• 제목/요약/키워드: Brain Neoplasms

검색결과 78건 처리시간 0.026초

기관세지폐포암의 장기결과분석 (Long-term Survival Analysis of Bronchioloalveolar Cell Carcinoma)

  • 이승현;김용희;문혜원;김동관;김종욱;박승일
    • Journal of Chest Surgery
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    • 제39권2호
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    • pp.106-110
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    • 2006
  • 배경: 기관세지페포암종은 흔치않은 폐암으로 $2{\~}14\%$의 유병률을 보인다. WHO의 분류에 따르면 일종의 선암으로 분류되며 최근의 정의에 의하면 흉강내 일차 원발성 선암병변이 없어야 하며, 중심기관지내의 원발병변이 없고, 말초기관에 국한되어야 하며 폐간질의 침범이 없고 암종의 실장이 폐포격막을 따라서 성장해야 한다. 또한 동일병기의 다른 비소세포폐암보다 술 후 생존율이 좋은 것으로 보고된다. 이에 기관세지폐포암의 장기결과에 대한 분석을 하였다. 대상 및 방법: 서울아산병원 흉부외과학교실에서 1990년 1월부터 2002년 12월까지 술 후 기관세지폐포암으로 병리 진단을 받은 31명의 환자를 대상으로 환자의 나이, 성별, 발생부위, 조직학적 병기, 술 후 부작용, 술 후 재발여부, 술 후 항암화학요법, 방사선요법 여부와 술 후 생존여부를 의무기록을 토대로 조사하였다. 결과: 환자의 평균연령은 61.09$\pm$10.63세($31{\~}79$세)이고 남녀의 성비는 12 : 19였다. 발병부위는 우상엽 7예, 우중엽 1예, 우하엽 4예, 좌상엽 8예, 좌하엽 11예였다. 수술은 엽절제술 28예, 전폐절제술 2예였고, 술 후 병리학적병기는 TIN0M0 (stage Ia) 12예($38.70\%$), T2N0M0 (stage Ib) 15예($48.38\%$), T1N1M0 (stageIIa) 1예($3.22\%$), T1N1M0 (stageIIb) 1예($3.22\%$), T2N2M0 (stage IIIa) 1예 ($3.22\%$), T1N0M1 (stage IV) 1예($3.22\%$)였다. 술 후 경과 추적 중에 사망은 4예($12.90\%$)였다. 한 명(T1N0M0, stage Ib)은 술 후 퇴원하였다가 2개월 후에 재발 없이 전신상태 악화에 의한 사망이었고, 한 명(T2N2M0, stage IIIa)은 술 후 29개월째에 우측 늑골 전이로 항암화학요법 중에 사망하였다. 한 명(T1N1M0, stage IIa)은 술후 항암화학요법 중 34개월에 뇌전이가 있었으나 치료거부 후 퇴원하였다가 사망하였다. 한 명(T1N0M0, stage Ib)은 술 후 방사선요법 중에 21개월 째에 양측폐에 다발성 결절을 보이는 전이로 치료 중 사망하였다. 술 후 평균 추적기간은 50.87$\pm$24.77개월이었다. 전체 생존율을 분석해보면 3년에 $97.1\%$, 5년에 $83.7\%$였다. 병기1기 환자의 경우 2년에 $96.3\%$, 5년에 $96.3\%$로 나왔다. 전체 환자의 재발 없는 생존율을 분석해보면 1년에 $100\%$, 2년에 $90\%$, 5년에 $76\%$이고 병기 1기의 경우 2년에 $96.4\%$, 5년에 $90.6\%$였다. 술 후 항암화학요법을 시행한 환자는 7명으로 $22.58\%$이고, 술 후 항암방사선요법을 시행한 환자는 1명으로 $3.22\%$, 2가지 모두 시행한 환자는 2명으로 $6.45\%$였다. 재발부위는 폐전이 3예, 골전이가 1예, 뇌전이가 1예였다. 결론: 기관세지폐포암은 동일병기의 다른 비소세포암보다 수술 절제 후에 비교적 재발률이 적고 병기가 초기인 경우 생존율이 우수함을 알 수 있었다.

