• Radiation Oncology Journal
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• 제18권1호
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• pp.11-16
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• 2000

목적 : 진행된 식도암 환자에서 외부 방사선 단독치료를 받았던 환자의 치료성적에 대하여 후향적 분석을 시행하였다. 재료 및 방법 : 흉곽내에 위치한 편평상피세포암의 식도암으로 1990년 7월부터 1996년 12월까지 전남대학교병원 치료방사선과에서 외부 방사선 단독 치료를 받은 106명을 대상으로 후향적 분석을 시행하였다. 근치 목적의 방사선은 6 MV 혹은 10 MV X선으로 55 Gy에서 70.8 Gy 의 선량으로 통상적인 분할치료를 시행하였다. 추적이 가능한 환자는 100명(94$\%$)으로 추적기간은 1개월에서 92개월(중앙값: 6개월)이었다. 결과 :전체환자의 중앙연령은 62세였으며, 남녀 비율은 104:2였다. 가장 흔한 병변부위는 중앙 부위로 54$\%$를 차지하였다. 83$\%$의 환자가 근치목적의 방사선치료를 받았고 이들의 평균 방사선 선량은 58.6 Gy였으며(55$\~$70.8 Gy)평균 치료소요기간은 53일이었다. 전체환자의 중앙생존기간은 6개월이었고, 1, 2년 생존율은 각각 27, 12$\~$였다. 연하곤란으로 위루술을 시행한 7명을 제외하고 대부분의 환자에서 증상의 완화를 보였다. 치료 직후 완전 관해율은 32$\~$ (34/106)였고 이들 환자의 중앙생존기간(14개월)과 2년 생존율(30$\%$)은 다른 환자의 중앙생존기간(4개월)과 2년 생존율(30$\%$)에 비해 좋았다(p=0.000). 진단시 연하곤란의 정도에 따른 중앙생존기간과 2년 생존율을 비교해보면, 정상적인 음식물 섭취가 가능한 경우는 9개월과 16$\%$인 반면, 전혀 음식물을 삼킬 수 있었던 환자의 경우는 3개월과 0$\%$였다(p=0.004). 그러나 식도주변조직의 침범이나 주변 임파절 침범 유무에 따른 두 군간의 성적의 차이는 보이지 않았다. 다요인 분석에서는 방사선치료 직후 종양의 완해 여부가 가장 중요하였고 그외 원발 병소의 길이, 진단 당시 연하곤란의 정도 순으로 생존율에 통계적으로 유의한 영향을 주는 인자였다. 치료로 인한 부작용은 10명의 환자에서 관찰되었다(9$\%$). 결론 : 진행된 식도암 환자의 외부방사선 단독 치료는 좋지 않은 결과를 보여 주었다. 이에 진행된 병기의 식도암환자의 치료 선택에 있어서 반드시 근접치료나 항암화학요법의 병행을 고려해야 하겠다.

• Radiation Oncology Journal
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• 제9권2호
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• pp.233-239
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• 1991

방사선치료 단독(25명) 또는 화학요법과 방사선 병용치료(37명)를 받은 62명의 식도암환자에 대한 후향성분석의 결과는 다음과 같다. 방사선 단독치료를 받은환자중 14명이, 병용치료를 받은환자 중 25명이 계획된 치료를 끝내었다. 추적기간은 6일에서 50개월 이었다. 39명중 완전관해는 3명($8\%$)에서, 부분관해는 28명($72\%$)에서 보였다. 중앙 생존기간은 11개월이었고, 1년 및 2년 생존율은 각각 $48.6\%,\;13\%$이었다. 나이와 병기가 예후에 유의한 영향을 미쳤다. 병기에 따른 1년 생존율은 1기에서 $70.1\%$, 2에서 $47.6\%$, 3기에서 $28.4\%$이었고, 중앙생존기간은 1기에서 19개월, 2기에서 11개월, 3기에서 6개월 원격전이가 있는 3기에서는 5.5개월 이었다. 나이에 따른 1년 생존률은 55세 이상에서 $69.6\%$, 54세 이하에서 $0\%$이었다. 치료방법, 종양의 위치, 원발병소의 반응에 따른 생존률에는 유의한 차이가 없었다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.247-250
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• 2012

