• Journal of Gastric Cancer
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• 제14권1호
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• pp.1-6
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• 2014

Aerobic glycolysis has been the most important hypothesis in cancer metabolism. It seems to be related to increased bioenergetic and biosynthetic needs in rapidly proliferating cancer cells. To this end, F-18 fluorodeoxyglucose (FDG), a glucose analog, became widely popular for the detection of malignancies combined with positron emission tomography/computed tomography (PET/CT). Although the potential roles of FDG PET/CT in primary tumor detection are not fully established, it seems to have a limited sensitivity in detecting early gastric cancer and mainly signet ring or non-solid types of advanced gastric cancer. In evaluating lymph node metastases, the location of lymph nodes and the degree of FDG uptake in primary tumors appear to be important factors affecting the diagnostic accuracy of PET/CT. In spite of the limited sensitivity, the high specificity of PET/CT for lymph node metastases may play an important role in changing the extent of lymphadenectomy or reducing futile laparotomies. For peritoneal metastases, PET/CT seems to have a poorer sensitivity but a better specificity than CT. The roles of PET/CT in the evaluation of other distant metastases are yet to be known. Studies including primary tumors with low FDG uptake or peritoneal recurrence seem suffer from poorer diagnostic performance for the detection of recurrent gastric cancer. There are only a few reports using FDG PET/CT to predict response to neoadjuvant or adjuvant chemotherapy. A complete metabolic response seems to be predictive of more favorable prognosis.

• 대한두경부종양학회지
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• 제23권1호
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• pp.50-53
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• 2007

Adrenal metastasis from papillary thyroid carcinoma is extremely rare. We present herein a patient with adrenal metastases from recurrent papillary carcinoma of the thyroid. A 54 year-old woman had received a total thyroidectomy and postoperative radioactive iodine therapy for locally advanced papillary thyroid carcinoma. One year after initial surgery, distant metastases to multiple organs including right cervical lymph nodes, left upper lung, left 2nd and 3rd ribs, 2nd thoracic vertebra and left adrenal gland were found by 18-FDG-PET-CT whole body scan. She underwent right modified neck dissection, partial resection of left 2nd and 3rd ribs, posterior arch of 2nd thoracic vertebra, left upper lobectomy of lung, and left adrenalectomy. On histologic examination, metastases to the left adrenal gland and cervical lymph nodes were papillary thyroid carcinomas, while other metastatic sites turned out to be anaplastic thyroid carcinomas. Despite aggressive surgery and postoperative adjuvant therapy, her general clinical conditions were getting worse day by day due to regrowing of the anaplastic thyroid carcinomas. To our knowledge, this is the first case reported in Korea.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6445-6449
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• 2015

Background: NSCLC is a disease involving uncontrolled cell growth, which could result in metastases into nearby tissues beyond the lungs. Materials and Methods: The aim of the present study was to analyze the influence of epidermal growth factor receptor (EGFR) gene expression on metastasis and survival in NSCLC patients. The present case-control study included 100 cases of NSCLC patients and 100 age and sex matched controls. EGFR gene expression was analyzed by quantitative real time PCR using serum RNA. Association with NSCLC patient survival was analyzed by the Kaplan-Meier method. Results: We analyzed EGFR gene expression and observed mean increased gene expression of 13.5 fold in NSCLC patients. Values reflected overall survival of patients with a median of 15.8 months in the cases of <13 fold increased gene expression vs 6.7 months with >13 fold increased EGFR gene expression (p=0.005). Distant metastatic patients with <13 fold increased EGFR gene expression had 7.9 months of median survival time while>13 fold increased EGFR gene expression had only 5 months of median survival time (p=0.03). Non metastatic patients with <13 fold increased EGFR gene expression had 18 months of median survival time as compared to only 7.1 months with >13 fold increased expression. Conclusions: Higher cell free EGFR mRNA expression may play an important role in causing distant metastases and reducing overall survival of NSCLC patients in the Indian population.

