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Changes in Distribution and Morphology of Rat Alveolar Macrophage Subpopulations in Acute Hyperoxic Lung Injury Model (고농도 산소로 유발한 흰쥐의 급성폐손상모델에서 폐포대식세포 아형군의 분포와 형태 변화)

  • Shin, Yoon;Lee, Sang-Haak;Yoon, Hyoung-Kyu;Lee, Sook-Young;Kim, Seok-Chan;Kwon, Soon-Seog;Kim, Young-Kyoon;Kim, Kwan-Hyung;Moon, Hwa-Sik;Song, Jeong-Sup;Park, Sung-Hak
    • Tuberculosis and Respiratory Diseases
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    • v.48 no.4
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    • pp.478-486
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    • 2000
  • Background : In acute lung injury, alveolar macrophages play a pivotal role in the inflammatory process during the initiation phase and in the reconstruction and fibrosis process during the later phase. Recently, it has been proven that alveolar macrophages are constituted by morphologically, biochemically and immunologically heterogenous cell subpopulations. The possibility of alterations to these characteristics of the alveolar macrophage population during lung disease has been raised. To investigate such a possibility a hyperoxic rat lung model was made to check the distributional and morphological changes of rat alveolar macrophage subpopulation in acute hyperoxic lung injury. Method : Alveolar macrophage were lavaged from normal and hyperoxic lung injury rats and separated by discontinuous gradients of percoll. After cell counts of each density fraction were accessed, the morphomeric analysis of alveolar macrophages was performed on cytocentrifuged preparations by transmission electron micrograph. Result : 1. The total alveolar macrophage cell count significantly increased up to 24 hours after hyperoxic challenge (normal control group $171.6{\pm}24.1{\times}10^5$, 12 hour group $194.8{\pm}17.9{\times}10^5$, 24 hour group $207.6{\pm}27.1{\times}10^5$, p<0.05). oHoHH However the 48 hour group ($200.0{\pm}77.8{\times}10^5$) did not show a significant difference. 2. Alveolar septal thickness significantly increased up to 24 hours after hyperoxic challenge(normal control group $0.7{\pm}0.2{\mu}m$, 12 hour group $1.5{\pm}0.4{\mu}m$, 24 hour group $2.3{\pm}0.4{\mu}m$, p<0.05). However the 48 hour group did not show further change ($2.5{\pm}0.4{\mu}m$). Number of interstitial macrophage markedly increased at 24 hour group. 3. Hypodense fraction(fraction 1 and fraction 2) of alveolar macrophage showed a significant increase following hyperoxic challenge ($\beta=0.379$.$\beta=0.694$. p<0.05) ; however, fraction 3 was rather decreased following the hyperoxic challenge($\beta=0.815$. p<0.05), and fraction 4 showed an irregular pattern. 4. Electron microscopic observation of alveolar macrophage from each fraction revealed considerable morphologic heterogeneity. Cells of the most dense subfraction(fraction 4) were small, round, and typically highly ruffled with small membrane pseudopods. Cells of the least dense fraction (fraction 1) were large and showed irregular eccentric nucleus and high number of heterogenous inclusions. Conclusion : In conclusion, these results suggest that specific hypodense alveolar macrophage subpopulation may play a an important role in an acute hyperoxic lung injury model But further study, including biochemical and immunological function of these subpopulations, is needed.

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Analysis of Prognostic Factors Related to Survival Time for Patients with Small Cell Lung Cancer (소세포폐암 환자의 생존기간에 관련된 인자 분석)

