• Journal of Chest Surgery
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• 제40권10호
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• pp.685-690
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• 2007

배경: 상부 식도암에 대한 종래의 표준적 치료는 방사선 조사였으나 결과는 만족스럽지 않았으며, 아직도 수술적 치료를 적용하는 데에는 의견의 차이가 있다. 저자들은 상부식도암에 대하여 수술적 치료를 적극적으로 시행하여 왔으며, 그의 효과를 분석해 보고자 하였다. 대상 및 방법: 1995년부터 2005년까지 저자들이 수술을 시행한 식도암 증례는 모두 147예였으며, 이들을 상부 식도암(경부 및 상흉부 식도암) 23예와 하부 식도암(중, 하흉부 및 복부 식도암) 124예의 2군으로 구분하여, 수술의 완전 절제율과 수술의 합병증 및 사망률, 재발률,그리고 생존율 등을 비교함으로써 양군에서의 수술의 유용성을 비교해 보았다. 결과: 양 군 간에 병기 분포는 유사하였으며, 완전 절제율에서도 유의한 차이를 발견할 수 없었다. 수술의 합병증 발생률은 상부 식도암군에서 유의하게 높았으나(39.1% vs 16.9%, p<0.05), 수술 사망률이나 재발률 및 장기 생존율에서의 차이는 없었다. 결론: 양 군 간에 수술 사망률이나 수술의 효과 면에서 차이가 없어 상부 식도암에서도 수술적 치료는 유용하다고 판단되었으나, 향후 보다 많은 증례의 분석이 필요할 것이라고 생각한다.

• Journal of Chest Surgery
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• 제29권6호
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• pp.681-688
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• 1996

경구경계부 식도에 발생된 악성종양의 경우에는 진단시에 이미 식도에 밀접해 있는 기관과 주요 신경 그리고 혈관등에 침범되어 있는 경우가 많으며, 또한 외과적 절제에도 기술적인 어려움이 있어 식도암 의 발생부위중 가장 예후가 불량한 부위로 알려져 있다. 저자들은 진행형 경흥경계부 식도암 환자 1례에서 합병치료로 종양의 묶췄를 향상시킨후, 흥강경 을 이용한비개흥적 종격동 림프절적출과 경부의 림프절을 확대적출함으로써 근치도III의 고치요도술을 시행하였다. 술후 끌병증의 발병없이 식도조영술에서 양호한 조명제의 통과소견을 보였으며, 병 리 조직학적 소견상 조기식도암(TINOMO, SM2)으로 판정되어 술후 합병치료는 시행하지 않고 경과를 관찰중에 있다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권3호
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• pp.803-807
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• 2012

For patients with neck and upper thoracic esophageal carcinoma, it is difficult to control lymph node metastases with conventional dose therapy. In this study, we assessed the feasibility of simplified intensity-modulated radiotherapy (sIMRT) and concurrent chemotherapy for 44 patients and boosted high-dose to metastatic lymph nodes. Three radiation treatment volumes were defined: PGTVnd, with which 68.1Gy was delivered in high dose group (hsIMRT group), and 60Gy in the conventional dose group (csIMRT group); PTV1, featuring 63.9Gy in the hsIMRT group and 60Gy in the csIMRT group; PTV2, with 54Gy given to both groups. The sIMRT plan included 5 equi-angular coplanar beams. All patients received the cisplatin and 5-FU regimen concurrently with radiotherapy. The treatment was completed within six weeks and one case with grade three acute bronchitis was observed in hsIMRT group. For esophageal lesions, 80% complete response (CR) and 20% partial response (PR) rates were found in the hsIMRT group, and 79.2% CR, with 20.8% PR, in the csIMRT group; for lymph node lesions, 75% CR and 25% PR rates were observed in the hsIMRT group, with 45.8% and 37.5% respectively in the csIMRT group (P<0.05). The differences in 1-, 2- and 3-year relapse-free survival rates were all statistically significant (P<0.05). The major toxicity observed in both groups was Grade I~II leucopenia. sIMRT can generate a desirable dose distribution in treatment of neck and upper thoracic esophageal carcinoma with a better short-term efficacy. Boosted high dosing to metastatic lymph nodes can increase the relapse-free survival rate.

