• Korean Journal of Head & Neck Oncology
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• v.31 no.2
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• pp.21-28
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• 2015

서론: 국소 진행성 두경부암 환자에서 선행 항암요법 후 동시 항암화학방사선요법은 원격 전이를 줄이고, 국소병변을 줄여 방사선 치료의 효과를 높이거나, 기관의 기능을 보존할 목적으로 시도된다. 선행 항암요법의 약제로 는 docetaxel, cisplatin, fluorouracil (DPF) 삼제요법이 가장 효과적인 것으로 알려져 있다. 선행 항암요법 후 동시 항암화학방사선요법과 표준치료인 동시화학방사선요법을 비교한 3상 연구들이 모두 선행 항암요법이 더 낫다는 결과를 보여 주지 못하였지만, 이 연구들은 충분한 환자를 모집하지 못하고 조기 종료된 불완전한 연구라는 한계가 있었다. 이에 저자들은 DPF 선행 항암요법 후 동시 화학방사선요법과 표준치료인 동시 화학방사선요법을 비교하는 메타분석을 시행하였다. 대상 및 방법: 체계적 문헌고찰을 통해 국소진행성 두경부암 환자를 대상으로 시행된 DPF 선행 항암요법 후 동시화학방사선요법과 현재 표준치료인 동시화학방사선요법을 비교한 5개의 3상 연구 결과를 분석하였다. 대상환자는 862 명이었고, 분석 결과 DPF 선행 항암요법 후 동시화학방사선요법은 표준치료와 비교하였을 때 반응률, 2년 및 3년 생존율, 2년 및 3년 무진행 생존율, 점막염 및 빈혈 발생 빈도에서 통계적으로 유의한 차이가 없었다. 하지만, 완전관해율과 3~4도의 백혈구감소증 및 혈소판 감소증의 빈도는 선행 항암요법 시행군에서 더 높았다. 결론: 국소진행성 두경부암의 치료에서 DPF 선행 항암요법 후 동시 항암화학방사선요법을 시행하는 것은 표준치료인 항암화학방사선요법에 비해 생존율 개선을 보이지 못하였다. 선행항암치료를 추가하는 것이 특정 환자군에서 효과가 있을지에 대해서는 추가적인 연구가 필요하다.

• Journal of Digestive Cancer Research
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• v.3 no.1
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• pp.17-20
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• 2015

Pancreatic cancer is an aggressive tumor and only 10-20% patients are considered candidates for curative resection at diagnosis. While surgery remains the only chance for cure, prognosis is poor even after surgery due to high rate of recurrence. A complementary chemotherapy and radiotherapy in a multimodal approach has been attempted to improved prognosis after surgery. Since adjuvant chemotherapy has yielded an only modest outcome improvement, various neoadjuvant approaches with chemotherapy, chemoradiation, or chemotherapy followed by chemoradiation have been attempted. In this article, current knowledge of the various neoadjuvant approaches for pancreatic cancer will be reviewed and the role of the neoadjuvant strategies will be discussed.

• Korean Journal of Head & Neck Oncology
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• v.29 no.2
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• pp.93-96
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• 2013

원격 전이된 비인두암 환자에서 주요한 치료 방법은 고식적 항암화학치료에 국한되어왔다. 그러나 적극적인 항암화학치료로 비인두암 환자 중 많은 환자에서 치료 반응을 보이며, 치료 반응을 보인 환자군에서는 국소 제어가 중요한 문제가 된다. 본 저자들은 원격 전이 된 환자 1예를 보고하고자 한다. 환자는 큰 크기의 다발성 전이가 있었으나 항암화학요법으로 관해 상태를 보였다. 이후 공고화 항암화학방사선요법을 추가하였고 현재 30개월 간 무병상태이다. 원격전이된 비인두암에서 공고화 항암화학방사선 요법의 역할에 대하여 문헌 고찰을 통해 논의하고자 한다.

• Radiation Oncology Journal
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• v.27 no.3
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• pp.133-139
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• 2009

Purpose: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. Results: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). Conclusion: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.

• Radiation Oncology Journal
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• v.27 no.2
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• pp.64-70
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• 2009

