• 대한두경부종양학회지
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• 제27권2호
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• pp.177-182
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• 2011

Backgrounds : Head and neck cancer is one of the most prevalent cancers in the world. It tends to remain localized at the primary site and regional lymph nodes, but if distant metastasis occurs, it has a poor prognosis. This study was performed to evaluate the prevalence of distant metastasis and to determine the risk factor in locally advanced head and neck cancer after induction chemotherapy followed locoregional control therapy. Methods : A retrospective review was performed in 420 patients with locally advanced head and neck cancer who treated with induction chemotherapy followed locoregional control therapy from January 2001 to December 2010. Among them, 31 patients who had distant metastasis as first relapse within 2 years after termination of therapy were analyzed for clinical features and the risk factors of distant metastasis. Results : The overall incidence of distant metastasis was 7.3%. The bone, lung, and liver were the most frequent metastatic organs. In univariate analysis, nodal stage, nasopharyngeal cancer, laryngeal cancer, G3/G4 neutropenia during induction chemotherapy, and concurrent chemoradiotherapy were the influencing factors for distant metastasis. In multivariate analysis, advanced N stage and nasopharynx were the risk factors of distant metastasis, and grade 3/4 neutropenia during induction chemotherapy was considered to decrease distant metastasis. Conclusion : This study suggests that the advanced N stage is the risk factor of distant metastasis and Grade 3/4 neutropenia during induction chemotherapy can be beneficial against distant metastasis in locally advanced head and neck cancer patients treated with induction chemotherapy followed locoregional control therapy.

• 대한두경부종양학회지
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• 제24권1호
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• pp.26-32
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• 2008

Purpose：Hypopharyngeal carcinoma is usually diagnosed as an advanced disease after an asymptomatic beginning, and it is related to a high frequency of lymph node metastases. An eventual negative outcome may occur not only because of possible locoregional failures but also for frequent distant metastases. Thus, the efficacy of induction chemotherapy followed by radiation therapy, with regards to the response, survival rate and complications for locally advanced hypopharyngeal carcinoma patients, was examined. Methods and Materials：Since July 1998 to February 2001, 18 patients having locally advanced hypopharyngeal carcinoma were treated with induction chemotherapy followed by radiation therapy, and the results were retrospectively analyzed. The regimen of the induction chemotherapy was the 5-flurouracil(5-FU, 1,000mg/$m^2$ daily for 5 consecutive days) and cisplatin(100mg/$m^2$ on day 1) combination at 3-week intervals for 2 cycles. The total radiation dose for the primary tumor and metastatic lymph nodes was 68.4-72.0Gy(median：70.2Gy) Results：The 3-year overall survival rate and disease free survival rate were 31.3% and 22.2%, respectively. In 6 patients(33.3%), preservation of the larynx for over 3 years was possible. After the induction chemotherapy and radiotherapy, a complete response was noted in 14 patients(77.8%), and a partial response in 4 patients (22.2%), with an overall response rate of 100%. Conclusion：Induction chemotherapy followed by radiation therapy is an effective treatment and larynx preservation rate was 33% in patients with locally advanced hypopharyngeal carcinoma in our report.

• Radiation Oncology Journal
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• 제17권3호
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• pp.195-202
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• 1999

