• Radiation Oncology Journal
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• v.33 no.3
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• pp.179-187
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• 2015

Purpose: The purpose of this study was to investigate the predictable value of pretreatment $^{18}F$-fluorodeoxyglucose positron emission tomography-computed tomography ($^{18}F$-FDG PET-CT) in radiotherapy (RT) for patients with hepatocellular carcinoma (HCC) or portal vein tumor thrombosis (PVTT). Materials and Methods: We conducted a retrospective analysis of 36 stage I-IV HCC patients treated with RT. $^{18}F$-FDG PET-CT was performed before RT. Treatment target was determined HCC or PVTT lesions by treatment aim. They were irradiated at a median prescription dose of 50 Gy. The response was evaluated within 3 months after completion of RT using the Response Evaluation Criteria in Solid Tumors (RECIST). Response rate, overall survival (OS), and the pattern of failure (POF) were analyzed. Results: The response rate was 61.1%. The statistically significant prognostic factor affecting response in RT field was maximal standardized uptake value (maxSUV) only. The high SUV group (maxSUV ${\geq}5.1$) showed the better radiologic response than the low SUV group (maxSUV < 5.1). The median OS were 996.0 days in definitive group and 144.0 days in palliative group. Factors affecting OS were the %reduction of alpha-fetoprotein (AFP) level in the definitive group and Child-Pugh class in the palliative group. To predict the POF, maxSUV based on the cutoff value of 5.1 was the only significant factor in distant metastasis group. Conclusion: The results of this study suggest that the maxSUV of $^{18}F$-FDG PET-CT may be a prognostic factor for treatment outcome and the POF after RT. A %reduction of AFP level and Child-Pugh class could be used to predict OS in HCC.

• Radiation Oncology Journal
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• v.33 no.4
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• pp.276-283
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• 2015

Purpose: We evaluated the efficacy and toxicity of repeated high dose 3-dimensional conformal radiation therapy (3D-CRT) for patients with unresectable hepatocellular carcinoma. Materials and Methods: Between 1998 and 2011, 45 patients received hepatic re-irradiation with high dose 3D-CRT in Samsung Medical Center. After excluding two ineligible patients, 43 patients were retrospectively reviewed. RT was delivered with palliative or salvage intent, and equivalent dose of 2 Gy fractions for ${\alpha}/{\beta}=10Gy$ ranged from $31.25Gy_{10}$ to $93.75Gy_{10}$ (median, $44Gy_{10}$). Tumor response and toxicity were evaluated based on the modified Response Evaluation Criteria in Solid Tumors criteria and the Common Terminology Criteria for Adverse Events (CTCAE) ver. 4.0. Results: The median follow-up duration was 11.2 months (range, 4.1 to 58.3 months). An objective tumor response rate was 62.8%. The tumor response rates were 81.0% and 45.5% in patients receiving ${\geq}45Gy_{10}$ and $<45Gy_{10}$, respectively (p = 0.016). The median overall survival (OS) of all patients was 11.2 months. The OS was significantly affected by the Child-Pugh class as 14.2 months vs. 6.1 months (Child-Pugh A vs. B, p < 0.001), and modified Union for International Cancer Control (UICC) T stage as 15.6 months vs. 8.3 months (T1-3 vs. T4, p = 0.004), respectively. Grade III toxicities were developed in two patients, both of whom received ${\geq}50Gy_{10}$. Conclusion: Hepatic re-irradiation may be an effective and tolerable treatment for patients who are not eligible for further local treatment modalities, especially in patients with Child-Pugh A and T1-3.

• Journal of Gastric Cancer
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• v.15 no.3
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• pp.191-200
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• 2015

Purpose: This study evaluated the functional and oncological outcomes of proximal gastrectomy (PG) in comparison with total gastrectomy (TG) for upper-third early gastric cancer (EGC). Materials and Methods: The medical records of upper-third EGC patients who had undergone PG (n=192) or TG (n=157) were reviewed. The PG group was further subdivided into patients who had undergone conventional open PG (cPG; n=157) or modified laparoscopy-assisted PG (mLAPG; n=35). Patients who had undergone mLAPG had a longer portion of their intra-abdominal esophagus preserved than patients who had undergone cPG. Surgical morbidity, recurrence, long-term nutritional status, and the incidence of reflux esophagitis were compared between the groups. Results: The rate of postoperative complications was significantly lower for PG than TG (16.7% vs. 31.2%), but the five-year overall survival rate was comparable between the two groups (99.3% vs. 96.3%). Postoperative levels of hemoglobin and albumin were significantly higher for patients who had undergone PG. However, the incidence of reflux esophagitis was higher for PG than for TG (37.4% vs. 3.7%; P<0.001). mLAPG was related to a lower incidence of reflux esophagitis after PG (P<0.001). Conclusions: Compared to TG, PG showed an advantage in terms of postoperative morbidity and nutrition, and there was a comparable prognosis between the two procedures. Preserving the intra-abdominal esophagus may lower the incidence of reflux esophagitis associated with PG.

