Stent Graft Implantation and Superselective Embolization with Liquid Embolic Agent, Onyx for Iatrogenic Common Iliac Artery Pseudoaneurysm and Persistant Endoleak

A 68-year-old male patient with a history of femoro-femoral bypass following unsuccessful intervention for chronic total iliac occlusion was found to have a saccular pseudoaneurysm of the right common iliac artery (CIA) due to interventional device-related injuries associated with the past endovascular intervention. An iatrogenic pseudoaneurysm in the CIA is generally asymptomatic, but it has a high risk of rupture, regardless of its size or symptoms. Endovascular therapy may be the best treatment option; however, ineffective sealing with a stent graft may lead to a type I endoleak. Under such conditions, use of the liquid embolic agent, Onyx, as a bailout solution for the type 1 endoleak is promising.

Self-Efficacy, Self-Care Behavior, Posttraumatic Growth, and Quality of Life in Patients with Cancer according to Disease Characteristics / 한국호스피스완화의료학회지

PURPOSE: This study examined self-efficacy, self-care behavior, posttraumatic growth, and quality of life in cancer patients and their levels by disease characteristics groups to identify patient groups that require psychosocial intervention. METHODS: We surveyed 107 patients using a structured questionnaire about the four factors and analyzed the factors by stratifying the patients by the period after the cancer diagnosis, by stage and by current treatment status. RESULTS: The mean score for self-efficacy was 37.78, and that for self-care behavior 49.96. Patients who were diagnosed less than one year ago scored higher on medication, a sub-category of self-care behavior, than the post-diagnosis period of 1~2 year group. The score was higher in the currently-treated group than the follow-up and distant metastasis groups. For posttraumatic growth, the mean was 56.17, and the factor was higher in the 1~2 year post-diagnosis group after than the less than one year group. The score was higher in the follow-up group than the currently-treated group. With regard to quality of life, the mean score was 25.79, and no significant correlation was found with disease characteristics. CONCLUSION: A shorter post-diagnosis period increased self-care behavior, and the greatest posttraumatic growth was reported by the 1~2 year post-diagnosis group. It may be necessary to provide cancer patients with an education program and other strategies less than one year after the diagnosis to improve self-efficacy and self-care behavior. To promote post-traumatic growth, it may be helpful to provide patients with psychosocial intervention within two years after the diagnosis.

Cardiac dose reduction with breathing adapted radiotherapy using self respiration monitoring system for left-sided breast cancer

PURPOSE: To quantify the cardiac dose reduction during breathing adapted radiotherapy using Real-time Position Management (RPM) system in the treatment of left-sided breast cancer. MATERIALS AND METHODS: Twenty-two patients with left-sided breast cancer underwent CT scans during breathing maneuvers including free breathing (FB), deep inspiration breath-hold (DIBH), and end inspiration breath-hold (EIBH). The RPM system was used to monitor respiratory motion, and the in-house self respiration monitoring (SRM) system was used for visual feedback. For each scan, treatment plans were generated and dosimetric parameters from DIBH and EIBH plans were compared to those of FB plans. RESULTS: All patients completed CT scans with different breathing maneuvers. When compared with FB plans, DIBH plans demonstrated significant reductions in irradiated heart volume and the heart V25, with the relative reduction of 71% and 70%, respectively (p < 0.001). EIBH plans also resulted in significantly smaller irradiated heart volume and lower heart V25 than FB plans, with the relative reduction of 39% and 37%, respectively (p = 0.002). Despite of significant expansion of lung volume using inspiration breath-hold, there were no significant differences in left lung V25 among the three plans. CONCLUSION: In comparison with FB, both DIBH and EIBH plans demonstrated a significant reduction of radiation dose to the heart. In the training course, SRM system was useful and effective in terms of positional reproducibility and patient compliance.

Establishment of linear accelerator-based image guided radiotherapy for orthotopic 4T1 mouse mammary tumor model / 한국실험동물학회지

