1.Pretreatment Prognostic Factors in Carcinoma of the Uterine Cervix.
Sung Whan HA ; Do Hoon OH ; Mi Sook KIM ; Kyung Hwan SHIN ; Jae Sung KIM ; Moo Song LEE ; Keun Young YOO
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):387-396
To identify pretreatment prognostic factors in carcinoma of the uterine cervix, a retrospective analysis was undertaken of 510 patients treated with curative radiation therapy in Seoul National University Hospital during the 7 year period, from March 1979 through December 1986. According to FIGO classification, 35 patients were stage IB, 89 were stage IIA, 232 were stage IIB, 8 were stage IIIA, 134 were III B, and 12 were stage IVA. Five year locoregional control (LRC) rates in stage IB, IIA, IIB, IIIA, IIIB, and IVA were 79%, 78%, 70%, 58%, 51% and 27%, respectively. Five year disease free survival(DFS) rates were 76%, 67%, 60%, 57%, 40%, and 25%, respectively. Overall survival(OS) rates at five years were 82%, 72%, 67%, 67%, 51%, and 33%, respectively. In univariate analyses, stage, age, initial hemoglobin level, type of histology, tumor size, and several CT findings including pelvic lymph node(LN) status, paraaortic lymph node(PAN) status, extent of parametrial invasion, bladder invasion, and rectal invasion were significant factors in terms of overall survival, stage, initial hemoglobin level, type of histology, tumor size, elevation of BUN or creatinine, and five CT findings associated with LRC were prognostically significant. In multivariate analysis excluding CT findings, stage IV disease, non-squamous histology, and tumor size > or=4 cm were associated with poor LRC and DFS. Stage IV disease and tumor size significantly affected OS. In multivariate analysis including CT findings, histology, tumor size, and pelvic LN status on CT were uniformly significant in terms of LRC, DFS, and OS. PAN status on CT affected overall survival only.
Cervix Uteri*
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Classification
;
Creatinine
;
Female
;
Humans
;
Multivariate Analysis
;
Retrospective Studies
;
Seoul
;
Urinary Bladder
;
Uterine Cervical Neoplasms
2.The Relationship between Radiation Dose and Late Complication of Bladder in Carcinoma of the Uterine Cervix.
Sung Whan HA ; Woong Ki CHUNG ; Jong Hoon KIM
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):377-386
Five hundred and fifty patients treated for carcinoma of the uterine cervix at the Department of Therapeutic Radiology, Seoul National University Hospital from 1979 to 1986, were analyzed retrospectively for late bladder complications. of them, 468 patients received primary radiotherapy for the cervix cancer in intact uterus, and the other 52 patients were treated postoperatively. The cumulative incidence of radiation induced bladder complication of grade 2 or 3 was 2.5% at five years. The mean bladder dose for the group of patients with complication was higher than that of the group without complication, and the difference was statistically significant(p<0.01). But relationship between mean bladder dose and severity of complication was not found. The frequency of complication(grade I,II,III) increased as a function of radiation dose to bladder from 5.0% for patients with bladder dose less than 6,500 cGy to 27.7% for patients with bladder dose higher than 8,000 cGy. Among various factors, the age of patient and the distance between ovoids turned out to have significant effect on the complication.
Cervix Uteri*
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Female
;
Humans
;
Incidence
;
Radiation Oncology
;
Radiotherapy
;
Retrospective Studies
;
Seoul
;
Urinary Bladder*
;
Uterine Cervical Neoplasms
;
Uterus
3.Cancinoma of Uterine Cervix Treated with High Dose Rate Intracavitary Irradiation: 1. Patterns of Failure.
