• Tuberculosis and Respiratory Diseases
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• v.84 no.2
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• pp.105-114
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• 2021

Background: Complementary and alternative medicine (CAM) has been used frequently, and its use continues to increase in lung cancer patients, despite insufficient scientific of its efficacy. To investigate this situation, we analyzed the current awareness and use of CAM in Korean lung-cancer patients. Methods: This prospective survey-based study was performed at seven medical centers in South Korea between August and October 2019. The survey assessed general patient characteristics and the awareness and use of CAM. We analyzed differences in the clinical parameters of patients aware and not aware of CAM and of CAM non-users and users. Results: Of the 434 patients included in this study, 68.8% responded that they were aware of CAM and 30.9% said they had experienced it. In univariate analysis, the patients aware of CAM were younger with poor performance status, had advanced-stage lung cancer, received more systemic therapy, and received concurrent chemoradiation therapy (CCRT). By multiple logistic regression, younger age, poor performance status, advanced stage, and prior CCRT were identified as independent risk factors for CAM awareness. There were no significant differences in the general characteristics and cancer-associated clinical parameters of CAM non-users and users. Conclusion: Specific clinical parameters were associated with patients' awareness of CAM, although there were no significantly different characteristics between CAM users and non-users.

• Journal of The Korean Society of Clinical Toxicology
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• v.1 no.1
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• pp.51-55
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• 2003

Caustic ingestion can produce a progressive and devastating injury to the esophagus and stomach, In the acute stage, perforation and necrosis may occur. Long-term complications include esophageal stricture, antral stenosis and the development of esophageal cancer. Endoscopy should be performed as soon as possible in all cases to evaluate the extent and severity of damage, unless there is evidence of perforation. Endoscopy is the diagnostic procedure of choice. However, when the endoscopy cannot be passed through due to esophageal stricture, upper GI barium studies may be useful as a follow-up measure and in the evaluation of complications. A 44-year-old man visited our hospital complaining frequent vomiting 1 hour after ingestion of unknown amount of hydrochloric acid. At the time of arrival, the patient's oral cavity was slightly swollen and erythematous. On the endoscopic examination fourteen hour after the caustic ingestion, marked swelling of the arytenoids and circumferential ulceration with brown and black pigmentation at the upper esophagus were observed. Four weeks after the caustic injury, upper esophageal narrowing was observed and then the scope could not be advanced to the stomach. Upper GI barium study performed at that time revealed diffuse luminal narrowing of the esophagus and concentric luminal narrowing from prepyloric antrum to pylorus with disturbance of barium passage. At a week after the Upper GI study, through endoscopic examination after bougie dilatation of the esophagus, barium impaction in the stomach and the pylorus was noticed.

• Journal of Gastric Cancer
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• v.8 no.2
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• pp.97-103
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• 2008

Purpose: Radical surgery is the standard therapy for patients with resectable cardia cancer. In the case of type II disease with esophageal invasion, a transhiatal extended radical total gastrectomy is needed or a gastroesophagectomy through an abdomino-thoracotomy, depending on the extent of the esophageal invasion. We analyzed the indications and outcome of left colon interposition as an esophageal substitution. Materials and Methods: Between 1 January 1994 and 31 December 2006, 10 patients underwent left colon interposition after gastroesophagectomy through an abdomino-thoracotomy or the tanshiatal approach for type II cardia cancer at the Department of surgery, Yonsei University College of Medicine. The outcomes of these patients were reviewed and compared, with those who underwent a Roux-en-Y, by gender and age matched analysis, retrospectively. Results: There were nine males and one female with a mean age of 52.5 (range, 16~72). The operation time was $449.00{\pm}87.39minutes$. The mean distance between the proximal resection margin and the cancer was $6.56{\pm}3.65cm$; the maximum size of the tumor was $9.90{\pm}3.97cm$. These measures differed significantly from patients who underwent Roux-en-Y. The patients had a double primary cancer in the cardia and esophagus. There were no events of colon necrosis. However, a pneumothorax occurred in one patient (10%) and a proximal anastomotic stricture occurred in one patient. There were no reports of heartburn, regurgitation, thoracic or epigastric fullness, and one patient even gained weight, 16 kg. Conclusion: Colon interposition after esophagogastrectomy was safe and effective and should be considered as an additional surgical option for locally advanced type II cardia cancer patients with esophageal invasion.

