• Radiation Oncology Journal
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• v.26 no.4
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• pp.247-256
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• 2008

Purpose: The purpose of this study is to evaluate anal sphincter preservation rates, survival rates, and prognostic factors in patients with rectal cancer treated with preoperative chemoradiotherapy. Materials and Methods: One hundred fifty patients with pathologic confirmed rectal cancer and treated by preoperative chemoradiotherapy between January 1999 and June 2007. Of the 150 patients, the 82 who completed the scheduled chemoradiotherapy, received definitive surgery at our hospital, and did not have distant metastasis upon initial diagnosis were enrolled in this study. The radiation dose delivered to the whole pelvis ranged from 41.4 to 46.0 Gy (median 44.0 Gy) using daily fractions of $1.8{\sim}2.0\;Gy$ at 5 days per week and a boost dose to the primary tumor and high risk area up to a total of $43.2{\sim}54\;Gy$ (median 50.4 Gy). Sixty patients (80.5%) received 5-fluorouracil, leucovorin, and cisplatin, while 16 patients (19.5%) were administered 5-fluorouracil and leucovorin every 4 weeks concurrently during radiotherapy. Surgery was performed for 3 to 45 weeks (median 7 weeks) after completion of chemoradiotherapy. Results: The sphincter preservation rates for all patients were 73.2% (60/82). Of the 48 patients whose tumor was located at less than 5 cm away from the anal verge, 31 (64.6%) underwent sphincter-saving surgery. Moreover, of the 34 patients whose tumor was located at greater than or equal to 5 cm away from the anal verge, 29 (85.3%) were able to preserve their anal sphincter. A pathologic complete response was achieved in 14.6% (12/82) of all patients. The downstaging rates were 42.7% (35/82) for the T stage, 75.5% (37/49) for the N stage, and 67.1% (55/82) for the overall stages. The median follow-up period was 38 months (range $11{\sim}107$ months). The overall 5-year survival, disease-free survival, and locoregional control rates were 67.4%, 58.9% and 84.4%, respectively. The 5-year overall survival rates based on the pathologic stage were 100% for stage 0 (n=12), 59.1% for stage I (n=16), 78.6% for stage II (n=30), 36.9% for stage III (n=23), and one patient with pathologic stage IV was alive for 43 months (p=0.02). The 5-year disease-free survival rates were 77.8% for stage 0, 63.6% for stage I, 58.9% for stage II, 51.1% for stage III, and 0% for stage IV (p<0.001). The 5-year locoregional control rates were 88.9% for stage 0, 93.8% for stage I, 91.1% for stage II, 68.2% for stage III, and one patient with pathologic stage IV was alive without local recurrence (p=0.01). The results of a multivariate analysis with age (${\leq}55$ vs. >55), clinical stage (I+II vs. III), radiotherapy to surgery interval (${\leq}6$ weeks vs. >6 weeks), operation type (sphincter preservation vs. no preservation), pathologic T stage, pathologic N stage, pathologic overall stage (0 vs. I+II vs. III+IV), and pathologic response (complete vs. non-CR), only age and pathologic N stage were significant predictors of overall survival, pathologic overall stage for disease-free survival, and pathologic N stage for locoregional control rates, respectively. Recurrence was observed in 25 patients (local recurrence in 10 patients, distant metastasis in 13 patients, and both in 2 patients). Acute hematologic toxicity ($\geq$grade 3) during chemoradiotherapy was observed in 2 patients, while skin toxicity was observed in 1 patient. Complications developing within 60 days after surgery and required admission or surgical intervention, were observed in 11 patients: anastomotic leakage in 5 patients, pelvic abscess in 2 patients, and others in 4 patients. Conclusion: Preoperative chemoradiotherapy was an effective modality to achieve downstaging and sphincter preservation in rectal cancer cases with a relatively low toxicity. Pathologic N stage was a statistically significant prognostic factor for survival and locoregional control and so, more intensified postoperative adjuvant chemotherapy should be considered in these patients.

• 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.

