• Asian Pacific Journal of Cancer Prevention
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• 제14권2호
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• pp.1127-1130
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• 2013

Background: The standard national protocol for treatment of acute lymphoblastic leukemia (ALL) in children was implemented in 2006. A systematic evaluation of the treatment outcome is needed. This study examined the relapse-free survival among childhood ALL cases treated with this protocol and related factors. Materials and Methods: A descriptive study was conducted in children aged between 0-15 years, newly diagnosed with ALL between March 2006 and March 2011 at Srinagarind Hospital, Department of Pediatrics, Faculty of Medicine, Khon Kaen University. The patients were treated on the basis of stratified risk as per the Thai national protocol. Data were compiled from the hospital records. The Kaplan-Meier method was used to describe relapse-free survival and the Cox proportional hazard model to investigate the associated factors. Results: Of the 103 children recruited, 86 (83.5%) achieved complete remission. The total follow-up time was 3132.5 person-months. Eighteen (20.9%) relapsed. The incidence density was 0.6 per 100 person-months (95%CI: 0.4, 0.9). The respective relapse-free rates at 1, 3 and 5 years were 93.0% (95%CI: 85.1, 96.8), 84.5% (95%CI: 74.0, 90.9) and 64.1% (95%CI: 45.6, 77.8). A factor associated with the relapse-free rate was age under 1 year (HR=6.0; 95%CI: 1.1, 33.8). Conclusions: The rate of being relapse-free in ALL children treated under the Thai national protocol at Srinagarind Hospital was better than with former protocols; however, it is still not as good as in developed countries. Further review of the treatment approach of ALL is needed.

• Childhood Kidney Diseases
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• 제22권1호
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• pp.1-6
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• 2018

Rituximab (RTX) is a chimeric monoclonal antibody that inhibits CD20-mediated B-cell proliferation and differentiation. Several studies have examined its use in intractable nephrotic syndrome (NS) with some positive results. However, those studies examined such effects for a short-term period of 1 year, and some patients continued to relapse after a lapse in RTX treatment. Our use of RTX as a maintenance therapy (RTX injection when the CD19 cell count exceeded $100-200/{\mu}L$ before relapse) showed some noticeable efficacy. We used RTX in 19 patients with steroid-dependent NS (SDNS). In 12 patients treated with RTX maintenance therapy, only one relapse occurred. The mean treatment period was $23.4{\pm}12.7months$, and the mean number of RTX administrations was $3.9{\pm}1.6$. The relapse rates were decreased (from 2.68/year to 0.04/year), and the drug-free period also increased (from 22.5 days/year to 357.1 days/year) during maintenance therapy. The other seven patients were treated with one cycle of RTX or additional cycles in case of relapse (non-maintenance therapy). Relapse rates were significantly decreased after RTX treatment (from 1.76/year to 0.96/year, P=0.017). The relapse-free period was $15.55{\pm}7.38$ (range, 5.3-30.7) months. No severe side effects of RTX were found except for a hypersensitivity reaction such as fever and chills during its infusion. In conclusion, RTX is considered an effective and safe option to reduce the relapse rate by a single- or maintenance-interval therapy in SDNS.

• Radiation Oncology Journal
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• 제13권2호
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• pp.129-142
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• 1995

