• The Korean Journal of Nuclear Medicine Technology
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• v.25 no.2
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• pp.25-28
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• 2021

Purpose CA 72-4 is a tumor marker that uses two monoclonal antibodies, CC49 and B72.3, to measure tumor-related glycoprotein(TAG72) in the serum. CA 72-4 is used to diagnose stomach, ovarian, and pancreatic cancers, and is known to perform high specificity for stomach cancer. The purpose of this study is to re-evaluate the reference value provided by the manufacturer through revalidation of the reference value in CA 72-4. Furthermore this study was conducted to provide useful help when making a clinical diagnosis at gastric cancer center. Materials and Methods We selected 271 patients who had been to health care center in national cancer center for the month of November 2020. The gender of the subjects was 140 males and 131 females, and the age group was from 30s to 60s. The reagent used in the study was a CA 72-4 IRMA KIT (ISOTOPES, Hungary) and the results were measured using a Dream Gamma-10 gamma counter (Shinjin medics, Korea). Results Statistical analysis of the results of this study used Hoffmann's method and Bayesian's method, which are primarily used in setting reference value. As a result of measuring CA 72-4 of 271 patients, the mean value was 4.54 U/mL and the median value was 3.30 U/mL. 24 people who deviated from 3SD were excluded from the measured value, the mean calculated after that was 3.53 U/mL, median was 3.00 U/mL and SD was 1.89. The reference value calculated based on this results was set to 7.31 U/mL. Conclusion The reference value provided by the manufacturer is less than 4 U/mL. It is slightly different from the value calculated in this study, 7.31 U/mL, so it seems necessary to reset the reference value according to the laboratory environment. Currently, we are receiving inquiries about the reference value from the center for gastric cancer at National Cancer Center. If additional research is carried out along with this study, it will be possible to set more accurate reference value.

• Journal of Gastric Cancer
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• v.23 no.1
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• pp.3-106
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• 2023

Gastric cancer is one of the most common cancers in Korea and the world. Since 2004, this is the 4th gastric cancer guideline published in Korea which is the revised version of previous evidence-based approach in 2018. Current guideline is a collaborative work of the interdisciplinary working group including experts in the field of gastric surgery, gastroenterology, endoscopy, medical oncology, abdominal radiology, pathology, nuclear medicine, radiation oncology and guideline development methodology. Total of 33 key questions were updated or proposed after a collaborative review by the working group and 40 statements were developed according to the systematic review using the MEDLINE, Embase, Cochrane Library and KoreaMed database. The level of evidence and the grading of recommendations were categorized according to the Grading of Recommendations, Assessment, Development and Evaluation proposition. Evidence level, benefit, harm, and clinical applicability was considered as the significant factors for recommendation. The working group reviewed recommendations and discussed for consensus. In the earlier part, general consideration discusses screening, diagnosis and staging of endoscopy, pathology, radiology, and nuclear medicine. Flowchart is depicted with statements which is supported by meta-analysis and references. Since clinical trial and systematic review was not suitable for postoperative oncologic and nutritional follow-up, working group agreed to conduct a nationwide survey investigating the clinical practice of all tertiary or general hospitals in Korea. The purpose of this survey was to provide baseline information on follow up. Herein we present a multidisciplinary-evidence based gastric cancer guideline.

• The Journal of Korean Society for Radiation Therapy
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• v.34
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• pp.13-20
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• 2022