  • Kim, Hee-Kyoo;Yook, Dong-Seung;Shin, Ho-Sik;Kim, Eun-Seok;Lim, Hyun-Jeung;Lim, Tae-Kwan;Ok, Chul-Ho;Cho, Hyun-Myung;Jung, Maan-Hong;Jang, Tae-Won
    • Tuberculosis and Respiratory Diseases
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    • v.54 no.1
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    • pp.57-70
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    • 2003
  • Background : Small cell lung cancer represents approximately 20% of all carcinomas of the lung, and is recognized as having a poor long term outcome compared to non-small cell lung cancer. Therefore, this study investigated the prognostic factors in small cell lung cancer patients in order to improved the survival rate by using the proper therapeutic methods. Material and method : The clinical data from 394 patients who diagnosed with small cell lung cancer and treated from 1993 to 2001 at the Kosin University Gospel Hospital, were analyzed. Result : There were 314 male patients (79.7%), and 80 female patients (20.3%). The number of those with limited disease was 177 (44.9%), and the number of those with extensive disease was 217 (55.1%). Overall, 366 out of 394 enrolled patients had died. The median survival time was 215 days (95% CI : 192-237days). The disease stage, Karnofsky performance state, 5% body weight loss for the recent 3 months, chemotherapy regimens, and the additive chest radiotherapy were identified as being statistically significant factors for the survival time. The median survival times of the supportive care group, one anticancer therapy, and two or more treatment groups were 17 days, 211 days, and 419 day, respectively (p<0.001). These data emphasize the importance of anticancer treatment to improve survival time for patients. The group of concurrent chemoradiotherapy (30 patients) showed significantly longer survival time than the group given sequential chemoradiotherapy (55 patients) (528 days versus 373 days, p=0.0237). The favorable prognostic factors of laboratory study were groups of leukocyte =8,000/mm3, ALP=200 U/L, LDH=450 IU/L, NSE=15 ng/mL, s-GOT=40 IU/L. In extensive disease, there was no difference according to the number of metastatic site. However, the median survival time of patients with ipsilateral pleural effusion had longer than patients having other metastatic sites. According to the survey periods, three groups were divided into 1993-1995, 1996-1998, and 1999-2001. The median survival time was significantly prolonged after 1999 in comparison to previous groups (177 days, 194 days, 289 days, p=0.001, 0.002, respectively). Conclusion: Disease stage and 5% body weight loss for recent 3 months at diagnostic state were significant prognostic factors. In addition, the performance status, serum ALP, LDH, NSE, CEA levels also appear to be prognostic factors. The survival time of those patients with small cell lung cancer has been prologned in recent years. It was suggested that the used of the EP (etoposied and cisplatin) chemotherapy method and concurrent chemoradiotherapy for patients with a limited stage contributed to the improved survival time.

An Analysis of the Psychiatric Characteristics of the Alopecia Areata in Female (여성 탈모증의 정신의학적 특성 분석)

  • Lee, Kil-Hong;Na, Chul;Lee, Young-Sik;Lee, Chang-Hoon;No, Byung-In;Hong, Chang-Kwon
    • Korean Journal of Psychosomatic Medicine
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    • v.8 no.1
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    • pp.31-45
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    • 2000
  • Objectives : The present study was performed to reveal differences between female and male cases of alopecia in their alopecia related variables such as patterns of hair loss, psychiatric characteristics, associate illnesses, and methods of treatment, and to use them as basic materials for proper management and early prevention of the alopecia prone cases. Methods : In order to analysis the gender difference in hair losses, the subjects were divided into two subgroups as the 51 cases of female alopecia and the 42 cases of male alopecia, who had visited to the department of psychiatry consulted from the department of dermatology, Yongsan hopital, ChungAng University, Seoul, Korea, from January 1998 to December 1998. In data analysis, the subjects were statistically assesed by chi-squre test and analysis of varaiance, through SPSS-$PC^+$ 9.0V. Results : 1) Female subjects were more likely showed lower socio-economical level including lower eonomical level, lower educational level, or lower occupational level in their parent's job, were more likely to have larger number of siblings and to have many sisters comparison to the male cases. 2) Female subjects were more likely visited to the department of dermatology, more history of alopecia in their female family members, lesser history of alopecia in their male family members, more loss of hairs in vertex or frontal region of scalp, lesser loss of hairs in occipital region, and lesser nail changes in comparison to the male cases. 3) Female subjects were more suffered from intra-familial conflicts and economical changes, or their introverted personality makeup, lesser likely suffered from changes of business and health changes, and showed lesser conflicts related with poorer adaptaion in their job life. 4) Female subjects were more likely diagnosed as depression or conversion disorders, more frequently complaint anxiety symptoms or depressive symptoms, higher level of anxiety index, lesser complaint somatization or obsessive compulsive symptoms, and lesser diagnosed as anxiety disorder in comparison to the male cases. 5) Female subjects were more likely tended to show personality makeup such as the introverted, the lie, the repressed, or the feminine trends than the male cases. 6) Female subjects were more significantly treated by antianxiety drug such as etizolam and dermatological therapies include tretinoin, and lesser treated by clotiazepam and prednicarbonate in comparison to the male cases. Conclusion : From the facts that The most important factors in developing hair loss in the female subjects in comparison to the male cases seems to be closely correlated with the serious psychopathology such as the presence of mental disorders including depression, the presence of complaining anxiety or depressive symptomatology, the presence of stressful life events such as intrafamilial life changes, and the presence of personality makeup such as the introverted, the lie, the repressed, or the feminine trends, the authors confirmed that dermatologists act as the primary care physician are in a unique position to recognize psychiatric comorbidity and execute meaningful intervention for female patients with the alopecia with psychiatrists.

