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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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Postoperative Radiation Therapy for Chest Wall Invading pT3N0 Non-small Cell Lung Cancer: Elective Lymphatic Irradiation May Not Be Necessary (흉벽을 침범한 pT3N0 비소세포폐암 환자에서 수술 후 방사선치료)

  • Park, Young-Je;Ahn, Yong-Chan;Lim, Do-Hoon;Park, Won;Kim, Kwan-Min;Kim, Jhingook;Shim, Young-Mog;Kim, Kyoung-Ju;Lee, Jeung-Eun;Kang, Min-Kyu;Nam, Hee-Rim;Huh, Seung-Jae
    • Radiation Oncology Journal
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    • v.21 no.4
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    • pp.253-260
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    • 2003
  • Purpose: No general consensus has been reached regarding the necessity of postoperative radiation therapy (PORT) and the optimal techniques of its application for patients with chest wall invasion (pT3cw) and node negative (NO) non-small cell lung cancer (NSCLC). We retrospectively analyzed the PT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. Materials and Methods: From Aug. 1994 till June 2000, 21 pT3cwN0 NSCLC patients received PORT at Samsung Medical Center; all of whom underwent curative on-bloc resection of the primary tumor plus the chest wall and regional lymph node dissection. PORT was typically stalled 3 to 4 weeks after operation using 6 or 10 MV X-rays from a linear accelerator. The radiation target volume was confined to the tumor bed plus the immediate adjacent tissue, and no regional lymphatics were included. The planned radiation dose was 54 Gy by conventional fractionation schedule. The survival rates were calculated and the failure patterns analyzed. Results: Overall survival, disease-free survival, loco-regional recurrence-free survival, and distant metastases-free survival rates at 5 years were 38.8$\%$, 45.5$\%$, 90.2$\%$, and 48.1$\%$, respectively. Eleven patients experienced treatment failure: six with distant metastases, three with intra-thoracic failures, and two with combined distant and intra-thoracic failures. Among the five patients with intra-thoracic failures, two had pleural seeding, two had in-field local failures, and only one had regional lymphatic failure in the mediastinum. No patients suffered from acute and late radiation side effects of RTOG grade 3 or higher. Conclusion: The strategy of adding PORT to surgery to improve the probability, not only of local control but also of survival, was justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. The incidence and the severity of the acute and late side effects of PORT were markedly reduced, which contributed to improving the patients' qualify of life both during and after PORT, without increasing the risk of regional failures by eliminating the regional lymphatics from the radiation target volume.

Intake of Snacks, and Perceptions and Use of Food and Nutrition Labels by Middle School Students in Chuncheon Area (춘천지역 중학생들의 간식 섭취 실태와 식품·영양표시에 대한 인식 및 이용실태)

  • Kim, Yoon-Sun;Kim, Bok-Ran
    • Journal of the Korean Society of Food Science and Nutrition
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    • v.41 no.9
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    • pp.1265-1273
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    • 2012
  • The purpose of this study was to investigate the BMI, intake of snacks, and perceptions and use of food and nutrition labels by middle school students (144 boys and 189 girls) in Chuncheon area. The average height and weight of boys were $171.0{\pm}6.4$ cm and $61.0{\pm}11.4$ kg, respectively, whereas those of girls were $160.0{\pm}4.8$ cm and $50.8{\pm}6.6$ kg, respectively. Average body mass index (BMI) of boys and girls were $20.8{\pm}3.3$ and $19.8{\pm}2.4$, respectively (p<0.01). Dietary intake attitude score of girls ($34.39{\pm}5.66$) was higher than that of boys ($33.92{\pm}5.40$) (p<0.05). Subjects bought and ate snacks 1 to 3 times per week (40.2%) by themselves, and most consumed snacks were cookies (23.1%), instant noodles (16.2%), ice cream (13.2%), and candy and chocolates (13.2%). The most important factor in purchasing of snacks was 'taste' ($4.49{\pm}0.67$). When subjects bought processed foods, the rates of reading food labels was 86.6%. The most important factor of the food labels was 'expiration date' (42.9%). The degree of reading food labels on processed foods by girls ($22.70{\pm}5.72$) was higher than that of boys ($20.96{\pm}5.35$) (p<0.01). Of the 13.2% of subjects that did not read food labels, the reason why was that they were not interested (50.0%). Of the 78.4% of subjects that read nutrition labels, the most important component of the nutrition labels was 'calories' (75.9%). The main reason for reading nutrition labels was 'to control weight' (45.6%). In general, use of food labels correlated positively with dietary intake attitude score (p<0.05) and use of nutrition labels (p<0.01). Using multiple regression analysis, we found that 'usefulness of dietary life' was the most significant variable that affects the importance of food and nutrition labels. Therefore, development of an educational program on food and nutrition labels for adolescents will be effective in improving dietary life.

