• Nuclear Medicine and Molecular Imaging
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• v.42 no.5
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• pp.414-418
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• 2008

The role of positron emission tomography (PET) with F-18 fluorodeoxyglucose (F-18 FDG) in the diagnosis of hepatocellulcar carcinoma (HCC) has been limited because of a variable FDG uptake in HCC. However, the usefulness of PET/CT for detecting extrahepatic metastasis and monitoring of the treatment response in HCC has been reported. A 55-year-old man with a hepatitis B surface antigen-positive, was admitted to our hospital due to dyspnea, general weakness and body weight loss for one month. Chest X-ray showed multiple reticulo-nodular densities on both lower lung fields, which implies metastatic lesions. F-18 FDG PET/CT revealed consecutively intense hypermetabolic mass in right hepatic lobe, inferior vena cava and right atrium. We report a case of HCC with IVC and right atrium invasion identified by F-18 FDG PET/CT.

• Radiation Oncology Journal
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• v.16 no.2
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• pp.159-165
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• 1998

Purpose : The best prognosis for hepatocellular carcinoma can be achieved with surgical resection. However, the number of resected cases is limited due to the advanced lesion or associated liver disease. A trial of combined transcatheter arterial chemoembolization(TACE) and local radiotherapy(RT) for unresectable hepatocellular carcinoma(HCC) was prospectively conducted and its efficacy and toxicity were investigated. Materials and Methods : From 1992 to 1994, 30 Patients with unresectable HCC due either to advanced lesion or to associated cirrhosis were entered in the study Exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child's class C, tumors occupying more than two-thirds of the whole liver, and an ECOG scale of more than 3. Patient cHaracteristics were : mean tumor size $8.95\pm3.4cm$, serum AFP+ in all patients, portal vein thrombosis in all patients, liver cirrhosis in 22 patients, and UICC stage III and IVA in 10 and 20 patients, respectively. TACE was performed with the mixture of Lipiodol(5ml) and Adriamycin(50mg) and Gelfoam embolizatin. RT(mean dose $44.0\pm9.3Gy$) 10 days with conventional fractionation. Results : An objective response was observed in 19 patients($63.3\%$). Survival rates at 1 2, and 3 years were $67\%,\;33.3\%$ and $22.2\%$, respectively. Median survival was 17 months. There were 6 patients surviving more than 3 years. Distant metastasis occurred in 10 patients, with 8 in the lung only and 2 in both lung and bone, Toxicity included transient elevation of liver function test in all patients, fever in 20, thrombocytopenia in 4, and nausea and vomiting in 1. There was no treatment-related death. Conclusion : Combined TACE and RT appear to produce a favorable response and survival results with minimal toxicity.

• The Korean Journal of Pain
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• v.20 no.2
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• pp.230-234
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• 2007

A diagnosis of shoulder pain is varied and difficult to make. The initial onset of liver cancer is difficult to detect and patients typically do not complain of symptoms as most tumors are asymptomatic. If the symptoms of the patients develop, the first symptom is usually pain that extends from the abdomen to the back and shoulder. A suprascapular nerve block is used in the treatment of the referred shoulder pain due to a metastatic hepatoma, but the effectiveness of the treatment has been limited because of its short duration. Recently, the advent of pulsed radiofrequency (PRF) lesioning has proved a successful treatment for chronic refractory pain involving the peripheral nerves. We experienced a case of a 66-year-old male patient complaining of referred right shoulder pain due to metastatic liver cancer, which was relieved after PRF lesioning of the suprascapular nerve.

• The Journal of Korean Society for Radiation Therapy
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• v.27 no.1
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• pp.31-43
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• 2015

