• The Korean Journal of Nuclear Medicine Technology
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• v.18 no.1
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• pp.26-32
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• 2014

Purpose: As PET-MRI which has excellent soft tissue contrast is developed as integration system, many researches about clinical application are being conducted by comparing with existing display equipments. Because PET-MRI is actively used for head and neck cancer diagnosis in our hospital, lymph node metastasis before the patient's surgery was diagnosed and clinical usefulness of head and neck cancer PET-MRI scan was evaluated using pathological opinions and idiopathy surrounding tissue metastasis evaluation method. Materials and Methods: Targeting 100 head and neck cancer patients in SNUH from January to August in 2013. $^{18}F-FDG$ (5.18 MBq/kg) was intravenous injected and after 60 min of rest, torso (body TIM coil, Vibe-Dixon) and dedication (head-neck TIM coil, UTE, Dotarem injection) scans were conducted using $Bio-graph^{TM}$ mMR 3T (SIEMENS, Munich). Data were reorganized using iterative reconstruction and lymph node metastasis was read with Syngo.Via workstation. Subsequently, pathological observations and diagnosis before-and-after surgery were examined with integrated medical information system (EMR, best-care) in SNUH. Patient's diagnostic information was entered in each category of $2{\times}2$ decision matrix and was classified into true positive (TP), true negative (TN), false positive (FP) and false negative (FN). Based on these classified test results, sensitivity, specificity, accuracy, false negative and false positive rate were calculated. Results: In PET-MRI scan results of head and neck cancer patients, positive and negative cases of lymph node metastasis were 49 and 51 cases respectively and positive and negative lymph node metastasis through before-and-after surgery pathological results were 46 and 54 cases respectively. In both tests, TP which received positive lymph node metastasis were analyzed as 34 cases, FP which received positive lymph node metastasis in PET-MRI scan but received negative lymph node metastasis in pathological test were 4 cases, FN which received negative lymph node metastasis but received positive lymph node metastasis in pathological test was 1 case, and TN which received negative lymph node metastasis in both two tests were 50 cases. Based on these data, sensitivity in PET-MRI scan of head and neck cancer patient was identified to be 97.8%, specificity was 92.5%, accuracy was 95%, FN rate was 2.1% and FP rate was 7.00% respectively. Conclusion: PET-MRI which can apply the acquired functional information using high tissue contrast and various sequences was considered to be useful in determining the weapons before-and-after surgery in head and neck cancer diagnosis or in the evaluation of recurrence and remote detection of metastasis and uncertain idiopathy cervical lymph node metastasis. Additionally, clinical usefulness of PET-MRI through pathological test and integrated diagnosis and follow-up scan was considered to be sufficient as a standard diagnosis scan of head and neck cancer, and additional researches about the development of optimum MR sequence and clinical application are required.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.321-329
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• 1997

Purpose : It is well known that the risk of lymph nodes metastases to head and neck cancers are influenced by the location and size of the Primary tumor. as well as the degree and types of histological differentiation. However, data on the statistical analyses of lymph node metastases from the head and neck cancers among Korean Population are not available at present. In order to obtain current status of such data, we have analyzed cancer patients at the department of radiation oncology, korea universityhospital for radiation treatment. Materials and Methods : We have evaluated nine-hundred and ninetyseven (997) head and neck cancer Patients who visited to the Department of radiation oncology, between November 1981 to December 1995. After careful physical examinations and CAT scan, Patients were divided into two groups, those with positive lymph node metastases and with negative lymph node metastases. The nodal status were classified according to the TNM system of American Joint Committee on Cancer (AJCC) Besults : Four-hundred and sixteen Patients out of the 997 patients were lymph node positive $(42\%)$ and 581 patients were lymph node negative $(58\%)$ when they were first presented at the department of radiation oncelogy. According to the AJCC classification, the distribution of positive lymph node is as follow: Nl:106 $(25.5\%),\;N2a:100\;(24\%),\;N2b:68\;(16.4\%),\;N2c:69\;(16.6\%),\;3:73\;(15\%).$ respectively. The frequency of lymph node metastases according to the primary sites is as follow : larynx 283 $(28.5\%)$, paranasal sinuses: 182 $(18\%),\;oropharynx:144\;(14.5\%)\;nasopharynx:122(12\%),\;oral\;cavity\;92\;(9\%),\;hypopharynx:71\;(7\%),\;falivary\;gland:58\;(6\%)$ unknown primary:31 $(3\%),\;skin:\;14(2\%)$,. The most frequent Primary site for the positive Iymph node metastases was nasopharynx $(71\%)$ followed by hypopharynx $(69\%),\;oropharynx\;(64\%),\;oral\;cavity\;(39\%)$ The most common histologic type was squamous cell carcinoma (652/997: $65.4\%$). followed by malignant lymphoma $(109/997:11\%)$. Conclusion : Statistical results of lymph node metastases from head and neck cancer at our department were very similar to those obtained from other countries. It is concluded that the location of Primary cancer influences sites of metastases on head and neck, and stage of the primary cancer also influences the development of metastatic lesions. Since the present study is limited on the data collected from one institute. further statistical analyses on Korean cancer Patients are warrented.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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• pp.65-70
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• 1987