두개강내 고형성 종양의 H-1 자기공명분광법 (In Vivo H-1 MR Spectroscopy of Intracranial solid Tumors)

  • 성수옥;장기현;한문희;연경모;한만청
    • Investigative Magnetic Resonance Imaging
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    • 제1권1호
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    • pp.86-93
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    • 1997
  • 목적: 두개강내 고형성 종야에서 병리조직학적 진단과 악성도에 따라 특징적 H-1자기공명분광(MRS) 양상이 나타나는지를 알아보고자 하였다. 대상 및 방법: 고형성 뇌종양 환자 81명(저등급 교종 17예, 고등ㅇ급 교종 31예, 림프종 9예, 뇌수막종 8예, 신경세포종 4예, 수아세포종 3예, 원시성신경외배엽종 3예, 전이암 2예, 기타 4예)을 대상으로 생체내 MRS를 시행하여 스펙트럼을 분석하였다. MRS는 1.5T 장치를 사용하여 PRESS기법으로 TR/TE 2000/270msec, VOI $2{\times}2{\times}2cm^3$로 얻었다. 대사 산물의 공명(resonance) 분석은 N-acetyl aspartate(NAA)/Creatine complix(Cr)비, Choline complex(Cho)/Cr비, Lactate(Lac)/Cr비를 구하였으며, 기타 산물에 대하여는 기존의 문헌에 기초하여 존재 유무를 분석하였다. 결과: 모든 고형성 뇌종양에서 NAA는 감소하고, Cho과 lactate는 증가하였다. Cr은 증가하거나 감소하는 등 다양한 결과를 보였다. 모든 종야에서 NAA/Cr이 감소한 반면, Cho/Cr과 Lac/Cr은 증가하였다. 고등급 교종에서는 평균 Cho/Cr과 lactate/Cr이 각각 저등급 교종에 비해 모두 유의하게 높았다(Cho/Cr ; $2.4{\pm}0.7{\;}vs.{\;}1.7{\pm}0.8,{\;}P<0.05,{\;}lactate/Cr{\;};{\;}1.3{\pm}1.9{\;}vs.{\;}0.4{\pm}0.6$, P<0.05). 그러나 NAA/Cr은 유의한 차이가 없었다. 뇌수막종과 신경세포종, 수아세포종에서 Cho/Cr이 고등급 교종의 수준 이상으로 높았다. 결론: H-1 MRS는 고형성 뇌종에서 저등급과 고등급 교종의 감별에 유용하게 이용될 수 있으나, 교종이외의 고형성 양성종양에서도 고등급 교종과 같은 양상을 보이므로 한게가 있다고 생각된다.

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Prognostic factors for survivals from first relapse in breast cancer patients: analysis of deceased patients

  • Kim, Haeyoung;Choi, Doo Ho;Park, Won;Huh, Seung Jae;Nam, Seok Jin;Lee, Jeong Eon;Ahn, Jin Seok;Im, Young-Hyuck
    • Radiation Oncology Journal
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    • 제31권4호
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    • pp.222-227
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    • 2013
  • Purpose: This study was performed to evaluate prognostic factors for survival from first relapse (SFFR) in stage I-III breast cancer patients. Materials and Methods: From June 1994 to June 2008, 3,835 patients were treated with surgery plus postoperative radiotherapy and adjuvant chemotherapy for stage I-III breast cancer at Samsung Medical Center. Among them, a total of 224 patients died by June 2009, and 175 deaths were of breast cancer. Retrospective review was performed on medical records of 165 patients who met the inclusion criteria of this study. Univariate and multivariate analysis were done on survivals according to variables, such as age, stage, hormone status of tumor, disease-free interval (DFI), sites of first failure, number of organs involved by recurrent disease (NOR), application of salvage treatments, and existence of brain or liver metastasis (visceral metastasis). Results: Patients' median overall survival time was 38 months (range, 8 to 123 months). Median SFFR was 17 months (range, 5 to 87 months). Ninety percent of deaths occurred within 40 months after first recurrence. The patients with SFFR ${\leq}1$ year had tendency of triple-negativity, shorter DFI (${\leq}2$ years), larger NOR (>3), visceral metastasis for first relapse than the patients with SFFR >1 year. In multivariate analysis, longer DFI (>2 vs. ${\leq}2$ years), absence of visceral metastasis, and application of salvage treatments were statistically significant prognosticators for longer SFFR. Conclusion: The DFI, application of salvage treatments, and visceral metastasis were significant prognostic factors for SFFR in breast cancer patients.

