No absract available.
Follow-Up Studies* ; Urinary Bladder Neoplasms* ; Urinary Bladder*

PURPOSE: Traditionally the patients with early stage non-Hodgkin's lymphoma of he head and neck was treated with radiotherapy. But the results were not satisfactory due to distant relapse. Although combined treatment with radiotherapy and chemotherapy was tried with some improved results and chemotherapy alone was also tried in recent years, the choice of treatment for the patients with early stage non-Hodgkin's lymphoma of the head and neck has not been defined. Therfore, in order to determine the optimum treatment method, we analysed retrospectively the outcomes of the patients with Ann Arbor stage I and II non-Hodgkin's lymphoma localized to the head and neck who were treated at Serverance Hospital. MATERIALS AND METHODS: 159 patients with stage I and II non-hodgkin's lymphoma localized to the head and neck were treated at our hospital from January, 1979 to December, 1992. Of these patients, 114 patients whose primary sites were Waldeyer's ring or nodal region, and received prescribed radiation dose and/or more than 2 cycles of chemotherapy, were selected to analyze the outcomes according to the treatment methods (radiotherapy alone, chemotherapy alone, and combined treatment with radiotherapy and chemotherapy). RESULTS: Five year overall actuarial survival of the patients whose primary site was Waldeyer's ring was 62.5%, and that of the patients whose primary site was nodal region was 53.8%. There was no statistically significant difference between survivals of both groups. Initial response rate to radiotherapy, chemotherapy, and combined treatment was 92%, 83%, 94% respectively, and 5 year relapse free survival was 49.9%, 52.4%, 58.5% respectively (statistically no significant). In the patients with stage I, 3 year relapse free survival of chemotherapy alone group was 75% and superior to other treatment groups. In the patients with stage II, combined treatment group revealed the best result with 60.1% of 3 year relapse free survival. The effect of sequential schedule of each treatment method in the patients who were treated by combined modality was analyzed and the sequence of primary chemotherapy + radiotherapy + maintenance chemotherapy shoed the best result (3 year relapse free survival was 79.1%). There was no significant survival difference between BACOP regimen and CHOP regimen. Response to treatment was only one significant (p<0.005) prognostic factor on univariate analysis and age and mass size was marginally significant (p<0.01). On multivariate analysis, age (p=0.026) and mass size (p=0.013) were significant prognostic factor for the relapse free survival. CONCLUSION: In summary, the patients who have non-Hodgkin's lymphoma of the head and neck with stage I and mass size smaller that 10cm , can be treated by chemotherapy alone, but remainder should be treated by combined treatment method and the best combination schedule was the sequence of initial chemotherapy followed by radiotherapy and maintenance chemotherapy.
Appointments and Schedules ; Drug Therapy ; Head* ; Humans ; Lymphoma, Non-Hodgkin* ; Maintenance Chemotherapy ; Multivariate Analysis ; Neck* ; Radiotherapy ; Recurrence ; Retrospective Studies

PURPOSE: To investigate the presence of adaptive response by low dose radiation in murine tumors in relation to radiation induced apoptosis as well as related mechanism. MATERIALS AND METHODS: Syngeneic murine tumors, OCa-I and HCa-I, were given 0.05 Gy pretreatment followed by therapeutic dose of 25 Gy radiation. Induction of apoptosis was analyzed for each treatment group. Regulating molecules of apoptosis, p53, Bcl-2, Bax, Bcl-X, were also analyzed by Western blotting. RESULTS: In 0.05 Gy pretreatment group of OCa-I, 25 Gy-induced apoptosis per 1000 cells was 229, which was estimated at 30% lower level than the expected (p<0.05). In contrast, this reduction in radiation induced apoptosis was not seen in HCa-I. In the expression of apoptosis regulating molecules, p53 increased in both tumors in response to radiation. Bcl-2 and Bax did not show significant change in both tumors however, the expression of Bcl-2 surpassed that of Bax in 0.05 Gy pretreatment group of OCa-I. Bcl-X was not expressed in OCa-I. In HCa-I, Bcl-X showed increased expression even with 0.05 Gy. CONCLUSION: Adaptive response by low dose radiation is shown in one murine tumor, OCa-I, in relation to radiation induced apoptosis. Apoptosis regulating molecules including Bcl-2/Bax and Bcl-X, appear to related. This study shows an evidence that adaptive response is present, but not a generalized phenomenon in vivo.
Apoptosis* ; Blotting, Western ; Radiation Dosage

