• Journal of Korean Neurosurgical Society
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• 제56권5호
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• pp.431-435
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• 2014

A fifty-year-old female non-smoker with no other specific medical history visited our institute. She complained of axial back pain with no other neurological deficit. Chest X-ray, chest computed tomography (CT) scan, CT-guided needle aspiration biopsy, whole-body positron emission tomography, spine CT and spine magnetic resonance image findings suggested NSCLC with epidermal growth factor receptor (EGFR) mutation, multiple brain metastases, and two isolated metastases to the T3 and L3 vertebral bodies. She underwent chemotherapy with gefitinib ($Iressa^{TM}$) for NSCLC and gamma knife surgery for multiple brain metastases. We performed a two-staged, total en bloc spondylectomy of the T3 and L3 vertebral bodies based on several good prognostic characteristics, such as the lack of metastases to the appendicular bone, good preoperative performance status, and being an excellent responder (Asian, never-smoker and adenocarcinoma histology) to EGFR inhibitors. Improved axial back pain after the surgery enabled her to walk with the aid of a thoracolumbosacral orthosis brace on the third postoperative day. Her Karnofsky performance status score (KPS) was 90 at the time of discharge and has been maintained to date 3 years after surgery. In selected NSCLC patients with good prognostic characteristics, we suggest that locally curative treatment such as total en bloc spondylectomy or radiosurgery should be emphasized to achieve longer term survival for the selected cases.

• Journal of Korean Neurosurgical Society
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• 제58권5호
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• pp.448-453
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• 2015

Objective : Recently, the survival of patients with hepatocellular carcinoma (HCC) has been prolonged with improvements in various diagnostic tools and medical treatment modalities. Consequently, spine metastases from HCC are being diagnosed more frequently. The accurate prediction of prognosis plays a critical role in determining a patient's treatment plan, including surgery for patients with spinal metastases of HCC. We investigated the clinical features, surgical outcomes, and prognostic factors of HCC presenting with spine metastases, in patients who underwent surgery. Methods : A retrospective review was conducted on 33 HCC patients who underwent 36 operations (three patients underwent surgical treatment twice) from February 2006 to December 2013. The median age of the patients was 56 years old (range, 28 to 71; male : female=30 : 3). Results : Overall survival was not correlated with age, sex, level of metastases, preoperative Child-Pugh classification, preoperative ambulatory function, preoperative radiotherapy, type of operation, administration of Sorafenib, or the Tokuhashi scoring system. Only the Tomita scoring system was shown to be an independent prognostic factor for overall survival. Comparing the Child-Pugh classification and ambulatory ability, there were no statistically differences between patients pre- and post-operatively. Conclusion : The Tomita scoring system represents a practicable and highly predictive prognostic tool. Even though surgical intervention may not restore ambulatory function, it should be considered to prevent deterioration of the patient's overall condition. Additionally, aggressive management may be needed if there is any ambulatory ability remaining.

• Journal of Korean Neurosurgical Society
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• 제44권6호
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• pp.358-363
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• 2008

Objective : This study was performed to assess the efficacy of GKS in patients with ten or more brain metastases. Methods : From Aug 2002 to Dec 2007, twenty-six patients (13 men and 13 women) with ten or more cerebral metastatic lesions underwent GKS. The mean age was 55 years (32-80). All patients had Karnofsky performance status (KPS) score of 70 or better. According to recursive partitioning analysis (RPA) classification, 3 patients belonged to class I and 23 to class II. The location of primary tumor was lung (21), breast (3) and unknown (2). The mean number of the lesions per patient was 16.6 (10-37). The mean cumulated volume was 10.9 cc (1.0-42.2). The median marginal dose was 15 Gy (9-23). Overall survival and the prognostic factors for the survival were retrospectively analyzed by using Kaplan Meier method and univariate analysis. Results : Overall median survival from GKS was 34 weeks (8-199). Local control was possible for 79.5% of the lesions and control of all the lesions was possible in at least 14 patients (53.8%) until 6 months after GKS. New lesions appeared in 7 (26.9%) patients during the same period. At the last follow-up, 18 patients died; 6 (33.3%) from systemic causes, 10 (55.6%) from neurological causes, and 2 (11.1 %) from unknown causes. Synchronous onset in non-small cell lung cancer (p=0.007), high KPS score (${\geq}80$, p=0.029), and controlled primary disease (p=0.020) were favorable prognostic factors in univariate analysis. Conclusion : In carefully selected patients, GKS may be a treatment option for ten or more brain metastases.

