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Efficacy of Neoadjuvant Chemotherapy and Radiotherapy for the Histology-confirmed Intracranial Germinoma - Preliminary Report (조직학적으로 확진된 두개내 배아종의 전보조화학요법 후 방사선치료의 성적 - 예비적 결과)

  • Noh, Young-Ju;Kim, Hak-Jae;Heo, Dae-Seog;Shin, Hee-Yung;Kim, Il-Han
    • Radiation Oncology Journal
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    • v.20 no.2
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    • pp.93-99
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    • 2002
  • Purpose : We intended to decrease late CNS reaction after radical radiotherapy for an intracranial germinoma by using combined neoadjuvant chemotherapy and involved-field radiotherapy. The efficacy in terms of its acute toxicity and short-term relapse patterns was analyzed. Materials and Methods : Eighteen patients were treated with combined neoadjuvant chemotherapy and radiotherapy between 1995 and 2001. The chemotherapy regimen used was the Children's Cancer Group (CCG) 9921A (cisplatin, cyclophosphamide, VP-16, vincristine) for 5 patients younger than 16 years, BEP (bleomycin, VP-16, cisplatin) for 12 patients, and EP (VP-16, cisplatin) for 1 patient. The radiotherapy covered the whole craniospinal axis for 5 patients, the whole brain for 1, and the partial brain (involved field) for 12. the primary lesion received tumour doses between 3,960 and 5,400 cGy. Results : The male to female ratio was 16:2 and the median age was 16 years old. The tumors were located in the pineal gland in 12 patients, in the suprasellar region in 1, in the basal ganglia In 1, in the thalamus in 1. Three patients had multiple lesions and ventricular seedings were shown at MRI. In 3 patients, tumor cells were detected in the cerebrospinal fluid and MRI detected a spinal seeding in 2 patients. The response to neoadjuvant chemotherapy was complete remission in 5 patients, partial remission in 12, and no response in 1. However, after radiotherapy, all except 1 patient experienced complete remission. The toxicity during or after chemotherapy greater than or equal to grade III was remarkable; hematologic toxicity was observed in 11 patients, liver toxicity in none, kidney toxicity in none, and gastrointestinal toxicity in one. One patient suffered from bleomycin-induced pneumonitis. Radiotherapy was therefore stopped and the patient eventually died of respiratory failure. The other 17 are alive without any evidence of disease or relapse during an average of 20 months follow-up. Conclusion : A high response rate and disease control was experienced, which was the same as observed other studies and the morbidity from chemotherapy-induced toxicity was similar. With these results, the results from adjuvant chemotherapy and involved-field radiotherapy cannot be concluded to be equal to those from extended-field radiotherapy. The long term follow-up study on later complications are required in order to draw definite conclusions on the optimal management with minimum side effects.

Influence of Oven Heating and Water Heating on the Physical and Mechanical Properties of Wood (열기(熱氣) 및 열수처리(熱水處理)가 목재(木材)의 이학적(理學的) 성질(性質)에 미치는 영향(影響))

  • So, Won-Tek;Jung, Hee-Suk
    • Journal of the Korean Wood Science and Technology
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    • v.8 no.1
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    • pp.13-21
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    • 1980
  • This experiment was carried out to investigate the effect of heating periods on the physical and mechanical properties of maple (Acer mono Max.) by oven heating and heating in water at 100$^{\circ}C$ for 0, 2, 4, and 6 days respectively. The results obtained are summarized as follows: 1. The green volume specific gravity due to oven heating decreased from 6 days of exposure, and that, due to heating in water decreased from 4 days of exposure. 2. The radial shrinkage due to oven heating decreased from 2 days of exposure, but that due to heating in water increased from 6 days of exposure. The tangential shrinkage due to oven heating decreased from 2 days of exposure, but that due to heating in water increased from 2 days of exposure. 3. The amount of water absorption due to oven heating decreased from 2 days of exposure, but that due to heating in water increased from 4 days of exposure. 4. The compressive strength pararelled to grain due to oven heating increased till 4 days of exposure but decreased from 6 days, and that due to heating in water decreased from 2 days of exposure. 5. The shearing strength pararelled to grain due to oven heating increased till 2 days of exposure, but decreased from 4 days of exposure, and that due to heating in water decreased from 4 days of exposure. 6. The bending strength due to oven heating increased till 4 days of exposure but decreased from 6 days, and that due to heating in water decreased from 6 days of exposure. The impact bending absorbed energy due to oven heating decreased from 4 days of exposure, and that due to hearing in water decreased from 2 days of exposure.

