• Radiation Oncology Journal
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• v.36 no.4
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• pp.285-294
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• 2018

Purpose: To determine the necessity of postmastectomy radiotherapy (PMRT) and which regions would be at risk for recurrence, we evaluated local and regional recurrence in breast cancer patients with 1-3 positive nodes and a tumor size of <5 cm. Materials and Methods: We retrospectively analyzed data of 133 female breast cancer patients with 1-3 positive nodes, and a tumor size of <5 cm who were treated with mastectomy followed by adjuvant systemic therapy between 2007 and 2016. The median follow-up period was 57 months (range, 12 to 115 months). Most patients (82.7%) were treated with axillary lymph node dissection. Adjuvant chemotherapy, endocrine therapy, and trastuzumab therapy were administered to 124 patients (93.2%), 112 (84.2%), and 33 (24.8%), respectively. The most common chemotherapy regimen was anthracycline and cyclophosphamide followed by taxane (71.4%). Results: Three patients (2.3%), 8 (6.0%), and 12 (9.0%) experienced local, regional, and distant failures, respectively. The 5-year cumulative risk of local recurrence, regional recurrence, distant metastasis, and disease-free survival was 3.1%, 8.0%, 11.7%, and 83.4%, respectively. There were no statistically significant clinicopathologic factors associated with local recurrence. Lymphovascular invasion (univariate p = 0.015 and multivariate p = 0.054) was associated with an increased risk of regional recurrence. Conclusion: Our study showed a very low local recurrence in patients with 1-3 positive nodes and tumor size of <5 cm who were treated with mastectomy and modern adjuvant systemic treatment. The PMRT volume need to be tailored for each patient's given risk for local and regional recurrence, and possible radiation-related toxicities.

• Journal of Chest Surgery
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• v.30 no.3
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• pp.308-314
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• 1997

A retrospective review of the histopathology and clinical information of primary lung cancer was performed to investigate the trends in the histologic type related to sex, age, and smoking history. During January 1988 and July 1995, 541 pateints were diagnosed as primary lung cancer at the Korea Univeristy Anam Hospital. Male (423) to female(118) ratio was 3. 6:1. The most frequent histologic type of lung cancer in male patients was squamous cell carcinoma (223 patients, 52.7%) followed by adenocarcinoma (86, 20.3%) and small cell carcinoma (85, 20.1 %). In female patients, adenocarcinoma (64, 54.2%) wa most common, which was followed by squamous cell carcinoma (22, 18.6%) and small cell carcinoma (22, 18. 6%). The incidence of adenocarnimoma had an increased tendency recently (14.3% in 1988, 33.3% in 1995)(P=0.019). The predominant type in smokers was squamous cell carcinoma; whereas adenocarcinoma was the most frequent type in non-smokers. The proportion of patients aged less than 40 years (younger group) was 4. 0% (n=22). Of them, adenocarcinoma (7) and small cell carcinoma (7) were most common. In patients older than 40 years (older group, n=519), 243 (46.8%) patients had squamous cell carcinoma, and 143 (27.6%) adenocarcinoma. As age increased, the prevalence of squamous cell carcinoma was increased (P=0.0005), adenocarcinoma decreased (P=NS), and small cell carcinoma remained unchanged. We suggest above data as a clinical guidance for management of primary lung cancer.

• Journal of Chest Surgery
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• v.33 no.1
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• pp.79-84
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• 2000

