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The effects of adjuvant therapy and prognostic factors in completely resected stage IIIa non-small cell lung cancer (비소세포 폐암의 근치적 절제술 후 예후 인자 분석 및 IIIa 병기에서의 보조 요법의 효과에 대한 연구)

  • Cho, Se Haeng;Chung, Kyung Young;Kim, Joo Hang;Kim, Byung Soo;Chang, Joon;Kim, Sung Kyu;Lee, Won Young
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.5
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    • pp.709-719
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    • 1996
  • Background: Surgical resection is the only way to cure non-small cell lung cancer(NSCLC) and the prognosis of NSCLC in patients who undergo a complete resection is largely influenced by the pathologic stage. After surgical resection, recurrences in distant sites is more common than local recurrences. An effective postoperative adjuvant therapy which can prevent recurrences is necessary to improve long tenn survival Although chemotherapy and radiotherapy are still the mainstay in adjuvant therapy, the benefits of such therapies are still controversial. We initiated this retrospective study to evaluate the effects of adjuvant therapies and analyze the prognostic factors for survival after curative resection. Method: From 1990 to 1995, curative resection was perfomled in 282 NSCLC patients with stage I, II, IIIa, Survival analysis of 282 patients was perfonned by Kaplan-Meier method. The prognostic factors, affecting survival of patients were analyzed by Cox regression model. Results: Squamous cell carcinoma was present in 166 patients(59%) ; adenocarcinoma in 86 pmients(30%) ; adenosquamous carcinoma in II parients(3.9%); and large cell undifferentiated carcinoma in 19 patients(7.1%). By TNM staging system, 93 patients were in stage I; 58 patients in stage II ; and 131 patients in stage rna. There were 139 postoperative recurrences which include 28 local and 111 distant failures(20.1% vs 79.9%). The five year survival rate was 50.1% in stage I ; 31.3% in stage II ; and 24.1% in stage IIIa(p <0.0001). The median survival duration was 55 months in stage I ; 27 months in stage II ; and 16 months in stage rna. Among 131 patients with stage rna, the median survival duration was 19 months for 81 patients who received postoperative adjuvant chemotherapy only or cherne-radiotherapy and 14 months for the other 50 patients who received surgery only or surgery with adjuvant radiotherapy(p=0.2982). Among 131 patients with stage IIIa, the median disease free survival duration was 16 months for 21 patients who received postop. adjuvant chemotherapy only and 4 months for 11 patients who received surgery only(p=0.0494). In 131 patients with stage IIIa, 92 cases were in N2 stage. The five year survival rate of the 92 patients with N2 was 25% and their median survival duration was 15 months. The median survival duration in patients with N2 stage was 18 months for those 62 patients who received adjuvant chemotherapy and 14 months for the other 30 patients who did not(p=0.3988). The median survival duration was 16 months for those 66 patients who received irradiation and 14 months for the other 26 patients who did not(p=0.6588). We performed multivariate analysis to identify the factors affecting prognosis after complete surgical resection, using the Cox multiple regression model. Only age(p=0.0093) and the pathologic stage(p<0.0001) were significam prognostic indicators. Conclusion: The age and pathologic stage of the NSCLC parients are the significant prognostic factors in our study. Disease free survival duration was prolonged with statistical significance in patients who received postoperative adjuvant chemotherapy but overall survival duration was not affected according to adjuvant therapy after surgical resection.

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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.

Environmental Pollution in Korea and Its Control (우리나라의 환경오염 현황과 그 대책)