Objective: To determine whether CDX2 and villin protein expression are associated with intestinal metaplasia (IM) in gastric cardiac mucosa and to explore the relationship with evolution of gastric cardiac adenocarcinoma (GCA). Methods: We studied 143 gastric cardiac biopsy or resection specimens from Henan province China, including 25 cardiac gastritis specimens with IM, 65 dysplasia specimens with IM and 35 gastric cardiac adenocarcinoma specimens and stained them for CDX2 and villin by the immunohistochemical SP method. 15 normal gastric cardiac biopsy specimens were also collected as control. Results: (1) Normal gastric mucosa presented no CDX2 and villin expression. The positive rates of CDX2 protein in cardiac gastritis with IM, dysplasia with IM, and carcinoma tissues were 84.0% (21/25), 66.7% (32/48) and 36.4% (20/55), respectively. While the positive rates of villin protein in cardiac gastritis with IM, dysplasia with IM, and carcinoma tissues were 76.0% (19/25), 70.8% (34/48) and 45.5% (25/55), respectively. There were significant differences among the three groups for both CDX2 and villin (P<0.01). Spearman's rank correlation coefficient(rho) showed a close correlation between the two proteins (r=0.843, P<0.01) and both were positively related with tumor differentiation (both P<0.05), but not associated with age, sex, invasion and metastasis of lymph node (P>0.05). Conclusion: Our results suggest that ectopic expression of CDX2 and villin may be involved in early-stage IM and tumorigenesis in gastric cardia and the expression of villin may be regulated by CDX2.

• Radiation Oncology Journal
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• 제12권2호
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• pp.191-199
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• 1994

Purpose : This study was undertaken to show the clinical results of combined radiotherapy and hyperthermia in primary hepatoma Materials and Methods : Between December 1989 and March 1993, 50 patients with hepatomas were treated by combined radiotherapy and hyperthermia. Among them, we analyzed retrospectively 33 patients who received the complete course of treatment. The ages of the patients ranged from 36 to 75(mean age: 55.5 years). Twenty-six patients ($78.8\%$) were men, and 7 ($21.2\%$ were women. According to Child's classification, nine patients ($27.3{\%}$) were A group, 9 ($27.3\%$) were B group, 15 ($45.4\%$) were C group. Radiation therapy was done by a 6 MV and 15 MV linear accelerator. Patients were treated with daily fractions of 150-180 cCy to doses of 2550 cGy -4950 cGy (median : 3000 cGy). Local hyperthermia was done by 8 MHZ RF capacitive heating device (Cancermia. Green Cross Co., Korea), 50-60 min/session, 1-2 sessions/wk, and 8.5 sessions (median number)/patient. We analyzed the prognostic factors including age, sex, tumor type, Child's classification, $\alpha$-fetoprotein, liver cirrhosis, ascites, portal vein invasion, esophageal varix, number of hyperthermia, chemotherapy, total bilirubin level, Karnofsky perfomance status. Results : The overall 1-year survival was $24.2\%$, with a mean survival of 10months. Of 33 patients, tumor regression (PR+MR) was seen in $30.4\%$, no response was seen in $52.2\%,\;17.4\%$ patient was progressed. In patients who had tumor regression, the overall 1-year survival was $42.1\%$ with a mean survival of 14 months. Factors influencing the survival were sex (p=0.05), tumor type (p=0.0248), Child's classification (p=0.0001), liver cirrhosis (p=0.0108), ascites (p=0.0009), and Karnofsky perfomance status (p=0.0028). Complications developed in 28 patients, including 18 hot pain,5 fat necrosis, 3 transient fever, 2 nausea and vomiting. Conclusion : In this study, the results suggests that combined radiotherauy and hyperthermia may improve the survival rate of hepatoma.

