Radiotherapy has been offered to patients with pancreatic cancer, either in the adjuvant or definitive setting. However, the role of radiotherapy in pancreatic cancer is increasingly doubted, especially after the introduction of gemcitabine to both domains. Although contradictory data exist, combined chemoradiotherapy improves both quantity and quality of life for patients with locally advanced tumors compared with radiotherapy alone or chemotherapy alone. Recently, induction chemotherapy strategy is being evaluated for better selection of patients for optimal benefit from consolidative chemoradiotherapy. Much controversy has been suggested concerning the role of adjuvant radiotherapy, but quality assurance for radiotherapy was not considered in the previously reported studies. Combined chemoradiotherapy in the adjuvant setting is still considered as a viable option. Current phase III randomized on-going studies will provide better answers on the role of radiotherapy in the treatment of pancreatic cancer.
Antimetabolites/therapeutic use ; Antimetabolites, Antineoplastic/therapeutic use ; Combined Modality Therapy ; Deoxycytidine/analogs & derivatives/therapeutic use ; Fluorouracil/therapeutic use ; Humans ; Pancreatic Neoplasms/drug therapy/*radiotherapy

Data collection is a major problem in large scale clinical studies, especially muticenter and international trials. Data collection by mailing is too slow and expensive. Furthermore, difficulty in understanding handwritten notes from many investigators could result in potential errors in data entry. We developed web-based data collection system for patterns of care study of radiation oncology to collect data nation-widely and efficiently. We introduced drop-down box, check box, and radio button in data entry form for rapid, convenient and correct data entry. Our system also checks blank item, logical errors and other validity of data in real time. For security, we committed the server to the care of Korea Internet Data Center, implemented secure socket layer for communication between web server and clients, and established two remote backup systems. Participating investigators are satisfied with this system and we are collecting data efficiently. We think that web-based data collection system should be considered in any large scale clinical studies.
Data Collection* ; Humans ; Internet ; Korea ; Logic ; Postal Service ; Radiation Oncology* ; Research Personnel

PURPOSE: To evaluate the outcome of ductal carcinoma in situ (DCIS) patients who underwent surgery followed by radiation therapy (RT). MATERIALS AND METHODS: We retrospectively reviewed 106 DCIS patients who underwent surgery followed by postoperative RT between 1994 and 2006. Ninety-four patients underwent breast-conserving surgery, and mastectomy was performed in 12 patients due to extensive DCIS. Postoperative RT was delivered to whole breast with 50.4 Gy/28 fx. Tumor bed boost was offered to 7 patients (6.6%). Patients with hormonal receptor-positive tumors were treated with hormonal therapy. RESULTS: The median follow-up duration was 83.4 months (range, 33.4 to 191.5 months) and the median age was 47.8 years. Ten patients (9.4%) had resection margin <1 mm and high-grade and estrogen receptor-negative tumors were observed in 39 (36.8%) and 20 (18.9%) patients, respectively. The 7-year ipsilateral breast tumor recurrence (IBTR)-free survival rate was 95.3%. Resection margin (<1 or > or =1 mm) was the significant prognostic factor for IBTR in univariate and multivariate analyses (p < 0.001 and p = 0.016, respectively). CONCLUSION: Postoperative RT for DCIS can achieve favorable treatment outcome. Resection margin was the important prognostic factor for IBTR in the DCIS patients who underwent postoperative RT.
Breast ; Breast Neoplasms ; Carcinoma, Ductal* ; Carcinoma, Intraductal, Noninfiltrating* ; Estrogens ; Follow-Up Studies ; Humans ; Mastectomy ; Mastectomy, Segmental ; Multivariate Analysis ; Recurrence ; Retrospective Studies ; Survival Rate ; Treatment Outcome*