Purpose: Traditionally the patients with early stage non-Hodgkin's lymphoma of the head and neck was treated with radiotherapy. But the results were not satisfactory due to distant relapse. Although combined treatment with radiotherapy and chemotherapy was tried with some improved results and chemotherapy alone was also tried in recent years, the choice of treatment for the patients with early stage non-Hodgkin's lymphoma of the head and neck has not been defined Therefore, in order to determine the optimum treatment method, we analysed retrospectively the outcomes of the patients with Ann Arbor stage I and II non-Hodgkin's lymphoma localized to the head and neck who were treated at Severance Hospital. Materials and Methods: 159 patients with stage I and II non-Hodgkin's lymphoma localized to the head and neck were treated at our hospital from January, 1979 to December, 1992. Of these patients, 114 patients whose primary sites were Waldeyer's ring or nodal region, and received prescribed radiation dose and/or more than 2 cycles of chemotherapy. were selected to analyze the outcomes according to the treatment methods ( radiotherapy alone, chemotherapy alone. and combined treatment with radiotherapy and chemotherapy ). Results: Five year overall actuarial survival of the patients whose Primary site was Waldeyer's ring was $62.5\%.$ and that of the Patients whose primary site was nodal region was $53.8\%$ There was no statistically significant difference between survivals of both groups. Initial response rate to radiotherapy. chemotherapy, and combined treatment was $92\%,\;83\%,\;94\%$ respectively, and 5 year relapse free survival was $49.9\%,\;52.4\%,\;58.5\%$ respectively ( statistically not significant ). In the patients with stage I. 3 year relapse free survival of chemotherapy alone group was $75\%$ and superior to other treatment groups. In the Patients with stage II, combined treatment group revealed the best result with $60.1\%$ of 3 year relapse free survival. The effect of sequential schedule of each treatment method in the Patients who were treated by combined modality was analyzed and the sequence of primary chemotherapy + radiotherapy + maintenance chemotherapy showed the best result ( 3 year relapse free survival was $79.1\%).$ There was no significant survival difference between BACOP regimen and CHOP regimen. Response to treatment was only one significant (p(0.005) prognostic factor on univariate analysis and age and mass size was marginally significant ( p(0.1). On multivariate analysis, age (p=0.026) and mass size (p=0.013) were significant prognostic factor for the relapse free survival. Conclusion: In summary, the patients who have non-Hodgkin's lymphoma of the head and neck with stage I and mass size smaller than 10 cm, can be treated by chemotherapy alone, but remainder should be treated by combined treatment method and the best combination schedule was the sequence of initial chemotherapy followed by radiotherapy and maintenance chemotherapy.

• Radiation Oncology Journal
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• 제30권2호
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• pp.62-69
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• 2012

Purpose: To evaluate the treatment outcome and prognostic factor of postoperative radiotherapy for extremity soft tissue sarcoma (STS). Materials and Methods: Forty three patients with extremity STS were treated with conservative surgery and postoperative radiotherapy from January 1981 to December 2010 at Korea University Medical Center. Median total 60 Gy (range, 50 to 74.4 Gy) of radiation was delivered and 7 patients were treated with chemotherapy. Results: The median follow-up period was 70 months (range, 5 to 302 months). Twelve patients (27.9%) sustained relapse of their disease. Local recurrence occurred in 3 patients (7.0%) and distant metastases developed in 10 patients (23.3%). The 5-year overall survival (OS) was 69.2% and disease free survival was 67.9%. The 5-year local relapse-free survival was 90.7% and distant relapse-free survival was 73.3%. On univariate analysis, no significant prognostic factors were associated with development of local recurrence. Histologic grade (p = 0.005) and stage (p = 0.02) influenced the development of distant metastases. Histologic grade was unique significant prognostic factor for the OS on univariate and multivariate analysis. Severe acute treatment-related complications, Common Terminology Criteria for Adverse Events (CTCAE) grade 3 or 4, developed in 6 patients (14.0%) and severe late complications in 2 patients (4.7%). Conclusion: Conservative surgery with postoperative radiotherapy achieved a satisfactory rate of local control with acceptable complication rate in extremity STS. Most failures were distant metastases that correlate with tumor grade and stage. The majority of local recurrences developed within the field. Selective dose escalation of radiotherapy or development of effective systemic treatment might be considered.

• Radiation Oncology Journal
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• 제11권2호
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• pp.303-309
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• 1993

Between November 1983 and December 1992, 121 patients with non-small cell lung cancer were treated with radiotherapy alone or combined with chemotherapy in Inje University, Seoul Paik Hospital. Of these,97 patients were evaluable and analyzed retrospectively. Group 1 (n=62)was treated with radiotherapy alone and group 2 (n=35) combined with chemotherapy. There were 7 patients, 1 patient with stage I and II ,20 patients, 11 patients with stage IIIA,28 patients, 20 patients with stage IIIB, and 6 patients, 3 patients with stage IV, respectively. Ninety percent of patients received more than 5000 cGy of radiaton. Median survival of patients in group 1 was 9 months, group 2 was 15 months. Overall 2 year survival rates of group 1 and 2 were $37\%\;and\;27\%$, respectively. Relapse free survival rates at 2 year were $27\%\;and\;15\%$, respectively. Overall survival rates at 5 year for group 1 and 2 were $15\%\;and\;11\%$, and relapse free survival rates were $16\%\;and\;6\%,$ respectively. Median survival of complete and partial responders was 47 months in group 1,18 months in group 2, and those of stable or progression was 6 months,11 months, respectively. The proportion of locoregional relapse and distant metastasis was not significantly different between group 1 and 2. The majority of relapse developed within 2 years. Although 2 cases of severe esophagitis and myelosuppression were noted in group 2, the treatment related toxicity was relatively acceptable. Our analysis showed no statistically significant differences between the two treatment groups in terms of response rate, survival, and sites of relapse.

