• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6779-6782
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• 2015

Background: Chemoradiotherapy is an important treatment modality for lung cancers. The aim of this study was to investigate alterations in, as well as the interrelationship between, lung function and quality of life of patients receiving chemoradiotherapy due to locally advanced non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) limited to the thorax. Materials and Methods: The study included patients receiving definitive chemoradiotherapy for lung carcinoma. The respiratory function of the patients was assessed by measuring forced expiratory volume in 1 s per unit (FEV1) and forced expiratory volume in 1s per unit of vital capacity (FEV1/VC) before, in the middle of and after treatment. During the study, EORTC QLQ C30 and LC13 questionnaires developed by the Committee of the European Organization for Research and Treatment of Cancer (EORTC) were employed to evaluate the quality of life on the same day as respiratory function tests (RFT). Findings: The study included 23 patients in total: 19 (82.6%) diagnosed with NSCLC and 4 (17.4%) with SCLC. The average percentage FEV1 was $55.6{\pm}21.8%$ in the pre-treatment period, $56.2{\pm}19.2%$ in the middle of treatment and $60.4{\pm}22%$ at the end of treatment. The improvement in functional scores, symptom scores and general health scores during treatment was not statistically significant (P= 0.568, P= 0.734, P= 0.680, P=0.757 respectively). Conclusions: Although this study showed an improvement in respiratory function and quality of life of patients during treatment with thoracic chemoradiotherapy, no statistically significant results were obtained. While evaluating the effectiveness of treatments for lung carcinoma, the effects of treatment on respiratory function and quality of life should be considered.

• Tuberculosis and Respiratory Diseases
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• 제47권6호
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• pp.797-806
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• 1999

연구배경: 소세포 폐암은 진단 당시 약 20% 이상에서 진단 당시 골수전이가 발견됨으로써 초기의 혈행성 전이가 중요한 예후인자일 것으로 추정되고 있다. 따라서 진단 또는 치료당시 기존의 검사수기로는 확인할 수 없었던 미세전이를 확인할 수 있다면 환자의 치료방침 및 예후결정에 유효한 지표가 될 수 있을 것으로 기대되어 왔다. 최근 cytokeratin(CK)-20 이 골수와 같은 조혈기관에서는 발현되지 않으면서 상피세포에서만 발현되는 것으로 알려져서 이 표지자가 소세포 폐암과 같은 상피세포암의 골수 미세전이의 발견에 효과적일 가능성을 사사하고 있다. 방 법: 소세포암세포주인 H209와 정상인의 혈구세포를 대상으로 CK-20 발현을 비교하였고, 소세포 폐암환자의 병기결정을 위한 경사로서 골수천자를 시행하면서 동시에 골수를 수집하여 이로부터 RNA를 수출하여 CK-20에 대한 primer를 이용하여 RT-PCR을 시행하였다. 결 과: H209 세포주에서는 CK-20의 발현이 관찰된 반면, 정상 혈구세포에서는 관찰되지 않아서 CK-20이 조혈세포에서는 발현되지 않고, 상피조직에 서만 특이적으로 발현되는 것으로 생각되었다. 28명의 소세포 폐암환자중 제한기가 11명, 확장기 환자가 17명이었으며, 17명의 확장기 환자가운데 골수조직검사상 골수 침범이 확인되었거나 또는 골주사검사상 전이가 확인된 환자는 7명(41%)이었다. CK-20에 대한 PCR 결과 각각 LD 11예종 l예(10%), ED 17예 중 1예(6%)에서 CK-20의 증폭이 관찰되었다. CK-20의 증폭이 관찰된 2예 중 ED 환자는 골수전이가 있었고, LD 환자는 진단당시는 원격전이가 없는 제한기의 환자였으나 후에 골전이가 관찰되었다. 결 론: 증폭이 관찰된 2 예의 환자가 모두 임상적으로는 골수 전이가 없는 상태에서 골전이가 발견됨으로써 CK-20의 발현이 혈행성 미세전이의 발견에 유용할 수 있을 가능성이 있을 것으로 추정할 수는 있으나, 골수전이가 확인되었던 7명중 6명에서는 CK-20이 발현되지 않아서, CK-20 보다 좀 더 유용한 표지자의 개발이 필요할 것으로 생각된다.

