• Radiation Oncology Journal
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• v.14 no.4
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• pp.317-322
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• 1996

Purpose : Patients with cervical cancer who have positive resection margins after radical hysterectomy are at increased risk for local recurrence. The result of postoperative pelvic radiotherapy for cervix cancer with positive resection margins were analyzed to evaluate the role of radiotherapy. Materials and Methods : Between n 1979 and 1992, 60 patients of cervix carcinoma were treated with postoperative radiotherapy after radical hysterectomy and pelvic lymphadenectomy because of positive vaginal (48 patients) or parametrial resection margins (12 patients). Patients were treated with external beam radiation therapy (EBRT) alone (12 Patients) or EBRT plus vaginal ovoid irradiation (VOI) (48 patients). The median followup period was 55 months. Results : The 5-year actuarial disease free and overall survival rates for all patients were $75.2\%$, $84.1\%$, respectively. The overall recurrence rate was $23\%$ (14/60). In 48 patients with Positive vaginal resection margins, the pelvic recurrence was $8\%$ (4/48). Distant metastasis was $15\%$(7/48). Of the 43 patients with positive vaginal resection margins treated with EBRT and VOI, recurrence rate was $21\%$(9/43) , while recurrence rate was $40\%$(2/5) in the EBRT only treated group. In 12 patients with positive parametrial margins, three patients ($25\%$) had distant metastases. The most significant prognostic factor was lymph node metastasis. Complications resulting from radiotherapy occurred at a rate of $32\%$(19/60) and grade III complications occurred in three patients ($5\%$). Conclusion : Postoperative radiotherapy can produce excellent pelvic control rates in patients with positive resection margins. In patients with positive vaginal margins, whole pelvic EBRT and VOI is recommended.

• Journal of Chest Surgery
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• v.40 no.11
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• pp.765-769
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• 2007

Background: The curative treatment of choice for empyema is decortication of the pleura. The risks of this treatment however are increased for the patient with reduced pulmonary function, complicated calcification or septic shock. In the past, open window thoracostomy was a final stage treatment for chronic empyema. Relatively safe treatment of empyema could be achieved in difficult cases with a closure of the open window after open drainage and use of a myocutaneous flap (one stage or staged). Material and Method: A retrospective study of the cause, progression and final outcome of empyema patients who received open window thoracostomy was performed. 21 patients were followed from 1995 to 2004 in the department of Thoracic and Cardiovascular Surgery in the College of Medicine, Pusan National University. Result: The average age of the patients was $57.5{\pm}15.5$ years (range $25{\sim}78$ years), of whom 16 (76.2%) were men and five (23.8%) were women. Pulmonary function test results showed an average FEV1 of $1.58{\pm}0.49 L$. The type of empyema was tuberculous empyema in 13 cases (61.9%), aspergillosis in three cases (14.3%), parapneumonic empyema in three cases (14.3%) and post-resectional empyema in two cases (10%). Bronchopulmonary fistula was seen in 14 cases. Eight cases were complicated by severe calcification of the pleura. For the four cases of bronchopulmonary fistula, the patients' serratus anterior muscle was covered in their first operation. The average number of ribs resected was $4{\pm}1$. Closure of the open window thoracostomy was performed in 12 cases. The average time to closure after open drainage was $10.22{\pm}3.11$ months and the average defect of the empyemal cavity before the final operation was $330{\pm}110 cc$. Among the 12 cases, there were two cases of spontaneous closure. In two cases closure was only achieved by using the reserved skin fold during the first surgery. Of the remaining eight cases, in seven we used the myocutaneous flap (four cases of lattisimus dorsi muscle and three cases of pectoralis major muscle), and in one case we used soft tissue. As regards complications of the closure, tissue necrosis occurred in one case, which led to failed closure, and there was one case of abdominal hernia in the rectus abdominis muscle flap. One patient died within 30 days of the surgery and one patient died of metastatic cancer. Conclusion: A staged operation with a final closure using open window thoracostomy, which consists of open drainage, transposition of the muscle and a myocutaneous flap, can be a safe and effective option for the chronic empyema patient who is difficult to cure with traditional surgical methods.

