The Efficacy and Safety of Cryolipolysis for Subcutaneous Fat Reduction

No abstract available.

Young Age Is Associated with Increased Locoregional Recurrence in Node-Positive Breast Cancer with Luminal Subtypes / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The effects of biological subtypes within breast cancer on prognosis are influenced by age at diagnosis. We investigated the association of young age with locoregional recurrence (LRR) between patients with luminal subtypes versus those with nonluminal subtypes. MATERIALS AND METHODS: Medical records of 524 breast cancer patients with positive lymph nodes between 1999 and 2010 were reviewed retrospectively. All patients received curative surgery and adjuvant chemotherapy based on contemporary guidelines. Radiation was delivered for patients who underwent breast conserving surgery or those who had four or more positive lymph nodes after mastectomy. Adjuvant hormone therapy was administered to 413 patients with positive hormone receptors according to their menstrual status. RESULTS: During median follow-up of 84 months, the 10-year locoregional recurrence-free survival rate (LRRFS) was 84.3% for all patients. Patients < 40 years showed significantly worse 10-year LRRFS than those ≥ 40 years (73.2% vs. 89.0%, respectively; p=0.01). The negative effect of young age on LRRFS was only observed in luminal subtypes (69.7% for < 40 years vs. 90.8% for ≥ 40 years; p < 0.01). Multivariate analysis using luminal subtypes ≥ 40 years as a reference revealed luminal subtypes < 40 years were significantly associated with increased risk of LRR (hazard ratio, 2.33; p < 0.01). CONCLUSION: Young breast cancer patients with positive lymph nodes had a higher risk of LRR than those aged ≥ 40 years. This detrimental effect of young age on LRR was confined in luminal subtypes.

Intramedullary Spinal Cord Metastasis From Rectal Cancer

Intramedullary spinal cord metastasis (ISCM) is an uncommon condition of the central nervous system (CNS) cause by systemic malignant tumors. Most ISCM cases are known to occur in patients with lung cancer and breast cancer; however, ISCM also very rarely occurs in patients with colorectal cancer. For the first time in Korea, we experienced a case of ISCM arising from rectal cancer, where a 75-year-old man presented with an abruptly-developed left-foot drop and numbness in both legs. The patient had lung metastases from rectal cancer that had been treated with chemotherapy. Magnetic resonance imaging revealed an intramedullary nodular lesion at the T12 level. ISCM was diagnosed and treated with steroids and radiotherapy. The patient's neurological symptoms were relieved for a while after treatment, but his condition deteriorated progressively. He died 4 months after ISCM had been diagnosed.

A Case of Pulmonary Artery Intimal Sarcoma Masquerading as Pulmonary Embolism / 결핵및호흡기질환

Pulmonary artery intimal sarcoma is a rare tumor with no characteristic symptoms. It is frequently misdiagnosed as pulmonary embolism. We report a case of pulmonary artery intimal sarcoma in a 48-year-old man with dyspnea, cough and blood-tinged sputum. He was initially suspected and treated as a pulmonary embolism. Computed tomography of the chest showed filling defects occupying the entire luminal diameter of the right and left pulmonary artery as well as extraluminal extension of the intraluminal mass. Surgical resection of the tumor confirmed pulmonary artery intimal sarcoma. After surgery, he received 8 cycles of combined chemotherapy consisting of doxorubicin and ifosfamide. After 8 cycles, Computed tomography of the chest showed interval regression of the residual tumor. Radiotherapy was done as total 6,000 cGy for 5 weeks, following the 8th chemotherapy. The patient's condition was successfully stabilized with chemotherapy and radiotherapy.

