• Radiation Oncology Journal
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• v.23 no.3
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• pp.137-142
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• 2005

Purpose: To analyze the outcome of radiation therapy for patients with a metastatic carcinoma of cervical lymph nodes from an unknown primary (MUO), and identify the prognostic factors for these patients. Materials and Methods: Between July 1981 and June 1999, 39 patients with MUO underwent radiation therapy with curative intent. Twelve patients were treated with radiation therapy alone (Group 1), 8 with neoadjuvant chemotherapy followed by radiation therapy (Group 2), and 19 with either an excision or neck dissection and postoperative radiation therapy (Group 3). There were 31 males and 8 females, with a median age of 55 years, ranging from 25 to 77 ears. The median duration of follow-up was 38 months, ranging from 3 to 249 months. Results: The 5-year overall survival rate was $55\%$. According to the treatment modality, the 5-year disease-free survival rates of Groups 1, 2 and 3 were 48, 19 and $75\%$, respectively (p=0.0324). In addition to the treatment modality, the appearance of the primary site was a significant prognostic factor for disease-free survival (p=0.0085). Conclusion: Surgical resection and radiation therapy achieves a superior disease-free survival compared to radiation therapy alone, either with or without chemotherapy Further investigation Is needed to evaluate the role of chemotherapy in the treatment of MUO.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.36-41
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• 1999

Purpose : We reviewed the treatment results for the patients with locally recurrent rectal carcinoma. The object was to evaluate the treatment outcome and to identify the prognostic factors influencing the survival. Methods and Materials: Twenty-eight patients with locally recurrent rectal carcinoma treated principally with external-beam radiation therapy between 1982 to 1996 in the Department of Radiation Oncology at Paik and Hanyang Hospital were reviewed retrospectively Of these, 17 patients had initially abdominoperineal resection, 9 had low anterior resection, and 2 had local excision. No patients had received adjuvant radiation therapy for the primary disease. There were 14 men and 14 women whose ages ranged from 31 to 72 years (median age:54.5). Median time from initial surgery to the start of radiation therapy for local recurrence was 11 months (4~47 months). Radiation therapy was given with total doses ranging from 27 to 64.8 Gy (median=51.2 Gy). Results : The median survival was 16.7 months. The 2-year and 5-year survival rates were 20.1%, 4.1% respectively. Upon multivariate analysis, overall survival was positively correlated with duration of intervals from initial surgery to local recurrence (P=0.039). Relief of pelvic symptoms was achieved in 17 of 28 patients (60.7%). Pain and bleeding responded in 40% and 100% of patients, respectively Conclusions : Patients with locally recurrent rectal carcinoma treated with radiotherapy have benefited symptomatically, and might have increased survivals with a small chance of cure. But, patient were rarely cured (median survival : 10 months, 5-year survival : less than 5%). Overall survival was positively correlated with long intervals from initial surgery to local recurrence. Future efforts should be directed to the use of effective therapy for patients with locally recurrent rectal carcinoma and adjuvant therapy for patients with rectal cancer to reduce the incidence of pelvic recurrence.

• Radiation Oncology Journal
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• v.17 no.1
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• pp.43-51
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• 1999

