• 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.28 no.3
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• pp.117-124
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• 2010

Purpose: To analyze the postoperative radiotherapy results and prognostic factors in patients with WHO grade 3 and 4 gliomas. Materials and Methods: A total of 99 patients with malignant gliomas who underwent postoperative radiotherapy between 1988 and 2007 were enrolled in this study. Total resections, subtotal resections ($\geq$50%), partial resections (<50%), and biopsies were performed in 16, 38, 22, and 23 patients, respectively. In total there were 32, 63 and 4 WHO grade 3, 4, and unspecified high grade gliomas, respectively. The biologically equivalent dose was in the range of 18.6 to $83.3\;Gy_{10}$ (median dose, $72.2\;Gy_{10}$). We retrospectively analyzed survival rate, patterns of failure, prognostic factors, and adverse effects. Results: The median follow-up time was 11 months and there were 54 patients (54.5%) with local failure. The one and 2-year survival rates were 56.6% and 29.3%, respectively, and the median survival duration was 13 months. The one and 2-year progression-free survival rates (PFS) were 31.3% and 18.2%, respectively, and the median PFS was 7 months. The prognostic factors for overall survival were age (p=0.0001), surgical extents (subtotal resection, p=0.023; partial resection, p=0.009; biopsy only, p=0.002), and enhancement of tumor in postoperative imaging study (p=0.049). The factors affecting PFS were age (p=0.036), tumor enhancement of the postoperative imaging study (p=0.006). There were 3 patients with grade 3 and 4 side effects during and after radiotherapy. Conclusions: In addition to age and surgical extents, tumor enhancement of the postoperative imaging study was included in the prognostic factors. The most common relapse patterns were local failures and hence, additional studies are needed to improve local control rates.

• Journal of Chest Surgery
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• v.43 no.5
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• pp.499-505
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• 2010

Background: There have been several reports using animal experiments that CD1-restricted T-cells have a key role in tumor immunity. To address this issue, we studied the expression of markers for CD1c+ myeloid dendritic cells (DCs) isolated from peripheral blood in the clinical setting. Material and Method: A total of 24 patients with radiologically suspected or histologically confirmed lung cancer who underwent pulmonary resection were enrolled in this study. The patients were divided according to histology findings into three groups: primary adenocarcinoma of lung (PACL), primary squamous cell carcinoma of lung (PSqCL) and benign lung disease (BLD). We obtained 20 mL of peripheral venous blood from patients using heparin-coated syringes. Using flow-cytometry after labeling with monoclonal antibodies, data acquisition and analysis were done. Result: The ratio of CD1c+CD19- dendritic cells to CD1c+ dendritic cells were not significantly different between the three groups. CD40 (p=0.171), CD86 (p=0.037) and HLA-DR (p=0.036) were less expressed in the PACL than the BLD group. Expression of CD40 (p=0.319), CD86 (p=0.036) and HLA-DR (p=0.085) were less expressed in the PACL than the PSqCL group, but the differences were only significant for CD86. Expression of co-stimulatory markers was not different between the PSqCL and BLD groups. Expression of markers for activated DCs were dramatically lower in the PACL group than in groups with other histology (CD40 (p=0.005), CD86 (p=0.013) HLA-DR (p=0.004). Conclusion: These results suggest the possibility that CD1c+ myeloid DCs participate in control of the tumor immunity system and that low expression of markers results in lack of an immune response triggered by dendritic cells in adenocarcinoma of the lung.

• Tuberculosis and Respiratory Diseases
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• v.41 no.4
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• pp.354-362
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• 1994

