• Journal of Korean Neurosurgical Society
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• 제64권4호
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• pp.631-643
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• 2021

Objective : Here, we evaluated whether cerebrospinal fluid (CSF) profiles and their changes after intraventricular chemotherapy for leptomeningeal carcinomatosis (LMC) could predict the treatment response or be prognostic for patient overall survival (OS) along with clinical factors. Methods : Paired 1) pretreatment lumbar, 2) pretreatment ventricular, and 3) posttreatment ventricular samples and their CSF profiles were collected retrospectively from 148 LMC patients who received Ommaya reservoir installation and intraventricular chemotherapy. CSF profile changes were assessed by calculating the differences between posttreatment and pretreatment samples from the same ventricular compartment. CSF cell counts were further differentiated into total and other based on clinical laboratory reports. Results : For the treatment response, a decreased CSF 'total' cell count tended to be associated with a 'controlled' increase in intracranial pressure (ICP) (p=0.059), but other profile changes were not associated with either the control of increased ICP or the cytology response. Among the pretreatment CSF profiles, lumbar protein level and ventricular cell count were significantly correlated with OS in univariable analysis, but they were not significant in multi-variable analysis. Among CSF profile changes, a decrease in 'other' cell count showed worse OS than 'no change' or increased groups (p=0.001). The cytological response was significant for OS, but the hazard ratio of partial remission was paradoxically higher than that of 'no response'. Conclusion : A decrease in other cell count of CSF after intraventricular chemotherapy was associated with poor OS in LMC patients. We suggest that more specific CSF biomarkers of cancer cell origin are needed.

• Tuberculosis and Respiratory Diseases
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• 제54권4호
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• pp.415-428
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• 2003

연구배경 : 소세포폐암에 대한 항암화학치료에 etoposide와 cisplatin(EP) 또는 etoposide와 carboplatin(EC)이 가장 흔히 사용되는 병합요법인데, 전반적인 관해율은 75-85%(제한기 65-90%), 완전관해율은 20-30%(제한기 45-75%)로 보고되고 있다. 치료후 재발되는 소세포폐암환자에 대하여 구제(salvage)화학요법제로 topotecan을 사용하였을 때 90일 이내에 재발되는 불응성 재발(refractory relapse, RR)인 경우 관해율이 6.4%인 반면에, 90일 이후에 재발되는 감수성 재발(sensitive relapse, SR)에서는 37.8%의 관해율이 보고되고 있다. 저자는 EC요법과 2차 구제화학요법으로 topotecan요법의 치료효과와 부작용을 조사하여 기존의 성적들과 비교하고자 하였다. 대상 및 방법 : 1996년부터 2002년 6월까지 전남대병원 내과에서 소세포 폐암으로 치료를 받았던 환자들 중에서 EC요법과 재발되어 topotecan구제 화학요법을 받은 환자를 대상으로 임상경과를 후향적으로 조사하였다. 일차치료로서 etoposide 100 $mg/m^2$ (day 1-3), carboplatin 300 $mg/m^2$(day 1)을 3주 이상의 간격을 두고 투여하여, 3주기 이상 화학요법을 받은 경우들을 대상으로 하였고, 이차치료로 topotecan을 투여한 경우에는 1.5 $mg/m^2$을 제 1일에서 제 5일까지 3주 간격으로 2주기 이상 받은 환자들을 대상으로 하였다. 치료에 대한 반응의 평가는 완전관해(complete remission, CR), 부분관해(partial remission, PR), 불변(stable disease, SD), 진행(progressive disease, PD)으로 구분하였고 생존기간은 치료시작일로부터 중앙생존기간(median survival time, MST)으로 표기하였다. 결 과 : 총 101예에서 1차 선택 약제로 EC요법 후 관해율은 57.4%(58예)로 CR은 15.8%(16예), PR은 41.6%(42예)이었다. 제한기(69명)에서의 관해율은 69.6%(48예)로 CR은 23.2%(16예), PR은 46.4%(32예)였으며, 확장기(32명)에서의 관해율은 31.3%(10예)로 모두 PR반응을 보였다. 수행 능력(performance status score, PS)과 동통, 호흡곤란, 기침 등 임상 증상의 변화를 평가하였는데 58예(57.4%)에서 전신상태와 증상의 호전을 보였다. 전체 관해군의 관해 유지기간(중앙값)은 10.3개월(5.8개월~57.7개월)이었고 치료에 따른 호중구 감소증(G4)은 24예(23.8%), 혈소판감소증(Grade 4)은 2예(2%)에서 관찰되었다. 1차 화학치료에 불응하여 바로 다른 약제로 바꾸어 치료한 9예와 1차 치료 후 2차구제화학요법을 받지 않았던 71예를 제외한, 21예의 환자들은 EC요법으로 SD이상 반응을 보였으나 재발하여 topotecan을 투여 받은 군이었다. 총 21예 중 관해율은 SR군(8예)의 경우 PR 25%(2예), SD 25%(2예), PD 50%(4예)를 보였고, RR군(13예)에서는 PR 15.4%(2예), SD 15.4%(2예), PD 69.2%(9예)를 나타냈으나 유의한 차이는 아니었다. 생존 기간의 비교에서도 SR군은 MST 8개월로 RR군의 MST 7개월과 비교하여 유의한 차이는 없었다. 치료에 따른 독성으로 호중구감소증(Grade 4)은 6예 (28.3%), 혈소판감소증(Grade 4)은 3예(14.3%)에서 관찰되었다. 결 론 : EC와 topotecan 치료 모두 기존의 보고들과 비슷한 관해율을 보였으며 수용 가능한 정도의 부작용이 관찰되었다.

