• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.4153-4156
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• 2012

Purpose: To investigate the efficacy and toxicity of a combination of gemcitabine with nedaplatin (GN) or cisplatin (GC) for patients with unresectable or recurrent esophagus squamous cell carcinoma. Methods: Gemcitabine was administered at 1 g/m2 intravenously on days 1 and 8; and nedaplatin or cisplatin were administered at 80 mg/m2 intravenously on day 1. We analyzed the response rate, overall survival time, progression-free survival time, and toxicity in 21 patients treated with GN and 27 patients treated with GC. Results: In patients treated with gemcitabine plus nedaplatin, the ORR was 47.6%, the median progression-free survival time was 4.1 months, and the median survival time was 9.3 months. In patients treated with gemcitabine plus cisplatin, the ORR was 48.2%, the median progression-free survival time was 3.9 months, and the median survival time was 9.1 months, respectively. There were no statistically significant differences in ORR, PFS and OS between the two groups. In both, the most commonly observed toxicities were thrombocytopenia and fatigue. Nausea and vomiting was more frequent in the GC group than in the GN group. Conclusion: Gemcitabine based chemotherapy was effective and tolerable for patients with unresectable or recurrent esophagus squamous cell carcinoma refractory to first line chemotherapy.

• Radiation Oncology Journal
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• 제11권2호
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• pp.277-283
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• 1993

Background: We peformed a retroslective study in patients with previously untreated advanced (Stage III or IV) laryngeal and hypopharyngeal cancer to compare the results of induction chemotherapy followed by definitive radiation therapy (CT+ RT) with those of conventional laryngectomy and postoperative radiation therapy (OP + RT). Method: Between 1985 and 1990, twenty-four patients were treated with two or three courses of chemotherapy and radiation therapy (66-75 Gy). Twenty-five patients were received laryngectomy and radical neck dissection (except 3 patients) and postoperative radiation therapy (55~64 Gy). Result: After a median fellow-up of 20 months, the actusrial 5-year overall survival rate was $24\%$ (chemotherapy group) and $36\%,$ (op group). (P>0.1). The local control rate was the $65\%,$ (13/20) and $68.2\%,$ (15/22). (p>0.1). The rate of laryngeal preservation was $65\%$ (13/20) in chemotherapy group. Conclusion: Induction chemotherapy and definitive radiation therapy can be effective in preserving the larynx in a high percentage of patients with advanced laryngeal and hypopharyngeal cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제16권15호
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• pp.6267-6272
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• 2015

Background: Extra nodal lymphoma (ENL) constitutes about 33 % of all non-Hodgkin's lymphoma. 18-28% develops in the head and neck region. A multimodality treatment with multi-agent chemotherapy (CT) and radiotherapy (RT) is considered optimum. Materials and Methods: We retrieved the treatment charts of patients of HNENL treated in our institute from 2001-2012. The charts were reviewed and the demographic, treatment details and outcome of HNENL patients were retrieved using predesigned pro-forma. Results: We retrieved data of 75consecutive patients HNENL. Median age was 47years (Range: 8-76 years). Of the 75 patients 51 were male and 24 were female. 55patients were evaluable. The patient and tumor characteristics are summarized in Table 1. All patients were staged comprehensively with contrast enhanced computed tomography of head, neck, thorax, abdomen, pelvis and bone marrow aspiration and biopsy 66 patients received a combination multi-agent CT with CHOP being the commonest regimen. 42 patients received 4 or lesser number of cycles of chemotherapy whereas 24received more than 4 cycles chemotherapy. Post radiotherapy, 41 out of 42 patients had a complete response at 3 months. Only 21patients had a complete response after chemotherapy. All patients received radiation (mostly involved field radiation) as a part of the treatment. The median radiation dose was 45 Gray (Range: 36 Gray-50 Gray). The radiation was planned by 2D fluoro simulation based technique in 37cases and by 3 Dimensional conformal radiation therapy (3DCRT) in 36 cases. Two patients were planned by the intensity modulated radiation therapy (IMRT) technique. IMRT was planned for one thyroid and one nasal cavity primary. 5 patients experienced relapse after a median follow up of 19 months. The median survival was not reached. The estimated two and three year survival were 92.9% (95%CI- 68.6- 95.35) and 88% (95%CI- 60.82 - 92.66) respectively. Univariate analysis revealed higher stage and poorer baseline performance status to be significantly associated with worse progression free survival. 5 patients progressed (relapse or primary disease progression) after treatment. Of the 5 patients, two patients were primary orbital NHL, two patients had NHL nasal cavity and one was NHL thyroid. Conclusions: Combined modality treatment in HNENL confers excellent disease control with acceptable side effects.

