• Radiation Oncology Journal
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• v.13 no.4
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• pp.377-383
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• 1995

Purpose : To obtain the optimal treatement method in patients with endometrial carcinoma(clinical stage FIGO I, II) by comparative analysis between preoperative radiotherapy (pre-op RT) and postoperative radiotherapy (post-op RT). Material and Methods : A retrospective review of 62 endometrial carcinoma patients referred to the Yonsei Cancer Center for radiotherapy between 1985 and 1991 was undertaken. Of 62 patients, 19 patients(Stagel : 12 patients. Stagell;7 patients) received pre-op RT before TAH(Total Abdominal Hysterectomy) and BSO (Bilateral Salphingoophorectomy) (Group 1) and 43 patients(Stage 1;32 patients, Stage 2; 11 patients) received post-op RT after TAH and BSO (Group 2). Pre-op irradiation was given 4-6 weeks prior to surgery and post-op RT administered on 4-5 weeks following surgery. All patients except 1 patient(Group 2: ICR alone) received external irradiation. Seventy percent(13/19) of pre-op RT group and 54 percent(23/42) of post-op RT group received external pelvic irradiation and intracavitary radiation therapy(ICR). External radiation dose was 39.6-55 Gy(median 45 Gy) in 5-6. 5weeks through opposed AP/PA fields or 4-field box technique treating daily, five days per week, 180 cGy per fraction. ICR doses were prescribed to point A(20-39.6 Gy, median 39 Gy) in Group 1 and 0.5cm depth from vaginal surface (18-30 Gy,median 21 Gy) in Group 2. Results : The overall 5 year survival rate was $95{\%}$. No survival difference between pre-op and post-op RT group.($89.3{\%}$ vs $97.7{\%}$, p>0.1) There was no survival difference by stage, grade and histology between two groups. The survival rate was not affected by presence of residual tumor of surgical specimen after pre-op RT in Group 1 (p>0.1), but affected by presence of lymph node metastasis in post-op RT group(P<0.5). The complication rate of pre-op RT group was higher than post-op RT. ($16{\%}$ vs $5{\%}$) Conclusion : Post-op radiotherapy offers the advantages of accurate surgical-pathological staging and low complication rate.

• The Journal of Korean Obstetrics and Gynecology
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• v.18 no.3
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• pp.67-76
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• 2005

Purpose : 귀전우(Euonymus alatus, EA)는 현재까지 항종양활성을 나타낸다고 보고되었지만 그 작용 메커니즘에 대해서는 아직 밝혀지지 않은 채 남아 있다. 본 연구에서는, 자궁근종세포(ULSMC)에서 EA의 분자적 수준에서의 작용메커니즘을 연구${\cdot}$검토하고자 하였다. Methods : EA의 열수추출액이 자궁근종세포(ULSMC)와 caspase-3 pretense의 활성도에 미치는 영향을 측정하였다. Results : 우리는 자궁근종에서 EA 유도 세포독성의 메커니즘을 검토하였는바, 근종 세포들은 20-200g/ml 농도의 EA추출물에 6시간 배양될 때, caspase-3가 활성화되고, 그때 세포들은 apoptosis를 유발하게 되었다. EA에 의한 apoptosis의 유도가 진행되었으며, cytochrome- c의 세포질분획에서 양적증가가 caspase-3의 활성보다도 우세하였다. GSH합성의 저해제인 5mM buthionine용액에 전처리는 EA유도 apoptosis를 용이하게 하지만 pan-caspase inhibitor인 Z-VAD-fmk용액 전 처리는 부분적으로 apoptosis유도를 억제하였다. 한편, EA는 건강한 지원자들로 부터 채취한 말초혈액 단핵세포들에 있어서는 독성의 효과는 없었다. Conclusion : 이들 결과들은 EA가 prooxidant로 작용을 하고 그리고 caspase-3 activation과 mitochondrial pathway를 경유하는 apoptosis를 유발한다는 것을 나타낸다. EA의 탕제약제로서 열수추출액이 항산화활성뿐만 아니라, 종양세포에 대한 세포독성효과를 나타낸다고 보고된 바, 이에 향후 근종치료에 대한 임상연구가 필요할 것으로 보인다.