Triple Negative Status is a Poor Prognostic Indicator in Chinese Women with Breast Cancer: a Ten Year Review

  • Ma, K.K.;Chau, Wai Wang;Wong, Connie H.N.;Wong, Kerry;Fung, Nicholas;Lee, J.T. Andrea;Choi, L.Y. Catherine;Suen, Dacita T.K.;Kwong, Ava
    • Asian Pacific Journal of Cancer Prevention
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    • 제13권5호
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    • pp.2109-2114
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    • 2012
  • Background: Ethnic variation in tumor characteristics and clinical presentation of breast cancer is increasingly being emphasized. We studied the tumor characteristics and factors which may influence the presentation and prognosis of triple negative breast cancers (TNC) in a cohort of Chinese women. Methods: A prospective cohort of 1800 Chinese women with breast cancer was recruited in a tertiary referral unit in Hong Kong between 1995 and 2006 and was followed up with a median duration of 7.2 years. Of the total, 216 (12.0%) had TNC and 1584 (88.0%) had non-TNC. Their clinicopathological variables, epidemiological variables and clinical outcomes were evaluated. Results: Patients with TNC had similar age of presentation as those with non-TNC, while presenting at earlier stages (82.4% were stage 1-2, compared to 78.4% in non-TNC, p=0.035). They were likely to be associated with grade 3 cancer (Hazard Ratio(HR)=5.8, p<0.001). TNC showed higher chance of visceral relapse (HR=2.69, p<0.001), liver metastasis (HR=1.7, p=0.003) and brain metastasis (HR=1.8, p=0.003). Compared with non-TNC group, TNC had similar 10-year disease-free survival (82% vs 84%, p=0.148), overall survival (78% vs 79%, p=0.238) and breast cancer-specific mortality (18% vs 16%, p=0.095). However, TNC showed poorer 10-year stage 3 and 4 specific survival (stage 3: 53% vs. 67%, p=0.010; stage 4: 0% vs. 40%, p=0.035). Conclusions: Chinese women with triple negative breast cancer do not have less aggressive biological behavior compared to the West and presentation at a later stage results in worse prognosis compared with those with non triple negative breast cancer.

Evaluation of the hybrid-dynamic conformal arc therapy technique for radiotherapy of lung cancer

  • Kim, Sung Joon;Lee, Jeong Won;Kang, Min Kyu;Kim, Jae-Chul;Lee, Jeong Eun;Park, Shin-Hyung;Kim, Mi Young;Lee, Seoung-Jun;Moon, Soo-Ho;Ko, Byoung-Soo
    • Radiation Oncology Journal
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    • 제36권3호
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    • pp.241-247
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    • 2018
  • Purpose: A hybrid-dynamic conformal arc therapy (HDCAT) technique consisting of a single half-rotated dynamic conformal arc beam and static field-in-field beams in two directions was designed and evaluated in terms of dosimetric benefits for radiotherapy of lung cancer. Materials and Methods: This planning study was performed in 20 lung cancer cases treated with the VERO system (BrainLAB AG, Feldkirchen, Germany). Dosimetric parameters of HDCAT plans were compared with those of three-dimensional conformal radiotherapy (3D-CRT) plans in terms of target volume coverage, dose conformity, and sparing of organs at risk. Results: HDCAT showed better dose conformity compared with 3D-CRT (conformity index: 0.74 ± 0.06 vs. 0.62 ± 0.06, p < 0.001). HDCAT significantly reduced the lung volume receiving more than 20 Gy (V20: 21.4% ± 8.2% vs. 24.5% ± 8.8%, p < 0.001; V30: 14.2% ± 6.1% vs. 15.1% ± 6.4%, p = 0.02; V40: 8.8% ± 3.9% vs. 10.3% ± 4.5%, p < 0.001; and V50: 5.7% ± 2.7% vs. 7.1% ± 3.2%, p < 0.001), V40 and V50 of the heart (V40: 5.2 ± 3.9 Gy vs. 7.6 ± 5.5 Gy, p < 0.001; V50: 1.8 ± 1.6 Gy vs. 3.1 ± 2.8 Gy, p = 0.001), and the maximum spinal cord dose (34.8 ± 9.4 Gy vs. 42.5 ± 7.8 Gy, p < 0.001) compared with 3D-CRT. Conclusions: HDCAT could achieve highly conformal target coverage and reduce the doses to critical organs such as the lung, heart, and spinal cord compared to 3D-CRT for the treatment of lung cancer patients.