하인두암은 거의 대부분 이상동(Pyriform Sinus) 에서 발생하며 상당한 정도 진행 시까지 별다른 증상을 나타내지 않는다. 저자들은 1966년부터 1985년까지 만 20년간 하인두에서 발생된 암환자 63명을 중심으로 임상 관찰 및 문헌고찰과 함께 발표하는바이다. 원발병소로는 전체 중 58명에서 이상동, 하인두벽(hypopharyngeal wall) 3명, Postcricoid hypopharynx 와 pharyngopalatine fold 에서 각각 1명씩의 발생빈도를 보였다. 저자들은 설저(base of tongue)암, supraglottic Ca. 및 경부 식도(cervical esophagus)암 경우는 모두 제외시켰다. 임상증상으로서는 경부 종괴(lump)가 33 예로써 가장 현저했으며 또한 첫증상으로써 연하곤란(dysphagia) 또는 sore throat를 나타낸 경우는 32 예 이었다. 그 외에 hoarseness 가 20 예, bloody sputum 4 례 및 호흡곤란 2 예의 순이었다. 내원까지의 증상기간은 대부분 $4{\sim}6$ 개월 이었다. 흡연관계는 1일 1값 이상의 중등도 흡연 경우는 전체의 58% 이었으며 흡연 사실이 있었던 경우는 전체의 88% 이었다. 연령별 발생빈도는 50대$\sim$60대에서 48명으로서 현저히 높았다. 완치 목적의 수술적 치료는 24명에서 시행하였으며 치료 거절은 16명이었다. 치료 거절하였던 환자들 중 81% 가 임상적 제 4 병기였으며 보조적 치료 요법을 실시한 환자들의 78% 에서 제 4 병기였다. 또한 완치 목적의 치료 실시 경우의 67% 에서 제 4 병기였다. 수술요법은 일반적으로 "후두 인두 적출술 및 양측 경정맥 임파군 곽청술"(laryngopharyngectomy with bilateral jugular dissection) 또는 후두 인두 적출술 및 동측의 표준 광범위 경부 곽청술(standard radical neck dissection) 과 반대측의 경정맥 임파군 곽청술을 시행하였다. 3 년 이내와 3 년 이상무병 상태(free of disease) 경우가 각각 4명씩이었다. 마지막 예후 추적 조사시까지 무병 상태였던 환자를 포함하여 예후 추적 조사기간 중 추적 실패 경우는 7명이었다. 확정된 3 년 생존율(determinate 3-year survival rate) 은 31% 이었다. 수술 사망이 1명 있었으며 재발경우는 9 명이었다. 재발부위로는 원발병소 재발이 7명, 경부 재발 1명 및 원격전이가 1명 이었으며, 저자들은 이에 대한 실패 원인을 규명코져 하였다.

• Korean Journal of Head & Neck Oncology
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• v.27 no.1
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• pp.22-26
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• 2011

목 적 : 두경부 암은 발생 순위에서 전체 6위에 해당하는 다빈도 암이나 최근 20여년 동안의 노력에도 불구하고 두경부 암의 독톡한 특성상 생존률에서 뚜렷한 향상을 보이지 못하고 있다. 특히, 하인두 암은 원발 부위의 점막하 침윤이 흔하며, 주변 림프절 전이와 원격 전이가 흔하고, 2차 원발 암종 발생이 흔하여 두경부 암 중에서도 가장 불량한 예후를 보이고 있는 악성 종양이다. 최근에 이러한 암을 치료하고 진단하기 위한 방법으로 분자생물학적 접근법들이 많이 시도 되고 있으며, 그 중 하나로 N-myc downstream regulated gene-1(Ndrg-1)이라는 유전자가 유방, 전립선, 방광 암 등의 타 악성 종양에서 종양의 전이 및 진행 양상과 관련되어 있다는 보고가 있었다. 이에 본 연구는 하인두 암에서의 Ndrg-1의 발현 양상을 살펴보고 이와 임상 양상과의 연관관계를 살펴보고자 하였다. 방 법 : 1996년부터 2003년까지 수술 받은 하인두 암 환자 56명을 대상으로 면역조직화학검사를 시행하여 Ndrg-1 발현을 확인하였고, 3명의 신선 조직을 대상으로 RT-PCR, Western blot을 시행하였다. 결 과 : Ndrg-1은 RT-PCR에서 정상 조직과 악성종양 조직 모두에서 비슷한 수준으로 발현되었다. 그러나 Western blot에서는 정상 조직에서 뚜렷한 증가 양상을 보여 타 연구와 동일한 결과를 보였고, 이는 불필요하며 비효율적인 mRNA수준에서의 발현이 있지만 최종적인 단백 산물 발현에서는 암종의 진행과 연계되어 악성 종양 진행군에서 발현이 억제되는 결과로 해석된다. 면역조직화학검사에서는 정상 상피조직에서 Ndrg-1 발현이 확인되었으며, 통계적으로 유의하지는 않으나 불량한 예후를 가진 그룹에서 대체로 발현이 억제되는 악성 종양과의 역 연관 관계를 확인할 수 있었고, 특히 림프절 전이를 보인 그룹과 그렇지 않은 그룹 사이에서는 통계적으로 유의미한 결과가 확인되었다. 결 론 : 즉, 림프절 전이가 없는 그룹에서 Ndrg-1이 종양의 전이에 관여할 것이라는 타 연구와 일관된 결과로 하인두 암에서도 그 역할이 있음을 나타내는 결과라 할 수 있다.