• Clinical and Experimental Reproductive Medicine
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• v.36 no.2
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• pp.111-119
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• 2009

Objective: The aim of this study was to compare the clinical efficacy of clomiphene citrate (CC) and letrozole combined with gonadotropins for controlled ovarian stimulation (COS) in patients with CC-induced thin endometrium Methods: Fifty-one intrauterine insemination cycles performed in patients who previously had a thin endometrium (<8 mm) to ovulation induction using CC were included in this study. A CC 100 mg/day (CC+gonadotropin group, n=26) or letrozole 2.5 or 5 mg/day (letrozole+gonadotropin group, n=25) was administered on day 3~7 of the menstrual cycle, combined with gonadotropins at dose 75~150 IU every other day starting on day 5~7. We compared total dose of gonadotropin used, endometrial thickness, endometrial pattern, number of follicles ${\geq}14\;mm$ on hCG day, pregnancy rate and multiple pregnancy rate between the two groups, which were statistically analyzed using Mann-Whitney U test or Fisher's exact test, where appropriate. Results: There were no significant differences in clinical characteristics such as age, duration of infertility, number of previous IUI cycles, basal serum hormone levels and cause of infertility between the two groups. In both groups, the endometrium was significantly thicker than that of previous ovulation induction cycles using CC. No significant differences were found in the total dose of gonadotropin used, day of hCG administration, the rate of triple endometrium and pregnancy rate. The number of follicles ${\geq}14\;mm$ was significantly lower ($3.7{\pm}1.7$ vs. $2.8{\pm}1.7$, p=0.03) and the endometrium on hCG day was significantly thicker ($7.7{\pm}1.5$ vs. $9.1{\pm}1.7$, p=0.001) in letrozole+gonadotropin group compared to CC+gonadotropin group. Conclusion: The clomiphene citrate and letrozole combined with gonadotropins appear to avoid the undesirable effects on the endometrium frequently seen with CC for ovulation induction. However, in terms of adequate endometrial development or optimal follicular growth, letrozole may be more beneficial than CC for gonadotropin-combined COS in patients with CC-induced thin endometrium. Further prospective randomized controlled studies in a larger scale will be necessary to confirm our findings.

• Radiation Oncology Journal
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• v.24 no.3
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• pp.164-170
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• 2006

[ $\underline{Purpose}$ ]: This study identified the result of postoperative radiation therapy and the prognostic factors to affect survival rates in cancer patients. $\underline{Materials\;and\;Methods}$: One hundred and thirty three patients with cervical cancer who were treated with postoperative radiation therapy following surgery at our institution between June 1985 and November 2002 were retrospectively analyzed. One hundred and thirteen patients had stage IB disease, and 20 patients had stage IIA disease. Histological examination revealed 118 squamous cell carcinoma patients and 15 adenocarcinoma patients. Sixty seven patients were noted to have stromal invasion greater than 10 mm, and 45 patients were noted to have stromal Invasion 10 mm or less. Positive lymphovascular invasion was found in 24 patients, and positive pelvic lymph nodes were noted in 39 patients. Positive vaginal resection margin was documented in 8 patients. All of the patients were treated with external beam radiation therapy to encompass whole pelvis and primary surgical tumor bed. Intracavitary radiation therapy was added to 19 patients who had positive or close surgical margins. $\underline{Results}$: Actuarial overall and disease-free survival rates for entire group of the patients were 88% and 84% at 5 years, respectively. Five-year disease-free survival rates for patients with stromal invasion greater than 10 mm and 10 mm or less were 76% and 97%, respectively (p<0.05). Also there was a significantly lower survival in patients with positive pelvic lymph nodes compared with patients with negative pelvic lymph nodes (p<0.05). However, lymphovascular invasion, positive vaginal resection margins were not statistically significant prognostic factors. Addition of neoadjuvant chemotherapy or type of surgery did not affect disease-free survival. $\underline{Conclusion}$: Postoperative radiation therapy appears to achieve satisfactory local control with limited morbidity in cervical cancer patients with high pathologic risk factors. Distant metastasis was a dominant failure pattern to affect survival in cervical cancer patients after radical surgery and radiation and more effective systemic treatment should be investigated in these high-risk patients.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.224-229
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• 2001

Purpose : The aim of this study is to analyze the treatment failure patterns and the risk factors for locoregional or distant failure of uterine cervical carcinoma treated with radiation therapy. Materials and methods . A retrospective analysis was undertaken of 154 patients treated with curative radiation therapy in Gyeongsang National University Hospital from April 1989 through December 1997. According to FIGO classification, 12 patients were stage IB, 24 were IIA, 98 were IIB, 1 were IIIA, 17 were IIIB, 2 were IVA. Results : Overall treatment failure rate was $42.1\%$ (65/154), and that of complete responder was $31.5\%$ (41/130). Among 65 failures, 25 failed locoregionally, another 25 failed distantly, and 15 failed locoregionally and distantly. Multivariate analysis confirmed tumor size (>4 cm) as risk factor for locoregional failure, and tumor size (>4 cm), pelvic lymph node involvement as risk factors for distant failure. Conclusion : On the basis of results of our study and recent published data of prospective randomized study for locally advanced uterine cervical carcinoma, we concluded that uterine cervical carcinoma with size more than 4 cm or pelvic lymph node involvement should be treated with concurrent chemoradiation.

