• Radiation Oncology Journal
• /
• 제20권1호
• /
• pp.62-67
• /
• 2002

목적 : 항문암의 치료에 있어 고전적으로는 복회음부절제술이 주된 치료였으나 현재는 화학방사선병용요법이 주된 치료방법으로 정립되었다. 저자들은 서울대학교병원에서 항문암으로 치료 받은 환자의 임상적 특성을 조사하고, 치료방법에 따른 치료성적과 예후인자를 분석하고자 하였다. 대상 및 방법 : 1979년 8월부터 1990년 7월까지 서울대학교병원 치료방사선과에서 근치적 또는 수술 후 방사선 치료를 받은 42명의 환자를 대상으로 후향적으로 분석하였다. 표피양암종이 38명으로 방사선치료가 4명에서, 복회음부절제술 및 수술 후 방사선치료${\pm}$화학요법이 19명에서, 화학방사선요법이 15명에서 시행되었다. 화학방사선요법은 복합화학요법$(5-FU\;1,000\;mg/m^2\;D1\~5,\;cisplatin\;60\;mg/m^2\;D1)$을 3회 시행 후 원발병소 및 영역림프절에 50.4 Gy를 조사하였고, 양측 서혜림프절에도 동일양을 조사하였다. 잔존암이 있는 경우 복합화학요법을 3회 추가 실시하였다. 중앙추적기간은 85개월이었다. 결과 : 전체 항문암 환자의 5년 생존율은 $80.3\%$이었다. 치료방법에 따른 5년 생존율은 복회음부절제술 및 수술 후 방사선치료${\pm}$화학요법군, 화학방사선요법군에서 각각 $88.9\%,\;79.4\%$이었으며 두군간의 생존율의 차이의 통계적인 의미는 없었다(p=0.495). 화학방사선요법을 시행 받은 환자군에서의 항문보존율은 $86.7\%$였다. 예후인자 중 단변량분석에서는 연령(p=0.0164)과 수행능력(p=0.0007)이 유의성을 보였으며, 다변량분석에서는 연령(p=0.0426)과 수행능력(p=0.0068) 및 서혜림프절 전이여부(p=0.0093)가 통계학적으로 유의하였다. 결론 : 항문암의 치료에 있어서 화학방사선요법을 시행할 경우 기존에 알려진 바와 같이 복회음부절제술과 유사한 생존율을 보이며, 항문기능을 보존할 수 있는 치료 방법임을 확인할 수 있었다. 나아가 병행화학요법이 아닌 선행화학요법을 시행하여 수반되는 합병증을 줄일 수 있는 가능성을 확인하였다.

• Tuberculosis and Respiratory Diseases
• /
• 제42권5호
• /
• pp.731-736
• /
• 1995

연구배경: 제1기 비소세포폐암의 경우 근치적절제술이 최선의 치료법이나 환자가 수술을 거부하거나 폐질환 또는 순환기질환과 같은 기저질환으로 수술을 할 수 없는 경우에는 근치적 방사선 요법이 차선의 치료법이다. 그러나 근치적 방사선치료 과 외과적 절제술후 치료성적에 관해서는 논란이 많다. 방법: 저자들은 경북대학교병원에서 1986년 6월부터 1992년 12월까지 제1기 비소세포폐암으로 진단받았으나 방사선치료를 받았던 15예와 1989년 1월부터 1992년 12월까지 제1기 비소포폐암으로 진단받고 외과적 절제술만을 시행하였던 24예를 대상으로 후향성조사(retrospective study)를 통하여 이들의 치료경험 및 생존율을 검토하였다. 생존율과 생존기간은 Kaplan-Meier 방법으로 산출하였다. 결과: 대상 환자들중 방사선치료를 받은 이유는 폐기능이 나쁜 경우가 8예, 수술을 거부한 경우가 5예, 수행상태가 나쁜 경우가 2예였다. 중간생존기간은 수술을 받은 군이 37.7개월, 방사선치료를 받은 군이 14.9개월이었다. 방사선치료를 받은 군 가운데 수술을 거부한 경우는 17.9개월, 폐기능이 나쁘거나 수행상태가 나쁜 경우는 10.5개월이었다. 수출을 받은 군의 2년 생존율은 65%, 5년 생존율은 41%, 방사선치료를 받은 군의 2년 생존율은 22%, 5년생존율은 없었다. 결론: 제1기 비소세포폐암에서 수술전후 효과적인 치료를 한다면 여러가지 이유로 수술이 힘든 경우라도 근치적절제술이 최선의 치료법이다. 그러나 수술을 시행하지 못할 경우 차선의 치료법으로 방사선치료를 시행할 수 있으며, 향후 전향성조사가 필요하리라 생각된다.