• Journal of Gastric Cancer
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• 제23권4호
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• pp.609-621
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• 2023

Purpose: Determination of optimal treatment strategies for HER2-positive advanced gastric cancer (AGC) in randomized trials is necessary despite difficulties in direct comparison between trastuzumab deruxtecan (T-DXd) and nivolumab as third or later-line treatments. Materials and Methods: This single-institution, retrospective study aimed to describe the real-world efficacy and safety of T-DXd and nivolumab as ≥ third line treatments for HER2-positive AGC between March 2016 and May 2022. Overall, 58 patients (median age, 64 years; 69% male) were eligible for the study (T-DXd group, n=20; nivolumab group, n=38). Results: Most patients exhibited a HER2 3+ status (72%) and presented metastatic disease at diagnosis (66%). The response rates of 41 patients with measurable lesions in the T-DXd and nivolumab groups were 50% and 15%, respectively. The T-DXd and nivolumab groups had a median progression-free survival of 4.8 months (95% confidence interval [CI], 3.3, 7.0) and 2.3 months (95% CI, 1.5, 3.5), median overall survival (OS) of 10.8 months (95% CI, 6.9, 23.8) and 11.7 months (95% CI, 7.6, 17.1), and grade 3 or greater adverse event rates of 50% and 2%, respectively. Overall, 64% patients received subsequent treatment. Among 23 patients who received both regimens, the T-DXd-nivolumab and nivolumab-T-DXd groups had a median OS of 14.0 months (95% CI, 5.0, not reached) and 19.3 months (95% CI, 9.5, 25.1), respectively. Conclusions: T-DXd and nivolumab showed distinct efficacy and toxicity profiles as ≥ third line treatments for HER2-positive AGC. Considering the distinct features of each regimen, they may help clinicians personalize optimal treatment approaches for these patients.

• Asian Pacific Journal of Cancer Prevention
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• 제16권7호
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• pp.2833-2838
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• 2015

Background: Repeating a prior chemotherapy (rechallenge therapy) is an option for selected patients with metastatic colorectal cancer, but there is very little evidence in the literature for this approach. Thus, we reviewed our registry to evaluate prognostic factors and survival of patients who received irinotecan and oxaliplatin-based regimens as rechallenge third and fourth-line therapy. Materials and Methods: Patients who received irinotecan-based or oxaliplatin-base regimen as first-line had been rechallenged with third-line or fourth-line therapy. These patients were selected from the database of Turkish mCRC registry archives between October 2006 and June 2013 and evaluated retrospectively for factors effecting progression free survival (PFS) and overall survival (OS) by the Kaplan-Meire and Cox-regression methods. Results: Thirty-nine patients were enrolled. The median duration of follow-up was 36 months (14-68 months). Thirty-one patients (76%) died during follow-up. In terms of rechallenge treatments, 29 patients had received third-line and 10 patients had received fourth-line. Response rate (RR) was found to be 12.9%, with stable disease in 19 (48.7%) patients. The median PFS was 6 months (95%CI=4.64-7.35 months) and the median OS was 11 months (95%CI=8.31-13.68 months). The factors effecting survival (PFS and OS) were only being PFS after first-line chemotherapy ${\geq}12months$ (p=0.007, 95% CI=1.75-35.22 and p=0.004, 95%CI=1.44-7.11), both in univariate and multivariate analyses. Conclusions: This study indicates that rechallenge treatment could be a good option as a third or later line therapy in patients who had ${\geq}12months$ PFS onreceiving first line therapy.

