• Asian Pacific Journal of Cancer Prevention
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• v.13 no.8
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• pp.3869-3872
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• 2012

Background: The majority of patients with gastric cancer in developing countries present with advanced disease. Systemic chemotherapy therefore has limited impact on overall survival. Patients eligible for chemotherapy should be selected carefully. The aim of this study was to analyze prognostic factors for survival in advanced gastric cancer patients undergoing first-line palliative chemotherapy. Methods: We retrospectively reviewed 107 locally advanced or metastatic gastric cancer patients who were treated with docetaxel and cisplatin plus fluorouracil (DCF) as first-line treatment between June 2007 and August 2011. Twenty-eight potential prognostic variables were chosen for univariate and multivariate analyses. Results: Among the 28 variables of univariate analysis, nine variables were identified to have prognostic significance: performance status, histology, location of primary tumor, lung metastasis, peritoneum metastasis, ascites, hemoglobin, albumin, weight loss and bone metastasis. Multivariate analysis by Cox proportional hazard model, including nine prognostic significance factors evident in univariate analysis, revealed weight loss, histology, peritoneum metastasis, ascites and serum hemoglobin level to be independent variables. Conclusion: Performance status, weight loss, histology, peritoneum metastasis, ascites and serum hemoglobin level were identified as important prognostic factors in advanced gastric cancer patients. These findings may facilitate pretreatment prediction of survival and can be used for selecting patients for treatment.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.7
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• pp.3455-3458
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• 2016

Osteosarcoma is a common primary malignant bone tumor in children and adolescents. Recent worldwide average incidences of osteosarcoma in people aged 0 to 24 years were 4.3 and 3.4 per million, respectively, with a ratio of 1.4:1. However, data on the incidence of osteosarcoma in Thailand are limited. This study analyzed the incidence of osteosarcoma in the upper northern region of Thailand, with a population of 5.85 million people (8.9% of the total Thai population), using data for the years 1998 to 2012, obtained from the Chiang Mai Cancer Registry (CMCR) at Chiang Mai University Hospital and the Lampang Cancer Registry (LCR) at the Lampang Cancer Hospital, a total of 144 cases. The overall annual incidence of osteosarcoma was 1.67 per million with a male:female ratio of 1.36:1. Incidences by age group (male and female) at 0 to 24, 25 to 59 and over 60 years were 3.5 (3.9 and 3.0), 0.8 (0.9 and 0.6), and 0.7 (0.8 and 0.5), respectively. The peak incidence occurred at 15 to 19 years for males and at 10 to 14 years for females. The median survival time was 18 months with a 5-year survival rate of 43%. Neither the age group nor the 5-year interval period of treatment was significantly correlated with survival during the 15-year period studied.

• Journal of Chest Surgery
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• v.31 no.10
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• pp.988-994
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• 1998

Background: Chest wall tumors can classified into soft tissue tumors and bone tissue tumors and can be subclassified into benign and malignant tumors. Materials and methods: We report an analysis of 68 patients with primary chest wall tumors treated at the department of thoracic and cardiovascular surgery at Hanyang University Hospital from January, 1973 to September 1997. Results: Among a total of 68 patients 33(48.5%) were males and 35(51.5%) were females. The ages of the patients ranged from 10 to 79 years with a mean age of 39.3 years. According to the age distribution, 23 patients (33.8%) were from the 4th decade, 12 patients(17.6%) were from the 6th decade, and 10 patients(14.7%) were from the 5th decade. Among the primary chest wall tumors, 53 cases were benign and 15 cases were malignant. Among the benign tumors, 17 cases(32.1%) were in the 4th decade and among the malignant tumors, 6 cases(40%) were in the 4th decade. In both malignant and benign tumors the most common ages were in the 4th decade. The most common tumors were fibrous dysplasia and chondroma, each with a total of 14 cases(26.4%). Osteochondroma and lipoma each had 8 cases(15.1%). Among malignant tumors, osteosarcoma was most common with 8 cases (53.3%). According to location, 49 cases occured in both bone and cartilage tissue, 19 cases occurred in cartilage. Among the presenting symptoms, palpable mass was present in all cases. Fifty-one patients complained of tenderness and among cases with involvement of the lung, 3 patients had complained of respiratory distress. Among the malignant tumors 6 cases underwent a radical operation and 4 cases of benign tumors underwent a radical operation. Postoperativly, there was one case with recurrence from a desmoid tumor. There were no deaths postoperativly and no deaths due to complications(and their postoperative courses were uneventful). Conclusions: Most patients with primary chest wall tumors initially present with mass at admission. Resection is sufficient treatment for benign tumors but in malignant tumors wide resection of the chest wall is needed and mchest wall reconstruction.