• Journal of Chest Surgery
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• 제29권9호
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• pp.1003-1009
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• 1996

식도위장문합술에서 주로 사용되는 원형기계를 사용하는 문합술은 편리하며 누공발생률이 적은 술기이나 문합부의 협착이 잘 생기며 이는 문합기가 작은 경우에 발생빈도가 높다. 경부에서 식도위장문합시 기계문합식으로 편리하게 수술하면서 협착을 방지하는 수술수기로흉강경용 봉합기를 사용하는 방법을 고폰하여서 임상적용한 결과를 보고한다. 식도암 환자 13례에서 식도재건술에 흉강경용 봉합기를 사용하여 경부식도위장 문합을 하였고 수술후 평균 8개월 관찰하여 문합부의 헙착발생을 관찰하였다. 식도암환자 13례중 수술후 사망한 1례를 제외한 12례중 1례에서 술후 위장궤사에 의한 누공이 있었고, 11례에서는 협착증상 없었다. 경부식도위장 문합술에서 흉강경용 봉합기를 사용한 결과 수술이 편리하고 협착 및 누공의 발생률은 매우 낮다. 흉강경용 봉합기 문합술식은수술이 간편하고,작은 내경의 식도와위장문합에서 생기는문합부의 협착을 방지할 수 있는 수술로 경부의식도장관문합의 변형술식으로 적용할 수 있다.

• Radiation Oncology Journal
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• 제3권2호
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• pp.123-129
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• 1985

1979년 3월부터 1982년 10월까지 식도의 편평상피암으로 진단되어 서울대학교병원 치료방사선과에서 근치적 목적으로 방사선치료를 받았던 46례에 대한 후향성 분석을 시행하여 다음과 같은 결과를 얻었다. 전체 환자의 2년 생존율은 $20\%$이었으며 식도암의 위치, 크기, 병기, 방사선조사량 그리고, 관해정도에 따라 생존율에 차이가 있었다. 식도 촬영상 5cm이하$(39.3\%)$ 또는 적도의 상부 1/3에 종양이 있는 경우$(29.5\%)$에 가장 좋은 2년 생존율을 보였으며 척적방사선 조사량은 $1,600\~l,700ret$였다. 관해정도에 따른 생존율은 완전관해를 보인 경우의 2년 생존율이 $42.2\%$인 반딘 전혀 반응이 없던 경우의 2년 생를율은 $0\%$이었다.

• 대한두경부종양학회지
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• 제33권2호
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• pp.89-93
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• 2017

Background. Ever since the first report of deltopectoral flap in pharyngo-esophageal reconstruction in 1965, various methods of flap reconstruction have been introduced, allowing surgical eradication of tumors that were once thought to be inoperable. Despite these advancement, many literatures emphasize distant metastasis and second primary malignancies as the most important factors that contribute to the low 5-year survival rate of the patients. Specific consensus about defining second primary cancer is still debatable, due to small number of reports regarding second primary tumors arising in flaps used for reconstruction of defects in the head and neck region. Case. We report a case of a 72-year-old male patient who, under the diagnosis of hypopharyngeal cancer, underwent total laryngectomy with partial pharyngectomy, extended right radical neck dissection with extended left lateral neck dissection, right hemithyroidectomy and radial forearm free flap reconstruction on June 16, 2003. After 37 cycles of radiation therapy, the patient exhibited no sign of recurrence. The patient revisited our department on June 14, 2016 with chief complaint of dysphagia that started two months before the visit. Radiologic studies and histology revealed squamous cell carcinoma in neopharynx, one that had been reconstructed with forearm free flap. Conclusion. Until now, only a handful of reports regarding patients with second primary cancer in reconstructed flaps have been described. Despite its rarity, diagnostic criteria for second primary cancer should always kept in consideration for patients with recurred tumor.

• Asian Pacific Journal of Cancer Prevention
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• 제15권18호
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• pp.7597-7602
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• 2014

Background: Amplification and overexpression of human epidermal growth factor receptor 2 (HER2/neu) oncogene has considerable prognostic value in breast and gastric cancers. This study aimed to evaluate the frequency, overexpression pattern, clinical significance, and concordance between the results for protein expression and gene amplification of HER-2/neu in gastric and gastro-esophageal junction carcinomas. Materials and Methods: In this study, 101 gastric tissue samples which were included in tissue microarray were immunohistochemically examined for overexpression of HER2/neu. Chromogenic in situ hybridization (CISH) was used for HER-2/neu amplification. The correlation of HER2/neu amplification with clinicopathological parameters was also assessed. In addition, concordance between CISH and IHC was detected. Results: This study demonstrated a significant difference in the overexpression of HER2/neu in gastric tumors. The overexpression of HER2/neu was significantly higher in intestinal type, poorly differentiated grade, large size ($5cm{\leq}$) and positive nodal involvement tumors (p-value=0.041, 0.015, 0.038 and 0.071, respectively). Also, amplification of HER2/neu according to CISH test, had a significant positive correlation with tumor size and tumor type (p-value=0.018 and 0.058, respectively).Concordance between CISH and IHC was 76.9% in 101 evaluable samples. Conclusions: IHC/CISH differences were attributed to basolateral membranous immunoreactivity of glandular cells resulting in incomplete membranous reactivity and/or a higher rate of tumor heterogeneity in gastric cancers compared to breast cancers. Therefore, this can be a potential marker for targeted therapy of malignant gastric tumors.