This study was conducted to assess the feasibility of image guided radiotherapy (IGRT) for orthotopic 4T1 mouse mammary tumor using linear accelerator (LINAC). Eighteen Balb/C mice were inoculated with 4T1 cells on left mammary fat pad and nine of them were irradiated using LINAC. Tumors, planning target volumes (PTV), bowels adjacent to tumors, bones and lungs were delineated on planning CT images. IGRT plans were generated to irradiate prescription dose to at least 90% of the PTV and then compared with conventional 2-dimensional plans with anterior-posterior and posterior-anterior beams with 5 mm margins (2D AP/PA plan). Homemade dose-build-up-cradle was designed to encompass mouse bed for homogeneous dose build up. To confirm the irradiated dose, tumor doses were measured using diode detector placed on the surface of tumors. Plan comparison demonstrated equivalent doses to PTV while sparing more doses to normal tissues including bowel (from 90.9% to 40.5%, median value of mean doses) and bone marrow (from 12.9% to 4.7%, median value of mean doses) than 2D AP/PA plan. Quality assurance using diode detector confirmed that IGRT could deliver 95.3-105.3% of the planned doses to PTV. Tumors grew 505.2-1185.8% (mean 873.3%) in the control group and 436.1-771.8% (mean 615.5%) in the irradiated group. These results demonstrate that LINAC-based IGRT provides a reliable approach with accurate dose delivery in the radiobiological study for orthotropic tumor model maintaining tumor microenvironment.

Clinical application of RapidArc volumetric modulated arc therapy as a component in whole brain radiation therapy for poor prognostic, four or more multiple brain metastases

PURPOSE: To determine feasibility of RapidArc in sequential or simultaneous integrated tumor boost in whole brain radiation therapy (WBRT) for poor prognostic patients with four or more brain metastases. MATERIALS AND METHODS: Nine patients with multiple (> or =4) brain metastases were analyzed. Three patients were classified as class II in recursive partitioning analysis and 6 were class III. The class III patients presented with hemiparesis, cognitive deficit, or apraxia. The ratio of tumor to whole brain volume was 0.8-7.9%. Six patients received 2-dimensional bilateral WBRT, (30 Gy/10-12 fractions), followed by sequential RapidArc tumor boost (15-30 Gy/4-10 fractions). Three patients received RapidArc WBRT with simultaneous integrated boost to tumors (48-50 Gy) in 10-20 fractions. RESULTS: The median biologically effective dose to metastatic tumors was 68.1 Gy10 and 67.2 Gy10 and the median brain volume irradiated more than 100 Gy3 were 1.9% (24 cm3) and 0.8% (13 cm3) for each group. With less than 3 minutes of treatment time, RapidArc was easily applied to the patients with poor performance status. The follow-up period was 0.3-16.5 months. Tumor responses among the 6 patients who underwent follow-up magnetic resonance imaging were partial and stable in 3 and 3, respectively. Overall survival at 6 and 12 months were 66.7% and 41.7%, respectively. The local progression-free survival at 6 and 12 months were 100% and 62.5%, respectively. CONCLUSION: RapidArc as a component in whole brain radiation therapy for poor prognostic, multiple brain metastases is an effective and safe modality with easy application.

The effects of Angelica keiskei Koidz on the expression of antioxidant enzymes related to lipid profiles in rats fed a high fat diet

This study was performed to examine the feeding effects of Angelica keiskei Koidz (AK) and its processed products on serum, liver, and body fat content and the expression of antioxidant genes in rats fed a high fat diet. AK and its processed products were added at 3-5% to a high fat diet and fed to adult rats for 6 weeks. In experiment 1 (EXP 1), the rats were fed with one of six diets including a control diet (normal fat), high fat diet (HF), and HF + AK additives groups (four groups). In experiment 2 (EXP 2), the rats were separated into three groups of HF, HF + AK whole leaves, and HF + fermented juice (FS) + squeeze (SA). Body weight was not different among the groups in either experiment. The liver weight was lower in the FS and SA groups compared to that in the other groups (P < 0.05). Serum luteolin was higher in the AK and processed products groups compared to that in the HF group (P < 0.05). Gene expression of the antioxidative enzymes catalase and glutathione-s-reductase in the liver was higher in the AK processed products group than that in the other groups (P < 0.05). The results suggest that the intake of AK and its processed products increased the expression of antioxidant enzymes in animals fed a high fat diet, reduced hepatic cholesterol content, and increased the effective absorption of luteolin.