• Journal of Chest Surgery
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• v.51 no.3
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• pp.187-194
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• 2018

Background: Death domain-associated protein (DAXX), originally identified as a pro-apoptotic protein, is now understood to be either a pro-apoptotic or an anti-apoptotic factor with a chromatin remodeler, depending on the cell type and context. This study evaluated DAXX expression and its clinical implications in squamous cell carcinoma of the esophagus. Methods: Paraffin-embedded tissues from 60 cases of esophageal squamous carcinoma were analyzed immunohistochemically. An immune reaction with more than 10% of tumor cells was interpreted as positive. Positive reactions were sorted into 2 groups: reactions in 11%-50% of tumor cells and reactions in more than 51% of tumor cells, and the correlations between expression and survival and clinical prognosticators were analyzed. Results: Forty-three of the 60 cases (71.7%) showed strong nuclear DAXX expression, among which 19 cases showed a positive reaction (31.7%) in 11%-50% of tumor cells, and 24 cases (40.0%) showed a positive reaction in more than 51% of tumor cells. A negative reaction was found in 17 cases (28.3%). These patterns of immunostaining were significantly associated with the N stage (p=0.005) and American Joint Committee on Cancer stage (p=0.001), but overall survival showed no significant difference. There were no correlations of DAXX expression with age, gender, or T stage. However, in stage IIB (p=0.046) and stage IV (p=0.014) disease, DAXX expression was significantly correlated with survival. Conclusion: This investigation found upregulation of DAXX in esophageal cancer, with a 71.7% expression rate. DAXX immunostaining could be used in clinical practice to predict aggressive tumors with lymph node metastasis in advanced-stage disease, especially in stages IIB and IV.

• Journal of Chest Surgery
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• v.36 no.6
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• pp.411-417
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• 2003

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, neoadjuvant therapy been used in an attempt to increase the long term survival but has not been shown as a clear advantage. We reviewed the recurrence and survival after complete resection of esophageal cancer without neoadjuvant therapy. Material and Method: From December 1994 to December 2001, 182 consecutive patients who underwent intrathoracic esophagectomy, transthoracic esophagogastrostomy and two-field lymph node dissection for esophageal canter without neoadjuvant therapy were studied retrospectively. Result: There were 167 men and 15 women. The median age was 65 years (range, 40 to 90 years). The tumor was located in the upper third part of the esophagus in 7 patients (3.8%), middle third in 86 (47.3%), and lower third in 89 (48.9%). The postsurgical stage were as follows: stage 0 in 2 patients (1.1%), stage I in 32 (17.6%), stageIIA in 47 (25.8%), stage IIB in 25 (13.7%), stage III in 54 (29.7%), stage IVA in 10 (5.5%), and stage IVB in 12 (6.6%). The in-hospital mortality rate was 3.8% (7 patients) and complications occurred in 65 patients (35%), Follow-up was complete in 95.6%. The recurrence occurred in 56 patients (30.8%) and the overall 5-year disease free rate was 55%. The overall 5-year survival rate was 57%; it was 80% for patients in stage I, 65% in stage IIA, 58% in stage IIB, 48% in stage III, and 40% in stage IVB. The overall 5-year survival rate of patients with postoperative adjuvant therapy was 59% compared to 34% in patients without postoperative adjuvant therapy (p<0.05). Conclusion: The most effective therapy for esophageal cancer may be complete resection. More aggressive surgical therapy and adjuvant therapy may improve the long-term survival, even for advanced stage esophageal cancer.

• Journal of Chest Surgery
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• v.50 no.5
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• pp.329-338
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• 2017

Background: The clinical value of 3-field lymph node dissection (3FLND) in esophageal squamous cell carcinoma (ESCC) remains controversial. This study aimed to identify the patterns and prognostic significance of cervical lymph node metastasis (CLNM) in ESCC. Methods: A retrospective review of 77 patients with E SCC who underwent esophagectomy and 3FLND between 2002 and 2016 was conducted. For each cervical node level, the efficacy index (EI), overall survival, recurrence rate, and complication rate were compared. Results: CLNM was identified in 34 patients (44.2%) who underwent 3FLND. Patients with CLNM had a significantly lower overall survival rate (22.7% vs. 58.2%) and a higher recurrence rate (45.9% vs. 16.3%) than patients without CLNM. CLNM was an independent predictor of recurrence in ESCC patients. Moreover, in patients with pathologic N3 tumors, the odds ratio of CLNM was 10.8 (95% confidence interval, 2.0 to 57.5; p=0.005). Level IV dissection had the highest EI, and level IV metastasis was significantly correlated with overall survival (p=0.012) and recurrence (p=0.001). Conclusion: CLNM was a significant prognostic factor for ESCC patients and was more common among patients with advanced nodal stages. Level IV exhibited the highest risk of metastasis, and dissection at level IV may be crucial when performing 3FLND, especially in advanced nodal stage disease.