Background: Esophageal perforation is an extremely lethal injury that requires careful management for survival,. Material and Method: We performed a retrospective clinical revi-ew of 14 patients treated for esophageal perforation at the Department of Thoracic and Cardiovascular Surgery hanyang University Hospital between July 1986 and August 1998. Cardiovascular Surgery Hanyang University Hospital between July 1986 and August 1998. Result: The ration between male and female patients was 12:2 and their ages ranged from 9 to 68 years( average: 446 years). Iatrogenic perforations were found in 6 patients(42.9%) spontaneous perforations in 3 patients(21.4%) traumatic perforations in 2 patients(14.3%) and caustic perforations foreign body origin and esophagel cancer in 1 patient (7.1%) each. Four of the patients(28.6%) had esophageal ruptures located cancer in 1 patient (7.1%) each. Four of the patients (28.6%) had esophageal ruptures located in the cervical esophagus and 10 patients (71.4%) in the thoracic esophagus, The most frequent location was in the mid third portion of the esophagus (35.7%) there were also 2 patients(14.3%) in the upper third portion and 3 patients(21.4%) in the lower third portion. Complications encountered included mediastinitis empyema or pleural effusion mediastinal or lung abscess sepsis and aspiration pneumonia. The most frequent complication that occurred was mediastinitis in 9 cases (57%) Three patients underwent conservative treatment. Among the patients who underwent surgical treatment 5 patients underwent primary closure 6 patients underwent open drainage and 2 patients underwent reconstrumction (1 patients had an initial primary closure and 1 patient had an initial open drainage procedure). The mortality rates for those with conservative and surgical treatment were 66.7% (2cases) and 9.1% (1 cases) respec- tively. Conclusion: Perforation of the esophagus although very rare has a high mortality rate and thus aggressive operative therapy is necessary.

• Archives of Reconstructive Microsurgery
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• v.8 no.1
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• pp.84-91
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• 1999

The female breast is a potent symbol of maternity, sexuality, and feminity. Unfortunately, the frequency of breast cancer and mastectomy are increasing in Korea, so the reconstruction of breast becomes a important surgical procedure. The purpose of this study is to analyze the results of breast reconstruction using free TRAM flap and to suggest the operative techniques for more successful results. This study is based on a series of 39 cases of breast reconstruction using free TRAM flap in mastectomized patients. Among these cases, 21 patients underwent immediate reconstruction and 18 patients underwent delayed reconstruction. 2 patients underwent immediate bilateral reconstruction. The postoperative courses of these cases are uneventful. Breast reconstruction following mastectomy is one of the most challenging problems in plastic surgery. Nowadays the free TRAM flap is accepted as an excellent method of autogenous tissue breast reconstruction. We conclude that this technique has advantages as follows. The free TRAM flap has not associated with the complications of implant-based reconstruction. It provides sufficient volume for ptotic and natural breast, easily concealed donor site, and secondary aesthetic benefit of abdominoplasty. Unlike conventional pedicled TRAM flap, it has superiority in blood supply, and can make liberal setting of flap and sparing of rectus muscle. So it can provide more satisfaction about the final result of breast reconstruction.

• Radiation Oncology Journal
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• v.25 no.2
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• pp.118-124
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• 2007

[ $\underline{Purpose}$ ]: This study was to evaluate the survival and pattern of failure after radiation therapy of sino-nasal cancer using partial attenuation filer and wedged beams and to help radiotherapy planning of sino-nasal cancer. $\underline{Materials\;and\;Methods}$: Between February 1992 and March 2003, 17 patients with sino-nasal cancers underwent radiation therapy using partial attenuation filter at Dongsan Medical Center, Keimyung university. There were 9 male and 8 female patients. Patients' age ranged from 40 to 75 years (median 59 years). There were 10 patients of maxillary sinus cancer, 7 patiens of nasal cancer. The histologic type was squamous cell carcinoma in 11, adenoid cystic carcinoma in 4 and olfactory neuroblastoma in 2. The distribution of clinical stage by the AJCC system was 3 for stage II, 7 for III and 6 for IV. The five patients were treated with radiation alone and 12 patients were treated with surgery and postoperative radiation therapy. The range of total radiation dose delivered to the primary tumor was from 44 to 76 Gy (median 60 Gy). The follow-up period ranged from 3 to 173 months with median of 78 months. $\underline{Results}$: The overall 2 year survival rate and disease free survival rate was 76.4%. The 5 year and 10 year survival rate were 76.4% and 45.6% and the 5 year and 10 year disease free survival rate was 70.6%. The 5 year disease free survival rate by treatment modality was 91.6% for postoperative radiation group and 20% for radiation alone group, statistical significance was found by treatment modality (p=0.006). There were no differences in survival by pathology and stage. There were local failure in 5 patients (29%) but no distant failure and no severe complication required surgical intervention. $\underline{Conclusion}$: Radiation therapy of sino-nasal cancer using partial attenuation filter was safe and effective. Combined modality with conservative surgery and radiation therapy was more advisable to achieve loco-regional control in sino-nasal cancer. Also we considered high precision radiation therapy with dose escalation and development of multi-modality treatment to improve local control and survival rate in advanced sino-nasal cancer.