Ok Bae KIM ; Tae Jin CHOI ; Jin Hee KIM ; Ho Jun LEE ; Yung Ae KIM ; Young Wook SUH ; Tae Sung LEE ; Soon Do CHA
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):369-376
226 patients with carcinoma of the uterine cervix treated with curative radiation therapy at the Department of Therapeutic Radiology, Dongsan hospital, Keimyung university, School of medicine, from July, 1988 to May, 1991 were evaluated. The patients with all stages of the disease were included in this study. The maximum and mean follow up durations were 60 and 43 months. The radiation therapy consisted of external irradiation to the whole pelvis (2700~4500 cGy) and boost parametrial doses(for a total of 4500~6300 cGy) with midline shill(4x10 cm), and combined with intracavitary irradiation irradiation(5700~7500 cGy to point A). The distribution of patients according to the stage was as follows: stage IB 37(16.4%), stage IIA 91 (40.3%), Stage IIB 58(25.7%), stage III 32(13.8%), stage IV 8 (3.5%). The overall failure rate was 23.9%(54 patients). The failure rate increased as a function of stage from 13.5% in stage 1B to 15.4% in stage IIA, 25.9% in stage IIB, 46.9% in stage III, and 62.5% in stage IV. The pelvic failure alone were 32 patients and 11 patients were as a components of other failure, and remaining 11 patients had distant metastasis only. Among the 43 patients of locoregional failure, 28 patients were not controlled initially and in other words nearly half of total failures were due to residual tumor. The mean medial paracervical(point A) doses were 6700 cGy in stage IIB, 7200 cGy in stage IIA, 7450 cGy in stage IIB, 7600 cGy in stage III and 8100 cGy in stage IV. The medial paracevical doses showed some correlation with tumor control rate in early stage of disease (stage Ib, IIA), but there were higher central failure rate in advanced stage in spite of higher paracervical doses. In advanced stage, failure were not reduced by simple Increment of paracervical doses. To improve a locoregional control rate in advanced stages, it is necessary to give additional treatment such as concomitant chemoradiation.
Brachytherapy
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Cervix Uteri*
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Female
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Follow-Up Studies
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Humans
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Neoplasm Metastasis
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Neoplasm, Residual
;
Pelvis
;
Radiation Oncology
4.Carcinoma of the Uterine Cervix Treated with External Beam Irradiation Alone.
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):363-368
A retrospective analysis was performed on 42 patients with carcinoma of the uterine cervix who were treated with external beam(EB) radiation therapy alone at the Department of Therapeutic Radiology, Seoul National University Hospital from March 1979 to December 1988. After whole pelvic field irradiation of 50 Gy, all the patients received additional booster dose of 12-22Gy to the primary tumor. Thirty one received EB radiotherapy alone because of poor geometry for intracavitary application, 5 because of medical problems and 6 because of other reasons. Five year locoregional control rate and file year survival rate were 34.5% and 35.4%, respectively. Five year survivals were 66.7%, 36.4%, 32.8% and 25.0% for stage IIA, IIB, IIIB and IVA, respectively. The response one month after treatment well correlated with prognosis. The incidence of grade 2 and 3 complication was 12% and 10%, respectively. There was tendency of increased complication with advanced stage.
Cervix Uteri*
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Female
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Humans
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Incidence
;
Prognosis
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Radiation Oncology
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Radiotherapy
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Retrospective Studies
;
Seoul
;
Survival Rate
5.Therapeutic Results of Postoperative Radiation Therapy for Early Stage Uterine cervical Cancer.
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):347-354
This is a retrospective analysis of 67 patients with histologically proven invasive carcinoma of uterine cervix treated with surgery followed by adjuvant radiotherapy at Inje University Seoul Paik Hospital between october 1983 and september 1991. Postoperative radiotherapy was carried out in patients with high risks of locoregional recurrence such as positive pelvic lymph node (38 pts), large tumor size more than 3 cm (22 pts), cervical stromal invasion more than 2/3 (46 pts), parametrial involvement (9 pts), positive resection margin (147ts), endo/myometrial extension (10 pts), and angiolymphatic invasion (13 pts). Stage IA, IB, and IIA were 2(3%), 39(58.2%), and 26(38.8%), respectively. Median follow-up period was 48 months with ranges from 13 to 115 months. All 67 patients were treated externally with standard pelvic field with radiation dose ranging from 4080 to 6120 cGy in 4~6 weeks period of time. Of these, 45 patients received intracavitary radiotherapy. The overall survival rate and disease free survival rate at 5-year were 88.0% and 82.1%, respectively. The survival rates by stage were 87.l% in IB and 88.4% in IIA. Local control rate was 86.6%(58 pts). The treatment failure was noted in 12 of 67 Patients(17.9%): locoregional failure in 7(10.4%), distant metastasis in 3(4.5%), and locoregional and distant metastasis in 2 (3%). The univariate analysis of prognostic factors disclosed endo/myometrial extension as a significant factor of survival and recurrence (70.0% vs 91.l% P< 0.05 & 30.0% vs 15.8%, respectively). The complication of postoperative radiothrapy was not significant and all patient were well tolerated. In conclusion, postoperative radiotherapy in patients with high risks of locoreginal recurrence is relatively well tolerated and it gives significantly improved survival rate especially in patients with positive lymph nodes, bulky tumor size( 3 cm), parametrial involvement, cervical stromal invasion more than 2/3, positive resection margin and angiolymphatic invasion.