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Breast Conservation Therapy Versus Mastectomy - Preliminary Results of Pattern of Failure and Survival Rate in Early Breast Cancer (조기유방암에서 유방보존치료와 유방전절제술의 치료결과 및 실패양상 비교)

  • Kim Yeon-Sil;Yoon Sei-Chul;Chung Su-Mi;Ryu Mi-Ryeong;Jung Sang-Sul;Choi Ihl-Bohng
    • Radiation Oncology Journal
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    • v.22 no.2
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    • pp.115-123
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    • 2004
  • Purpose : This retrospective study was conducted to compare early preliminary results of breast conservation therapy (BCT) with mastectomy In early breast cancer. Materials and Methods : We evaluated 171 women with AJCC stage I and II breast cancer who had been treated at Kangnam St. Mary's Hospital from March 1989 to August 1996. Eighty-eight patients underwent mastectomy and 85 patients did conservative surgery with breast irradiation. in the BCT group, all patients received whole breast irradiation to a total dose of 45$\~$50 Gy/5$\~$6 wks, followed by a boost to the original tumor site at least 60 Gy. Chemotherapy was administered to 29 (34.1$\%$) patients in BCT and 40 (45.5$\%$) in mastectomy, with various sequencing of surgery and/or radiation. We compared survival rate, patterns of failure in each treatment group and the prognostic factors that had a significant effect on treatment failure. The median follow-up time was 63 months (19$\~$111 months). Log rank test was used to estimate the prognostic factors for treatment failure. Results : Overall survival, disease free survival, locoregional recurrence and distant metastasis rates were not significantly different between the two treatment groups. During the follow-up period, 11 patients (12.5$\%$)in the mastectomy group and 10 patients (11.8%$\%$ in the BCT group were failed. Six local recurrences occurred after mastectomy and 5 after BCT Five patients fatted at distant site in mastectomy and 4 in BCT. Of the local recurrence cases, five of 6 mastectomy patients and 3 of S BCT patients were alive with no evidence of disease after salvage surgery and/or chemoirradiation. Our results indicated that the major influence on survival was distant metastasis. Unfortunately, control of distant metastasisis was not frequently achieved. Even with salvage systemic therapy or radiotherapy, most of distant metastasis patients died or had uncontrolled disease in both treatment groups: only one of 4 BCT patients and none of mastectomy patients were alive without disease. There was no apparent difference in the incidence rate of contralateral breast cancer and non-breast 2$^{nd}$ primary tumor between the two treatment groups. Univariate Log-rank test identified the N stage and the involved axillary LN number as distinct prognostic factors that were highly predictive of treatment failure in both treatment groups. Additionally, marginal status in BCT and histologic nuclear grade In the mastectomy group were risk factors for treatment fallure (p < 0.05). Concousion : Although further careful follow-up is necessary to confirm the trends evident In this serles, it would appear that patterns of failure and survival rate following conservative surgery and radiotherapy in early breast cancer are similar to those following mastectomy. The great majority of patients with local recurrence had an exellent salvage rate in both treatment groups. Therefore, these preliminary short term results support BCT as an equally effective management for early breast cancer as an alternative to mastectomy.

