• Clinical and Experimental Pediatrics
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• 제61권2호
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• pp.49-52
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• 2018

Purpose: Tularemia is an infection caused by Francisella tularensis. Its diagnosis and treatment may be difficult in many cases. The aim of this study was to evaluate treatment modalities for pediatric tularemia patients who do not respond to medical treatment. Methods: A single-center, retrospective study was performed. A total of 19 children with oropharyngeal tularemia were included. Results: Before diagnosis, the duration of symptoms in patients was $32.15{\pm}17.8days$. The most common lymph node localization was the cervical chain. All patients received medical treatment (e.g., streptomycin, gentamicin, ciprofloxacin, and doxycycline). Patients who had been given streptomycin, gentamicin, or doxycycline as initial therapy for 10-14 days showed no response to treatment, and recovery was only achieved after administration of oral ciprofloxacin. Response to treatment was delayed in 5 patients who had been given ciprofloxacin as initial therapy. Surgical incision and drainage were performed in 9 patients (47.5%) who were unresponsive to medical treatment and were experiencing abcess formation and suppuration. Five patients (26.3%) underwent total mass excision, and 2 patients (10.5%) underwent fine-needle aspiration to reach a conclusive differential diagnosis and inform treatment. Conclusion: The causes of treatment failure in tularemia include delay in effective treatment and the development of suppurating lymph nodes.

• 대한두개안면성형외과학회지
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• 제18권2호
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• pp.105-111
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• 2017

Background: The author analyse the impact of extracapsular lymph node spread and bone engagement in the ipsilateral neck of patients suffering squamous cell carcinoma (SCC) of the lower lip. Methods: The data of 56 neck dissections performed in patients suffering SCC of the lower lip between January 2000 and December 2008 were retrospectively analysed. Statistical analysis was performed with the Kaplan-Meier life table method, and the survival rate was investigated with the log rank statistic and significance test. The values were considered statistically significant at p<0.05. Results: Nine patients took advantage from simultaneous treatment of tumor and prophylactic neck dissection (level I-III), reaching 100% survival rate. Patients suffering metastasized disease, who received radical neck dissection at the time of tumor treatment, presented 83.3% survival rate. Patients who underwent previous surgery and radiotherapy presented worse prognosis although radical neck dissection in case of extra-capsular spread only (24.7%) and osseous engagement (22.2%). Conclusion: Prophylactic neck dissection (level I-III) is recommended in T3-T4 N0 SCC. Simultaneous treatment of tumor and cervical lymph nodes provides a better prognosis as respect to delayed nodal management. Extra-capsular spread with or without bone engagement represents independent risk factor responsible for high mortality rate of SCC of the lower lip.

• 방사선산업학회지
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• 제17권4호
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• pp.391-396
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• 2023

Currently, state-of-the-art devices such as SPECT, PET/CT, and PET/MRI are rapidly spreading nationwide, and the penetration rate of nuclear medical devices is also ranked fifth in the world. However, PET/MRI's system is slower and less common because it is more complex than PET/CT. The purpose of this study is to provide optimal information on PET/MRI according to the patient's disease. The subjects obtained information on head and neck cancer, pediatric patients, breast cancer patients, heart disease patients, lung cancer patients, and rectal cancer patients. We tried to accumulate protocols by obtaining a lot of information about each disease. In diagnosing head and neck cancer, it is believed that it is highly likely to be used in evaluating preoperative stage determination, recurrence and remote metastasis after treatment, and unclear primary cervical lymph node metastasis. Diagnosis and continuous follow-up of pediatric patients can increase patient benefits by minimizing radiation exposure. Breast cancer provides a comprehensive evaluation of the clinical need to determine the extent of disease in breast and local lymph nodes and the systematic stages of early diagnosis or recurrence. In diagnosing heart disease patients, MR-based PET motion correction helps to realize the full potential of PET images. For lung cancer patients, the clinical value and usefulness of the resolution and detection ability of integrated PET/MRI for soft tissues such as lung cancer will be sufficient. In diagnosing rectal cancer patients, the detection of missing residual diseases can change the clinical response evaluation for rectal cancer patients treated with TNT, and both the initial stage and treatment response evaluation are possible. Therefore, this literature study provided basic clinical data for PET/MRI tests.

• Asian Pacific Journal of Cancer Prevention
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• 제16권12호
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• pp.5075-5079
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• 2015