• Journal of Chest Surgery
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• 제25권12호
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• pp.1530-1536
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• 1992

From January 1984 to December 1991, One hundred sixty five patients with carcinomoa of the esophagus were treated surgically at the department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital. Among them, hospital records were available in 121 patients and were included in this study. There were 115 men and 6 women, with ages ranging from 40 years to 79 years[mean age of 59.2 years]. The most frequent preoperative symptoms included dysphagia[72.7%], weight loss[60.3%], chest pain or discomfort[14.9%], general malaise[13.2%]. All were treated surgically: 100 patients were managed by curative or palliative resection with reconstruction, and 6 by palliative bypass surgery. In 15 patients, explorative thoracotomy or laparotomy was only done due to unresectability. [operability: 87.6%, resectability: 82.6%] All specimens[those from resectable 100 cases] were sent to pathology, and histopathologic examinations were done; squamous cell carcinomas were found in 95 cases, adenocarcinoma in l. Adenosquamous carcinomas were found in 3, and malignant melanoma in l. Postoperative complications occurred in 34 cases; anastomotic site leakage[10], which was followed by empyema in 9 of them, wound problem[7], hepatic failure[6], pneumonia [3], post-operative bleeding[3], chylothorax[2], post-operative stricture[2], sepsis[1], and tracheobronchial fistula[1]. Hospital deaths were in 6 cases[Hospital mortality: 5.0%]. During the follow up period, 26 patients were proven to be recurrence of cancer locally or distantly. The one, two, and five-year actuarial survival raf.es were 71.3$\pm$4.5%, 57.4$\pm$5.6%, 34.7$\pm$8.9%, respectively. The data from this study suggested that esophagectomy with reconstruction of gastrointestinal tract could be performed with a low operative mortality and a few serious postoperative complications and achieved reasonable long term palliation for carcinoma of the esophagus.

• Journal of Chest Surgery
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• 제25권5호
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• pp.504-510
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• 1992

Overall 25,095 cases of general thoracic surgery were analysed, which were performed by 48 institutes in Korea during recent 6 years[242 hospital-years]. The proportions of tumorous disease and infectious disease to be operated were 6,864 cases[27.4%] and 6,775 cases [27.0%], The most common organ involved for operation was lung-bronchus 16,542 cases [69.5%], and remainders were pleura 2,500 [10.0%], esophagus 2,433[9.7%], mediastinum 1,902[7.6%], chest wall 1,297 [5.2%], and diaphragm 421 [1.7%] in order. Among 6,864 cases of tumorous diseases, the most common causes for operation were lung-bronchus tumor 3132 cases [45.6%] and most of them were lung cancer 2,731 cases [88.7%]. In the 2,019 cases of primary lung cancer with known cell type, squamous cell carcinoma 1,296 cases [64.2%] and adenocarcinoma 460 cases [22.8%] were the most. The common types in the 1,207 cases of mediastinal tumor with known cell type were neurogenic tumor 348 cases [28.8%], thymoma 311 [25.8%], and teratoma 252[20.9%]. The annual cases of operation for tumorous disease including malignant tumor were increased steadily. Operation for infectious lung diseases [including bronchiectasis and tuberculosis] were about twice common than infectious pleural disease [i.e. empyema], and operations for tuberculous disease occupied about half cases of infectious lung disease. In 11,456 cases of other disease entities, excluding tumorous and infectious disease, there were bullous lung disease 9,074 cases[79.2%], benign esophageal disease 484[4.2%], myasthenia gravis 356[3.1%], chest wall deformity 483[4.2%], and diaphragmatic lesion 421[3. 7%] in order. We propose that above results for inquiry can be used as the basic data of general thoracic surgery in Korea.