• Journal of Gastric Cancer
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• v.5 no.2
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• pp.127-132
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• 2005

A hepatoid adenocarcinoma of stomach, a subtype of gastric cancr, is characterized by a histologic resemblance to a hepatocellular carcinoma and $\alpha$-feto protein production. Another feature is early metastasis to the liver and lymph nodes, thus revealing a poor prognosis. We report a case of a hepatoid adenocarcinoma of the stomach with liver metastasis. A 52-year-old male visited our hospital with a chief complaint of indigestion. Gastroscopic examination showed a Borrmann type-II lesion on the lesser curvature of the antrum. The CT scan showed a suspected advanced gastric cancer with liver metastasis. The serum AFP level was 123 ng/ml. A radical subtotal gastrectomy and a right hemihepatectomy were performed simultaneously. Pathologic examination confirmed the lesion to be confined to the submucosa. The gastric lesion was a hepatoid adenocarcinoma, and the hepatic lesion was a metastatic adenocarcinoma from the stomach. Therefore, he was classified as having stage IV (T1N1M1) gastric cancer. In cases of a hepatoid adenocarcinoma of the stomach, even patients with early gastric cancer can be staged into the poor prognostic group.

• Radiation Oncology Journal
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• v.19 no.3
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• pp.237-244
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• 2001

Purpose : To assess the tolerance, complete response rate, bladder preservation rate and survival rate in patients with muscle-invading bladder cancer treated with selective bladder preservation protocol. Method and Materials : From October 1990 to June 1998, twenty six patients with muscle-invading bladder cancer (clinical stage T2-4, N0-3, M0) were enrolled for the treatment protocol of bladder preservation. They were treated with maximal TURBT (transurethral resection of bladder tumor) and 2 cycles of MCV chemotherapy (methotrexate, crisplatin, and vinblastine) followed by $39.6\~45\;Gy$ pelvic irradiation with concomitant cisplatin. After complete urologic evaluation (biopsy or cytology), the patients who achieved complete response were planed for bladder preservation treatment and treated with consolidation cisplatin and radiotherapy (19.8 Gy). The patients who had incomplete response were planed to immediate radical cystectomy. If they refused radical cystectomy, they were treated either with TURBT followed by MCV or cisplatin chemotherapy and radiotherapy. The median follow-up duration is 49.5 months. Results : The Patients with stage T2-3a and T3b-4a underwent complete removal of tumor or gross tumor removal by TURBT, respectively. Twenty one out of 26 patients $(81\%)$ successfully completed the protocol of the planned chemo-radiotherapy. Seven patients had documented complete response. Six of them were treated with additional consolidation cisplatin and radiotherapy. One patient was treated with 2 cycles of MCV chemotherapy due to refusal of chemo-radiotherapy. Five of 7 complete responders had functioning tumor-free bladder. Fourteen patients of incomplete responders were further treated with one of the followings : radical cystectomy (1 patient), or TURBT and 2 cycles of MCV chemotherapy (3 patients), or cisplatin and radiotherapy (10 patients). Thirteen patients of them were not treated with planned radical cystectomy due to patients' refusal (9 patients) or underlying medical problems (4 patients). Among twenty one patients, 12 patients $(58\%)$ were alive with their preserved bladder, 8 patients died with the disease, 1 patient died of intercurrent disease. The 5 years actuarial survival rates according to CR and PR after MCV chemotherapy and cisplatin chemoradiotherapy were $80\%\;and\;14\%$, respectively (u=0.001). Conclusion : In selected patients with muscle-invading bladder cancer, the bladder preservation could be achieved by MCV chemotherapy and cisplatin chemo-radiotherapy. All patients tolerated well this bladder preservation protoco. The availability of complete TURBT and the responsibility of neoadjuvant chemotherapy and chemoradiotherapy were important predictors for bladder preservation and survival. The patients who had not achieved complete response after neoadjuvant chemotherapy and chemoradiotherapy should be immediate radical cystectomy. A randomized prospective trial might be essential to determine more accurate indications between cystectomy or bladder preservation.

