• Journal of Korea Port Economic Association
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• v.39 no.1
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• pp.131-147
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• 2023

Gwangyang Port Marine Industry Cluster is the only marine industry cluster in Korea that is currently in operation, but despite the implementation of various revitalization policies since its opening, the occupancy rate has been low so far. Accordingly, this study aims to identify the constraints of the current system that hinder the inducement of tenant companies and to suggest revitalization measures. For this purpose, this study analyzed the current status of research and development(R&D) projects in the port, shipping and logistics sector, which is a core industry of the Gwangyang Port Marine Industry Cluster. And a survey was conducted on companies with potential to move in. As a result, the proportion of R&D in the core industry sectors is lower than in other sectors, and most of R&D projects are being carried out mainly by small and medium-sized enterprises. In addition, the low need for port facilities and low accessibility to Gwangyang Port were derived as constraints. Considering the results, this study suggests four revitalization measures to induce tenant companies as follows. First, it is necessary to expand the scope of core industries from the current shipping, ports, and logistics to the entire maritime and fisheries, so that companies performing R&D in the industry can move in. Second, the industry code currently specified as a qualification need to be revised to include both the industry of the enterprise carrying out R&D projects and the core industry. Therefore, this study suggests an expanded industry code list that can replace current list. Third, a transition of tenant recruitment system from the regular system(once or twice a year) to the occasional system is proposed so that companies can move in flexibly when demand arises. Finally, in order to overcome geographically low accessibility, technology development support projects specialized in R&D that prospective tenant companies actually need are needed rather than financial support.

• Korean Journal of Environmental Biology
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• v.41 no.2
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• pp.109-125
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• 2023

This study was conducted to select target fish species as baseline research for accumulation analysis of major hazardous chemicals entering the aquatic ecosystem in Korea and to analyze the impact on fish community. The test bed was selected from a sewage treatment plant, which could directly confirm the impact of the inflow of harmful chemicals, and the Geum River estuary where harmful chemicals introduced into the water system were concentrated. A multivariable metric model was developed to select target candidate fish species for hazardous chemical analysis. Details consisted of seven metrics: (1) commercially useful metric, (2) top-carnivorous species metric, (3) pollution fish indicator metric, (4) tolerance fish metric, (5) common abundant metric, (6) sampling availability (collectability) metric, and (7) widely distributed fish metric. Based on seven metric models for candidate fish species, eight species were selected as target candidates. The co-occurring dominant fish with target candidates was tolerant (50%), indicating that the highest abundance of tolerant species could be used as a water pollution indicator. A multi-metric fish-based model analysis for aquatic ecosystem health evaluation showed that the ecosystem health was diagnosed as "bad conditions". Physicochemical water quality variables also influenced fish feeding and tolerance guild in the testbed. Eight water quality parameters appeared high at the T1 site, indicating a large impact of discharging water from the sewage treatment plant. T2 site showed massive algal bloom, with chlorophyll concentration about 15 times higher compared to the reference site.

• The Journal of The Korea Institute of Intelligent Transport Systems
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• v.22 no.1
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• pp.172-191
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• 2023

This study was undertaken to strategize the mixed traffic operation of autonomous vehicles in the pilot zone. This was achieved by analyzing the changes expected when autonomous vehicles are mixed in the autonomous vehicle pilot zone. Although finding a safe and efficient traffic operation strategy is required for the pilot zone to serve as a test bed for autonomous vehicles, there is no available operation strategy based on the mixture of autonomous vehicles. In order to presents a traffic operation strategies for each period of autonomous vehicle introduction, traffic efficiency and safety analysis was performed according to the autonomous vehicle market percentage rate. Based on the analysis results, the introduction stage was divided into introductory stage, transition period, and stable period based on the autonomous vehicle market share of 30% and 70%. This study presents the following traffic operation strategies. Considering the traffic flow operation strategy, we suggest the advancement of the existing road infrastructure at the introductory stage, and operating an autonomous driving lane and the mileage system during the transition period. We also propose expanding the operation of autonomous driving lanes and easing the speed limit during the stable period. In the traffic safety strategy, we present a manual and legal system for responding to autonomous vehicle accidents in the introductory stage, an analysis of the causes of autonomous vehicle accidents and the implementation of preventive policies in the transition period, and the advancement of the autonomous system and the reinforcement of the security system during the stable period. Through the traffic operation strategy presented in this study, we foresee the possibility of preemptively responding to the changes of traffic flow and traffic safety expected due to the mixture of autonomous vehicles in the autonomous vehicle pilot zone in the future.

