• Korean Journal of Head & Neck Oncology
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• v.15 no.1
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• pp.29-34
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• 1999

Objectives: This study was carried out to analyze the clinical profile and the results of treatment of a series of patients with extramedullary plasmacytoma(EMP) of the head and neck. Materials and Methods: The clinical features, treatment and survival of 14 patients with EMP seen at Yonsei Medical Center between 1970 and 1998 were carefully reviewed. Results: The median age was 48 years(range 15-75) and there was a male predominance(M:F 1.8:1). Nasal cavities and paranasal sinuses account for 50% of the primary sites and the most common symptom was airway obstruction(50%). Five patients(36%) showed evidence of adjacent bone destruction, one patient had lymph node involvement and one patient had an IgG monoclonal gammopathy at the time of diagnosis. All 5 patients treated with radiotherapy alone achieved local control. Of 5 patients treated with surgery alone, 2 patients(40%) had local failure. Of 3 patient treated with a combination of surgery and radiotherapy, one patient had local recurrence. A total of7 patients(54%) had local, distant or nodal relapses after primary treatment. Six of them received salvage treatment. With salvage treatment of surgery and/or radiotherapy, local control was achieved in 4 of 6 patients. Conversion to multiple myeloma was seen in one patient. Conclusion: Radiotherapy should be recommanded as treatment of choice for EMP of the head and neck. Surgery should be reserved for radioresistant or recurrent tumors, but tumors that are localized and can be removed relatively easily with little morbidity may be treated by primary surgery.

• Journal of Korean Neurosurgical Society
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• v.52 no.1
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• pp.37-41
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• 2012

Objective : The aim of this study was to describe a single center's experience in the management of craniopharyngiomas in children over a 15-year period. Methods : The clinical records of pediatric patients treated for craniopharyngiomas between December 1995 and February 2011 were reviewed. Thirty-five pediatric patients diagnosed with craniopharyngioma were treated, and their medical records and imaging data were analyzed retrospectively. Results : The mean follow-up duration was 76 months (range, 10-195). Overall survival and local control rates at 10 years were $94.7{\pm}5.1%$ and $37.1{\pm}11.9%$, respectively. The female-to-male ratio was 16 : 19, and the mean age was 8.6 years (range, 1-17). Initially, gross total resection (GTR) was performed in 30 patients; subtotal resection (STR) followed by radiotherapy was performed in 5 patients. Of the 14 cases that showed recurrence after GTR, 5 patients were treated with GTR, 1 with radiation therapy (RT), 4 with gamma knife radiosurgery (GKRS), and 4 with subtotal resection followed by RT. No patients who underwent RT or GKRS had recurrences. Two cases with recurrence after STR followed by RT were treated with GTR. One patient died of hormonal insufficiency 64 months after the first surgery. The overall median time progression was 51.2 months (range, 3-182) : 49.7 months in the patients who underwent GTR and 60.2 months in the patients who underwent STR followed by RT. Conclusion : If safe resection is possible, GTR at the initial treatment should be attempted to reduce the tumor recurrence. However, if the tumor recurs after the first surgery, RT or GKRS with/without reoperation may be an effective salvage treatment for recurrent craniopharyngioma.

• Radiation Oncology Journal
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• v.12 no.3
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• pp.331-336
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• 1994

Purpose : To assess the effectiveness and problems of the primary radiation therapy and salvage surgery in a series of patients affected by T1-T2NO glottic cancers treated from 1985 to 1991 at the Pusan National University Hospital. Materials and Methods : From 8/85 to 12/91,34 patients affected by early glottic carcinoma histologically proven were treated with curative radiation therapy, Distribution of patients according to T stage was 30 for T1 and 4 for T2. Male to female ratio was 33:1. Age of patients ranged from 31 to 73 with mean age of 58 years. All of the patients were treated with radical radiation with total tumor dose of 63-75. 3Gy(median 68.2Gy), of 5 weekly fractions of 1.8-2Gy and with 6MV photon beams through two laterally opposed fields. Results : The overall 5-year local control rates were $74\%$(8/30) for Tl, and $25\%$(3/4) for T2. The main cause of failure was progression or recurrence in T(10/11). One failures were observed in T and N at the same time. Of these 11 patients, 9($81\%$) were salvaged with surgery, After surgical salvage of radiation failures, the 5-year survival rates were $96\%$ for T1 and $75\%$ for T2. Among the survivors, $73\%$ of T1 and $33\%$ of T2 were able to preserve the larynx. Conclusion : It can be concluded that radiotherapy is the first choice in the treatment of glottic T1 carcinoma.

