• The Journal of Korean Society for Radiation Therapy
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• v.28 no.1
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• pp.7-16
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• 2016

Purpose : This study aimed to compare and evaluate between the efficiency of two respective devices, 3D-bolus and step-bolus when the devices were used for the treatment of patients whose chest walls were required to undergo the electron beam therapy after the surgical procedure of modified radical mastectomy, MRM. Materials and Methods : The treatment plan of reverse hockey stick method, using the photon beam and electron beam, had been set for six breast cancer patients and these 6 breast cancer patients were selected to be the subjects for this study. The prescribed dose of electron beam for anterior chest wall was set to be 180 cGy per treatment and both the 3D-bolus, produced using 3D printer(CubeX, 3D systems, USA) and the self-made conventional step-bolus were used respectively. The surface dose under 3D-bolus and step-bolus was measured at 5 measurement spots of iso-center, lateral, medial, superior and inferior point, using GAFCHROMIC EBT3 film (International specialty products, USA) and the measured value of dose at 5 spots was compared and analyzed. Also the respective treatment plan was devised, considering the adoption of 3D-bolus and stepbolus and the separate treatment results were compared to each other. Results : The average surface dose was 179.17 cGy when the device of 3D-bolus was adopted and 172.02 cGy when step-bolus was adopted. The average error rate against the prescribed dose of 180 cGy was -(minus) 0.47% when the device of 3D-bolus was adopted and it was -(minus) 4.43% when step-bolus was adopted. It was turned out that the maximum error rate at the point of iso-center was 2.69%, in case of 3D-bolus adoption and it was 5,54% in case of step-bolus adoption. The maximum discrepancy in terms of treatment accuracy was revealed to be about 6% when step-bolus was adopted and to be about 3% when 3D-bolus was adopted. The difference in average target dose on chest wall between 3D-bolus treatment plan and step-bolus treatment plan was shown to be insignificant as the difference was only 0.3%. However, to mention the average prescribed dose for the part of lung and heart, that of 3D-bolus was decreased by 11% for lung and by 8% for heart, compared to that of step-bolus. Conclusion : It was confirmed through this research that the dose uniformity could be improved better through the device of 3D-bolus than through the device of step-bolus, as the device of 3D-bolus, produced in consideration of the contact condition of skin surface of chest wall, could be attached to patients' skin more nicely and the thickness of chest wall can be guaranteed more accurately by the device of 3D-bolus. It is considered that 3D-bolus device can be highly appreciated clinically because 3D-bolus reduces the dose on the adjacent organs and make the normal tissues protected, while that gives no reduction of dose on chest wall.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.265-276
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• 2000

Purpose : Between January 1983 and December 1988, 218 female Patients with known breast cancer and positive axillary nodes were treated with adjuvant radiotherapy and chemotherapy following radical mastectomy. Treatment results were retrospectively analysed at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University of College of Medicine. Materials and Methods : The patients were classified into 3 groups; group I included II patients treated with adjuvant chemotherapy alone; in group 2, 52 patients treated with radiotherapy alone; and in group 3, n patients treated with combined chemo-radiotherapy. The mean age was 44 years and ranged from 27 to 70. The median follow-up time was 51 months. Results :Seven-year relapse free and overall survival rates were 56$\%$ and 67$\%$; in group 1, 50$\%$ and 56$\%$ in group 2, 51$\%$ and 65$\%$ and in group 3, 62$\%$ and 75$\%$ respectively. This difference was not statistically significant(p<0.05). The loco-regional failure rates were 13$\%$ and distant failure rates were 33$\%$. There was less risk of loco-regional failure in group 2 and 3 which included radiotherapy (p<0.05). But there was no significantly difference in the rates of distant failure( p>0.05). By univariate analysis, the only significant prognostic factor affecting relapse-free survival was the percentage of positive axillary nodes; and the overall survival significantly correlated with the primary tumor site, the number or percentage of positive axillary nodes, and stage. But in multivariate analysis, the only significant prognostic factor was treatment modality. By univariate analysis of prognostic factors affecting the rates of overall failure and distant failure, the significant prognostic factors was the percentage of positive axillary nodes; and the risk of the loco-regional failure significantly correlated with the treatment modality. Conclusion :In conclusion, these results suggest a potential for decreasing the risk of loco-regional failure with the addition of postoperative radiotherapy to chemotherapy in the premenopausal patients, and in the patients with number or percentage of positive nodes more than 4 or 1/3. The results of this study suggest that the combined chemo-radiotherapy as adjuvant treatment following radical mastectomy was the most effective modaliw in groups of 2$\~$5 cm sized tumor, stage IIB, and in patients with more than 4 or 1/3 of number or percentage of positive nodes.

