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Gender Differences in Pain in Cancer Patients (성별에 따른 암환자의 통증 차이)

  • Kim, Hyun-Sook;Lee, So-Woo;Yun, Young-Ho;Yu, Su-Jeong;Heo, Dae-Seog
    • Journal of Hospice and Palliative Care
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    • v.4 no.1
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    • pp.14-25
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    • 2001
  • Purpose : To determine whether there exist gender differences in pain in Korean cancer patients and whether the depression and performance that are often expressed differently between men and women with cancer interact with pain. Method : The results of survey were collected from 140 in- and out-patients (78 male and 62 female) who had cancer treatment at one of the university hospital in Seoul for four months from February of 1999. The severity and interference of pain were examined with the self-reported survey based on Korean version of Brief Pain Inventory (BPI-K). Demographic and clinical information for all patient were compiled by reviewing their medical records, and the level of depression was examined with the Korean version of Beck Depression Inventory (BDI-K). Usual statistical methods, e.g., frequences, means and SDs were used to characterize the sample. The chi-square tests for categorical data and t-test for numerical data were used for group comparison. And the correlation between variables were performed using Pearson correlation coefficient. Resuts : 1) The mean scores of the worst pain for last 24-hours measured with the pain severity of BPI-K were 5.77 in male and 6.45 in female. The pain interference of BPI-K in men was in the order of mood (5.49), enjoy (5.36), and work (5.00), and in women were work (7.48), enjoy (7.16), and mood (6.53). 2) In pain severity, significant difference was found between men and women in the average pain for last 24-hours (t=-2.130, P=.035). In pain interference, significant difference was found between men and women in activity (t=-2.450, P=.015), mood (t=-2,321, P=.022), walk (t=-2.762, P=.007), work (t=-4.946, P=.000), relate (t=-2.595, P=.010), sleep (t=-2.071, P=.040), enjoy (t=-3.198, P=.001). 3) It was found that the items of pain and depression are significantly correlated in men but not in women. Men also exhibited higher correlation in the items of pain and performance status than women. Conclusions : Women report significantly greater average pain for last 24-hours and for all items of pain interference than men. Pain and depression are significantly correlated in men. The results of this study suggest that gender differences in pain should be considered for planning effective pain management program.

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A Research on Investigation Results of Teenagers' Civic and Ethic Awareness - Confucian values and a Treatise of Human Nature (유교사상을 통한 청소년의 시민윤리의식 실증조사연구)

  • Moon, Ki-young;Lee, In-young
    • The Journal of Korean Philosophical History
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    • no.52
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    • pp.393-424
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    • 2017
  • This study investigates the relationship between South Korean youths' Confucian values and sense of citizen ethics while presenting outlook on the sense of citizen ethics based on the theory of human nature. The purpose of this study, by doing so, is to present educational measures. For this purpose, empirical research method was applied in this study. In the empirical study, youths were surveyed and the answers were statistically analyzed and discussed with a view to achieve the study purpose. In the empirical research part of the study, Korean youths' awareness on Confucian values was examined along with its relationship with the sense of citizen ethics. The effect of Confucian values on sense of citizen ethics and their relationship were analyzed to evaluate the receptivity of youths on Confucian ideas and usefulness of sense of citizen ethics. This study investigated a total of final 311 sets of data from male and female students at middle and high schools located in Seoul, Gyeonggi, South Korea. First, to identify the youths' Confucian values and level of sense of citizen ethics, descriptive statistical analysis was conducted. As a result, the survey subjects were found to have, concerning the Confucian values, world view M=3.54, human relations view M=3.66, morality cultivation M=3.76, and social order M=3.45, higher than 3.0 to represent positive levels. The morality cultivation, in particular, was recorded the highest among all whereas the social order was relatively lower, which represents the degree of relying on Confucian values to establish social order. Second, the sub-variables of Confucian values were verified according to the personal characteristics of the surveyed youths and differences in their entire perception was investigated. As a result, according to gender, morality cultivation was found higher in female students (M=3.85) than in male students (M=3.64). According to the subjective economic level of their household, world view was found higher in upper class (M=3.98) than middle-low class (M=3.25) and low class (M=3.22) while human relations view was found higher in middle-upper class (M=3.79) than low class (M=3.46). As for the family type, morality cultivation was found higher in extended family (M=3.83) than nuclear family (M=3.62); and social order was higher in extended family (M=3.54) than nuclear family (M=3.36). Third, to verify the study theme of identifying the effects of youths' Confucian values on sense of citizen morality, hierarchical regression analysis was employed in this study, which used the multi-level model of multiple regression analysis. As a result, the Confucian values was found to have significant positive (+) correlations with the entire sense of citizen ethics in order of human relations view(${\beta}=.499$), world view(${\beta}=.412$), social order(${\beta}=.341$), and morality cultivation(${\beta}=.241$). Confucian value showed significant positive (+) correlations with autonomy in order of morality cultivation(${\beta}=.458$), human relations view(${\beta}=.454$), social order(${\beta}=.362$), and world view(${\beta}=.158$). Confucian values was found to have significant positive (+) correlations with community spirit in order of human relations view(${\beta}=.295$), social order(${\beta}=.281$), and morality cultivation(${\beta}=.232$). As shown in the findings above, youths' Confucian values was found to have significant positive (+) effects on the sense of citizen ethics. It is noted that the higher the Confucian values, the more positive the sense of citizen ethics would be. Consequentially, the Confucian values was identified to play an important role in the sense of citizen ethics in the modern society. Based on this analysis, this study presented specific measures - the necessity and possibility of education on sense of citizen ethics under the theory of human nature. To this end, this study proposed to find an optimal interface between the contemporary sense of citizen ethics and Confucian ethics through the respect for human life and nature, man of virtue as the ideal human model, and united society as a desirable society model.

