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Antecedents of Manufacturer's Private Label Program Engagement : A Focus on Strategic Market Management Perspective (제조업체 Private Labels 도입의 선행요인 : 전략적 시장관리 관점을 중심으로)

  • Lim, Chae-Un;Yi, Ho-Taek
    • Journal of Distribution Research
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    • v.17 no.1
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    • pp.65-86
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    • 2012
  • The $20^{th}$ century was the era of manufacturer brands which built higher brand equity for consumers. Consumers moved from generic products of inconsistent quality produced by local factories in the $19^{th}$ century to branded products from global manufacturers and manufacturer brands reached consumers through distributors and retailers. Retailers were relatively small compared to their largest suppliers. However, sometime in the 1970s, things began to slowly change as retailers started to develop their own national chains and began international expansion, and consolidation of the retail industry from mom-and-pop stores to global players was well under way (Kumar and Steenkamp 2007, p.2) In South Korea, since the middle of the 1990s, the bulking up of retailers that started then has changed the balance of power between manufacturers and retailers. Retailer private labels, generally referred to as own labels, store brands, distributors own private-label, home brand or own label brand have also been performing strongly in every single local market (Bushman 1993; De Wulf et al. 2005). Private labels now account for one out of every five items sold every day in U.S. supermarkets, drug chains, and mass merchandisers (Kumar and Steenkamp 2007), and the market share in Western Europe is even larger (Euromonitor 2007). In the UK, grocery market share of private labels grew from 39% of sales in 2008 to 41% in 2010 (Marian 2010). Planet Retail (2007, p.1) recently concluded that "[PLs] are set for accelerated growth, with the majority of the world's leading grocers increasing their own label penetration." Private labels have gained wide attention both in the academic literature and popular business press and there is a glowing academic research to the perspective of manufacturers and retailers. Empirical research on private labels has mainly studies the factors explaining private labels market shares across product categories and/or retail chains (Dahr and Hoch 1997; Hoch and Banerji, 1993), factors influencing the private labels proneness of consumers (Baltas and Doyle 1998; Burton et al. 1998; Richardson et al. 1996) and factors how to react brand manufacturers towards PLs (Dunne and Narasimhan 1999; Hoch 1996; Quelch and Harding 1996; Verhoef et al. 2000). Nevertheless, empirical research on factors influencing the production in terms of a manufacturer-retailer is rather anecdotal than theory-based. The objective of this paper is to bridge the gap in these two types of research and explore the factors which influence on manufacturer's private label production based on two competing theories: S-C-P (Structure - Conduct - Performance) paradigm and resource-based theory. In order to do so, the authors used in-depth interview with marketing managers, reviewed retail press and research and presents the conceptual framework that integrates the major determinants of private labels production. From a manufacturer's perspective, supplying private labels often starts on a strategic basis. When a manufacturer engages in private labels, the manufacturer does not have to spend on advertising, retailer promotions or maintain a dedicated sales force. Moreover, if a manufacturer has weak marketing capabilities, the manufacturer can make use of retailer's marketing capability to produce private labels and lessen its marketing cost and increases its profit margin. Figure 1. is the theoretical framework based on a strategic market management perspective, integrated concept of both S-C-P paradigm and resource-based theory. The model includes one mediate variable, marketing capabilities, and the other moderate variable, competitive intensity. Manufacturer's national brand reputation, firm's marketing investment, and product portfolio, which are hypothesized to positively affected manufacturer's marketing capabilities. Then, marketing capabilities has negatively effected on private label production. Moderating effects of competitive intensity are hypothesized on the relationship between marketing capabilities and private label production. To verify the proposed research model and hypotheses, data were collected from 192 manufacturers (212 responses) who are producing private labels in South Korea. Cronbach's alpha test, explanatory / comfirmatory factor analysis, and correlation analysis were employed to validate hypotheses. The following results were drawing using structural equation modeling and all hypotheses are supported. Findings indicate that manufacturer's private label production is strongly related to its marketing capabilities. Consumer marketing capabilities, in turn, is directly connected with the 3 strategic factors (e.g., marketing investment, manufacturer's national brand reputation, and product portfolio). It is moderated by competitive intensity between marketing capabilities and private label production. In conclusion, this research may be the first study to investigate the reasons manufacturers engage in private labels based on two competing theoretic views, S-C-P paradigm and resource-based theory. The private label phenomenon has received growing attention by marketing scholars. In many industries, private labels represent formidable competition to manufacturer brands and manufacturers have a dilemma with selling to as well as competing with their retailers. The current study suggests key factors when manufacturers consider engaging in private label production.

