• Radiation Oncology Journal
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• 제11권2호
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• pp.303-309
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• 1993

Between November 1983 and December 1992, 121 patients with non-small cell lung cancer were treated with radiotherapy alone or combined with chemotherapy in Inje University, Seoul Paik Hospital. Of these,97 patients were evaluable and analyzed retrospectively. Group 1 (n=62)was treated with radiotherapy alone and group 2 (n=35) combined with chemotherapy. There were 7 patients, 1 patient with stage I and II ,20 patients, 11 patients with stage IIIA,28 patients, 20 patients with stage IIIB, and 6 patients, 3 patients with stage IV, respectively. Ninety percent of patients received more than 5000 cGy of radiaton. Median survival of patients in group 1 was 9 months, group 2 was 15 months. Overall 2 year survival rates of group 1 and 2 were $37\%\;and\;27\%$, respectively. Relapse free survival rates at 2 year were $27\%\;and\;15\%$, respectively. Overall survival rates at 5 year for group 1 and 2 were $15\%\;and\;11\%$, and relapse free survival rates were $16\%\;and\;6\%,$ respectively. Median survival of complete and partial responders was 47 months in group 1,18 months in group 2, and those of stable or progression was 6 months,11 months, respectively. The proportion of locoregional relapse and distant metastasis was not significantly different between group 1 and 2. The majority of relapse developed within 2 years. Although 2 cases of severe esophagitis and myelosuppression were noted in group 2, the treatment related toxicity was relatively acceptable. Our analysis showed no statistically significant differences between the two treatment groups in terms of response rate, survival, and sites of relapse.

• Asian Pacific Journal of Cancer Prevention
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• 제15권14호
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• pp.5557-5563
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• 2014

Background: This study investigated the survival benefit of radiotherapy (RT) of the supra- and infraclavicular lymphatic drainage area in Chinese women with T1-2N1M0 breast cancer receiving mastectomy. Methods: A total of 593 cases were retrospectively reviewed from 1998 to 2007. The relationship between supra- or infraclavicular fossa relapse (SCFR) and post-operative RT at the supra-/infraclavicular lymphatic drainage area was evaluated. Results: The majority of patients (532/593; 89. 8%) received no RT while 61 patients received RT. The median follow-up was 85 months. Among patients without RT, 54 (10. 2%) developed recurrence in the chest wall or ipsilateral SCFR. However, none of the 61 patients who underwent RT demonstrated SCFR. One patient who received RT (1. 6%) experienced recurrence in the chest wall. Univariate analysis revealed that age and molecular subtype (both P < 0. 05) were two prognostic factors related to supraclavicular and infraclavicular fossa relapse-free survival (SFRFS). Multivariate analysis revealed that only Her-2 positive status (P = 0. 011) was an independent predictor of SFRFS. RT had no influence on distant metastasis (P = 0. 328) or overall survival (P = 0. 541). SCFR significantly affected probability of distant metastasis (P < 0. 001) and overall survival (P < 0. 001). Conclusion: Although RT was not significantly associated with SFRFS, postoperative RT was significantly associated with a lower locoregional (i. e., supraclavicular/infraclavicular and chest wall) recurrence rate. SCFR significantly influenced distant metastasis-free survival, which significantly influenced the overall survival of T1-2N1M0 breast cancer patients after mastectomy. Thus, prophylactic RT is recommended in T1-2N1M0 breast cancer patients, especially those who have Her-2 positive lesions.

• Asian Pacific Journal of Cancer Prevention
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• 제15권1호
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• pp.315-320
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• 2014

Purpose: The purpose of this study was to investigate the recurrence pattern and characteristics of patients based on the 2013 St. Gallen surrogate molecular subtypes after breast-conserving surgery (BCS) in Chinese women. Methods: This retrospective analysis included 709 consecutive breast cancer patients undergoing BCS from 1999-2010 at our institution. Five different surrogate subtypes were created using combined expression of the estrogen receptor, progesterone receptor, and human epidermal growth factor receptor-2. Locoregional relapse-free survival (LRRFS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) rates were calculated. Results: The 5-year LRRFS, DMFS, and DFS rates were 90.5%, 88.2%, and 81.5%, respectively. Multivariate analysis revealed that young age, node-positive disease, and HER2 enrichment were independent prognostic factors in LRRFS patients. There was also an independent prognostic role of lymph node-positive disease in DMFS and DFS patients. Patients with luminal A tumors had the most favorable prognosis, with LRRFS, DMFS, and DFS rates of 93.2%, 91.5%, and 87.4% at 5 years, respectively. Conversely, HER-2-enriched tumors exhibited the highest rate of locoregional recurrence (20.6%). Conclusion: Surrogate subtypes present with significant differences in RFS, DMFS, and LRRFS. Luminal A tumors have the best prognosis, whereas HER2-enriched tumors have the poorest.