  • 윤명조
    • Proceedings of the KOR-BRONCHOESO Conference
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    • 1972.03a
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    • pp.5-6
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    • 1972
  • Noise and air pollution, which accompany the development of industry and the increase of population, contribute to the deterioration of urban environment. The air pollution level of Seoul has gradually increased and the city residents are suffering from a high pollution of noise. If no measures were taken against pollution, the amount of emission of pollutant into air would be 36.7 thousand tons per year per square kilometer in 1975, three times more than that of 1970, and it would be the same level as that of United States in 1968. The main sources of air pollution in Seoul are the exhaust has from vehicles and the combustion of bunker-C oil for heating purpose. Thus, it is urgent that an exhaust gas cleaner should be instaled to every car and the fuel substituted by less sulfur-contained-oil to prevent the pollution. Transportation noise (vehicular noise and train noise) is the main component of urban noise problem. The average noise level in downtown area is about 75㏈ with maximum of 85㏈ and the vehicular homing was checked 100㏈ up and down. Therefore, the reduction of the number of bus-stop the strict regulation of homing in downtown area and a better maintenance of car should be an effective measures against noise pollution in urban areas. Within the distance of 200 metres from railroad, the train noise exceeds the limit specified by the pollution control law in Korea. Especially, the level of noise and steam-whistle of train as measured by the ISO evaluation can adversely affect the community activities of residents. To prevent environmental destruction, many developed countries have taken more positive action against worsening pollution and such an action is now urgently required in this country.

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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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Effect of EGF and IGF-I on in vitro Maturation of Porcine Oocytes and Development of Porcine IVM/IVF Embryos (EGF와 IGF-I의 첨가배양이 돼지 미성숙 난포란의 체외성숙과 배발달에 미치는 영향)

  • Baek, Jun-Jong;Han, Man-Hye;Park, Byung-Kwon;Seo, Kil-Woog;Lee, Kyu-Seung
    • Korean Journal of Agricultural Science
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    • v.34 no.1
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    • pp.19-35
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    • 2007
  • The present study was carried out to examine the effect of EGF and IGF-I in vitro maturation (IVM) of porcine oocytes and development of porcine IVM/IVF embryos. The results were summarized as follows : 1. The rates of nuclear maturation, penetrated oocytes, pronuclear formation, polyspermic oocytes and mean numbers of the penetrated sperm were not different in NCSU-23 maturation medium with 0, 1, 5 and 10 ng/ml EGF and IGF-I (P>0.05). 2. The rates of blastocyst formation at day 7 after in vitro fertilization in 0, 1, 5 and 10 ng/ml EGF groups were $11.2{\pm}1.5%$, $15.0{\pm}8.3%$, $16.8{\pm}2.8%$ and $21.4{\pm}2.0%$, also 0, 1, 5 and 10 ng/ml IGF-I groups were $11.2{\pm}1.5%$, $15.0{\pm}8.3%$, $16.8{\pm}2.8%$ and $21.4{\pm}2.0%$, respectively. In the total cells case, EGF groups were $22.8{\pm}3.7$, $25.7{\pm}5.5$, $26.0{\pm}4.2$ and $35.1{\pm}4.7$, also IGF-I groups were $21.5{\pm}3.7$, $25.2{\pm}2.8$, $26.2{\pm}2.9$ and $33.2{\pm}3.6$, respectively. Both 10 ng/ml EGF group and 10 ng/ml IGF-I group were significantly higher than those of other treatment groups (P<0.05). 3. The rates of blastocyst formation at day 7 in the NCSU23 culture medium of porcine IVF-produced embryos with 0, 1, 5, and 10 ng/ml EGF groups were $14.0{\pm}1.7%$, $16.2{\pm}1.4%$, $16.9{\pm}1.2%$ and $23.1{\pm}1.6%$, also 0, 1, 5, 10 ng/ml IGF-I groups were $13.6{\pm}1.7$, $15.7{\pm}4.5$, $16.0{\pm}0.2$ and $25.0{\pm}0.8$, respectively. And in the total cells case, EGF grups were $21.8{\pm}2.9$, $25.2{\pm}2.8$, $39.7{\pm}2.7$ and $46.2{\pm}3.6$, also IGF-I groups were $20.7{\pm}2.9$, $26.2{\pm}2.9$, $24.6{\pm}2.4$ and $46.1{\pm}3.5$, respectively. Both 10 ng/ml EGF group and 10 ng/ml IGF-I group were significantly higher than those of any other treatment groups (P<0.05). In conclusion, these results suggested that the addition of 10 ng/ml EGF and IGF-I were effective on the blastocyst formation and total cells of blastocysts.

