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

The anterior cruciate ligament(ACL) is one of the most important structure for maintenance of the sta- bility of the knee joint. Chronic instability as a result of insufficiency can lead to functional disability, pain, meniscal tears, and degenerative change in articular cartilage. The incidence of injuries of this liga- ment is increasing tendency due to development of vehicle system, industrial system and sports activities. Different authors have recommended both operative and nonoperative treatment for anterior cruciate ligament injuries. Variable methods for functional recovery of anterior cruciate ligament were introduced and argued about ideal method. As arthroscopic techniques improve, surgeons are more inclined to rec- ommend surgical treatment. The methods of repair of acute rupture of the anterior cruciate ligament through the arthrotomy tech- nique have been used widely, but the arthroscopic repair is a relatively new technique. This arthroscopic technique is idealy applicable for rupture at femoral and tibial attachment site. A arthroscopic repair of anterior cruciate ligament was performed with use of the arthroscopy, in 15 consecutive, selected anterior cruciate ligaments that were ruptured at femoral or tibial attachment site, and within 2 weeks after injury. The 15 patients were followed for a minimum of one year(mean, eighteen months; maximum, thirty-eight months). The mean age of the 15 patients at the operation was thirty years(range, seventeen to forty-eight years). The results of arthroscopic repair of anterior cruciate ligament in 15 cases were satisfactory, and as fol- lows. l. All of the 15 cases, the laxity of repaired anterior cruciate ligaments were decreased. 2. The average Lysholm Knee Score Scale was increased from 16 points preoperatively to 89 points postoperatively. Five of the patients(33%) were rated as excellent, and ten patients(67%) were rated as good. 3. The range of motion of the repaired knee joints were from Oo to 135o that results were achieved at postoperative 6 months.
Anterior Cruciate Ligament* ; Arthroscopy ; Cartilage, Articular ; Humans ; Incidence ; Knee ; Knee Joint ; Range of Motion, Articular ; Rupture* ; Sports

Gastric mucosa-associated lymphoid tissue (MALT) lymphoma represents approximately 9% of all malignant lymphoma in Korean, and its incidence is higher than that of western and other Asian countries. Helicobacter pylori eradication is the first line treatment in limited stage gastric MALT lymphoma. There is no consensus about initial treatment with chemotherapy or radiotherapy for the patient with insufficient response to H. pylori eradication or H. pylori negative. Radiotherapy is a conventional therapeutic modality and showed the excellent long term results. The radiotherapy for limited gastric MALT lymphoma shows that the 4-5-year disease free survival rate is 85-100% and acute toxicities is reasonable. However, only non-randomized studies support a role of local radiotherapy in gastric MALT lymphoma.
Asian Continental Ancestry Group ; Consensus ; Disease-Free Survival ; Helicobacter pylori ; Humans ; Incidence ; Lymphoid Tissue ; Lymphoma ; Lymphoma, B-Cell, Marginal Zone

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

PURPOSE: This study quantitatively evaluated the apoptosis in human peripheral blood lymphocytes using flow cytometry, and investigated the possibility of using this method, with a small amount of blood, and the time and dose dependence of radiation-induced apoptosis. MATERIALS AND METHODS: Peripheral blood lymphocytes were isolated from the heparinized venous blood of 11 healthy volunteers, 8 men and 3 women, with each 10 ml of blood being divided into 15 samples. The blood lymphocytes were irradiated using a linear accelerator at a dose rate of 2.4 Gy/min, to deliver doses of 0.5, 1, 2 and 5 Gy. The control samples, and irradiated cells, were maintained in culture medium for 24, 48 and 72 hours following the irradiation. The number of apoptotic cells after the in vitro X-irradiation was measured by flow cytometry after incubation periods of 24, 48 and 72 hours. We also observed the apoptotic cells using a DNA fragmentation assay and electron microscopy. RESULTS: The rate of spontaneous apoptosis increased in relation to the time interval following irradiation (1.761+/-0.161, 3.563+/-0.564, 11.098+/-2.849, at 24, 48, and 72 hours). The apoptotic cells also increased in the samples irradiated with 0.5, 1, 2 and 5 Gy, in a radiation dose and time interval after irradiation manner, with the apoptosis being too great at 72 hours after irradiation. The dose-response curves were characterized by an initial steep increase in the number of apoptotic cells for irradiation doses below 2 Gy, with a flattening of the curves as the dose approached towards 5 Gy. CONCLUSION: The flow cytometric assay technique yielded adequate data, and required less than 1 mL of blood. The time and dose dependence of the radiation-induced apoptosis, was also shown. It is suggested that the adequate time interval required for the evaluation of apoptosis would be 24 to 48 hours after blood sampling.
Apoptosis* ; DNA Fragmentation ; Female ; Flow Cytometry ; Healthy Volunteers ; Heparin ; Humans ; Lymphocytes* ; Male ; Microscopy, Electron ; Particle Accelerators