Purpose : Stereotactic body radiation therapy (SBRT) has proved its efficacy in several patient populations with primary and metastatic limited tumors. Because SBRT prescription is high dose level than Conventional radiation therapy. SBRT plan is necessary for effective Organ at risk (OAR) protection and sufficient Planning target volume (PTV) dose coverage. In particular, multi-target cases may result excessive doses to OAR and hot spot due to dose overlap. This study evaluate usefulness of Volumetric modulated arc therapy (VMAT) in dosimetric and technical considerations using Flattening filter free (FFF) beam. Materials and Methods : The treatment plans for five patients, being treated on TrueBeam STx(Varian$^{TM}$, USA) with VMAT using 10MV FFF beam and Standard conformal radiotherapy (CRT) using 15MV Flattening filter (FF) beam. PTV, liver, duodenum, bowel, spinal cord, esophagus, stomach dose were evaluated using the dose volume histogram(DVH). Conformity index(CI), homogeneity index(HI), Paddick's index(PCI) for the PTV was assessed. Total Monitor unit (MU) and beam on time was assessed. Results : Average value of CI, HI and PCI for PTV was $1.381{\pm}0.028$, $1.096{\pm}0.016$, $0.944{\pm}0.473$ in VMAT and $1.381{\pm}0.042$, $1.136{\pm}0.042$, $1.534{\pm}0.465$ in CRT respectively. OAR dose in CRT plans evaluated 1.8 times higher than VMAT. Total MU in VMAT evaluated 1.3 times increase than CRT. Average beam on time was 6.8 minute in VMAT and 21.3 minute in CRT. Conclusion : VMAT for SBRT in multi-target liver cancer using FFF beam is effective treatment techniqe in dosimetric and technical considerations. VMAT decrease intra-fraction error due to treatment time shortening using high dose rate of FFF beam.

• The Journal of Internal Korean Medicine
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• v.36 no.1
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• pp.58-68
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• 2015

Objectives : To evaluate the long-term survival effects of traditional Korean medicine (TKM) on refractory metastatic lung cancer and small cell lung cancer (SCLC), which have historically poor survival rates. Methods : A retrospective study was conducted using the medical records of two patients in Daejeon University hospital. The first patient, with SCLC, was treated from January 2000 to December 2009 and the other, with metastatic pulmonary cancer from primary hepatocellular carcinoma (HCC), was treated from September 2004 to February 2014. The patients were treated with herbal medicines at one-month intervals. During hospitalization, acupuncture and indirect moxibustion were performed concurrent with the administration of Western therapy. Treatment efficacy was assessed monthly using chest radiography, chest computed tomography, and laboratory examination data, and by measuring patient performance status. Results : Both patients exhibited a stable disease course for more than 9 years after the initial diagnosis of intractable lung cancer, suggesting that their disease status was controlled by TKM. Conclusions : We suggest that a combination of TKM with conventional Western therapy for refractory lung cancer patients is effective in controlling various symptoms related to lung cancer and improving quality of life, and may potentially prolong overall survival.

• Nuclear Medicine and Molecular Imaging
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• v.42 no.1
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• pp.70-73
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• 2008

A 65 year-old man with hepatocellulcar carcinoma (HCC) admitted to treat left lower leg swelling and pus discharge suspecting osteomyelitis. MRI of his lower leg revealed the bone metastasis. Whole body FDG PET/CT additionally detected left shoulder and right ilium metastasis. Hematemesis suddenly developed in this patient after 3 weeks. Metastasis of right tonsil was histologically proven. When we reviewed his FDG PET/CT, there was asymmetric mild hypermetabolism in the right tonsil. When focal hypermetabolism is shown in the organ physiologically taking glucose up such as tonsil, we should cautiously assess whole body PET/CT in the examination of distant metastasis. We present a patient with multiple distant metastasis including tonsil from HCC showing increased FDG uptake with the literature review.

• The Journal of Internal Korean Medicine
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• v.26 no.2
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• pp.459-466
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• 2005

Ascites is the retention of body fluids in abdominal cavity, which is induced by salt increase, and disorders in such things as water retention and albumin synthesis. Ascites are especially common in cases of progressed liver cirrhosis and metastatic cancer. One patient was diagnosed with liver cirrhosis and Metastatic cancer at Rt. liver from Lt. ovarian tumor by abdominal CT. To measure the response to treatment of ascites, these clinical symptoms were observed: weight, abdominal circumference, and lab findings. Clinical symptoms and ascites were improved after oriental medical treatment. Abdominal circumference decreased. Results suggest oriental medical treatment was effective for this patient for this disease, but more extensive research is needed.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.61-70
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• 2004

