Purpose : To evaluate the result of conservative management on recurrence, survival and prognostic factors of patient with operable breast cancer. Materials and Methods : Fifty three patients, treated for localized breast cancer by lumpectomy or quadrantectomy followed by radiotherapy between January 1985 and December 1996, were retrospectively studied. All patients followed up for at least five years. Their median age was 43 years $(range\;24\~72)$. The tumor stages were as follows : T1 in 30 patients, T2 in 21, Tis in 2. Thirty-eight patients had negative and 15 had positive axillary nodes. The histological types were 42 infiltrating ductal, 2 infiltrating lobular, and 2 intraductal carcinomas with 7 other histologies. The tumor locations were the outer quadrant in 38 breasts, the inner quadrant in 13 and central in 2. Radiation doses of $46\~50\;Gy$ were given to the entire breast areas with additional doses of 14-18 Gy delivered to the tumor bed areas. Results : The overall five and 10 yea actuarial and disease free survivals were $94.3\%\;and\;92.4\%,\;91.2\%\;and\;81\%$, respectively. The overall five year survivals were $100\%$ in stage I and IIa, and $66.7\%$ in stage IIb and IIIa tumors. Seven patients failed either locally or distantly. Incidence of local failure and distant metastasis for the first failure were $7.5\%\;and\;5.7\%$, respectively. Local recurrence appeared within 2 years of treatment at the primary site and after more than 8 years outside of primary lesion, whereas distant metastasis appeared between 2 and 6 years following treatment. The overall recurrences were high at a young age (< or = 35 years), with 5 out of 12 (2 local, 3 distant), and in T2 lesions with 5 out of 21 (1 local, 3 distant, and 1 in both). Distant metastasis was high in the positive axillary lymph node group with 4 out of 15 $(26.6\%)$. A high incidence in the axillary node was noted at a young age with 7 out of 12 $(58.3\%)$ and in T2 lesions with 8 out of 21 $(38.4\%)$. A young age, positive axillary node and large tumor size were all related with poor survival. Conclusion : Based on this study, lumpectomy or quadrantectomy, followed by radiation appears to be an adequate therapeutic method in operable breast cancer. A long term follow-up is necessary because a recurrence of breast can occur long time after treatment. The poor prognostic group, especially young patients with an aggressive biological behavior needs more effective treatment modalities to improve their survival.
Nho Young Ju;Cho Jeong Gill;Ahn Seung Do;Choi Eun Kyung;Kim Jong Hoon;Kang One Chul;Chang Hyesook
Radiation Oncology Journal
/
v.15
no.4
/
pp.305-313
/
1997
Purpose : This is a retrospective study to evaluate the results of radiation therapy and prognostic factors influencing the results in nasopharyngeal carcinoma. Materials and Methods: From October 1989 to May 1996. 56 Patients were treated for nasopharyngeal carcinoma at Department of Radiation On-cology. According to stage, patients were distributed as follows : stage I (2), II (13). II (11), IV (30). Twenty-eight patients were treated with radiation therapy only, 7 patients were treated with neoadiuvant chemotherapy followed by radiation therapy. Twenty-one Patients were treated with radiation therapy and weekly CDDP. After external beam radiotherapy of 60Gy, 46Patients received boost dose with intracavitary radiation and 9 Patients with 3D conformal therapy. One patient received boost dose with 2 dimensional Photon beam therapy. The tumor dose ranged from 69.4Gy to 86.2Gy with median dose of 74.4Gy. The follow-up Period ranged from 5 months to 92 months with a median of 34 months. Results : Forty-seven patients achieved complete response and 8 Patients showed partial response. One Patient showed minimal response. Patterns of failure were as follows : locoregional recurrence (8) and distant metastasis (18). Among these patients, 2 patients failed locoregionally and distantly. The sites of distant metastasis were bone (8), lung (8) and liver (4). Five years survival rate was $67.2\%$ and 5 years disease-free survival rate was $53.6\%$. KPS (P=0.005) and response ol radiation therapy (P=0.0001) were significant prognostic factors for overall survival. KPS (P= 0.02) and response of radiation therapy (P=0.005) were significant Prognostic factors for disease-free survival. Conclusion : This retrospective study showed that distant metastasis was the Predominant pattern of relapse in nasopharyngeal cancer Neoadiuvant chemotherapy or weekly CDOP did not influence the distant metastasis-free survival. For advanced T stage, 3D conformal therapy Provided an improved dose coverage compared to ICR But further follow-up was needed in Patients with 3D conformal therapy to assess the efficacy of this therapy. Development of techniques of radiation therapy to improve locoregional control and of more effective systemic chemotherapy regimen are needed.
