• Radiation Oncology Journal
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• v.23 no.3
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• pp.143-156
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• 2005

Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.363-372
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• 1997

One hundred forty-four patients underwent operation for coarctation of the aorta at Seoul National University Children's Hospital between June 1986 and Decembsr 1995. Age ranged 0.1 to 191 months. Of these 78.5%(113) were infants. We classified the patients in terms of the anatomic location of coarctatiln and the associatCd anomalies(I[401= primary coarctation, 11(741=isthmic hypoplasia, lIIf30)=tubular hypoplasia involving transverse arch, Ar63 =with ventricular septal defect, B(28)=with other major cardiac defects). Subcalvian flap coarctoplasty(60), resection & anastomosis(44), extended aortoplasty(26), and onlay patch(14) were used as surgical methods. Overall operative mortality was 16.0(23/144)%. The hospital mortality was signific'antly higher in patheints with type 111, subtype B, younger age(under 3 months), extended aortoplasty(p(0.01). However, one-stage total repair in patients with subtype A or B were not found to be a predictor of hospital death. Restenosis had occured in 18 patients among 121 survivals(14. 9%). The mean follow-up period was 29.1 $\pm$28.8(0~129.2) months. Preoperative, immediate postoperative(within 3 months after operation) and postoperative(later than 6 months after operation) echocardiographic data on the dimensions of ascending aorta(AA), transverse arch(TA), an4 aortic isthmus(Al) were available in 77 patients(I=20, ll=42, 111= 15). Preoperative and postoperative aortic isthmus(All) and tra sverse arch indices(TAI), defined as TAIAA & AIIAA respectively, were compared. Immediate postoperative All in type 1, II and TAI in type 111 were significantly smaller in stenotic than non-stenotic group suggesting incomplete relieves of stenotic segment Younger age, subclavian coarctoplasty in patient under 3 months of age were round to be the risk factors for restenosis in this series. In conclusion, We found that aortic arch index and transverse arch index can be a useful tool to figure out the anatomic and clinical characteristics of the patients with aortic coarctation, and that anatomy, associated anomalies, age, and surgical methods may influence the surgical outcome of the coarctation repair.

• The Journal of the Korean bone and joint tumor society
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• v.20 no.2
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• pp.66-73
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• 2014

Purpose: Various diagnostic imaging modalities have been used to evaluate the effect of neoadjuvant chemotherapy for osteosarcoma early and noninvasively. We evaluated the effectiveness of imaging studies of plain radiographs and positron-emission tomography/computed tomography (PET/CT) in predicting neoadjuvant chemotherapy effect for osteosarcoma and tried to establish a general principle in interpretation of PET/CT parameters. Materials and Methods: Eighteen patients who underwent two cycles of neoadjuvant chemotherapy and surgical excision for osteosarcoma were enrolled. There were 13 males and 5 females, with a median age of 19 (11-63) years. Fifteen patients of 18 had the American Joint Committe on Cancer (AJCC) stage IIB. They had plain radiographs and PET/CT before and after neoadjuvant chemotherapy. The resected tumor specimens were pathologically examined to determine histological response grade using a conventional mapping method. Statistical analysis was performed to evaluate the correlation between histopathological necrosis rate, and radiographic finding category, post-chemotherapy maximum standardized uptake value (SUVmax), average standardized uptake value and metabolic tumor volume (MTV) as well as reduction rates of them. Results: Eight patients were good responders to neoadjuvant chemotherapy based on histological evaluation. Median SUVmax reduction rate was 73 (23-77) % in good responders and 42 (-32-76) % in poor responders. Median MTV reduction rate was 93.5 (62-99) % in good responders and 46 (-81-100) % in poor responders. While radiographic finding category was not different according to histological response (p=1.0), SUVmax reduction rate was significantly different (p=0.041). Difference in MTV reduction rates approached statistical significance as well (p=0.071). Conclusion: While radiographic finding category was not reliable to assess neoadjuvant chemotherapy effect for osteosarcoma, reduction rate of SUVmax was a useful indicator in this study. As parameters of PET/CT can be influenced by various factors of settings, different centers have to make an effort to establish their own standard of judgement with reference of previous studies.

