• Journal of Chest Surgery
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• v.43 no.6
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• pp.833-837
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• 2010

This is a report of successful management for pulmonary metastasis following chemotherapy in patient with testicular germ cell tumor. Postchemotherapy PET-CT was not uptake FDG in metastatic lesion. Pulmonary metastasectomy was performed, which is important to manage a residual postchemotherapy lung mass in testicular germ cell tumor for histological correlation with primary testicular lesion to select the patients who require subsequent chemotherapy. Our patient was well 6 months after operation, not carried out chemotherapy because of no viable tumor.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.162-166
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• 2001

배경: 흉선암은 드문 질환으로 치료경과 및 예후가 침윤성 흉선종에 비해 나쁜 것으로 알려져 있으며 병기의 분류나 병기에 따른 치료방법이 아직 표준화 되어있지 않아 치료에 어려운 점이 있다. 이에 본교실에서 흉선암으로 진단되었던 환자들의 피료방법 및 성적을 분석하여 그 결과를 보고하고자 한다. 대상 및 방법: 계명대학교 동산의료원 흉부외과학교실에서는 1984년 8월에서 흉선암으로 진단되었던 8례의 환자를 대상으로 의무기록을 참고하여 병기에 따른 치방법료 및 예후 등을 후향적으로 분석하였다. 결과: 연령은 23세에서 67세까지로 평균 46세였으며 전흉부통증이 주증상이었다. 조직학적으로는 임파상피양암(lymphoepithelioma-like carcinoma)이 2례, 편평상피암(squamous cell carcinoma)이 2례, 기저세포암(basaloid carcinoma)이 1례, 혼합형(mixed type)이 3례 있었다. 임상적 병기분류는 Masoka의 분류법을 사용하였으며 제I기 2례, 제II기 4례, 제III기 1례, 제IVAr기가 1례 있었다. 4례의 환자에서는 종양의 완전적출이 가능했으며 3례에서는 고식적 수술을 시행하였다. 1례의 환자는 주위조직으로의 침윤과 심낭에 퍼져있어 조직생검만을 시행하였다. 전례에서 보조적 항암치료를 받았고 술후 병기가 제III기 이상이거나 종양의 절제가 불완전했던 5례의 환자에서는 보조적 방사선치료를 병행하였다. 이들 중 5례에서 술후 보조적 항암치료 및 방사선치료를 받고 현재까지 생존해있다. 평균추적기간은 55.3$\pm$64.6 개원이었고, 3례의 환자는 사망하였으며 4례의 환자는 종양의 재발증거 없이 생존해있다. 결론: 종양의 조기진단과 완전종양적출후 적극적인 보조적 항암치료 및 방사선치료가 흉선암을 치료하는데 도움이 될 것으로 사료된다.

• Proceedings of the Korean Society for Bioinformatics Conference
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• 2006.02a
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• pp.91-96
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• 2006

현대의학의 발전으로 많은 질병들의 치료율이 개선되고 있으나, 암은 여전히 낮은 치료율과 약제 내성 및 부작용으로 많은 환자들이 의학적 고통 뿐 아니라 정신적, 경제적 문제점들을 호소하고있다. 이와같은 문제점은 동일한 병리학적 특성을 가지는 종양이라도 사람마다 그 생물학적 특성이 다르며, 동일한 환자안에서도 종양의 시기에 따라 다양한 특성의 세포들이 공존하며 다양한 문제를 발생하는 tumor heterogeneity에서 기인하게된다. 다행히 최근의 분자생물학의 발전과 인간유전체연구들의 활성화로 이와같은 다양한 암의 특성과 환자들의 특성을 이해하는 연구 방법들의 개발로 환자의 특성에 맞는 항암제를 효율적으로 투여하는 맞춤치료를 향한 노력을 지속하고 있다. 이와같은 맞춤치료의 일환으로 약제의 환자에서의 반응과 부작용을 예측하고자 최신의 high-throughput 기법을 도입한 것이 Pharmacogenomics이다. 즉, 지금까지의 항암치료는 암의 종류에 따라 임상연구 결과에 근거한 항암제를 선택하고 있다. 그러나 앞서 설명한 것처럼 암의 특성과 환자 반응의 다양화로 실제 항암효과는 기대에 미치지 못하여 많은 수의 환자들이 치료에 내성을 보일 뿐 아니라 치명적인 부작용으로 새로운 문제에 대면하게 되었다. 따라서 각 항암제011 최대의 효과를 보이며 최소의 부작용을 나타내는 최선의 치료책을 선정하는 것이 중요한 과제이다. 이를 위해서 암환자의 치료 단계에서 정확한 진단 및 병기 설정, 생물학적 특성 이해 뿐 아니라, 치료 반응을 예측할 수 있는 생물학적 표지자를 찾고자 하는 노력의 결과로 현재 임상에 사용되는 몇 가지 종양표지자를 포함하여 다양한 유전자 칩들이 연구단계에 있다. 특히 다양한 생물학적 현상이 많은 유전자들의 변화에 의한다는 근거하여 약제의 효과와 부작용을 예측할 수 있는 표지자 발굴도 DNA chip 등의 high-throughput technology를 사용하여 그 특이도와 민감도가 향상된 표지자 발굴이 시도되고 있다. 아직은 시작단계이고 많은 검증이 필요하나 여러 가지 가능성의 증거들로 멀지않은 시기에 맞춤치료가 가능하리라 기대하며, 암 연구에 있어서 pharmacogenomics의 현황을 소개하고자 한다.

