Ultrasonography of intrascrotal torsed appendages: size and interval between symptom onset and the ultrasonographic examination according to echogenicity

Purpose@#This study investigated the size of torsed appendages and the interval between symptom onset and the ultrasonographic examination according to the echogenicity of the torsed appendages. @*Methods@#This was a retrospective analysis of 54 cases in 46 patients with torsion of the testicular appendages between December 2008 and July 2021. Eight patients received follow-up ultrasonography 7-48 days after initial ultrasonography. The echogenicity of torsed appendages was classified into three groups: hypoechoic, hyperechoic, or isoechoic. @*Results@#The 54 torsed appendages were hypoechoic (n=40), hyperechoic (n=9), or isoechoic (n=5). The size of the torsed appendages ranged from 4 to 14 mm (8.0±3.1 mm) in hypoechoic torsed appendages and from 2.6 to 5.0 mm (3.7±0.9 mm) in hyperechoic torsed appendages. The interval between symptom onset and the ultrasonographic examination ranged from 0 to 17 days (4.2±4.4 days) in hypoechoic torsed appendages and from 8 to 48 days (29.8±16.0 days) in hyperechoic torsed appendages. The hyperechoic torsed appendages were smaller and had longer intervals between symptom onset and the ultrasonographic examination than the hypoechoic torsed appendages (P<0.05). Three hypoechoic torsed appendages and a single isoechoic torsed appendage on initial ultrasonography became hyperechoic on follow-up ultrasonography. @*Conclusion@#The size of the torsed appendages and the interval between symptom onset and the ultrasonographic examination varied according to the echogenicity of the torsed appendages. The hyperechoic torsed appendages were smaller and had longer intervals until the examination than the hypoechoic torsed appendages.

Lobular Capillary Hemangioma of the Hypopharynx / 대한이비인후과학회지

Lobular capillary hemangioma (LCH) is a rapidly growing benign vascular neoplasm of unknown etiology. LCH usually occurs on the cutaneous and mucosal surfaces, such as gingiva, lips, fingers, and face. LCH was previously called ‘pyogenic granuloma (PG),’ because it was thought to be granulation of tissue occurring in reaction to an infectious etiology despite the fact that it demonstrates no infectious signs in histology or microbiology. Instead, its features seem more like angiomatous lesions rather than granulomatous lesions, so the term ‘LCH’ has been used thereafter. Reports of LCH of hypopharynx have been rare. Here we report a 63-yearold male patient with LCH of hypopharynx with a review of related literature.

Transcriptomic Analysis of Papillary Thyroid Cancer: A Focus on Immune-Subtyping, Oncogenic Fusion, and Recurrence

Objectives@#. Thyroid cancer is the most common endocrine tumor, with rapidly increasing incidence worldwide. However, its transcriptomic characteristics associated with immunological signatures, driver fusions, and recurrence markers remain unclear. We aimed to investigate the transcriptomic characteristics of advanced papillary thyroid cancer. @*Methods@#. This study included 282 papillary thyroid cancer tumor samples and 155 normal samples from Chungnam National University Hospital and Seoul National University Hospital. Transcriptomic quantification was determined by high-throughput RNA sequencing. We investigated the associations of clinical parameters and molecular signatures using RNA sequencing. We validated predictive biomarkers using the Cancer Genome Atlas database. @*Results@#. Through a comparison of differentially expressed genes, gene sets, and pathways in papillary thyroid cancer compared to normal tumor-adjacent tissue, we found increased immune signaling associated with cytokines or T cells and decreased thyroid hormone synthetic pathways. In addition, patients with recurrence presented increased CD8+ T-cell and Th1-cell signatures. Interestingly, we found differentially overexpressed genes related to immune-escape signaling such as CTLA4, IDO1, LAG3, and PDCD1 in advanced papillary thyroid cancer with a low thyroid differentiation score. Fusion analysis showed that the PI3K and mitogen-activated protein kinase (MAPK) signaling pathways were regulated differently according to the RET fusion partner genes (CCDC6 or NCOA4). Finally, we identified HOXD9 as a novel molecular biomarker that predicts the recurrence of thyroid cancer in addition to known risk factors (tumor size, lymph node metastasis, and extrathyroidal extension). @*Conclusion@#. We identified a high association with immune-escape signaling in the immune-hot group with aggressive clinical characteristics among Korean thyroid cancer patients. Moreover, RET fusion differentially regulated PI3K and MAPK signaling depending on the partner gene of RET, and HOXD9 was found to be a recurrence marker for advanced papillary thyroid cancer.

