Recurrence patterns after maximal surgical resection and postoperative radiotherapy in anaplastic gliomas according to the new 2016 WHO classification

We assessed the appropriateness of current radiotherapy volume for WHO grade III gliomas. The records of 73 patients with WHO grade III gliomas who received postoperative radiotherapy between 2001 and 2013 were retrospectively reviewed. Based on the 2016 WHO classification, 25/73 (34.2%) patients had anaplastic oligodendroglioma (AO), IDH-mutant and 1p/19q-codeleted; 11/73 (15.1%) patients had anaplastic astrocytoma, IDH-mutant; and 37/73 (50.7%) patients had anaplastic astrocytoma, IDH-wildtype. The extent of resection (EOR) was total in 43 patients (58.9%). The median follow-up time was 84 months. The 5-year overall survival was 65.4%. Of 31 patients with documented recurrences, 20 (64.5%) had infield gross tumor volume (GTV) failure, six (19.4%) had clinical target volume (CTV)/marginal failure, and five (16.1%) had outfield failure/seeding. In 13 recurrences among 43 patients who underwent gross total resection (GTR), six (46.2%) had infield CTV/marginal failure. However, among 30 patients for whom GTR was not conducted, infield GTV failure was dominant (77.8%). Seventeen patients with AO, IDH-mutant and 1p/19q-codeleted who underwent GTR experienced no recurrence. In conclusion, maximal surgical resection and postoperative radiotherapy resulted in a favorable prognosis, especially in patients with GTR, IDH mutation, and 1p/19q codeletion. Patterns of failure differed by EOR.ope

Role of Radiotherapy in the Multimodal Treatment of Ewing Sarcoma Family Tumors

PURPOSE: The aim of this study was to evaluate the role of radiotherapy (RT) in the management of Ewing sarcoma family tumors (ESFT). MATERIALS AND METHODS: Retrospective analysiswas performed on 91 patientswith localized ESFT treated from 1988 to 2012. Primary tumor size was ≥ 8 cm in 33 patients. Surgery, RT, and combined surgery with RT were applied in 37, 15, and 33 patients, respectively. RESULTS: Median follow-up was 43.8 months. Forty-three patients (47.3%) showed recurrence or progressive disease. Twelve patients (13.2%) showed local failure after initial treatment. Thirty-nine patients (42.9%) experienced distant metastases. The 5-year overall survival (OS), progression-free survival, and local control (LC) were 60.5%, 58.2%, and 85.1%, respectively. According to treatment, 5-year LCwas 64.8% with RT and 90.2% with combined surgery and RT (p=0.052). Prognostic factors for OS were tumor size (≥ 8 cm, p < 0.001) and surgical resection (p < 0.001). In large tumors (≥ 8 cm), combined surgery and RT produced better LC compared to RT (p=0.033). However, in smaller tumors (< 8 cm), RT without surgery resulted in a similar LC rate as RT with surgery (p=0.374). CONCLUSION: RT used for patients with unfavorable risk factors resulted in worse outcome than for patientswho received surgery. Smallertumors could be controlled locallywith chemotherapy and RT. For large tumors, combined surgery and RT is needed. Proper selection of local treatment modality, RT, surgery, or both is crucial in the management of ESFT.ope

Surgery Alone Versus Surgery Followed by Chemotherapy and Radiotherapy in Resected Extrahepatic Bile Duct Cancer: Treatment Outcome Analysis of 336 Patients

