• Asian Pacific Journal of Cancer Prevention
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• v.16 no.15
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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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• v.26 no.3
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• pp.149-159
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• 2008

Purpose: To evaluate the results and prognostic factors for postoperative adjuvant radiation therapy in patients at stages I and II of endometrial cancer. Materials and Methods: Between January 1991 and December 2006, 35 patients with FIGO stages I and II disease, who received adjuvant radiation therapy following surgery for endometrial cancer at Ewha Womans University Hospital, were enrolled in this study. A total of 17 patients received postoperative pelvic external beam radiation therapy; whereas, 12 patients received vaginal brachytherapy alone, and 6 patients received both pelvic radiation therapy and vaginal brachytherapy. Results: The median follow-up period for all patients was 54 months. The 5-yr overall survival and disease-free survival rates for all patients were 91.4% and 81.7%, respectively. The 5-yr overall survival rates for low-risk, intermediate-risk, and high-risk groups were 100%, 100% and 55.6%, respectively. In addition, the 5-yr disease-free survival rates were 100%, 70.0%, and 45.7%, respectively. Although no locoregional relapses were identified, distant metastases were observed in 5 patients (14%). The most common site of distant metastases was the lung, followed by bone, liver, adrenal gland, and peritoneum. A univariate analysis revealed a significant correlation between distant metastases and risk-group (p=0.018), pathology type (p=0.001), and grade (p=0.019). A multivariate analysis also revealed that distant metastases were correlated with pathology type (p=0.009). Papillary, serous and clear cell carcinoma cases demonstrated a poor patient survival rate compared to cases of endometrioid adenocarcinoma or adenosquamous carcinoma. The most common complication of pelvic external beam radiation therapy was enteritis (30%), followed by proctitis, leucopenia, and lymphedema. All these complications were of RTOG grades 1 and 2; no grades 3 and 4 were observed. Conclusion: For the low-risk and intermediate-risk groups (stages 1 and 2) endometrial cancer, pelvic control, and overall survival rate was free of severe toxicity when pelvic radiation therapy or vaginal brachytherapy was performed. In the high-risk group, pelvic control rate was excellent, but the survival rate was poor due to distant metastases, in spite of the pelvic radiation therapy. The combined modality of chemotherapy and radiation therapy is recommended for high-risk groups. For the intermediate-risk group, a prospective randomized study is required to compare the efficacy between whole pelvic radiation therapy and vaginal brachytherapy.

• Radiation Oncology Journal
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• v.38 no.1
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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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• v.14 no.5
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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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• v.16 no.14
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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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• v.42 no.4
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• pp.594-599
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• 1995

Although papillary carcinoma of the thyroid generally follows an indolent course characterized by slow growth and the absence of distant metastases, several available reports suggest that metastasis to bone and/or lung parenchyma may occur infrequently. But pleural metastases are known to be very rare, so there have been only two case reports about the pleural metastases of papillary thyroid carcinoma in the literatures. Even the case of occult papillary thyroid carcinoma presenting as a metastatic pleural effusion has been never been reported. Recently we experienced a case with the chief complaint of dyspnea due to massive pleural effusion, the cytologic examination of which revealed the papillary carcinoma with psamomma bodies. The examination of the thyroid revealed no definite primary tumor. The total thyroidectomy was done with the plan of post-operative radioactive iodine treatment and the pathologic result confirmed the occult papillary microcarcinoma as expected. With the present case report, the extension of the clinical spectrum. of metastatic papillary carcinoma of the thyroid is expected.

