• Asian Pacific Journal of Cancer Prevention
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• 제13권4호
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• pp.1487-1489
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• 2012

Objective: To compare the clinical efficacy of concurrent chemoradiotherapy, neoadjuvant chemotherapy, and intracavity brachytherapy in comprehensive treatment for young patients with stage Ib2 cervical cancer. Methods: One hundred and twelve young patients with stage Ib2 cervical cancer were enrolled retrospectively in our hospital from January 2003 to June 2005. They were categorized into three groups according to preoperative regimens, including the concurrent chemoradiotherapy group (Group 1, n=38), the neoadjuvant chemotherapy (Group 2, n=49), and the intracavity brachytherapy group (Group 3, n=25). Radical hysterectomy was performed following these regimens. Chemotherapy and radiotherapy were given according to pelvic lymph node metastasis, deep cervical stromal invasion, intravascular cancer emboli, histological grading, vaginal stump and positive surgical margin. Results: The cancer disappearance and superficial muscle invasion rates were statistically significantly better in the concurrent chemoradiotherapy group than in the other two groups (P<0.01). No statistically significant difference was noted in the deep muscle invasion rate, surgical time and intraoperative blood loss among three groups, but significantly more postoperative complications occurred in the concurrent chemoradiotherapy group. The 2-year pelvic recurrence was statistically significantly lower in the concurrent chemoradiotherapy group compared to other two groups, while the 5-year survival was higher. Conclusion: Concurrent chemoradiotherapy is efficacious for young patients with stage Ib2 cervical cancer.

• Asian Pacific Journal of Cancer Prevention
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• 제17권7호
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• pp.3511-3514
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• 2016

Purpose: To evaluate the treatment outcomes of patients with locally advanced rectal cancer treated with preoperative concurrent chemoradiotherapy (CCRT) or combined chemotherapy together with radiotherapy (CMT-RT) without surgery. Materials and Methods: A total of 84 patients with locally advanced rectal adenocarcinoma (stage II or III) between January $1^{st}$, 2003 and December $31^{st}$, 2013 were enrolled, 48 treated with preoperative CCRT (Gr.I) and 36 with combined chemotherapy and radiotherapy (CMT-RT) without surgery (Gr.II). The chemotherapeutic agents used concurrent with radiotherapy were either 5-fluorouracil short infusion plus leucovorin and/or capecitabine or 5-fluorouracil infusion alone. All patients received pelvic irradiation. Results: There were 5 patients (10.4%) with a complete pathological response. The 3 year-overall survival rates were 83.2% in Gr.I and 24.8 % in Gr.II (p<0.01). The respective 5 year-overall survival rates were 70.3% and 0% (p<0.01). The 5 year-overall survival rates in Gr.I for patients who received surgery within 56 days after complete CCRT as compared to more than 56 days were 69.5% and 65.1% (p=0.91). Preoperative CCRT used for 12 of 30 patients in Gr.I (40%) with lower rectal cancer demonstrated that in preoperative CCRT a sphincter sparing procedure can be performed. Conclusions: The results of treatment with preoperative CCRT for locally advanced rectal cancer showed comparable rates of overall survival and sphincter sparing procedures as compared to previous studies.

• Radiation Oncology Journal
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• 제13권1호
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• pp.33-40
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• 1995