Cervix Uteri
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Disease-Free Survival
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Female
;
Follow-Up Studies
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Humans
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Lymph Nodes
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Neoplasm Metastasis
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Radiotherapy
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Radiotherapy, Adjuvant
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Recurrence
;
Retrospective Studies
;
Seoul
;
Survival Rate
;
Treatment Failure
;
Uterine Cervical Neoplasms*
6.Postoperative Radiotherapy for the Early Stage Carcinoma of the Uterine cervix.
Jin Hee KIM ; Ok Bae KIM ; Tae Sung LEE
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):337-346
This is a retrospective cohort analysis of 58 patients who treated with postoperative radiation therapy following radical hysterectomy and bilateral pelvic adenectomy for early stage carcinoma of uterine cervix between January 1988 and December 1990 at department of radiation oncology, Keimyoung University Hospital. Sixteen percent of patients(9/58) had chemotherapy. Most patients were FIGO I b (47 patients), and FIGO I a and IIa were one and ten patients, respectively. The median follow-up periods were 48.5 months. The indications for radiation therapy included pelvic lymph node metastasis, large tumor size, deep stromal invasion, lymphovascular invasion, positive surgical margin, endometrial invasion and parametrial invasion. Eighty five percent of the patients had more than one risk factor. The actuarial overall five year survival rate(5 YSR) and five year disease free survival rate(5 YDFSR) were 89.5% and 87.8%, respectively. Their overall recurrence rate was 12.1%,(7/58). Distant metastasis was the most common cause of treatment failure (71.4%: 5/7). The univariate analysis of prognostic factors affecting to five year survival rate disclosed pelvic lymph node status (negative: 95.5%, positive: 69.2%, p=0.006) and hemoglobin level(< or =11:75%, >11g/dl:93.3% p= 0.05) as significant factor. The age status was marginally significant (< or =40:96.0%, >40:84.3% p=0.15). Multivariate analysis clarified three independent prognostic factors: pelvic lymph node metastasis(p=p.006), hemoglobin level (p=0.015) and age (p=0.035). Multivariate analysis of prognostic factor affecting to five year disease free survival rate disclosed pelvic lymph node status (p=0.0078) and status of surgical margin (p=0.008). Complications relating to radiotherapy were 10.3%(6/58). There were no severe major complication requiring surgical intervention or a long hospital stay. It is our opinion that the benefit of postoperative pelvic radiotherapy may be gained in such a high risk patient population with acceptable morbidity.
Cervix Uteri*
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Cohort Studies
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Disease-Free Survival
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Drug Therapy
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Female
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Follow-Up Studies
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Humans
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Hysterectomy
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Length of Stay
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Lymph Nodes
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Multivariate Analysis
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Neoplasm Metastasis
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Radiation Oncology
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Radiotherapy*
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Recurrence
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Retrospective Studies
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Risk Factors
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Survival Rate
;
Treatment Failure
7.Treatment of Locally Advanced Pancreatic Cancer.
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):331-336
From January 1981 to December 1991, forty patients with localized advanced carcinoma of the pancreas were treated at the Department of Therapeutic Radiology, Seoul National University Hospital. The treatment protocol consisted of two split course external radiation therapy with each 2000 cGy over two weeks separated by two week rest period. Intravenous 5-fluorouracil (5-FU) was administered on the first three days of each radiotherapy course. Twenty three of these patients were treated by maintenance 5-FU or FAM (5-FU, adriamycin, mitomycin) chemotherapy. Median survival was 9 months and the 2-year survival rate was 10.0%. Good prognostic indicators were good performance status, palliative bypass surgery and tumor located in the head of pancreas.
Clinical Protocols
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Doxorubicin
;
Drug Therapy
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Fluorouracil
;
Head
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Humans
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Pancreas
;
Pancreatic Neoplasms*
;
Radiation Oncology
;
Radiotherapy
;
Seoul
;
Survival Rate
8.Radiation-induced Pulmonary Damage in Lung Cancer Patients.
Su Mi CHUNG ; Ihl Bohng CHOI ; Ki Mun KANG ; In Ah KIM ; Kyung Sub SHINN
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):321-330
PURPOSE: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. MATHOD AND MATERIALS: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinDma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years(range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range of 2 to 150 days (median 40 days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose(ED) model, ED=D.N-0.377.T-0.058 was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. RESULT: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic charges consistent with radiation pneumonitis were seen in 100% of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced charge between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy. No correlation was seen between incidence of radiation pneumonitis and age or sex. CONCOUSIONS: The occurrence cf radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.