Treatment Outcome of Scalp Angiosarcoma: A Single Institute Experience / 대한이비인후과학회지

Background and Objectives@#Scalp angiosarcoma is a rare but aggressive vascular malignancy. It is often found in the advanced state and tends to cause distant metastasis at an early stage. There is no consensus on a treatment modality, although wide excision followed by adjuvant therapy is currently used. The purpose of this study was to analyze the treatment results and disease progress pattern of scalp angiosarcoma in a single institution.Subjects and Method We enrolled patients who diagnosed with scalp angiosarcoma at Asan Medical Center from March 2011 to September 2019. Disease course and prognostic factors were analyzed by estimating overall survival rate and disease free survival. @*Results@#A total 12 patients were enrolled in this study. The median overall survival was 16.0 months. The 3-year-survival rate was 10.6%, and the median disease free survival was 5.0 months. On the average, it took 11.4 months till death after recurrence. @*Conclusion@#Although wide surgical excision and multiple adjuvant therapies are employed, scalp angiosarcoma showed frequent recurrences and metastasis which led to poor outcomes. Further investigations for scalp angiosarcoma are necessary to improve treatment outcomes.

Unilateral Vocal Cord Palsy Caused by Cervical Osteophyte / 대한이비인후과학회지

Cervical osteophytes are bone spurs that grow on any part of the cervical spine. Osteophytes in the spine are a normal sign of aging and can be associated with conditions such as degenerative disc diseases, osteoarthritis, spinal stenosis, and others. When cervical osteophytes become large enough, main symptoms can include neck pain, radicular pain, neurological problems, and sometimes dysphagia, as well as hoarseness in rare cases. The authors report a case of left vocal cord palsy in a 75-year-old male patient with a large cervical osteophyte with a left anterior protrusion in the C5/C6 level.

BaSDAS: a web-based pooled CRISPR-Cas9 knockout screening data analysis system

We developed the BaSDAS (Barcode-Seq Data Analysis System), a GUI-based pooled knockout screening data analysis system, to facilitate the analysis of pooled knockout screen data easily and effectively by researchers with limited bioinformatics skills. The BaSDAS supports the analysis of various pooled screening libraries, including yeast, human, and mouse libraries, and provides many useful statistical and visualization functions with a user-friendly web interface for convenience. We expect that BaSDAS will be a useful tool for the analysis of genome-wide screening data and will support the development of novel drugs based on functional genomics information.

BaSDAS: a web-based pooled CRISPR-Cas9 knockout screening data analysis system

We developed the BaSDAS (Barcode-Seq Data Analysis System), a GUI-based pooled knockout screening data analysis system, to facilitate the analysis of pooled knockout screen data easily and effectively by researchers with limited bioinformatics skills. The BaSDAS supports the analysis of various pooled screening libraries, including yeast, human, and mouse libraries, and provides many useful statistical and visualization functions with a user-friendly web interface for convenience. We expect that BaSDAS will be a useful tool for the analysis of genome-wide screening data and will support the development of novel drugs based on functional genomics information.

Change of Pain, Lumbar Sagittal Alignment and Multifidus after Sling Exercise Therapy for Patients with Chronic Low Back Pain

PURPOSE: This study examined the effects of sling exercise therapy on vertebral alignment, VAS, muscle activity, and multifidus of patients with chronic low back pain. METHODS: Simple random sampling was used to divide the patients (n=116) into the sling exercise therapy group (SETG) and conservative physical therapy group (CPTG), with each group provided a intervention program in 3 sessions a week for 12 weeks. The lumbar lordosis angle (LLA), lumbar intervertebral disc angle (LIVDA) for vertebral alignment, lumbar muscle activity, and multifidus atrophy were measured before and after the intervention. RESULTS: SETG showed significant changes in LLA, LIVDA of rate of change (delta score), and in relieving pain. The right-left balance gap for the lumbar dynamic muscle activity decreased after the intervention. The SETG showed significant changes in the grade of lumbar multifidus atrophy. CONCLUSION: The sling exercise therapy program is an effective exercise therapy method on vertebral alignment, muscle activity, recovery from multifidus atrophy, and pain relief for patients with chronic low back pain.