• Journal of Chest Surgery
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• v.32 no.7
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• pp.653-659
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• 1999

Background: Despite the recent promising efforts to improve survival in patients with esophageal carcinoma, the long term survival results of patients with esophageal cancer have seldom been reported in Korea. To establish standard control for future studies, we re trospectively analyzed the surgical treatment results of the esophageal cancer patients managed in our department at Seoul National University Hospital. Material and Method: From January 1984 to December 1996, 734 patients were diagnosed with esophageal cancer. Among them, 253 patients underwent surgery in our department. We retrospectively analyzed the operative results and long term survival rates of these patients. Result: The majority of patients(237) had squamous cell histology and only 6 patients had adenocarcinoma. The final TNM stage grouping for these patients was based on the 1988 revised American Joint Commitee on Cancer classification. Twenty one patients were surgically classified as stage I, 109 as stage II, and 107 as stage III. C respiratory failure in 8, sepsis in 1, hepatic failure in 1, bleeding in 1 and unknown etiology in the remaining 3. The actuarial survival of 222 patients in whom the curative resection was accomplished at 1-, 2-, 3- and 5 years was 74.7${\pm}$3.1%, 46.5${\pm}$3.7%, 32.3${\pm}$3.7%, and 19.9${\pm}$3.3%, respectively. CONCLUSION: The poor long term survival rates suggest that an alternative treatment method such as intensive combined modality therapy should be developed for the management of esophageal cancer.

• Radiation Oncology Journal
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• v.9 no.1
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• pp.93-102
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• 1991

To evaluate the role of postoperative pelvic radiation therapy in rectal cancer, a retrospective analysis was done on 189 patients with modified Astler-Coiler stages B2+3, Cl , and C2+3 who were treated from February 1979 to June 1980. Forty-seven patients were staged as B2+3,17 as Cl, and 125 as C2+3. As a curative resection,41 received low anterior resection,143 received abdomino-perineal resection, and five received pelvic exenteration. The survival and disease-free survival rates of the total patients at five year were $45.3\%\;and\;44.1\%$, respectively. The stage was an important prognostic factor for survival and disease-free survival: the survival rates at five year were $63.4\%$ in stage B2+3, $62.4\%$ in C1, and $37.2\%$ in C2+3 (p<0.005): the disease-free survival rates at five year were $55.7\%$ in B2+3, $65.7\%$ in C1, and $30.4\%$ in C2+3, respectively (p<0.01). The liver was the most frequently involved organ of recurrence followed by the lung and the perineum. The patients who received low anterior resection achieved better disease-free survival but were more prone to late radiation bowel morbidities than those who received abdominoperineal resection. Postperative Pelvic radiation therapy Proved to be effective in locoregional disease control but did not prevent the appearance of distant metastasis, which was of major concern in advanced stages. Patterns of treatment failure, and factros relating to radiation morbidity are discussed, and therapeutic options for better results are proposed.

• Radiation Oncology Journal
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• v.20 no.1
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• pp.62-67
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• 2002

Purpose : This study was undertaken to analyze the efficacy and sphincter preservation rate of platinum based neoadjuvant chemotherapy Plus radiotherapy versus abdominoperineal resection and Postoperative radiotherapy for anal cancer. Materials and Methods : Data of forty-two patients with anal cancer were retrospectively analyzed. Among thirty-eight patients with epidermoid histology, four patients received radiotherapy, and nineteen patients received abdominoperineal resection and adjuvant radiotherapy with or without chemotherapy $(APR+RT{\pm}CT)$, and fifteen patients received neoadjuvant chemotherapy and radiotherapy (CRT). The CRT regimen was composed of three cycles of 5-fluorouracil $(1,000\;mg/m^2\;bolus\;on\;D1\~5)$ and cisplatin $(60\;mg/m^2\;bolus\;on\;D1)$ followed by 50.4 Gy to the tumor bed and regional lymphatics over 5.5 weeks. Both inguinal lymphatics were treated with an identical dose schedule. Residual disease was treated with an additional three cycles of identical adjuvant chemotherapy. An identical dose schedule was used for post-operative radiotherapy. Median follow-up period was eighty-five months. Results : Overall five-year survival rates were $80.3\%$, 88.9 and $79.4\%$ for entire patients, $APR+RT{\pm}CT$ group, and the CRT group, respectively. No significant difference was found between the two groups (p=0.49). Anus preservation rate for the CRT group was $86.7\%$. Age (0=0.0164) and performance status (p=0.0007) were found to be significant prognostic factors by univariate analysis. Age (p=0.0426), performance status (p=0.0008), and inguinal lymph node metastasis (e=0.0093) were statistically significant prognostic factors by multivariate analysis. No case of RTOG grade 3 complication or higher was reported. Conclusion : This and other recent studies have shown that combined chemotherapy plus radiotherapy for anal cancer results in a high rate of anal sphincter preservation as well as local control and survival. Furthermore, neoadjuvant use of chemotherapy with a cisplatin based regimen rather than a concurrent regimen may lead to a decrease in complications.

