• Title/Summary/Keyword: new treatment modality

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Multidisciplinary team approach for the management of patients with locally advanced non-small cell lung cancer: searching the evidence to guide the decision

  • Oh, In-Jae;Ahn, Sung-Ja
    • Radiation Oncology Journal
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    • v.35 no.1
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    • pp.16-24
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    • 2017
  • Locally advanced non-small cell lung cancer (LA-NSCLC) is composed of heterogeneous subgroups that require a multidisciplinary team approach in order to ensure optimal therapy for each patient. Since 2010, the National Comprehensive Cancer Network has recommended chemoradiation therapy (CRT) for bulky mediastinal disease and surgical combination for those patients with single-station N2 involvement who respond to neoadjuvant therapy. According to lung cancer tumor boards, thoracic surgeons make a decision on the resectability of the tumor, if it is determined to be unresectable, concurrent CRT (CCRT) is considered the next choice. However, the survival benefit of CCRT over sequential CRT or radiotherapy alone carries the risk of additional toxicity. Considering severe adverse events that may lead to death, fit patients who are able to tolerate CCRT must be identified by multidisciplinary tumor board. Decelerated approaches, such as sequential CRT or high-dose radiation alone may be a valuable alternative for patients who are not eligible for CCRT. As a new treatment strategy, investigators are interested in the application of the innovative radiation techniques, trimodality therapy combining surgery after high-dose definitive CCRT, and the combination of radiation with targeted or immunotherapy agents. The updated results and on-going studies are thoroughly reviewed in this article.

Autophagy: Noble target mechanisms in natural medicines as anticancer agents (자가식세포작용: 천연물항암제로서의 신규작용기전)

  • Kang, Se-Chan
    • Journal of Plant Biotechnology
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    • v.37 no.1
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    • pp.57-66
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    • 2010
  • Programmed cell death systems are important for an active type of cell deaths. Among them, a type of programmed cell death, autophagy is activated in cancer cells in response to multiple stresses and has been demonstrated to promote tumor cell survival and drug resistance. Thus, in the area of cancer, over the time frame form around the 1940s to date, of the 155 small molecules, 73% are other than "synthetic", with 47% actually being either "natural products" or "directly derived therefrom". Autophagy has multiple physiological functions in multicellular organisms, including protein degradation and organelle turnover. Genes and proteins that constitute the basic machinery of the autophagic process were first identified in the yeast system and some of their mammalian orthologues have been characterized as well. Numerous oncogenes, including Akt1, Bcl-2, NF1, PDPK1, class I PI3K, PTEN, and Ras and oncosuppressors, inculuding Bec-1, Bif-1, DAPK-1, p53 and UVRAG suppress or promote the autophagy pathway. Regulation of autophagy in tumors is governed by similar principles of the normal cells, only in a much more complicated manner, given the frequently observed abnormal PI3K activation in cancer and the multitude of interactions between the PI3K/AKT/mTOR pathway and other cell signaling cascades, often also deregulated in tumor cells. Autophagy induction by some anticancer agents underlines the potential utility of its induction as a new cancer treatment modality of development for natural medicines.

Reconstruction of esophageal stenosis that had persisted for 40 years using a free jejunal patch graft with virtual endoscopy assistance

  • Fujisawa, Daisuke;Asato, Hirotaka;Tanaka, Katsunori;Itokazu, Tetsuo;Kojya, Shizuo
    • Archives of Plastic Surgery
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    • v.47 no.2
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    • pp.178-181
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    • 2020
  • In this report, we present a case in which good results were achieved by treatment using a free jejunal patch graft with virtual endoscopy (VE) assistance in a patient whose swallowing had failed to improve for 40 years after he mistakenly swallowed sulfuric acid, despite pectoralis major myocutaneous flap grafting and frequent balloon dilatation surgery. During the last 20 years, virtual computed tomography imaging has improved remarkably and continues to be used to address new challenges. For reconstructive surgeons, the greatest advantage of VE is that it is a noninvasive modality capable of visualizing areas inaccessible to a flexible endoscope. Using VE findings, we were able to visualize the 3-dimensional shape beyond the stenosis. VE can also help predict the area of the defect after contracture release.