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Graves' Disease in Prepubertal Children Compared with Pubertal Children (소아 Graves병의 임상적 고찰 : 사춘기 이전군과 사춘기군의 비교)

  • Kim, Hyun Mi;Yoon, Ju Yun;Jung, Min Ho;Suh, Byung Kyu;Lee, Byung Churl
    • Clinical and Experimental Pediatrics
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    • v.46 no.1
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    • pp.76-82
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    • 2003
  • Purpose : The aim of this study was to determine whether differences exist in the presentation, clinical course, and outcome of Graves' disease between prepubertal children and adolescents. Methods : A retrospective chart review of 14 prepubertal(PREPUB, $7.2{\pm}0.9yr) and 38 pubertal (PUB, $12.4{\pm}1.5yr$) children with Graves' disease between January 1989 and November 1995 at St. Mary's Hospital and Kangnam St. Mary's Hospital was undertaken. Results : There were no significant differences in $T_3$, $T_4$, TSH between two the groups at diagnosis. The PUB group had significantly higher titers of antimicrosomal antibody(positive dilution factor $11,727.3{\pm}22,888.4$) than did the PREPUB group($2,111.5{\pm}2,285.0$, P<0.001). The PREPUB group had significantly higher titers of TSH-binding inhibitory immunoglobulin(TBII, $62.5{\pm}39.6$) than did the PUB group($44.9{\pm}10.4$, P<0.05) before treatment started. The duration(months) of medical therapy before thyroid function tests were normalized was longer in the PREPUB group than in the PUB group($T_3:6.8{\pm}5.0$ vs. $5.4{\pm}13.2$, $T_4:2.3{\pm}1.9$ vs. $2.1{\pm}2.2$, $TBII:26.7{\pm}24.0$ vs. $20.8{\pm}12.1$), especially that of TSH was significantly longer in the PREPUB group($14.6{\pm}11.0$ vs. $6.8{\pm}7.8$, P< 0.05). Total length of medical therapy was significantly longer in the PREPUB group than the PUB group($52.3{\pm}19.3$ vs. $37.9{\pm}16.3months$, P<0.01). During three years of antithyroid drug therapy, in the PREPUB group, the remission rate was lower and the relapse rate was higher than in the PUB group. Total length of treatment correlated negatively with chronological age(P=0.03). Conclusion : Prepubertal children require longer medical therapy to achieve a remission than do pubertal children. But there is an obvious need for more studies because of the small number of patients and the short duration of the follow-up.

The Effects of Intention Inferences on Scarcity Effect: Moderating Effect of Scarcity Type, Scarcity Depth (소비자의 기업의도 추론이 희소성 효과에 미치는 영향: 수량한정 유형과 폭의 조절효과)

