• Radiation Oncology Journal
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• v.10 no.1
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• pp.49-58
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• 1992

From January 1985 to September 1990, 7 patients with carcinoma of the extrahepatic biliary system received external radiaiton therapy combined with hyperthermia. Of the 3 patients with extrahepatic bile duct cancer, two were primary cholangiocarcinoma and one was metastatic peripancreatic carcinoma. Of the 4 patients with carcinoma of the gallbladder, two were locor-egionally advanced and unresectable carcinoma and the remaining two were local-regional recurrence after cholecystectomy. They were all pathologicallly proven adenocarcinoma. The radiation dose received ranged from 3000 cGy/2weeks to 5040 cGy/7 weeks. The hyperthermia was done once or twice a week and 4 to 12 sessions in total. The tumor response was confirmed by T-tube cholangiography, percutaneous transhepatic cholangiography and CT scan. 6 out of 7 ($86\%$) showed partial regression of the tumor. The median survival time was 7 months (range $4\~11$ months).6 out of 7 patients were dead: one died of septicemia, 4 of primary disease, one of distant metastases. Only one out of 7 patients is still alive but new metastatic lesion was found. There was not any treatment related deaths. There was also no evidence of treatment related problems with liver, stomach and duodenum, although the observation period was short.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.283-292
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• 2000

Purpose :A retrospective review of 72 patients with locally advanced gallbladder carcinoma, between January 1990 and December 1996, was peformed. Survival results and prognostic factors are analyzed for the patients treated with a various modalities. Materials and Methods :We patients were classified by treatment modality: group 1 included to 27 patients treated with palliative surgery alone, and group 2 for 11 patient treated with palliative surgery and radiotherapy; group 3 for 18 patients not treated by any treatment modality, and group 4 for 16 patients treated with radiotherapy alone. Age distribution ranged from 35 to 80 years with mean of 63 years. The stage was classified by TNM and Nevin's staging system; all patients had an advanced stage more than III. Palliative surgery was done in .: patients and adiuvant radiation therapy (RT) was followed in 11. For 34 patients, in whom no resection was tried, definitive RT was done in 16. Radiation delivered to tumor site and draining nodes up to 45~61.2 Gy using 10 MV linear accelerator. Chemotherapy was given to 25 patients with 5-FU based regimens. Results :Modian suwival time was 10.3 months and 3-year survival rates (3-YSR) were 13.0$\%$ in all patients. Survival rates according to the treatment modalities were as followed; in palliative surgery alone, 3-YSR was 2.5$\%$; in palliative surgery and adjuvant RT, 3-YSR was 45.5$\%$, in no treatment group, 3-VSR were 8.3$\%$; and definitive RT was 13.1$\%$. It was better survival in additional RT after palliative surgery group than palliative surgery alone (p=0.0009). It was better survival in definitive RT group than no treatment group (p=0.002). Significant prognostic factors by univariate analysis were treatment moonlities, the type of tumor and TNM stage. Significant prognostic factors by multivariate analysis were treatment modalities, the type of tumor and the presence of jaundice. Conclusion : It is suggested that RT could be potentially of effective as adjuvant treatment modalities after palliative surgery or primary treatment for locally advanced and unresectable gallbladder carcinoma.

• The Journal of Internal Korean Medicine
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• v.31 no.3
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• pp.667-674
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• 2010

Objective : To investigate the therapeutic effects of Hang-Am-Dan(HAD) on gallbladder cancer patients. Method : We prescribed HAD three times a day(3,000-6,000 mg/day) during a treatment period of 8 and 34 months respectively. Computed tomography(CT) was taken to evaluate the therapeutic efficacy. Results : Two patients diagnosed with gallbladder cancer were recommended to go through chemotherapy. However, they refused the standard regimen due to their old age and the fear of side effects, and chose to go with Oriental medicine treatments instead. The patients were treated for 8 and 34 months respectively. Each patient showed stable disease(SD) state during the treatment period. Conclusion : According to these cases, it could be concluded that HAD may offer potential benefits in treating gallbladder cancer patients.

• Tuberculosis and Respiratory Diseases
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• v.43 no.4
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• pp.527-535
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• 1996

Background : Cell adhesion molecules knave been Implicated In the various stages of tumor progression and metastasis. ICAM-1 plays a important roles in cell-cell interactions in inflammatory and immune response of several diseases. Recently, elevated levels of sICAM-1 in circulation was reported as association with liver metastasis in gastric, Colonic, gall bladder and pancreatic cancer, with reduced survival in malignant melanoma. This study was performed to measure the sICAM-1 in patients with lung cancer and to evaluate the relations between staging of lung cancer and level of sICAM-1. Methods : Serum sICAM-1 was measured in 36 patients with lung cancer according to the pathologic types and clinical staging before therapy and in 8 controls with ICAM-1 ELISA kit. Results : Serum sICAM-1 levels were elevated in patients with lung cancer except small cell type. Also progression and metastasis of lung cancer associated with elevation of sICAM-1 levels. Conclusion : These results suggest that higher levels of serum ICAM-1 reflect the progression and metastasis of lung cancer and it may be used as a marker with diagnostic and prognostic significance.