Recent Developments in Nuclear Medicine Instrumentation (최근 핵의학 영상 기기 발전 동향)

  • Kim, Joon-Young;Choi, Yong;Kim, Jong-Ho;Im, Ki-Chun;Choe, Yearn-Seong;Lee, Kyung-Han;Kim, Sang-Eun;Kim, Byung-Tae
    • The Korean Journal of Nuclear Medicine
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    • v.32 no.6
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    • pp.471-481
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    • 1998
  • The goals of developments in nuclear medicine instrumentation are to offer a higher-quality image and to aid diagnosis, prognosis assessment or treatment planning and monitoring. It is necessary for physicists and engineers to improve or design new instrumentation and techniques, and to implement, validate, and apply these new approaches in the practice of nuclear medicine. The researches in physical properties of detectors and crystal materials and advances in image analysis technology have improved quantitative and diagnostic accuracy of nuclear medicine images. This review article presents recent developments in nuclear medicine instrumentation, including scatter and attenuation correction, new detector technology, tomographic image reconstruction methods, 511 keV imaging, dual modality imaging device, small gamma camera, PET developments, image display and analysis methods.

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Preoperative Chemotherapy in Advanced Stomach Cancer (Cons) (진행성 위암에서의 수술 전 항암화학요법 치료 (in the View of Cons))

  • Oh, Sang Cheul
    • Journal of Gastric Cancer
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    • v.8 no.2
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    • pp.65-69
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    • 2008
  • Surgery is the only curative modality for the treatment of gastric cancer. There has been no drastic improvement in the treatment of gastric cancer with chemotherapy. Clinical trials have attempted to demonstrate the benefit of the preoperative chemotherapy for gastric cancer. The benefit of the use of preoperative chemotherapy or chemoradiotherapy has been demonstrated for other solid cancers such as breast cancer, esophageal cancer and rectal cancer. Despite the rationale of the use of preoperative chemotherapy for patients with gastric cancer, the evidence of positive results with the use of preoperative chemotherapy has not been clear. Recently the British Medical Research Council Adjuvant Gastric Cancer Infusional Chemotherapy (MAGIC) study demonstrated the survival benefit of preoperative and postoperative chemotherapy. However, this study had several problems with the use of a heterogeneous population of patients, the method of surgery and the use of perioperative chemotherapy. Further studies with new drugs are warranted to determine the role of pre-operative chemotherapy for patients with gastric cancer.

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Benzochloroporphyrin Derivative Induced Cytotoxicity and Inhibition of Tumor Recurrence During Photodynamic Therapy for Osteosarcoma

  • Gong, Hai-Yang;Sun, Meng-Xiong;Hu, Shuo;Tao, Ying-Ying;Gao, Bo;Li, Guo-Dong;Cai, Zheng-Dong;Yao, Jian-Zhong
    • Asian Pacific Journal of Cancer Prevention
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    • v.14 no.5
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    • pp.3351-3355
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    • 2013
  • Photodynamic therapy (PDT) is a promising cancer treatment modality that uses dye-sensitized photooxidation of biologic matter in target tissue. This study explored effects of the photosensitizer BCPD-17 during PDT for osteosarcoma. LM-8 osteosarcoma cells were treated with BCPD-17 and cell viability after laser irradiation was assessed in vitro with the 3-(4, 5-dimethylthiazol-2-yl)-2, 5-diphenyltetrazolium bromide assay. The effects of BCPD-17 during PDT recurrence were then examined on tumor-bearing mice in vivo. BCPD-17 had dosedependent cytotoxic effects on LM-8 osteosarcoma cells after laser irradiation which also had energy-dependent effects on the cells. The rate of local recurrence was reduced when marginal resection of mice tumors was followed by BCPD-17-mediated PDT. Our results indicated BCPD-17-mediated PDT in combination with marginal resection of tumors is a potentially new effective treatment for osteosarcoma.

