• The Journal of Korean Obstetrics and Gynecology
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• v.35 no.4
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• pp.174-185
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• 2022

Objectives: The purpose of this study is to report the improvement of recurrent cervical intraepithelial neoplasia (CIN) and chief complaint including dysmenorrhea, premenstrual syndrome after Korean medicine treatment. Methods: The patient who diagnosed CIN even after undergoing two times of loop electrosurgical excision procedure (LEEP) and complained dysmenorrhea with premenstrual syndrome was treated by acupuncture, moxibustion and herbal medicine as Ojeok-san-gami-bang along with mistletoe extract injection (Abnobaviscum^®). The effect of treatment was evaluated by the results of liquid based cytology and HPV genotyping. Other symptoms were evaluated according to the patient's subjective complaint. Results: Before the treatment, the result of cytology was low grade squamous intraepithelial lesion and a low-risk group for HPV was detected. At the first examination after treatment, cytology showed negative for intraepithelial lesion or malignancy and the HPV genotyping was negative. The result showed negative findings in 3 consecutive follow-up tests. In addition, the chief complaint and general conditions were improved. Conclusion: This study shows that the recurrent cervical intraepithelial neoplasia (CIN) was improved after the Korean traditional treatment and it can be effective medical alternatives or options for patients receiving mistletoe injection during follow-up.

• Radiation Oncology Journal
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• v.9 no.2
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• pp.285-291
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• 1991

One hundred and twenty six patients with early uterine cervical cancer who had been treated at Departmen of Radiation Oncology of Korea University Hospital from Jan.1981 to Dec.1988 were analysed retrospectively by the treatment result and pattern of of failures. All patients had stage Ia to IIa disease and were grouped whether they had combination of operation and postop irradiation or radiation therapy alone. 1) Sixty six patients belonged to the combination treatment group and 60 patients to the radiation alone group. 2) Combination group consisted of $18.1\%$(12/66) stage Ia, $71.2\%$(47/66) stage Ib and $10.6\%$ (7/66) stage IIa patients. There were no stage Ia, 18.8$\%$(l1/60) stage Ib and 81.6$\%$(49/60) stage IIa patients for RT alone gronp. 3) There were total 23$\%$(29/126) treatment failures,13 patients in combination group and 16 patients in RT alone group. In 66 patients of combination group, they were found to have 5 locoregional failures, 7 distant failures and 1 at both sites. In 60 patients of RT alone group, 9 locoreginal failure and 7 distant failures occured. Eighty six percent (25/29) of total failures appeared within 18 month after completion of treatment. About 60$\%$ of the patients with regional recurrences which were located at pelvic side wall or pelvic lymph nodes paesented their recurrent disease after 1 year of completion of treatment, whereas same percent of distant failures appeared within 6 month. 5) In RT alone group, the first sites of distant failure were mostly para-aortic lymph node and/or left supraclavicular lymph node (71.4$\%$,5/7). In combination group, various sites such as inguinal lymph node, mediastinal lymph node, liver, lung and bone appeared first or at the same time with para-aortic and supraclavicular lymph node metastasis. 6) Logistic regression analysis was done for multivariate analysis of the factors contributing to locoregional and distant failures. In combination group, adequacy of the resection margin and the presence of positive pelvic node were found to be the most significant factors (p=0.0423 & 0.0060 respectively). In RT alone group, less than complete regression of the tumor at the end of treatment was the only significant contributing factor for the treatment failures (p=0.0013) with good liklihood ratio.