• Journal of Korean Public Health Nursing
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• v.13 no.2
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• pp.101-114
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• 1999

This study was designed to investigate the effects of an aquatic exercise program on the shoulder joint function. physical symptom. quality of life and stress among the patients who received modified radical mastectomy between 6 to 12 months prior to their visits. The subjects were 31 women aged between 40 and 60 who visited the out-patient department at Kang Nam St. Mary's Hospital for follow-up care. and were not under the treatment of intravenous cancer chemotherapy or radiation therapy. and had no complications. Twelve of them were assigned to the control group. while nineteen subjects to the experimental group. The aquatic exercise program was developed by the author with the assistance of exercise specialists. The program includes warming uP. aerobic and cooling down exercises in water. The aquatic exercise program for the experimental group was carried out 3 times a week with 60 minutes in each time for 8 weeks from September 20th to November 15th. 1995 in a regular swimming pool in Seoul. Changes in the range of motion of the shoulder joint. muscle strength. physical symptom. quality of life. and stress were examined after the completion of treatment. The data were collected through isokinetic muscle strength evaluation and questionnaire survey before and after the treatment. Paired and unpaired t-test were adopted to analyze the data. The results were as follows ; 1. The increment in the range of motion of the shoulder joint in the experimental group after the exercise was significantly greater than those in the control group. 2. The peak torque of shoulder girdle muscles increased significantly after the exercise in the experimental group only. 3. The physical symptom score decreased significantly after the exercise in the experimental group only. 4. The experimental group revealed significantly higher level of quality of life and lower level of stress after the exercise compared with those before the exercise. whereas the control group showed no significant changes in those levels. These findings may indicate that the aquatic exercise program is effective in increasing the range of motion of the shoulder joint and muscle strength and quality of life. and also effective in decreasing physical symptoms. and the level of stress in postmastectomy patients. Accordingly. the acquatic exercise program' can be adopted as an effective nursing intervention for postmastectomy rehabilitation.

• Journal of The Korean Society of Integrative Medicine
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• v.8 no.1
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• pp.47-56
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• 2020

Purpose : The purpose of this study was to determine the effects of upper extremity volume, pain, and range of motion after participation in thera-band exercises according to the hand grip type in patients with breast cancer with upper extremity edema. We also aimed to determine the most efficient type of grip. Methods : The subjects were 10 female patients diagnosed with stage 2 breast cancer who had stage 2 lymphedema. Randomly, 5 patients each were allocated to the experimental and control groups. For six weeks, the patients in both the experimental and control groups exercised daily. In both groups, manual lymph drainage was applied for 1 hour. Afterward, patients in the experimental group placed their hands in the thera-band ring and exercised with their fingers outstretched. Patients in the control group exercised while holding the thera-band ring with a finger. Both the experimental group and the control group underwent measurements of the circumference of the upper extremity, pain, and range of motion of the shoulder joint at weeks 1, 2, 4, and 6 before and after exercise. Results : The upper arm circumference decreased by more in the experimental group in all weeks than before than that in the control group, and there was a statistically significant difference at 6 weeks. Compared with the difference between pre-exercise and 6 weeks post-exercise, the change in pain significantly decreased in the experimental group and showed a statistically significant difference. The shoulder range of motion increased in extension, external rotation, and internal rotation compared with that in the control group, and there was a statistically significant difference. Although the operating range increased in flexion and abduction, there were no statistically significant differences. Conclusion : In this study, we found that thera-band exercises with an open-hand grip are more efficient than thera-band exercises with a closed-hand grip in edema reduction, pain, and range of motion. In addition, it was found that it was more effective to continue the thera-band exercises with open-hand grip extended for at least 6 weeks rather than for a short time.