Purpose: Concurrent chemoradiotherapy (CCRT) is the standard treatment for locally advanced unresectable pancreatic cancer. However, the introduction of gemcitabine and the recognition of a benefit in patients with advanced disease stimulated the design of trials that compare chemotherapy alone to concurrent chemoradiation. Therefore, we evaluated role of CCRT for locally advanced unresectable pancreatic cancer. Materials and Methods: We carried out a retrospective analysis of treatment results for patients with locally advanced unresectable pancreatic cancer between January 2000 and January 2008. The radiation was delivered to the primary tumor and regional lymph nodes with a 1~2 cm margin at a total dose of 36.0~59.4 Gy (median: 54 Gy). The chemotherapeutic agent delivered with the radiation was 5-FU (500 mg/$m^2$). The patients who underwent chemotherapy alone received gemcitabine (1,000 mg/$m^2$) alone or gemcitabine with 5-FU. The follow-up period ranged from 2 to 38 months. The survival and prognostic factors were analyzed using Kaplan-Meier method and log-rank test, respectively. Results: Thirty-four patients received concurrent chemoradiotherapy, whereas 21 patients received chemotherapy alone. The median survival time was 12 months for CCRT patients, compared to 11 months for chemotherapy alone patients (p=0.453). The median progression-free survival was 8 months for CCRT patients, compared to 5 months for chemotherapy alone patients (p=0.242). The overall response included 9 partial responses for CCRT and 1 partial response for chemotherapy alone. In total, 26% of patients from the CCRT group experienced grade 3~4 bowel toxicity. In contract, no grade 3~4 bowel toxicity was observed in the chemotherapy alone group. The significant prognostic factors of overall survival were lymph node status, high CA19-9, and tumor location. Conclusion: The response rate and progression-free survival were more favorable in the CCRT group, when compared with the chemotherapy alone group. Therefore, radiation therapy seems to be an effective tool for local tumor control.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1994.04a
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• pp.330-330
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• 1994

항암화학요법후 가장 심각한 부작용의 하나는 중성구 감소에 의한 감염이다. 본원에서는 rhGM-CSF을 이용한 제 I상 임상연구에서 150-500$\mu$g/M$^2$/day가 biologically active dose임을 보고한 바 있다. 연자들은 연세암센터에 내원하여 진행성 악성종양으로 병리조직학적 진단을 받고 항암화학요법 시행후 골수억제가 예상되는 환자를 대상으로 GM-CSF 용량에 따른 안전성 및 독성을 검토하고 백혈구 감소증 및 감염의 예방, 치료효과를 분석하여 임상사용권장량을 결정하기위한 2상 연구덜 대상환자의 동의를 얻은후 시행하였다. 대상환자는 37명 (여 26, 남 11)이었고, 항암제는 Adriamycin, Cisplatin, VP-l6 이 주로 사용되었다. 최적임상사용권장량을 결정하기 위하여 1500$\mu\textrm{g}$/M$^2$/day을 12명, 250$\mu\textrm{g}$/M$^2$/day을 12명, 350$\mu\textrm{g}$/M$^2$/day을 13명의 환자에게 투여하였다. 첫번째 항암요법에는 rhGM-CSF을 투여하지않고 (비투여기) 두번째 항암요법에서는 항암요법후 익일부터 10일간 연속, 매일 1회 피하주사하여 (투여기), rhGM-CSF 투여기와 비투여기의 백혈구 감소중 정도의 차이를 비교하였다.

• Journal of Gastric Cancer
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• v.9 no.4
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• pp.269-274
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• 2009

Purpose: There have been reported that preoperative chemotherapy for treating noncurative gastric cancer could increase the R0 resection rate by downstaging the gastric cancer. Yet there have been only rare reports about the effect of preoperative chemotherapy on performing surgery for noncurative gastric cancer. Our study was designed to analyze our experiences with these effects. Materials and Methods: We retrospectively analyzed 46 patients who had undergone gastrectomy after chemotherapy between December 2001 and January 2009. The patients' preoperative condition, the operative findings and the postoperative clinical coursed were analyzed. Results: Preoperative chemotherapy was performed for a mean of 4.4 cycles. Four patients showed a level of ANC below 1,500 (${\mu}/L$) and above a 10 percentile weight loss, respectively. For an operation, we found fibrosis or fixation between the tumor and the adjacent organs in 29 patients, and 4 of the 13 patients who underwent resection with another organ were documented to have invasion by tumor. Forty one patients underwent curative resection. Ten patients developed postoperative complications. There was no mortality at postoperative 60 days. Conclusion: We assumed that preoperative chemotherapy had little effect on the patient preoperatively, and it had some effect on down-staging pathologically. Preoperative chemotherapy didn't increase the postoperative complication rate.

• Journal of Gastric Cancer
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• v.8 no.2
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• pp.57-64
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• 2008

In gastric cancer, the only potentially curative treatment is surgery that attempts to achieve curative (R0) resection. However, despite the use of curative resection, a recurrence develops in a high percentage of patients, especially in cases of serosa and/or lymph node involvement. As a strategy to improve the survival of the patients with resectable advanced gastric cancer, neoadjuvant chemotherapy has been evaluated in several phase II trials and a few phase III trials. The results of these trials have confirmed the feasibility and safety of this approach with no apparent increase in surgical complications. Recently, the findings of a large phase III randomized trial (MAGIC trial) have indicated that compared to the use of surgery alone, perioperative chemotherapy, using both a neoadjuvant and adjuvant strategy, decreased the number of T and N stage cancers and improved survival. The results of another recent phase III trial (FNLCC 94012/FFCD 9703) also showed that compared to the use of surgery alone, perioperative chemotherapy improved the R0 resection rate and survival. In both trials, the improved outcomes may be attributed to the use of neoadjuvant chemotherapy because of poor compliance with adjuvant chemotherapy. These results cannot be directly translated to clinical practice in Korea due to differences in surgical techniques and outcomes. However, the findings of a few small phase II and III trials performed in patients with locally advanced gastric cancer in Korea have also suggested that neoadjuvant chemotherapy would result in the improvement of the R0 resection rate and down-staging of the disease. More effective chemotherapy regimens are needed in future large randomized trials to determine the subset of patients that will benefit from neoadjuvant chemotherapy and to determine the extent of benefit.

