• Radiation Oncology Journal
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• 제32권1호
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• pp.7-13
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• 2014

Purpose: To evaluate the results of postoperative radiotherapy in patients with extra-hepatic bile duct cancer (EHBDC) and identify the prognostic factors for local control and survival. Materials and Methods: Between January 2001 and December 2010, we retrospectively reviewed the cases of 70 patients with EHBDC who had undergone curative resection and received postoperative radiotherapy. The median radiation dose was 50.4 Gy (range, 41.4 to 54 Gy). The resection margin status was R0 in 30 patients (42.9%), R1 in 25 patients (35.7%), and R2 in 15 patients (21.4%). Results: The 5-year rates of overall survival (OS), event-free survival (EFS), and locoregional control (LRC) for all patients were 42.9%, 38.3%, and 61.2%, respectively. The major pattern of failure was distant relapses (33 patients, 47.1%). A multivariate analysis showed that the postradiotherapy CA19-9 level, radiation dose (${\geq}50$ Gy), R2 resection margins, perineural invasion, and T stage were the significant prognostic factors for OS, EFS, and LRC. OS was not significantly different between the patients receiving R0 and R1 resections, but was significantly lower among those receiving R2 resection (54.6%, 56.1%, and 7.1% for R0, R1, and R2 resections, respectively). Conclusion: In patients with EHBDC who had undergone curative resection, a postoperative radiotherapy dose less than 50 Gy was suboptimal for OS and LRC. Higher radiation doses may be needed to obtain better LRC. Further investigation of novel therapy or palliative treatment should be considered for patients receiving R2 resection.

• 한국간담췌외과학회지
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• 제27권1호
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• pp.28-39
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• 2023

We aimed to compare resection and survival outcomes of neoadjuvant chemoradiotherapy (CRT) and immediate surgery in patients with resectable pancreatic cancer (RPC) or borderline resectable pancreatic cancer (BRPC). In compliance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement standards, a systematic review of randomized controlled trials (RCTs) was conducted. Random effects modeling was applied to calculate pooled outcome data. Likelihood of type 1 or 2 errors in the meta-analysis model was assessed by trial sequential analysis. A total of 400 patients from four RCTs were included. When RPC and BRPC were analyzed together, neoadjuvant CRT resulted in a higher R0 resection rate (risk ratio [RR]: 1.55, p = 0.004), longer overall survival (mean difference [MD]: 3.75 years, p = 0.009) but lower overall resection rate (RR: 0.83, p = 0.008) compared with immediate surgery. When RPC and BRPC were analyzed separately, neoadjuvant CRT improved R0 resection rate (RR: 3.72, p = 0.004) and overall survival (MD: 6.64, p = 0.004) of patients with BRPC. However, it did not improve R0 resection rate (RR: 1.18, p = 0.13) or overall survival (MD: 0.94, p = 0.57) of patients with RPC. Neoadjuvant CRT might be beneficial for patients with BRPC, but not for patients with RPC. Nevertheless, the best available evidence does not include contemporary chemotherapy regimens. Patients with RPC and those with BRPC should not be combined in the same cohort in future studies.

• Radiation Oncology Journal
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• 제35권4호
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• pp.359-367
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• 2017

Purpose: This study sought to identify potential candidates for adjuvant radiotherapy and patterns of regional failure in patients who underwent curative-intent surgery for gallbladder cancer. Materials and Methods: Records for 70 patients with gallbladder cancer who underwent curative resection at a single institution between 2000 and 2016 were analysed retrospectively. No patients received adjuvant radiotherapy. Initial patterns of failure were evaluated. Regional recurrence was categorized according to the definitions of lymph node stations suggested by the Japanese Society of Hepato-Biliary-Pancreatic Surgery. Results: Median follow-up was 23 months. Locoregional recurrence as any component of first failure occurred in 29 patients (41.4%), with isolated locoregional recurrence in 13 (18.6%). Regional recurrence occurred in 23 patients, and 77 regional recurrences were identified. Commonly involved regional stations were #13, #12a2, #12p2, #12b2, #16a2, #16b1, #9, and #8. Independent prognostic factors for locoregional recurrence were ${\geq}pT2$ disease (hazard ratio [HR], 5.510; 95% confidence interval [CI], 1.260-24.094; p = 0.023) and R1 resection (HR, 6.981; 95% CI, 2.378-20.491; p < 0.001). Conclusion: Patients with pT2 disease or R1 resection after curative surgery for gallbladder cancer may benefit from adjuvant radiotherapy. Our findings on regional recurrence may help physicians construct a target volume for adjuvant radiotherapy.