PURPOSE: The main purpose of this study is to develop new payment rates for services of Radiation Oncology, considering costs of treating patients. MATERIAL AND METHODS: A survey of forty hospitals has been conducted in order to analyze the costs of treating patients. Before conducting the survey, we evaluated and reclassified the individual service items currently using as payments units on the fee-for-service reimbursement system. This study embodies the analysis of replies received from the twenty four hospitals. The survey contains informations about the hospitals' costs of 1995 for the reclassified service items on Radiation Oncology. After we adjust the hospital costs by the operating rate of medical equipment, we compare the adjusted costs with the current payment rates of individual services. RESULTS: The current payment rates were 5.05-6.58 times lower than the adjusted costs in treatment planning services, 2.22 times lower in block making service, 1.57-2.86 times lower in external beam irradiation services, 3.82-5.01 times lower in intracavitary and interstitial irradiation and 1.12- 2.55 times lower in total body irradiation. CONCLUSION: We could conclude that the current payment system on Radiation Oncology does not only reflect the costs of treating patients appropriately but also classify the service items correctly. For an example, when the appropriate costs and classification are applied to TBI, the payment rates of TBI should be increased five times more than current level.
Classification* ; Fee-for-Service Plans ; Hospital Costs ; Humans ; Radiation Oncology* ; Whole-Body Irradiation

PURPOSE: This study was undertaken to determine the parotid gland tolerance dose levels following intensity modulated radiation therapy (IMRT) for treating patients who suffered with head and neck cancer. MATERIALS AND METHODS: From February 2003 through June 2004, 34 head and neck patients with 6 months of follow-up were evaluated for xerostomia after being treated by IMRT. Their median age was 59 years (range: 29~78). Xerostomia was assessed using a 4-question xerostomia questionnaire score (XQS) and a test for the salivary flow rates (unstimulated and stimulated: USFR and SSFR, respectively). The patients were also given a validated LENT SOMA scale (LSS) questionnaire. Evaluations were performed before IMRT and at 1, 3 and 6 months after IMRT. RESULTS: All 34 patients showed significant changes in the XQS, LSS and Salivary Flow rates (USFR and SSFR) after IMRT. No significant changes in the XQS or LSS were noted in 12 patients who received a total parotid mean dose of < or =3,100 cGy at 1, 3 and 6 months post-IMRT relative to the baseline values. However, for the 22 patients who received >3,100 cGy, significant increases in the XQS and LSS were observed. The USFR and SSFR from the parotid glands in 7 patients who received < or =2,750 cGy were significantly preserved at up to 6 months after IMRT. However, the USFR and SSFR in 27 patients who were treated with >2,750 cGy were significantly lower than the baseline values at all times after IMRT. CONCLUSION: We suggest that the total parotid mean dose should be limited to < or =2,750 cGy to preserve the USFR and SSFR and so improve the subsequent quality of life.
Carisoprodol ; Follow-Up Studies ; Head and Neck Neoplasms* ; Head* ; Humans ; Neck ; Parotid Gland* ; Quality of Life ; Xerostomia ; Surveys and Questionnaires

PURPOSE: Preoperative chemoradiation treatment (CCRT) for locally advanced rectal cancer has been known to be safe and effective. The aim of study is to find any correlation between tumor volume reduction and histopathologic downstaging in locally advanced rectal cancer by preoperative CCRT. METHODS: A total of 16 patients of rectal cancer were selected. They had been T3,4 N (+) preoperatively staged by using a transrectal ultrasonography and pelvic MRI. Radiation was given, a total of 5,040 cGy over 5 weeks, and systemic chemotherapy was also given 5 FU 450 mg/m2 and leucovorin 20 mg/m2 concurrently intravenously during the first and the fifth week of CCRT. Surgery was done 4~6 weeks after completion of CCRT. A 3D CT image was obtained with AcQsim PQ 5000 3D (Philips, USA). Tumor volume was measured before and after CCRT. RESULTS: The type of operative procedures were abdominoperineal resection 7, low anterior resection 5, coloanal anastomosis 3 and Hartmann operation 1. Volume reduction was ranged from 14.6% to 84.4%. Over a 50% tumor volume reductions were in 9 patients (56.2%). Pathologic complete remission was observed in 2 patients (12.5%), who showed 72% and 58.5% tumor volume reductions. Patients showing pT and/or pN downstaging patients (N=9) had a 55.9% tumor reductions (14.6~84.4%), and patients showing no pT and/or pN downstaging (N=7) had 51.8% volume reduction (24.7~79%). CONCLUSIONS: Preoeperative CCRT has been thought to be able to decrease tumor size and volume and to increase respectability. However, among our 9 patients who showed over 50% tumor volume reductions, 3 patients did not show any T and N downstaging, which is really important for long-term oncologic outcomes.
Drug Therapy ; Humans ; Leucovorin ; Magnetic Resonance Imaging ; Rectal Neoplasms* ; Surgical Procedures, Operative ; Tumor Burden* ; Ultrasonography

Among the patients with rectal cancer who entered Yonsei University Hospital for management from Jan. 1980 to Dec. 1990, we selected 23 subjects who were received surgical resection of tumor in rectum, and who proved to have liver metastasis during the diagnostic work-up, at the time of the operation, or within 3 months after starting definitive treatment. With those subjects, we investigated the role of radiation therapy by comparison of the treatment results of the patients without radiation therapy (S group) with those of the patients with radiation therapy to the primary site (S+R group). The local control rates of S group and S+R group were 64% and 89%, and 2-year survival rates were 50% and 78%, respectively. Although there was not statistically meaningful difference, local control rate and 2-year survival rate were higher in the group with radiation therapy to primary site than that without radiation therapy. The 2-year survival rates of the case with resection of the liver and the case without it were 03.6% and 58.3% respectively, which was not statistically significant. Also, the 2-year survival rate of the case with sustained local control was higher than that of the case with local failure, which was statistically significant(70.5% and 16.7%, p<0.005). From the above results, it is thought that radiation therapy to the primary site might improve the local control rate even in the patients with liver metastasis, which seems to be correlated to the higher survival rate.
Humans ; Liver* ; Neoplasm Metastasis* ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Survival Rate