Purpose : IMRT using Tomotherapy during nasopharyngeal cancer radiation therapy irradiate an accurate dose to tumor tissues and is effective to reduce a dose rapidly in normal tissues. However, this has high MU and long Beam On Time. This study aims to analyze differences in tumors, normal tissues and low-dose distributions and the efficiency of Split VMAT after applying Helical IMRT (Tomotherapy), VMAT (Linac : 2Arc) and Split VMAT (Linac : 4Arc) plans. Materials and Methods : This study targeted ten nasopharyngeal cancer patients of this hospital and compared three treatment plans (Helical IMRT, VMAT, Split VMAT). For Helical IMRT planning, Precision^® (Version 1.1.1.1, Accuray, USA) was used, and for VMAT and Split VMAT planning, Pinnacle^3® (Version 9.10, Philips, USA) was used. The total dose applied was 38.4 Gy / 32 Gy (Daily Dose 2.4 Gy (GTV + 0.3 cm) / 2 Gy (CTV + 0.3 cm) 16Fx), and for GTV + 0.3 cm (P_GTV), 95% of V_38.4Gy was prescribed. VMAT with an angle of 360° 2Arc was applied, and for Split VMAT, the field was divided into the right, the left, the top and the bottom and an angle of 360° 4Arc, 6MV was set. For evaluating the quality of the treatment plans, differences in tumors, normal tissues and low-dose area were compared, and Beam On Time was measured to analyze the efficiency. Results : When calculating the mean values of evaluation items of the three treatment plans (Helical IMRT, VMAT, Split VMAT) for the patients, the H.I (Homogeneity Index) of P_GTV was 1.04, 1.11 and 1.1 respectively, and the C.I (Confomity Index) of P_CTV was 1.03, 0.99 and 1.00 respectively. The mean dose of RT Parotid Gland (Gy) was 14.54, 17.06 and 14.76 respectively, the mean dose of LT Parotid Gland (Gy) was 14.32, 17.32 and 15.09 respectively, the maximum dose of P_Cord (Spinal Cord + 0.3 cm) (Gy) was 20.57, 22.59 and 21.06 respectively, and the maximum dose of Brain Stem (Gy) was 22.35, 23.99 and 21.68 respectively. The 50% isodose curve (cc) was 1332, 1132.5 and 1065.2 respectively. Beam On Time (sec) was 373.7, 130.7 and 254.4 respectively. Conclusion : Displaying a similar treatment plan quality to Helical IMRT, which is used a lot for head and neck treatment, Split VMAT reduced the low-dose area and Beam On Time and produced a better result than VMAT. Therefore, it is considered that Split VMAT is effective not only for nasopharyngeal cancer but also for other head and neck cancers.

• The Journal of Korean Society for School & Community Health Education
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• v.25 no.2
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• pp.45-57
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• 2024

Objectives: The purpose of this study is to determine the impact of artificial menopause on the diagnosis of thyroid cancer, breast cancer, and cervical cancer, and to provide basic data for cancer prevention and early diagnosis in women. Methods: Analysis was conducted using raw data from the 2011-2020 National Health and Nutrition Examination Survey. Among the 79,262 people surveyed in the 2011-2020 National Health and Nutrition Examination Survey, 10,207 people were selected as the final research subjects, excluding men, those under 18 years old, those over 80 years old, those who did not participate in the health survey, those with missing data, and those who were not in menopause. Among them, 248 people were diagnosed with thyroid cancer (2.7%), 225 people were diagnosed with breast cancer (2.5%), and 143 people were diagnosed with cervical cancer (21.5%). Results: First, there appeared to be differences between the thyroid cancer diagnosed group and the non-diagnosed group depending on educational level, childbirth experience, and menopause type. Second, there appeared to be differences between the breast cancer diagnosis group and the non-diagnosis group depending on educational level, menopause age, pregnancy experience, childbirth experience, subjective health status, and menopause type. Third, there appeared to be differences between the cervical cancer diagnosis group and the non-diagnosis group depending on menopause age, subjective health status, and menopause type. Fourth, compared to natural menopause, in the case of artificial menopause, the diagnosis probability of women increased by 2.010 times for thyroid cancer, 3.872 times for breast cancer, and 14.902 times for cervical cancer. Conclusion: For thyroid cancer, breast cancer, and cervical cancer, the probability of cancer diagnosis increases in the case of artificial menopause compared to natural menopause, so it is considered important to avoid experiencing artificial menopause to prevent cancer.

• Journal of the Korean Society of Radiology
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• v.82 no.2
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• pp.371-381
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• 2021