Risk Factors of Red Blood Cell Transfusion in Isolate off Pump Coronary Artery Bypass Surgery

BACKGROUND: Perioperative transfusion of red blood cell (RBC) may cause adverse effects. Bloodless-cardiac surgery has been spotlighted to avoid those problems. Off pump coronary artery bypass (OPCAB) surgery can decrease the transfusion. However, the risk factors of transfusions in OPCAB have not been investigated properly. MATERIALS AND METHODS: One hundred and thirteen patients (male:female=35:78, mean age=66.7+/-9.9 years) who received isolated OPCAB were retrospectively analyzed from March 2006 to September 2007. The threshold of RBC transfusion was 28.0% of hematocrit. Bilateral internal thoracic arteries graft were used for 99 patients (87.6%). One hundred and three (91.1%) and 35 patients (31.5%) took aspirin and clopidogrel just before surgery. RESULTS: Sixty-five patients (47.5%) received the RBC transfusion (mean 2.2+/-3.2 units). Mortality and major complications were not different between transfusion and no-transfusion group. But, ventilator support time, intensive care unit stay and hospitalization period had been reduced in no-transfusion group (p75 minutes) and total operation time (>5.5 hours, p<0.05). CONCLUSION: We performed the transfusion according to transfusion guideline; over 40% cases could conduct the OPCAB without transfusion. There were no differences in major clinical results between transfusion and non-transfusion group. In addition, when used together with accurate understanding of transfusion risk factors, it is expected to increase the proportion of patients that do not undergo transfusions.

The Evaluation of Metabolizable Energy of Angelica Keiskei (Angelica utilis Makino) Products

We conducted comparative study on metabolizable energy content of extracts of angelica keiskei and its byproduct. Total six different groups consisting of five test groups treated with angelica keiskei and one control group were compared. Each of the five test groups were given 30% of one of whole plant, extracts, fermented of extracts, byproduct and extracts plus byproduct, respectively, mixed with AIN93M. After 3 days of adjustment period, all groups were subjected to 4 days of test period during which the amounts of feed intake and excretion were measured everyday. All feces were treated for the prevention of decomposition and changes before its energy content were measured using a bomb calorimeter. The amount of excretion was 4.8 +/- 0.3 g/rat/3 days in control group and 9.9-15.0 g/rat/3 days in the groups were added with extracts of angelica keiskei indicating that the angelica keiskei-treated groups produce 2-3 times more excretion. Metabolic energy of control diet was 4,133.3 kcal. This was found to be 15 to 20% higher compared with the metabolic energy content ranging from 3,117.0 kcal/kg (extracts of angelica keiskei) to 3,259.8 kcal/kg (extracts plus byproducts) angelica keiskei-treated groups. This is interpreted as the result of the decreased metabolic energy in the test diets were substituted with 30% of ngelica keiskei-treated ingredient which has low metabolic content itself. One notable finding is that the metabolic content of the group mixed with byproducts and extracts (1,763.0 kcal/kg) is 27% higher than that of extracts of angelica keiskei (1,286.8 kcal/kg) indicating that mechanical grinding increases the rate of digestion and absorption increasing, in turn, the energy content used in the body. The results of analysis of overall caloric absorption showed absorption rate in order of Whole plant < extracts < byproduct < extract plus byproduct < fermented of extract.

Chamber-to-chamber Variations in the Same Type of a Cylindrical Chamber for the Measurements of Absorbed Doses / 의학물리

For the measurements of an absorbed dose using the standard dosimetry based on an absorbed dose to water the variety of factors, whether big, small, or tiny, may influence the accuracy of dosimetry. The beam quality correction factor kappa(Q, Q(0))of an ionization chamber might also be one of them. The cylindrical type of ionization chamber, the PTW30013 chamber, was chosen for this work and 9 chambers of the same type were collected from several institutes where the chamber types are used for the reference dosimetry. They were calibrated from the domestic Secondary Standard Dosimetry Laboratory with the same electrometer and cable. These calibrated chambers were used to measure absorbed doses to water in the reference condition for the photon beam of 6 MV and 10 MV and the electron beam of 12 MeV from Siemens ONCOR. The biggest difference among chambers amounts to 2.4% for the 6 MV photon beam, 0.8% for the 10 MV photon beam, and 2.4% for the 12 MeV electron beam. The big deviation in the photon of 6 MV demonstrates that if there had been no problems with the process of measurements application of the same kappa(Q, Q(0)) to the chambers used in this study might have influenced the deviation in the photon 6 MV and that how important an external audit is.

