• Title/Summary/Keyword: two- stage procedure

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Possibility of Local Recurrence Caused by Surgical Instruments in the Mouse Skin Cancer Model (백서 모델에서 수술 기구를 통한 피부악성종양의 국소 재발 가능성)

  • Kim, Gook-Jin;Lee, Hyoung-Suk;Kim, Nam-Gyun;Lee, Kyung-Suk;Kim, Jun-Sik;Park, Sang-Woo
    • Archives of Plastic Surgery
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    • v.38 no.4
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    • pp.339-344
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    • 2011
  • Purpose: The goal of cancer surgery is complete removal of cancer tissue and prevention of recurrence. Surgeons can change the surgical instruments after total resection of the cancer mass. The purpose of this procedure is to prevent dissemination of the cancer cells attached to the surgical instruments. Authors hypothesize the possibility of local recurrence caused by the cancer cells attached to the surgical instruments in the skin cancer cases. Methods: Skin cancers were induced by using DMBA-TPA two-stage carcinogenesis model in 10 of Balb/c mice. In 2-weeks, skin cancer was developed in all 10 mice. cancer cell attached surgical instruments were made by pinching the removed cancer tissue using Adson tissue forcep 10, 20, 30 times each. To count number of cancer cells in each forcep with different number of pinching was done, the forceps were washed in 30 mL of the normal saline and Cytospin preparation was done. To make recurrence models from cancer cell attached surgical instrument, three incisions were made in normal skin of each mouse, and local seeding was done by pinching subcutaneous tissue in 10, 20, 30 times each by using Adson teeth forceps mentioned above as cancer cell attached surgical instrument. Results: All skin cancers were squamous cell carcinoma. Local recurrences were developed in 7 mice (3 in 10 times forceping site, 2 in 20 times forceping and 3 in 30 times forceping). In the cytospin test, the mean number of squamous cells in 100 microscope was 28.6 in 10 times, 47.2 in 20 times, 93.6 in 30 times, respectively. P value was 0.002 in Wilcoxon-Sign test. Conclusion: The number of cell count was significantly increased as number of pinching was increased. And these cells are able to induce local recurrence by local seeding. Considering this result, authors are able to confirm that the minimal handling in cancer surgery is important factor to prevent local recurrence.

Management of Post-Pneumonectomy Empyema (전폐절제술후 생긴 농흉의 치료)

  • Song, Jong-Phil;Chung, Sung-Hyock;Hur, Yong;Kim, Byung-Yul;Lee, Jeong-Ho;Ahn, Wook-Su
    • Journal of Chest Surgery
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    • v.32 no.3
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    • pp.276-280
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    • 1999
  • Background: Post-pneumonectomy empyema(PPE) is an uncommon but a serious complication. The management remains as challenge for general thoracic surgeons. Material and Method: During the period of January 1990 to December 1996, we evaluated the results of 20 patients with post-pneumonectomy empyema. Result: Sex ratio were 15 male and 5 female patients with mean age of 41.5${\pm}$21.5 yrs. The occurrence ratio of left to right side was 8:12. The most common disease for prior pneumonectomy was pulmonary tuberculosis. The duration between pneumonectomy and PPE was variable in 1 month to 6yrs. Fever was the most frequent symptom and S. aureus was the most frequent pathogen. In 13 cases, there were combined with BPF. Four patients underwent trans-sternal closure, and Clagett procedure was performed. There was one recurrence that later underwent muscle plombage and omentopexy later. Nine patients underwent omentopexy, muscle plombage and thoracoplasty. There were 7 cases that were not combined with BPF. All 7 patients underwent thoracoplasty, and two of them were combined with muscle plombage. Mean follow-up duration is 40${\pm}$32.3 months. There were no late deaths nor recurrences of PPE. Conclusion: We conclude that early diagnosis and proper drainage in PPE patients are important in its initial stage of management, and also management is completely achieved in thoracoplasty with muscle plombage or omentopexy.

