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Optimum Radiotherapy Schedule for Uterine Cervical Cancer based-on the Detailed Information of Dose Fractionation and Radiotherapy Technique (처방선량 및 치료기법별 치료성적 분석 결과에 기반한 자궁경부암 환자의 최적 방사선치료 스케줄)

  • Cho, Jae-Ho;Kim, Hyun-Chang;Suh, Chang-Ok;Lee, Chang-Geol;Keum, Ki-Chang;Cho, Nam-Hoon;Lee, Ik-Jae;Shim, Su-Jung;Suh, Yang-Kwon;Seong, Jinsil;Kim, Gwi-Eon
    • Radiation Oncology Journal
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    • v.23 no.3
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    • pp.143-156
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    • 2005
  • Background: The best dose-fractionation regimen of the definitive radiotherapy for cervix cancer remains to be clearly determined. It seems to be partially attributed to the complexity of the affecting factors and the lack of detailed information on external and intra-cavitary fractionation. To find optimal practice guidelines, our experiences of the combination of external beam radiotherapy (EBRT) and high-dose-rate intracavitary brachytherapy (HDR-ICBT) were reviewed with detailed information of the various treatment parameters obtained from a large cohort of women treated homogeneously at a single institute. Materials and Methods: The subjects were 743 cervical cancer patients (Stage IB 198, IIA 77, IIB 364, IIIA 7, IIIB 89 and IVA 8) treated by radiotherapy alone, between 1990 and 1996. A total external beam radiotherapy (EBRT) dose of $23.4\~59.4$ Gy (Median 45.0) was delivered to the whole pelvis. High-dose-rate intracavitary brachytherapy (HDR-IBT) was also peformed using various fractionation schemes. A Midline block (MLB) was initiated after the delivery of $14.4\~43.2$ Gy (Median 36.0) of EBRT in 495 patients, while In the other 248 patients EBRT could not be used due to slow tumor regression or the huge initial bulk of tumor. The point A, actual bladder & rectal doses were individually assessed in all patients. The biologically effective dose (BED) to the tumor ($\alpha/\beta$=10) and late-responding tissues ($\alpha/\beta$=3) for both EBRT and HDR-ICBT were calculated. The total BED values to point A, the actual bladder and rectal reference points were the summation of the EBRT and HDR-ICBT. In addition to all the details on dose-fractionation, the other factors (i.e. the overall treatment time, physicians preference) that can affect the schedule of the definitive radiotherapy were also thoroughly analyzed. The association between MD-BED $Gy_3$ and the risk of complication was assessed using serial multiple logistic regression models. The associations between R-BED $Gy_3$ and rectal complications and between V-BED $Gy_3$ and bladder complications were assessed using multiple logistic regression models after adjustment for age, stage, tumor size and treatment duration. Serial Coxs proportional hazard regression models were used to estimate the relative risks of recurrence due to MD-BED $Gy_{10}$, and the treatment duration. Results: The overall complication rate for RTOG Grades $1\~4$ toxicities was $33.1\%$. The 5-year actuarial pelvic control rate for ail 743 patients was $83\%$. The midline cumulative BED dose, which is the sum of external midline BED and HDR-ICBT point A BED, ranged from 62.0 to 121.9 $Gy_{10}$ (median 93.0) for tumors and from 93.6 to 187.3 $Gy_3$ (median 137.6) for late responding tissues. The median cumulative values of actual rectal (R-BED $Gy_3$) and bladder Point BED (V-BED $Gy_3$) were 118.7 $Gy_3$ (range $48.8\~265.2$) and 126.1 $Gy_3$ (range: $54.9\~267.5$), respectively. MD-BED $Gy_3$ showed a good correlation with rectal (p=0.003), but not with bladder complications (p=0.095). R-BED $Gy_3$ had a very strong association (p=<0.0001), and was more predictive of rectal complications than A-BED $Gy_3$. B-BED $Gy_3$ also showed significance in the prediction of bladder complications in a trend test (p=0.0298). No statistically significant dose-response relationship for pelvic control was observed. The Sandwich and Continuous techniques, which differ according to when the ICR was inserted during the EBRT and due to the physicians preference, showed no differences in the local control and complication rates; there were also no differences in the 3 vs. 5 Gy fraction size of HDR-ICBT. Conclusion: The main reasons optimal dose-fractionation guidelines are not easily established is due to the absence of a dose-response relationship for tumor control as a result of the high-dose gradient of HDR-ICBT, individual differences In tumor responses to radiation therapy and the complexity of affecting factors. Therefore, in our opinion, there is a necessity for individualized tailored therapy, along with general guidelines, in the definitive radiation treatment for cervix cancer. This study also demonstrated the strong predictive value of actual rectal and bladder reference dosing therefore, vaginal gauze packing might be very Important. To maintain the BED dose to less than the threshold resulting in complication, early midline shielding, the HDR-ICBT total dose and fractional dose reduction should be considered.

