• Journal of Korean Neurosurgical Society
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• v.50 no.4
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• pp.299-303
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• 2011

Objective : Brainstem metastases are rarely operable and generally unresponsive to conventional radiation therapy or chemotherapy. Recently, Gamma Knife Radiosurgery (GKRS) was used as feasible treatment option for brainstem metastasis. The present study evaluated our experience of brainstem metastasis which was treated with GKRS. Methods : Between November 1992 and June 2010, 32 patients (23 men and 9 women, mean age 56.1 years, range 39-73) were treated with GKRS for brainstem metastases. There were metastatic lesions in pons in 23, the midbrain in 6, and the medulla oblongata in 3 patients, respectively. The primary tumor site was lung in 21, breast in 3, kidney in 2 and other locations in 6 patients. The mean tumor volume was $1,517mm^3$ (range, 9-6,000), and the mean marginal dose was 15.9 Gy (range, 6-23). Magnetic Resonance Imaging (MRI) was obtained every 2-3 months following GKRS. Follow-up MRI was possible in 24 patients at a mean follow-up duration of 12.0 months (range, 1-45). Kaplan-Meier survival analysis was used to evaluate the prognostic factors. Results : Follow-up MRI showed tumor disappearance in 6, tumor shrinkage in 14, no change in tumor size in 1, and tumor growth in 3 patients, which translated into a local tumor control rate of 87.5% (21 of 24 tumors). The mean progression free survival was 12.2 months (range, 2-45) after GKRS. Nine patients were alive at the completion of the study, and the overall mean survival time after GKRS was 7.7 months (range, 1-22). One patient with metastatic melanoma experienced intratumoral hemorrhage during the follow-up period. Survival was found to be associated with score of more than 70 on Karnofsky performance status and low recursive partitioning analysis class (class 1 or 2), in terms of favorable prognostic factors. Conclusion : GKRS was found to be safe and effective for management of brainstem metastasis. The integral clinical status of patient seems to be important in determining the overall survival time.

• Radiation Oncology Journal
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• v.12 no.3
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• pp.331-336
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• 1994

Purpose : To assess the effectiveness and problems of the primary radiation therapy and salvage surgery in a series of patients affected by T1-T2NO glottic cancers treated from 1985 to 1991 at the Pusan National University Hospital. Materials and Methods : From 8/85 to 12/91,34 patients affected by early glottic carcinoma histologically proven were treated with curative radiation therapy, Distribution of patients according to T stage was 30 for T1 and 4 for T2. Male to female ratio was 33:1. Age of patients ranged from 31 to 73 with mean age of 58 years. All of the patients were treated with radical radiation with total tumor dose of 63-75. 3Gy(median 68.2Gy), of 5 weekly fractions of 1.8-2Gy and with 6MV photon beams through two laterally opposed fields. Results : The overall 5-year local control rates were $74\%$(8/30) for Tl, and $25\%$(3/4) for T2. The main cause of failure was progression or recurrence in T(10/11). One failures were observed in T and N at the same time. Of these 11 patients, 9($81\%$) were salvaged with surgery, After surgical salvage of radiation failures, the 5-year survival rates were $96\%$ for T1 and $75\%$ for T2. Among the survivors, $73\%$ of T1 and $33\%$ of T2 were able to preserve the larynx. Conclusion : It can be concluded that radiotherapy is the first choice in the treatment of glottic T1 carcinoma.

• Asian Pacific Journal of Cancer Prevention
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• v.14 no.7
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• pp.4205-4208
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• 2013

Objective: The aim of this study was to explore change and significance of serum carcino-embryonic antigen (CEA) before and after gefitinib therapy in patients with advanced non-small-cell lung cancer (NSCLC). Methods: Forty patients with advanced NSCLCs in III~IV stages were selected as study objects given gefitinib therapy combined with routine local radiotherapy until tumor progression or intolerable toxicity. After treatment, all patients were divided into control and non-control groups according to the results of evaluation based on RECIST 1.1 (Response Evaluation Criteria in Solid Tumors in 2009). Peripheral fasting blood from all patients was collected in the early morning and serum CEA was assessed by electro-chemiluminescence immunoassay (ECLIA) before and after treatment. Before treatment, patients were divided into high CEA group (CEA level > 50 ng/mL) and low CEA group (CEA level ${\leq}$ 50 ng/mL). Adverse reactions were noted and progression-free survival (PFS) in both groups was recorded after long-term follow-up that ended in December, 2012. Results: There was no difference between control and non-control groups in CEA level before treatment (P>0.05), whereas serum CEA decreased more markedly lower in the control group after treatment (P<0.01). All patients were divided into high CEA group (26) and low CEA group (14) according to serum CEA level. There was no statistically significant difference between two groups in adverse reactions (P>0.05) but the rate in former group was lower. Additionally, survival rates at 9 and 12 months in high CEA group were clearly higher than in the low CEA group (P<0.01). Conclusions: Serum CEA level can serve as a biochemical index to evaluate the prognosis with gefitinib treatment for NSCLC.