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Effects of $\beta-Carotene$ on the Thermal Oxidation Stability of Deep Fried Lard (튀김용 돈지의 열산화 안정성에 미치는 $\beta-Carotene$의 효과)

  • Han Kyu-Ho;Park Pyo-Jam;Jeon Byung-Tae;Park Woo-Joon;Lee Chi-Ho
    • Food Science of Animal Resources
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    • v.25 no.4
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    • pp.507-512
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    • 2005
  • This study was designed to investigate the effect of $\beta-carotene$ on the heat oxidation stability of deep fried laid with different healing temperature. Commercially purchased $\beta-carotene$ was used to this experiment $\beta-carotene$ was added to the deep fried lard at final concentration of $0\%\;0.001\%\;and\;0.004\%$ (wt/wt fat basis). Total plate count peroxide value, acid value, and TBA(thiobarbituric acid) values of the samples were determined regulary at $50^{\circ}C$ during 15 days. The result of the study are as follows: The number of microorganism was decreased by $\beta-carotene$ added to the deep fried lard Deep fried lard with $0.004\%$ $\beta-carotene$ have higher antioxidative effect than those of control and $0.001\%$ treated group. Peroxide and TBA values were significantly (P<0.05) decreased in all samples by added $\beta-carotene$ at $0.004\%$ Antioxidative effect increased with increasing concentration of $\beta-carotene$. These results suggest that $\beta-carotene$ might inhibit the growth of microganisms and retard lipid oxidation in the deep fried lard.

Interpretation of the Umbrella Clause in Investment Treaties (국제투자조약상 포괄적 보호조항(Umbrella Clauses)의 해석에 관한 연구)