• Journal of the Daesoon Academy of Sciences
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• v.27
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• pp.171-200
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• 2016

This paper will analyze the filial piety based ethics of Daesoonjinrihoe (大巡眞理會) and the traditional filial piety of Confucianism (儒敎), Buddhism (佛敎) and Taoism (道敎) through comparing and contrasting their unique systems. The traditional Korean ethics regarding filial piety are in great need of reformation as the relationship between the parents and children should not be vertical or unilateral but parallel and reciprocal. However, there have not been sufficient in-depth studies on this specific ideology and alternative approaches. Regarding this prospect, one representative Korean indigenous new religion, Daesoonjinrihoe has emerged and directly engages in the collision between traditionalism and modernity. The modernity of Daesoonjinrihoe, enables the observation of how the filial piety based ethics have developed within a system of doctrine and thereby provides an exemplary model of traditional filial piety reimagined in accordance with modern sensibilities. A brief summary of comparative findings is as follows: First, Daesoonjinrihoe and Confucianism have taken serving parents with respect as an ethic within filial piety, but Confucianism engenders this ideal through the unilateral and unconditional sacrifice of younger people based on patriarchal feudalism whereas Daesoonjinrihoe has rejected such unilateral sacrifice and instead promotes mutual beneficience between parents and children. This difference occurs, in part, due to the filial piety of Confucianism rising in the midst of the feudal order whereas the ideology of Daesoonjinrihoe contains ideals such as "the reciprocation of favor for mutual beneficence (報恩相生)" and "respect for humanity (人尊)," both of which serve as key principles of the new religious world as envisioned by Daesoonjinrihoe. Second, filial piety in Buddhism and Taoism tends to be passive and inactive and is often expressed by praying for happiness and longevity for one's parents while they are alive and later praying for the heavenly rebirth of one's parents after they die. The filial piety of Daesoonjinrihoe also partially contains such ideas, however; they are extended much further and arrive upon novel and profound expressions. The spectrum of the filial piety in Daesoonjinrihoe expands to the extent children perform actions to resolve their parent's sins and pave a new road for their parents. This filial piety requires a cultivation practice from both parents and children. This system of dual cultivation was established because the world-view of Daesoonjinrihoe enables both parents and children to enjoy happiness and wealth both of which are achieved through the completion of religious objectives following cultivation practice. Third, Confucianism and Daesoonjinrihoe hold memorial services for ancestors with sincerity as an expression of filial piety. Filial piety in the Confucian context excludes ideas from Shamanism and thereby memorial services are held for impersonal entities, however; in the Daesoonjinrihoe context, memorial services are held for personal-entities. Accordingly, holding a memorial service for ancestors with sincerity has a greater sense of realism in Daesoonjinrihoe than it does in Confucianism. Fourth, while Confucianism and Daesoonjinrihoe both aim to requite the grace received from ancestors, the contents of grace and reciprocation of favors (報恩) are viewed differently. In Confucianism, since the ancestors existed previously and bestowed the gift of life to their children and indirectly, all of their descendents. Therefore, memorial services for ancestors are held to convey gratitude and filial piety. However, in Daesoonjinrihoe, ancestors not only bestowed the gift of earthly life to their descendents, in the spirit realm, ancestral spirits also spend sixty years accumulating the merit necessary to imbue each of their descendents with spiritual insight. Consequently, filial piety is expressed through memorial services as well as spiritual cultivation. Fifth, in Confucianism, achieving the fame and prestige indicative of success in the mundane world can be an act of filial piety as it would bring pride to one's ancestors, but in Daesoonjinrihoe, succeeding in religious objectives through spiritual cultivation is considered to be a higher form of filial piety. Sixth, Confucianism, Buddhism and Taoism all observe filial piety as system of familial ethics based in morality. This is likewise true of Daesoonjinrihoe, however; Daesoonjinrihoe confers greater importance on filial piety as an essential form of ethics for religious redemption. This is due to the Daesoon interpretation that the absence of filial piety was the direct cause which led to the sickened state of the world and its collapse. Forgetting the grace of parents who have given the gift of life or the grace of ancestral spirits who have accumulated merit on behalf of their descendents are acts of ingratitude which are unacceptable during the period of Reordering of the Universe. Judging from these findings, Daesoonjinrihoe embraces parts of traditional filial piety as it exists in Confucianism, Buddhism and Taoism, but it does so on the ground of its own unique culture. Through re-interpretation and re-creation, ideas regarding filial piety are being further developed. Namely, filial piety in Daesoonjinrihoe is regulations founded upon the reciprocation of favors for mutual beneficence and respect for humanity. Therefore, it is understood as a concept wherein one's own cultivation practice is performed in order to reach religious objectives, the perfection of personal character, and spiritual insight. This requires that even recipents of filial piety (i.e., parents) perform certain cultivation practices to enjoy happiness and wealth. Additionally, filial piety in Daesoonjinrihoe manifests a reinforced religious character and also serves as a system ethics which is soteriologically essential for salvation during the period known as the Reordering of the Universe.