• Journal of Chest Surgery
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• 제23권4호
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• pp.707-714
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• 1990

Despite of mortality and morbidity rates that are higher than other forms of therapy, surgical resection has been mainstay for the treatment of esophageal cancer because of a prompt completeness as well as a high possibility of cure. But a substantial numbers of patients are unsuitable for surgical treatment and those undergoing resection have still poor long term survival rate. With hopes of improving long term survival, we have attempted multimodal approach, composed of preoperative induction chemotherapy utilizing Cisplatin and 5 \ulcornerFU, surgery and postoperative loco-regional radiotherapy for the treatment of esophageal cancer since 1985. During the period of 1967 \ulcorner1985, 27 patients[group A] were treated by surgery only and during recent 5 years 28 patients[group B] by multimodal treatment, Clinical review and comparison between the two groups were as follows: l. Applied surgical procedures were hand-sewn esophagogastrostomy, esophagocologastrostomy and esophagojejunostomy in group A. In group B, only esophagogastrostomy was underwent using stapler mainly. 2. Incidence of peri and postoperative complication showed no remarkable differences between the two groups, but the occurrences of leakage from the anastomotic site were 5[19% ] out of group A and 1[4%] out of group B. 3. The response rate to induction chemotherapy was 36% in group B, 4. The number of local cancer recurrence at the site of anastomosis was 6[22%] out of group A, whereas 2[7%] out of group B. 5. Postoperative I year and 2 year survival were 61%, 15% in group A and 75%, 42% in group B.

• 한국방사선학회논문지
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• 제18권3호
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• pp.249-256
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• 2024

식도암 방사선치료에서 폐렴 등의 방사선치료 부작용을 줄이고 정상장기를 보호하기 위하여 Full Arc와 Partial Arc를 이용한 동일평면 체적 조절 호형 방사선치료와 비동일평면 체적 조절 호형 방사선치료의 치료계획을 비교 분석하여 주변 정상 조직의 선량 차이를 평가하였다. 동시 항암 화학 방사선요법을 받은 환자 30명의 식도암 환자를 대상으로 fVMAT(2 Full Arc), pVMAT(4 Partial Arc), ncVMAT(2 Partial Arc + 2 Non-Coplanar Arc) 세 가지 치료계획의 PTV와 폐, 심장, 척수, Total MU를 비교하였다. 모든 치료계획이 PTV의 대한 조건을 충족하고 균일한 분포를 보였으며 심장의 평균선량은 fVMAT, pVMAT, ncVMAT 각각 5.8 Gy, 6.97 Gy, 7.60 Gy이었고 척수의 최대선량은 36.85 Gy, 42.51 Gy, 43.08 Gy로 fVMAT가 가장 낮은 값을 보였으며 통계적으로 유의했다. 그러나 폐의 평균선량은 각각 9.01 Gy, 7.71 Gy, 7.12 Gy이었고 V_5Gy는 52.22%, 38.61,%, 36.35%이며 V_10Gy은 37.79%, 27.33%, 24.15%로 ncVMAT가 가장 낮은 값을, fVMAT가 가장 높은 값을 보였고 통계적으로 유의했다. 따라서 ncVMAT는 식도암 방사선치료에서 폐의 선량 분포를 최소화하고 폐렴과 같은 부작용 발생률을 낮추는데 기여할 수 있을 것으로 판단된다. 하지만 Non-Coplanar Beam을 사용함으로써 셋업의 정확성과 치료 시간 증가 등을 고려하여 각 상황에 맞춰 적절한 치료계획을 적용함으로써 보다 나은 결과를 얻을 수 있을 것으로 사료된다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.4163-4167
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• 2012

