• The Journal of the Korean bone and joint tumor society
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• v.12 no.1
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• pp.30-36
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• 2006

Purpose: Epitheliod sarcoma is an obscure clinical entity. This study analyzes the correlation between the clinical course and the AJCC stage, presence of residual tumor and ezrin-expression. Materials and Methods: Twenty-three cases of epithelioid sarcoma were eligible. All the cases had operation. Fifteen cases had systemic chemotherapy and 6 cases had adjuvant radiotherapy. Immumohistochemical analysis was done for 15 cases. Analyzed factors were initial stage, adjuvant treatment, local recurrence, residual tumor immumohistochemical results and surgical margin. Results: The event free survival rate of 15 stage II, III cases was 47.4% at 129 months. The actual survival rate of 8 stage IV cases was 37.5% at 80 months. The presence of residual tumor tissue on re-excision specimen showed statistical significance on event free survival rate(P=0.03). Adjuvant therapy showed no impact on outcome. The stage IV and locally recurrent cases had a positive relation with Ezrin-positivity. Conclusion: Residual tumor showed correlation in the outcome of epitheliod sarcoma. Chemotherapy and radiation therapy did not affect the outcome. Further case collection and analysis is needed for the significance between Ezrin expression and clinical behavior.

• Radiation Oncology Journal
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• v.8 no.2
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• pp.199-205
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• 1990

During a ten-year period from 1978 through 1987, 44 patients with T2NOMO glottic cancer were treated with radical radiation therapy at the Yonsei University Medical Center. Forty-two patients had a minimum follow-up of 3 years, and $81\%$ had at least five years of follow-up. Patients were staged according to the AJCC system. Forty-two patients have been analyzed in detail with respect to two variables: the status of vocal cord mobility and the degree of local extension of the disease. Five-year local recurrence free survival rates were as follows: All 42 patients, $53.3\%$ patients with normal vocal cord mobility (n =18), $69.1\%$ versus patients with impaired vocal cord mobility (n=24), $43.4\%$(p<0.05); patients with subglottic extension (n=15), $36.7$ versus patients without subglottic extension (n=29), $61.9\%$ (p<0.05). The most favorable Prognostic group included the patients with normal mobility without subglottic extension (n=14), $83.1\%$. On the basis of this analysis, we confirmed the presence of heterogeneity in T2NOMO glottic cancer This study indicates that further randomized controlled trials are warranted to evaluate.

• Radiation Oncology Journal
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• v.12 no.3
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• pp.307-313
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• 1994

Purpose : Maxillary sinus cancers usually are locally advanced and involve the structures around sinus. It is uncommon for this cancer to spread to the regional lymph-nodes. For this reason, local control is of paramount important for cure. A policy of combined treatment is generally accepted as the most effective means of enhancing cure rartes. This paper reports our experience of a retrospective study of 31 Patients treated with radiation therapy alone and combination therapy of surgery and radiation. Materials and Methods: Between July 1974 and January 1992, 47 Patients with maxillary sinus cancers underwent either radiation therpay alone or combination therapy of surgery and radiation. Of these, only 31 patients were eligible for analysis. The distribution of clinical stage by the AJCC system was $26\%$(8/31) for T2 and $74\%$(23/31) for T3 and T4. Eight patients had palpable lymphadenopathy at diagnosis. Primary site was treated by Cobalt-60 radiation therapy using through a $45^{\circ}$ wedge-pair technique. Elective neck irradiation was not routinely given. Of these 8 patients, the six who had clinically involved nodes were treated with definite radiation therapy. The other two patients had received radical neck dissection. The twenty-two patients were treated with radiation alone and 9 patients were treated with combination radiation therapy, The RT alone patients with RT dose less than 60 Gy were 9 and those above 60 Gy were 13. Results : The overall 5 year survival rate was $23.8\%$. The 5 year survival rate by T-stage was $60.5\%$ and $7.9\%$ for T2 and T3,4, respectively. Statistical significance was found by T-stage(p<0.005). The 5 year survival rate by N-stage was $30\%$ for N (-) and $8.3\%$ for N(+), but statistically no significant difference was seen(p${\geq}$0.1). The 5 year survival rate for RT alone and combination RT was $22.5\%$ and $27.4\%$, respectively. The primary local control rate was $65\%$ (20/31). Conclusion : This study did not show significant difference in survival between RT alone and combination RT. There is still much controversy with regard to which treatment is optimum. Improved RT technique and development of multimodality treatment are essential to improve the local control and the survival rate in patients with advanced maxillary sinus cancer.

