• Title/Summary/Keyword: Negative Side-Effects

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A Study on Management Measures of Street Vendors in the Vicinity of Traditional Markets (전통시장 및 인접구역의 생계형 노점상 관리방안에 관한 연구)

  • Kim, Young-Ki
    • Journal of Distribution Research
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    • v.15 no.5
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    • pp.155-174
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    • 2010
  • In many cases, street vendors are means of living and/or a solution to unemployment for low income group. Street vendors have both of positive and negative effects on traditional market revitalization. This two-sided perspective of the vendors has produced different views of interests groups. In this study, the features of street vendors are examined to present related issues, and a survey result conducted on interests groups is presented to offer effective management measures. As traditional management about street vendors are focused on crackdown, relationship between street traders and government has been not very much mutually cooperative, and at times some traders organized groups who are against government policies. With the premise admitting street vendors as one element of distribution network, it is possible to access the management measures for street vendors in organizational, quantitative or qualitative perspectives. However, I believe it is not recommendable to enforce multi-perspective approach at a time. It is because street traders still have quite strong animosity against government policies. Therefore, serious misunderstanding and side-effects on our society could be brought if the government makes hasty and forcible attempts to legalize street vendors. In political position, overreaching actions of government could hardly produce positive results because policy making and its enforcement need each of timeliness. In a similar way, government's policies for street vendors need to come into effect gradually. Management measures for street vendors can come in short-, mid- and long-term. In short-term, government should try to reduce animosity of street traders along with minimizing institutional and political pressure on them. As a mid-term solution, plans to bring vendors over to institutional boundaries by improving them are required. Last but not least, in the long term, government should design policies which are to help street vendors settle down and maintain successfully in the boundaries. Besides, policies related to street vendors need to come in effect in a way that closely connected to interests groups and businesses because those policies would get involve many interests groups and businesses in diverse perspectives.

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Retrograde Autologous Priming: Is It Really Effective in Reducing Red Blood Cell Transfusions during Extracorporeal Circulation? (역행성 자가혈액 충전법: 체외순환 중 동종적혈구 수혈량을 줄일 수 있는가?)

  • Lim, Cheong;Son, Kuk-Hui;Park, Kay-Hyun;Jheon, Sang-Hoon;Sung, Sook-Whan
    • Journal of Chest Surgery
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    • v.42 no.4
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    • pp.473-479
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    • 2009
  • Background: Retrograde autologous priming (RAP) is known to be useful in decreasing the need of transfusions in cardiac surgery because it prevents excessive hemodilution due to the crystalloid priming of cardiopulmonary bypass circuit. However, there are also negative side effects in terms of blood conservation. We analyzed the intraoperative blood-conserving effect of RAP and also investigated the efficacy of autotransfusion and ultrafiltration as a supplemental method for RAP. Material and Method: From January 2005 to December 2007, 117 patients who underwent isolated coronary artery bypass operations using cardiopulmonary bypass (CPB) were enrolled. Mean age was 63.9$\pm$9.1 years (range 36$\sim$83 years) and 34 patients were female. There were 62 patients in the RAP group and 55 patients in he control group. Intraoperative autotransfusion was performed via the arterial line. RAP was done just before initiating CPB using retrograde drainage of the crystalloid priming solution. Both conventional (CUF) and modified (MUF) ultrafiltrations were done during and after CPB, respectively. The transfusion threshold was less than 20% in hematocrit. Result: Autotransfusions were done in 79 patients (67.5%) and the average amount was 142.5$\pm$65.4 mL (range 30$\sim$320 mL). Homologous red blood cell (RBC) transfusion was done in 47 patients (40.2%) and mean amount of transfused RBC was 404.3$\pm$222.6 mL. Risk factors for transfusions were body surface area (OR 0.01, 95% CI 0.00 $\sim$ 0.63, p=0.030) and cardiopulmonary bypass time (OR 1.04, 95% CI 1.01 $\sim$ 1.08, p=0.019). RAP was not effective in terms of the rate of transfusion (34.5% vs 45.2%, p=0.24). However, the amount of transfused RBC was significantly decreased (526.3$\pm$242.3ml vs 321.4$\pm$166.3 mL, p=0.001). Autotransfusion and ultrafiltration revealed additive and cumulative effects decreasing transfusion amount (one; 600.0$\pm$231.0 mL, two; 533.3$\pm$264.6 mL, three; 346.7$\pm$176.7 mL, four; 300.0$\pm$146.1 mL, p=0.002). Conclusion: Even though RAP did not appear to be effective in terms of the number of patients receiving intraoperative RBC transfusions, it could conserve blood in terms of the amount transfused and with the additive effects of autotransfusion and ultrafiltration. If we want to maximize the blood conserving effect of RAP, more aggressive control will be necessary - such as high threshold of transfusion trigger or strict regulation of crystalloid infusion, and so forth.