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The Significance of Audience's Reception and the Imagination on Transcendental World in Yungyungdang Jinjak(演慶堂進爵) (연경당 진작(演慶堂進爵)의 관극 체험과 무대미학)

  • Sa, Jean Sill
    • (The) Research of the performance art and culture
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    • no.18
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    • pp.379-412
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    • 2009
  • According to "Jinjak-yigwe(進爵儀軌)", a special banquet was held at Yungyungdang(演慶堂, a kind of royal theatre) to celebrate the 40th birthday of Queen Soonwon(純元王后) in 1828. This banquet is famous for the presentation of nineteen new Jungjae(呈才) repertoires that the Crown Prince Hyomyung(孝明) created. In order to explore the theoretical basis for the reproduction and presentation of Yungyungdang(演慶堂) Jinjak(進爵, a type of royal banquets), in this article, the imagination and experience of the presentation of Yungyungdang Jinjak are pursued, while focussing on audience's reception. In Yungyungdang Jinjak, King Soonjo(純祖), Queen Soonwon and the prince were the special audience; they participated in the procedure of Ye(禮, etiquette of ceremony) and also were considered as the characters of certain repertoire of Jungjae. Hyomyung arranged the spectacles from the myths of Taoist gods and immortal hermits, as well as historic episodes of the past emperors' elegant tastes of music. These mythic and historic images lead the audience toward the imagination and experience on the transcendental world. Hyomyung, managing the administration as the representative of King Soonjo, tried to show absolute royal authority through the splendid performances of Yungyungdang Jinjak, so as to overcome the politicaly difficult situation. He set up the sacred world for his father King Soonjo, distinct from the secular ordinary world, and emphasized his position as the bridge between the two sides. He expressed his filial duty through the devotion of performing arts to display absolute royal authority.

The Importance of Qualitative Approach to Managing the Regulatory Lag of Convergence New Products: Focusing on the Certification of Compliance of New Products of Industrial Convergence (융합 신제품 규제 시차 관리를 위한 정성적 접근의 중요성: '산업융합 신제품의 적합성 인증제도'를 중심으로)

  • Kim, Hyung-Jin
    • Informatization Policy
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    • v.29 no.3
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    • pp.26-47
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    • 2022
  • "The certification of compliance of new products of industrial convergence" (hereinafter referred to as "certification of compliance") is a legal certification system in accordance with the Industrial Convergence Promotion Act through which a convergence new product can be officially certified without legislation when the certification standards applicable to the product are not yet provided. Unlike other certification systems, the certification of compliance is characterized by the role of resolving the certification difficulties driven by the regulatory lag of convergence new products. Nevertheless, studies that analyzed the certification of compliance in detail from the viewpoint of regulatory improvement were surprisingly rare. Through the sequential matching of the steps of certification of compliance with the process from the occurrence of a regulatory problem to resolution, our study provided clear understanding as to how the regulatory lag could be reduced by the procedure for certification of compliance. Furthermore, we divided the perspective on regulatory lag management into quantitative and qualitative, and the structures and practices of certification of compliance were then analyzed from the two perspectives. By doing this, the present study emphasized that the fundamental reason the certification of compliance could effectively solve the regulatory lag problem of convergence new products was not only the quantitative elements such as legal deadlines for each step but also several qualitative approaches to securing the quality of every stage.

Deriving adoption strategies of deep learning open source framework through case studies (딥러닝 오픈소스 프레임워크의 사례연구를 통한 도입 전략 도출)