Studies on the Improvement of Nursery for Better Ripening Percentage and Prevention of Red Discoloration of Rice Variety "Tongil" (통일벼의 등숙(登熟) 향상(向上)과 적고방지(赤枯防止)를 위(爲)한 묘대개선(苗垈改善)에 관(關)한 연구(硏究))

  • Choi, Boum Rawl
    • Korean Journal of Agricultural Science
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    • v.1 no.1
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    • pp.9-26
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    • 1974
  • 1. Results in Nursery This experiment was carried out on the effect of the seed treament, soil preparations, kinds of covering soil and inside covering methods in two rice varieties, 'Tongil' and 'Akibare' to find out the most reasonable model of the flat nursery bed, with which lower cost is required comparing with the tunnel nursery. The results obtained are as follows: (1) The seedling of all plots of the ordinary seed were very poor compared to the plots of sprouted seed. (2) In case that the variety 'Tongil' was cultivated on the dry nursery bed, the good seedling percentage and the plant height rat io were significantly increased but the other characteristics of the seedling were not noticeable. (3) The kinds of the covering soil had not an effect on the seedling growth significantly. (4) Inside straw mulching was seemed effective for the protection in the case of the extreme high temperature and heavy rain fall, even though there was not significant differences between inside straw mulching and no treatments at the flat type nursery. (5) Difference of seedling growth between the flat type nursery and the tunnel type nursery was not significant. And it's reason was thought that the covering period of polyethylene film was short in semi hot nursery for the common early transplanting cultivation of rice. (6) The percentage of good seedling was higher at 'Akibare' than 'Tongil', variety but the number of seedling leaf and the seedling growth ratio in height were significantly increased in the variety 'Tongil'. The other seedling characters between there two varieties were not significantly different. 2. Results after transplanting This experiment was conducted to study on the ripening percentage, rice yield and disease, appearance of the seedling from sprouted seed plots including common irrigated nursery as check plot after transplantnig. The results obtained are summarized as follows: (1) The rice yield, the yield components and the appearance of leaf discoloration of both varieties, 'Tongil' and 'Akibare' were slightly betterat the plot of the standard tunnel nursery than that of the flat nursery with inside mulching or the among these three plots. (2) For 'Tongil' variety, the ripening percentage and the rice yield were significantly decreased at the common irrigated nursery compared with semi hot nursery. (3) The ripening percentage and the rice yield of 'Akibare' contrasted with 'Tongil' were significantly decreased at thesemi 'hot-nursery compared with common irrigated nursery. The main reason was thought to be the injury of the rice stripe disease (Rice stripe disease virus). Considering above mentioned experimental result, the seedling of 'Tongil' must be cultivated on the semi bot nursery for better ripening percentage as well as rice yield and for prevention of red discoloration. And as a model of semi hot nursery, the polyethylene covering nursery of standard tunnel type is most desirable but that of flat type with inside straw mulching is thought to be desirable too.

