• Radiation Oncology Journal
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• v.27 no.2
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• pp.78-83
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• 2009

Purpose: To examine the effect of suboptimal chemotherapy in patients undergoing preoperative chemoradiotherapy for the treatment of rectal cancer. Materials and Methods: The medical records of 43 patients who received preoperative concurrent chemoradiotherapy, followed by radical surgery for the treatment of pathologically proven adenocarcinoma of the rectum from April 2003 to April 2006 were retrospectively reviewed. The delivered radiation dose ranged from 41.4 to 50.4 Gy. The standard group consisted of patients receiving two cycles of a 5-FU bolus injection for three days on the first and fifth week of radiotherapy or twice daily with capecitabine. The standard group included six patients for each regimen. The non-standard group consisted of patients receiving one cycle of 5-FU bolus injection for three days on the first week of radiotherapy. The non-standard group included 31 patients. Radical surgery was performed at a median of 58 days after the end of radiotherapy. A low anterior resection was performed in 36 patients, whereas an abdominoperineal resection was performed in 7 patients. Results: No significant difference was observed between the groups with respect to pathologic responses ranging from grades 3 to 5 (83.3% vs. 67.7%, p=0.456), downstaging (75.0% vs. 67.7%, p=0.727), and a radial resection margin greater than 2 mm (66.7% vs. 83.9%, p=0.237). The sphincter-saving surgery rate in low-lying rectal cancers was lower in the non-standard group (100% vs. 75%, p=0.068). There was no grade 3 or higher toxicity observed in all patients. Conclusion: Considering that the sphincter-saving surgery rate in low-lying rectal cancer was marginally lower for patients treated with non-standard, suboptimal chemotherapy, and that toxicity higher than grade 2 was not observed in the both groups, suboptimal chemotherapy should be avoided in this setting.

• Radiation Oncology Journal
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• v.27 no.2
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• pp.55-63
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• 2009

Purpose: This study was performed to objectively evaluate the rate of tumor response to hypofractionated radiotherapy for advanced squamous cell carcinomas of the head and neck. Materials and Methods: Thirty-one patients with advanced squamous cell carcinoma of the head and neck, who were treated by hypofractionated radiotherapy with 3 Gy per fraction for palliative purpose between 1998 and 2008, were reviewed retrospectively. Every tumor-volume was measured and evaluated from CT (computed tomography) images obtained before and 2~3 months after radiotherapy. The radiation toxicity was assessed during and after radiotherapy. A statistical analysis was performed to investigate overall survival, progressionfree survival, and the prognostic factors for survival and response. Results: The median age of the study patients was 70 years. In addition, 85% of the patients were in stage 4 cancer and 66.7% had an ECOG performance status of 1~2. The mean tumor-volume was 128.4 cc. Radiotherapy was administered with a total dose of 24~45 Gy (median: 36 Gy) over 10~25 days. Twenty-nine patients were treated with 30 Gy or more. The observed complete response rate was 12.9% and the partial response rate was 61.3%. Median survival time was 8.9 months and the 1-year progression-free survival rate was 12.9%. The treatment response rate was confirmed as a prognostic factor in the rate of survival. The primary site, stage, tumor-volume, radiotherapy field and overall radiation-dose showed a significant relationship with survival and treatment response. No grade 4 toxicity was observed during and after radiotherapy. Conclusion: There was an objective tumor-regression in about 74% of patients treated by hypofractionated radiotherapy. Further evaluation is needed to select the appropriate fraction-size and patient who may require the additional radiotherapy.