The Effect of Lidocaine Dose and Pretreated Diazepam on Cardiovascular System and Plasma Concentration of Lidocaine in Dogs Ansthetized with Halothane-Nitrous Oxide (Diazepam 전투여와 Lidocaine 투여용량이 혈중농도 및 심혈역학적 변화에 미치는 영향)

  • Lee, Kyeong-Sook;Kim, Sae-Yeon;Park, Dae-Pal;Kim, Jin-Mo;Chung, Chung-Gil
    • Journal of Yeungnam Medical Science
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    • v.10 no.2
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    • pp.451-474
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    • 1993
  • Lidocaline if frequently administered as a component of an anesthetic : for local or regional nerve blocks, to mitigate the autonomic response to laryngoscopy and tracheal intubation, to suppress the cough reflex, and for antiarrythmic therapy. Diazepam dectease the potential central nervous system (CNS) toxicity of local anesthetic agents but may modify the sitmulant action of lidocaine in addition to their own cardiovascular depressant. The potential cardiovascular toxicity of local anesthetics may be enhanced by the concomitant administration of diazepam. This study was designed to investigate the effects of lidocaine dose and pretreated diazepam to cardiovascular system and plasma concentration of lidocaine. Lidocaine in 100 mcg/kg/min, 200 mcg/kg/min, and 300 mcg/kg/min was given by sequential infusion to dogs anesthetized with halothane-nitrous oxide (Group I). And in group II, after diazepam pretreatment, lidocaine was infused by same way when lidocaine was administered in 100 mcg/kg/min, the low plasma levels ($3.97{\pm}0.22-4.48{\pm}0.36$ mcg/ml) caused a little reduction in cardiovascular hemodynamics. As administered in 200 mcg/kg/min, 300 mcg/kg/min, the higher plasma levels ($7.50{\pm}0.66-11.83{\pm}0.59$ mcg/ml) reduced mean arterial pressure (MAP), cardiac index (CI), stroke index (SI), left ventricular stroke work index (LVSWI), and right ventricular stroke work index (PVSWI) and increased pulmonary artery wedge pressure (PAWP), central venous pressure (CVP), systemic vascular resistance index (SVRI), but was associated with little changes of heart rate (HR), mean pulmonary artery pressure (MPAP), and pulmonary vascular resistance index (PVRI). When lidocaine with pretreated diazepam was administered in 100 mcg/kg/min, the low plasma level, the lower level than when only lidocaine administered, reduced MAP, but was not changed other cardiovascular hemodynamics. While lidocaine was infused in 200 mcg/kg/min, 300 mcg/kg/min in dogs pretreated diazepam, the higher plasma level ($7.64{\pm}0.79-13.79{\pm}0.82$ mcg/ml) was maintained and was associated with reduced CI, SI, LVSWI and incresed PAWP, CVP, SVRI but was a little changes of HR, MPAP, PVRI. After $CaCl_2$ administeration, CI, SI, SVRI, LVSWI was recovered but PAWP, CVP was rather increased than recovered. The foregoing results demonstrate that pretreated diazepam imposes no additional burden on cardiovascular system when a infusion of large dose of lidocaine is given to dogs anesthetized with halothanenitrous oxide. But caution may be advised if the addition of lidocaine is indicated in subjects who have impared autonomic nervous system and who are in hypercarbic, hypoxic, or acidotic states.