• Journal of Gastric Cancer
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• 제22권4호
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• pp.339-347
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• 2022

Purpose: Lymphovascular invasion is a criterion for non-curative resection in patients who have undergone endoscopic submucosal dissection (ESD) for early gastric cancer (EGC). We aimed to determine the rate of extragastric metastasis (EGM) and identify the predictors of EGM in patients with negative resection margins (R0 resection) and lymphovascular invasion in post-ESD pathology. Materials and Methods: A total of 2,983 patients underwent ESD for EGC. Among them, 110 had a pathology of R0 resection and positive lymphovascular invasion. Patients underwent additional gastrectomy (n=63) or further follow-up without gastrectomy (n=47). Results: The 110 patients were assigned to one of the 3 groups according to ESD indications based on post-ESD pathology. The first group satisfied the absolute indication for ESD (n=18), the second group satisfied the expanded indications for ESD (n=34), and the last group satisfied the beyond indication (n=58). The number of occurrences of EGM in each group was 1 (5.6%), 3 (8.8%), and 3 (5.2%), respectively. The logistic regression analysis adjusted for age, sex, tumor size, and indication for ESD, showed that larger tumor size was associated with EGM (odds ratio, 1.76; 95% confidence interval, 1.00-3.10; P=0.048). In contrast, ESD indication criteria did not affect EGM (P=0.349). Conclusions: Tumor size was the only predictive indicator for EGM in patients who underwent R0 resection and lymphovascular invasion on post-ESD pathology. Even patients with pathology corresponding to the absolute indication criteria of ESD had lymphovascular invasion, which means that they require additional gastrectomy due to the risk of EGM.

• Journal of Yeungnam Medical Science
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• 제40권1호
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• pp.65-77
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• 2023

Background: This study aimed to compare clinical outcomes between surveillance and adjuvant therapy (AT) groups after R0 resection for cholangiocarcinoma (CCA). Methods: A total of 154 patients who underwent R0 resection for CCA at the Daegu Catholic University Medical Center between January 2010 and December 2019 were included. Overall survival (OS) and progression-free survival (PFS) were analyzed. Results: The median follow-up duration was 899 days. There were 109 patients in the AT group and 45 patients in the surveillance group. The patients in the AT group were younger (67 years vs. 74 years, p<0.001) and included more males (64.2% vs. 46.7%, p=0.044). The proportion of patients with stage III CCA was larger in the AT group than in the surveillance group (13.8% vs. 2.2%, p=0.005). In addition, AT did not improve OS (5-year OS rate, 69.3% in the AT group vs. 64.2% in the surveillance group, p=0.806) or PFS (5-year PFS rate, 42.6% in the AT group vs. 48.9% in the surveillance group, p=0.113). In multivariate analysis using the Cox proportional hazards model, stage III CCA (hazard ratio [HR], 10.81; 95% confidence interval [CI], 2.92-40.00; p<0.001) was a significant predictor of OS. American Society of Anesthesiologists classification II (HR, 0.50; 95% CI, 0.31-0.81; p=0.005), and American Joint Committee on Cancer stages II (HR, 3.14; 95% CI, 1.25-7.89; p=0.015) and III (HR, 8.08; 95% CI, 2.80-23.32; p<0.001) were independent predictors of PFS. Conclusion: AT after R0 resection for CCA did not improve OS or PFS.

