• 대한암한의학회지
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• 제19권1호
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• pp.43-51
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• 2014

This report is aimed to investigate the effect of Integrative Medicine Therapy (IMT) in treating breast cancer metastasized to several portion. A 55-year-old woman who was diagnosed breast cancer and treated by breast conservation surgery (BCS) IN 2002. (pT2M0N0), adjuvant chemotherapy and radiotherapy till Jan. in 2013. But cancer had metastasized to sacrum (2009), liver (2012) and ribs (2013). Finally cause of several side effects of Xeloda(neuralgia and vommiting), she gave up to be treated by Xeloda and started to receive IMT including Abnoba Viscum, Vitamin C therapy Xeloda again, Korean herbal medicine and pharmacopuncture from Jul. in 2013. The effect was evaluated with Positron Emission Tomography and Computed Tomography (PET-CT) and Abdomen Computed Tomography (CT). The metastatic tumor in liver was disappeared and cancers to ribs, their size decreased after 12 months and pain of sacrum maintained VAS 2 continually. These results suggest that IMT is a therapeutic method to treat metastatic tumor originated from breast cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제15권13호
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• pp.5331-5336
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• 2014

Background: Early onset breast cancer is associated with poor outcomes but variable results have been reported. It is a significant problem in Pakistani women but remains under reported. Breast conservation plays an important role in surgical management of this younger patient group. The objective of this study was to determine the outcome of breast conservative therapy in patients with early onset breast cancer in our population and compare it with their older counterparts. Materials and Methods: A review of patients with invasive breast cancer who underwent breast conservation surgery at Shaukat Khanum Cancer Hospital from 1997 to 2009 was performed. Patients were divided into two groups i.e. Group I age ${\leq}40$ and Group II >40 years. A total of 401 patients with breast cancer were identified in Group I and 405 patients in Group II. Demographics, histopathological findings and receptor status of the two groups were compared. The Chi square test was used for categorical variables. Outcome was assessed on basis of 10 year locoregional recurrence free survival (LRRFS), disease free survival (DFS) and overall survival (OS). For survival analysis Kaplan Meier curves were used and significance was determined using the Log rank test. Cox regression was applied for multivariate analysis. Results: Median follow up was 4.31 (0.1-15.5) years. Median age at presentation was 34.6 years (17-40) and 51.9 years (41-82) for the two groups. Groups were significantly different from each other with respect to grade, receptor status, tumor stage and use of neoadjuvant therapy. No significant difference was present between the two groups for estimated 10 year LRRFS (86% vs 95%) (p=0.1), DFS (70% vs 70%) (p=0.5) and OS (75% vs 63%) (p=0.1). On multivariate analysis, tumor stage was an independent predictor of LRRFS, DFS and OS. Conclusions: Early onset breast cancer is associated with a distinct biology but does not lead to poorer outcomes in our population.

• Asian Pacific Journal of Cancer Prevention
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• 제17권6호
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• pp.2917-2921
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• 2016

Background: To explore factors that influence quality of life (QOL) in patients receiving breast conserving therapy (BCT). Materials and Methods: In this sequential mixed methods study, 118 women from Songklanagarind Hospital were included. We used participants' characteristics, Body Image Scale (BIS), and Functional Assessment of Cancer Therapy with the Breast Cancer Subscale (FACT-B) for analysis. The BIS transformed into presence of body image disturbance (BID). Factors that influenced QOL were determined by stepwise multiple linear regression. Forty-one participants were selected for qualitative analysis. Our female researcher performed the semi-structured interviews with questions based on the symbolic interaction theory. Final codes were analysed using thematic analysis along with investigator triangulation methods. Results: Ninety percent had early stage breast cancer with post-completed BCT, for an average of 2.7 years. The median BIS score and FACT-B score were 2 (IQR=10) and 130 (IQR=39). In the regression analysis, an age of more than 50 years and BID were significant factors. As for the value of conserved breasts, two themes emerged: a conserved breast is an essential part of a participant's life and also the representation of her womanhood; the importance of a breast is related to age. Conclusions: Body image influenced QOL in post BCT participants. The conserved breasts also lead to positive and better impact on their body image as an essential part of their life.