목적 : 국소 진행된 비소세포성 폐암의 치료에 있어서 예후 인자를 분석하고, 유도 화학요법이 생존율 및 치료 실패양상에 미치는 영향을 알아 보고자 본 연구를 시행하였다. 대상 및 방법 : 1986년 1월부터 1996년 10월까지 국소 진행된 비소세포성 폐암으로 진단받고 근치적 목적으로 방사선치료 혹은 병합요법(유도 화학요법 및 방사선치료)을 받은 130명의 환자를 대상으로 후향적 분석을 시행하였다. 방사선치료 단독군이 85명, 병합요법군이 45명이었다. 연령, 성별, 전신 수행능력, 병리조직학적 유형, 그리고 병기 등은 양군에서 고르게 분포하였다. 방사선치료는 6 MV 혹은 10 MV 선형가속기를 사용하였고, 일일 선량 $1.8\~2.0$ Gy를 주 5회 조사하였다. 총 방사선량은 129명에서 59.6 Gy 이상($56\~66$ Gy, 중앙값 60 Gy) 조사되었다. 유도 화학요법은 $2\~5$회(중앙값 2회) 시행하였다. 사용된 약제는 CAP (Cyclophosphamide, Adriamycin, Cisplatin)가 6명, MVP (Mitomycin, Vinblastine, Cisplatin)가 9명, MIC (Mitomycin, ifosfamide Cisplatin)이 13례, 그리고 EP (Etoposide, Cisplatin)가 17명에서 시행되었으며, 모든 요법이 Cis-platinum을 포함하였다. 결과 : 전체 환자의 생존율은 1, 2, 3 년 전체 생존율이 각각 41.5, 13.7, $7\%$였고, 중앙 생존기간은 11개월이었다. 치료 방법별 1, 2, 3 년 전체 생존율, 그리고 중앙 생존기간은, 방사선치료 단독군의 경우 각각 32.9, 10.5, $6\%$, 9개월이었으며, 병합요법군의 경우는 각각 57.8, 20, $7.6\%$, 14 개월이었다(p=0.0005). 최종 치료반응을 관찰할 수 있었던 126명 중 38명($30.2\%$)에서 완전관해를 보였고, 치료 방법별로 나누어 분석하였을 경우, 방사선치료 단독군에서 완전관해가 $25\%$ (21/84), 병합요법군의 경우는 $40.5\%$, (17/42)에서 완전관해를 보였다(p=0.09). 생존율에 영향을 미치는 예후인자는 혈색소치(p=0.04), NSE (neuron-specific enolase)치(p=0.004), 그리고 최종 치료반응(p=0.004)등이었다. 치료 방법별로 나누어서 분석한 결과, 방사선치료 단독군의 경우는 WSE치(p=0.006)와 최종 치료반응(p=0.003), 병합요법군의 경우는 최종 치료반응(p=0.007)이 예후인자였다. 치료 실패양상은 추적 관찰이 가능했고 치료에 대한 반응을 알 수 있었던 120명을 대상으로 분석한 결과, 양 군간에 특이한 차이를 보이지 않았다. 그러나, 치료에 완전관해를 보인 환자들을 대상으로 살펴보면 병합요법 군에서 원격전이가 감소하는 경향을 보였는데, 방사선치료 단독군은 19명중 11명에서, 병합요법군은 13명중 3명에서 원격전이가 발견되었다(p=0.07). 국소 실패는 완전관해를 보인 환자에서도 양 군에서 차이가 없었다(10/19 vs 6/13). 결론 : 국소 진행된 비소세포성 폐암의 경우 유도 화학요법을 시행함으로써, 방사선치료 단독보다 2년 생존율이 향상 되었고, 적어도 완전관해를 보인 경우는 원격전이가 감소하는 경향을 보였다. 그러나, 국소 실패양상 및 장기생존율에는 유도 화학요법이 도움이 되지 않았다. 따라서, 국소 제어율을 높이기 위한 다각적인 노력이 요구된다.

• Radiation Oncology Journal
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• 제8권2호
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• pp.207-212
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• 1990

