• Radiation Oncology Journal
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• v.34 no.2
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• pp.145-155
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• 2016

Purpose: Radiation therapy targeting axilla and groin lymph nodes improves regional disease control in locally advanced and high-risk skin cancers. However, trials generally used conventional two-dimensional radiotherapy (2D-RT), contributing towards relatively high rates of side effects from treatment. The goal of this study is to determine if three-dimensional conformal radiation therapy (3D-CRT), intensity-modulated radiation therapy (IMRT), or volumetric-modulated arc therapy (VMAT) may improve radiation delivery to the target while avoiding organs at risk in the clinical context of skin cancer regional nodal irradiation. Materials and Methods: Twenty patients with locally advanced/high-risk skin cancers underwent computed tomography simulation. The relevant axilla or groin planning target volumes and organs at risk were delineated using standard definitions. Paired t-tests were used to compare the mean values of several dose-volumetric parameters for each of the 4 techniques. Results: In the axilla, the largest improvement for 3D-CRT compared to 2D-RT was for homogeneity index (13.9 vs. 54.3), at the expense of higher lung $V_{20}$ (28.0% vs. 12.6%). In the groin, the largest improvements for 3D-CRT compared to 2D-RT were for anorectum $D_{max}$ (13.6 vs. 38.9 Gy), bowel $D_{200cc}$ (7.3 vs. 23.1 Gy), femur $D_{50}$ (34.6 vs. 57.2 Gy), and genitalia $D_{max}$ (37.6 vs. 51.1 Gy). IMRT had further improvements compared to 3D-CRT for humerus $D_{mean}$ (16.9 vs. 22.4 Gy), brachial plexus $D_5$ (57.4 vs. 61.3 Gy), bladder $D_5$ (26.8 vs. 36.5 Gy), and femur $D_{50}$ (18.7 vs. 34.6 Gy). Fewer differences were observed between IMRT and VMAT. Conclusion: Compared to 2D-RT and 3D-CRT, IMRT and VMAT had dosimetric advantages in the treatment of nodal regions of skin cancer patients.

• Archives of Plastic Surgery
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• v.35 no.6
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• pp.743-747
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• 2008

Purpose: Malignant changes of Marjolin's ulcer arising from chronic burn scar are rare. The majority of them are squamous cell carcinoma and basal cell carcinoma. Malignant fibrous histiocytoma is a deep seated pleomorphic sarcoma, which occurs principally as a mass of the extremities, abdominal cavity, or retroperitoneum in adults. Methods: We report a 58-year-old male patient who was admitted due to $3.5{\times}5cm$ chronic ulceration of anterior chest wall on the center of old burn scar. His scar had been occurred by boiling oil and treated with conservative treatment 45 years ago. Preoperative punch biopsy showed suspicious malignant changes and contrast enhanced chest CT showed well-defined, irregular shape enhancing lesion on anterior chest wall without intrathoracic metastasis. Results: The tumor was widely excised and defect was covered with skin graft without infection, necrosis and any other complication. The pathologic findings are compatible with malignant fibrous histiocytoma(storiform - pleomorphic type). The patient underwent 3 cycles of chemotheraphy. Although distant metastasis to the lung developed 6 months later and the patient died 9 month later, there was no local reoccurrence. Conclusion: Aggressive and early excision is needed because malignant fibrous histiocytoma has characteristics of high malignancy with a propensity for early and distant spread. Furthermore, the patient's education about disease entity and postoperative regular follow-up for local recurrence or metastasis is very important. To prevent malignancy from secondly healing burn scar, early skin graft is recommended for patients with deep second degree burn.

• Journal of Chest Surgery
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• v.36 no.2
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• pp.79-85
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• 2003