Purpose To evaluate the usefulness and effectiveness of bronchial occluders in the treatment of postoperative bronchopleural fistula (BPF). Materials and Methods The subjects of the study were six out of seven postoperative BPF patients who underwent surgery due to tuberculosis or lung cancer between 2009 and 2019. Each patient had a bronchial occluder inserted to treat BPF that occurred after surgery. Of the six patients, five had lung cancers and one had tuberculosis. Five were male and one was female; their ages ranged from 59 to 74 years, with an average of 69 years. The diagnosis of BPF was based on findings from bronchoscopy and CT, and treatment was initiated approximately 1 to 2 weeks after diagnosis. The technical and clinical success of the bronchial occluders in the treatment of BPF was evaluated. The study assessed the postoperative clinical effects of the occluders, survival duration, and additional treatments. Results All six patients were successfully treated. Clinical success was achieved in five patients, while partial clinical success was achieved in one; there was no clinical failure. No complications during the migration of the device or device perforations were observed. Two patients were diagnosed with BPF by CT, while four were diagnosed by bronchoscopy. Lobectomy, bilobectomy, and pneumonectomy were performed on two patients each. The periods between surgery and diagnosis ranged from 1 to 34 months; the average was 10 months. Four patients (59-103 days; an average of 80.5 days) died and two (313 days, 3331 days) survived. The causes of death were aggravation of the underlying disease (n = 2), pulmonary edema and pleural effusion (n = 1), and pneumonia (n = 1). Additional catheter drainage was performed in one patient, and a chest tube was maintained in two patients. Conclusion Bronchial occluders are useful and effective in the treatment of BPF after pulmonary resection.

• Radiation Oncology Journal
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• v.25 no.1
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• pp.7-15
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• 2007

[ $\underline{Purpose}$ ]: To determine the patterns of evaluation and treatment in patients with breast cancer after mastectomy and treated with radiotherapy. A nationwide study was performed with the goal of improving radiotherapy treatment. $\underline{Materials\;and\;Methods}$: A web- based database system for the Korean Patterns of Care Study (PCS) for 6 common cancers was developed. Randomly selected records of 286 eligible patients treated between 1998 and 1999 from 17 hospitals were reviewed. $\underline{Results}$: The ages of the study patients ranged from 20 to 80 years (median age 44 years). The pathologic T stage by the AJCC was T1 in 9.7% of the cases, T2 in 59.2% of the cases, T3 in 25.6% of the cases, and T4 in 5.3% of the cases. For analysis of nodal involvement, N0 was 7.3%, N1 was 14%, N2 was 38.8%, and N3 was 38.5% of the cases. The AJCC stage was stage I in 0.7% of the cases, stage IIa in 3.8% of the cases, stage IIb in 9.8% of the cases, stage IIIa in 43% of the cases, stage IIIb in 2.8% of the cases, and IIIc in 38.5% of the cases. There were various sequences of chemotherapy and radiotherapy after mastectomy. Mastectomy and chemotherapy followed by radiotherapy was the most commonly performed sequence in 47% of the cases. Mastectomy, chemotherapy, and radiotherapy followed by additional chemotherapy was performed in 35% of the cases, and neoadjuvant chemoradiotherapy was performed in 12.5% of the cases. The radiotherapy volume was chest wall only in 5.6% of the cases. The volume was chest wall and supraclavicular fossa (SCL) in 20.3% of the cases; chest wall, SCL and internal mammary lymph node (IMN) in 27.6% of the cases; chest wall, SCL and posterior axillary lymph node in 25.9% of the cases; chest wall, SCL, IMN, and posterior axillary lymph node in 19.9% of the cases. Two patients received IMN only. The method of chest wall irradiation was tangential field in 57.3% of the cases and electron beam in 42% of the cases. A bolus for the chest wall was used in 54.8% of the tangential field cases and 52.5% of the electron beam cases. The radiation dose to the chest wall was $45{\sim}59.4\;Gy$ (median 50.4 Gy), to the SCL was $45{\sim}59.4\;Gy$ (median 50.4 Gy), and to the PAB was $4.8{\sim}38.8\;Gy$, (median 9 Gy) $\underline{Conclusion}$: Different and various treatment methods were used for radiotherapy of the breast cancer patients after mastectomy in each hospital. Most of treatment methods varied in the irradiation of the chest wall. A separate analysis for the details of radiotherapy planning also needs to be followed and the outcome of treatment is needed in order to evaluate the different processes.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.23-29
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• 1999