• Archives of Craniofacial Surgery
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• v.11 no.1
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• pp.58-61
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• 2010

Purpose: Sebaceous carcinoma is a rare malignant tumor that occurs mostly in head and neck regions. Early diagnosis and treatment are necessary because it tends to be locally aggressive and goes through distal metastasis with fast progression. This study presents reliable surgical methods for sebaceous carcinoma in head and neck regions. Methods: Three patients were included in this study. First, a 61-year-old woman visited the hospital with a yellow-colored, slowly growing mass on the left ala. A 54-year-old woman had a brown-colored mass on her right preauricle. Last case was a 62-year-old man who had a yellow-colored mass on his scalp. CT scan and punch biopsy were done. All cases were diagnosed as sebaceous carcinoma. The lesions were resected with 10 mm safety margin and various regional flaps were used for reconstruction. Results: Histological examination revealed sebaceous differentiation and local invasions. Postoperatively, all patients did not suffer from complication and no recurrence was found. Conclusion: We recommend early wide excision with an enough safety margin, and a regional flap as a treatment of sebaceous carcinoma.

• The Journal of Korean Medicine
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• v.39 no.4
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• pp.171-176
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• 2018

Background: Small cell lung cancer (SCLC) tends to grow more rapidly and spread much faster than non-small cell lung cancer (NSCLC). A concurrent combination of chemotherapy and thoracic radiotherapy is suggested as the standard conventional treatment, but it is more challenging for elderly patients having pulmonary and cardiovascular comorbidities. Case presentation: Here we present a case of an 80-year-old male, current smoker diagnosed with SCLC in limited stage T3N0M0 (36mm right upper lobe, satellite nodule) in Dec, 2015. The standard concurrent chemoradiotherapy was not available for his comorbidities, which included chronic obstructive pulmonary disease (COPD) and angina pectoris. Furthermore, he and his family refused the recommended chemotherapy or radiotherapy exclusively. Alternatively, he received various non-conventional treatments including local radiofrequency hyperthermia, mistletoe, and Traditional Korean medicine including acupuncture, moxibustion and herbs since Jan. 2016. Despite the progression in primary tumor size, there have been no other distant relapse so far, and the patient has been in stable condition ever since. Conclusion: We suggest that a combination of various alternative treatments could be a candidate for elderly patients intolerable to conventional cytotoxic treatments.

• Radiation Oncology Journal
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• v.32 no.3
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• pp.163-169
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• 2014

Purpose: To report the results of stereotactic body radiotherapy (SBRT) for unresectable primary or recurrent cholangiocarcinoma. Materials and Methods: From January 2005 through August 2013, 58 patients with unresectable primary (n = 28) or recurrent (n = 30) cholangiocarcinoma treated by SBRT were retrospectively analyzed. The median prescribed dose was 45 Gy in 3 fractions (range, 15 to 60 Gy in 1-5 fractions). Patients were treated by SBRT only (n = 53) or EBRT + SBRT boost (n = 5). The median tumor volume was 40 mL (range, 5 to 1,287 mL). Results: The median follow-up duration was 10 months (range, 1 to 97 months). The 1-year, 2-year overall survival rates, and median survival were 45%, 20%, and 10 months, respectively. The median survival for primary group and recurrent group were 5 and 13 months, respectively. Local control rate at 1-year and 2-year were 85% and 72%, respectively. Disease progression-free survival rates at 1-year and 2-year were 26% and 23%, respectively. In univariate analysis, ECOG performance score (0-1 vs. 2-3), treatment volume (<50 vs. ${\geq}50mL$), and pre-SBRT CEA level (<5 vs. ${\geq}5ng/mL$) were significant in overall survival rate. In multivariate analysis, ECOG score (p = 0.037) and tumor volume (p = 0.030) were statistically significant. In the recurrent tumor group, patients with >12 months interval from surgery to recurrence showed statistically significant higher overall survival rate than those with ${\leq}12$ months (p = 0.026). Six patients (10%) experienced ${\geq}$grade 3 complications. Conclusion: SBRT can be considered as an effective local modality for unresectable primary or recurrent cholangiocarcinoma.

