PURPOSE: To discuss the technical aspect of interstitial brachytherapy including method of implant, insertion time of radioactive source, total radiation dose, and complication, we reviewed patients who had diagnoses of soft tissue sarcoma and were treated by conservative surgery, interstitial implant and external beam radiation therapy. MATERIALS AND METHODS: Between May 1995 and Dec. 1997, ten patients with primary or recurrent soft tissue sarcoma underwent surgical resection (wide margin excision) and received radiotherapy including interstitial brachytherapy. Catheters were placed with regular intervals of 1~1.5 cm immediately after tumor removal and covering the critical structures, such as neurovascular bundle or bone, with gelform, muscle, or tissue expander in the cases where the tumors were close to those structures. Brachytherapy consisted of high dose rate, iridium-192 implant which delivered 12~15 Gy to 1 cm distance from the center of source axis with 2~2.5 Gy/fraction, twice a day, starting on 6th day after the surgery. Within one month after the surgery, total dose of 50~55 Gy was delivered to the tumor bed with wide margin by the external beam radiotherapy. RESULTS: All patients completed planned interstitial brachytherapy without acute side effects directly related with catheter implantation such as infection or bleeding. With median follow up duration of 25 months (range 12~41 months), no local recurrences were observed. And there was no severe form of chronic complication (RTOG/EORTC grade 3 or 4). CONCLUSION: The high dose rate interstitial brachytherapy is easy and safe way to minimize the radiation dose delivered to the adjacent normal tissue and to decrease radiation induced chronic morbidity such as fibrosis by reducing the total dose of external radiotherapy in the management of soft tissue sarcoma with conservative surgery.
Axis, Cervical Vertebra ; Brachytherapy* ; Catheters ; Diagnosis ; Fibrosis ; Follow-Up Studies ; Hemorrhage ; Humans ; Radiotherapy ; Recurrence ; Sarcoma* ; Tissue Expansion Devices

PURPOSE: To evaluate the treatment results and prognostic factors after radiotherapy in stage IIB uterine cervix cancer. MATERIALS AND METHODS: We retrospectively analyzed the records of 90 patients with stage IIB uterine cervix cancer who received radiotherapy between 9/94 and 12/99. Age was ranged from 28 to 79 years (median 57). Tumor size was > or = 4 cm in 64 patients. Preteatment SCC level was measured in 76 patients. Twenty nine patients received conventional radiotherapy (QD) and the others received modified hyperfractionated radiotherapy (BID). Only 7 patients in BID had tumor size <4 cm. All patients received high dose rate brachytherapy (4 Gy x 7 or 5 Gy x 6). No patient received concurrent chemotherapy during radiotherapy. Follow up period was ranging from 9 to 76 months (median 38). RESULTS: The 5-year overall and disease free survival rates were 73.4% and 71.6%, respectively. Local recurrences occurred in 10% of patients, and distant metastasis in 18.9%. There was a significant correlation between OS/DFS and tumor size (<4 cm; OS 95.2%, DFS 91.4%, > or = 4 cm; OS 63.4%, DFS 63.4%). Pretreatment SCC level was one of prognostic factors only in univariate analysis. CONCLUSION: With modified hyperfractionated radiotherapy, there was very low local recurrence rate (6.6%) and high 5-year overall and disease free survival rate (75.4% and 70.5%), which is comparable to results after concurrent chemoradiotherapy in bulky, locally advanced stage IIB uterine cervix cancer.
Brachytherapy ; Cervix Uteri* ; Chemoradiotherapy ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Neoplasm Metastasis ; Radiotherapy* ; Recurrence ; Retrospective Studies

Radiation proctitis is a frequent acute complication encountered with pelvic irradiation. This study was aimed at establishing the optimal radiation dose for radiation-induced proctitis in rats. Female Wistar rats were used. The rectal specimens were examined morphologically at 5th and 10th day following 10-30 Gy irradiation in single fraction. With increasing dose, mucosal damage became worse, and there was a prominent reaction after > or =15 Gy. We selected 17.5 Gy as an optimal dose for radiation proctitis and examined specimens at day 1-14 and at week 4, 6, 8, and 12 after 17.5 Gy. The rectal mucosa revealed characteristic histological changes with time. An edema in lamina propria started as early as 1-2 days after irradiation and progressed into acute inflammation. On day 7 and 8, regeneration was observed with or without ulcer. Four weeks later, all regeneration processes have been completed with end result of either fibrosis or normal appearing mucosa. This study showed that the radiation injury of the rectum in rat develops in dose-dependent manner as it has reported in previous studies and suggested that 17.5 Gy in single fraction is the optimum dose to evaluate the protective effect of various medications for radiation proctitis in face of the clinical situation.
Animal ; Disease Models, Animal ; Dose-Response Relationship, Radiation ; Female ; Proctitis*/pathology ; Proctitis*/mortality ; Proctitis*/etiology ; Rats ; Rats, Wistar ; Rectum/radiation effects* ; Rectum/pathology ; Time Factors