A ChIP-Seq Data Analysis Pipeline Based on Bioconductor Packages

Nowadays, huge volumes of chromatin immunoprecipitation-sequencing (ChIP-Seq) data are generated to increase the knowledge on DNA-protein interactions in the cell, and accordingly, many tools have been developed for ChIP-Seq analysis. Here, we provide an example of a streamlined workflow for ChIP-Seq data analysis composed of only four packages in Bioconductor: dada2, QuasR, mosaics, and ChIPseeker. ‘dada2’ performs trimming of the high-throughput sequencing data. ‘QuasR’ and ‘mosaics’ perform quality control and mapping of the input reads to the reference genome and peak calling, respectively. Finally, ‘ChIPseeker’ performs annotation and visualization of the called peaks. This workflow runs well independently of operating systems (e.g., Windows, Mac, or Linux) and processes the input fastq files into various results in one run. R code is available at github: https://github.com/ddhb/Workflow_of_Chipseq.git.

Comparisons of Subthreshold Versus Full Posttraumatic Stress Disorder Distinguished by Subjective Functional Impairment Among Train Drivers: A Population-Based Nationwide Study in South Korea

OBJECTIVE: Subthreshold posttraumatic stress disorder (SPTSD), a condition that meets the full symptomatic criteria of posttraumatic stress disorder (PTSD) without subjective functional impairment, has yet to be fully investigated. In this study, we aimed to determine the prevalence and characteristics of SPTSD. METHODS: The web-based survey including psychiatric diagnosis and experience of human error was conducted in actively working train drivers in South Korea. RESULTS: Of the 4,634 subjects, 103 (2.23%) were categorized as full PTSD and 322 (6.96%) were categorized as having SPTSD. Individuals with full PTSD showed higher impulsivity and anxiety compared to those with SPTSD and those without PTSD, while those with SPTSD had more frequent clinically meaningful depression, posttraumatic stress, and alcohol and nicotine dependence and significant human error. CONCLUSION: Despite not qualifying as a subjective functional disability, SPTSD still had significant psychiatric symptoms. More clinical attentions need to be given to the diagnosis and treatment of SPTSD.

Ultrasonographic diagnosis of ovary-containing hernias of the canal of Nuck

PURPOSE: The purpose of this study is to describe the ultrasonographic findings of ovary-containing hernias of the canal of Nuck. METHODS: This was a retrospective analysis of 22 hernia cases of the canal of Nuck. The following gray scale and color Doppler ultrasonographic features were analyzed: the site and the size of the hernia, the texture of the hernia contents, and the presence or absence of blood flow in the hernia contents. RESULTS: All of the patients had swelling of the right inguinal region (n=10), left inguinal region (n=8), or both (n=2). On ultrasonography, the hernias appeared as either solid masses (n=17) or solid masses containing cysts (n=5). The mean anteroposterior diameter of the hernia sac of the canal of Nuck was 9.1 mm (range, 5 to 18 mm). The mean anteroposterior diameters of the hernia sac were 11.6 mm (range, 7.6 to 18 mm) for hernias containing an ovary, and 8.3 mm (range, 5 to 13 mm) for hernias containing omental fat. During surgery, among the 17 cases with solid-appearing hernia contents on ultrasonography, omental fat was identified in the hernia sac in four cases, but no structure was identified in 13 cases. All five cases that appeared as solid masses containing cysts on ultrasonography contained ovary tissue in the hernia sac. Among the four cases of ovary-containing hernias, color Doppler ultrasonography identified blood flow within the ovary in three cases, but no flow signal was seen in one case of incarcerated hernia. CONCLUSION: Ultrasonography may be helpful for the diagnosis of ovary-containing hernias of the canal of Nuck by detecting solid masses containing small cysts.

