• 대한두경부종양학회:학술대회논문집
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• 대한두경부종양학회 1990년도 제7차 학술대회 연제순서 및 초록집
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• pp.20.2-22
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• 1990

• Archives of Plastic Surgery
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• 제33권5호
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• pp.546-551
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• 2006

Purpose: The reconstruction of oropharyngeal defect after cancer surgery is very difficult because of their complicated structure and the functional importance to prevent velopharyngeal incompetence. In this article we investigated affecting factors of velopharyngeal function after reconstruction and a fundamental rule of reconstruction for saving their functions such as swallowing, speeching and breathing. Methods: We classified 18 patients into three group under Kimata's grouping. Type I defect(6 patients) was healed by primary closure or secondary intention. In Type II or III defect, two operation methods were used - the folded flap(8 patients) and modified Gehanno method(4 patients), which include a lateral-posterior pharyngeal rotation-advancement flap. We evaluated wound dehiscence between the flap and the soft palate, speech intelligibility using Hirose's method, regurgitation during oral feeding, and hypernasality. Results: Most of type I or II defects patients recovered satisfactory velopharyngeal function. But, in patients with type III defects we found wound dehiscence, worse speech function, and common velopharyngeal incompetence. Conclusion: The large defect size and presence of wound dehiscence are major factors of postoperative velopharyngeal function. We conclude that folded flap or modified Gehanno method is a good reconstructive operation method for broad contact between the flap and defect site, preventing wound problem.

• 대한두경부종양학회지
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• 제38권2호
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• pp.7-13
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• 2022

Human papillomavirus (HPV) is a causative agent for a subset of oropharyngeal cancer (OPC). The current standard of care (SOC) for locally advanced OPC is 70 Gy definitive radiotherapy (RT) concurrent with cisplatin, which entails significant proportions of acute and late grade 3 or higher toxicities. Accordingly, discovery of favorable prognosis of HPV-related OPC has led to enthusiasm to attenuate subspecialties therapy in multidisciplinary treatment. Diverse deintensification strategies were investigated in multiple phase 2 trials with an assumption that attenuated treatments result in comparable oncologic outcome and less toxicities compared with SOC. Several trials on chemotherapy deintensification revealed that concomitant administration of cisplatin is not to be omitted or substituted for cetuximab without compromising progression-free survival or local control. A transoral robotic surgery (TORS) is investigated as alternative local treatment, but TORS plus SOC or mild deintensified adjuvant RT showed similar toxicities and inferior oncologic outcomes compared with SOC definitive RT or moderately deintensified RT. However, it has been reported that TORS plus deintensified 30-36 Gy adjuvant RT results in excellent outcome and less late toxicity compared with SOC adjuvant RT. Several phase 2 trials reported apparently equivalent progression-free survival and local control and similar adverse effects with moderately deintensified 60 Gy RT compared with SOC 70 Gy RT. Further dose reduction below 60 Gy has been investigated using biology-directed approaches, which use response to induction chemotherapy or metabolic images to triage HPV-positive OPC for deintensified RT. In summary, these trials provide valuable insights for future directions. Available evidence consistently showed that moderately deintensified RT is effective and safe for HPV-positive OPC in both definitive and adjuvant settings. Concurrent cisplatin remains an essential component without which progression-free survival is significantly compromised for advanced HPV-positive OPC. A simple incorporation of TORS to SOC may be detrimental for oncologic outcome without anticipated toxicity reduction. Given the lack of level 1 evidence, it is prudent to curb an unjustified deviation from the current SOC and limit any deintensified strategies to clinical trials and adhere to the current SOC.

• 대한두경부종양학회:학술대회논문집
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• 대한두경부종양학회 2001년도 제17차 학술대회 및 제6차 심포지움
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• pp.106-106
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• 2001

• Radiation Oncology Journal
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• 제14권1호
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• pp.1-8
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• 1996

