• Pediatric Gastroenterology, Hepatology & Nutrition
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• 제10권1호
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• pp.86-90
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• 2007

저자들은 내원 1년 전부터 간헐적인 복통과 함께 복통 시에 항상 동반되는 소량의 비특이적인 설사가 반복되어 내원한 13세 남아에서 직장 유암종을 진단하고 내시경적 절제술로 치료한 증례를 경험하였기에 문헌고찰과 함께 보고한다.

• Radiation Oncology Journal
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• 제34권4호
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• pp.305-312
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• 2016

Purpose: The objective of this prospective study was to evaluate the relationship between the circulating lymphocyte subpopulation counts during preoperative chemoradiotherapy (CRT) and tumor response in locally advanced rectal cancer. Materials and Methods: From August 2015 to June 2016, 10 patients treated with preoperative CRT followed by surgery were enrolled. Patients received conventional fractionated radiotherapy (50.4 Gy) with fluorouracil-based chemotherapy. Surgical resection was performed at 4 to 8 weeks after the completion of preoperative CRT. The absolute blood lymphocyte subpopulation was obtained prior to and after 4 weeks of CRT. We analyzed the association between a tumor response and change in the lymphocyte subpopulation during CRT. Results: Among 10 patients, 2 (20%) had evidence of pathologic complete response. In 8 patients with clinically node positive, 4 (50%) had nodal tumor response. All lymphocyte subpopulation counts at 4 weeks after CRT were significantly lower than those observed during pretreatment (p < 0.01). A high decrease in natural killer (NK) cell, count during CRT (baseline cell count - cell count at 4 weeks) was associated with node down staging (p = 0.034). Conclusion: Our results suggest that the change of lymphocyte subset to preoperative CRT may be a predictive factor for tumor response in rectal cancer.

• 대한물리치료과학회지
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• 제11권3호
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• pp.5-13
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• 2004

The use of therapeutic ultrasound(US) in humans with malignant neoplasms has been contra-indicated in physical therapy practice. Some studies have shown the results after application of US inhibited of tumor growth but some studies have shown the results facilitated of tumor growth in mouse. The purpose of this study were to determine the effects of US on rectal sarcoma(CT-26) in mouse and to determine the histological change of tumor. Thirty-five female BALB/C mouse, age 6 to 8 weeks received subcutaneous injection of 0.1 105 tumor cells. When tumors grew to 5 mm in diameters, the mouse were randomly assigned to control group(n=7) and high powered continuous US group(n=7) and low powered continuous US group(n=7) and high powered pulsed US group(n=7) and low powered pulsed US group(n=7). The experimental group (four groups) received 10 treatments over a 10-day period of 3 MHz ultrasound. Tumor dimension were measured on days 1(start of treatment), 5(midtreatment), and 10(end of treatment, preexcision and postexcision). Tumors were weighed after excision and the mouse were observated histological change of tumor. All tumors grew larger over time. Mean tumor weights(in grams) and volumes(in cubic millimeters) were 2.063 g and $2729.313\;mm^3$ for the high powered continuous US group 1.881 g and $2428.002\;mm^3$ for the low powered continuous US group 1.730 g and $2381.002\;mm^3$ for the high powered pulsed US 1.673 g and $2289.562\;mm^3$ for the low powered pulsed US group 1.670 g and $2297.333\;mm^3$ for the control group. Ultrasound increased the weight and volume of subcutaneous tumor in mouse. We urge caution in the use of ultrasound in the areas of tumors.

• Radiation Oncology Journal
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• 제31권2호
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• pp.97-103
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• 2013

Purpose: To investigate the patterns of locoregional recurrence of pathologic T3N0 (pT3N0) lower rectal cancer omitting postoperative radiotherapy (RT) and explore the potential of modification of a RT field. Materials and Methods: From Jan 2003 to Nov 2011, 35 patients omitting preoperative or postoperative RT for pT3N0 lower rectal cancer were included. We defined the lower rectal cancer as the tumor with the inferior margin located below the virtual line-a convergent level between rectal wall and levator ani muscle. All patients had radiologic examinations for recurrence evaluation during the follow-up duration. Results: The median follow-up duration was 66.4 months (range, 1.4 to 126.1 months). Eight (22.9%) of the 35 patients had recurrence. Three (8.6%) was local recurrence (LR) only, 3 (8.6%) was distant metastasis (DM) only, and 2 (5.7%) was LR with DM. All LR were located at primary tumor sites. The overall survival rate, LR-free survival rate, and DM-free survival rate at 5 years was 79.8%, 83%, and 87%, respectively. All LR developed from tumors over 5 cm. However, there was no statistical significance (p = 0.065). There was no other risk factor for LR. Conclusion: Even though the patients included in this study had pathologically favorable pT3N0 rectal cancer, LR developed in 14.3% of patients. Most of the LR was located at primary tumor sites prior to surgery. Based on these findings, it might seem reasonable to consider postoperative RT with a smaller radiation field to the primary tumor site rather than the conventional whole pelvic irradiation.