• Radiation Oncology Journal
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• v.20 no.2
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• pp.123-129
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• 2002

Purpose : The purpose of this study 띤as to determine the potential role of three-dimensional conformal radiotherapy (3D-CRT) in the treatment of primary unresectable hepatocellular carcinoma. The preliminary results on the efficacy and the toxicity of 3D-CRT are reported. Materials and Methods : Seventeen patients were enrolled in this study, which was conducted prospectively from January 1995 to June 1997. The exclusion criteria included the presence of extrahepatic metastasis, liver cirrhosis of Child-Pugh classification C, tumors occupying more than two thirds of the entire liver, and a performance status of more than 3 on the ECOG scale. Two patients were treated with radiotherapy only while the remaining 15 were treated with combined transcatheter arterial chemoembolization. Radiotherapy was given to the field including the tumor plus a 1.5 cm margin using a 3D-CRT technique. The radiation dose ranged from $36\~60\;Gy$ (median; 59.4 Gy). Tumor response was based on a radiological examination such as the CT scan, MR imaging, and hepatic artery angiography at $4\~8$ weeks following the completion of treatment. The acute and subacute toxicities were monitored. Results : An objective response was observed in 11 out of 17 patients, giving a response rate of $64.7\%$. The actuarial survival rate at 2 years was $21.2\%$ from the start of radiotherapy (median survival; 19 months). Six patients developed a distant metastasis consisting of a lung metastasis in 5 patients and bone metastasis in one. The complications related to 30-CRT were gastro-duodenitis $(\geq\;grade\;2)$ in 2 patients. There were no treatment related deaths and radiation induced hepatitis. Conclusion : The preliminary results show that 3D-CRT is a reliable and effective treatment modality for primary unresectable hepatocellular carcinoma compared to other conventional modalities. Further studies to evaluate the definitive role of the 3D-CRT technique in the treatment of primary unresectable hepatocellular carcinoma are needed.

• Journal of the Korean Orthopaedic Association
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• v.55 no.3
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• pp.244-252
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• 2020

Purpose: Total femoral replacement (TFR) is an extreme form of limb salvage. Considering the rarity of this procedure, reports have focused on the complications and a proper indication is unclear. This study analyzed 36 patients with TFR who were asked the following: 1) prognostic factors related to survival in patients who underwent TFR with a tumoral cause; 2) overall implant and limb survival; 3) complications, functional outcome, and limb status for patients surviving for more than 3 years. Materials and Methods: According to the causes for TFR, 36 patients were categorized into three groups: extensive primary tumoral involvement (group 1, 15 cases), tumoral contamination by an inadvertent procedure or local recurrence (group 2, 16 cases), and salvage of a failed reconstruction (group 3, 5 cases). The factors that may affect the survival of patients included age, sex, cause of TFR, and tumor volume change after chemotherapy. Results: The overall five-year survival of the 36 patients was 31.5%±16.2%. The five-year survival of 31 patients with tumoral causes was 21.1%±15.6%. The five-year survival of 50.0%±31.0% in patients with a decreased tumor volume after chemotherapy was higher than that of increased tumor volume (p=0.02). The five-year survival of 12 cases with a wide margin was 41.7%±27.9%, whereas that of the marginal margin was 0.0%±0.0% (p=0.03). The ten-year overall implant survival of 36 patients was 85.9%±14.1%. The five-year revision-free survival was 16.6%±18.2%. At the final follow-up, 12 maintained tumor prosthesis, three underwent amputation (rotationplasty, 2; above knee amputation, 1), and the remaining one had knee fusion. Among 16 patients with a follow-up of more than three years, 14 patients underwent surgical intervention and two patients had conservative management. Complications included infection in 10 cases, local recurrences in two cases, and one case each of hip dislocation, bushing fracture, and femoral artery occlusion. Conclusion: Patients showing an increased tumor volume after chemotherapy and having an inadequate surgical margin showed a high chance of early death. In the long-term follow-up, TFR showed a high infection rate and the functional outcome was unsatisfactory. Nevertheless, this procedure is an inevitable option of limb preservation in selected patients.