• The Korean Journal of Pain
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• v.21 no.2
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• pp.164-167
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• 2008

Frozen shoulder is known to be a self-limited disease, and it is associated with chronic pain and limitation of joint movement. Although its etiology is still unknown, frozen shoulder is associated with several diseases. The diagnosis is made based on the medical history, the clinical and radiological examinations and exclusion of other shoulder pathologies. The skeleton is one of the most common sites of metastasis in patients with lung cancer. It has been reported that the incidence of bone metastases in lung cancer patients is approximately 30-40%, and the median survival time of patients with such metastases is 6-7 months. We experienced a case of a 77-year-old female patient who complained of right shoulder pain and limited joint mobility, and these symptoms were due to metastatic lung cancer in the shoulder.

• Korean Journal of Radiology
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• v.19 no.6
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• pp.1130-1139
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• 2018

Objective: To compare the therapeutic efficacy between conventional transarterial chemoembolization (cTACE) and combined therapy using cTACE and radiofrequency ablation (RFA) in ultrasound (US)-invisible early stage hepatocellular carcinoma (HCC). Materials and Methods: From January 2008 to June 2016, 167 patients with US-invisible early stage HCCs were treated with cTACE alone (cTACE group; n = 85) or cTACE followed by immediate fluoroscopy-guided RFA targeting intratumoral iodized oil retention (combined group; n = 82). Procedure-related complications, local tumor progression (LTP), time to progression (TTP), and overall survival (OS) were compared between the two groups. Multivariate analyses were performed to identify prognostic factors. Results: There was no major complication in either group. The cTACE group showed higher 1-, 3-, and 5-year LTP rates than the combined group; i.e., 12.5%, 31.7%, and 37.0%, respectively, in the cTACE group; compared to 7.3%, 16.5%, and 16.5%, respectively, in the combined group; p = 0.013. The median TTP was 18 months in the cTACE group and 24 months in the combined group (p = 0.037). Cumulative 1-, 3-, and 5-year OS rates were 100%, 93.2%, and 87.7%, respectively, in the cTACE group and 100%, 96.6%, and 87.4%, respectively, in the combined group (p = 0.686). Tumor diameter > 20 mm and cTACE monotherapy were independent risk factors for LTP and TTP. Conclusion: Combined therapy using cTACE followed by fluoroscopy-guided RFA is a safe and effective treatment in US-invisible early stage HCCs. It provides less LTP and longer TTP than cTACE alone.

• Clinical Endoscopy
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• v.57 no.3
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• pp.375-383
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• 2024

Background/Aims: Endoscopic self-expandable metal stent (SEMS) placement is currently the standard technique for treating unresectable malignant distal biliary obstructions (MDBO). Therefore, covered SEMS with longer stent patency and fewer migrations are required. This study aimed to assess the clinical performance of a novel, fully covered SEMS for unresectable MDBO. Methods: This was a multicenter single-arm prospective study. The primary outcome was a non-obstruction rate at 6 months. The secondary outcomes were overall survival (OS), recurrent biliary obstruction (RBO), time to RBO (TRBO), technical and clinical success, and adverse events. Results: A total of 73 patients were enrolled in this study. The non-obstruction rate at 6 months was 61%. The median OS and TRBO were 233 and 216 days, respectively. The technical and clinical success rates were 100% and 97%, respectively. Furthermore, the rate of occurrence of RBO and adverse events was 49% and 21%, respectively. The length of bile duct stenosis (<2.2 cm) was the only significant risk factor for stent migration. Conclusions: The non-obstruction rate of a novel fully covered SEMS for MDBO is comparable to that reported earlier but shorter than expected. Short bile duct stenosis is a significant risk factor for stent migration.