Objectives and Methods : The presence of aneuploidy or high proliferative activity in cytologic specimens is considered as complementary for the diagnosis of malignancy. To evaluate the diagnostic usefulness of DNA ploidy and cell cycle analysis in lung cancer, we compared the diagnostic yielding rates of DNA ploidy test by brushing specimens using flow cytometry with bronchoscopic forceps biopsy and brushing cytology. Results : Of the seventy-six cases, 55 cases proved to have malignant diseases(squamous cell cancer: 27, adenocarcinoma: 7, large cell cancer: 1, undifferentiated: 4 and small cell cancer: 16). The incidence of aneuploidy in lung cancer patients was 32.7%(18/55), as opposed to no cases in benign disease. And the proportion of high proliferative activity(S+G2M>22%) in lung cancer patients was 42.9%(15/35), but none in benign diseases. In fifty-six of 75 cases(74.7%), cytology of brushing specimens and DNA analysis(either aneuploidy or high proliferative activity vs. diploidy and low proliferative activity) were in concordance. The sensitivity with only brushing cytology was 41.8%(23/55), but with the addition of DNA analysis, it was increased to 56.4%(31/55), without decreasing the specificity(100%). And there was a case whose clue for malignancy was absent except aneuploidy, and he was confirmed to have squamous cell cancer following open thoracotomy. There were no differences in the frequency of aneuploidy or high proliferative activity between histologic subtypes of bronchogenic malignancy. Conclusions : The diagnostic detection rate of lung cancer was improved with the addition of DNA ploidy and cell cycle analysis, and the presence of aneuploidy or high proliferative activity was a relatively specific indicator of malignant disease. It would be useful to test DNA ploidy and cell cycle analysis with brushing specimen for the diagnosis of bronchogenic malignancy particularly in patients whose biopsy specimen could not be obtainable.

• Tuberculosis and Respiratory Diseases
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• v.41 no.4
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• pp.389-396
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• 1994

Background : The two most important purposes of fiberoptic bronchoscopy in lung cancer patients are obtaining tissue diagnosis and staging. The direct sign of lung cancer on FOB includes visible tumor, with smooth or nodular surface, with or without necrosis and infiltration. Variant cell types of lung cancer have their characteristic biological behaviors respectively. For example, squamous cell carcinoma grows slowly, invades locally and has easy necrosis resulting in cavitation, whereas adenocarcinoma shows early metastasis, small cell carcinoma shows rapid growth and higher early metastasis rate. Based on this, it could be hypothesized that each cell type may have characteristic bronchoscopic finding. Method : To answer this question, we reviewed 106 cases which were diagnosed as primary lung cancer and had bronchoscopically visible specific cancerous lesions. Results : The results were as follows. 1) Squamous cell carcinoma accounted for 66 cases(62.2%), adenocarcinoma 15 cases(14.2%), large cell carcinoma 3 cases(2.8%). 2) The endobronchial tumor lesion was arbitrarily classified into 5 types according to gross characteristics. Type A, multilobulating mass with necrosis, accounted for 24.5%, type B, multilobulating mass without necrosis, 25.5%, type C, round beefy mass, 9.4%, type D, infiltration with mucosal irregularity, 6.6%, and type E, infiltration without mucosal irregularity, 34%. 3) The analysis of correlation between endobronchial tumor pattern and specific cell type revealed that squamous cell carcinoma had relation with the morphologic type B and small cell carcinoma had relation with the morphologic type E, but adenocarcinoma had no preponderance in morphologic type. The gross appearance had influence on the diagnostic yields of biopsies and the diagnostic yields of lobulating mass types(type A, B) were higher than those of other types. Conclusion : From the above observations, it could be concluded that squamous cell carcinoma and small cell carcinoma have relations with specific types of bronchoscopic morphology, but not the case in adenocarcinoma.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.495-500
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• 1993

Background: For the relief of the occlusion of major bronchi, laser therapy, radiation therapy or combined therapy is generally used. But the effect of radiation therapy is very slow and not consistent and laser therapy requires expensive equipments and technical expertise with occasional serious side effects. Direct ethanol injection has been widely used for the control of bleeding in gastrointestinal lesion, esophageal varices or renal cell carcinoma with good results. So we tried direct injection of ethanol into the tumor to relieve the obstruction of major bronchus in 11 patients. Method: All procedures were done under the fiberoptic bronchoscopy with continuous oxygen supplement and aliquoted 0.5-1.0 ml of absolute ethanol directly into the tumor through the endobronchial aspiration needle. The tumor was endoscopically removed with a biopsy forceps immediately after ethanol injection. The whole procedure was repeated 3-4 days interval until the lumen opens. Usually after 2-3 trials of ethanol injection, the lumen opened up. Results: The immediate effect of ethanol injection was whitening of the mucosa and prompt cessation of bleeding. The late effect was necrosis of the tumor. The final results of this procedure were improvement of symptoms and reexpnasion of the lung in all patients. $FEV_{1.0}$ and FVC were improved and $PaO_2$ was increased from $68.1{\pm}9.2$ mmHg to $83.9{\pm}8.1$ mmHg, $SaO_2$: from $94{\pm}8.5%$ to $96.6{\pm}1.1%$, and $AaDO_2$ was reduced from $26.5{\pm}8.5$ mmHg to $10.9{\pm}9.1$ mmHg. Conclusion: Direct ethanol injection into the tumor tissue is a rapid, cheap and relatively safe method of relieving the complete occlusion of major bronchus.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.584-594
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• 1993