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Tissue Culture Method as a Possible Tool to Study Herbicidal Behaviour and Herbicide Tolerance Screening (조직배양(組織培養) 방법(方法)을 이용(利用)한 제초제(除草劑) 작용성(作用性) 및 제초제(除草劑) 저항성(抵抗性) 검정방법(檢定方法) 연구(硏究))

  • Kim, S.C.;Lee, S.K.;Chung, G.S.
    • Korean Journal of Weed Science
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    • v.6 no.2
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    • pp.174-190
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    • 1986
  • A series of laboratory and greenhouse experiments were conducted to find out the possibility of tissue culture and cell culture methods as a tool to study herbicidal behaviour and herbicide tolerance screening from 1985 to 1986 at the Yeongnam Crop Experiment Station. For dehulled-rice culture, pure agar medium was the most appropriate in rice growth campared to other media used for plant tissue culture method. All the media but the pure agar medium resulted in growth retardance by approximately 50% and this effect was more pronounced to root growth than shoot growth. Herbicidal phytotoxicity was enhanced under light condition for butachlor, 2.4-D, and propanil while this effect was reversed for DPX F-5384 and CGA 142464, respectively. And also, herbicides of butachlor, chlornitrofen, oxadiazon, and BAS-514 resulted in more phytotoxic effect when shoot and root of rice were exposed to herbicide than root exposure only while other used herbicides exhibited no significant difference between two exposure regimes. Similar response was obtained from Echinochloa crusgalli even though the degree of growth retardance was much greater. Particularly, butachlor, 2.4-D, chlornitrofen, oxadiaxon, pyrazolate and BAS-514 totally inhibited chlorophyll biosynthesis even at the single contact of root. Apparent cultivar differences to herbicide were observed at the young seedling culture method and dehulled rice cultivars were more tolerant in DPX F-5384, NC-311, pyrazolate and pyrazoxyfen, respectively. For derant than other types or rice cultivar in butachlor, pretilachlor, perfluidone and oxadiazon while Tongil-type rice cultivars were more tolerant in DPXF-5384, NC-311, Pyrazolate and Pyrazoxyfen, respectively. For dehulled rice culture, on the other hand, Japonica-type rice cultivar was less tolerant to herbicides of butachlor, propanil, chlornitrofen and oxadiazon that was reversed trend to young seedling culture test. Cultivar differences were also exhibited within same cultivar type. In general, relatively higher tolerant cultivars were Milyang 42, Cheongcheongbyeo, Samgangbyeo, Chilseoungbyeo for Tongil-type, Somjinbyeo for Japonica-type and IR50 for Indica-type, respectively. The response of callus growth showed similar to dehulled rice culture method in all herbicides regardless of property variables. However, concentration response was much sensitive in callus response. The concentration ranges of $10^{-9}M-10^(-8)M$ were appropriate to distinguish the difference between herbicides for E. crusgalli callus growth. Among used herbicides, BAS-514 was the most effective to E. crusgalli callus growth. Based on the above results, tissue culture method could be successfully used as a tool for studying herbicidal behaviour and tolerance screening to herbicide.

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Treatment Results of Ovarian Dysgerminoma (난소 미분화세포종의 치료 결과)

