• Journal of Gastric Cancer
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• 제13권2호
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• pp.73-78
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• 2013

Surgery is still considered to be the mainstay for the treatment of localized gastric cancer with negative margins (R0-resection) and an adequate lymph-node-dissection (D2-lymphadenectomy). Unfortunately, most cases of gastric cancer are only diagnosed at an advanced stage due to frequent recurrences after primary resection in curative intent. In order to improve prognosis after curative resection, in the recent past, patients with locally advanced tumors were subjected to a pre-, peri-, or postoperative treatment. Interestingly, postoperative chemotherapy has significantly improved survival after gastric resection in Asia, adjuvant radiochemotherapy is favored in North America and perioperative chemotherapy is considered as a treatment of choice in Europe indicating region specific approach towards the treatment. Recently there has also been growing evidence of positive outcomes of neoadjuvant radiochemotherapy on patient survival. In the present article, we discuss the concepts of neoadjuvant treatment approach and provide recommendations to surgeons based on current evidence.

• Asian Pacific Journal of Cancer Prevention
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• 제15권6호
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• pp.2465-2472
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• 2014

Background: The American Joint Committee on Cancer (AJCC) published a new staging system ($7^{th}$ edition) in 2009. In our study, we evaluated the survival results and prognostic factors among T4 local advanced non-small cell lung cancer (LA-NSCLC) patients in a large heterogeneous group, in accordance with this new system. Materials and Methods: We retrospectively evaluated the files of 122 T4 N0-3 M0 LA-NSCLC patients, identified according to the new staging system, treated at two centers between November 2003 and June 2012. Variables correlating with univariate survival at p<0.20 were later included in multivariate Cox regression analysis. Here, selection of relevant predictors of survival was carried out in accordance with the likelihood ratio formula with p<0.05 regarded as significant. Results: The median age was 60 and the median follow-up period was 17.4 months. Median overall survival (OS) was 18.3 months, the 1 year overall survival (OS) rate was 72%, and the 5 year OS rate was 28%. Statistically significant predictors of survival were (p<0.20) ECOG-PS (Eastern Cooperative Oncology Group Performance Status), age, T4 factor subgroup, stage and primary treatment in OS univariate analysis. On multivariate analysis for OS ECOG-PS (p=0.001), diagnostic stage (p=0.021), and primary treatment (p=0.004) were significant. In the group receiving non-curative treatment, the median OS was 11.0 months, while it was 19.0 months in the definitive RT group and 26.6 months in the curative treatment group. There was a significant difference between the non-curative group and the groups which had definitive RT and curative operations (respectively p<0.001 and p=0.001) in terms of OS, but not between the groups which had definitive RT and curative operations. The median event free survival (EFS) rate was 9.9 months, with rates of 46% and 19% at 3 and 5 years, respectively. On univariate analysis of EFS rate with ECOG-PS, weight loss and staging, statistical significance was found only for thorax computerized tomography (CT)+18F-fluorodeoxy-glucose positron emission tomography-CT (PET-CT) use, stage and primary treatment (p<0.20). In multivariate analysis with EFS, only the primary treatment was statistically significant (p=0.001). In the group receiving non-curative treatment, the median EFS was 10.5 months while in the curative operation group it was 14.7 months. When all the primary treatment groups were taken into consideration, grade III/IV side effect swas observed in 57 patients (46.6%). Esophagitis was most prominent among those that received definitive radiotherapy. Conclusions: Independent prognostic factors among these 122 heterogeneous LA-NSCLC T4 N0-3 M0 patients were age at diagnosis, ECOG-PS, stage and primary treatment, the last also being a significant prognostic indicator of EFS. Our findings point to the importance of appropriate staging and a multidisciplinary approach with modern imaging methods in this patient group. In those with T4 lesions, treatment selection and the effective use of curative potential should be the most important goal of clinical care.

• Maxillofacial Plastic and Reconstructive Surgery
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• 제41권
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• pp.3.1-3.9
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• 2019

