• Title/Summary/Keyword: Dose modification

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Paclitaxel and Cisplatin with Induction Chemotherapy Followed by Concurrent Chemoradiotherapy for Stage IIIB Non-small Cell Lung Cancer (IIIB 병기 비소세포폐암에서 Paclitaxel과 Cisplatin을 이용한 선행항암화학요법과 동시 항암화학방사선치료)

  • Kang, Ki-Mun;Lee, Gyeong-Won;Kang, Jung-Hoon;Kim, Hoon-Gu;Lee, Won-Seob;Chai, Gyu-Young
    • Radiation Oncology Journal
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    • v.24 no.4
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    • pp.223-229
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    • 2006
  • $\underline{Purpose}$: Combined modality therapy including chemotherapy, surgery and radiotherapy is considered the standard of care for the treatment of stage III non-small cell lung cancer (NSCLC). This study was conducted to evaluate the efficacy of paclitaxel and cisplatin with induction chemotherapy followed by concurrent chemoradiotherapy for stage IIIB NSCLC. $\underline{Materials\;and\;Methods}$: Between July 2000 and October 2005, thirty-nine patients with stage IIIB NSCLC were treated with two cycles of induction chemotherapy followed by concurrent chemoradiotherapy. The induction chemotherapy included the administration of paclitaxel ($175\;mg/m^2$) by intravenous infusion on day 1 and treatment with cisplatin ($75\;mg/m^2$) by intravenous infusion on day 1 every 3 weeks. Concurrent chemoradiotherapy included the use of paclitaxel ($60\;mg/m^2$) plus cisplatin ($25\;mg/m^2$) given intravenously for 6 weeks on day 43, 50, 57, 71, 78 and 85. Thoracic radiotherapy was delivered with 1.8 Gy daily fractions to a total dose of $54{\sim}59.4\;Gy$ in $6{\sim}7$ weeks (median: 59.4 Gy). $\underline{Results}$: The follow up period was $6{\sim}63$ months (median: 21 months). After the induction of chemotherapy, 41.0% (16 patients) showed a partial response and 59.0% (23 patients) had stable disease. After concurrent chemoradiotherapy, 10.3% (4 patients) had a complete response, 41.0% (16 patients) had a partial response, and the overall response rate was 51.3% (20 patients). The 1-, 2-, 3-year overall survival rates were 66.7%, 40.6%, and 27.4% respectively, with a median survival time of 20 months. The 1-, 2-, 3-year progression free survival rates were 43.6%, 24.6%, and 24.6%, respectively, with median progression free survival time of 10.7 months. Induction chemotherapy was well tolerated. Among 39 patients who completed the entire treatment including chemoradiotherapy, 46.3% (18 patients) had esophagitis greater than grade 3 and 28.2% (11 patients) had radiation pneumonitis greater than grade 3. $\underline{Conclusion}$: Paclitaxel and cisplatin with induction chemotherapy followed by concurrent chemoradiotherapy for stage IIIB NSCLC seems to be an effective treatment. Occurrence of esophagitis and pneumonitis represents a significant morbidity and suggests a modification of the treatment regimen, either with the chemotherapy schedule or with radiotherapy treatment planning.

Dosimetric Comparison of Left-sided Whole Breast Irradiation using a Virtual Bolus with VMAT and static IMRT (좌측 유방의 세기변조 방사선치료 시 Virtual Bolus 적용에 따른 선량 변화 비교 평가)