• Radiation Oncology Journal
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• 제26권4호
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• pp.204-212
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• 2008

목 적: 유방 보존수술 후 방사선 치료를 받은 환자에서 치료의 성적과 무병 생존율 및 재발에 영향을 주는 위험인자에 대해 알아보고자 하였다. 대상 및 방법: 1997년 3월부터 2003년 12월 까지 유방 보존수술 시행 후 방사선 치료를 받은 환자 77명을 대상으로 후향적으로 분석하였다. 추적 관찰 기간의 중앙값은 58.4개월($43.8{\sim}129.4$개월)이었다. 전체 환자의 평균 연령은 41세, 중앙 연령은 40세이었다. 수술 후 조직학적 T 병기는 Tis가 7명, T1 38명(49.3%), T2 28명(36.3%), T3 3명, 미확인이 1명이었다. 액와 림프절 전이가 없는 경우가 52명(67.5%), $1{\sim}3$개 전이가 14명(18.1%), 4개 이상이 3명(0.03%)이었다. 절제연이 음성인 환자는 59명이었고, 2 mm 이내로 근접한 경우는 15명, 양성인 경우는 2명이었다. 방사선치료는 전체 유방에 접사면으로 조사한 후 원발 병소 부위에 전자선으로 추가조사 하여 총 59.4 Gy에서 66.4 Gy를 시행하였다. 액와 림프절의 개수가 4개 이상인 경우에는 액와 림프절과 쇄골 상 림프절을 포함하여 $41.4{\sim}60.4$ Gy를 조사하였다. 항암화학요법은 59명에서 시행되었고, 호르몬 치료로는 tamoxifen 또는 fareston을 사용하였으며 29명에서 시행하였다. 결 과: 5년 생존율은 98.1%이었으며, 5년 무병 생존율은 93.5%이었다. 총 77명의 환자 중 4명(5.2%)의 환자가 재발을 하였다. 1명은 쇄골 상 림프절 재발, 1명은 쇄골 상 림프절과 동시에 다발성 원격전이, 다른 2명은 원격전이가 발견되었다. 원발 병소 주위의 국소 재발은 추적 관찰 기간 중 발견되지 않았다. 림프절 전이 유무나 숫자는 재발이나(p=0.195)무병 생존율(p=0.30)에 영향을 미치지 않았다. 절제연이 양성인 2명 중 1명이 7개월 만에 재발을 하였고, 재발 기간까지 걸린 기간인 무병 생존기간이 통계적으로 의미 있게 짧은 것으로 나타났으며(p<0.0001), 재발 빈도도 절제연이 음성이거나 가까운 경우에 비해서 통계적으로 의미가 있는 것으로 나타났다(p=0.0507). 그러나 절제연이 근접한 경우에는 절제연 음성인 경우와 비교하여 통계적으로 재발 빈도에 차이가 없었다(p=1.000). 재발된 4명은 모두 40세 이하로 9.2%의 재발률을 보인 반면, 40세 이상에서는 재발이 없었으나 두 그룹 간에 통계적으로 유의한 차이는 없었다(p=0.1255). 수술 후 조직학적 T 병기는 T2의 경우 4명(14%)이 재발한 반면, T1에서는 재발이 발견되지 않았으며 통계적으로 유의한 차이를 보였다(p=0.0284). 무병 생존율도 T2 환자의 경우에 통계적으로 의미 있게 낮은 것으로 나타났다(p=0.0379). 무병 생존율에 영향을 미치는 단변량 분석에서 수술 후 조직학적 T 병기, 절제연의 상태, p53 수용체 변이가 통계적으로 의미 있게 나왔다. 결 론: 초기 유방암에서 유방 보존수술 후 방사선치료는 높은 국소제어율과 무병 생존율을 보이는 안전한 치료이다. 절제연 양성, 수술 후 조직학적 T병기, p53 수용체 변이 등은 통계적으로 유의하게 재발 위험이 높은 군에 속하였으며, 무병 생존율에 영향을 미치는 것으로 밝혀졌다.