Mid-Term Results of Mitral Valve Repair Using a Partial Flexible Band and a Completely Rigid Ring in Patients with Degenerative Mitral Regurgitation / 대한흉부외과학회지

BACKGROUND: We evaluated mid-term results of mitral annuloplasty using a flexible band and a completely rigid ring for mitral valve repair in patients with degenerative mitral regurgitation (MR). MATERIAL AND METHOD: From January 2004 to September 2008, 71 patients (M:F=36:35, 55+/-13 years) underwent mitral valve repair with mitral annuloplasty for degenerative MR. Ring annuloplasty was done using a Cosgrove-Edwards flexible band (Group I, n=43) or a Carpentier-Edwards classic ring (Group II, n=28). There were no differences in preoperative characteristics of the participants. Average duration of follow-up was 36 months (range: 2~69 mos). RESULT: There was no in-hospital mortality. Postoperative morbidity, which included atrial fibrillation (n=7) and low cardiac output syndrome (n=5) in groups I and II were similar. There was one late death in group II. The proportion exhibiting freedom from recurrent mitral regurgitation (> or =moderate) at 4 years in Groups I and II were, respectively, 94.5 and 91.8%, (p=0.695). Left ventricular ejection fraction decreased in the early postoperative period (7+/-2 days) and recovered by last follow-up (25+/-16 mos; p=0.002). The pattern was similar in groups I and II (p=0.905). Re-operation was performed in 3 patients (1 in Group I and 2 in Group II, p=0.316). Four-year event-free survival (free of adverse valve-related events) was 95.2% for Group I and 92.6% for Group II; this difference was not significant, p=0.646). CONCLUSION: The type of technique used in mitral annuloplasty to repair the mitral valve repair after degenerative MR did not affect mid-term clinical and functional results.

Analysis and Investigation for the Status of Radiation Therapy QA in Korea / 의학물리

We have taken surveys about total 72 departments of radiation oncology which is performing the treatment with linear accelerator and brachytherapy unit in Korea. The survey was included the research about the linear accelerator, brachytherapy, Also, we surveyed the various performance (QA period, manpower, time) of quality control for understanding of efficiency. The survey results show that the QA test of daily and weekly are almost same comparing to USA and Europe but the QA performance of monthly and yearly in Korea are 15.5 which is less than USA and Europe recommended QA item number of 17 to 21. The manpower and QA time in Korea also lower than 50% of USA and Europe recommended because the manpower and QA time limitation in Korea. It will be expected that the manual of quality management in each clinic could be appropriately established when combining the present results with previously published AAPM TG-40 and other protocols.

Bloodless Cardiac Surgery in a Neonate Weighing 2.8 kg / 대한흉부외과학회지

Despite increased interest in bloodless cardiac surgery, its use has been mostly confined to adult patients. Especially, bloodless pediatric cardiovascular surgery using cardiopulmonary bypass has been avoided mainly due to hemodilution. Authors recently experienced a case of bloodless cardiac surgery in a 2.8 kg-weighing neonate whose parents were Jehovah's Witness.

Suspected Intimal Sarcoma in the Abdominal Aorta: A case report / 대한흉부외과학회지

A 68 year-old man visited our institution due to chest pain. Coronary angiography revealed triple vessel disease. A computed tomographic angiogram performed as a routine preoperative examination demonstrated an intraluminal spider-web-like mass from the infrarenal abdominal aorta to both common iliac arteries. The infrarenal aorta and both common iliac arteries were excised and replaced with concomitant off-pump coronary artery bypass grafts. Histologic examination of the aorta suggested an intimal sarcoma. A postoperative computed tomographic angiogram performed 3 months postoperatively showed no evidence of a residual or a recurred lesion.

The Study on the Use of a Cylindrical Ionization Chamber for the Calibration of a 6 MeV Electron Beam / 의학물리

The standard dosimetry systems based on an absorbed dose to water recommend to use a planeparallel chamber for the calibration of such a low-megavoltage electron beam as a nominal energy of 6 MeV. For this energy ranges of an electron beam a cylindrical chamber should not be used for the routinely regular beam calibration, but the feasibility of the temporary use of a cylindrical chamber was studied to give temporary solutions for special situations users meet. The PTW30013 chambers and the electron beam quality of R(50)=2.25 g/cm2 were selected for this study. 10 PTW30013 chambers, a cylindrical type of chamber, were calibrated in KFDA, the secondary standards dosimetry laboratories, and given the absorbed dose-to-water calibration factors, respectively. A "temporary" kappa(Q,Q0) for each chamber were calculated using the absorbed dose determined by a cross-calibrated planeparallel chamber, with the result of an average 0.9352 for 10 chambers. This value for PTW30013 chamber was used to determine an absorbed dose to water at the reference depth. The absorbed doses determined by PTW30013 chambers were in an agreement within 2% with that by ROOS chamber. In a certain situation where a cylindrical chamber be used instead of a planeparellel chamber, the value of 0.9352 might be useful to determine an absorbed dose to water in the same beam quality of electron beam as this study.