• Radiation Oncology Journal
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• 제12권3호
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• pp.369-376
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• 1994

This is a retrospective analysis of 64 patients who was treated with postoperative radiation therapy after radical hysterectomy and bilateral pelvic lymphadenectomy (53 patients) or total abdominal hysterectomy(11 patients) for uterine cervix cancer between May 1980 and September 1991 at the Department of Radiation Oncology, Kyung Hee University Hospital. Most patients were FIGO IB (31 Patients) and IIA (25 patients), and median period of follow-up was 5.1 years. Of these patients,24 received adjuvant whole pelvis irradiation of 6000 cGy and 40 received 5000-5500 cGy whole pelvis irradiation and/or intracavitary radiation (7 Patients). The actuarial overall and relapse free 5 year survival rate were $71.0\%$, $68.3\%$ respectively. The survival rates by stage were $79.1\%$ in stage I, and $61.2\%$ in stage II. Treatment failure was noted in 18 of 64 patients ($28.1\%$), Iocoregional failure in 8 ($12.5\%$), distant metastasis in 8 ($12.5\%$), paraaortic node metastasis in 1 and one patient and concurrent locoregional and distant metastasis. The univariate analysis of prognostic factors affecting to overall survival rate represented lymph node status, the number and site of metastatic lymph node, parametrial invasion, the thichness of cervical wall invasion, and size of cancer mass. Histology, vessel invasion, endometrial extension, hemoglobin level. resection margin status, age, radiation dose were not significant prognostic factors. Complication relating to operation and postoperative radiation were variable according to radiation therapy method: 6000 cGy RT group 8/24($33.3\%$), 5000-5500 cGy+ICR 3/7 ($42.9\%$), 5000-5500 cGy external RT only group 3/33 ($9.1\%$). In conclusion, the results suggest that postoperative radiotherapy is necessary in high risk patients for locoregional control and improving survival rate, and higher dose does not improve results but only increases complication.

• Radiation Oncology Journal
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• 제30권3호
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• pp.124-131
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• 2012

Purpose: To determine whether triple negative (TN) early stage breast cancers have poorer survival rates compared with other molecular types. Materials and Methods: Between August 2000 and July 2006, patients diagnosed with stage I, II early stage breast cancers, in whom all three markers (estrogen receptor, progesterone receptor, and human epidermal growth factor receptor [HER]-2) were available and treated with modified radical mastectomy or breast conserving surgery followed by radiotherapy, were retrospectively reviewed. Results: Of 446 patients, 94 (21.1%) were classified as TN, 57 (12.8%) as HER-2 type, and 295 (66.1%) as luminal. TN was more frequently associated with young patients younger than 35 years old (p = 0.002), higher histologic grade (p < 0.0001), and nuclear (p < 0.0001). The median follow-up period was 78 months (range, 4 to 130 months). There were 9 local relapses (2.0%), 15 nodal (3.4%), 40 distant metastases (9.0%), and 33 deaths (7.4%) for all patients. The rates of 5-year OS, DFS, LFS, and DMFS for all patients were 95.5%, 89.9%, 95.4%, and 91.7%, respectively. There were no significant differences in OS, DFS, LFS, and DMFS between triple negative and other subtypes (p > 0.05). Conclusion: We found that patients with TN early stage breast cancers had no difference in survival rates compared with other molecular subtypes. Prospective study in homogeneous treatment group will need for a prognosis of TN early stage breast cancer.

• Radiation Oncology Journal
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• 제8권2호
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• pp.225-230
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• 1990

