• 대한두경부종양학회지
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• 제12권1호
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• pp.26-31
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• 1996

Radiation therapy in T1 glottic cancer offers an excellent cure rate with preservation of voice. From 1983 to 1992 eighty nine patients with TNM staged T1N0M0 invasive squamous cell carcinoma of the glottis were treated at the Dept. of Radiation Oncology, Yonsei Cancer Center, Yonsei University. There were 84 men and 5 women with median age of 59 years. All patients were treated either with Co-60 teletherapy unit or 4MV linear accelerator with an median dose of 6400 cGy(6000-7000 cGy), 200 cGy per day, 5 days in a week. Fourteen local failures have been observed and the median time to local recurrence was 17 months. There were no nodal failure without local recurrence or distant metastases. The 5 year local control rate was 84.3%. The 5 year actuarial surivival rate and the 5 year disease free survival rate were 89.2%, 87.5%, respectively. The 5 year actuarial survival rate and the 5 year disease free survival rate of the nineteen patients with anterior commissure involvement were 77.8% and 74.5% which were lower than those of seventy patients without anterior commissure involvement(91.6%, 90.6%)(p < 0.05). Among the several influencing factors, anterior commissure involvement was the significant prognostic foctor. Final local control rate, taking into account the salvage surgery, was 89.9% at 5 years.

• Asian Pacific Journal of Cancer Prevention
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• 제17권5호
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• pp.2439-2443
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• 2016

Purpose: To determine the risk factors, clinical symptoms and patterns of spread in laryngeal cancer. Materials and Methods: A cross sectional study was carried out in the Regional Cancer Centre, Imphal, Manipur, India. One hundred and sixteen patients with laryngeal cancer were retrospectively reviewed for epidemiological data and descriptive statistics were reported for various variables. Results: Median age at presentation was 65 years and 32.8% were undernourished at presentation. The male to female ratio was 5.4:1. Heavy smoking and tobacco chewing was associated in 91.4% and 33.6% of patients respectively. Tracheostomy was required in 21.5% leading to diagnosis of laryngeal cancer. Almost all were squamous cell carcinoma with neuroendocrine and verrucous carcinoma accounting for less than 2%. Supraglottic, glottic and trans-glottic tumors were 56.9%, 36.3% and 6.9% respectively. Nodal metastases were seen in 81.8% of supraglottic cancers and 31.6% of glottic cancers with supraglottic involvement. Level II neck nodes were the commonest site followed by level III. Distant metastases (only liver) were apparent in 1.7% at presentation. Including these liver metastases, unresectable cases were limited to 6% of the patients. Conclusions: Tobacco use is implicated in almost all of the cases and the sex ratio has also decreased due to increased female smokers. The supraglottis remains the commonest site and incidence of nodal metastases is higher than in other countries. There is also a higher requirement for tracheostomy at presentation in this region.

• 대한기관식도과학회지
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• 제4권1호
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• pp.91-95
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• 1998

Background： Laryngeal cancer, the most common malignancy of head and neck, is being detected and treated in earlier and more effectively due to introduction of endoscope, continuous development of radiographic technology, and advancement in new surgical techniques such as laser surgery and conservation laryngeal surgery Objectives To compare the different treatment results for early laryngeal cancer to determine which methos provides the good prognosis. Materials and Methods： Retrospective study was done for 135 patients with early laryngeal squamous cell carcinoma(Stage I or II) who were treated at our institute between 1989 to 1996. There were 105 patients with glottic cancer(Stage I: 68 patients, Stage II：37 Patients) and 30 patients with supraglottic cancer(Stage I: 12 patients, Stage II：18 patients) Initial treatment included radiation therapy for 54 patients, endoscopic laser surgery for 8 patients, laryngofissure and cordectomy for 8 patients, vertical partial laryngectomy for 37 patients, supraglottic laryngecomy for 14 patients and supracricoid laryngectomy for 5 patiens, and total laryngectomy for 9 patients. Results : Salvage treatments, such as total laryngectomy, conservation laryngeal surgery, radiation therapy and neck dissection were performed for initial treatment failure with 9 patients after radiation therapy, 8 patients after conservation laryngeal surgery, 2 patients after endoscopic laser and 3 patients after total laryngectomy. Overall 3-year survival rate for glottic 71 was 92.4%, glottic f 84.3%, supraglottic 7172.7%, and supraglottic f was 63.%%. However, survival rate of the same stage was variable according to the choice of initial treatment. Conclusion New classification of the early laryngeal cancer was necessary and helpful for the choice of the initial treatment.