Chamber to Chamber Variations of a Cylindrical Ionization Chamber for the Calibration of an (192)Ir Brachytherapy Source Based on an Absorbed Dose to Water Standards / 의학물리

This work is for the preliminary study for the calibration of an (192)Ir brachytherapy source based on an absorbed dose to water standards. In order to calibrate brachytherapy sources based on absorbed dose to water standards using a clyndirical ionization chamber, the beam quality correction factor kappa(Q,Q0) is needed. In this study kappa(Q,Q0)s were determined by both Monte carlo simulation and semiexperimental methods because of the realistic difficulties to use primary standards to measure an absolute dose at a specified distance. The 5 different serial numbers of the PTW30013 chamber type were selected for this study. While chamber to chamber variations ran up to maximum 4.0% with the generic kappa gen(Q,Q0), the chamber to chamber variations were within a maximum deviation of 0.5% with the individual kappa ind(Q,Q0). The results show why and how important ionization chambers must be calibrated individually for the calibration of (192)Ir brachytherapy sources based on absorbed dose to water standards. We hope that in the near future users will be able to calibrate the brachytherapy sources in terms of an absorbed dose to water, the quantity of interest in the treatment, instead of an air kerma strength just as the calibration in the high energy photon and electron beam.

Analysis of Dose Distribution on Critical Organs for Radiosurgery with CyberKnife Real-Time Tumor Tracking System / 의학물리

We measured the dose distribution for spinal cord and tumor using Gafchromic film, applying 3D and 4D-Treatment Planning for lung tumor within the phantom. A measured dose distribution was compared with a calculated dose distribution generated from 3D radiation treatment planning and 4D radiation treatment planning system. The agreement of the dose distribution in tumor for 3D and 4D treatment planning was 90.6%, 97.64% using gamma index computed for a distance to agreement of 1 mm and a dose difference of 3%. However, a gamma agreement index of 3% dose difference tolerence of and 2 mm distance to agreement, the accordance of the dose distribution around cord for 3D and 4D radiation treatment planning was 57.13%, 90.4%. There are significant differences between a calculated dose and a measured dose for 3D radiation treatment planning, no significant differences for 4D treatment planning. The results provide the effectiveness of the 4D treatment planning as compared to 3D. We suggest that the 4-dimensional treatment planning should be considered in the case where such equipments as Cyberknife with the real time tracking system are used to treat the tumors in the moving organ.

Verification of X-sight Lung Tracking System in the CyberKnife / 의학물리

To track moving tumor in real time, CyberKnife system imports a technique of the synchrony respiratory tracking system. The fiducial marker which are detectable in X-ray images were demand in CyberKnife Robotic radiosurgery system. It issued as reference markers to locate and track tumor location during patient alignment and treatment delivery. Fiducial marker implantation is an invasive surgical operation that carries a relatively high risk of pneumothorax. Most recently, it was developed a direct lung tumor registration method that does not require the use of fiducials. The purpose of this study is to measure the accuracy of target applying X-sight lung tracking using the Gafchromic film in dynamic moving thorax phantom. The X-sight Lung Tracking quality assurance motion phantom simulates simple respiratory motion of a lung tumor and provides Gafchromic dosimetry film-based test capability at locations inside the phantom corresponding to a typical lung tumor. The total average error for the X-sight Lung Tracking System with a moving target was 0.85+/-0.22 mm. The results were considered reliable and applicable for lung tumor treatment in CyberKnife radiosurgery system. Clinically, breathing patterns of patients may vary during radiation therapy. Therefore, additional studies with a set real patient data are necessary to evaluate the target accuracy for the X-sight Lung Tracking system.

Verification of X-sight Lung Tracking System in the CyberKnife / 의학물리

To track moving tumor in real time, CyberKnife system imports a technique of the synchrony respiratory tracking system. The fiducial marker which are detectable in X-ray images were demand in CyberKnife Robotic radiosurgery system. It issued as reference markers to locate and track tumor location during patient alignment and treatment delivery. Fiducial marker implantation is an invasive surgical operation that carries a relatively high risk of pneumothorax. Most recently, it was developed a direct lung tumor registration method that does not require the use of fiducials. The purpose of this study is to measure the accuracy of target applying X-sight lung tracking using the Gafchromic film in dynamic moving thorax phantom. The X-sight Lung Tracking quality assurance motion phantom simulates simple respiratory motion of a lung tumor and provides Gafchromic dosimetry film-based test capability at locations inside the phantom corresponding to a typical lung tumor. The total average error for the X-sight Lung Tracking System with a moving target was 0.85+/-0.22 mm. The results were considered reliable and applicable for lung tumor treatment in CyberKnife radiosurgery system. Clinically, breathing patterns of patients may vary during radiation therapy. Therefore, additional studies with a set real patient data are necessary to evaluate the target accuracy for the X-sight Lung Tracking system.