  • Choi, Eunjoo;Lee, Junyeong;Han, Ingoo
    • Journal of Intelligence and Information Systems
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    • v.26 no.4
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    • pp.27-65
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    • 2020
  • Many companies on information and communication technology make public their own developed AI technology, for example, Google's TensorFlow, Facebook's PyTorch, Microsoft's CNTK. By releasing deep learning open source software to the public, the relationship with the developer community and the artificial intelligence (AI) ecosystem can be strengthened, and users can perform experiment, implementation and improvement of it. Accordingly, the field of machine learning is growing rapidly, and developers are using and reproducing various learning algorithms in each field. Although various analysis of open source software has been made, there is a lack of studies to help develop or use deep learning open source software in the industry. This study thus attempts to derive a strategy for adopting the framework through case studies of a deep learning open source framework. Based on the technology-organization-environment (TOE) framework and literature review related to the adoption of open source software, we employed the case study framework that includes technological factors as perceived relative advantage, perceived compatibility, perceived complexity, and perceived trialability, organizational factors as management support and knowledge & expertise, and environmental factors as availability of technology skills and services, and platform long term viability. We conducted a case study analysis of three companies' adoption cases (two cases of success and one case of failure) and revealed that seven out of eight TOE factors and several factors regarding company, team and resource are significant for the adoption of deep learning open source framework. By organizing the case study analysis results, we provided five important success factors for adopting deep learning framework: the knowledge and expertise of developers in the team, hardware (GPU) environment, data enterprise cooperation system, deep learning framework platform, deep learning framework work tool service. In order for an organization to successfully adopt a deep learning open source framework, at the stage of using the framework, first, the hardware (GPU) environment for AI R&D group must support the knowledge and expertise of the developers in the team. Second, it is necessary to support the use of deep learning frameworks by research developers through collecting and managing data inside and outside the company with a data enterprise cooperation system. Third, deep learning research expertise must be supplemented through cooperation with researchers from academic institutions such as universities and research institutes. Satisfying three procedures in the stage of using the deep learning framework, companies will increase the number of deep learning research developers, the ability to use the deep learning framework, and the support of GPU resource. In the proliferation stage of the deep learning framework, fourth, a company makes the deep learning framework platform that improves the research efficiency and effectiveness of the developers, for example, the optimization of the hardware (GPU) environment automatically. Fifth, the deep learning framework tool service team complements the developers' expertise through sharing the information of the external deep learning open source framework community to the in-house community and activating developer retraining and seminars. To implement the identified five success factors, a step-by-step enterprise procedure for adoption of the deep learning framework was proposed: defining the project problem, confirming whether the deep learning methodology is the right method, confirming whether the deep learning framework is the right tool, using the deep learning framework by the enterprise, spreading the framework of the enterprise. The first three steps (i.e. defining the project problem, confirming whether the deep learning methodology is the right method, and confirming whether the deep learning framework is the right tool) are pre-considerations to adopt a deep learning open source framework. After the three pre-considerations steps are clear, next two steps (i.e. using the deep learning framework by the enterprise and spreading the framework of the enterprise) can be processed. In the fourth step, the knowledge and expertise of developers in the team are important in addition to hardware (GPU) environment and data enterprise cooperation system. In final step, five important factors are realized for a successful adoption of the deep learning open source framework. This study provides strategic implications for companies adopting or using deep learning framework according to the needs of each industry and business.