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Rural Migration and Changes of Agricultural Population (농민이촌(農民離村)과 농업인구(農業人口)의 변화(變化))

  • Wu, Tsong-Shien;Kim, Kuong-Ho
    • Korean Journal of Agricultural Science
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    • v.1 no.1
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    • pp.91-116
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    • 1974
  • Taiwan agricultural development in the last decade has not been changed much since the accomplishment of land reform program. This is mainly due to the rapid development taken place within industry that agricultural development can not keep pace with. The increasing gap of rural-urban income discrepancy has caused socio-psychological unstability among rural people and inspire wants of out-migration. From 1961 to 1970, population of the ten largest cities showed an annual growth rate of 4.05%, while the population of the remainder of Taiwan showed 2.06%. Assuming the natural increase rate of these two population sections are similar, the difference of rural and urban annual growth rate can be at tributed to the flow of people from rural to urban sectors. The main objective of this paper is to identify the amount of agricultural out-migration and its impact on agricultural development and agricultural extension programs. Specifically, the objectives are to examine (1) rural-urban population composition (2) rural out-migration estimation (3) changes of agricultural population, and (4) implications for agricultural development and extension programs Some of the important findings are listed below; (1) The average agricultural out migration of the period 1960-1969 is estimated at around 60,000 per year. Take Tainan prefecture for example, the Male-Female Migration Ratio is 0.39 for age 20-24, 0.55 for age 25-29, 0.90 for 30-34. It is understood between age 20 and 34, the rural female migration rate is higher than the rural male. (2) Based on the population growth rate of 1950-1969, agricultural population is projected for the period of 1953 to 1989. By 1978, the agricultural population will reach its peak and begin to dedaine from 1980. The projected agricultural population in 1989 is 5,847,566 which occupies 29% of the Taiwan total population. (3) Assuming area of cultivated land keep unchanged as 905,263 ha. in 1970, and tif we can eliminate all 72% of part-time farms, then the average farm acreage for hose full-time farms will be increased to 3.6 hactares. This is unlikely to happen before 1989 without the government interference. (4) Less than 10% of adult farmer s of age 25-64 in 1969 enrolled in Farm Discussion Club, only 5% of adult farm women enrolled in Home Economics Club, and 5% of rural youth enrolled in 4-H Club. These statistics show a fact that only few farmers are reached by extension workers. Based on findings in this paper, some important suggestions are listed for future agricultural development. (1) Improve agricultural structure by decreasing agricultural population (a) Encourage farmers with less than 0.5 ha. of land to seek jobs outside of agriculture (b) Encourage joint cultivation and farm mechanization (c) Discourage rural migrants to Keep farm land (d) Provide occupational guidance program through extension education programs (2) Establish future farmers settlement project to assure rural youth have enough resources for farming. (3) An optimum Population policy should be integrated into rural socio-economic development and national development programs.

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Effect of Geijibokryunghwan and each constituent herb on inhibition of platelet aggregation (계지복령환(桂枝茯笭丸) 및 그 구성약물(構成藥物)의 혈소판응집억제(血小板凝集抑制)에 관(關)한 연구(硏究))

