中等學校 家政科 實驗學習 敎員ㆍ設備基準의 適正性에 關한 硏究

강혜숙,윤인경 한국 가정과 교육 학회 1993 한국가정과교육학회지 Vol.5 No.-

Because of the specificity of subjects belong to middle school curriculum of Home Economics Education of function training is very important. But it pointed out that the existing standards are out-dated, and because of it, it incongruent to our realities. Therefore, whenever the curriculum of education and the national textbook are reorgrnized periodically, the reform of standards of educational materials & facilities must be followed by it. But in my opinion, in korean middle school, especially in Home Economics Education, educational facilities are not reformed at a proper time. Therefore, to enhance the qualities of experimentation/practice of Home Economics Education, in the first place, the preparation for the given conditions of standards of educational materials & facilities are needed. But the educational facilities of Home Economics Education have many problems not only in the qualitative aspect but also in the quantitative aspect. And in addtion to it, lots of educational facilities which cannot match contents of national textbook of Home Economics Education are exist. Therefore, this thesis aims at examining comprehensively the problem of experimentation/practice of experimental materials & facilties of Home Economics Education, connect with contents of Home Economics Education, holding several problems of experimentation/practice of Home Economics Education in middle school, grouping ; the principles and ways concerning the innovation of experimental materials & facilties of Home Economics Education by which many teachers and students make sure of more efficient teaching/studying, and obtaining basic data which guarantee the ability of innovation concerning problems of the education of experimentation/practice of Home Economics Education. Methods are : 1) grasp our educational realities with my original(question). 2) integrate/analyse results of 1) 3) check the frequency, percentage with methods of X?-test, T-test, and 'One-way Analysis of Variances'. 4) suggest my own alternative proposal. Conclusions are : 1) To the problems concerning the plan, method, frequency, choice of contents, budget, and experimental materials & facilties of experimentation/practice, any meaningful difference are not revealed likewise, but, these problems can affect to teachers' guidance of practical examination, therefore it needs to give a indirect financial, and administration aids to teachers/schools from the government. 2) Contents of experimentation/practice are subjected to contents of textbook. In this reason, educational facilities are suitable to contents of textbook for the efficacy of experimentation/practice. Therefore, whenever contents of national textbooks are revised, the proper experimental materials & facilties must be established. And then, according to these standards, educational facilities must be prepared equally. 3) The capacity of educational facilities are conciderably different according to the type, region, and established pattern of school. Therefore, in order to eliminate these differences, it needs to prepare practice classrooms, and to import the new educational facilities. For these preperations, and for the efficient education of practical skill, financial aids from government are necessary. 4) In comparison with contents of textbook the educational facilities which are not enlisted in experimental materials & facilties but very important and very necessary for the classwork of Home Eocnomics Education must be included in new experimental materials & facilities. 5) The problems of existing experimental materials & facilties of Home Economics Education are identified as following ; i) disagreement between names of educational facilities and contents of the textbook of Home Economics Education. ii) the standard of need in relation to the number of class, isn't fit to our educational reality likewise. iii) the difficulty of elastic application. Therefore, to be sure of the development of Home Economics Education, various efficient methods of education must be groped, and endeavour for correction of imperfection must be maintained continuously.

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.