• Journal of Navigation and Port Research
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• v.47 no.3
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• pp.147-154
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• 2023

This study aims to determine the necessity, role, utilization, and operation and management plan in relation to the underwater space platform where humans can newly reside. It provides a comprehensive opinion on the need for creating undersea space and operation plans based on opinions of industry-university-affiliated organizations involved in the R&D project of the Ministry of Maritime Affairs and Fisheries for the utilization of undersea space and external experts participating in marine technology development. In this study, a survey was conducted on researchers participating in the construction of a Korean submarine space platform. FGI was conducted on marine technology development experts. Results were then derived. As a result of the analysis, the need for subsea space construction was found to be high. As for the role of subsea space, the most common opinion was to develop technology for utilizing subsea space and to secure marine science research functions. It was found that the creation of subsea space would have a positive impact on the domestic industry, especially the deep-sea development industry and the shipbuilding/offshore structure industry. In terms of utilization, after the end of the seabed space test bed, the response to utilization as a marine observation base and marine ecosystem research had the highest proportion. As for expected inconvenience, discomfort in the psychological environment was the highest. Experts suggest that securing a continuous budget is most important for stable operation in the future and that securing a manpower budget is essential for itemized budgets. In addition, it was judged that it would be appropriate to establish a prior agreement from the time of the prior agreement and prepare a countermeasure before proceeding with the project in order to ensure ownership issues, consignment management issues, and cost issues when using the project after the end of the project.

• Journal of Korea Water Resources Association
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• v.56 no.11
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• pp.775-784
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• 2023

With the increasing trend of extreme rainfall that exceeds the design frequency of man-made structures due to extreme weather, it is necessary to review the safety of agricultural reservoirs designed in the past. However, there are no local government-managed reservoirs (13,685) that can be discharged in an emergency, except for reservoirs over a certain size under the jurisdiction of the Korea Rural Affairs Corporation. In this case, it is important to quickly deploy a mobile siphon to the site for preliminary discharge, and this study evaluated the applicability of a mobile siphon with a diameter of 200 mm, a minimum water level difference of 6 m, 420 (m²/h), and 10,000 (m²/day), which can perform both preliminary and emergency discharge functions, to the Yugum Reservoir in Gyeongju City. The test bed, Yugum Reservoir, is a facility that was completed in 1945 and has been in use for about 78 years. According to the hydrological stability analysis, the lowest height of the current dam crest section is 27.15 (EL.m), which is 0.29m lower than the reviewed flood level of 27.44 (EL.m), indicating that there is a possibility of lunar flow through the embankment, and the headroom is insufficient by 1.72 m, so it was reviewed as not securing hydrological safety. The water level-volume curve was arbitrarily derived because it was difficult to clearly establish the water level-flow relationship curve of the reservoir since the water level-flow measurement was not carried out regularly, and based on the derived curve, the algorithm for operating small and medium-sized old reservoirs was developed to consider the pre-discharge time, the amount of spillway discharge, and to predict the reservoir lunar flow time according to the flood volume by frequency, thereby securing evacuation time in advance and reducing the risk of collapse. Based on one row of 200 mm diameter mobile siphons, the optimal pre-discharge time to secure evacuation time (about 1 hour) while maintaining 80% of the upper limit water level (about 30,000 m²) during a 30-year flood was analyzed to be 12 hours earlier. If the pre-discharge technology utilizing siphons for small and medium-sized old reservoirs and the algorithm for reservoir operation are implemented in advance in case of abnormal weather and the decision-making of managers is supported, it is possible to secure the safety of residents in the risk area of reservoir collapse, resolve the anxiety of residents through the establishment of a support system for evacuating residents, and reduce risk factors by providing risk avoidance measures in the event of a reservoir risk situation.