  • Kim, Jong-Goo;Park, Sun-Dong;Park, Won-Hwan
    • The Journal of Dong Guk Oriental Medicine
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    • v.8 no.2
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    • pp.115-129
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    • 2000
  • The cause that the increase of animality fat intakes, under exercise, fatness, adding the stress, advanced age etc., the occurrence rate of the circulation system disease has been increased. And the thrombosis importantly came to the front as the risk factor of these circulation system's disease. Nowadays, the ischemic disease has especially discussed, for example the angina or myocardial infarction, originated in thrombosis that came from the platelet aggregation. In the western medicine, as the cure and prevention, using the aspirin or ticlopidine for platelet aggregation suppressant. But in the , the curing method must be used properly according to the pectoralgia or heartache's kind, state, grade. The platelet do not attache to the normal hemangioendothelial cell. But when it stimulated by endothelium peronia and so on, it attache to the injury endothelium or rise aggregation between the platelet. On this time, it secrete the platelet aggregation inducer as like ADP, thromboxane A2 from the inside of platelet. So it has first defensive function through the aggregation augment that prevent the celerity consumption of blood. But the activation of abnormal platelet occur the platelet grume and thrombogenesis. So it bring up the occlusive angiosis, so to speak, cardiovascular disease, cerebrovascular disease, arterial sclerosis. In oriental medicine, the thrombosis in the category of blood stasis and this blood stasis present the generalise or local blood circulation disturbance that generated by all kinds of pathological fact or blood stream retention accompanying with a series of syndrome. As the syndrome, stabbing pain fixed at certain region, squamous and dry skin, fullness and pain of the chest and hypochondrium, firmness and fullness of the lower abdomen, black stool, dark purple tongue or with ecchymoses and petechiae etc.. has been created. And it becomes the pathopoiesis cause that the convulsion and palpitation, severe palpitatiion, tympanites, the symtom complex with a mass or swelling in the abdomen, insanity, stricken by wind etc.. Moreover, it used the drugs for invigorating blood circulation and eliminating blood stasis or drugs for removing blood stasis for all kinds of syndrome through the blood stasis. And the drugs for activating the blood circulation, such as Salviae Radix, Angelicae Sinensis Radix, Persicae Semen, Achyranthis Radix, Cnidii Rhizoma, Carthami Flos are used for that. And it is used to the herbs of insects that has strong effect about the disintergrating blood stasis such as Hirudo, Scolopendrae Corpus, Buthus, Lumbricus etc.. On this study, It used Geijibokryunghwan(GBH) and the consisting herbs to investigate the influence of platelet aggregation about drugs that used to improvement various symptoms created by the thrombosis in oriental medicine. GBH formula has as formula recorded in the , action of 'eleminating the evil and not impairment of healthy energy' and 'promoting the flow of QI and cold and heat, so used for the expel blood stasis herbs from the ancient. Therefore we investigated the restraint effect of GBH and the consisting herbs about the platelet agregation induced to the ADP, AA or collagen. The conclusion is following. 1. When it added the aggregation inducer after that it added GBH and individual consisting herbs in the PRP, GBH showed the (+) inhibition effect on the platelet aggregation and it showed the (+) inhibition effect in the individual consisting herbs as like Paeoniae Radix and Moutan Cortex Radicis. 2. It showed the (+), (+,++) inhibition effect on the platelet aggregation in Paeoniae Radix Hoelen, Paeoniae Radix Moutan Cortex Radicis, Hoelen Moutan Cortex Radicis etc. 3. In the aggregation inhibition activating on the difference of density, GBH showed strong inhibition effect to the aggregation state induced to collagen, and it showed the inhibition effect in the individual consisting herbs as like Paeoniae Radix and Moutan Cortex Radicis about the aggregation induced by the collagen. 4. It showed the strong inhibition effect about the aggregation induced by the collagen in Paeoniae Radix Hoelen, Paeoniae Radix Moutan Cortex Radicis, Hoelen Moutan Cortex Radicis etc Like this, as confirm GBH and the individual consisting herb's inhibition effect of platelet aggregation, We considerated that GBH and the individual consisting herbs have practical applicational value of clinical trial in the thrombosis caused by platelet aggregation.

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The Validation Study of the Questionnaire for Sasang Constitution Classification (the 2nd edition revised in 1995) - In the field of profile analysis (사상체질분류검사지(四象體質分類檢査紙)(QSCC)II에 대(對)한 타당화(妥當化) 연구(硏究) -각(各) 체질집단(體質集團)의 군집별(群集別) Profile 분석(分析)을 중심(中心)으로-)