• Korean Journal of Head & Neck Oncology
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• v.3 no.1
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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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• v.15 no.4
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• pp.331-337
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• 1997

Purpose : To evaluate our experience in the breast-conserving treatment for early breast cancer with special regard to recurrence Pattern and related risk factors. Materials and Method :Two hundred and sixteen patients with AJC stage 1and 11 breast cancer who received breast conserving treatment between January 1991 and December 1994 were evaluated A9e distribution ranged from 23-80 year old with a median a9e of 44. One hundred and seventeen Patients had 71 lesions and 99 Patients had 72 lesions. Axillary lymph nodes were involved in 73 patients. All patients received a breast conserving surgery (wide excision to quadrantectomy) and axillary node dissection followed by radiotherapy. Ninety six patients received chemotherapy before or after radiotherapy. Results : During the follow-up period (3-60 months, median 30 months), local recurrences were noted in six Patients (true: 3, elsewhere; 1, skin: 2). Sixteen patients developed distant metastases as the first sign of recurrence at 8-38 months (median 20 months) after surgery. Among them, three patients simultaneously developed local recurrence with distant metastases. Contralateral breast cancer developed in one Patient and non-mammary cancers developed in three patients. The actuarial 5 year survival rate was $88.4\%\;(stage\;I\;96.7\%,\;stage\;IIa\;95.2\%,\;stage\;IIb\;69.9\%)$. Age, I stage, number of involved axillary lymph nodes. and AJC stage were risk factors for distant metastases in univariate analysis. In the multivariate analysis, the number of involved axillary lymph nodes was the most significant risk factor for metastases. Conclusion : Local recurrence was not common in the early years after radiotherapy. Distant metastases occurred at a steady rate during the first three years and was more common in the Patients with larger tumors, higher number of involved axillary nodes, and younger age.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.5
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• pp.2439-2443
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• 2016

Purpose: To determine the risk factors, clinical symptoms and patterns of spread in laryngeal cancer. Materials and Methods: A cross sectional study was carried out in the Regional Cancer Centre, Imphal, Manipur, India. One hundred and sixteen patients with laryngeal cancer were retrospectively reviewed for epidemiological data and descriptive statistics were reported for various variables. Results: Median age at presentation was 65 years and 32.8% were undernourished at presentation. The male to female ratio was 5.4:1. Heavy smoking and tobacco chewing was associated in 91.4% and 33.6% of patients respectively. Tracheostomy was required in 21.5% leading to diagnosis of laryngeal cancer. Almost all were squamous cell carcinoma with neuroendocrine and verrucous carcinoma accounting for less than 2%. Supraglottic, glottic and trans-glottic tumors were 56.9%, 36.3% and 6.9% respectively. Nodal metastases were seen in 81.8% of supraglottic cancers and 31.6% of glottic cancers with supraglottic involvement. Level II neck nodes were the commonest site followed by level III. Distant metastases (only liver) were apparent in 1.7% at presentation. Including these liver metastases, unresectable cases were limited to 6% of the patients. Conclusions: Tobacco use is implicated in almost all of the cases and the sex ratio has also decreased due to increased female smokers. The supraglottis remains the commonest site and incidence of nodal metastases is higher than in other countries. There is also a higher requirement for tracheostomy at presentation in this region.

• Radiation Oncology Journal
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• v.7 no.1
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• pp.37-43
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• 1989

Sixty-six patients with squamous cell carcinoma of the supraglottic larynx received irradiation with curative intent between 1979 and 1985 were retrospectively analysed. All patients had a minimum follow-up of 4 years. Of the entire group consisting of $73\%$T3 and T4 lesions and $58\%$ lymph node metastases, a 5-year acturial survival rate was $31.3\%$. A 5-year acturial survival rates for stage II, III and IV were $60.7\%,\;45.7\%\;and\;13.5\%$ respectively (p<0.05). Patients without lymphnode metastases had better survival rate than those with postive lymphnode metastases $(54.8\%\;vs\;12.2\%)$ (p<0.005). Surgical salvage rate w8s 4/7 $(57\%)$. Three patients developed distant metastases. Major complications requiring surgery were seen in $11\%$, Radiation therapy alone with surgical salvage was an effective, voice preserving treatment for stage I, II and selected III carcinoma of the supraglottic carcinoma, however planned combined treatment with surgery and radiation therapy is advised for stage III and IV carcinoma of the supraglottic larynx with resectable neck disease.