• Tuberculosis and Respiratory Diseases
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• 제43권3호
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• pp.331-338
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• 1996

배경 : 비소세포 폐암은 미국에서 암 사망율 원인 중의 1위를 차지하고, 또한 한국에서도 위암, 간암에 이어 3위를 차지할 만큼 흔하고 중요한 질병이다. 이러한 비소세포 폐암의 완치를 위한 많은 치료적 접근방법이 시도되었으나 아직도 근치적 절제술만이 완치를 기대할 수 있는 거의 유일한 방법이라고 하겠다. 따라서 수술 전의 정확한 병기 판정 및 이에 다른 근치적 절제술은 환자의 장기 생존을 결정짓는 중요한 요인이라고 할 수 있을 것이다. 이에 본 연구는 비소세포 폐암 대상으로 수술 전후의 병기 판정을 비교하여 그 일치율을 평가하고 수술 후의 재발율 및 재발 부위등을 알아 보았고 병기에 따른 장기 예후를 생존 곡선을 그려 알아 보고자 하였다. 방법 : 서울 대학교 병원에서 완치를 목적으로 개흉술을 시행받았던 217명의 비소세포 폐암 환자들을 대상으로 하여 의무기록을 열람, 분석하는 후향적 연구를 시행하였다. 특히 완전 절제가 가능하였던 170명의 환자들을 대상으로 하여 재발율 및 재발부위, 장기 생존곡선을 분석하였다. 결과 : 217명의 대상환자들 중 남자가 157명, 여자가 30명으로 그 성비는 5:1 이었고 나이의 분포는 23세에서 74세까지 다양했으며, 그 중앙값은 58세로 남, 여 간에 차이가 나지 않았다. 수술 선후의 병기가 차이가 나는 경우가 약 40%에 달했으며 특히 T 병기 보다 N 병기의 차이가 두드러졌다. 병기 및 조직형에 따른 재발율이나 재발 부위의 차이 등은 관찰되지 않았으며, 병기에 따른 생존곡선을 그렸을때, 그 relapse-free survival rate는 병기 I, II, IIIa에서 각각 73%, 53%, 48%로 나타났다. 결론 : 수술 후의 조직학적 병기 (pathologic staging) 가 비소세포 폐암의 예후를 결정짓는 가장 중요한 요인으로 작용하며 따라서 정한 병기 결정이 필수적이다. 그러나 수술 전의 임상적 병기가 이를 정확히 예측해 주지는 못하므로 술전 병기가 치료방침을 결정하는 절대적인 기준으로는 작용하지 못한다. 따라서 수술 전후의 병기의 차이를 줄일 수 있는 새로운 진단적 기술의 개발이 요구된다.

• Clinical and Experimental Pediatrics
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• 제51권1호
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• pp.78-83
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• 2008

목 적 : 골육종은 소아 청소년기에 뼈에 발생하는 가장 흔한 악성종양으로 종양 제거술 및 집중적 항암 화학요법을 시행한 경우에도 약 30-40%에서 재발하는 매우 침습적인 질환이다. 하지만 아직까지 재발한 골육종의 예후 및 예후인자에 대한 연구가 부족한 상태이다. 저자들은 치료 후 재발한 골육종 환아의 치료성적 및 재발 후 생존율에 영향을 주는 요인들을 분석하고자 하였다. 방 법 : 1985년 2월부터 2004년 2월까지 원자력병원에서 골육종으로 치료한 461명의 환아 중 재발한 180명의 의무기록을 후향적으로 조사하였으며 재발 후 생존율과 재발 후 예후인자로 재발병소의 위치, 재발 후 치료 방법, 원발병소의 수술전 화학요법에 대한 병리학적 반응도, 첫 진단 시 전이여부 및 재발기간을 분석하였다. 결 과 : 전체 재발율은 39%였고 재발한 골육종 환아의 5년 및 10년 재발 후 생존율은 각각 13%와 4%였다. 평균 재발기간은 15개월이었다. 재발 후 5년 생존율에 영향을 주는 인자는 재발 부위(폐, 39%; 원발병소, 0%; 폐와 뼈의 재발, 25%; 기타 부위의 재발, 12%), 병소 부위 절제 여부(절제한 경우 38%; 절제하지 않은 경우 11%), 재발기간(1년 이내에 재발한 경우 13%, 1년 이후에 재발한 경우 44%)이었다. 결 론 : 재발된 골육종 환자의 생존율은 높지 않다. 하지만 본 연구에서는 재발된 병변을 적극적으로 치료할 때 생존율이 향상됨을 보여주고 있으며 특히 재발기간이 길고 폐에 재발된 경우에는 수술 및 항암 화학요법과 그 외의 적극적인 치료가 필요하다 하겠다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권10호
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• pp.5811-5816
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• 2013

