Concurrent Chemoradiation Therapy in Stage III Non-small Cell Lung Cancer

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),강기문(Ki Mun Kang),장지영(Jie Young Jang),문한림(Han Lim Mun),송정섭(Jung Sub Song),이선희(Sun Hee Lee),곽문섭(Mun Sub Kuak),신경섭(Kyung Sub Shinn) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.1

목 적 : 국소진행된 III기 비소세포성 폐암에서 방사선감작제로서의 저용량 Cisplatin과 방사선 동시병합요법의 효과를 알아보고자하여, 관해율, 전체생존율, 무병생존율 및 치료에 따른 부작용을 방사선 단독치료군과 후향적으로 비교분석하였다. 대상 및 방법 : 1992년 4월부터 1994년 3월까지 32명의 III기 비소세포성 폐암환자(IIIa 12명, IIIb 20명)가 항암제 및 방사선동시병합요법을 받았다. 방사선치료는 3000cGy/ 10회를 2주간에 걸쳐 시행한 뒤 3주후에 2500cGy/ 10회를 추가하였으며, 방사선감작제로 cis platin 6mg/m2를 매일 방사선치료 전에 정맥주사하였다. 추적관찰기간은 13개월에서 48개월로 중간값은 24개월이었다. 방사선단독치료군 32명(IIIa 13명, IIIb 19명)은 매일 170- 200cGy씩 총 5580- 7000cGy (중간값 5960cGy) 치료받았으며, 추적관찰기간은 36개월에서 105개월로 중간값은 62개월이었다. 결 과 : cis platin- 방사선동시요법군이 방사선 단독치료군에 비해 유의하게 높은완전반응률(18.8% vs . 5.6%)및 낮은 조사야내 재발율(25% vs . 47%)을 나타내었다. 2년 전체생존율은 Cisplatin- 방사선동시요법군이 17%, 방사선단독치료군이 9.4%로 유의한 차이는 보이지 않았다.국소재발 없는 2년 무병생존율(16.5% vs. 5.3%) 및 원격전이 없는 2년 무병생존율(17% vs. 4.6%)도 두군간에 유의한 차이를 보이지 않았다. 그러나 Karnofsky performance scale 80 이상인 환자군만을 대상으로 분석한 결과, cisplatin- 방사선동시요법군이 방사선단독치료군에 비해 유의하게 높은 2년 전체생존율을 보였다(62.5% vs. 15.6%). 전체생존율에 영향을 미치는 예후인자로 cisplatin- 방사선동시요법군에 있어서는 performance status 및 조직학적 진단유형(상피세포암 vs. 비상피세포암)으로 나타났고, 방사선단독치료군에 있어서는 performance status 및 병기(IIIa vs. IIIb)로 나타났다. 치료에 따른 급성부작용으로 RTOG/ECOG grade 2 이상의 오심, 구토는 cisplatin- 방사선동시요법군이 방사선단독치료군 (22% vs. 6%)에 비해 유의하게 높은 빈도를 나타내었다. Gra de 2 이상의 혈액학적 독성은 Cis platin- 방사선동시요법군에서 방사선단독치료군에 비해 높은 빈도를 나타내었다(25% vs. 15.6%). 방사선단독치료군에 비해 cis platin- 방사선동시요법군에서, RTOG/ECOG Grade 2 이상의 폐독성의 빈도(31% vs. 19%)나 WHO Grade 3 이상의 폐섬유화의 빈도(38% vs. 25%)의 유의한 증가는 관찰되지 않았다. 방사선치료부위의 면적이 200cm2 이상이었던 경우, 두군 모두에서 폐독성 빈도의 유의한 증가를 보였다. 결 론 : cisplatin- 방사선동시병합요법이 방사선단독치료군에 비해 높은 국소제어율을 나타내었으나, 전체생존율이나 무병생존율의 유의한 증가는 보이지 않았다. KPS 80이상인 환자군에 있어서는 cisplatin- 방사선동시요법군이 방사선단독군에 비해 높은 전체생존율을 보였다. cisplatin- 방사선동시병합요법군에서 급성부작용이 증가되는 경향을 보였으나, 방사선에 의한 폐독성의 유의한 증가는 관찰되지 않았다. cisplatin- 방사선동시병합요법군이 방사선단독치료군에 비해 1년 이내에 조기사망율이 높은 반면, 2년이상 장기생존율이 높은 경향을 보여, 이러한 환자군에 대한 장기적인 추적조사를 통해 생존율에 대한 본 치료의 영향을 좀더 명확하게 평가할 수 있을것으로 기대되며, 향후 치료효과를 증가시키기위해 large fraction size의 split course RT 대신 continuous course의 conventional RT 혹은 hyperfractionated RT와 Cisplatin의 동시병합요법 등이 고려되어야할 것으로 사료된다. Purpose : This study was tried to evaluate the potential be nefits of concurrent chemoradiation therapy (low dose daily cisplatin combined with split course radiation therapy) compared with conventional radiation thera py alone in stage III non- small cell lung cancer. The end points of analyses were responserate , overalls urvival, survival without locoregional failure , survival without distant metastasis , prognostic factors affecting survival and treatment related toxicities. Materials and Methods : Between April 1992 and March 1994, 32 patients who had stage III non-small cell lung cancer were treated with concurrent chemoradiation