An Exploratory Study on the Effects of Relational Benefits and Brand Identity : mediating effect of brand identity (관계혜택과 브랜드 동일시의 역할에 관한 탐색적 연구: 브랜드 동일시의 매개역할을 중심으로)

  • Bang, Jounghae;Jung, Jiyeon;Lee, Eunhyung;Kang, Hyunmo
    • Asia Marketing Journal
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    • v.12 no.2
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    • pp.155-175
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    • 2010
  • Most of the service industries including finance and telecommunications have become matured and saturated. The competitions have become severe while the differences among brands become smaller. Therefore maintaining good relationships with customers has been critical for the service providers. In case of credit card and debit card, the similar patterns are shown. It is important for them to maintain good relationships with customers, and therefore, they have used marketing program which provides customized services to customers and utilizes the membership programs. Not only do they build and maintain good relationships, but also highlight their brands from the emotional aspects. For example, KB Card or Hyundai Card uses well-known designers' works for their credit card design. As well, they differentiate the designs of credit cards to stress on their brand personalities. BC Card introduced the credit card with perfume that a customer would like. Even though the credit card is small and not shown to public easily, it becomes more important for those companies to touch the customers' feelings with the brand personalities and their images. This is partly because of changes in consumers' lifestyles. Y-generations becomes highly likely to express themselves in many different ways and more emotional than X-generations. For the Y-generations, therefore, even credit cards in the wallet should be personalized and well-designed. In line with it, credit cards with good design can be seen as an example of brand identity, where different design for each customer can be used to recognize the membership groups that customers want to belong. On the other hand, these credit card companies offer the special treatment benefits for those customers who are heavy users for the cards. For example, those customers who love sports will receive some special discounts when they use their credit cards for sports related products. Therefore this study attempted to explore the relationships between relational benefits, brand identification and loyalty. It has been well known that relational benefits and brand identification lead to loyalty independently from many other studies, but there has been few study to review all the three variables all together in a research model. Furthermore, as reviewed above, in the card industry, many companies attempt to associate the brand image with their products to fit their customers' lifestyles while relational benefits are still playing an important role for their business. Therefore in our research model, relational benefits, brand identification, and loyalty are all included. We focus on the mediating effect of brand identification. From the relational benefits perspective, only special treatment benefit and confidence benefit are included. Social benefit is not applicable for this credit card industry because not many cases of face-to-face interaction can be found. From the brand identification perspective, personal brand identity and social brand identity are reviewed and included in the model. Overall, the research model emphasizes that the relationships between relational benefits and loyalty will be mediated by the effect of brand identification. The effects of relational benefits which are confidence benefit and special treatment benefits on loyalty will be realized when they fit to the personal brand identity and social brand identity. In the research model, therefore, the relationships between confidence benefit and social brand identity, and between confidence benefit and personal identity are hypothesized while the effects of special treatment benefit on social brand identity and personal brand identity are hypothesized. Loyalty, then, is hypothesized to have positive relationships with personal brand identity and social brand identity. In addition, confidence benefit among the relational benefits is expected to have a direct, positive relationship with loyalty because confidence benefit has been recognized as a critical factor for good relationships and satisfaction. Data were collected from college students who have been using either credit cards or debit cards. College students were regarded good subjects because they are in Y-generation cohorts and have tendency to express themselves more. Total sample size was two hundred three at the beginning, but after deleting those data with many missing values, one hundred ninety-seven data points were remained and used for the model testing. Measurement items were brought from the previous literatures and modified for this research. To test the reliability, using SPSS 14, chronbach's α was examined and all the values were from .874 to .928 exceeding over .7. Using AMOS 7.0, confirmatory factor analysis was conducted to investigate the measurement model. The measurement model was found good fit with χ2(67)=188.388 (p= .000), GFI=.886, AGFI=.821, CFI=.941, RMSEA=.096. Using AMOS 7.0, structural equation modeling has been used to analyze the research