목적 : 통상적인 외부 방사선 단독 치료 또는 유도 화학 병용요법으로 치료한 구인두암 환자들을 대상으로 생존율과 예후 인자를 후향적으로 분석하여 이들 치료방법의 역할을 평가하고자 하였다. 대상 및 방법 : 1985년 11월부터 1993년 4월까지 구인두암으로 근치적 방사선 치료를 시행한 47명의 환자들 중, 26명은 통상적인 외부 방사선 치료만을, 나머지 21명은 유도 화학요법을 시행하였고 화학요법의 약제는 대부분 Cisplatin과 Pepleomycin으로 2회 시행하였으며, 방사선 단독 치료군과 유도 화학 병용요법군간의 환자 특성은 대체로 유사하였다. 방사선 치료는 6MV-LINAC으로 1일 선량 1.8-2.0 Gy씩 원발병소에는 54.0-79.2 Gy까지, 경부 임파절 병소에는 병소의 크기에 따라 55.8-90.0 Gy까지 조사하였다. 추적 기간은 3개월에서 102개월로 중앙값은 20개월이었고, 연령 분포는 33세에서 79세로 중앙값은 58세였다. 결과 : 전체 환자의 3년 생존율은 $39\%$였고, AJCC에 의한 병기별 3년 생존율은 I기 (n=5), II기 (n=11), III기 (n=12), IV기 (n=19)에서 각각 60, 55, 33, $32\%$이었다. 원발병소와 경부 임파절 병소의 병기별 3년 생존율은 T1+2, T3+4와 No, N+에서 각각 55, $18\%$ (p=0.005)와 43, $36\%$ (p>0.1)이었다. 방사선 단독 치료군과 유도 화학 병용요법군의 3년 생존율은 각각 38, $43\%$이었으나 통계적인 유의한 차이는 없었다(p>0.1). 원발병소 부위별 3년 생존율은 편도암(n=32), 설근암(n=8), 연구개 및 구개수암(n=6), 인두벽암(n=1)에서 각각 36, 38, 67, $0=%$이었으나 통계적인 유의한 차이는 없었다(p>0.1). 편도암 환자 32명 중, 22명은 주위 조직으로 침습이 있었고 그렇지 않은 군(10명)과의 3년 생존을은 24 대 $60\%$로 낮은 경향을 보였다 (p=0.08). 전체 환자에 대하여 원발병소 부위, 원발병소의 병기, 경부 임파절 병소의 병기, 방사선 치료 기간, 나이, 유도 화학요법 사용 유무 등에 대한 다요인 분석에서 원발병소의 병기만이 유의한 예후 인자였다. 결론 : 통상적인 외부 방사선 단독 치료군과 유도 화학 병용요법군간의 3년 생존율의 유의한 차이는 없었고, 이와 같은 치료방법으로 구인두암의 조기 병변, 특히 연구개암과 구개수암, 또는 주위 조직으로 침습이 없는 편도암에서 근치적 효과를 볼 수 있었다. 그러나 대부분의 진행된 병기의 생존율을 높이기 위해서는 통상적인 방사선 치료나 유도 화학요법 대신 다분할 조사 또는 가능한 수술적 방법의 추가나 동시적 화학 방사선 병용요법 등 보다 적극적이고 다면적인 치료가 필요할 것으로 사료된다.

• 대한두경부종양학회지
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• 제25권1호
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• pp.28-32
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• 2009

Background : The most frequently reported risk factors for head and neck suamous cell carcinoma are smoking and alcohol. But in a recent overview, human papilloma virus(HPV) infection was revealed the important carcinogenic factor in oropharyngeal cancer. We aimed to clarify whether HPV directly effects on the oncogenesis and biologic behavior of hean and neck squamous cell carcinoma by comparison with infection prevalence, and physical status of virus. Material and Method : We used HPV genotyping DNA chip(Biocore, Korea, Seoul) arrayed by multiple oligonucleotide probes of L1 sequence of 26 types of HPV and HPV genotypes are identified by fluorescence scanner. The copy numbers of HPV E2 and E6 open reading frames(ORF) were assessed using a TaqMan-based 5'-exonuclease quantitative real-time PCR assay. The ratio of E2 to E6 copy numbers was calculated to determine the physical status of HPV-16 viral gene. Results : We observed a significant difference in HPV prevalence between tonsillar cancer group and control group(73.1% vs. 11.6%), and most of the HPVs were type 16(87.2%) and integrated(94.1%) state. In terms of oral tongue cancer, we demonstrate that 30.5% has integrated HPV-16 in cancer tissue. But Glottic cancer only 1% is related to HPV-16 integration. Conclusion : This study revealed significant relationship of HPV prevalence with oropharyngeal and oral tongue squamous cell carcinoma. Most of HPV were 16 type and integrated or mixed, HPV-16 integration could be directly related to the carcinogenesis.