• Radiation Oncology Journal
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• 제20권2호
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• pp.93-99
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• 2002

목적 : 두개내 배아종은 방사선치료 단독으로도 완치율이 높은 종양이나 방사선치료로 인한 부작용의 감소를 위해 현재 서울대학교 병원에서는 전보조화학요법 후 방사선치료를 하고 있으며 이 환자들의 치료 성적과 부작용을 분석하고자 하였다. 대상 및 방법 : 1995년에서 2001년까지 치료를 받은 두개내 배아종으로 조직학적으로 진단된 18명의 환자를 대상으로 하였다. 12명은 BEP (bleomycin, VP-16, cisplatin) 항암치료, 5명은 9921A (cisplatin, cyclophosphamide, VP-16, vincristine) 항암치료, 1명은 EP (VP-16, cisplatin) 항암치료를 받았고 5명은 두개척수조사, 1명은 두개방사선조사, 12명은 종양 부위에만 방사선치료를 받았다. 원발 종양에 조사된 방사선량은 39.6에서 54 Gy였다. 결과 : 남자는 16명, 여자는 2명이었고 중간 나이는 16세였다. 자기공명영상 상 12명은 송과체에, 각각 1명에서 안상, 시상, 대뇌기저핵에 원발성 종괴가 있었고 3명에서 다발성 종괴가 있었다. 6명은 뇌실 내 전이 소견이 보였고 3명은 뇌척추액검사 상 종양 세포가 관찰되었고 2명에서는 척수 자기공명영상에서 전이 소견이 있었다. 종양지표검사 상 1명에서 $\beta-human$ chorionic gonadotropin의 수치가 44 mlU/mL로 상승되어 있었다. 항암치료 후 5명은 완전 관해, 12명은 부분 관해를 보였고, 1명은 반응이 없었다. 현재 중앙 추적 기간 20개월로 17명은 무병 상태로 관찰되고 있고 1명은 bleomycin으로 인한 것으로 추정되는 폐의 부작용으로 사망하였다. 사망한 환자를 제외한 다른 환자들은 방사선치료 후 모두 완전 관해 상태이다. 6명에서 백혈구 감소로 인한 감염이 발생하였으며 $3\~4$도의 혈액학적 부작용이 11명에서 발생하였다. 방사선조사 중 두개척수조사를 받은 5명의 환자를 제외한 나머지 환자에서는 2도 이상의 부작용은 보이지 않았다. 결론 : 서울대학교병원에서의 전보조화학요법 후 방사선치료는 기존의 보고와 마찬가지로 높은 관해율을 보이고 있고 항암치료로 인한 치료 중이나 치료 후의 부작용의 정도와 빈도는 다른 보고와 비슷하였다. 방사선이나 항암치료로 인한 만성 부작용에 대해서는 좀더 관찰이 필요하며 이 결과가 나온 후에 두개내 배아종에서 가장 적절한 치료에 대해 결론을 내릴 숱 있을 것으로 보인다.