Cardiac Rupture Induced by Angiosarcoma / 대한흉부외과학회지

Angiosarcoma is the most common primary intracardiac malignancy, but many published papers have reported it to be rather rare. The prognosis of angiosarcoma is known to be very poor, and the treatment of choice has been surgery until recently, but many centers currently tend to try multimodal therapies, including chemotherapy and radiotherapy. In this report, we present a rare case in which an intracardiac angiosarcoma could have threatened the patient's life in short time by the rapid progression of the tumor, which caused right atrial rupture.

Radiation Therapy and Chemotherapy after Breast Conserving Surgery for Invasive Breast Cancer: An Intermediate Result / 대한방사선종양학회지

PURPOSE: Breast conserving surgery (BCS) followed by chemotherapy (CTx.) and radiation therapy (RT) is widely performed for the treatment of early breast cancer. This retrospective study was undertaken to evaluate our interim results in terms of failure patterns, survival and relative risk factors. MATERIALS AND METHODS: From January 1999 through December 2003, 129 patients diagnosed with invasive breast cancer and treated with BCS followed by RT were subject to retrospective review. The median age of the patients was 45 years (age distribution, 27~76 years). The proportions of patients according to their tumor, nodes, and metastases (TNM) stage were 65 (50.4%) in stage I, 41 (31.7%) in stage IIa, 13 (10.1%) in stage IIb, 9 (7.0%) in stage III, and 1 patient (0.8%) in stage IIIc. For 32 patients (24.8%), axillary node metastasis was found after dissection. BCS consisted of quadrantectomy in 115 patients (89.1%) and lumpectomy in 14 patients (10.6%). Axillary node dissection at axillary level I and II was performed for 120 patients (93%). For 7 patients (5.4%), only sentinel node dissection was performed with BCS. For 2 patients (1.6%) axillary dissection of any type was not performed. Postoperative RT was given with 6 MV X-rays. A tumor dose of 50.4 Gy was delivered to the entire breast area using a tangential field with a wedge compensator. An aditional dose of 9~16 Gy was given to the primary tumor bed areas with electron beams. In 30 patients (23.3%), RT was delivered to the supraclavicular node. Most patients had adjuvant CTx. with 4~6 cycles of CMF (cyclophosphamide, methotrexate, 5-fluorouracil) regimens. The median follow-up period was 50 months (range: 17~93 months). RESULTS: The actuarial 5 year survival rate (5Y-OSR) was 96.9%, and the 5 year disease free survival rate (5Y-DFSR) was 93.7%. Local recurrences were noted in 2 patients (true: 2, regional node: 1) as the first sign of recurrence at a mean time of 29.3 months after surgery. Five patients developed distant metastases as the first sign of recurrence at 6~33 months (mean 21 months). Sites of distant metastatic sites were bone in 3 patients, liver in 1 patient and systemic lesions in 1 patient. Among the patients with distant metastatic sites, two patients died at 17 and 25 months during the follow-up period. According to stage, the 5Y-OSR was 95.5%, 100%, 84.6%, and 100% for stage I, IIa, IIb, and III respectively. The 5Y-DFSR was 96.8%, 92.7%, 76.9%, and 100% for stage I, IIa, IIb, and III respectively. Stage was the only risk factor for local recurrence based on univariate analysis. Ten stage III patients included in this analysis had a primary tumor size of less than 3 cm and had more than 4 axillary lymph node metastases. The 10 stage III patients received not only breast RT but also received posterior axillary boost RT to the supraclavicular node. During the median 53.3 months follow-up period, no any local or distant failure was found. Complications were asymptomatic radiation pneumonitis in 10 patients, symptomatic pneumonitis in 1 patient and lymphedema in 8 patients. CONCLUSION: Although our follow up period is short, we had excellent local control and survival results and reaffirmed that BCS followed by RT and CTx. appears to be an adequate treatment method. These results also provide evidence that distant failure occurrs earlier and more frequent as compared with local failure. Further studies and a longer follow-up period are needed to assess the effectiveness of BCS followed by RT for the patients with less than a 3 cm primary tumor and more than 4 axillary node metastases.