Background: The infratemporal fossa (ITF) is an anatomical lateral skull base space composed by the zygoma, temporal, and the greater wing of the sphenoid bone. Due to its difficult approach, surgical intervention at the ITF has remained a heavy burden to surgeons. The aim of this article is to review basic skull base approaches and ITF structures and to avoid severe complications based on the accurate surgical knowledge. Methods: A search of the recent literature using MEDLINE (PubMed), Embase, Cochrane Library, and other online tools was executed using the following keyword combinations: infratemporal fossa, subtemporal fossa, transzygomatic approach, orbitozygomatic approach, transmaxillary approach, facial translocation approach, midface degloving, zygomatico-transmandibular approach, and lateral skull base. Aside from our Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) trial, there have been very few randomized controlled trials. The search data for this review are summarized based on the authors' diverse clinical experiences. Results: We divided our results based on representative skull base approaches and the anatomy of the ITF. Basic approaches to the ITF include endoscopic endonasal, transzygomatic, orbitozygomatic, zygomatico-transmandibular, transmaxillary, facial translocation, and the midfacial degloving approach. The borders and inner structures of the ITF (with basic lateral skull base dissection schemes) are summarized, and the modified zygomatico-transmandibular approach (ZTMA) is described in detail. Conclusions: An anatomical basic knowledge would be required for the appropriate management of the ITF pathology for diverse specialized doctors, including maxillofacial, plastic, and vascular surgeons. The ITF approach, in conjunction with the application of microsurgical techniques and improved perioperative care, has permitted significant advances and successful curative outcomes for patients having malignancy in ITF.

• Korean Journal of Head & Neck Oncology
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• 제12권1호
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• pp.92-99
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• 1996

The primary treatment of the nasopharyngeal carcinoma is at this time, mainly based on radiotherapy. In most studies for patient treated with radiotherapy, overall 5-year survival rate is in the range of 35 to 55%. Obviously, these therapeutic results may be influenced by various factors such as clinical stages, histopathological types and radiation techniques, etc. Though the radiotherapy had a good therapeutic result, there is a limitation to apply the radiotherapy only in cases of the advanced nasopharyngeal carcinoma. Anatomical complexity of the skull base and difficulties in complete surgical intervention were the trouble of the surgery but in the case of radiation failure, there is no adequate choice of other curative modalities. So it is appropriate to investigate whether surgical resection may improve the outcome of treatment of nasopharyngeal carcinoma. The purpose of this papaer is to report our surgical experience of the nasopharyngeal carcinoma, then to take into consideration of the new model of treatment strategy of nasopharyngeal carcinoma.

• Journal of Korean Physical Therapy Science
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• 제15권2호
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• pp.79-86
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• 2008

Background: The purpose of this study was to present a practical method of medical treatment to improve the balance and motor ability of the mentally retarded child with a single mentally retarded child-subject. Methods: The subject of the study was a 39-month-old mentally retarded female. This study included a 2-week basic period and a 13-week treatment period. The treatment method was based on the Bobath Approach. Gross motor function measurement (GMFM) was used to examine changes in motor ability, and the Pediatric Balance Scale (PBS) was used to measure changes in balance ability. The curative program was composed of normalization of muscle tone, strengthening of leg endurance and muscular strength, the improvement of trunk alignment, and the increase of balance. Visual rate of change was used to examine the results. Results: As a result of this study, balance ability increased on the Pediatric Balance Scale (PBS) by 24 points, and motor function increased in terms of Gross Motor Function Measurement (GMFM) by 6.9% (18 points). Standing increased by 41% (16 points), and walking, running, and jumping increased by 31.9% (23 points) compared to thebasic period. Therefore, the Bobath Approach appears to be an appropriate method to improve balance and motor ability in mentally retarded children. Conclusion: It is surmised that aggressive intervention by physical therapists and occupational therapists, and a follow-up study, are required for the growth of motor ability in mentally retarded children.

• Clinical and Experimental Pediatrics
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• 제53권9호
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• pp.830-833
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• 2010

Crohn's disease is characterized by chronic inflammation involving any portion of the gastrointestinal tract. Treating Crohn's disease is a major challenge for clinicians, as no curative therapy currently exists. Pediatric Crohn's disease is characterized by frequent relapses, a wide extent of disease, a high prevalence of extraintestinal manifestations, and a severe clinical course. The classic therapeutic approach is known as the 'step-up' strategy, and follows a progressive course of treatment intensification as disease severity increases. Although this approach is usually effective for symptom control, many patients become either resistant to or dependent on corticosteroids. The efficacy of infliximab suggests that, rather than a progressive course of treatment, early intense induction may reduce complications associated with conventional treatment and improve quality of life. Intensive early therapy with infliximab is known as the 'top-down' strategy. Such therapy offers the potential for altering the natural history of Crohn's disease, and is changing treatment paradigms. However, the relatively new concept of an early aggressive or 'top-down' treatment approach is not yet widely accepted, especially in pediatric patients. The results of our current study demonstrate that early and intensive treatment of pediatric Crohn's disease patients with infliximab, at initial diagnosis, was more effective for maintaining remission and reducing flares.