• Korean Journal of Soil Science and Fertilizer
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• v.12 no.4
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• pp.189-213
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• 1980

1. Aiming at supply of basic informations on tree species siting and forest fertilization by understanding of soil properties that are demanded by each tree species through studies of forest soil's morphological, physical and chemical properties in relation to tree growth in our country, the necessary data have been collected in the last 10 years, are quantified according to quantification theory and are analyzed in accordance with multi-variate analysis. 2. Test species, larch and the Korean white pine, are plantable in extensive areas from mid to north in the temperate zone and are the two most recommended reforestation tree species in Korea. However, their respective site demands are not known and they have been in confusion or considered demanding the same site during reforestation. When the Korean white pine is planted in larch sites, it has shown relatively good growth. But, when larch is planted in the Korean white pine site it can be hardly said that the larch growth is good. To understand on such a difference soil factors have been studied so as to see how the soil's morphological, physical and chemical factors affect tree growth helped with the electronic computer. 3. All the stands examined are man-made mature forests. From 294 larch plots and 259 white pine plots dominant trees are cut as samples and through stem analysis site index is determined. For each site index soil profiles are made in the related forest-land for analysis. Soil samples are taken from each profile horizon and forest-land productivity classification tables are worked out through physical and chemical analysis of the soil samples for each tree species for the study of relationships between physical, chemical and the combined physical/chemical properties of soil and tree growth. 4. In the study of relationships between physical properties of soil and tree growth it is found out that larch growth is influenced by the following factors in the order of deposit form, soil depth, soil moisture, altitude, relief, soil type, depth of A-horizon, soil consistency content of organic matter soil texture bed rock gravel content aspect and slope. For the Korean white pine the influencing factors' order is soil type, soil consistency bed rock aspect depth of A-horizon soil moisture altitude relief deposit form soil depth soil texture gravel content and slope. 5. In the study of relationships between chemical properties of soil and tree growth it is found out that larch growth is influenced by the following factors in the order of base saturation organic matter CaO C/N ratio, effective $P_2O_5$ PH.exchangeable $K_2O$ T-N MgO C E C Total Base and Na. For the Korean white pine the influencing factors' order is effective $P_2O_5$ Total Base T-N Na C/N ratio PH CaO base saturation organic matter exchangeable $K_2O$ C E C and MgO. 6. In the study of relationships between the combined physical and chemical properties of soil and tree growth it is found out that larch growth is influenced by the following factors in the order of soil depth deposit form soil moisture PH relief soil type altitude T-N soil consistency effective $P_2O_5$ soil texture depth of A-horizon Total Base exchangeable $K_2O$ and base saturation. For the Korean white pine the influencing factors' order is soil type soil consistency aspect effective $P_2O_5$ depth of A-horizon exchangeable $K_2O$ soil moisture Total Base altitude soil depth base saturation relief T-N C/N ratio and deposit from. 7. In the multiple regression of forest soil's physical properties larch's correlation coefficient is 0.9272 and for the Korean white pine it is 0.8996. With chemical properties larch has 0.7474 and the Korean white pine has 0.7365. So, the soil's physical properties are found out more closely related with tree growth than chemical properties. However, this seems due to inadequate expression of soil's chemical factors and it is proved that the chemical properties are not less important than the physical properties. In the multiple regression of the combined physical and chemical properties consisting of important morphological and physical factors as well as chemical factors of forest soils larch's multiple correlation coefficient is found out to be 0.9434 and for the Korean white pine it is 0.9103 leading to the highest correlation. 8. As shown in the partial correlation coefficients larch needs deeper soil depth than the Korean white pine and in the deposit form colluvial and creeping soils are demanded by the larch. Adequately moist to too moist should be soil moisture and PH should be from 5.5 to 6.1 for the larch. Demands of T-N soil texture and soil nutrients are higher for the larch than the Korean white pine. Thus, soil depth, deposit form, relief soil moisture PH N altitude and soil texture are good indicators for species sitings with larch and the Korean white pine while soil type and soil consistency are indicative only limitedly of species sitings due to their wide variation as plantation environments. For larch siting soil depth deposit form relief soil moisture PH soil type N and soil texture are indicators of good growth and for Korean white pine they are soil type soil consistency effective $P_2O_5$ and exchangeable $K_2O$, which is demanded more by the Korean white pine than larch generally. 9. Physical properties of soil has been known as affecting tree growth to greatest extent so far. However, as a result of this study it is proved through computer analysis that chemical properties of soil are not less important factors for tree growth than chemical properties and site demands for larch and the Korean white pine that have been uncertain So far could be clarified.