• The Korean Journal of Nuclear Medicine
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• v.33 no.5
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• pp.439-451
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• 1999

Purpose : It is important to differentiate malignant from benign lesions of intraocular masses in choosing therapeutic plan. Biopsy of intraocular tumor is not recommended due to the risk of visual damage. We evaluated the usefulness of F-18-FDG PET imaging in diagnosing intraocular neoplasms. Materials and Methods: F-18-FDG PET scan was performed in 13 patients (15 lesions) suspected to have malignant intraocular tumors. There were 3 benign lesions (retinal detachment, choroidal effusion and hemorrhage) and 10 patients with 12 malignant lesions (3 melanomas, 7 retinoblastomas and 2 metastatic cancers). Regional eye images ($256{\times}256$ and $128{\times}128$ matrices) were obtained with or without attenuation correction. Whole body scan was also performed in eight patients (3 benign and 6 malignant lesions). Results: All malignant lesions were visualized while all benign lesions were not visualized. The mean peak standardized uptake value (SUV) of malignant lesions was $2.64{\pm}0.57g/ml$. There was no correlations between peak SUV and tumor volume. Two large malignant lesions ($> 1000 mm^3$) showed hot uptake on whole body scan. But two medium-sized lesions ($100-1000mm^3$) looked faint and two small ($<100mm^3$) lesions were not visualized. The images reconstructed with $256{\times}256$ matrix showed lesions more clearly than those with $128{\times}128$ matrix Conclusion: F-18-FDG PET scan is highly sensitivity in detecting malignant intraocular tumor For the evaluation of small-sized intraocular lesions, whole body scan is not appropriate because of low sensitivity. A regional scan with sufficient acquisition time is recommended for that purpose. Image reconstruction in matrix size of $256{\times}256$ produced clearer images than the ones in $128{\times}128$, but it does not affect the diagnostic sensitivity.

• The Journal of the Korean bone and joint tumor society
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• v.1 no.1
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• pp.38-44
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• 1995

Metastatic bone tumor is the most common bone tumor and 32.5% of all primary malignant tumors are eventually metastasize to bone. Metastatic bone tumor has been more frequently encountered disease in the orthopedic fields due to the greater longevity of life of the patients with primary visceral cancers by major advances in early detection, diagnosis, and surgical/radiotherapeutic/chemotherapeutic treatment of primary and metastatic lesions. Therefore, the epidemiologic data about the incidences and the patterns of bone metastasis is important. We reviewed 417 patients who were diagnosed and treated for metastatic bone tumor at Kosin University Medical Center from 1985 to 1993 to analyse the primary lesion, age and sex distributions, location of bone metastasis, patterns of metastasis according to the primary. The results were as follows : 1. The common origin of bone metastasis were lung(29.5%), stomach(15.3%), breast(11.3%), unknown(7.7%), cervix(5.3%), liver(4.8%) in order of frequency. 2. There were 251 men and 166 women and their mean age was 54.8 years and the peak age incidence was in 6th decades. Most cases(85.3%) were occured beyond 5th decades. 3. The preferred sites of metastatic deposits were spine(64.0%), pelvis(40.5%), rib(38.8%), femur(36.7%), skull(21.1%), humerus(13.9%), scapula(13.0%) in order of frequency. In the spine, thoracic(42.1%), lumbar(39.1%), cervical(13.2%), sacral(5.6%) vertebrae were involved in order of frequency. 4. Multiple bone metastases were more common(73.1%) than single metastasis(26.9%). 5. In the lung cancer, the peak age incidence was 6th decades, and the preferred sites of bone metastasis were spine, pelvis, femur. 6. In the stomach cancer, the peak age incidence was 6th decades, and the preferred sites of bone metastasis were spine, femur, pelvis. 7. In the breast cancer, the peak age incidence was 5th decades, and the preferred sites of bone metastasis were spine, rib, pelvis. 8. In the bone metastasis with unknown primary site, the peak age incidence was 7th decades, the preferred sites of bone metastasis were spine, femur, pelvis, and the common histologic types were adenocarcinoma and squamous cell carcinoma.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.69-76
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• 2003