A Study on Appropriate Military Strength of Unified Korea (Focused on relative balance strategy and conflict scenario) (통일 한국의 적정 군사력에 관한 연구 - 분쟁 시나리오와 상대적 균형전략을 중심으로 -)

  • Hong, Bong-Gi
    • Journal of National Security and Military Science
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    • s.13
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    • pp.687-738
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    • 2016
  • To prepare for the complicated international relationship regarding Korean Peninsula after reunification, this thesis started off with the awareness that Unified Korea should build its international posture and national security at an early stage by determining its appropriate military strength for independent defense and military strategies that Unified Korea should aim. The main theme of this thesis is 'The research on appropriate military strength of the Unified Korean military'. To derive appropriate military strength of Unified Korea, this research focuses on conflict scenario and relative balance strategy based on potential threats posed by neighboring countries, and this is the part that differentiates this research from other researches. First of all, the main objective of the research is to decide appropriate military strength for Unified Korea to secure defense sufficiency. For this, this research will decide efficient military strategy that Unified Korea should aim. Than by presuming the most possible military conflict scenario, this research will judge the most appropriate military strength for Unified Korea to overcome the dispute. Second, after deciding appropriate military strength, this research will suggest how to operate presumed military strength in each armed force. The result of this thesis is as in the following. First, Unified Korea should aim 'relative balance strategy'. 'Relative balance strategy' is a military strategy which Unified Korea can independently secure defense sufficiency by maintaining relative balance when conflicts occur between neighboring countries. This strategy deters conflicts in advance by relative balance of power in certain time and place. Even if conflict occurs inevitably, this strategy secures initiative. Second, when analyzing neighboring countries interest and strategic environment after unification, the possibility of all-out war will be low in the Korean Peninsula because no other nation wants the Korean Peninsula to be subordinated to one single country. Therefore appropriate military strength of the Unified Korean military would be enough when Unified Korea can achieve relative balance in regional war or limited war. Third, Northeast Asia is a region where economic power and military strength is concentrated. Despite increasing mutual cooperation in the region, conflicts and competition to expand each countries influence is inherent. Japan is constantly enhancing their military strength as they aim for normal statehood. China is modernizing their military strength as they aspire to become global central nation. Russia is also enhancing their military strength in order to hold on to their past glory of Soviet Union as a world power. As a result, both in quality and quantity, the gap between military strength of Unified Korea and each neighboring countries is enlarged at an alarming rate. Especially in the field of air-sea power, arms race is occurring between each nation. Therefore Unified Korea should be equipped with appropriate military strength in order to achieve relative balance with each threats posed by neighboring countries. Fourth, the most possible conflicts between Unified Korea and neighboring countries could be summarized into four, which are Dokdo territorial dispute with Japan, Leodo jurisdictional dispute with China, territorial dispute concerning northern part of the Korea Peninsula with China and disputes regarding marine resources and sea routes with Russia. Based on those conflict scenarios, appropriate military strength for Unified Korea is as in the following. When conflict occurs with Japan regarding Dokdo, Japan is expected to put JMSDF Escort Flotilla 3, one out of four of its Japan Maritime Self-Defense Force Escort Fleet, which is based in Maizuru and JMSDF Maizuru District. To counterbalance this military strength, Unified Korea needs one task fleet, comprised with three task flotilla. In case of jurisdictional conflict with China concerning Leodo, China is expected to dispatch its North Sea fleet, one out of three of its naval fleet, which is in charge of the Yellow Sea. To response to this military action, Unified Korea needs one task fleet, comprised with three task flotilla. In case of territorial dispute concerning northern part of the Korean Peninsula with China, it is estimated that out of seven Military Region troops, China will dispatch two Military Region troops, including three Army Groups from Shenyang Military Region, where it faces boarder with the Korean Peninsula. To handle with this military strength, Unified Korea needs six corps size ground force strength, including three corps of ground forces, two operational reserve corps(maneuver corps), and one strategic reserve corps(maneuver corps). When conflict occurs with Russia regarding marine resources and sea routes, Russia is expected to send a warfare group of a size that includes two destroyers, which is part of the Pacific Fleet. In order to balance this strength, Unified Korea naval power requires one warfare group including two destroyers. Fifth, management direction for the Unified Korean military is as in the following. Regarding the ground force management, it would be most efficient to deploy troops in the border area with china for regional and counter-amphibious defense. For the defense except the border line with china, the most efficient form of force management would be maintaining strategic reserve corps. The naval force should achieve relative balance with neighboring countries when there is maritime dispute and build 'task fleet' which can independently handle long-range maritime mission. Of the three 'task fleet', one task fleet should be deployed at Jeju base to prepare for Dokdo territorial dispute and Leodo jurisdictional dispute. Also in case of regional conflict with china, one task fleet should be positioned at Yellow Sea and for regional conflict with Japan and Russia, one task fleet should be deployed at East Sea. Realistically, Unified Korea cannot possess an air force equal to neither Japan nor China in quantity. Therefore, although Unified Korea's air force might be inferior in quantity, they should possess the systematic level which Japan or China has. For this Unified Korea should build air base in island areas like Jeju Island or Ullenong Island to increase combat radius. Also to block off infiltration of enemy attack plane, air force needs to build and manage air bases near coastal areas. For landing operation forces, Marine Corps should be managed in the size of two divisions. For island defense force, which is in charge of Jeju Island, Ulleung Island, Dokdo Island and five northwestern boarder island defenses, it should be in the size of one brigade. Also for standing international peace keeping operation, it requires one brigade. Therefore Marine Corps should be organized into three divisions. The result of the research yields a few policy implications when building appropriate military strength for Unified Korea. First, Unified Korea requires lower number of ground troops compared to that of current ROK(Republic of Korea) force. Second, air-sea forces should be drastically reinforced. Third, appropriate military strength of the Unified Korean military should be based on current ROK military system. Forth, building appropriate military strength for Unified Korea should start from today, not after reunification. Because of this, South Korea should build a military power that can simultaneously prepare for current North Korea's provocations and future threats from neighboring countries after reunification. The core of this research is to decide appropriate military strength for Unified Korea to realize relative balance that will ensure defense sufficiency from neighboring countries threats. In other words, this research should precisely be aware of threats posed by neighboring countries and decide minimum level of military strength that could realize relative balance in conflict situation. Moreover this research will show the path for building appropriate military strength in each armed force.