Purpose : To evaluate the efficacy of radiation therapy and extrafascial hysterectomy in bulky stage IB, IIA-B uterine cervix cancers. Methods and Materials : Twenty four patients with bulky stage IB and IIA-B carcinoma of the uterine cervix were treated with extrafascial hysterectomy following radiation therapy due to doubts of residual disease at Department of therapeutic radiology, Keimyung University, Dongsan Hospital, from April 1986 to December 1997 According to FIGO staging system, there were 7 patients with stage IB, 9 patients with IIA and 8 patients with IIB stage whose median age was 45. Pathologic distribution showed 16 patients with squamous cell carcinoma and 8 patients with adenocarcinoma. Seven patients had tumors that are less than 5cm in size and 17 patients had tumors with larger than 5cm. The mean interval between radiation therapy and extrafascial hysterectomy was 57 days. The radiation therapy consisted of external irradition to the whole pelvis (180 cGy/fraction, mean 4100 cGy) and parametrial boost (for a mean total dose of 5000 cGy) with midline shield (4H 10 cm), followed by intracavitary irradiation up to 7500 cGy to point A (maximum 8500 cGy). The maximum follow up duration was 107 months and mean follow up duration was 42 months. Results :Ten out of 24 patients (41.7%) had residual disease found at the time of extrafascial hysterectomies. Five year overall survival rate (5Y OSR) and five year disease free survival rate (5Y DFSR) were 63.6% and 62.5% respectively. Five year overall survival rate for stage IB and IIA was 71.4% and 50% for stage IIB. There was a significant difference in 5Y OSR and 5Y DFSR between patients with and those without residual disease (negative vs positive, 83.3% vs. 40% (P=0.01), 83.3% vs 36% (P=0.01) respectively). There was a notable tendency of better survival with adenocarcinoma than with squamous cell carcinoma (adenocarcinoma vs squamous cell carcinoma, 85.7% vs. 53.3% (P=0.1), 85.7% vs. 50.9% (P=0.1) of 5Y OSR and 5Y DFS respectivey). Total dose to A point did not make a significant difference in survival rate or the existence of residual lesion (< 7500 cGy, ${\geq}$ 7500 cOy). It was also noted that significantly more frequent local failures have occurred in patients with positive residual disease compared with negative residual disease (5/10 vs. 0/14, p=0.003), There was no death related to the treatment. Conclusion : There was no improvement of residual disease and to the overall survival rate in spite of increased total dose to point A. We conclude that there is a possible beneficial effect of radiation therapy followed by extrafaseial hysterectomy in survival for adenocarcinoma of bulky stage IB and IIA-B uterine cervix. We need to confirm this with longer follow up and with large number of patients.

• Tuberculosis and Respiratory Diseases
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• v.52 no.4
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• pp.317-329
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• 2002

Background : Immunotherapy is another treatment modality for various cancers. There is little information on the antitumor effects of immunotherapy on implanted lung cancer mouse models. Toxoplasma gondii is able to potently induce a nonspecific stimulation of the host immune system. Therefore, this study evaluated the antitumor and antimetastatic effect of nonspecific immune stimulation by T. gondii in a Lewis lung cancer mouse model. Methods : Female C57BL/6 mice were injected with either Lewis lung cancer cells ($1{\times}10^6$ per mouse) or 5 cysts from the T. gondii Me49 strain with various schedules. The number of survival days, the tumor size of the implanted muscle and the histopathological findings of each group were noted. In addition to these mice, the Toxoplasma antigen($50{\mu}g$ per mouse) or a lymphokine (0.5 ml per mouse) was added to boost the immunotherapy. Results : No mouse in the Toxoplasma-infected group had died, whereas the mice receiving only the cancer cells (cancer control) survived for $29.1{\pm}4.4$ days. Cancer cells were revealed from 1 week after cancer cell inceulation in the muscle and from 3 weeks in the lung of the cancer control, whereas cancer cells were found in both the preinfection control and coinfection control groups from 2 weeks and 4 weeks in the lung respectively. The in the number of survival days were $32.4{\pm}3.3$ in the mice receiving T. gondii 2 weeks prior to the cancer cells inoculation (preinfection control), $30.9{\pm}5.1$ in mice received both simultaneously (coinfection control), and $34.9{\pm}2.9$ in mice received T. gondii 2 weeks after cancer cells implantation (postinfection control). These 3 infection groups had significantly longer survival days and suppressed tumor growth than those of the cancer control. In addition to these mice, and injection with the Toxoplasma antigen alone or in combination with lymphokine resulted in a significant increase in the number of survival days. Conclusion : These findings suggest that an injection with T. gondii can induce the antitumor and antimetastatic effects in Lewis lung cancer mouse models. Moreover, these effects were increased with an injection of the Toxoplasma antigen alone or in combination with lymphokine. However, this therapy can not prevent the development of cancer.

