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A Study on the Quality of Life of Elderly People with Dementia and the Environmental Factor of Facilities (치매노인의 삶의 질과 시설 환경 요인에 관한 연구)

  • Park, Sejeong;Kim, Hangon
    • 한국노년학
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    • v.29 no.4
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    • pp.1361-1381
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    • 2009
  • There have lately been a variety of social issues in our society due to rapid social changes. Specifically, how to approach elderly people who suffer from dementia is never an easy task, and few in-depth studies have ever focused on their quality of life due to that. The purpose of this study was to examine the quality of life of elderly people with dementia and the relationship between their quality of life and the environments of facilities for them in an attempt to lay the foundation for the development of compatible programs tailored to the environments of the facilities and for relevant policy setting. It's ultimately meant to improve the quality of life of the elderly with dementia and the environments of facilities for them. The subjects in this study were elderly people with dementia who were housed in senior residential and medical welfare facilities in Daegu and Gyeongsangbukdo. The collected data were analyzed with a SPSS 12.0 program, and frequency analysis, cross-tabs and multiple logistic regression analysis were utilized. As a result, facility environments were identified as one of the variables that had a significant impact on the quality of life of the elderly people with dementia. There are some suggestions about how to boost their quality of life: First, good environments should be prepared in consideration of the characteristics of elderly people with dementia in order for themto be satisfied with their own quality of life, and the way of looking at their potentials should be changed. Second, it's found that main caregivers affected the quality of life of the elderly people with dementia, and the kind of programs that focus on the improvement of the relationship between elderly people with dementia and their main caregivers is required. Third, there should be a change in the environments of the facilities. The facilities should be well equipped to successfully respond to the symptoms of elderly people with dementia. To redress their poor accessibility to the facilities, infrastructure involving nursing homes and professional personnels should be built by utilizing the Internet, and the facilities and local community should make concerted efforts to provide quality care to elderly people in want of it.

Research on the Circumstance for Agricultural Investment of Cambodia (캄보디아 농업투자 환경에 관한 연구)

  • Lee, Kyu-Seong;Bae, Dong-Jin;Kim, Seong-Nam;Kang, Young-Shin
    • Journal of the Korean Society of International Agriculture
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    • v.23 no.5
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    • pp.475-484
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    • 2011
  • International price of cereal has been dramatically increasing for the past few years. This price hike amplified the importance of food self-sufficiency in numerous countries due to the fact that food security is directly proportional to food self-sufficiency. In this study, we conducted a survey to provide useful information of Cambodia's agricultural environment to possible Korean agricultural investors and as to highlight Cambodia as a strong candidate for the establishment of Korea's foreign base for cereal production. The survey conducted includes information regarding Cambodia's agricultural environment and investment circumstances including the political, economical and other contributing factors affecting agricultural investment in Cambodia. Seventy percent of the Cambodia's total population engage in agriculture and this comprises about 30% of the country's GDP. This statistics reflects the possibility of Cambodia's poverty alleviation which proves that agriculture in Cambodia is the driving force for the improvement of the country's economy. In addition, low labor cost, fertile land, abundant water resources, like the Tonle sap lake and the Mekong river, and unreclaimed lands are the strong points that could attract agricultural investors to Cambodia. Poor infrastructure, irrigation systems, law reforms, including social and cultural differences may be the biggest setbacks for the acceleration of Cambodia's agriculture development. However, the Cambodian government is open and willing to make adjustments for Cambodia to be both foreign and domestic agricultural investor-friendly, expecting that it will boost its country's agricultural development. Making the best out of this opportunity, the coordination of KOICA with Korean agricultural investors in building infrastructures and with the help of the KOPIA program for the transfer of agricultural technology will benefit both countries and will play an important role in Cambodia's agriculture.