• Tuberculosis and Respiratory Diseases
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• v.42 no.4
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• pp.481-491
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• 1995

Background: Recently there has been a trend of an increasing incidence of mediastinal tuberculous lymphadenitis(MTL) in adults. MTL often cause bronchial stenosis or esophago-mediastinal fistula. In spite of effective treatment, it is difficult to cure. Moreover, relapse frequently occurs. Authors analyzed chest CT findings and clinical features of 29 cases with MTL Methods: 29 cases with MTL were retrospectively studied with the clinical and radiologic features from April 1990 to March 1995 Results: 1) A total of 29 cases were studied. 12 cases were male and 17 cases were female. The male to female ratio was 1:1.4 Mean age was 29 years old. The 3rd decade(45%) was the most prevalent age group 2) The most common presenting symptoms and signs were palpable neck masses(62%) followed by cough(59%) and sputum(38%) 3) Except in one case of MTL, all patients had coexisting pulmonary tuberculosis, cervical tuberculous lymphadenitis, endobronchial tuberculosis and tuberculous pleurisy. Among the coexisting tuberculous diseases, Pulmonary tuberculosis was the most common(76%) 4) On simple chest X-ray, mediastinal enlargement was noted in 21 cases(72%), but it was not noted in 8 cases(28%). The most frequently involving site was the paratracheal node in 16 cases(72%). Rt side predominence(73%) was noted 5) Patterns of node appearance on a postcontrast CT scan were classified into 3 types. There were 19 cases(30%) of the Homogenous type, 30 cases(47%) of the Central low density type and 15 cases(23%) of the Peripheral fat obliteration type. The most common type was the central low density type. The most common lymph node size was 1~2 cm(88%) 6) The most frequently involved site was the paratracheal node in 26 cases(89%) by chest CT. Rt side(63%) was predominant 7) 9 cases(43%) had complete therapy and most common treatment duration was 13 - 18 months. 12 cases(57%) had incomplete continuing antituberculous medication and half of the cases had been treated above 19 months. Conclusion: Chest CT findings of MTL showed central low density area and peripheral rim enhancement, so this characteristic findings could differentiate it from other mediastinal diseases and help a diagnosis of tuberculosis. In spite of effective antituberculous medication, it is difficult to cure. Moreover, relapse frequently occurs. Further studies will be needed of the clinical features and the treatment of MTL.

• Radiation Oncology Journal
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• v.11 no.1
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• pp.149-158
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• 1993

This is a retrospective analysis of 135 patients with invasive carcinoma of the uterine cervix treated with curative radiotherapy from March 1983 through October 1989 at the Department of Therapeutic Radiology, Kang-Nam 51. Mary's Hospital. Among them, 78 patients received radiotherapy alone and 42 patients treated with neoadjuvant chemotherapy followed by radiotherapy and 15 patients were lost to follow up. All patients had follow up from 2 to 106 months (median; 62 months). Age of the patients ranged from 32 to 79 years at presentation (median; 59 years). According to FIGO classification, there were 20 ($16.7{\%}$) in stage IB, 19 ($15.8{\%}$) in stage IIA,49 ($40.8{\%}$) in stage IIB, 5 ($4.2{\%}$) in stage IIIA, 13 ($10.8{\%}$,) in stage IIIB,14 ($11.7{\%}$) in stage IVA. The pathological classification showed 96 ($80.0{\%}$) squamous cell carcinomas, 5 ($4.2{\%}$) adenocarcinomas and 19 ($15.8{\%}$) proven by cytology. The overall 5-year survival rates was $50.8{\%}$, and the 5-year survival rates by stage IB, IIA, IIB, IIIA, IIIB, IVA was $47.7{\%},\;70.2{\%},\;64.1{\%},\;40.0{\%},\;23.1{\%},\;14.3{\%}$, respectively. The 5-year survival rates was noted $51.2{\%}$ of radiotherapy alone and $50.4{\%}$of neoadjuvant chemotherapy followed by radiotherapy. The overall failure rate was $18.3{\%}$(22/120) including $11.7{\%}$ (14/120) locoregional failure, $5.8{\%}$ (7/120) distant metastasis and $0.8{\%}$(1/120) locoregional failure with distant metastasis. Treatment failure rates by the stages were $15{\%}$ (3/20) in stage IB. $10.5{\%}$ (2/19) in stage IIA, $10.2{\%}$, (5/49) in stage IIB, $20{\%}$ (1/5) in stage IIIA, $61.5{\%}$(8/13) in stage IIB, and $28.6{\%}$ (4/14) in stage IVA. The overall complication rate was $34.2{\%}$(41/120) including wet desquamation $7.5{\%}$, (9/120), diarrhea $6.7{\%}(8/120), radiation proctitis $5.8{\%}$(7/120) in decreasing order. A multivariate analysis of factors influencing the survival showed patient age (p < 0.0291), FIGO stage (p<0.0001), Karnofsky performance status (p<0.0043), initial hemoglobin level (p<0.0001), and intracavitary radiation (p<0.0004), but, no significancy in histology (p<0.29) and treatment method (p < 0.87).