Perceptional Change of a New Product, DMB Phone

  • Kim, Ju-Young;Ko, Deok-Im
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.3
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    • pp.59-88
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    • 2008
  • Digital Convergence means integration between industry, technology, and contents, and in marketing, it usually comes with creation of new types of product and service under the base of digital technology as digitalization progress in electro-communication industries including telecommunication, home appliance, and computer industries. One can see digital convergence not only in instruments such as PC, AV appliances, cellular phone, but also in contents, network, service that are required in production, modification, distribution, re-production of information. Convergence in contents started around 1990. Convergence in network and service begins as broadcasting and telecommunication integrates and DMB(digital multimedia broadcasting), born in May, 2005 is the symbolic icon in this trend. There are some positive and negative expectations about DMB. The reason why two opposite expectations exist is that DMB does not come out from customer's need but from technology development. Therefore, customers might have hard time to interpret the real meaning of DMB. Time is quite critical to a high tech product, like DMB because another product with same function from different technology can replace the existing product within short period of time. If DMB does not positioning well to customer's mind quickly, another products like Wibro, IPTV, or HSPDA could replace it before it even spreads out. Therefore, positioning strategy is critical for success of DMB product. To make correct positioning strategy, one needs to understand how consumer interprets DMB and how consumer's interpretation can be changed via communication strategy. In this study, we try to investigate how consumer perceives a new product, like DMB and how AD strategy change consumer's perception. More specifically, the paper segment consumers into sub-groups based on their DMB perceptions and compare their characteristics in order to understand how they perceive DMB. And, expose them different printed ADs that have messages guiding consumer think DMB in specific ways, either cellular phone or personal TV. Research Question 1: Segment consumers according to perceptions about DMB and compare characteristics of segmentations. Research Question 2: Compare perceptions about DMB after AD that induces categorization of DMB in direction for each segment. If one understand and predict a direction in which consumer perceive a new product, firm can select target customers easily. We segment consumers according to their perception and analyze characteristics in order to find some variables that can influence perceptions, like prior experience, usage, or habit. And then, marketing people can use this variables to identify target customers and predict their perceptions. If one knows how customer's perception is changed via AD message, communication strategy could be constructed properly. Specially, information from segmented customers helps to develop efficient AD strategy for segment who has prior perception. Research framework consists of two measurements and one treatment, O1 X O2. First observation is for collecting information about consumer's perception and their characteristics. Based on first observation, the paper segment consumers into two groups, one group perceives DMB similar to Cellular phone and the other group perceives DMB similar to TV. And compare characteristics of two segments in order to find reason why they perceive DMB differently. Next, we expose two kinds of AD to subjects. One AD describes DMB as Cellular phone and the other Ad describes DMB as personal TV. When two ADs are exposed to subjects, consumers don't know their prior perception of DMB, in other words, which subject belongs 'similar-to-Cellular phone' segment or 'similar-to-TV' segment? However, we analyze the AD's effect differently for each segment. In research design, final observation is for investigating AD effect. Perception before AD is compared with perception after AD. Comparisons are made for each segment and for each AD. For the segment who perceives DMB similar to TV, AD that describes DMB as cellular phone could change the prior perception. And AD that describes DMB as personal TV, could enforce the prior perception. For data collection, subjects are selected from undergraduate students because they have basic knowledge about most digital equipments and have open attitude about a new product and media. Total number of subjects is 240. In order to measure perception about DMB, we use indirect measurement, comparison with other similar digital products. To select similar digital products, we pre-survey students and then finally select PDA, Car-TV, Cellular Phone, MP3 player, TV, and PSP. Quasi experiment is done at several classes under instructor's allowance. After brief introduction, prior knowledge, awareness, and usage about DMB as well as other digital instruments is asked and their similarities and perceived characteristics are measured. And then, two kinds of manipulated color-printed AD are distributed and similarities and perceived characteristics for DMB are re-measured. Finally purchase intension, AD attitude, manipulation check, and demographic variables are asked. Subjects are given small gift for participation. Stimuli are color-printed advertising. Their actual size is A4 and made after several pre-test from AD professionals and students. As results, consumers are segmented into two subgroups based on their perceptions of DMB. Similarity measure between DMB and cellular phone and similarity measure between DMB and TV are used to classify consumers. If subject whose first measure is less than the second measure, she is classified into segment A and segment A is characterized as they perceive DMB like TV. Otherwise, they are classified as segment B, who perceives DMB like cellular phone. Discriminant analysis on these groups with their characteristics of usage and attitude shows that Segment A knows much about DMB and uses a lot of digital instrument. Segment B, who thinks DMB as cellular phone doesn't know well about DMB and not familiar with other digital instruments. So, consumers with higher knowledge perceive DMB similar to TV because launching DMB advertising lead consumer think DMB as TV. Consumers with less interest on digital products don't know well about DMB AD and then think DMB as cellular phone. In order to investigate perceptions of DMB as well as other digital instruments, we apply Proxscal analysis, Multidimensional Scaling technique at SPSS statistical package. At first step, subjects are presented 21 pairs of 7 digital instruments and evaluate similarity judgments on 7 point scale. And for each segment, their similarity judgments are averaged and similarity matrix is made. Secondly, Proxscal analysis of segment A and B are done. At third stage, get similarity judgment between DMB and other digital instruments after AD exposure. Lastly, similarity judgments of group A-1, A-2, B-1, and B-2 are named as 'after DMB' and put them into matrix made at the first stage. Then apply Proxscal analysis on these matrixes and check the positional difference of DMB and after DMB. The results show that map of segment A, who perceives DMB similar as TV, shows that DMB position closer to TV than to Cellular phone as expected. Map of segment B, who perceive DMB similar as cellular phone shows that DMB position closer to Cellular phone than to TV as expected. Stress value and R-square is acceptable. And, change results after stimuli, manipulated Advertising show that AD makes DMB perception bent toward Cellular phone when Cellular phone-like AD is exposed, and that DMB positioning move towards Car-TV which is more personalized one when TV-like AD is exposed. It is true for both segment, A and B, consistently. Furthermore, the paper apply correspondence analysis to the same data and find almost the same results. The paper answers two main research questions. The first one is that perception about a new product is made mainly from prior experience. And the second one is that AD is effective in changing and enforcing perception. In addition to above, we extend perception change to purchase intention. Purchase intention is high when AD enforces original perception. AD that shows DMB like TV makes worst intention. This paper has limitations and issues to be pursed in near future. Methodologically, current methodology can't provide statistical test on the perceptual change, since classical MDS models, like Proxscal and correspondence analysis are not probability models. So, a new probability MDS model for testing hypothesis about configuration needs to be developed. Next, advertising message needs to be developed more rigorously from theoretical and managerial perspective. Also experimental procedure could be improved for more realistic data collection. For example, web-based experiment and real product stimuli and multimedia presentation could be employed. Or, one can display products together in simulated shop. In addition, demand and social desirability threats of internal validity could influence on the results. In order to handle the threats, results of the model-intended advertising and other "pseudo" advertising could be compared. Furthermore, one can try various level of innovativeness in order to check whether it make any different results (cf. Moon 2006). In addition, if one can create hypothetical product that is really innovative and new for research, it helps to make a vacant impression status and then to study how to form impression in more rigorous way.