• The Korean Journal of Nuclear Medicine
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• v.32 no.1
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• pp.71-80
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• 1998

This study examines the levels of carbohydrate antigen 19-9(CA19-9) and cancer antigen 125(CA125) in serum and its related factors in healthy Korean population. Although CA19-9 and CA125 have been widely used tumor markers for gastroenteric cancers and ovarian cancer in Western countries, there are no information available on the serum levels of CA19-9 and CA125 in healthy population and the factors affecting the levels of these tumor markers in Korea. A cross-sectional study was performed to measure CA19-9 and CA125 among 76 healthy males and 95 healthy females in Korea. CA19-9 and CA125 were quantitated using solid-phase radioimmunoassay kits. Informations on the factors which might be related to the levels of these markers were collected by questionnaire(e.g., smoking, alcohol consumption, menstruation, oral pill use, breast-feeding history, etc.). There was no statistically significant difference in the mean of CA19-9 concentration between men(10.4 u/ml) and women(10.1 u/ml), whereas the mean of CA125 levels(11.2 u/ml) was higher in women than that(2.5 u/ml) in men. Although there was a statistically significant association between CA19-9 and average number of cigarette consumed per day(r=0.59, p=0.026) and total number of cigarettes consumed in women(r=0.74, p=0.003), the significance disappeared by multiple regression analysis after adjusting age and body mass index. Later age of menopause(p=0.035) and longer duration of breast-feeding(p=0.050) were significant predictors for CA125 levels in women by multiple regression analysis after adjusting age and body mass index. In conclusion, CA19-9 can be used as a stable tumor marker in clinical practices, however, menstruation and breast-feeding should be considered when CA125 is used in women.

• Journal of Chest Surgery
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• v.42 no.5
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• pp.624-629
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• 2009

Background: Making the histologic diagnosis of small pulmonary nodules and ground glass opacity (GGO) lesions is difficult. CT-guided percutaneous needle biopsies often fail to provide enough specimen for making the diagnosis. Video-assisted thoracoscopic surgery (VATS) can be inefficient for treating non-palpable lesions. Preoperative localization of small intrapulmonary lesions provides a more obvious target to facilitate performing intraoperative. resection. We evaluated the efficacy of CT-guided localization with using a hook wire and this was followed by VATS for making the histologic diagnosis of small intrapulmonary nodules and GGO lesions. Material and Method: Eighteen patients (13 males) were included in this study from August 2005 to March 2008. 18 intrapulmonary lesions underwent preoperative localization by using a CT-guided a hook wire system prior to performing VATS resection for intrapulmonary lesions and GGO lesions. The clinical data such as the accuracy of localization, the rate of conversion-to-thoracotomy, the operation time, the postoperative complications and the histology of the pulmonary lesion were retrospectively collected. Result: Eighteen VATS resections were performed in 18 patients. Preoperative CT-guided localization with a hook-wire was successful in all the patients. Dislodgement of a hook wire was observed in one case. There was no conversion to thoracotomy, The median diameter of lesions was 8 mm (range: $3{\sim}15\;mm$). The median depth of the lesions from the pleural surfaces was 5.5 mm (range: $1{\sim}30\;mm$). The median interval between preoperative CT-guided with a hook-wire and VATS was 34.5 min (range: ($10{\sim}226$ min). The median operative time was 43.5.min (range: $26{\sim}83$ min). In two patients, clinically insignificant pneumothorax developed after CT-guided localization with a hook-wire and there were no other complications. Histological examinations confirmed 8 primary lung cancers, 3 cases of metastases, 3 cases of inflammation, 2 intrapulmonary lymph nodes and 2 other benign lesions. Conclusion: CT-guided localization with a hook-wire followed by VATS for treating small intrapulmonary nodules and GGO lesions provided a low conversion thoracotomy rate, a short operation time and few localization-related or postoperative complications. This procedure was efficient to confirm intrapulmonary lesions and GGO lesions.