PURPOSE: While curative resection is the only chance of cure in pancreatic cancer, controversies exist about the impact of surgical margin status on survival. Non-standardized pathologic report and different criteria on the R1 status made it difficult to implicate adjuvant therapy after resection based on the margin status. We evaluated the influence of resection margins on survival by meta-analysis. MATERIALS AND METHODS: We thoroughly searched electronic databases of PubMed, EMBASE, and Cochrane Library. We included studies reporting survival outcomes with different margin status: involved margin (R0 mm), margin clearance with ≤ 1 mm (R0-1 mm), and margin with > 1 mm (R>1 mm). Hazard ratio (HR) for overall survival was extracted, and a random-effects model was used for pooled analysis. RESULTS: A total of eight retrospective studies involving 1,932 patients were included. Pooled HR for overall survival showed that patients with R>1 mm had reduced risk of death than those with R0-1 mm (HR, 0.74; 95% confidence interval [CI], 0.61 to 0.88; p=0.001). In addition, patients with R0-1 mm had reduced risk of death than those with R0 mm (HR, 0.81; 95% CI, 0.72 to 0.91; p < 0.001). There was no heterogeneity between the included studies (I2 index, 42% and 0%; p=0.10 and p=0.82, respectively). CONCLUSION: Our results suggest that stratification of the patients based on margin status is warranted in the clinical trials assessing the role of adjuvant treatment for pancreatic cancer.
Humans ; Pancreatic Neoplasms* ; Population Characteristics ; Retrospective Studies

PURPOSE: While curative resection is the only chance of cure in pancreatic cancer, controversies exist about the impact of surgical margin status on survival. Non-standardized pathologic report and different criteria on the R1 status made it difficult to implicate adjuvant therapy after resection based on the margin status. We evaluated the influence of resection margins on survival by meta-analysis. MATERIALS AND METHODS: We thoroughly searched electronic databases of PubMed, EMBASE, and Cochrane Library. We included studies reporting survival outcomes with different margin status: involved margin (R0 mm), margin clearance with ≤ 1 mm (R0-1 mm), and margin with > 1 mm (R>1 mm). Hazard ratio (HR) for overall survival was extracted, and a random-effects model was used for pooled analysis. RESULTS: A total of eight retrospective studies involving 1,932 patients were included. Pooled HR for overall survival showed that patients with R>1 mm had reduced risk of death than those with R0-1 mm (HR, 0.74; 95% confidence interval [CI], 0.61 to 0.88; p=0.001). In addition, patients with R0-1 mm had reduced risk of death than those with R0 mm (HR, 0.81; 95% CI, 0.72 to 0.91; p < 0.001). There was no heterogeneity between the included studies (I2 index, 42% and 0%; p=0.10 and p=0.82, respectively). CONCLUSION: Our results suggest that stratification of the patients based on margin status is warranted in the clinical trials assessing the role of adjuvant treatment for pancreatic cancer.
Humans ; Pancreatic Neoplasms* ; Population Characteristics ; Retrospective Studies

PURPOSE: Total body irradiation (TBI) or whole body irradiation is used to acquire immune suppression, to treat malignant lymphoma and leukemia, and as an conditioning regimen for bone marrow transplantation. For these purposes, many methods were developed to obtain homogenous dose distribution. The objective of this study was to analyze and confirm the accuracy and the homogeneity of the treatment setup, the parallel opposed lateral technique, currently used in Seoul National University Hospital. MATERIALS AND METHODS: Surface dose data, measured with a thermoluminescent dosimeter, of 8 patients among 10 patients, who were given total body irradiation with the parallel opposed lateral technique between September 1996 to August 1998, at Seoul National University Hospital were analyzed. Surface doses were measured at the head, neck, axilla, thigh, and ankle level. Surface and midline doses were measured with similar set-up and technique in the Humanoid phantom. RESULTS: Measured surface doses relative to prescribed dose for the head, neck, axilla, thigh, and ankle level were 91.3+/-7.8, 98.3+/-7.5, 95.1+/-6.3, 98.3+/-5.5, and 95.3+/-6.3%, respectively. The midline doses of the head, neck, axilla, thigh, and ankle level estimated from the surface-to-midline ratios in the Humanoid phantom were 103.4+/-9.0, 107.8+/-10.5, 91.1+/-6.1, 93.8+/-4.5, and 104.5+/-9.3%, respectively. Measured surface doses and estimated midline doses ranged from -8.9% to + 7.8%. Midline doses at the neck and the axilla level deviated more than 5% from the prescribed doses. The difference of the estimated midline doses at the neck and the axilla level and the actual doses were attributed to the thickness differences between the Humanoid phantom and the patients. CONCLUSION: Distribution of the midline doses as well as the surface doses were measured to be within -8.7 - +7.8% range. Actual dose distribution in the patient is expected to be better than the measured dose range mainly attributed to thickness difference between the patient and the Humanoid phantom.
Ankle ; Axilla ; Bone Marrow Transplantation ; Head ; Humans ; Leukemia ; Lymphoma ; Neck ; Seoul ; Thigh ; Whole-Body Irradiation*

