PURPOSE: To find out the role of postoperative adjuvant radiotherapy in the treatment of rectal cancer by comparing survival, pelvic control, complication rate, and any prognostic factor between surgery alone and postoperative radiotherapy group. MATERIALS AND METHODS: From Feb. 1982 to Dec. 1996 total 212 patients were treated by radical surgery with or without postoperative radiotherapy due to rectal carcinoma of modified Astler-Coller stage B2-C3. Of them, 18 patients had incomplete radiotherapy and so the remaining 194 patients were the database analyzed in this study. One hundred four patients received postoperative radiotherapy and the other 90 patients had surgery only. Radiotherapy was performed in the range of 39.6-55.8 Gy (mean: 49.9 Gy) to the whole pelvis and if necessary, tumor bed was boosted by 5.4-10 Gy. Both survival and pelvic control rates were calculated by Kaplan-Meier method and their statistical significance was tested by Log-rank test. Multivariate analysis was performed by Cox proportional hazards model. RESULTS: 5-year actuarial survival rate (5YSR) and 5-year disease-free survival rate (5YDFSR) of entire patients were 53% and 49%, respectively. 5YSRs of surgery alone group and adjuvant radiotherapy group were 63% vs 45%, respectively ( p=0.03). This difference is thought to reflect uneven distribution of stages between two treatment groups ( p<0.05 by x2-test) with more advanced disease patients in adjuvant radiotherapy group. 5YSRs of surgery alone vs adjuvant radiotherapy group in MAC B2+3, C1, C2+3 were 68% vs 55% ( p=0.09), 100% vs 100%, 40% vs 33% ( p=0.71), respectively. 5YDFSRs of surgery alone vs adjuvant radiotherapy group in above three stages were 65% vs 49% ( p=0.14), 100% vs 100%, 33% vs 31% ( p=0.46), respectively. 5-year pelvic control rate (5YPCR) of entire patients was 72.5%. 5YPCRs of surgery alone and adjuvant radiotherapy group were 71% vs 74%, respectively (p=0.41). 5YPCRs of surgery alone vs adjuvant radiotherapy group in B2+3, C1, C2+3 were 79% vs 75% ( p= 0.88), 100% vs 100%, 44% vs 68% ( p=0.01), respectively. Multivariate analysis showed that only stage was significant factor affecting overall and disease-free survival in entire patients and also in both treatment groups. In view of pelvic control, stage and operation type were significant in entire patients and only stage in surgery alone group but in adjuvant radiotherapy group, operation type instead of stage was the only significant factor in multivariate analysis as a negative prognostic factor in abdominoperineal resection cases. CONCLUSION: Our retrospective study showed that postoperative adjuvant radiotherapy could improve the pelvic control in MAC C2+3 group. To improve both pelvic control and survival in all patients with MAC B2 or more, other treatment modality such as concurrent continuous infusion of 5-FU, which is the most standard agent, along with radiotherapy should be considered.
Disease-Free Survival ; Fluorouracil ; Humans ; Multivariate Analysis ; Pelvis ; Proportional Hazards Models ; Radiotherapy ; Radiotherapy, Adjuvant* ; Rectal Neoplasms* ; Retrospective Studies ; Survival Rate