The Usefulness of Stereotactic Radiosurgery for Radioresistant Brain Metastases

OBJECTIVE: We investigated the effectiveness of stereotactic gamma knife Radiosurgery (GKR) for radioresistant brain metastases with the impact upon histology. METHODS: Between April 2004 and May 2011, a total of 23 patients underwent GKR for 67 metastatic brain tumors from 12 renal cell cancers, 5 sarcomas and 6 melanomas. The mean age was 56 years (range, 18 to 79 years). Most of the patients were classified as the Radiation Therapy Oncology Group recursive partitioning analysis class II (91.3%). The synchronous metastasis was found in 6 patients (26.1%) and metachronous metastasis in 17 patients (73.9%). We analyzed the local control rate, intracranial progression-free survival (PFS) and overall survival (OS). RESULTS: The mean tumor volume for GKR was 2.24 cc and the mean prescription dose was 19.4 Gy (range, 10 to 24) to the tumor margin. Out of metachronous metastases, the median duration to intracranial metastasis was 3.3 years in renal cell cancer (RCC), 2.4 years in melanoma and 1.1 years in sarcoma (p=0.012). The total local control rate was 89.6% during the mean 12.4 months follow-up. The six-month and one-year local control rate was 90.2% and 83% respectively. Depending on the pathology, the control rate of RCC was 95.7%, sarcoma 91.3% and melanoma 80.5% during the follow-up. The common cause of local failure was the tumor bleeding in melanoma. The median PFS and OS were 5.2 and 8.4 months in RCC patients, 6.5 and 9.8 months in sarcoma, and 3.8 and 5.1 months in melanoma. CONCLUSION: The GKR can be one of the effective management options for the intracranial metastatic tumors from the radioresistant tumors. The melanoma showed a poor local control rate compared to other pathologies because of the hemorrhage.

Use of Dietary Supplements in Cancer Patients / 가정의학회지

BACKGROUND: Dietary supplements (DS) have been increasingly utilized as a way of the promoting health and complementary therapy. This study aimed to evaluate the patterns of dietary supplement use in Korean cancer patients and to examine the related factors. METHODS: Between April and May of 2008, 366 patients who were hospitalized for diagnosis and treatment of cancer in a university affiliated tertiary hospital were surveyed using a self-administered structured questionnaire after receiving written informed consent. Among them, 322 patients with adequate answers were fi nally included. RESULTS: Two hundred forty patients (72.3%) reported to have ever taken DS with the mean number of 3.6 +/- 2.98. Vitamins were the most frequently used, followed by ginseng steamed red, ginseng, and glucosamine. The most infl uential factor regarding DS use was the recommendation by family members or relatives. The main reason for DS use was for resolution of fatigue, followed by supplementation of therapy, and immune enhancement. Information concerning DS most eager to know about was the effect of DS (44.6%), followed by interaction of DS with therapeutics (33.2%). Doctor (74.4%) was the most preferred health care provider to be consulted concerning DS, but only 34% of DS users have actually consulted with a doctor. Multiple logistic regression analysis showed that increasing age, Catholicism, and higher educational level were associated with higher use of DS. CONCLUSION: DS use was very prevalent in cancer patients. In spite of the great need, only small proportion of cancer patients using DS has consulted with a doctor.

Effect of Cancer Diagnosis on Smoking Behavior / 가정의학회지

BACKGROUND: Smoking is universally recognized as the foremost preventable cause of cancer. And smoking behavior causes many negative effects in cancer patients. Based on the mounting evidence that smoking affects cancer treatment outcomes and survival, we studied whether the cancer diagnosis affects smoking behavior. METHODS: During August 2007, 279 patients who were hospitalized with the diagnosis of cancer were surveyed by a questionnaire and a follow up survey was performed at 3 months and 7 months afterwards. Follow up survey was performed via telephone and finally 246 patients were enrolled. Questions in the survey included smoking history, nicotine dependence, stage of change and the reason for quit smoking or keep smoking. In the follow up survey at 7 month, we asked whether they needed smoking cessation interventions. RESULTS: At the end of the study, the subjects who kept smoking were 27 patients, but the degree of nicotine dependence was decreased compared to the preceding 2 surveys and contemplation as well as preparation stage turned out to be the most prevalent stage of change. The main reasons to keep smoking were behavioral habits and stress. Regardless of their smoking history, almost all cancer patients wanted smoking cessation interventions. CONCLUSION: Smoking is a critical variable that affects cancer treatment and outcome. We surely found there is a smoking subgroup after cancer diagnosis and we should advise them to quit smoking.

