Regional nodal irradiation in pT1-2N1 breast cancer patients treated with breast-conserving surgery and whole breast irradiation

Purpose@#To evaluate the necessity of regional nodal irradiation (RNI) for pT1-2N1 breast cancer patients treated with breast-conserving surgery and radiotherapy, we compared clinical outcomes of patients treated with and without RNI. @*Materials and Methods@#We retrospectively analyzed the data of 214 pT1-2N1 breast cancer patients treated with breast-conserving surgery and whole breast irradiation from 2009–2016. There were 142 (66.4%), 51 (23.85%), and 21 (9.8%) patients with one, two, and three positive lymph nodes, respectively. Thirty-six patients (16.8%) underwent RNI. Adjuvant chemotherapy, endocrine therapy, and anti-HER2 therapy were given to 91.6%, 79.0%, and 15.0% patients, respectively. The most common chemotherapy regimen was anthracycline + cyclophosphamide, followed by taxane (76.5%). The median follow-up was 64 months (range, 6 to 147 months). Patients were propensity matched 1:2 into RNI and no-RNI groups. @*Results@#Two patients experienced locoregional recurrences simultaneously with distant metastases, ten patients developed distant metastases, and one patient died. Before matching, the 5-year actuarial locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates in the RNI and no-RNI groups were 100.0% and 99.4% (p = 0.629), 94.1% and 96.0% (p = 0.676), and 100.0% and 99.4% (p = 0.658), respectively. After matching, the 5-year LRC, DMFS, and OS were 98.3% and 100.0% (p = 0.455), 96.6% and 93.9% (p = 0.557), and 100.0% and 100.0% (p > 0.999) in the RNI and no-RNI groups, respectively. No clinicopathologic or treatment-related factors were significantly associated with LRC, DMFS, or OS. @*Conclusion@#Adding RNI did not show superior LRC, DMFS, or OS in pT1-2N1 breast cancer patients.

Local and regional recurrence following mastectomy in breast cancer patients with 1–3 positive nodes: implications for postmastectomy radiotherapy volume

PURPOSE: To determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1–3 positive nodes and a tumor size of <5 cm. MATERIALS AND METHODS: We retrospectively analyzed data of 133 female breast cancer patients with 1–3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%). RESULTS: Three patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence. CONCLUSION: Our study showed a very low local recurrence in patients with 1–3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient’s given risk for local and regional recurrence, and possible radiation-related toxicities.

Evaluation of the hybrid-dynamic conformal arc therapy technique for radiotherapy of lung cancer

PURPOSE: A hybrid-dynamic conformal arc therapy (HDCAT) technique consisting of a single half-rotated dynamic conformal arc beam and static field-in-field beams in two directions was designed and evaluated in terms of dosimetric benefits for radiotherapy of lung cancer. MATERIALS AND METHODS: This planning study was performed in 20 lung cancer cases treated with the VERO system (BrainLAB AG, Feldkirchen, Germany). Dosimetric parameters of HDCAT plans were compared with those of three-dimensional conformal radiotherapy (3D-CRT) plans in terms of target volume coverage, dose conformity, and sparing of organs at risk. RESULTS: HDCAT showed better dose conformity compared with 3D-CRT (conformity index: 0.74 ± 0.06 vs. 0.62 ± 0.06, p < 0.001). HDCAT significantly reduced the lung volume receiving more than 20 Gy (V20: 21.4% ± 8.2% vs. 24.5% ± 8.8%, p < 0.001; V30: 14.2% ± 6.1% vs. 15.1% ± 6.4%, p = 0.02; V40: 8.8% ± 3.9% vs. 10.3% ± 4.5%, p < 0.001; and V50: 5.7% ± 2.7% vs. 7.1% ± 3.2%, p < 0.001), V40 and V50 of the heart (V40: 5.2 ± 3.9 Gy vs. 7.6 ± 5.5 Gy, p < 0.001; V50: 1.8 ± 1.6 Gy vs. 3.1 ± 2.8 Gy, p = 0.001), and the maximum spinal cord dose (34.8 ± 9.4 Gy vs. 42.5 ± 7.8 Gy, p < 0.001) compared with 3D-CRT. CONCLUSIONS: HDCAT could achieve highly conformal target coverage and reduce the doses to critical organs such as the lung, heart, and spinal cord compared to 3D-CRT for the treatment of lung cancer patients.