• Applied Microscopy
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• v.40 no.4
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• pp.229-235
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• 2010

Cervical cancer is associated with low antioxidant status. It has a high prevalence especially amongst woman in Asia and is a leading cause of cancer death. Cancer chemotherapy in vivo improved in cases with high p53 expression in the tumor tissue. The restoration of p53 levels could be a potential strategy to increase chemoresponsiveness. Under circumstances where damage is extensive, p53 plays a direct role in trigering apoptosis. To investigate the effect of curcumin (CMN) as an antioxidant agent on anticancer agent 5-fluorouracil (5FU) induced apoptosis and p53 expression, HPV-18 positive HeLa cells were treated with noncytotoxic amounts of antioxidant. Curcumin induced apoptosis in cervical cancer cells. Morphological hallmarks of apoptosis such as nuclear fragmentation and internucleosomal fragmentation of DNA were observed. CMN caused upregulation of p53 expression, evident from Western blotting data and also increased the susceptibility/apoptosis induced by 5FU. These results show that increasing drug sensitivity of cervical cancer cells by upregulation of p53 using CMN is novel approach and could have a possible therapeutic potential in cervical cancer.

• Journal of Yeungnam Medical Science
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• v.5 no.2
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• pp.121-128
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• 1988

Clinical and histopathological studies were made on 202 cases of malignancy of cervix, that were visited to the Department of Obstertrics and Gynecology, Yeungnam University Hospital, during 5 years from 1983 to 1987. The results were summarised as follows. 1. Malignancies of the uterine cervix were 10% of total female malignancies. 2. Among 202 cases, 195 cases(96.5%) were squamous cell carcinoma, in which 60 cases(30.0%) of carcinoma in situ, 9 cases(4%) of microinvasive, and 126 cases(62.5%) of invasive carcinoma were included. 3. The average age of the patients with squamous cell carcinoma was 49.4 years old. ; In cases of carcinoma in situ, it was 43.8, microinvasive, 40.0, invasive 52.1 years old. 4. Clinical symptoms of the patient with squamous cell carcinoma in order of frequency were as follows. ; vaginal bleeding(47.5%), abnormal cytology(15.4%), and abnormal vaginal discharge(9.4%). 5. Duration of the chief complaints was most commanly less than 6 months(73.2%), and the average duration was 3.8 months. 6. The most common age of marriage was between 19 to 22 years 0Id(46.5%). The average was 21.5 years old. 7. The gravity was 51.5% in 5~8 times, and average 6.2 times. The parity was 61.9% in 1~4 times, and average 3.9 times. 8. The subdivision of 126 cases of invasive carcinoma was made according to FIGO stage classification, stage I, 40 cases(31.8%), stage II, 54 cases(42.9%), stage III, 11 cases(8.7%), and stage IV, 8 cases(6.3%). 9. The histologic subtypes of invasive squamous cell carcinoma were distributed as follows. ; large cell keratinizing type, 25 cases(19.8%), large cell nonkeratinizing type, 101 cases(80.2%). 10. In the cytologic diagnosis, class I was 2 cases(l.9%), class II was 16 cases(15.1%), class III was 33 cases(31.1%), class IV was 31 cases(29.3%), class V was 24 cases(24.6%). 11. The frequency of lymph node metastasis was 7.5% in stage I, and 11.1% in stage II.

• Development and Reproduction
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• v.10 no.4
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• pp.255-261
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• 2006

Although some phytoes rogens might have beneficiary rather than adverse effects, most endocrine disrupting compounds(EDCs) are considered to be harmful to human and wildlife health through interfering the endocrine system. Previously we found that prepubertal exposure to genistein(GS), a well-known isoflavone phytoestrogen, could activate the reproductive system of immature female rats resulting precocious puberty. Interestingly, di(2-ethyl hexyl) phthalate(DEHP) exposure brought inverse result, a delayed puberty, in the same experimental regimen. In this study, we examined whether prepubertal exposure to GS or DEHP affect the gene expressions of estrogen receptors($ER\;{\alpha}$ and $ER\;{\beta}$) and LH receptor(LHR) which represent the maturational status of ovary and uterus in immature rats. GS (100 mg/kg/day) was administered daily from postnatal day 25 to the day when the first vaginal opening(VO) was observed, and the animals were sacrificed on the next day(day 32). Similarly, DEHP(l00 mg/kg/day) was administered daily from postnatal day 25 through the day when the first V.O. in control group was observed, and the animals were sacrificed on the next day(day 36). To determine the transcriptional changes in the hormone receptors, total RNAs were extracted from ovary and uterus and were applied to semi-quantitative reverse transcription polymerase chain reaction(RT-PCR). In the GS group, the transcriptional activities of $ER\;{\alpha}$, $ER\;{\beta}$ and LHR in uterus and LHR in ovary were significantly increased when compared to those of control group. In the DEHP group, the transcriptional activities of all the hormone receptors measured were significantly lowered when compared to those of control group. These alteration of the reproductive hormone receptor expressions in ovary and uterus might be represent the phenotypic aspects(secondary sexual characteristics) such as tissue weights and reproductive hormone levels during perinatal period in immature female rats.