PURPOSE: This study analyzed the outcomes of patients with resected extrahepatic bile duct cancer (EHBDC) in order to clarify the role of adjuvant treatments in these patients. MATERIALS AND METHODS: A total of 336 patients with EHBDC who underwent curative resection between 2001 and 2010 were analyzed retrospectively. The treatment types were as follows: surgery alone (n=168), surgery with chemotherapy (CTx, n=90), surgery with radiotherapy (RT) alone (n=29), and surgery with chemoradiotherapy (CRT, n=49). RESULTS: The median follow-up period was 63 months. The 5-year rates of locoregional failure-free survival (LRFFS), distant metastasis-free survival (DMFS), progression-free survival (PFS), and overall survival (OS) for all patients were 56.5%, 59.7%, 36.6%, and 42.0%, respectively. In multivariate analysis, surgery with RT and CRT was a significant prognostic factor for LRFFS, and surgery with CTx was a significant prognostic factor for DMFS, and surgery with CTx, RT, and CRT was a significant prognostic factor for PFS (p < 0.05). Surgery with CTx and CRT showed association with superior OS (p < 0.05), and surgery with RT had marginal significance (p=0.078). In multivariate analysis of the R1 resection patients, surgery with CRT showed significant association with OS (p < 0.05). CONCLUSION: Adjuvant RT and CTx may be helpful in improving clinical outcomes of patients with resected EHBDC who have a high risk of disease recurrence, particularly R1 resection patients. Conduct of additional prospective, larger-scale studies will be required in order to confirm the benefit of adjuvant RT and CTx in these patients.ope

Perceptions of Directors and Teachers at Kindergartens Participating in the Kindergarten Accreditation Model Project