  • Lim, Kyeong Jin;Kim, Tae Woan;Jang, Yo Jong;Yang, Jin Ho;Lee, Seong Hyeon;Yeom, Du Seok;Kim, Seon Yeong
    • The Journal of Korean Society for Radiation Therapy
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    • v.31 no.2
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    • pp.51-63
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    • 2019
  • Purpose: Radiation therapy for breast cancer should consider the change in breast shape due to breathing and swelling. In this study, we evaluate the benefit of using virtual bolus for IMRT of left breast cancer. Materials and methods: 10 patients with early breast cancer who received radiation therapy after breastconserving surgery compared the VMAT and IMRT plans using the virtual bolus method and without using it. The first analysis compared the V95%, HI, CI of treatment volume, Dmean, V5, V20, V30 of ipsilateral lung, and Dmean of heart in VMAT plan made using the virtual bolus method(VMAT_VB) to the plan without using it(VMAT_NoVB) in case there is no change in the breast. In IMRT, the same method was used. The second analysis compared TCP and NTCP based on each treatment plan in case there is 1cm expansion of treatment volume. Result: If there is no change in breast, V95% in VB Plan(VMAT_VB, IMRT_VB) and NoVB Plan(VMAT_NoVB, IMRT_NoVB) is all over 99% on each treatment plan. V95% in VMAT_NoVB and VMAT_VB is 99.80±0.17% and 99.75±0.12%, V95% in IMRT_NoVB and IMRT_VB is 99.67±0.26% and 99.51±0.15%. Difference of HI, CI is within 3%. OAR dose in VB plan is a little high than NoVB plan, and did not exceed guidelines. If there is 1cm change in breast, VMAT_NoVB and IMRT_NoVB are less effective for treatment. But VMAT_VB and IMRT_VB continue similar treatment effect compared in case no variation of breast. Conclusion: This study confirms the benefit of using a virtual bolus during VMAT and IMRT to compensate potential breast shape modification.

Concurrent Chemoradiotherapy with Biweekly Gemcitabine and Cisplatin in Patients with Locally Advanced Non-small Cell Lung Cancer (진행성 비소세포폐암 환자에서 Gemcitabine/Cisplatin을 이용한 동시 화학 방사선 요법)

  • Oak, Chul-Ho;Kim, Ja-Kyung;Jang, Lee-La;Moon, Dae-Sung;Jang, Tae-Won;Jung, Maan-Hong;Cho, Sung-Whan;Jeung, Tae-Sig
    • Radiation Oncology Journal
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    • v.26 no.3
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    • pp.160-165
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    • 2008
  • Purpose: In cases of locally advanced non-small cell lung cancer (NSCLC), concurrent chemoradiotherapy(CCRT) is the leading therapeutic modality. However, much controversy exists about the chemotherapeutic regimens and radiation methods. Materials and Methods: During concurrent chemoradiotherapy, three or four cycles of gemcitabine ($500\;mg/m^2$) and cisplatin ($30\;mg/m^2$) were administered every two weeks while 50.4 Gy of irradiation was administered in 28 fractions (once/day, 5 treatment days/week) to the tumor site, mediastinum, and the involved lymph node region. In addition, a booster irradiation dose of 18 Gy in 10 fractions was administered to the primary tumor site unless the disease progressed. Two or three cycles of consolidation chemotherapy were performed with gemcitabine ($1,200\;mg/m^2$, $1^{st}$ and 8th day) and cisplatin ($60\;mg/m^2$) every three weeks. Results: A total of 29 patients were evaluable for modality response. Response and treatment toxicities were assessed after concurrent chemoradiotherapy and consolidation chemotherapy, respectively. One patient (4%) achieved a complete response; whereas 20 patients (69%) achieved a partial response after concurrent chemoradiotherapy. Following the consolidation chemotherapy, three patients (10.3%) achieved complete responses and 21 patients (72.4%) achieved partial responses. The median follow-up period was 20 months (range $3{\sim}39$ months) and the median survival time was 16 months (95% CI; $2.4{\sim}39.2$ months). The survival rates in one, two, and three years after the completion of treatment were 62.7%, 43.9%, and 20%, respectively. Complications associated to this treatment modality included grade 3 or 4 esophagitis, which occurred in 15 patients (51.7%). In addition, an incidence of 24% for grade 3 and 14% for grade 4 neutropenia. Lastly, grade 2 radiation pneumonitis occurred in 6 patients (22%). Conclusion: The response rate and survival time of concurrent chemoradiotherapy with biweekly gemcitabine ($500\;mg/m^2$) and cisplatin ($30\;mg/m^2$) were encouraging in patients with locally advanced NSCLC. However, treatment related toxicities were significant, indicating that further modification of therapy seems to be warranted.