Purpose: We studied to decide the operative indication of the metastatic tumor in pelvis according to the oncologic results, the Eastern Cooperative Oncologic Group (ECOG) performance status and complication. Materials and methods: From May 1994 to May 2003, 9 patients who were performed on palliative treatment and 10 paitents on operative treatment due to metastatic tumor of pelvic bone were investigated. On palliative/operative group, the mean age of patients was 57.6/48.0 years old and the ratio of male to female was 5:4/7:3. Primary origins were 3 cases from kidney, 3 from cervix and 2 of lung, 2 of myeloma, 2 of Non-Hodgkin's Lymphoma, and 1 from breast, bladder, testis, prostate, stomach, liver and retroperitoneal leimyosarcoma respectively. The palliative treatment was performed in 5 cases with radiotherapy, 1 with chemotherapy, 2 with combined chemo-radiotherapy and 1 with percutaneous cementation. The operative methods were 1 case of bone cement insertion after curettage, 2 of Girdlestone with internal hemipelvectomy and 7 of reconstruction after wide excision. Reconstructions were done.: 1 case of bone cementation, 5 of autograft prosthesis composite with irradiation or pastuerization and 1 of saddle prosthesis. We have observed the oncologic results, the ECOG performance status and complication. Results: The oncologic results of palliative/operative groups are NED 0/1, AWD 2/6, DOC 1/2 and DOD 6/1. The ECOG performance status was changed from 1.5 into 4.3 in palliative group and from 2.6 into 2.2 in operative group. The complications were 3 cases of the prosthesis failure and 2 of infection. Conclusion: The indication of operation of metastatic pelvic tumor is decided in consideration of the patient's condition, the grade of malignancy in primary tumor and the life expectancy.

• The Korean Journal of Nuclear Medicine
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• v.24 no.2
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• pp.274-278
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• 1990

Metastases to the liver presents a common clinical problem in the management of patients with cole-rectal cancer, and are responsible for a high degree of morbidity and mortality associated with this malignancy. Unfortunately, attempts at preventing the development of liver metastases in "high risk" patients has so far been unsuccessful. Ongoing studies of adjuvant chemotherapy have not yet illustrated a significant increase in survival in patients receiving such therapy. The purpose of the study is to investigate the value of adjuvant radiotherapy given in the form of colloidal chromic phosphate P-32 suspension administered via portal vein after radical resection of the primary cancer, in preventing the growth of occult metastases in the liver. Twenty one patients (10 patients of treated group with 11 controls) were followed 18 months after operation. There was no significant change in the CBC and liver functions after administration of P-32 labeled colloidal chromic phosphate. The number of patients who showed local metastases at 18 months were 2 in the treated group and 3 in the control group. While liver metastases occurred in one patient at 6 months and in three at 12 months in the control group, there was no development of liver metastases by 12 months in the treated group. At 18 month follow-up CT scan one patient in the treated group showed a single nodule in the liver. In conclusion liver metastasis rate was lower in the patients who received colloidal P-32 chromic phosphate via portal vein after radical resection of the primary cole-rectal cancer.

• Journal of Physiology & Pathology in Korean Medicine
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• v.38 no.1
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• pp.10-15
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• 2024

Previous studies have highlighted the pivotal role of the β-adrenergic receptor (β-AR) signaling pathway in stimulating cancer metastasis induced by chronic stress. According to the theory of traditional Korean medicine, chronic stress can induce Qi stagnation. Based on the traditional role of premature citrus unshiu peel in moving Qi, we hypothesized that an ethanol extract of premature citrus unshiu peel (EPCU) can attenuate chronic stress-induced cancer progression. In this study, we investigated the potential role of EPCU on modulating the adrenergic agonists-induced metastatic properties of liver cancer cells. Our findings revealed that adrenergic agonists, including norepinephrine (NE), epinephrine (E), and isoproterenol (ISO), augmented the migratory capacity of Hep3B human hepatocellular carcinoma cells, which was completely abrogated by EPCU treatment in a concentration-dependent manner. Consistently, EPCU inhibited the E-induced invasive property of Hep3B cells in a dose-dependent manner. These results suggest that EPCU efficiently attenuates adrenergic agonists-induced metastatic abilities of liver cancer cells. As a molecular mechanism, EPF suppressed the phosphorylation of major components of β-AR signaling pathway, including Src, signal transducer and activator of transcription 3 (STAT3) and ERK, induced by E treatment. Taken together, our results demonstrate that EPCU impedes the adrenergic agonists-driven metastatic potential of cancer cells by inhibiting β-AR signaling pathway. This study provides basic evidence supporting the probable use of premature citrus unshiu peel to prevent metastasis in liver cancer patients under chronic stress.