Simultaneous integrated boost intensity-modulated radiotherapy versus 3-dimensional conformal radiotherapy in preoperative concurrent chemoradiotherapy for locally advanced rectal cancer

PURPOSE: To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria. RESULTS: SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups. CONCLUSION: SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.

Simultaneous integrated boost intensity-modulated radiotherapy versus 3-dimensional conformal radiotherapy in preoperative concurrent chemoradiotherapy for locally advanced rectal cancer

PURPOSE: To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). MATERIALS AND METHODS: Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria. RESULTS: SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups. CONCLUSION: SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.

The response of thrombosis in the portal vein or hepatic vein in hepatocellular carcinoma to radiation therapy

PURPOSE: The purpose of current study is to evaluate the response of the patients with portal vein thrombosis (PVT) or hepatic vein thrombosis (HVT) in hepatocellular carcinoma (HCC) treated with three-dimensional conformal radiation therapy (3D-CRT). In addition, survival of patients and potential prognostic factors of the survival was evaluated. MATERIALS AND METHODS: Forty-seven patients with PVT or HVT in HCC, referred to our department for radiotherapy, were retrospectively reviewed. For 3D-CRT plans, a gross tumor volume (GTV) was defined as a hypodense filling defect area in the portal vein (PV) or hepatic vein (HV). Survival of patients, and response to radiation therapy (RT) were analyzed. Potential prognostic factors for survival and response to RT were evaluated. RESULTS: The median survival time of 47 patients was 8 months, with 1-year survival rate of 15% and response rate of 40%. Changes in Child-Pugh score, response to RT, Eastern cooperative oncology group performance status (ECOG PS), hepatitis C antibody (HCVAb) positivity, and additional post RT treatment were statistically significant prognostic factors for survival in univariate analysis (p = 0.000, p = 0.018, p = 0.000, p = 0.013, and p = 0.047, respectively). Of these factors, changes in Child-Pugh score, and response to RT were significant for patients’ prognosis in multivariate analysis (p = 0.001 and p = 0.035, respectively). CONCLUSION: RT could constitute a reasonable treatment option for patients with PVT or HVT in HCC with acceptable toxicity. Changes in Child-Pugh score, and response to RT were statistically significant factors of survival of patients.

Preoperative chemoradiation for locally advanced rectal cancer: comparison of three radiation dose and fractionation schedules

PURPOSE: The standard radiation dose for patients with locally rectal cancer treated with preoperative chemoradiotherapy is 45-50 Gy in 25-28 fractions. We aimed to assess whether a difference exists within this dose fractionation range. MATERIALS AND METHODS: A retrospective analysis was performed to compare three dose fractionation schedules. Patients received 50 Gy in 25 fractions (group A), 50.4 Gy in 28 fractions (group B), or 45 Gy in 25 fractions (group C) to the whole pelvis, as well as concurrent 5-fluorouracil. Radical resection was scheduled for 8 weeks after concurrent chemoradiotherapy. RESULTS: Between September 2010 and August 2013, 175 patients were treated with preoperative chemoradiotherapy at our institution. Among those patients, 154 were eligible for analysis (55, 50, and 49 patients in groups A, B, and C, respectively). After the median follow-up period of 29 months (range, 5 to 48 months), no differences were found between the 3 groups regarding pathologic complete remission rate, tumor regression grade, treatment-related toxicity, 2-year locoregional recurrence-free survival, distant metastasis-free survival, disease-free survival, or overall survival. The circumferential resection margin width was a prognostic factor for 2-year locoregional recurrence-free survival, whereas ypN category was associated with distant metastasis-free survival, disease-free survival, and overall survival. High tumor regression grading score was correlated with 2-year distant metastasis-free survival and disease-free survival in univariate analysis. CONCLUSION: Three different radiation dose fractionation schedules, within the dose range recommended by the National Comprehensive Cancer Network, had no impact on pathologic tumor regression and early clinical outcome for locally advanced rectal cancer.