BACKGROUNDS/AIMS: To investigate survival rates and prognostic factors of patients with gallbladder cancer who were treated with surgery and postoperative radiation therapy. METHODS: Seventeen gallbladder cancer patients who received surgery and postoperative radiotherapy from October 1989 to April 1998 were included in this retrospective study. Five patients had stage II, 8 patients had stage III, and 4 patients had stage IV disease according to the 1997 American Joint Committee on Cancer (AJCC) staging. All patients received > or =40 Gy of postoperative radiotherapy with a daily dose of 2.0 Gy/fraction and 15 patients received concurrent chemotherapy. An analysis was performed for the endpoints of overall and disease-free survival. RESULTS: Of the 17 patients, 13 had no residual disease (R0), 1 had microscopic residual disease (R1), and 3 had macroscopic residual disease (R2) after surgery. Among patients with no residual disease, 4 had locoregional recurrences during the follow-up period. One patient with microscopic residual disease had local recurrence. The 5-year overall survival rate was 38.2%. The median overall survival time was 21 months and the median disease-free survival time was 12 months. Old age (> or =60 years old), female gender, a high pathological stage (> or =IVA), and the presence of residual disease after surgery were significant prognostic factors for disease-free survival. CONCLUSIONS: Despite a high proportion of patients with advanced disease and macroscopic residual disease, the prognosis of gallbladder patients who had postoperative radiotherapy is encouraging. Additional investigation to improve the loco-regional control of gallbladder cancer patients with adverse prognostic factors is warranted.
Disease-Free Survival ; Female ; Follow-Up Studies ; Gallbladder ; Gallbladder Neoplasms ; Humans ; Joints ; Prognosis ; Recurrence ; Retrospective Studies ; Survival Rate

PURPOSE: This study was performed to evaluate the radiotherapy effects on metastatic epidural cord compressions. MATERIALS AND METHODS: One hundred and thirty eight cases received palliative radio- therapy (30 Gy/10 fractions) with (15) or without (123) surgical decompression. Only 36% of cases were ambulatory before treatment and 34% of cases started treatment within 3 days after symptom onset. RESULTS: Ambulation was possible after radiotherapy in 38% of all patients and in 73% of cases who was ambulatory before treatment. But the treatment made ambulation possible for 18% of cases who was paraplegic before treatment. Complete response rate, partial response rate, minimal response rate, and progression after treatment were as follows; 7%, 37%, 53%, and 3% respectively for the motor function, 8%, 32%, 58%, and 2% respectively for the sensory function, and 17%, 17%, 65%, and 1% respectively for the autonomic function. Responses were not influenced by the primary tumor site, histology, or involved level of the spine. Good responses were associated with starting treatment within 3 days after symptom onset. CONCLUSION: Radiotherapy gave optimal palliative effects on metastatic epidural cord compression syndrome. Maximum responses or quality of life could be obtained from prompt treatment with awareness of this syndrome in cancer patients.
Decompression, Surgical ; Humans ; Quality of Life ; Radiotherapy* ; Sensation ; Spine ; Walking