• Asian Pacific Journal of Cancer Prevention
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• 제17권11호
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• pp.4819-4823
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• 2016

Bckground: Adjuvant radiation therapy is commonly administered following breast-conserving surgery for breast cancer patients. Hypofractionated radiotherapy can significantly reduce the waiting time for radiotherapy, working load on machines, patient visits to radiotherapy departments and medical costs. Material/Methods: Fifty-two patients with operable breast cancer (pT1-3pN0M0) who underwent breast conservation surgery in Tehran Cancer Institute during January 2011 to January 2012, were randomly assigned to undergo radiotherapy in two arms (hypofractionated radiotherapy arm with 30 patients, dose 42.5 Gy in 16 fractions; and conventional radiotherapy arm with 22 patients, dose 50 Gy in 25 fractions). W compared these two groups in terms of overall survival, locoregional control, late skin complications and cosmetic results. Results: At a median follow-up of 52.4 months (range: 0-64 months), the follow-up rate was 82.6%. Overall, after 60 months, there was no detectable significant differences between groups regarding cosmetic results (p = 0.857), locoregional control or survival. Conclusions: The results confirm that hypofractionated radiotherapy with a subsequent boost is as effective as conventional radiotherapy, is well-tolerated and can be used as an alternative treatment method following breast conservation surgery.

• Asian Pacific Journal of Cancer Prevention
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• 제17권10호
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• pp.4783-4790
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• 2016

Purpose: Cancer-related fatigue is frequently experienced by patients during and after therapy. The present study was conducted to assess the impact of energy conservation strategies and health promotion in breast cancer survivors. Methods: A randomized controlled trial was carried out to compare the intervention effect (n=69.0) with controls (n=66.0) based on routine oncology ward care. The intervention was five weekly sessions for groups of 6-8 breast cancer survivors. Data on fatigue and health promotion lifestyle were obtained before and after completion the intervention and then 8 weeks later for analysis of variance (ANOVA) with repeated measures. Results: Our findings showed cancer-related fatigue to be reduced in the intervention group from pre- to post-intervention, and this persisted over the 8-weeks follow-up period (F = 69.8, p<0.001). All subscales of the cancer fatigue scale demonstrated statistically significant effects with partial eta-squared values ranging from 0.15 (the smallest effect in cognitive fatigue) to 0.21 (the largest for affective fatigue). Changes in the health promotion life style indicated a significant promotion from pre- to post-intervention, and this again continued after 8-weeks follow-up (F = 41.6, p < 0.001). All six domains of a health promoting life style featured significantly elevated values, the largest effect being seen in the interpersonal relations subscale (F=57.7, partial ${\eta}^2=0.21$, p<0.001) followed by physical activity (F=51.9, partial ${\eta}^2=0.18$, p<0.001). Conclusions: The program was effective in decreasing cancer related fatigue and promoting a healthy lifestyle.

• Asian Pacific Journal of Cancer Prevention
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• 제16권11호
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• pp.4685-4690
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• 2015

Purpose: To evaluate the correlation between cosmetic outcome (CO), body image, and quality of life in post breast-conserving therapy (BCT) women. Materials and Methods: This cross-sectional study concerned one-year post-completed BCT Thai women. The data included subjective and objective CO with a questionnaire covering demographic and clinical data, anti-hormonal treatment status, Eastern Cooperative Oncology Group (ECOG) performance status, Self-Reported Cosmetic Outcomes (SRCO), Self-Reported Breast Symmetry (SRBS), Body Image Scale (BIS), and the Functional Assessment of Cancer Therapy with Breast Cancer subscale (FACT-B). Participants had breast photographs taken for the evaluation of objective cosmetic outcome (OCO) after breast cancer conservation treatment. The relationship between CO and FACT-B was tested using Spearman's rank correlation Results: A total 127 participants volunteered for the study. The participant characteristics were age 52(${\pm}9$), Buddhist 87%, married 65%, body mass index 25.0(${\pm}4.6$), breast cup size A-C 91%, college educated 60%, employed 66%, ECOG 0-1 95%, tumor size less than or equal to 2 cm 55%, no lymph node metastasis 98%, and taking tamoxifen 57%. Two percent of the participants regretted their decision to undergo BCT. The SRCO was excellent in 2%, good in 68%, fair in 30%, and poor in 0%. For SRBS, rates were 17%, 58%, 24% and 1% for excellent, good, fair and poor cosmetic outcomes, respectively. The BCCT scores were excellent 24%, good 39%, fair 32%, and poor 6%. The median total QOL score of the participants was 130 (93-144). There was no significant correlation between CO and FACT-B scores. Conclusions: The significance of CO for FACT-B in Thai women with breast cancer could not be assessed in detail because of a very low level of correlation. The results may be due to the effects of cultural background.