• Journal of Gastric Cancer
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• v.5 no.4 s.20
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• pp.295-303
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• 2005

The Korean laparoscopic Gastrointestinal Surgery Study Group made a survey of laparoscopic gastric surgeries which were performed in Korea during 2004. Thirty-eight surgeons from 36 Institutions responded to the questionnaires. One thousand eighty-nine laparoscopic gastric operations were performed during 2004. The cumulative number from 1995 to 2004 was about 2,386. Seven hundred fifty-four operations for a gastric adenocarcinoma were performed during 2004 which is almost two times the number performed during 2003. Laparoscopic radical procedures, such as a laparoscopy-assisted distal gastrectomy or total gastrectomy (LADG and LATG) have increased rapidly since 2001 (55 cases in 2001, 150 cases in 2002, 364 cases in 2003 and 738 cases in 2004). Especially, laparoscopic total gastrectomies were explosively adopted last year (20 cases in 2003 and 112 cases in 2004). However, laparoscopic function-preserving gastrectomies, which included one laparoscopy-assisted pylorus-preserving gastrectomy and laparoscopy-assisted proximal gastrectomy, are rarely performed at this time. One hundred forty-two wedge resections for a gastric submucosal tumor were performed during 2004. Hand-assisted laparoscopic surgery (HALS) was performed in 39 cases in 2001, 55 in 2002, and 49 in 2003; however, only 5 such surgeries were performed during 2004. In 2003, laparoscopic bariatric surgery began, and during 2004, 49 operations were performed. In terms of indications of laparoscopic gastric surgery for adenocarcinoma, 19 surgeons performed a LADG only for a T1 lesion, and 7 surgeons extended their indications to T2N0 lesions. In the near future, laparoscopic procedures for gastric cancer will be widely adopted in Korea if the medical-insurance obstacle is overcome, and the long-term survival results are verified.

• Journal of Gastric Cancer
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• v.7 no.4
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• pp.228-236
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• 2007

Purpose: We have evaluated changes of body composition for patients that underwent a radical gastrectomy for stomach cancer by the use of available bioelectrical impedance analysis during the first year following surgery. We plan to utilize these findings in nutritional and physiological studies. Materials and Methods: We evaluated clinical changes in body composition in patients using the bioelectrical impedance method (Inbody 4.0, Biospace, Korea), between November 2003 to November 2004. A total of 98 patients agreed to enroll in this study among all of the patients that underwent a radical gastrectomy. Results: The average weight decreased by 6.7%, and 9.4%, within the first and 6 months after surgery, respectively (P<0.01). The fat free mass (FFM) dropped by 4.9% within the first month and there were no more changes after this period (P<0.01). The fat mass (FM) and visceral fat area (VFA) decreased 24.3% and 14.1% within the first 6 months (P<0.01), respectively. The reduction effects for female patients were greater than for male patients for weight, FFM and VFA (P<0.05). The edema index was higher in patients with stage III-IV disease than in patients with stage I-II disease (P<0.05). There were significant differences for Billroth I and Billrothl II patients as compared to patients that underwent an esophagojejunostomy for a reduction of the FM, as measured in the in the 12th month after surgery (27.6%, 22.1%, and 41.2%, respectively; P<0.05). Conclusion: Since nutritional supplementation and an improvement in body weight loss after a radical gastrectomy is significantly related with quality of life, nutritional and physiological studies should be greatly considered. In this study, bioelectrical impedance analysis was very useful in analyzing the diminution of body composition and we hope this study on the nutritional and physiological aspects related to a radical gastrectomy will be useful for later studies.

• Radiation Oncology Journal
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• v.18 no.3
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• pp.194-199
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• 2000