Association between Living Arrangements and Influenza Vaccination Rates among Elderly South Korean People: The Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2) / 가정의학회지

BACKGROUND: This study aimed to investigate the association between living arrangements and influenza vaccination among elderly South Korean subjects. METHODS: We used data from the fifth Korean National Health and Nutrition Examination Survey. Participants older than 65 years were included and categorized into 4 groups according to the type of living arrangement as follows: (1) living alone group; (2) living with a spouse group; (3) living with offspring (without spouse) group; and (4) living with other family members group. A total of 1,435 participants were included in this cross-sectional analysis. RESULTS: A lower vaccination rate was observed in the living with offspring (without spouse) group, whereas the living with a spouse group had higher rates of both seasonal and H1N1 influenza vaccination. After adjusting for age, sex, region, education level, income level, and number of comorbidities, the living with offspring (without spouse) group had a higher H1N1 vaccination non-receipt rate than the living alone group (odds ratio, 2.03; 95% confidence interval, 1.08-3.82). CONCLUSION: Influenza vaccination rates differed according to the type of living arrangement. Particularly, those living with offspring (without spouse) had the lowest H1N1 influenza vaccination rate compared to those with other living arrangements, and this difference was significant. Interventions to improve influenza vaccination coverage should target not only elderly persons who live alone, but also those living with offspring.

Virtual lymph node analysis to evaluate axillary lymph node coverage provided by tangential breast irradiation

PURPOSE: To investigate the coverage of axillary lymph node with tangential breast irradiation fields by using virtual lymph node (LN) analysis. MATERIALS AND METHODS: Forty-eight women who were treated with whole breast irradiation after breast-conserving surgery were analyzed. The axillary and breast volumes were delineated according to the Radiation Therapy Oncology Group (RTOG) contouring atlas. To generate virtual LN contours, preoperative fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) scans with identifiable LN were fused with the CT scans, and the virtual LN contour were delineated on the CT. RESULTS: The median level I and II axillary volume coverage percentages at the VD95% line were 33.5% (range, 5.3% to 90.4%) and 0.6% (range, 0.0% to 14.6%), respectively. Thirty-one LNs in 18 patients were delineated (26 in level I and 5 in level II). In the level I axilla, 84.6% of virtual LNs were encompassed by the 95% isodose line. In the level II axilla, by contrast, none of the virtual LNs were encompassed by the 95% isodose volumes. There was a substantial discrepancy between the RTOG contouring atlas-based axillary volume analysis and the virtual LN analysis, especially for the level I axillary coverage. The axillary volume coverage was associated with the body mass index (BMI) and breast volume. CONCLUSION: The tangential breast irradiation did not deliver adequate therapeutic doses to the axillary region, particularly those in the level II axilla. Patients with small breast volumes or lower BMI showed reduced axillary coverage from the tangential breast fields. For axillary LN irradiation, individualized anatomy-based radiation fields for patients would be necessary.

Comparison of Electron and X-Ray Beams for Tumor Bed Boost Irradiation in Breast-Conserving Treatment / 한국유방암학회지

PURPOSE: This study aimed to compare the dosimetric profiles of electron beams (EB) and X-ray beams (XB) for boosting irradiation in breast cancer patients who underwent breast-conserving surgery and postoperative radiotherapy. METHODS: For 131 breast cancer patients who underwent breast-conserving surgery, we compared plans for EB and XB boost irradiation after whole-breast irradiation. The organs at risk (OAR) included the cardiac chambers, coronary arteries, ipsilateral lung, and skin. The conformity index (CI), inhomogeneity index (IHI), and dose-volume parameters for the planning target volume (PTV), and OAR were calculated. Postradiotherapy chest computed tomography scans were performed to detect radiation pneumonitis. RESULTS: XB plans showed a significantly better CI and IHI for the PTVs, compared to the EB plans. Regarding OAR sparing, the XB reduced the high-dose volume at the expense of an increased low-dose volume. In 33 patients whose radiation fields included nipples, IHI was higher in the EB plans, whereas the presence of a nipple in the radiation field did not interfere with the XB. EB-treated patients developed more subclinical radiation pneumonitis. CONCLUSION: XB plans were superior to EB plans in terms of PTV coverage (homogeneity and conformity) and high-dose volume sparing in OAR when used as boost irradiation after breast-conserving surgery. A disadvantage of the XB plan was an increased low-dose volume in the OAR, but this was offset by the increased electron energy. Consequently, tailored plans with either XB or EB are necessary to adapt to patient anatomic variance and tumor bed geometric properties.