• Journal of Korean Society of Forest Science
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• v.53 no.1
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• pp.1-26
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• 1981

1. Aiming at supply of basic informations on tree species siting and forest fertilization by understanding of soil properties that are demanded by each tree species through studies of forest soil's morphological, physical and chemical properties in relation to tree growth in our country, the necessary data have been collected in the last 10 years, are quantified according to quantification theory and are analyzed in sccordance with multi-variate analysis. 2. Test species, japanese larch (Larix leptolepis Gord) and the Korean white pine, (pinus koraiensis S et Z.) are plantable in extensive areas from mid to north in the temperate forest zone and are the two most recommended reforestation tree species in Korea. However, their respective site demands are little known and they have been in confusion or considered demanding the same site during reforestation. When the Korean white pine is planted in larch sites, it has shown relatively good growth, but, when Japanese larch is planted in Korean white pine site it can be hardly said that the Japanese Larch growth is good. To understand on such a difference soil factors have been studied so as to see how th soil's morphological, physical and chemical factors affect tree growth helped with the electronic computer. 3. All the stands examined are man-made mature forests. From 294 Japanese larch plots and 259 Korean white pine plots dominant trees are cut as samples and through stem analysis site index is determined. For each site index soil profiles are made in the related forest-land for analysis. Soil samples are taken from each profile horizon and forest-land productivity classification tables are worked out through physical and chemical analyses of the soil samples for each tree species for the study of relationships between physical, chemical and the combined physical/properties of soil and tree growth. 4. In the study of relationships between physical properties of soil and tree growth it is found out that Japanese larch growth is influenced by the following factors in the decreasing order of weight deposit form, soil depth, soil moisture, altitude, relief, soil type, depth a A-horizon, soil consistency, content of organic matter, soil texture, bed rock, gravel content, aspect and slope. For the Korean white pine the influencing factors' order is soil type, soil consistency, bed rock, aspect, depth of A-horizon, soil moisture, altitude, relief, deposit form, soil depth, soil texture, gravel content and slope. 5. In the study of relationships between chemical properties of soil and tree growth it is found out that Japanese larch growth is influenced by the following factors in the order of base saturation, organic matter, CaO, C/N ratio, effective $P_2O_5$, PH, exchangeable, $K_2O$, T-N, MgO, CEC, Total Base and Na. For the Korean white pine the influencing factors' order is effective $P_2O_5$, Total Base, T-N, Na, C/N ratio, PH, CaO, base saturation, organic matter, exchangeable $K_2O$, CEC and MgO. 6. In the study of relationships between the combined physical and chemical properties of soil and tree growth it is found out that Japanese larch growth is influenced by the following factors in the order of soil depth, deposit form, soil moisture, PH, relief, soil type altitude, T-N, soil consistency, effective $P_2O_5$, soil texture, depth of A-horizon, Total Base, exchangeable $K_2O$ and base saturation. For the Korean white pine the influencing factors' order is soil type, soil consistency, aspect, effective $P_2O_5$, depth of A-horizon, exchangeable $K_2O$, soil moisture, Total Base, altitude, soil depth, base saturation, relief, T-N, C/N ratio and deposit form. 7. In the multiple correlation of forest soil's physical properties larch's correlation coefficient for Japanese Larch is 0.9272 and for Korean white pine, 0.8996. With chemical properties larch has 0.7474 and Korean white pine has 0.7365. So, the soil's physical properties are found out more closely related with tree growth than chemical properties. However, this seems due to inadequate expression of soil's chemical factors and it is proved that the chemical properities are not less important than the physical properties. In the multiple correlation of the combined physical and chemical properties consisting of important morphological and physical factors as well as chemical factors of forest soils larch's multiple correlation coefficient is found out to be 0.9434 and for Korean white pine it is 0.9103 leading to the highest correlation. 8. As shown in the partial correlation coefficients Japanese larch needs deeper soil depth than Korean white pine and in the deposit form of colluvial and creeping soils are demanded by the larch. Moderately moist to not moist should be soil moisture and PH should be from 5.5 to 6.1 for the larch. Demands of T-N, soil texture and soil nutrients are higher for the larch than the Korean white pine. Thus, soil depth, deposit form, relief, soil moisture, PH, N, altitude and soil texture are good indicators for species sitings with larch and the Korean white pine while soil type and soil consistency are indicative only limitedly of species sitings due to their wide variations as plantation environments. For the larch siting soil depth, deposit form, relief, soil moisture, pH, soil type, N and soil texture are indicators of good growth and for the Korean white pine they are soil type, soil consistency, effective $P_2O_5$ and exchangeable $K_2O$. In soil nutrients larch has been found out demanding more than the Korean white pine except $K_2O$, which is demanded more by the Korean white pine than Japanese larch generally. 9. Physical properties of soil has been known as affecting tree growth to the greatest extent so far. However, as a result of this study it is proved through computer analysis that chemical properties of soil are not less important factors for tree growth than chemical properties and site demands for the Japanese larch and the Korean white pine that have been uncertain so far could be clarified.