• Radiation Oncology Journal
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• v.36 no.3
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• pp.182-191
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• 2018

Purpose: To investigate the clinical outcome of proton therapy (PT) in patients with chordoma. Materials and Methods: Fifty-eight patients with chordoma treated with PT between June 2007 and December 2015 at the National Cancer Center, Korea, were retrospectively analyzed. The median total dose was 69.6 cobalt gray equivalent (CGE; range, 64.8 to 79.2 CGE). Local progression-free survival (LPFS), distant metastasis-free survival (DMFS), overall survival (OS), and disease-specific survival (DSS) rates were calculated by the Kaplan-Meier method. Results: With the median follow-up of 42.8 months (range, 4 to 174 months), the 5-year LPFS, DMFS, OS, and DSS rates were 87.9%, 86.7%, 88.3%, and 92.9%, respectively. The tumor location was associated with the patterns of failure: the LPFS rates were lower for cervical tumors (57.1%) than for non-cervical tumors (93.1%) (p = 0.02), and the DMFS rates were lower for sacral tumors (53.5%) than for non-sacral tumors (100%) (p = 0.001). The total dose was associated with both the LPFS rate and DMFS rate. The initial tumor size was associated with the DMFS rate, but was not associated with the LPFS rate. Three patients had grade 3 late toxicity with none ≥grade 4. Conclusion: PT is an effective and safe treatment in patients with chordomas. The tumor location was associated with the patterns of failure: local failure was common in cervical tumors, and distant failure was common in sacral tumors. Further refinement of PT, such as the utilization of intensity modulated PT for cervical tumors, is warranted to improve the outcome.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.2
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• pp.737-742
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• 2012

To evaluate efficacy of microwave ablation in a primary clinical study, sixty patients (44 men, 16 women; mean age 53 years) with 96, 1-8 cm (mean $3.20{\pm}0.17$ cm) liver cancers were treated with 2,450-MHz internally cooled-shaft antenna. Complete ablation (CA) and local tumor progression (LTP) rates as well as complications were determined. CA rates in small (< 3.0 cm), intermediate (3.1-5.0 cm) and large (5.1-8.0 cm) liver cancers were 96.4% (54/56), 92.3% (24/26) and 78.6% (11/14), respectively. During a mean follow-up period of $17.17{\pm}6.52$ months, LTP occurred in five (5.21%) treated cases. There was no significant difference in the CA and LTP rates between the HCC and liver metastasis patient subgroups (P<0.05). Microwave ablation provides a reliable, efficient, and safe technique to perform hepatic tumor ablation.

• Journal of Korean Neurosurgical Society
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• v.58 no.3
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• pp.217-224
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• 2015

Objective : To investigate the efficacy and safety of fractionated stereotactic radiosurgery for large brain metastases (BMs). Methods : Between June 2011 and December 2013, a total of 38 large BMs >3.0 cm in 37 patients were treated with fractionated Cyberknife radiosurgery. These patients comprised 16 men (43.2%) and 21 women, with a median age of 60 years (range, 38-75 years). BMs originated from the lung (n=19, 51.4%), the gastrointestinal tract (n=10, 27.0%), the breast (n=5, 13.5%), and other tissues (n=3, 8.1%). The median tumor volume was 17.6 cc (range, 9.4-49.6 cc). For Cyberknife treatment, a median peripheral dose of 35 Gy (range, 30-41 Gy) was delivered in 3 to 5 fractions. Results : With a median follow-up of 10 months (range, 1-37 months), the crude local tumor control (LTC) rate was 86.8% and the estimated LTC rates at 12 and 24 months were 87.0% and 65.2%, respectively. The median overall survival (OS) and progression-free survival (PFS) rates were 16 and 11 months, respectively. The estimated OS and PFS rates at 6, 12, and 18 months were 81.1% and 65.5%, 56.8% and 44.9%, and 40.7% and 25.7%, respectively. Patient performance status and preoperative focal neurologic deficits improved in 20 of 35 (57.1%) and 12 of 17 patients (70.6%), respectively. Radiation necrosis with a toxicity grade of 2 or 3 occurred in 6 lesions (15.8%). Conclusion : These results suggest a promising role of fractionated stereotactic radiosurgery in treating large BMs in terms of both efficacy and safety.

• Journal of Korean Neurosurgical Society
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• v.29 no.5
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• pp.701-705
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• 2000

Solitary plasmacytomas are rare and account for 5-10% of all plasma cell disorders. These tumors are categorized as solitary plasmacytomas of bone(osseous) or extramedullary plasmacytomas(non-osseous). About a half of solitary plasmacytomas of bone occur in the spine but rarely in the skull. We report a case of solitary plasmacytoma of the skull presented with a painless palpable left parietal calvarial mass in an otherwise asymptomatic 38- year-old man. Skull radiographs showed a large radiolucent lesion with well defined non-sclerotic margins. Computed tomograph scan demonstrated a markedly enhancing mass extending from the epidural to the subcutaneous space. The patient underwent surgery and tumor was completely excised. Pathological examination showed tumor to be a plasmacytoma synthesizing IgG. Postoperatively, the patient received radiotherapy. There was no evidence of systemic involvement on postoperative laboratory wokups. Our recommended treatment is a complete surgical excision combined with postoperative radiation therapy. The patient should be follwed carefully for more than 10 years because of either local recurrence or possible progression to multiple myeloma.