Pelvic insufficiency fracture after radiotherapy in patients with cervical cancer in the era of PET/CT

PURPOSE: To determine the incidence, risk factors, and clinical characteristics of pelvic insufficiency fracture (PIF) in patients with cervical cancer. MATERIALS AND METHODS: Between July 2004 and August 2009, 235 patients with non-metastatic cervical cancer were treated with definitive chemoradiation or postoperative radiotherapy. Among 235 patients, 117 (49.8%) underwent the first positron emission tomography/computed tomography (PET/CT) within 1 year after radiotherapy. The median radiation dose was 55 Gy (range, 45 to 60 Gy). Medical charts and imaging studies, including PET/CT, magnetic resonance imaging (MRI), CT, bone scintigraphy were reviewed to evaluate the patients with PIF. RESULTS: Among 235 patients, 16 developed PIF. The 5-year detection rate of PIF was 9.5%. The 5-year detection rate of PIF in patients who underwent the first PET/CT within a year was 15.6%. The median time to development of PIF was 12.5 months (range, 5 to 30 months). The sites of fracture included 12 sacroiliac joints, 3 pubic rami, 3 iliac bones, and 1 femoral neck. Eleven of 16 patients having PIF complained of hip pain requiring medications. One patient required hospitalization for pain control. The significant risk factors of PIF were old age, body mass index less than 23, bone mineral density less than -3.5 SD, and the first PET/CT within a year after radiotherapy. Radiation dose and concurrent chemotherapy had no impact on PIF rate. CONCLUSION: PIFs were not rare after pelvic radiotherapy in cervical cancer patients in the era of PET/CT. Timely diagnosis and management of PIF can improve quality of life in patients with cervical cancer, in addition to reducing unnecessary medical expenses.

Hypothyroidism after Radiotherapy of Locally Advanced Head and Neck Cancer / 대한방사선종양학회지

PURPOSE: The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. MATERIALS AND METHODS: From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. RESULTS: The 1- and 3-year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. CONCLUSION: Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patientsespecially with the risk factor of neck node dissection.

Definitive Chemoradiotherapy with Capecitabine and Cisplatin in Patients with Esophageal Cancer: A Pilot Study

We aimed to evaluate the feasibility of concurrent chemoradiotherapy (CRT) with capecitabine and cisplatin in patients with squamous cell carcinoma of the esophagus. Eighteen patients with esophageal cancer were enrolled on the study. The chemotherapy during CRT consisted of two cycles of intravenous cisplatin of 60 mg/ m2 on day 1 and oral capecitabine 825 mg/m2 twice daily from day 1 to 14 at 3-week intervals. The radiotherapy (2.0 Gy fraction/day to a total dose of 60 Gy) was delivered to the primary tumor site and regional lymph node. After concurrent CRT, 2 cycles of capecitabine (1,000 mg/m2 b.i.d from days 1 to 14) plus cisplatin (60 mg/m2 on day 1) were added every 3 weeks. All patients completed the planned treatment. After the chemoradiotherapy, 12 complete responses (CR, 66.7%) and 6 partial responses (PR, 33.3%) were confirmed. Grade 3 or 4 neutropenia only occurred in 2 patients, plus no treatment-related death was observed. At a median follow-up duration of 14.9 months, the estimated overall survival and progression-free survival rate at 2-yr was 70.7% and 54.4%, respectively. Concurrent CRT with capecitabine and cisplatin was found to be well-tolerated and effective in patients with esophageal cancer.