The UGT1A9*22 genotype identifies a high-risk group for irinotecan toxicity among gastric cancer patients

  • Lee, Choong-kun;Chon, Hong Jae;Kwon, Woo Sun;Ban, Hyo-Jeong;Kim, Sang Cheol;Kim, Hyunwook;Jeung, Hei-Cheul;Chung, Jimyung;Rha, Sun Young
    • Genomics & Informatics
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    • 제20권3호
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    • pp.29.1-29.12
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    • 2022
  • Several studies have shown associations between irinotecan toxicity and UGT1A genetic variations in colorectal and lung cancer, but only limited data are available for gastric cancer patients. We evaluated the frequencies of UGT1A polymorphisms and their relationship with clinicopathologic parameters in 382 Korean gastric cancer patients. Polymorphisms of UGT1A1*6, UGT1A1*27, UGT1A1*28, UGT1A1*60, UGT1A7*2, UGT1A7*3, and UGT1A9*22 were genotyped by direct sequencing. In 98 patients treated with irinotecan-containing regimens, toxicity and response were compared according to the genotype. The UGT1A1*6 and UGT1A9*22 genotypes showed a higher prevalence in Korean gastric cancer patients, while the prevalence of the UG1A1*28 polymorphism was lower than in normal Koreans, as has been found in other studies of Asian populations. The incidence of severe diarrhea after irinotecan-containing treatment was more common in patients with the UGT1A1*6, UGT1A7*3 and UGT1A9*22 polymorphisms than in controls. The presence of the UGT1A1*6 allele also showed a significant association with grade III-IV neutropenia. Upon haplotype and diplotype analyses, almost every patient bearing the UGT1A1*6 or UGT1A7*3 variant also had the UGT1A9*22 polymorphism, and all severe manifestations of UGT1A polymorphism-associated toxicity were related to the UGT1A9*22 polymorphism. By genotyping UGT1A9*22 polymorphisms, we could identify high-risk gastric cancer patients receiving irinotecan-containing chemotherapy, who would experience severe toxicity. When treating high-risk patients with the UGT1A9*22 polymorphism, clinicians should closely monitor them for signs of toxicity such as severe diarrhea or neutropenia.

Long-term Surgical Outcomes in Oligometastatic Non-small Cell Lung Cancer: A Single-Center Study