• Asian Pacific Journal of Cancer Prevention
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• 제14권7호
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• pp.4151-4155
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• 2013

Background: To compare response evaluation criteria in solid tumours (RECIST) and volumetric evaluation (VE) for colorectal cancer with liver-limited metastasis. Patients and Methods: VE of liver metastases was performed by manual contouring before and after chemotherapy on 45 pairs of computed tomography (CT) images in 36 patients who suffered from metastatic colorectal cancer (mCRC) with liver metastasis only. Cohen kappa was used to compare the agreement between VE and RECIST. Pearson correlation was performed for their comparison after cubic root transformation of the aggregate tumor volumes. Logistic regression was done to identify clinical and radiographic factors to account for the difference which may be predictive in overall response (OR). Results: There were 16 partial response (PR), 23 stable disease (SD) and 6 progressive disease (PD) cases with VE, and 14 PR, 23 SD and 8 PD with RECIST. VE demonstrated good agreement with RECIST (${\chi}$=0.779). Discordant objective responses were noted in 6 pairs of comparisons (13.3%). Pearson correlation also showed excellent correlation between VE and RECIST ($r^2$=0.966, p<0.001). Subgroup analysis showed that VE was in slightly better agreement with RECIST for enlarging lesions than for shrinking lesions ($r^2$=0.935 and $r^2$=0.780 respectively). No factor was found predictive of the difference in OR between VE and RECIST. Conclusions: VE exhibited good agreement with RECIST. It might be more useful than RECIST in evaluation shrinking lesions in cases of numerous and conglomerate liver metastases.

• Journal of Hospice and Palliative Care
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• 제17권4호
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• pp.207-215
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• 2014

암의 다발성 뼈 전이는 폐암, 유방암, 전립선암, 신장암 등 다양한 암에서 흔히 관찰된다. 뼈 전이는 뼈에 발생한 이차적인 암으로 통증, 골절, 그리고 체중을 지지하는 뼈의 불안정성을 유발할 수 있어 신체활동과 삶의 질을 저하시킨다. 뼈 전이 치료 시 병리조직소견, 환자의 전신 상태, 침범 부위, 그리고 환자의 신경학적 소견등 다양한 요인을 고려하여 진통제, 수술, 항암화학요법 그리고 방사선 치료 등을 시행하게 된다. 외부 방사선 치료는 전통적으로 국소 뼈 전이로 인한 통증의 치료에 이용되어왔지만 특히 유방암이나 전립선암의 다발성 골형성 뼈 전이의 경우 $^{89}Sr$, $^{186}Re$, $^{188}Re$, $^{153}Sm$ and $^{117m}Sn$ 등의 방사성동위원소를 이용한 치료가 시행되고 있는데, 약제 투여의 간편함, 낮은 부작용, 방사능 피폭위험에서의 안전성, 높은 치료 반응 등 다양한 장점을 가진 치료로 임상에서의 유용성이 점차 증가되고 있다.

• Radiation Oncology Journal
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• 제7권1호
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• pp.37-43
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• 1989

1979년 3월부터 1984년 2월까지 성문상부의 편평상피암으로 진단되어 근치적 방사선치료를 시행한 66명을 대상으로 치료성적을 분석하였다. 전체 환자군의 최소 추적기간은 4년이었다. 진단당시 전체 환자군의 $78\%$가 T3 T4 병변이었고 임파절 전이율은 $58\%$이었으며, 전체 환자군의 5년 생존율은 $31.3\%$, 병기에 따른 생존율은 병기 II, III, IV에서 각각 $60.7\%,\;46.7\%\;및\;13.5\%$이었다. 3명의 환자$(5\%)$에서 원격전이가 관찰되었으며 수술을 요하는 주부작용률은 $11\%$이었다. 방사선치료 후 잔유병변 또는 재발에 대한 구제수술 성공률은 $57\%$이었다. 병기 I, II및 병기 III 초기의 성문상부암은 방사선 단독 치료만으로도 높은 근치율과 생존자의 성대기능 보존이 가능 하나, 병기 III과 IV의 성문상부암 환자 중 경부에 전이된 임파절의 절제가 가능한 환자는 수술과 방사선치료의 병용이 권장된다.