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Effect of Low-dose Aspirin on Implantation and Pregnancy Rates in Patients Undergoing Frozen-thawed Embryo Transfer (동결보존 배아 이식에서 저 용량 아스피린 투여가 임신율과 착상율에 미치는 영향에 관한 연구)

  • Kim, Min Ji;Lee, Hyun Jung;Yu, Young;Seo, Back Kyung;Cha, Sun Hwa;Kim, Hae Suk;Song, In Ok;Byun, Hye Kyung;Koong, Mi Kyoung;Kang, Inn Soo;Yang, Kwang Moon
    • Clinical and Experimental Reproductive Medicine
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    • v.32 no.3
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    • pp.243-251
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    • 2005
  • Objective: Low-dose aspirin have been proposed to improving endometrial receptivity and pregnancy rate in COH-IVF by increasing endometrial perfusion. However, the effect of low-dose aspirin in COH-IVF could be negligible because there have been large quantity of other important factors responsible for changing endometrial perfusion accompanied by COH procedure. In contrast, in frozen-thawed embryo transfer cycles which were not accompanied by COH procedure, the effects of low-dose aspirin in endometrial blood flow seems to be more certain than in COH-IVF cycles. In this study, we analyzed the effect of low-dose aspirin treatment on implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer Methods: From January 2003 to December 2003, total 264 cycles from 264 patients who attended infertility clinic at Samsung Cheil Hospital were enrolled in this study. All cases included in this study, embryos were frozen and thawed at the pronuclear stage and three days after incubation, at least 2 or more good quality embryos were transferred into uterus. In study group, low dose aspirin (100 mg/day) was administrated from the first or second date of menstrual day to 9 days after embryo transfer. On the other hand, control group did not take any medicine except estradiol valerate for endometrial priming. Several variables including implantation and pregnancy rates were compared in both groups. After then, each groups were stratified by endometrial thickness checked at embryo transfer (ET) day such as (28 mm versus <8 mm) and same variables above described were compared between study and control groups. Results: The mean age, infertility duration, endometrial thickness at embryo transfer day and mean number of transferred embryo were not significantly different in both groups. Also, implantation rates (study group: 15.8%, control group: 20.5%) and pregnancy rate (study group: 45.1%, control group: 43.5%) were not significantly different between two groups. (p>0.05) After we analyzed same variables stratified by endometrial thickness checked at embryo transfer day, we could not found any significant difference between study and control groups. Conclusions: Low-dose aspirin treatment seems to have no advantage of improving implantation and pregnancy rates in patients undergoing frozen-thawed embryo transfer.