  • Chung, Eun-Ji;Suh, Chang-Ok;Seong, Jin-Sil;Keum, Ki-Chang;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.14 no.3
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    • pp.221-228
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    • 1996
  • Purpose : We tried to evaluate the clinical characteristics, the treatment methods, the results of treatments, and the Patterns of failure in ovarian dysgerminoma retrospectively According to the results we would like to suggest the proper management guideline of stage la ovarian dysgerminoma patients who want to maintain fertility. Materials and Methods : Between 1975 and 1990, 34 patients with ovarian dysgerminoma were treated at the Yonsei University Hospital. The case records of these patients have been reviewed for presenting symptoms, treatment methods, local control and survival following treatment. Excluded from analysis were five patients with mixed ovarian germ cell tumors and gonadoblastomas (46,XY) Treatment results of the twenty nine patients were analysed by each treatment modality. Twenty one patients were treated with surgery and postoperative adjuvant radiotherapy (group 2). The other eight patients were treated with operation alone (group 2). The median age of twenty-nine patients was 23 years with a range of 8 to 39 years. Presenting symptoms were abdominal mass (20) pelvic discomfort or pain (5) et al. Radiotherapy was performed by 10MV LINAC or Co-60 teletherapy unit. The total radiation dose of the whole abdomen was 20-25 Gy/3weeks, 1-1.5 Gy/fraction with a boost to the whole pelvis 10-15 Gy/l-2weeks 1.8-2.0 Gy/fraction. Advanced stage disease (stage II or stage III) patients received prophylactic mediastinal and supraclavicular irradiation to a dose of 16-26 Gy. Median duration of follow-up of living patients was 80 months (range 13-201 months). Results : All of the twenty one patients of group 1 were alive without disease ($100\%$). Among the eight patients who were not treated with radiotherapy (group 2), six patients developed local recurrence. Four Patients referred with recurrent disease were treated with salvage radiotherapy. Three of four patients were salvaged and one Patient who had recurrent intra-abdominal disease died of progressed carcinomatosis at 11 months after salvage radiotherapy. The other two patients with recurrence were salvaged with chemotherapy (1 patient) or re-operation (1 Patient). Twenty eight patients remained alive without disease at last follow up, so the 5 year local control rate and 5 year overall survival rate for all groups were $96.6\%$ (28/29), respectively. Among thirteen patients with stage la unilateral tumors seven patients were treated with postoperative radiotherapy and the other six patients were treated with unilateral salpingo-oophorectomy alone. Five patients who did not received radiotherapy developed local failure but all of the recurrent ovarian dysgerminomas were salvaged with radiotherapy, chemotherapy or re-operation. So all the 13 patients with stage la ovarian dysgerminoma were free of disease from 20-201 months (median 80 months). Conclusion : The authors consider external irradiation to be an effective treatment as a complement to surgery in ovarian dysgerminoma. For those patients with disease presenting in stage la tumors who wish to maintain fertility, unilateral salpingo-oophorectomy alone may be curative and spare ovarian function considering excellent salvage rate of recurrent ovarian dysgerminoma in present study.

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The Effects of Preoperative Radiation Therapy in Resectable Rectal Cancer - in view of pathologic aspects - (절제 가능한 직장암에서 수술전 방사선 치료의 효과 -병리 조직학적인 연구를 중심으로-)