• Radiation Oncology Journal
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• 제4권1호
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• pp.21-27
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• 1986

이하선 악성종양의 치료는 근치적 수술이 주된 치료법으로 알려져 왔으나 이하선이 해부학적으로 주위의 근육, 골조직, 혈관, 신경등과 밀접하게 부착되어 있어 피막 및 주위 조직의 침윤이 있거나 조직학적으로 high grade tumor, 임파절 전이가 있는 경우 등에서 광범위한 근치적 수술로도 종양을 완전히 제거하기가 어렵고 수술 후 국소재발이 빈번한 것으로 알려져 있다. 수술만으로는 국소재발율이 상당히 높은 데도 북구하고 이 종양이 방사선치료에 반응하지 않는 것으로 잘못 인식되어져와서 수술후 방사선치료를 시행해 오지 않다가 근래에 와서 수술후 방사선치료가 실시되었고 수술만 시행한 경우에서보다 국소재발율이 현저히 감소한 것으로 보고되고 있어 현재는 방사선치료가 치료 결과를 향상시키는 중요한 치료방법으로 인식되고 있다. 이에 저자들은 1970년 1월부터 1982년 12월 사이 연세대학교 의과대학 연세암센터, 치료방사선과에서 이하선암으로 치료를 받은 31예를 대상으로 후향적 추적조사를 통하여 치료방법과 치료실패 양상을 분석하여 향후 치료방법의 실정과 치료 결과의 향상을 위하여 본 연구를 실시하였다.

• Asian Pacific Journal of Cancer Prevention
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• 제13권1호
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• pp.319-323
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• 2012

Objective: To explore the feasibility of shrinking field technique after 40 Gy radiation through 18F-FDG PET/CT during treatment for patients with stage III non-small cell lung cancer (NSCLC). Methods: In 66 consecutive patients with local-advanced NSCLC, 18F-FDG PET/CT scanning was performed prior to treatment and repeated after 40 Gy. Conventionally fractionated IMRT or CRT plans to a median total dose of 66Gy (range, 60-78Gy) were generated. The target volumes were delineated in composite images of CT and PET. Plan 1 was designed for 40 Gy to the initial planning target volume (PTV) with a subsequent 20-28 Gy-boost to the shrunken PTV. Plan 2 was delivering the same dose to the initial PTV without shrinking field. Accumulated doses of normal tissues were calculated using deformable image registration during the treatment course. Results: The median GTV and PTV reduction were 35% and 30% after 40 Gy treatment. Target volume reduction was correlated with chemotherapy and sex. In plan 2, delivering the same dose to the initial PTV could have only been achieved in 10 (15.2%) patients. Significant differences (p<0.05) were observed regarding doses to the lung, spinal cord, esophagus and heart. Conclusions: Radiotherapy adaptive to tumor shrinkage determined by repeated 18F-FDG PET/CT after 40 Gy during treatment course might be feasible to spare more normal tissues, and has the potential to allow dose escalation and increased local control.

• Asian Pacific Journal of Cancer Prevention
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• 제13권10호
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• pp.4989-4992
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• 2012

Purpose: Guide-wire localization (GWL) has been a standard technique for many years. Excision of nonpalpable malignant breast lesions with clear surgical margins reduces the risk of undergoing re-excision. The objective of the present study was to evaluate the efficacy of GWL biopsy for assessing surgical margins. Methods: This retrospective study concerned 53 patients who underwent GWL biopsy for non-palpable breast lesions and breast carcinoma diagnosed by histological examination. Age of the patients, tumour size, radiographic findings, breast density specifications, specimen volumes, menopausal status and family history of the patients and surgical margin status were recorded. Results: Median age was 53.3 years, median tumour size was 1.5 cm and median specimen volume was $71.5cm^3$. In fifteen patients (28%) DCIS and in 38 patients (72%) invasive ductal carcinoma was diagnosed. There was positive surgical margins in twenty eight (52.8%) patients. The median distance to the nearest surgical margin was 7.2 mm in clear surgical margins. Younger age and denser breast specifications were found as statistically significant factors for surgical margin status. Median age of the patients who had positive margins was 49.4 years where it was 56.9 years in the patients with negative margins (p=0.04). 79% of the patients with positive margins had type 3-4 pattern breast density according to BIRADS classification as compared to 48% in the patients who had negative margins (p=0.03). Some 38 patients who had positive or close surgical margins received re-excision (72%). Conclusion: Positive margin rates may be higher because of inherent biological differences and diffuse growth patterns in younger patients. There are also technical difficulties that are relevant to denser fibroglandular tissue in placing hooked wire. High re-excision rates must be taken into consideration while performing GWL biopsy in non-palpable breast lesions.