• The Korean Journal of Nuclear Medicine Technology
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• v.13 no.1
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• pp.86-92
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• 2009

Purpose: The PET/CT has a clear distinction on the lesion of the functional image by adding anatomical information. It also could reduce the examination time using CT data as the attenuation-correction. When the stomach was contracted from a fast, it could bring a misinterpretation of the cancer of the lesion with a presence of physiological $^{18}F$-FDG uptake in stomach and it occasionally would bring an additional scan to confirm. To complement this shortcoming, the method that the patients had water before the examination to extend the stomach had been attempted. However, a short excretion time of the stomach did not give sufficiently extended image of the stomach. Then the patients had additional water and had the examination again. Therefore, the noticed fact is that the stomach excretion time depends on calories, protein content, and the level of carbohydrate. In this study, we use an orange juice to evaluate the extension of the stomach and usefulness of it. Materials and Methods: PET/CT scan were obtained on total 150 of patient from February 2008 to October2008, There were 3 groups in this study and each group had 50 patients. First group drank nothing, Second group drank water and third group drank orange juice. The patients (man 25, female 25) not drinking are the age of 30~71 years old (average: 54), the patients (man: 25, female: 25) drinking water (400 cc) are the age of 28~71 years old (average: 54) and the patients (man: 25, female: 25) drinking orange juice (400 cc) are the age of 32~74 years old (average: 56). The patients were fasted in 6-8 hours before the test, the patients were not diabetic. $^{18}F$-FDG 370~555 MBq were injected intravenously. The patients were in stable position for 1 hour, than the image was obtained. The patients drank water and other patients drank orange juice before Whole body scan. The image scan started from mid-femur to skull base. The emission scan acquired for three minutes per bed and the images were reconstructed. Stomach extension analysis is measured from vertical and horizontal length. Results: Stomach Extension was described as the vertical length of the Non Drink Group was $1.20{\pm}0.50\;cm$, horizontal length was $1.4{\pm}0.53\;cm$, the vertical length of the Water Drink Group was $1.67{\pm}0.63\;cm$, horizontal length was $1.65{\pm}0.77\;cm$, the vertical length of Orange juice Drink Group was $3.48{\pm}0.77\;cm$, horizontal length was $3.66{\pm}0.77\;cm$ in coronal image. Stomach Extension was described the vertical length of the Non Drink Group was $2.03{\pm}0.62\;cm$, horizontal length was $1.69{\pm}0.68\;cm$, the vertical length of Water Drink Group was $5.34{\pm}1.62\;cm$, horizontal length was $2.45{\pm}0.72\;cm$, the vertical length of Orange juice Drink Group was $7.74{\pm}1.62\;cm$, horizontal length was $3.57{\pm}0.77\;cm$ in transverse image. The Stomach Extension has specific differences (p<0.001). The SUVs shows the Non Drink Group were measured as Liver $2.52{\pm}0.42$, Lung $0.51{\pm}0.14$, the Water Drink Group were measured as Liver $2.47{\pm}0.38$, Lung $0.50{\pm}0.14$, Orange juice Drink Group were measured as Liver $2.47{\pm}0.38$, Lung $0.50{\pm}0.14$. The SUVs did not have specific differences (p>0.759). Conclusions: There was not a large difference of SUV in three groups. When the patients drank Orange juice and water, the range extension of stomach was higher than without drinking nothing and it was possible to acquire fully extended images. Therefore, it will be possible that unnecessary additional stomach scans will be reduced by drinking orange juice before the examination so that the patients' claim from uncomfortable and long period of fast will be minimized.