• Radiation Oncology Journal
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• 제26권3호
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• pp.149-159
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• 2008

목 적: 본 연구는 자궁내막암 병기 $1{\sim}2$ 환자에 수술 후 방사선치료의 결과와 예후인자를 분석하여 향후 치료원칙을 결정하는 데 도움을 얻고자 시행하였다. 대상 및 방법: 1991년 1월부터 2005년 12월까지 이화여자대학교 의과대학부속병원에서 자궁내막암으로 진단받고 수술 후 방사선치료를 받은 병기 $1{\sim}2$환자를 대상으로 후향적 분석을 하였다. 전체 환자는 35명이었으며 17명은 자궁절제술과 양측 난소제거술을 시행하였고 18명은 완전한 수술적 병기의 수술을 시행하였다. 골반강 방사선치료를 받은 환자는 17명, 질강내근접치료를 받은 환자는 12명, 골반강 방사선치료와 질강내근접치료를 받은 환자는 6명이었다. 결 과: 추적기간의 중앙값은 54개월이었다. 전체 환자의 5년 생존율은 91.4%, 무병생존율은 81.7%이었다. 저위험군, 중간위험군, 고위험군의 위험군에 따른 5년 생존율은 각각 100%, 100%, 55.6%이었으며 무병생존율은 각각 100%, 70.0%, 45.7%이었다. 국소재발된 환자는 없었으며 5명(14%)에서 원격전이가 발생하였으며 호발부위는 폐, 뼈, 간, 부신, 전복강의 순이었다. 원격전이에 대한 단변량 통계분석에 따르면 위험군, 조직학적 세포형태와 조직학적 등급이 유의성이 있었으며, 다변량 통계분석에 따르면 조직학적 세포형태로서 유두형, 장액형, 그리고 투명세포암은 자궁내막양암과 샘암편평암에 비하여 원격전이율이 높고 생존율이 낮았다. 골반강 방사선치료에 의한 후유증은 장염이 30%에서 나타났으며 다음으로 직장염이었으나 대부분 등급 $1{\sim}2$로 등급 $3{\sim}4$의 후유증은 발생하지 않았다. 결 론: 수술 후 골반강 방사선치료 혹은 질강내근접치료를 시행한 자궁내막암 병기 $1{\sim}2$환자들의 경우 저위험군과 중간위험군은 국소제어율과 생존율이 높았으나, 고위험군은 골반강 방사선치료를 시행하여 국소제어율은 높으나 원격전이율이 높고 생존율이 낮았다. 따라서 고위험군은 방사선치료와 동시에 항암화학요법이 요구된다. 중간 위험군의 더 효율적인 치료를 위하여 많은 환자를 대상으로 골반강 방사선치료와 강내근접치료를 비교하는 전향적 무작위연구가 필요하다.

• Radiation Oncology Journal
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• 제38권1호
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• pp.44-51
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• 2020

Purpose: To evaluate the necessity of regional nodal irradiation (RNI) for pT1-2N1 breast cancer patients treated with breast-conserving surgery and radiotherapy, we compared clinical outcomes of patients treated with and without RNI. Materials and Methods: We retrospectively analyzed the data of 214 pT1-2N1 breast cancer patients treated with breast-conserving surgery and whole breast irradiation from 2007-2016. There were 142 (66.4%), 51 (23.85%), and 21 (9.8%) patients with one, two, and three positive lymph nodes, respectively. Thirty-six patients (16.8%) underwent RNI. Adjuvant chemotherapy, endocrine therapy, and anti-HER2 therapy were given to 91.6%, 79.0%, and 15.0% patients, respectively. The most common chemotherapy regimen was anthracycline + cyclophosphamide, followed by taxane (76.5%). The median follow-up was 64 months (range, 6 to 147 months). Patients were propensity matched 1:2 into RNI and no-RNI groups. Results: Two patients experienced locoregional recurrences simultaneously with distant metastases, ten patients developed distant metastases, and one patient died. Before matching, the 5-year actuarial locoregional control (LRC), distant metastasis-free survival (DMFS), and overall survival (OS) rates in the RNI and no-RNI groups were 100.0% and 99.4% (p = 0.629), 94.1% and 96.0% (p = 0.676), and 100.0% and 99.4% (p = 0.658), respectively. After matching, the 5-year LRC, DMFS, and OS were 98.3% and 100.0% (p = 0.455), 96.6% and 93.9% (p = 0.557), and 100.0% and 100.0% (p > 0.999) in the RNI and no-RNI groups, respectively. No clinicopathologic or treatment-related factors were significantly associated with LRC, DMFS, or OS. Conclusion: Adding RNI did not show superior LRC, DMFS, or OS in pT1-2N1 breast cancer patients.

