: This study was a retrospective evaluation of the efficacy of stereotactic radiosurgery (SRS) in patients with >4 metastases to the brain. Materials and Methods: Between January 2004 and December 2006, 68 patients with $\geq$4 multiple brain metastases were included and reviewed retrospectively. Twenty-nine patients received SRS and 39 patients received whole brain radiotherapy (WBRT). Patients with small cell lung cancers and melanomas were excluded. The primary lesions were non-small cell lung cancer (69.0%) and breast cancer (13.8%) in the SRS group and non-small cell lung cancer (64.1%), breast cancer (15.4%), colorectal cancer (12.8%), esophageal cancer (5.1%) in the WBRT group. SRS involved gamma-knife radiosurgery and delivered 10~20 Gy (median, 16 Gy) in a single fraction with a 50% marginal dose. WBRT was delivered daily in 3 Gy fractions, for a total of 30 Gy. After completion of treatment, a follow-up brain MRI or a contrast-enhanced brain CT was reviewed. The overall survival and intracranial progression-free survival were compared in each group. Results: The median follow-up period was 5 months (range, 2~19 months) in the SRS group and 6 months (range, 4~23 months) in the WBRT group. The mean number of metastatic lesions in the SRS and WBRT groups was 6 and 5, respectively. The intracranial progression-free survival and overall survival in the SRS group was 5.1 and 5.6 months, respectively, in comparison to 6.1 and 7.2 months, respectively, in the WBRT group. Conclusion: SRS was less effective than WBRT in the treatment of patients with >4 metastases to the brain.