급성 췌장염에서 내시경적 역행성 담췌관 조영술의 임상적 의의

강진경,박인서,송건훈,정재복,송시영,한기준 대한소화기내시경학회 1996 Clinical Endoscopy Vol.16 No.3

The safety of endoscopic retrograde cholangiopancreatography(ERCP) in patients with acute pancreatitis(AP) was confirmed in the past decade. Especially in ease of acute gallstone panereatitis, early ERCP/EST(endoscopic sphincterotomy) may reduce the incidence of complications by removing gallstone which causes acute attack of pancreatitis. To assess clinical usefulness of ERCP/EST in the setting of AP, we reviewed clinical records of 58 patients with AP who had undergone ERCP /EST during the same period of admission. 1) There were thirty-four men and twenty-four women with a mean age of 51.4 (range 14-82). According to the Atlanta classification, forty-two patients were determined to have 'mild' pancreatitis, while the remaining sixteen were determined to have `severe' pancreatitis. 2) The most common indication which urged to perform ERCP was common bile duct(CBD) stones suspected by other imaging reodalities(23 cases). The next common was dilatation of CBD detected on ultrasonography in nine cases. 3) Seven patients received ERCP within 24 hours and seventeen underwent ERCP between the period of 24-72 hours after admission. Therefore 24 patients(41.4%) underuvent ERCP within 72 hours after admission. 4) The rate of visualization of either bile duct(BD) or pancreatic duct(PD) was 93.1 %. There was no significant complication attributable to the procedure itself. 5) In 8 patients(21.1%), pancreatogram revealed chronic pancreatitis. This finding was more commonly encountered in patients who were determined to have 'severe' pancreatitis. Eighteen patients(39.1%) had stones of common bile duct and this was the most common cholangiographic finding. But the incidence of CBD stone was not different between `mild' and 'severe' pancretitis groups. 6) Among various predictors of gallstone panreatitis such as elevated total blirubin, alcalin pbosphatase, gamma-glutamyl transpeptidase and suspected stones on sonography the stones found orb sonography was proceed to be the most sgnificant factor in prediction of gallstaMe pancreatitis(p=0.032). 7) EST was successfully performed in 13 patents without significant procedurerelated complication. 8) In patients who were treated for acute gallstone pancreatitis, there was no significant difference in various clinical paramlters including severity, in-hospital stay, incidence of complication and laboratory indings between the surgery group and the EST group. 9) ERCP was useful in 35 patients(60.3%) by providing diagnostic information or therapeutic modalities. The confirmation and endoscopic removal of CBD stones represented the most part of advantages. In conclusion, we have found ERCP/EST to be a safe and useful modality in both diagnostic and therapeutic aspects for patients with AP. Especially in patients with gallstone pancreatitis, ERCPIEST lave evolved into an important role by early identification and safe removal of gallstone.

Low serum bilirubin level predicts the develop-ment of chronic kidney disease in patients with type 2 diabetes mellitus

( Kang Hee Ahn ),( Sang Soo Kim ),( Won Jin Kim ),( Jong Ho Kim ),( Yun Jeong Nam ),( Su Bin Park ),( Yun Kyung Jeon ),( Bo Hyun Kim ),( In Joo Kim ),( Yong Ki Kim ) 대한내과학회 2017 The Korean Journal of Internal Medicine Vol.32 No.5

Background/Aims: We evaluated whether serum bilirubin levels can predict the development of chronic kidney disease (CKD) in patients with type 2 diabetes mellitus (T₂DM). Methods: This was a retrospective observational longitudinal study of patients presenting at the Pusan National University Hospital. A total of₃₄₉ patients with T₂DM and preserved kidney function (estimated glomerular filtration rate ≥ 60 mL/min/1.73 m²) were enrolled. The main outcome was the development of CKD stage 3 or greater. The patients were divided into four groups according to the quartiles of the total serum bilirubin levels at baseline. Results: The group with the lowest range of total serum bilirubin level (Q₁) showed the highest cumulative incidence of CKD stage 3 or greater than that of the other lower quartiles (Q₁ vs. Q₄; hazard ratio [HR], 6.75; 95% confidence in-terval [CI], 1.54 to 29.47; p = 0.011). In multivariate analysis, the risk of developing CKD stage 3 or greater was higher in the second lowest quartile of the serum bili-rubin level than that in the highest quartile of the serum bilirubin level (Q₂ vs. Q₄; HR, 9.36; 95% CI, 1.33 to 65.73; p = 0.024). In the normoalbuminuria subgroup (n = 236), multivariate analysis showed that the risk of developing CKD stage 3 or greater was higher in the lowest quartile of the serum bilirubin level than that in the highest quartile of the serum bilirubin level (Q1 vs. Q4; HR, 7.36; 95% CI, 1.24 to 35.82; p = 0.019). Conclusions: Serum bilirubin might be an early clinical marker for predicting the progression of CKD in patients with T₂DM and preserved renal function.

진로 교육 자료의 중학교 가정과 수업에의 적용 연구

강인애,윤인경 한국 가정과 교육 학회 1993 한국가정과교육학회지 Vol.5 No.-

This study, in order to seek for a more effective teaching method, I am to propose a measure that the carrer education materials for female middle school students, a program produced already, could be applicable on the class and to understand the efficiency by examining practically it to the student. The research method was to make up a questionnaire, and gaze two kinds of educational effect. The procedure was that, after surveying the general features in order to help them know their consciousness on the carrer education, Researcher practiced common theorectical teaching on comparative class and moduling teaching on comparative class through making a guiding data. Then Researcher analysed the changing of consciousness on carrer, knowledge on kinds and numbers of jobs, and the results and rate of interest in the teaching with persentage and t-test. The results are as followed; First, on the consciousness on carrer, both group showed little change on their wishful job between before and after teaching. On the purpose to get a job, consciousness on work and job, and fixed idea of job gender, there were some changes, but groups had few defferences in the changing rate. Second, on the consciousness on work and job, experimental group recognized the variety of hob more than comparative group and wrote more hind of job. Third, on the evaluating result, the record of experimental group was higher. Fourth, on the rate of interesting in learning, the rate of experimental group was higher. As observed, the class applied by the module of female carrer education is effective, since experimental group showed more consciousness on work and job, evaluation of record after teaching, and the rat of interesting in learning, though there was no difference in the consciousness of the carrer.