Purpose : To discuss the technical aspect of interstitial brachytherapy including method of implant, insertion time of radioactive source, total radiation dose, and complication, we reviewed patients who had diagnoses of soft tissue sarcoma and were treated by conservative surgery, interstitial implant and external beam radiation therapy Materials and Methods : Between May 1995 and Dec. 1997, ten patients with primary or recurrent soft tissue sarcoma underwent surgical resection (wide margin excision) and received radiotherapy including interstitial brachytherapy. Catheters were placed with regular intervals of 1 ~l.5 cm immediately after tumor removal and covering the critical structures, such as neurovascular bundle or bone, with gelform, muscle, or tissue expander in the cases where the tumors were close to those structures. Brachytherapy consisted of high dose rate, iridium-192 implant which delivered 12~15 Gy to 1 cm distance from the center of source axis with 2~2.5 Gy/fraction, twice a day, starting on 6th day after the surgery, Within one month after the surgery, total dose of 50~55 Gy was delivered to the tumor bed with wide margin by the external beam radiotherapy. Results : All patients completed planned interstitial brachytherapy without acute side effects directly related with catheter implantation such as infection or bleeding. With median follow up duration of 25 months (range 12~41 months), no local recurrences were observed. And there was no severe form of chronic complication (RTOGIEORTC grade 3 or 4). Conclusion : The high dose rate interstitial brachytherapy is easy and safe way to minimize the radiation dose delivered to the adjacent normal tissue and to decrease radiation induced chronic morbidity such as fibrosis by reducing the total dose of external radiotherapy in the management of soft tissue sarcoma with conservative surgery.

• Radiation Oncology Journal
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• v.26 no.3
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• pp.135-141
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• 2008

Purpose: To evaluate the clinical outcomes and prognostic factors in retroperitoneal soft tissue sarcomas treated by postoperative radiotherapy. Materials and Methods: The records of 23 patients with retroperitoneal soft tissue sarcomas, who underwent postoperative radiotherapy between 1985 and 2003, were analyzed. The median follow-up period was 77 months (range, $8{\sim}240$ months). A total of 21 patients presented with primary disease, and two patients presented with recurrent disease. Liposarcomas and leiomyosarcomas represented 78% of the diagnosed tumor cases. Moreover, 17 cases were of high grade (grade 2 or 3). The median tumor size was 13 cm (range, $3{\sim}50\;cm$). Complete excision was achieved in 65% of patients. The median radiation dose was 50.4 Gy (range, 45.0 to 59.4 Gy), with conventional fractionation. Results: The 5-year overall, local recurrence-free, and distant metastasis-free survival rates were 68%, 58%, and 71%, respectively. Eleven patients experienced local recurrence, while 9 patients experienced distant metastasis. The most common site for distant metastasis was the liver. A univariate analysis revealed that adjacent organ invasion and age (>60 years) as the significant risk factors contributing to the prediction of poor overall survival. Moreover, multivariate analyses indicated that adjacent organ invasion remained significantly associated with a higher risk of death. In addition, patient age (>60 years) was the other identified risk factor for local recurrence by univariate and multivariate analyses. Except for one case of grade 3 diarrhea, no patient suffered grade 3 or higher complications. Conclusion: Our results were comparable to previous reports in that adjacent organ invasion and patient age (>60 years) were significant predictors of poor survival and tumor recurrence, respectively.

• Journal of Gastric Cancer
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• v.13 no.3
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• pp.164-171
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• 2013

Purpose: Laparoscopy-assisted distal gastrectomy for early gastric cancer has gained acceptance and popularity worldwide. However, laparoscopy-assisted distal gastrectomy for advanced gastric cancer is still controversial. Therefore, we propose this prospective randomized controlled multi-center trial in order to evaluate the safety and feasibility of laparoscopy assisted D2-gastrectomy for advanced stage gastric cancer. Materials and Methods: Patients undergoing distal gastrectomy for advanced gastric cancer staged cT2/3/4 cN0/1/2/3a cM0 by endoscopy and computed tomography are eligible for enrollment after giving their informed consent. Patients will be randomized either to laparoscopyassisted distal gastrectomy or open distal gastrectomy. Sample size calculation revealed that 102 patients are to be included per treatment arm. The primary endpoint is the non-compliance rate of D2 dissection; relevant secondary endpoints are three-year disease free survival, surgical and postoperative complications, hospital stay and unanimity rate of D2 dissection evaluated by reviewing the intraoperative video documentation. Discussion: Oncologic safety is the major concern regarding laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Therefore, the non-compliance rate of clearing the N2 area was chosen as the most important parameter for the technical feasibility of the laparoscopic procedure. Furthermore, surgical quality will be carefully reviewed, that is, three independent experts will review the video records and score with a check list. For a long-term result, disease free survival is considered a secondary endpoint for this trial. This study will offer promising evidence of the feasibility and safety of Laparoscopy-assisted distal gastrectomy for advanced gastric cancer. Trial Registration: NCT01088204 (international), NCCCTS-09-448 (Korea).