• Radiation Oncology Journal
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• 제13권2호
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• pp.163-171
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• 1995

목적: 조기 유방암에서 보존적 수술후 방사선치료는 외국에서 과거 20여년 동안 근치적 수술과 비슷한 생존율을 보였다. 그러나 아직 우리 나라에서는 보편화되지는 못한 실정이다. 이 논문은 원자력병원에서 시행한 조기 유방암환자에서 보존적 수술의 성적 및 부작용의 결과를 알기 위함이다. 방법: 1987년 1월부터 1989년 12월까지 원자력 병원 치료방사선과에서 보존적 수술후 방사선치료를 받은 조기 유방암 환자 45명에 대해 후향적 연구를 시행하였다. 추적 관찰기간은 4-82개월이었고 중앙값은 54개월이었다. 수술은 조직 생검만 시행한 경우 및 Tumorectomy 또는 Quadrantectomy를 시행한 경우가 있었다. 28예에서 액와림프절 박리를 시행하였다. 방사선 치료는 전유방에 Tangential field로 하루 1.8-2 Gy씩 총 50 또는 50.4 Gy를 조사하였다. 항암 요법은 30예의 환자에서 시행되었고 호르몬 치료는 11예에서 시행되었다. 결과: 5년 생존율, 5년 무병생존율 및 5년 국소제어율은 각각 87.2%, 86.5%, 및 97.6%였다. 전신 요법을 시행하는 군이 시행하지 않은 군에 비하여 5년 생존율에서 좋은 성적을 보였으나 통계학적인 의미는 없었다 (0.05

• Asian Pacific Journal of Cancer Prevention
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• 제15권1호
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• pp.315-320
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• 2014

Purpose: The purpose of this study was to investigate the recurrence pattern and characteristics of patients based on the 2013 St. Gallen surrogate molecular subtypes after breast-conserving surgery (BCS) in Chinese women. Methods: This retrospective analysis included 709 consecutive breast cancer patients undergoing BCS from 1999-2010 at our institution. Five different surrogate subtypes were created using combined expression of the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2. Locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) rates were calculated. Results: The 5-year LRRFS, DMFS, and DFS rates were 90.5%, 88.2%, and 81.5%, respectively. Multivariate analysis revealed that young age, node-positive disease, and HER2 enrichment were independent prognostic factors in LRRFS patients. There was also an independent prognostic role of lymph node-positive disease in DMFS and DFS patients. Patients with luminal A tumors had the most favorable prognosis, with LRRFS, DMFS, and DFS rates of 93.2%, 91.5%, and 87.4% at 5 years, respectively. Conversely, HER-2-enriched tumors exhibited the highest rate of locoregional recurrence (20.6%). Conclusion: Surrogate subtypes present with significant differences in RFS, DMFS, and LRRFS. Luminal A tumors have the best prognosis, whereas HER2-enriched tumors have the poorest.

• Radiation Oncology Journal
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• 제22권2호
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• pp.115-123
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• 2004