• Asian Pacific Journal of Cancer Prevention
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• 제14권5호
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• pp.2925-2929
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• 2013

Objective: To explore the relationships between primary tumor $^{18}F$-FDG uptake measured as the SUVmax and local extension, and nodal or distant organ metastasis in patients with NSCLC on pretreatment PET-CT. Methods: 93 patients with NSCLC who underwent $^{18}F$-FDG PET-CT scans before the treatment were included in the study. Primary tumor SUVmax was calculated; clinical stages, presence of local extension, nodal and distant organ metastases were recorded. The patients with SUVmax${\geq}2.5$ were divided into low and high SUVmax groups by using the median SUVmax. The low SUVmax group consisted of 45 patients with SUVmax<10.5, the high SUVmax group consisted of 46 patients with SUVmax${\geq}10.5$. Their data were compared statistically. Results: 91 cases with SUVmax${\geq}2.5$ were included for analysis. The mean SUVmax in patients without any metastasis was $7.42{\pm}2.91$ and this was significantly lower than that ($12.18{\pm}4.94$) in patients with nodal and/or distant organ metastasis (P=0.000). In the low SUV group, 19 patients had local extension, 22 had nodal metastasis, and 9 had distant organ metastasis. In the high SUV group, 31 patients had local extension, 37 had nodal metastasis, and 18 had distant organ metastases. There was a significant difference in local extension (P =0.016), distant organ metastasis (P =0.046), and most significant difference in nodal metastasis rate (P =0.002) between the two groups. In addition, there was a moderate correlation between SUVmax and tumor size (r = 0.642, P<0.001), tumor stage (r = 0.546, P<0.001), node stage (r = 0.388, P<0.001), and overall stage (r = 0.445, P= 0.000). Conclusion: Higher primary tumor SUVmax predicts higher extensional or metastatic potential in patients with NSCLC. Patients with higher SUVmax may need a close follow-up and more reasonable individual treatment because of their higher extensional and metastatic potential.

• Asian Pacific Journal of Cancer Prevention
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• 제16권14호
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• pp.5709-5714
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• 2015

Aim: To assess the treatment outcome in patients with malignant skin melanoma and prognostic factors for distant metastases (DM), disease-free survival (DFS) and overall survival (OS). Materials and Methods: A retrospective analysis was conducted on 113 patients with malignant skin melanoma (60 females, 53 males, average age-55 years) who were treated surgically. Primary treatment consisted of local excision. In 12 cases, it was accompanied by lymph node excision. In 93 (82%) cases, radicalization was necessary, which was either local only (19 cases) or accompanied by lymph node surgery/biopsy (74 cases). Possible prognostic factors such as Clark's stage and Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases (pN+), gender, tumor location and primary excision margins were considered. Results: In 51 (45%) cases, treatment failure occurred. The 5-year DM rate was 47%, the 5-year DFS was 38%, and the 5-year OS was 56%. In the univariate analysis, the important factors with respect to at least one endpoint included Clark's stage, Breslow's depth of invasion, ulceration, average tumor dimensions, lymph nodes metastases, gender and primary tumor localization. The presence of metastasic nodes was the most important prognostic factor, with a 5-year DM rates of 30% for pN(-) and 76% for pN(+) and a 5-year DFS and OS of 56% and 76% for pN(-) and 13% and 24% for pN(+), respectively. The average tumor dimension was independently significant for DFS and OS, with 5-year rates of 69% and 80% for ${\leq}1cm$, 28% and 53% for 1-2 cm, and 18% and 30% for >2 cm, respectively. Tumor location was also significant for DM and OS, with 5-year rates of 69% vs 33% and 41% vs 66% for trunk vs other locations, respectively. Conclusions: The natural course of a malignant skin melanoma treated radically is disadvantageous, with unsuccessful outcome in nearly half of the cases. Common clinical factors, such as Clark's tumor stage, Breslow's depth of invasion and the presence of metastatic nodes, have high prognostic significance. The size and location of the primary lesion may be considered independent prognostic factors. The most important negative prognostic factor is the presence of metastatic regional lymph nodes. Only one quarter of patients with metastases in lymph nodes survive 5 years from primary surgery.

• Tuberculosis and Respiratory Diseases
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• 제42권4호
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• pp.594-599
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• 1995

저자들은 젊은 남자에서 잠재성 유두상 갑상선암이 흉막전이되어 호흡곤란을 유발할 정도의 대량 흉수로 발현된 증례에서 전갑상선절제술로 원발 종양을 병리학적으로 확인하고 악성흉수에 대한 흉막유착술과 전이성 유두양 갑상선암에 대한 방사선 옥소치료를 시행한 증례를 경험하였기에 문헌고찰과 함께 보고하는 바이다.