PHOTODYNAMIC THERAPY OF PREMALIGNANT AND MALIGNANT LESIONS IN ORAL AND MAXILLOFACIAL SURGERY (구강악안면외과 영역의 전암병소 및 악성종양 치료를 위한 광역학 요법의 이용)

  • Oh, Jung-Hwan;Kubler, Alexander;Zoller, Joachim E.
    • Journal of the Korean Association of Oral and Maxillofacial Surgeons
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    • v.28 no.3
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    • pp.234-238
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    • 2002
  • Photodynamic therapy (PDT) is based on a photochemical reaction which is initiated by light activation of a photosensitizer. The photosensitizer accumulates more in tumor tissues than in normal tissues and is activated with specific wavelength of light, usually laser. The photochemical reaction produces highly reactive oxygen products causing cytotoxiciy and vascular shutdown to the tumor. The advantages of PDT are its relative selective tumor destruction and tissue healing by regeneration, which can maintain important structures with very good functional and esthetic results. Therefore, PDT is considered as an alternative modality for cancers of the head and neck. In this article, we will report three cases of photodynamic therapy for treatment of oral leukoplakia, squamous cell carcinoma, and basal cell carcinoma of head and neck. It was observed that premalignant and malignant lesions responded well to the photodynamic therapy with Aminolevulinic acid (ALA) and $Foscan^{(R)}$. Photodynamic therapy can be considered as a new treatment method for the premalignant and malignant tumors in Oral and Maxillofacial Surgery.

Results of Application of Video-Assisted Thoracoscopic Surgery for the Treatment of Empyema Thoracis (흉강경을 이용한 농흉 치료의 결과)

  • Choi, Gi Hoon;Choi, Goang Min;Kim, Hyoung Soo;Cho, Seong Joon;Ryu, Se Min;Ahn, Hee Cheol;Seo, Jeong Yeol
    • Tuberculosis and Respiratory Diseases
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    • v.61 no.5
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    • pp.463-472
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    • 2006
  • Background: Since video-assisted thoracoscopic surgery (VATS) was introduced as a new treatment modality for empyema thoracis, numerous reports have suggested that VATS is a more effective treatment method than the traditional methods that mainly use antibiotics and drainage apparatus. However, no confirmative evidence of the superiority of VATS over the traditional method has been provided yet. Methods: We attempted to evaluate the efficacy of VATS for the treatment of empyema thoracis by reviewing past medical records and simple chest films. First, we divided the patients into two groups based on the treatment method: group A of 15 patients who were treated with the traditional method between January 2001 and December 2003, and group B of 9 patients who were treated with VATS between December 2003 and August 2006. The final outcomes used in this study were the number of days of hospital stay, chest tube duration, leukocytosis duration, febrile duration, and intravenous antibiotics usage duration. In addition, radiological improvements were compared. Results: The mean age(${\pm}$standard deviation) of 11 men and 4 women in group A was $58.2{\pm}15.7$ years, and of 9 men and 2 women in group B was $51.6{\pm}9.5$ years. Group B had a significantly shorter hospital stay ($16.6{\pm}7.4$ vs. $33.7{\pm}22.6$ days; p=0.014), shorter chest tube duration ($10.5{\pm}5.7$ vs. $19.5{\pm}14.4$ days; p=0.039), shorter leukocytosis duration ($6.7{\pm}6.5$ vs. $18.8{\pm}13.2$ days; p=0.008), shorter febrile duration ($0.8{\pm}1.8$ vs. $9.4{\pm}9.2$ days; p=0.004), and shorter duration of intravenous antibiotics usage ($14.9{\pm}6.4$ vs. $25.4{\pm}13.9$ days; p=0.018). However, radiological improvements did not show any statistical differences. Conclusion: Early application of VATS for empyema thoracis treatment reduced hospital stay, thoracostomy tube duration, leukocytosis duration, febrile duration, and antibiotics usage duration in comparison with the traditional methods. The early performing of VATS might be an effective treatment modality for empyema thoracis.

Attenuation of airway hyperreactivity and inflammation by Cheongsangbiyeum administration in a mouse model of asthma (마우스 천식모델에서 청상비음(淸上秘飮)의 기도 과민반응 및 염증의 억제 효과)