The Effect of Employment Types of Middle and Old Age Group of Wage Earner on Life Satisfaction (중·노년층 임금근로자의 고용형태에 따른 삶의 만족도)

  • Lee, Seo-yeong;Song, Hee-kyong
    • 한국노년학
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    • v.39 no.3
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    • pp.517-529
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    • 2019
  • The study was conducted on the impact of employment types middle and old age group of wage earner on life satisfaction and analyzed by dividing it into variables in the employment types and demographic characteristics. Based on the data for the 12th year of the Korea Welfare Panel Study, 1,244 respondents who answered that the main types of economic activities were 'full-time, temporary, daily wage earners' or 'self-help labor, public labor, and elderly empolyment program in public sector.' among 4,341 people over 55 years of age under the age of 75 as of 2017 standard. The survey covered 1,244 people. By age group, 826 people aged 55-64 (middle-age group) and 418 people aged 65-74(old-age group). Middle age group showed that education level, spouse, health condition, beneficiaries of basic livelihood and average monthly income variables were the factors that influence the satisfaction of life. But The type of employment did not significantly affect. Old age group showed that the higher education level, in spouse with-living or spouse death, the better health condition is perceived, the less experience of beneficiaries of basic livelihood, the higher average monthly income, the more satisfied life is. The survey also found that old-aged people who participate in "self-help labor, public labor, and elderly employment program in public sector" are also found to be more satisfied with their lives. According to these results, policy for the old age group should be focused on hunting and expanding of employment program in public sector for the elderly. In order to boost life satisfaction of the elderly, more intensive vocational education and employment training should be provided.

Two Faces of Entrepreneurial Leadership: The Paradoxical Effect Reflecting Followers' Regulatory Focus (기업가적 리더십의 양면성: 구성원의 조절 초점 성향에 따른 패러독스 효과)

  • Sang-Jib Kwon
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.18 no.4
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    • pp.165-175
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    • 2023
  • In venture creation research, studying 'entrepreneurial leadership' is important for uncovering and comprehending the underlying causal process in innovative behavior performance. Although previous studies provide that entrepreneurial leadership enhances followers' innovative behavior, there is few research on entrepreneurial leadership and followers' characteristics interaction. The present study's focus is paradoxical effects of entrepreneurial leadership on self-efficacy and innovative behavior. On the basis of individual regulatory focus, this study suggests that interaction effects of entrepreneurial leadership and followers' regulatory focus differed in promotion view and prevention view followers' innovative behavior. To strengthen the casual mechanism, this study conducted in priming experiment method using employees in SMEs. This study used a 2(entrepreneurial leadership vs. control) x 2 (regulatory focus: promotion vs. prevention) between-participants design. The results of this study provide that (1) Individuals in promotion focus especially benefited from entrepreneurial leadership in terms of its effect on their self-efficacy and innovative behavior; (2) whereas entrepreneurial leadership was negatively related to self-efficacy and innovative behavior of followers' prevention focus. In sum, results of the present study supporting evidence for hypotheses, combined effect of entrepreneurial leadership and regulatory focus on innovative behavior through self-efficacy. Experimental results confirmed hypotheses of this study, revealing that promotion focus show more innovative behavior than prevention focus when their leaders' leadership style is entrepreneurial leadership. Also, the paradoxical effect of entrepreneurial leadership and regulatory focus of followers on innovative behavior was mediated by followers' self-efficacy. This study helps explain how leaders' entrepreneurial leadership boost followers' innovative behavior, particularly for those employees who have promotion focus. The current study contributes to the theory of entrepreneurial leadership and regulatory focus and innovation literature. Findings of this study shed light on the organizational processes that shape innovative behavior in venture/startup corporations and provide contributions for venture business field.

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The Effect of the Gap between College Students' Perception of the Importance of Coffee Shops and Their Satisfaction after Patronizing Coffee Shops on Their Purchasing Behavior (대전원교학생대가배점중요성적감지화타문광고가배점지후적만의도지간적차거대타문구매행위적영향(大专院校学生对咖啡店重要性的感知和他们光顾咖啡店之后的满意度之间的差距对他们购买行为的影响))