본 연구는 2007년 유치원 시범평가에 참여한 원장과 교사를 대상으로 유치원 평가 과정에 대한 전반적인 인식과 유치원 평가 지표의 적절성에 대한 인식을 살펴보는 것에 목적이 있다. 이를 토대로 2008년 전면 도입되는 각 시·도의 유치원 평가의 바람직한 방향을 제시하는데 있어 기초자료를 마련해주고자 한다. 연구의 목적을 달성하기 위하여 선정한 구체적인 연구문제는 다음과 같다. 1. 유치원 원장과 교사의 유치원 평가에 대한 전반적인 인식은 어떠하며 차이가 있는가? 2. 유치원 원장과 교사의 유치원 평가 지표에 대한 인식은 어떠하며 차이가 있는가? 본 연구의 대상은 2007년 유치원 시범평가에 참여한 전국 16개 시·도의 국·공립유치원 42개원의 원장/감 33명과 교사85명, 사립유치원 39개원의 원장/감 34명과 교사 83명이었다. 연구도구는 유치원 평가 및 평가 지표에 대한 인식을 알아보기 위해 질문지를 사용하여 조사하였다. 원장 2명과 유치원 교사 5명을 대상으로 사전조사를 실시한 후 수정하였고, 유아교육 전문가로부터 내용타당도를 검증받아 배부 및 회수하였다. 본 연구에서 수집된 자료는 연구대상자의 유치원 평가 과정에 대한 인식을 알아보기 위하여 빈도와 백분율을 산출하고 χ²로 집단 간 차이를 비교하였다. 또한 연구대상자가 유치원 평가 지표에 대하여 얼마나 적절하다고 인식하고 있는지 알아보기 위하여 적절성 정도에 대하여 평가 영역별, 평가 항목별로 집단별 평균과 표준 편차를 산출하고, 집단 간 차이를 알아보기 위해서는 T검증을 하였다. 본 연구의 결과를 요약하면 다음과 같다. 첫째, 유치원 시범평가에 참여한 원장과 교사들은 먼저 유치원 평가의 목적이 전반적인 유아교육의 질을 향상시키는데 있다는 것으로 인식하고 있었다. 또한 전체적으로 다른 유치원에 유치원 평가 신청을 권할 의향이 있는 것으로 나타났으며, 원장과 교사 모두 유치원 평가에 대하여 긍정적으로 인식하고 있었다. 유치원 시범평가 절차 및 준비과정에 대해서는 원장과 교사 모두 관계 서류 준비가 가장 힘들었으며, 평가 영역 및 지표에 대한 이해가 가장 어려웠다고 답하였다. 유치원 평가 영역 중 가장 개선하기 힘들었던 영역과 개선 기간이 가장 오래 걸린 영역에 대하여 원장과 교사 모두 교육환경 영역이었다는 의견이 가장 많았다. 현장평가에 대한 인식에 있어서는 현장 평가위원들의 인원 구성에 대하여 대부분의 원장과 교사가 적절하다고 생각하고 있는 것으로 나타났다. 유치원에 방문했던 평가위원들의 현장평가 과정에 대해 긍정적으로 인식하고 있었으며, 또한 현장평가 방법으로 평가위원단이 1일 관찰을 실시하는 것에 대해 시간적으로 충분하다고 생각하고 있었다. 유치원 시범평가에 대한 만족도에 대해서는 대부분 만족하고 있었다. 둘째, 유치원 시범평가에 참여한 원장과 교사들은 유치원 평가 지표를 이해하는데 있어서 난이도는 원장과 교사 모두 보통으로 인식하고 있는 것으로 나타났다. 원장과 교사 모두 교육과정 영역, 교육환경 영역, 실외 교육환경 구성의 적합성, 유아의 건강·안전 영역, 운영관리 영역, 종일반 운영 영역의 유치원 평가 지표 전체 영역에 걸쳐 적절히 구성되어 있다고 인식하고 있었다.;The purpose of the study is to research the kindergarten directors and teachers&amp;apos; perception of kindergarten accreditation in Korea participated in the 2007 kindergarten accreditation model project. In addition, the further purpose is to offer basic information about kindergarten accreditation for 2008 kindergarten accreditation. The study mainly focused on the following two questions: 1. What is the recognition of the directors and teachers on the kindergarten accreditation? 2. What is the recognition of the directors and teachers on the kindergarten accreditation index? This study was conducted with 33 directors, 85 teachers at public kindergarten and 34 directors, 83 teachers at private kindergarten participated in the 2007 kindergarten accreditation model project in Korea. A survey was conducted by mail and the subjects were asked to return their completed answer sheets by using enclosed envelopes. For data handling, SPSS 12.0 was used to analyze frequency and percentage in order to examine the recognition of directors and teachers at the kindergarten about accreditation system. The results of the research are as followings: First, as for their awareness of the accreditation system, most of the kindergarten directors and teachers reported positively on the kindergarten accreditation system. It was found that the quality level of education was improved as well as the environment of facilities. They were satisfies that the acquisition of accreditation served to enhance the quality of kindergarten. Secondly, the kindergarten directors and teachers responded positively on the kindergarten accreditation index and the validity of the accreditation index.Ⅰ. 서론 = 1 A. 연구의 필요성 및 목적 = 1 B. 연구문제 = 3 Ⅱ. 이론적 배경 = 4 A. 유치원 평가 도입배경 및 필요성 = 4 B. 유치원 평가의 개념과 목적 = 8 C. 유치원 평가의 과정 = 9 1. 자체평가 = 10 2. 서면평가 = 10 3. 현장평가 = 11 Ⅲ. 연구방법 = 15 A. 연구대상 = 15 B. 연구도구 = 16 C. 연구절차 = 17 1. 예비연구 = 17 2. 본 연구 = 17 D. 자료분석 = 18 Ⅳ. 연구결과 및 해석 = 19 A. 유치원 평가에 대한 인식 = 19 1. 유치원 평가에 대한 전반적인 인식 = 19 2. 유치원 평가 절차 및 준비과정에 대한 인식 = 23 3. 현장평가에 대한 인식 = 28 4. 유치원 시범평가에 대한 만족도 = 30 5. 유치원 시범평가 과정에서의 어려움 = 36 B. 유치원 평가 지표에 대한 인식 = 38 1. 교육과정 영역 평가 지표에 대한 인식 = 39 2. 교육환경 영역 평가 지표에 대한 인식 = 40 3. 유아의 건강 · 안전 영역 평가 지표에 대한 인식 = 41 4. 운영관리 영역 평가 지표에 대한 인식 = 43 5. 종일반 운영 영역 평가 지표에 대한 인식 = 44 Ⅴ. 논의 및 결론 = 45 A. 논의 = 45 B. 결론 및 제언 = 49 참고문헌 = 51 부록 = 56 ABSTRACT = 7