  • Park, Jong-Chul;Na, June-Hee
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.4
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    • pp.195-215
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    • 2008
  • The scarcity is pervasive aspect of human life and is a fundamental precondition of economic behavior of consumers. Also, the effect of scarcity message is a power social influence principle used by marketers to increase the subjective desirability of products. Because valuable objects are often scare, consumers tend to infer the scarce objects are valuable. Marketers often do base promotional appeals on the principle of scarcity to increase the subjective desirability their products among consumers. Specially, advertisers and retailers often promote their products using restrictions. These restriction act to constraint consumers' ability th take advantage of the promotion and can assume several forms. For example, some promotions are advertised as limited time offers, while others limit the quantity that can be bought at the deal price by employing the statements such as 'limit one per consumer,' 'limit 5 per customer,' 'limited products for special commemoration celebration,' Some retailers use statements extensively. A recent weekly flyer by a prominent retailer limited purchase quantities on 50% of the specials advertised on front page. When consumers saw these phrase, they often infer value from the product that has limited availability or is promoted as being scarce. But, the past researchers explored a direct relationship between the purchase quantity and time limit on deal purchase intention. They also don't explored that all restriction message are not created equal. Namely, we thought that different restrictions signal deal value in different ways or different mechanism. Consumers appear to perceive that time limits are used to attract consumers to the brand, while quantity limits are necessary to reduce stockpiling. This suggests other possible differences across restrictions. For example, quantity limits could imply product quality (i.e., this product at this price is so good that purchases must be limited). In contrast, purchase preconditions force the consumer to spend a certain amount to qualify for the deal, which suggests that inferences about the absolute quality of the promoted item would decline from purchase limits (highest quality) to time limits to purchase preconditions (lowest quality). This might be expected to be particularly true for unfamiliar brands. However, a critical but elusive issue in scarcity message research is the impacts of a inferred motives on the promoted scarcity message. The past researchers not explored possibility of inferred motives on the scarcity message context. Despite various type to the quantity limits message, they didn't separated scarcity message among the quantity limits. Therefore, we apply a stricter definition of scarcity message(i.e. quantity limits) and consider scarcity message type(general scarcity message vs. special scarcity message), scarcity depth(high vs. low). The purpose of this study is to examine the effect of the scarcity message on the consumer's purchase intension. Specifically, we investigate the effect of general versus special scarcity messages on the consumer's purchase intention using the level of the scarcity depth as moderators. In other words, we postulates that the scarcity message type and scarcity depth play an essential moderating role in the relationship between the inferred motives and purchase intention. In other worlds, different from the past studies, we examine the interplay between the perceived motives and scarcity type, and between the perceived motives and scarcity depth. Both of these constructs have been examined in isolation, but a key question is whether they interact to produce an effect in reaction to the scarcity message type or scarcity depth increase. The perceived motive Inference behind the scarcity message will have important impact on consumers' reactions to the degree of scarcity depth increase. In relation ti this general question, we investigate the following specific issues. First, does consumers' inferred motives weaken the positive relationship between the scarcity depth decrease and the consumers' purchase intention, and if so, how much does it attenuate this relationship? Second, we examine the interplay between the scarcity message type and the consumers' purchase intention in the context of the scarcity depth decrease. Third, we study whether scarcity message type and scarcity depth directly affect the consumers' purchase intention. For the answer of these questions, this research is composed of 2(intention inference: existence vs. nonexistence)${\times}2$(scarcity type: special vs. general)${\times}2$(scarcity depth: high vs. low) between subject designs. The results are summarized as follows. First, intention inference(inferred motive) is not significant on scarcity effect in case of special scarcity message. However, nonexistence of intention inference is more effective than existence of intention inference on purchase intention in case of general scarcity. Second, intention inference(inferred motive) is not significant on scarcity effect in case of low scarcity. However, nonexistence of intention inference is more effective than existence of intention inference on purchase intention in case of high scarcity. The results of this study will help managers to understand the relative importance among the type of the scarcity message and to make decisions in using their scarcity message. Finally, this article have several contribution. First, we have shown that restrictions server to activates a mental resource that is used to render a judgment regarding a promoted product. In the absence of other information, this resource appears to read to an inference of value. In the presence of other value related cue, however, either database(i.e., scarcity depth: high vs. low) or conceptual base(i.e.,, scarcity type special vs. general), the resource is used in conjunction with the other cues as a basis for judgment, leading to different effects across levels of these other value-related cues. Second, our results suggest that a restriction can affect consumer behavior through four possible routes: 1) the affective route, through making consumers feel irritated, 2) the cognitive making route, through making consumers infer motivation or attribution about promoted scarcity message, and 3) the economic route, through making the consumer lose an opportunity to stockpile at a low scarcity depth, or forcing him her to making additional purchases, lastly 4) informative route, through changing what consumer believe about the transaction. Third, as a note already, this results suggest that we should consider consumers' inferences of motives or attributions for the scarcity dept level and cognitive resources available in order to have a complete understanding the effects of quantity restriction message.