• Journal of Korean Medical Ki-Gong Academy
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• 제20권1호
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• pp.148-162
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• 2020

Objective : The purpose of this study is not only to examine the negative functions of alcohol, but also to examine the positive functions and look at it with a balanced perspective. Methods : We investigated the number of times the word "酒"(alcohol) appears in 《Hwangjenaegyeong》 and 《Gyeongakjeonseo》. The meaning of alcohol was divided into seven categories. The number of positive and negative functions of alcohol was counted and the ratio was calculated. Results : 1. In the 《Hwangjenaegyeong》, the word alcohol appears 23 times, of which 9 times has positive functions, 10 times has negative functions, and the remaining 4 times does not correspond anywhere. The ratio of positive functions is 39.13% and negative functions 43.48%. 2. In the 《Gyeongakjeonseo》, the word alcohol appears 1,487 times, of which 1,140 times (76.66%) has positive functions, and 327 times (21.99%) has negative functions. Conclusions : 1. In 《Hwangjenaegyeong》, the number of comments about positive and negative functions of alcohol is similar. 2. 《Gyeongakjeonseo》 has commented a lot about the positive functions of alcohol. However, it has more mentions to negative functions of alcohol except for those related to herbs and prescriptions (48 to 64 chapter). 3. It is somewhat unreasonable to judge the emphasis on the positive and negative function of alcohol according to the number of references to alcohol in oriental medicine classics. But in these books, we can find a balanced approach between the two sides, not a one-sided biased view. 4. From a curative point of view, it is desirable to know and to use the positive and negative functions of alcohol, and drink alcohol as appropriate control.

• Journal of Gastric Cancer
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• 제8권2호
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• pp.57-64
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• 2008

In gastric cancer, the only potentially curative treatment is surgery that attempts to achieve curative (R0) resection. However, despite the use of curative resection, a recurrence develops in a high percentage of patients, especially in cases of serosa and/or lymph node involvement. As a strategy to improve the survival of the patients with resectable advanced gastric cancer, neoadjuvant chemotherapy has been evaluated in several phase II trials and a few phase III trials. The results of these trials have confirmed the feasibility and safety of this approach with no apparent increase in surgical complications. Recently, the findings of a large phase III randomized trial (MAGIC trial) have indicated that compared to the use of surgery alone, perioperative chemotherapy, using both a neoadjuvant and adjuvant strategy, decreased the number of T and N stage cancers and improved survival. The results of another recent phase III trial (FNLCC 94012/FFCD 9703) also showed that compared to the use of surgery alone, perioperative chemotherapy improved the R0 resection rate and survival. In both trials, the improved outcomes may be attributed to the use of neoadjuvant chemotherapy because of poor compliance with adjuvant chemotherapy. These results cannot be directly translated to clinical practice in Korea due to differences in surgical techniques and outcomes. However, the findings of a few small phase II and III trials performed in patients with locally advanced gastric cancer in Korea have also suggested that neoadjuvant chemotherapy would result in the improvement of the R0 resection rate and down-staging of the disease. More effective chemotherapy regimens are needed in future large randomized trials to determine the subset of patients that will benefit from neoadjuvant chemotherapy and to determine the extent of benefit.

• Radiation Oncology Journal
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• 제32권2호
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• pp.99-102
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• 2014

We present a case of unresectable cancer of the base of tongue treated with hypofractionated 3D conformal radiotherapy and concomitant chemotherapy. Based on the excellent tumour response in this radiotherapy regimen and international experience in short course treatments we shortly reviewed, we propose that this therapeutic approach could be considered in a curative setting for patients unsuitable for the a standard long course radiochemotherapy schedule.

• Korean Journal of Pharmacognosy
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• 제3권4호
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• pp.187-197
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• 1972

In spite of the fact that the system of oriental medicine still remains in the realm of 'unproven-method of treatment', no one can deny that the oriental medicine is a rich source of idea and motivation for the discovery of new drug from natural sources. However, non-scientific, mystic hypothetical system of oriental medicine refuses to be revealed scientifically. For the purpose of drawing useful parameters for inductive reasoning of the system, a new approach which comprises statistical analyses of prescription was attempted in this study. One hundred and thirty two ginseng-compounds prescription in 'Bang-Yak-Hap-Pyon', one of the most popular formularies of oriental medicine in Korea, were analysed by multivariate analysis technique. The results revealed ginseng from many points of view, e.g., therapeutic indications, dose, and compatibility, etc. Among these, the most striking coincidence with scientific achievements of modern pharmacology, is the fact that the oriental medicine has characterized ginseng already from remote ancient times as neither a specific curative nor an aphrodisiac, but a non-specific adaptogenic drug for general infirmity.