PURPOSE: We performed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. METHODS AND MATERIALS: One hundred and six patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (9 4%) and ranged from 1 month to 92 months (median; 6 months). RESULTS: The median age was 62 years old and male to female ratio was 104:2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was performed in 83%. Mean tumor dose delivered with curative aim was 58.6 Gy (55-70.8 Gy) and median duration o f the radiation therapy was 53 days. The median survival of all patients was 6 months and 1-year and 2-year overall survival rte was 27% and 12%, respectively. Improvement of dysphagia was obtained in most patients except fo 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32% (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30% respectively, while those of the nonresponder was 4 months and 0% respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 rnonths and 16% while those of the patients who could not tolerate regular diet was 3 months and 0%, respectively (p=0.004). The survival difference between the patients with 5 cm or less turnor length and those with more than 5 cm tumor length was rnarginally statistically significant (p=0.06). However, the survival difference according to the periesophageal invasion or mediastinal lymphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9%). CONCLUSION: The survival outcome for advanced esophageal cancer patients treated by external be am radiotherapy alone was very poor, In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.
Brachytherapy ; Carcinoma, Squamous Cell ; Deglutition Disorders ; Diet ; Drug Therapy ; Esophageal Neoplasms* ; Esophagus ; Female ; Follow-Up Studies ; Gastrostomy ; Humans ; Lymphatic Diseases ; Male ; Middle Aged ; Multivariate Analysis ; Radiotherapy* ; Retrospective Studies ; Survival Rate ; Thorax ; Tomography, X-Ray Computed ; Treatment Outcome

Twenty one patients of malignant thymoma treated with curative aim at the Department of Therapeutic Radiology of Seoul National University Hospital from 1979 to 1987 were analysed retrospectively. The 3 year overall and relapse free survival rate was 80.5% and 78.6%, respectively. Myasthenia gravis (Mg) was seen in 43.5% at presentation and disappeared in 40% (4/10) after radiotherapy with or without operation. The 3 year cumulative survival rate with and without Mg was 90% and 78.8%, respectively. We could consider that Mg was no longer abverse prognostic factor. The complete response rate after partial resection was 100% (3/3), and that after biopsy was 20% (3/15). The overall local control rate including complete and partial response rate (33% vs 56%) was 89% and the 3 year actuarial survival rate by the response rate was 88.9% and 81.7%, respectively. There was no statistically significant survival difference between two groups. The crude rate of relapse at 3 years was 23.8% (5/21), and 80% (4/5) were locoregional failures. All failures were observed in biopsy only group, while no failure was observed in resected group. The major pattern of the treatment failure was the locoregional failure and the distant metastases was rarely observed.
Biopsy ; Humans ; Myasthenia Gravis ; Neoplasm Metastasis ; Radiation Oncology ; Radiotherapy* ; Recurrence ; Retrospective Studies ; Seoul ; Survival Rate ; Thymoma ; Treatment Failure

OBJECTIVE: Because endometriosis is difficult to diagnose and has a high recurrence rate after treatment, a reliable serum marker of endometriosis is necessary. Therefore, the aim of this study is to measure the serum levels of CA125 and CA19-9 in patients with endometriosis before and after treatment and during recurrence, and to assess the usefulness of these levels in the diagnosis, clinical follow up and prediction of recurrence in endometriosis. METHODS: Eighty-eight patients who visited the department of Obstetrics and Gynecology of Ewha Mokdong Hospital from January 1994 to December 1998 and were diagnosed as endometriosis by laparoscopy or explo-laparotomy were enrolled as subjects. A retrospective analysis of serum CA125 and CA19-9 levels at 1 month before and 3 to 6 months after initiation of treatment was done. RESULTS: The serum CA125 and CA19-9 levels of endometriosis group(81.0+/-252.5, 36.6+/-53.4 ; mean+/-2SD, U/ml) before treatment was significantly higher than control group(11.6+/-12.8, 9.4+/-8.6)(p<0.05). Overall sensitivity rate for CA125, CA19-9 levels and both was 53.4%, 42.9% and 64.3% respectively. The sensitivity rate for endometriosis, stage 3 and 4(85.4%, 55.0%) was significantly higher than that, stage 1 and 2(p<0.05). The serum CA125 level in endometriosis group showed a significant increment according to stages(p<0.05) while the serum CA19-9 level showed an increasing trend(p=0.055) and both levels decreased significantly after treatment(p<0.05). The serum CA125 level was also higher at recurrence after treatment(p<0.05). CONCLUSIONS: The serum CA125 and CA19-9 levels are a useful marker for diagnosing severity of disease, monitoring efficacy of treatment and predicting recurrence in endometriosis.
Biomarkers ; Diagnosis ; Endometriosis* ; Female ; Follow-Up Studies ; Gynecology ; Humans ; Laparoscopy ; Obstetrics ; Recurrence ; Retrospective Studies