Purpose: This study was designed to provide the data base for the diagnosis and treatment of the foot tumor by investigation of the clinical and pathological characteristics and distribution of the foot tumor. Materials and Methods: 142 foot tumors of 141 patients were studied. All patients were diagnosed with surgical biopsy. We investigated clinical and pathological characteristics and epidemiologic distribution of the foot tumor by reviewing the medical records and imaging materials. The location of the tumors were classified with zone of Kirby et al. Results: 75 patients were female and 66 were male. The average age of the patients was 33.2 years old. Benign soft tissue tumors were the most as 68 cases, and followed by 57 benign bone tumors, 12 malignant soft tissue tumors and 5 malignant bone tumors. Ganglia were the most in benign soft tissue tumors as 36 cases, subungual exostoses in benign bone tumors as 18, squamous cell carcinomas in malignant soft tissue tumors as 7, and metastatic lung cancers in malignant bone tumors as 2. The rate of pain complaints was the highest in malignant bone tumors, the duration of symptom was longest in benign soft tissue tumors, and the size of the tumor was the biggest in malignant bone tumors. Neurological symptoms were found in only 3 benign soft tissue tumors. For the zonal distribution, zone 5 was the most in 59 cases and zone 4 was the least as 10. The most numbers of the benign bone tumors located in zone 5, of benign soft tissue tumors in zone 1, of malignant bone tumors in zone 1 and 2, and of malignant soft tissue tumors in zone 5. The methods of surgical treatment included intralesional or marginal resection, curettage with or without bone graft, toe amputation, below knee amputation and limb salvage. Conclusion: The tumors of the foot were rare and various, and mostly benign (88%), but we can do proper treatment of those tumors without excluding malignant tumors by considering the age of patients, pain, duration of symptom, size of the tumors, and zonal distribution.

• The Journal of the Korean bone and joint tumor society
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• v.9 no.1
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• pp.12-17
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• 2003

Purpose: In this report we are going to discuss about the functional evaluation and the outcome of treatment of metastatic tumor in the lower extremities treated with tumor prosthetic arthroplasty. Materials and Methods: This report is based on nine patients diagnosed as a metastatic tumor and treated by tumor prosthetic arthroplasty, from June 1998 to December 2001. Age of the patients ranged from 49 to 63 with the average of 56.3. The average follow up period was 23.4 months. Two patients had lung cancer, three had breast cancer, two had renal cancer, one colon cancer, and one had multiple myeloma. All these were primary cancers. The site of metastasis were six in proximal femur, two in distal femur, and one in proximal tibia. Tumor excision was performed after biopsy in following the principle of primary tumor management. Excision with wide surgical margin was tried as possible could. Six cases were treated with tumor prosthesis, and the other three cases were reconstructed with bone cement and arthroplasty. Results: The functional evaluation in the extremities at the last follow up was performed on Enneking evaluation score with 6 categories. The highest scored 26, and the lowest scored 10, with an average of 19.5. A case in which the patient died 15 days after the operation was excluded from the evaluation. Among the categories, emotional acceptance to postoperative function and pain relief were highly scored. At the final follow up, seven patients survived, and one colon cancer patient died 68 days after operation. Conclusion: Metastatic tumor occurring in joints of lower extremities could be treated in accordance to the treatment principle of primary tumor. By insertion of tumor prosthesis, we can get satisfactory results of function in the lower extremity and pain relief especially. So, this aspect of medical favor must be considered in treating patients.

• Journal of the Korean Society of Radiology
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• v.12 no.3
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• pp.403-407
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• 2018

Currently, the highest cancer death rate in Korea is lung cancer, which is a typical cancer that is difficult to detect early. Low-dose chest CT is being used for early detection, which has a greater lung cancer diagnosis rate of about three times than regular chest x-ray images. However, low-dose chest CT not only significantly reduces image resolution but also has a weak signal and is sensitive to noise. Also, air filled lungs are low-density organs and the presence of noise can significantly affect early diagnosis of cancer. This study used Visual C++ to set a circle inside a large circle with a density of 2.0, with a density of 1.0, which is the density of water, in which five small circle of mathematics have different densities. Gaussian noise was generated by 1%, 2%, 3%, and 4% respectively to determine the effect of noise on the mean value, the standard deviation value, and the relative noise ratio(SNR). In areas where the density difference between the large and small circles was greatest in the event of 1 % noise, the SNR in the area with the greatest variation in noise was 4.669, and in areas with the lowest density difference, the SNR was 1.183. In addition, the SNR values can be seen to be high if the same results are obtained for both positive and negative densities. Quality was also clearly visible when the density difference was large, and if the noise level was increased, the SNR was reduced to significantly affect the noise. Low-density organs or organs in areas of similar density to cancers, will have significant noise effects, and the effects of density differences on the probability of noise will affect diagnosis.