Purpose : To assess the efficacy and toxicity of the preoperative radiotherapy with or without chemotherapy in locally advanced rectal cancer Methods : Forty three patients (clinically diagnosed stages above or equal to Astler-Coiler stage B2 without distant metastasis) were assigned to preoperative radiotherapy alone arm (n=16) or combined preoperative radiotherapy and chemotherapy arm (n=27). Preoperative radiotherapy of 4500 cGy to whole pel-vis +/-540 cGy boost to primary site and concurrent chemotherapy of 2 cycles of 5-FU (500 mg/$m^2$) and leucovorin (20 mg/$m^2$) were used. Fifteen patients of preoperative radiotherapy alone arm and 19 of combined arm received surgical resection after preoperative treatment. Results : During the preoperative treatment, no significant complication was developed in both groups. Pathologic results were as follows; complete remission 1, Bl 1, B2 6, C1 2, C2, 5 in preoperative radiotherapy alone arm and complete remission 2, Bl 8, B2 4, C2 3, D 2 in combined arm. Postoperative complications were delayed perineal wound healing in three patients, intestinal obstruction in three patients (one managed by conservative medical treatment, two by surgical treatment). Conclusion : The combined preoperative radiotherapy and chemotherapy arm was more effective in pathological response and lymph node negativity rate than the preoperative radiotherapy alone arm. Both the preoperative radiotherapy alone arm and the combined arm were generally well tolerated and did not result in an increased postoperative morbidity.

• Journal of Chest Surgery
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• 제33권8호
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• pp.662-668
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• 2000

Background: Many recent results of clinical trials show that pre-operative concurrent chemoradiotherapy and surgical resection could increase the survival of N2 positive stage IIIA non-small cell lung cancer. This study was performed to assess the feasibility, toxicity, and affect rates of concurrent chemoradiotherapy and surgical resection in N2 positive stage IIIA non-small cell lung cancer. Material and Method: Thirty-one patients who underwent preoperative concurrent chemoradiotherapy for N2 positive stage IIIA non-small-cell lung cancer from May 1997 to April 1999 were entered into the study. Mean age was 61 yrs(43∼70 yrs), There were 24 men and 7 women. The confirmation of N2 disease were achieved through mediastinoscopic biopsy(24) and CT scans(7). Induction was achieved by two cycles of cisplatin and etoposide(EP) plus concurrent chest radiotherapy to 45 Gy. Resections were done at 3 weeks after the complection of preoperative concurrent chemoradiotherapy. Resections were performed in 23 patients, excluding 5 refusals and 3 distant metastasis. Result: All patients were compled the thoracic radiotherapy except one who had distant metastasis. Twenty three patients were completed the planned 2 cycles of EP chemotherapy, and 8 patients were received only 1 cycle for severe side effects(6), refusal(1), and distant metastasis(1). There was one postoperative mortality, and the cause of death was ARDS. Three patients who had neutropenic fever and one patient who had radiation pneumonitis were required admission and treatment. Esophagitis was the most common acute side effect, but relatively well-tolerated in most patients. The complection rate of concurrent chemoradiotherapy was 74%, resection rate was 71%, pathologic complete remission rate was 13.6%, and pathologic down-staging rate was 68%. Conclusion: Morbidity related to each treatment was acceptable and many of the patients have benefited down staging of its disease. Further prospective, preferably randomized, clinical trials of larger scale may be warranted to confirm the actual benefit of preoperative concurrent chemoradiotherapy and surgical resection in N2-positive stage IIIA non-small cell lung cancer.

• Radiation Oncology Journal
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• 제34권2호
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• pp.106-112
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• 2016

Purpose: To identify possible predictors of pathologic complete response (pCR) of rectal cancer after preoperative concurrent chemoradiotherapy (CCRT). Materials and Methods: We conducted a retrospective review of 53 patients with rectal cancer who underwent preoperative CCRT followed by radical surgery at a single center between January 2007 and December 2012. The median radiotherapy dose to the pelvis was 54.0 Gy (range, 45.0 to 63.0 Gy). Five-fluorouracil-based chemotherapy was administered via continuous infusion with leucovorin. Results: The pCR rate was 20.8%. The downstaging rate was 66%. In univariate analyses, poor and undifferentiated tumors (p = 0.020) and an interval of ${\geq}7$ weeks from finishing CCRT to surgery (p = 0.040) were significantly associated with pCR, while female gender (p = 0.070), initial carcinoembryonic antigen concentration of <5.0 ng/dL (p = 0.100), and clinical stage T2 (p = 0.100) were marginally significant factors. In multivariate analysis, an interval of ${\geq}7$ weeks from finishing CCRT to surgery (odds ratio, 0.139; 95% confidence interval, 0.022 to 0.877; p = 0.036) was significantly associated with pCR, while stage T2 (odds ratio, 5.363; 95% confidence interval, 0.963 to 29.877; p = 0.055) was a marginally significant risk factor. Conclusion: We suggest that the interval from finishing CCRT to surgery is a predictor of pCR after preoperative CCRT in patients with rectal cancer. Stage T2 cancer may also be an important predictive factor. We hope to perform a robust study by collecting data during treatment to obtain more advanced results.