therapy. Radiation therapy for 2 weeks (300cGy given 10 times up to 3000cGy) followed by a 3 weeks rest period and then radiation therapy for 2 more weeks (250cGy given 10 times up to 2500cGy) was combined with 6mg/M2 of cisplatin. Follow-up period ranged from 13 months to 48 months with median of 24 months . Historical control group consisted of 32 patients who had stage III non-small cell lung cancer were received conventionally fractionated (daily 170- 200cGy) radiation therapy a lone. Total radiation dose ranged from 5580cGy to 7000cGy with median of 5940cGy. Follow-up period ranged from 36 months to 105 months with median of 62 months . Results : Complete reponse rate was higher in chemoradiation therapy (CRT) group than radiation therapy (RT) group (18.8% vs. 6.3%). CRT group showed lower in-field failure rate compared with RT group(25% vs. 47%). The overall survival rate had no significant differences in between CRT group and RT group(17.5% vs. 9.4% at 2 years). The survival without locoregional failure (16.5% vs. 5.3% at 2 years) and survival without distant metastas is (17% vs. 4.6% at 2 years) also had no significant differences . In subgroup analyses for patients with good performance status (Karnofsky performance scale 80), CRT group showed significantly higher overall survival rate compared with RT group (62.5% vs. 15.6% at 2 years). The prognostic factors affecting survival rate were performance status and pathologic subtype (squamous cell cancer vs. nonsquamous cell cancer) in CRT group. In RT alone group, performance status and stage (IIIa vs IIIb) were identified as a prognostic factors . RTOG/EORTC grade 2-3 nausea and vomiting(22% vs. 6%) and bone marrow toxicities (25% vs. 15.6%) were significantly higher in CRT group compared with RT alone group. The incidence of RTOG/EORTC grade 3-4 pulmona ry toxicity had no significant differences in between CRT group and RT group (16% vs. 6%). The incidence of WHO grade 3-4 pulmonary fibrosis also had no significant differences in both group(38% vs . 25%). In analyses for relationship of field size and pulmonary toxicity, the patients who treated with field size beyond 200cm2 had s ignificantly higher rates of pulmonary toxicities. Conclusion : The CRT group showed significantly higher local control rate than RT group. There were no significant differences of survival rate in between two groups. The subgroup of patients who had good performa nce status showed higher overall survival rate in CRT group than RT group. In spite of higher incidence of acute toxicities with concurrent chemoradiation therapy, the survival gain in subgroup of patients with good pe rformance status were encouraging. CRT group showed higher rate of early death within 1 year, higher 2 year survival rate compared with RT group. The refore, to evaluate the accurate effect on survival of concurrent chemoradiation therapy, systematic follow-up for long term survivors are needed.