• 대한두경부종양학회지
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• 제3권1호
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• pp.5-13
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• 1987

Cancer of the head and neck is an uncommon disease accounting for 5 % of all cancers. In an anatomic area so readily visible and palpable for examination without special and expensive diagnositic tools, it is unfortunate that many patients still present with advanced diseases. Since the prognosis is so intimately related to stage of disease, it is very important to detect the earliest stage of cancer with a complete head and neck examination. In the evaluation of cancer at any anatomic site, the description of the extent of the lesion is important. Not only does proper staging of the tumor lead to make decision of the most appropriate treatment, it also serves as a guide for the results of treatment. Proper staging demands a careful clinical assesment of the extent of the cancer. The current staging system for head and neck cancer uses the TNM system devised by American Joint Committee for Cancer Staging and End Result Reporting. T represent the primary tumor, N, regional nodal metastases, and M, distant metastases. The detection, diagnosis, and appropriate treatment of eary cancer will result in improved survival.

• Radiation Oncology Journal
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• 제15권4호
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• pp.331-337
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• 1997

목적 : 연세의대 연세암센터에서는 1991년도부터 조기유방암에 대하여 유방보존술을 실시해오고 있으며 본원에서 사용하는 치료방법과 치료에 따르는 부작용 등에 대해서는 이미 보고한 바 있다. 아직 추적 관찰 기간이 짧기 때문에 치료결과를 평가하기는 어려운 시점이지만 치료 후 수년 이내에 재발하는 양상을 알아보고 그에 관련되는 위험인자를 알아봄으로써 본원에서 시행 되고 있는 유방보존술을 중간 점검해 보고자 하였다. 대상 및 방법 : 1991년 1월부터 1994년 12월까지 AJCC 병기 1기, 2기 유방암으로 유방 보존적 수술을 받은 후 연세암센터 방사선종양학과에서 근치적 방사선치료를 받았던 216명의 환자들을 대상으로 하였다. 환자들의 연령 분포는 23세에서 80세로 중앙값이 44세였으며, 40대가 86명$(39.8\%)$, 30대가 73명$(33.8\%)$, 50대가 38명$(17.6\%)$였다. T 병기 별로는 T1이 117명, T2가 99명이었으며 이 중 Tlc와 3cm 이하의 T2가 전체의 $79\%$를 차지하였다. 액와림프절은 73명에서 양성이었다. 따라서 stage 1이 89명$(41.2\%)$, 113가 81명$(37.5\%)$, llb가 46명$(21.3\%)$이었다. 모든 환자들은 유방부분절제술과 액와림프절 곽청술을 시행받은 후 방사선치료를 받았으며 96명의 환자들이 방사선치료 후, 또는 방사선치료 전후에 항암화학요법을 받았다. 추적 기간은 3-60개월로 정중앙 추적기간이 30개월이었다. 결과 : 추적 기간 동안에 19명이 재발하였는데 3명은 국소 재발(true recurrence;1, elsewhere; 1, skin;1)만 있었고 13명은 원격전이만 있었으며, 3명은 국소재발과 원격 전이가 동시에 있었다. 이 외 반대편 유방암이 1예에서 발생하였고, 3예에서 2차 원발암이 발생하였다. 국소 재발을 보인 예들 중, 유방의 피부에서 재발하였던 예는 곧 이어 원격전이를 보였지만, 나머지 2예는 유방전적출술을 받은 후 무병 생존중이다. 원격전이를 보인 예들은 대부분(12/16) 2년 이내에 재발하여 빠르게 진행되어 11명이 사망하였고 원격전이 후 정중앙 생존기간이 8개월이었다. 병기별 5년 생존율은 1기 $96.7\%$, IIa기 $95.2\%$, IIb기 $69.9\%$이었고, 5년 무병생존율은 I기, IIa기, IIb기가 각각 $97.1\%,\;91.7\%,\;59.9\%$이었다. 원격전이에 영향을 주는 인자로는 연령, 1병기, N병기,AJCC stage가 의미 있었으며, 병리학적 유형, 화학요법 여부, 수술절제연 침범 유무는 원격전이에 영향을 주지 못하였다. 결론 : 조기유방암의 유방보존술 후 수년 이내에는 유방내 국소재발은 적으나, 원격전이는 주로 3년이내에 발생하였는데 40세 이하의 젊은 연령층에서, 종양이 클수록, 침범된 액와림프절의 숫자가 많을수록 원격전이율이 높았다.