PURPOSE: The adjuvant postoperative radiotherapy has been usually applied to the patients with unfavorable prognostic factors after radical operation in early cervical cancer. We focused on the evaluation of the survival status and failure patterns of the patients with postoperative radiotherapy. MATERIALS AND METHODS: We retrospectively analyzed ninety patients with FIGO stage IB and IIA cervix cancer who received postoperative pelvic irradiation at Chonnam University Hospital between August 1985 and December 1988. Seventy-eight patients had adequate follow-up information for survival anlysis. Median follow-up time of these patients was 64 months. RESULTS: The 5 year overall and disease free survival rate of ninety patients was 80.0% and 80.2% respectively. The prognostic significance to the survival was determined by multivariate analysis. Adequacy of resection margin(p=0.005) and lymph node status(p=0.005) appeared to be independent prognostic factors. Recurrence occurred in 13 Patients, 5 in the pelvis and 8 at distant sites. He median time to recurrence was 19 months(range;3-39 months). The pelvic recurrence was more prevalent in the group of patients with adenocarcinoma, depth of stromal invasion more that 10mm and use of chemotherapy. The distant failure was more prevalent in the group of positive resection margin or positive lymph node with statistical significance. CONCLUSION: Patients with pelvic lymph node or surgical margin involvement clearly constitute a high risk group in this analysis and should be considered as candidates for some form of adjuvant therapy.
Adenocarcinoma ; Cervix Uteri* ; Disease-Free Survival ; Drug Therapy ; Female ; Follow-Up Studies ; Humans ; Jeollanam-do ; Lymph Nodes ; Multivariate Analysis ; Pelvis ; Radiotherapy ; Recurrence ; Retrospective Studies ; Uterine Cervical Neoplasms

PURPOSE: We undertook this study to evaluate the significance of p53 immunoreactivity in squamous cell carcinoma of the cervix, treated with radiotherapy alone. MATERIALS AND METHODS: Immunohistochemical staining of p53 proteins were performed in eighty patients with squamous cell carcinoma of the cervix, and who completed curative radiotherapy between Jan. 1996 and Apr. 1998 at the Department of Therapeutic Radiology, Chonnam National University Hospital. External- beam radiotherapy was combined with intracavitary brachytherapy. Results were analyzed for the end points of pelvic tumor control and distant failure rates. The follow-up time ranged from 7 to 58 months with a median of 40 months. RESULTS: p53 positive and negative groups involved 45 and 35 patients, respectively, and the positive p53 immunoreactivity rate was 56% (45/80). p53 immunoreactivity showed no significant correlation with age, tumor size, serum tumor marker (SCC), or HPV18 expression, while there was a statistically marginally significant correlation with HPV16 expression. The pelvic tumor control rate of the p53 positive group was 87% and that of p53 negative group was 83% (0.05). The other parameters influencing negatively to the pelvic tumor control and with statistical significance were tumor ulceration and barrel type. Multivariate analysis also showed that p53 immunoreactivity had no prognostic value for pelvic tumor control of the disease, and that the statistically significant factor was tumor ulceration. The treatment failure rate of the p53 positive group was 23% and that of the negative group was 26% (p>0.05). CONCLUSION: p53 immunoreactivity in the cervix cancer stage IB, II patients seems to have no value as a predictor of tumor behavior after curative radiotherapy.
Brachytherapy ; Carcinoma, Squamous Cell* ; Cervix Uteri* ; Female ; Follow-Up Studies ; Humans ; Jeollanam-do ; Multivariate Analysis ; Radiation Oncology ; Radiotherapy* ; Treatment Failure ; Ulcer ; Uterine Cervical Neoplasms