Analgesic Effects of Dexmedetomidine in Vincristine-Evoked Painful Neuropathic Rats

Dexmedetomidine, which is a selective alpha2-adrenoceptor agonist, was recently introduced into clinical practice for its analgesic properties. The purpose of this study was to evaluate the effects of dexmedetomidine in a vincristine-evoked neuropathic rat models. Sprague-Dawley rats were injected intraperitoneally with vincristine or saline (0.1 mg/kg/day) using a 5-day-on, 2-day-off schedule for 2 weeks. Saline and dexmedetomidine (12.5, 25, 50, and 100 microg/kg) were injected to rats developed allodynia 14 days after vincristine injection, respectively. We evaluated allodynia at before, 15, 30, 60, 90, 120, 180, and 240 min, and 24 hr after intraperitoneal drug (normal saline or dexmedetomidine) injection. Saline treatment did not show any differences for all the allodynia. Maximal paw withdrawal thresholds to mechanical stimuli were 3.0 +/- 0.4, 9.1 +/- 1.9, 13.0 +/- 3.6, 16.6 +/- 2.4, and 24.4 +/- 1.6 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Minimal withdrawal frequency to cold stimuli were 73.3 +/- 4.2, 57.1 +/- 6.8, 34.3 +/- 5.7, 20.0 +/- 6.2, and 14.3 +/- 9.5 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Dexmedetomidine shows a dose-dependent antiallodynic effect on mechanical and cold stimuli in vincristine-evoked neuropathic rat models (P < 0.05).

Analgesic Effects of Dexmedetomidine in Vincristine-Evoked Painful Neuropathic Rats

Dexmedetomidine, which is a selective alpha2-adrenoceptor agonist, was recently introduced into clinical practice for its analgesic properties. The purpose of this study was to evaluate the effects of dexmedetomidine in a vincristine-evoked neuropathic rat models. Sprague-Dawley rats were injected intraperitoneally with vincristine or saline (0.1 mg/kg/day) using a 5-day-on, 2-day-off schedule for 2 weeks. Saline and dexmedetomidine (12.5, 25, 50, and 100 microg/kg) were injected to rats developed allodynia 14 days after vincristine injection, respectively. We evaluated allodynia at before, 15, 30, 60, 90, 120, 180, and 240 min, and 24 hr after intraperitoneal drug (normal saline or dexmedetomidine) injection. Saline treatment did not show any differences for all the allodynia. Maximal paw withdrawal thresholds to mechanical stimuli were 3.0 +/- 0.4, 9.1 +/- 1.9, 13.0 +/- 3.6, 16.6 +/- 2.4, and 24.4 +/- 1.6 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Minimal withdrawal frequency to cold stimuli were 73.3 +/- 4.2, 57.1 +/- 6.8, 34.3 +/- 5.7, 20.0 +/- 6.2, and 14.3 +/- 9.5 g at saline, 12.5, 25, 50, and 100 microg/kg dexmedetomidine injection, respectively. Dexmedetomidine shows a dose-dependent antiallodynic effect on mechanical and cold stimuli in vincristine-evoked neuropathic rat models (P < 0.05).

The Effect of Adjuvant Radiotherapy in Patients Undergoing Complete Resection for Gallbladder Cancer with Lymph Node Metastasis

PURPOSE: We evaluated the effect of adjuvant radiotherapy on survival in patients who underwent curative resection for gallbladder cancer with lymph node metastasis. METHODS: Among the patients underwent curative resection even though there was lymph node metastasis; fifteen patients underwent adjuvant radiotherapy with over 40 Gy (RTx group) and 10 patients did not (no RTx group). We compared these two groups retrospectively. RESULTS: The median disease free survival (DFS) of the RTx group (21.6 months) was longer than for the no RTx group (6.6 months, p=0.451). The median overall survival (OS) of the RTx group (30.5 months) was also longer than the no RTx group (14.2 months). One-, 2-, and 5-yr OS rates were 60.0%, 40.0% and 40.0% in the no RTx group, and 86.7%, 70.9% and 26.6% in the RTx group, respectively (p=0.507). Five patients developed recurrence within 1 year (50.0%) in the no RTx group; there were 3 (20.0%) in the RTx group. CONCLUSION: Our study was limited by its retrospective nature and small numbers of patients. However, it suggests that adjuvant radiotherapy might improve DFS and OS for patients with completely resected but lymph node metastasized gallbladder cancer. Also this therapy seems to delay time to postoperative recurrence.