• Radiation Oncology Journal
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• v.13 no.4
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• pp.331-338
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• 1995

Purpose : To evaluate our clinical experience with the combination of teletherapy and intraluminal brachytherapy in patients with unresectable or inoperable esophageal cancers. Materials and Methods : From Nov 1989 to Mar 1993, twenty patients with esophageal cancer were treated with radical radiotherapy and intraluminal brachytherapy at Yonsei Cancer Center. All patients had squamous histolgy and stage distribution was as follows: stage II, 4($20{\%}$)patients; III, 15 ($75{\%}$)patients; IV, 1($5{\%}$)patients. A dose of S-12Gy/1-3weeks with intraluminal brachytherapy (3-5Gy/fraction) to 5mm from the outside of the esophageal tube using high dose rate Iridium-192 remotely afterloading brachytherapy machine was given 2 weeks after a total dose of 59-64Gy with external radiotherapy. Induction chemotherapy using cisplatin and 5-FU was performed in 13 patients with median 3 cycles(1-6 cycles), Response rate, local control rate, survival and complications were analysed retrospectively. Results : Two-year overall survival rate and median survival were $15.8{\%}$ and 13.5 months. Response rates were as follows complete remission(CR) 5($25{\%}$): partial remission a(PRa) 7($35{\%}$): partial remission b(PRb) 7($35{\%}$), no response(NR) 1($5{\%}$). Patterns of failure were as follows; local failure 13($65{\%}$), local and distant failure 3($15{\%}$), distant failure 0($0{\%}$). Ultimate local control rate was $20{\%}$. Treatment related complications included esophageal ulcer in two patients and esophageal stricture in one. Conclusion : Though poor local conrol rate, median survival was improved as compared with previous results of radiation therapy alone(8months) and chemoradiation combined treatment(11 months) in Yonsei Cancer Center High-dose-rate intraluminal brachytherapy following external irradiation is an effective treatment modality with acceptable toxicity in esophageal cancer.

• Radiation Oncology Journal
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• v.10 no.2
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• pp.219-225
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• 1992

Fifty patients with carcinoma of the uterine cervix received curative radiotherapy by external irradiation of the whole pelvis and intracavitary radiation at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital from September, 1983 to October, 1986. External beam whole pelvic irradiation was done first up to 4500-5940 cGy in 5 weeks to 6.5 weeks, followed by an intracavitary radiation. Total dose of radiation to point A varied from 6500 cGy to 11344 cGy (average 6764 cGy). Of the 50 patients, one patient was lost to follow up and follow up period of the remaining 49 patients ranged from 3 months to 93 months (median 32 months). According to FIGO classification, 6 ($12.2\%$) were in stage Ib, 6 ($12.2\%$) in stage IIa, 25 ($51\%$) in stage IIb, 7 ($14\%$) in stage III, and 5 ($10.2\%$) in stage IV. Age of the patients ranged from 33 to 76 years (median 60 years). Pathologically, fourty six ($94\%$) patients had squamous cell carcinoma, 2 ($4\%$) had adenocarcinoma, and 1 ($2\%$) had adenosquamous cell carcinoma. Overall response rate was $84\%$. 5-year survival rate was $49\%$ for entire group ($75\%$ for stage Ib, $83\%$ for Stage IIa, $42.5\%$ for stage IIb, $25\%$ for stage III, $40\%$ for stage IV). Complications were observed in 11 ($22.4\%$) patients, who revealed rectal complications with most common frequency. Others were self limiting trifle ones such as wet desquamation, fatigue, mild leukopenia, etc. The correlation of the survival rate with various factors (age, dose, Hb level, pelvic lymph node status, performance status, local recurrence) was evaluated but showed no statistical significance except the age and local recurrence in this series; survival of patients less than 50 years of age was worse than that of the older, and the presence of local recurrence had worse prognosis (p<0.05).