PURPOSE: A retrospective study was undertaken to determine the role of conventional radiotherapy with or without surgery for treating a supraglottic carcinoma in terms of the local control and survival. MATERIALS AND METHODS: From Jan. 1986 to Oct. 1996, a total of 134 patients were treated for a supraglottic carcinoma by radiotherapy with or without surgery. Of them, 117 patients who had completed the radiotherapy formed the base of this study. The patients were redistributed according to the revised AJCC staging system (1997). The number of patients of stage I, II, III, IVA, IVB were 6 (5%), 16 (14%), 53 (45 %), 32 (27%), 10 (9%), respectively. Eighty patients were treated by radical radiotherapy in the range of 61.2~79.2 Gy (mean : 69.2 Gy) to the primary tumor and 45.0~93.6 Gy (mean : 54.0 Gy) to regional lymphatics. All patients with stage I and IVB were treated by radiotherapy alone. Thirty-seven patients underwent surgery plus postoperative radiotherapy in the range of 45.0~68.4 Gy (mean : 56.1 Gy) to the primary tumor bed and 45.0~59.4 Gy (mean : 47.2 Gy) to the regional lymphatics. Of them, 33 patients received a total laryngectomy (+-lymph node dissection), three had a supraglottic horizontal laryngectomy (+-lymph node dissection), and one had a primary excision alone. RESULTS: The 5-year survival rate (5YSR) of all patients was 43%. The 5YSRs of the patients with stage I+I, III+V were 49.9%, 41.2%, respectively (p=0.27). However, the disease-specific survival rate of the patients with stage I (n=6) was 100%. The 5YSRs of patients who underwent surgery plus radiotherapy (S+T) vs radiotherapy alone (RT) in stage II, III, IVA were 100% vs 43% (p=0.17), 62% vs 52% (p=0.32), 58% vs 6% (P<0.001), respectively. The 5-year actuarial locoregional control rate (5YLCR) of all the patients was 57%. The 5YLCR of the patients with stage I, II, III, IVA, IVB was 100%, 74%, 60%, 44%, 30%, respectively (p=0.008). The 5YLCR of the patients with S+T vs RT in stage II, III, IVA was 100% vs 68% (p=0.29), 67% vs 55% (p=0.23), 81% vs 20% (P<0.001), respectively. In the radiotherapy alone group, the 5YLCR of the patients with a complete, partial, and minimal response were 76%, 20%, 0%, respectively (P<0.001). In all patients, multivariate analysis showed that the N-stage, surgery or not, and age were significant factors affecting the survival rate and that the N-stage, surgery or not, and the ECOG performance index were significant factors affecting the locoregional control. In the radiotherapy alone group, multivariate analysis showed that the radiation response and N-stage were significant factors affecting the overall survival rate as well as locoregional control. CONCLUSION: In early stage supraglottic carcinoma, conventional radiotherapy alone is an equally effective modality compared to surgery plus radiotherapy and could preserve the laryngeal function. However, in the advanced stages, radiotherapy combined with concurrent chemotherapy for laryngeal preservation or surgery should be considered. In bulky neck disease, all the possible planned neck dissections after induction chemotherapy or before radiotherapy should be attempted.
Drug Therapy ; Humans ; Induction Chemotherapy ; Laryngectomy ; Multivariate Analysis ; Neck ; Neck Dissection ; Radiotherapy* ; Retrospective Studies ; Survival Rate

The cone-beam CT (CBCT) which is acquired using on-board imager (OBI) attached to a linear accelerator is widely used for the image guided radiation therapy. In this study, the effect of respiratory motion on the quality of CBCT image was evaluated. A phantom system was constructed in order to simulate respiratory motion. One part of the system is composed of a moving plate and a motor driving component which can control the motional cycle and motional range. The other part is solid water phantom containing a small cubic phantom (2 x 2 x 2 cm3) surrounded by air which simulate a small tumor volume in the lung air cavity. CBCT images of the phantom were acquired in 20 different cases and compared with the image in the static status. The 20 different cases are constituted with 4 different motional ranges (0.7 cm, 1.6 cm, 2.4 cm, 3.1 cm) and 5 different motional cycles (2, 3, 4, 5, 6 sec). The difference of CT number in the coronal image was evaluated as a deformation degree of image quality. The relative average pixel intensity values as a compared CT number of static CBCT image were 71.07% at 0.7 cm motional range, 48.88% at 1.6 cm motional range, 30.60% at 2.4 cm motional range, 17.38% at 3.1 cm motional range. The tumor phantom sizes which were defined as the length with different CT number compared with air were increased as the increase of motional range (2.1 cm: no motion, 2.66 cm: 0.7 cm motion, 3.06 cm: 1.6 cm motion, 3.62 cm: 2.4 cm motion, 4.04 cm: 3.1 cm motion). This study shows that respiratory motion in the region of inhomogeneous structures can degrade the image quality of CBCT and it must be considered in the process of setup error correction using CBCT images.
Cone-Beam Computed Tomography* ; Lung ; Particle Accelerators ; Radiotherapy, Image-Guided ; Tumor Burden ; Water