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Evaluation for Rock Cleavage Using Distribution of Microcrack Spacings (III) (미세균열의 간격 분포를 이용한 결의 평가 (III))

  • Park, Deok-Won
    • The Journal of the Petrological Society of Korea
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    • v.25 no.4
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    • pp.311-324
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    • 2016
  • The characteristics of the rock cleavage in Jurassic granite from Geochang were analysed. The evaluation for three quarrying planes and three rock cleavages was performed using the parameters such as (1) reduction ratio between the value of spacing and the value of length, (2) microcrack spacing frequency(N), (3) total spacing($1mm{\geq}$), (4) exponential constant(a), (5) magnitude of exponent(${\lambda}$), (6) mean spacing($S_{mean}$), (7) difference value($S_{mean}-S_{median}$) between mean spacing and median spacing($S_{median}$) and (8) density of spacing. Especially the close dependence between the above spacing parameters and the parameters from the spacing-cumulative frequency diagrams was derived. The discrimination factors representing three quarrying planes and three rock cleavages were acquired through these mutual contrast. The analysis results of the research are summarized as follows. First, the reduction ratios of frequency(N), mean value, median value, the above difference value($S_{mean}-S_{median}$) and density for three rock cleavages are in orders of G(grain, (G1 + G2)/2) < H(hardway, (H1 + H2)/2) < R(rift, (R1 + R2)/2), H < G $\ll$ R, H < G $\ll$ R, H < G < R and H < G $\ll$ R. The values of the above five parameters for three planes show the various orders of R'(rift plane) $\ll$ H'(hardway plane) < G'(grain plane), R' $\ll$ G' < H', R' < H' < G', R' < G' < H' and R' $\ll$ H' < G', respectively. Second, the values of (I) parameters(2, 3, 4 and 5) and (II) parameters(6, 7 and 8) are in orders of (I) H < G < R and (II) R < G < H. On the contrary, the values of the above two groups(I~II) of parameters for three planes show reverse orders. Third, to review the overall characteristics of the arrangement among the six diagrams, these diagrams show an order of R2 < R1 < G2 < G1 < H2 < H1 from the related chart. In other words, above six diagrams can be summarized in order of rift(R1 + R2) < grain(G1 + G2) < hardway(H1 + H2). These results indicate a relative magnitude of rock cleavage related to microcrack spacing. Especially, two parameters for each diagram, the above difference value($S_{mean}-S_{median}$) and mean spacing, could provide advanced information for prediction the order of arrangement among the diagrams. Finally, the general chart for three planes and three rock cleavages were made. From the related chart, three exponential straight lines for three rock cleavages show an order of R(R1 + R2) < G(G1 + G2) < H(H1 + H2). On the contrary, three lines for three planes show an order of H'(R2 + G2) < G'(R1 + H2) < R'(G1 + H1). Consequently, correlation of the mutually reverse order between three planes and three rock cleavages can be drawn from the related chart.

Recent Research for the Seismic Activities and Crustal Velocity Structure (국내 지진활동 및 지각구조 연구동향)