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Ecological Studies on the Burned Forest - On the Germination of Remained Seed on Burned Area - (산화적지(山火跡地)의 생태학적(生態學的) 연구(硏究) - 산화후(山火後)의 잔여종자(殘餘種子) 발아율(發芽率)에 대(對)하여 -)

  • Kim, Ok Kyung
    • Journal of Korean Society of Forest Science
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    • v.10 no.1
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    • pp.29-39
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    • 1970
  • Forest fires often destory forests that have taken years to grow in a few minutes. Forest fire therefore, is an important problem in forest management and have caused heavy losses to the nations economy. In order to resolve this problem many investigations have been made in many countries. However, ecological studies on the forest after accidental fire have not yet been made in Korea. In order to conduct such a study, a burned area on Mt. Samak which is located at Dukduwon-ri, Seo-myon, Chunsung-gun, Kangwon-do, was chosen as experimental plot in 1967. The remaining seeds were collected from the burned area, and investigations on their germination rate and their productivity were made comparing to those of the seeds of undemaged area, and following results were obtained. 1. The number of seed collected from the control plots were 740 while it was 537 from the test plots (Table 3, 4). It was considered that this difference between burned and unburned area was mainly due to the fact that some of the seeds had been burnt by the fire, and the unfavorable environmental conditions in the burned area was also considered to be a reason. In the germination rate in the control plots showed 28.1% while it was 3.2% in the test plots. This difference was considered to be due to complete loss of viability of the seed by burning and high heat. 2. In the test plots, sixteen seeds of the Alnus japonica were collected and six of these seeds germinated (index number 100) which was the highest germination rate among the species of collected seeds. From these results, it was considered that a high temperature (above $150^{\circ}C$) caused reduction of the germination rate (Quadrat. 1.2). Seeds of Carex lanceolata var. Nana, were appeared much more in the higher plots than in the lower plots and it seemed to be due to the fact that the forest floor plants were much more abundant in the lower plots than in the higher plots which is covered with shrubbery. And some small seeds midght be able to avoid the effect of fire being burried in the soil or under the gravel. 3. With Pinus densiflora, 43 seeds were collected, and 11 of these germinated in the control plots. However in the test plots, 11 seeds were collected and no seed germinated. This shows that the Pinus densiflora was the weakest in resisting to heat among the observed species in this study. 4. Without exception the germination rate showed a higher index in the herbs than in the woody plants and it is believed that the herbs produced more seed than the wood plants because of the abundance of herbs colony.

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Comparative analysis of status of safety accidents and importance-performance analysis (IPA) about precautions of safety accidents by employment type of industry foodservices in Jeonbuk area (전북지역 산업체급식소 조리종사자의 고용형태에 따른 안전사고 실태 및 안전사고 예방관리에 대한 중요도와 수행도 분석)

  • So, Hee;Rho, Jeong Ok
    • Journal of Nutrition and Health
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    • v.50 no.4
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    • pp.402-414
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    • 2017
  • Purpose: The purpose of the study was to evaluate the status of safety accidents and importance-performance analysis (IPA) between regular and non-regular employees in industry foodservices. Methods: The participants were regular employees (n = 119) and non-regular employees (n = 163) in industry foodservices in the Jeonbuk area. Demographic characteristics, status of safety accidents, safety education, and importance and performance status were assessed using a self-administered questionnaire. Results: Approximately 66.4% of regular employees and 53.4% of non-regular employees experienced safety accidents (p < 0.05). Types of safety accidents of regular and non-regular employees were mostly burns, and causes were mostly from their own negligence. Approximately 98.3% of regular employees and 95.1% of non-regular employees experienced safety education. Approximately 88.9% of regular employees and 96.8% of non-regular employees received safety education from dietitians. Approximately 41.9% of regular employees and 50.0% of non-regular employees had difficulty applying the contents of safety education due to lack of time during work. As a result of IPA, regular and non-regular employees were aware of the importance of the following and performed them well: 'Clean the floor of the work place', 'Arrange in the work area', 'Wear safety shoes', 'Check for heater cord', and 'Safety cooking when using oil'. On the other hand, they were not aware of the importance of the following and performed them insufficiently: 'Check for the MSDS', 'Aware of chemical signs', 'Wear protection gloves etc.', 'Do stretching exercise', and 'Using ancillary tools'. Conclusion: Therefore, it is necessary to improve the consciousness of dietitians for effective application of safety education contents, development of contents, especially MSDS, and related things.