유도화학요법과 방사선치료후 종양 관해의 상호 관련성을 파악하고자 1986년부터 1989년까지 원자력병원에서 소정의 충분한 유도화학요법과 근치적 방사선치료를 받은 국소적으로 진행된 두경부 악성종양 환자 60예에 대한 후향적 분석을 시도하였다. 유도화학요법은 CDDP를 기본으로한 복합요법을 2 내지 3회 시행한바, 20예에서 Bleomycin+CDDP(BP), 37예에서 5-FU+CDDP(FP), 그리고 3예에서 BP/FP의 교대요법을 시행하였으며, 방사선은 병소에 따라서 65 Gy 내지 75 Gy 또는 그이상을 조사하였다. 유도화학요법에 의한 종양의 관해율은원발병소에서는 $80\%$(48/60), 경부임파절에서는 $79\%$(31/39)였으며, 약제, T-병기, 그리고 N-병기에 의한 통계적 유의성은 관찰되지 않았다. 방사선조사 6개월후 원발부위에서는 $67\%$(40/60)의 완전관해를, 경부임파절에서는 $77\%$(30/39)의 완전관해를 보인바, 이를 유도화학요법에 의한 관해 유무에 따른 차이를 분석한 결과 원발부위에서는 유도화학요법에 의한 관해(완전관해 또는 부분 관해)를 얻었던 48예중 39예에서 완전관해를 얻었으나($81\%$), 관해를 얻지못한 12예에서는 1예에서만이 방사선 치료에 의해 완전관해를 얻을 수 있었으며 ($8\%$) (p<0.0005), 경부임파절에서는 유도화학요법에 의해 관해를 얻었던 32예중 28예에서 완전관해를 얻은 반면 ($90\%$), 관해를 얻지 못한 8예에서는 2예에서만이 방사선 치료에 의해 완전관해를 얻을 수 있었던바($25\%$) (p<0.001), 모두 통계적으로 유의한 차이를 보였다. 한편 이를 원발부위, T-병기 그리고 N-병기에 따라 분석해본 결과, 특히 T-병기중 T3, 4에서는 유의한 차이가 관찰되었으나(p<0.0005), T1, 2에서는 유의한 차이가 관찰 되지 않았다(0.3

• 대한두경부종양학회지
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• 제24권2호
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• pp.162-168
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• 2008

Purpose：To know the results after induction chemotherapy followed by curative radiation therapy for locally advanced hypopharyngeal cancer Methods and Materials：From August 1990 to December 2003, forty patients who were treated with induction chemotherapy and curative radiation therapy were analyzed retrospectively. Median age of patients was 60 years(range：40-78 years) and clinical stage was wholly stage 3 or 4. Induction chemotherapy used cisplatin with 5-FU or docetaxel, and its interval was 3 weeks. Irradiated radiation dose was 70 to 78Gy (median：70.8Gy). Results：Median follow-up time was 39.4 months(range：8-115 months). Treatment failures were observed in 52.5% patients, and main failure pattern was local recurrence in 16 patients. 3 and 5 year disease free survival were 52.6%, 48.2% respectively and values of overall survival were 60.0, 43.9% and median survival time was 44.7 months. Treatment response was only a prognostic factor for survival. Laryngeal preservation was observed in twenty-four(60.0%) patients. Conclusion：Initial primary tumor stage was a significant prognostic factor for laryngeal preservation, and response after radiation therapy was a prognostic factor for long-term survival after induction chemotherapy followed by curative radiation therapy for locally advanced hypopharyngeal cancer.

• 대한두경부종양학회지
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• 제6권1호
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• pp.11-23
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• 1990

Systemic chemotherapy is usually regarded as the standard treatment for palliation in patients with recurrent or metastatic cancer who have failed the definite local treatment with surgery and/or radiotherapy. Recently, with the introduction of more active chemotherapeutic agents and combinations, systemic chemotherapy is being increasingly used before or after local therapy in patients with previously untreated locally advanced head and neck cancer. The most active agents for the head and neck caner are methotrexate, 5-fluorouracil (5-FU), cisplatin and bleomycin. The overall response rates to each of these four drugs are 15-30% expecially when used as first line therapy. But most of these responses are partial with a mean duration of 3-5 months. Various combinations with methotrexate, 5-FU, cisplatin, and bleomycin have been tried with overall response rates of 50-90%, and 10-20% of complete responses. The introduction of chemotherapy prior to local therapy, induction chemotherapy, has been investigated with improved survivals in patients with complete response, especially pathologic, though improvement in overall survival has not been proved yet after the induction chemotherapy. Other therapeutic modalities, such as 'Sandwich' chemotherapy between surgery and radiotherapy, concomittent chemo-radiotherapy and post local treatment adjuvant chemotherapy have been pursued with some hopeful results but these trials should be compared with prospective randomized Phase III trials. To increase the response rates and enhance the survival, important work still remains; 1. Identification of better prognostic factors, 2. Improvement in staging, 3. Development of more active and safter chemotherapeutic agents, 4. Identification of the proper sequence for the addition of chemotherapy to multimodality treatment, and 5. Testing the value of such chemotherapy in locally advanced cancer patients.