• Radiation Oncology Journal
• /
• 제20권3호
• /
• pp.215-220
• /
• 2002

목적 : $T_2,\;T_3$ 하부직장암에서 항문 괄약근 보전술을 위한 수술 전 방사선치료를 시행하여 그에 따른 효과를 알아보고자 하였다. 대상 및 방법 : 1995년 11월부터 1997년 6월까지 하부 직장암으로 진단받고 수술 전 방사선치료 후 항문 괄약근 보존술을 시행한 15례를 대상으로 하였다. $T_2$가 7례, $T_3$는 8례였다. 방사선치료는 선형가속기 6 MV와 15 MV X-ray를 이용하여 주 5회, 1회 1.8 Gy로 총 조사선량은 $45\~50.4\;Gy$까지 조사하였다(중앙선량:50.4 Gy). 항문 괄약근 보존술은 방사선치료 후 $4\~6$주 뒤에 시행하였다. 추적관찰기간은 $16\~37$개월이었고 중앙값은 22개월이었다. 결과 : 1례$(6.7\%)$에서 수술 후 병리학적으로 병변의 완전 소실을 보였다. 수술 전 임상 소견과 수술 후 병리학적 소견을 비교시, 1병기는 15례 중 11례$(73.3\%)$에서 병기감소를 보였으며 림프절 전이가 관찰되었던 5례 중 2례에서 림프절이 관찰되지 않았다. 치료동안에 병변이 진행된 경우는 없었다. 국소 재발은 2례$(13.3\%)$로 방사선치료 후 7개월, 17개월에 각각 발생하였으며 그 중 1명은 방사선치료 후 30개월 때 원격전이를 보였다. 합병증으로 Grade 3 또는 4는 없었다. 결론 : $T_2,\;T_3$ 하부직장암에서 항문 괄약근 보존술을 위한 수술 전 방사선치료가 비교적 안전하고 병변을 줄이는데 효과적인 치료방법임을 알 수 있었다.

• Asian Pacific Journal of Cancer Prevention
• /
• 제16권16호
• /
• pp.7025-7029
• /
• 2015

Background: The optimal sequence and extent of multimodality therapy remains to be defined for extrapulmonary small cell carcinoma because of its rarity. The purpose of our study was to assess the response to neoadjuvant chemotherapy followed by chemoradiation/radiation in patients with extrapulmonary small cell carcinoma. Materials and Methods: Four consecutively diagnosed patients were included in this study. The primary tumor site was oropharynx in three patients and esophagus in one. The patients with the limited disease were treated with chemotherapy followed by concurrent chemoradiation (n=2) or radiotherapy (n=1). The patient with the extensive disease with the primary site in vallecula was treated with chemotherapy and palliative radiotherapy to the metastatic site. Results: The median follow-up was 22.5 months (range, 8-24 months). Three patients with the limited disease (base of tongue, n=2; esophagus, n=1) were in complete remission. The patient with the extensive disease died of loco-regional tumor progression at 8 months from the time of diagnosis. Conclusions: The combination of chemotherapy and radiotherapy is the preferred therapeutic approach for patients with extrapulmonary small cell carcinoma. Induction chemotherapy followed by concurrent chemoradiation or radiation provides a good loco-regional control in patients with limited disease.