HPLC를 이용한 지역 농산물의 비타민 B₆ 함량 분석

최소라 ( So-ra Choi ),송은주 ( Eun-ju Song ),송영은 ( Young-eun Song ),최민경 ( Min-kyung Choi ),한현아 ( Hyun-ah Han ),이인석 ( In-sok Lee ),신소희 ( So-hee Shin ),이기권 ( Ki-kwon Lee ),최용민 ( Young-min Choi ),김행란 ( Haeng-r 한국식품영양학회 2017 韓國食品營養學會誌 Vol.30 No.4

Contents of water soluble vitamin B6 in a total of 62 agricultural products cultivated in local areas in Korea were analyzed by high performance liquid chromatography with fluorescence detector (HPLC/FLD). To verify the method of vitamin B6 analysis, a quality control chart was formulated with in-house control using a mixture of broccoli and shiitake mushrooms. Among cereals, high content of vitamin B6 measured 234.3~260.3 μg/100 g in dried mung bean and soybean. Vitamin B6 content of non-glutinous and glutinous black rice measured 105.0 μg/100 g and 129.7 μg/100 g, respectively. In vegetables, high content of vitamin B6 were measured in passion fruit (104.3 μg/100 g), gat (55.7~84.3 μg/100 g), gomchwi (31.3~88.0 μg/100 g) and garlic (72.7~98.3 μg/100 g). Among fruits, gold kiwi 'Zespri' and green kiwi 'Hayward' revealed high vitamin B6 content of 116.3 μg/100 g and 78.7 μg/100 g, respectively. In persimmons, daebongsi had high vitamin B6 content (36.0~72.7 μg/100 g) than bansi and sweet persimmon. Vitamin B₆ content in dried jujube and persimmon increased more than 86.7 μg/100 g compared to fresh materials. Among specialty crops, green tea powder (64.7~251.0 μg/100 g) and sansuyu (172.3 μg/100 g) revealed high content. Of mushrooms, vitamin B6 content of Sparassis crispa (139.3 μg/100 g) was the highest. Vitamin B6 content information of agricultural products in local areas in Korea collected from this experiment will be used as valuable preliminary data for grasp national nutritional status.

개의 행동유전 : 고등동물 행동특질 유전의 연구 전략 Investigative strategy for the inheritance of behavioral traits in higher mammals

이인아,이춘길 한국심리학회 1996 한국심리학회지 생물 및 생리 Vol.8 No.1

신경과학과 분자유전학의 연구 기법의 발달로 인하여 이제 사람의 성격을 포함한 행동특질의 원인을 유전자 수준까지 추적하고 있다. 특히 1996년은 인간의 성격과 관련한 유전자를 최초로 규명하기 시작한 해였다. 본 논문은 행동의 기술을 토대로 행동의 다양성에 관한 유전적 배경을 정량적으로 분석하고자 했던 일련의 동물 행동유전에 관한 연구의 성과를 정리하였다. 개의 행동유전연구가 인간을 포함한 고등 동물의 행동특질의 유전적 바탕과 이의 생리적 표현 과정에 관한 연구의 전형이 될 수 있을 것으로 우리는 믿는 바, 개의 행동유전에 관한 연구에 중점을 두었다. 동시에 행동유전 연구의 결과를 해석하는데 제기될 수 있었던 다음과 같은 문제점들을 논의하였다: 1) 동물의 지각 체계에 관한 불충분한 이해와 이에 따른 결과 해석의 타당성 결여, 2) 동물행동 측정 절차의 주관성과 비정밀성, 3) 행동의 측정에 영향하는 동물과 실험자 간의 상호작용. 이러한 문제의 해결을 통하여, 고등동물의 행동유전학 모델로서의 개-행동유전학이 보다 과학적으로 진행되기 위해서는 1) 유전적 영향이 큰 행동특질과 그에 맞는 행동지표의 선정, 2) 행동측정의 정밀성 확보, 3) 개의 게놈에 대한 지식 축적 등이 필요함을 강조하였다. Following the seminal reports on genes affecting human personality in 1996, explosive number of reports relating genes and behavioral traits in higher mammals are expected to be witnessed in the near future. Successful genetic explanation of behavioral variablity should include mechanisms by which genotypes affecting behaviors are expressed. We reviewed controlled studies on canine behavioral genetics and proposed that canine behavioral genetics can be used as an experimental model for investigating the expression mechanisms of genes in determining the variablity of behavioral phenotypes in higher mammals. Problems in establishing inheritance factors in previous studies were discussed: 1) insufficient information on perceptual mechanisms of animal subjects, 2) subjective and imprecise measurement of animal behavior, 3) uncontrolled interactions between animals and experimenters. Suggestions were made for more rigorous studies of canine behavioral genetics: 1) identifying behavioral traits and indices reflecting genetic background, 2) precise measurement of behavior, 3) accumulating informations on dog genome.