• Tuberculosis and Respiratory Diseases
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• 제55권4호
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• pp.388-394
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• 2003

배 경 : 지금까지 폐암의 종양표지자로 알려진 것들 중에 최근에는 CK 19뿐만 아니라 폐암에서 많이 발견되는 CK 8, 18에 대해 특이적인 세가지 단클론항체를 이용한 면역방사선계수법(MonoTotal$^{TM}$)이 개발되어 폐암의 진단에 이용할 수 있는 것으로 보고되었다. 따라서 저자들은 Cyfra 21-1에 비교하여 CK 8, 18, 19의 폐암표지자로서의 진단적 가치에 대해 연구하였다. 대상 및 방법 : 2002년 5월 l일부터 2002년 9월 30일까지 서울대학교병원 내과에 입원하여 기관지내시경 또는 객담도말세포검사, 경피적 조직생검으로 확진된 원발성 폐암환자 129명을 폐암군으로 하고 폐암이 배제된 비악성 호흡기 질환자 160명을 환자 대조군으로 연구에 동의한 건강한 성인 57명을 정상 대조군으로 하여 본 연구를 시행하였다. Cyfra 21-1의 측정은 Fujibebio Diagnostics사(USA)의 immnoradiometric assay kit인 Cyfra$^{TM}$ 21-1을 사용하였고 CK 8, 18, 19의 측정은 IDL biotech사의 2-hour immunoradiometric sandwich test kit인 Monototal$^{TM}$을 사용하였다. 결 과 : 폐암의 조직학적 분류에 따른 Monototal의 혈중평균치(mean${\pm}$SD)는 비소세포폐암이 $412.47{\pm}455.45$ U/L, 소세포폐암이 $237.08{\pm}145.15$ U/L로 환자 대조군 $126.54{\pm}95.72$ U/L, 정상 대조군 $63.68{\pm}31.66$ U/L에 비해 유의하게 증가되어 있었다(p<0.01). Monotoal의 정상범위를 정상 대조군의 가장 높은 수치인 188U/L 이내로 하였을때 비소세포폐암의 민감도는 66.4%, 특이도는 81.9%였다. 병기를 I,II군(32명)과 III,IV군(84명)의 두 군으로 나누어 Monototal의 평균을 비교해 보았을 때 각각 $227.6{\pm}185.2$ U/L, $482.9{\pm}506.4$ U/L로 두 군간에 통계적으로 유의한 차이가 있었다(p<0.001). 환자대조군 세부질환별로 Monototal의 평균치를 보면 미만성폐질환 환자군(11명)에서 $298.7{\pm}210.0$ U/L로 환자 대조군 평균치인 $126.54{\pm}95.72$ U/L에 비해 통계적으로 유의하게 높게 측정되었다(p<0.001)(Table 4). 결 론 : cytokeratin 8, 18, 19의 측정은 폐암의 대표적인 종양 표지자중의 하나인 Cyfra 21-1과 비슷한 민감도와 특이도를 보이고 있어 효과적인 종양표지자로 앞으로 사용될 수 있다.

• Tuberculosis and Respiratory Diseases
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• 제43권6호
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• pp.903-915
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• 1996