  • Lee, Jung-Chan;Go, Byeong-Hui;Song, Il-Byeong
    • Journal of Sasang Constitutional Medicine
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    • v.8 no.1
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    • pp.247-294
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    • 1996
  • By means of the statistical data which has been collected with newly revised QSCC made use of the outpatient group examined at Kyung-Hee Medical Center and an open ordinary person group, the author proceeded statistical analysis for the validation study of the revised questionnaire itself. First, check the accurate discrimination rate by performing discriminant analysis on the statistical data of the patient group. And next, sought T-score by applying the norms gained in process of standadization of the open ordinary person group to the Sasang scale score of the outpatient group and investigated the distinctive feature between the subpopulations which was devided in the process of multivarite cluster analysis. The result was summarized as follows ; 1. The validity of the questionnaire was established through the fact that the accurate discrimination rate the ratio between predicted group and actual group was figured out 70.08%. 2. At the profile analysis the response to the relevant scale showed notable upward tendency in each constitutional group and therefore it seems to be pertinent in the field of constitutional discrimination. 3. In the observation of the power of expression through the profile analysis of each constitutional group the Soyang group demonstrated the most remarkable outcome, the Soeum group was the most inferior and the Taieum group revealed a sort of dual property. 4. What is called the group of seceder out of three subpopulation of each constitutional group distinguished definitely from the contrasted groups at the point of the distinctive profile feature and the content is like following description. (1) The seceder group of Soyang-in showed considerably passive disposition differently from general character of ordinary Soyang group and an appearance attracting the attention is that they demonstrated comparatively higher response at Soeum scale (2) The seceder group of Taieum-in gained low scores in general that informed the passive disposition of the group and the other way of the general property of Taieum group which showed accompanied ascension in Taiyang-Taieum scales they demonstrated sharply declined score at Taiyang scale (3) The seceder group of Soeum-in demonstrated distinctive property similar to the profile feature of Soyang group and it notifies that the passive property of Soeum group was diluted for the most part. According to the above result, the validity of newly revised questionnaire has been proven successfully and the property of seceder groups could be noticed to some degree through the profile analysis on the course of this study. The result of this study is expected to use as a research materials to produce next edition of the questionnaire and it is regarded that further inquisition about the difference between the seceder group and the contrasted group is required for the promotion of the questionnaire as it refered several times in the contents of the main discourse.

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Clinical Experience of Three Dimensional Conformal Radiation Therapy for Non-Small Cell Lung Cancer (비소세포성 폐암에서 3차원 입체조형 방사선 치료 성적)

  • Choi Eun Kyung;Lee Byong Yong;Kang One Chul;Nho Young Ju;Chung Weon Kuu;Ahn Seung Do;Kim Jong Hoon;Chang Hyesook
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.265-274
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    • 1998
  • Purpose : This prospective study has been conducted to assess the value of three dimensional conformal radiation therapy (3DCRT) for lung cancer and to determine its potential advantage over current treatment approaches. Specific aims of this study were to 1) find the most ideal 3DCRT technique 2) establish the maximum tolerance dose that can be delivered with 3DCRT and 3) identify patients at risk for development of radiation pneumonitis. Materials and Methods : Beginning in Nov. 1994, 95 patients with inoperable non-small cell lung cancer (stage I; 4, stage II; 1, stage IIIa; 14, stage IIIb; 76) were entered onto this 3D conformal trial Areas of known disease and elective nodal areas were initially treated to 45 Gy and then using 3DCRT technique 65 to 70 Gy of total dose were delivered to the gross disease. Sixty nine patients received 65 Gy of total dose and 26 received 70 Gy Seventy eight patients (82.1$\%$) also received concurrent MVP chemotherapy. 3DCRT plans were compared with 2D plans to assess the adequacy of dose delivery to target volume, dose volume histograms for normal tissue, and normal tissue complication Probabilities (NTCP). Results : Most of plans (78/95) were composed of non-coplanar multiple (4-8) fields. Coplanar segmented conformal therapy was used in 17 pateints, choosing the proper gantry angle which minimize normal lung exposure in each segment. 3DCRT gave the full dose to nearly 100$\%$ of the gross disease target volume in all patients. The mean NTCP for ipsilateral lung with 3DCRT (range; 0.17-0.43) was 68$\%$ of the mean NTCP with 2D treatment planning (range; 0.27-0.66). DVH analysis for heart showed that irradiated volume of heart could be significantly reduced by non-coplanar 3D approach especially in the case of left lower lobe lesion. Of 95 patients evaluable for response, 75 (79$\%$), showed major response including 25 (26$\%$) with complete responses and 50 (53$\%$) with partial responses. One and two rear overall survivals of stage III patients were 62.6$\%$ and 35.2$\%$ respectively. Twenty percent (19/95) of patients had pneumonitis; Eight patients had grade 1 pneumonitis and 11 other patients had grade 2. Comparison of the average of NTCP for lung showed a significant difference between patients with and without radiation pneumonitis. Average NTCP for Patients without complication was 62$\%$ of those with complications. Conclusions : This study showed that non-coplanar multiple fields (4-8) may be one of the ideal plans for 3DCRT for lung cancer. It also suggested that 3DCRT may provide superior delivery of high dose radiation with reduced risk to normal tissue and that NTCP can be used as a guideline for the dose escalation.

