• Radiation Oncology Journal
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• v.28 no.4
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• pp.193-204
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• 2010

Purpose: To analyze the treatment outcomes, complications, prognostic factors after a long-term follow-up of patients with nasopharyngeal carcinoma treated with radiation therapy (RT) alone or concurrent chemoradiation therapy (CCRT). Materials and Methods: Between December 1981 and December 2006, 190 eligible patients with non-metastatic nasopharyngeal carcinoma were treated at our department with a curative intent. Of these patients, 103 were treated with RT alone and 87 patients received CCRT. The median age was 49 years (range, 8~78 years). The distributions of clinical stage according to the AJCC 6th edition included I: 7 (3.6%), IIA: 8 (4.2%), IIB: 33 (17.4%), III: 82 (43.2%), IVA: 31 (16.3%), IVB: 29 (15.3%). The accumulated radiation doses to the primary tumor ranged from 66.6~87.0 Gy (median, 72 Gy). Treatment outcomes and prognostic factors were retrospectively analyzed. Acute and late toxicities were assessed using the RTOG criteria. Results: A total of 96.8% (184/190) of patients completed the planned treatment. With a mean follow-up of 73 months (range, 2~278 months; median, 52 months), 93 (48.9%) patients had relapses that were local 44 (23.2%), nodal 13 (6.8%), or distant 49 (25.8%). The 5- and 10-year overall survival (OS), disease-free survival (DFS), and disease-specific survival (DSS) rates were 55.6% and 44.5%, 54.8% and 51.3%, in addition to 65.3% and 57.4%, respectively. Multivariate analyses revealed that CCRT, age, gender, and stage were significant prognostic factors for OS. The CCRT and gender were independent prognostic factors for both DFS and DSS. There was no grade 4 or 5 acute toxicity, but grade 3 mucositis and hematologic toxicity were present in 42 patients (22.1%) and 18 patients (9.5%), respectively. During follow-up, grade 3 hearing loss in 9 patients and trismus in 6 patients were reported. Conclusion: The results of our study were in accordance with findings of previous studies and we confirmed that CCRT, low stage, female gender, and young age were related to improvement in OS. However, there are limitations in the locoregional control that can be achieved by CCRT with 20 conventional radiation therapy. This observation has led to further studies on clarifying the efficacy of concurrent chemotherapy by intensity modulated radiation therapy.

• Radiation Oncology Journal
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• v.20 no.3
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• pp.221-227
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• 2002

Purpose : To evaluate the role of postoperative chemoradiotherapy in locally advanced rectal cancer, we retrospectively analyzed the treatment results of patients treated by curative surgical resection and postoperative chemoradiotherapy. Materials and Methods : From April 1989 through December 1998, 119 patients were treated with curative surgery and postoperative chemoradiotherapy for rectal carcinoma in Gyeongsang National University Hospital. Patient age ranged from 32 to 73 years, with a median age of 56 years. Low anterior resection was peformed in 59 patients, and abdominoperineal resection in 60. Forty-three patients were AJCC stage II and 76 were stage III. Radiation was delivered with 6 MV X rays using either AP-PA two fields, AP-PA both lateral four fields, or PA both lateral three fields. Total radiation dose ranged from 40 Gy to 56 Gy. In 73 patients, bolus infusions of 5-FU $(400\;mg/m^2)$ were given during the first and fourth weeks of radiotherapy. After completion of radiotherapy, an additional four to six cycles of 5-FU were given. Oral 5-FU (Furtulone) was given for nine months in 46 patients. Results : Forty $(33.7\%)$ of the 119 patients showed treatment failure. Local failure occurred in 16 $(13.5\%)$ patients, 1 $(2.3\%)$ of 43 stage II patients and 15 $(19.7\%)$ of 76 stage III patients. Distant failure occurred in 31 $(26.1\%)$ patients, among whom 5 $(11.6\%)$ were stage II and 26 $(34.2\%)$ were stage III. Five-year actuarial survival was $56.2\%$ overall, $71.1\%$ in stage II patients and $49.1\%$ in stage III patients (p=0.0008). Five-year disease free survival was $53.3\%$ overall, $68.1\%$ in stage II and $45.8\%$ in stage III (p=0.0006). Multivariate analysis showed that T stage and N stage were significant prognostic factors for five year survival, and that T stage, N stage, and preoperative CEA value were significant prognostic factors for five year disease free survival. Bowel complication occurred in 22 patients, and was treated surgically in 15 $(12.6\%)$, and conservatively in 7 $(5.9\%)$. Conclusion : Postoperative chemoradiotherapy was confirmed to be an effective modality for local control of rectal cancer, but the distant failure rate remained high. More effective modalities should be investigated to lower the distant failure rate.