• 대한두경부종양학회:학술대회논문집
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• 1998.11a
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• pp.290-290
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• 1998

• Korean Journal of Head & Neck Oncology
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• v.30 no.2
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• pp.74-78
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• 2014

갑상선 암 진단과 치료기술이 발전하면서 최근 그 수술 건 수가 급격하게 증가하고 있다. 하지만이와 관련된 합병증과 부작용을 면밀하게 평가해야 할 필요 역시 점차 늘어나고 있다. 갑상선 암 수술 후 발생할 수 있는 드문 합병증의 하나로 횡격막 신경마비(phrenic nerve paralysis)가 있다. 이러한 횡격막신경마비는 대부분 증상이 경미하고 쉽게 호전되어 임상적으로 크게 중요하게 다루어지지 않았다. 하지만, 갑상선 수술 후 갑작스런 호흡곤란이 발생한다면 횡격막 신경마비에 의한 횡격막 마비(diaphragmatic paralysis)와 관련되었을 가능성을 놓치지 말아야 한다. 저자들은 최근 갑상선암 수술 후 발생한 호흡곤란으로 2년 동안 심각한 호흡곤란을 호소하던 73세 여자환자에서 투시촬영(fluoroscopy) 상 편측으로 상승되고 운동성이 저하된 횡격막을 확인하여 일측성 횡격막신경마비(Unilateral phrenic nerve paralysis)를 확진 하였다. 갑상선수술 후 발생하는 일측 횡경막 신경마비는 임상에서 드물게 관찰되는 수술 합병증이기에 환자는 상당기간 이에 대한 감별이 제대로 이루어지지 않았다. 우리는 횡격막 마비의 조기 진단과 적극적인 치료를 통하여 심한 호흡곤란을 호소하는 환자의 증상 및 병의 경과를 호전 시킬 수 있었다.

• Radiation Oncology Journal
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• v.28 no.2
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• pp.64-70
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• 2010

Purpose: The aim of the present study was to retrospectively evaluate the incidence of hypothyroidism in locally advanced head and neck cancer patients who received radiotherapy (RT) either with or without neck dissection. Materials and Methods: From January 2000 to December 2005, 115 patients with locally advanced head and neck cancer and who received definitive RT or postoperative RT including standard anterior low-neck field were recruited to be part of this study. Nineteen patients had undergone ipsilateral neck dissection, whereas, 18 patients underwent bilateral neck dissection, and 78 patients were received RT alone. Patients' ages ranged from 28 to 85 years (median, 59 years) and there were a total of 73 male and 42 female patients. The primary tumor sites were the oral cavity, oropharynx, hypopharynx, larynx, and other sites in 18, 40, 28, 22 and 7 patients, respectively. Radiation dose to the thyroid gland ranged from 44 Gy to 66 Gy with a median dose of 50 Gy. Follow-up time ranged from 2 to 91 months, with a median of 29 months. Results: The 1- and 3- year incidence of hypothyroidism was 28.7% (33 patients) and 33.0% (38 patients), respectively. The median time to detection of hypothyroidism was 8.5 months (range, 0 to 36 months). A univariate analysis revealed that neck node dissection was a risk factor for hypothyroidism (p=0.037). However, no factor was statistically significant from the results of a multivariate analysis. Conclusion: Patients treated for advanced head and neck cancer with radiotherapy with or without neck dissection will develop hypothyroidism. It is important to check the thyroid function periodically in these patientsespecially with the risk factor of neck node dissection.