  • Lee, Won-Ok
    • Journal of Global Scholars of Marketing Science
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    • v.19 no.4
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    • pp.1-10
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    • 2009
  • The purpose of this study was to categorize the gap between coffee shop 'importance' (as perceived by customers before patronizing the coffee shop) and 'satisfaction' (perception of customers after patronizing the coffee shop) as positive or negative and to analyze the effect of these gaps on purchasing behavior. To do this, I used the gap between importance and satisfaction regarding the choice of a coffee shop as the explanatory variable and performed an empirical analysis of the direction and size of the effect of the gap on purchasing behavior (overall satisfaction, willingness-to-revisit) by applying the Ordered Probit Model (OPM). A previous study that used IPA to evaluate the effects of gaps estimated the direction and size of a quadrant but failed to analyze the effect of gaps on customers. In this study, I evaluated the effects of positive and negative gaps on customer satisfaction and willingness-to-revisit. Using OPM, I quantified the effect of positive and negative gaps on overall customer satisfaction and willingness-to-revisit. Per-head expenditure, frequency of visits, and coffee-purchasing place had the most positive effects on overall customer satisfaction. Frequency of visits, followed by per-head expenditure and then coffee-purchasing place, had the most positive impact on willingness-to-visit. Thus per-head expenditure and frequency of visits had the greatest positive effects on overall satisfaction and willingness-to-revisit. This finding implies that the higher the actual satisfaction (gap) of customers who spend KRW5,000 or more once or more per week at coffee shops is, the higher their overall satisfaction and willingness-to-revisit are. Despite the fact that economical efficiency had a significant effect on overall satisfaction and willingness-to-revisit, college and university students still use coffee shops and are willing to spend KRW5,000 because they do not only purchase coffee as a product itself, but use the coffee shop for other activities, such as working, meeting friends, or relaxing. College and university students also access the Internet in coffee shops via personal laptops, watch movies, and study; thus, coffee shops should provide their customers with the appropriate facilities and services. The fact that a positive gap for coffee shop brand had a positive effect on willingness-to-revisit implies that the higher the level of customer satisfaction, the greater the willingness-to-revisit. A negative gap for this factor, on the other hand, implies that the lower the level of customer satisfaction, the lower the willingness-to-revisit. Thus, the brand factor has a comparatively greater effect on satisfaction than the other factors evaluated in this study. Given that the domestic coffee culture is becoming more upscale and college/university students are sensitive to this trend, students are attentive to brands. In most upscale coffee shops in Korea, the outer wall is built out of glass that can be opened, the interiors are exotic with an open kitchen. These upscale coffee shops function as landmarks and match the taste of college/university students. Coffee shops in Korea have become a cultural brand. To make customers feel that coffee shops are upscale, good quality establishments and measures to provide better services in terms of brand factor should be instituted. The intensified competition among coffee shop brands in Korea as a result of the booming industry indicates that provision of additional services is needed to differentiate competitors. These customers can also use a scanner free of charge. Another strategy that can be used to boost brands could be to provide and operate a seminar room for seminars and group study. If coffee shops adopt these types of strategies, college/university students would be more likely to consider the expenses they incur worthwhile and, subsequently, they would be more likely to be satisfied with the brands of these coffee shops, with an associated increase in their willingness-to-revisit. Gender and study year had the most negative effects on overall satisfaction and willingness-to-revisit. Female students were more likely to be satisfied and be willing to return than male students, and third and fourth-year students were more likely to be satisfied and willing-to-return than first or second-year students. Students who drink coffee, read books, and use laptops alone at coffee shops are easily noticeable. High-grade students tend to visit coffee shops alone in order to use their time efficiently for self-development and to find jobs. The economical efficiency factor had the greatest effect on overall satisfaction and willingness-to-revisit in terms of a positive gap. The higher the actual satisfaction (gap) of students with the price of the coffee, the greater their overall satisfaction and willingness-to-revisit. Economical efficiency with a negative gap had a negative effect on willingness-to-revisit, which implies that a less negative gap will result in a greater willingness-to-revisit. Amid worsening market conditions, coffee shops located around colleges/universities are using strategies, such as a point or membership card, strategic alliances with credit-card companies, development of a set menu or seasonal menu, and free coffee-shot services to increase their competitive edge. Product power also had a negative effect in terms of a negative gap, which indicates that a higher negative gap will result in a lower willingness-to-revisit. Because there are many more customers that enjoy coffee in this decade, as compared to previous decades, the new generation of customers, namely college/university students, want various menu items in addition to coffee, and coffee shops should, therefore, add side menu items, such as waffles, rice cakes, cakes, sandwiches, and salads. For example, Starbucks Korea is making efforts to enhance product power by selling rice cakes flavored in strawberry, wormwood, and pumpkin, and providing coffee or cream free of charge. In summary, coffee shops should focus on increasing their economical efficiency, brand, and product power to enhance the satisfaction of college/university students. Because shops adjacent to colleges or universities enjoy a locational advantage, providing differentiated services in terms of economical efficiency, brand, and product power, is likely to increase customer satisfaction and return visits. Coffee shop brands should, therefore, be innovative and embrace change to meet their customers' desires. Because this study only targeted college/university students in Seoul, comparative studies targeting diverse regions and age groups are required to generalize the findings and recommendations of this study.