• Radiation Oncology Journal
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• v.6 no.2
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• pp.183-194
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• 1988

Twenty five patients with histologically proven medulloblastoma received craniospinal radiotherapy (CSRT) at the Seoul National University Hospital from 1979 to 1984. The extent of tumor removal was biopsy only in 2 patients, partial in 18, and near total in 5. With orthogonal technique of CSRT, mainly 55Gy was delivered to the posterior fossa (PF), 40Gy to whole brain (WB), and 30Gy to whole spine (WS). And with AP; PA technique, 50Gy to PF, 45-50Gy to WB, and 36 Gy to WS. Complete remission was obtained in $84\%$ of patients. Among 21 CR's 10 failures were observed, thus total failure rate was $56\%$ (14/25). Of 14 faiure 13 had the primary failure, 11 failed in primary site alone, 1 failure was combined with ventricular seeding, and another 1 was combined with neck node metastasis. There was 1 isolated spinal failure. Actuarial overall survival rates at 3 and 5 years were $75\%$ and $54\%$, and disease-free survival rates were $58\%$ and $36\%$, respectively. Better 5 year disease-free survival was noted in patients with 55 Gy to the posterior fossa than those with 50Gy $(62\%\;vs\;17\%,\;p<0.05)$, in patients treated with orthogonal technique than those treated with AP:PA technique $(87\%\;vs\;12\%,\;p<0.05)$, and in patients with near total removal than those with partial or less removal of tumor $(56\%\;vs\;30\%,\;N.S.)$ Re-irradiation was not satisfactory No severe late sequelae was noted among the survivors. For the higher control of medulloblastoma, dose to posterior fossa should be at least 55Gy with orthogonal CSRT to small tumor burden. And dose reduction in the subarachnoidal spaces might be safe, but optimal dose to the subarchnoidal spaces should be determined by the thorough tumor staging before radiotherapy.

• Radiation Oncology Journal
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• v.21 no.4
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• pp.283-290
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• 2003

Purpose: To evaluate the long term significance of the squamous cell carcinoma (SCC) antigen (Ag) as a tumor marker in uterine cervix carcinoma. Materials and Methods: The SCC antigen levels of pre-radiotherapy and serial post-radiotherapy serum were analyzed in 48 patients who received radiotherapy with histologically proven primary SCC of the uterine cervix. Results: Pre-radiotherapy SCC Ag level was high ($\geq$2 ng/ml) at 79.2$\%$. After the treatment, the SCC Ag level was significantly decreased. The SCC Ag level measured at about 3 months after radiotherapy was high at 23.0$\%$. In further follow up measurements, a rise of the SCC Ag to a high level was well associated with clinical relapse. The specificity of the elevated SCC Ag level in association with recurrent or persistent disease was 100$\%$, and the sensitivity was 85.7$\%$. In 3 of 4 lung metastasis cases, lung lesions were detected in chest PA before elevation of the SCC Ag level. The median lead time of the high SCC Ag level to clinical recurrence was 4 months. Conclusion: SCC Ag was a good tumor marker for monitoring treatment effect in patients with increased pre-treatment levels except in case of early lung metastasis. Elevation of the SCC Ag level after radiotherapy accurately predicted the treatment failure with lead time of 4 months. But, in early lung metastasis cases, the SCC level may be normal temporarily. Thus, chest PA should be checked to evaluate the presence of lung metastasis.