• Journal of Chest Surgery
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• v.34 no.2
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• pp.138-147
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• 2001

배경: 폐암발생에 EGF의 자가 분비는 암의 성장과정에 직, 간접적인 영향을 주고 있으며, TNF-$\alpha$는 면역 반응의 급성체로서 폐암의 발생을 억제하고 이미 발생한 폐암종의 치료에도 이용되고 있는 실정이다. 폐암 조직과 혈장에서 epidermal growth factor(EGF)와 tumor necrosis factor-$\alpha$(TNF-$\alpha$)를 면역 방사선 분석법을 이용하여 정량분석 하여 발현 정도를 분석해보고자 하였다. 대상 및 방법: 폐암환자 20례와 양성종양 및 육아종 환자 4례에 대해서 AJCCS에 의한 조직학적 분류와 TNM 분류에 따라 구분하여 절제수술을 받은 환자를 대상으로 수술전 혈액을 채취하고 수술직후 적출한 표본을 암이 없는 건강하다고 판단되는 대조조직과 폐암조직에서 일정량의 조직을 절취하여 액화질소 내에 실험시까지 급속 냉동보관 하였다. 수술후 혈액을 재 채취하여 혈장을 분리하여 냉동고에 검사시까지 보관하였다. EGF의 정량은 Human Epidermal Growth Factor kit(Amersham Phamacia Biotech, England)를 사용하였으며, TNF-$\alpha$ 정량은 TNF-$\alpha$ IRMA kit(Biosouce, Belgium)을 사용하여 IRMA 방법으로 각각 정량분석하여 표현유무를 연구한 결과 다음과 같은 결론을 얻었다. 결과: 1. 대조조직, 양성종양 및 육아종과 폐암 수술전후의 조직과 혈청 모두에서 EGF와 TNF-$\alpha$가 발현되었다. 2. EGF와 TNF-$\alpha$의 농도는 대조조직과 양성종양(0.11$\pm$0.06 ng/ml, 20,3$\pm$9.08 pg/ml)에 비하여 폐암조직(0.13$\pm$0.05 ng/ml, 34.34$\pm$47.74pg/ml)에서 유의하게 높은 농도가 발현되고 있었다. 3. 폐암중 선암조직에서 특히 TNF-$\alpha$(80.92$\pm$104.08 ng/ml)의 발현이 강하게 나타났다. 4. 혈청내의 EGF와 TNF-$\alpha$의 발현되는 양이 조직내의 양보다도 높았다. EGF는 5.7배정도 TNF는 1.3배정도 강하게 표현되었다. 5. 폐암의 조직학적 종류에 따라서 EGF는 거의 차이가 없었으나 TNF-$\alpha$ 정량치에는 차이가 있었다. 6. TNM stage가 진행함에 따라 EGF는 농도가 증가하였고 TNF-$\alpha$는 오히려 감소하는 반대되는 교차현상이 있었다. 7. 수술직후 EGF는 증가하였으나 TNF-$\alpha$는 오히려 감소하였다. 결론: 결론적으로 저자는 암조직과 대조조직간에 EGF와 TNF-$\alpha$의 표현량의 차이가 있음을 관찰하였으며 또한 조직과 혈청사이에도 표현량에 차이가 있으며 조직보다도 오히려 혈청내의 농도가 높다는 사실을 관찰하였다. EFG와 TNF-$\alpha$는 정상조직이나 양성조직과 폐암조직 모두에서 분비작용되는 cytokines으로 세포기능에 따라 다양하게 표현이 되며 계속적인 연구로서 밝혀야만 할 과제라고 판단된다.