• Journal of the Korean Society of Radiology
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• v.15 no.4
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• pp.445-453
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• 2021

CT scan is reported to have a high risk of cancer due to a relatively high dose among medical radiological examinations. In particular, exposure to radiation to the breast, which is sensitive to radiation, is inevitable during a chest CT scan for female patient. In this study, the dose reduction effect of wearing a compression band during chest CT scans in women was evaluated, and the lifetime attributable risk due to the effective dose exposed during the CT scan was estimated. As a result, when the compression band was used, the effective tube current decreased as the outer perimeter of the chest became smaller, and it was analyzed that the CT dose index and effective dose were also reduced. In addition, the lifetime attributable risk by chest CT scan was found to reduce the cancer risk by 3.2 per 100,000 for all cancers, 0.2 per 100,000 for solid cancer, and 0.8 per 100,000 for breast cancer, based on women in their 30s when using a compression band. It is judged that the risk of cancer can be reduced through the use of appropriate scan parameters and dose optimization measures such as compression bands for future CT examinations.

• Radiation Oncology Journal
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• v.24 no.4
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• pp.263-271
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• 2006

$\underline{Purpose}$: To evaluate the effectiveness and safety of fentanyl-TTS in the management of radiotherapy induced acute pain and cancer pain treated with radiotherapy. $\underline{Materials\;and\;Methods}$: Our study was open labelled prospective phase IV multi-center study. the study population included patients with more 4 numeric rating scale(NRS) score pain although managed with other analgesics or more than 6 NRS score pain without analgesics. Patients divided into two groups; patients with radiotherapy induced pain (Group A) and patients with cancer pain treated with radiotherapy (Group B). All patients received 25 ug/hr of fentanyl transdermal patch. Primary end point was pain relief; second end points were change in patient quality of life, a degree of satisfaction for patients and clinician, side effects. $\underline{Results}$: Between March 2005 and June 2005, 312 patients from 26 participating institutes were registered, but 249 patients completed this study. Total number of patients in each group was 185 in Group A, 64 in Group B. Mean age was 60 years and male to female ratio was 76:24. Severe pain NRS score at 2 weeks after the application of fentanyl was decreased from 7.03 to 4.01, p=0.003. There was a significant improvement in insomnia, social functioning, and quality of life. A degree of satisfaction for patients and clinician was very high. The most common reasons of patients' satisfactions was good pain control. Ninety six patients reported side effect. Nausea was the most common side effect. There was no serious side effect. $\underline{Conclusion}$: Fentanyl-TTS was effective in both relieving pain with good tolerability and improving the quality of life for patients with radiotherapy induced acute pain and cancer pain treated with radiotherapy. The satisfaction of the patients and doctors was good. There was no major side effect.

• 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.

• The Korean Journal of Nuclear Medicine Technology
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• v.25 no.2
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• pp.48-54
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• 2021