• Journal of Chest Surgery
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• v.10 no.2
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• pp.205-213
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• 1977

In order to evaluate the therapeutic effect of thoracostomy on the patients with pathological changes in pleural cavity which were caused by various etiological factors, a clinical study was carried out during a period of 5 and half years from May 1972 to September 1977 in the department of thoracic surgery, Hanyang University Hospital, and the following results were obtained. Of a total of 264 patients, 205 cases were male, and 59 female, exhibiting the ratio of male to female being 3.5 to 1. The pathological changes in pleural cavity could occur at any age from 4 months after birth to 76 years old, the peak incidence being in the third decade in either male or female. The incidence decreased in the second, fifth and fourth decade in order. The type of pathological changes observed and their frequencies of occurrences were 93 cases [35.2%] in pneumothorax, 62 cases [23.5%] in hemothorax, 48 cases [18.2%] in pyothorax, 46 cases [17. 4%] in hemopneumothorax, 13 cases [4.9%] in hydropneumothorax, and one case each in hydrothorax and chylothorax. The incidence of the primary diseases which predisposed the pathological changes in pleural cavity were, 119 cases [45-1%] in trauma, 64 cases [24.2%]in lung tuberculosis, 38 cases [14.4%] in pneumonia or empyema, 14 cases [5.3%] in lung emphysema and blebs, 13 cases [4.9%] in process after thoracotomy, 3 cases [1.1%] each in lung malignant tumor and lung paragonimiasis, one case in mechanical ventilator and 9 cases [3.4%] in unknown origin. The pathological changes in pleural cavity were located in the right side of the cavity in 124 cases, in the left side in 133 cases and in both sides in 7 cases, indicating that the difference between the incidence of the left and rightside occurences was insignificant. Of 93 cases of pneumothorax studied, 63 cases were found to have been tension pneumothorax and 30 cases non-tension pneumothorax, showing greater prevalence of tension type over non-tension type. Of 119 cases of trauma observed, 82 cases were accompanied with rib fractures and 37 cases were without any fracture [non-bone fracture]. Patients with the rib fractures were characterized by multiple rib fractures and multiple double fractures of ribs, accompanying with or without fracture of bones other than ribs, and patients with non-bone fracture were characterized by penetrating stab wound and blunt trauma. Of 264 cases who received thoracostomy, 207 cases [78.4%] demonstrated that their pathological changes in pleural cavity were removed and subsided by a simple measure of thoracostomy. In 43 cases [16.3%], various surgical measures including radical operation and thoracotomy were required for complete healing, since their pathological changes were not abolished by thoracostomy alone. The rest 14 cases [5.3%] were expired following thoracostomy.

• International Journal of Oral Biology
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• v.36 no.4
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• pp.173-178
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• 2011