• Journal of Breast Disease
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• 제6권2호
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• pp.46-51
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• 2018

Purpose: Endocrine therapy is the preferred treatment for hormone receptor (HR)-positive metastatic breast cancer (MBC). We investigated the efficacy of combined aromatase inhibitor (AI) and luteinizing hormone-releasing hormone (LHRH) agonist in premenopausal patients with HR-positive MBC. Methods: We retrospectively analyzed the medical records of 21 HR-positive premenopausal MBC patients treated with combined AI and LHRH agonist therapy. Results: The median follow-up period was 32.9 months. The overall response rate was 47.6%, with three complete responses (14.3%) and seven partial responses (33.3%). Nine patients (42.9%) achieved stable disease lasting more than 6 months; thus, the clinical benefit rate was 90.4%. The median time to progression was 45.4 months. No patients experienced grade 3 or 4 toxicity. Conclusion: Combined AI and LHRH agonist treatment safely and effectively induced remission or prolonged disease stabilization, suggesting that this could be a promising treatment option for HR-positive premenopausal patients with MBC.

• Asian Pacific Journal of Cancer Prevention
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• 제16권8호
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• pp.3111-3116
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• 2015

Background: This study was designed to investigate the value of CEA and CA199 in predicting the treatment response to palliative chemotherapy for advanced gastric cancer. Materials and Methods: We studied 189 patients with advanced gastric cancer who received first-line chemotherapy, measured the serum CEA and CA199 levels, used RECIST1.1 as the gold standard and analyzed the value of CEA and CA199 levels changes in predicting the treatment efficacy of chemotherapy. Results: Among the 189 patients, 80 and 94 cases had increases of baseline CEA (${\geq}5ng/ml$) and CA199 levels (${\geq}27U/ml$), respectively. After two cycles of chemotherapy, 42.9% patients showed partial remission, 33.3% stable disease, and 23.8% progressive disease. The area under the ROC curve (AUC) for CEA and CA199 reduction in predicting effective chemotherapy were 0.828 (95%CI 0.740-0.916) and 0.897 (95%CI 0.832-0.961). The AUCs for CEA and CA199 increase in predicting progression after chemotherapy were 0.923 (95%CI 0.865-0.980) and 0.896 (95%CI 0.834-0.959), respectively. Patients who exhibited a CEA decline ${\geq}24%$ and a CA199 decline ${\geq}29%$ had significantly longer PFS (log rank p=0.001, p<0.001). With the exception of patients who presented with abnormal levels after chemotherapy, changes of CEA and CA199 levels had limited value for evaluating the chemotherapy efficacy in patients with normal baseline tumor markers. Conclusions: Changes in serum CEA and CA199 levels can accurately predict the efficacy of first-line chemotherapy in advanced gastric cancer. Patients with levels decreasing beyond the optimal critical values after chemotherapy have longer PFS.

• Radiation Oncology Journal
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• 제11권2호
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• pp.295-301
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• 1993