Sluggish decline in a post-transplant model for end-stage liver disease score is a predictor of mortality in living donor liver transplantation / 대한마취과학회지

BACKGROUND: The pre-transplant model for end-stage liver disease (pre-MELD) score is controversial regarding its ability to predict patient mortality after liver transplantation (LT). Prominent changes in physical conditions through the surgery may require a post-transplant indicator for better mortality prediction. We aimed to investigate whether the post-transplant MELD (post-MELD) score can be a predictor of 1-year mortality. METHODS: Perioperative variables of 269 patients with living donor LT were retrospectively investigated on their association with 1-year mortality. Post-MELD scores until the 30th day and their respective declines from the 1st day post-MELD score were included along with pre-MELD, acute physiology and chronic health evaluation (APACHE) II, and sequential organ failure assessment (SOFA) scores on the 1st post-transplant day. The predictive model of mortality was established by multivariate Cox's proportional hazards regression. RESULTS: The 1-year mortality rate was 17% (n = 44), and the leading cause of death was graft failure. Among prognostic indicators, only post-MELD scores after the 5th day and declines in post-MELD scores until the 5th and 30th day were associated with mortality in univariate analyses (P or =24 hours were the earliest independent predictors of 1-year mortality. CONCLUSIONS: A sluggish decline in post-MELD scores during the early post-transplant period may be a meaningful prognostic indicator of 1-year mortality after LT.

Outcome of Locally Advanced Esophageal Cancer Treated with Concurrent Chemo-radiotherapy / 대한방사선종양학회지

PURPOSE: We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and METHODS: Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of > or =45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). RESULTS: The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. CONCLUSION: This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.

The Results of Radiotherapy in Locally Advanced, Unresectable Pancreatic Cancer / 대한방사선종양학회지

PURPOSE: We retrospectively studied the outcomes and prognostic factors of patients with locally advanced, unresectable pancreatic cancer who were treated with concurrent chemoradiotherapy (CCRT) or radiotherapy only. MATERIALS AND METHODS: Fifty-one patients with locally advanced, unresectable pancreatic cancer (stage IIA~III) who recevied radiotherapy (> or =30 Gy) between January 1994 and August 2008 were reviewed retrospectively. The median radiation dose was 39 Gy. Chemotherapy consisted of gemcitabine, cisplatin, or 5-FU alone or in various combinations, and was administered concurrently with radiotherapy in 38 patients. RESULTS: The follow-up period ranged from 2~40 months (median, 8 months). The median survival, and the 1- and 2-year overall survival (OS) rates were 7 months, 15.7%, and 5.9%, respectively. Based on univariate analysis, the baseline CA19-9, performance status, and chemotherapy regimen were significant prognostic factors. The median survival was 8 months for CCRT, and 6 months for radiotherapy alone. The patients treated with gemcitabine-containing regimens had longer survival (median, 10 months) than the patients treated with radiotherapy alone (p=0.027). Twenty-three patients were available to evaluate the patterns of failure. Distant metastases (DM) occured in 18 patients and regional recurrences were demonstrated in 4 patients. Local progression developed in 14 patients. We analyzed the association between the time-to-DM and the baseline CA19-9 levels for 18 evaluable patients. The median time-to-DM was 20 months for patients with normal baseline CA19-9 levels and 2 months for patients with baseline CA19-9 levels > or =200 U/ml. CONCLUSION: CCRT with gemcitabine-based regimens was effective in improving OS in patients with locally advanced, unresectable pancreatic cancer. We suggest that the baseline CA19-9 level is valuable in determining the treatment strategy for patients with locally advanced, unresectable pancreatic cancer.

The Outcome of Postoperative Radiation Therapy for Patients with Stage II Pancreatic Cancer (T3 or N1 Disease) / 대한방사선종양학회지

PURPOSE: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. MATERIALS AND METHODS: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. RESULTS: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1- and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2- and 3-year overall survival rates were 31.6% and 15.8%, respectively. CONCLUSION: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.

