• Asian Pacific Journal of Cancer Prevention
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• 제17권4호
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• pp.1625-1630
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• 2016

Prostate cancer is the secondary most frequently diagnosed cancer in the world. Although numerous prospective randomized trial have been conducted to guide the management of patients with localized or locally advanced prostate cancer, few clinical trials targeting node-positive prostate cancer have been reported. Therefore, there are still controversies in the optimal management of node-positive prostate cancer. Recently, efficacy of multimodality treatment, including radiation therapy (RT), for such patients has been reported in several articles. The results indicate potential benefit of RT both in adjuvant therapy after prostatectomy and in definitive therapy for node-positive prostate cancer. The aim in this article was to summarize the current evidence for RT and evaluate the role in multimodality treatment for patients with node-positive prostate cancer.

• Journal of Yeungnam Medical Science
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• 제22권2호
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• pp.131-140
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• 2005

Heart failure is a clinical syndrome comprised of a number of symptoms and signs associated with congestion and/or hypoperfusion. Specific pharmacologic therapies have been developed to slow disease progression from early to more advanced stages. Once symptoms have developed, aggressive multimodality interventions are instituted to alleviate symptoms and improve clinical status and quality of life; especially in those patients that present symptoms. Recently, an evolving adjunctive therapeutic modality, that involves using implanted electrical devices: cardiac resynchronization with or without implantable cardioverter defibrillators (ICD). has been used for management. Cardiac resynchronization therapy (CRT) is a proven treatment for selected patients with heart failure-induced conduction disturbances and ventricular dyssynchrony. When used in combination with stable, optimal medical therapy, CRT is designed to reduce symptoms and improve cardiac function by restoring the mechanical sequence of ventricular activation and contraction. This review summarizes the rationale, procedure, clinical trials, and clinical indications for CRT.

• Tuberculosis and Respiratory Diseases
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• 제42권4호
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• pp.502-512
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• 1995

연구배경: 최근까지 국소 진행된 비소세포 폐암의 치료율을 높이려는 여러 노력들이 있어왔지만 향상은 보이지 않는 설정에서 최근의 유도 화학요법 및 다각적 병합요법의 치료결과와 본 병원의 예를 봄으로 반응률 및 치료 성적을 비교하고 생존에 영향을 미치는 제반 요소들과의 상호 관계에 대해 조사하여 보고하는 바이다. 방법: stage III로 진단된 비소세포 폐암환자 총 67 명을 각각의 치료별로 분류하여 화학치료만 받은 군은 A 군이라 칭하였고, 화학 치료및 방사선 치료를 받은 군은 B군, 수술과 화학 치료를 받은 군은 C군, 비 치료군으로는 D군으로 명하여 이들 군간의 반응률 및 치료 성적을 상호 비교하였고 생존에 영향을 미칠 여러 제반요소들과의 상관관계를 알아 보았다. 결과: 1) 화학 치료만 받은 군은 27 명, 화학 치료 및 방사선 치료를 같이 받은 군은 18 명, 수술 및 화학 치료를 받은 군은 15 명, 비 치료군은 7 명으로 각 군간의 나이, 운동능력, 혈액형, 조직학적, 성별, 흡연력의 분포에 있어서 차이가 없었다(p>0.05). 2) 화학 치료만 받은 군과 방사선 치료도 병합하여 받은 군의 총 반응률은 47%으로 A군의 경우가 10%, B군이 11%를 차지하였으며 이들 간에 의미있는 반응율의 차이는 없었다(p=0.97). 3) 나이, 성별, 운동능력, 혈액형, 조직학적 차이, 흡연력의 치아가 반응률에 영향을 미치지는 않았다(p>0.05). 4) 치료별 A, B, C, D 각 군에 따론 생존 기간은 8.6개월, 13.4개월, 19.2개월, 5.4 개월로 의미있는 차이를 보였다(p=0.003). 비치료군보다는 치료군이, 화학 치료로 단독 치료만 받은 군보다는 병합 치료를 받은 군이 오랜 생존 기간을 보였다. 5) 치료시 생존기간에 영향을 미칠 요소라는 운동능력과 진단 당시 임상병기로 나타났으나 그 외 나이, 성별, 혈액형, 조직학적 분류, 흡연력이 의미있는 차이를 가져오지는 않았다. 결론: 국소 진행된 비소세포 폐암환자에서 복합 화학요법을 포함하여 수술 및 방사선 치료와의 병행은 화학요법 단독으로 치료한 군이든지 혹을 비치료군에 비해 월등하게 생존 기간의 향상을 가져옴으로 좋은 적응증을 가진 환자들을 선택하여 효과적인 화학 치료 및 다른 치료법을 병행하여야 할 것으로 사료된다. 하지만 이러한 여러 치료법들이 표준 치료로 정립되기 위해서는 보다 충분한 증례에서 추후연구가 필요하리라 여겨지는 바이다.