Background: Adverse effects of treatment prolongation beyond 8 weeks with radiotherapy for cervical cancer have been established. Clinical data also show that cisplatin increases the biologically effective dose of radiotherapy. However, there are no data on the effect of overall treatment time in patients with locally advanced cervical cancer treated with concomitant chemo-radiotherapy (CCRT) in an Indian population. The present study concerned the feasibility of concurrent chemotherapy and interspacing brachytherapy during the course of external radiotherapy to reduce the overall treatment time and compare the normal tissue toxicity and loco-regional control with a conventional schedule. Materials and Methods: Between January 2009 and March 2012 fifty patients registered in the Gynaecologic Oncology Clinic of Institute Rotary Cancer Hospital with locally advanced cervical cancer (FIGO stage IIB-IIIB) were enrolled. The patients were randomly allocated to treatment arms based on a computer generated random number. Arm I (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions, and weekly cisplatin $40mg/m^2$. High dose rate intra-cavitary brachytherapy (HDR-ICBT) was performed after one week of completion of external beam radiotherapy (EBRT). The prescribed dose for each session was 7Gy to point A for three insertions at one week intervals. Arm II (n=25) treatment consisted of irradiation of the whole pelvis to a dose of 50 Gy in 27 fractions. Mention HDR-ICBT ICRT was performed after 40Gy and 7Gy was delivered to point A for three insertions (days 23, 30, 37) at one week intervals. Cisplatin $20mg/m^2/day$ was administered from D1-5 and D24-28. Overall treatment time was taken from first day of EBRT to last day of HDR brachytherapy. The overall loco-regional response rate (ORR) was determined at 3 and 6 months. Results: A total of 46 patients completed the planned treatment. The overall treatment times in arm I and arm II were $65{\pm}12$ and $48{\pm}4$ days, respectively (p=0.001). At three and six months of follow-up the ORR for arm I was 96% while that for arm II was 88%. No statistically significant difference was apparent between the two arms. The overall rate of grade ${\geq}3$ toxicity was numerically higher in arm I (n=7) than in arm II (n=4) though statistical significance was not reached. None of the predefined prognostic factors like age, performance status, baseline haemoglobin level, tumour size, lymph node involvement, stage or histopathological subtype showed any impact on outcome. Conclusions: In the setting of concurrent chemoradiotherapy a shorter treatment schedule of 48 days may be feasible by interspacing brachytherapy during external irradiation. The response rates and toxicities were comparable.

• Radiation Oncology Journal
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• 제14권4호
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• pp.307-315
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• 1996

목적 : 방사선치료를 시행한 자궁경부암 환자들의 생존율을 예후인자별로 비교분석함으로써 방사선 치료의 지표로 삼고자 하였다. 방법 : 1987년 1월부터 1988년 12월까지 자궁경부암으로 진단받고 본원 치료방사선과에서 방사선치료를 시행하였던 460명의 환자에 대한 치료결과를 후향적으로 분석하였다. 방사선치료 방법으로는 외부방사선 조사만 시행한 군이 103예, 외부방사선 조사 및 자궁강내 방사선 치료를 함께 시행한 군이 357예였다. 추적율은 88%, 총 추적 기간의 중앙값은 48개월이었다. 결과 : 전체 환자의 5년 생존율은 66.2%였다. FlGO 병기에 따른 5년 생존율은 Ib 81.2%, IIa 76.3%, IIb 73.1%, IIIa 50%, IIIb 52.3%, IVa 11.5%였다. 예후인자에 대한 분석에서 종양의 크기(P=0.0002), 림프절의 전이여부(p=0.0001), 종양의 성장형태(p=0.003), 치료 당시의 혈중 혈색소 농도(p=0.0001), 종양 세포의 종류(p=0.0001)등이 통계적으로 유의한 예후인자였으며, 35세 미만의 조기 발병인 경우 생존율의 감소가 관찰되었다(p=0.03). 그외 편평상피세포암의 종양 세포의 각질화 유무, 강내 방사선 치료 회수 등에 의한 생존율의 차이는 유의하지 않았다. 결론 : 자궁경부암의 방사선 치료시 주요 예후인자로는 종양의 크기 및, 성장형태, 림프절의 전이여부, 방사선치료시의 평균 혈중 혈색소치, 종양 세포의 종류등 이었다. 또한 35세 이전의 조기 발병 시에도 생존율이 감소하였다. 종양의 크기가 크면서 내장성 종양이거나, III기 이상이면서 종양이 큰 경우 등은 생존율의 향상을 위해 좀더 적극적인 치료가 필요하다.

• 대한영상의학회지
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• 제84권1호
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• pp.185-196
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• 2023

목적 갑상선 유두암 환자에서 림프절 전이를 예측할 수 있는 잠재적인 바이오마커를 개발하기 위해 초음파 영상에 대한 radiomics를 조사하는 것이다. 대상과 방법 2013년 8월부터 2014년 5월까지 431명의 환자가 연구에 포함되었고 통계 소프트웨어를 사용하여 훈련 및 검증 세트로 구분되었다. 총 730개의 radiomics 특징이 자동으로 추출되었다. 훈련 데이터 세트에서 가장 예측 가능한 특징을 선택하기 위해 최소 절대 수축 및 선택 연산자가 사용되었다. 결과 Radiomics 점수는 림프절 전이와 관련이 있었다(p < 0.001). 림프절 전이는 젊은 연령(p = 0.007) 및 더 큰 종양 크기(p = 0.007)와 같은 다른 임상 변수와도 관련이 있었다. 수신자 조작 특성 곡선 하 면적 결과 값은 훈련 세트의 경우 0.687 (95% 신뢰 구간: 0.616-0.759), 검증 세트의 경우 0.650 (95% 신뢰 구간: 0.575-0.726)이었다. 결론 본 연구 결과는 초음파 영상 기반의 radiomics가 papillary thyroid carcinoma 환자에서 경부 림프절 전이를 예측하고 바이오마커로 작용할 가능성을 보여주었다.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2369-2374
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• 2016