Comparative Study on the Regimens with Pyrazinamide or Ofloxacin in the retreatment of pulmonary tuberculosis (폐결핵 재치료에서 Pyrazinamide 복합처방과 Ofloxacin 복합처방의 효과에 관한 비교 연구)

  • Choi, In Hwan;Park, Seung Kyu;Kim, Kyeong Ho;Kim, Jin Ho;Kim, Cheon Tae;Song, Sun Dae
    • Tuberculosis and Respiratory Diseases
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    • v.43 no.6
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    • pp.871-881
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    • 1996
  • Objective: In the early short-term therapy of pulmonary tuberculosis, PZA is used for the first two months on 6EHRZ therapy but PZA is not effective in the case of long-tenn use PZA for retreatment in the sensitive relapse or acquired drug resistance for PZA. But in the endemic area as Korea, if we can't use PZA in the retreatment of pulmonary tuberculosis, we can't expect the success for retreatment of pulmonary tuberculosis, therefore we need new drugs substituting for PZA. In these days, 4 - fluoroquinolone derivatives were investigated and only ofloxacin and ciprofloxacin of derivatives were known to be effective but the effectiveness was also not certain because the result was experimental or combined with other bacteriocidal drugs and datas on effectiveness of pulmonary tuberculosis were so little. Therefore these drugs should be use with other two or three strong-acting drugs in the last period of retreatment of pulmonary tuberculosis. The ofloxacin or ciprofloxacin is used in some area in Korea but randomly and needed more study. We did this study for proving the effectiveness of these drugs and establishment of retreatment regimen for pulmonary tuberculosis. Methods: Retrospective cohort study of 83 drug-resistant pulmonary tuberculosis patients at National Masan Tuberculosis Hospital from Jan. 1994 to dec. 1995 was made. All the patients taken medicine for 2nd ami-tuberculosis regimens for the first lime. We separated the patients by two groups.(Group I : OFX+ PTA + CS+PAS + Injection, Group II: PZA + PTA+ CS + PAS + Injection). We compared the difference between two groups and tested the confidence limit about results after treatment by $\chi$2-test and T-test. Results : 1. The age distribution was most frequent in fourth decade(29.2% in Group I, 37.1% in Group II) and the mean age was 43.9 year in Group I, and 39.0 year in Group II, but had no significant difference between two groups. The sex distribution was more frequent in the males(68.8% in Group I, 85.7% in Group II), but had no significant difference. 2. Family history was 29.2% in Group I, 28.6% in Group II, but had no significant difference. 3. In the respect of extent of disease, far-advanced stare was 60.4% in Group I, 74.3% in Group II, but had no significant difference. 4. The side effects for drugs showed in 58.3% in Group I and 65.7% in Group II, and the gastrointestinal trouble showed 25.0% in Group and arthralgia 34.3% in Group II predominantly respectively and had the significant difference(p<0.05). 5. The negative conversion rate on sputum AFB smear was 87.5% in Group I and 80.0% in Group II, but had no significant difference. But the negative conversion rate on sputum AFB culture was 83.3% in Group I and 57.1 % in Group II and had the significant difference(p<0.05). 6. The success rate of treatment was 87.5 % in Group I and 83.3 % in Group II but had no significant difference. Conclusion : In the retreatment of pulmonary tuberculosis, ofloxacin is useful drug for the patients who are not available to use PZA and can be use effectively substituting for PZA.