• Korean Journal of Head & Neck Oncology
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• v.23 no.2
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• pp.153-156
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• 2007

Objectives : We study the feasibility and pharmacokinetics of cisplatin concurrent chemoradiation for advanced head and neck cancer patient undergoing hemodialysis. Materials and Methods : A 57-year old male with end stage renal disease developed stage III external auditory canal cancer. Complete resection surgery was done. Postoperative 6 months, local recurrence was occurred. Despite excision and adjuvant radiotherapy, local tumor was recurred. We decided to treat a cisplatin concurrent chemoradiotherapy. Cisplatin was administered at a dose of $20mg/m^2$ for 30 min. Hemodialysis was started 30 min after completion of the cisplatin infusion and performed for 4 hours. Hemodialysis was performed on day 3 and 5 of chemotherapy. Plasma samples were collected at specified times after administration of cisplatin. Result : At the end of the third cycle of cisplatin concurrent chemoradiotherapy, the tumor size was markedly decreased. The maximum plasma concentrations of plasma platinum and free platinum were 0.74 and $0.37{\mu}g/ml$ respectively. The area under the curve of plasma platinum and free platinum were 94.7 and $11.3{\mu}g{\cdot}h/ml$ respectively. Conclusion : We report a case of Cisplatin concurrent chemoradiation for hemodialysis patient with advanced head and neck cancer and suggest full dose cisplatin concurrent chemoradiotherpay is tolerable for these patients.

• Childhood Kidney Diseases
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• v.2 no.2
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• pp.125-132
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• 1998

Purpose : To study whether a low protein diet increase the efficacy of antihypertensive therapy on the progression of renal failure, we conducted an experimental study using 5/6 nephrectomized rats(n=63). Methods : At 7 days after surgery, rats were randomly assigned to three groups according to receiving antihypertensive drug: no antihypertensive drug (U), enalapril (E), and nicardipine (N), respectively and fed a low protein diet (6$\%$ protein). Proteinuria, mesangial matrix expansion score and glomerular volume were assessed at 4, 12 and 16 weeks after renal ablation. Results : Group U rats on a low protein diet developed progressive hypertension ($140{\pm}8,\;162{\pm}5,\;171{\pm}5\;and\;184{\pm}11\;mmHg$ at 4, 8, 12 and 16 weeks) which were controlled by E and N. Group U rats on a low protein diet developed proteinuria ($74{\pm}15\;mg/day$ at 16 weeks) which were decreased by E ($42{\pm}12 mg/day$) or N ($48{\pm}8 mg/day$) (p<0.05). Mesangial matrix expansion score and glomerular volume were not different between groups U, E and N on a low protein diet regardless of the antihypertensive drugs administered. Conclusion : A low protein diet did not affect blood pressure. Enalapril and nicardipine-treated rats on a low protein diet did not have different mesangial matrix expansion and glomerular volumes from rats on a low protein diet at 12 weeks and 16 weeks, in spite of the better controlling of systemic hypertension and lessening of proteinuria. Thus, combined treatment with a low protein diet and antihypertensive drugs didn't appear to show any addition,11 effects to attenuate glomerular injury.