Incase of Same Region Treatment by using a Tomotherapy and a Linear Accelerator Absorbed Dose Evaluation of Normal Tissues and a Tumor (토모테라피와 선형가속기를 이용한 동일 부위의 치료 시 종양 및 정상조직의 흡수선량 평가)

  • Cheon, Geum-Seong;Kim, Chang-Uk;Kim, Hoi-Nam;Heo, Gyeong-Hun;Song, Jin-Ho;Hong, Joo-Yeong;Jeong, Jae-Yong
    • The Journal of Korean Society for Radiation Therapy
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    • v.22 no.2
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    • pp.97-103
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    • 2010
  • Purpose: Treating same region with different modalities there is a limit to evaluate the total absorbed dose of normal tissues. The reason is that it does not support to communication each modalities yet. In this article, it evaluates absorbed dose of the patients who had been treated same region by a tomotherapy and a linear accelerator. Materials and Methods: After reconstructing anatomic structure with a anthropomorphic phantom, administrate 45 Gy to a tumor in linac plan system as well as prescribe 15 Gy in tomotherapy plan system for make an ideal treatment plan. After the plan which made by tomoplan system transfers to the oncentra plan system for reproduce plan under the same condition and realize total treatment plan with summation 45 Gy linac treatment plan. To evaluate the absorbed dose of two different modalities, do a comparative study both a simple summation dose values and integration dose values. Then compare and analyze absorbed dose of normal tissues and a tumor with the patients who had been exposured radiation by above two differents modalities. Results: The result of compared data, in case of minimum dose, there are big different dose values in spleen (12.4%). On the other hand, in case of the maximum dose, it reports big different in a small bowel (10.2%) and a cord (5.8%) in head & neck cancer patients, there presents that oral (20.3%), right lens (7.7%) in minimum dose value. About maximum dose, it represents that spinal (22.5), brain stem (12%), optic chiasm (8.9%), Rt lens (11.5%), mandible (8.1%), pituitary gland (6.2%). In case of Rt abdominal cancer patients, there represents big different minimum dose as Lt kidney (20.3%), stomach (8.1%) about pelvic cancer patients, it reports there are big different in minimum dose as a bladder (15.2%) as well as big different value in maximum dose as a small bowel (5.6%), a bladder (5.5%) in addition, making treatment plan it is able us to get. Conclusion: In case of comparing both simple summation absorbed dose and integration absorbed dose, the minimum dose are represented higher as well as the maximum dose come out lower and the average dose are revealed similar with our expected values data. It is able to evaluate tumor & normal tissue absorbed dose which could had been not realized by treatment plan system. The DVH of interesting region are prescribed lower dose than expected. From now on, it needs to develop the new modality which are able to realize exact dose distribution as well as integration absorbed dose evaluation in same treatment region with different modalities.

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The Irradiated Lung Volume in Tangential Fields for the Treatment of a Breast (유방암의 접선 조사시 피폭 폐용적)