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Clinical Outcome after Breast Conserving Surgery and Radiation Therapy for Early Breast Cancer (초기 유방암의 유방 보존수술 후 방사선 치료 결과)

  • Cho, Heung-Lae;Kim, Cheol-Jin;Park, Sung-Kwang;Oh, Min-Kyung;Lee, Jin-Yong;Ahn, Ki-Jung
    • Radiation Oncology Journal
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    • v.26 no.4
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    • pp.204-212
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    • 2008
  • Purpose: This study was performed to evaluate the disease-free survival and risk factors of recurrence in early breast cancer patients who have undergone breast conserving surgery and radiation therapy. Materials and Methods: From March 1997 to December 2002, 77 breast cancer patients who underwent breast conserving surgery and radiation therapy were reviewed retrospectively. The median follow-up time was 58.4 months (range $43.8{\sim}129.4$ months) and the mean subject age was 41 years. The frequency distribution of the different T stages, based on the tumor characteristics was 38 (49.3%) for T1, 28 (36.3%) for T2, 3 for T3, 7 for T is and 1 for an unidentified sized tumor. In addition, 52 patients (67.5%) did not have axillary lymph metastasis, whereas 14 patients (18.1%) had $1{\sim}3$ lymph node metastases and 3 (0.03%) had more than 4 lymph node metastases. The resection margin was negative in 59 patients, close (${\leq}2\;mm$) in 15, and positive in 4. All patients received radiation therapy at the intact breast using tangential fields with a subsequent electron beam boost to the tumor bed at a total dose ranging from 59.4 Gy to 66.4 Gy. Patients with more than four positive axillary lymph nodes received radiation therapy ($41.4{\sim}60.4\;Gy$) at the axillary and supraclavicular area. Chemotherapy was administered in 59 patients and tamoxifen or fareston was administered in 29 patients. Results: The 5 year overall survival and disease-free survival rates were 98.08% and 93.49%, respectively. Of the 77 patients, a total of 4 relapses (5.2%), including 1 isolated supraclavicular relapse, 1 supraclavicular relapse with synchronous multiple distant relapses, and 2 distant relapses were observed. No cases of local breast relapses were observed. Lymph node metastasis or number of metastatic lymph nodes was not found to be statistically related with a relapse (p=0.3289) nor disease-free survival (p=0.1430). Patients with positive margins had a significantly shorter disease-free survival period (p<0.0001) and higher relapse rates (p=0.0507). However, patients with close margins were at equal risk of relapse and disease-free survival as with negative margins (p=1.000). Patients younger than 40 years of age had higher relapse rates (9.3% vs. 0%) and lower disease-free survival periods, but the difference was not statistically significant (p=0.1255). The relapse rates for patients with tumors was 14% for tumor stage T2, compared to 0% for tumor stage T1 tumors (p=0.0284). A univariate analysis found that disease-free survival and relapse rates, T stage, positive resection margin and mutation of p53 were significant factors for clinical outcome. Conclusion: The results of this study have shown that breast conservation surgery and radiation therapy in early breast cancer patients has proven to be a safe treatment modality with a low relapse rate and high disease-free survival rate. The patients with a positive margin, T2 stage, and mutation of p53 are associated with statistically higher relapse rates and lower disease-free survival.