Background: Combination chemotherapy is now considered to be the cornerstone of small cell lung cancer (SCLC). management but the optimal management of limited SCLC is not well defined. The role of thoracic radiotherapy (TRT) is less well established. Recent meta-analyses reports revealed that TRT combined with chemotherapy produce "good" local control and prolonged survival. But other reports that survival was not changed. The liming, dose, volume and fractionation for TRT with the combined chemotherapy of SCLC remains unsettled. In this study, we analyzed the effects according to the timing of thoracic radiotherapy in limited SCLC. Method: All fifty one patients received cytoxan, adriamycin and vincristine(CAV) alternating with etoposide and cisplatin(VPP) every 3 weeks for 6 cycles were randomized prospectively into two groups: concurrent and sequential. 27 patients received 4500cGy in 30 fractions(twice daily 150cGy fractional dose) over 3 weeks 10 the primary site concurrent with the first cycle of VPP(concurrent gorup). 24 patients received 4000 to 5000cGy over 5 or 6 weeks after completion of sixth cycles of chemotherapy(sequential group). Results: 1. Response rates and response duration : Response rates were not significantly different between two groups(p=0.13). But response duration was superior in the concurrent group(p=0.03). 2. Survival duration was nor different between two groups(p=0.33). 3. Local control rate was superior in the concurrent group(p=0.00). 4. Side effects and toxicities: Hematologic toxicities, especially leukopenia, infection and frequency of radiation esophagitis were higher in the concurrent group (p=0.00, 0.03, 0.03). Conclusion: The concurrent use of TRT with chemotherapy failed to improve the survival of limited stage SCLC patients compared with the sequential use of TRT but response duration and local control rate were superior in the concurrent group. Frequency of radiation esophagitis, life threatening hematologic toxicities and infection were more frequent in the concurrent group than sequential group. So, the selection of an optimal schedule of chemotherapy combined with TRT that would lead to a major increase in survival with minimal toxicity is remained to be validated in large scale study in the future.

• Asian Pacific Journal of Cancer Prevention
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• 제16권1호
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• pp.77-81
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• 2015

Background: The aim of the study was to determine whether the expression of baseline phosphorus (P) and magnesium (Mg) levels were prognostic in terms of stage and overall survival (OS) in newly diagnosed non-small cell lung cancer (NSCLC) and small cell lung cancer (SCLC) patients. Materials and Methods: Retrospectively, 130 patients were selected at the time of diagnosis oflung cancer (100 with NSCLC and 30 with SCLC), before the initialization of any chemo-radiotherapy. The median age was 67 (range 29-92). IA, IB, IIA, IIB, IIIA, IIIB and IV stages were present in 3, 4, 19, 6, 25, 8, and 65 patients, respectively. After centrifugation, the levels of serum P and Mg were measured using the nephelometric method/ photometry and evaluated before any type of treatment. Results: Higher than normal levels of P were found in 127/130 patients, while only four patients had elevated Mg serum values. In terms of Spearman test, higher P serum values correlated with either stage (rho=- 0.334, p<0.001) or OS (rho=-0.212, p=0.016). Additionally, a significant negative correlation of Mg serum levels was found with stage of disease (rho=-0.135, P=0.042). On multivariate cox-regression survival analysis, only stage (p<0.01), performance status (p<0.01) and P serum (p=0.045) showed a significant prognostic value. Conclusions: Our study indicated that pre-treatment P serum levels in lung cancer patients are higher than the normal range. Moreover, P and Mg serum levels are predictive of stage of disease. Along with stage and performance status, the P serum levels had also a significant impact on survival. This information may be important for stratifying patients to specific treatment protocols or intensifying their therapies. However, larger series are now needed to confirm our results.

• Tuberculosis and Respiratory Diseases
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• 제73권5호
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• pp.288-291
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• 2012

Typhlitis is a necrotizing colitis that usually occurs in neutropenic patients and develops most often in patients with hematologic malignancies such as leukemia and lymphoma. Typhlitis may proceed to bowel perforation, peritonitis and sepsis, which requires immediate treatment. Irinotecan is a semisynthetic analogue of the natural alkaloid camptothecin which prevents DNA from unwinding by inhibition of topoisomerase I. It is mainly used in colon cancer and small cell lung carcinoma (SCLC), of which the most common adverse effects are gastrointestinal toxicities. To the best of our knowledge, no case of typhlitis after chemotherapy with a standard dose of irinotecan in a solid tumor has been reported in the literature. We, herein, report the first case of typhlitis developed after chemotherapy combining irinotecan and cisplatin in a patient with SCLC.