  • Jo, Hee-Moon
    • Journal of Arbitration Studies
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    • v.19 no.2
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    • pp.95-126
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    • 2009
  • One of the controversial issues in investor-state investment arbitration is the interpretation of "umbrella clause" that is found in most BIT and FTAs. This treaty clause requires on Contracting State of treaty to observe all investment obligations entered into with foreign investors from the other Contracting State. This clause did not receive in-depth attention until SGS v. Pakistan and SGS v. Philippines cases produced starkly different conclusions on the relations about treaty-based jurisdiction and contract-based jurisdiction. More recent decisions by other arbitral tribunals continue to show different approaches in their interpretation of umbrella clauses. Following the SGS v. Philippines decision, some recent decisions understand that all contracts are covered by umbrella clause, for example, in Siemens A.G. v. Argentina, LG&E Energy Corp. v. Argentina, Sempra Energy Int'l v. Argentina and Enron Corp. V. Argentina. However, other recent decisions have found a different approach that only certain kinds of public contracts are covered by umbrella clauses, for example, in El Paso Energy Int'l Co. v. Argentina, Pan American Energy LLC v. Argentina and CMS Gas Transmission Co. v. Argentina. With relation to the exhaustion of domestic remedies, most of tribunals have the position that the contractual remedy should not affect the jurisdiction of BIT tribunal. Even some tribunals considered that there is no need to exhaust contract remedies before bringing BIT arbitration, provoking suspicion of the validity of sanctity of contract in front of treaty obligation. The decision of the Annulment Committee In CMS case in 2007 was an extraordinarily surprising one and poured oil on the debate. The Committee composed of the three respected international lawyers, Gilbert Guillaume and Nabil Elaraby, both from the ICJ, and professor James Crawford, the Rapportuer of the International Law Commission on the Draft Articles on the Responsibility of States for Internationally Wrongful Acts, observed that the arbitral tribunal made critical errors of law, however, noting that it has limited power to review and overturn the award. The position of the Committee was a direct attack on ICSID system showing as an internal recognition of ICSID itself that the current system of investor-state arbitration is problematic. States are coming to limit the scope of umbrella clauses. For example, the 2004 U.S. Model BIT detailed definition of the type of contracts for which breach of contract claims may be submitted to arbitration, to increase certainty and predictability. Latin American countries, in particular, Argentina, are feeling collectively victims of these pro-investor interpretations of the ICSID tribunals. In fact, BIT between developed and developing countries are negotiated to protect foreign investment from developing countries. This general characteristic of BIT reflects naturally on the provisions making them extremely protective for foreign investors. Naturally, developing countries seek to interpret restrictively BIT provisions, whereas developed countries try to interpret more expansively. As most of cases arising out of alleged violation of BIT are administered in the ICSID, a forum under the auspices of the World Bank, these Latin American countries have been raising the legitimacy deficit of the ICSID. The Argentine cases have been provoking many legal issues of international law, predicting crisis almost coming in actual investor-state arbitration system. Some Latin American countries, such as Bolivia, Venezuela, Ecuador, Argentina, already showed their dissatisfaction with the ICSID system considering withdrawing from it to minimize the eventual investor-state dispute. Thus the disagreement over umbrella clauses in their interpretation is becoming interpreted as an historical reflection on the continued tension between developing and developed countries on foreign investment. There is an academic and political discussion on the possible return of the Calvo Doctrine in Latin America. The paper will comment on these problems related to the interpretation of umbrella clause. The paper analyses ICSID cases involving principally Latin American countries to identify the critical legal issues arising between developing and developed countries. And the paper discusses alternatives in improving actual investor-State investment arbitration; inter alia, the introduction of an appellate system and treaty interpretation rules.

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A Study on the Concentration of Nanoparticles and Heavy Metals in Indoor/Outdoor Air in a University Administrative Public Office (대학교 행정실 실내 외 공기 중 나노입자와 중금속 농도에 관한 연구)

  • Choi, Su-Hyeon;Im, Ji-Young;Park, Hee-Jin;Chung, Eun-Kyung;Kim, Jong-Oh;Son, Bu-Soon
    • Journal of Environmental Health Sciences
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    • v.38 no.6
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    • pp.493-502
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    • 2012
  • Objectives: The purpose of this study is to investigate the mass concentration of nanoparticles and understand the characteristics of elements of heavy metal concentrations within nanoparticles in the air using Micro-Orifice Uniform Deposit Impactor Model-110 (MOUDI-110), based on indoor and outdoor air. Methods: This Study sampled nanoparticles using MOUDI-110 indoors (office) and outdoors at S University in Asan, Korea in order to reveal the concentration of nanoparticles in the air. Sampling continued for nine months (10 times indoors and 14 times outdoors) from March to November 2010. Mass concentrations of nanoparticle and concentrations of heavy metals (Al, Mn, Zn, Ni, Cu, Cr, Pb) were analyzed. Results: Indoors, geometric mean concentration of nanoparticles ranged in size from 0.056 ${\mu}m$ to 0.10 ${\mu}m$ and those of 0.056 ${\mu}m$ or less recorded 0.929 ${\mu}g/m^3$ and 1.002 ${\mu}g/m^3$, respectively. On the other hand, the levels were lower outdoors with 0.819 ${\mu}g/m^3$ and 0.597 ${\mu}g/m^3$. Mann-Whitney U tests showed that the difference between the indoors and the outdoors was statistically meaningful in terms of particles of 0.056 ${\mu}m$ or less (p<0.05) in size. These results are possibly influenced by the use of printers and duplicators as the factor that increased the concentration of nanoparticles. In seasonal concentration distribution, the level was higher during the summer compared to in the autumn. Those of 0.056 ${\mu}m$ or less in size presented a statistically meaningful difference during the summer (p<0.05). These results may be influenced by photochemical event as the factor that makes the levels high. Regarding zinc, among the other heavy metals, the fine particles ranged in size from 0.056 ${\mu}m$ to 0.10 ${\mu}m$ and those of 0.056 ${\mu}m$ or less recorded 1.699 $ng/m^3$ and 1.189 $ng/m^3$ in the outdoors. In the indoors, the levels were lower, with 0.745 $ng/m^3$ and 0.617 $ng/m^3$. Cr and Ni at the size of 0.056 ${\mu}m$ or less, both of which have been known to pose severe health effects, recorded higher concentrations indoors with 0.736 $ng/m^3$ and 0.177 $ng/m^3$, compared to 0.444 $ng/m^3$ and 0.091 $ng/m^3$ outdoors. By season, Zn, Ni, Cu and Pb posted a high level of indoor concentration during the fall. As for Cr, the level of concentration indoors was higher than outdoors both during the summer and the autumn. Conclusion: This study indicates the result of an examination of nano-sized particles and heavy metal concentrations. It will provide useful data for the determination of basic nanoparticle standards in the future.