• Radiation Oncology Journal
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• 제15권4호
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• pp.315-319
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• 1997

목적 : 조기성문암의 치료시 근치적방사선치료의 효율성과 치료실패시 구제술 시행의 효과를 알아보고자 하였다. 대상 및 방법 : 1989년 6월부터 1994년 12월 사이에 경상대학교병원에서 방사선치료를 시행 받은 18명의 T1N0M0과 5명의 T2N0M0을 포함하는 23명의 조기성문암 환자에 대하여 후향적분석을 시행하였다. 모든 환자가 남자이었고, 연령분포는 33세부터 70세로 중앙값은 57세이었다. 추적조사기간의 중앙값은 46개월이었고, $100\%$의 환자에서 추적이 가능하였다. 결과 : 전체환자의 5년 생존율은 $84.3\%$이었고, 병기에 따라서 T1 $94.4\%,\;T2\;53.3\%$이었다. 전체환자의 5년 국소치유율은 $67.8\%$이었고, 병기에 따라서 T1 $70.0\%,\;T2\;60.0\%$이었다. 치료실패한 환자 8명 중 5명에서 구제술이 시행되었다. 구제술후 5년 국소치유율은 T1 $85.6\%,\;T2\;80.0\%$이었다. 결론 : 병기 T1, T2의 조기성문암의 치료시 우선 근치적 방사선치료를 시행하고, 치료실패시구제술을 시행하는 것이 높은 국소치유율과 성대보존율을 기대할 수 있는 효과적인 치료방법이라고 판단된다.

• Radiation Oncology Journal
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• 제24권4호
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• pp.217-222
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• 2006

목 적: T2N0 병기 성문암 환자에서 방사선치료의 결과 및 무병생존율에 영향을 미치는 예후인자를 알아보고자 하였다. 대상 및 방법: 1986년 9월부터 2004년 6월까지 본원에서 방사선치료를 받은 30예의 T2N0 병기 성문암 환자를 후향적으로 분석하였다. 대상 환자 모두 남자였으며 연령 범위는 39세에서 79세였다(중간값 62세). 조직학적 유형은 30예 모두 편평상피세포암이었다. 방사선치료는 6 MV 선형가속기를 이용하였고, 후두에 조사된 총방사선량은 $66{\sim}70\;Gy$의 범위였다(중간값 66 Gy). 추적기간의 중간값은 63개월이었다. 결 과: 대상 환자 전체의 5년 무병생존율은 79%였다. 성문하 침범이 있는 환자에서는 5년 무병생존율이 감소하는 양상을 보였다(p<0.05). 전연합 침범, 성문상 침범, 성문 운동성 감소 등은 5년 무병생존율의 감소와 무관하였다. 동시 화학요법 추가 또한 통계적 의의가 없었다. 원발병소 재발 3예 및 경부림프절 재발 2예는 근치적 수술로 구제되었으나, 원발병소 및 림프절 동시재발 2예는 근치적 수술로 구제되지 못하였다. 최종 국소제어율은 86%였고, 성대 보존율은 83%였다. 결 론: T2N0 성문암에서 근치적 방사선치료 시 성문하 침범이 무병생존율에 영향을 줄 수 있는 인자로 분석되었다.

• 대한두경부종양학회지
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• 제21권2호
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• pp.132-138
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• 2005