• Radiation Oncology Journal
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• 제19권4호
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• pp.353-358
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• 2001

척수내 전이암은 암환자에서 매우 드문 합병증으로 증상이 있는 척수 전이암 중 $3.4\%$정도를 차지한다고 보고된 바 있다. 척수내 전이암 환자의 생존 기간은 매우 짧아서 2개월 이내인 경우가 대부분인데 그 이유는 신경학적으로 빨리 악화되고 뇌전이를 포함하여 여러 곳에 전이암이 동반되기 때문이다. 국내 문헌상 척수내 전이암에 대한 보고가 거의 없고 저자들이 경험한 두 증례는 서로 다른 임상 경과를 보였기에 문헌 고찰과 함께 보고하는 바이다. 원발암이 접형동암인 환자에서 척수내 전이암으로 인해 이차성 척수공동증을 동반한 증례는 세계 문헌상 세번째 증례이다. 한 증례는 증상이 서서히 진행되었고 척수에 방사선치료를 시행한 후 생존기간이 26개월이었고, 다른 증례는 증상이 매우 빠르게 진행되었고 생존기간이 훨씬 짧았다. 척수내 전이암도 신경학적 증상이 가역적인 상태에서 조기 진단이 내려진다면 더욱 효과적인 증상완화를 기대할 수도 있다.

• Tuberculosis and Respiratory Diseases
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• 제61권2호
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• pp.162-166
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• 2006

The lung is the most common site for the metastasis of extrapulmonary malignant tumors. However, endobronchial metastases (EBM) from extrapulmonary malignant tumors are rare. The most common extrathoracic malignancies associated with EBM are the breast, renal and colorectal carcinomas. Lung metastasis from prostate cancer is often encountered but EBM is rare. We report a 74-year old man with endobronchial metastases from prostatic carcinoma presented with cough. The diagnosis of prostatic cancer and the endobronchial metastasis were confirmed by immunohistological staining with the prostate specific antigen. Hormonal therapy (lutenizing hormone releasing hormone agonist) was applied to this patient.

• Journal of Gastric Cancer
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• 제20권1호
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• pp.106-114
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• 2020

Breast metastases of extramammary malignant neoplasms are rare, with an incidence of 0.3%-2.7% among all malignant mammary tumors. Breast metastases from gastric carcinoma are very rare (<0.1%), and this event is even rarer during pregnancy. Herein, we describe a 39-year-old Caucasian woman with a history of an Epstein-Barr virus-associated gastric carcinoma (EBVaGC) that was characterized by prominent tumor infiltrating lymphocytes. Three years after undergoing radical surgery, the patient developed bilateral breast nodules during her pregnancy. A breast biopsy was performed, and histology confirmed a diagnosis of EBVaGC; tumor cells showed positivity for cytokeratin 8/18 and E-cadherin, and negativity for cytokeratin 7, cytokeratin 20, cytokeratin 5/6, caudal type homebox 2, androgen receptor, mammaglobin, gross cystic disease fluid protein-15, and estrogen and progesterone receptors. We also discuss the main diagnostic pitfalls. To our knowledge, this is the first report of an EBVaGC with lymphoid stroma that developed breast metastases during pregnancy.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.5731-5734
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• 2013

Background: The object of this study was to examine whether a new protocol including step-sectioning and immunohistochemistry (IHC) staining of axillary sentinel nodes (SN) would lead to detection of more metastases in patients with breast cancer. Materials and Methods: Sixty-nine tumor free sentinel lymph nodes were examined. Step frozen sectioning was performed on formalin fixed SN and stained both by hematoxylin and eosin (H and E) and cytokeratin markers using IHC. Any tumoral cell in IHC stained slides were considered as a positive result. Metastases up to 0.2 mm were considered as isolated tumor cells and 0.2 up to 2 mm as micrometastasis. Results: Mean age of the patients was $48.7{\pm}12.2$ years. Step sectioning of the SN revealed 11 involved by metastasis which was statistically significant (p<0.001). Furthermore, 15 (21.7%) of the patients revealed positive results in IHC staining for pan-CK marker and this was also statistically significant (p=0.001). Ten patients had tumoral involvement in lymph nodes harvested from axillary dissection and 4 out of 15 lymph nodes with positive result for CK marker were isolated tumor cells. However, 4 of 10 patients with tumor positive lymph nodes in axillary dissection were negative for CK marker and in contrast 6 of the pan-CK positive SN were in patients with tumor-free axillary lymph nodes. Conclusions: Both IHC and step sectioning improve the detection rate of metastases. Considering the similar power of these two methods, we recommend using either IHC staining or step sectioning for better evaluation of harvested SNs.