• Journal of Chest Surgery
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• 제52권1호
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• pp.25-31
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• 2019

Background: The primary goal of this study was to characterize the clinical outcomes of adult patients with hematologic malignancies (HM) who were treated with extracorporeal membrane oxygenation (ECMO) support when conventional treatments failed. Methods: In this retrospective, observational study at a tertiary medical center, we reviewed the clinical course of 23 consecutive patients with HM requiring ECMO who were admitted to the intensive care unit at Asan Medical Center from March 2010 to April 2015. Results: A total of 23 patients (8 female; median age, 44 years; range, 29-51 years) with HM and severe acute circulatory and/or respiratory failure received ECMO therapy during the study period. Fourteen patients received veno-arterial ECMO, while 9 patients received veno-venous ECMO. The median ECMO duration was 104.7 hours (range, 37.1-221 hours). Nine patients were successfully weaned from ECMO. The in-hospital mortality rate was 91.1% (21 of 23). There were complications in 3 patients (cannulation site bleeding, limb ischemia, and gastrointestinal bleeding). Conclusion: ECMO is a useful treatment for patients with circulatory and/or pulmonary failure. However, in patients with HM, the outcomes of ECMO treatment results were very poor, so it is advisable to carefully decide whether to apply ECMO to these patients.

• Journal of Hospice and Palliative Care
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• 제13권1호
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• pp.24-31
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• 2010

목적: 암환자에게 있어 중심 정맥관 삽입은 항암치료나 수혈, 비경구 영양공급 목적으로 흔히 시행된다. 중심정맥관 삽입으로 인해 발생하는 합병증으로는 감염, 혈전, 물리적 합병증이 있는데, 이 연구는 합병증의 빈도와 관련 인자들을 규명하기 위해 계획되었다. 방법: 2001년 3월부터 2006년 8월까지 중심 정맥관을 삽입한 고형암과 혈액암 환자를 대상으로 경과기록 분석을 통한 후향적 연구를 시행하였다. 감염, 혈전, 물리적 합병증 각각의 빈도를 조사하였고, 감염과 혈전의 발생에 영향을 미치는 여러 인자들과 그 연관성을 분석하기 위해 교차 분석을 사용하였다. 또한, 삽입관 수명에 영향을 미치는 인자들을 알기 위해 단변량 분석에는 log-rank test를 이용한 Kaplan-Meier 방법과 다변량 분석에는 Cox regression analysis 를 사용하였다. 결과: 310명의 암환자들에게 310개의 중심 정맥관 삽입이 시술되었고, 남자 157명, 여자 153명이었고, 혈액암 환자가 132명, 고형암 환자 178명이었으며, 평균 연령은 52세였다(range: 15~82). 60예(19%)의 환자에서 합병증이 나타났으며, 혈전을 가진 환자에서 감염이 더 빈번하게 일어났고(P=0.003), 암이나 삽입관의 종류, 수혈 및 비경구 영양 시행 여부와 합병증 발생과는 큰 연관성이 없었다. 삽입관의 평균수명은 99일(range: 2~1,330)이었는데 삽입관의 수명은 터널식 삽입관(P=0.000)을 가진 경우에, 그리고 중심정맥관을 통해 수혈을 하지 않은 경우(P=0.030) 더 연장되었다. 결론: 중심 정맥관 삽입의 주요 합병증은 혈전과 감염이었다. 터널식 정맥관은 장기적인 사용에 효과적인 방법이며, 특히 중심정맥관을 통해 수혈을 받지 않는 경우에 그러하다. 중심 정맥관 장기 사용을 위해 혈전과 감염의 예방 및 치료에 대한 연구가 더욱 이루어져야할 것으로 여겨진다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1081-1091
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• 2012

Myelodysplastic syndromes (MDS) represent a heterogeneous group of clonal hematologic neoplasms characterized by morphologic dysplasia, aberrant hematopoiesis and peripheral blood refractory cytopenias. MDS is recognized to be associated with an increased risk of symptomatic anemia, infectious complications and bleeding diathesis, as well as a risk of progression to acute myeloid leukemia, particularly in patients with a high IPSS score. The advent of use of hematopoietic growth factors such as granulocyte colony-stimulating factor (G-CSF) and recombinant erythropoietin (EPO) has improved symptoms in MDS patients in addition to some data that suggest there might be an improvement in survival. G-CSF is an effective therapeutic option in MDS patients, and it should be considered for the management of refractory symptomatic cytopenias. G-CSF and EPO in combination can improve outcomes in appropriate MDS patients such as those with lower-risk MDS and refractory anemia with ring sideroblasts (RARS). This article reviews use of growth factors for lower-risk MDS patients, and examines the data for G-CSF, EPO and thrombopietic growth factors (TPO) that are available or being developed as therapeutic modalities for this challenging disease.

• Radiation Oncology Journal
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• 제38권2호
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• pp.119-128
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• 2020

Purpose: Colorectal cancer is becoming an increasing concern in the middle-aged population of Iran. This study aimed to compare the preliminary results of short-course and long-course neoadjuvant chemoradiotherapy treatment for rectal cancer patients. Materials and Methods: In this clinical trial we recruited patients with rectal adenocarcinoma located from 5 cm to 15 cm above the anal verge. Patients in group I (short-course) received three-dimensional conformational radiotherapy with a dose of 25 Gy/5 fractions in 1 week plus concurrent XELOX regimen (capecitabine 625 mg/㎡ from day 1-5 twice daily and oxaliplatin 50 mg/㎡ on day 1 once daily). Patients in group II (long-course) received a total dose of 50-50.4 Gy/25-28 fractions for 5 to 5.5 weeks plus capecitabine 825 mg/㎡ twice daily. Both groups underwent consolidation chemotherapy followed by delayed surgery at least 8 weeks after radiotherapy completion. The pathological response was assessed with tumor regression grade. Results: In this preliminary report on complications and pathological response, 66 patients were randomized into two study groups. Mean duration of radiotherapy in the group II (long-course) was 5 ± 1 days (range, 5 to 8 days) and 38 ± 6 days (range, 30 to 58 days). The median follow-up was 18 months. Pathological complete response was achieved in 32.3% and 23.1% of patients in the shortcourse and long-course groups, respectively (p = 0.558). Overall, acute grade 3 or higher treatment-related toxicities occurred in 24.2% and 22.2% of patients in group I and II, respectively (p = 0.551). No acute grade 4 or 5 adverse events were observed in either group except one grade 4 hematologic toxicity that was seen in group II. Within one month of surgery, no significant difference was seen regarding grade ≥3 postoperative complications (p = 0.333). Conclusion: For patients with rectal cancer located at least 5 cm above the anal verge, short-course radiotherapy with concurrent and consolidation chemotherapy and delayed surgery is not different in terms of acute toxicity, postoperative morbidity, complete resection, and pathological response compared to long-course chemoradiotherapy.