  • Kim, Sung-Kyun;Jun, Myung-Soon;Jeon, Jeong-Soo
    • Economic and Environmental Geology
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    • v.39 no.4 s.179
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    • pp.369-384
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    • 2006
  • Korean Peninsula, located on the southeastern part of Eurasian plate, belongs to the intraplate region. The characteristics of intraplate earthquake show the low and rare seismicity and the sparse and irregular distribution of epicenters comparing to interplate earthquake. To evaluate the exact seismic activity in intraplate region, long-term seismic data including historical earthquake data should be archived. Fortunately the long-term historical earthquake records about 2,000 years are available in Korea Peninsula. By the analysis of this historical and instrumental earthquake data, seismic activity was very high in 16-18 centuries and is more active at the Yellow sea area than East sea area. Comparing to the high seismic activity of the north-eastern China in 16-18 centuries, it is inferred that seismic activity in two regions shows close relationship. Also general trend of epicenter distribution shows the SE-NW direction. In Korea Peninsula, the first seismic station was installed at Incheon in 1905 and 5 additional seismic stations were installed till 1943. There was no seismic station from 1945 to 1962, but a World Wide Standardized Seismograph was installed at Seoul in 1963. In 1990, Korean Meteorological Adminstration(KMA) had established centralized modem seismic network in real-time, consisted of 12 stations. After that time, many institutes tried to expand their own seismic networks in Korea Peninsula. Now KMA operates 35 velocity-type seismic stations and 75 accelerometers and Korea Institute of Geoscience and Mineral Resources operates 32 and 16 stations, respectively. Korea Institute of Nuclear Safety and Korea Electric Power Research Institute operate 4 and 13 stations, consisted of velocity-type and accelerometer. In and around the Korean Peninsula, 27 intraplate earthquake mechanisms since 1936 were analyzed to understand the regional stress orientation and tectonics. These earthquakes are largest ones in this century and may represent the characteristics of earthquake in this region. Focal mechanism of these earthquakes show predominant strike-slip faulting with small amount of thrust components. The average P-axis is almost horizontal ENE-WSW. In north-eastern China, strike-slip faulting is dominant and nearly horizontal average P-axis in ENE-WSW is very similar with the Korean Peninsula. On the other hand, in the eastern part of East Sea, thrust faulting is dominant and average P-axis is horizontal with ESE-WNW. This indicate that not only the subducting Pacific Plate in east but also the indenting Indian Plate controls earthquake mechanism in the far east of the Eurasian Plate. Crustal velocity model is very important to determine the hypocenters of the local earthquakes. But the crust model in and around Korean Peninsula is not clear till now, because the sufficient seismic data could not accumulated. To solve this problem, reflection and refraction seismic survey and seismic wave analysis method were simultaneously applied to two long cross-section traversing the southern Korean Peninsula since 2002. This survey should be continuously conducted.

Clinical Findings of Mycoplasma pneumoniae pneumonia under 3 Year-Old Children (3세 이하 Mycoplasma pneumoniae 폐렴환자의 임상적 고찰)