  • Oh Young Taek;Kim Juree;Kang Haejin;Sohn Jeong Hye;Kang Seung Hee;Chun Mison
    • Radiation Oncology Journal
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    • v.15 no.2
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    • pp.137-143
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    • 1997
  • Purpose : Radiation pneumonitis is one of the complications caused by radiation therapy that includes a Portion of the lung tissue. The severity of radiation induced pulmonary dysfunction depends on the irradiated lung volume, total dose, dose rate and underlying Pulmonary function. It also depends on whether chemotherapy is done or not. The irradiated lung volume is the most important factor to predict the pulmonary dysfunction in breast cancer Patients following radiation therapy. There are some data that show the irradiated lung volume measured from CT scans as a part of treatment Planning with the tangential beams. But such data have not been reported in Korea. We planned to evaluate the irradiated lung volume quantitatively using CT scans for the breast tangential field and search for useful factors that could Predict the irradiated lung volume Materials and Methods : The lung volume was measured for 25 patients with breast cancer irradiated with tangential field from Jan.1995 to Aug.1996. Parameters that can predict the irradiated lung volume included; (1) the peruendicular distance from the Posterior tangential edge to the posterior part of the anterior chest wall at the center of the field (CLD) ; (2) the maximum perpendicular distance from the posterior tangential field edge to the posterior Part of the anterior chest wall (MLD) ; (3) the greatest perpendicular distance from the Posterior tangential edge to the posterior part of anterior chest wall on CT image at the center of the longitudinal field (GPD) ; (4) the length of the longitudinal field (L). The irradiated lung volume(RV), the entire both lung volume(EV) and the ipsilateral lung volume(IV) were measured using dose volume histogram. The relationship between the irradiated lung volume and predictors was evaluated by regression analysis. Results :The RV is 61-279cc (mean 170cc), the RV/EV is $2.9-13.0\%\;(mean\;5.8\%)$ and the RV/IV is $4.9-29.0\%\;(mean\;12.2\%)$. The CLD, the MLD and the GPD ave 1.9-3.3cm, 1.9-3.3cm and 1.4-3.1cm respectively. The significant relations between the irradiated lung volume such as RV. RV/EV, RV/IV and parameters such as CLD, MLD, GPO, L. $CLD\timesL,\;MLD\timesL\;and\;GPD\timesL$ are not found with little variances in parameters. The RV/IV of the left breast irradiation is significantly larger than that of the right but the RV/EVS do not show the differences. There is no symptomatic radiation pneumonitis at least during 6 months follow up. Conclusion : The significant relationship between the irradiated lung volume and predictors is not found with little variation on parameters. The irradiated lung volume in the tangential held is liss than $10\%$ of entire lung volume when CLO is less than 3cm. The RV/IV of the left tangential field is larger than that of the right but there was no significant differences in RV/EVS. Symptomatic radiation pneumonitis has not occurred during minimum 6 months follow up.

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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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A Prospective Randomized Trial Comparing the Seciuence of Adiuvant Chemotherapy and Radiotherapy following Curative Resection of Stage II, III Rectal Cancer (직장암의 근치적 수술 루 방사선치료와 화학요법의 순서에 대한 고찰 -전향적 무작위 3상 임상연구 중간 결과 보고-)