• Radiation Oncology Journal
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• v.19 no.4
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• pp.301-305
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• 2001

Purpose : This study was peformed for the evaluation of the feasibility and toxicity of hypofractionated radiation therapy for early glottic cancer Methods and Materials : From February 1999 to February 2000, 20 patients with Histologically confirmed Stage I, II glottic cancer were enrolled into this study. There were 18 males and 2 females, the median age of the patients was 59 years. The distribution of stage distribution was as fellows; T1aN0-16 patients, T1bN0-1 patient, T2N0-3 patients. Eighteen patients underwent laryngomicroscopic biopsy only, and two patients underwent laser cordectomy. All patients received radical radiation therapy (2.5 Gy per fraction, 24 fractions, total 60 Gy). Median duration of treatment was 36 days (range $31\~45\;days$). Results : Radiation therapy were well tolerated. Most common acute reactions were odynophagia and hoarseness, and these reactions resolved after radiation therapy. There were one case of RTOG grade 3 odynophagia $(5\%)$, six cases of grade 3 hoarseness $(30\%)$. Response of radiation therapy was evaluated one month after completion of treatment. All patients revealed complete response. During follow up, total three cases of treatment failure were detected. two cases were local recurrence in 10 and 13 months of radiation therapy and one case was local recurrence and distant metastasis in 2 months of radiation therapy. Conclusion : This hypofractionated radiation therapy schedule was feasible and effective for control of early glottic cancer But longer follow up time would be required to assess the long-term disease control and the late complication by shortening radiation therapy duration.

• Radiation Oncology Journal
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• v.15 no.2
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• pp.129-136
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• 1997

Purpose : We analyzed the survival and failure patterns of cervix cancer patients treated with irradiation alone to evaluate our treatment method and to compare with the others Methods and Materials : Two hundred and twenty cervical cancer patients, Stage IB, II A, and II B who completed the planned treatment between Mar 1987 and December 1991 were analyzed retrospectively. The Stage IB patients were restaged to the Stage IB1 and IB2 by the recently revised FIGO classification, Patients were treated with a combination of external irradiation and the intracavitary brachytherapy Determination of the tumor control was done at the time of 6 months Postirradiation. The follow-up time was ranged from 3 to 115 months and the mean was 62 months and the follow-up rate was $93.6\%$(206/220) Results : The overall 5-year survival rate of Stage IB1 (N=50), IB2(N: 15). II A(N=58), and II B(N=97) was $94\%,\;87\%,\;69\%,\;and\;56\%$. respectively. In the univariate analysis of prognostic factors, stage(0.00), initial Hg level (P=0.00), initial TA-4(tumor-associated) antigen level(p= 0.02), initial CEA level(p=0.02), barrel-shaped tumor(p=0.02), whole cervical involvement (0.00), pelvic tyrnphadenopathy(LAP) in CT(p=0.04), and Post-irradiation adiuvant chemotherapy(P=0.00) were statistically significant in survival analysis. In a while multivariate analysis showed that the stage was the most powerful Prognostic indicator and the Post-irradiation chemotherapy factor also showed the statistical significance. The overall local control rate was $81\%$ and by the stage, $100\%$ in Stage IBI, $86.7\%$ in Stage IBS, $84.5\%$ in Stage IIA, and $68.1\%$ in Stage IIB, respectively The overall tumor recurrence rate was $15.5\%$(27/174) and by the stage, $8\%$(4/50) in Stage IB1, $0\%$(0/l3) in Stage IB2, $22.4\%$(l1/49) in Stage II A, and $19.4\%$(12/62) in Stage II B, respectively. Conclusions : We obtained the similar treatment results to the other's ones in early stage cervical cancer patients. But in Stage II B, the local control rate was lower than that of the other institutes and also the survival was poorer. So it seems to be necessary to reevaluate the treatment method in advanced cervical cancer patients.