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Modeling of Estimating Soil Moisture, Evapotranspiration and Yield of Chinese Cabbages from Meteorological Data at Different Growth Stages (기상자료(氣象資料)에 의(依)한 배추 생육시기별(生育時期別) 토양수분(土壤水分), 증발산량(蒸發散量) 및 수량(收量)의 추정모형(推定模型))

  • Im, Jeong-Nam;Yoo, Soon-Ho
    • Korean Journal of Soil Science and Fertilizer
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    • v.21 no.4
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    • pp.386-408
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    • 1988
  • A study was conducted to develop a model for estimating evapotranspiration and yield of Chinese cabbages from meteorological factors from 1981 to 1986 in Suweon, Korea. Lysimeters with water table maintained at 50cm depth were used to measure the potential evapotranspiration and the maximum evapotranspiration in situ. The actual evapotranspiration and the yield were measured in the field plots irrigated with different soil moisture regimes of -0.2, -0.5, and -1.0 bars, respectively. The soil water content throughout the profile was monitored by a neutron moisture depth gauge and the soil water potentials were measured using gypsum block and tensiometer. The fresh weight of Chinese cabbages at harvest was measured as yield. The data collected in situ were analyzed to obtain parameters related to modeling. The results were summarized as followings: 1. The 5-year mean of potential evapotranspiration (PET) gradually increased from 2.38 mm/day in early April to 3.98 mm/day in mid-June, and thereafter, decreased to 1.06 mm/day in mid-November. The estimated PET by Penman, Radiation or Blanney-Criddle methods were overestimated in comparison with the measured PET, while those by Pan-evaporation method were underestimated. The correlation between the estimated and the measured PET, however, showed high significance except for July and August by Blanney-Criddle method, which implied that the coefficients should be adjusted to the Korean conditions. 2. The meteorological factors which showed hgih correlation with the measured PET were temperature, vapour pressure deficit, sunshine hours, solar radiation and pan-evaporation. Several multiple regression equations using meteorological factors were formulated to estimate PET. The equation with pan-evaporation (Eo) was the simplest but highly accurate. PET = 0.712 + 0.705Eo 3. The crop coefficient of Chinese cabbages (Kc), the ratio of the maximum evapotranspiration (ETm) to PET, ranged from 0.5 to 0.7 at early growth stage and from 0.9 to 1.2 at mid and late growth stages. The regression equation with respect to the growth progress degree (G), ranging from 0.0 at transplanting day to 1.0 at the harvesting day, were: $$Kc=0.598+0.959G-0.501G^2$$ for spring cabbages $$Kc=0.402+1.887G-1.432G^2$$ for autumn cabbages 4. The soil factor (Kf), the ratio of the actual evapotranspiration to the maximum evapotranspiration, showed 1.0 when the available soil water fraction (f) was higher than a threshold value (fp) and decreased linearly with decreasing f below fp. The relationships were: Kf=1.0 for $$f{\geq}fp$$ Kf=a+bf for f$$I{\leq}Esm$$ Es = Esm for I > Esm 6. The model for estimating actual evapotranspiration (ETa) was based on the water balance neglecting capillary rise as: ETa=PET. Kc. Kf+Es 7. The model for estimating relative yield (Y/Ym) was selected among the regression equations with the measured ETa as: Y/Ym=a+bln(ETa) The coefficients and b were 0.07 and 0.73 for spring Chinese cabbages and 0.37 and 0.66 for autumn Chinese cabbages, respectively. 8. The estimated ETa and Y/Ym were compared with the measured values to verify the model established above. The estimated ETa showed disparities within 0.29mm/day for spring Chinese cabbages and 0.19mm/day for autumn Chinese cabbages. The average deviation of the estimated relative yield were 0.14 and 0.09, respectively. 9. The deviations between the estimated values by the model and the actual values obtained from three cropping field experiments after the completion of the model calibration were within reasonable confidence range. Therefore, this model was validated to be used in practical purpose.

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