model. Overall, the research model fit were χ2(68)=188.670 (p= .000), GFI=.886, AGFI=,824 CFI=.942, RMSEA=.095 indicating good fit. In details, all the paths hypothesized in the research model were found significant except for the path from social brand identity to loyalty. Personal brand identity leads to loyalty while both confidence benefit and special treatment benefit have a positive relationships with personal and social identities. As well, confidence benefit has a direct positive effect on loyalty. The results indicates the followings. First, personal brand identity plays an important role for credit/debit card usage. Therefore even for the products which are not shown to public easy, design and emotional aspect can be important to fit the customers' lifestyles. Second, confidence benefit and special treatment benefit have a positive effects on personal brand identity. Therefore it will be needed for marketers to associate the special treatment and trust and confidence benefits with personal image, personality and personal identity. Third, this study found again the importance of confidence and trust. However interestingly enough, social brand identity was not found to be significantly related to loyalty. It can be explained that the main sample of this study consists of college students. Those strategies to facilitate social brand identity are focused on high social status groups while college students have not been established their status yet.

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An Exploratory Study on Customers' Individual Factors on Waiting Experience (고객의 개인적 요소가 대기시간 경험에 미치는 영향에 대한 탐색적 연구)

  • Kim, Juyoung;Yoo, Bomi
    • Asia Marketing Journal
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    • v.12 no.1
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    • pp.1-30
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    • 2010
  • Customers often experience waiting for buying service. Managing customers' waiting time is important for service providers since customers who are dissatisfied with waiting, secede from a service place at last. Not a few studies have been done to solve waiting time problem and improve customers' waiting experience. Hui & Tse(1996) identify evaluation factors in customers' behavioral mechanism as customers wait. That is, customers experience perceived waiting time, waiting acceptability and emotional response to the wait when they wait. Since customers evaluate the wait using these factors, service provider should manage these factors in order to minimize customers' dissatisfaction. Therefore, this study explores that evaluation factors of waiting are influenced by customers' situational and experiential characteristics, which include customer loyalty, transaction importance for customer and waiting expectation level. Those situational and experiential characteristics are usually given to service providers so they can't control these at waiting point. The major findings derived from two exploratory studies can be summarized as follows. First, according to the result from the study 1 (restaurant setting), customers' transaction importance has the greatest positive influence on waiting experience. The results show restaurant service provider could prevent customers' separation effectively through strategies which raise customers' transaction importance, like giving special coupons for important events. Second, in study 2 (amusement part setting) customer loyalty has large positive impact on waiting experience as well as transaction importance. This results show that service provider could minimize customers' dissatisfaction using strategies which raise customer loyalty continuously. This results show customer perceives waiting experience differently according to characteristics of service place and service itself. Therefore, service provider should grasp the unique customers' situational and experiential characters for each service and service place. It could provide an effective strategy for waiting time management. Third, the study finds transaction importance and waiting expectation level have direct influence customers' waiting experience as independent variables, while existing studies treated them as moderators. Customer loyalty which has not been incorporated in previous waiting time research is known to affect waiting experience. It suggests that marketing strategy which builds up customer loyalty for long period of time is also quite effective, compared to short term tactics to help customers endure waiting time. Fourth, this study reveals the importance of actual waiting time along with perceived waiting time. So far most studies only focus on customers' perceived waiting time. Especially, this study incorporates the concept of patient limit on waiting time to investigate effect of actual waiting time. The results show that there were various responses to the wait depending on how actual waiting time exceeds individual's patent limit on waiting time or not, even though customers wait about the same period of time. Finally, using structural equation model, conceptual path between behavioral responses is verified. As customer perceives waiting time, then she decides whether she can endure it or not, and then her emotional response occurs. This result are somewhat different from Hui & Tse(1996)'s study. The study also includes theoretical contributions as well as practical implications.