• Radiation Oncology Journal
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• 제24권4호
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• pp.223-229
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• 2006

목 적: III 병기 비소세포폐암의 치료는 항암화학요법, 수술, 방사선치료가 포함된 병용치료가 표준방법으로 알려져 있다. 본 연구에서는 IIIB 병기 비소세포폐암에서 paclitaxel과 cisplatin을 이용한 선행항암 화학요법과 동시 항암화학방사선치료를 시행하여 그 효과에 대하여 알아보고자 하였다. 대상 및 방법: 2000년 7월부터 2005년 10월까지 IIIB 병기 비소세포폐암으로 선행항암화학요법과 동시 항암화학방사선치료를 받았던 39명을 대상으로 하였다. 선행항암화학요법은 3주 간격으로 paclitaxel ($175\;mg/m^2$)과 cisplatin ($75\;mg/m^2$)을 1일째와 21일째 정맥투여하였다. 동시 항암화학요법은 43일째, 50일째, 57일째, 71일째, 78일째, 85일째 paclitaxel ($60\;mg/m^2$)과 cisplatin ($25\;mg/m^2$)을 정맥투여하였다. 흉부방사선치료는 1회 1.8 Gy씩, 주 5회 분할조사 하였으며 총방사선량은 $54{\sim}59.4\;Gy$이었다(중앙값: 59.4 Gy). 결 과: 추적관찰기간은 $6{\sim}63$개월이었으며 중앙추적관찰기간은 21개월이었다. 선행항암화학요법 후 치료반응은 부분반응 41.0% (16명), 무반응 59.0% (23명)였다. 동시 항암화학방사선치료 후 치료반응은 완전관해가 10.3% (4명), 부분반응 41.0% (16명), 무반응 49.7% (19명)로 치료 반응률은 51.3%였다. 1년, 2년, 3년 생존율은 각각 66.7%, 40.6%, 27.4%였으며 중앙 생존기간은 20개월이었다. 1년, 2년, 3년 무진행 생존율은 각각 43.6%, 24.6%, 24.6%였으며 중앙 무진행 생존기간은 10.7개월이었다. 동시 항암화학방사선치료 후 부작용으로 3도 이상의 식도염은 46.3% (18명), 폐렴은 28.2% (11명)에서 발생하였다. 결론: IIIB 병기 비소세포폐암에서 paclitaxel과 cisplatin을 이용한 선행항암화학요법과 동시 항암화학방사선치료를 시행한 결과 비교적 효과적이었다. 그러나 식도염과 폐렴이 많아 부작용을 줄이기 위해 적절한 항암제의 선택 또는 방사선치료와의 병용치료의 변화가 필요할 것으로 판단되었다.

• 대한두경부종양학회지
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• 제10권1호
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• pp.13-24
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• 1994

Despite optimal local therapy such as surgery and/or radiotherapy, the long term outcome is poor for patients with advanced squamous cell carcinomma of head and neck, due to frequent loco-regional recurrence and distant metastases. We studied to determine whether the combination chemotherapy, especially as an adjuvant chemotherapy, would improve the survival of these patients. Between January, 1986 and December, 1992, 57 patients with previously untreated, locally advanced squamous cell arcinoma of head and neck were assigned to receive 2-3 cycles of induction chemotherapy consisting of 5-fluorouracil(F) and cisplatin(P) every 3 weeks and standard local therapy such as surgery and/or radiotherapy followed by adjuvant chemotherapy with the same FP regimens. Of the 57 enroled patients, 45 patients were evaluable. The obtained results were as following: 1) Among 45 evaluable patients, 18 patients finished all treatment protocol including adjuvant chemotherapy and 27 patients had no adjuvant chemotherapy. The difference of age, sex, performance status, disease stage, and tumor differentiation was not significant statistically between adjuvant chemotherapy group and no-adjuvant chemotherapy group. 2) After induction chemotherapy, 7/45(15.4%), 30/45(67%) achieved complete remission and partial remission respectively with 82.4% overall response rates in entire patients. 3) The 4year progression free survival was 43.3% in adjuvant chemotherapy group and 24.1% in no-adjuvant chemotherapy group(p>0.05). The 4year overall survival was 56.9% and 25.5% respectively(p>0.05). There was no significant different in the patterns of local recurrence and distant metastasis between the two groups. 4) Adverse reactions from combination chemotherapy included nausea, vomiting, mucositis, diarrhea and hematologic bone marrow depression. These were mild and tolerated by patients, and these was no episode of any life threatening toxicities. In conclusion, adjuvant chemotherapy after induction chemotherapy and local therapy did not show statistically significant survival improvement, but there was trend of prolongation of survival when compared to no adjuvant chemotherapy. Thus, large scale phase III randomized controlled studies are strongly recommended.