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A study on oral discomfort in gynecological cancer patients undergoing chemotherapy (화학요법을 받는 부인암환자의 구강불편감에 관한 연구)

  • 정재원
    • Journal of Korean Academy of Nursing
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    • v.25 no.2
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    • pp.372-389
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    • 1995
  • The frequency with which administration of chemotherapy for gynecological cancer treatment is used has increased along with the use of surgery and radiotherapy Among the various side effects of chemotherapy, stomatitis causes a problem of function and sensation in the oral cavity. This oral discomfort can be categorized into two components ; perceived oral symptoms and observed oral symptoms. If the oral problem continues, it may cause infection, bleeding and nutritional deficiencies. As a result of this condition, compliance with the treatment process can be affected as well as the prognosis for the cancer patients. But as the oral discorrfort usually appears after chemotherapy, it is often not reported to the health care personnel as a patient problem. Without problem identification of the oral discomfort and ability to assess the problem, effective intervention cannot be planned. Therefore, this study was conducted to identify the pattern and the degree of oral discomfort due to cancer chemotherapy and thus to provide data for identification of the patient problem and for nursing assessment. The design of this study was a longitudinal de-scriptive study The subjects were in - patients who received chemotherapy under the diagnosis of gynecological cancer between Mar. 15, 1994 and May 15, 1994 at a general hospital in Seoul, Korea. The number of subjects was 64 and they were divided into two groups, one of 41 (A : 5FU & Neoplatin), the other of 23(B : Neoplatin, Cytoxan, Adriamycin), according to the treatment regimen. The data were collected for 24 days using self-re-port instruments. The instruments were the 「Perceived Oral Symptom Assessment Tool」 and 「Observed Oral Symptom Assessment Tool」 developed by this researcher. Data were analyzed using the SPSS-PC program, ANOVA, t-test, paired t-test and the Pearson Correlation Coefficient were applied. The results of this study are as follows : 1. In A regimen the peak time for perceived oral symptom scores was the fifth day after chemotherapy, and the tenth day for observed oral symptom scores. Both of the problems started on first day of chemotherapy and were not resolved completely until the 24th day after treatment. 2. In B regimen, the peak time for perceived oral symptom scores was on the seventh day after chemotherapy, and the eighth day for observed oral symptom scores. It was noted that perceived oral symptom scores were higher than observed oral symptom scores consistently for 24 days. Both also started on first day of chemotherapy, and were not resolved completely until the 24th day after chemotherapy. 3. There were no differences statistically in perceived oral symptom scores between A and B regimen. The loss of appetite and xerostomia caused the most severe discomfort in both of these two groups. 4. The were no differences statistically in observed oral symptom scores between the A and B regi moil. In the A regimen, the highest observed symptom scores were the lips, gingiva, tongue and buccal membrane in that order. But in the B regimen, the highest observed symptom scores were tongue, lips, buccal membrane and gingiva in that order. 5. In A regimen, the patients who had gingival edema and dentures had significantly higher perceived oral symptom scores. And those who had gingival edema and bleeding, foul odor and aphthous stomatitis had significantly higher observed oral symptom scores. 6. In B regimen, the patients who had the experience of stomatitis in the last course of chemotherapy had significantly higher perceived oral symptom scores. Those who had gingival edema had significantly higher observed oral symptom scores. 7. In the A regimen there was no correlation between lab values for lymphocytes and albumin with perceived oral symptom scores and observed oral symptom scores. In the B regimen, there was a significant negative correlation between lymphocytes and albumin with the observed oral symptom scores, but not between perceived oral symptom scores and lymphocytes and albumin values. In conclusion, the nurse should expect that the patient undergoing chemotherapy will complain severely about subjective discomfort and before objective physical change is observed. Also the patients who have chronic oral problems such as dentures, gingival edema and bleeding, foul odor, aphthous stomatitis will complain of severe oral discomfort due to chemotherapy.