• Radiation Oncology Journal
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• 제36권1호
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• pp.17-24
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• 2018

Purpose: This study aimed to assess complications and outcomes of a new approach, that is, combining short course radiotherapy (SRT), concurrent and consolidative chemotherapies, and delayed surgery. Materials and Methods: In this single arm phase II prospective clinical trial, patients with T3-4 or N+ M0 rectal adenocarcinoma were enrolled. Patients who received induction chemotherapy or previous pelvic radiotherapy were excluded. Study protocol consisted of three-dimensional conformal SRT (25 Gy in 5 fractions in 1 week) with concurrent and consolidation chemotherapies including capecitabine and oxaliplatin. Total mesorectal excision was done at least 8 weeks after the last fraction of radiotherapy. Primary outcome was complete pathologic response and secondary outcomes were treatment related complications. Results: Thirty-three patients completed the planned preoperative chemoradiation and 26 of them underwent surgery (24 low anterior resection and 2 abdominoperineal resection). Acute proctitis grades 2 and 3 were seen in 11 (33.3%) and 7 (21.2%) patients, respectively. There were no grades 3 and 4 subacute hematologic and non-hematologic (genitourinary and peripheral neuropathy) toxicities and perioperative morbidities such as anastomose leakage. Grade 2 or higher late toxicities were observed among 29.6% of the patients. Complete pathologic response was achieved in 8 (30.8%) patients who underwent surgery. The 3-year overall survival and local control rates were 65% and 94%, respectively. Conclusion: This study showed that SRT combined with concurrent and consolidation chemotherapies followed by delayed surgery is not only feasible and tolerable without significant toxicity but also, associated with promising complete pathologic response rates.

• Radiation Oncology Journal
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• 제21권2호
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• pp.125-134
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• 2003

목적: 수술 전 동시병용 방사선-항암 화학 요법의 초기 치료성적과 급성 부작용에 대해 알아보고자 하였다. 대상 및 방법: 1999년 6월부터 2002년 4월까지 T3또는 T4 병기의 직장암으로 진단 받고 완전절제가 어렵거나, 종양이 하부직장에 위치하여 수술 시 항문 괄약근의 보존이 불가능하리라고 예견된 40명의 환자에게 수술 전 동시병용 방사선-항암 화학요법을 적용하여 37명의 환자가 수술 전 치료방침을 완료하였다. 방사선치료는 전 골반부에 일일 1.8 Gy씩 5주간에 45 Gy를 엎드린 자세로 조사하였다. 항암 화학요법은 경구 UFT와 Leucovorin (LV)(12명), 정주 5-fluorouracil (FU)와 LV (10명), 정주 5-FU 단독요법(일시 정주 10명, 지속 정주 5명)을 각각 시행하였다. 수술은 수술 전 치료 종료 후 4$\~$6주경에 예정하였으며 35명에 대해서 수술을 시도하였다. 결과: 본 연구의 수술 전 방사선-항암 화학요법에 대한 순응도는 매우 높았. (92.5$\%$, 37/40). 수술 전에 간과 폐에 새로운 원격전이가 확인된 2명을 제외한 35명의 환자에서 절제수술을 시도하였고, 22명(62.9$\%$)에서 항문 괄약근의 보존이 가능하였으나, 2명(5.7$\%$)은 개복 후 절제수술을 포기하였다. 절제수술을 시행한 33명 중 30명은 육안적 완전절제를, 1명은 육안적 불완전절제를 시행하였으며 2명은 병리소견에 관한 정보를 얻을 수 없었다. 수술 및 병리소견에 근거한 병기하강률은 45.5$\%$ (15/33), 절제연 음성 완전절제율은 78.8$\%$ (26/33)였다. 수술 전 방사선치료 도중 급성 부작용으로 Grade 3$\~$4 호중구 감소가 4명(10.8$\%$)에서 발생하였다. 절제수술 후 국소 재발이 12.1$\%$ (4/33), 수술 전 치료방침 완료 후 원격 전이는 21.6$\%$ (8/37)에서 각각 나타났으며, 3년 생존율은 87$\%$였다. 결론: 직장암에 대한 수술 전 동시병용 방사선-항암 화학요법은 낮은 부작용으로 높은 수술절제율, 병기하강률, 완전절제율, 항문 괄약근 보존율 등을 얻을 수 있는 효과적인 방법으로 판단되며 앞으로 장기간에 걸친 추적관찰을 요한다.