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Results of Radiation Therapy and Extrafascial Hysterectomy in Bulky Stage IB, IIA-B Carcinoma of the Uterine Cervix (종괴가 큰 병기 IB, IIA-B 자궁경부암에서 방사선치료와 Extrafascial Hysterectomy의 결과)

  • Kim Jin Hee;Lee Ho Jun;Choi Tae Jin;Do Cha Soon;Lee Tae Sung;Kim Ok Bae
    • Radiation Oncology Journal
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    • v.17 no.1
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    • pp.23-29
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    • 1999
  • Purpose : To evaluate the efficacy of radiation therapy and extrafascial hysterectomy in bulky stage IB, IIA-B uterine cervix cancers. Methods and Materials : Twenty four patients with bulky stage IB and IIA-B carcinoma of the uterine cervix were treated with extrafascial hysterectomy following radiation therapy due to doubts of residual disease at Department of therapeutic radiology, Keimyung University, Dongsan Hospital, from April 1986 to December 1997 According to FIGO staging system, there were 7 patients with stage IB, 9 patients with IIA and 8 patients with IIB stage whose median age was 45. Pathologic distribution showed 16 patients with squamous cell carcinoma and 8 patients with adenocarcinoma. Seven patients had tumors that are less than 5cm in size and 17 patients had tumors with larger than 5cm. The mean interval between radiation therapy and extrafascial hysterectomy was 57 days. The radiation therapy consisted of external irradition to the whole pelvis (180 cGy/fraction, mean 4100 cGy) and parametrial boost (for a mean total dose of 5000 cGy) with midline shield (4H 10 cm), followed by intracavitary irradiation up to 7500 cGy to point A (maximum 8500 cGy). The maximum follow up duration was 107 months and mean follow up duration was 42 months. Results :Ten out of 24 patients (41.7%) had residual disease found at the time of extrafascial hysterectomies. Five year overall survival rate (5Y OSR) and five year disease free survival rate (5Y DFSR) were 63.6% and 62.5% respectively. Five year overall survival rate for stage IB and IIA was 71.4% and 50% for stage IIB. There was a significant difference in 5Y OSR and 5Y DFSR between patients with and those without residual disease (negative vs positive, 83.3% vs. 40% (P=0.01), 83.3% vs 36% (P=0.01) respectively). There was a notable tendency of better survival with adenocarcinoma than with squamous cell carcinoma (adenocarcinoma vs squamous cell carcinoma, 85.7% vs. 53.3% (P=0.1), 85.7% vs. 50.9% (P=0.1) of 5Y OSR and 5Y DFS respectivey). Total dose to A point did not make a significant difference in survival rate or the existence of residual lesion (< 7500 cGy, ${\geq}$ 7500 cOy). It was also noted that significantly more frequent local failures have occurred in patients with positive residual disease compared with negative residual disease (5/10 vs. 0/14, p=0.003), There was no death related to the treatment. Conclusion : There was no improvement of residual disease and to the overall survival rate in spite of increased total dose to point A. We conclude that there is a possible beneficial effect of radiation therapy followed by extrafaseial hysterectomy in survival for adenocarcinoma of bulky stage IB and IIA-B uterine cervix. We need to confirm this with longer follow up and with large number of patients.