  • Choi, Ihl-Bong;Jang-Ji-Young;Kim, In-Ah;Shinn-Kyung-Sub;Lee, Jong-Suh;Chang-Suk-Kyun;Choi, Kyu-Young;Kim, Young-Ha;Kim, Jun-Gi;Chun-Chung-Soo;Kay-Chul-Seung
    • Radiation Oncology Journal
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    • v.15 no.1
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    • pp.49-56
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    • 1997
  • Purpose : To evaluate the pathologic effects of preoperative radiotherapy o the resectable distal rectal cancer, we analyzed the results of postoperative pathologic findings for the patients with preoperative radiotherapy ant surgery Materials and Methods: From July 1995 to April 1996, we treated sixteen patients of resectable rectal cancer with preoperative radiation therapy and curative surgery At diagnosis, Thomas Jefferson (TJ) system was used for the clinical stage of the Patients. We treated the patients with conventional radiation therapy of 4500~5000cGy before surgery. The surgery was carried out 4 weeks after completion of radiation therapy. Modified Astler Coller (MAC) system was used for the postoperative pathologic stage. We analyzed the pathologic stages and findings according to preoperative clinical stage and compared with those of the control group in similar clinical stages. Result : All patients were treated with sphincter preservation surgery after Preoperative radiation therapy. Pathoiogic complete response (CR) was shown in 1 case $(6.3\%)$. We compared the results between preoperative radiation therapy group (Preop.RT group) and surgery only group (control group). In TJ stage II, among nine patients of Preop.RT group, 8 patients $(88.9\%)$ were in MAC stage 8 except 1 CR patient, but among 17 patients of control group. 11 patients$(64.7\%)$ were in MAC stage B and 6 Patients $(35.3\%)$ in MAC stage C. In TJ stage III, among 7 patients of Preop.RT group, 4 patients $(57.1\%)$ were in MAC stage B and 3 patients$(42.9\%)$ in MAC stage C. Among 14 Patients of control group, 4 patients $(28.6\%)$ were in MAC stage B and 10 Patients $(71.4\%)$ in MAC stage C. Above results showed that postoperative Pathologic stage was decreased in Preop.RT group with statistical significance (P=0.049). The postoperative Pathologic findings (blood vessel invasion. Iymphatic vessel invasion, perineural invasion) were decreased in the Preop.RT group compared with those of control group. But statistical significance was found only in Iymphatic vessel invasion (p=0.019). Conclusion : The Postoperative pathologic stages and adverse Prognostic pathologic findings were decreased in preoperative radiation therapy group. The Iymphatic vessel invasion and MAC stage C findings were abruptly decreased in Preoperative radiation therapy group. The preoperative radiation therapy was found to be effective in resectable rectal cancer. The patients group in our study was very small and long term follow up was not done. Therefore, further study about this issues is needed.

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The Results of Hyperfractionated Radiotherapy on Locally Advanced Non-Small Cell Lung Cancer (국소적으로 진행된 비소세포 폐암에 대한 과분할 방사선 치료의 성적)

  • Hur, Won-Joo;Lee, Hyung-Sik;Kim, Jeong-Ki;Choi, Young-Min;Lee, Ho-Jun;Youn-Seon-Min;Kim, Jae-seok;Kim, Hyo-Jin;Woo-Jong-Soo;Choi, Pill-Jo;Lee, Ki-Nam
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.275-282
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    • 1998
  • Purpose : The effect of hyperfractionated radiotherapy on locally advanced non-small lung cancer was studied by a retrospective analysis. Materials & Methods : We analyzed sixty one patients of biopsy-confirmed, IIIA and IIIB non-small cell lung cancer. Using the ECOG performance scale, all the patients were scored less than 2. They were treated by curative hyperfractionated radiotherapy alone from Oct. 1992 to Oct. 1995 at the Department of Radiation Oncology. All the patients received 120cGy b.i.d with more than 6 hours interval between each fraction. The total dose of radiation was reached up to 6400-7080 cGy with a mean dose of 6934 cGy. The results were analyzed retrospectively. Results : The overall survival rate was 53 1$\%$ in 1 year, 9.9$\%$ in 2 years with a median survival time (MST) of 13.9 months. The progression free survival (PFS) rate was 37.0$\%$ in 1 year, 8.9$\%$ in 2 years. Twenty two Patients were classified as complete responders to this treatment and their MST was 19.5 months When this was compared with that of partial responders (MST: 11 7months), it was statistically significant (p=0.0003). Twenty nine patients of stage IIIA showed a better overall survival rate (1yr 63.3$\%$, 2yr 16.8$\%$) than IIIB patients (1yr 43.3$\%$, 2yr 3.6$\%$), which was also statistically significant (p=0.003). Patients with adenocarcinoma showed a better survival rate (1yr 64.3$\%$, 2yr 21.4$\%$) than that of squamous cell counterpart (1yr 49.4$\%$, 2yr 7.4$\%$), although this was not significant statistically (p=0.61). Two patients developed fatal radiation-induced pneumonia right after the completion of the treatment which progressed rapidly and they all died within 2 months. One patient developed radiation-induced fibrosis after 13 months. He refused further treatment and died soon after the development of fibrosis. Conclusion : Among locally advanced NSCLC, hyperfractionated radiotherapy was effective on stage IIIA patients by increasing MST with acceptable toxicities. Acute radiation-induced pneumonia should be carefully monitored and must be avoided during or after this treatment.