• Journal of Gastric Cancer
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• v.6 no.2
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• pp.97-102
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• 2006

Purpose: The prognosis for patients with a Borrmann type IV gastric cancer is extremely poor despite an aggressive surgical approach. We evaluated the clinicopathological features for Borrmann type IV cancers to find treatment strategy. Materials and Methods: The 1098 patients with advanced gastric cancer who underwent surgical resection between 1990 and 2001 were analyzed. These patients were divided into two groups: 81 patients with a Borrmann type IV carcinoma, and 1017 patients with all other types of gastric carcinomas. Results: Patients with a Borrmann type IV carcinoma were younger than those with other types, and female was prevalent (p=0.000). Of the patients with a Borrmann type IV gastric carcinoma, 68 patients (84%) were classified as stage III or IV at the initial diagnosis. The histologic type was commonly undifferentiated and serosal infiltration; nodal involvement and lymphatic invasion were more frequent in patients with a Borrmann type IV than in those with other types of cancer. Multivariate analysis confirmed that the extent of lymph node metastasis was a negative prognostic factor for Borrmann type IV gastric carcinomas. The curability for a Borrmann type IV carcinoma was only 53.1%, and peritoneal dissemination rate was 25.9%. The predominant pattern of recurrence for a Borrmann type IV gastric carcinoma was peritoneal dissemination, and it was significantly different with other types (93.1% vs 55.8%, P<0.05). The 5-year survival rate of patients with a Borrmann type IV gastric carcinoma was significantly lower than those of patients with other types of cancer, even though a curative resection had been accomplished (26% vs 63%, p<0.005). The 5-year survival rates of patients with a Borrmann type IV carcinoma following a curative resection were 44.9%, 24%, and 0% for stages II, III and IV, respectively (p<0.05). Conclusion: Because the prognosis for patients of a Borrmann type IV gastric cancer is extremely poor despite a curative resection, preoperative and/or intraperitoneal chemotherapy should be considered. And diagnostic laparoscopy and peritoneal cytology may be used to play an important role in accurate staging workup. (J Korean Gastric Cancer Assoc 2006;6:97-102)

• Tuberculosis and Respiratory Diseases
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• v.43 no.5
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• pp.709-719
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• 1996

Background: Surgical resection is the only way to cure non-small cell lung cancer(NSCLC) and the prognosis of NSCLC in patients who undergo a complete resection is largely influenced by the pathologic stage. After surgical resection, recurrences in distant sites is more common than local recurrences. An effective postoperative adjuvant therapy which can prevent recurrences is necessary to improve long tenn survival Although chemotherapy and radiotherapy are still the mainstay in adjuvant therapy, the benefits of such therapies are still controversial. We initiated this retrospective study to evaluate the effects of adjuvant therapies and analyze the prognostic factors for survival after curative resection. Method: From 1990 to 1995, curative resection was perfomled in 282 NSCLC patients with stage I, II, IIIa, Survival analysis of 282 patients was perfonned by Kaplan-Meier method. The prognostic factors, affecting survival of patients were analyzed by Cox regression model. Results: Squamous cell carcinoma was present in 166 patients(59%) ; adenocarcinoma in 86 pmients(30%) ; adenosquamous carcinoma in II parients(3.9%); and large cell undifferentiated carcinoma in 19 patients(7.1%). By TNM staging system, 93 patients were in stage I; 58 patients in stage II ; and 131 patients in stage rna. There were 139 postoperative recurrences which include 28 local and 111 distant failures(20.1% vs 79.9%). The five year survival rate was 50.1% in stage I ; 31.3% in stage II ; and 24.1% in stage IIIa(p <0.0001). The median survival duration was 55 months in stage I ; 27 months in stage II ; and 16 months in stage rna. Among 131 patients with stage rna, the median survival duration was 19 months for 81 patients who received postoperative adjuvant chemotherapy only or cherne-radiotherapy and 14 months for the other 50 patients who received surgery only or surgery with adjuvant radiotherapy(p=0.2982). Among 131 patients with stage IIIa, the median disease free survival duration was 16 months for 21 patients who received postop. adjuvant chemotherapy only and 4 months for 11 patients who received surgery only(p=0.0494). In 131 patients with stage IIIa, 92 cases were in N2 stage. The five year survival rate of the 92 patients with N2 was 25% and their median survival duration was 15 months. The median survival duration in patients with N2 stage was 18 months for those 62 patients who received adjuvant chemotherapy and 14 months for the other 30 patients who did not(p=0.3988). The median survival duration was 16 months for those 66 patients who received irradiation and 14 months for the other 26 patients who did not(p=0.6588). We performed multivariate analysis to identify the factors affecting prognosis after complete surgical resection, using the Cox multiple regression model. Only age(p=0.0093) and the pathologic stage(p<0.0001) were significam prognostic indicators. Conclusion: The age and pathologic stage of the NSCLC parients are the significant prognostic factors in our study. Disease free survival duration was prolonged with statistical significance in patients who received postoperative adjuvant chemotherapy but overall survival duration was not affected according to adjuvant therapy after surgical resection.