• Radiation Oncology Journal
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• v.15 no.4
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• pp.369-377
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• 1997

Purpose : This study was Performed to identify the histopathologic feature by the reevaluation of the Pathologic specimen of the cervical tumors and to evaluate the clinical findings and the treatment results of the patients with small cell carcinoma of the cervix treated by radiotherapy. Materials and Methods : 2890 patients with cervical carcinoma received radiotherapy at the Department of Radiation Oncology. Yonsei Cancer Center, Yonsei University College of Medicine between October 1981 and April 1995. Of the 2890 patients in this data base, sixty were found to have small cell carcinomas $(2.08\%)$. Among them thirty six patients were transferred from other hospitals. the biopsy specimens of those Patients were not available. So we could review the slides of the other twenty four patients who were diagnosed at our hospital. Twenty four patients with small cell carcinoma of the cervix were analyzed retrospectively based on the assessment of H & E staining and other four immunohistochemical stains for neuroendocrine differentiation (neuron specific enolase, chromogranin. synaptophysin and Grimelius stain). And we also evaluate the Patients and tumor characteristics. response to radiation. patterns of failures, 5 year overall and disease free survival rates. Results : Thirteen tumors were neuroendocrine carcinomas(13/24 = $54.2\%$) and eleven tumors were squamous carcinomas, small cell type (11/24 = $47.8\%$) based on the assessment of H & E staining and other four neuroendocrine marker studies. So we classified the Patients two groups as neuroendocrine carcinoma and small cell type of squamous carcinoma, Among the 13 neuroendocrine carcinomas, five were well to moderately differentiated tumors and the other eight were Poorly differentiated or undifferentiated ones. The median age was 54 years old (range 23-79 years). Eight Patients had FIGO stage IB disease, 12 had stage 11, 3 had stage III and one had stage IV disease, Pelvic lymph node metastases were found in five Patients $(20.8\%)$. three of them were diagnosed by surgical histologic examination and the other two were diagnosed by CT scan. There was no difference between two histopathologic groups in terms of patients and tumor characteristics. response to radiation. 5 year overall and disease free survival rates. However the distant metastases rate was higher in neuroendocrine carcinoma Patients (6/13:$46.2\%$) than in small cell type of squamous carcinoma Patients (2/11:$18.2\%$), but there was no statistically significant difference because of the small number of patients (P>0.05). Conclusion : More than half of the small cell carcinoma of the cervix patients were neuroendocrine carcinoma (13/24 : $54.1\%$) by reevaluation of the biopsy specimen of the cervical tumors. The tendency of distant metastases of the neurolndocrine carcinoma was greater than those of the small cell type of squamous carcinoma $(46.2\%\;vs.\;18.2\%)$. But there were no differences in the patients and tumor characteristics and other clinical treatment results in both groups. These data suggest that radical local treatment such as radiotherapy or radical surgery combined with combination systemic cytotoxic chemotherapy might provide these patients with the best chance for cure.

• Journal of radiological science and technology
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• v.30 no.3
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• pp.219-225
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• 2007

This study was performed for the purpose of providing basic data of the pelvic disorders through survey of the frequency of management of occurrence by major risk factor. Female pelvic mass was detected using sonography, and necessary data were collected from 604 female visitors to a obstetrics and gynecology hospital located at S-si. Female pelvic mass was uterus mass, ovarian mass, cervical cyst, endometrial disease. For the analysis, such variables as age, weight and frequency of pregnancy were chosen as risk factors. Results of the analysis and conclusions are as follows ; 1) The frequency of occurrence of the female pelvic mass is highest, as 38.9% of the component ratio, in the age of 35 to 54. It maintains high level of 35.8% even in the age of 55 and above. 2) The frequency of occurrence of the female pelvic mass increases in proportion as the weight and frequency of pregnancy increase. 3) The size of the uterus tumor has no statistical relationship with the risk factors, age, weight and frequency of pregnancy.