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Radiotherapy in Medically Inoperable Early Stage Non-small Cell Lung Cancer (내과적 문제로 수술이 불가능한 조기 비소세포성 폐암에서의 방사선치료)

  • Kim, Bo-Kyoung;Park, Charn-Il
    • Radiation Oncology Journal
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    • v.18 no.4
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    • pp.257-264
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    • 2000
  • Purpose: For early stage non-small-cell lung cancer, surgical resection is the treatment of choice. But when the patients are not able to tolerate it because of medical problem and when refuse surgery, radiation therapy is considered an acceptable alternative. We report on the treatment results and the effect of achieving local control of primary tumors on survival end points, and analyze factors that may influence survival and local control. Materials and Method : We reviewed the medical records of 32 patients with medically inoperable non-small cell lung cancer treated at our institution from June, 1987 through June, 1997. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidate for surgical resection because of either patients refusal (4), old age (2), lung problem (21), chest wail invasion (3) and heart problems (3). In 8 patients, there were more than 2 problems. The median age of the patients was 68 years (ranging from 60 to 86 years). Histologic cell type included souamous (24), adenocarcinoma (6) and unclassiried squamous cell (2). The clinical stages of the patients were 71 in 5, 72 in 25, 73 in 2 patients. Initial tumor size was 3.0 cm in 11, between 3.0 cm and 5.0 cm in 13 and more than 5.0 cm in 8 patients. Ail patients had taken chest x-rays, chest CT, abdomen USG and bone scan. Radiotherapy was delivered using 6 MV or 10 MV linear accelerators. The doses of primary tumor were the ranging from 54.0 Gy to 68.8 Gy (median; 61.2 Gy). The duration of treatment was from 37 days through 64 days (median; 0.5 days) and there was no treatment interruption except 1 patient due to poor general status. In 12 patients, concomitant boost technique was used. There were no neoadjuvant or adjuvant treatments such as surgery or chemotherapy. The period of follow-up was ranging from 2 months through 93 months (median; 23 months). Survival was measured from the date radiation therapy was initiated. Results : The overall survival rate was 44.6$\%$ at 2 years and 24.5$\%$ at 5 years, with the median survival time of 23 months. of the 25 deaths, 7 patients died of intercurrent illness, and cause-specific survival rate was 61.0$\%$ at 2 years and 33.5$\%$ at 5 years. The disease-free survival rate was 38.9$\%$ at 2 years and 28.3$\%$ at 5 years. The local-relapse-free survival rate was 35.1$\%$, 28.1$\%$, respectively. On univariate analysis, tumor size was significant variable of overall survival (p=0.0015, 95$\%$ C.1.; 1.4814-5.2815), disease-free survival (P=0.0022, 95$\%$ C.1., 1.4707-5.7780) and local-relapse-free survival (p=0.0015, 95$\%$ C.1., 1.2910- 4.1197). 7 stage was significant variable of overall survival (p=0.0395, 95$\%$ C.1.; 1.1084-55.9112) and had borderline significance on disease-free survival (p=0.0649, 95$\%$ C.1.; 0.8888-50.7123) and local-relapse-free survival (p=0.0582, 95$\%$ C,1.; 0.9342-52.7755). On multivariate analysis, tumor size had borderline significance on overall survival (p=0.6919, 955 C.1., 0.9610-5.1277) and local-relapse-free survival ( p=0.0585, 95$\%$ C.1.; 0.9720-4.9657). Tumor size was also significant variable of disease-free survival (p=0.0317, 95% C.1.; 1.1028-8.4968). Conclusion : Radical radiotherapy is an effective treatment for small (71 or f3 cm) tumors and can be offered as alternative to surgery in elderly or infirmed patients. But when the size of tumor is larger than 5 cm, there were few long-term survivors treated with radiotherapy alone. The use of hypefractionated radiotherapy, endobronchial boost, radisensitizer and conformal or IMRT should be consider to improve the local control rate and disease-specific survival rate.

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