A Survey of the Current Information Activities in the Advanced Developing Countries (중진국의 정보유통체제 연구)

  • Choi Sung-jin
    • Journal of the Korean Society for Library and Information Science
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    • v.7
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    • pp.89-195
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    • 1980
  • The advanced developing countries including Korea are assumed to have reached a developmental stage which necessitates them to formulate and implement a plan for a national information network. Most of the governments in the advanced developing countries are well aware of the necessity for such a plan and some of them have actually commenced their studies on the feasibility of a national network of their own hoping to achieve maximum utility of their limited information resources. Two urgent problems facing planners in the design of a national information network are identified. One is lack of an optimum organisational model to enable them to meet their own situations, and the other is lack of a guideline to help designers evaluate the alternative structures and models when they are available. In resolving these two problems, network planners in the advanced developing countries would benefit from the achievement of the objectives of the present study. The major objective is to elicit and describe common information needs, desires and value of the people using information, and other common factors which are responsible for the present information services in the advanced developing countries and which have implications for the basic structure of the national information network. The value of this study is to aid administrators in Korea and those in the other advanced developing countries who are responsible for making national policies and who are now beginning to recognise the need for information services with the planning of economic and social development so as to enable all the groups in the community to have access to the information which are essential for decision making, research work, studies and even for recreational reading. This recognition will hopefully give them a rational basis for formulating right policies on information services. The methodology utlised for collecting the required data in this study falls under the category of observation and largely consists of the two techniques: literature review and postal questionnaire. Background information on the individual advanced developing: countries was gathered from monographic and periodical literature. and country reports presented at the various international conferences were analysed for other relevant data. For most of the data needed for the present study, a questionnaire on 'Library and Information Services as They Are Available in the Selected Countries' was formulated. This questionnaire was designed to be completed without help, by an expert who was well informed of the library and information services in his or her country. The questionnaire was intended to look in details at what information services in the advanced developing countries were doing-whom they were serving, in what way, and how well and establish to what extent they were meeting the nation's information requirements. It was also intended to ascertain the respondents' ideas on possible future developments in information provision in their countries, that is, in the advanced devanced developing countries. The questionnaire was posted to a total of 63 natinal librarians, directors of national information centres and those of other major libraries or information centres in 21 selected countries. Complete usable responses were received from 34 persons in 14 countries. In order to identify common characteristics of the information needs and desires in the advanced developing countries and the present situation of the information services to meet them, and the requirements and constraints peculiar to those countries which bought to be considered in the design of a national information network for advanced developing countries, an individual report on the current status of information activities for each of the fourteen countries chosen for this study, was presented. The procedure used was to arrange the data acquired in the questionnaire responses and other sources, in the form of fifteen country reports to be summarised by cross-section characteristics later.