절제 불가능한 제 3기 비소세포 폐암에서의 MVP(Mitomycin C 6 $mg/m^2$, Vinblastine 6 $mg/m^2$, Cisplatin 60 $mg/m^2$) 복합 항암요법과 다분할 방사선 치료의 효과를 판정하기 위하여 1991년 1월부터 전향성 임의 선택연구(prospective randomized study)를 시작하였다. 본 연구는 제 III기의 비소세포 폐암중 절제가 불가능한 환자를 대상으로 하여 MVP 항암요법을 3 회 시행한 후 다분할 방사선 치료 (120 cGy/fx, BID)를 6480 cGy까지 시행하였다. 방사선 치료가 끝난 1개월 후 유도 항암요법에 부분 관해 이상의 반응을 보였던 환자를 대상으로 추가 항암요법을 시행하는 군과 계속 관찰하는 군으로 임의 분류하였다. 1992년 12월까지 48명의 환자가 등록되었으며, 이중 3명은 항암요법후 치료를 중단하였으며, 6명은 방사선 치료중 치료를 중단하거나, 개인적 사정으로 다분할 방사선 치료를 시행받지 못하여 39명의 환자에 대한분석을 시행하였다. 유도 항암요법을 마친 환자중 2명은 완전 관해를 보였으며, 21명은 부분 관해를 보여 MVP 유도항암요법에 대한 관해율은 $58\%$ (23/39)이었다. 항암요법에 부분관해를 보인 21명중 1명은 방사선 치료후 완전관해를 보였으며, 10명은 부분관해를 보였으나, 나머지 10명은 방사선 치료에 반응을 보이지 않았다. 항암요법에 반응을 보이지 않았던 16명의 환자중 9명은 방사선 치료에도 전혀 반응을 보이지 않았다. 유도항암 요법과 다분할 방사선 치료후의 관해율은 $64\%$이었다. 방사선 치료후 19명의 환자에 대하여 추가 항암요법에 대한 임의 선택을 시행하여 이중 9명은 추가 항암요법 군으로 분류되어, 3회의 추가 항암요법을 시행하였다. 아직까지는 추가 항암요법군과 관찰군 사이에 원격전이나 생존율의 차이가 관찰되지 않았다. 전체 환자의 중앙 생존은 13개월이었고, 6개월과 12개월의 생존율은 각각 $84.6\%$와 $53.7\%,\;40.3\%$이었다. 특히 유도항암요법에 부분관해 이상의 반응을 보였던 환자들은 무반응환자에 비하여 통계적으로 유의하게 증가된 생존율을 보였다(p=0.0287). 아직까지 추적 관찰기간이 짧으나, $64\%$의 높은 치료 관해율과 증가된 생존율, 그리고 합병증의 증가가 관찰되지 않는 점으로 보아 본 연구를 계속 진행함으로써 더 좋은 결과를 얻을 수 있을 것으로 기대된다.

• 대한한방내과학회지
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• 제41권2호
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• pp.166-176
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• 2020

Objectives: This study reports on the effect of Integrative Medicine Therapy (IMT) on a patient with pancreatic cancer with liver metastasis. Methods: One pancreatic cancer with liver metastasis patient was treated using IMT in conjunction with Gemcitabine/Abraxane since September 2019. The cycle was repeated every four weeks for a total of 11 times. At the same time, the patient was treated with IMT. Tumor size was measured by scanning with Computed Tomography (CT). Adverse events were evaluated using the National Cancer Institute Common Terminology Criteria for Adverse Events (NCI-CTCAE), version 5.0. Results: After treatment with Gemcitabine/Abraxane and IMT for eight months, the size of the body and tail of the cancer tumor and several hepatic metastatic regions decreased (partial response, [PR]), size, and number of multiple nodules in both lungs decreased. No evidence of newly developed metastatic lesions was found. The patient has maintained a good treatment outcome and has shown prolonged overall survival. Conclusions: This case demonstrates that treatment with IMT may have substantial benefits for patients with end-stage pancreatic cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제15권23호
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• pp.10375-10379
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• 2015

Background: XELOX plus bevacizumab (XELOX-Bev) and FOLFIRI plus Bevacizumab (FOLFIRI - Bev) treatments are an effective strategies patients with metastatic colorectal cancer (mCRC).The aim of this study was to compare efficacy of first-line XELOX-Bev treatment vs FOLFIRI-Bev treatment for mCRC. Materials and Methods: A total of 409 patients with mCRC who received chemotherapy were included and divided into 2 groups. Group 1 (n=298) received XELOX-Bev and Group 2 (n=111) FOLFIRI-Bev. Comparisons were made in terms of overall (OS) and progression-free (PFS) survival, response rate (RR), and grade 3-4 toxicity. Results: Median follow-up was 11 months in Group 1 and 15 months for Group 2. Complete remission was observed in 29 (9.7%) and 2 (1.8%) patients, partial remission in 139 (46.6%) and 27 (24.5%), stable disease in 88 (29.5%) and 49 (44.1%) and progressive disease in 42 (14.1%) and 33 (30.0%) patients in Group 1 and 2, respectively. Median OS was 25 months (range 2-57 months, 95%CI; 22.2-27.7) for Group 1 and 20 months (range 1-67 months, 95%CI; 16.8-23.1) for Group 2 (p=0.036). Median PFS was 9.6 months (range 2-36 months, 95%CI; 8.8-10.4) for Group 1 and 9 months (range 1-44 months, 95%CI; 7.4-10.5) for Group 2 (p=0.019). Objective RR was 56.4% in Group 1 and 26.1% in Group 2 (p<0.001). Conclusions: First-line XELOX-Bev is more effective with a better response rate, prolongation of median PFS/OS, and a superior safety profile compared with FOLFIRI-Bev.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.9009-9013
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• 2014

