• Radiation Oncology Journal
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• 제35권2호
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• pp.153-162
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• 2017

Purpose: To evaluate intracranial control after surgical resection according to the adjuvant treatment received in order to assess the optimal radiotherapy (RT) dose and volume. Materials and Methods: Between 2003 and 2015, a total of 53 patients with brain oligometastases from non-small cell lung cancer (NSCLC) underwent metastasectomy. The patients were divided into three groups according to the adjuvant treatment received: whole brain radiotherapy (WBRT) ${\pm}$ boost (WBRT ${\pm}$ boost group, n = 26), local RT/Gamma Knife surgery (local RT group, n = 14), and the observation group (n = 13). The most commonly used dose schedule was WBRT (25 Gy in 10 fractions, equivalent dose in 2 Gy fractions [EQD2] 26.04 Gy) with tumor bed boost (15 Gy in 5 fractions, EQD2 16.25 Gy). Results: The WBRT ${\pm}$ boost group showed the lowest 1-year intracranial recurrence rate of 30.4%, followed by the local RT and observation groups, at 66.7%, and 76.9%, respectively (p = 0.006). In the WBRT ${\pm}$ boost group, there was no significant increase in the 1-year new site recurrence rate of patients receiving a lower dose of WBRT (EQD2) <27 Gy compared to that in patients receiving a higher WBRT dose (p = 0.553). The 1-year initial tumor site recurrence rate was lower in patients receiving tumor bed dose (EQD2) of ${\geq}42.3Gy$ compared to those receiving <42.3 Gy, although the difference was not significant (p = 0.347). Conclusions: Adding WBRT after resection of brain oligometastases from NSCLC seems to enhance intracranial control. Furthermore, combining lower-dose WBRT with a tumor bed boost may be an attractive option.

• Radiation Oncology Journal
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• 제32권3호
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• pp.132-137
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• 2014

Purpose: To evaluate non-sentinel lymph node (LN) status after sentinel lymph node biopsy (SNB) in patients with breast cancer and to identify the predictive factors for disease failure. Materials and Methods: From January 2006 to December 2007, axillary lymph node (ALN) dissection after SNB was performed for patients with primary invasive breast cancer who had no clinical evidence of LN metastasis. A total of 320 patients were treated with breast-conserving surgery and radiotherapy. Results: The median age of patients was 48 years, and the median follow-up time was 72.8 months. Close resection margin (RM) was observed in 13 patients. The median number of dissected SNB was two, and that of total retrieved ALNs was 11. Sentinel node accuracy was 94.7%, and the overall false negative rate (FNR) was 5.3%. Eleven patients experienced treatment failure. Local recurrence, regional LN recurrence, and distant metastasis were identified in 0.9%, 1.9%, and 2.8% of these patients, respectively. Sentinel LN status were not associated with locoregional recurrence (p > 0.05). Close RM was the only significant factor for disease-free survival (DFS) in univariate and multivariate analysis. The 5-year overall survival, DFS, and locoregional DFS were 100%, 96.8%, and 98.1%, respectively. Conclusion: In this study, SNB was performed with high accuracy and low FNR and high locoregional control was achieved.

• Journal of Chest Surgery
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• 제44권3호
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• pp.269-271
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• 2011

Pilomatrix carcinoma originates in the matrix cell and is marked by exophytic growing and common local recurrence. There is no established treatment for wide local invasion and metastasis of the pilomatrix besides wide surgical resection. We report a case of rapidly progressive pilomatrix carcinoma, which arose around an Eloesser open window with direct invasion to the adjacent tissue.

• 대한두개안면성형외과학회지
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• 제19권4호
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• pp.283-286
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• 2018

Malignant pilomatricoma (pilomatrical carcinoma) is a rare, locally occurring malignant tumor with a high rate of recurrence in the case of incomplete excision. This tumor has two characteristics. First, recurrences of pilomatrical carcinoma are common; second, distant metastasis is rare, but if it occurs, it is very fatal. It has characteristic features of high mitotic counts, cellular atypia, and local invasion. Although fine needle aspiration and excisional biopsy could help to confirm this tumor diagnosis, pathologic findings are critical. Pilomatricomas have some characteristic features in histological aspect, such as epithelial islands of basaloid cells and shadow cells or ghost cell. Also, various types of immunohistochemical staining are used to confirm the diagnosis. Despite the lack of clear surgical criteria, treatment is a wide local excision with histologically clear resection margins with or without adjuvant radiotherapy.