Bone Metastasis from Primary Hepatocellular Carcinoma: Characteristics of Soft Tissue Formation / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: To assess the characteristics of bone metastasis from hepatocellular carcinoma and the radiation field arrangement based on imaging studies. MATERIALS AND METHODS: Fifty-three patients (84 lesions) with bone metastasis from a primary hepatocellular carcinoma completed palliative radiation therapy. All patients underwent one of following imaging studies prior to the initiation of radiation therapy: a bone scan, computed tomography or magnetic resonance imaging. The median radiation dose was 30 Gy (7~40 Gy). We evaluated retrospectively the presence of soft tissue formation and the adjustment of the radiation field based on the imaging studies. RESULTS: Soft tissue formation at the site of bony disease was identified from either a CT/MRI scan (41 lesions) or from a symptomatic palpable mass (5 lesions). The adjustment of the radiation field size based on a bone scan was necessary for 31 of 41 soft tissue forming lesions (75.6%), after a review of the CT/MRI scan. The median survival from the initial indication of a hepatoma diagnosis was 8 months (2 to 71 months), with a 2-year survival rate of 38.6%. The median survival from the detection of a bone metastasis was 5 months (1 to 38 months) and the 1-year overall survival rate was 8.7%. CONCLUSION: It was again identified that bone metastasis from a primary hepatocellular carcinoma is accompanied by soft tissue formation. From this finding, an adjustment of the radiation field size based on imaging studies is required. It is advisable to obtain a CT or MRI scan of suspected bone metastasis for better tumor volume coverage prior to the initiation of radiation therapy.

Pulsed Radiofrequency of Lumbar Dorsal Root Ganglia for Treatment of Chronic Inguinal Herniorrhaphy Pain: A case report / 대한통증학회지

Inguinal hernia repair can result in paresthesia and/or pain in the inguinal region. Pharmacological and surgical management often yield inconsistent results associated with considerable risks and side effects. Radiofrequency thermocoagulation (RF) is a neuro-destructive treatment for severe pain, but associated with hypoesthesia, neuritis-like reactions, and occasional neuroma formation. Pulsed radiofrequency (PRF), unlike RF, delivers high intensity currents in pulses, is non-neurodestructive, and therefore less painful, without the potential complications. Here we report on PRF in chronic postoperative inguinal pain. A 23-year-old male who received right inguinal hernia repair and complained of right sided groin pain for approximately 10 years underwent PRF at the L1 and L2 dorsal root ganglia (DRG). He then reported a decrease in pain from 80-90/100 mm to 15-30/100 mm on a visual analogue scale (VAS), which lasted for twelve months.

Medical-and-Psychosocial Factors Influencing on the Quality of Life in Patients with Cervix Cancer / 대한방사선종양학회지

PURPOSE: Quality of life in patients with cancer may be influenced by various kinds of variables, such as personal, environmental, and medical factors. The purpose of this study was to identity the influencing factors on the quality of life in patients with cancer. MATERIALS AND METHODS: One hundred and forty seven patients, who were taking medical therapy or following up after surgery for cervix cancer, participated in the present study. Quality of life, medical variables (cancer stage, types of treatment, follow-up status, and symptom distress), and psychosocial variables (mood disturbance, orientation to life, and social support) were measured. The obtained data were computed using multiple regression analyses. RESULTS: The medical-and-psychosocial variables explained 63.3% of the total variance in the quality of life (R2=0.633, F=16.969, p=.000). Cancer stage, symptom distress, mood disturbance, social support (family), and optimistic orientation to life were significant factors influencing on the quality of life in patients with cervix cancer. CONCLUSION: An integrative care program which includes medical - and - psychosocial characteristics of patients is essential to improve quality of life in patients with cervix cancer.