• Clinical and Experimental Pediatrics
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• v.52 no.4
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• pp.429-434
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• 2009

Purpose : Severe aspiration of the amniotic fluid is known to cause fatal respiratory distress in neonates. We conducted this study to investigate the clinical findings of severe amniotic fluid aspiration pneumonia (AFAP) in neonates and the effect of pulmonary surfactant replacement therapy (SRT). Methods : Retrospective analysis of medical records was conducted on 28 patients who received ventilator care due to severe AFAP in a neonatal intensive care unit over a 7-year period (2000-2006). Patients whose amniotic fluid was contaminated with meconium were excluded. Results : A large number of cases were term infants (82.1%) and infants born by caesarean section (85.7%), and the 1- and 5-min Apgar scores of these patients were $6.5{\pm}1.2$ and $7.5{\pm}1.3$, respectively. Soon after birth, the amount of amniotic fluid sucked out from airway below the vocal cord was $16.0{\pm}10.1$ mL. All patients received SRT with a modified bovine-derived surfactant (120 mg/kg/dose), and one dose was administered in most cases (75%). Compared with pre-SRT, the oxygenation index ($8.0{\pm}9.6$ vs. $18.9{\pm}7.3$) according to ventilator care was a significant improvement at 12 h after SRT (P<0.001). Furthermore, most cases showed radiological improvement for aeration at 12 h post-treatment. Many cases (46.4%) had cardiorespiratory complications, but their final outcomes were excellent (survival rate, 96.4%). Conclusion : AFAP may be an important cause of serious respiratory distress in near-term and term infants, and SRT seems to be an effective adjuvant therapy in mechanically ventilated neonates with severe AFAP.

• Radiation Oncology Journal
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• v.10 no.1
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• pp.35-41
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• 1992

Forty eight patients with adenoid cystic carcinoma (ACC) in the head and neck treated between 1979 and 1990 were reviewed according to treatment modalities and clinical courses. The common site of origin was minor salivary gland ($69\%$), mostly hard palate and maxillary sinus. 11 patients received radiation therapy (RT) alone and 37 patients received combined surgery and radiation therapy. The follow-up period of the survivors ranged from 4 to 118 months (median 49.5 months). The 5 year local control rate was $69.3\%$, $67.3\%$ and 83.9$\%$ in RT alone, conservative operation (OP)+RT and radical OP+RT group, respectively (p>0.05). The control of local disease was best achieved with radical OP+RT. In postoperative RT, high dose ($\ge$60 Gy) and generous field size($\ge$64 cm$^2$) yielded a better local control rate. Actuarial overall survival rate was $79.0\%$, at 5 years and $19.2\%$ at 10 years. Distant metastases (DM) developed in $40\%$ of patients, mostly in the lung. Disease-free (NED) survival rate was $45.8\%$ at 5 years and significant differences did not exist according to primary sites and treatment options. Survival rate after the onset of DM was $19.5\%$ at 5 years. Occurrence of DM tends to lower survival significantly. In an effort to find the role of RT in the treatment of ACC, our data suggest that a well-planned postoperative RT employing a high dose and generous field size can produce high local control rate and remaining urgent problem of distant metastasis demands more effective chemotherapy for the purpose of improving survival of ACC patients.

• The Journal of the Korean bone and joint tumor society
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• v.10 no.2
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• pp.96-106
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• 2004

Purpose: To determine the usefulness of limb salvage operation with recycled autogenous bone graft in musculoskeletal malignant tumors. Materials and Methods: Twenty nine cases, who underwent limb salvage operation with recycled autogenous bone graft for the treatment of musculoskeletal malignant tumor between February 1990 and January 2003, were included. There were 18 males and 11 females and the mean age was 33 years (range, 10 to 65 years). The mean follow-up period was 51.8 months (range, 18 to 117 months). The Enneking stage was IIA in 10 cases and IIB in 19 cases. The recycling method of autogenous bone was deep freezing in 6 cases, autoclaving in 11 cases, pasteurization in 7 cases and the composite of autoclaving and vascularized fibular graft in 5 cases. The union of junctional site was evaluated radiologically and the functional results was analyzed by the grading systems of the International Symposium On Limb Salvages (ISOLS). Results: The mean union time was 7.2 months (range, 3 to 15 months). The union took 5.8 months (range, 4 to 8 months) in deep freezing, 9.7 months (range, 6 to 15 months) in autoclaving, 5.9 months (range, 4 to 8 months) in pasteurization, and 5 months (range, 4 to 8 months) in the composite of autoclaving and vascularized fibular graft. The mean functional evaluation percentage was 76.8% (range, 40 to 90%). It was 65.8% (range, 40 to 85%) in deep freezing, 76.6% (range, 40 to 90%) in autoclaving, 81.6% (range, 70 to 90%) in pasteurization, and 83.4% (range, 75 to 90%) in the composite of autoclaving and vascularized fibular graft. There were 6 cases of complications including 1 case of local recurrence, lung metastasis, infection, fracture, respectively and 2 cases of nonunion. Conclusion: The limb salvage operation with recycled autogenous bone graft is a useful treatment method for the musculoskeletal malignant tumors. Particularly, autoclaving is the most reliable sterilization method. The vascularized fibular graft can compensate decreased osteoinductivity and mechanical strength of recycled bone. So, the composite of autoclaving and vascularized bone graft seems to be a favorable treatment method for high grade malignant musculoskeletal tumors.