• Journal of Korean Neurosurgical Society
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• 제30권3호
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• pp.349-357
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• 2001

목 적 : 높은 재발율과 전이 가능성의 특징을 갖고 있는 수막 혈관외세포종은 perivascular pericytes에서 기원하는 드문 종양으로, 저자들이 경험한 수막 혈관외세포종에 있어서 종양의 재발 및 신경계외 전이에 대하여 알아 보고자 한다. 연구 대상 및 방법 : 1982년부터 1999년까지 수술을 시행하여 수막 혈관외세포종으로 진단받은 31명의 환자를 대상으로 후향적 연구를 시행하였다. 진단 후 재발까지의 기간, 재발에 영향을 미칠 수 있는 여러 가지 인자들, 그리고 신경계외 전이의 기간 및 부위 등을 분석하였다. 결 과 : 총 31명의 환자들 중 12명의 환자들에서 원발성 부위에 종양이 재발하였다(38.7%). 전체의 환자들에서 재발이 발생하지 않았던 평균 기간(recurrence-free period : RFP)은 104개월이었으며 처음 수술 후 5년, 그리고 10년의 재발이 발생하지 않았던 율(recurrence free period : RFP)은 각각 59.2%, 33.6% 이었다. 원발성 부위에 종양의 재발을 보였던 12명의 환자들 중 4명의 환자들에서 첫 수술 후 5년 이후에 재발을 관찰 할 수 있었다. 처음 수술시의 절제 정도가 재발에 가장 큰 영향을 미쳤다. 처음 수술시에 완전 절제한 군의 RFP는 111 개월이었으며, 추적 관찰 5년째 RFR는 완전 절제한 경우 72.7%, 불완전 절제한 경우 20.8%로 그 차이는 통계 적으로 유의하였다(p=0.0060). 통계적으로 유의성은 없었지만 완전 절제 후 부가적인 방사선 치료를 시행하였을 경우가 완전 절제만을 시행한 경우보다 RFR가 높아 추적 관찰 5년째의 RFR는 각각 100%, 그리고 70.3% 이었다(p=0.3359). 4명의 환자들(12.9%)에서 수막 혈관외세포종의 신경계외 전이가 발생하였으며, 이 경우 신경계 외 전이의 평균 기간은 107개월, 그리고 추적 관찰 5년, 10년째의 신경계외 전이율은 각각 4.4%, 24.9% 이었다. 결 론 : 수막 혈관외세포종은 수술적 제거 후 원발성 부위에 또는 원발성 부위에서 멀리 떨어진 부위에 재발의 가능성이 무척 높은 종양이다. 이러한 재발의 가능성을 줄이는 가장 중요한 인자는 수술적 제거 정도로 처음 수술시에 가능한 완전 절제를 시도하여야 한다. 그리고 처음 수술시에 완전 절제가 가능하였다고 하여도 완전 절제 후 부가적인 방사선 치료를 시행하는 것이 재발의 위험성을 낮출 수 있을 것으로 생각한다. 원발성 부위의 재발 또는 신경계외 전이는 오랜 시간이 지난 후에도 가능할 수 있으므로 장기간의 추적 관찰이 필요하다고 생각한다.

• Radiation Oncology Journal
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• 제30권4호
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• pp.213-217
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• 2012

Purpose: To evaluate treatment outcome of patients with high risk locally advanced gastric cancer after postoperative chemoradiotherapy. Materials and Methods: Between May 2003 and May 2012, thirteen patients who underwent postoperative chemoradiotherapy for gastric cancer with resection margin involvement or adjacent structure invasion were retrospectively analyzed. Concurrent chemotherapy was administered in 10 patients. Median dose of radiation was 50.4 Gy (range, 45 to 55.8 Gy). Results: The median follow-up duration for surviving patients was 48 months (range, 5 to 108 months). The 5-year overall survival rate was 42% and the 5-year disease-free survival rate was 28%. Major pattern of failure was peritoneal seeding with 46%. Locoregional recurrence was reported in only one patient. Grade 2 or higher gastrointestinal toxicity occurred in 54% of the patients. However, there was only one patient with higher than grade 3 toxicity. Conclusion: Despite reported suggested role of adjuvant radiotherapy with combination chemotherapy in gastric cancer, only very small portion of the patients underwent the treatment. Results from this study show that postoperative chemoradiotherapy provided excellent locoregional control with acceptable and manageable treatment related toxicity in patients with high risk locally advanced gastric cancer. Thus, postoperative chemoradiotherapy may improve treatment result in terms of locoregional control in these high risk patients. However, as these findings are based on small series, validation with larger cohort is suggested.