Diagnosing and determining the stage of lung cancer by means of positron emission tomography (PET) ha.. been proven valuable because of the limitations of diagnosis by computed tomography (CT). We compared the efficacy of PET with that of CT in diagnosing pulmonary tumor and staging of lung cancer Material and Method: We performed F-18 FDG PET to determine the malignancy and the staging on patients who have been suspicious or were diagnosed as lung cancer by chest X-ray and CT. The findings of PET and of CT of 41 patients (male, 29: female, 12: mean age, 59) were compared with pathologic findings obtained from a mediastinoscopy and thoracotomy. Result: Out of 41 patients, 35 patients had malignant lesions (squamous cell carcinonla 19 cases, adenocarcinoma 14 cases, adenosquamous cell carcinoma 2 cases) and 6 patients had benign lesions. Diagnosing of lung cancer, the sensitivity, specificity and accuracy of CT and PET were the same for two method and the numbers were 100%, 50%, and 92.7% respectively. Eighteen LN groups out of 108 mediastinal LN groups who recieved histologic examination proved to be malignant. Pathologic lymph node (LN) stage was N0-Nl 31 cases, N2 8 cases, N3 2 cases. The correct identification of the nodal staging with CT, PET scans were 31 cases (75.6%), 28 cases (68.3%) respectively. The LN group was underestimated in each 6 cases of CT and PET. In 4 cases of CT and 7 cases of PET, they were overestimated in compare to histologic diagnosis. In the detection of mediastinal LN groups invasion, the sensitivity, specificity and accuracy of CT were 39.8 %, 93.3 %, and 84.3 % respectively. For PET, they were 61.1 %, 90.0 %, and 85.2 %. When two methods considered together (CT+PET), they were increased to 77.8 %, 93.3 %, and 90.7 % respectively. Conclusion: PET appears to be similar to CT in the diagnosis and the nodal taging of pulmonary tumor. Two tests may stage patients with lung cancer more accurately than CT alone.

• Korean Journal of Head & Neck Oncology
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• v.23 no.1
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• pp.15-20
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• 2007

Background and Objectives：Supraglottic partial laryngectomy is oncologically sound surgical procedure for selected cases of laryngeal cancer which maintains physiologic speech and swallowing without permanent tracheostoma. The purpose of this study is to evaluate the oncologic and functional results of supraglottic partial laryngectomy and neck dissection for supraglottic cancer. Materials and Methods：Between 1991-2005, Twenty-three supraglottic cancer patients, underwent supraglottic partial laryngectomy, were studied retrospectively. There were 5 patients with cT1, 14 with cT2, 4 with cT3 and 11 patients with cN0, 1 with cN1, 10 with cN2, 1 with cN3. All patients underwent neck dissection and postoperative radiotherapy was added to twenty patients. They were reviewed with respect to primary subsites, extended subsites, treatment result, survival rate, factors affecting the prognosis, postoperative complication, time of decannulation and oral diet, and postoperative voice. Results：Among eleven patients with clinically negative node, six patients had pathologically positive nodes. So occult metastasis was 54.5%. Two patients recurred at cervical lymph node and one had distant metastasis to lung. Local and regional control were 100% and 91.3%. The overall 3-year and 5-year survival rate were 84%, 78%, respectively. Nineteen cases were squamous cell carcinomas and four were basaloid squamous cell carcinomas. Basaloid subtype was significantly affected to survival. Decannulation and oral feeding were possible in 100%. Conclusions：Supraglottic partial laryngectomy is oncologically safe and functionally good procedure in supraglottic cancers. Elective neck dissection is beneficial in management of occult cervical metastasis.

• Tuberculosis and Respiratory Diseases
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• v.48 no.5
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• pp.757-765
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• 2000

Background : Angiogenesis plays a critical role in human tumor growth and metastasis. Microvessel count as a measure of tumor angiogenesis, has been significantly correlated with invasive and metastatic patterns in breast. prostate and cutaneous carcinomas. Materials and Methods : Fifty patients with curatively resected non-small cell lung cancer were evaluated. Tumor tissues embedded in paraffin block were stained by anti CD 31 (PECAM, platelet endothelial cellular adhesion molecule) using immunohistochemical method to assess microvessel count. Microvessels were counted in the most active areas of neovascularization(microscopy, 200$\times$). Results: 1) Mean microvessel count was 47.1$\pm$17.7(per 200$\times$field) in total 50 cases. 2) Mean microvessel count of adenocarcinoma (54.4$\pm$19.9) was significantly higher than that of squamous cancer (43.9$\pm$16.2) (p<0.05), but there were no relationship between microvessel count and TNM stages. 3) Median survival time, 2-year and 5-year survival rates of the low microvascular group (microvessel count<45, 22 cases) were 61 months, 80% and 40%, respectively, and those of the high microvascular group(microvessel count$\geq$45, 28 cases) were 46 months, 75% and 12%, respectively. As results, prognosis of low microvascular group is statistically significantly superior to that of the high microvascular group (p=0.0162, Kaplan-Meier, log-rank). Conclusion : Angiogenesis assessed by microvessel count can be used as one of the significant prognostic factors in non-small cell lung cancer.