PURPOSE: Proctitis is one of acute complications encountered when radiotherapy was applied to the pelvis. Radiation-induced proctitis represents similar microscopic findings that are observed in inflammatory bowel disease (IBD). Nitric oxide (NO) plays an important role in the inflammatory process and many data suggest a close relationship between NO production and gastrointestinal inflammation. This study was aimed to establish the optimal radiation dose for radiation-induced proctitis in rat and to find a relationship between radiation proctitis and NO production. MATERIALS AND METHODS: Female Wistar rats, weighing from 150 to 220 g, received various doses(10-30 Gy) of radiation to the rectum. On the 5th and 10th day after irradiation, rectal specimens were evaluated grossly and microscopically. In addition, the degree of NO production by irradiation dose was evaluated by study with NOS expression and nitrite production in the irradiated rectal tissue. To evaluate relationship between radiation proctitis and NO, we administered aminoguanidine, iNOS inhibitor and L-arginine, substrate of NOS to rats from 2 days before to 7 days after the irradiation. RESULTS: There were obvious gross and histological changes after 17.5 Gy or higher radiation dose but not with 15 Gy or less radiation dose. Twenty Gy or higher dose of radiation caused Grade 4 damage in most of rectal specimens which were more likely to be related to the late complications such as fibrosis, rectal bleeding and rectal obstruction. A single fraction of 17.5 Gy to the rat rectum is considered to be an optimal dose to produce commonly experienced proctitis in the clinic. The result demonstrated that severity of microscopic damage of rectal mucosa from irradiation significantly correlated with iNOS overexpression. However, administration of iNOS inhibitor or substrate of iNOS did not influence the degree of rectal damage. CONCLUSION: A single fraction of 17.5 Gy irradiation to the rat rectum considered to be an optimal dose for radiation induced proctitis model. These results indicated that an excess production of NO contributes to pathogenesis of radiation-induced proctitis in part but was not the direct cause of rectal damage.
Animals ; Arginine ; Female ; Fibrosis ; Hemorrhage ; Humans ; Inflammation ; Inflammatory Bowel Diseases ; Models, Animal ; Mucous Membrane ; Nitric Oxide Synthase ; Nitric Oxide* ; Pelvis ; Proctitis* ; Radiotherapy ; Rats* ; Rats, Wistar ; Rectum

PURPOSE: Chemotherapy, followed by radiation therapy, improves the survival of patients with locally advanced non-small cell lung cancer (NSCLC). However, it is not clear whether chemotherapy, followed by concurrent chemo-radiation therapy, can improve survivals compared to only concurrent chemo-radiation therapy. We conducted this study to evaluate the role played by induction chemotherapy followed by concurrent chemo-radiation therapy. MATERIALS AND METHODS: Between 1995 and 2000, 55 patients with locally advanced NSCLC were treated with concurrent chemo-radiation therapy. Twenty-seven patients received the induction chemotherapy prior to the chemo-radiation therapy, and their characteristics and survival compared. RESULTS: There were no significant differences in patient characteristics, with the exception of weight loss. The group receiving the induction chemotherapy showed a lesser weight loss, but with no statistical difference in the survival results. CONCLUSION: No advantage was shown with the induction chemotherapy when followed by concurrent chemo-radiation therapy in the treatment of locally advanced NSCLC.
Carcinoma, Non-Small-Cell Lung* ; Drug Therapy ; Humans ; Induction Chemotherapy ; Weight Loss

The purpose of this study is to determine the stress and the dietary habits of elementary school children and assess the associations with mother's employment status. The subjects were 423 students of 5th and 6th grade students (210 boys and 213 girls) in Seoul and Gyeonggi-Do. Two hundred fifty-two mothers had some kinds of job and 171 mothers were housewives. The students had stress the most from their studies/schoolwork (M = 2.37), while the least from "teacher/school" (M=1.51). The average stress score of the subjects was 1.76. The average score of dietary habits was 3.43. More specifically, the statement "not skipping breakfast" had the highest score (M = 4.04) and the statement "not substituting cereals, breads or drink milk for any meal" had the lowest score. Students with employed mothers had higher stress level than students with unemployed mothers. Students with employed mothers who have blue color job showed the lower dietary habits score than those with employed mothers who had other types of job. Students of employed mothers who go to school at dawn showed the lowest dietary habits score. In both employed and unemployed mothers, the stress score of students negatively correlated with the score of dietary habits. It was important for the mother to be at home when the students go to school and return. Based on this study, mothers should be aware of the stress level of their children get depending on their employment status. They should also provide their children to have good dietary habits and nutritional education regularly.
Bread ; Edible Grain ; Child ; Employment ; Food Habits ; Humans ; Milk ; Mothers