Purpose: The purpose of this study was to establish general guidelines for the treatment of patients with early glottic cancer(T1-2N0M0), by assessing the role of primary radiation therapy and by analyzing the tumor-related and treatment-related factors that influence treatment results. We also studied the results of hypofractionated radiation therapy for early glottic cancer. Material and Methods: This retrospective study comprised 48 patients who suffered from early glottic cancer and were treated by primary radiotherapy at Inha University Hospital, between May 1997 and October 2004. T-stage distribution showed 38 patients as T1 and 10 patients as stage T2. Thirty-eight patients underwent hypofractionated radiotherapy using a 6 MY photon beam, a total tumor dose of 63Gy, in 5 weekly fractions of 2.25Gy, with an overall radiation treatment time of 38 days. Ten patients in the T2 stage tolerated a total dose of 63-72 Gy(median 68.4Gy) in 5 weekly fractions of 1.8-2.0Gy, with an overall radiation treatment time of 40-87 days(median 51 days). All patients were followed up for at least 3 years. Univariate and multivariate analyses were performed to identify the prognostic factors affecting the treatment results. Result: The 5-year survival rate was 92% for all patients, 94% for T1 patients and 91% for T2 patients. The local control rate was 93.5% for all patients, 95% for T1 and 92.2% for T2 patients. Three patients suffered a relapse following radiotherapy, and underwent subsequent salvage surgery. We included T-stage, tumor location, total radiation dose, field size and overall radiation treatment time as potential prognostic factors. Only T-stage was found to be statistically significant in the univariate analysis, but in the multivariate analysis, it was not found to be significant. Conclusion: High curative and voice preservation rates were obtained with hypofractionated radiotherapy. Further study with a larger number of patients is needed to determine the prognostic factors affecting treatment results.

• Radiation Oncology Journal
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• 제34권1호
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• pp.26-33
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• 2016

Purpose: To compare the dose distribution between carotid sparing intensity modulated radiotherapy (IMRT) and opposed lateral field technique (LAFT), and to determine the effects of carotid sparing IMRT in early glottic cancer patients who have risk factors for atherosclerosis. Materials and Methods: Ten early glottic cancer patients were treated with carotid sparing IMRT. For each patient, the conventional LAFT plan was developed for comparison. IMRT and LAFT plans were compared in terms of planning target volume (PTV) coverage, conformity index, homogeneity index, and the doses to planning organ at risk volume (PRV) for carotid arteries, spinal cord and pharyngeal constrictor muscle. Results: Recurrence was not observed in any patients during the follow-up period. $V_{95%}$ for PTV showed no significant difference between IMRT and LAFT plans, while $V_{100%}$ was significantly higher in the IMRT plan (95.5% vs. 94.6%, p = 0.005). The homogeneity index (11.6%) and conformity index (1.4) in the IMRT plan were significantly better than those in the LAFT plans (8.5% and 5.1, respectively) (p = 0.005). The median $V_{5Gy}$ (90.0%), $V_{25Gy}$ (13.5%), and $V_{50Gy}$ (0%) for carotid artery PRV in the IMRT plan were significantly lower than those in the LAFT plan (99.1%, 89.0%, and 77.3%, respectively) (p = 0.005). Conclusion: Our study suggests that carotid sparing IMRT can significantly decrease the dose to carotid arteries compared to LAFT, and it would be considered for early glottic cancer patient with high risk of atherosclerosis.

• 대한두경부종양학회지
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• 제17권2호
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• pp.198-204
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• 2001

Background and Objectives: As the laryngopharyngeal cancer is usually found at a advanced stage, it is difficult to get a wide surgical margin that preserves functional aspect and that is oncologically safe simultaneously. There were many operative technique to fulfill this principle, but none were satisfactory. Recently there were some reports about glottic and pharyngeal reconstruction using radial forearm free flap(RFFF) with palmaris longus tendon, which provided satisfactory oncologic and functional results. We attempted to perform this technique and to test usefulness at patients of laterally localized laryngopharyngeal tumor. Materials and Methods: Three patients were reconstructed glottis and pharynx using radial forearm free flap with palmaris longus tendon. Two hypopharyngeal cancer (T2N0M0) patients were performed wide vertical hemilaryngopharyngectomy and one supraglottic cancer(T2N0M0) patient was performed horizontovertical laryngopharyngectomy. Deglutitional function was evaluated with modified barium swallow and speech function was evaluated by speech pathologist. Results: Mean follow-up time was 29.3 months. There were no cancer recurrence. Their speech was satisfy-actory at social communication and oral feeding. They all have a complete oral nutrition from 26 days to 53 days. Decanulation time was from 71 days to 30 months. Conclusion: Glottic and pharyngeal reconstruction with radial forearm free flap could be accepted as a promising technique which offers a wide resection margin but satisfactory functional result in lateralized laryngohypopharyngeal cancer patients.