• Tuberculosis and Respiratory Diseases
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• v.53 no.3
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• pp.265-274
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• 2002

Background : Tumor associated antigens, which are produced specifically by tumor cells, are promising targets for the early diagnosis and immunotherapy. Among the tumor associated antigens, MAGE (a melanoma antigen), BAGE, GAGE, PRAME and NY-ESO were named as cancer/testis specific antigens they are detected exclusively in the testis or cancer cells If MAGE is easily detectable in the sputum, it would become a convenient method for diagnosing lung cancer. This study was undertaken to investigate MAGE expression in the induced sputum obtained from lung cancer patients. Materials and Methods : In 14 control patients and 30 lung cancer patients, the induced sputum was collected after inhaling 3% saline(5 cc) delivered by nebulizer for approximately 5 minutes after a mouth rinse and bronchodilator inhalation. The induced sputum was placed in a conservative-mixed solution (guanidinium isothiocyanate, Triton X-100). The total cellular mRNA was extracted from the cells and RT PCR and nested PCR were run in 30 and 35 cycles respectively, with two different types of primers specially designed to detect six subtypes of MAGE DNA simultaneously. Results : MAGE expression was not detected in the 14 controls, but in the 30 cancer patients, MAGE was found in 24 patients (80%, p=0.001). In the cancer patients, there were no differences in the expression level according to the tissue types (squamous cell cancer 13/17, adenocarcinoma 7/9, and small cell cancer 4/4, p-0.56). Among the 24 MAGE-positive patients, the tumor was not visible on a bronchoscopy in 11 patients (45.8%). Conclusion : A study of MAGE in induced sputum appears to be a useful and complementary method in the diagnosis of lung cancer. A further prospective study with more patients is recommended.

• Tuberculosis and Respiratory Diseases
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• v.67 no.6
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• pp.545-550
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• 2009

Background: Endobronchial ultrasonogram (EBUS) has increased the diagnostic yield of a bronchoscopic biopsy of peripheral pulmonary lesions (PPL). This study evaluated the diagnostic yield of EBUS-guided transbronchial biopsy (TBB) and the visibility of EBUS PPL. Methods: Between August 2007 and November 2008, 50 patients (32 men and 18 women, median age, 61.1${\pm}$10 yrs; range, 16 to 80 yrs) whose PPL lesions could not be detected with flexible bronchoscopy were enrolled in this study. Among the 50 patients, 40 cases were malignant lesions (adenocarcinoma 25, squamous cell carcinoma 10, small cell carcinoma 5) and 10 cases were benign lesions (tuberculoma 7, fungal ball 1, other inflammation 2). Results: The mean diameter of the target lesion was 35.4${\pm}$4.3 mm. Of the 50 patients examined, the overall diagnostic yield by EBUS-TBLB was 46.0% (23/50). The visualization yield of EBUS was 66.0% (33/50). A definitive diagnosis of PPL localized by EBUS was established using EBUS-TBLB in 69.6% (23/33) of cases. The diagnostic yields from washing cytology and brushing cytology from a bronchus identified by EBUS were 27.0% and 45.4% respectively. The diagnostic yields reached 78.7% when the three tests (washing cytology, brushing cytology and EBUS-TBLB) were combined. The visualization yield of EBUS in lesions <20 mm was significantly lower than that in lesions ${\geq}$20 mm (p=0.04). The presence of a bronchus leading to a lesion (open bronchus sign) on the chest CT scan was associated with a high visualization yield on EBUS (p=0.001). There were no significant complications associated with EBUS-TBLB. Conclusion: EBUS-TBLB is a safe and effective method for diagnosing PPL. The lesion size and open bronchus signs are significant factors for predicting the visualization of EBUS.

• Journal of Chest Surgery
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• v.8 no.2
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• pp.149-152
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• 1975