Background: Differentiated thyroid cancer (DTC) is a cancer group that shares molecular and cellular origin but shows different clinical courses and prognoses. Several prognostic factors have been reported for predicting recurrence for individual patients. This literature review aimed to evaluate prognostic scores for predicting recurrence of DTC. Materials and Methods: A search of the MEDLINE database for articles published until December 2015 was carried out using the terms "thyroid neoplasms AND (recurrent OR persistent) AND (score OR model OR nomogram)". Studies were eligible for review if they indicated the development of prognostic scoring models, derived from a group of independent prognostic factors, in predicting disease recurrence in DTC patients. Results: Of the 308 articles obtained, five were eligible for evaluation. Two scoring models were developed for DTC including both papillary and follicular carcinoma, one for papillary carcinoma, and the other two for papillary microcarcinoma. The number of patients included in the score development cohort ranged from 59 to 1,669. The number of evaluated potential prognostic factors ranged from 4 to 25. Tumor-related factors were the most common factors included in the final scores, with cervical lymph node metastases being the most common. Only two studies showed internal validation of the derived score. Conclusions: There is a paucity of prognostic scores for predicting disease recurrence in patients with DTC, in particular for follicular thyroid carcinoma. Several limitations of the created scores were found. Performance of the scores has not been adequately studied. Comprehensive validation in multiple cohorts is recommended before widespread use.

• Radiation Oncology Journal
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• 제1권1호
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• pp.85-94
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• 1983

A total of 47 patients with a diagnosis of nasopharyngeal carcinoma was treated in Department of Therapeutic Radiology, Seoul National University Hospital during last 4 years. Of the 47 patients, 23(49%) had undifferentiated carcinoma, 20(43%) had squamous cell carcinoma, while 4(8%) had lymphoepithelioma. Most of the patients(71%) has Stage IV disease, cervical lymph node metastases were found in 36(77%) and distant metastasis was found in 1 at the time of diagnosis. Complete response rate after radiotherapy for 47 patients of nasopharyngeal carcinoma was 85.1%. The overall actuarial 3 year survival rates was 0.718 and the disease free actuarial 3 year survival rates was 0.468. Nodal involvement and symptom duration were statistically significiant influencing factors for actuarial survival rate. Treatment failures were found in 20 patients (42.6%), local recurrence only in 6(30%), local and neck recurrence in 3(15%), local recurrence with metastasis in 4(20%) and distant metastasis only in 7(35%). Local failures were more frequent in the patients with cranial nerve symptoms (P=0.032). Distant metastases were more frequent with T4 lesions (P=0.047), and with nodal involvement (P<0.01). Retreatment after the tumor recurrence was chemotherapy and/or radiotherapy, two pationts refreated for local recurrence were alive without evidence of disease for more than 19 and 44 months after retreatment.

• Tuberculosis and Respiratory Diseases
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• 제44권5호
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• pp.1125-1131
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• 1997

Occult papillary adenocarcinoma of the thyroid is known to be indolent, slow metastatic, and has a good prognosis. Occult thyroid carcinoma presenting as a blood-borne metastasis without obvious cervical lymph node involvement is extremely rare. A 65-year-old male patient was visited for hoarseness, dysphagia, and shortness of breath. Bronchoscopy with biopsy revealed a papillary carcinoma of thyroid by immunohistochemical staining. Head & neck CT revealed that involving both the upper esophagus and the posterior tracheal wall, extending into the mediastinum along the upper thoracic spine at $T_1-T_2$. We have experienced a rare case of occult papillary carcinoma which invaded the trachea, esophagus and fascia of thoracic spine. Treatment was initiated with radioactive iodine and external bean therapy.

• 대한세포병리학회지
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• 제11권1호
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• pp.41-45
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• 2000

Thymoma is the most common anterior mediastinal tumor in adults. Rarely, it is presented as the anterior neck mass, commonly located in the anterolateral aspect of the neck or adjacent to the thyroid. We experienced two cases of fine needle aspiration cytology of thymoma, mimicking thyroid mass. The first case was an ectopoic cervical thymoma in a 31-year-old female. The fine needle aspiration cytology was misinterpreted as reactive hyperplasia of lymph node. But the histologic diagnosis was thymoma, predominantly lymphocytic type. The second case was an invasive thymoma in a 66-year-old female, who complained a large anterior neck mass. The fine needle aspiration cytology revealed biphasic population of some clusters of epithelial cells and scattered lymphocytes. The cytologic diagnosis was thymoma and was confirmed as invasive thymoma after the biopsy. Therefore, when the cytologic feature of anterior neck mass shows the both lymphocyte and epithelial component, the differential diagnosis should Include the possibility of thymoma.