OXIDES OF NITROGEN SPECIES MEASUREMENTS AND ANALYSIS IN THE CENTRAL PIEDMONT OF NORTH CAROLINA, U.S.A.

  • Kim, Deug-Soo;Viney P. Aneja
    • Journal of Korean Society for Atmospheric Environment
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    • v.10 no.E
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    • pp.311-324
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    • 1994
  • The quantitative knowledge of N $O_{\gamma}$ (=N $O_{x}$ +HN $O_3$+/PAN+N $O_3$$N_2$ $O_{5}$ +HN $O_2$+N $O_3$$^{-10}$ +organic nitrates+......)distribution is essential in tropospheric chemistry, especially, especially that related to understanding the processes leading to ozone production. Ambient concentrations of NO, N $O_2$, HN $O_3$ and PAN as well as total N $O_{\gamma}$ were measured during June and early July 1992 at a rural site(Candor, NC), in the central Piedmont region of NC. The measurements of N $O_{\gamma}$ species were made in an effort to provide a comprehensive understanding of nitrogen chemistry and to investigate the total nitrogen budget at the site. N $O_{\gamma}$, N $O_2$, and NO showed diurnal variations with maxima in the morning. The maximum N $O_{\gamma}$ concentration reached was 14.5 ppbv, and the maximum concentrations of NO and N $O_2$ were 5.4 and 7.8 PPbv, respectively. The mean N $O_{\gamma}$ concentration as found to be 2.88$\pm$1.58 ppbv(n=743). The mean concentrations of NO and N $O_2$, were found to be 0.15 $\pm$ 0.29 ppbv(n=785) and 1.31 $\pm$ 0.99 ppbv(n=769). Products of photochemical oxidants, (N <$O_{\gamma}$-N $O_{x}$ ), such as HN $O_3$ and PAN, as well as ozone showed diurnal variation with maxima in the afternoon and minima at night The fractions of individual reactive nitrogen species to total N $O_{\gamma}$ were investigated and contrasted to the results from remote marine site and rural continental sites. N $O_{x}$ was the major species to total N $O_{\gamma}$(45%). NO concentrations appeared to be nearly constant whether the Prevailing winds were from continental areas or from oceanic areas. Linear regression of $O_3$ with (N $O_{\gamma}$- N $O_{x}$ )/N $O_{\gamma}$ (i.e. percent N $O_{x}$ converted to the photochemical products of N $O_{\gamma}$) yielded ( $O_3$) =25.8 〔 N $O_{\gamma}$-N $O_{x}$ 〕/(N $O_{\gamma}$) +27, ( $r^{2}$=0.58). The regression intercept is interpreted as the ozone back ground (intercept=27ppbv) and the slope suggests that 8.6 molecules of ozone are formed per molecule of N $O_{x}$ oxidized products (when the average N $O_{\gamma}$ concentration, about 3 ppbv at the site, is used). The N $O_{x}$ N $O_{\gamma}$ ratio was used as an indicator of the chemical age of airmasses and the ratio showed strong positive correlations with HN $O_3$( $r^{2}$=0.58), PAN ( $r^{2}$=0.46) and $O_3$( $r^{2}$=0.62). Larger N $O_{\gamma}$ and N $O_{x}$ N $O_{\gamma}$ ratio were found when winds came from continental sides. It may suggest that synoptic meteorological conditions and transport of N $O_{x}$ are important in the distribution of N $O_{\gamma}$ and its relationship with photochemical oxidants at the site.