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The Effect of Coffee Consumption Motivation on the Future Coffee Consumption Intentions (커피의 소비동기와 향후 소비의도에 관한 연구)

  • Jung, Ja Young
    • Asia-Pacific Journal of Business Venturing and Entrepreneurship
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    • v.8 no.4
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    • pp.129-144
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    • 2013
  • The consumption of coffee has been drastically increased last two decades. Now almost all the Korean adult people enjoy the coffee and diverse cultures related coffee have been spread widely in Korea. Therefore new marketing strategies are necessary to satisfy consumers according to ages, attitudes, and other characters. It has been continuously discussed whether the coffee gives negative impacts to health. Regardless of the discussions of the effects to health, now coffee became a part of modern daily lives. In this study the motivations of coffee consumption were classified to five; wellbeing motivation, refreshment motivation, social motivation, habitual motivation, and emotional motivation. Future intention of coffee consumption were also classified to five factors: sound mental intention, addictive intention, side-effect recovery intention, economic intention, and psychological intention. The survey was conducted in Seoul City and Kyeongki Province from January 3 to February 2, 2013. Total 500 questionaries were distributed and 450 were collected and 428 samples were used for the analysis of this study. The data were analyzed by SPSS Win 18 Version. The methods used in this study were factors analysis test, reliability test, validity test, t-testy, One-Way ANOVA, and regression analysis. The hypnosis in this study were as follows. First, The motivations of coffee consumption would influence to the intention of coffee consumption. Second, there would be statistical differences to the intention of coffee consumption according to the demographic characteristics. According to the result of the study, the motivation of coffee partially affected to the intention of coffee consumption. And there were statistical differences according to age, occupations, educational levels, and monthly incomes. The implications of this study were the factors related health and emotional feeling were considered more important than tastes and characters of coffee-shop that people thought more important before.

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Evaluation of Blood Volume State Using the Quotient of Urine Sodium and Potassium Excretion in Primary Nephrotic Syndrome in Children (일차성 신증후군 환아에서 소변 나트륨과 칼륨 농도를 이용한 저혈량증 평가)

  • Choi, Jung-Youn;Park, Yong-Hoon
    • Childhood Kidney Diseases
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    • v.11 no.1
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    • pp.9-15
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    • 2007
  • Purpose : Edema is one of the cardinal features of nephrotic syndrome. Although the pathogenesis of edema is not entirely understood, it is caused by hypovolemia or hypervolemia by different mechanisms. Accordingly it is important to evaluate the volume status of patients in order to treat the edema, but it is difficult to evaluate the patient's volume status only by clinical parameters. The quotient of urine sodium and potassium excretion $U_K/(U_{Na}+U_K)$ is introduced as a more useful way to evaluate volume status. In this study we will propose the usefulness of $U_K/(U_{Na}+U_K)$ in evaluating the volume status of children with nephrotic syndrome. Methods : Primary nephrotic syndrome patients at Yeungnam University Hospital since January 1995 to June 2005, were included in the study. We analyzed clinical parameters such as tachycardia, cardiomegaly, pleural effusion, blood chemistry and urinalysis prospectively. We defined hypovolemia when $U_K/(U_{Na}+U_K)$ exceeded 60%. Intravenous albumin and diuretics were administered to hypovolemic edematous patients. On the other hand, hypervolemic edematous patients were treated only with diuretics. Results : There were 50 cases of primary nephrotic syndrome patients(hypervolemia: 29 vs hypovolemia: 21). There were no significant differences in clinical symptoms and laboratory findings except for FeNa While $F_eNa$ and $U_K/(U_{Na}+U_K)$ had a significant negative correlation, BUN and $U_K/(U_{Na}+U_K)$ had a significant positive correlation. Urine output after edema treatment was effective and there were no treatment-related side effects in both groups. Conclusion : FeNa, BUN and $U_K/(U_{Na}+U_K)$ are a useful parameters for evaluating volume status of edematous nephrotic syndrome patients. We could suggest a therapeutic option for using albumin and/or diuretics according to volemic status by means of measured $U_K/(U_{Na}+UK)$.