Role of adjuvant radiotherapy in extrahepatic bile duct cancer: A multicenter retrospective study (Korean Radiation Oncology Group 18-14)

Purpose: To evaluate the role of adjuvant radiotherapy (RT) after curative resection in patients with extrahepatic bile duct (EHBD) cancer. Methods: Between January 2000 and December 2015, 1475 patients with EHBD cancer who underwent curative resection were accrued from 14 institutions in Korea. Among these, 959 patients did not receive any adjuvant therapy (RT(-) group), while 516 underwent postoperative RT with or without chemotherapy (RT(+) group). Results: The median age was 67 years. Nodal involvement was present in 482 patients (32.7%), and resection margin was involved in 293 patients (19.9%). RT(+) group had more patients with proximal tumours, advanced tumours, nodal involvement, perineural invasion, and involved resection margin than RT(-) group (all p < 0.001). With a median follow-up of 36 months, there were 211 locoregional recurrences, 307 distant metastases and 322 combined locoregional and distant failures. On multivariate analysis incorporating age, tumour location, differentiation, pT classification, pN classification, perineural invasion and resection margin, adjuvant RT was associated with improved overall survival (hazard ratio, 0.74; 95% confidence interval, 0.63-0.86; p < 0.001). When RT(+) group was separated into RT alone, concurrent chemoradiotherapy (CCRT) and CCRT followed by chemotherapy, the greatest benefit was observed in patients treated with CCRT followed by chemotherapy (hazard ratio, 0.52; 95% confidence interval, 0.41-0.68). Conclusions: Adjuvant RT combined with chemotherapy improved survival outcomes of resected EHBD cancer patients. Considering the greatest benefit observed in patients receiving CCRT followed by chemotherapy, a randomised controlled trial comparing chemotherapy alone and CCRT followed by chemotherapy is urgently needed.restrictio

진단 시 원격전이된 자궁경부암 환자에서 방사선치료의 역할

Dept. of Medicine/석사Purpose: The objective of this study was to clarify the role of radiotherapy (RT) for patients presenting with disseminated cervical cancer at initial diagnosis.Patients and Methods: We retrospectively analyzed 77 patients diagnosed with disseminated cervical cancer between September 1980 and August 2012. All patients received external beam RT to the pelvis (median dose 45 Gy) and 60 patients (77.9%) treated with high dose rate brachytherapy (median dose 30 Gy). Sixty-four patients (83.1%) received chemotherapy and 12 patients (15.6%) underwent radical surgery including hysterectomy. We divided into two groups; 58 patients had distant lymph node metastasis only or peritoneal seeding without visceral organ metastasis (group A), 19 patients had visceral organ metastasis (group B).Results: Median follow-up time was 55 months (range, 15 to 296 months). The 5-year pelvic control rates (PCR), progression free survival (PFS), and overall survival (OS) were 83.7%, 25.1%, and 31.7%, respectively. On univariate analysis, OS rate of the group A were significantly better than that of group B (38.9% vs. 10.5%, P = .001). Multivariate analysis indicated that group B was the only significant independent prognostic factor for PFS and OS. Five-year PCR of group A and B were 82.6% and 89.5%, respectively.Conclusion: Our data suggests definitive RT be beneficial to disseminated cervical cancer patients without visceral organ metastasis. External beam pelvic RT alone might be considered to palliate symptom and delay pelvic progression in patients with visceral organ metastasis who are expected to have poor prognosis and need systemic chemotherapy.ope

산업간 연구개발 파급효과 (R&D Spillover Effects) 분석 : 식음료 산업을 중심으로

학위논문(석사)--서울대학교 대학원 :농경제사회학부,2004.Maste

인터넷을 이용한 온실 감시 시스템의 개발

학위논문(석사)--서울대학교 대학원 :생물자원공학부 농업기계전공,2001.Maste