An Experimental Study on Radioprotective Effect of DDC, MEA, and WR-2721 (DDC, MEA, WR-2721의 방사선(放射線) 방호효과(防護效果)에 관(關)한 연구(硏究))

  • Chung, In-Young;Koh, Joo-Hwan;Chung, Hyun-Woo;Chil, Soo-Yil;Yoo, Seong-Yul;Koh, Kyoung-Hwan
    • Journal of Radiation Protection and Research
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    • v.11 no.2
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    • pp.114-122
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    • 1986
  • At present, the treatments of the radiation-induced diseases are only performing by the palliative treatment technique. Moreover, radiation protective agents are a little toxic for human being and this seriously limits their applicability with various complications in clinical uses. Accordingly, as a part of the aim of gain of the basic data for protective roles of some radioprotectors, the present investigation was carried out to evaluate the comparative radioprotective effects by the administration of DDC, MEA, WR-2721. Results are shown for statistically significant analysis and correlation with each group as follows; 1. The proper doses of the radioprotectors were DDC; 1,550 mg/kg, MEA; 450 mg/kg, WR-2721; 780 mg/kg of the mouse body weight. 2. DMF(Dose modification factor) of LD 50/10 and LD 50/30 for whole body irradiation was DDC; 1.2, MEA; 1.4, WR-2721; 1.9 and DDC; 1.7, MEA; 1.8, WR-2721; 2.5 respectively. 3. DMF for radiation reaction of jejunal crypt was DDC: 1.07, MEA: 1.21 and WR-2721: 1.76 and that of jejunal crypt cell was DDC: 1.04, MEA: 1.08 and WR-2721: 1.38 respectively. 4. Conclusively, WR-2721 was the most effective drung among the three radioprotectors and this result must be a supportive data for further study for clinical application.

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Concurrent Docetaxel/Cisplatin and Thoracic Radiotherapy for Locally Advanced Non-Small Cell Lung Cancer (국소 진행성 비소세포 폐암에서 Docetaxel Cisplatin을 사용한 화학-방사선 동시치료의 효과)

  • Jang, Tae Won;Park, Jung Pil;Kim, Hee Kyoo;Ok, Chul Ho;Jeung, Tae Sig;Jung, Maan Hong
    • Tuberculosis and Respiratory Diseases
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    • v.57 no.3
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    • pp.257-264
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    • 2004
  • Background : There are many combinations of treatment for locally advanced non-small cell lung cancer (NSCLC). Recent studies have showed the efficacy of concurrent chemoradiotherapy (CCRT) in NSCLC. At present, however, there is no consensus about the optimal dosages and timing of radiation and chemotherapeutic agents. The aims of study were to determine the feasibility, toxicity, response rate, and survival rate in locally advanced NSCLC patients treated with doxetaxel and cisplatin based CCRT. Method : Sixteen patients with unresectable stage III NSCLC were evaluated from May 2000 until September 2001. Induction chemoradiotherapy consisted of 3 cycles of docetaxel (75 $mg/m^2/IV$ on day 1) and cisplatin (60 $mg/m^2/IV$ on day 1) chemotherapy every 3 weeks and concomitant hyperfractionated chest irradiation (1.15 Gy/BID, total dose of 69 Gy) in 6 weeks. Patient who had complete or partial response, and stable disease were applied consolidation chemotherapy of docetaxel and cisplatin. Results : All patients showed response to CCRT. Four patients achieved complete response (25%), partial responses in 12 patients (75%). The major common toxicities were grade III or more of neutropenia (87.3%), grade III esophagitis (68.8%), pneumonia (18.8%) and grade III radiation pneumonitis (12.5%). Thirteen patients were ceased during follow-up period. Median survival time was 19.9 months (95% CI; 4.3-39.7 months). The survival rates in one, two, and three years are 68.7%, 43.7%, and 29.1%, respectively. Local recurrence was found in 11 patients (66.8%), bone metastasis in 2, and brain metastasis in 1 patient. Conclusion : The response rate and survival time of CCRT with docetaxel/cisplatin in locally advanced NSCLC were encouraging, but treatment related toxicities were high. Further modification of therapy seems to be warranted.