• Asian Pacific Journal of Cancer Prevention
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• 제15권5호
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• pp.2205-2210
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• 2014

Objective: To retrospectively review the clinical characteristics and analyze the prognostic factors of Chinese patients with pulmonary neuroendocrine tumors. Materials and Methods: The clinical data of 176 patients with pulmonary neuroendocrine tumors in Chinese PLA General Hospital from Mar., 2000 to Oct., 2012 were retrospectively analyzed. The parameters were evaluated by univariate and multivariate analysis, including the gender, age, smoking history, family history, TNM staging, localization (central or peripheral), tumor size, nodal status, histological subtype and treatment (operation or non-operation). Results: There were 23 patients with typical carcinoids (TC) (13.1%), 41 with atypical carcinoids (AC) (23.3%), 10 with large cell neuroendocrine carcinoma (LCNEC) (5.7%) and 102 with small cell lung cancer (SCLC) (57.9%). The median follow-up time was 64.5 months for AC, 38 months for LCNEC and 27 months for SCLC. The typical carcinoid censored data was 18 (more than 50% of the patients), so the median follow-up time was not obtained, and actuarial 5-year survivals for TC, AC, LCNEC and SCLC were 75.1%, 51.7%, 26.7% and 38.8%, respectively. COX univariate analysis revealed that the age (P=0.001), histological subtype (P=0.005), nodal status (P=0.000), treatment (P=0.000) and TNM staging (P=0.000) were the prognostic factors of the patients with pulmonary neuroendocrine tumors, whereas its multivariate analysis showed that only the age(P=0.001), TNM staging (P=0.002) and treatment (P=0.000) were independent prognostic factors. Conclusions: Radical surgery remains the treatment of choice, and is the only curative option. The age, TNM staging and treatment are confirmed to be the independent prognostic factors in multivariable models for pulmonary neuroendocrine tumors.

• Tuberculosis and Respiratory Diseases
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• 제76권5호
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• pp.218-225
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• 2014

Background: Small cell lung cancer (SCLC) is an extremely aggressive tumor with a poor clinical course. Although many efforts have been made to improve patients' survival rates, patients who survive longer than 2 years after chemotherapy are still very rare. We examined the baseline characteristics of patients with long-term survival rates in order to identify the prognostic factors for overall survivals. Methods: A total of 242 patients with cytologically or histologically diagnosed SCLC were enrolled into this study. The patients were categorized into long- and short-term survival groups by using a survival cut-off of 2 years after diagnosis. Cox's analyses were performed to identify the independent factors. Results: The mean patient age was 65.66 years, and 85.5% were males; among the patients, 61 of them (25.2%) survived longer than 2 years. In the multivariate analyses, CRP (hazard ratio [HR], 2.75; 95% confidence interval [CI], 1.25-6.06; p=0.012), TNM staging (HR, 3.29; 95% CI, 1.59-6.80; p=0.001), and progression-free survival (PFS) (HR, 11.14; 95% CI, 2.98-41.73; p<0.001) were independent prognostic markers for poor survival rates. Conclusion: In addition to other well-known prognostic factors, this study discovered relationships between the long-term survival rates and serum CRP levels, TNM staging, and PFS. In situations with unfavorable conditions, the PFS would be particularly helpful for managing SCLC patients.

• Radiation Oncology Journal
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• 제31권4호
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• pp.185-190
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• 2013