• 대한두경부종양학회지
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• 제32권2호
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• pp.41-46
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• 2016

Sinonasal undifferentiated carcinoma (SNUC) is an extremely rare, highly aggressive malignancy of the nasal cavity and paranasal sinuses. Patients with SNUC usually being asymptomatic until the tumor has extensively progressed therefore frequently present with invasion of the orbit or cranial vault. Most case series of SNUC report very poor prognosis despite aggressive multimodality therapy. We recently experienced a 78-year-old male patient diagnosed as SNUC occurred from the left sphenoid sinus with invasion to the cavernous sinus and orbital content, which was treated intranasal endoscopic debulking surgery combined with curative radiation therapy successfully, and report this case with a review of literature.

• Journal of Yeungnam Medical Science
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• 제21권1호
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• pp.120-126
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• 2004

Sinonasal Undifferentiated Carcinoma (SNUC) is a very rare, highly aggressive malignant tumor of the nasal cavity and paranasal sinuses. SNUC tends to present with advanced-stage disease, often with intracranial invasion. It requires an aggressive multimodality therapy that includes surgical resection. A cure rate of less than 20% is generally reported in the literature, with most patients dying within 1 year of onset of the disease. Three patients diagnosed as SNUC were treated at the Yeungnam University Medical Center between the years 2000 and 2003 were analyzed retrospectively. All patients presented with the disease very advanced. The three cases were given chemotherapy or chemotherapy with radiotherapy. Two patients died of the disease, surviving only 6 and 11 months following treatment, respectively. We did a follow-up on just the one remaining case with incomplete controlled disease for 27 months. The overall prognosis of SNUC is very poor. We consider that more intensive multimodality therapies are recommended for all patients with SNUC.

• Nuclear Medicine and Molecular Imaging
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• 제42권2호
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• pp.153-163
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• 2008

다중영상기기는 1990년대 초에 처음 개발되어 현재 주요 영상 장비 회사에서 상품으로 개발되어 판매되고 있다. 단순한 소프트웨어적인 정합과 융합을 통해 해부학적 영상과 기능적 영상의 상호 보완하는 단계에서 발전하여 하드웨어적으로 정합하는 하드웨어의 개발은 새로운 연구의 시작이다. 다중영상기기의 발전 이전에는 해부학적 구조를 보여주는 영상 장비와 기능적 영상을 표현하는 장비가 각각 고 분해능과 고 해상도로 많은 발전을 이루어 왔다. 현재는 각 영상 장비의 특징을 살려 효과적으로 결합시킨 다중영상기기의 개발이 활발하게 이루어지고 있다. 다중영상기기는 단순하게 두 장비를 결합시키는 개념에서 기능적 영상에서 필요한 감쇠 보정을 하면서 동시에 해부학적 위치를 융합 영상 형태로 표현하는 새로운 영상 장비로 발전하고 있다 다중영상기기의 특징을 살릴 수 있는 프로토콜이 개발되고 하드웨어적으로도 상호 보완적으로 결합되고 있다. 실제로 PET/CT와 같은 다중영상기기는 임상적으로 중요한 역할을 하고 있으며 PET 영상기기를 대체하고 있다. PET/CT 스캐너는 PET에서 나오는 기능적 영상과 CT에서 나오는 해부학적 영상뿐만 아니라 융합 영상을 함께 보여 주므로 임상적으로 유용한 정보를 제공하고 있다. 현재 SPECT/CT는 아직 보급이 많이 되지 않았으나 PET/CT와 같이 임상적으로 유용한 SPECT와 CT 장비가 결합된 상품들이 나오고 있어 그 시장이 점점 성장할 것으로 기대된다. 다중영상기기는 각각의 단독 영상장비에서 갖고 있는 문제뿐만 아니라 두 영상 장비를 결합시키므로 인해 새로운 문제들이 발생하고 있다. 대표적으로 호흡에 의한 움직임, 조영제의 영향, 금속 물질의 영향과 환자의 피폭에 관한 문제가 있다. 이를 해결하기 위해 새로운 프로토콜과 프로세싱 방법이 개발되고 있다. 뇌를 동시에 촬영할 수 있는 PET/MR의 개발은 뇌 과학에 많은 발전을 줄 것으로 기대된다. PET/MR의 개발은 PET/CT 에서 촬영한 영상의 일부분을 대체할 것으로 예상된다. MR 영상이 CT 영상보다 우수한 분해능을 보이는 분야에서는 PET/MR을 이용한 검사와 연구가 활발하게 진행될 것으로 보인다. 해부학적 영상과 기능적 영상을 결합시킨 융합 영상을 함께 제공하는 다중영상기기는 환자의 질병을 진단뿐만 아니라 치료 후의 효과를 보는데 있어서 중요한 역할을 할 것으로 기대된다. 또 앞으로 검사 목적에 맞는 다양한 다중영상기기의 개발이 이루어질 것으로 기대된다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4583-4589
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• 2013