PURPOSE: Simulation using computed tomography (CT) is now widely available for radiation treatment planning for breast cancer. It is an important tool to help define the tumor target and normal tissue based on anatomical features of an individual patient. In Korea, most patients have small sized breasts and the purpose of this study was to review the margin of treatment field between conventional two-dimensional (2D) planning and CT based three-dimensional (3D) planning in patients with small breasts. MATERIALS AND METHODS: Twenty-five consecutive patients with early breast cancer undergoing breast conservation therapy were selected. All patients underwent 3D CT based planning with a conventional breast tangential field design. In 2D planning, the treatment field margins were determined by palpation of the breast parenchyma (In general, the superior: base of the clavicle, medial: midline, lateral: mid - axillary line, and inferior margin: 2 m below the inframammary fold). In 3D planning, the clinical target volume (CTV) ought to comprise all glandular breast tissue, and the PTV was obtained by adding a 3D margin of 1 cm around the CTV except in the skin direction. The difference in the treatment field margin and equivalent field size between 2D and 3D planning were evaluated. The association between radiation field margins and factors such as body mass index, menopause status, and bra size was determined. Lung volume and heart volume were examined on the basis of the prescribed breast radiation dose and 3D dose distribution. RESULTS: The margins of the treatment field were smaller in the 3D planning except for two patients. The superior margin was especially variable (average, 2.5 cm; range, -2.5 to 4.5 cm; SD, 1.85). The margin of these targets did not vary equally across BMI class, menopause status, or bra size. The average irradiated lung volume was significantly lower for 3D planning. The average irradiated heart volume did not decrease significantly. CONCLUSION: The use of 3D CT based planning reduced the radiation field in early breast cancer patients with small breasts in relation to conventional planning. Though a coherent definition of the breast is needed, CT-based planning generated the better plan in terms of reducing the irradiation volume of normal tissue. Moreover it was possible that 3D CT based planning showed better CTV coverage including postoperative change.
Body Mass Index ; Breast ; Breast Neoplasms ; Cardiac Volume ; Clavicle ; Female ; Humans ; Korea ; Lung ; Menopause ; Palpation ; Skin

No abstract available.
Esophagitis* ; Nitric Oxide ; Sucralfate*

This study utilized the Community Multiscale Air Quality model to simulate the spatial distribution of benzene, toluene, and xylene (BTX) concentrations from large national industrial complexes (IC) located in the Ulsan metropolitan region (UMR). Through controlling pollutant emissions from major IC, this study performed a quantitative analysis of the influence of pollutant emissions on BTX concentrations in surrounding urban areas. The results showed that approximately 40% of the annual average BTX concentrations in nearby urban grids were directly influenced by pollutant emissions from the IC. Seasonal modeling results indicated that average BTX concentrations were high around petrochemical complexes, with higher concentrations in the surrounding urban areas during the summer (July). All three of the BTX pollutants showed similar seasonal differences. Daily contributions differed significantly throughout the modeling period, with some values reaching a maximum of 80% during July. Overall, when urban areas were located downwind of the IC, contributions rose. Moreover, this study compared the differences in BTX contributions at each measurement point within the IC and urban areas, which showed that the influence of the IC emissions decreased significantly with distance. The spatial distribution and direct influence of the IC on BTX concentrations in the UMR identified through this study could be used to provide input data in environmental epidemiological studies.
Benzene ; Epidemiologic Studies ; Seasons ; Toluene ; Ulsan ; Xylenes

Objective: To investigate the correlation between videofluoroscopic swallowing study (VFSS) and radionuclide salivagram findings in chronic brain-injured patients with dysphagia. Methods: Medical records of chronic brain-injured patients who underwent radionuclide salivagram and VFSS were retrospectively analyzed. Patients were divided into two groups according to salivagram findings. Differences in patient characteristics and clinical factors, including Mini-Mental State Examination (MMSE), Modified Barthel Index (MBI), Functional Ambulatory Category (FAC), feeding method, tracheostomy state, and VFSS findings between the two groups were investigated. Results: A total of 124 patients were included in this study. There were no significant differences in MMSE, MBI, FAC, feeding method, and presence of tracheostomy between the two groups. However, the incidence of aspiration pneumonia history was significantly higher in the positive salivagram group. The Functional Dysphagia Scale (FDS) was significantly associated with positive salivagram findings, especially in the pharyngeal phase. A multivariate logistic regression analysis showed that laryngeal elevation and epiglottic closure was statistically significant FDS parameter in predicting salivary aspiration on a salivagram (odds ratio=1.100; 95% confidence interval, 1.017–1.190; p=0.018). The receiver operating characteristic (ROC) curve of FDS in the pharyngeal phase showed that an optimum sensitivity and specificity of 55.1% and 65.4%, respectively, when the cut-off value was 39. Conclusion In chronic brain-injured patients, inappropriate laryngeal elevation and epiglottic closure is predictive variable for salivary aspiration. Therefore, performing a radionuclide salivagram in patients with FDS of 39 or less in the pharyngeal phase for prevents aspiration pneumonia from salivary aspiration.