일부 흡연 대학생의 지각된 스트레스와 흡연실태에 대한 상관관계 연구

강초록,권시내,권혜림,박수경,송인혜,오해인,이미지,한승아,황선아,김수지 이화여자대학교 간호과학대학 2003 이화간호학회지 Vol.- No.37

In spite of the seriousness of smoking harm has been developed these days. the increase of national smoking rate and that the people in the twenties are especially leading the rise of national smoking rate is an important issue of national health. Smoking of the university students can occur health problem and cause loss of manpower and expenses in their social activity period. So then the actual state for prevention of smoking and development of a program to prohibit smoking has to be seized urgently and starting with the study of the realities of university students, the effort to find a related fluent of smoking has to be studied. Related to this, the purpose of this study is to seize the general characteristics of smoking university students and to find out the relationship between perceived stress and smoking status among smoking university students. In addition, by collating the relationship between perceived stress and smoking status among smoking university students we have the purpose to furnish the basal data of stress care, the best way to cope with stress through group training and the plan for nursing implementation to decrease the smoking rate. For this study, a survey was conducted for 204 smoking university students of 13 universities in Seoul from 9th of May to 16th of May, 2003. The collected data was analyzed by t-test, Pearson Correlation and ANOVA in the statistical packages SPSS/PC. Major findings of this study are as follows; 1. Of the 204 respondents 85.4% of them were male and 14.6% of them were female. The average age of the sample was 23.19 years old and 41.8% of them were in senior, 21.4% in junior, 16.9% in sophomore, 19.9% in freshman grade. The major motivation to start smoking was 'because of curiosity'(33.8%) and the first smoking experience was at 'senior high school' (41.9%) and at 'college' (41.9%). 2 The highest scored stress factor of smoking university students were stresses about school work. 3. 72.7% had experience to quit smoking at least one or more times. Most of the reason to keep on smoking was 'short will to quit'(51.0%) and the smoking place was usually at 'school' (41.4%). Most respondents for the number ofsmoking friends were '5 people and above' (73.2%). 4. There was a negative relationship between the general characteristics and the entire perceived stress, however, there was a positive relationship between the general characteristics and the perceived stress in 4 categories which is 'sex distinction', 'major of study', 'residence form' and' inmate'. 5. There was a negative relationship between the general characteristics and the entire smoking status, however, there was a positive relationship between the general characteristics and the smoking status in 2 categories which is 'presence of hobby' and 'number of smoking friends'. 6. There was a negative relationship between the perceived stress and the smoking status. Through this study we have seized the relationship between the general characteristics, perceived stress and the smoking status of smoking university students. There was a positive relationship between some of the general characteristics with the perceived stress and the smoking status of smoking university students. Also there was a negative relationship between the perceived stress and the smoking status.

초등 과학 생명 영역 내용에 대한 학생들의 의문 유형과 해결방법에 관한 연구

임채성,최은아,박정인,이수진 부산교육대학교 과학교육연구소 2004 科學敎育硏究 Vol.29 No.-

In this study, the frequencies and types of questions about LIFE areas of the Science Curriculum of elementary school students were investigated through in-depth interviews with twelve 4th and 5th graders. The results of the research can be summarized as follows: (1) In conjectural question, the proportions of 'object exploration question' and 'object verification question' were high in all of the 4th graders and the students of low achievement level. (2) The numbers of causal questions generated by the 4th graders were much higher than those of the 5th graders. (3) The frequencies of the predictive, methodological, applicative questions were very low both in 4th and 5th grade students. (4) The numbers of conjectural questions were more in all students except the low achievement level of 4th graders at not-yet-taken contents than at already-taken ones. (5) The numbers of causal questions were more in all students except the low and middle achievement levels of 4th graders at not-yet-taken contents than at already-taken ones. (6) The numbers of the predictive, methodological, applicative questions of the 4th graders were more at not-yet-taken contents than at already-taken ones, whereas opposite trend in the 5th graders. (7) The numbers of students' curriculum-related questions were more in all students except the low and middle achievement levels of 4th graders at not-yet-taken contents than at already-taken ones. (8) As ways for solving or seeking answers about questions, the 4th graders suggested methods of consulting experts or teachers (23.9%), internet searching (21.6%), and books or science-related encyclopedia (20.3%), while the 5th graders suggested the internet searching (36.5%), consulting experts or teachers (24.8%), and books or science-related encyclopedia (17.7%). Based an these results, we suggest several ways for improving the question-posing abilities of the students and adequate use of students' questions in the process of science teaching learning.