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Dietary total sugar intake of Koreans: Based on the Korea National Health and Nutrition Examination Survey (KNHANES), 2008-2011 (한국인의 총 당류 섭취실태 평가: 2008~2011년 국민건강영양조사 자료를 이용하여)

  • Lee, Haeng-Shin;Kwon, Sung-Ok;Yon, Miyong;Kim, Dohee;Lee, Jee-Yeon;Nam, Jiwoon;Park, Seung-Joo;Yeon, Jee-Young;Lee, Soon-Kyu;Lee, Hye-Young;Kwon, Oh-Sang;Kim, Cho-Il
    • Journal of Nutrition and Health
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    • v.47 no.4
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    • pp.268-276
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    • 2014
  • Purpose: The aim of this study is to estimate total sugar intake and identify major food sources of total sugar intake in the diet of the Korean population. Methods: Dietary intake data of 33,745 subjects aged one year and over from the KNHANES 2008-2011 were used in the analysis. Information on dietary intake was obtained by one day 24-hour recall method in KNHANES. A database for total sugar content of foods reported in the KNHANES was established using Release 25 of the U.S. Department of Agriculture National Nutrient Database for Standard Reference, a total sugar database from the Ministry of Food and Drug Safety, and information from nutrition labeling of processed foods. With this database, total sugar intake of each subject was estimated from dietary intake data using SAS. Results: Mean total sugar intake of Koreans was 61.4 g/person/day, corresponding to 12.8% of total daily energy intake. More than half of this amount (35.0 g/day, 7.1% of daily energy intake) was from processed foods. The top five processed food sources of total sugar intake for Koreans were granulated sugar, carbonated beverages, coffee, breads, and fruit and vegetable drinks. Compared to other age groups, total sugar intake of adolescents and young adults was much higher (12 to 18 yrs, 69.6 g/day and 19 to 29 yrs, 68.4 g/day) with higher beverage intake that beverage-driven sugar amounted up to 25% of total sugar intake. Conclusion: This study revealed that more elaborated and customized measures are needed for control of sugar intake of different subpopulation groups, even though current total sugar intake of Koreans was within the range (10-20% of daily energy intake) recommended by Dietary Reference Intakes for Koreans. In addition, development of a more reliable database on total sugar and added sugar content of foods commonly consumed by Koreans is warranted.