Objective: This study aimed to investigate the effect of multimodality treatment of advanced paediatric hepatoblastoma (HB) and the factors affecting prognosis. Methods: A total of 35 children underwent multimodality treatments consisting of chemotherapy, surgery, interventional therapy, and autologous peripheral blood stem cell transplantation. The patients were followed up every month. Results: Serum AFP levels in 33 out of 35 patients in this study were significantly increased (P = 0.0002). According to the statistical scatter plot, the values of serum AFP on the 25th, 50th, and 75th percentages were 1,210, 1,210 and 28,318 ng/dl, respectively. Of the 35 cases, 21 were stage IV. 18 cases were treated with systemic chemotherapy before surgery, and 3 cases with locally interventional chemotherapy before surgery. Statistical analysis showed that the preferred interventional treatment affected prognosis, and that there was a statistically significant difference (P = 0.024). Some 33 patients completed the follow-up, of which 17 were in complete remission (CR), 5 were in partial remission (PR), 1 became disease progressive (DP), and 10 died. The remission and overall survival rates were 66.7% (22/33) and 69.7% (23/33), respectively. Patients with the mixed HB phenotypes had worse prognoses than the epithelial phenotype (P < 0.001), and patients in stage IV had a lower survival rate than those in stage III (P < 0.001). Conclusion: Multimodality treatment can effectively improve remission rate and prolong the survival of children with advanced HB. In addition, alpha-fetoprotein (AFP), a tumor marker of liver malignant tumors, HB pathological classification, and staging are highly useful in predicting prognosis.

• Journal of Korean Neurosurgical Society
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• 제45권3호
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• pp.133-142
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• 2009

The advent of endovascular therapy for intracranial aneurysms and the rapid advances in that field have supplanted microsurgical treatment for many intracranial aneurysms. Applying current outcome data and other parameters, nuances of selecting the modality of treatment for intracranial aneurysms are reviewed. Patient factors, such a age, co-morbidities, vasospasm and other medical conditions, are addressed. A custom-tailored multimodality treatment paradigm for the management of ruptured and unruptured aneurysms will maximize the favorable results seen in this difficult patient population.

• Radiation Oncology Journal
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• 제7권2호
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• pp.227-233
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• 1989

From April 1986 to Dec 1988, fifty one patients with carcinoma of lung were treated by radiation therapy in Department of Therapeutic Radiology, Yeungnam University Hospital Of the 51 patients, $31(61\%)$ were squamous cell ca, $8(15.7\%)$ were small cell ca, and remained $4(7.9\%)$ were other cell types. Total radiation dose was average $64Gy (60\~75 Gy)$ for group A and 45Gy $(40\~59Gy)$ for group B. The mass regression and the response of airway obstruction to radiation therapy was established on the basis of follow up chest X-ray. The mass regression above $50\%$ of total volume was noted in 23 patients $(74.2\%)$ among 31 patients and the difference between two groups was not seen. In squamous cell ca, however, the mass regression rate (above $50\%$ of total volume) was $83.3\%$ (10/12) in group A compared to $50\%$ (3/6) in group B(p<0.05). The alleviation of airway obstruction was noted as follows. In group A, CR $42.9\%$, PR $35.7\%$, no response $21.4\%$ and in group B, CR $55.6\%,\;PR\;33.3\%$, no response $11.1\%$. But, in squamous cell ca, responsiveness is higher than group B. The study indicates that the importance of higher radiation dose in the management of primary tumor mass and airway obstruction caused by lung cancer especially squamous cell ca. So, meticulous treatment planning and multimodality combination therapy without increasing si.do elect or complication is recommended in management of inoperable bronchogenic carcinoma.

• 대한두경부종양학회지
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• 제10권2호
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• pp.218-224
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• 1994

Soft tissue sarcoma of the head and neck is not frequent neoplasm, accounting for less than 1% of all malignant neoplasm in the region. The histological varieties include osteogenic sarcoma, malignant fibrous histiocytoma, rhabdomyosarcoma, fibrosarcoma, tenosynovial sarcoma, angiosarcoma and chondrosarcoma. Rhabdomyosarcomas of the head and neck usually occur in children under the age of 10 years (over 70%) and rarely develop in adults over the age of 20 years. The prevalent sites of involvement include the orbit, nasal cavity, external ear, paranasal sinus and soft tissue of mouth and the primary location of tumor is considered to be one of the important prognostic factors. Before the 1960s, when surgical resection was the only method of treatment, the 5-year survival rate was less than 20%, but recently it has been greatly improved by the multimodality treatment, combining surgery with chemotherapy and radiation therapy. Here we treated a rhabdomyosarcoma woman with three cycles of high dose chemotherapy followed by radiation therapy. After the, completion of preoperative treatments, successful result of more than partial response was achieved. Three months later total maxillectomy and radical neck dissection was performed. There was no evidence of tumor infiltration in the resected tumor and regional lymphnodes but metastasized tumor cells in cervical lymphnodes were detected. Tumor cell infiltration was also found on the bone marrow biopsy to evaluate the pancytopenia which occurred during postoperative recovery. Two months later she died of secondary bone marrow failure. We think that this multimodality treatment combining pre-operative chemotherapy, radiotherapy and surgery might play an important role in curative resection and eyeball preservation in patients with rhabdomyosarcoma involving the eyeball.