Comprehensive Evaluation of the NeoBase 2 Non-derivatized MSMS Assay and Exploration of Analytes With Significantly Different Concentrations Between Term and Preterm Neonates

Lee Beomki,Heo Won Young,Kim Jee Ah,Lee Hyun-Seung,Hwang Narae,Park Hyung-Doo,Sung Se In,Chang Yun Sil,Park Won Soon,Lee Soo-Youn 대한진단검사의학회 2023 Annals of Laboratory Medicine Vol.43 No.2

Background: Despite the popularity of the NeoBase 2 Non-derivatized MSMS assay (PerkinElmer, Turku, Finland), there are no reports of its comprehensive evaluation, including the ability to distinguish transient tyrosinemia of the newborn (TTN) from tyrosinemia type 1 (TYR 1) using succinylacetone (SUAC). No newborn screening (NBS) cutoffs for preterm neonates in the Korean population have been suggested. We evaluated the NeoBase 2 assay and identified analytes requiring different cutoffs in preterm neonates. Methods: Residual NBS dried blood spot samples and proficiency testing (PT) materials of the Newborn Screening Quality Assurance Program and the Korean Association of External Quality Assessment Service were used. Precision, accuracy, limit of detection (LOD), lower limit of quantification (LLOQ), linearity, recovery, carryover, and performance of SUAC were evaluated. Cutoffs were determined, and analytes requiring different cutoffs in preterm neonates were investigated. Results: Mean CVs for within-run and between-day precision were within 15%. Accuracy analysis indicated high agreement with in-house derivatized assay results and results of other PT participants. All analytes demonstrated acceptable LOD, LLOQ, and linearity. Recoveries were acceptable, except for SUAC. Carryover was negligible. Cutoffs were established for all analytes; Tyr, adenosine, and C20:0-lysophosphatidylcholine required different cutoffs in preterm neonates. Differential diagnosis of TYR 1 and TTN was successful with simultaneous Tyr and SUAC measurement. Conclusions: The NeoBase 2 assay demonstrated satisfactory performance. The additional analytes provide a wider diagnostic coverage, and the simultaneous measurement of Tyr and SUAC is efficient in excluding TYR 1. The new cutoffs for preterm neonates may decrease false-positive rates, without compromising diagnostic sensitivity.

절개선을 활용한 직물의 신장변화에 관한 연구

이정숙,성수광,이인아 한국의류산업학회 2002 한국의류산업학회지 Vol.4 No.3

To propose a basic material that can improve the crumples in the knee area and can be applied as an element of garment design, the present study examined the elongation rates of the samples by differentiating the number of cutting lines according to the direction of the fabric, and then determined the puckering phenomenon by judging the conditions of the seams based on the looks of seam lines after bi-axil elongation. After the subjective evaluation on the knee areas of both the standard and modified trousers, the following conclusion was drawn : The elongation rates of the samples are: warp (3.98%)<warp1 (4.29%)<weft1 (5.30%)<weft (5.82%)<warp2 (5.68%)<bias (6.96%)<weft2 (8.64%). The samples in the warp direction: as the cutting lines increase, the elongation rate grows by 1.4%. The elongation rates of the samples in the weft direction: the sample with one cutting line has 0.52% lower rate than that in the weft direction without cutting line; that with two cutting lines has 1.68% higher rate than that running on the bias. The subjective evaluation on the knee areas: the subjects wearing the standard trousers feel more comfortable when sitting on a chair (0.2) >cross-legged (-0.2) > squatting down (-0.4); those in the modified trousers feel more comfortable when sitting on a chair (0.2) > cross-legged (0)> squatting down (-0.6). In the cross-legged posture, the modified trousers (0) has higher scores in the subjective evaluation than the standard ones (-0.2). The evaluation on the looks of needleworks in the samples with cutting lines along the direction of the fabric: weft2 (5.0)<weft1 (4.8)<warp1 (3.8)<warp2 (2.8).