  • Kim Kyoung Ju;Kim Jong Hoon;Choi Eun Kyung;Chang Hyesook;Ahn Seung Do;Lee Je Hwan;Kim Jin Cheon;Yu Chang Sik
    • Radiation Oncology Journal
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    • v.18 no.1
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    • pp.17-25
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    • 2000
  • Purpose : To evaluate the side effects, pattern of failure, and survival rate according to the sequence of postoperative adjuvant radiotherapy and chemotherapy, patients with stages II and III rectal cancer who had undergone curative resection were randomized to 'early radiotherapy group (arm I)' or' late radiotherapy group (arm II)', then we intend to determine the most effective sequence of the radiotherapy and chemotherapy. Materials and Methods . From January 1996 to March 1999, 313 patients with curatively resected stages II and III rectal cancer have been randomized to' early' or' late' radiation therapy group and received combined chemotherapy (5-FU 375 mg/m$^{2}$/day, ieucovorin 20 mg/m$^{2}$, IV bolus daily Dl-5, 8 cycles) and radiation therapy (whole pelvis with 45 Gy/25 fractions/s weeks). Arm I received radiation therapy from day 1 with first cycle of chemotherapy and arm II received radiation therapy from day 57 with third cycle of chemotherapy after completion of first two cycles. Preliminary analysis was peformed with 228 patients registered up to Jun 1998. Two out of the 228 patients were excluded because of double primary cancer. Median follow-up period was 23 months. Results :Local recurrence occurred in 11 patients (9.7$\%$) for arm I and 9 patients (8$\%$) for arm 11. There was no significant difference between both groups ( p=0.64). However, distant metastasis was found in 22 patients (19.5$\%$) for arm I and 35 patients (31.0$\%$) for arm II and which showed statistically significant difference between the two groups ( p=0.046). And neither 3-year disease-free survival (70.2$\%$ vs 59.2$\%$, p=0.2) nor overall survival (89.4$\%$ vs 88.0$\%$, p=0.47) showed significant differences. The incidence of leukopenia during radiation therapy and chemotherapy was 78.3$\%$ and 79.9$\%$ respectively but leukopenia more than RTOG grade 3 was only 2.1$\%$ and 6.0$\%$ respectively. The incidence of diarrhea more than 10 times per day was significantly higher in the patients for arm I than for arm II (71.2$\%$ vs 41.6$\%$, p=0.02) but this complication was controlled with supportive cares. Conclusion : Regardless of the sequence of postoperative adjuvant radiation therapy and chemotherapy after curative resection for rectal cancer, local recurrence rate was low with combined chemoradlotherapy. But distant metastasis rate was lower in early radiation therapy group than in late radiation therapy group and the reason is unclear. Most patients completed these treatments without severe complication, so these were thought to be safe treatments but the treatment compliance should be improved.

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The Results of Postoperative Radiation Therapy for Perihilar Cholangiocarcinoma (간문부 담도암에서 수술 후 방사선 치료의 결과)

  • Lee, Yu-Sun;Park, Jae-Won;Park, Jin-Hong;Choi, Eun-Kyung;Ahn, Seung-Do;Lee, Sang-Wook;Song, Si-Yeol;Lee, Sung-Gyu;Hwang, Shin;Lee, Young-Joo;Park, Kwang-Min;Kim, Ki-Hun;Ahn, Chul-Soo;Moon, Deok-Bog;Chang, Heung-Moon;Ryu, Min-Hee;Kim, Tae-Won;Lee, Jae-Lyun;Kim, Jong-Hoon
    • Radiation Oncology Journal
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    • v.27 no.4
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    • pp.181-188
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    • 2009
  • Purpose: The aim of this study was to evaluate the results of postoperative radiotherapy in a case of perihilar cholagiocarcinoma by analyzing overall survival rate, patterns of failure, prognostic factors for overall survival, and toxicity. Materials and Methods: Between January 1998 and March 2008, 38 patients with perihilar cholangiocarcinoma underwent a surgical resection and adjuvant radiotherapy. The median patient age was 59 years (range, 28 to 72 years), which included 23 men and 15 women. The extent of surgery was complete resection in 9 patients, microscopically positive margins in 25 patients, and a subtotal resection in 4 patients. The tumor bed and regional lymphatics initially received 45 Gy or 50 Gy, but was subsequently boosted to a total dose of 59.4 Gy or 60 Gy in incompletely resected patients. The median radiotherapy dose was 59.4 Gy. Concurrent chemotherapy was administered in 30 patients. The median follow-up period was 14 months (range, 6 to 45 months). Results: The 3-year overall survival and 3-year progression free survival rates were 30% and 8%, respectively. The median survival time was 28 months. A multivariate analysis showed that differentiation was the only significant factor for overall survival. The 3-year overall survival was 34% in R0 patients and 20% in R1 patients. No statistically significant differences in survival were found between the 2 groups (p=0.3067). The first site of failure was local in 18 patients (47%). No patient experienced grade 3 or higher acute toxicity and duodenal bleeding developed in 2 patients. Conclusion: Our results suggest that adjuvant RT might be a significant factor in patients with a positive margin following a radical resection. However, there was still a high locoregional recurrence rate following surgery and postoperative radiotherapy. Further study is necessary to enhance the effect of the adjuvant radiotherapy.