Purpose : It is not a simple task to achieve the ideal isodose curve with a standard vaginal applicator or sing1e plane needle impant in the paravaginal tissue when primary or recurrent gynecological neoplasms(cervical cancers, vaginal cancers and vulvar cancers) are treated as a boost following external beam radiotherapy. The authors introduce the development and construction of a simple, inexpensive, customized applicator for volume implant to maximize the radiation dose to the tumor while minimizing the dose to the rectum and the bladder. Materials and Methods : Nine patients underwent Ir-192 transperineal interstitial implantation for either recurrent(5 cases) or primary(3 cases) cervical cancers or primary vaginal cancer(1 case) between August 1994 and February 1998 at Ajou university hospital. First 3 cases were performed with a sing1e plane implant guided by digital palpation. Because of inadequate isodose coverage in the tumor volume in first 3 cases, we designed and constructed interstitial vaginal applicator for volume implant to improve tumor dose distribution and homogeneity while sparing the surrounding normal tissue. Our applicators consist of vaginal obturator and perineal template that made of the clear acrylamide and dental mold material$(Provil^{(R)})$. The applicators were customized individually according to the tumor size and its location Both HDR and LDR irradiation were given with these applicators accomodating 6 Fr needles(Microselectron Nucletron). The pretreatment planning prior to actual implant was performed whenever possible. Results : Needles can be inserted easily and evenly into the tumor volume through the holes of templates, requiring less efforts and time for the implant procedure. Our applicators made of materials available from commercial vendors. These have an advantage that require easy procedure, and spend relatively short time to construct. Also it was possible to fabricate applicators to individualize according to the tumor size and its location and to achieve the ideal isodose coverage. We found an accurate needle arrangement and ideal dose distribution through the CT scan that was obtained in 3 cases after needle implant. Three patients with primary cervical and vaginal cancers were controlled locally at final follow up. But all recurrent cases failed to do so. Conclusion : The authors introduce inexpensive, simple interstitial vaginal templates which were self-designed and constructed using materials available from commercial vendors such as acrylanide and dental mold material $(Provil^{(R)})$.
Noh Young Joo;Ahn Yong Chan;Kim Won Seog;Ko Young Hyeh
Radiation Oncology Journal
/
v.22
no.3
/
pp.177-183
/
2004
Purpose: Authors would report the results of sequential CHOP chemotherapy (cyclophosphamide, adriamycin, vincristine, and prednisone) and involved field radiotherapy (IFRT) for early stage nasal natural killer/T-cell Iymphoma (NKTCL). Materials and Methods: Fourteen among 17 patients, who were registered at the Samsung Medical Center tumor registry with stage I and II nasal NKTCL from March 1995 to December 1999 received this treatment protocol. Three to four cycles of CHOP chemotherapy were given at 3 weeks' interval, which was followed by local IFRT including the known tumor extent and the adjacent draining lymphatics. Results: Favorable responses after chemotherapy (before IFRT) were achievable only in seven patients (5 CR's+2 PR's: 50%), while seven patients showed disease progression. There were six patients with local failures, two with distant relapses, and none with regional lymphatic failure. The actuarial overall survival and progression-free survival at 3 years were 50.0% and 42.9%. All the failures and deaths occurred within 13 months of the treatment start. The factors that correlated with the improved survival were the absence of 'B' symptoms, the favorable response to chemotherapy and overall treatment, and the low risk by international prognostic index on univariate analyses. Conclusion: Compared with the historic treatment results by IFRT either alone or followed by chemotherapy, the current trial failed to demonstrate advantages with respect to the failure pattern and survival. Development of new treatment strategy in combining IFRT and chemotherapy is required for improving outcomes.