P067 A retrospective analysis of low dose acitretin and cyclosporine combination therapy in psoriasis patients

( In-hye Kang ),( Hye-jin Ahn ),( Eun-jae Shin ),( Min Jae Gwak ),( Min Kyung Shin ),( Nack-in Kim ) 대한피부과학회 2016 대한피부과학회 학술발표대회집 Vol.68 No.2

<div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div><div style="display:none">fiogf49gjkf0d</div> Background: Psoriasis is a chronic in.ammatory disorder. Approximately 25% of patients present with a moderate-to-severe form of psoriasis and may require lifelong systemic therapy. Up until recently, there have been few reports showing the effectiveness and safety of adding cyclosporine to acitretin for treatment. Objectives: The aim of our study was to gain more knowledge about systemic combination therapies with retinoids and cyclosporine. Methods: Retrospective review of the databases of dermatological departments at Kyung Hee Medical Center was performed. 11 patients treated with oral acitretin and cyclosporine combination therapy, 12 and 14 patients treated with acitretin and cyclosporine monotherapy, respectively were included in the study. The data including age, gender, comorbidity, treatment regimen, period, presence of adverse events, and the PASI score were collected. Results: There were no significant differences in the degree of reduction of PASI scores after 12 weeks among the three groups. The number of patients with adverse events was 19 in the acitretin monotherapy group, 10 in the cyclosporine monotherapy group, and 9 in the combination treatment group. Conclusion: Although low dose combination therapy of acitretin and cyclosporine has similar effects compared to the monotherapy, side effects was lower in combination therapy because of drug sparing effects. We suggest combination therapy employing systemic agents are becoming more widely used for the treatment of psoriasis.

IL-β의 인슐린 분비 자극효과와 그 과정에 관여하는 인자들

정인경,오승훈,강동묵,정재훈,민용기,이명식,이문규,김광원 대한당뇨병학회 2002 Diabetes and Metabolism Journal Vol.24 No.4

연구배경: IL­1β는 용량과 노출시간에 따라 인슐린분비에 대해 상반되는 효과를 가지고 있다. IL­1β의 인슐린 분비 억제효과는 제1혁명 당뇨병의 자가면역 기전과 관련되어 잘 알려져 있으나 인슐린 자극효과에 대해서는 아직 명백히 밝혀지지 않았다. 이에 저자 등은 IL­1β의 다양한 농도에 따라 백서의 췌도세포에서 인슐린 분비에 미치는 영향을 살펴보고, 그 기전으로 인슐린 생합성, iNOS의 발현, 칼슘통로의 활성도 변화여부를 알아보고자 하였다. 방법:200∼300g인 수컷 Sprague­Dawley 백서의 췌도를 변형된 Lacy&Kostianovsky's 방법으로 분리한 후 IL­1β의 다양한 농도(0, 0.5, 5, 50, 500pmol/L)에 2, 6, 24시간 노출시켜 췌도세포의 형태, 생존능을 관찰하고 인슐린 분비능 및 췌도세포내 인슐린 함량을 측정하였으며, 전전구 인슐린 mRNA발현, iNOS mRNA발현을 RT­PCR을 통해 확인하였고, 세포의 칼슘 통로 활성도 변화 여부를 측정하였다. 결과:1) IL­1β에 노출되 췌도의 생존능:2시간 노출시는 대조군과 차이가 없었으나, 6시간 고농도군과 24시간 모든 군에서 생존능이 감소되었다. 2)인슐린 분비능은 IL­1β를 2시간 5poml/L이상의 고농도와 6시간 0.5pmol/L 저농도 처리시 대조군에 비해 의미있게 증가하였으나, 6시간과 24시간 5poml/L이상의 고농도에서는 의미있게 인슐린의 분비가 억제 되었다. 3)췌도내 인슐린양의 변화는 IL­1β의 시간과 농도에 따라 배지내의 인슐린 변화와 비슷한 경향을 보였으나 통계학적으로 의미있는 차이는 없었다. 4)전전구인슐린의 mRNA발현은 2시간 50pmol/L이상 고농도의 IL­1β에서 의미있게 증가하였고, 6시간 처리군에서는 의미있는 차이는 없었으나, 24시간에서 IL­1β의 용량의존적으로 억제되었다. 5)iNOS mRNA는 IL­1β 처리 후 2시간부터 발현되기 시작하여, 6시간에 최고에 달한 후 24시간에는 점차 감소하였다. IL­1β의 처리시간과 무관하게 5poml/L이상의 고농도에서 용량에 따라 발현이 증가하였다. 6)칼슘통로 활성도는 IL­1β의 농도나 시간에 따라 유의한 차이가 없었다. 결론: IL­1β는 단시간 고용량이나 장기간 저용량에서 인슐린 분비와 생합성을 증가시키며, 이런 효과는 iNOS나 칼슘 통로 활성도 변화와는 무관한 것으로 생각된다. Background : The inhibitory effort of IL-1β on the insulin secretion has been validated in pathogenesis of type 1 diabetes, but complex results about the stimulatory effect of IL-1β have been reported. The aims of this study are to clarify the effects of IL-1βon insulin secretion of pancreatic islets and to investigate the mechanisms in terms of preproinsulin synthesis, inducible NOS expression, and calcium channel activity. Method : Islets were isolated from male Sprague-Dawley (SD) rat by modified Lacy-Kostianovsky's method. After islets were treated with different concentrations (0, 0.5, 5, 50, 500 pmol/L) and exposure time (2, 6, 24 hours) of IL-1β, morphology, viability, static stimulation of insulin to glucose, insulin content, preproinsulin mRNA expression, iNOS mRNA expression and calcium channel activity were measured. Results : 1) Viability o islets was reduced in high concentrations of long term exposure of IL-1β. 2) Insulin secretion was stimulated in islets treated with 5, 50, and 500 pmol/L of IL-1β for 2 hours. 3) Insulin content was not significantly different regardless of concentration and exposure time of IL-1β. 4) Preproinsulin mRNA expression increased in islets treated with 50, 500 pmol/L of IL-1β for 2 hours. After 24 hours, it decreased in dose dependent manner. 5) iNOS mRNA expression was detectable after 2 hours in the presence of IL-1β, peaks at 6 hour and decreased after 24 hours. It was increased above 5 pmol/L of IL-1β in dose dependent manner. 6) Activities of the voltage-dependent Ca^2+ channels were not different among groups. Conclusion : IL-1β plays a positive role in terms of insulin secretion and insulin synthesis in high concentration of short term or low concentration of long term. These effects of IL-1β might be neither dependent of iNOS pathway nor Ca^2+ channel activity (J Kor Diabetes Asso 431~443, 2000).