Aims: To prospectively assess the efficacy and safety of moderately hypofractionated conformal radiotherapy in patients with thoracic esophageal cancer. Methods and Materials: From Sept. 2002 to Oct, 2005, 150 eligible patients with T2-4N0-1M0 stage thoracic esophageal squamous cell cancers were enrolled to receive either conventional fractionated radiation (CFR) or moderately hypofractionated radiation (MHR) with a three-dimensional conformal radiation technique. Of the total, 74 received moderately hypofractionated radiation with total dose of 54-60Gy/18-20fractions for 3.5-4 weeks in the MHR arm, and 76 received conventional radiation with total dose of 60Gy/30 fractions for 6 weeks in the CFR arm. Concurrent chemotherapy comprised of paclitaxel and cisplatin. Safety was evaluated, and local control and overall survival rates were calculated. Results: Statistically significant differences between the CFR versus MHR arms were observed in local/regional failure rate (47.3% v 27.0%, P=0.034) and the percentage of patients with persistent local disease (26.3% v 10.8%, P=0.012). But 3 and 5-year overall survival rates (43.2%, 38.8% v 38.2%, 28.0%, respectively) were not different between the two arms (P=0.268). There were no significant differences in the incidences of grade 3 or higher acute toxicities (66.3% v 50.0%) and late complications rates (27.0% v 22.4%) between the MHR and CFR arms. Conclusions: Moderately hypofractionated, three-dimensional radiation treatment could improve the local control rate of esophageal cancer and potentially increase patients' survival.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.199-203
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• 2012

Purpose: To evaluate the prognostic value of serum CYFRA21-1, CEA and hemoglobin levels regarding long-term survival of patients with esophageal squamous cell carcinoma (ESCC) treated with concurrent chemoradiotherapy (CRT). Methods: Age, gender, Karnofsky Performance Status (KPS), tumor location, tumor length, T stage, N stage and serum hemoglobin, and CYFRA21-1 and CEA levels before concurrent CRT were retrospectively investigated and related to outcome in 113 patients receiving 5-fluorouracil and cisplatin combined with radiotherapy for ESCC. The Kaplan-Meier method was used to analyze prognosis, the log-rank to compare groups, the Cox proportional hazards model for multivariate analysis, and ROC curve analysis for assessment of predictive performance of biologic markers. Results: The median survival time was 20.1 months and the 1-, 2-, 3-, 5- year overall survival rates were 66.4%, 43.4%, 31.9% and 15.0%, respectively. Univariate analysis showed that factors associated with prognosis were KPS, tumor length, T-stage, N-stage, hemoglobin, CYFRA21-1 and CEA level. Multivariate analysis showed T-stage, N-stage, hemoglobin, CYFRA21-1 and CEA level were independent predictors of prognosis. By ROC curve, CYFRA21-1 and hemoglobin showed better predictive performance for OS than CEA (AUC= 0.791, 0.704, 0.545; P=0.000, 0.000, 0.409). Conclusions: Of all clinicopathological and molecular factors, T stage, N stage, hemoglobin, CYFRA21-1 and CEA level were independent predictors of prognosis for patients with ESCC treated with concurrent CRT. Among biomarkers, CYFRA21-1 and hemoglobin may have a better predictive potential than CEA for long-term outcomes.

• Tuberculosis and Respiratory Diseases
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• 제84권2호
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• pp.148-158
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• 2021