• The Korean Journal of Rehabilitation Nursing
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• v.2 no.1
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• pp.61-71
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• 1999

This quasi-experimental study was intended to test the effect of self-help group program, which is one of the way to enhance adaptation and quality of life to mastectomy patients. Data was collected from July 14, 1998 to Oct. 31, 1998 at two Medical Center in Seoul. The subjects for this study were the patients who had undergone mastectomy and were follow-up ; 14 in experimental group and 14 in control group matched with age and treatment. The instruments for this study were adaptation in Lee(1994)'s physical symptom questionnaire, Zung's Self-rating Depression Scale(SDS, 1965), and Self-rating Anxiety Scale(SAS, 1970), quality of life in Spranger(1996)'s and No(1988)'s Quality of Life Questionnaire. The self-help group program for mastectomy patients was developed based on literature review and pilot study by the investigator. The subjects of experimental group were participated in 6 weeks self-help group program and were received arm and shoulder exercise, informational support, and interpersonal support by group members. The control group were received no intervention, Both group answered questionnaires prior to intervention and 6 weeks later. The data analyzed by frequency, $X^2$-test, Mann-Whitney U test. Wilcoxon Signed Rank test, Pearson's Correlation Coefficient and Stepwise Multiple Regression using SPSS WIN. The results are as follows ; Hypothesis 1. "The experimental group with the self-help group program will have a higher score on adaptation state than control group." was not supported. But the post test score of anxiety and depression in experimental group were declined and the depression score was reduced relatively. Hypothesis 2. "The experimental group with the self-help group program will have a higher score on quality of life than control group." was not supported. But the posttest score of quality of life in experimental group was reduced relatively. Hypothesis 3. "The higher adaptation state of mastectomy patients, the higher quality, of life." was supported(r=,80, p<.001). Additionally, the lower physical symptom, depression and anxiety, the higher quality of life And depression, which was the main predictor of quality of life, accounted for 59.5%, depression and anxiety accounted for 65.5% of the variance in quality of life. In conclusion, when the self-help group program was intervened to mastectomy patients, it was tended to increase quality of life and to reduce depression and anxiety. So self-help group program can be considered useful nursing inter vention effect on adaptation and quality of life of mastectomy patients. With discussion, I suggest repeated further re search on self-help group with appropriate sample size and longitudinal study. Also during adjuvant therapy, it is needed to develop convenient method to be supported from peer group and family, such as computer mediated support group.

• Physical Therapy Korea
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• v.8 no.1
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• pp.35-50
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• 2001

The purposes of this study were to investigate the therapeutic effects of an early exercise program after mastectomy and to provide the early exercise program protocol for patients who had undergone mastectomy. The subjects were seventy women who were diagnosed with breast cancer. They were randomly as signed either to a experimental group (n=35) that received early postoperative exercise program or to a control group (n=35) that received only education by nurses. Data were obtained for each patient from goniometric measurements of shoulder flexion, abduction, external rotation, 10 elements of functional performance, and subjective pain evaluation using visual analogue scale (VAS). All variables were measured preoperatively, three days postoperatively, and one month postoperatively. Data were compared by groups using independent t-test and Mann-Whitney U test for parametric or non-parametric data, respectively. There were no significant differences between the groups for all variables preoperatively and at three days postoperatively. But there were significant differences at one month postoperatively. The experimental group showed a statistically significant increases in shoulder flexion, abduction, and external rotation and in the pain VAS at one month postoperatively (p<.05). Also, at one month postoperatively, the experimental group had less difficulty with three elements of functional performance-doing up a 'back' zippered article of clothing, reaching the ipsilateral scapula, and contralateral scapula with the fingers on the operated side-than the control group (p<.05). The results of this study suggest that, after mastectomy, the early exercise program conducted by a well-trained physical therapist can make a significant contribution to the return of more normal shoulder function and activities of daily living and to an increased quality of life.

• The Journal of the Society of Korean Medicine Diagnostics
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• v.19 no.2
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• pp.75-90
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• 2015

Objectives The purposes of this study was to develope a Qi gong exercise that suits characteristics of post mastectomy women, and to evaluate the effect of Qi gong exercise on immune response, blood circulation index, pulse wave parameter and heart rate variability. Methods This study was applied to total 35 post mastectomy women, including 17 for experiment group and 18 for control group. The Qi gong exercise was composed of total 24 times of 90 minutes per each time, twice a week, and 12 weeks and it was conducted by the oriental medicine professor who was an expert of Qi gong exercise. Results 1. Two group comparison revealed that the experimental group had significantly improved immune response(p<.021), HR(beats/min)(p<.001), ESV(ml/beat)(p=.038), ESI($ml/beat/m^2$)(p=.040), ECO (L/min)(p=.019), ECI($L/min/m^2$)(p=.023), ECRI($dyne^*sec/cm$)(p=.015), Left Kwan($div^3$)(p=.021), Right Kwan($div^3$)(p=.038), Mean HRV(cycle/min)(p<.001), SDNN(ms)(p=.043), RMSSD(ms)(p=.040), and TP(log $ms^2$)(p=.039). 2. Two group comparison revealed that the experimental group had significantly decreased ECR ($dyne^*sec^*cm^{-5}$) (p=.034), Left RAI(p=.044), Right RAI(p=.042), and pNN50(%)(p=.038). Conclusions These results from Qi gong exercise program can be used as basic data for development of health promotion program for Post Mastectomy Women.