Background: Breast cancer is the most common cancer among women. Molecular subtypes are important in determining prognosis. This study evaluated five-year disease-free survival among four molecular subtypes in patients with early stages of breast cancer. Materials and Methods: In this retrospective descriptive-analytical study, information on patients with breast cancer between 2001-2010 was evaluated. Five hundred ninety two patients in the early stages of breast cancer (stages 1 and 2) were selected to undergo anthracycline-based chemotherapy. Relapse, death or absence (censor) were considered as the end of the study. Patients based on ER, PR and HER-2 expression were divided into four subtypes (luminal A, luminal B, HER-2 enriched and triple negative). Information based upon questionnaire was analysed. To show the patients survival rate, life table and Kaplan-Meyer methods were used, and for comparing mean survival among different groups, the Log-Rank test was utilized. Results: Mean age at diagnosis was $47.9{\pm}9.6$. Out of the 592 patients, 586 were female (99%) and 6 were male (1%). Considering breast cancer molecular subtypes, 361 patients were in the luminal A group (61%), 49 patients in the luminal B group (8.3%), 48 patients in the HER-2 enriched group (8.1%) and 134 in the triple negative group (22.6%). Mean disease-free survival was 53.7 months overall, 55.4 months for the luminal A group, 48.3 months for the luminal B group, 43 months for the HER-2enriched group and 54.6 months for the triple negatives. Disease free survival differed significantly among the molecular subtypes (p value=0.0001). Conclusions: The best disease-free survival rate was among the luminal A subgroup and the worst disease-free survival rate was among the HER-2 enriched subgroup. Disease free survival rate in the HER-2 positive groups (luminal B and HER-2 enriched) was worse than the HER-2 negative groups (luminal A and triple negative).

• Radiation Oncology Journal
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• 제26권2호
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• pp.91-95
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• 2008

목적: 본 연구는 흉골에 단독 전이된 유방암 환자들에 대하여 삼차원 입체조형 방사선요법을 적용한 치료 성적에 대해 알아보고자 하였다. 대상 및 방법: 1996년 5월부터 2005년 6월까지 유방암의 흉골 단독 전이 병변에 대해 구제적 방사선 치료를 받은 17명의 환자를 분석하였다. 방사선 치료 범위는 종양으로부터 2 cm 여유를 두었으며 치료 선량은 하루 $1.8{\sim}3$ Gy로 총 $35.0{\sim}61.5$ Gy이었다. 종양 반응은 방사선 치료 종료 후 $1{\sim}3$개월에 시행한 컴퓨터 전산화 단층촬영영상으로 평가하였다. 결과: 전체 환자 중, 5명이 완전반응을, 12명이 부분반응을 보여, 모든 환자들이 방사선 치료에 객관적 반응을 보였다. 환자들의 5년 생존율은 51.9%, 중앙 생존기간은 27개월이었다. 환자들의 생존율은 유방암의 초기 수술일로부터 흉골 전이가 발견되기까지의 무병 생존기간에 영향을 받았는데, 무병 생존기간이 12개월 이상인 환자들의 5년 생존율은 61.8%이었던 반면, 무병 생존기간이 12개월 미만인 환자들의 5년 생존율은 0.0%였다(p=0.03). 결론: 흉골에 단독 전이된 유방암 환자들의 방사선 치료에 대한 반응은 우수하였다. 유방암의 초기 수술로부터 흉골재발이 발생하기까지의 무병 생존기간이 긴 환자에서 방사선 치료 후 생존율이 양호한 것으로 나타났다.