• The Journal of the Korean bone and joint tumor society
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• v.5 no.3
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• pp.169-177
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• 1999

Osteosarcoma in patients older than 40 years are rare, however they have different clinical, radiological and pathological features from those of younger patients. Sometimes accurate histologic diagnosis is not easy, which is important in determining the correct surgical treatment and appropriate chemotherapy. Since January 1995, 11 patients with osteosarcoma occurring in patients older than 40 years have been diagnosed, treated and followed up for more than 6 months. In contrast to osteosarcoma in children and adolescents, only 4 cases(36.4%) were conventional types, while the others included 2 malignant fibrous histiocytoma-like types, 2 small cell types, 2 periosteal osteosarcomas and 1 giant cell-rich type. Seven cases showed purely osteolytic or predominantly osteolytic bony lesions and 8 were in Enneking stage IIB. Performed surgical treatments included 2 amputations, 6 wide resections and reconstructions, and one curettage and autogenous bone graft. In the remaining 2 cases, definitive surgical treatments included not carried out because of old age, multifocal involvement or poor medical tolerance. Neoadjuvant and adjuvant chemotherapies were performed in 9 of 11 patients. At last follow-up, there were 6 continuously disease-free survivals, 3 alive with diseases and 2 died of diseases. The overall cumulative 4-year survival rate calculated using Kaplan-Meier's productlimit method was 59.3%. For improved oncologic outcomes and survivals, early and accurate diagnosis, surgical treatment with adequate margin and neoadjuvant and adjuvant chemotherapy will be necessary.

• Asia-Pacific Journal of Business Venturing and Entrepreneurship
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• v.7 no.1
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• pp.245-255
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• 2012

Greenberg(1990) suggested that organizational justice research may potentially explain many organizational behavior outcome variables. One such example of nontraditional job behavior is organizational citizenship behavior and service quality, for they are part of the spontaneous and innovative behaviors noted by Katz(1964). Stimulated by conceptualizations of justice in organizations by such theorists as Homans(1961), Admans(1965), and Walster, Berscheid, and Walster(1973), organizational researchers devoted considerable attention in the 1960s and 1970s to testing propositions about the distribution of payment and other work-related rewards derived from equity theory. Although reviews and critiques of equity theories once dominated the pages of organizational journals, more recently it has been the subject of far more attention(Reis, 1986). In one notable recent trend, researchers and theorists have expanded on conceptualizations of procedural and distributive justice by turning attention to the interpersonal aspects of justice, the perceived fairness of the way people are treated by others. With the rapid and uncertain changes of organization, such voluntary behaviors as OCB, service quality, and innovative behavior have become more important for the development and survival of organization. Thus it is very important to keep the organization fair for keeping employees participative in organization. Here it is reviewed the relationship between organizational justice and it's related factors(OCB, service quality and innovative behavior).

• Journal of Trauma and Injury
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• v.28 no.3
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• pp.115-122
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• 2015

Purpose: To calculate Preventable Trauma Death Rate (PTDR), Trauma and Injury Severity Score (TRISS) is the most utilized evaluation index of the trauma centers in South Korea. However, this method may have greater variation due to the small number of the denominator in each trauma center. Therefore, we would like to develop new indicators that can be used easily on quality improvement activities by increasing the denominator. Methods: The medical records of 1005 major trauma (ISS >15) patients who visited 2 regional trauma center (A center and B center) in 2014 were analyzed retrospectively. PTDR and PARK Index (Preventable Major Trauma Death Rate, PMTDR) were calculated in 731 patients with inclusion criteria. We invented PARK Index to minimize the variation of preventability of trauma death. In PTDR the denominator is all number of deaths, and in PARK Index the denominator is number of all patients who have survival probability (Ps) larger than 0.25. Numerator is the number of deaths from patients who have Ps larger than 0.25. Results: The size of denominator was 40 in A center, 49 in B center, and overall 89 in PTDR. The size of denominator was significantly increased, and 287 (7.2-fold) in A center, 422 (8.6-fold) in B center, and overall 709 (8.0-fold) in PARK Index. PARK Index was 12.9% in A center, 8.3% in B center, and overall 10.2%. Conclusion: PARK Index is calculated as a rate of mortality from all major trauma patients who have Ps larger than 0.25. PARK Index obtain an effect that denominator is increased 8.0-fold than PTDR. Therefore PARK Index is able to compensate for greater disadvantage of PTDR. PARK Index is expected to be helpful in implementing evaluation of mortality outcome and to be a new index that can be applied to a trauma center quality improvement activity.