• BMB Reports
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• 제51권11호
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• pp.584-589
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• 2018

Secondary prevention via earlier detection would afford the greatest chance for a cure in premalignant lesions. We investigated the exomic profiles of non-malignant and malignant changes in head and neck squamous cell carcinoma (HNSCC) and the genomic blueprint of human papillomavirus (HPV)-driven carcinogenesis in oropharyngeal squamous cell carcinoma (OPSCC). Whole-exome (WES) and whole-genome (WGS) sequencing were performed on peripheral blood and adjacent non-tumor and tumor specimens obtained from eight Korean HNSCC patients from 2013 to 2015. Next-generation sequencing yielded an average coverage of $94.3{\times}$ for WES and $35.3{\times}$ for WGS. In comparative genomic analysis of non-tumor and tumor tissue pairs, we were unable to identify common cancer-associated early mutations and copy number alterations (CNA) except in one pair. Interestingly, in this case, we observed that non-tumor tonsillar crypts adjacent to HPV-positive OPSCC appeared normal under a microscope; however, this tissue also showed weak p16 expression. WGS revealed the infection and integration of high-risk type HPV16 in this tissue as well as in the matched tumor. Furthermore, WES identified shared and tumor-specific genomic alterations for this pair. Clonal analysis enabled us to infer the process by which this transitional crypt epithelium (TrCE) evolved into a tumor; this evolution was accompanied by the subsequent accumulation of genomic alterations, including an ERBB3 mutation and large-scale CNAs, such as 3q27-qter amplification and 9p deletion. We suggest that HPV16-driven OPSCC carcinogenesis is a stepwise evolutionary process that is consistent with a multistep carcinogenesis model. Our results highlight the carcinogenic changes driven by HPV16 infection and provide a basis for the secondary prevention of OPSCC.

• Archives of Plastic Surgery
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• 제40권4호
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• pp.353-358
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• 2013

Background Robots have allowed head and neck surgeons to extirpate oropharyngeal tumors safely without the need for lip-split incision or mandibulotomy. Using robots in oropharyngeal reconstruction is new but essential for oropharyngeal defects that result from robotic tumor excision. We report our experience with robotic free-flap reconstruction of head and neck defects to exemplify the necessity for robotic reconstruction. Methods We investigated head and neck cancer patients who underwent ablation surgery and free-flap reconstruction by robot. Between July 1, 2011 and March 31, 2012, 5 cases were performed and patient demographics, location of tumor, pathologic stage, reconstruction methods, flap size, recipient vessel, necessary pedicle length, and operation time were investigated. Results Among five free-flap reconstructions, four were radial forearm free flaps and one was an anterolateral thigh free-flap. Four flaps used the superior thyroid artery and one flap used a facial artery as the recipient vessel. The average pedicle length was 8.8 cm. Flap insetting and microanastomosis were achieved using a specially manufactured robotic instrument. The total operation time was 1,041.0 minutes (range, 814 to 1,132 minutes), and complications including flap necrosis, hematoma, and wound dehiscence did not occur. Conclusions This study demonstrates the clinically applicable use of robots in oropharyngeal reconstruction, especially using a free flap. A robot can assist the operator in insetting the flap at a deep portion of the oropharynx without the need to perform a traditional mandibulotomy. Robot-assisted reconstruction may substitute for existing surgical methods and is accepted as the most up-to-date method.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제42권6호
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• pp.327-336
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• 2016

Cervical cancer is the second most prevalent cancer among women, and it arises from cells that originate in the cervix uteri. Among several causes of cervical malignancies, infection with some types of human papilloma virus (HPV) is well known to be the greatest cervical cancer risk factor. Over 150 subtypes of HPV have been identified; more than 40 types of HPVs are typically transmitted through sexual contact and infect the anogenital region and oral cavity. The recently introduced vaccine for HPV infection is effective against certain subtypes of HPV that are associated with cervical cancer, genital warts, and some less common cancers, including oropharyngeal cancer. Two HPV vaccines, quadrivalent and bivalent types that use virus-like particles (VLPs), are currently used in the medical commercial market. While the value of HPV vaccination for oral cancer prevention is still controversial, some evidence supports the possibility that HPV vaccination may be effective in reducing the incidence of oral cancer. This paper reviews HPV-related pathogenesis in cancer, covering HPV structure and classification, trends in worldwide applications of HPV vaccines, effectiveness and complications of HPV vaccination, and the relationship of HPV with oral cancer prevalence.

• Journal of Digestive Cancer Research
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• 제6권1호
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• pp.36-39
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• 2018

여러 가지 원인으로 인해 다발성 원발암은 증가하고 있으며, 발생 가능성을 염두에 두고 필요한 선별 검사를 시행하여야 적절한 치료가 이루어질 수 있다. 저자들은 국내에서는 보고된 적이 없고 전세계적으로도 희귀한 5중 원발암의 증례를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.