Purpose: We evaluated the effect of early chemoradiotherapy on the treatment of patients with limited stage small cell lung cancer (LS-SCLC). Materials and Methods: Between January 2006 and December 2011, thirty-one patients with histologically proven LS-SCLC who were treated with two cycles of chemotherapy followed by concurrent chemoradiotherapy and consolidation chemotherapy were retrospectively analyzed. The chemotherapy regimen was composed of etoposide and cisplatin. Thoracic radiotherapy consisted of 50 to 60 Gy (median, 54 Gy) given in 5 to 6.5 weeks. Results: The follow-up period ranged from 5 to 53 months (median, 22 months). After chemoradiotherapy, 35.5% of the patients (11 patients) showed complete response, 61.3% (19 patients) showed partial response, 3.2% (one patient) showed progressive disease, resulting in an overall response rate of 96.8% (30 patients). The 1-, 2-, and 3-year overall survival (OS) rates were 66.5%, 41.0%, and 28.1%, respectively, with a median OS of 21.3 months. The 1-, 2-, and 3-year progression free survival (PFS) rates were 49.8%, 22.8%, and 13.7%, respectively, with median PFS of 12 months. The patterns of failure were: locoregional recurrences in 29.0% (nine patients), distant metastasis in 9.7% (three patients), and both locoregional and distant metastasis in 9.7% (three patients). Grade 3 or 4 toxicities of leukopenia, anemia, and thrombocytopenia were observed in 32.2%, 29.0%, and 25.8%, respectively. Grade 3 radiation esophagitis and radiation pneumonitis were shown in 12.9% and 6.4%, respectively. Conclusion: We conclude that early chemoradiotherapy for LS-SCLC provides feasible and acceptable local control and safety.

• Tuberculosis and Respiratory Diseases
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• 제49권1호
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• pp.49-59
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• 2000

연구배경 : 암 발생 및 진행 과정 중 암유전자의 활성화, 종양억제유전자의 불활성화 등이 중요한 역할을 한다고 알려져 있으며, 종양억제유전자의 불활성화는 많은 경우에서 하나의 대립형질의 돌연변이와 다른 대립 형질의 결손에 의한다고 한다. 따라서 암 발생 및 진행에 관여하는 특이 종양 억제유전자를 찾고자 종양 억제유전자 불활성의 특성인 LOH를 분석하는 다양한 연구를 시행하여 왔다. 아직까지 소세포폐암과 관련된 특이 유전자가 확인되지 않았기 때문에 원발성 소세포폐암의 발생과 진행에 병인적 중요성을 갖는 종양억제 유전자를 찾고자 시행하였다. 대상 및 방법 : 연세대학교 의과대학 세브란스병원에서 원발성 소세포폐암으로 진단된 15명의 남자 환자를 대상으로 하였다. 암 조직과 이에 대응하는 정상 조직의 파라핀포매 블록으로부터 DNA를 추출하였으며, 염색체 5번 장완에 위치하는 19개의 현미부수체 표지자들을 이용하여 PCR-LOH 분석을 시행하였다. 결과 : 1) 15예 중에서 LOH가 1개라도 관찰된 경우는 10예로 66.7%이었다 (Fig. 1). 2) LOH가 있는 10예 중 검사를 시행한 모든 표지자들의 결혼이 있는 경우는 2예(SCLC1, SCLC3)로써 13%이었다 (Fig. 1). 3) 경사를 시행한 19개의 표지자들중 5개에서 50% 이상의 LOH 빈도를 확인할 수 있었는데 5q14-15에 위치하는 D5S409와 5q23-31에 위치하는 D5S404와 사이인 18.3 cM 간격에서 57.1%, 5q31.l에 위치한 IRF-1에서 63.6%, 5q31.3-33.3에 위치하는 D5S209에서 54.5%, 5q34-35에 위치하는 D5S400에서 54.5%, 그리고 5q34-qter에 위치하는 D5S429와 5q35.2-35.3에 위치하는 D5S498사이인 5.5cM 간격에서 75%의 빈도로 관찰되었다(Table 1, Fig. 1, Fig. 2). 4) Shifted bands는 15예 중 3예에서 관찰되었는데 SCLC8에서 26.3%, SCLC 6 에서 5.3%, SCLC14 에서 5.3%의 altered loci가 관찰되었다 (Fig. 1, Fig. 2). 5) Shifted bands는 검사한 총 285 loci 중 2.5%인 7 loci에서 관찰되었다 (Fig. 1). 결론 : 염색체 5번의 장완에는 원발성 소세포폐암 일부에서 발생 및 진행에 관여하는 최소 5개의 종양억제유전자좌가 존재할 것으로 생각되며, 향후 특이 유전자를 찾기 위한 추가적인 노력이 있어야 할 것으로 생각된다.