• Radiation Oncology Journal
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• v.18 no.1
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• pp.11-16
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• 2000

Purpose :We peformed the retrospective analysis to find the outcome of external beam radiotherapy alone in advanced esophageal cancer patients. Methods and Materials : One hundred and six Patients treated with external beam radiotherapy alone between July 1990 and December 1996 were analyzed retrospectively. We limited the site of the lesions to the thoracic esophagus and cell type to the squamous cell carcinoma. Follow-up was completed in 100 patients (94$\%$) and ranged from 1 month to 92 months (median; 6 months). Results :The median age was 62 years old and male to female ratio was 104 2. Fifty-three percent was the middle thorax lesion and curative radiotherapy was peformed in 83$\%$. Mean tumor dose delivered with curative aim was 58.6 Gy (55$\~$70.8 Gy) and median duration of the radiation therapy was 53 days. The median survival of all patients was 6 months and )-year and 2-year overall survival rate was 27$\%$ and 12$\%$, respectively, Improvement of dysphagia was obtained in most patients except for 7 patients who underwent feeding gastrostomy. The complete response rate immediately after radiation therapy was 32$\%$ (34/106). The median survival and 2-year survival rate of the complete responder was 14 months and 30$\%$ respectively, while those of the nonresponder was 4 months and 0$\%$ respectively (p=0.000). The median survival and 2-year survival rate of the patients who could tolerate regular diet was 9 months and 16$\%$ while those of the patients who could not tolerate regular diet was 3 months and 0$\%$, respectively (p=0.004). The survival difference between the patients with S cm or less tumor length and those with more than 5 cm tumor length was marginally statistically significant (u=0,06). However, the survival difference according to the periesophageal invasion or mediastinal tyrnphadenopathy in the chest CT imaging study was not statistically significant in this study. In a multivariate analysis, the statistically significant covariates to the survival were complete response to radiotherapy, tumor length, and initial degree of dysphagia in a decreasing order. The complication was observed in 10 patients (9$\%$). Conclusion :The survival outcome for advanced esophageal cancer patients treated by external beam radiotherapy alone was very poor. In the treatment of these patients, the brachytherapy and chemotherapy should be added to improve the treatment outcome.

• Radiation Oncology Journal
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• v.14 no.1
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• pp.17-23
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• 1996

Purpose : To evaluate the role of combination therapy of external radio-therapy and chemotherapy in the management of advanced esophageal cancer as a primary treatment compared with radiation therapy alone. Materials and Methods : A retrospective review of evaluable 55 esophageal cancer patients referred to the Department of Therapeutic Radiology, Paik Hospital for the external radiotherapy between Jul, 1983 and Dec. 1994 was undertaken. Combined therapy patients (A group) were 30 and radiation alone patients (B group) were 25. Median age was 60 years old in A group (ranges : 42-81) and 65 years old in B group (ranges : 50-81). The male patients were 53. The fifty patients had squamous cell carcinomas. Radiation doses of 2520-6480c0y were delivered over a period of 4-7weeks, using 4MV LINAC. Chemotherapy was administered in bolus injection before, after, or during the course of external radiotherapy. The local control rate and patterns of failure according to both treatment modalities and 1, 2 year survival rates according to prognostic factors (stage, tumor length, radiation dose etc.) were analysed. Resuts : Median follow up Period was 7 months (range : 2-73 months). Median survival was 7.5 months (20 days-29 months) in A group and 5 months (20 days-73 months) in B group. The 1, 2 YSRs were $26.7\%$, $8.9\%$ in A group, $12.7\%$, $4.3\%$ in B group (p>0.05), respectively. The 1, 2 YSRs according to stage(II/III), tumor length (5cm more or less). radiation dose (5000cGymore or less) of A and B group were analyzed and the differences of survival rates of both treatments were not statistically significant. But among group B, patients who received 5000cGy or more showed significant survival benefits (p<0.05). The treatment response rates of A and B group were $43.8\%$. $25.0\%$, respectively. Complete response rate of $25.0\%$ in A and $8.3\%$ in B were achieved. The local failure and distant metastsis were $52.4\%$. $23.8\%$ in A group, $64.3\%$, $14.3\%$ in 8 group, respectively. The combination therapy revealed more frequent leukopenia and nausea/vomiting than radiation alone group, but degree of side effects was only mild to moderate. Conclusion : The combined external radiotherapy and chemotherapy for advanced esophageal cancer appears to improve the response rate, local control rate and survival rate, but the improvement was not statistically significant. The side effects of combined modalities were mild to moderate without significant morbidity. Therefore it may be worthwhile to continue the present combined external radiotherapy and chemotherapy in the management of advanced esophageal cancer to confirm our result.

