• Radiation Oncology Journal
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• v.28 no.2
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• pp.79-84
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• 2010

Purpose: We retrospectively analyzed the long-term results of radical surgery and intraoperative radiation therapy (IORT) in patients with stomach cancer. Materials and Methods: From 1988 to 1994, 51 patients were treated with curative surgery and IORT. Postoperative external beam radiotherapy (EBRT) was administered to 30 patients, while adjuvant chemotherapy was administered to 35 patients. A dose of 15 Gy was irradiated with a 9 MeV electron beam as the IORT and a median dose of EBRT was 43.2 Gy (range, 7.2 to 45 Gy). The follow-up period ranged from 1~254 months, with a median follow-up period of 64 months. Results: The median age of all the patients was 58 years (range, 30 to 71 years). The distribution of pathologic stage (American Joint Committee on Cancer [AJCC] 2002 tumor-note-metastasis [TNM]) was as follows: 13 stage I (25.5%), 10 stage II (19.6%), 25 stage III (49.0%), and 3 stage IV (5.9%). Distant metastases occurred in 11 patients (10 in the peritoneum and 1 in bone), including one patient with concurrent local recurrence (anastomosis site). The 5-year locoregional control, disease free survival and overall survival rates were 94.7%, 66.5%, and 51.7%, respectively. For the multivariate analysis, age, TNM stage, and EBRT were significant prognostic factors for overall survival, and only TNM stage for disease free survival. Conclusion: We could have achieved a high loco-regional control rate in patients with locally advanced stomach cancer by adding IORT to radical surgery. However, the benefit of IORT on survival remains to be elucidated.

• Journal of Gastric Cancer
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• v.4 no.1
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• pp.7-14
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• 2004

Purpose: The purpose of this study was to evaluate the treatment result of surgical resection after preoperative chemotherapy in inoperable gastric cancer patients. Materials and Methods: We analyzed 18 gastric cancer patients who underwent gastric resection after preoperative chemotherapy because they showed some clinical response to chemotherapy (15 with distant metastasis and 3 with locally advanced lesions). The mean postoperative follow-up period was $15.3\pm15.5$ ($1\∼56$) months. Results: In 15 patients with distant metastasis, 2 ($13.3\%$) showed complete response (CR), 10 ($66.7\%$) partial response (PR), 2 ($13.3\%$) stable disease (SD), and 1 ($6.7\%$) progressive disease (PD). The clinical response rate was $80.0\%$ Five subtotal gastrectomies, 4 total gastrectomies, and 6 extended total gastrectomies were performed. Two cases of CR were alive without recurrence for 4 and 26 months, respectively. Mean survival period in PR case was 37.7 months, but 2 cases of SD and 1 case of PD died after 11.7, 17.9, and 0.9 months, respectively. Postoperative survival was significantly associated with the response to chemotherapy (P<0.01). The mean survival period of the 10 patients with a complete resection was 44.1 months, which was significantly better than that of the 5 patients with an incomplete resection (9.8 months, P=0.03). Among 3 patients with locally advanced gastric cancer, 2 cases showed PR to chemotherapy, and complete resection was possible only by gastrectomy for those patients. Conclusion: In some selected cases, surgical resection was achievable after preoperative chemotherapy for patients with inoperable metastatic or locally advanced gastric cancer.

• Journal of Gastric Cancer
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• v.10 no.1
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• pp.5-12
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• 2010

Purpose: The aim of this study was to evaluate the preoperative and postoperative nutritional statuses of patients with gastric cancer and to investigate the nutritional factors that are correlated with perioperative complications. Materials and Methods: From January 2008 to Jun 2008, 669 patients who underwent curative gastrectomy were enrolled in a retrospective study. To evaluate the changes of their nutritional status preoperatively and postoperatively, we measured the total lymphocyte count, the serum albumin, the body weight change and the BMI. The nutritional factors correlated with short-term postoperative complications were analyzed. Results: The total lymphocyte count and serum albumin decreased from the first preoperative day to the $5^{th}$ day after operation, but they tended to increase and approach the normal range 6 months after operation. The only factor correlated with the short-term postoperative complications (defined as the ones that occurred for 30 days) was the serum albumin checked on the $5^{th}$ day after operation. Conclusion: Low serum albumin on the $5^{th}$ day after operation was correlated with postoperative short-term complications. Serum albumin can be the preoperative statistical parameter that can predict the occurrence of postoperative complications.