1979년부터 1987년까지의 서울대학교병원 치료방사선과에서 흉선암으로 근치목적의 방사선치료를 받은 21명을 대상으로 조사하였다. 전체환자의 3년생존율은 $80.5{\%}$, 3년 무병생존율은 $78.6{\%}$였다. 근무력증을 동반한 환자는 $43.5{\%}$였고 치료후 $40{\%}$ (4/10)에서 증상의 호전을 보였다. 증상의 유무에 따른 3년생존율을 비교하여보면 각각 $90{\%}$, $78.8{\%}$였으며 근무력증이 예후에 나쁜 영향을 주는 인자가 아님을 알 수 있었다. 방사선치료후 완전관해율은 절제술을 시행한 경우는 $100{\%}$(3/3)인 반면, 절제가 불가능한 경우는 $20{\%}$(3/15)였다. 완전관해율 및 부분관해율은($33{\%}$ vs $56{\%}$) $89{\%}$였고 이에 따른 3년생존율은 각각 $89.8{\%},\;81.7{\%}$로 통계학적으로 유의한 차이는 보이지 않았다. 수술정도에 따른 치료실패율을 비교하여보면 절제가 가능한 환자에서는 치료실패가 없었으나, 절제가 불가능하였던 환자 15명중 4명에서 국소실패, 1명이 골전이 소견을 보였다. 국소치료실패가 대부분으로 원격전이율은 낮은 양상을 보였다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권5호
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• pp.2101-2107
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• 2012

Treatment responses of $N_0$ stage nasopharyngeal carcinoma were firstly analyzed comprehensively to evaluate long term outcomes of patients and identify prognostic factors. A total of 610 patients with $N_0$ NPC, undergoing definitive radiotherapy to their primary lesion and prophylactic radiation to upper neck, were reviewed retrospectively. Concomitant chemotherapy was administrated to 65 out of the 610. Survival rates of the patients were calculated using the Kaplan-Meier method and compared by log-rank test. Prognostic factors were identified by the Cox regression model. The study revealed the 5-year and 10-year overall, disease-free, disease-specific, local failure-free, regional failure-free, locoregional failure-free and distant metastasis-free survival rates to be 78.7% and 66.8%, 68.8% and 55.8%, 79.9% and 70.4%, 81.2% and 72.5%, 95.8% and 91.8%, 78.3% and 68.5%, 88.5% and 85.5%, respectively. There were 192 patients experiencing failure (31.5%) after radiotherapy or chemoradiotherapy. Of these, local recurrence, regional relapse and distant metastases as the first event of failure occurred in 100 (100/610, 16.4%), 15(15/610, 2.5%) and 52 (52/610, 8.5%), respectively. Multivariate analysis showed that T stage was the only independent prognostic factor for patients with $N_0$ NPC (P=0.000). Late T stage (P=0.000), male (P=0.039) and anemia (P=0.007) were independently unfavorable factors predicting disease-free survival. After treatment, satisfactory outcome wasgenerally achieved in patients with $N_0$ NPC. Local recurrence represented the predominant mode of treatment failure, while T stage was the only independent prognostic factor for overall survival. Late T stage, male gender, and anemia independently predicted lower possibility of the disease-free survival.

• Radiation Oncology Journal
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• 제11권2호
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• pp.259-265
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• 1993

1985년 1월부터 1992년 7월까지 경북대학교병원 치료방사선과에서 화학요법후 방사선치료를 받은 국소진행된 비인강암 환자 52명을 대상으로 화학요법의 효과를 판정하기 위하여 후향적 조사를 실시하였다. 남녀성비는 3.3:1이었고 중앙연령은 41세였다. 병리조직학소견은 40예에서 편평세포암이었고, 나머지 12예에서는 미분화세포암이었다. AJC병기에 따른 분류는 III기가 7예였고, 나머지 45예는 IV기였다. 모든환자는 2회의 화학요법후 방사선치료를 받았으며 사용된 화학요법 제재는 CVB (cyclo-phosphamide+vincristine+ bleomycin)이나 CF (cicplantin+5-FU)였다. 방사선조사량은 원발병소에 6000~7500 cGy, 임파절은 병의 정도에 따라 최대 7000 cGy까지 조사하였다. 국소관해율, 생존율 및 무병생존율을 분석하였다. 화학요법에 대한 완전관해율은 $15\%,$ 부분관해율은 $46\%$였으며 방사선치료후 완전관해율은 $87\%$였다. 중앙추적기간은 51개월 이었으며 3년 생존율 및 무병생존율은 각각 $54\%$와 $49\%$였다. 중앙재발기간은 15개월이었으며 완전관해 후 재발의 양상은 국소재발단독이 12예, 원격전이단독이 11예, 국소재발 및 원격 전이가 2예였다. Cox's multivariate regression model에 따르면 임파절전이 유무가 무병생존율에 영향을 미치는 가장 중요한 예후인자이었다(p=0.001). 다른 보고에서의 방사선 단독치료의 결과와 비교하여 볼 때 화학요법에 대한 종양의 반응율은 높으나 화학요법 및 방사선치료가 국소관해율 및 생존율의 향상으로는 연결되지는 않았다. 결론적으로 진행된 비인강암에서의 화학요법은 좀더많은 비교대조군 연구(controlled clinical trial)를 통해서만 역 할을 이야기할 수 있을 것으로 사료된다.