  • Seungmo Yoo;Won Chul Cho;Geun Dong Lee;Sehoon Choi;Hyeong Ryul Kim;Yong-Hee Kim;Dong Kwan Kim;Seung-Il Park;Jae Kwang Yun
    • Journal of Chest Surgery
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    • 제56권1호
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    • pp.25-32
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    • 2023
  • Background: We reviewed the clinical outcomes of patients with oligometastatic (OM) non-small cell lung cancer (NSCLC) who received multimodal therapy including lung surgery. Methods: We retrospectively analyzed 117 patients with OM NSCLC who underwent complete resection of the primary tumor from 2014 to 2017. Results: The median follow-up duration was 2.91 years (95% confidence interval, 1.48-5.84 years). The patients included 73 men (62.4%), and 76 patients (64.9%) were under the age of 65 years. Based on histology, 97 adenocarcinomas and 14 squamous cell carcinomas were included. Biomarker analysis revealed that 53 patients tested positive for epidermal growth factor receptor, anaplastic lymphoma kinase, or ROS1 mutations, while 36 patients tested negative. Metastases were detected in the brain in 74 patients, the adrenal glands in 12 patients, bone in 5 patients, vertebrae in 4 patients, and other locations in 12 patients. Radiation therapy for organ metastasis was performed in 81 patients and surgical resection in 27 patients. The 1-year overall survival (OS) rate in these patients was 82.8%, and the 3- and 5-year OS rates were 52.6% and 37.2%, respectively. Patients with positive biomarker test results had 1-, 3-, and 5-year OS rates of 98%, 64%, and 42.7%, respectively. These patients had better OS than those with negative biomarker test results (p=0.031). Patients aged ≤65 years and those with pT1-2 cancers also showed better survival (both p=0.008). Conclusion: Surgical resection of primary lung cancer is a viable treatment option for selected patients with OM NSCLC in the context of multimodal therapy.

IMRT에 있어 Jaw Tracking 의 임상적 유용성 검증 (Verification of Clinical Usefulness of Jaw Tracking in IMRT)

  • 김진영;김기환
    • 한국방사선학회논문지
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    • 제14권2호
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    • pp.105-109
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    • 2020
  • 세기조절방사선치료(IMRT)는 치료범위의 선량분포를 향상시키고 주변 정상조직을 보호한다는 점에서 두경부, 전립선, 뇌와 같은 부위에 널리 사용되고 있다. 그러나 이러한 세기조절방사선치료는 입체조형방사선치료에 비해 많은 방사선조사량으로 인해 누적선량이 증가하고 다엽콜리메이터의 누설선량이나 투과선량으로 인한 저선량이 증가하는 양상을 보인다. 이러한 누적선량이나 저선량의 증가는 악성 종양의 재발생율을 증가시키는 것으로 보고되고 있다. 본 논문에서는 뇌종양의 방사선치료에 있어 기존 선형가속기의 단점을 보완하고 다엽콜리메이터의 누설선량이나 투과선량을 줄이기 위해 개발된 Varian사의 TRUEBEAM 의 Jaw Tracking 기능의 임상적인 유용성을 검증하고자 하였다. Jaw tracking 기능의 임상적 유용성을 검증하기 위해 Varian사의 Eclipse11을 이용하여 치료범위에서 1) Organ At Risk(OAR)에 2 cm 이상 떨어진 경우 2) OAR에 2 cm 이하로 떨어진 경우 3) OAR를 포함하는 경우 3 가지의 원본 치료계획을 만들고 이를 복사한 후, Smart LMC Version 11.0.31을 이용하여 Jaw tracking 기능을 사용한 치료계획을 만들었다. 비교는 두 치료계획 간의 Cumulative Dose Volume Histogram(DVH) 에서 OAR의 평균선량 및 최대선량의 차이를 통해 평가하였다. 두 치료계획 간의 DVH 비교 결과 PTV가 OAR에 2 cm 이상 떨어진 경우 두 치료계획 간의 차는 최대 0.5 % 차이, 2 cm 이하로 떨어진 경우 최대 0.6 % 차이, PTV가 OAR을 포함하는 경우 최대 2.3 % 차이를 가졌다. 이 결과에 의하면 OAR과 PTV 간의 거리가 가까워짐에 따라 인접해있는 OAR 평균선량 및 최대선량에 있어 두 치료계획간 차가 커짐을 알 수 있다. 따라서 Jaw Tracking을 사용한 경우 일관성 있게 선량 감소가 있고 표면선량이 증가하지 않으므로 임상적인 유용성을 검증할 수 있었다. 향후 본 연구결과를 토대로 뇌, 두경부, 전립선과 같은 부위에 방사선 치료 시 선량감소 정도에 대한 추가 연구를 진행하여 각 부위에 따른 Jaw Tracking의 임상적 유용성 검증이 가능할 것으로 사료된다.