• Journal of Gastric Cancer
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• v.5 no.2
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• pp.79-88
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• 2005

Quality assurance may be defined as the complete set of systemic actions that is required to achieve a better treatment result by standardizing treatment and by using various audit programs. In general, application of a quality assurance program in surgery is considered to be more difficult than it is in chemotherapy or radiotherapy. However, recently, the importance of quality assurance in the surgical field has been emphasized in clinical trials comparing different surgical procedures and evaluating the role of postoperative adjuvant therapy. In the case of gastric cancer surgery, excellent quality assurance programs have rarely been applied in most large prospective clinical trials. Although the quality assurance in Dutch trial was conducted very systemically and strictly, the situation is quite different from ours. On the other hand, several quality assurance programs in Japanese trials comparing D2 and D2 plus para-arotic lymph node dissection seem to be applicable to Korean clinical trials. Several factors, including selection of appropriate surgeons based on personal experience and annual number of operations, standardization of surgical procedures by education and consensus, development of a unified database program, application of standardized perioperative management, and standardization of pathologic examination, are required to guarantee a successful multi-institutional prospective clinical trial. In contrast, one needs to realize that protocols that are too strict and sophisticated can make the enrollment of patients and surgeons more difficult and can promote protocol violation during the clinical trials. (J Korean Gastric Cancer Assoc 2005;5:79-88)

• Journal of the Korean Institute of Intelligent Systems
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• v.15 no.4
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• pp.473-478
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• 2005

The gastric cancer takes the great part of the cancer occurrence and the mortality from cancer in Korea, and the early detection of gastric cancer is very important in the treatment and convalescence. This paper. for the early detection of gastric cancer, Proposes the analysis system of endoscopic image of the stomach that detects the abnormal region by using the change of color in the image and provides the surface tissue information to the detector. While the advanced inflammation and the cancer may be easily detected, the early inflammation and the cancer have a difficulty in detection and require the more attention lot detection. This paper, at first, converts the endoscopic image to the Image of IHb(Index of Hemoglobin) model and removes noises incurred by illumination, and next, automatically detects the regions suspected as cancer and provides the related information to the detector, or provides the surface tissue information for the regions appointed by the detector. This paper does not intend to provide the final diagnosis of the detected abnormal regions as gastric cancer, but provides the supplementary mean that reduces the load and mistaken diagnosis of the detector by automatically detecting the abnormal regions being not easily detected by human eyes and providing the additional information for the diagnosis. The experiments using practical endoscopic images for performance evaluation showed that the proposed system is effective in the analysis of endoscopic image of the stomach.

• Journal of the Korean Society of Food Science and Nutrition
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• v.23 no.2
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• pp.340-347
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• 1994

The specimens used in this study were obtained from patients with primary gastric carcinoma and adjacent non-malignant mucosa from the same patients. Using the techniques of immunocyto chemicstry and in situ hybridization, transforming growth $factor-{\alpha}(TGF-{\alpha})$ and epiderimal growth factor receptor (EGF-R) nRNAs were identified. $TGF-{\alpha}$ was observed in macrophages and dividing tumor cells but, not in normal cells. EGF-R was observed both in malignant and non-malignant gastric tissues. Although normally, $TGF-{\alpha}$ is not seen in normal gastric tissues, $TGF-{\alpha}$ was discovered in the adjacent non-malignant tissue of histolgically normal, which strongly suggest that $TGF-{\alpha}$ is involved in the differentiation of cancer cells. Immunocytochemicstry using EMB-11 antibody identified the existence of macrophages which express $TGF-{\alpha}$ and EGF-R mRNA. Protein products of EGF-R was identfified using monoclonal antibody. Cancer cells were also identified in the non-malignant normal tissues by the method of immunocytochemicstry using carcino embryonic antigen (CEA)antibody. It is considered that the activity of $TGF-{\alpha}$ increased as tumor cell prolifierates. Immunocytochemistry and in situ hybridization techniques can be used to diagnose gastric cancer along with the use of ${\alpha}-feto$ protein and CEA.

• Journal of Gastric Cancer
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• v.6 no.3
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• pp.193-197
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• 2006

Melanoma is a malignant neoplasm of melanocytes most frequently arising from the skin, but primary melanoma can also arise from the mucosa of the gastrointestinal tract. Gastrointestinal melanomas are most commonly metastases from a cutaneous melanoma. Primary melanoma of the stomach is rare and carries a poor prognosis. Reported here is the case of a 75-year-old man with a primary gastric melanoma who presented with a melena, abdominal pain, and weight loss. Most cases of melanoma are treated by excision of the primary tumor. Patients with melanoma have been treated with adjuvant chemotherapy, radiation therapy, and immunotherapy. None of these modalities has been demonstrated to prolong the survival rate. To improve long-term disease-free survival, early diagnosis and surgical intervention are very important.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.176-181
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• 2008