PURPOSE: To clarify the clinical benefit derived from the combined modality therapy (CMT) consisting of chemotherapy (CT) and involved field radiotherapy (RT) for stage I and II angiocentric lymphomas of the head and neck. MATERIALS AND METHODS: Of 143 patients with angiocentric lymphoma of the head and neck treated at our hospital between 1976 and 1995, 104 patients (RT group) received involved field RT alone with a median dose of 50.4 Gy (range : 20-70 Gy), while 39 patients (CMT group) received a median 3 cycles (range : 1-6 cycles) of CT before involved field RT. The response rate, patterns of failure, complications, and survival data of the RT group were compared with those of the CMT group. RESULTS: Despite a higher response rate, local failure was the most common pattern of failure in patients of both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination CT. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignancies were more frequently observed in patients of the CMT group. The prognosis of patients in the RT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic CT. Achieving complete remission was the most important prognostic factor by univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival. Conclusions : Involved field RT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the addition of CT to involved field RT failed to demonstrate any therapeutic advantage over involved field RT alone.
Combined Modality Therapy ; Disease-Free Survival ; Drug Therapy* ; Head* ; Hemorrhage ; Humans ; Lymphohistiocytosis, Hemophagocytic ; Lymphoma* ; Multivariate Analysis ; Neck* ; Prognosis ; Radiotherapy* ; Recurrence ; Sepsis ; Survival Rate

PURPOSE: Gastrointestinal stromal tumors (GISTs) are rare. The aim of this study is to investigate and describe the clinicopathologic characteristics of rectal GISTs. METHODS: We retrospectively analyzed the medical records of seven patients who underwent surgery for GIST of the rectum from 1998 to 2003. RESULTS: Male and female patients were two and five respectively. The mean age was 55 years (range, 41~72 years) at the time of diagnosis. The median follow-up period was 23 months (range, 7~75 months). The chief complaints were hematochezia, constipation and anal pain. Curative resections were done in all cases. Abdominoperineal resection was done in five cases and transanal excision was done in one case. In one case, Hartmann's operation with prostatectomy was done. The mean size of tumor was 6.6 cm (1~12 cm). The pathologic feature of all cases were spindle cell type. The mitotic count shown > or =5 in 50 high power field was identified in four cases and that shown < or =5 in 50 high power field in three cases. Adjuvant radiation therapy was done in four cases. Two local recurrences occurred on 54 month and 23 month later after surgery, respectively. CONCLUSION: In cases of GIST of the rectum, the common symptom was same as other rectal tumors. Immuonhistiochemical staning of c-kit is helpful for differential diagnosis. Curative surgical resection should be done for treatment.
Constipation ; Diagnosis ; Diagnosis, Differential ; Female ; Follow-Up Studies ; Gastrointestinal Hemorrhage ; Gastrointestinal Stromal Tumors* ; Humans ; Male ; Medical Records ; Prostatectomy ; Rectal Neoplasms ; Rectum* ; Recurrence ; Retrospective Studies

The purpose of this study is to develop the optimization method for adjusting the film isocenter shift and to suggest the quantitative acceptable criteria for film dosimetry after optimization in the dynamic conformal arc radiation therapy (DCAR). The DCAR planning was performed in 7 patients with brain metastasis. Both absolute dosimetry with ion chamber and relative film dosimetry were performed throughout the DCAR using BrainLab's micro-multileaf collimator. An optimization method for obtaining the global minimum was used to adjust for the error in the film isocenter shift, which is the largest part of systemic errors. The mean of point dose difference between measured value using ion chamber and calculated value acquired from planning system was 0.51+/-0.43% and maximum was 1.14% with absolute dosimetry. These results were within the AAPM criteria of below 5%. The translation values of film isocenter shift with optimization were within +/-1 mm in all patients. The mean of average dose difference before and after optimization was 1.70+/-0.36% and 1.34+/-0.20%, respectively, and the mean ratios over 5% dose difference was 4.54+/-3.94% and 0.11+/-0.12%, respectively. After optimization, the dose differences decreased dramatically and a ratio over 5% dose difference and average dose difference was less than 2%. This optimization method is effective in adjusting the error of the film isocenter shift, which is the largest part of systemic errors, and the results of this research suggested the quantitative acceptable criteria could be accurate and useful in clinical application of dosimetric verification using film dosimetry as follows; film isocenter shift with optimization should be within +/-1 mm, and a ratio over 5% dose difference and average dose difference were less than 2%.
Brain ; Film Dosimetry ; Humans ; Neoplasm Metastasis ; Radiotherapy*