• Journal of Chest Surgery
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• v.36 no.7
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• pp.535-538
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• 2003

Spontaneous pneumothorax accompanying primary lung cancer is rare and its occurrence as an initial sign of primary lung cancer is much rarer. A few articles on spontaneous pneumothorax accompanying lung cancer have been published in Korea so far. Lung cancers, diagnosed after spontaneous pneumothorax, are usually in advanced stage, so that conservative treatment modalities such as closed tube thoracostomy, chemotherapy, or radiotherapy are the mainstream of the treatment. We experienced a case of local recurrence of primary lung cancer in six months after radical resection and radiotherapy of neoplasm performed immediately after the diagnosis by excisional biopsy of bulla, for which resection and pleurodesis had been done under the impression of spontaneous pneumothorax. In this paper, we report the case and follow-up observation of the patient.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.662-665
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• 2009

A 65-year-old-male had a mass in the oral cavity, and this was ultimately determined to be squamous cell carcinoma and he underwent wide excision for it. Postoperatively, he underwent the staging work up; this showed that he had other cancers in the esophagus, stomach and lung. We performed a curative resection of all the lesions simultaneously. We report here on a case of synchronous multiple cancers of the esophagus, stomach, lung and oral cavity.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.

• Radiation Oncology Journal
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• v.7 no.1
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• pp.37-43
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• 1989

Sixty-six patients with squamous cell carcinoma of the supraglottic larynx received irradiation with curative intent between 1979 and 1985 were retrospectively analysed. All patients had a minimum follow-up of 4 years. Of the entire group consisting of $73\%$T3 and T4 lesions and $58\%$ lymph node metastases, a 5-year acturial survival rate was $31.3\%$. A 5-year acturial survival rates for stage II, III and IV were $60.7\%,\;45.7\%\;and\;13.5\%$ respectively (p<0.05). Patients without lymphnode metastases had better survival rate than those with postive lymphnode metastases $(54.8\%\;vs\;12.2\%)$ (p<0.005). Surgical salvage rate w8s 4/7 $(57\%)$. Three patients developed distant metastases. Major complications requiring surgery were seen in $11\%$, Radiation therapy alone with surgical salvage was an effective, voice preserving treatment for stage I, II and selected III carcinoma of the supraglottic carcinoma, however planned combined treatment with surgery and radiation therapy is advised for stage III and IV carcinoma of the supraglottic larynx with resectable neck disease.

• Radiation Oncology Journal
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• v.3 no.1
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• pp.29-33
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• 1985

흉선종은 비교적 드문 종양으로 알려져 있다. 예후를 알 수 있는 가장 중요한 인자는 수술시 육안적인 종양의 침윤정도이며, 치료는 수술에 의한 종양의 제거가 무엇보다 중요하고, 방사선 치료 역시 수출 후 국소적 계발의 방지를 위해 쓰이고 있다. 근치적 목적의 방사선 치료도 수술이 어려운 경우에 시행되고 있는 형편이다. 저자들은 1977년 1월부터 1984년 12월까지 세브란스병원 연세암센타 치료방사선과에서 흉선종 진단받고 치료한 14명의 환자를 후향성 분석에 의해 다음과 같은 결과를 얻었다. 1. 6명의 환자$(14\%)$가 근무력증을 나타냈다. 2. 주변조직의 침윤이 $86\%(12/14)$에서 관찰되었다. 3. $43\%$에서 육안적 완전 절제를 시행하였고 $14\%$에서 부분결제, 그리고 $43\%$에서는 생검만 시행 하였다. 4. 수술 후 혹은 근치적 목적의 방사선치료는 8명의 환자에서 시행하였으며 그중 현재 5명은 생존(4년, 2.8년, 1.6년, 1.4년, 1.3년), 3명은 사망(1년, 0.6년, 0.6년)하였다. 5. 방사선 치료선량은 대체료 $4,000\~4,500rad(1950\~7,000rad)$를 전후 흉곽 부위에 외부 조사하였다.

• Journal of Digestive Cancer Research
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• v.3 no.2
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• pp.108-112
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• 2015

A 54-year-old male patient who was diagnosed with advanced gastric cancer underwent a distal gastrectomy, D2 lymph node dissection, and adjuvant chemoradiotherapy. After a year, in a follow-up PET-CT, lymph node metastases were observed in the neck and abdomen, and therefore, the patient underwent chemotherapy. After treatment, the follow-up PET-CT revealed a growth of the posterior neck lymph node. Thus, an excisional biopsy was performed, and the growth was diagnosed as metastatic adenocarcinoma. Therefore, the patient received chemotherapy with FOLFIRI. Another follow-up PET-CT after chemotherapy revealed a growth in the right inguinal lymph node, and the patient underwent salvage radiotherapy for this lesion. The PET-CT taken for the response evaluation showed no evidence of further metastasis of the lymph node. We hereby report a case of advanced gastric cancer with neck and inguinal lymph node recurrence showing complete remission after palliative chemotherapy and salvage radiotherapy.