A Patterns of Care Study of the Various Radiation Therapies for Prostate Cancer among Korean Radiation Oncologists in 2006 / 대한방사선종양학회지

PURPOSE: To conduct a nationwide academic hospital patterns of the practice status and principles of radiotherapy for prostate cancer. The survey will help develop the framework of a database of Korean in Patterns of Case Study. MATERIALS AND METHODS: A questionnaire about radiation treatment status and principles was sent to radiation oncologists in charge of prostate cancer treatment at thirteen academic hospitals in Korea. The data was analyzed to find treatment principles among the radiation oncologists when treating prostate cancer. RESULTS: The number of patients with prostate cancer and treated with radiation ranged from 60 to 150 per academic hospital in Seoul City and 10 to 15 outside of Seoul City in 2006. The primary diagnostic methods of prostate cancer included the ultrasound guided biopsy on 6 to 12 prostate sites (mean=9), followed by magnetic resonance imaging and a whole body bone scan. Internal and external immobilizations were used in 61.5% and 76.9%, respectively, with diverse radiation targets. Whole pelvis radiation therapy (dose ranging from 45.0 to 50.4 Gy) was performed in 76.9%, followed by the irradiation of seminal vesicles (54.0~73.8 Gy) in 92.3%. The definitive radiotherapy doses were increased as a function of risk group, but the range of radiation doses was wide (60.0 to 78.5 Gy). Intensity modulated radiation therapy using doses greater than 70 Gy, were performed in 53.8% of academic hospitals. In addition, the simultaneous intra-factional boost (SIB) technique was used in three hospitals; however, the target volume and radiation dose were diverse. Radiation therapy to biochemical recurrence after a radical prostatectomy was performed in 84.6%; however, the radiation dose was variable and the radiation field ranged from whole pelvis to prostate bed. CONCLUSION: The results of this study suggest that a nationwide Korean Patterns of Care Study is necessary for the recommendation of radiation therapy guidelines of prostate cancer.

Emergency Abdominal Ultrasonography for Differential Diagnosis of Acute Abdominal Pain : COUCH (Complaint-oriented Ultrasonography with CHecklist) approach

PURPOSE: The purpose of this study was to verify objectively whether abdominal ultrasonography performed by emergency physicians (EP) in emergency departments (ED) immediately after history taking and physical examination could give effective diagnostic information and to check the feasibility and usefulness of the COUCH method. METHODS: From May 1, 2005 to September 30, 2005 we recruited 368 patients who complained of abdominal pain in the ED. Senior level emergency physicians (EP) conducted history taking and physical examinations, following which they were asked for their suspected diagnosis and their level of confidence (from maximum 5 to minimum 1) regarding each diagnosis. The same EP then performed abdominal ultrasonography (US), using the COUCH method and were again asked for their suspected diagnosis and level of confidence. We compared the suspected diagnoses and levels of confidence before and after abdominal US by using the t-test. RESULTS: A total of 106 patients (55 male, 51 female, average age 35.46+/-18.11 years) were enrolled. The number of patients with a suspected diagnosis of after history taking and physical examination only (2.43+/-0.5) was significantly greater than after abdominal US (1.34+/-0.5) (p<0.01). The level of confidences of suspected diagnosis of after history taking and physical examination only (3.43+/-1.14), by contrast, was less than after abdominal US (4.40+/-1.22) (p<0.01). Each year of postgraduate residents could have the same results after US. CONCLUSION: We found that abdominal ultrasonography could give EP more informations for pronouncing a correct diagnosis for patients with abdominal pain in the ED, and the COUCH method could lead the EP to get better training for ultrasonography and to diagnose more rapidly and accurately.

Development of LSM(Local Store Marketing) Strategy Using the IPA Analysis of Service Quality Attributes by the Location in a Theme Restaurant

The purposes of this study were to a) examine using status, b) measure the service quality attributes, c) analyze IPA and customer satisfaction, d) develop the LSM(Local Store Marketing) by location of K theme restaurant such as residential type(A), complex type(B) and downtown type(C). The questionnaires were handed out to 346 of 450(usage rate 76.9%). The statistical data analysis was completed using SPSS(ver 12.0) for descriptive analysis, X2, t-test, ANOVA, reliability analysis, factor analysis, multiple linear regression. From an analysis on service quality attributes, most importance of service quality attributes was more highly perceived than performance of those, except for 'attractive exterior', 'variety of kid's menu', 'convenient facilities for kid' and perceived importance and performance were also significantly different by location of branch restaurant. The attributes to be improved were 'convenience of restaurant's parking lot', 'food tast', 'speedy service' and 'service competency' as branch A(residential type) restaurant, 'convenience of the restaurant location' as branch B(complex type) restaurant and 'convenience of the restaurant location' and 'speedy service' as branch C(downtown type) through IPA analysis. The Overall customer satisfaction was 3.74 and service quality factors had significant effect on overall customer satisfaction. Location of restaurant, which gives a great effect on its operation and marketing, has a important correlation with success or failure of restaurant business enterprises. Therefore, marketing strategy by restaurant location should be developed.