• Journal of Chest Surgery
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• v.31 no.7
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• pp.679-683
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• 1998

From June 1995 to May 1997, we have implanted 52 Sorin Bicarbon mechanical valves in 41 patients. They were 16 men and 25 women, and their mean age was 47.4${\pm}$14.8(range; 18∼74 y.o.). 35(27 mm∼31 mm) were in mitral position, 15(19 mm∼25 mm) in aortic position, and 2(31 mm) in tricuspid position. 3 CABGs and a tumor excision were taken concomittantly. 35 patients were primary operation, and 6 were re-do operations. By intraoperative transesophageal doppler echocardiography, transvalvular peak/mean pressure gradient was 6.1${\pm}$2.7/2.4${\pm}$1.4 mmHg in mitral position and 27.6/10.7 mmHg in aortic position. The effective valve opening area in mitral position was 3.2${\pm}$0.6 cm2. Follow-up was total 508.6 patient-months, and mean follw-up was 12.7${\pm}$9.2 months. NYHA class was improved from 2.6${\pm}$0.6 to 1.2${\pm}$0.3 in average postoperatively. During that period, there was no operative death. 2 late non-valve related deaths were occurred. One was died of COPD, and the other was possible acute myocardial infarction. Among 7 postoperative complications, one valve related complication(minimal paravalvular leakage) was noticed. In conclusion, Sorin Bicarbon mechanical valve is believed one of the safe choice in clinical settings. It showed excellent hemodynamic and mechanical functions, and very low postoperative valve related complications in short term clinical experience.

• Journal of the Korean Arthroscopy Society
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• v.6 no.1
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• pp.14-20
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• 2002

Purpose : To analyze the clinical result of the arthroscopic decompression of meniscal cyst and meniscus resection or repair of meniscus tear. Materials and Methods : From April 1994 and October 2001, 19 patients with diagnosis of meniscal cyst associated with tears of the meniscus were treated by arthroscopic meniscal resection or repair with decompression of the cyst. The mean age was 39.8 years(range, 22-58years). The follow-up period ranged from 3 months to 36 months with an average of 18 months. Seven of 19 patients had tenderness over the joint line with palpable mass. Treatment consists of arthroscopic resection or repair of meniscal tear with decompression of the cyst through transmeniscal approach. Open excision of cyst was performed in one case. Clinical evaluation was performed using Lysholm knee score and Tegner activity. All cases were executed proper treatment using arthroscopy. Results : Twelve cysts involved the lateral meniscus$(64\%)$ and seven cysts were on medial cyst$(36\%)$. Most of lateral meniscal cysts were located in anterior one-third and medial meniscal cyst were on posterior one-third. Meniscal tear were observed in seventeen cases$(89.5\%)$ and most tears were horizontal$(79\%)$. Preoperative symptom disappeared and no cyst recurrences were observed at last follow-up(mean follow-up: 18 months). Conclusion : Meniscal cysts involved lateral side in $64\%$ and most of them were associated with meniscus tear$(89.5\%)$ which consists of mainly horizontal component$(79\%)$.

• Journal of the Korean Arthroscopy Society
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• v.10 no.2
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• pp.178-183
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• 2006

Purpose: We reported the results and efficiency of arthroscopic treatment in a state of the lateral traction about the degenerative arthris of elbow Materials and Methods: Twenty one elbows with the degenerative arthritis who were followed up for at 12 months were enrolled in this study. Male were 15 cases, female were 6 cases, the mean age was 47 years and right dominant hand was 14 cases. In all cases, during arthroscopic treatment under the traction of 10 pounds, we had done synovectomy, excision of loose body and anteroposterior spur. After operation, immobilization was done in the full extension state, and then continuous passive motion (CPM) was started two day Results: The average preoperative ROM of the elbow joint was $30{\sim}l15$ degree and the average postoperative ROM of the elbow joint was $5{\sim}130$ degree. The increasement of ROM was totally 41 degree in extension 25 degree and flexion 16 degree. The decrement of VAS in pain was from 7.5 into 2.3 and the increasement of the satisfactory function was from 1.8 into 9.0. Complication was in two cases. One was paresthesia of ulnar nerve, but resolved. The other was bullae formation around the elbow joint, but cured. Conclusion: Regarding degenerative arthritis of elbow, arthroscopic treatment showed excellent result in recovery of range of motion and relief of pain. We could obtain good visual field with distraction in lateral position.