• Journal of Chest Surgery
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• 제24권8호
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• pp.802-806
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• 1991

Primary neoplasms of the ribs and sternum are rare. Most primary bony chest wall neoplasms are malignant, and chondrosarcoma is the most common malignancy in this location The etiology of chondrosarcoma is unknown. Definitive diagnosis of chondrosarcoma can only be made pathologically. The natural history of chest wall chondrosarcoma is one of slow growth and local recurrence. Most tumors of the sternum require wide resection and reconstruction procedures, with potentially serious postoperative problems. Advances in chest wall reconstruction primarily through refinement in muscle transposition and clarification of the functional anatomy and blood supply of trunk muscles, has resulted in a more aggressive resection of the these tumors . Recently we experienced a case with chondrosarcoma of the sternum. A 56 year-old man was admitted to our hospital due to painless, slowly enlarging mass at the left sternoclavicular junctional area. The chest radiograph strongly suggested an underlying cartilaginous neoplasm owing to the appearance of typical flocculent and curvilinear calcifications within the lesion. On CT of the chest, the tumor exhibited a scalloped or lobulated contour, hypodensity of the nonmineralized component in comparison to adjacent muscle, and characteristic stippled cartilaginous matrix mineralization, also typical for cartilaginous neoplasm. The patient underwent wide resection of the chest wall tumor include with a 2-3cm margin of normal tissue on all sides and the thoracic skeletal defect was reconstructed with polytetrafluoroethylene [Gore-Tex] soft-tissue patch. Soft tissue reconstructive procedure was done with the pectoralis major muscle transposition. The patient had an uneventful postoperative course and discharged without adjuvant treatment such as radiation and chemotherapy.

• Journal of Chest Surgery
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• 제36권9호
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• pp.707-710
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• 2003

척삭종은 원시 척삭(primitive notochord)의 잔유물에서 발생하여 서서히 성장하는 악성종양으로 매우 드문 종양이다. 뿐만 아니라, 후총격동 종양으로 나타나는 흉부 척삭종은 보고된 모든 척삭종의 1∼2％만을 차지하고 있다. 이러한 척삭종은 불완전한 절제가 될 경우 국소재발과 원격전이를 하여 예후가 불량하지만, 완전 절제와 수술 후 보조적 방사선 요법이 병행된 경우에는 완치를 기대할 수 있다. 삼성서울병원 흥부외과에서는 최근, 후종격동 종양으로 나타난 흉부 척삭종을 완전절제술 및 술 후 보조적 방사선요법을 시행하여 2년 동안 재발 및 전이가 없는 예를 경험하였기에 보고하는 바이다

• Journal of Chest Surgery
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• 제40권7호
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• pp.526-528
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• 2007

골조직에 발생하는 거대세포종은 국소적으로는 양성이지만 재발률이 매우 높고, 아주 드물게 원격전이를 일으킬 수 있다. 우측 요골에 발생한 거대세포종이 치료 후 재발되어, 요골을 제거한 후, 다시 동측 흉벽 연부조직에 전이된 29세의 남자환자를 보고하는 바이다. 종양은 흉벽의 골조직과는 연관이 없었다. 수술은 주위 연부조직과 함께 광범위 절제하였으며, 조직학적 검사상 악성 종양을 시사하는 소견은 없었다.

• 대한두경부종양학회지
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• 제13권1호
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• pp.81-85
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• 1997

Basal cell adenocarcinoma is a rare, recently described neoplasm of the salivary gland. We have experienced three cases of basal cell adenocarcinoma of the parotid gland. The tumors from patient 1 and patient 2 showed intraparotid growth in superficial lobe without cervical lymphnode metastasis. So, patient 1 and patient 2 underwent only a superficial parotidectomy and subdigastric lymphnode dissection without any adjuvant therapy. They are alive without recurrence or distant metastasis. But that of patient 3 showed widely invasive growth with multiple cervical lymph node metastases. The CT scan showed a $8{\times}7cm$ sized huge mass replacing the parotid gland with irregular margin and multiple lymphnode enlargements along the internal jugular vein. Total parotidectomy with sacrifying the facial nerve and standard radical neck dissection were caried out. Microscopically, the tumor consisted of solid nest and sheet of uniform basaloid cells separated by a fibrous connective tissue stroma with the evidence of lymphovascular invasion. As a result of the lymphnode metastasis and invasiveness of the tumor, radiation therapy was given postoperatively. We thought that close follow-up would be mandatory in this patient because of high risk of possible local recurrence and distant metastasis.