The Implication of Cardiac Injury Score on In-hospital Mortality of Coronavirus Disease 2019

Kim In-Cheol,Song Jin Eun,Lee Hee Jung,Park Jeong-Ho,Hyun Miri,Lee Ji Yeon,Kim Hyun Ah,Kwon Yong Shik,Park Jae Seok,윤종찬,Hwang Jongmin,Lee Cheol Hyun,Cho Yun-Kyeong,Park Hyoung-Seob,Yoon Hyuck-Jun,Nam 대한의학회 2020 Journal of Korean medical science Vol.35 No.39

Backgrounds: The severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) has spread worldwide. Cardiac injury after SARS-CoV-2 infection is a major concern. The present study investigated impact of the biomarkers indicating cardiac injury in coronavirus disease 2019 (COVID-19) on patients' outcomes. Methods: This study enrolled patients who were confirmed to have COVID-19 and admitted at a tertiary university referral hospital between February 19, 2020 and March 15, 2020. Cardiac injury was defined as an abnormality in one of the following result markers: 1) myocardial damage marker (creatine kinase-MB or troponin-I), 2) heart failure marker (N-terminal-pro B-type natriuretic peptide), and 3) electrical abnormality marker (electrocardiography). The relationship between each cardiac injury marker and mortality was evaluated. Survival analysis of mortality according to the scoring by numbers of cardiac injury markers was also performed. Results: A total of 38 patients with COVID-19 were enrolled. Twenty-two patients (57.9%) had at least one of cardiac injury markers. The patients with cardiac injuries were older (69.6 ± 14.9 vs. 58.6 ± 13.9 years old, P = 0.026), and were more male (59.1% vs. 18.8%, P = 0.013). They showed lower initial oxygen saturation (92.8 vs. 97.1%, P = 0.002) and a trend toward higher mortality (27.3 vs. 6.3%, P = 0.099). The increased number of cardiac injury markers was significantly related to a higher incidence of in-hospital mortality which was also evidenced by Kaplan-Meier survival analysis (P = 0.008). Conclusion: The increased number of cardiac injury markers is related to in-hospital mortality in patients with COVID-19.

정부주도 대학평가의 쟁점과 과제: 박근혜정부를 중심으로

이인수(Lee In Su),서경화(Seo Kyung Wha),강재혁(Kang Jae Hyeok),장아름(Jang Ah reum),윤기현(Yoon Ki hyun),이예슬(Lee Ye seul),김미란(Kim Mi ran) 고려대학교 교육문제연구소 2017 敎育問題硏究 Vol.30 No.1

The purpose of this paper is to examine and to draw out the issues and the implications of systematic improvement based on the CK, ACE, LINC, BK, PRIME and university restructuring. In terms of evaluation objective, contents, method and utilization, The issues analysis of the governmental funding projects give the implication to systematic improvement of the governmental funding projects in higher education as follow. First, the objective of governmental funding projects in higher education should be established to lead the whole university community to work out change and innovation. Second, the minimal standard of evaluation method and process should be established to decrease the evaluation burden and a new evaluation indicator should be developed to consider each university characteristics. Third, the evaluation process should be organized with long term point of view to support enough for the university itself to prepare the evaluation. Finally, an in-depth research on the evaluation utilization are needed to manage the achievement of the governmental funding projects in higher education and to develop the identity and the autonomy of university. 본 연구는 박근혜정부의 대학 특성화사업(CK), 학부교육 선도대학 육성사업(ACE), 산학협력선도대학 사업(LINC), 두뇌한국 21 플러스 사업(BK21 PLUS), 산학연계 교육활성화 선도대학 사업(PRIME) 및 대학구조개혁평가를 중심으로 정부주도 대학 평가의 쟁점과 과제를 논의하였다. 평가의 목표, 내용, 방법, 결과활용 측면에서 분석한 결과, 목표의 수월성 의 관점 편중, 평가지표의 유사성으로 인한 수혜의 중복과 정성평가의 객관성 및 공정성에 관한 문제, 대학 구성원 간의 합의의 부재와 자금 위주의 정책수단의 한계점, 정부 대학평가의 효과성과 지속성 쟁점이 도출되었다. 쟁점을 바탕으로 다음과 같은 과제가 도출되었다. 첫째, 대학사회 전체의 변화와 혁신을 일으키는 방향으로 목표가 설정되어야 한다. 둘째, 각 사업의 특성과 대학의 유형을 반영한 차별화된 평가기준을 중심으로 선택지표를 개발해야한다. 셋째, 대학구성원들에게 적합한 합리적인 정책수단을 활용하여 정책 효과성을 높여야 한다. 마지막으로 대학의 정체성과 자생력을 길러주는 방향으로 결과가 활용되어야 한다.