Appointments and Schedules
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Carcinoma, Large Cell
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Carcinoma, Small Cell
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Drug Therapy
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Female
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Humans
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Incidence
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Lung Neoplasms*
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Lung*
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Male
;
Particle Accelerators
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Pneumonectomy
;
Radiation Pneumonitis
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Radiography, Thoracic
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Radiotherapy
;
Retrospective Studies
;
Thorax
9.Local Control and Survival in Radiation Treatment of Locally Advanced Non-Small Cell Lung Cancer.
Mi Hee SONG ; Jin Yeung YANG ; Won Young OH ; Nam Soo YOO ; In Soon WHANG
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):311-320
The retrospective analysis was performed on 37 patients with stage III non small cell lung cancer who received the radiotherapy from Feb. 1986 to Dec. 1990 at the Dept. of Radiation Oncology, National Medical Center. This analysis, with 29 patients (78.4%) having been followed from 10 to 60 months, was done to know the survival rate and significant prognostic factor. The actuarial 2, 5-year survival rates were 20.6%, 6.9% in our all patients and Median survival time was 10 months. Of patients with KPS(Karnofsky performance status) greater than 80%, the 2, 5 year survival rate and median survival time were 29.2%, 9.7% and 13 months, respectively. The 2-year survival rate and median survival time of patients with KPS less than 80% were 13.7% and 7 months, respectively. The survival difference according to performance status was statistically significant(29.2% vs. 13.7%)(p<0.05). In stage IIIa, the 2, 5-year survival rate and median survival rate and median survival time were 29.2%, 9.7% and 12 months, respectively. The 2-year survival rate and metian survival time of stage IIIb were 8.6% and 10 months, respectively. The survival difference between stage IIIa and IIIb did not show statistical significance(p>0.1). Of the prognostic factors, the difference of survival rate by initial performance status was statistically significant (p<0.05). But the difference of survival rates by pathologic cell type, stage, total radiation dose, radiotherapy response, and combination with chemotherapy were not statistically significant.
Carcinoma, Non-Small-Cell Lung*
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Drug Therapy
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Humans
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Radiation Oncology
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Radiotherapy
;
Retrospective Studies
;
Small Cell Lung Carcinoma
;
Survival Rate
10.Therapeutic Results of Radiation Therapy Alone and Combination with Chemotherapy in Non-Small Cell Lung Carcinoma.
Journal of the Korean Society for Therapeutic Radiology 1993;11(2):303-310
Between November 1983 and December 1992, 121 patients with non-small cell lung cancer were treated with radiotherapy alone or combined with chemotherapy in Inje University, Seoul Paik Hospital. Of these, 97 patients were evaluable and analyzed retrospectively. Group 1(n=62) was treated with radiotherapy alone and group 2(n=35) combined with chemotherapy. There were 7 patients, 1 patient with stage I and II, 20 patients, 11 patients with stage IIIA, 28 patients,20 patients with stage IIIB, and 6 patients, 3 patients with stage IV, respectively. Ninety percent of patients received more than 5000 cGy of radiaton. Median survival of patients in group 1 was 9 months, group 2 was 15 months. Overall 2 year survival rates of group 1 and 2 were 37% and 27%, respectively. Relapse free survival rates at 2 year were 27% and 15%, respectively. Overall survival rates at 5 year for group 1 and 2 were 15% and 11%, and relapse free survival rates were 16% and 6%, respectively. Median survival of complete and partial responders was 17 months in group 1, 18 Months in group 2, and those of stable or progression was 6 mouths, 11 months, respectively. The proportion of locoregional relapse and distant metastasis was not significantly different between group 1 and 2. The majority of relapse developed within 2 years. Although 2 cases of severe esophagitis and myelosuppression were noted in group 2, the treatment related toxicity was relatively acceptable. Our analysis showed no statistically significant differences between the two treatment groups in terms of response rate, survival, and sites of relapse.
Carcinoma, Non-Small-Cell Lung
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Drug Therapy*
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Esophagitis
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Humans
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Lung*
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Mouth
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Neoplasm Metastasis
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Radiotherapy
;
Recurrence
;
Retrospective Studies
;
Seoul
;
Survival Rate