  • Lee, Sung-Soo;Youn, Kyung-Lim;Kang, Hyeon-Ho;Cho, Byoung-Soo;Cha, Sung-Ho
    • Pediatric Infection and Vaccine
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    • v.6 no.1
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    • pp.78-85
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    • 1999
  • Purpose : Mycoplasma pneumoniae pneumonia has been to be developed frequently in school age children and adolescence and hard to see under 3 year-old children. But it seems to be increased in number of patients with Mycoplasma pneumoniae pneumonia under 3-year old in clinical practice in these days. We have aimed to examine the characteristics of clinical findings of Mycoplasma pneumonia under 3 year-old children. Methods : We had performed retrospective review of medical records of 30 patients with Mycoplasmal pneumonia under 3-year old children who admitted to Department of Pediatrics, Kyunghee University Hospital from Jan. 1994 to Dec. 1997. The diagnostic criteriae was Cold agglutinin titer>1:64 or Mycoplasma antibody titer>1:80. Results : Mycoplasmal pneumonia was 30 out of 235 cases(12.7%) of total pneumonia under 3 year old children. Male female ratio was 1.3 : 1 and age distributions were 0~1y : 0, 1~2y : 8, 2~3y : 22 cases. Clinical symptoms and signs were cough(100.0%), sputum(83.3%), fever(80.0%) rhinorrhea(33.3%), vomiting(33.3%), moist rale(86.7%), decreased breathing sound(26.7%), wheezing(20.0%), and pharyngeal injection(30.0%). Thirteen out of 30 cases(43.3%) had unilateral infiltration, 10 cases(33.4%) had bilateral infiltration, 1 case(3.3%) had pleural effusion, and 6 cases(20.0%) had negative findings on chest radiography and there was no cases of atelectasis. On laboratory findings, 6 out of 30 cases(20.0%) had leukocytosis, 1 case(3.3%) had neutrophilia, 10 cases(30.0%) had eosinophilia, 17 cases(56.7%) had increased ESR, and 18 cases(60.6%) had positive CRP. Positive cold agglutinin titers(>1 : 64) were 19 cases(63.3%), and positive mycoplasma antibody(M-ab) titers(>1 : 80) were 27 cases(93.3%). Mycoplasma antibody test was more valuable than cold agglutinin test for the diagnosis of Mycoplasmal pneumonia and there was no correlation between cold agglutinin titer and mycoplasma antibody titer. Mycoplasma-polymerase chain reaction(M-PCR) was done with 13 cases, 12 out of 13 cases(92.3%) were positive. M-PCR test was valuable to the diagnosis of Mycoplasmal pneumonia but it will be needed to further study for their clinical application. Among 30 cases, 5 cases(16.7%) had complications, 3 cases(10.0%) had skin rash, 1 case(3.3%) had pleural effusion, 1 case(3.3%) had arthralgia, but all complications were mild and recovered without residual sequelae. Conclusion : The occurrence of Mycoplasmal pneumonia under 3 year-old children was not rare from this study. Clinical characteristics of Mycoplasmal pneumonia under 3-year old were normal radiologic findings in many cases, low complication rate, mild clinical course, and tend to rapid recovery compared with general manifestations of Mycoplasmal infectionsin children and adolescence. There were likely to be missed patients with Mycoplasmal pneumonia which did not diagnose by conventional serologic tests that had low sensitivity and specificity. We have to pay attention to the Mycoplasmal infection of the young children with pneumonia during epidemic periods of Mycoplasmal infection.

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A Study on Health Awareness of Middle and High School Students in Yong Nam Area (영남지역(嶺南地域) 중고등학교학생(中高等學校學生)들의 보건의식행태조사(保健意識行態調査) 연구(硏究))