• Radiation Oncology Journal
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• v.21 no.2
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• pp.112-117
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• 2003

Purpose: The effects of hypefractionation radiation therapy, such as the failure pattern and survival, on the treatment results in advanced stage head and neck cancer were studied. Materials and Methods: Between September 1990 and October 1998, 24 patients with advanced stage (III, IV) head and neck cancers, were treated using hyperfractionation radiation therapy in the Department of Radiation Oncology at the Keimyung University Dongsan Medical Center. The male to female ratio was 7 : 1, and the age range from 38 to 71 years with the median of 56 years. With regard to the TNM stage, 11 patients were stage III and 13 were stage IV. The sites of primary cancer were the nasopharynx in six, the hypopharynx in 6, the larynx in five, the oropharynx in three, the maxillary sinus in three, and the oral cavity in one patient. The radiotherapy was delivered by 6 MV X-ray, with a fraction size of 1.2 Gy at two fractions a day, with at least 6 hours inter-fractional interval. The mean total radiation doses was 72 Gy, (ranging from 64.4 to 75.8 Gy). Follow-up periods ranged between 3 and 136 months, with the median of 52 months. Results: The overall survival rates at 3 and 5 years in all patients were 66.7$\%$, and 52.4$\%$. The disease-free survival rates at 3 and S years (3YDFS, 5YDFS) in all patients were 66.7$\%$ and 47.6$\%$. The 3YDFS and 5YDFS in stage III patients were 81.8$\%$ and 63.6$\%$, and those in stage IV patients were 53.8$\%$ and 32.3$\%$. Ten patients were alive with no local nor distant failures at the time of analyses. Six patients (25$\%$) died due to distant metastasis and 12.5$\%$ died due to local failure. Distant metastasis was the major cause of failure, but 2 patients died due to unknown failures and 3 of other diseases. The distant metastasis sites were the lung (3 patients), the bone (1 patient), and the liver (2 patients). One patient died of second esophageal cancer. There were no severe late complications, with the exception of 1 osteo-radionecrosis of the mandible 58 months after treatment. Conclusion: Although this study was peformed on small patients group, we considered hypefractionated radiation therapy for the treatment of advanced stage head and neck cancer might improve the disease free survival and decrease the local failure with no increase in late complications despite of the slight Increase in acute complications.

• Korean Journal of Head & Neck Oncology
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• v.27 no.2
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• pp.183-189
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• 2011

서 론: 5-FU와 cisplatin 병용항암화학요법은 국소진행성 두경부편평상피암의 유도화학요법으로 널리 사용되고 있는 요법이다. 저자들은 5-FU 대신 경구제재인 S-1을 cisplatin과 병용하는 복합항암요법의 효과와 안전성에 대해 연구하였다. 대상 및 방법: 저자들은 2007년 2월부터 2008년 12월까지 S1과 cisplatin의 복합유도화학요법을 시행받은 3/4기 구인두, 하인두, 후두, 구강 편평상피세포암 환자 52명의 치료결과를 후향적으로 분석하였다. 유도항암화학요법은 제 1일에 cisplatin(75 또는 60mg/$m^2$), 제1일부터 14일까지 S-1(40mg/$m^2$)을 1일 2회, 21일 간격으로 투여하였고 가능한 경우에는 항암방사선동시요법 또는 수술을 뒤이어 시행하였다. 결 과: 전체 52명 중 37명(71.2%)에서 부분반응을 보였으나 완전반응은 관찰되지 않았다. 2년 무진행생존율은 56.9%, 2년 전체생존율은 68.2%였다. 유도항암요법과 관련된 유해반응으로는 호중구감소증(71.2%) 및 빈혈(63.5%) 등과 같은 혈액학적 부작용이 가장 흔했다. 결 론: S-1과 cisplatin의 복합항암화학요법은 국소진행성 두경부편평상피암 환자를 대상으로 한 유도화학요법으로 적용이 가능한 것으로 판단된다.

• Proceedings of the KOR-BRONCHOESO Conference
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• 1993.05a
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• pp.105-105
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• 1993

Laryngeal cancer is the commonest of all head and neck malignancies and, in Korea, constitutes approximately 2.3% of all malignancies among males. Survival rate is rather higher than any other head and neck malignancies. Treatment results of 121 laryngeal cancer patients were analyzed. 1. Glottic region 44%, supraglottic 41%, subglottic 8%, transglottic 7%. 2. Rate of cervical metastasis according to T stage was 19% in T2 stage, 47% in T3 stage, 69% in T4 stage. 3. Overall 3-year NED survival rate was 65% and showed stage I 93%, stage II 76%, stage III 63%, stage IV 53%. 4. Glottic cancer showed much better prognosis(3-year NED 82%) than supraglottic cancer(3-year NED 58 %). 5. According to treatment modality, complication rates in surgery with postoperative radiation was higher than in surgery along and disproportionally higher in salvage surgery after failed curative radiation.