• Journal of Hospice and Palliative Care
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• v.7 no.2
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• pp.232-237
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• 2004

Purpose: DNR order is generally accepted for cancer patients near the end of life at Hospice Ward. It means not only no CPR when cardiopulmonary arrest develops but no aggressive meaningless medical interventions. Usually on admission, we discuss with the patients' family about DNR order at the Hospice Ward. Recently, we experienced a terminal lung cancer patient who had been on the ventilator for two months after pulmonary arrest. CPR and artificial ventilation were performed because patient's family refused DNR order. There is no consensus when, who, and how DNR order could be written for terminal cancer patients in Korea, yet. Methods: Hospice charts of 60 patients who admitted between Jan and Jun 2003 to Hospice Ward were reviewed retrospectively. Results: The median age was 66(range $31{\sim}93$) and there were 31 males and 29 females. Their underlying cancers were lung (12), stomach (12), biliary tract (7), colon (6), pancreas (4) and others (19). The persons who signed DNR order were son (22), spouse(19), daughter (16) and others (3). But, there was no patients who signed DNR order by oneself. Thirty families of 60 patients signed on day of admission and 30 signed during hospitalization when there were symptom aggravation (19), vital sign change (4), organ failure (3) and others (4). There were 13 patients who died within 5 days after DNR order. Most of patients died at our hospice ward, except in 1 patient. The level of care was mostly 1, except in 2 patients. (We set level of care as 3 categories. Level 1 is general medical care: 2 is general nursing care: 3 is terminal care.) Conclusion: We have to consider carefully discussing DNR order with terminal cancer patients in the future & values on withholding futile intervention.

• Radiation Oncology Journal
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• v.21 no.1
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• pp.35-43
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• 2003

Purpose :To analyze the survival period, prognostic factors and complications of patients having undergone high-dose-rate intraluminal brachytherapy (HDR-ILB) as a salvage radiation therapy, while having a catheter, for percutaneous transhepatic billary drainage (PTBD), inserted due to biliary obstruction caused by a secondary malignant biliary tumor Methods and Materials : A retrospective study was performed on 24 patients having undergone HDR-ILB, with PTBD catheter Insertion, be)ween December 1992 and August 2001. Their median age was 58.5, ranging from 35 to 82 years. The primary cancer site were the stomach, gallbladder, liver, pancreas and the colon, with 12, 6, 3, 2 and 1 cases, respectively. Eighteen patients were treated with external beam radiation therapy and HDR-lLB, while slx were treated with HDR-lLB only. The 4otal external beam, and brachytherapy radiations dose were 30$\~$61.2 and 9$\~$30 Gy, with median doses of 50 and 15 Gy, respectively. Results : Of the 24 patients analyzed, 22 died during the follow-up period, with a median survival of 7.3 months. The 6 and 12 months survival rates were 54.2 (13 patients) and 20.8$\%$ (5 patients), respectively. The median survivals for stomach and gailbladder cancers were 7.8 and 10.2 months, respectively, According to the unlvariate analysis, a significant factor affecting survival of over one year was the total radiation dose (over 50 Gy) (o=0.0200), with all )he patients surviving more than one year had been Irradiated with more than 50 Gy. The acute side effects during the radiation therapy were managed with conservative treatment. During the follow-up period, 5 patients showed symptoms of cholangltis due to the radiation therapy Conclusion :An extension to the survival of those patients treated with HDR-ILB is suggested compared to the median historical survival of 4hose patients treated with external biliary drainage. A boost radiation dose could be effectively given, by performing HDR-lLB, which is a prognostic factor In addition, the acute complications of radiation therapy were effectively controlled by conservative management, and It could be regarded as a safe treatment.

• Radiation Oncology Journal
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• v.16 no.1
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• pp.63-69
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• 1998

Purpose : This study is to evaluate the efficacy of small bowel displacement system(SBDS) in post-operative pelvic radiation therapy(RT) of rectal cancer patients by measurement of small bowel volume included in the radiation fields receiving therapeutic dose. Materials and Method : Ten consecutive new rectal cancer patients referred to the department of Radiation Oncology of Samsung Medical Center in May of 1997 were included in this study. All patients were asked to drink $Castrographin^(R)$ before simulation and were laid prone for conventional simulation and CT scans with and without SBDS. The volume of opacified small bowel on CT scans, which was to be included in the radiation fields receiving therapeutic dose, was measured using Picture archiving and communication system (PACS). Results : The average small bowel volumes with and without SBDS were 176.0ml(5.2-415.6ml) and 185.1ml(54.5-434.2ml), respectively The changes of small bowel volume with SBDS compared to those without SBDS were more than $10\%$ decrease in three, less than 10% decrease in two, less than $10\%$ increase in three, and more than $10\%$ increase in two patients. Conclusion : No significant advantage of using SBDS in post-operative pelvic RT for rectal cancer patients has been shown by small bowel volume measurement using CT scan considering additional effort and time needed for simulation and treatment setup.