The Effect of Thermo-undulation Therapy on the Patients with Chronic Low Back Pain

OBJECTIVE: To verify the effect of thermo-undulation therapy on the patients with chronic low back pain. METHOD: 115 patients with back pain (mean age: 51.2 year-old; male, female: 46, 69) were recruited. Experimental group (n=85) was subjected to thermo-undulation therapy for 30 minutes, once a day, five days a week during eight weeks and control group (n=30) was administered with sham procedure. Before and after the therapy, range of motion (ROM) the spine and flexibility of lower extremity muscles were evaluated with goniometry. The functional status was measured by Roland Morris disability questionnaire and quality of life was measured by the SF-36 (36-Item Short Form Health Survey Instrument) and SF-12 scales. The STAI-6 (Spielberger State-Trait Anxiety Inventory) was used for anxiety. We checked the intensity of pain by visual analog scale (VAS) and evaluated the effect of far-infrared ray with Digital Infrared Thermographic Imaging (DITI) technique. RESULTS: After therapy, the scores of muscle flexibility, spine ROM, VAS, Roland Morris disability questionnaire, SF-36, SF-12 and STAI-6 showed a tendency to improve in experimental group (p0.05). Only the temperature differences of experimental group by DITI were significantly lower than those of control group (p<0.05). CONCLUSION: Thermo-undulation therapy may be an adjuvant therapy for chronic low back pain.

Graded Spinal Cord Contusive Rat Model by a Weight-drop Device

OBJECTIVE: To investigate the reproducibility of graded spinal cord contusion by a weight-drop device, and to establish a graded spinal cord contusive rat model based on the functional analysis and morphometric measurement. METHOD: The weight-drop device developed was composed of impactor with a guidance rod, stereotaxic frame and spine stabilizing device. We investigated the reproducibility of impact by reliability analysis two weeks later. Thirty Sprague-Dawley rats were injured by the weight-drop device from the height of 12.5, 25.0 and 50.0 mm. The three groups of each drop-height (n=10) as well as laminectomized sham group (n=10) were subjected to functional analysis by Basso Beattie Bresnahan Locomotor Scales (BBB scales) and inclined plane test after contusion for four weeks. The morphometric measurement was performed at regularly spaced intervals including the epicenter according to the graded drop-height. RESULTS: The impact of weight-drop was significantly increased according to the drop-height (p <0.05) and revealed high reproducibility. The changes of BBB scales and maximal angle of inclination had an inverse correlation with the contusion severity (p <0.05). There was an inverse correlation between the amount of residual white matter and drop-height (p <0.05). CONCLUSION: The weight-drop device newly developed provides a constant and reproducible spinal cord contusion model.

The Significance of Evoked Potentials according to the Injury Severity of Spinal Cord Contusive Rat Model

OBJECTIVE: To investigate the prognostic values of somatosensory evoked potential (SEP) and electric motor evoked potential (eMEP) studies according to the varying spinal cord injury by incremental height of weight-drop impactor and progress of functional recovery METHOD: Thirty Sprague-Dawley rats (300+/-50 grams, male) were used. The spinal cord injury was made by weight-drop device from 12.5, 25.0 and 50.0 mm height at T10 cord segment. The three groups of each drop-height (n=10) and laminectomized sham group (n=10) were subjected to functional analysis using inclined plane test and Basso Beattie Bresnahan (BBB) locomotor scales at the 1, 3, 5, 7, 14, 21 and 28th day after the contusive injury. SEP by sciatic nerve stimulation and eMEP at the gastrocnemius muscle were recorded. RESULTS: Maximal angle of inclination and BBB scales had an inverse relation with the contusion severity (p <0.05). There were significant correlations among the changes of peak latencies and amplitudes of SEP, contusion severity, and the motor recovery (p <0.05). The changes of onset latencies and amplitudes of eMEP were significantly correlated with the contusion severity and the motor recovery (p <0.05). CONCLUSION: The SEP and eMEP studies had significant values according to the contusion severity and functional recovery in contusive rat model of the spinal cord.

Effect of Passy-Muir Speaking Valve in Brain-injured Patients with Dysphagia: Two cases report

It is well known that the brain-injured patients with tracheostomy is prone to frequent tracheopulmonary aspiration and dysphagia problems. We experienced two brain-injured patients with dysphagia, who revealed the improvement of clinical and videofluoroscopic parameters after application of Passy-Muir speaking valve (PMV 2000(R), Passy-Muir Inc., USA). Two brain-injured patients had kept on nasogastiric and tracheostomy tubes. After PMV application for 2 weeks, the frequency of aspiration decreased, sleep hygiene and emotional lability improved, and also videofluoroscopic parameters such as pharyngeal delay time, pharyngeal transit time, and epiglottic closure were improved. Eventually, they could be free from tracheostomy tubes within 1 month after PMV application.