목적 : 조기 유방암에서 유방보존치료(유방보존수술+방사선치료) 혹은 유방전절제술로 치료했던 환자의 초기 치료성적과 실패양상을 비교하고자 후향적으로 분석하였다. 대상 및 방법 : 1989년 3월부터 1996년 8월까지 강남성모병원에서 AJCC병기 I, II로 치료를 받았던 유방암 환자를 대상으로 하였다. 88명은 유방전절제술을 시행하였고 85명은 유방보존술 후 방사선치료를 시행하였다. 방사선치료는 50 Gy 전 유방조사 후 원발부위에 10$\~$15 Gy 추가 조사하였다. 유방보존치료 환자의 34.1%$\%$ 유방전절제 환자의 45.5$\%$에서 항암화학요법이 병용되었다 양 치료군의 5년생존율과 5년무병생존율, 실패양상을 비교하였으며 치료실패와 연관된 위험인자를 Log-rank test를 이용하여 분석하였다. 중앙 추적기간은 63개월이 었다. 결과 : 양 치료군 간에 5년생존율, 5년무병생존율의 유의한 차이(p>0.05)는 없었으며 국소재발 및 원격전이의 치료실패양상에도 차이가 없었다. 추적기간 중, 유방전절제군에서 11명(12.5$\%$) 유방보존치료군에서 10명(11.8$\%$) 재발하였다. 초기 실패양상은 국소재발이 각각 6명, 5명이었고 원격전이가 각각 5명, 4명으로 차이가 없었다. 국소재발 단독의 경우 양 치료군에서 구제치료 후 대부분의 환자가 무병생존 (5/6 유방전절제술, 3/5 유방보존치료)하였다 그러나 원격전이 환자의 경우 양 치료군 모두에서 방사선-항암화학요법의 구제치료에도 불구하고 대부분의 환자가 진행 혹은 사망하였으며 유방보존치료군의 1명의 환자만이 원격전이 후 구제치료에 성공하여 무병생존하였다. 양 치료군 간에 반대편유방암 발생률 및 다른 장기의 2차 원발암 발생률의 차이는 없었고 유방암으로 인한 사망률도 차이가 없었다. Log-rank 단변량분석에서 치료 실패와 관련된 유의한 위험인자는 양 군 모두에서 N 병기, 액와 림프절 전이 숫자였으며 유방보존치료군에서는 수술절연침범유무가, 유방전절제군에서는 high nuclear grade가 치료실패와 관련된 위험인자였다(p<0.05). 결론 : 분석결과 AJCC 병기I, II 조기유방암에서 유방보존치료와 유방전절제술은 생존율뿐 아니라 치료 실패양상에도 차이가 없었으며 향후 이와 같은 결과를 확인하기 위한 장기간의 추적연구가 필요하다.

• Radiation Oncology Journal
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• 제28권1호
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• pp.39-49
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• 2010

목 적: 좌측 유방의 방사선치료에 있어, 3 빔 또는 5 빔을 이용한 세기변조방사선치료(intensity modulated radiation therapy, IMRT)와 다중빔조사영역 치료기법(multistatic fields techniques, MSF) 사이의 선량학적 차이를 분석하고자 하였다. 대상 및 방법: 개선된 선량 균일성을 만들 수 있는 가능성을 지닌 두 종류의 방사선치료 기술을 서로 비교 분석하였다. 첫째, 다중빔조사영역치료로 주조사야와 소조사야를 동시에 사용하여 치료하였다. 둘째, 고정된 다엽 조준기를 사용하는 IMRT로, 3 빔 또는 5 빔을 이용하였다. 유방보존술 후 방사선치료를 받은 16명의 초기 좌측 유방암 환자들을 대상으로 방사선치료계획들을 세운 다음, 이들을 선량학적 측면에서 비교 분석하였다. 결 과: $V_{95}$와 선량균일지수의 평균값은, 이 세 치료 사이에 통계학적으로 유의한 차이가 없었다. 방사선처방선량의 110% 이상을 받는 극심한 열점은 세 치료 모두에서 관찰되지 않았다. 동측 폐와 심장의 피폭 선량측정인자들에 대한 Tukey 검정에서, 세기변조방사선치료가 다중빔조사영역치료에 비해 저선량 영역의 피폭 선량을 유의하게 증가시킨 반면, 오히려 고선량 영역에서는 다중빔조사영역치료가 방사선 피폭을 약간 증가시켰다. 결 론: 선량 균일성 개선을 위해, 통상적인 쐐기기법 대신, 세기변조방사선치료보다 쉽게 계획되고 실시 될 수 있는 다중빔조사영역치료의 적용은 초기 좌측 유방암의 방사선치료 기술로 적합하다고 생각한다.