鷄糞의 飼料利用性에 關한 硏究 : 乾燥鷄糞의 採卵鷄育成에 있어서의 經濟性 Economic returns of Dried poultry waste in brooding of Laying hens

扈敬鎭,印致雄,한기영,許康七 안성산업대학교 1978 論文集 Vol.10 No.-

1. In order to decide a feasibility for partial substitution of dried poultry waste for complete formula feed and to decide an eligible levels for the substitution, growing trials were carried out under four treatments with three veplications in randomized block design, and the treatments were based upon the substitution rates such as 5%, 10%, 15% and check for two groups of chicks for Layer, namely, 7 to 12 weeks aged one and 13 to 20 weeks aged one. 2. While no significant differences were found in the increased body weight, feed consumption and egglaying rate among the treatments, partial substitution of the D. P. W, for complete formula feed seemed to be feasible, like as that of grain or grain bran, since no any interruptions were occurred in the way of the substitution. 3. The reason that the feeding efficiency of substitution of D. P. W. for complete formula feed to those of 13 to 20 weeks aged chicks, was shown far better than that of those of 7 to 12 weeks aged chicks, seemed to be attributable to the less nutrient deficlency derived from those substitutions. Therefore, such results might be reflected to those advantages for 13 to 20 weeks aged chicks over those of the other chicks. 4. While no significant differences were found in egg laying rate and egg weight among the treatments, 15% substitution plot showed a little over that of check plot, and this result might indicate that the egg laying may not be influenced by the substitution of feeding. 5. Refering to economic returns of substitution utilization of D. P. W for complete formula feed, while the advantages were shown top grade at 5% and in order of 10%, 15% of the substitution on 7 to 12 weeks aged chicks, advantages were also shown in order of 5%, 10%, 15% of the substitution on 13 to 20 weeks aged chicks. These results seemed to be feasible even in beyond of 15% of the substitution. 6. Since it was not able to find out the eligible levels of the substitution D. P. W. for complete formula feed for 13 to 20 weeks aged chicks in this study, the following studies shall be desirable in the future. (1) eligible substitution levels of D. P. W. for complete formula feed in those of 13 to 20 weeks aged chicks. (2) economic returns for Laying Hens through substitution D. P. W. for complete foumula feed in growing.

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.

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.