Qualitative and Quantitative Measurement of Human Brain Activity Using Pixel Subtraction Algorithm

PURPOSE: To develop an automated quantification program, which is called FALBA (Functional & Anatomical Labeling of Brain Activation), and to provide information on the brain centers, brain activity (%) and hemispheric lateralization index on the basis of a brain activation map obtained from functional MR imaging. MATERIALS AND METHODS: The 3-dimensional activation MR images were processed by a statistical parametric mapping program (SPM99, The Wellcome Department of Cognitive Neurology, University College London, UK) and MRIcro software (www.mricro.com). The 3-dimensional images were first converted into 2-dimensional sectional images, and then overlapped with the corresponding T1-weighted images. Then, the image dataset was extended to -59 mm to 83 mm with a 2 mm slice-gap, giving 73 axial images. By using a pixel subtraction method, the differences in the R, G, B values between the T1-weighted images and the activation images were extracted, in order to produce black & white (B/W) differentiation images, in which each pixel is represented by 24-bit R, G, B true colors. Subsequently, another pixel differentiation method was applied to two template images, namely one functional and one anatomical index image, in order to generate functional and anatomical differentiation images containing regional brain activation information based on the Brodmann's and anatomical areas, respectively. In addition, the regional brain lateralization indices were automatically determined, in order to evaluate the hemispheric predominance, with the positive (+) and negative (-) indices showing left and right predominance, respectively. RESULTS: The manual counting method currently used is time consuming and has limited accuracy and reliability in the case of the activated cerebrocortical regions. The FALBA program we developed was 240 times faster than the manual counting method: -10 hours for manual accounting and -2.5 minutes for the FALBA program using a Pentium IV processor. Compared with the FALBA program, the manual quantification method showed an average error of 0.334+/-0.007 (%). Thus, the manual counting method gave less accurate quantitative information on brain activation than the FALBA program. CONCLUSION: The FALBA program is capable of providing accurate quantitative results, including the identification of the brain activation region and lateralization index with respect to the functional and anatomical areas. Also, the processing time was dramatically shortened in comparison with the manual counting method.

Postmastectomy Radiotherapy and Chemotherapy in Patients with Breast Cancer / 대한방사선종양학회지

PURPOSE: To evaluate the treatment outcomes after postmastectomy radiotherapy (PMRT) and chemotherapy in patients with breast cancer. MATERIALS AND METHODS: The PMRT were retrospectively analyzed in 83 patients with stage II-III female breast cancer treated between 1989 and 1995. The median age was 46 years (range, 23-77); Seventy- seven patients had modified radical mastectomies, 5 radical mastectomies and 1 simple mastectomy. Three patients (4%) had pathologically negative axillae, and the remaining 80 (96%) had positive axillae. Eleven, 23, 44 and 5 patients had pathological stages IIA, IIB, IIIA, and IIIB, retrospectively. Eighty (96%) patients were treated with hockey-stick fields. The median dose of PMRT was 50.4 Gy, in 1.8 Gy fractions. Adjuvant systemic chemotherapy was given to 74 patients (89%). CMF-based or doxorubicin-containing regimens were given to 54 patients (65%). The median follow-up time was 82 months (range, 8-171) after the mastectomy. RESULTS: The 5 and 10-year overall survival rates for all patients were 65 and 49%, respectively. The univariate and multivariate analyses of the factors affecting the overall survival revealed the stage to be the most significant prognostic factor (p=0.002), followed by the combination of chemotherapy. Thirteen patients (16%) developed a LRF, at an interval of 4-84 months after radiotherapy, with a median of 20 months. The only significant prognostic factor affecting LRF was the combination of chemotherapy, in both the univariate and multivariate analyses. With respect to the sequence of chemoradiation, the sequence had no statistical significance (p=0.90). According to the time interval from mastectomy to the onset of radiotherapy, the LRFR of the patients group treated by RT within or after 6 month postmastectomy 6 months were 14 vs. 27%, respectively (p=0.24). One third of the patients (26/83) developed distant metastasis, in 2-92 months, after radiotherapy, with a median of 21 months. The most commonly involved site was bone in 13 cases. The pathological staging was the only significant prognostic factor in both the univariate and multivariate analyses that affected distant failure. Radiological findingof radiation pneumonitis on a simple chest x-ray was shown in 20% (17/83), with a time interval ranging from 2 to 7 months post-radiotherapy, with a median of 3 months. The stable lung fibrosis settled in 11 patients (65%). CONCLUSIONS: It was concluded through this analysis that the combination of PMRT with in chemotherapy resulted in better overall survival and local control than PMRT alone in patients needing PMRT.