• Journal of Chest Surgery
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• v.35 no.12
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• pp.882-889
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• 2002

Acute Complications of Remodelling Plasty of Costochondral Rib Cage For Pectus excavatum Recently, Remodelling Plasty of Costochondral Rib Cage has been introduced as an minimally invasive procedure and expanded its application for pectus excavatum. Outcomes and acute complications were reviewed Material and Method: A retrospective survey of 55 patients who underwent Remodelling Plasty of Costochondral Rib Cage from September, 1999 to February, 2002 was conducted to review complications, postoperative treatments, and outcomes. Result: Age ranged from 1 to 27 years(mean 11.4 $\pm$ 7.1). 35(64%) were less than 15-year old and 20(36%) were more than 15-year old. There were 44(80%) Male patients and 11(20%) female patients. Length of hospital stay was 7.8 $\pm$ 2.1 days for less than 15-Y-old group, 10.6 $\pm$ 6.2 days for more than 15-Y-old group(p ＝ 0.042) One substernal bar was inserted in 52 patients and two substernal bars were inserted in 3 patients. As for stabilizer, one lateral side was fastened in 15 patients and both lateral sides were fastened in 6 patients. In the less than 15-Y-old group, 4 patients needed stabilizer, whereas in the more than 15-Y-old group, 18 patients needed stebilizer(s)(p ＝ 0.000). Including all kinds of complications, 28(51 %)patients had postoperative complications. Of them, only 7 patients were treated for complications(C-tube insertion was done in 7 patients and reoperation for bar refixation or removal was done in 3 patients of them). Conclusion: Most complications after Remodelling Plasty of Costochondral Rib Cage For Pectus Excavatum were trivial without treatment although C-tube drainage was needed in some patients. However bar displacement such as rotation and lateral sliding should be corrected as soon as detected in order not to remove the bar(the worst situation).

• Journal of Chest Surgery
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• v.30 no.9
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• pp.869-875
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• 1997

Perimembranous ventri ular septal defects(PMVSDS) are the most common type of ventricular septal defects(VSDs) and consist morphologically of deficiency of the membranous septum and variable portions of the adjacent muscular septum. Repair of VSD has begun via a right ventriculotomy. Even with this exposure, however, it mght lead to ventricular dysfunction. Transatrial exposure of VSDs is luiown to a versatile approach to PMVSDS and even malaligunent defects can be repaired by this method. Although transatrial exposure can be improved by taking down'the atrioventricular valve at the annulus, surgeons have been hesitant to do so because of concern for valvular competence. Therefore, this study was undertaken to clarity the effects of transamlular approach of tricuspid valve (TATV) at operation of PMVSD. During last 5 years, twenty eight cases from 96 patients of PMVSD were closed by TATV and follow up study was done from 3 months to 33 months and results were obtained as follows. 1. Age at operation was fr m 4 months to 38 years and most patients(17, 62%) were above 5 years. 2. Preoperative pulmonary-systemic flow ratio(QPIQS) was ranged from 1 to 2.8 and 22 patients(79%) were less than 2. 3. Peak systolic pulmonary artery pressure was below 30mmHg in 8, 30-50mmHg in 17, above 50mmHg in 3 patients and 25 patients(89%) were less than 50mmHg. 4. Preoperative tricuspid regurgitation(TR) is none in 12, trivial in 6, mild in 3, moderate in 5, severe in 2 patients but postoperative TR was none in 18, trivial in 6, mild in 4 patients, so TR in most patients had decreased or not. 5. Indications for operation were based on the presence of a significant shunt. However, in patients with small shunts, indications for operation were included additional factors, tricuspid valve pouch, RVOT obstruction(right ventricular outflow tract obstruction), subacute bacterial endocarditis and associated anomalies. 6. There were no hospital deaths and residual shunts in postoperative echocardiography. Therefore TATV is especially a good method in PMVSn where patients have trcuspid valve pouch. And it is a safe and effective technique that improves exposure for PMVSD repair and does not adversely affect tricuspid valvular competence.