Literature Analysis of Radiotherapy in Uterine Cervix Cancer for the Processing of the Patterns of Care Study in Korea / 대한방사선종양학회지

PURPOSE: Uterine cervix cancer is one of the most prevalent women cancer in Korea. We analysed published papers in Korea with comparing Patterns of Care Study (PCS) articles of United States and Japan for the purpose of developing and processing Korean PCS. MATERIALS AND METHODS: We searched PCS related foreign-produced papers in the PCS homepage (212 articles and abstracts) and from the Pub Med to find Structure and Process of the PCS. To compare their study with Korean papers, we used the internet site "Korean Pub Med" to search 99 articles regarding uterine cervix cancer and radiation therapy. We analysed Korean paper by comparing them with selected PCS papers regarding Structure, Process and Outcome and compared their items between the period of before 1980's and 1990's. RESULTS: Evaluable papers were 28 from United States, 10 from the Japan and 73 from the Korea which treated cervix PCS items. PCS papers for United States and Japan commonly stratified into 3~4 categories on the bases of the scales characteristics of the facilities, numbers of the patients, doctors. Researchers restricted eligible patients strictly. For the process of the study, they analysed factors regarding pretreatment staging in chronological order, treatment related factors, factors in addition to FIGO staging and treatment machine. Papers in United States dealt with racial characteristics, socioeconomic characteristics of the patients, tumor size (6), and bilaterality of parametrial or pelvic side wall invasion (5), whereas papers from Japan treated of the tumor markers. The common trend in the process of staging work-up was decreased use of lymphangiogram, barium enema and increased use of CT and MRI over the times. The recent subject from the Korean papers dealt with concurrent chemoradiotherapy (9 papers), treatment duration (4), tumor markers (8) and unconventional fractionation. CONCLUSION: By comparing papers among 3 nations, we collected items for Korean uterine cervix cancer PCS. By consensus meeting and close communication, survey items for cervix cancer PCS were developed to measure structure, process and outcome of the radiation treatment of the cervix cancer. Subsequent future research will focus on the use of brachytherapy and its impact on outcome including complications. These finding and future PCS studies will direct the development of educational programs aimed at correcting identified deficits in care.

Anesthetic Management of Small Bowel Transplantation for Short Bowel Syndrome: A case report / 대한마취과학회지

General treatment of short bowel syndrome is long-term total parenteral nutrition (TPN). But long-term TPN therapy produces thrombus, infection and obstruction of central veins and results in the life-threatening complications. Recently we experienced first case of small bowel transplantation in a 57-year old female with only 30 cm jejunum and distal part of colon to the splenic flexure who was suffering short bowel syndrome due to previous wide resection of small bowel. We report successful anesthetic management of small bowel transplantation in the patient with short bowel syndrome who has been suffered from life threatening complications due to long-term TPN therapy.

Arm Morbidity after Breast Cancer Treatments and Analysis of Related Factors / 대한방사선종양학회지

PURPOSE: To evaluate the incidence of arm morbidity following breast cancer surgery including axillary dissection and to identify related factors. MATERIASL AND METHODS: One hundred and fifty nine patients were studied using a self-report questionnaire and a clinical examination. Lymphedema, reduction of range of motion in shoulder joint and subjective symptoms (pain, impaired arm movement, numbness, stiffness) were evaluated. As related factors, demographic, oncologic characteristics and types of treatment were analysed. RESULTS: The incidence of lymphedema (> or =2 cm difference comparing to unaffected arm) was 6.3%, 10.7%, 22.6% and 23.3% at each 10 cm, 20 cm, 30 cm, and 40 cm from wrist. Reduction of range of motion in shoulder joint (> or =20 degree difference comparing to unaffected arm) was noted in more than 1/3 patients for flexion, abduction and internal rotation. Especially the reduction of range of motion in internal rotation was severe (> 50% reduction) in 1/3 patients. Approximately 50 to 60% of patients complained impaired arm movement, numbness, stiffness and pain. Body mass index (BMI) was the significant risk factor for lymphedema. CONCLUSION: Lymphedema was present in 1/3 of patients and the common sites of edema were 30 cm 40 cm proximal from the wrist. Also most severe reduction of range of motion in shoulder joint was with internal rotation. There needs weight control for lymphedema because BMI was the significant risk factor for lymphedema. Also rehabilitation program for range of motion especially internal rotation in shoulder joint should be developed.