• Tuberculosis and Respiratory Diseases
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• v.45 no.1
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• pp.5-19
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• 1998

Introduction: Direct histologic and bacteriologic examination of a representative specimen of lung tissue is the only certain method of providing an accurate diagnosis in various pulmonary diseases including diffuse pulmonary diseases. The purpose of national survey was to define the indication, incidence, effectiveness, safety and complication of open and thoracoscopic lung biopsy in korea. Methods: A multicenter registry of 37 university or general hospitals equipped more than 400 patient's bed were retrospectively collected and analyzed for 3 years from the January 1994 to December 1996 using the same registry protocol. Results: 1) There were 511 cases from the 37 hospitals during 3 years. The mean age was 50.2 years(${\pm}15.1$ years) and men was more prevalent than women(54.9% vs 45.9%). 2) The open lung biopsy was performed in 313 cases(62%) and thoracoscopic lung biopsy was performed in 192 cases(38%). The incidence of lung biopsy was more higher in diffuse lung disease(305 cases, 59.7%) than in localized lung disease(206 cases, 40.3%) 3) The duration after abnormalities was found in chest X-ray until lung biopsy was 82.4 days(open lung biopsy: 72.8 days, thoracoscopic lung biopsy: 99.4 days). The bronchoscopy was performed in 272 cases(53.2%), bronchoalveolar lavage was performed in 123 cases(24.1%) and percutaneous lung biopsy was performed in 72 cases(14.1%) before open or thoracoscopic lung biopsy. 4) There were 230 cases(45.0%) of interstitial lung disease, 133 cases(26.0%) of thoracic malignancies, 118 cases(23.1%) of infectious lung disease including tuberculosis and 30 cases (5.9 %) of other lung diseases including congenital anomalies. No significant differences were noted in diagnostic rate and disease characteristics between open lung biopsy and thoracoscopic lung biopsy. 5) The final diagnosis through an open or thoracoscopic lung biopsy was as same as the presumptive diagnosis before the biopsy in 302 cases(59.2%). The identical diagnostic rate was 66.5% in interstitial lung diseases, 58.7% in thoracic malignancies, 32.7% in lung infections, 55.1 % in pulmonary tuberculosis, 62.5% in other lung diseases including congenital anomalies. 6) One days after lung biopsy, $PaCO_2$ was increased from the prebiopsy level of $38.9{\pm}5.8mmHg$ to the $40.2{\pm}7.1mmHg$(P<0.05) and $PaO_2/FiO_2$ was decreased from the prebiopsy level of $380.3{\pm}109.3mmHg$ to the $339.2{\pm}138.2mmHg$(P=0.01). 7) There was a 10.1 % of complication after lung biopsy. The complication rate in open lung biopsy was much higher than in thoracoscopic lung biopsy(12.4% vs 5.8%, P<0.05). The incidence of complication was pneumothorax(23 cases, 4.6%), hemothorax(7 cases, 1.4%), death(6 cases, 1.2%) and others(15 cases, 2.9%). 8) The 5 cases of death due to lung biopsy were associated with open lung biopsy and one fatal case did not describe the method of lung biopsy. The underlying disease was 3 cases of thoracic malignancies(2 cases of bronchoalveolar cell cancer and one malignant mesothelioma), 2 cases of metastatic lung cancer, and one interstitial lung disease. The duration between open lung biopsy and death was $15.5{\pm}9.9$ days. 9) Despite the lung biopsy, 19 cases (3.7%) could not diagnosed. These findings were caused by biopsy was taken other than target lesion(5 cases), too small size to interpretate(3 cases), pathologic inability(11 cases). 10) The contribution of open or thoracoscopic lung biopsy to the final diagnosis was defininitely helpful(334 cases, 66.5%), moderately helpful(140 cases, 27.9%), not helpful or impossible to judge(28 cases, 5.6%). Overall, open or thoracoscopic lung biopsy were helpful to diagnose the lung lesion in 94.4 % of total cases. Conclusions: The open or thoracoscopic lung biopsy were relatively safe and reliable diagnostic method of lung lesion which could not diagnosed by other diagnostic approaches such as bronchoscopy. We recommend the thoracoscopic lung biopsy when the patients were in critical condition because the thoracoscopic biopsy was more safe and have equal diagnostic results compared with the open lung biopsy.

• Radiation Oncology Journal
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• v.22 no.4
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• pp.237-246
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• 2004

Purpose: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). Materials and Methods: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received $63\~70$ Gy (Median 66 Gy, fraction size $1.8\~2$ Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. Results: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were $15{\pm}1.65$ and $11{\pm}0.95$ months, respectively. The was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were $21{\pm}5.03$ and $12{\pm}1.59$ months, respectively, while for Arm 2 patients they were $14{\pm}0.94$ and $10{\pm}1.63$ months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; $44.7\%$ versus $19.2\%$. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. Conclusion: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.