• Radiation Oncology Journal
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• 제21권4호
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• pp.299-305
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• 2003

목적: 후두암 방사선치료의 표준화를 위하여 후두암에 관한 기본적인 임상 자료를 축적하고 필요한 조사 항목을 결정하여 전국적인 웹 기반 데이터 베이스 시스템을 개발하고자 하였다. 대상 및 방법: 1998년 1월부터 1999년 12월까지 호서호남 지역에서 후두암으로 진단되어 방사선치료를 받은 환자를 대상으로 임상적 분석을 시행하였다. 환자 선정 기준은 18세 이상이며 과거력상 타 장기의 암 진단 병력이 없고 후두에서 기원한 원발성 상피세포암으로 과거 후두에 대한 다른 질환으로 치료력이 없는 환자를 대상으로 하였다. 후두암에 관한 조사 항목 개발은 대한방사선종양학회 호서호남지회 소속 병원의 전문의들이 합의하여 일차적으로 선정한 항목에 대하여 각 병원에서 자체적으로 조사하였다. 통계처리는 SPSS v10.0을 이용하였다. 결과: 자료가 수집된 총 증례수는 45예이었다. 환자의 연령분포는 28$\~$88세(중앙값: 61)이었고 남녀비는 10 대 1로 대부분 남자에 발생하였다. 원발부위는 성문암이 28예(62$\%$), 성문상부암이 17예(38$\%$)이었다. 병리소견으로는 편평세포암이 대부분이었다(44/45, 98$\%$). AJCC (1997년도) 병기 I+II는, 성문암 28예 중 24예(86$\%$)에 비해 성문상부암의 경우는 16예 중 8예(50$\%$)이었다(p=0.002). 증상은 애성이 n예(89%$\%$로 가장 많았다. 진단은 간접후두경이 전체환자에서, 직접후두경검사는 43예(98$\%$)에서 각각 시행되었다. 치료로서 성문암 28예와 성문상부암 17예 중, 방사선 단독치료는 21예(75$\%$), 6예(35$\%$)에서 각각 시행되었다. 또한 수술요법과 방사선요법의 병용은 각각 5예(18$\%$), 8예(47$\%$)이었고, 항암화학요법과 방사선요법의 병용치료는 각각 2예(7$\%$), 3예(18$\%$)이었으나 두 원발 병소 간에 병용치료 빈도의 유의한 차이는 없었다(p=0.20). 방사선치료는 모두 선형가속기 6 MV X-ray를 이용하여 통상적 분할조사 법으로 시행되었다. 분할선량은 성문암 환자의 86$\%$에서 2.0 Gy를 사용한 반면 성문상부암은 59$\%$에서 1.8 Gy를 각각 사용하였다. 방사선단독치료를 완료한 환자에서 원발병소의 평균 총방사선량은 성문암에서 65.98 Gy, 성문상부암에서 70.15 Gy이었다. 수집된 자료를 기초로 후두암 방사선치료형태 연구에 필요한 총 12개의 모듈과 90개의 항목을 개 발하였다. 결론: 본 연구에서는 후두암 데이터베이스 시스템에 필요한 연구 항목을 개발하였다. 향후 웹 기반 데이터 베이스 시스템을 완성하고 전국의 방사선치료 자료를 축적하여 후두암에 대한 한국형 방사선치료의 표준화 및 적정화를 기하고자 한다.

• 한국정보통신학회논문지
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• 제6권1호
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• pp.76-82
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• 2002

본 연구에서는 계층적 신경회로망을 사용하여 정상, 후두질환(polyp, nodule, palsy 등), 후두질환 중 성문암 시기별 감별진단이 가능한 후두질환 감별진단 분류기를 구현하였다. 후두질환을 가진 환자군과 정상군, 그리고 성문암의 각 시기별에 해당되는 환자군으로부터 /a/, /e/, /i/, /o/, /u/ 모음에 따른 분류작업을 수행하였다. 각 모음별 분류 실험을 수행한 결과 모든 입력 파라미터에 대해서 /a/모음이 다른 모음에 비해 우수한 분류율을 나타내므로, /a/모음만을 사용하여 후두질환을 감별진단하기 위한 계층적 신경회로망을 구현하였다. 구현된 계층적 신경회로망은 각 계층별로 서로 다른 파라미터들을 적용하여 여러 후두질환을 감별진단하도록 구성되었다.