The Change of the Optic Nerve Sheath Diameter (ONSD) Following Treatment in Patients with Increased ICP

PURPOSE: Many reports have shown that the optic nerve sheath diameter (ONSD) can be measured easily by ultrasonography, and that it becomes wider when the intra-cranial pressure (ICP) is increased. However, there have been no reports comparing the two ONSDs following proper treatment. We measured the 2nd ONSDs of patients who were diagnosed with intra-cranial hemorrhage and increased ICP and who were admitted to an intensive care unit following management of their conditions, and analyzed the changes of the ONSDs and their relationship to the outcomes. METHODS: During the 10 months beginning December 1, 2004, we recruited 29 patients who were suspected to have increased ICP as indicated by computed tomography at the emergency center. Meeting any one of the following criteria was defined as elevated ICP: mid-line shifting of 3 mm or greater due to mass effect; a collapsed 3rd ventricle; hydrocephalus; effacement of sulci with significant edema; abnormal mesencephalic cisterns. We determined initial ONSDs by ultraonography and the Glasgow Coma Scale (GCS). At the 7th hospital day, GCS and ONSDs were re-evaluated and compared against the previous data. RESULTS: 29 patients (21 male, 8 female, average age 55.55 years) were enrolled. Mean GCS at the admission was 7.86+/-3.60. 18 patients had spontaneous hemorrhage (62%) and 11 patients had traumatic hemorrhage (38%). 22 patients received emergency surgery, 18 patients (62%) showed improved neurological outcomes and 11 (38%) failed to achieve any good outcomes. The initial mean ONSD was 5.41+/-0.70 mm. The average ONSD for traumatic hemorrhage (5.51+/-0.45 mm) was not statistically different from the ONSD for non-traumatic hemorrhage (5.35+/-0.84 mm) (p=0.55). The mean ONSD after 7 days of admission was 4.41+/-0.53 mm, which represented a significant decrease compared with the initial measurements (p<0.05). The mean GCS and ONSD showed significant differences between the improved group and the nonimproved group (GCS: 13.44+/-2.15, 3.82+/-3.82 respectively; and ONSD: 4.13+/-0.40 mm, 4.86+/-0.37 mm respectively; p<0.05). CONCLUSION : Among the patients with increased ICP, the ONSDs who progressed to good neurological outcomes after treatment had a significantly smaller diameter than those of the others. Through measurement of the ONSDs using ultrasonography, we could not only predict increased ICP but also determine the correlation between a patient's ICP and clinical course.

The Change of the Optic Nerve Sheath Diameter (ONSD) Following Treatment in Patients with Increased ICP

PURPOSE: Many reports have shown that the optic nerve sheath diameter (ONSD) can be measured easily by ultrasonography, and that it becomes wider when the intra-cranial pressure (ICP) is increased. However, there have been no reports comparing the two ONSDs following proper treatment. We measured the 2nd ONSDs of patients who were diagnosed with intra-cranial hemorrhage and increased ICP and who were admitted to an intensive care unit following management of their conditions, and analyzed the changes of the ONSDs and their relationship to the outcomes. METHODS: During the 10 months beginning December 1, 2004, we recruited 29 patients who were suspected to have increased ICP as indicated by computed tomography at the emergency center. Meeting any one of the following criteria was defined as elevated ICP: mid-line shifting of 3 mm or greater due to mass effect; a collapsed 3rd ventricle; hydrocephalus; effacement of sulci with significant edema; abnormal mesencephalic cisterns. We determined initial ONSDs by ultraonography and the Glasgow Coma Scale (GCS). At the 7th hospital day, GCS and ONSDs were re-evaluated and compared against the previous data. RESULTS: 29 patients (21 male, 8 female, average age 55.55 years) were enrolled. Mean GCS at the admission was 7.86+/-3.60. 18 patients had spontaneous hemorrhage (62%) and 11 patients had traumatic hemorrhage (38%). 22 patients received emergency surgery, 18 patients (62%) showed improved neurological outcomes and 11 (38%) failed to achieve any good outcomes. The initial mean ONSD was 5.41+/-0.70 mm. The average ONSD for traumatic hemorrhage (5.51+/-0.45 mm) was not statistically different from the ONSD for non-traumatic hemorrhage (5.35+/-0.84 mm) (p=0.55). The mean ONSD after 7 days of admission was 4.41+/-0.53 mm, which represented a significant decrease compared with the initial measurements (p<0.05). The mean GCS and ONSD showed significant differences between the improved group and the nonimproved group (GCS: 13.44+/-2.15, 3.82+/-3.82 respectively; and ONSD: 4.13+/-0.40 mm, 4.86+/-0.37 mm respectively; p<0.05). CONCLUSION : Among the patients with increased ICP, the ONSDs who progressed to good neurological outcomes after treatment had a significantly smaller diameter than those of the others. Through measurement of the ONSDs using ultrasonography, we could not only predict increased ICP but also determine the correlation between a patient's ICP and clinical course.