Background: The aim of this study was to explore the efficacy and adverse reactions of CT-guided radioactive 125I-seed implantation treatment combined with chemotherapy for platinum-resistant recurrent ovarian carcinoma. Materials and Methods: From September 2010 to December 2012, 23 patients with platinum-resistant recurrent ovarian carcinoma were enrolled. All the patients refused, could not bear, or were not suitable for surgery. They all had no more than 3 lesions, which were detected and could also be measured by CT. All were clarified as single-lesion or multiple-lesion groups. A total of 41 lesions underwent implantation of from 8 to 106 125I seeds (median=43). Multi-plane implanting was adopted and 125I-seeds of (0.4-0.7)mCi were placed at intervals of (0.5-1.0) cm. After implantation treatment, all patients underwent 4 cycles of chemotherapy with gemcitabine $800mg/m^2$ (days 1, 8 and 15). Results: The outcome was evaluated with CT 3 weeks and every 3 months after implantation treatment. After 6 months, the volume of 32 out of 41 lesions (78.0%) was reduced at least 30%, within which 9 lesions completely disappeared(22.0%). Complete response was observed in 7 cases (30.4%), with a partial response in 4 cases (17.4%), 4 cases stable(17.4%)and 8 cases showing progression (34.8%). The total clinical remission rate was 47.8% (11/23). The clinical remission rate was 77.8% (7/9) in the single-lesion group and 28.6% (4/14) in the multiple-lesion group with a significant difference between the two(P=0.036). The common side effects observed were mild gastrointestinal reactions. Conclusions: 125I-seed implantation combined with chemotherapy applies an effective way in the treatment of platinum-resistant recurrent ovarian epithelial carcinoma with the advantages of high local control rates, good short-term effects, little trauma and less side effects.

• 대한두경부종양학회지
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• 제17권2호
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• pp.179-184
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• 2001

Objective: The role of chemotherapy in locally advanced head and neck cancer has been established in nasopharynx and larynx as definitive therapy and organ preserving therapy, respectively. Oral cavity cancers are relatively uncommon and local recurrence is the main cause of treatment failure. We planned this retrospective study to evaluate the role of neoadjuvant chemotherapy in locally advanced oral cavity cancer patients. Materials and Methods: From 1988 March to 2001 February, locally advanced, previously untreated oral cavity cancer patients who received neoadjuvant chemotherapy were examined. Chemotherapy had been done in the following patients: Histologically proven squamous cell or poorly differentiated carcinoma, stage 3 or 4, and performance state 0-2 patients. Chemotherapy regimen consisted of cisplatin and infusional 5-fluorouracil. Response was evaluated after 2 cycles and in case of no response, definitive local therapy was done; otherwise 3 cycles was done before local treatment. Results: 48 patients were treated and 47 patients were evaluable for responses. Complete response rate was 6.4%(3/47) and partial response 80.0%(38/47), scoring overall response rate of 87.2%. Median time to progression was 27.0 months (95% CI : 0-58months) and overall 5 year survival was 54.8%. 5-year disease-free survival in the patients in remission after local treatment was 51.9%. In multivariate analysis, contributing factor to the survival were response to neoadjuvant chemotherapy and local treatment modalities. Extensive surgery was done in 10 patients and 25 patents (52.1%) was followed up with preserved function. With median follow-up of 57.0 months, 19 recurrences were detected, most of which were local or regional type. Conclusion: Neoadjuvant chemotherapy followed by local treatment in oral cavity cancer showed high response rate and was thought to be effective therapeutic approach especially in view of organ preservation.