The Acceptance Testing of 5 Mega Pixels Primary Electronic Display Devices and the Study of Quality Control Guideline Suitable for Domestic Circumstance (5 Mega 화소 진단용 전자표시장치 인수검사 및 국내 실정에 적합한 정도관리 가이드라인 연구)

  • Jung, Hai-Jo;Kim, Hee-Joung;Kim, Sung-Kyu
    • Progress in Medical Physics
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    • v.18 no.2
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    • pp.98-106
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    • 2007
  • In June 2005, Yonsei University Medical Center, Severance Hospital upgraded a full-PACS system by adding twenty (5 mega pixels) Totoku ME511L flat panel LCD display devices for diagnostic interpretation purposes. Here we report upon the quantitative (or visual) acceptance testing of the twenty Totoku ME511L display devices for reflection, luminance response, luminance spatial dependency, resolution, noise, veiling glare, and display chromaticity based on AAPM TG 18 report. The tools used in the tests included a telescopic photometer, which was used as a colorimeter, illuminance meter, light sources for reflection assessment, light-blocking devices, and digital TG18 test patterns. For selected 8 flat panel displays, mean diffuse reflection coefficient ($R_d$) was $0.019{\pm}0.02sr^{-1}$. In the luminance response test, luminance ratio (LR), maximum luminance difference ($L_{max}$), and deviation of contrast response were $550{\pm}100,\;2.0{\pm}1.9%\;and\;5.8{\pm}1.8%$, respectively. In the luminance uniformity test, maximum luminance deviation was $14.3{\pm}5.5%$ for the 10% luminance of the TG18-UNL10 test pattern. In the resolution test with luminance measurement method, percent luminance (${\Dalta}L$) at the center was $0.94{\pm}0.64%$. In all cases of noise testing, rectangular target In every square in the three quadrants was visible and all 15 targets except the smallest one in the every corner pattern and the center pattern. The glare ratio (GR) was $12,346{\pm}1,995$. The color uniformity, (u',v'), was $0.0025{\pm}0.0008$. Also, the research results of qualify control guideline of primary disply devices suitable for domestic circumstance are presented All test results are in-line with the criteria recommended by AAPM TG18 report and are thus fully acceptable for diagnostic image interpretation. As a result, the acceptance testing schedule described provides not only an acceptance standard but also guidelines for quality control, optimized viewing conditions, and a means for determining the upgrading time of LCD display devices for diagnostic interpretation.

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The effect of enamel matrix derivative (EMD) in combination with deproteinized bovine bone material (DBBM) on the early wound healing of rabbit calvarial defects (법랑기질 단백질 유도체와 혼합된 이종골 이식재가 토끼 두개골 결손부 초기 치유에 미치는 영향)