In spite of great advances in surgical treatment during past several decades, surgery of the trachea failed to develop correspondingly, partly because of relative rarity of the tracheal lesions and partly because of difficulties in surgical technique and anesthesia. Surgical diseases of the trachea are largely obstructions due to neoplasm or cicatrical stenosis and tracheal malacia. The present treatment of respiratory failure, using cuffed endotracheal and tracheostomy tubes, has produced, apparently with increasing frequency, tracheal stenosis, tracheomalized tracheal erosion. Surgery is presently the only reasonable way to treat stenotic lesions of the tracheobronchial tree. In the case of tumors, the current trend has been that of radical excision. Primary end-to--end reconstruction of the trachea has been generally recognized as the ideal method of repair following resection. However, for decades it was believed that a maximum of four tracheal rings only might be excised and primary healing achieved with safety. A great variety of procedures, developed by numerous investigations and directed at tracheal substitution, have almost invariably met with discouraging results. A meticulous study done by Grillo and associates on autopsy specimens has shown that an average 6.4cm of mediastinal trachea can be safely resected by full mobilization of the right lung and transplantation of the left main bronchus into the bronchus intermedius. Recently, we experienced a case of successful resection of a tumor of the tracheal carina and primary tracheo-left main bronchial anastomosis at the Department of Thoracic & Cardiovascular Surgery, the National Medical Center in Seoul. The patient, a 29-year-old man, was admitted to the hospital with complaints of dyspnea and cough. On admission, chest film showed hydropneumothorax on the right. After closed thoracostomy, hydropneumothorax disappeared, but hazy densities, developed in the right middle and lower lung fields, resisted to treatment. Bronchoscopy uncovered irregular tumor covering the carina and the right main bronchus, and biopsy indicated well differentiated squamous Cell carcinoma. Operation was performed on July 2, 1975. A right postero-lateral thoracotomy was used. Excision involved the lower trachea, the carina, the left main bronchus and the right lung. This was followed by direct anastomosis between the trachea and the left main bronchus. Bronchography was done on 17th postoperative day revealed good result of operation without stricture at the site ofanastomosis. About one month after the operation symptoms and signs of bronchial irritation with dyspnea developed, and these responded to respiratory care. On 82nd postoperative day, sudden dyspnea developed at night and the patient expired several hours later. Autopsy was not done and the cause of death was uncertain.

• Journal of Yeungnam Medical Science
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• v.7 no.2
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• pp.151-158
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• 1990

We reviewed 30 cases of superior vena cava syndrome in adult patients who were seen at the Yeungnam University Hospital from January 1985 to June 1990. The results were as follows : 1. The male-to-female ratio was 6.5:1, and the most patients were in the age group between the sixth and seventh decades. 2. The most common symptoms were dyspnea (87%) and followed by cough (63%), facial swelling (63%) and chest pain (44%) and the physical signs were dilated neck vein (97%), facial edema (93%) and facial flushing (45%) in order of frequency. 3. The simple chest x-ray findings were superior mediastinal widening (90%), right hilar mass (77%) and pleural effusion (31%). 4. Diagnosis was made by history and physical examination (100%), chest C-T scan (100%), simple chest x-ray (97%), bronchoscopy with biopsy (40%) and so on. 5. 21 cases of patients were confirmed by histology : 14 cases (46%) of bronchogenic ca. 4 cases (14%) of lymphoma, 3 cases (10%) of metastic lung ca. Of bronchogenic ca. small cell ca was 7 cases (23%), squamous cell ca, 5 cases (17%), and unclassified ca was 2 cases (6%). 6. In response of treatment, the clinical improvement was achieved in 18 cases with radiotherapy alone. 1 case with chemotherapy only, and 6 cases with radio-chemotherapy.

• Journal of Chest Surgery
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• v.29 no.6
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• pp.614-620
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• 1996

The method of treatment in lung cancer patients with invasion to parietal pleura, diaphragm, peri- cardium or vertebra is controversial, and resection of these invasion together with pneumonectomy is called "complex pneumonectomy" From March 1990 to February 1994 we performed 18 cases of "complex pneumonectomy". Seven patients had resection of chest wall, 10 patients had pericardial re- section, and one patient had resection of diaphragm Right pneumonectomy was done in 8 cases and left pneumonectomy was done in 10 cases. The age of patients were from 40 to 70 years(mean 58 years) with male to female ratio of 17 to 1. The chief complaints of the patients on admission were cough (13), dyspnea on exertion (11), chest pain (10), weight loss (9), general fatigue (9), and sputum production (4 . Postoperative pathology were 13 squamous cell carcinoma, 3 adenocarcinoma, and one case each of adenosquamous carcinoma and small cell carcinoma. The postoperative pathologic stages were 2 T3NO MO, 4 TIWIMO, 6 T3N2MO, 5 T4N2MO, and 1 TIWIMO. There was one operative mortality(5.5%). Excluding one follow up loss, 14 patients expired during the follow-up and the mean survival was 9.07 $\pm$ 4.82 months. One patient with stage TINOMO who had chest wall resection is alive at 35 months follow-up and a patient with T3N2MO who had diaphragm resection is alive at 36 months follow-up. Therefore, selection of patients for "complex pneumonec- tomy" is very important, and a long term survival is possible.ong term survival is possible.