Purpose : Then determining the lower margin of post-operative pelvic radiation therapy field according to the traditional method (recommended by Gunderson), the organs located in the low pelvic cavity and the perineum are vulnerable to unnecessary radiation. This study evaluated the effect of individualized determination of the lower margin at 2 cm to 3 cm below the anastomotic site on the failure patterns. Materials and Methods . Authors included ぉ patients with modified Astler-Coiler (MAC) stages from B2 through C3, who received low anterior resection and post-operative pelvic radiation therapy from Sept. 1994 to May 1998 at Samsung Medical Center, Sungkyunkwan University. The numbers of male and female patients were 44 and 44, and the median age was 57 years (range: 32-81 years). Three field technique (posterior-anterior and bilateral portals) by 6, 10, 15 MV X-rays was used to deliver 4,500 cGy to the whole pelvis followed by Sn cGy's small field boost to the tumor bed over 5.5 weeks. Sixteen patients received radiation therapy by traditional field margin determination, and the lower margin was set either at the low margin of the obturator foramen or at 2 cm to 3 cm below the anastomotic site, whichever is lower. In 72 patients, the lower margin was set at 2 cm to 3 cm below the anastomotic site, irrespectively of the obturator foramen, by which the reduction of radiation volume was possible in 55 patients ($76\%$). Authors evaluated and compared survival, local control, and disease-free survival rates of these two groups. Results : The median follow-up period was 27 months (range : 7-58 months). MAC stages B2 in 32($36\%$), B3 in 2 ($2\%$), Cl in 2 ($2\%$), C2 in 50 ($57\%$), and C3 in 2 ($2\%$) Patients, respectively. The entire patients' overall survival rates at 2 and 4 years were $94\%$ and $68\%$, respectively, and disease-free survival rates at 2 and 4 years were $86\%$ and $58\%$, respectively. The first failure sites were local only in 4, distant only in 14, and combined local and distant in 1 patient, respectively. There was no significant difference with respect to local control and disease-free survival rates ( p=0.42, p=0.68) between two groups of different lower margin determination policies. Conclusion : The new concept in the individualized determination of the lower margin depending on the anastomotic site has led to the equivalent local control and disease-free survival rates, and is expected to contribute to the reduction of unnecessary radiation-related morbidity by reduction of radiation volume, compared with the traditional method of lower margin determination.

• Radiation Oncology Journal
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• v.21 no.2
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• pp.118-124
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• 2003

Purpose: The goal of this study was to determine the role of postoperative radiation therapy in extrahepatic bile duct cancers. Materials and Methods: Between 1997 and 2001, 41 patients with extrahepatic bile duct cancer having undergone surgical resection were retrospectively analyzed. Of the 41 patients, 22 were treated by surgery alone (Group I) with remaining 19 treated by surgery and postoperative radiation therapy (Group II). A gross total surgical resection with pathologically negative margins was peformed in 11 of the patients (50$\%$) in Group 1, and in 7 of the patients (36.8$\%$) in Group II. There were no significant differences in the disease stage, surgical procedure or pathological characteristics of the two groups. The patients in group II received 45$\~$54 Gy (median: 50.4 Gy) of external beam radiation therapy to the tumor bed and draining nodal area. Results: The local failure rate was significantly higher In group I (54.5$\%$) than in group II (15.8$\%$)(p=0.01). Of the 12 failed patients in Group I and the 3 failed patients in group II, 7 and 3 had a positive resection margin. The overall 3-year survival rates were 38.3 and 38.9$\%$ and the 3-year disease free survival rates were 18.8 and 26.3$\%$ in groups I and II, respectively. However, the patients with positive resection margins who received adjuvant radiation therapy had higher 3-year overall survival rates than those with surgery alone (36.4$\%$ vs. 24.2$\%$, p=0.06), and 3-year disease free survival rate was significantly higher in the group II patients who had positive margins compared with those in group I (25.0$\%$ vs. 18.2$\%$, p=0.04). Conclusion: Postoperative adjuvant radiation therapy appeared to reduce the incidence of local failure in patients with extrahepatic bile duct cancer, and might improve the survival rate in the patients with positive resection margins.

• Journal of Gastric Cancer
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• v.6 no.1
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• pp.31-35
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• 2006

Purpose: A primary adenosquamous carcinoma of the stomach is relatively rare, accounting for only about 0.5% of all gastric cancers. However, its histopathologic characteristics are still unclear, and the most appropriate form of therapy has not been established yet. Materials and Methods: We retrospectively reviewed the clinicopathologic features of 8 patients with pathologically confirmed primary adenosquamous carcinomas out of 8,268 patients who underwent gastric cancer surgery at Samsung Medical Center between September 1994 and December 2004. Results: The median age of the 8 patients was 49 ($41{\sim}69$) years, and the male : female ratio was 5 : 3. In 3 patients, the tumor was located at the mid body of the stomach, and in 5 patients, at the lower body or antrum. The tumor sizes were $2.5{\sim}8cm$. Seven patients showed metastases to the regional lymph nodes. The UICC stage distribution were: 5 stage II, 2 stage III, and 1 stage IV. In the stage IV patient, a palliative gastrojejunostomy was performed, and he died 5 months after surgery. Of the 7 patients who underwent a radical gastrectomy and adjuvant chemotheratpy, the median survival was 34 ($12{\sim}66$) months, 2 patients died of cancer recurrence, and 4 patients are being followed up without evidence of recurrence. Conclusion: As for an adenocarcinoma of the stomach, a radical gastrectomy including regional lymph node dissection and postoperative adjuvant therapy should be performed for appropriate treatment of an adenosquamous carcinoma of the stomach.