• Asian Pacific Journal of Cancer Prevention
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• 제15권20호
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• pp.8667-8671
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• 2014

Background: Survival rates after resection of advanced gastric cancer are extremely poor. An increasing number of patients with gastric carcinomas (GC) are therefore being treated with preoperative chemotherapy. We evaluated 36 month survival rate of GC patients that were treated by adding a neoadjuvant chemoradiotherapy before gastrostomy.Materials and Methods: Patients with stage II or III gastric adenocarcinomas were enrolled. The patients divided into two groups: (A) Neoadjuvant group that received concurrent chemoradiation before surgery (4500cGy of radiation at 180cGy per day plus chemotherapy with cisplatin and 5-fluorouracil, in the first and the end four days of radiotherapy). Resection was attempted 5 to 6 weeks after end of chemoradiotherapy. (B) Adjuvant group that received concurrent chemo-radiation after surgical resection. Results: Two (16.7%) patients out of 12 patients treated with neoadjuvant chemo-radiotherapy and 5 (38.5%) out of 13 in the surgery group survived after 36 months. These rates were not significantly different with per protocol and intention-to-treat analysis. The median survival time of patients in group A and B were 13.4 and 21.6 months, respectively, again not significantly different. Survival was significantly greater in patients with well differentiated adenocarcinoma in group B than in group A (p<0.004). Conclusions: According to this study we suggest surgery then chemoradiotherapy for patients with well differentiated gastric adenocarcinoma rather than other approaches. Additional studies with greater sample size and accurate matching relying on cancer molecular behavior are recommended.

• Archives of Plastic Surgery
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• 제38권5호
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• pp.621-626
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• 2011

Purpose: Implant-based breast reconstruction has multiple advantages such as decreased morbidity, shorter operative time and faster recovery. However, postoperative infection with tissue expander increases medical cost and causes a delay in concurrent antineoplastic treatment. To reduce tissue expander infection, it is important to identify related risk factors and minimize them when possible. Methods: A retrospective review of patient records in a single breast cancer center was performed. Eighty-six tissue expanders were placed in 80 women for postmastectomy breast reconstruction. Variables including patients'age, body mass index (BMI), preoperative breast volume, operation time, drain indwelling time, postoperative seroma/hematoma formation, chemotherapy, and radiation therapy were evaluated. Infection was defined as the status that shows any symptom of local inflammation and identification of pathogens. Representative values were compared through Student's t-test and univariate and multivariate analyses. Results: We examined 86 postmastectomy tissueexpanders which were placed between June 2004 and April 2010. Seven cases of tissue expander infection (8.1%) were identified. The infected tissue expander was removed in three of the cases. The relationship between BMI, and preoperative breast volume and that between infection and non-infection groups were significant ($p$ <0.05). Univariate analysis showed significant association between BMI ($p$=0.023) and preoperative breast volume ($p$=0.037). Multivariate analysis revealed that BMI and preoperative breast volume were independent variables regarding tissue expander infection. Conclusion: Certain characteristics of implant-based breast reconstruction patients increase infection rate of tissue expander. These risk factors should be monitored and evaluated before surgeries for more successful outcome.