Roles of Perceived Use Control consisting of Perceived Ease of Use and Perceived Controllability in IT acceptance (정보기술 수용에서 사용용이성과 통제가능성을 하위 차원으로 하는 지각된 사용통제의 역할)

  • Lee, Woong-Kyu
    • Asia pacific journal of information systems
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    • v.18 no.2
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    • pp.1-14
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    • 2008
  • According to technology acceptance model(TAN) which is one of the most important research models for explaining IT users' behavior, on intention of using IT is determined by usefulness and ease of use of it. However, TAM wouldn't explain the performance of using IT while it has been considered as a very good model for prediction of the intention. Many people would not be confirmed in the performance of using IT until they can control it at their will, although they think it useful and easy to use. In other words, in addition to usefulness and ease of use as in TAM, controllability is also should be a factor to determine acceptance of IT. Especially, there is a very close relationship between controllability and ease of use, both of which explain the other sides of control over the performance of using IT, so called perceived behavioral control(PBC) in social psychology. The objective of this study is to identify the relationship between ease of use and controllability, and analyse the effects of both two beliefs over performance and intention in using IT. For this purpose, we review the issues related with PBC in information systems studies as well as social psychology, Based on a review of PBC, we suggest a research model which includes the relationship between control and performance in using IT, and prove its validity empirically. Since it was introduced as qa variable for explaining volitional control for actions in theory of planned behavior(TPB), there have been confusion about concept of PBC in spite of its important role in predicting so many kinds of actions. Some studies define PBC as self-efficacy that means actor's perception of difficulty or ease of actions, while others as controllability. However, this confusion dose not imply conceptual contradiction but a double-faced feature of PBC since the performance of actions is related with both self-efficacy and controllability. In other words, these two concepts are discriminated and correlated with each other. Therefore, PBC should be considered as a composite concept consisting of self-efficacy and controllability, Use of IT has been also one of important areas for predictions by PBC. Most of them have been studied by analysis of comparison in prediction power between TAM and TPB or modification of TAM by inclusion of PBC as another belief as like usefulness and ease of use. Interestingly, unlike the other applications in social psychology, it is hard to find such confusion in the concept of PBC in the studies for use of IT. In most of studies, controllability is adapted as PBC since the concept of self-efficacy is included in ease of use explicitly. Based on these discussions, we can suggest perceived use control(PUC) which is defined as perception of control over the performance of using IT and composed of controllability and ease of use as sub-concepts. We suggest a research model explaining acceptance of IT which includes the relationships of PUC with attitude and performance of using IT. For empirical test of our research model, two user groups are selected for surveying questionnaires. In the first group, there are freshmen who take a basic course for Microsoft Excel, and the second group consists of senior students who take a course for analysis of management information by Excel. Most of measurements are adapted ones that have been validated in the other studies, while performance is real score of mid-term in each class. In result, four hypotheses related with PUC are supported statistically with very low significance level. Main contribution of this study is suggestion of PUC through theoretical review of PBC. Specifically, a hierarchical model of PUC are derived from very rigorous studies in the relationship between self-efficacy and controllability with a view of PBC in social psychology. The relationship between PUC and performance is another main contribution.

Comparison of Liver, Kidney, Bone Metal Concentration in OhJeokSan-Treated Rats (오적산(五積散)을 투여한 흰쥐의 간장, 신장, 골중 금속농도 비교에 관한 연구)