Purpose In ¹⁸F-FDG PET/CT, the absorption of ¹⁸F-FDG due to the activation of Brown Adipose Tissue (BAT) greatly interferes with the discrimination of lymph node malignant metastasis. Warming the patient's body temperature before and after injection of ¹⁸F-FDG to prevent FDG absorption by BAT is a safe and non-pharmacological approach. The purpose of this study was to identify and select patients with a high potential for BAT activation in advance, and to investigate whether BAT can inhibit FDG absorption when the body temperature is raised for a short time by directly applying heat to the target patient. Materials and Methods Among the patients who underwent ¹⁸F-FDG PET/CT at the National Cancer Center from January 2020 to December 2020, 825 female patients (415 in the thermal group, 410 in the non-thermal group) under 50 years old were included. The thermal group was administered heat for 10 minutes before injection of ¹⁸F-FDG. For statistical analysis, the Z test comparing the ratios between the two groups was used, and logistic regression analysis was performed to correct for important variables (BMI, outdoor temperature, blood sugar) according to the results of the previous retrospective study. Results Among 825 patients, 19 patients with BAT activated (Thermal group: 5(1.2%), Non-thermal group: 14(3.41%)) accounted for 2.3% of the total. As a result of performing the Z test to compare the ratios between the two groups, the activation of BAT in the thermal group was significantly decreased (P=0.034). In the univariate logistic regression analysis, the activation of BAT was also decreased in the thermal group (OR: 0.34, P<0.05). In the multivariate results, BAT activation increased in patients younger than 45 years old (OR: 4.46, P<0.05) and outdoor temperature less than 13.2 degrees (OR: 9.97, P<0.05). BAT activation tended to decrease in the thermal group, but there was no significant difference (OR: 0.37, P=0.066). Conclusion We confirmed that the activation of BAT tends to decrease by 62.5% in the group subjected to the thermal method, and it will be of great help in preventing FDG absorption of BAT more effectively in the future.

• Journal of Chest Surgery
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• v.38 no.2 s.247
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• pp.157-163
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• 2005

Background: Clinical outcomes of esophageal cancer have not been satisfactory in spite of the development of surgical skills and protocols of adjuvant therapy. We analyzed the results of corrective surgical patients for esophageal cancer from January 1992 to July 2002. Material and Method: Among 129 patients with esophageal cancer, this study was performed in 68 patients who received corrective surgery. The ratio of sex was 59 : 9 (male : female) and mean age was $61.07\pm7.36$ years old. Chief complaints of this patients were dysphagia, epigastric pain and weight loss, etc. The locations of esophageal cancer were 4 in upper esophagus, 36 in middle, 20 in lower, 8 in esophagogastric junction. 60 patients had squamous cell cancer and 7 had adenocarcinoma, and 1 had malignant melanoma. Five patients had neoadjuvant chemotherapy. Result: The postoperative stage I, IIA, IIB, III, IV patients were 7, 25, 12, 17 and 7, respectively. The conduit for replacement of esophagus were stomach (62 patients) and colon (6 patients). The neck anastomosis was performed in 28 patients and intrathoracic anastomosis in 40 patients. The technique of anastomosis were hand sewing method (44 patients) and stapling method (24 patients). One of the early complications was anastomosis leakage (3 patients) which had only radiologic leakage that recovered spontaneously. The anastomosis technique had no correlation with postoperative leakage, which stapling method (2 patients) and hand sewing method (1 patient). There were 3 respiratory failures, 6 pneumonia, 1 fulminant hepatitis, 1 bleeding and 1 sepsis. The 2 early postoperative deaths were fulminant hepatitis and sepsis. Among 68 patients, 23 patients had postoperative adjuvant therapy and 55 paitents were followed up. The follow up period was $23.73\pm22.18$ months ($1\~76$ month). There were 5 patients in stage I, 21 in stage 2A, 9 in stage IIB, 15 in stage III and 5 in stage IV. The 1, 3, 5 year survival rates of the patients who could be followed up completely was $58.43\pm6.5\%,\;35.48\pm7.5\%\;and\;18.81\pm7.7\%$, respectively. Statistical analysis showed that long-term survival difference was associated with a stage, T stage, and N stage (p<0.05) but not associated with histology, sex, anastomosis location, tumor location, and pre and postoperative adjuvant therapy. Conclusion: The early diagnosis, aggressive operative resection, and adequate postoperative treatment may have contributed to the observed increase in survival for esophageal cancer patients.