• Tuberculosis and Respiratory Diseases
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• v.57 no.3
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• pp.257-264
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• 2004

Background : There are many combinations of treatment for locally advanced non-small cell lung cancer (NSCLC). Recent studies have showed the efficacy of concurrent chemoradiotherapy (CCRT) in NSCLC. At present, however, there is no consensus about the optimal dosages and timing of radiation and chemotherapeutic agents. The aims of study were to determine the feasibility, toxicity, response rate, and survival rate in locally advanced NSCLC patients treated with doxetaxel and cisplatin based CCRT. Method : Sixteen patients with unresectable stage III NSCLC were evaluated from May 2000 until September 2001. Induction chemoradiotherapy consisted of 3 cycles of docetaxel (75 $mg/m^2/IV$ on day 1) and cisplatin (60 $mg/m^2/IV$ on day 1) chemotherapy every 3 weeks and concomitant hyperfractionated chest irradiation (1.15 Gy/BID, total dose of 69 Gy) in 6 weeks. Patient who had complete or partial response, and stable disease were applied consolidation chemotherapy of docetaxel and cisplatin. Results : All patients showed response to CCRT. Four patients achieved complete response (25%), partial responses in 12 patients (75%). The major common toxicities were grade III or more of neutropenia (87.3%), grade III esophagitis (68.8%), pneumonia (18.8%) and grade III radiation pneumonitis (12.5%). Thirteen patients were ceased during follow-up period. Median survival time was 19.9 months (95% CI; 4.3-39.7 months). The survival rates in one, two, and three years are 68.7%, 43.7%, and 29.1%, respectively. Local recurrence was found in 11 patients (66.8%), bone metastasis in 2, and brain metastasis in 1 patient. Conclusion : The response rate and survival time of CCRT with docetaxel/cisplatin in locally advanced NSCLC were encouraging, but treatment related toxicities were high. Further modification of therapy seems to be warranted.

• Asian Pacific Journal of Cancer Prevention
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• v.17 no.4
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• pp.1909-1915
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• 2016

Background: The purpose of this study was to determine the benefit of tertiary cytoreductive surgery (TC) for secondary recurrent epithelial ovarian cancer (EOC), focusing on whether optimal cytoreduction has an impact on disease-free survival, and whether certain patient characteristics could identify ideal candidates for TC. Materials and Methods: Retrospective analysis of secondary recurrent EOC patients undergoing TC at three Turkish tertiary institutions from May 1997 to July 2014 was performed. All patients had previously received primary cytoreduction followed by intravenous platinum-based chemotherapy and secondary cytoreduction for first recurrence. Clinical and pathological data were obtained from the patients' medical records. Survival analysis was caried out using the Kaplan Meier method. Actuarial curves were compared by the two tailed Logrank test with a statistical significance level of 0.05. Results: Median age of the patients was 49.6 years (range, 30-67) and thirty-eight (72%) had stage III-IV disease at initial diagnosis. Twenty six (49%) had optimal and 27 (51%) suboptimal cytoreduction during tertiary debulking surgery. Optimal initial cytoreduction, time to first recurrence, optimal secondary cytoreduction, time interval between secondary cytoreduction and secondary recurrence, size of recurrence, disease status at last follow-up were found to be significant risk factors to predict optimal TC. Optimal cytoreduction in initial and tertiary surgery and serum CA-125 level prior to TC were independent prognostic factors on univariate analysis. Conclusions: Our results and a literature review clearly showed that maximal surgical effort should be made in TC, since patients undergoing optimal TC have a better survival. Thus, patients with secondary recurrent EOC in whom optimal cytoreduction can be achieved should be actively selected.

• Radiation Oncology Journal
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• v.28 no.1
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• pp.1-8
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• 2010