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Studies on the Appraisal of Stumpage Value in the Forest Land - With Respect to Kyung-Ju Area - (산원지(山元地) 임목평가(林木平価)에 관(関)한 연구(研究) - 경주지방(慶州地方)을 중심(中心)으로 -)

  • Rha, Sang Soo;Park, Tai Sik
    • Journal of Korean Society of Forest Science
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    • v.52 no.1
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    • pp.37-49
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    • 1981
  • The purpose of the study is to find out the objective method of valuation on the forest stands through the analysis of logging costs that is positively related to timber production. The two forest (Amgog, Whangryoung), located nereby, but forest type, logging and skidding conditions being slightly different, were slected to carry out the study. The objective timber stumpage value were determined by investigating the appropriate timber production costs and profits of logging operations. The main result obtained in this study are as follows: 1. The rate of logging cost in consisting of timber market price is 13.15% in the area of Amgog logging place and 19.48% in Whangryoung. 2. The rate of the other production cost excluding logging cost is 15.36% in the area of Amgog logging place and 28.85% in Whangryoung. 3. The total rate of timber production cost in consisting of the market price is more than 28.51% in the area of Amgog logging place and 48.33% in Whangryoung, 4. Though the productivity of forest land is affected by the selection of tree species, tending, treatments and effective management of forest land, the more important problem is improvement of logging condition. 5. The rate of production cost in timber price is so high that we should endeavore to improve the productivity of labour and its quality, and minimize the difference of piece work per day in accordance to the various site condition. 6. Although the profit of forest industry is related to the period of recapturing investment, it is more closely related to the working condition, risk of investment and continuous change of social investment interest. 7. If the right variables which are related to the timber market, are objectively obtained, the stumpage value of mature forests can be objectively caculated by applying straight line discounting method or compound discounting method in caculating the stump to market price.

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The Effects on CRM Performance and Relationship Quality of Successful Elements in the Establishment of Customer Relationship Management: Focused on Marketing Approach (CRM구축과정에서 마케팅요인이 관계품질과 CRM성과에 미치는 영향)