  • Kim, Hyung Nam;Nam, Chul Hyun
    • Journal of the Korean Society of School Health
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    • v.4 no.2
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    • pp.119-135
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    • 1991
  • The study was designed to gain necessary basic data order to grasp health knowledge, attitude, practice level of middle and high school students and to analyse th problem and to point out the method of improvement in the field of school health education. The survery was carried out through this reporter's interview for 2,400 students who attend to ten schools in Young Nam area during the period of a month from 25 the June to 25th July 1989. The result of this study can be summaried as follows. 1. The total number of answers on the question was 2,346. As for general characteristics the percent of female middle school students was 60.6% and the percent of male students was 77.7%, 45.9% of high school students was evening school students. 52.9% of middle school students and 42.3% of high school students were borne in rural area. 2. The percentage of unknown and misunderstanding for Epidemic Hepatitis infection was 46.3% of middle school students and 29.6% of high school students. 3. The percentage of unknown and misunderstanding for Epidemic Hemorrhage fever infection was 85.6% of middle school students and 66.9% of high school students. 4. The percentage of right knowledge for AIDS infection was 66.0% of middle school students and 90.4% of high school students. 5. The percentage of right knowledge for Typhoid infection was 47.8% of middle school students and 69.4% of high school students. 6. The percentage of unknown and misunderstanding for Tuberculosis infection was 71.6% of middle school students and 62.2% of high school students. 7. As for personal hygiene, the percentage of toothbrushing after every meal was high level : 44.2% of middle school students and 42.0% of high school students. 8. 60.9% of middle school students take a bath twice a week, 49.2% oh high school students take a bath a week. Times of bath of middle school students was higher than that of high school students. 9.The percentage of washing hand after using toilet was 42.1% of middle school students and 35.1% of high school students. 49.0% of middle school students and 55.1% of high school students wash hand sometimes after using toilet. 10. The percentage of change of underwear twice a week was 57.6% of middle school students and 49.8% of high school students. 11. The percentage of habit of unbalanced diet was 30.% of middle school students and 27.6% of high school students. 50.8% of middle school students and 51.7% of high school students have balanced diet. 12. Index of health practice of personal hygiene can be summarized as follows. A. A case of middle school students. 1) The percentage of health practice index in male and female was 49.6% and 48.1% respectively. Index of female students was higher than that of male students. 2) As for parent's occupation, public servants and company emplyee was upper level. Farming was low level. 3) As for income level, middle, level with 56.5% was highest in high income level and low level with 27.4% was highest in low income level. B. A case of high school students. 1) Middle level of health practice index was 46.0% of male students, upper and low level was 32.4% and 28.0% of female students respectively. 2) Middle level of health practice index was high in farming and company employee and upper level was high in commerce and service, low level with 60.0% was high in unemployed. 3) Upper practice index 35.7% appears in the rich and low practice index 38.3% appears in the poor. 13. Average points of Health practice about personal hygiene were as follows. (Full marks at 4). A. A case of middle school. Female (1.87 point) was higher than male (1.26 point). Night time (2.03 point) was higher than day time (1.66 point) and middle or small cities (2.17 point) are high than any other places. As for parent's occupation, students whose parents are company clerk get high marks (2.32) and ten students whose parent's job are service get next high marks (2.20). B. A case of high school. Female (1.53 point) was higher than male (1.22 point), as parents educational level were higher the point were higher, and as income level was higher, the points of health practice (1.78) were higher, and as for parents occupation, service get highest point (1.93) and commerce get next high point (1.86) public servant get low point (1.66). 14. The percentage of experience in smoking was 11.9% of middle school students and 60.9% of high school students. 15. The percentage of experience in inhalation of bond and administrating LSD was 4.3% of male middle school students, 8.4% of female middle school students, 6.9% of male high school students and 4.2% of female high school students. The knowledge level of communicable disease infection are very low in middle and high school students and practice level of personal hygiene are also very low. As a whole we can evaluate that middle and high school students are low level of health knowledge and practice. In conclusion, we must consider preparation for school health education program through establishing of health subjects in the carriculum, and securing of health education teachers and using materials and media program of health education. It is very important to establish macroscopic policy and strategy for public health education and to get people have right knowledge and practice for health.

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Surgery Alone and Surgery Plus Postoperative Radiation Therapy for Patients with pT3N0 Non-small Cell Lung Cancer Invading the Chest Wall (흉벽을 침범한 pT3N0 비소세포폐암 환자에서 수술 단독과 수술 후 방사선치료)