Postoperative Radiation Therapy in the Management of Early Cervical Cancer / 대한방사선종양학회지

PURPOSE: This study identified the result of postoperative radiation therapy and the prognostic factors to affect survival rates in cervical cancer patients. MATERIALS AND METHODS: One hundred and thirty three patients with cervical cancer who were treated with postoperative radiation therapy following surgery at our institution between June 1985 and November 2002 were retrospectively analyzed. One hundred and thirteen patients had stage IB disease, and 20 patients had stage IIA disease. Histological examination revealed 118 squamous cell carcinoma patients and 15 adenocarcinoma patients. Sixty seven patients were noted to have stromal invasion greater than 10 mm, and 45 patients were noted to have stromal invasion 10 mm or less. Positive lymphovascular invasion was found in 24 patients, and positive pelvic lymph nodes were noted in 39 patients. Positive vaginal resection margin was documented in 8 patients. All of the patients were treated with external beam radiation therapy to encompass whole pelvis and primary surgical tumor bed. Intracavitary radiation therapy was added to 19 patients who had positive or close surgical margins. RESULTS: Actuarial overall and disease-free survival rates for entire group of the patients were 88% and 84% at 5 years, respectively. Five-year disease-free survival rates for patients with stromal invasion greater than 10 mm and 10 mm or less were 76% and 97%, respectively (p<0.05). Also there was a significantly lower survival in patients with positive pelvic lymph nodes compared with patients with negative pelvic lymph nodes (p<0.05). However, lymphovascular invasion, positive vaginal resection margins were not statistically significant prognostic factors. Addition of neoadjuvant chemotherapy or type of surgery did not affect disease-free survival. CONCLUSION: Postoperative radiation therapy appears to achieve satisfactory local control with limited morbidity in cervical cancer patients with high pathologic risk factors. Distant metastasis was a dominant failure pattern to affect survival in cervical cancer patients after radical surgery and radiation and more effective systemic treatment should be investigated in these high-risk patients.

Radiation Therapy for T2N0 Glottic Cancer / 대한방사선종양학회지

PURPOSE: This study evaluated the results of definitive radiation therapy and the prognostic factors that affect survival rates for T2N0 glottic cancer patients. MATERIALS AND METHODS: Thirty patients with T2N0 glottic cancer who were treated with definitive radiation therapy at our institution between September 1986 and June 2004 were retrospectively reviewed. All patients were pathologically confirmed as having squamous cell carcinoma and were staged as AJCC T2N0. The age of the patients ranged from 39 to 79 (median 62) years and all were male. A total dose of 66~70 Gy (median 66 Gy) was delivered with a 6-MV linear accelerator in 6.5~7 weeks. The median follow-up period was 63 months. RESULTS: The actuarial disease-free survival rate for the entire group of the patients was 79% at 5 years. The five-year disease-free survival rates for patients without and with subglottic extension were 90% and 56%, respectively (p=0.03). However, anterior commissure involvement, supraglottic extension, and impaired cord mobility were not statistically significant prognostic factors. The five-year disease-free survival rates for patients with and without concurrent chemotherapy were 86% and 69%, respectively (p=0.47). CONCLUSION: Subglottic extension can be considered a poor prognostic factor for T2N0 glottic cancer.