  • Jang, Hyeong-Yu
    • Journal of Global Scholars of Marketing Science
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    • v.18 no.4
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    • pp.119-155
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    • 2008
  • Customer Relationship Management(CRM) has been a sustainable competitive edge of many companies. CRM analyzes customer data for designing and executing targeted marketing analysing customer behavior in order to make decisions relating to products and services including management information system. It is critical for companies to get and maintain profitable customers. How to manage relationships with customers effectively has become an important issue for both academicians and practitioners in recent years. However, the existing academic literature and the practical applications of customer relationship management(CRM) strategies have been focused on the technical process and organizational structure about the implementation of CRM. These limited focus on CRM lead to the result of numerous reports of failed implementations of various types of CRM projects. Many of these failures are also related to the absence of marketing approach. Identifying successful factors and outcomes focused on marketing concept before introducing a CRM project are a pre-implementation requirements. Many researchers have attempted to find the factors that contribute to the success of CRM. However, these research have some limitations in terms of marketing approach without explaining how the marketing based factors contribute to the CRM success. An understanding of how to manage relationship with crucial customers effectively based marketing approach has become an important topic for both academicians and practitioners. However, the existing papers did not provide a clear antecedent and outcomes factors focused on marketing approach. This paper attempt to validate whether or not such various marketing factors would impact on relational quality and CRM performance in terms of marketing oriented perceptivity. More specifically, marketing oriented factors involving market orientation, customer orientation, customer information orientation, and core customer orientation can influence relationship quality(satisfaction and trust) and CRM outcome(customer retention and customer share). Another major goals of this research are to identify the effect of relationship quality on CRM outcomes consisted of customer retention and share to show the relationship strength between two factors. Based on meta analysis for conventional studies, I can construct the following research model. An empirical study was undertaken to test the hypotheses with data from various companies. Multiple regression analysis and t-test were employed to test the hypotheses. The reliability and validity of our measurements were tested by using Cronbach's alpha coefficient and principal factor analysis respectively, and seven hypotheses were tested through performing correlation test and multiple regression analysis. The first key outcome is a theoretically and empirically sound CRM factors(marketing orientation, customer orientation, customer information orientation, and core customer orientation.) in the perceptive of marketing. The intensification of ${\beta}$coefficient among antecedents factors in terms of marketing was not same. In particular, The effects on customer trust of marketing based CRM antecedents were significantly confirmed excluding core customer orientation. It was notable that the direct effects of core customer orientation on customer trust were not exist. This means that customer trust which is firmly formed by long term tasks will not be directly linked to the core customer orientation. the enduring management concerned with this interactions is probably more important for the successful implementation of CRM. The second key result is that the implementation and operation of successful CRM process in terms of marketing approach have a strong positive association with both relationship quality(customer trust/customer satisfaction) and CRM performance(customer retention and customer possession). The final key fact that relationship quality has a strong positive effect on customer retention and customer share confirms that improvements in customer satisfaction and trust improve accessibility to customers, provide more consistent service and ensure value-for-money within the front office which result in growth of customer retention and customer share. Particularly, customer satisfaction and trust which is main components of relationship quality are found to be positively related to the customer retention and customer share. Interactive managements of these main variables play key roles in connecting the successful antecedent of CRM with final outcome involving customer retention and share. Based on research results, This paper suggest managerial implications concerned with constructions and executions of CRM focusing on the marketing perceptivity. I can conclude in general the CRM can be achieved by the recognition of antecedents and outcomes based on marketing concept. The implementation of marketing concept oriented CRM will be connected with finding out about customers' purchasing habits, opinions and preferences profiling individuals and groups to market more effectively and increase sales changing the way you operate to improve customer service and marketing. Benefiting from CRM is not just a question of investing the right software, but adapt CRM users to the concept of marketing including marketing orientation, customer orientation, and customer information orientation. No one deny that CRM is a process or methodology used to develop stronger relationships being composed of many technological components, but thinking about CRM in primarily technological terms is a big mistake. We can infer from this paper that the more useful way to think and implement about CRM is as a process that will help bring together lots of pieces of marketing concept about customers, marketing effectiveness, and market trends. Finally, a real situation we conducted our research may enable academics and practitioners to understand the antecedents and outcomes in the perceptive of marketing more clearly.

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The Effects of Consumer Value Cognition on Benefits and Attributes of Culture-Art Products (문화예술상품 소비자의 가치인식이 추구혜택과 상품속성에 미치는 영향)