  • Park Chul-Soo;Lee Sun-Dong;Park Hae-Mo;Park Yeong-Chul
    • Journal of Society of Preventive Korean Medicine
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    • v.6 no.2
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    • pp.66-85
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    • 2002
  • Traditional herbal medicine is used extensively among the Korean populations, and other Asian countries employ similar therapies as well In recent years, extensive focus was laid on adulteration of the herbal medicine with heavy metals. This may be mainly due to a soil contamination by an environmental pollution. The objective of this study is to identify the contents of various heavy metals in the blood from OhJeokSan-Decoction (OD) treated-rats. For this study, 13 kinds of metals including essential and heavy metals, i.e. Al, As, Cd, Co, Cr, Cu, Fe, Hg, Mn, Ni, Pb, Se and Zn were analyzed by a slight modification of EPA methods and the following results are obtained. ; 1. There is no significant difference between the OD-treated groups and control group in liver, kidney, bone, brain, weight, food intake. 2. The amount of each metal analyzed in the liver are as follows; Al ; $0.235{\sim}4.215mg/kg$, As ; $0.103{\sim}0.461mg/kg$, Cd ; $0.005{\sim}0.010mg/kg$, Co ; $0.017{\sim}0.046mg/kg$, Cr ; $0.137{\sim}0.403mg/kg$, Cu ; $1.736{\sim}4.827mg/kg$, Fe ; $54.472{\sim}381.447mg/kg$, Hg ; not detected, Mn ; $1.159{\sim}2.803mg/kg$, Ni ; $0.007{\sim}0.095mg/kg$, Pb ; not detected, Se ; $0.682{\sim}1.887mg/kg$, Zn ; $10.213{\sim}26.119mg/kg$, by groups, respectively. In control and other experimental group, several metal (Co, Cu, Mn, Zn, As, Cr) has a significant difference, but in experimental I and other experimental II, III, IV, V groups, there are no significant difference. 3. The amount of each metal analyzed in the kidney are as follows; Al ; $1.712{\sim}31.230mg/kg$, As ; $0.062{\sim}0.439mg/kg$, Cd ; $0.010{\sim}0.062mg/kg$, Co ; $0.000{\sim}0.101mg/kg$, Cr ; $0.125{\sim}0.636mg/kg$, Cu ; $3.385{\sim}12.502mg/kg$, Fe ; $41.148{\sim}99.709mg/kg$, Hg ; $0.000{\sim}0.270mg/kg$, Mn ; $0.433{\sim}2.301mg/kg$, Ni ; $0.000{\sim}0.221mg/kg$, Pb ; $0.000{\sim}0.584mg/kg$, Se ; $0.540{\sim}1.600mg/kg$, Zn ; $8.775{\sim}17.060mg/kg$, by groups, respectively. The concentration of Cu, Se, Cr, and Hg are variated significantly in control and other experimental group, and Cu, Se, Cd, Cr are variated significantly in experimental I and other experimental II, III, IV, V groups. 4. The amount of each metal analyzed in the bone(tibia and fibula) are as follows; Al ; $9.557{\sim}119.464mg/kg$, As ; $0.139{\sim}12.250mg/kg$, Cd ; $0.000{\sim}0.295mg/kg$, Co ; $0.022{\sim}0.243mg/kg$, Cr ; $0.239{\sim}1.999mg/kg$, Cu ; $0.000{\sim}2.291mg/kg$, Fe ; $240.249{\sim}841.956mg/kg$, Hg ; $0.000{\sim}0.983mg/kg$, Mn ; $0.214{\sim}7.353mg/kg$, Ni ; $5.473{\sim}11.453mg/kg$, Pb ; $0.000{\sim}8.502mg/kg$, Se ; $0.000{\sim}3.005mg/kg$, Zn ; $61.158{\sim}195.038mg/kg$, by groups, respectively. The concentration of Se, Cd are variated significantly in control and other experimental groups, and Se is variated significantly in experimental I and other experimental II, III, IV, V groups. 5. Exceptionally several metal concentration is increased or decreased. but there is no significant harmful difference of metal concentration in the liver, kidney and bone, from the OD-treated-rats compared to those of the control group even if higher dosage($1{\sim}8$ times dosage of person) of OD was administered. Thus, it is expected that the herbal decoction in the traditional herbal medicine would not lay any burden on the body and the heavy metal toxins would not affect our physiological system. However, other kinds of herbal treatment, such as i.v. and i.p. should be considered in terms of metal toxicity in the body since the level of certain metal.

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