  • 박영제;임도훈;김관민;김진국;심영목;안용찬
    • Journal of Chest Surgery
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    • v.37 no.10
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    • pp.845-855
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    • 2004
  • Background: No general consensus has been available regarding the necessity of postoperative radiation therapy (PORT) and its optimal techniques in the patients with chest wall invasion (pT3cw) and node negative (N0) non-small cell lung cancer (NSCLC). We did retrospective analyses on the pT3cwN0 NSCLC patients who received PORT because of presumed inadequate resection margin on surgical findings. And we compared them with the pT3cwN0 NSCLC patients who did not received PORT during the same period. Material and Method: From Aug. of 1994 till June of 2002, 22 pT3cwN0 NSCLC patients received PORT-PORT (+) group- and 16 pT3cwN0 NSCLC patients had no PORT-PORT (-) group. The radiation target volume for PORT (+) group was confined to the tumor bed plus the immediate adjacent tissue only, and no regional lymphatics were included. The prognostic factors for all patients were analyzed and survival rates, failure patterns were compared with two groups. Result: Age, tumor size, depth of chest wall invasion, postoperative mobidities were greater in PORT (-) group than PORT (+) group. In PORT (-) group, four patients who were consulted for PORT did not receive the PORT because of self refusal (3 patients) and delay in the wound repair (1 patient). For all patients, overall survival (OS), disease-free survival (DFS), loco-regional recurrence-free survival (LRFS), and distant metastases-free survival (DMFS) rates at 5 years were 35.3%, 30.3%, 80.9%, 36.3%. In univariate and multivariate analysis, only PORT significantly affect the survival. The 5 year as rates were 43.3% in the PORT (+) group and 25.0% in PORT (-) group (p=0.03). DFS, LRFS, DMFS rates were 36.9%, 84.9%, 43.1 % in PORT (+) group and 18.8%, 79.4%, 21.9% in PORT(-) group respectively. Three patients in PORT (-) group died of intercurrent disease without the evidence of recurrence. Few suffered from acute and late radiation side effects, all of which were RTOG grade 2 or lower. Conclusion: The strategy of adding PORT to surgery to improve the probability not only of local control but also of survival could be justified, considering that local control was the most important component in the successful treatment of pT3cw NSCLC patients, especially when the resection margin was not adequate. Authors were successful in the marked reduction of the incidence as well as the severity of the acute and late side effects of PORT, without taking too high risk of the regional failures by eliminating the regional lymphatics from the radiation target volume.

The Histologic Type of Lung Cancer in Idiopathic Pulmonary Fibrosis : the Difference According to the Presence of Fibrosis at Cancer Location (특발성 폐섬유화증에서 발생한 폐암의 조직형의 특성 : 폐암 위치의 섬유화 유무에 따른 조직형의 차이)

  • Kwon, Sung-Youn;Kim, Deog-Kyeom;Lee, Suk-Young;Yoo, Chul-Gyu;Lee, Choon-Taek;Kim, Young-Whan;Im, Jung-Gi;Shim, Young-Soo;Han, Sung-Koo
    • Tuberculosis and Respiratory Diseases
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    • v.49 no.4
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    • pp.441-452
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    • 2000
  • Background : It is well known that the prevalence of lung cancer is higher in idiopathic pulmonary fibrosis (IPF) patients than in the general population. This high prevalence is explained by the concept of 'scar carcinoma'. There have been several reports on the prevalence of histologic typo of lung cancer in IPF with conflicting results. Despite of the high smoker rate in almost all previous reports, none considered the smoking history of patients. Therefore we performed a separate studies on fibrosis associated lung cancer and smoking associated lung cancer. The purpose of this study is to investigate the proportion of lung cancer in IPF that is fibrosis associated and to determine the most common histologic type in fibrosis associated lung cancer in IPF. Method : A retrospective review of medical records and radiologic studies was performed for cases of lung cancer with IPF. We investigated smoking history, sequence of diagnosis of lung cancer and IPF, histologic type of lung cancer and the cancer location, especially whether the location is associated with fibrosis. To evaluate the proportion of fibrous associated lung cancer, the lung cancer in IPF were categorized according to the presence of fibrosis at cancer location. Results : Fifty seven patients were subjects for this analysis. Six (11%) cases were diagnosed as lung cancer during follow-up for IPF, and both diseases were diagnosed simultaneously in the others. Ninety four percent of patients were smokers and the average smoking amount was 47.1$\pm$21.9 pack-year. Among the patients with IPF and lung cancer, 42(80.8%) cases were considered as "fibrosis associated". The remainder was "not fibrosis associated" and probably was due to smoking etc. Although the most frequent histologic type was squamous cell carcinoma as a whole, adenocarcinoma was the prominent histologic type in "fibrosis associated lung cancer." Conclusion : Considering the proportion of "fibrosis not associated lung cancer" in the patients with IPF and lung cancer, significant proportion of lung cancer in IPF may not be fibrosis induced. This may influence the distribution of histologic type of lung cancer in IPF.

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