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The Effect of Risperidone on Serum Prolactin Concentrations (Risperidone이 혈청 Prolactin 농도에 미치는 영향)

  • Cheon, Jin-Sook;Cho, Woong;Oh, Byoung-Hoon
    • Korean Journal of Biological Psychiatry
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    • v.5 no.2
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    • pp.253-262
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    • 1998
  • Objectives : Risperidone, an atypical antipsychitics which blocks both dopaminergic and serotonergic receptors, have a good response to the negative symptoms as well as positive symptoms, and improve cognitive dysfunction of schizophrenic patients. Furthermore, it has few extrapyramidal side effects and tardive dyskinesia. Although it had been reported that the atypical antipsychotics have less effect on prolactin(PRL) than the classical antipsychotics, we could experience PRL-associated symptoms such as amenorrhea, galactorrhea and hyperprolactinemia in practice. Therefore, we tried to identify the sex differences of risperidone-induced hyperprolactinemia, to evaluate factors affecting PRL levels, and to know the association between cognitive disorders and PRL. Methods : The baseline levels of PRL and TSH prior to risperidone administration were measured by enzyme immunoassay method for 50 patients(25 ma-les and 25 females) admitted with schizophrenia, schizoaffective disorder or schizophreniform disorder according to the DSM-IV classification, and the measurements of PRL were repeated on the 2nd and the 4th wks of risperidone administration. Concomitantly, the severity of psychotic symptoms using CGI, BPRS and PANSS, and the cognitive dysfunction using PANSS-CF were assessed prior to, on the 2nd and the 4th wks of risperidone administration. The PRL and TSH levels of 54 healthy controls(29 males and 25 females) who had no medical, neurological and psychiatric illnesses were also evaluated. Furthermore, the correlation with the psychiatric diagnosis, education, age, sex, duration of illnesses, risperidone dosage, duration of risperdone administration, TSH concentration, cognitive function, severity of psychotic symptoms were also identified. Results : 1) The baseline PRL levels of female schizophrenics($74.3{\pm}49.6ng/ml$) were significantly(p<0.005) higher than those of males($36.3{\pm}24.6ng/ml$), which were significantly(p<0.0001 respectively) higher than those of controls(females $16.9{\pm}6.1ng/ml$, males $13.3{\pm}4.9ng/ml$). The PRL levels measured on the 2nd wks(females $133.7{\pm}47.8ng/ml$, males $56.9{\pm}23.6ng/ml$) and on the 4th wks(females $146.1{\pm}45.9ng/ml$, males $70.0{\pm}31.5ng/ml$) after risperidone administration were significantly(p<0.0001 respectively) higher in females. The mean dosages of risperidone on the 2nd wks were $3.8{\pm}1.7mg$(2-6mg) for the females and $4.0{\pm}1.6mg$(2-6mg) for the males, and on the 4th wks were $4.5{\pm}2.1mg$(2-8mg) for the females and $5.4{\pm}2.2mg$(2-8mg) for the males. 2) The rise of PRL levels were positively correlated with increased risperidone dosage in males(${\gamma}$=0.307 on the 2nd wks and ${\gamma}$=0.280 on the 4th wks), while they were not correlated with dosages in females. For the females, the PRL levels were negatively correlated(${\gamma}$=-0.320) with decrease of TSH concentration. The baseline PRL levels were not correlated with age, education, duration of illnesses, psychopathology, cognitive disorders in both males and females, while it was negatively correlated with TSH levels only in females(${\gamma}$=-0.320). 3) The cognitive dysfunction was not correlated with PRL levels in males, while PANSS-CF scores were negatively correlated with PRL levels(${\gamma}$=-0.220 on the 2nd wks and ${\gamma}$=-0.366 on the 4th wks) in females. The psychopathology was positively correlated with cognitive dysfunction in both males and females. Therefore, the risperidone-induced cognitive improvement seemed to be correlated with improvement of psychopathology in both males and females, and with increase in PRL levels only in females. Conclusions : The fact that the serum PRL levels of schizophrenics were higher than those of controls, especially in females suggested that it could be related with risperidone dosage in males and with primary pathological process in females. The risperidone-associated cognitive improvement seemed to be related with general improvement of psychopathology as well as the rise of PRL levels especially in females. The facts that the effect of risperidoneinduced hyperprolactinemia and the cognitive function were more in females suggested that somewhat different mechanisms could be exerted on them.