• Korean Journal of Head & Neck Oncology
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• v.17 no.2
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• pp.185-189
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• 2001

Background: Cervical metastasis of unknown origin is defined as histologic evidence of malignancy in the cervical lymph nodes with no apparent primary site of origin for the metastatic tumor. Patients and Methods: A retrospective review of 20 cervical metastasis of unknown origin diagnosed and managed between january 1989 and December 1999 at the Korea University was undertaken to determine outcome. Patient age ranged 46 to 78 years (mean 60). There were 17 men and 3 women. The aim of this study is to ananlyze the diagnostic approach and the result of treatment of the cervical metastasis of unknown origin. Result: Histopathologically, squamous cell carcinoma (15 case, 75%) were the most common, followed by adenocarcinoma (4 case, 20%), undifferentiated carcinoma (1 case, 5%) According to the criteria of the AJCC on staging, N1 was 2 cases, N2a 2 cases, N2b 5 cases, N2c 1 cases, N3 10 cases. Overall survival rate for all patients at 2 years was 45% and 5 years 25%, and in the combination therapy(surgery and radiotherapy group (12 cases)) it was 67% and 34% respectively, high compared with other treatment modality such as surgery or radiotherapy alone. In extracapsular spread positive group, 5 year survival rate was 12%, but was 33% in the extracapsular spread negative group. Conclusion: With no stastatical significance, extracapsular spread group was poor outcome in our study. Combination of radiotherapy and surgery was more effective treatment result than surgery alone or radiotherapy alone in our study. But, overall prognosis of cervical metastasis of unknown origin was very poor despite aggressive treatment (5 year survival rate: 25%).

• The Journal of the Korean life insurance medical association
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• v.25
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• pp.9-24
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• 2006

지속적으로 증가 하고 있는 악성 종양 발병률의 증가, 생존률의 향상, 조기발견의 증가 등이 암 기왕자의 보험 수요 상승을 가져오고 있으며, 보험시장에서 더 이상 암 기왕자를 도외시하기 어렵게 만들고 있다. 그러나, 현재 국내에서는 암 기왕자를 인수할 수 있는 상품과 언더라이팅 인수 기법이 부족한 실정이다. 본 논문은 이러한 상황 하에서 기존에 거절체로 인식되었던 암 기왕자의 적극적인 인수를 위해 악성종양에 대한 보험 의학적인 고찰과 사망률, 위험도에 대해 분석하고, 국내에서 암 기왕자의 보험 인수 시 문제점과 그 해결방안을 모색해 보았다. 종양은 종양세포의 성장과 확산의 정도를 나타내는 병기와 조직학적 등급에 의해 그 예후와 경과가 예측 가능하며, 이 병기를 표준화하려는 국제적 시도로 1977년 American Joint Committee on Cancer(AJCC)는 TNM system 을 제시하였다. 병기를 기초로 치료의 결정도 함께 이루어지는데, 주요 치료법을 수술, 방사선치료, 항암치료, 면역요법이 있다. 이러한 치료법들은 후기 부작용을 일으키거나 이차성 암(Secondary malignant neoplasm)의 원인이 되기도 한다. 병기에 따른 암환자의 사망률을 살펴 보면, 암은 일정시기 동안 사망률이 급격히 증가하다가 이후에 점차 사망률이 감소하고, 그 이후에는 사망률에 영향을 미치지 않는다. 이러한 사망률 변화의 특성은 암 기왕자에게 평준식 정액 할증법(Per mille flat extra)의 적용이 적절함을 보여준다. 그러나, 현재 국내에서는 악성 종양 기왕자를 위한 상품이 전무한 상태이며, 암의 병리적 병기와 치료에 관련된 정보를 얻을 수 있는 도구도 부족하고, 명확한 인수 기법이 없다. 또한, 자체의 경험통계의 부족으로 위험에 대한 부담감이 큰 것이 현실이다. 하지만, 병기에 따른 사망률의 변화에서도 알 수 있듯이 평준식 정액 할증법의 도입이나, 악성종양의 병기(Stage)별 정액 할증률을 삭감법으로 전환하는 기준을 개발한다면, 종신보험은 충분히 인수가 가능하다. 또한, CI 보험도 암에 대한 부담보를 하는 선진사의 인수 기법을 도입하거나, 암 기왕자만을 위한 CI 상품을 개발하는 등 새로운 인수 기법을 모색한다면, 암기왕자 인수의 폭은 넓어질 것이다. 이와 같은 노력과 함께, 언더라이팅의 정보 획득을 위한 암 기왕자만의 고지서를 개발하고, 전문 언더라이터의 양성을 위한 노력을 게을리 하지 않는다면, 암기왕자를 적극적으로 인수할 수 있을 것이다. 앞으로 국내 보험사가 위와 같은 노력을 지속적으로 해 나가고, 비교적 예후와 경과가 양호한 0기와 1기 암 기왕자부터 단계적으로 종신보험의 인수를 시도한다면, 비교적 안전하게 경험치를 축적할 수 있을 것이다. 뿐만 아니라 국내 보험업계는 새로운 시장의 확보와 보험에 대한 대외 이미지 개선이라는 효과도 함께 얻게 될 것이다.