The effects of gamma irradiation on the survival and development of C. sinensis metacercariae were studied to evaluate the feasibility of irradiation as a control measure for clonorchiasis. Pseudorasbora parve were collected at an endemic river of clonorchiasis and were used for irradiation of the fluke in three schemes. The first (Scheme 1) was irradiation of the isolated metacercariae from the fish followed by infection to experimental rats. The second (Scheme 2) was irradiation of the fish, and then the metacercariae were isolated and in(ected to rats. The third (Scheme 3) was irradiation on the rat livers after infection with normal metacercariae. Irradiation doses varied from 5 to 100 Gy for Schemes 1 and 2, and 10 to 25 Gy for Scheme 3. The rats were sacrificed 2 to 6 weeks after infection. In Scheme 1, the metacercariae irradiated at 50 Gy failed to survive in the rats after 2 or 6 weeks. However, 1 to 44% of the metacercariae irradiated at 5∼30 Gy survived. The estimated LD50 of Scheme 1 was 16.5 Gy. The flukes irradiated in Scheme 2 survived better than those in Scheme 1. The average worm recovery rate in 50 Gy was 28%(7∼39% individually). Increasing the dose up to 100 Gy brought a remarkably low survival rate of an average 1%(0∼3% individually). The LD50 of Scheme 2 was 47.5 Gy. Worm recovery rates in the 10 Gy group of Scheme 3 were 21∼39%, and those in the 25 Gy group were 2% and 34%. Although the metacercariae were irradiated, all of the recovered worms were morphologically normal. Only the worms irradiated with 10 Gy or 25 Gy after 9 days from infection in Scheme 3 showed underdeveloped testes and seminal receptacle. The present results suggest that irradiation of the fish by 100 Gy could be adopted as a control measure for clonorchiasis.
Background: The incidence of gastroesophageal reflux disease(GERD) is increasing recently, but medical management for GERD has many limitations. Therefore, variable surgical treatments have been introduced. Material and Method: A retrospective study was done in 10 patients who underwent the Belsey Mark IV operation at Korea university Guro hospital between 1996 and 2001. Preoperative diagnoses were hiatal hernia with gasroesophageal reflux in 8 patients and achalasia in 2 patients. Result: Mean age of the patients was 54.3$\pm$19.0 years. Belsey Mark IV operation was performed on patients where preoperative medical failed and mean hospital days were 13.1$\pm$2.6 days. We routinely practiced follow-up endoscopy on postoperative 3rd, 6th, 9th, and 12th months. After remission for reflux and esophagitis, they were transferred to internal medicine department. Six patients of hiatal hernia with reflux (one patient who lost follow-up and the other patient who didn't practice the follow-up endoscopy due to short postoperative follow-up period were excluded) had lowered endoscopic gradings and two patients of achalasia did not complained of reflux symptoms, postoperatively. We experienced 10% operation failure rate. Conclusion: We experienced satisfactory operation results with Belsey Mark IV in hiatal hernia with GERD and achalasia patients.
Purpose: The aim of this study is to investigate the current use of dexamethasone rescue therapy (DRT) for bronchopulmonary dysplasia (BPD). Methods: This is a retrospective study of 251 BPD patients managed in the neonatal intensive care units at Seoul National University Childrens Hospital and Seoul National University Bundang Hospital between March 2004 and August 2008. The demographic data and clinical characteristics of the mothers and infants were analyzed. The infants were compared based on DRT responsiveness. The DRT complications were investigated. Results: Ninety-three patients (37.1%) were classified with severe BPD, DRT was only given to patients with severe BPD. Dexamethasone was administered to 24 patients (9.6%) whose respiratory status had precluded extubation, which indicated that conventional BPD management had failed. Fourteen patients (58.3%) who received DRT were responsive. DRT non-responders required more oxygenation and more complicated with pulmonary arterial hypertension (PAH). Responder had shorter length's of hospitalization and lower mortality rates. High dose dexamethasone was no more effective in weaning neonates from the ventilatior than low dose dexamethasone. Sepsis was the most common complication of DRT. Conclusion: DRT is a valuable treatment for severe BPD ahead of PAH development. DRT should not be performed in BPD patients with PAH due to the possibility of complications.
Background: With increasing coronary bypass and peripheral vascular surgeries, the demand for homologous vascular or synthetic conduits has continued to grow, but wide-spread application has been limited by dismal patency rates. Although cryopreserved allograft valves may provide a suitable alternative, current viability or patency of implanted allograft vascular conduits has been unsatisfactory. Material and Method: We serially analyzed the outcomes of canine femoral artery and saphenous vein allograft implants after storage in either $4^{\circ}C\;or\;-170^{\circ}C$. Result: There were no differences in graft flow rate (patency) (p=0.264), rate of thrombosis (p=0.264), presence of endothelium (p=0.587), or immunohistochemical staining for thrombomodulin (p=0.657) were detected between grafts stored in $4^{\circ}C\;and\;-170^{\circ}C$. Greater flow occurred in the arterial grafts versus the venous grafts (p=0.030), irrespective of the preservation method, with a significantly lower incidence of thrombosis (p=0.030) in arterial allografts. There was a correlation coefficient of -0.654 between thrombosis and positive immunohistochemical staining for thrombomodulin (p=0.006) and a correlation coefficient of 0.520 (p=0.0049) between the endothelial presence and positive immunohistochemical staining for thrombomodulin. The relationship between the presence of endothelium and thrombomodulin expression failed to show any correlation within the first 2 weeks (p=0.306). However, a strong correlation was seen after 1 month (p=0.0008). Conclusion: Tissue storage in either $4^{\circ}C\;or\;-170^{\circ}C$ in 10% DMSO/RPMI-1640 preservation solution preserved grafts equally well. In terms of thrombosis and graft patency, arterial grafts were superior to venous grafts. Considering the poor correlation between thrombomodulin expression and the presence of an endothelium in the implanted graft within the first two weeks, grafts in this period would not be thromboresistant.