Plexiform schwannoma is a rare benign tumor arising from the peripheral nerve sheath and characterized by a multinodular and plexiform growth pattern. This tumor usually arises sporadically. In rare cases, plexiform schwannomas have been associated with neurofibromatosis type 2. Plexiform schwannoma should be differentiated from plexiform neurofibroma, because the latter is pathognomonic tumor of neurofibromatosis type 1 and has a potential of malignant transformation. We report a case of multiple plexiform schwannomas associated with bilateral acoustic neuromas and meningioma.
Meningioma ; Neurilemmoma* ; Neurofibroma, Plexiform ; Neurofibromatoses* ; Neurofibromatosis 1 ; Neurofibromatosis 2* ; Neuroma, Acoustic ; Peripheral Nerves

Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article.
Carcinoma, Non-Small-Cell Lung* ; Chemoradiotherapy ; Combined Modality Therapy ; Humans ; Immunotherapy ; Lung Neoplasms ; Mediastinal Diseases ; Neoadjuvant Therapy ; Patient Care Team ; Radiotherapy ; Research Personnel ; Surgeons

Repeat cesarean section is one of the leading causes to make increasing a rate of cesarean section. Trial of labor TOL after cesarean section is attempt to reduce the rate of repeat cesarean section. Trial of labor has been well established as a safe alternative in carefully selected women with transverse scars in the lower uterine segment. This study was based on 104 cases of delivery with prior cesarean birth at the Chonbuk National University Hospital from January, 1991 to June, 1997. The results were as follows: 1) Among 1400 cases with previous cesarean delivery, trial of labor was done in 104 cases (7.4%). Among 104 cases, vaginal birth was successfully completed in 96 cases (92.3%). 2) Among 28 cases with PGE2, vaginal tablet, vaginal delivery was done in 23 cases (82.1%). 3) Among 22 cases with more than 4 of Bishop score, vaginal delivery was done in 21 cases (95.5%), and among 6 cases with less than 3 of Bishop score, vaginal delivery was done only 2 cases (33.3%). 4) There was no matemal death or uterine rupture in the cases of trial of labor, But in 2 cases, uterine dehiscence was observed in 4 cases and postpartal bleeding (more than 400ml) was developed. 5) In the cases of cesarean section, mean of hospital day was 7 days and medical fee was about 400,000 won. In the cases of vaginal birth after cesarean section, mean of hospital day was 2.6 days and medical fee was about 100,000 won. In condusion, vaginal birth after cesarean section is safe and effective alternative to elective repeat cesarean section and also the use of PGE, vaginal tablet is so effective to increase success rate of vaginal delivery. After all, positive these trials might decrease cesarean rate and increase maternal health and quality of medical care.
Cesarean Section ; Cesarean Section, Repeat ; Cicatrix ; Dinoprostone ; Fees, Medical ; Female ; Hemorrhage ; Humans ; Jeollabuk-do ; Maternal Health ; Parturition ; Pregnancy ; Prostaglandins E ; Trial of Labor ; Uterine Rupture ; Vaginal Birth after Cesarean* ; Vaginal Creams, Foams, and Jellies

Ninety patients of esophageal cancer treated with radiation since November 1985 to June 1990 at the Deprtment of Therapeutic Radiology, Chonnam University Hospital, were analysed retrospectively regarding survival. Seventy five patients (94.9%) revealed squamous cell carcinoma in its histologic type, and most ofpatients were in advanced stage with 25 patients (27.8%) of T2 and 64 patients (71.1%) of T3 Minimum follow up period was 12 months and median was 5 months. Overall actuarial 2 year survival rate was 11.6%. Two year survival rates according to the parameters such as treatment aim, T stage, site, length, radiation dose and response were compared and resulted that survival by tumor length only had statistically significant impact on survival of esophageal carcinoma.
Carcinoma, Squamous Cell ; Esophageal Neoplasms* ; Follow-Up Studies ; Humans ; Jeollanam-do ; Radiation Oncology ; Radiotherapy* ; Retrospective Studies ; Survival Rate