• Tuberculosis and Respiratory Diseases
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• v.45 no.3
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• pp.574-582
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• 1998

Background: Bronchofiberscopy is a procedure with a chance of airway irritation and it may cause pathophysiologic changes of respiratory system. So we tried to evaluate the influence of bronchofibercopy on $O_2$ saturation, ABGA and PIT by patient's basal status and procedure type. Method: $O_2$ saturation was measured every 1 minute from the left index finger tip with percutaneous oximetry. ABGA was done before and right after the bronchofiberscopy and PIT was done before and within 10 minutes after the bronchofiberscopy. Results: The mean time for bronchofiberscopy procedure was 14.5mim and $SaO_2$ maximally fall to 89.0 below 8% of the baseline after mean time of 8.4min, which was recovered at the end of the procedure. $SaO_2$ change amount was 8.4 % on Non-$O_2$ supply group, which was lower compared to 6.4 % of the $O_2$-supply group without statistically significance. Biopsy Group and BAL group showed more $SaO_2$ fall than washing only group. The level of $PaO_2$ and FEV1 of the patient didn't influence significantly on $SaO_2$ fall during the procedure. ABGA taken before and after the bronchofiberscopy showed mild fall of $PaO_2$ and mild rise of $PaCO_2$. Whereas PFT showed decrease of FEV1(P<0.05) and increase of RV without changes in airway resistance and pulmonary diffusion capacity. Comparing before and after the bronchofiberscopy, the washing group showed no significant changes on PIT, while the biopsy group and the BAL group showed increase of RV & decrease of $FEV_1$ after the bronchofiberscopy. BAL group showed more changing tendency rather than biopsy group although not statistically significant. Conclusion: Bronchofiberscopy is considered as a relatively safe procedure, but it would be better to be done with $O_2$ supply especially in the patient with low $PaO_2$ and in the case of biopsy and BAL.

• Journal of Chest Surgery
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• v.39 no.8 s.265
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• pp.626-632
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• 2006

Background: Pulmonary hypertension caused by chronic pulmonary embolism is underrecognized and carries a poor prognosis. Medical therapy is generally unsatisfactory and palliative. With the improvement of operative technique and postoperative management, pulmonary endarterectomy has been the treatment of choice for this condition. Material and Method: Between January 2001 and December 2005, eleven patients were received pulmonary endarterectomy. All patients had chronic dyspnea and exercise intolerance. Diagnosis was made with cardiac echocardiography, lung perfusion scan and computed tomography. Before the operation, Greenfield vena cava filter were placed in all patient except one. Deep hypothermic circulatory arrest was used for the distal-most portion of the endarterectomy procedure. More than moderate degree of tricuspid reguirgitation was repaired during operation. Result: There was no early and late death. Right ventricular systolic pressure was reduced significantly after operation from $91{\pm}21$ mmHg to $40{\pm}17$ mmHg on echocardiography (p=0.001). NYHA class and tricuspid reguirgitaion were improved postoperatively. Although mild reperfusion injury in three case and postoperative delirium in one case were observed, all of them recovered without complication. Conclusion: Pulmonary thromboendarterctomy offers to patient an acceptable morbidity rate and anticipation of clinical improvement. This method is safe and effective operation for pulmonary hypertension caused by chronic pulmonary thromboembolism.

• Journal of Chest Surgery
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• v.29 no.7
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• pp.700-712
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• 1996

Transpulmonary sequestration of leukocyte following cardiopulmonary bypass(CPB) has been recognized as one of main causes of postoperative pulmonary dysfunction. The purpose of this study is to investigate the effect of a single dose of prebypass corticosteroid on pulmonary leukostasis and postoperative pulmonary dysfunction. The study was performed prospectively in randomized-blind fas ion for 50 patients from January 1995 to June 1995. All patients were divided into two groups; In the steroid group(n=25), corticosteroid(Solu-Medrol 30mg1kg) was injected prior to CPB and in the placebo group (n=25), normal saline was injected before CPB. The results were summarized as follows. 1. Total peripheral leukocyte counts decreased significantly at 5 minutes of CPB in all patients(P<0.01), and began to increase progressively at later periods of CPB with neutrophilia. The significant rise remained at postoperative 7th day. 2. During partial CPB, transpulmonary leukostasis occurred in placebo group(P< 0.001), whereas it was prevented in steroid group. 3. In both groups, peripheral Lymphocyte counts were stable during CPB, but began to reduce at time of intensive care unit(ICV) and the Iymphocytopenia remained until postoperative )rd day. The Iympho- cyte counts recovered on postoperative 7th day. 4. In both groups, peripheral counts of monocyte were relatively stable in the e rly peroid of CPB, and increased gradually in the later periods of CPB. This significant monocytosis remained throughout postoperative periods(P< 0.05). 5. The mean value of postoperative PaOa was lower than that of pre-CPB In placebo group(P=0.01), but in steroid group, there was no significant difference(P=0. 90) and fever was higher in placebo group compared to steroid group(P=0.001).