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Individualized Determination of Lower Margin in Pelvic Radiation Field after Low Anterior Resection for Rectal Cancer Resulted in Equivalent Local Control and Radiation Volume Reduction Compared with Traditional Method (하전방 절제술을 시행한 직장암 환자에서 방사선조사 영역 하연의 개별화)

  • Park Suk Won;Ahn Yong Chan;Huh Seung Jae;Chun Ho Kyung;Kang Won Ki;Kim Dae Yong;Lim Do Hoon;Noh Young Ju;Lee Jung Eun
    • Radiation Oncology Journal
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    • v.18 no.3
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    • pp.194-199
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    • 2000
  • Purpose : Then determining the lower margin of post-operative pelvic radiation therapy field according to the traditional method (recommended by Gunderson), the organs located in the low pelvic cavity and the perineum are vulnerable to unnecessary radiation. This study evaluated the effect of individualized determination of the lower margin at 2 cm to 3 cm below the anastomotic site on the failure patterns. Materials and Methods . Authors included ぉ patients with modified Astler-Coiler (MAC) stages from B2 through C3, who received low anterior resection and post-operative pelvic radiation therapy from Sept. 1994 to May 1998 at Samsung Medical Center, Sungkyunkwan University. The numbers of male and female patients were 44 and 44, and the median age was 57 years (range: 32-81 years). Three field technique (posterior-anterior and bilateral portals) by 6, 10, 15 MV X-rays was used to deliver 4,500 cGy to the whole pelvis followed by Sn cGy's small field boost to the tumor bed over 5.5 weeks. Sixteen patients received radiation therapy by traditional field margin determination, and the lower margin was set either at the low margin of the obturator foramen or at 2 cm to 3 cm below the anastomotic site, whichever is lower. In 72 patients, the lower margin was set at 2 cm to 3 cm below the anastomotic site, irrespectively of the obturator foramen, by which the reduction of radiation volume was possible in 55 patients ($76\%$). Authors evaluated and compared survival, local control, and disease-free survival rates of these two groups. Results : The median follow-up period was 27 months (range : 7-58 months). MAC stages B2 in 32($36\%$), B3 in 2 ($2\%$), Cl in 2 ($2\%$), C2 in 50 ($57\%$), and C3 in 2 ($2\%$) Patients, respectively. The entire patients' overall survival rates at 2 and 4 years were $94\%$ and $68\%$, respectively, and disease-free survival rates at 2 and 4 years were $86\%$ and $58\%$, respectively. The first failure sites were local only in 4, distant only in 14, and combined local and distant in 1 patient, respectively. There was no significant difference with respect to local control and disease-free survival rates ( p=0.42, p=0.68) between two groups of different lower margin determination policies. Conclusion : The new concept in the individualized determination of the lower margin depending on the anastomotic site has led to the equivalent local control and disease-free survival rates, and is expected to contribute to the reduction of unnecessary radiation-related morbidity by reduction of radiation volume, compared with the traditional method of lower margin determination.

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Antitumor and Antimetastatic Effects of Toxoplasma Gondii in Mice with Lewis Lung Carcinoma (Lewis 폐암 마우스 모델에서 톡소포자충에 의한 항암 및 항전이 효과)