• Korean Journal of Heritage: History & Science
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• v.44 no.4
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• pp.86-111
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• 2011

Wan is a tableware in which boiled rice or soup, side dish are put, and it is a representative model which shows the development of personal tableware. From the establishing period of Hanseong Baekje, the form of wan which is Jung-do Style(中島式) Plain Pottery of previous period Proto-Three Kingdoms Period was succeeded to, but wan is produced and used as a wan baked in the kiln, which is far development of the producing technique including hardness and clay. By and large, the size of $0.3{\sim}0.4{\ell}$ was the majority and the production technique of wan which used carefully selected soft quality clay are largely confirmed to be two methods which are, first, basic method by which on a clay tablet on the rotating table, clay band is accumulated and moulding is finished, and second, the new method which had the same basic moulding as that of basic method but in the last stage takes wan off the rotating table and reverse it to trim the bottom and remove the angle of flat bottom. The former, basic production method is the classical production method since wan of Jung-do Style Plain Pottery and wan was produced and used for all periods of Hanseong Baekje. On the other hand, the latter is the production method obtained through form imitation of China made porcelain flowed into through interchange between Baekje and China, and through comparison with Chinese chronogram material it is estimated to have been produced and used after middle of 4th century. Therefore it can be known that the Baekje people's demand for China made articles was big and imitation pottery was produced and used with Baekje pottery. In addition, bowl with outward mouth are confirmed in multiple number in Lakrang(樂浪) pottery wan and it is assumed that wan was the form produced under the influence.

• Radiation Oncology Journal
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• v.22 no.1
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• pp.17-24
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• 2004

Purpose: To evaluate the treatment outcomes after postmastectomy radiotherapy (PMRT) and chemotherapy in patients with breast cancer. Materials and Methods: The PMRT were retrospectively analyzed in 83 patients with stage II-III female breast cancer treated between 1989 and 1995. The median age was 46 years (range, 23-77): Seventy-seven patients had modified radical mastectomies, 5 radical mastectomies and 1 simple mastectomy. Three patients ($4\%$) had pathologically negative axillae, and the remaining 80 ($96\%$) had positive axillae. Eleven, 23, 44 and 5 patients had pathological stages IIA, IIB, IIIA, and IIIB, retrospectively. Eighty ($96\%$) patients were treated with hockey-stick fields. The median dose of PMRT was 50.4 ey, in 1.8 Gy fractions. Adjuvant systemic chemotherapy was given to 74 patients ($89\%$). CMF-based or doxorubicin-containing regimens were given to 54 patients ($55\%$). The median follow-up time was 82 months (range, 8-171) after the mastectomy. Results: The 5 and 10-year overall survival rates for all patients were 65 and $49\%$, respectively. The univariate and multivariate analyses of the factors affecting the overall survival revealed the stage to be the most significant prognostic factor (p=0.002), followed by the combination of chemotherapy. Thirteen patients $16\%$ developed a LRF, at an interval of 4-84 months after radiotherapy, with a median of 20 months. The only significant prognostic factor affecting LRF was the combination of chemotherapy, in both the univariate and multivariate analyses. With respect to the sequence of chemoradiation, the sequence had no saatistical significance (p=0.90). According to the time interval from mastectomy to the onset of radiotherapy, the LRFR of the patients group treated by RT within or after 6 month postmastectomy 6 months were 14 vs. $27\%$ respectively (p=0.24). One third of the pa41en1s (26/83) developed distant metastasis, in 2-92 months, after radiotherapy, with a median of 21 months. The most commonly involved site was bone in 13 cases. The pathological staging was the only significant prognostic factor in both the univariate and multivariate analyses that affected distant failure. Radiological finding of radiation pneumonitis on a simple chest x-ray was shown in $20\%$ (17/83), with a time interval ranging from 2 to 7 months post-radiotherapy, with a median of 3 months. The stable lung fibrosis settled in 11 patients ($65\%$). Conclusion: It was concluded through this analysis that the combination of PMRT with in chemotherapy resulted in better overall survival and local control than PMRT alone in patients needing PMRT.