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Dynamic Characteristics of Water Column Properties based on the Behavior of Water Mass and Inorganic Nutrients in the Western Pacific Seamount Area (서태평양 해저산 해역에서 수괴와 무기영양염 거동에 기초한 동적 수층환경 특성)

  • Son, Juwon;Shin, Hong-Ryeol;Mo, Ahra;Son, Seung-Kyu;Moon, Jai-Woon;Kim, Kyeong-Hong
    • Journal of the Korean Society for Marine Environment & Energy
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    • v.18 no.3
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    • pp.143-156
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    • 2015
  • In order to understand the dynamic characteristics of water column environments in the Western Pacific seamount area (approximately $150.2^{\circ}E$, $20^{\circ}N$), we investigated the water mass and the behavior of water column parameters such as dissolved oxygen, inorganic nutrients (N, P), and chlorophyll-a. Physico-chemical properties of water column were obtained by CTD system at the nine stations which were selected along the east-west and south-north direction around the seamount (OSM14-2) in October 2014. From the temperature-salinity diagram, the main water masses were separated into North Pacific Tropical Water and Thermocline Water in the surface layer, North Pacific Intermediate Water in the intermediate layer, and North Pacific Deep Water in the bottom layer, respectively. Oxygen minimum zone (OMZ, mean $O_2$ $73.26{\mu}M$), known as dysoxic condition ($O_2<90{\mu}M$), was distributed in the depth range of 700~1,200 m throughout the study area. Inorganic nutrients typified by nitrite + nitrate and phosphate showed the lowest concentration in the surface mixed layer and then gradually increased downward with representing the maximum concentration in the OMZ, with lower N:P ratio (13.7), indicating that the nitrogen is regarded as limiting factor for primary production. Vertical distribution of water column parameters along the east-west and south-north station line around the seamount showed the effect of bottom water inflowing at around 500 m deep in the western and southern region, and concentrations of water column parameters in the bottom layer (below 2,500 m deep) of the western and southern region were differently distributed comparing to those of the other side regions (eastern and northern). The value of Excess N calculated from Redfield ratio (N:P=16:1) represented the negative value throughout the study area, which indicated the nitrogen sink dominant environments, and relative higher value of Excess N observed in the bottom layer of western and southern region. These observations suggest that the topographic features of a seamount influence the circulation of bottom current and its effects play a significant role in determining the behavior of water column environmental parameters.

Validation of Load Calculation Method for Greenhouse Heating Design and Analysis of the Influence of Infiltration Loss and Ground Heat Exchange (온실 난방부하 산정방법의 검증 및 틈새환기와 지중전열의 영향 분석)