Purpose: This retrospective study was performed to evaluate the efficacy of radiation therapy (RT) and to investigate the prognostic factors for thymoma when treated with RT. Materials and Methods: We analyzed 21 patients with thymoma and also received RT from March 2002 to January 2008. The median follow-up time was 37 months (range, 3 to 89 months). The median patient age was 57 years (range, 24 to 77 years) and the gender ratio of males to females was 4：3. Of the 21 patients, complete resections (trans-sternal thymectomy) and R2 resections were performed in 14 and 1 patient, respectively. A biopsy was performed in 6 patients (28.7%). The WHO cell types in the 21 patients were as follows: 1 patient (4.8%) had type A, 10 patients (47.6%) had type B1-3, and 10 patients (47.6%) had type C. Based on Masaoka staging, 10 patients (47.6%) were stage II, 7 patients (33.3%) were stage III, and 4 patients (19.1%) were stage IVa. Three-dimensional RT was adminstered to the tumor volume (planned target volume), including the anterior mediastinum and the residual disease. The total RT dose ranged from 52.0 to 70.2 Gy (median dose, 54 Gy). Consistent with the WHO criteria, the response rate was only analyzed for the 6 patients who received a biopsy only. The prognostic factors analyzed for an estimate of survival included age, gender, tumor size, tumor pathology, Masaoka stage, the possibility of treatment by performing surgery, the presence of myasthenia gravis, and RT dose. Results: The 3-year overall survival rate (OS) and the progression free survival rate (PFS) were 80.7% and 78.2%, respectively. Among the 10 patients with WHO cell type C, 3 of 4 patients (75%) who underwent a complete resection and 3 of 6 patients (50%) who underwent a biopsy survived. Distant metastasis developed in 4 patients (19.1%). The overall response rate in the 6 patients who received biopsy only were as follows: partial remission in 4 patients (66.7%), stable disease in 1 patient (16.6%), and progressive disease in 1 patient (16.6%). Acute RTOG radiation pneumonitis occurred in 1 patient (4.8%), grade 2 occurred in 2 patients (9.5%), grade 3 occurred in 1 patient (4.8%), and grade 4 occurred in 1 patient (4.8%). A univariate analysis revealed that the significant prognostic factors for OS were age (${\geq}60$, 58.3%; <60, 100%; p=0.0194), pathology (WHO cell type A-B3, 100%; C, 58.3%; p=0.0194) and, whether the patient underwent surgery (yes, 93.3%; no, 50%; p=0.0096). Conclusion: For the 15 patients who received surgery, there was no local failure within the radiation field. In patients with WHO cell type C, surgical procedures could have resulted in a more favorable outcome than biopsy alone. We report here our clinical experience in 21 patients with thymoma who were treated by radiation therapy.

• Journal of Chest Surgery
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• v.37 no.4
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• pp.356-363
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• 2004

Esophageal cancer is an aggressive disease with a poor prognosis. Recently, every effort has been made to improve the long term survival, but the general prognosis for patients with this disease remains poor. In this study, we reviewed 8 years of experiences with esophageal cancer patients managed in our department at Dong-A University Hospital and evaluated the effectiveness of cervical lymph node dissection performed selectively. Material and Method: From January 1995 to August 2003, 70 patients underwent esophagectomy for esophageal cancer in our department. Among them, 51 patients who underwent curative resection, had no double primary tumors and no neoadjuvant therapy were analyzed retrospectively. In most patients, intrathoracic esophagectomy and cervical esophago-gastrostomy was performed. Since 1997, 3-field lymph node dissection was performed selectively. Result: There were 46 men and 15 women. The median age was 60 years. The tumor was located in the upper third part in 10 patients (19%), middle third in 21 (41%), and lower third in 20 (40%). Majority of the patients (90%) had squamous cell carcinoma. Cervical anastomosis was made in 41 patients, and intrathoracic anastomosis in 10. 2-field lymph node dissection was done in 40 patients, and 3-field lymph node dissection in 11. The pathologic staging were as follows: stage I in 9 patients (17.6%), IIA in 20 (39.2%), IIIB in 7 (13.7%), III in 11 (21.6%), IVA in 2 (3.9%), and IVB in 2 (3.9%). The in-hospital mortality was 3.9% (2 patients) and complications occurred in 24 patients (47%). Overall actuarial 1, 3, and 5-year survival rates were 74.4%, 48.4%, and 48.4% including operative mortality. The 4-year survival rate did not differ significantly between 3-field lymph node dissection group (50.5%) and 2-field lymph node dissection group (48.9%). In 3-field lymph node dissection group, the respiratory complications were more frequent and operative time was significantly longer. Conclusion: We think that curative resection for esophageal cancer can be performed with acceptable mortality, and aggressive surgical approach may improve the long term survival. even for advanced stages. Effectiveness of 3-field lymph node dissection needs further investigations.