PURPOSE: Before we report the results of curative radiotherapy in cervix cancer patients, we review the significance and safety of our dose specification methods in the brachytherapy system to have the insight of the potential predictive value of doses at specified points. MATERIALS AND METHODS: We analyze the 45 cases of cervix cancer patients treated with intracavitary brachytherapy. In the lateral simulation film we draw the isodose curve and observe the absorbed dose rate of point A, the reference point of bladder(SBD) and rectum(SRD). In the sagittal view of pelvic MRI film we demarcate the tumor volume(TV) and determine whether the prescription dose curve of point A covers the tumor volume adequately by drawing the isodose curve as correctly as possible. Also we estimate the maximum point dose of bladder(MBD) and rectum(MRD) and calculate the inclusion area where the absorbed dose rate is higher than that of point A in the bladder(HBV) and rectum(HRV), respectively. RESULTS: Of forty-five cases, the isodose curve of point A seems to cover tumor volume optimally in only 24(53%). The optimal tumor coverage seems to be associated not with the stage of the disease but with the tumor volume. There is no statistically significant association between SBD/SRD and MBD/MRD, respectively. SRD has statistically marginally significant association with HRV, while TV has statistically significant association with HBV and HRV. CONCLUSION: Our current treatment calculation methods seem to have the defect in the aspects of the nonoptimal coverage of the bulky tumor and the inappropriate estimation of bladder dose. We therefore need to modify the applicator geometry to optimize the dose distribution at the position of lower tandem source. Also it appears that the position of the bladder in relation to the applicators needs to be defined individually to define "hot spots".
Brachytherapy* ; Cervix Uteri* ; Female ; Humans ; Magnetic Resonance Imaging* ; Prescriptions ; Radiotherapy ; Tumor Burden ; Urinary Bladder ; Uterine Cervical Neoplasms

To evaluate the toxicities and efficacies of two fractionation regimens of high-doserate brachytherapy in uterine cervical cancer, patients were stratified by stage Ib- IIa versus IIb-IVa, and randomly assigned to receive 3 Gy fractions (group A) or 5 Gy fractions (group B). External radiotherapy was performed using a 10 MV radiography with a daily 1.8 Gy up to 30.6 Gy to the whole pelvis, and then with a midline shield up to 45.0 Gy. Brachytherapy was performed with 3 Gy x 10 times or 5 Gy x5 times, and this was followed by booster brachytherapy of a smaller fraction to the residual tumor. Between August 1999 to July 2000, 46 patients were eligible. Median follow-up period was 42 months (5-49). The range of age was 37-83 yr (median, 58). The three-year disease-specific survival rates of group A (n=23) and B (n=23) were 90.5%, 84.9%, respectively (p=0.64). The three-year pelvic control rates of group A and B were 90.0% and 90.9%, respectively (p=0.92). The incidences of late complications of the rectum or bladder of grade 2 or greater in groups A and B were 23.8% and 9.1%, respectively (p=0.24). Our study showed that the results of two regimens were comparable. Fractionation regimen using 5 Gy fractions seems to be safe and effective, and offers shorter treatment duration.
Adult ; Aged ; Aged, 80 and over ; Brachytherapy/*methods ; Carcinoma/mortality/*radiotherapy ; Cervix Neoplasms/mortality/*radiotherapy ; Combined Modality Therapy ; Disease-Free Survival ; *Dose Fractionation ; Female ; Human ; Middle Aged ; Prospective Studies ; Time Factors ; Treatment Outcome