• Radiation Oncology Journal
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• v.36 no.1
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• pp.17-24
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• 2018

Purpose: This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery. Materials and Methods: In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin. Total mesorectal excision was done at least 8 weeks after the last fraction of radiotherapy. Primary outcome was complete pathologic response and secondary outcomes were treatment related complications. Results: Thirty-three patients completed the planned preoperative chemoradiation and 26 of them underwent surgery (24 low anterior resection and 2 abdominoperineal resection). Acute proctitis grades 2 and 3 were seen in 11 (33.3%) and 7 (21.2%) patients, respectively. There were no grades 3 and 4 subacute hematologic and non-hematologic (genitourinary and peripheral neuropathy) toxicities and perioperative morbidities such as anastomose leakage. Grade 2 or higher late toxicities were observed among 29.6% of the patients. Complete pathologic response was achieved in 8 (30.8%) patients who underwent surgery. The 3-year overall survival and local control rates were 65% and 94%, respectively. Conclusion: This study showed that SRT combined with concurrent and consolidation chemotherapies followed by delayed surgery is not only feasible and tolerable without significant toxicity but also, associated with promising complete pathologic response rates.

• The Journal of the Korean bone and joint tumor society
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• v.17 no.1
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• pp.17-22
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• 2011

Purpose: We analyzed the oncological outcome and prognostic factor of the chondrosarcoma arising from benign bone tumor due to malignant transformation. Materials and Methods: From April 1986 to April 2009, 18 cases were considered eligible. We analyzed retrospectively the patient's characteristics and prognostic factors that affect to the local recurrence and distant metastasis. Results: As classified by primary benign bone tumor, 4 cases were solitary osteochondroma, 11 cases were multiple osteochondromatosis and 3 cases were multiple enchondromatosis. The mean follow-up period was 85 months. The 5-year disease free survival rate of 18 patients was 85.9%. Their overall MSTS score was 25.2 (84%). There were local recurrence in 3 cases and no distant metastasis. We found that tumor location and surgical margin affected to the prognosis significantly. Conclusion: In secondary chondrosarcoma patients, the prognosis was good relatively and tumor location and surgical margin are important prognosis factor.

• Journal of Korean Neurosurgical Society
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• v.30 no.4
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• pp.472-478
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• 2001

Objectives : The authors present a retrospective analysis of 100 consecutive adult patients harboring craniopharyngiomas who underwent microsurgical resection between 1981 and 1999 to assess the long-term outcome of surgical treatment and to determine the most optimal management strategy. Methods : The extent of surgical removal was divided into four categories ; GTR(gross total removal), RSTR(radical subtotal removal), STR(subtotal removal),and PR(partial removal). The median follow-up period was 50 months(4-198). CT scan and/or MR imaging and hormonal status were evaluated to the last follow-up. Results : Visual disturbance was the most common presentation, which was improved in 42 cases and aggravated in 19 cases following the operation. Hypopituitarism was detected in 56 patients preoperatively, 82 during the immediate postoperative period, and 76 at the last follow-up. Improvement of pituitary function was not observed in any of these patients. Twenty of 100 patients showed recurrence at the mean of 27 months(3 to 196). The median progression-free survival(PFS) time of all patients was 145 months and 5-year PFS rate was 74%. Five-year PFS rate of GTR or RSTR group(71%) was significantly higher than that of STR or PR group(30%)(p=0.01). Postoperative radiation therapy significantly prolonged the PFS from 94 months in non-radiation group to 182 months(p=0.002). However, there was no statistical difference in number of patients who required hormonal replacement therapy between radiation and non-radiation group. Conclusion : Visual disturbance can be improved by early diagnosis and surgical decompression. GTR or RSTR in selected patients is considered a proper surgical strategy. Post-operative radiation therapy for residual tumors must be considered, although the ideal timing of radiation therapy is to be determined.

• Journal of Chest Surgery
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• v.46 no.2
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• pp.104-110
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• 2013

Background: We reviewed the long-term outcomes of aortic root replacement at Asan Medical Center and investigated the predictors affecting mortality. Materials and Methods: A retrospective analysis was performed on 225 consecutive adult patients undergoing aortic root replacement with mechanical conduits (n=169), porcine aortic root prosthesis (n=23), or aortic homografts (n=33) from January 1992 to September 2009. The median follow-up duration was 6.1 years (range, 0 to 18.0 years). Results: The porcine root group was older than the other groups (freestyle $55.9{\pm}14.3$ years vs. mechanical $46.3{\pm}14.6$ years, homograft $48.1{\pm}14.7$ years; p=0.02). The mechanical group had the highest incidence of the Marfan syndrome (mechanical 22%, freestyle 4%, homograft 3%; p=0.01). Surgery performed for infective endocarditis was more frequent in the homograft group (mechanical 10%, freestyle 10%, homograft 40%; p<0.001). The overall 30-day mortality was 5.3% (12/225). Actuarial survival rates in the mechanical, porcine root, and homograft groups were 79.4%, 81.5%, and 83.5% at 5 years and 67%, 61.9%, and 61.1% at 10 years, respectively (p=0.73). By multivariate analysis, preoperative diabetes mellitus, older age, and longer cardiopulmonary bypass time were independent predictors of mortality. Incidence of postoperative complications, including infective endocarditis and thromboembolism were comparable in all of the groups. Conclusion: Aortic root replacement can be safely performed with different types of prostheses as the outcome was not affected by the choice of prosthesis. Further studies are required to assess the long-term durability of biological prostheses.