  • Kim, Ju-Ock;Jung, Sung-Soo;Park, Hee-Sun;Kim, Myoung-Hoon;Kim, Sun-Young;Lee, Young-Ha
    • Tuberculosis and Respiratory Diseases
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    • v.52 no.4
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    • pp.317-329
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    • 2002
  • Background : Immunotherapy is another treatment modality for various cancers. There is little information on the antitumor effects of immunotherapy on implanted lung cancer mouse models. Toxoplasma gondii is able to potently induce a nonspecific stimulation of the host immune system. Therefore, this study evaluated the antitumor and antimetastatic effect of nonspecific immune stimulation by T. gondii in a Lewis lung cancer mouse model. Methods : Female C57BL/6 mice were injected with either Lewis lung cancer cells ($1{\times}10^6$ per mouse) or 5 cysts from the T. gondii Me49 strain with various schedules. The number of survival days, the tumor size of the implanted muscle and the histopathological findings of each group were noted. In addition to these mice, the Toxoplasma antigen($50{\mu}g$ per mouse) or a lymphokine (0.5 ml per mouse) was added to boost the immunotherapy. Results : No mouse in the Toxoplasma-infected group had died, whereas the mice receiving only the cancer cells (cancer control) survived for $29.1{\pm}4.4$ days. Cancer cells were revealed from 1 week after cancer cell inceulation in the muscle and from 3 weeks in the lung of the cancer control, whereas cancer cells were found in both the preinfection control and coinfection control groups from 2 weeks and 4 weeks in the lung respectively. The in the number of survival days were $32.4{\pm}3.3$ in the mice receiving T. gondii 2 weeks prior to the cancer cells inoculation (preinfection control), $30.9{\pm}5.1$ in mice received both simultaneously (coinfection control), and $34.9{\pm}2.9$ in mice received T. gondii 2 weeks after cancer cells implantation (postinfection control). These 3 infection groups had significantly longer survival days and suppressed tumor growth than those of the cancer control. In addition to these mice, and injection with the Toxoplasma antigen alone or in combination with lymphokine resulted in a significant increase in the number of survival days. Conclusion : These findings suggest that an injection with T. gondii can induce the antitumor and antimetastatic effects in Lewis lung cancer mouse models. Moreover, these effects were increased with an injection of the Toxoplasma antigen alone or in combination with lymphokine. However, this therapy can not prevent the development of cancer.

Low Dose Cisplatin as a Radiation Sensitizer in Management of Locally Advanced Scluamous Cell Carcinoma of the Uterine Cervix : Evaluation of Acute Toxicity and Early Response (국소 진행된 자궁경부암의 방사선치료와 저용량 cisplatin 항암요법 동시치료시 급성독성 밀 초기반응 평가)

  • Kim Hunjung;Cho Young Kap;Kim Chulsu;Kim Woo Chul;Lee Sukho;Loh J K
    • Radiation Oncology Journal
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    • v.17 no.2
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    • pp.113-119
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    • 1999
  • Purpose : To evaluate possible acute toxicity and early response of concurrent radiation therapy and low dose daily cisplatin as a radiosensitizer in patients with locally advanced uterine cervical carcinomas. Materials and Method : From December 1996 to January 1999, 38 previously untreated Patients with locally advanced squamous cell carcinoma of the uterine cervix (from stage IIB to stage IIIB) were treated at Inha University Hospital. All patients underwent standard pretreatment staging Procedures after the initial evaluation by gynecologists and radiation oncologists. Sixteen Patients with huge cervical mass (>4 cm) were submitted to the group treated with concurrent radiation therapy and low dose daily cisplatin while the remainder was treated with radiation therapy alone. Radiation therapy consisted of 4500 cGy external beam irradiation to whole pelvis (midline block after 3000 cGy), 900$\~$1000 cGy boost to involved parametrium, and high dose-rate intracavitary brachytherapy (a total dose of 3000$\~$3500 cGy/500 cGy per fraction to point A, twice per week). In the group treated with low dose cisplatin concurrently, 10 mg of daily intravenous cisplatin was given from the 1st day of radiation therapy to the 20th day of radiation therapy. Acute toxicity was measured according to expanded common toxicity criteria of the NCI (C) Clinical Trials. Early response data were analyzed at minimum 4 weeks' follow-up after completion of the treatment protocol. Results: Hematolgic toxici쇼 was more prominent in patients treated with radiation therapy and cisplatin. Six of 16 patients (37.5$\~$) treated with radiation therapy and cisplatin and one of 22 patients (4.5$\~$) treated with radiation therapy alone experienced grade 3 leukopenia. In Fisher's exact test, there was statistically significant difference between two groups regarding leukopenia (P=0.030). There was no apparent difference in the frequency of gastrointestinal and genitourinary toxicity between two groups (P=0.066). Three of 16 patients (18.7$\~$) treated with radiation therapy and cisplatin and two of 22 patients (9.1$\~$) treated with radiation therapy alone experienced more than 5 kg weight loss during the treatment. There was no statistically significant difference on weight loss between two groups (P=0.63). Two patients on each group were not evaluable for the early response because of incomplete treatment. The complete response rate at four weeks' follow-up was 80$\~$(16/20) for the radiation therapy alone group and 78$\~$ (11/14) for the radiation therapy and cisplatin group. There was no statistically significant difference in early response between two treatment groups (P=0.126). Conclusion : This study led to the conclusion that the hematologic toxicity from the treatment with concurrent radiation therapy and low dose daily cisplatin seems to be more prominent than that from the treatment of radiation therapy alone. There was no grade 4 hematologic toxicity or mortality in both groups. The hematologic toxicity in both treatment groups seems to be well managable modically. Since the risk factors were not balanced between two treatment groups, the direct comparison of early response of both groups was not possible. However, preliminary results regarding early response for patients with bulky cervical tumor mass treated with radiation therapy and low dose daily cisplatin was encouraging. Longer follow-up is necessary to evaluate the survival data. A phase III study is needed to evaluate the efficacy of concurrent daily low dose cisplatin with radiation therapy in bulky cervical cancer.