Background: Among the respiratory diseases, there are a lot of cases of pleural effusion. The most common cause is tuberculosis. But the other cause such as lung malignancy is in an increasing tendency because of the development of diagnostic procedure, the decrease of the prevalence of the tuberculosis and the increase of the longevity. We need to know the accurate diagnosis as soon as possible for the correct therapy. Method: A clinical observation was made on 315 cases of pleural effusion seen at Pusan Adventist Hospital, from Jan, 1989 to Dec, 1992. For diagnostic procedure, thoracentesis, lymph node biopsy, bronchoscopy and percutaneous biopsy of the parietal pleura with Cope needle were performed. The following are parameters used in seperating the exudate from the transudate: pleural protein 3.0 g/dl, pleural protein/serum protein ratio 0.5, pleural LDH 200 IU, pleural LDH/serum LDH ratio 0.6, pleural cholesterol 60 mg/dl and pleural cholesterol/serum cholesterol ratio 0.3. Each parameters were compared, and misclassified rate and diagnostic efficiency were calculated. Results: The most common cause of exudate pleurisy was tuberculosis (82.3%) and malignancy was next (12.2%). The chief complaints of pleural effusion were noted as dyspnea (58.7%), chest pain (54.9%), coughing (50.2%) and fever (36.2%). Location of pleural effusion was noted as right side (51.4%), left side (41.3%) and both sides (7.3%). Amount of pleural effusion of the chest X-ray was minimum (46.8%), moderate (40.5%) and maximum (12.7%). Misclassified rates for each parameters in seperating the exudates from the transudates were as follows; protein: 5.2%, pleural protein/serum protein:7.6%, LDH: 13.9%, pleural LDH/serum LDH: 6.9%, cholesterol: 8.0%, pleural cholesterol/serum cholesterol: 5.6%. On the pleural biopsy, the tuberculosis granuloma was 60.8%, malignancy was 13.6%, infection was 2.3% and nonspecific inflammatory reaction was 23.3%. Conclusion: on the basis of the above results, the most common cause of exudative pleurisy was tuberculosis. We think that the plerual cholesterol/serum cholesterol ratio is the most useful supportive parameter in separating the exudates from the transudates. For accurate diagnosis, the pleural biopsy is the first procedure and repeated pleural biopsy of nonspedcific inflammatory reaction is required.

• Tuberculosis and Respiratory Diseases
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• v.40 no.5
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• pp.575-583
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• 1993

Background: Mediastinal masses are not uncommon, and an overall incidence of one case per 100,000 population per year in individuals of all ages and with no difference in sex incidence may be a reasonable estimation. At least half of all mediastinal masses are asymptomatic and this proportion has increased in recent decades with wider use of screening chest roentgenography. Symptoms in patients with mediastinal mass lesions are usually due to compression or invasion of nearby intrathoracic structures. Most mediastinal mass lesions have characteristic predilectional locations. The basic focus of diagnostic evaluation is an orderly preparation for obtaining a tissue diagnosis but even lesions discovered to be benign must generally be removed. Seldom is this status known for certain preoperatively. In additaion, benign tumors may continue to enlarge, thus compromising vital organs; they may rupture, hemorrhage, become infected or have the possibility of various malignant degeneration. Therefore, all mediastinal masses must be surgically removed whether they are malignant or benign. Methods: We reviewed the medical records of 344 cases previously confirmed as mediastinal tumors or cysts from January, 1960 to August, 1992 and investigated the clinical findings. Results: Neurogenic tumors were the most common(24.7%) and thymomas were distinctively increased recently. Overall ratio between males and females was 1.1:1 and age distribution was relatively even among all age groups. Predilectional sites were posterior for neurogenic tumors, and anterior for teratodermoid tumors, thymomas and lymphomas. Dyspnea was the most common symptom in the patients of the mediastinal tumors and asymptomatic patients were 19.5%, Benign mediastinal mass lesions were 66.0% and malignant, 34.0%, Complete or partial resection was done in 42.4%. Conclusion: We could find the increasing incidence and the tendency of aggressive resection as possible in the mediastinal tumors. We expect the discovery of more mediastinal tumors with wider use of regular check-up and development of diagnostic methods.