• Physical Therapy Korea
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• v.22 no.1
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• pp.9-18
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• 2015

This study aimed to compare the characteristics of breast cancer surgery and shoulder surgery patients on the shoulder range of motion (ROM), degree of pain and dysfunction, and scapular position. This study was carried out with a total of 90 women: a breast cancer surgery group (BS, $n_1=30$), a shoulder surgery group (SS, $n_2=30$) and a control group ($n_3=30$). Shoulder ROM, the Quadruple Visual Analogue Scale (QVAS), the Shoulder Pain and Disability Index (SPADI), and the Scapular Index (SI) were used to assess shoulder function. Statistical analyses were performed using a one-way analysis of variance, crosstab test, and independent sample t-test. Post-hoc testing was carried out with Bonferroni test. There were significant differences in shoulder ROM when the BS and the SS were compared with the control group. However, there was no significant difference in ROM between the BS and SS. Furthermore, there was a significant difference in shoulder pain between both surgery groups, and there was greater shoulder dysfunction in the SS than in the BS. There was also a significant difference in upper extremity posture when the BS and the SS were compared to the control group. Finally, there was no significant difference in upper extremity posture between the BS and the SS. This study compared shoulder ROM, pain, dysfunction, and upper extremity postures between the BS and SS. While there were no significant differences in shoulder ROM, pain, and upper extremity posture between both surgery groups, the level of dysfunction was found to be significantly different. Therefore, health professionals managing for breast cancer surgery or shoulder surgery patients should consider these outcomes.

• Journal of the Korean Society of Physical Medicine
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• v.11 no.4
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• pp.147-156
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• 2016

PURPOSE: The purpose of this study was to investigate the effects of sensory motor training using ball exercise on shoulder range of motion, pain, dysfunction, and quality of life in Breast Cancer Women after Mastectomy. METHODS: A total of 26 patients from D University Hospital in Daejeon were included and randomly allocated to two groups (n=13 per group). The two groups performed the exercise five times a week for 4 weeks. A sensory motor training group (SMTG) received general physical treatment for 10 minutes and sensorimotor training for 20 minutes. A control group (CG) received general physical therapy for 30 minutes. Shoulder pain (the Visual Analog Scale), range of motion, disability (the shoulder pain and disability index) and quality of life (the Functional Assessment Cancer Therapy-Breast instrument) were measured in both groups before and after 4-weeks intervention. RESULTS: A significant difference was found in joint range of motion, shoulder pain, functional disability level, and quality of life within the two groups (p <.05). In addition, changes in joint range of motion, pain, functional disability level, and quality of life after then intervention were significantly different between the two groups (p <.05). CONCLUSION: These results suggest that a sensory motor training program is feasible, safe, and suitable exercise for shoulder functions and quality of life in Breast Cancer Women after Mastectomy.

• Journal of Chest Surgery
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• v.30 no.4
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• pp.462-466
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• 1997

Primary mediastinal choriocarcinoma is characteristically seen in young males presenting with the symptomes of cough, chest pale, and gynccomastia. A 33-year-old woman was admitted to the hospital because of severe dyspnea and chest pain which was aggravated rapidly 2 or 3 days ago. Posterior mcdiastinal mass measuring about 1 cm in diameter was seen in Chest P-A, left lateral view of chest, and chest CT. Serum $\beta$-HCG level was markedly elevated up to 200, 000 mIxt. Whole body CT and other studies could not find any lesion on ovary and uterus. But, a single nodule nEeasuring about 1 cm in diameter was identified in the brain CT. The tumor cells (syncytiotrophoblastic cells) from resected mass revealed positivity on i histochemical staining for $\beta$-HCG. She was treated with EMA-CO after resection of tumor, But, 7 months later, she was readmitted and showed cerebral hemorrhage due to metastatic choriocarcinoma. She was operated again for the brain tumor, and was doing well for further 7 months.