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Clinical Result of a Staged Reimplantation of Fungus Related Periprosthetic Joint Infection after Total Knee Arthroplasty (슬관절 전치환술 후 인공관절 주위 진균 감염의 임상적 결과)

  • Kim, Hyung Joo;Bae, Ki Cheor;Min, Kyung Keun;Choi, Hyeong Uk
    • Journal of the Korean Orthopaedic Association
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    • v.54 no.1
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    • pp.52-58
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    • 2019
  • Purpose: Fungal periprosthetic joint infection (PJI) is a rare but devastating complication following total knee arthroplasty (TKA). On the other hand, a standardized procedure regarding an accurate treatment of this serious complication of knee arthroplasty is lacking. The clinical progress of staged reimplantation in patients who had fungus-related PJI after TKA was reviewed retrospectively. Materials and Methods: Ten patients who had a fungal related PJI after TKA between 2006 and 2017 using staged reimplantation surgery were reviewed. These patients were compared with 119 patients who had a PJI in the same period. The failure rate of infection control, intravenous antimicrobial using the period, and the clinical results were evaluated by comparing the range of motion and Korean knee score (KKS) between pre-staged reimplantation and the last follow-up. Results: In the fungal infection group, 7 out of 10 cases (70.0%) had failed in infection control using staged reimplantation and in the non-fungal group, 7 out of 119 cases (5.9%) had failed (p=0.04). In the non-fungal group, the mean duration of antibiotics was 6.2 weeks. In the fungus group, the mean duration of antibiotics was 15.3 weeks, which was 9.1 weeks longer (p<0.001). The range of motion of the knee was increased in the two groups (p=0.265). At the last follow-up, the KKS was 71.01 points in the non-fungal group and 61.3 points in the fungal group (p=0.012). Erythrocyte sedimentation rate and C-reactive protein (CRP) decreased in the two groups, but the CRP was significantly different in the two groups (p=0.007). Conclusion: The treatment of fungus-related PJIs using staged reimplantation showed uneven clinical progress and unsatisfactory clinical improvements compared to non-fungal PJI. Therefore, it is necessary to consider the use of an antifungal mixed cement spacer at resection arthroplasty and oral antifungal agent after reimplantation.

Results of Postoperative Radiation Therapy of Rectal Cancers - with the Emphasis of the Overall Treatment Time - (직장암의 수술 후 방사선치료의 성적 - 예후 인자와 전체 치료기간이 미치는 영향에 관한 고찰 -)

  • Kim Joo-Young;Lee Myung-Hag;Lee Kyu-Chan
    • Radiation Oncology Journal
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    • v.16 no.3
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    • pp.303-310
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    • 1998
  • Purpose : To evaluate the results of the treatment of locally advanced but resectable rectal cancers and to analyze prognostic factors. especially with the emphasis on the treatment time factor. Materials and Methods : There were 71 patients with rectal cancer who had been treated by curative surgical procedure and postoperative radiotherapy from August 1989 to December 1993. The minimum follow up period was 24 months and the median follow-up was 35 months Radiation therapy had been given by 6 MV linear accelerator by parallel opposing or four-box portals. Whole pelvis was treated up to 5040 cGy in most cases. Systemic chemotherapy had been given in 94$\%$ of the patients, mostly with 5-FU/ACNU regimen. Assessment for the overall and disease-free survival rates were done by life-table method and prognostic factors by Log-Rank tests. Results : Five-year overall survival, disease-free survival were 58.8$\%$ and 57$\%$, respectively. Two-year local control rate was 76.6$\%$. Stage according to Modified Astler-Coller (MAC) system, over 4 positive lymph nodes, over 6weeks interval between definitive surgery and adjuvant radiotherapy and over 7 days of interruption during radiotherapy period were statistically significant, or borderline significant prognostic factors. Conclusion : The treatment results of patients with rectal cancers are comparable to those of other large institutes. The treatment results for the patients with bowel wall penetration and/or positive regional lymph nodes were still discouraging for their high local recurrence rate for the patients with MAC 'c' stage diseases and high distant metastases rate even for the patients with node-negative diseases. Maybe more effective regimen of chemotherapy would be needed with proper route and schedule. To maximize postoperative adjuvant treatment. radiotherapy should be started at least within 6 weeks after surgery and preferably as soon as wound healing is completed. Interruption of treatment during radiotherapy course affects disease-free survival badly, especially if exceeds 7 days. So, the total treatment period trout definitive surgery to the completion of radiotherapy should be kept as minimal as possiable.

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