• Tuberculosis and Respiratory Diseases
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• v.49 no.4
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• pp.453-465
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• 2000

Background : Lung carcinogenesis is a multistage process involving alterations in multiple genes and diverse pathway. Mutational activation of oncogenes and inactivation of tumor suppressor genes, and subsequent increased genetic instability are the major genetic events. The p53 gene and FHIT gene as tumor suppressor genes contribute to the pathogenesis of lung cancer, evidenced by mutation, microsatellite instability(MI) and loss of heterozygosity(LOH). Methods : We analysed genetic mutations of p53 and FHIT gene in 29 surgical specimens of nonsmall cell lung cancer using PCR-single strand conformation polymorphism, DNA sequencing and RT-PCR. MI and LOH were analyzed in loci of D3S1285, D9S171, and TP53. Results : In 2 cases, point mutation of p53 gene was observed on exon 5. MI of 3 times and LOH of 14 times were observed in at least one locus. In terms of the location of microsatellite, D3S1285 as a marker of FH1T was observed in 5 cases out of 26 specimens; D9S171 as a marker of p16 in 5 out of 17; and TP53 as a marker of p53 in 7 out of 27. In view of histologic type, squamous cell carcinoma presented higher frequency of microsatellite alteration, compared to others. Mutation of FHIT gene was observed in 11 cases and 6 cases of those were point mutation as a silent substitution on exon 8. FHIT mRNA expression exhibited deletion on exon 6 to 9 in 4 cases among 15 specimens, presenting beta-actin normally. Conclusion : Our results show comparable frequency of genetic alteration in nonsmall cell lung cancer to previous studies of Western countries. Microsatellite analysis might have a role as a tumor marker especially in squamous cell carcinoma. Understanding molecular abnormalities involved in the pathogenesis could potentially lead to prevention, earlier diagnosis and the development of novel investigational approaches to the treatment of lung cancer.

• Journal of Yeungnam Medical Science
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• v.8 no.2
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• pp.106-113
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• 1991

A clinical review of 31 cases of multiple myeloma which were diagnosed by criteria of the SWOG between May 1983 and February 1990 at Yeungnam University Hospital was done. The results were as followings : 1. The peak incidence was in 7th decade and male to female ratio was 1.8 : 1. 2. The most common presenting symptom at first diagnosis was bone pain (58%), but fever, dyspnea, dizziness and palpable mass were also noted. 3. The distribution of laboratory findings as following diagnostic criteria of Southwest oncology group(SWOG) : plasmacytoma on tissue biopsy was noted 6 cases, bone marrow plasmacytosis with more than 10% plasma cells was 22 cases, monoclonal globulin spike on serum electrophoresis was 24 cases, lytic bone lesions was observed 22 cases. 4. Initial clinical stages were classified as 2 cases in stage I, 3 cases in stage II, 26 cases in stage III(84%) 5. Immunoelectrophoresis revealed the distribution of IgG 64%, light chain 22%, IgA 10%. Kappa to Lambda ratio of 1.1 : 1. 6. Hematologic & biochemical fingins revealed anemia with <8.5% of hemoglobulin in 42%, hypercalcemia with < 10.6mg% of serum calcium in 22%, azotemia >2.0mg% of serum creatinine in 19%. 7. The multiple punched out lesion of bone x-ray examination were noticed skull(65%), rib(42%), L-spine(35%), pelvis(23%), T-spine(19%). The initial skeletal roentgenographic findings showed osteoporosis, osteolytic lesion and fracture in 55%, only osteolytic lesion in 23%, only osteoporosis in 10%. 8. Complications of multiple myeoloma, such as 10 cases of renal impairment, 8 cases of infection, 16 cases of compression fracture of spine were observed.