Background: Radiotherapy is a common treatment option for lung or esophageal cancer, particularly when surgery is not feasible for patients with poor lung function. However, radiotherapy can affect pulmonary function and thereby induce pneumonitis or pneumonia, which can be fatal in patients with respiratory impairment. The purpose of this study is to evaluate if reductions in pulmonary function after radiotherapy can be minimized through simultaneous pulmonary rehabilitation (PR). Methods: In this matched case control study, we retrospectively analyzed patients who had undergone radiotherapy for thoracic malignant disease between January 2018 and June 2019. We analyzed results from pulmonary function tests and 6-minute walking tests (6MWT) conducted within the six months before and after radiotherapy treatment. Results: In total, results from 144 patients were analyzed, with 11 of the patients receiving PR and radiotherapy simultaneously. Of the 133 patients in the control group, 33 were matched with 11 patients in the PR group. Changes in forced expiratory volume in one second (FEV₁) and FEV₁/forced vital capacity were significantly different between the PR group and the matched control group (240 mL vs. -10 mL, p=0.017 and 5.5% vs. 1.0%, p=0.038, respectively). The median distance of 6MWT in the PR group also increased significantly, from 407.5 m to 493.0 m after radiotherapy (p=0.017). Conclusion: Simultaneous PR improved pulmonary function, particularly in measures of FEV₁, and exercise capacity for patients with lung or esophageal cancer even after radiotherapy treatment. These findings may provide an important base of knowledge for further large population studies with long-term follow-up analysis in the identification of the PR's effects during thoracic radiotherapy.

• Radiation Oncology Journal
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• 제9권2호
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• pp.241-248
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• 1991

1985년 11월부터 1990년 6월까지 전남대학교병원 치료방사선과에서 방사선 치료를 받은 90예의 식도암 환자를 대상으로 생존율에 관하여 후향적 분석을 시행하였으며 다음과 같은 결과를 얻었다. 조직학적으로 75예 ($94.9\%$)가 편평상피 세포암으로 관찰되었으며, 병기는 25예 ($27.8\%$)가 T2, 64예 ($71.1\%$)가 T3로 대부분 진행된 암이었다. 최소 추적기간은 12개월 이었으며 중앙값은 5개월이었다. Kaplan Meier 법에 의한 2년 생존율은 $11.6\%$이었다. 치료목표, T병기, 병변부위, 병변길이, 방사선량, 관해정도에 따른 2년 생존율을 구하여 비교하였으며, 이들중 종양의 침범길이만 생존율에 영향을 미쳤다.

• 한국방사선학회논문지
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• 제12권5호
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• pp.583-592
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• 2018

세기변조방사선치료와 입체적세기조절회전치료 시 조사체적과 선량 퍼짐 현상을 줄이기 위한 방법으로 조사 각도를 제한하는 부분 각도에 의한 회전치료 기능을 적용하여 표적체적과 주변 정상장기의 선량에 대해 입체조형방사선치료와 비교 분석하였다. 치료계획에 따른 표적체적의 선량분포는 통계적으로 유의한 차이를 확인할 수 없었으며, 폐의 5 Gy(V5) 체적에서 입체조형방사선치료 56.53%, 세기변조방사선치료 52.03%, 입체적세기조절회전치료 47.84%를 나타내어 유의한 차이를 나타내었다(CRT-IMRT p=0.035, CRT-VMAT p<0.001, IMRT-VMAT p<0.001). 10 Gy 체적(V10)에서는 입체조형방사선치료 35.12%, 세기변조방사선치료 34.04%, 입체적세기조절회전치료 33.28%를 보여, 입체조형방사선치료와 세기변조방사선치료(p=0.018), 입체적세기조절회전치료(p=0.035)에서 유의한 차이를 나타내었으나 20 Gy 체적(V20)에서는 유의한 선량 차이를 확인할 수 없었다. 심장의 평균선량과 20 Gy 체적은 치료계획에 따라 유의한 차이를 확인할 수 없었으나, 30, 40 Gy 체적은 입체적세기조절회전치료에서 37.16%, 22.46%를 나타내어 입체조형방사선치료와 비교에서 유의한 차이(p=0.028)를 보였다. 이와 같이 조사체적 감소에 따른 폐의 저 선량 체적(V5, V10)의 감소를 확인할 수 있었으며, 세기변조방사선치료와 입체적세기조절회전치료 시 조사 각도를 일부 제한함으로써 표적체적의 선량분포는 동일하게 유지함과 동시에 조사체적을 줄일 수 있었다. 이로 인해 폐의 선량 퍼짐 현상의 감소로부터 폐의 독성을 낮추는데 기여할 수 있을 것으로 사료된다.