• Korean Journal of Bronchoesophagology
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• v.5 no.2
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• pp.191-197
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• 1999

Background and Objective : Soft palate plays a great role in function of speech and swallowing. Ablation of tonsil cancer results in multi-demensional defect including soft palate in most cases and restoration of the postoperative oral cavity function is a continuing surgical challenge. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for these defect, which offers a thin, pliable, and relatively hairless skin, and a long vascular pedicle. The aim of the present study is to report the speech and swallowing function test results of our 5 consecutive radial forearm free flaps used for tonsil cancers. Materials and Methods : We reviewed the medical records of 5 patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for tonsil cancers, from Dec. 1997 to Oct. 1998, and analyzed the surgical methods, complications, and speech and swallowing function test results. We have examined with modified barium swallow to evaluate postoperative wallowing function and articulation and resonance test for speech. Results : The tumor sizes by TNM stage(AJCC, 1997) were T1(1), T2(2), and T4(3). The paddles of flaps were tailored in multilobed designs from oval shape to pentalobed design and in variable size from 24$cm^2$ to 108$cm^2$(average size = 78.4$cm^2$), according to the defect after ablation. This procedures resulted in satisfactory flap success and functional results all but 1 case of flap contracture in 2 postoperative week, achieved early oral diet until 16-57 postoperative day(average, 28 days) and social speech. The oropharyngeal defect including soft palate reconstruction with radial forearm free flap might be an excellent method for the maximal functional results, after ablative surgery of tonsil cancer that results in multidimensional defect.

• Korean Journal of Bronchoesophagology
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• v.15 no.2
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• pp.49-56
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• 2009

Purpose : To evaluate the treatment outcome for patients with locally advanced, unresectable esophageal cancer treated with relatively high dose radiation therapy(RT). Materials and Methods : From January 2000 to December 2008, 32 patients with locally advanced unresectable or medically inoperable esophageal cancer were treated with radiation therapy(RT) with or without concurrent chemotherapy. Ten patients were excluded from analysis because of distant metastasis and drop off. Patient distributions according to AJCC stages II, III IVa were 7(31.8%), 12(54.6%), 3(13.6%) respectively. The locations of tumor were cervical/upper thorax 3 (13.6%), mid thorax 13(59.1%), and lower thorax/abdominal 6(27.3%), respectively. Eleven patients received RT only, and 11 patients received cisplatin based concurrent chemoradiotherapy(CCRT). Median radiation dose was 65 Gy(range 57.6~72 Gy). Results : The median follow-up was 9.1 months(range 1.9~43.8 months). The response rates for complete response, Partial response, stable disease and Persistent disease were 6(27.3%), 11(50.0%), 4(18.2%) and 1(4.5%), respectively. Two patients(9.1%) suffered from esophageal stenosis and stents were inserted. Two patients(9.1%) had Grade 3 radiation pneumonitis and one of them expired due to acute respiratory distress syndrome(ARDS) at 36 days after completion of radiation therapy. The recurrence rate was 11(50.0%). The patterns of recurrence were persistent disease and local progression in 5(22.7%), local recurrence 3(13.7%) and concomitant local and distant recurrence in 3(13.7%). The overall survival(OS) rate was 32.1% at 2 years and 21.4% at 3 years(median 12.0 months). Disease free survival(DFS) rate was 17.3% at 2 and 3 years. All patients who had no dysphagia at diagnosis showed complete response after treatment and 100% OS at 3 years(p=0.0041). The OS for above 64.8 Gy group and 64.8 Gy or below group at 3 years were 60.6% and 9.1%(p=0.1341). The response to treatment was the only significant factor affecting OS(p=0.004). Conclusion : Relatively high dose radiation therapy in unresectable esophageal cancer tended to have a better outcome without increased complication rate. Further study with more patients is warranted to justify improved result.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.217-223
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• 1996