• Journal of Hospice and Palliative Care
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• v.4 no.2
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• pp.137-144
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• 2001

Purpose : Pain is the most serious symptom that cancer patients experience. About $60{\sim}90%$ of advanced cancer patients and four million patients worldwide, according to the WHO statistics, are reported to suffer from cancer pain. Although about $70{\sim}80%$ of the pain could be controlled according to the pain control principles, to our regret, only $30{\sim}40%$ are managed appropriately. This research was aimed to (1) investigates the prevalence of pain among cancer patients, (2) compare patients' perception of pain with physician's recognition and (3) evaluate appropriateness of the doctor's prescription of analgesic. Materials and Methods : Patients with advanced or terminal cancers admitted at department of internal medicine of Seoul National University Hospital for at least 7 days were enrolled. A questionnaire for the patients and the physicians in charge were given and the answers were compared for each other. We also examined their medical records and the physician's orders. Results : Total 59 patients were enrolled. Among them, 43 patients answered the questionnaire, and 27 patients (62.8%) suffered hem cancer pain. The survey also showed that physicians underestimated the severity of pain, overlooked frequently analgesic prescription principle, and that as the patients' pain became severe, the less adequate was pain managements. Conclusion : For cancer patients, pain was frequently overlooked, and treatment still inadequate. Based on this evidence, it seemed that more active practice and education about evaluation and management of cancer pain are needed.

• Journal of Yeungnam Medical Science
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• v.9 no.1
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• pp.102-109
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• 1992

Bone metastases represent an important and frequent clinical problem in patients with advanced cancers. Especially, painful bone metastases are common features in these patients. Radiotherapy is an effective tool for palliative aim of painful metastatic osseous lesions. Various treatment results have been previously reported. The present retrospective study was aimed to evaluate the efficacy of palliative irradiation on pain relief, with the goal of selecting appropriate irradiation dose schedule. Radiotherapy consisted of 5times a week with a various fractional dose between 180 and 400cGy. The response of pain relief and the survival time after completion of radiotherapy are related to total dose and most of the patients have shown a similar response by the end of radiotherapy. The higher dose and the more aggressive multimodality treatment, the better pain control and the longer survival time.

• Journal of Yeungnam Medical Science
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• v.9 no.1
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• pp.29-43
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• 1992

A case-control study was conducted to investigate the association between the risk of cancer and selenium concentration in blood and toenails. Seventy three patients and two hundreds eighty three controls were, selected at the Yeungnam University Hospital between May and September in 1991. The selected cases were patients who had been hospitalized for stomach or colon cancer at the Depertment of General Surgery. The controls were people who visited to check physical examination at the Automated Mediscreening Center. The selenium concentration in whole blood and toenails were measured by atomic absorption spectrophotometer equipped with graphite furnace atomizer. The following information was ascertained for all cancer patients and controls : sex, age, body mass index, blood pressure, total serum cholesterol, and history of smoking and drinking. The mean selenium concentration in blood and toenail for all cancer patients were $143.6{\pm}10.8{\mu}g/l$ and $1.04{\pm}0.62{\mu}g/g$ and for the controls, $167.0{\pm}14.5{\mu}g/l$ and $1.15{\pm}0.55{\mu}g/g$, respectively. The difference in blood and toenail selenium concentrations of the two cancer sites was not statistically significant. Metastasis did not influence the concentration of selenium in blood and toenails. In the multiple logistic regression analysis, the blood selenium concentration($_aOR$: 0.888, 95% CI : 0.860-0.918), age, BMI and total serum cholesterol were significant variables for risk of cancer, but the selelenium concentration in toenail was not shown to be a significant variable in this regression analysis. The coefficient for blood selenium concentration adjusted for age, sex, diastolic blood pressure, total serum cholesterol, body mass index and smoking was -0.1184(p<0.01). These findings suggest that low selenium concentration is associated with gastrointestinal cancers. Further epidemiologic studies including important variables such as other antioxidant micronutrients will be necessary.