• Journal of Yeungnam Medical Science
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• 제39권4호
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• pp.300-308
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• 2022

Background: This study investigated the prognostic impact of spine magnetic resonance imaging (MRI) in patients newly diagnosed with multiple myeloma (MM). Methods: We retrospectively evaluated 214 patients who were newly diagnosed with MM between March 2015 and December 2019. The patients were classified into five different infiltration patterns based on spine MRI as follows: (1) normal appearance, (2) focal, (3) diffuse, (4) combined focal and diffuse infiltration, and (5) "salt-and-pepper." Results: Forty patients (18.7%) showed a normal appearance, whereas focal, diffuse, combined focal and diffuse infiltration, and "salt-and-pepper" patterns were identified in 68 (31.8%), 40 (18.7%), 52 (24.3%), and 14 patients (6.5%), respectively. The patients with normal and "salt-and-pepper" patterns were younger than patients with other patterns (median age, 61.6 vs. 66.8 years; p=0.001). Moreover, 63% and 59.3% of patients with normal and "salt-and-pepper" patterns were scored International Staging System (ISS) stage I and revised ISS (R-ISS) stage I, respectively, whereas only 12.5% of patients with other patterns were scored ISS stage I and R-ISS stage I. Patients with normal and "salt-and-pepper" patterns had a better prognosis than those with other patterns, whereas relapse and death rates were significantly higher in patients with focal, diffuse, and combined MRI patterns. Conclusion: Characteristic MRI findings have a significant prognostic value for long-term survival in patients newly diagnosed with MM. In particular, focal, diffuse, and combined focal and diffuse infiltration patterns are unfavorable prognostic factors.

• Asian Pacific Journal of Cancer Prevention
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• 제13권8호
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• pp.4119-4123
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• 2012

Background: Neoadjuvant systemic chemotherapy is the accepted approach for women with locally advanced breast cancer. Anthracycline- and taxane-based regimens have been extensively studied in clinical trials and consequently are widely used. In this study aimed to research the complete response (pCR) rates in different regimens for neoadjuvant setting and determine associated clinical and biological factors. Methods: This study included 63 patients diagnosed with breast carcinoma among 95 patients that had been treated with neoadjuvant chemotherapy between 2007 and 2010. TNM staging system was used for staging. The histologic response to neoadjuvant chemotherapy was characterized as a pCR when there was no evidence of residual invasive tumor in the breast or axillary lymph nodes. Biologic subclassification using estrogen receptor (ER), progesterone receptor (PR), HER2 were performed. Luminal A was defined as ER+, PR+, HER2-; Luminal B tumor was defined as ER+, PR-, HER2-; ER+, PR-, HER2+; ER-, PR+, HER2-; ER+, PR+, HER2+; HER2 like tumor ER-, PR+, HER2+; and triple negative tumor ER, PR, HER2 negative. Results: Patients median age was 54.14 (min-max: 30-75). Thirty-two patients (50.8%) were premenapousal and 31 (49.2%) were postmenapousal. Staging was performed postoperatively based on the pathology report and appropriated imaging modalities The TNM (tumor, lymph node, metastasis) system was used for clinical and pathological staging. Fifty-seven (90.5%) were invasive ductal carcinomas, 6 (9.5%) were other subtypes. Thirty nine (61.9%) were grade II and 24 (38.1%) were grade III. Seven (11.1%) patients were stage II and 56 (88.9) patients were stage III. The patients were classified for ER, PR receptor and HER2 positivity. Seventeen patients had complete response to chemotherapy. Forty patients (63.5%) were treated with dose dense regimen (cyclophosphamide 600 mg/m2 and doxorubicine 60 mg/m every two weeks than paclitaxel 175 mg/m2 every two weeks with filgrastim support) 40 patients (48%) were treated anthracycline and taxane containing regimens. Thirteen patients (76%) from 17 patients with pCR were treated with the dose dense regimen but without statistical significance (p=0.06). pCR was higher in HER2(-), ER(-), grade III, premenopausal patients. Conclusion: pCR rate was higher in the group that treated with dose dense regimen, which should thus be the selected regimen in neoadjuvant setting. Some other factors can predict pCR in Turkish patients, like grade, menopausal status, triple negativity, percentage of ER positivity, and HER2 expression.