• 한국임상약학회지
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• 제28권3호
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• pp.181-187
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• 2018

Background: Posaconazole is a broad-spectrum triazole antifungal agent and the most recommended prophylactic antifungal agent for patients with acute myeloid leukemia (AML) undergoing induction chemotherapy. In this study, we evaluated the status and effectiveness of posaconazole as a prophylactic antifungal agent in pediatric patients receiving induction chemotherapy for AML. Methods: We retrospectively reviewed the electronic medical records of 36 pediatric patients with AML (between January 2013 and September 2017) at the Yonsei University Health System. Invasive fungal disease (IFD) was assessed as the primary endpoint of prophylactic antifungal effect. The secondary endpoints were incidence of fever, persistent fever despite the use of broad-spectrum antibiotics for 72 h, alteration of antifungal agent, intensive care unit admission, and death within 100 days. Results: Among the 36 patients, 18 patients used posaconazole, 12 were treated with suspension formula, and 6 of them were treated with tablets. Eighteen patients did not use antifungal agents prophylactically. The mean number of days of posaconazole administration was $26.8{\pm}16days$. IFD occurred in 2/18 (11.1%) patients in the no prophylaxis group and in 1/18 (5.6%) patients in the posaconazole group (p=0.49). Conclusion: Posaconazole is expected to be useful for the prevention of IFD in pediatric patients with AML undergoing induction chemotherapy. Prospective studies of the effectiveness of posaconazole prophylaxis should be conducted in more pediatric patients in the future.

• Asian Pacific Journal of Cancer Prevention
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• 제17권12호
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• pp.5251-5256
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• 2016

Background: Diagnostic karyotyping analysis is routinely used in acute myeloid leukemia (AML) clinics. Categorization of patients into risk stratified groups (favorable, intermediate and adverse) according to cytogenetic findings can serve as a valuable independent prognostic factor. Method and Material: A retrospective descriptive study was conducted based on the patient records of newly diagnosed non-M3 AML young adult cases undergoing standard 3+7 i.e, Daunorubicin and Ara-C (DA) as remission induction chemotherapy. Diagnostic cytogenetic analysis reports were analyzed to classify the patients into risk stratified groups according to South West Oncology Group criteria and prognostic significance was measured with reference to achievement of haematological remission after 1st induction chemotherapy. Results:A normal karyotype was commonly expressed, found in 47.2% of patients, while 65% (n=39) appeared to have intermediate risk cytogenetics, and 13.3% (n=8) adverse or unclassified findings. Favourable cytogenetics was least frequent in the patient cohort, accounting for only 8.3 % (n=5).The impact of cytogenetic risk groups on achievement of haematological remission was evaluated by applying Pearson Chi-square, and was found to be non-significant (df=12, p=0.256) but when the outcomes of favourable risk groups with intermediate, adverse and unclassified findings compared, results were highly significant (df=6, p=0.000) for each comparison. In patients of the favourable cytogenetic risk group, HR?? was reported in 40% (n=2/5), as compared to 62.2% (n=23/37) in the intermediate cytogenetic risk group, 57.1% (n=4/7) in the adverse cytogenetic risk group and 28.6% (n=2/7) in hte unclassified cytogenetic risk group. Conclusion: Cytogenetic risk stratification for AML cases following criteria provided by international guidelines did not produce conclusive results in our Pakistani patients. However, we cannot preclude an importance as the literature clearly supports the use of pretreatment karyotyping analysis as a significant predictive marker for clinical outcomes. The apparent differences between Pakistani and Western studies indicate an urgent need to develop risk stratification guidelines according to the specific cytogenetic makeup of South Asian populations.