• Radiation Oncology Journal
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• v.16 no.4
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• pp.447-454
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• 1998

Purpose : This study evaluated the survival, local control, prognostic factor, and failure pattern of patients with esophageal cancer treated with operation and adjuvant radiation therapy to use as fundermental data of postoperative radiation therapy. Materials and Methods : A retrospective analysis was undertaken of 82 patients who had locally advanced esophageal cancer treated with operation and adjuvant radiation therapy from January 1988 to December 1995. According to AJCC staging, stage IIA were in 26 patients, stage IIB in 4 patients, and stage III in 52 patients. Squamous cell carcinoma were in 77 patients, adenosquamous carcinoma in 3 patients, and adenocarcinoma in 2 patients. The patients received radiation therapy ranging from 41.0 Gy to 64.8 Gy. Five patients received neoadjuvant chemotherapy. Results : Two-year survival and local control rates for all patients were 36.8$\%$ and 30.4$\%$ respectively. And they were 9.3$\%$ and 26.3$\%$ respectively at 5 years. According to stages, 2-year survival rates were 50.2$\%$ in IIA, 0$\%$ in IIB and 23.3$\%$ in III (p=0.004). Two-year local control rates were 49.2 $\%$ in IIA, 66.6$\%$ in IIB and 24.7$\%$ in III (p=0.01). Sixty patients developed recurrence, which were 3 tumor margin, 23 lymph node recurrence, 4 tumor margin and lymph node, 1 tumor margin and distant metastasis, 9 lymph node and distant metastasis, 17 distant metastasis and 3 unknown metastatic site. Prognostic factors affecting survival were smoking (p=0.02), T-staging (p=0.0092), N-staging (p=0.0045). Prognostic factors affecting local control were T-staging (p=0.019), N-staging (p=0.047). Conclusion : In spite of post-operative radiation therapy, predominant failure pattern was local failure. Especially regional lymph node failure was major cause of local failure. So strategy of aggresive adjuvant radiation therapy to regional lymph node area in post operative treatment should be proposed.

• Journal of Gastric Cancer
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• v.24 no.3
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• pp.267-279
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• 2024

Purpose: The optimal treatment for gastroesophageal junction adenocarcinoma (GEJA) remains controversial. We evaluated the treatment patterns and outcomes of patients with locally advanced GEJA according to the histological type. Materials and Methods: We conducted a single-institution retrospective cohort study of patients with locally advanced GEJA who underwent curative-intent surgical resection between 2010 and 2020. Perioperative therapies as well as clinicopathologic, surgical, and survival data were collected. The results of endoscopy and histopathological examinations were assessed for Siewert and Lauren classifications. Results: Among the 58 patients included in this study, 44 (76%) were clinical stage III, and all received neoadjuvant therapy (72% chemoradiation, 41% chemotherapy, 14% both chemoradiation and chemotherapy). Tumor locations were evenly distributed by Siewert Classification (33% Siewert-I, 40% Siewert-II, and 28% Siewert-III). Esophagogastrectomy (EG) was performed for 47 (81%) patients and total gastrectomy (TG) for 11 (19%) patients. All TG patients received D2 lymphadenectomy compared to 10 (21%) EG patients. Histopathological examination showed the presence of 64% intestinal-type and 36% diffuse-type histology. The frequencies of diffuse-type histology were similar among Siewert groups (37% Siewert-I, 36% Siewert-II, and 33% Siewert-III). Regardless of Siewert type and compared to intestinal-type, diffuse histology was associated with increased intraabdominal recurrence rates (P=0.03) and decreased overall survival (hazard ratio, 2.33; P=0.02). With a median follow-up of 31.2 months, 29 (50%) patients had a recurrence, and the median overall survival was 50.5 months. Conclusions: Present in equal proportions among Siewert types of esophageal and gastric cancer, a diffuse-type histology was associated with high intraabdominal recurrence rates and poor survival. Histopathological evaluation should be considered in addition to anatomic location in the determination of multimodal GEJA treatment strategies.