The Optimal Dose Range of Epidural Naloxone to Minimize Nausea during Continuous Epidural Infusion of Morphine / 대한마취과학회지

BACKGROUND: This study was designed to determine the optimal dose range of epidural naloxone that can preserve analgesia while minimizing nausea, one of the most common side effects caused by epidural morphine. METHODS: Seventy-four patients undergoing combined epidural and general anesthesia for hysterectomy were randomly assigned to one of three groups. All received 2 mg epidural morphine bolus just before closing abdominal cavity and a continuous epidural infusion was started containing 4 mg morphine in 100 ml bupivacaine 0.125% with either no naloxone (Group 1, n = 24), 0.167 mg/kg/hr of naloxone (Group 2, n = 19) or 0.412 mg/kg/hr of naloxone (Group 3, n = 31) for postoperative pain control. Analgesia and nausea were evaluated by blinded observers. RESULTS: The combination of epidural morphine and bupivacaine provided good analgesia. Pain scores in group 3 were lower than in group 1 after surgery, but there were no significant statistical differences except at 16 hr. Group 2 showed the lowest pain scores at 8, 16 and 24 hr (P < 0.05). Nausea scores were lower in group 2 and 3 than in group 1 at 16 and 24 hr (P < 0.05). CONCLUSIONS: Epidural administration of naloxone below 0.412 mg/kg/hr was optimal and safe dose range that maintained the analgesic effects of morphine while minimizing nausea.

Conservative Split Course Radiation Therapy for Unresectable Stage III Non-Small Cell Lung Carcinoma with Poor Prognostic Factors

PURPOSE: Many studies for unresectable stage III non-small cell lung carcinomas (NSCLC) have focused on patients with good prognostic factors. However, there have been few reports on patients with poor prognostic factors. Herein, those patients with poor prognostic factors were treated with conservative split course radiation therapy (RT) alone, and the feasibility and survivals evaluated. Methods and Materials: Between Jan 1997 and Dec 2001, 73 patients started conservative split course RT. They were confirmed to have unresectable stage III NSCLC with poor prognostic factors; performance scale> or = ECOG 2 or weight loss> or =5% during the last 6 months. They initially received 30 Gy of radiation in 2.5 or 3 Gy per fractions to the gross tumor volume (GTV). The tumor response was evaluated 2~3 weeks later. A second course of RT was also recommended for good responders: > or =50% tumor diameter reduction or improved distal atelectasis. The treatment related toxicity was also evaluated. RESULTS: Nine patients failed to finish the initial course of RT (3~27 Gy) due to disease progression or personal reasons. Thirty-four (53.1%) of the 64 patients who completed the first course of RT showed a good tumor response. Twenty-seven good responders received the second course of RT, with a total of 51 to 60 Gy. Seven of these did not receive the second course of RT due to distant metastasis or poor performance. The two-year survival rate and median survival in all patients and in the 27 good responders who completed the second course of RT were 19.7% and 12 months and 30.3 and 20 months, respectively. Five (12.8%) of the 39 evaluable patients had grade III radiation esophagitis (N=1) or pneumonitis (N=4). Conclusions: Conservative split course RT was a tolerable and effective modality for unresectable stage III NSCLC with poor prognostic factors. In addition, it was able to produce relatively good survival results in patients showing a good response after the first course and who completed the second course of RT

LINAC-Based Radiosurgery of Arteriovenous Malformation involving Visual Pathway: A Report of Two Cases / 대한뇌혈관외과학회지

The authors present two cases of arteriovenous malformation (AVM) involving the visual pathway following linear accelerator (LINAC) stereotactic radiosurgery. Both patients were treated with 18 Gy (marginal dose, 70-80% isodose line, 3 isocenter) delivered to the malformed vascular mass involving the optic tract on the right side. For both patients, however, less than 8 Gy were irradiated onto the ipsilateral optic chiasm and optic nerve, and 4.5 Gy were irradiated onto the contralateral optic nerve (20% isodose line). On the five-year follow-up MRI scan and angiogram, the AVM was totally obliterated in one patient and the AVM was markedly decreased in size in the other patient. Their visual fields were well preserved and visual acuities were even improved for both patients. We report here with on two cases of AVM involving the visual pathway that were effectively and safely treated with 18 Gy using LINAC-based radiosurgery, and we also attempt to define the safe and effective radiation dosage for the patients with AVM involving visual apparatus.