A retrospective analysis was performed to assess the relationship between the treatment modalities and treatment results in patients with adenoid cystic carcinoma of the maxillary sinus. From Feb. 1977 to March 1994, 10 patients with the disease were treated at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine. Six men and 4 women were presented with median age of 57 years. According to AJCC TNM system, all patients except one had advanced T3 and T4 disease. Only one patient had the regional metastasis to lymph node but none of them had hematogenous metastasis on initial admission. One patient(Group 1) was treated with surgery alone, 3 patients(Group 2) were treated with definitive radiotherapy and 6 patients(Group 3) were treated with combination of surgery and radiotherapy. One patient who was treated with surgery alone had experienced a locoregional recurrence 9 months later and 3 patients who were treated with radiation therapy alone had PRs(partial response) followed by the subsequent progression of the local disease. Whereas all patients who were treated with combination of surgery and radiation therapy had CRs(complete response). Among them, only one patient was recurred in the primary site, who was salvaged by reoperation and reirradiation therapy. In conclusion, combination of surgery and radiotherapy resulted in the best treatment modality for adenoid cystic carcinoma of the maxillary sinus. Improved radiotherapy technique and development of multimodality treatment are needed to improve the local control and the survival rate in patients with advanced adenoid cystic carcinoma of the maxillary sinus.

• Asian Pacific Journal of Cancer Prevention
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• v.15 no.20
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• pp.8871-8876
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• 2014

Background: Postoperative chemoradiotherapy (CRT) of gastric carcinoma improves survival among high-risk patients. This study was undertaken to analyse long-term survival probability and the impact of certain covariates on the survival outcome in affected individuals. Materials and Methods: Between January 2000 and December 2005, 244 patients with gastric cancer underwent adjuvant radiotherapy (RT) in our institution. Data were retrieved retrospectively from patient files and analysed with SPSS version 21.0. Results: A total of 244 cases, with a male to female ratio of 2.2:1, were enrolled in the study. The median age of the patients was 52 years (range, 20-78 years). Surgical margin status was positive or close in 72 (33%) out of 220 patients. Postoperative adjuvant RT dose was 46 Gy. Median follow-up was 99 months (range, 79-132 months) and 23 months (range, 2-155 months) for surviving patients and all patients, respectively. Actuarial overall survival (OS) probability for 1-, 3-, 5- and 10-year was 79%, 37%, 24% and 16%, respectively. Actuarial progression free survival (PFS) probability was 69%, 34%, 23% and 16% in the same consecutive order. AJCC Stage I-II disease, subtotal gastrectomy and adjuvant CRT were significantly associated with improved OS and PFS in multivariate analyses. Surgical margin status or lymph node dissection type were not prognostic for survival. Conclusions: Postoperative CRT should be considered for all patients with high risk of recurrence after gastrectomy. Beside well-known prognostic factors such as stage, lymph node status and concurrent chemotherapy, the type of gastrectomy was an important prognostic factor in our series. With our findings we add to the discussion on the definition of required surgical margin for subtotal gastrectomy. We consider that our observations in gastric cancer patients in our clinic can be useful in the future randomised trials to point the way to improved outcomes.