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Postoperative Adjuvant Chemotherapy and Chemoradiation for Rectal Cancer (직장암의 근치적 절제술 후 보조 화학요법과 보조 화학방사선 병용요법)

  • Lee Kang Kyoo;Park Kyung Ran;Lee Ik Jae;Kim Ik Yong;Sim Kwang Yong;Kim Dae Sung;Lee Jong Young
    • Radiation Oncology Journal
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    • v.20 no.4
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    • pp.334-342
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    • 2002
  • Purpose : The aim of this study was to determine if postoperative adjuvant chemotherapy (CT) alone and concurrent chemoradiation (CCRT), following radical surgery, improved the disease free survival (DFS) and overall survival (OS) in rectal cancer AJCC stage II and III patients. Materials and Methods : A total of 144 patients with AJCC stage II and III rectal cancer who had had radical surgery between 1989 and 1999 were included in the study. Of these patients, 72 had been treated with postoperative CT, and the other 72 with postoperative CCRT. The chemotherapy regimen consisted of oral UFT on a daily basis for $1\~12$ months (median 12 months) or 5-FU ($500\;mg/m^2$ for 5 days) intravenous (IV) chemotherapy with 4 week intervals for $1\~18$ cycles (median 6 cycles). Radiation of 4,500 cGy was delivered to the surgical bed and regional pelvic lymph nodes area, followed by $540\~1,440\;cGy$ (median 540 cGy) boost to the surgical bed. The follow-up period ranged from 20 to 150 months, with a median of 44 months. Results : The 5-year OS was $60.9\%\;and\;68.9\%$ (p=0.0915), and the 5-year DFS was $56.1\%\;and\;63.8\%$ (p=0.3510) for postoperative CT and postoperative CCRT, respectively. In the stage nm patients, the 5-year OS was $71.1\%\;and\;92.2\%$, and the 5-year DFS was $57.3\%\;and\;85.4\%$ for postoperative CT and CCRT, respectively. The OS was significantly improved (p=0.0379) but the DFS was not with postoperative CCRT compared to the postoperative CT (p=0.1482). In the stage III patients, the 5-year OS was $52.0\%\;and\;55.0\%$, and the 5-year DFS was $47.8\%\;and\;49.8\%$ for postoperative CT and postoperative CCRT. There were no statistically significant differences between postoperative CT and CCRT (p=0.4280 and p=0.7891) in OS and DFS. The locoregional relapses were $16.7\%\;and\;12.5\%$ for postoperative CT and CCRT, respectively. The distant relapses were $25.0\%\;and\;26.4\%$ for postoperative CT and CCRT, respectively. Conclusion : These results showed that postoperative CCRT compared with CT alone improved OS in stage II patients. Although there was no statistical significance, the addition of postoperative RT to CT reduced locoregional relapses compared to CT alone.