• 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.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.93-99
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• 2002

Purpose : We intended to decrease late CNS reaction after radical radiotherapy for an intracranial germinoma by using combined neoadjuvant chemotherapy and involved-field radiotherapy. The efficacy in terms of its acute toxicity and short-term relapse patterns was analyzed. Materials and Methods : Eighteen patients were treated with combined neoadjuvant chemotherapy and radiotherapy between 1995 and 2001. The chemotherapy regimen used was the Children's Cancer Group (CCG) 9921A (cisplatin, cyclophosphamide, VP-16, vincristine) for 5 patients younger than 16 years, BEP (bleomycin, VP-16, cisplatin) for 12 patients, and EP (VP-16, cisplatin) for 1 patient. The radiotherapy covered the whole craniospinal axis for 5 patients, the whole brain for 1, and the partial brain (involved field) for 12. the primary lesion received tumour doses between 3,960 and 5,400 cGy. Results : The male to female ratio was 16:2 and the median age was 16 years old. The tumors were located in the pineal gland in 12 patients, in the suprasellar region in 1, in the basal ganglia In 1, in the thalamus in 1. Three patients had multiple lesions and ventricular seedings were shown at MRI. In 3 patients, tumor cells were detected in the cerebrospinal fluid and MRI detected a spinal seeding in 2 patients. The response to neoadjuvant chemotherapy was complete remission in 5 patients, partial remission in 12, and no response in 1. However, after radiotherapy, all except 1 patient experienced complete remission. The toxicity during or after chemotherapy greater than or equal to grade III was remarkable; hematologic toxicity was observed in 11 patients, liver toxicity in none, kidney toxicity in none, and gastrointestinal toxicity in one. One patient suffered from bleomycin-induced pneumonitis. Radiotherapy was therefore stopped and the patient eventually died of respiratory failure. The other 17 are alive without any evidence of disease or relapse during an average of 20 months follow-up. Conclusion : A high response rate and disease control was experienced, which was the same as observed other studies and the morbidity from chemotherapy-induced toxicity was similar. With these results, the results from adjuvant chemotherapy and involved-field radiotherapy cannot be concluded to be equal to those from extended-field radiotherapy. The long term follow-up study on later complications are required in order to draw definite conclusions on the optimal management with minimum side effects.

• Journal of Korean Traditional Oncology
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• v.28 no.1
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• pp.33-44
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• 2023