• Radiation Oncology Journal
• /
• 제6권2호
• /
• pp.227-233
• /
• 1988

1979년 3월부터 1986년 8월까지 식도의 편평상피암으로 진단되어 서울대학교병원 치료방사선과에서 방사선치료를 받은 177명중 근치적 방사선 치료를 시행한 152명을 대상으로 후향성 분석을 시행하여 다음과 같은 결과를 얻었다. $80\%$이상의 환자에서 관해를 보였으며, 이중 완전관해는 $22\%$, 부분 관해는 $63\%$이었다. 전체 환자의 2년, 5년 생존율은 각각 $22.9\%,\; 13.3\%$이었으며 식도암의 위치, 크기, 병기 그리고 관해 정도에 따라 생존율에 차이가 있었다. 식도 촬영상 5cm 이하$(17\%)$ 또는 식도의 상부 1/3에 종양이 있는 경우$(25.6\%)$에 가장 좋은 5년 생존율을 보였다. 관해 정도에 따른 생존율은 완전관해를 보인 경우의 5년 생존율이 $34.3\%$인 반면 반응이 없던 경우는 $0\%$이었다

• Asian Pacific Journal of Cancer Prevention
• /
• 제14권7호
• /
• pp.4273-4278
• /
• 2013

Objective: We aimed to define clinicopathologic risk factors associated with regional recurrence (RR) and thus the effectiveness of postoperative radiotherapy (PORT) for neck control for head and neck squamous cell carcinomas (HNSCCs) with differing cervical lymph node status. Methods: A retrospective study was performed in 196 HNSCC patients with pathologically positive neck node (N+) to evaluate the high-risk factors for RR and to define the role of PORT in control after neck dissection and postoperative radiotherapy (PORT). Results: Overall, the RR rate after neck dissection and PORT was 29%. Extracapsular spread (ECS) was confirmed to be the only independent risk factor for RR. There were no significant risk factors associated with RR in the ECS- group. The 5-year disease-specific survival rate was 45%, which descended to 10% with the emergence of RR. Conclusions: ECS remains a determined risk factor for RR after neck dissection and PORT in patients with N+. PORT alone is not adequate for preventing RR in the neck with ECS after neck dissection. More intensive postoperative adjuvant therapies, especially combined chemotherapy and radiotherapy, are needed to prevent regional failure in HNSCC patients with ECS.

• Archives of Plastic Surgery
• /
• 제39권5호
• /
• pp.497-503
• /
• 2012

Background Postmastectomy adjuvant therapy is used to prevent locoregional recurrence and improve overall breast cancer specific survival rates. However, it can adversely affect the cosmetic results of reconstruction. Therefore, the authors examined flap stability and patients' satisfaction with immediate breast reconstruction after adjuvant therapy. Methods We retrospectively reviewed the medical records of 204 patients from January 2006 to November 2011. For complication rates, the authors categorized the patients who underwent the immediate breast reconstruction into 4 groups: adjuvant chemotherapy and radiotherapy group, adjuvant chemotherapy only group, adjuvant radiotherapy only group, and the group that did not undergo adjuvant therapy. For comparison of patients' satisfaction, the study was performed with an additional 16 patients who had undergone delayed breast reconstruction. Results Regarding complication rates, the group that had undergone adjuvant therapy showed no significant difference compared to the group that did not undergo adjuvant therapy. In evaluating the patients' satisfaction, there was no significant difference. Conclusions Even after adjuvant therapy, immediate breast reconstruction showed good results with respect to flap stability and patients' satisfaction. Immediate breast reconstruction and adjuvant therapy is a safe and useful option for breast cancer patients.

• Archives of Plastic Surgery
• /
• 제39권3호
• /
• pp.222-226
• /
• 2012

Background : Immediate breast reconstruction after mastectomy and delayed breast reconstruction with post-supplementary treatment are the two types of breast reconstruction currently performed when treating breast cancer. Post-mastectomy radiation therapy (PMRT) not only reduces local recurrence but also improves overall survival. However, the complications and survival rates associated with PMRT need to be clear when determining the timing of breast reconstruction. Accordingly, we investigated the optimal timing of breast reconstruction by observing patients who underwent mastectomy followed by PMRT, based on their overall health and aesthetic satisfaction. Methods : We retrospectively reviewed 21 patients who underwent breast reconstruction with PMRT between November 2004 and November 2010. We collected data regarding the various methods of mastectomy, and the modality of adjuvant therapy, such as chemotherapy, hormone therapy, and radiotherapy. Telephone interviews were conducted to study the general and aesthetic satisfaction. Results : Patients who received PMRT after breast reconstruction showed a greater complication rate than those undergoing breast reconstruction after PMRT (P=0.02). Aesthetic satisfaction was significantly higher in the groups undergoing breast reconstruction after PMRT (P=0.03). Patients who underwent breast reconstruction before PMRT developed complications more frequently, but they expressed greater aesthetic satisfaction with the treatment. Conclusions : It is recommended that the complication rates and aesthetic satisfaction after breast reconstruction be carefully considered when determining the optimal timing for radiotherapy.