Purpose: The adipocyte-derived cytokine leptin plays a major role in the control of stable body weight by suppressing food intake and increasing energy metabolism. Leptin regulates the cell proliferation of various epithelial cells and it may be involved in the promotion of cancer. Leptin and its receptor are highly expressed in gastric adenocarcinoma, but the association between the serum leptin level and the tissue expression of leptin is uncertain. We evaluated the serum leptin level and the expressions of leptin and leptin receptor in gastric cancer, and we explore the possible mechanism and role of leptin in the carcinogenesis of gastric cancer. Materials and Methods: 72 carcinomas that were curatively resected at our hospital from October 2005 to March 2007 were included in this study. By immunoassay and immunohistochemical staining, we evaluated the serum leptin level and the expressions of leptin and its receptor, and we analyzed their relationship together with the clinicopathological variables. Results: The serum leptin level was increased as the patient's BMI increased and it was decreased in H. pylori infected patients. The expression of leptin was increased as the TNM stage increased (P=0.014), and the expression of leptin receptor in the intestinal type gastric adenocarcinoma was higher than that in the diffuse type gastric adenocarcinoma (71.4% vs 28.6%, respectively, P=0.033). Conclusion: There was no significant correlation between the serum leptin level and expression of leptin in gastric cancer patients. The expression of leptin was associated with the TNM stage, but its role in the pathogenesis of gastric cancer has to be elucidated.

• Journal of Life Science
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• v.25 no.8
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• pp.849-860
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• 2015

The anti-cancer activities of Rhus verniciflua Stokes (GC), Ulmus davidiana var. japonica Nakai (UGP) and arsenium sublimatum (SS) extracts, which have been used Oriental medicine therapy for various diseases, were investigated. The treatment of GC, UGP and SS alone, and combined treatment with GC, UGP and SS did not affect the cell viability in the mouse normal cell lines (RAW 264.7 macrophages and C2C12 myoblasts). However, co-treatment with GC, UGP and SS markedly induces apoptosis in human gastric cancer AGS cells, but not in other various cancer cell lines (human lung cancer A549, colon cancer HCT116, liver cancer Hep3B and bladder T24 cells) as evidenced by formation of apoptotic bodies, chromatin condensation, and accumulation of annexin-V positive cells. Co-treatment with GC, UGP and SS effectively induced the expression levels of Fas and Fas ligand, and inhibited the levels IAP family proteins such as XIAP, cIAP-1 and survivin, and anti-apoptotic Bcl-xL proteins compared with treatment with either agent alone. Combined treatment also significantly induced the loss of mitochondrial membrane potential, which was associated with the activation of caspases (-3, -8, and -9) and degradation of poly (ADP-ribose) polymerase. However, the cytotoxic effects induced by co-treatment with GC, UGP and SS were significantly attenuated by pan-caspases inhibitor, z-VAD-fmk, indicating an important role for caspases. These results indicated that the caspases were key regulators of apoptosis in response to co-treatment of GC, UGP and SS in human gastric cancer AGS cells and further studies will be needed to identify the active compounds.

• Journal of Gastric Cancer
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• v.10 no.1
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• pp.26-33
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• 2010

Purpose: We wanted to evaluate the technical feasibility and safety of totally laparoscopic total gastrectomy (TLTG) for treating early gastric cancer. Materials and Methods: The medical records of 11 consecutive patients who underwent TLTG after being diagnosed with early gastric cancer at Incheon St. Mary's Hospital, The Catholic University of Korea from February 2005 to September 2009 were retrospectively reviewed and their clinicopathologic characteristics and the surgical results wereinvestigated. Results: The mean operation time was $385.6{\pm}94.1$ minutes, the mean time for creating an intracorporeal anastomosis was $97.5{\pm}60.0$ minutes and the mean number of the harvested lymph nodes was $46.6{\pm}15.4$ The mean number of days after operation until starting a liquid diet was the $6.1{\pm}7.6^{th}$ postoperative day and the mean hospital stay after surgery was $14.2{\pm}11.9$ days. There was no case of open conversion, but there were 2 cases of intraoperative complication and 3 cases of postoperative complication. There was one case of postoperative mortality. The patient suffered from thrombocytopenia of an unknown cause, which was refractory to platelet transfusion, on $4^{th}$ postoperative day and the patient died of intraabdominal bleeding on the $6^{th}$ postoperative day. Conclusion: TLTG was a technically feasible and relatively safe procedure. However, a long time for creating the intracoproeal anastomosis and a long operation time are still problems to be solved.