  • Shin, Eun Joo;Rhee, Young Sun
    • Asia Marketing Journal
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    • v.14 no.2
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    • pp.177-207
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    • 2012
  • Today's consumers perceive consumption as a representation of themselves. It is not simply an act that fulfills a consumer's physical and practical needs. Even in terms of life quality, consumers increasingly want to achieve an emotional and sensible experience through consumption. Consumers now make decisions based on their need to express their position in relation to other people, pursue emotional satisfaction, and try to improve the quality of life. Culture-art products that meet such internal and external demands of consumers have made significant improvements in both quantity and quality, because of the social interest and policy support. The recognition of personal and social values of culture and arts has brought about interest in and need for culture-art products. Businesses have agilely embraced such change and actively implemented various marketing strategies utilizing culture and arts. For example, businesses began to sponsor artists who produce culture-art products while building facilities for cultural and art performances or exhibitions. Businesses have also provided performances and exhibitions free-of-charge or at affordable prices. As a result, the supply in the market has started to exceed its demand as is often the case in many of other markets. However, such imbalance has occurred not because of over-supply but because of a lack of demand. Given these circumstances, the government and culture and art related organizations, which had mainly concentrated on the supply side, started to recognize the importance of creating personal and social values in culture and arts. As a result, the government and various organizations are now creating various strategies that include policy measures to achieve their new found goal. Unfortunately however, such efforts are not meeting the expectations. Focusing on above-mentioned circumstances and problems, this study aims to find measures to create demand for culture-art products in the internal conditions of those who consume culture-art products. In other words, given that the demand for culture-art products has not increased despite all external conditions to encourage consumption, this study aims to find the reasons in consumers' value judgment on culture-art products. Though there were recent studies on culture-art products that applied consumer behavior on marketing theories, most of them focused on peripheral aspects such as people's motivation for or satisfaction from watching culture-art events. Hence, there is a need to understand what kind of value consumers perceive from culture-art products and how such value cognition leads to consumption in a comprehensive manner. This study acts as follow-up to a separate study entitled "Qualitative Study about Value Cognition and Benefits of Consumer on Culture-Art Products". The current study aims to extend practical implications that enhance the effectiveness of marketing strategies among the producing and policy agencies in the industry. The purpose of this study is to investigate dimensions of value cognition, benefits and attributes of culture-art products, and identify the effects of consumer value cognition on benefits and attributes. The questionnaire was developed based on the conceptual structure of qualitative research and previous researches. It was composed of value cognition, benefits, attributes of culture-art products and demographic variables. This survey was conducted on-line and off-line among a total of 662 persons ranging from their teens to their 50's who were living in Seoul, Gyeonggi-do, various metropolitan cities, and small and medium-sized cities. The data collected was analyzed by factor analysis and path analysis using SPSS WIN 18.0 and AMOS 16.0. This empirical study found that the dimensions of value cognition of culture-art products were categorized into personal goods, aesthetic goods and public property. This shows that the consumers perceive culture-art products as products that are worthy enough to pay the costs not just for personal benefits but also for their social values. Also the formation of value cognition for culture-art products requires special conditions unlike that for physical consumer goods and services, which simply require marketing stimuli. The dimensions of benefits pursued by consuming culture-art products were found to be composed of four types - pursuit of aesthetic benefits, pursuit of actual benefits, pursuit of emotional benefits, and pursuit of conspicuous character. This result implies that people consume culture-art products not just to pursue pleasure from emotional and intelligent satisfaction as well as social relations, but also to seek the needs and benefits embodied at a social level. The dimensions of attributes of culture-art products had seven different factors, - environmental, price, evaluation, people, artwork, composition, and personal relations - which is plentiful. This is because the attributes of culture-art products are very complicated compared to other consumer goods or services. Since culture-art products include not just cultural or artistic works but also all physical, human, environmental, and systemic elements of the products in a comprehensive manner, consumers perceive everything they experience in the process of consuming culture-art products as part of the products. The dimensions of value cognition was found to affect attributes of the products, mostly using pursued benefits as a mediating factors. This result is consistent with the result of qualitative research, and proves that applying the means-end chain theory in the reverse direction is reasonable. The result can be interpreted that consumers' value cognitions for culture-art products turns into actual benefits leading to consumers' decisions. Furthermore, this result reveals that when consumers choose culture-art products, they take into account the attributes of culture-art products depending on the benefits they pursue. These results confirm that despite their conceptual and abstract attributes, culture-art products have values that contribute to actual benefits for individual consumers and society. Hence, value cognition generates benefits to be pursued and this in turn affects the consumers' choices of attributes on products. Based on the conceptual structure of consumers' value cognitions on culture-art products and its dimensions, it is possible to find detailed methods to provide opportunities for education and training to form and reinforce positive value cognition on culture-art products. And through those methods, it will be possible to develop attributes of culture-art products according to the dimensions of pursued benefits, and allow conceptual products become the subject to valuable consumption in real life. These results provide theoretical understanding of consumer behavior in culture marketing and useful information to culture-art producers, companies that use culture and art, and government agencies that use culture-art as a mean to improve the public perception of quality of life. As a follow up on this study, there should be experimental studies that can develop criteria visualizing the demands of consumers who purchase culture-art products and identify their detailed attributes. Studies that compare characteristics of different areas within the culture-art product category and in-depth studies on a specific area or genre will also be needed. In order to develop marketing strategies for culture-art products, studies on the formation and reinforcement of positive value cognition on culture-art products and education for the development of consumer demand as well as on the development and differentiation of attributes of culture-art products depending on types of consumer groups should also follow.