• Radiation Oncology Journal
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• 제23권2호
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• pp.85-91
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• 2005

목적 : 본 연구는 흉선상피종의 수술 및 수술 후 방사선치료의 치료 성적과 예후 인자로서 WHO세포형의 중요성에 대하여 알아보고, 방사선 조사 범위를 종양이 있던 부위로 국한하였을 때 재발 양상을 분석하여 조사 범위의 적절성을 평가하였다. 대상 및 방법 : 1994년 12월부터 2004년 6월까지 흉선상피종으로 진단 받고 수술을 시행 받은 160명을 대상으로 하였다. 수술 및 병리조직 소견 상 (1) 종양의 완전 절제가 의심되는 경우, (2) 병리 검사결과 절제연이 양성인 경우, (3) 조직병리가 WHO 세포형 B2이상인 경우, (4) Masaoka 병기 2기 이상인 경우에 수술 후 방사선치료를 추가하도록 권유하였으며, 실제 99명이 수술 후 방사선치료를 시행받았다. 방사선치료의 표적 용적은 종양 원발 부위에서 $1.5\~2$ cm 여유를 두고 결정하였으며, 매일 1.8 Gy또는 2 Gy씩, 주 5회 조사하는 통상분할조사법으로 목표선량은 54 Gy였다. 결과 : 전체 환자의 5년 생존율은 $87.3\%$였다. 단변량 분석결과 5년 생존율에 유의한 영향을 미치는 인자는 연령(60세 이상 $77.8\%$, 60세 미만 $91.3\%$: p=0.03), Masaoka 병기(1기 $92.2\%$, 2기 $95.4\%$, 3기 $82.1\%$, 4기 $67.5\%$: p=0.001), WHO세포형(A-B1 $96.0\%$, B2-C $82.4\%$: p=0.001), 절제 정도(완전절제 $92.3\%$, 부분절제 및 조직검사 $72.3\%$: p=0.001)였다. 다변량 분석 결과는 WHO 세포형만이 유의한 차이(p=0.03)를 보였다. 육안적 완전 절제(R0-1 절제) 후 보조적 방사선 치료를 종양 원발 부위에만 시행 받았던 Masaoka 병기 1-3기 환자 71명 중 총 5명에서 재발이 확인되었고, 재발 부위는 늑막강 파종이 2명, 심장막강 파종 및 폐 전이 1명, 폐 전이 1명이었고, 단 1명만이 종격동 림프절 재발이었다. 모든 환자에서 방사선 조사범위 안에서 재발은 없었다. 결론 : WHO 세포형은 Masaoka 병기, 완전 절제 여부, 연령과 함께 흉선상피종 환자의 생존율에 영향을 미치는 중요한 예후인자로 확인되었다. 또한 수술 후 보조적 방사선치료는 조사범위를 종양 원발 부위에 국한하여 시행하는 것이 재발 양상 및 부작용을 고려할 때 안전하고 유효한 방법으로 판단되며, 늑막강 및 심장막강 파종에 의한 재발을 막기 위해서는 효과적인 보조적 항암화학요법에 대한 연구가 진행되어야 할 것이다.

• Journal of Chest Surgery
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• 제28권4호
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• pp.371-375
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• 1995

Surgical resection of lung cancer or other disease is recently required in patients with severely impaired lung function resulting from chronic obstructive pulmonary disease or disease extension. So prediction of pulmonary function after lung resection is very important in thoracic surgeon. We studied the accuracy of the prediction of postoperative pulmonary function using perfusion lung scan with 99m technetium macroaggregated albumin in 22 patients who received the pneumonectomy. The linear regression line derived from correlation between predicting[X and postoperative measured[Y values of FEV1 and FVC in patients are as follows: 1 Y[ml =0.713X + 381 in FEV1 [r=0.719 ,[P<0.01 2 Y[ml =0.645X + 556 in FVC [r=0.675 ,[P<0.01 In conclusion,the perfusion lung scan is noninvasive and very accurate for predicting postpneumonectomy pulmonary function.