Pseudomonas aeruginosa, a Gram-negative bacterium, is an ubiquitous and opportunistic human pathogen, which expresses many virulence factors through quorum sensing (QS) regulation. QscR, one of the QS signal receptors of P. aeruginosa, has unique features that make it possible to distinguish QscR from other QS receptors. In the present study, we focused on amino acid residues responsible for such a broad signal specificity of QscR. Thus we constructed mutant QscRs: $QscR_{T72I}$, $QscR_{R132M}$, and $QscR_{T140I}$ by substituting $72^{nd}$ threonine, $132^{nd}$ arginine, and $140^{th}$ threonine residues with isoleucine, methionine, and isoleucine, respectively by site-directed mutagenesis. When we examined the activity of these mutant QscRs, $QscR_{R132M}$ failed to respond to N-3-oxododecanoyl homoserine lactone (3OC12-HSL), but $QscR_{T72I}$ and $QscR_{T140I}$ remained the ability to respond to 3OC12-HSL despite much reduction of the sensitivity. When we treated a variety of acyl-HSLs with different structure, $QscR_{T72I}$ and $QscR_{T140I}$ showed better responsiveness to N-decanoyl HSL (C10-HSL) or N-dodecanoyl HSL (C12-HSL) that has no oxo-moiety at $3^{rd}$ carbon of acyl group than to 3OC12-HSL, and $QscR_{R132M}$ showed no responsiveness to any acyl-HSLs tested here. In addition, $QscR_{T72I}$ and $QscR_{T140I}$ were inhibited by 5f, a QscR inhibitor as similarly as wild type QscR was. These results suggest that while the $130^{th}$ arginine is crucial in both activity and acyl-HSL binding of QscR, the $72^{nd}$ and $140^{th}$ threonines are important in the activity, but they are little responsible for the discrimination of acyl-HSLs or competitive inhibitor.
Korean Journal of Agricultural and Forest Meteorology
/
v.18
no.2
/
pp.74-87
/
2016
Potato phenology, growth, and yield are projected to be highly affected by global warming in the future. The objective of this study was to examine the responses of potato growth and yield to environmental elements like temperature, solar radiation, and daylength. Planting date experiments under open field condition were conducted using three cultivars differing in maturity group (Irish Cobbler and Superior as early; Atlantic as mid-late maturing) at eight different planting dates. In addition, elevated temperature experiment was conducted in four plastic houses controlled to target temperatures of ambient temperature (AT), $AT+1.5^{\circ}C$, $AT+3^{\circ}C$, and $AT+5^{\circ}C$ using cv. Superior. Tuber initiation onset was found to be hastened curve-linearly with increasing temperature, showing optimum temperature around $22-24^{\circ}C$, while delayed by longer photoperiod and lower solar radiation in Superior and Atlantic. In the planting date experiments where the average temperature is near optimal and solar radiation, rainfall, pest, and disease are not limiting factor for tuber yield, the most important determinant was growth duration, which is limited by the beginning of rainy season in summer and frost in the late fall. Yield tended to increase along with delayed tuber initiation. Within the optimum temperature range ($17^{\circ}-22^{\circ}C$), larger diurnal range of temperature increased the tuber yield. In an elevated temperature treatment of $AT+5.0^{\circ}C$, plants failed to form tubers as affected by high temperature, low irradiance, and long daylength. Tuber number at early growth stage was reduced by higher temperature, resulting in the decrease of assimilates allocated to tuber and the reduction of average tuber weight. Stem growth was enhanced by elevated temperature at the expense of tuber growth. Consequently, tuber yield decreased with elevated temperature above ambient and drop to almost nil at $AT+5.0^{\circ}C$.
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