Tumor necrosis factor alpha ($TNF{\alpha}$) is a multifunctional cytokine that is elevated in inflammatory diseases such as atherosclerosis, diabetes and rheumatoid arthritis. Recent evidence has suggested that ${\beta}2$ adrenergic receptor (${\beta}2AR$) activation in osteoblasts suppresses osteogenic activity. In the present study, we explored whether $TNF{\alpha}$ modulates ${\beta}AR$ expression in osteoblastic cells and whether this regulation is associated with the inhibition of osteoblast differentiation by $TNF{\alpha}$. In the experiments, we used C2C12 cells, MC3T3-E1 cells and primary cultured mouse bone marrow stromal cells. Among the three subtypes of ${\beta}AR$, ${\beta}2$ and ${\beta}3AR$ were found in our analysis to be upregulated by $TNF{\alpha}$. Moreover, isoproterenol-induced cAMP production was observed to be significantly enhanced in $TNF{\alpha}$-primed C2C12 cells, indicating that $TNF{\alpha}$ enhances ${\beta}2AR$ signaling in osteoblasts. $TNF{\alpha}$ was further found in C2C12 cells to suppress bone morphogenetic protein 2-induced alkaline phosphatase (ALP) activity and the expression of osteogenic marker genes including Runx2, ALP and osteocalcin. Propranolol, a ${\beta}2AR$ antagonist, attenuated this $TNF{\alpha}$ suppression of osteogenic differentiation. $TNF{\alpha}$ increased the expression of receptor activator of NF-${\kappa}B$ ligand (RANKL), an essential osteoclastogenic factor, in C2C12 cells which was again blocked by propranolol. In summary, our data show that $TNF{\alpha}$ increases ${\beta}2AR$ expression in osteoblasts and that a blockade of ${\beta}2AR$ attenuates the suppression of osteogenic differentiation and stimulation of RANKL expression by $TNF{\alpha}$. These findings imply that a crosstalk between $TNF{\alpha}$ and ${\beta}2AR$ signaling pathways might occur in osteoblasts to modulate their function.

• Radiation Oncology Journal
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• v.18 no.4
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• pp.257-264
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• 2000

Purpose: For early stage non-small-cell lung cancer, surgical resection is the treatment of choice. But when the patients are not able to tolerate it because of medical problem and when refuse surgery, radiation therapy is considered an acceptable alternative. We report on the treatment results and the effect of achieving local control of primary tumors on survival end points, and analyze factors that may influence survival and local control. Materials and Method : We reviewed the medical records of 32 patients with medically inoperable non-small cell lung cancer treated at our institution from June, 1987 through June, 1997. All patients had a pathologic diagnosis of non-small cell lung cancer and were not candidate for surgical resection because of either patients refusal (4), old age (2), lung problem (21), chest wail invasion (3) and heart problems (3). In 8 patients, there were more than 2 problems. The median age of the patients was 68 years (ranging from 60 to 86 years). Histologic cell type included souamous (24), adenocarcinoma (6) and unclassiried squamous cell (2). The clinical stages of the patients were 71 in 5, 72 in 25, 73 in 2 patients. Initial tumor size was 3.0 cm in 11, between 3.0 cm and 5.0 cm in 13 and more than 5.0 cm in 8 patients. Ail patients had taken chest x-rays, chest CT, abdomen USG and bone scan. Radiotherapy was delivered using 6 MV or 10 MV linear accelerators. The doses of primary tumor were the ranging from 54.0 Gy to 68.8 Gy (median; 61.2 Gy). The duration of treatment was from 37 days through 64 days (median; 0.5 days) and there was no treatment interruption except 1 patient due to poor general status. In 12 patients, concomitant boost technique was used. There were no neoadjuvant or adjuvant treatments such as surgery or chemotherapy. The period of follow-up was ranging from 2 months through 93 months (median; 23 months). Survival was measured from the date radiation therapy was initiated. Results : The overall survival rate was 44.6$\%$ at 2 years and 24.5$\%$ at 5 years, with the median survival time of 23 months. of the 25 deaths, 7 patients died of intercurrent illness, and cause-specific survival rate was 61.0$\%$ at 2 years and 33.5$\%$ at 5 years. The disease-free survival rate was 38.9$\%$ at 2 years and 28.3$\%$ at 5 years. The local-relapse-free survival rate was 35.1$\%$, 28.1$\%$, respectively. On univariate analysis, tumor size was significant variable of overall survival (p=0.0015, 95$\%$ C.1.; 1.4814-5.2815), disease-free survival (P=0.0022, 95$\%$ C.1., 1.4707-5.7780) and local-relapse-free survival (p=0.0015, 95$\%$ C.1., 1.2910- 4.1197). 7 stage was significant variable of overall survival (p=0.0395, 95$\%$ C.1.; 1.1084-55.9112) and had borderline significance on disease-free survival (p=0.0649, 95$\%$ C.1.; 0.8888-50.7123) and local-relapse-free survival (p=0.0582, 95$\%$ C,1.; 0.9342-52.7755). On multivariate analysis, tumor size had borderline significance on overall survival (p=0.6919, 955 C.1., 0.9610-5.1277) and local-relapse-free survival ( p=0.0585, 95$\%$ C.1.; 0.9720-4.9657). Tumor size was also significant variable of disease-free survival (p=0.0317, 95% C.1.; 1.1028-8.4968). Conclusion : Radical radiotherapy is an effective treatment for small (71 or f3 cm) tumors and can be offered as alternative to surgery in elderly or infirmed patients. But when the size of tumor is larger than 5 cm, there were few long-term survivors treated with radiotherapy alone. The use of hypefractionated radiotherapy, endobronchial boost, radisensitizer and conformal or IMRT should be consider to improve the local control rate and disease-specific survival rate.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• v.33 no.6
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• pp.660-668
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• 2007