• Radiation Oncology Journal
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• 제28권4호
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• pp.205-210
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• 2010

목적: 항문암으로 근치적 목적의 동시 항암화학 방사선치료를 받은 환자들을 대상으로 치료반응의 예측인자, 생존율과 관련된 예후인자를 알아보고자 하였다. 대상 및 방법: 전남대학교병원에서 1993년부터 2008년까지 병리조직학적으로 항문의 편평상피세포암으로 진단받고 근치적 목적의 동시 항암화학 방사선치료를 받은 42명의 환자를 대상으로 후향적으로 분석하였다. 환자들 나이의 중앙값은 61.5세 (39~89에)였고 방사선량의 중앙값은 50.4 Gy (30.0~64.0 Gy)였다. T병기 상 2기 이하였던 환자는 총 36명 (85.7%)이었다. 영역림프절전이는 14명(33.3%)에서 있었다. 항암화학요법으로는 5-fluorouracil, mltomycin 병행요법으로 치료받은 환자가 36명 (85.7%)이었고 나머지는 5-fluorouracil, cisplatin 병행요법을 받았다. 결과: 전체 환자의 추적관찰기간의 중앙값은 62개월 (2~202개월)이었다. 5년 전체생존율, 국소영역제어율, 무병생존율, 무장루생존율은 각각 86.0%. 71.7%. 71.7%. 78.2%였다. 전체생존율과 관련된 인자로 단변량분석에서는 Eastem Cooperative Oncology Group (ECOG) 수행능력과 완전관해여부가 유의하였고 다변량분석에서는 ECOG 수행능력만이 유의하였다. 국소영역제어율, 무병생존율과 무장루생존률에 관련된 인자는 단변량이나 다변량분석 모두 유의한 인자는 없었다. 치료 후 완전관해 여부와 관련하여 유의하게 예측할 수 있는 인자는 없었다. 국소영역재발은 7명에서, 원격전이는 1명에서 발생하였다. 전체 환자에서 평가가 가능하였던 급성 부작용으로 3도의 피부염이 4명(9.5%), 2도는 22명(52.4%)에서 발생하였다. 결론: 본 연구에서 항문의 편평상피세포암에 대한 근치적 목적의 동시 항암화학 방사선치료로 양호한 생존율을 얻을 수 있었고, 특히 ECOG 수행능력이 1 이하인 환자의 생존율이 유의하게 높았다. 그러나 치료 후 종양반응을 예측할 수 있는 유의한 인자는 없었다.

• Radiation Oncology Journal
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• 제35권3호
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• pp.198-207
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• 2017

Purpose: Whether preoperative chemoradiotherapy (CRT) is better than postoperative CRT in oncologic outcome and toxicity is contentious in prospective randomized clinical trials. We systematically analyze and compare the treatment result, toxicity, and sphincter preservation rate between preoperative CRT and postoperative CRT in stage II-III rectal cancer. Materials and Methods: We searched Medline, Embase, and Cochrane Library from 1990 to 2014 for relevant trials. Only phase III randomized studies performing CRT and curative surgery were selected and the data were extracted. Meta-analysis was used to pool oncologic outcome and toxicity data across studies. Results: Three randomized phase III trials were finally identified. The meta-analysis results showed significantly lower 5-year locoregional recurrence rate in the preoperative-CRT group than in the postoperative-CRT group (hazard ratio, 0.59; 95% confidence interval, 0.41-0.84; p = 0.004). The 5-year distant recurrence rate (p = 0.55), relapse-free survival (p = 0.14), and overall survival (p = 0.22) showed no significant difference between two groups. Acute toxicity was significantly lower in the preoperative-CRT group than in the postoperative-CRT group (p < 0.001). However, there was no significant difference between two groups in perioperative and chronic complications (p = 0.53). The sphincter-saving rate was not significantly different between two groups (p = 0.24). The conversion rate from abdominoperineal resection to low anterior resection in low rectal cancer was significantly higher in the preoperative-CRT group than in the postoperative-CRT group (p < 0.001). Conclusions: As compared to postoperative CRT, preoperative CRT improves only locoregional control, not distant control and survival, with similar chronic toxicity and sphincter preservation rate in rectal cancer patients.