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Radiation Dose-escalation Trial for Glioblastomas with 3D-conformal Radiotherapy (3차원 입체조형치료에 의한 아교모세포종의 방사선 선량증가 연구)

  • Cho, Jae-Ho;Lee, Chang-Geol;Kim, Kyoung-Ju;Bak, Jin-Ho;Lee, Se-Byeoung;Cho, Sam-Ju;Shim, Su-Jung;Yoon, Dok-Hyun;Chang, Jong-Hee;Kim, Tae-Gon;Kim, Dong-Suk;Suh, Chang-Ok
    • Radiation Oncology Journal
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    • v.22 no.4
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    • pp.237-246
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    • 2004
  • Purpose: To investigate the effects of radiation dose-escalation on the treatment outcome, complications and the other prognostic variables for glioblastoma patients treated with 3D-conformal radiotherapy (3D-CRT). Materials and Methods: Between Jan 1997 and July 2002, a total of 75 patients with histologically proven diagnosis of glioblastoma were analyzed. The patients who had a Karnofsky Performance Score (KPS) of 60 or higher, and received at least 50 Gy of radiation to the tumor bed were eligible. All the patients were divided into two arms; Arm 1, the high-dose group was enrolled prospectively, and Arm 2, the low-dose group served as a retrospective control. Arm 1 patients received $63\~70$ Gy (Median 66 Gy, fraction size $1.8\~2$ Gy) with 3D-conformal radiotherapy, and Arm 2 received 59.4 Gy or less (Median 59.4 Gy, fraction size 1.8 Gy) with 2D-conventional radiotherapy. The Gross Tumor Volume (GTV) was defined by the surgical margin and the residual gross tumor on a contrast enhanced MRI. Surrounding edema was not included in the Clinical Target Volume (CTV) in Arm 1, so as to reduce the risk of late radiation associated complications; whereas as in Arm 2 it was included. The overall survival and progression free survival times were calculated from the date of surgery using the Kaplan-Meier method. The time to progression was measured with serial neurologic examinations and MRI or CT scans after RT completion. Acute and late toxicities were evaluated using the Radiation Therapy Oncology Group neurotoxicity scores. Results: During the relatively short follow up period of 14 months, the median overall survival and progression free survival times were $15{\pm}1.65$ and $11{\pm}0.95$ months, respectively. The was a significantly longer survival time for the Arm 1 patients compared to those in Arm 2 (p=0.028). For Arm 1 patients, the median survival and progression free survival times were $21{\pm}5.03$ and $12{\pm}1.59$ months, respectively, while for Arm 2 patients they were $14{\pm}0.94$ and $10{\pm}1.63$ months, respectively. Especially in terms of the 2-year survival rate, the high-dose group showed a much better survival time than the low-dose group; $44.7\%$ versus $19.2\%$. Upon univariate analyses, age, performance status, location of tumor, extent of surgery, tumor volume and radiation dose group were significant factors for survival. Multivariate analyses confirmed that the impact of radiation dose on survival was independent of age, performance status, extent of surgery and target volume. During the follow-up period, complications related directly with radiation, such as radionecrosis, has not been identified. Conclusion: Using 3D-conformal radiotherapy, which is able to reduce the radiation dose to normal tissues compared to 2D-conventional treatment, up to 70 Gy of radiation could be delivered to the GTV without significant toxicity. As an approach to intensify local treatment, the radiation dose escalation through 3D-CRT can be expected to increase the overall and progression free survival times for patients with glioblastomas.