We investigated 248 patients who were diagnosed as malignant tumor in the department of Oral and maxillofacial Surgery of Kyungpook National University from 1999 to 2006, and following results were obtained. 1. Among 248 patients who have malignant tumor, 164 were men and 84 were women, which made the ratio of male to female 1.95:1. 2. The average age of oral cancer patients was 58.3. 3. As of the primary origin site, lower alveolus and gingiva were the greatest with 70 cases(28.2%), followed by tongue(l6.9%), upper alveolus and gingiva(14.9%), palate(13.7%), mouth floor(9.7%), buccal mucosa(4.8%), retromolar trigone(4.4%), Mx. & Mn. bone(3.2%) and lip(2.8%). 4. As of histologic distribution, squamous cell carcinoma was the greatest with 170 cases(68.6%), followed by sarcoma with 17 cases(6.9%), adenoid cystic carcinoma with 17 cases(6.9%), malignant lymphoma with 15 cases(6.0%), mucoepidermoid carcinoma with 13 cases(5.2%), metastatic carcinoma with 6 cases(2.4%) and malignant melanoma with 4 cases(1.6%). 5. Period between recognition of the symptom and the first visit to hospital was less than 3 months for 58.9% of the patients, and more than 3 months for 41% of the patients. 6. Investigation of whether the patients drink or smoke revealed that the number of non-smoking and non-drinking patients was 63 among 170 patients(37.0%) that were able to investigate. The number of patients who smoke only was 29(17.1%) and both drinking and smoking patients were 78(45.9%). 7. In clinical stage order, Stage IV(61.7%) was found th be the largest, followed by stage I(17.2%), stage II(13%) and stage III(7.8%). 8. The 5-year survival rate of the entire oral cancer patients appeared to be 57.7%. The survival rate was higher in younger group and women had higher survival rate but there was no statistical significance to this. In the aspect of stage, the survival rate was Stage I, Stage II, Stage IV and Stage III in decreasing order. The order according to T classification was the same. In N classification, patients with N0 had the highest survival rate and the survival rate decreased in the order of N1 and N2. Survival rate was especially low in patients with N2.

• The Journal of the Korean bone and joint tumor society
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• v.15 no.1
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• pp.44-51
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• 2009

Purpose: We evaluated the results of surgical treatment for metastatic pathologic or impending pathologic fractures. Materials and Methods: From January 2004 to December 2007, 18 patients 19 cases were included. Male were 6 and female were 12. The mean age was 65.1. Mean follow up period was 15.2 months. Pathologic fractures were 14 and impending pathologic fractures were 5. MSTS score, periodic radiologic follow up and postoperative complications were evaluated. Results: The primary malignancies were 6 cases of multiple myeloma, 4 cases of renal cell carcinoma, 2 cases of cholangiocarcinoma, 2 cases of colon cancer, 2 cases of breast cancer and 2 cases of leiomyosarcoma. Metastatic lesions were 10 cases of femur, 4 cases of clavicle, 2 cases of humerus, 2 cases of tibia and 1 case of radius. Surgical options were curettage, cementation, internal fixation and arthroplasty. Mean MSTS score was 15.9. Postoperative complications were 1 case of infection, 1 case of local recurrence and 1 case of implant loosening. Ten patients were alive with disease, 8 patients died of disease. Conclusion: Surgical treatment of metastatic skeletal lesions allowed early ambulation and improving dexterity. It improved pain and emotional acceptance. Surgery is necessary for improving qualities of remaining lives.