• Proceedings of the Korean Society of Applied Pharmacology
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• 1994.04a
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• pp.306-306
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• 1994

항암화학요법후 가장 심각한 부작용의 하나는 중성구 감소에 의한 감염이다. 본원에서는 rhGM-CSF을 이용한 제 I상 임상연구에서 150-500$\mu$g/M$^2$/day가 biologically active dose임을 보고한 바 있다. 연자들은 연세암센터에 내원하여 진행성 악성종양으로 병리조직학적 진단을 받고 항암화학요법시행후 골수억제가 예상되는 환자를 대상으로 GM-CSF 용량에 따른 안전성 및 독성을 검토하고 백혈구 감소증 및 감염의 예방, 치료효과를 분석하여 임상사용권장량을 결정하기위한 2상 연구를 대상환자의 동의를 얻은후 시행하였다. 대상환자는 37명 (여 26, 남 11)이었고, 항암제는 Adriamycin, Cisplatin, VP-16이 주로 사용되었다. 최적임상사용권장량을 결정하기 위하여 1500$\mu\textrm{g}$/M$^2$/day을 12명, 250$\mu\textrm{g}$/M$^2$/day을 12명, 350$\mu\textrm{g}$/M$^2$/day을 13명의 환자에게 투여하였다. 첫번째 항암 요법에는 rhGM-CSF을 투여하지않고 (비투여기) 두 번째 항암요법에서는 항암요법후 익일부터 10일간 연속, 매일 1회 피하주사하여 (투여기), rhGM-CSF 투여기와 비투여기의 백혈구 감소증 정도의 차이를 비교하였다.

• Radiation Oncology Journal
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• v.11 no.2
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• pp.295-301
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• 1993

Since Jan. 1991 a prospective randomized study for Stage III unresectable non small cell lung cancer (NSCLC) has been conducted to evaluate the response rate and tolerance of induction chemotherapy with MVP followed by hyperfractionated radiotherapy and evaluate the efficacy of maintenance chemotherapy in Asan Medical Center. All patients in this study were treated with hyperfractionated radiotherapy (120 cGy/fx BID, 6480 cGy/54 fx) following 3 cycles of induction chemotherapy, MVP (Mitomycin C 6 $mg/m^2,$ Vinblastin 6 $mg/m^2,$ Cisplatin 60 $mg/m^2$) and then the partial and complete responders from induction chemotherapy were randomized to 3 cycles of adjuvant MVP chemotherapy group and observation group. 48 patients were registered to this study until December 1992; among 48 patients 3 refused further treatment after induction chemotherapy and 6 received incomplete radiation therapy because of patient's refusal, 39 completed planned therapy. Twenty-three $(58\%)$ patients including 2 complete responders showed response from induction chemotherapy. Among the 21 patients who achieved a partial response after induction chemotherapy,1 patient rendered complete clearance of disease and 10 patients showed further regression of tumor following hyperfractionated radiotherapy. Remaining 10 patients showed stable disease or progression after radiotherapy. Of the sixteen patients judged to have stable disease or progression after induction chemotherapy, seven showed more than partial remission after radiotherapy but nine showed no response in spite of radiotherapy. Of the 39 patients who completed induction chemotherapy and radiotherapy, 25 patients $(64\%)$ including 3 complete responders showed more than partial remission. Nineteen patients were randomized after radio-therapy. Nine Patients were allocated to adjuvant chemotherapy group and 4/9 showed further regression of tumor after adjuvant chemotherapy. For the time being, there is no suggestion of a difference between the adjuvant chemotherapy group and observation group in distant metastasis rate and survival. Median survival time was 13 months. Actuarial survival rates at 6,12 and 18 months of 39 patients who completed this study were $84.6\%,\;53.7\%\;and\;40.3\%,$ respectively. The partial and complete responders from induction chemotherapy showed significantly better survival than non-responders (p=0.028). Incidence of radiation pneumonitis in this study group was less than that in historical control group inspite of induction chemotherapy. All patients tolerated hypertractionated radiotherapy without definite increase of acute complications compared with conventional radiotherapy group. The longer follow up is needed to evaluate the efficacies of induction and maintenance chemotherapy and survival advantage by hyperfractionated radiotherapy but authors are encouraged with an excellent tolerance, higher response rate and improvement of one year survival rate in patients of this study.