  • Kim, San;Sung, Byung-Gon;Lee, Sung-Jin;Lim, Kyu-Sang
    • The Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology
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    • v.19 no.2
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    • pp.1-18
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    • 2006
  • Objective : Although management of asthma has become increasingly effective, its cure remains elusive, necessitating a new modality to prevent or eliminate causes triggering clinical progress. Based in the clinical experiences, a novel decoration Cheongsangbiyeum (CSB), has been developed to treat asthma, which consists of Polyporus, Semen Myristicae, Pericarpium citri Reticulatae, Rhizoma Cimicifugae, Cortex Albizziae, Fructus Rubi, Rhizoma Zedoariae, and Rhizoma Rhei. In the current study, its anti-asthmatic efficacy was evaluated using a mouse model of asthma. Methods : Experimental allergic asthma was induced by repeated intraperitioneal sensitization and intranasal challenge of ovalbumin (OVA). Water extract of CSB (1 mg/mouse/day) was administrated orally whereas control mice on given with identical volume of phosphate-buffered saline (PBS) for 5 days during the course of antigen challenge. When airway hyperreactivity(AHR) measured by ${\bata}-methacoline-induced$ airflow obstruction was compared, AHR of CSB-treated mice was significantly lower than those of control mice, indicating that CM extract can attenuate an asthmatic symptom. Airway recruitment of leukocytes and eosinophils was also markedly reduced by CSB treatment suggesting that oral treatment of CSB can alleviate the airway inflammation. For a better understanding of possible mechanisms underlying anti-asthmatic effet of CSB, cytokine (IL-4, IL-5, IL-13 and $IFN{\gamma}$ levels in bronchoalveola lavage fluid (BALF) and lung tissues were determined. Results : The results showed that cytokine levels were significantly lowered by CSB treatment. Additionally, number of draining lymph node cells was significantly lower than those of control mice. These data indicate that CSB suppress in vivo allergen-specific response. However, notably, levels of type 2 cytokines such as IL-5 and IL-13 were more profoundly influenced. Moreover, in vitro OVA-specific proliferative response and type 2 cytokine (IL-4, IL-5 and IL-13) production lymph node cells was markedly decreased in CSB-treated mice, whereas their $IFN{\gamma}$ production was not significantly altered Thrse data clearly showed a preferential inhibition of type 2 T cell (Th2) response by CSB treatment. This finding was also supported by serum antibody data showing that levels of OVA-specific type 2 antibodies, IgE and IgG1, in CSB-treated mice were significantly lower than in control mice, while type 1 antibody, IgG2a level m rather higher than controls, although the difference was in significant. Conclusions : In conclusion, oral administration of CSB attenuates asthmatic manifestations including AHR ad airway recruitment of eosinophils in a mouse model which possibly results from selective inhibition of Th2 cell response to allergen. Our data suggest a potential clinical application of CSB for control of allergic asthma.

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Daily localization of partial breast irradiation patients with three-dimensional ultrasound imaging

  • Sayan, Mutlay;Vergalasova, Irina;Hard, Daphne;Wrigth, Heather;Archambault, Jessica;Gagne, Havaleh;Nelson, Carl;Heimann, Ruth
    • Radiation Oncology Journal
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    • v.37 no.4
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    • pp.259-264
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    • 2019
  • Purpose: Accurate localization of the lumpectomy cavity during accelerated partial breast radiation (APBR) is essential for daily setup to ensure the prescribed dose encompasses the target and avoids unnecessary irradiation to surrounding normal tissues. Three-dimensional ultrasound (3D-US) allows direct visualization of the lumpectomy cavity without additional radiation exposure. The purpose of this study was to evaluate the feasibility of 3D-US in daily target localization for APBR. Materials and methods: Forty-seven patients with stage I breast cancer who underwent breast conserving surgery were treated with a 2-week course of APBR. Patients with visible lumpectomy cavities on high quality 3D-US images were included in this analysis. Prior to each treatment, X-ray and 3D-US images were acquired and compared to images from simulation to confirm accurate position and determine shifts. Volume change of the lumpectomy cavity was determined daily with 3D-US. Results: A total of 118 images of each modality from 12 eligible patients were analyzed. The average change in cavity volume was 7.8% (range, -24.1% to 14.4%) on 3D-US from simulation to the end-of-treatment. Based on 3D-US, significantly larger shifts were necessary compared to portal films in all three dimensions: anterior/posterior (p = 7E-11), left/right (p = 0.002), and superior/inferior (p = 0.004). Conclusion: Given that the lumpectomy cavity is not directly visible via X-ray images, accurate positioning may not be fully achieved by X-ray images. Therefore, when the lumpectomy cavity is visible on US, 3D-US can be considered as an alternative to X-ray imaging during daily positioning for selected patients treated with APBR, thus avoiding additional exposure to ionizing radiation.