• Radiation Oncology Journal
• /
• 제11권2호
• /
• pp.347-354
• /
• 1993

This is a retrospective analysis of 67 patients with histologically proven invasive carcinoma of uterine cervix treated with surgery followed by adjuvant radiotherapy at Inje University Seoul Paik Hospital between october 1983 and september 1991, Postoperative radiotherapy was carried out in patients with high risks of locoregional recurrence such as positive pelvic lymph node (38 pts), large tumor size more than 3 cm (22 pts), cervical stromal invasion more than 2/3 (46 pts), parametrial involvement (9 pts), positive resection margin (14 pts), endo/myometrial extension (10 pts), and angiolymphatic invasion (13 pts). Stage I A, I B, and IIA were 2 $(3\%),$ 39 $(58.2\%),\;and\;26\;(38.8\%),$ respectively. Median follow-up period was 48 months with ranges from 13 to 115 months. All 67 patients were treated externally with standard pelvic field with radiation dose ranging from 4080 to 6120 cGy in 4~6 weeks period of time. Of these, 45 patients received intracavitary radiotherapy. The overall survival rate and disease free survival rate at 5-year were $88.0\%\;and\;82.1\%,$ respectively. The survival rates by stage were $87.1\%$ in IB and $88.4\%$ in IIA. Local control rate was $80.6\%(58\;pts).$ The treatment failure was noted in 12 of 67 patients $(17.9\%):$ locoregional failure in $7(10.4\%),$ distant metastasis in 3 $(4.5\%),$ and locoregional and distant metastasis in $2(3\%),$ The univariate analysis of prognostic factors disclosed endo/myometrial extension as a significant factor of survival and recurrence $(70.0\%\;vs\;91.1\%\;P<0.05\;&\;30.0\%\;vs\;15.8\%,\;respectively).$ The complication of postoperative radiothrapy was not significant and all patient were well tolerated. In conclusion, postoperative radiotherapy in patients with high risks of locoreginal recurrence is relatively well tolerated and it gives significantly improved survival rate especially in patients with positive lymph nodes, bulky tumor size $(\geqq3\;cm),$ parametrial involvement, cervical stromal invasion more than 2/3, positive resection margin and angiolymphatic invasion.

• Journal of Yeungnam Medical Science
• /
• 제39권1호
• /
• pp.77-80
• /
• 2022

Fistulas between the arteries and the gastrointestinal tract are rare but can be fatal. We present a case of an ilioenteric fistula between the left external iliac artery and sigmoid colon caused by radiotherapy for cervical cancer, which was treated with endovascular management using a stent graft. A 38-year-old woman underwent concurrent chemoradiotherapy for cervical cancer recurrence. Approximately 9 months later, the patient suddenly developed hematochezia. On her first visit to the emergency room of our hospital, computed tomography (CT) images did not reveal extravasation of contrast media. However, 8 hours later, she revisited the emergency room because of massive hematochezia with a blood pressure of 40/20 mmHg and a heart rate of 150 beats per minute. At that time, CT images showed the presence of contrast media in almost the entire colon. The patient was referred to the angiography room at our hospital for emergency angiography. Inferior mesenteric arteriography did not reveal any source of bleeding. Pelvic arteriography showed contrast media extravasation from the left external iliac artery to the sigmoid colon; this was diagnosed as an ilioenteric fistula and treated with a stent graft. When the bleeding focus is not detected on visceral angiography despite massive arterial bleeding, pelvic arteriography is recommended, especially in patients with a history of pelvic surgery or radiotherapy.