목적: 항암유발말초신경병증은 암 환자가 겪는 흔한 항암 부작용이나 현재까지 효과적으로 알려진 치료법은 없다. 본 연구의 목적은 항암유발말초신경병증에 대한 침 치료와 가바펜틴의 병용 요법의 효과와 안전성을 평가하는 것이다. 방법: 항암유발말초신경병증을 겪고 있는 24명의 암 환자를 침 치료 단독군 (AG, acupuncture group)과 침과 가바펜틴의 병용요법군 (CG, combined acupuncture and gabapentin group)으로 무작위 배정하였다. 두 그룹 모두 침 치료는 주 3회, 4주간 수행하였다. 병용 요법군은 침 치료와 더불어 1일 900mg의 가바펜틴을 복용하도록 하였다. 치료 효과는 Neuropathic Pain Symptom Inventory (NPSI), visual analogue scale (VAS), European Organization for Research and Treatment of Cancer Quality of Life Questionnaire-Chemotherapy-Induced Peripheral Neuropathy 20 items (EORTC-CIPN20)를 이용하여 측정하였다. 치료로 인한 부작용은 대상자가 방문할 때마다 조사하였다. 결과: 총 23명의 대상자(AG, n=12; CG, n=11)의 평가지표를 분석한 결과, 치료 4 주 후 침 치료 단독군은 NPSI 점수가 44.33±25.04에서 30.58±21.55으로 감소하였고, 병용 요법군은 30.55±25.59에서 18.64±19.42로 감소하였으며, 두 군 모두 통계적으로 유의미하게 감소하였다(p<0.001). VAS점수는 침 치료 단독군에서는 4.79±2.17 에서 3.42±2.49으로 감소하였고, 병용 요법군에서는 3.55±2.07에서 2.73±2.49 로 감소하였다(p<0.05). 치료 효과는 치료 완료 2주후까지 지속되었으며, 두 군간의 유의미한 차이는 없었다. EORTC-CIPN20은 침 치료 단독군은 30.27±18.87에서 20.84±16.35으로 감소하여(p<0.01), 두 군 모두에서 삶의 질이 향상되었다. 결론: 본 연구로 침 치료와 가바펜틴의 병용 요법이 항암유발말초신경병증 환자의 증상 및 삶의 질 개선에 효과적이며 안전한 치료법임을 확인하였다. 그러나 침 치료와 가바펜틴의 시너지 효과에 대해서는 확인 할 수 없었으며, 이를 확인하기 위해 추가적인 연구가 필요할 것으로 사료된다.

• 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.

• Tuberculosis and Respiratory Diseases
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• v.53 no.4
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• pp.369-378
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• 2002

Background : The effects of chemotherapy on pulmonary function are mainly a reduced diffusion capacity and a restrictive ventilatory impairment. Exercise can expose cardiovascular and pulmonary abnormalities not evident at rest. Exercise related cardiopulmonary function is important in patients with malignant disease as a determinant of quality of life. We performed this study to evaluate the changes of body composition and cadiopulmonary exercise perfoemance of patients with locally advanced, non-small cell, lung cancer (NSCLC) before and after chemotherapy. Methods : We evaluated resting pulmonary function, body composition, physiologic performance status, and cardiopulmonary exercise function in 11 patients with locally advanced NSCLC, at diagnosis and prior to the fourth cycle of chemotherapy. Results : After chemotherapy, 4 patients (36.4%) showed partial response and 7 (63.4%) had stable disease. After chemotherapy, diffusion capacity of the lung for carbon monoxide was reduced ($89.7{\pm}34.1%$, vs. $71.9{\pm}20.5%$) but not significantly. There were no significant changes in body composition or the state of physiologic performance after chemotherapy. There was a significant impairment of cardiopulmonary exercise tolerance in patients with NSCLC, evidenced by a reduction of maximal oxygen uptake ($VO_2$max, ml/kg/min, $17.9{\pm}2.6$ : $12.6{\pm}6.1$, <0.05) and $O_2$pulse ($O_2$ pulse, ml/beat, $7.0{\pm}1.7$, $5.2{\pm}2.1$, <0.05). Conclusion : Systemic chemotherapy resulted in a loss of cardiopulmonary exercise function in patients with locally advanced NSCLC within the short-term period, but not a physiologic change of body composition within the same period.

• 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.

• Journal of Veterinary Clinics
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• v.28 no.6
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• pp.603-606
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• 2011

An 11-year-old castrated male cocker spaniel presented with halitosis, anorexia, and swelling of the left face. Upon physical examination, a firm mass was detected in the left buccal mucosa. Fine needle aspiration cytology revealed a malignant tumor of mesenchymal origin. We performed biopsy, which gave a diagnosis of oral fibrosarcoma. The client refused surgical treatment, and carboplatin chemotherapy (300 $mg/m^2$, IV, q 21 days) was initiated. The mass gradually decreased in size and disappeared about 89 days after the initial chemotherapy. Complete remission was attained, and the tumor did not relapse. This case report shows that a single carboplatin chemotherapy session can achieve macroscopic complete remission of oral fibrosarcoma.