  • Shin, Hyun-Ho;Nam, Sang-Woon
    • Horticultural Science & Technology
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    • v.33 no.5
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    • pp.647-657
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    • 2015
  • To investigate a method for calculation of the heating load for environmental designs of horticultural facilities, measurements of total heating load, infiltration rate, and floor heat flux in a large-scale plastic greenhouse were analyzed comparatively with the calculation results. Effects of ground heat exchange and infiltration loss on the greenhouse heating load were examined. The ranges of the indoor and outdoor temperatures were $13.3{\pm}1.2^{\circ}C$ and $-9.4{\sim}+7.2^{\circ}C$ respectively during the experimental period. It was confirmed that the outdoor temperatures were valid in the range of the design temperatures for the greenhouse heating design in Korea. Average infiltration rate of the experimental greenhouse measured by a gas tracer method was $0.245h^{-1}$. Applying a constant ventilation heat transfer coefficient to the covering area of the greenhouse was found to have a methodological problem in the case of various sizes of greenhouses. Thus, it was considered that the method of using the volume and the infiltration rate of greenhouses was reasonable for the infiltration loss. Floor heat flux measured in the center of the greenhouse tended to increase toward negative slightly according to the differences between indoor and outdoor temperature. By contrast, floor heat flux measured at the side of the greenhouse tended to increase greatly into plus according to the temperature differences. Based on the measured results, a new calculation method for ground heat exchange was developed by adopting the concept of heat loss through the perimeter of greenhouses. The developed method coincided closely with the experimental result. Average transmission heat loss was shown to be directly proportional to the differences between indoor and outdoor temperature, but the average overall heat transfer coefficient tended to decrease. Thus, in calculating the transmission heat loss, the overall heat transfer coefficient must be selected based on design conditions. The overall heat transfer coefficient of the experimental greenhouse averaged $2.73W{\cdot}m^{-2}{\cdot}C^{-1}$, which represents a 60% heat savings rate compared with plastic greenhouses with a single covering. The total heating load included, transmission heat loss of 84.7~95.4%, infiltration loss of 4.4~9.5%, and ground heat exchange of -0.2~+6.3%. The transmission heat loss accounted for larger proportions in groups with low differences between indoor and outdoor temperature, whereas infiltration heat loss played the larger role in groups with high temperature differences. Ground heat exchange could either heighten or lessen the heating load, depending on the difference between indoor and outdoor temperature. Therefore, the selection of a reference temperature difference is important. Since infiltration loss takes on greater importance than ground heat exchange, measures for lessening the infiltration loss are required to conserve energy.

Effects of Concurrent Chemotherapy and Postoperative Prophylactic Paraaortic Irradiation for Cervical Cancer with Common Iliac Node Involvement (자궁경부암의 근치적 절제술 후 총장골동맥림프절 침범 시 동시항암화학치료와 예방적 대동맥주위림프절 방사선조사의 효과)

  • Han, Tae-Jin;Wu, Hong-Gyun;Kim, Hak-Jae;Ha, Sung-Whan;Kang, Soon-Beom;Song, Yong-Sang;Park, Noh-Hyun
    • Radiation Oncology Journal
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    • v.28 no.3
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    • pp.125-132
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    • 2010
  • Purpose: To retrospectively assess the advantages and side effects of prophylactic Paraaortic irradiation in cervical cancer patients with common iliac nodal involvement, the results for survival, patterns of failure, and treatment-related toxicity. Materials and Methods: From May 1985 to October 2004, 909 patients with cervical carcinoma received postoperative radiotherapy at the Seoul National University Hospital. Among them, 54 patients with positive common iliac nodes on pathology and negative Paraaortic node were included in the study. In addition, 44 patients received standard pelvic irradiation delivered 50.4 Gy per 28 fractions (standard irradiation group), and chemotherapy was combined in 16 of them. The other 10 patients received pelvic irradiation at a dose of 50.4 Gy per 28 fractions in addition to Paraaortic irradiation at 45 Gy per 25 fractions (extended irradiation group). In addition, all of them received chemotherapy in combination with radiation. Follow-up times for pelvic and Paraaortic irradiation ranged from 6 to 201 months (median follow-up time, 58 months) and 21 to 58 months (median follow-up time, 47 months), respectively. Results: The 4-year overall survival, disease free survival, and distant metastasis free survival in the standard irradiation group and extended irradiation group were 67.2% vs. 90.0% (p=0.291), 59.0% vs. 70.0% (p=0.568) and 67.5% vs. 90.0% (p=0.196), respectively. The most common site of first failure for the standard irradiation group was the paraaortic lymph node, while no paraaortic failure was observed in the extended irradiation group. Relatively, hematologic toxicity grade 3 or greater was common in the extended irradiation group (2/10 extended vs. 2/44 standard), while gastrointestinal toxicity of grade 3 or greater was lower (2/10 extended vs. 6/44 standard), and urologic toxicity of grade 3 or greater was observed in the standard irradition group only (0/10 vs. 3/44). Conclusion: Concurrent chemotherapy and prophylactic Paraaortic irradiation in patients with common iliac nodal involvement showed slightly improved clinical outcomes aside from increased hematologic toxicity, which was statistically insignificant. Considering the relatively small number of patients and short follow-up times, additional studies are needed to obtain more conclusive outcomes.