• Korean Journal of Heritage: History & Science
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• v.44 no.3
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• pp.178-199
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• 2011

The ancient tombs found in Bokcheon-dong, Busan originate from the time between the $4^{th}$ and $5^{th}$ centuries, the period of the Three Nations. They are known as the tombs where the Vertical Plate Armour was mainly buried. In 2006, two units of the Vertical Plate Armour were additionally investigated in the tombs No.164 and No.165 which had been constructed at the end of the eastern slope near the hill of the group of ancient tombs in Bokcheon-dong. Throughout this study, the contents of the two units of the Vertical Plate Armour, whose preservation process has been completed, have been arranged, while the group of constructed ancient tombs in Bokcheon-dong from the $4^{th}$ century has been observed through the consideration of the burial pattern. The units of the Vertical Plate Armour from the tombs No.164 and No.165 can be classified as the IIa-typed armor showing the Gyeongju and Ulsan patterns, according to the attribute of the manufacturing technology. Also, they can be chronologically recorded as those from the early period of Stage II among the three stages regarding the chronological recording of the Vertical Plate Armour. While more than two units of the Vertical Plate Armour were buried in the largesized tomb on the top of the hill of the group of ancient tombs, one unit of the Vertical Plate Armour was buried in the small-sized tomb. By considering such a trend, it can be said that in the stage of burying the armor showing the Gyeongju and Ulsan patterns (I-type and IIa-type), different units of the Vertical Plate Armour were buried according to the size of the tomb. However, as the armor showing the Busan pattern (IIb-type) was settled, only one unit was buried. Meanwhile, the tombs No.164 and No.165 can be included in the wooden chamber tomb showing the Gyeongju pattern, which is a slender rectangular wooden chamber tomb with the aspect ratio of more than 1:3. However, according to the trend shown by the buried earthenware, it can be said that there seem to be common types and patterns shared with the earthenware which has been found in the area of Gimhae and is called the one showing the Geumgwan Gaya pattern. In other words, there seem to be close relationships between the subject tombs and the tomb No.3 in Gujeong-dong and the tomb No.55 in Sara-ri, Gyeongju, regarding the types of armor and tombs and the arrangement of buried artifacts. However, the buried earthenware shows a relationship with the areas of Busan and Gimhae. By considering the combined trend of the Gyeongju and Gimhae elements found in one tomb, it is possible to assume that the group of constructed ancient tombs in Bokcheon-dong used to be actively related with both areas. It has been thought that the Vertical Plate Armour used to be the exclusive property of the upper hierarchy until now, since it was buried in the large-sized tomb located on the top of the hill of the group of ancient tombs in Bokcheondong. However, as shown in case of the tombs No.164 and No.165, it has been verified that the Vertical Plate Armour was also buried in the small-sized tomb in terms of such factors as locations, sizes, the amount of buried artifacts and the qualitative aspect. Therefore, it is impossible to discuss the hierarchical characteristic of the tomb just based on the buried units of the Vertical Plate Armour. Also, it is difficult to assume that armor used to symbolize the domination of the military forces. The hierarchical characteristic of the group of constructed ancient tombs in Bokcheon-dong from the $4^{th}$ century can be verified according to the location and size of each tomb. As are sult, the re seem to be some differences regarding the buried units of the vertical plate armour. However, it would be necessary to carry out amore multilateral examination in order to find out whether the burial of the vertical plate armour could be regarded as the artifact which symbolizes the status or class of the deceased.