국소재발된 두경부종양의 무고정틀 정위적 분할방사선치료

김인아(In Ah Kim),최일봉(Ihl Bhong Choi),장지영(Ji Young Jang),강기문(Ki Mun Kang),조승호(Seung Ho Jho),김형태(Hyung Tae Kim),이경진(Kyung Jin Lee),최창락(Chang Rak Choi) 대한두경부종양학회 1998 대한두경부 종양학회지 Vol.14 No.2

Background & Objectives: Frameless fractionated stereotactic radiotherapy(FFSRT) is a modification of stereotactic radiosurgery(SRS) with radiobiologic advantage of fractionation without losing mechanical accuracy of SRS. Local recurrence of head and neck cancer at or near skull base benefit from reirradiation. Main barrier to successful palliation is dose limitation secondary to normal tissue tolerance. We try to evaluate the efficacy and safety of FFSRT as a new modality of reirradaton in these challenging patients. Materials & Methods: Seven patients with recurrent head & neck cancer involving at or near skull base received FFSRT from September 1995 to November 1997. Six patients with nasopharyngeal cancer had received induction chemotherapy and curative radiation therapy. One patient with maxillary sinus cancer had received total maxillectomy and postoperative radiation therapy as a initial treatment. Follow-up ranged from 11 to 32 months with median of 24 months. Three of 7 patients received hyperfractionated radiation therapy(1.1-1.2Gy/fraction, bid, total 19.8-24Gy) just before FFSRT. All patients received FFSRT(3-5Gy/fraction, total 15-30Gy/5-10fractions). Chemotherapy(cis-platin 100mg/m(2)) were given concurrently with FFSRT in four patients. Second course of FFSRT were given in 4 patients with progression or recurrence after initial FFSRT. Because IF(irregularity factor; ratio of surface area of target to the surface area of sphere with same volume as a target) is too big to use conventional stereotactic RT using multiple arc method for protection of radiation damage to critical normal tissue, all patients received FFSRT with conformal method using irregular static ports. Results: Five of 7 patients showed complete remission in follow-up CT &/or MRI. Three of these five patients who developed marginal, in-field, and out-field recurrences, respectively. Another one of complete responders has been dead of G-I bleeding without evidence of local recurrence. One partial responder who showed progressive disease 15 months after initial FFSRT has received additional FFSRT, and then he is well-being with symptomatic improvement. One minmal responder who showed progression of locoregional disease 9 months after 1st FFSRT has received 2nd FFSRT, and then he is alive with stable disease. Five of 7 case had showed direct invasion to skull base and had complaint headache and various symptoms of cranial nerve involvement. Four of these five case showed improvement of neurologic symptoms after FFSRT. No significant neurologic complicaltion related to FFSRT was observed during follow-up periods. Tumor volumes were ranged from 3.9 to 50.7 cc and surface area ranged from 16.1 to 114.9cm(2). IF ranged from 1.21 to 1.74. The average ratio of volume of prescription isodose shell to target volume was 1.02 that indicated the improvement of target coverage and dose distribution with FFSRT with conformal method compared to target coverage with FFSRT with multiple arc method. Conclusion: Our initial experience suggests that FFSRT with conformal method was relatively effective and safe modality in the treatment of recurrent head and neck cancer involving at or near skull base. Treatment benefit included good palliation of symptoms and reasonable radiographic response. However, more experience and additional follow-up are needed to better assess its ultimate role in treating these challenging patients.