• Radiation Oncology Journal
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• 제25권3호
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• pp.160-169
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• 2007

목적 : 본 연구는 국소 진행된 식도암 환자들에 대하여 수술 전 동시병용 방사선-항암 화학요법을 적용한 치료 성적과 예후인자에 대해 알아보고자 하였다. 대상 및 방법: 1998년 3월부터 2005년 5월까지 삼성서울병원에서 식도암으로 진단 받고 수술 전 동시병용 방사선 항암화학요법을 적용한 환자는 모두 68명이었다. 이들 중 원발병변이 흉곽 내 식도에 위치하고, 조직형이 편평상피암이며 임상병기가 T3이상 또는 Nl이상 또는 혈행성 원격전이 없이 절제 가능한원격 림프절에 전이가 국한되어있는 M1A/B병기이며 다른 내과적 질환이나 이차암이 없는 61명의 환자들에 대해 분석을 시행하였다. 방사선치료는 임상 정사 등으로 확인된 병변에 대하여 5주 동안 45 Gy를 조사하였고, 항암화학요법은 2주기의 5-FU (1,000 $mg/m^{2}/day$, days 1-4 & 29-32)와 Cisplatin (60 $mg/m^{2}/day$, days l & 29)을 방사선치료와 동시에 병용하였다. 수술은 방사선-항암화학요법 종료 후 $4{\sim}6$주경에 계획하였으며 53명에 대해 lvor-Lewis 술기와 2-영역 혹은 3-영역 림프절 적출술을 시행하였다. 결과: 57명이 예정된 방사선-항암화학요법을 완료하였고(93.4%) 수술을 거부하거나 수술 전 방사선-항암화학요법 중 질병이 진행된 8명의 환자를 제외한 53명(86.8%)에서 식도 절제술을 시행하였는데, 이 중 49명(92.6%)에서 완전절제가 가능하였으며 38명(71.6%)에서 병기하강을 얻을 수 있었고, 17명(32.0%)에서 병리학적 완전 관해를 얻었다. 1명이 수술 후 호흡기 합병증으로, 1명이 방사선 병용 항암화학치료 연관 폐렴으로 사망하여 치료 연관 사망률은 3.2%였다. 전체 61명의 중앙 생존기간은 30개월, 2년 및 5년 생존율은 각각 59.0%와 38.0%였으며 수술을 시행 한 53명의 중앙 생존기간은 37개월, 2년 및 5년 생존율은 각각 61.6%와 40.1%없고, 중앙 무병 생존기간은 24개월, 2년 및 5년 무병생존율은 각각 53.3%와 41.8%였다. 전체 환자의 생존율에 영향을 미치는 예후인자는 수술 여부없으며 수술을 시행한 환자의 생존율이 단변량 분석(p=0.03)과 다변량 분석(p<0.01)에서 수술을 시행하지 않은 환자의 생존율에 비해 높았다. 수술을 시행한 환자를 대상으로 한 단변량 분석 결과 수술 전 임상병기가 IV병기가 아닌 경우, 수술 후 병리학적 완전관해를 얻은 경우 유의하게 생존율과 무병생존율이 높았으나 다변량 분석에서 의미 있는 예후인자는 없었다. 수술을 시행한 53명 중 5명(9.4%)에서 국소재발이, 10명(18.8%)에서 국소재발 및 원격전이가, 12명(22.6%)에서 원격전이가 발생하였다. 결론: 국소 진행된 병기의 식도암에서 수술 전 동시병용 방사선-항암화학요법으로 양호한 병기 하강률, 장기 생존율을 얻을 수 있었고 원격 림프절 전이가 없는 경우, 수술 후 병리학적 완전관해를 얻은 경우에서 높은 장기 생존율을 보였다.