  • Kim, You-Seok;Jang, Hyun-Seon;Park, Ju-Chol;Kim, Heoung-Jung;Lee, Jong-Woo;Kim, Chong-Kwan;Kim, Byung-Ock
    • Journal of Periodontal and Implant Science
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    • v.35 no.1
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    • pp.199-216
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    • 2005
  • 치주치료의 가장 중요한 목적은 상실된 치주조직의 형태적, 기능적 재건이다. 법랑기칠 단백질 유도체(enamel matrix derivative: EMD)는 치주 병소에 사용시 상피세포의 증식을 억제하며 치주인대 및 백악아세포를 활성화시켜 무세포성 백악질 및 치주인대와 골조직의 생성을 유도한다고 보고되고 있다. 또한 법랑기질 단백칠 유도체는 골모세포의 증식 및 분화를 촉진시키며 alkaline phosphatase의 활성 및 mineralized nodule의 형성을 촉진시킨다고 보고되고 있다. 이에 본 연구에서는 토끼 두개골 결손부에 법랑기질 단백질 유도체와 이종골 이식재를 이식한 후 골밀도를 방사선학적으로 분석하고, 신생골 형성 및 주변 조직 반응을 조직학적으로 관찰, 평가하고자 하였다. 토끼 두개골에 6mm trephine bur(외경 8mm)를 이용하여 경뇌막에 손상을 주지 않도록 하면서 4개의 결손부를 형성하였다. 아무것도 이식하지 않은 군을 음성 대조군으로, 이종골 이식재 ($Bio-Oss^{(R)}$, Geistlich, Wolhusen, Switzerland)을 이식한 군을 양성 대조군으로 설정하였다. 법랑기질 단백질 유도체 ($Emdogain^{(R)}$, Biora, Inc., Sweden)만 이식한 군과 법랑기질 단백질 유도체와 이종골 이식재를 혼합하여 이식한 군을 설험군으로 설정하였다. 각각의 재료를 이식한 후 비흡수성 차폐막 ($Tefgen^{(R)}$, Lifecore Biomedical, Inc., U.S.A.)을 위치시키고 흡수성 봉합사로 일차봉합을 시행하였다. 각 군당 술 후 1, 2, 4주의 치유기간을 설정하였다. 동물을 희생시킨 후 두개골을 절제하여 먼저 방사선학적인 골밀도측정을 시행한 후 10% formalin에 고정한 후 통법에 따라 조직표본을 제작하여 광학현미경으로 관찰하였다. 1. 방사선학적인 평가에서 1, 2, 4주에 대조군과 법랑기질 단백질 유도체만 이식한 군과 비교해 이종골 이식재만 이식한 군과 이종골 이식재에 법랑기질 단백질 유도체를 이식한 군에서 더 큰 골의 밀도를 보이고 있었다 (P<0.01). 하지만, 동일한 시기에 대조군과 법랑기질 단백질 유도체만 이식한 군과의 차이는 발견할 수 없었으며 (P>0.05), 이종골 이식재만 이식한 군과 이종골 이식재에 법랑기질 단백질 유도체를 이식한 군의 차이 또한 발견할 수 없었다 (P>0.05). 2. 조직학적인 평가에서 1, 2, 4주에 대조군과 법랑기질 단백질 유도체만 이식한 군과 비교해 이종골 이식재만 이식한 군과 이종골 이식재에 법랑기질 단백질 유도체를 이식한군에서 골의 형성이 더 진행됨을 알 수 있었다. 법랑기질 단백질 유도체만 이식한 군이 대조군보다 2주에서 더 많은 신생골을 볼 수 있었으며, 이종골 이식재에 법랑기질 단백질 유도체를 이식한 군이 이종골 이식재만 이식한 군보다 1, 2주에서 더 많은 신생골을 관찰할 수 있었다. 이상의 결과에서 법랑기질 단백질 유도체는 토끼 두개골 결손부 치유단계에서 초기 골 형성을 촉진하는 것으로 사료되며 골 이식시에 법랑기질 단백질 유도체를 적용하는 것은 유용한 술식으로 사료된다.

External Beam Radiotherapy Alone in Advanced Esophageal Cancer (진행된 식도암의 방사선 단독치료 성적)

  • Ahn Sung Ja;Chung Woong Ki;Nah Byung Sik;Nam Taek Keun
    • Radiation Oncology Journal
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    • v.18 no.1
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    • pp.11-16
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    • 2000
  • Purpose :We peformed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. Methods and Materials : One hundred and six Patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (94$\%$) and ranged from 1 month to 92 months (median; 6 months). Results :The median age was 62 years old and male to female ratio was 104 2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was peformed in 83$\%$. Mean tumor dose delivered with curative aim was 58.6 Gy (55$\~$70.8 Gy) and median duration of the radiation therapy was 53 days. The median survival of all patients was 6 months and )-year and 2-year overall survival rate was 27$\%$ and 12$\%$, respectively, Improvement of dysphagia was obtained in most patients except for 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32$\%$ (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30$\%$ respectively, while those of the nonresponder was 4 months and 0$\%$ respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 months and 16$\%$ while those of the patients who could not tolerate regular diet was 3 months and 0$\%$, respectively (p=0.004). The survival difference between the patients with S cm or less tumor length and those with more than 5 cm tumor length was marginally statistically significant (u=0,06). However, the survival difference according to the periesophageal invasion or mediastinal tyrnphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9$\%$). Conclusion :The survival outcome for advanced esophageal cancer patients treated by external beam radiotherapy alone was very poor. In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.

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