• Journal of Chest Surgery
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• 제18권3호
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• pp.517-528
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• 1985

Pulmonary function studies today are generally accepted as an integral part of the evaluation of poor-risk patients who are to have pulmonary surgery. The effect of various pulmonary surgery on lung function was investigated in 54 patients in whom comprehensive lung function test were performed before and between 2 months and 14 months after operation at the Department of Thoracic Surgery, Seoul National University Hospital. According to the result of analysis, the effect of pulmonary resection on forced flow rate was keeping with the change of lung volume, and the preoperative level of ventilatory function plays a major role in determining postoperative loss of functioning lung. Although all measures of expiratory flow [FVC, FEV1, FEFO.2-1.2, MEF50, FEF25-75] have the same percentage of reproducibility, but FEV1 shows most sensitive, reliable linear correlation with the functioning pulmonary tissue loss than other parameters. The linear regression lines derived from the correlation between preoperative [X] and postoperative [Y] FEV1 on various surgical procedures were as follows: 1. Y = 0.57X 0.03. in pneumonectomy group of lung cancer[r=0.84]. 2. Y = 0.56X + 0.33. in lobectomy group of lung cancer[r=0.79]. 3. Y = 0.69X + 0.25. in lobectomy group of pulmonary infection[r=0.91].

• 대한후두음성언어의학회지
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• 제21권1호
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• pp.42-47
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• 2010

Backgrounds and Objects: Carcinoma of the tongue is the most common cancer of the oral cavity. A primary treatment strategy includes surgery and/or radiotherapy. Resection of the tongue often results in speech dysfunction, which depends on the site and extent of resection, type of reconstruction, and the mobility of remaining tongue. This study aimed to evaluate the characteristics of articulation errors that were resulted from the partial glossectomy without free flap reconstruction. Materials & Method : Articulation evaluations including speech intelligibility and percent of correct consonants (PCC) were performed for 24 patients who underwent partial glossectomy for their T1 or T2 tongue cancer. Mobility of the tongue, size of the resected tongue, and the history of adjuvant radiotherapy were analyzed for their relationship with the results of articulation evaluation. Results: Speech intelligibility score was $6.4{\pm}0.9$ (on 7-point scale) and overall PCC was 96.9%. There were close relationships between the size of resection and limitations in the tongue mobility, especially in "protrusion and elevation (r=-0.687)" and "retroflexion (r=-0.775)". Errors in "alveolar fricatives" and "palatal affricates" were also closely related with the size of resection (r=-0.537 and -0.538, respectively). PCC for "liquid sound" /r/ was 83.2%, which was closely related with the history of radiation therapy. Conclusion : Overall articulatory function was satisfactory in cases of early tongue cancer after partial glossectomy of a limited volume without flap reconstruction. However, the size of resection and the history of radiation therapy were closely related to the limitations in some types of tongue mobility and the resultant articulation errors.

• Clinical Endoscopy
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• 제56권1호
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• pp.55-64
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• 2023

Background/Aims: Endoscopic submucosal dissection (ESD) has been established as a treatment modality for superficial esophageal squamous cell carcinoma (ESCC). Long-term follow-up data are lacking in Western countries. The aim of this study was to analyze long-term survival in a Western center. Methods: Patients undergoing ESD for ESCC were included. The analysis was performed retrospectively using a prospectively collected database. Results: R0 resection rate was 96.7% (59/61 lesions in 58 patients). Twenty-seven patients (46.6%) fulfilled the curative resection criteria (M1/M2) (group A), 11 patients (19.0%) had M3 lesions without lymphovascular invasion (LVI) (group B), and 20 patients (34.5%) had lesions with submucosal invasion or LVI (group C). Additional treatment was recommended after non-curative resection. It was not performed in 20/31 patients (64.5%), mainly because of comorbidities (75%). Twenty-nine out of 58 (50.0%) patients died during a mean follow-up of 3.7 years. Death was related to ESCC in 17.2% (5/29) of patients. The disease-specific survival rate after curative resection was 100%. Overall survival rates after 5 years were 61.5%, 63.6% and 28.1% for groups A, B, and C, respectively. The overall survival was significantly worse after non-curative resection (p=0.038). Conclusions: Non-curative resection is frequent after ESD for ESCC in Western patients. The long-term prognosis is limited and mainly determined by comorbidity. Early diagnosis and pre-interventional assessments need to be improved.