• Asian Pacific Journal of Cancer Prevention
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• 제14권6호
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• pp.3881-3885
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• 2013

Objective: The objective of this study was to identify clinical predictive factors for tumor response after neoadjuvant chemoradiotherapy (nCRT) in locally advanced rectal cancer (LARC). Methods: All factors were evaluated in 88 patients with LARC treated with nCRT. After a long period of 4-8 weeks of chemoradiotherapy, 3 patients achieved clinical complete response (cCR) and thus aggressive surgery was avoided, and the remaining 85 patients underwent a curative-intent operation. The response to nCRT was evaluated by tumor regression grade (TRG) system. Results: There were 32 patients (36.4%) with good tumor regression (TRG 3-4) and 56 (63.6%) with poor tumor regression (TRG 0-2). Lymphocyte counts and ratios were higher in good response cases (P=0.01, 0.03, respectively) while neutrophil ratios and N/L ratios were higher in poor response cases (P=0.04, 0.02, respectively). High lymphocyte ratios before nCRT and good tumor regression (TRG3-4) were significantly associated with improved 5-year disease-free survival (P<0.05). Pretreatment nodal status was also significantly associated with 5-year disease-free survival and 5-year overall survival (P<0.05). Multivariate analysis confirmed that the pretreatment lymphocyte ratio and lymph nodal status were independent prognostic factors. Conclusion: Our study suggested that LARC patients with high lymphocyte ratios before nCRT would have good tumor response and high 5-year DFS and OS.

• Asian Pacific Journal of Cancer Prevention
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• 제15권21호
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• pp.9271-9275
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• 2014

Background: Schistosomiasis is an infectious disease that affects more than 230 million people worldwide, according to conservative estimates. Some studies published from China and Japan reported that schistosomiasis is a risk factor for colorectal cancer in Asia where the infective species is S. japonicum. Hoqwever, there have been only few reports of prognosis of patients with schistosomal rectal cancer SRC. Objectives: This study aimed to analyze differences in prognosis between SRC and non-schistosomal rectal cancer(NSRC) with current treatments. Materials and Methods: A retrospective review of 30 patients with schistosomal rectal cancer who underwent laparoscopic total mesorectal excision operation (TME) was performed. For each patient with schistosomal rectal cancer, a control group who underwent laparoscopic TME with non-schistosomal rectal cancer was matched for age, gender and tumor stage, resulting in 60 cases and controls. Results: Univariate analysis showed pathologic N stage (P=0.006) and pathologic TNM stage (P=0.047) statistically significantly correlated with disease-free survival (DFS). Pathologic N stage (P=0.014), pathologic TNM stage (P=0.002), and with/without schistosomiasis (P=0.026) were statistically significantly correlated with overall survival (OS). Schistosomiasis was the only independent prognostic factor for DFS and OS in multivariate analysis. Conclusions: The prognosis of patients with schistosomal rectal cancer is poorer than with non-schistosomal rectal cancer.

• Radiation Oncology Journal
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• 제35권3호
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• pp.217-226
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• 2017

Purpose: Hematotoxicity following anti-cancer treatment is known to be related to treatment efficacy in several malignancies. The purpose of this study was to examine the hematologic parameters related to the tumor response and survival in patients treated with curative surgery following preoperative chemoradiotherapy (CRT) for rectal cancer. Materials and Methods: Four hundred eighteen patients with rectal cancer who underwent preoperative CRT and curative surgery were analyzed, retrospectively. The main clinical factors and blood cell counts before and after CRT were investigated with respect to their relationships with tumor downstaging and patient survival. Results: The post-CRT leukocyte count was significantly different between the tumor downstaging group and the non-downstaging group (median, 4740/uL vs. 5130/uL; p = 0.013). Multivariate analysis showed that histological grade, circumferential extent, and post-CRT leukocyte count were related to tumor downstaging. In addition, histological grade, post-CRT leukocyte count, and tumor downstaging were related to disease-free survival. The 5-year disease-free survival and overall survival in patients with post-CRT leukocyte count ${\leq}3730/uL$, which is the cut-off value derived from the receiver operation characteristic (ROC) curve analysis, were significantly higher than those with higher counts (88.0% vs. 71.6%, p = 0.001; 94.4% vs. 84.1%, p = 0.024). Conclusion: Post-CRT leukocyte count of ${\leq}3730/uL$ could be regarded as a good prognostic factor for tumor response and survival in rectal cancer patients treated with preoperative CRT.

• Journal of Digestive Cancer Reports
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• 제7권2호
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• pp.45-50
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• 2019

Incidence of rectal neuroendocrine neoplasms (NEN) has increased tremendously over the decades due to disease awareness and widespread use of screening colonoscopy. Although NEN has been recognized as malignant disease, most rectal NENs are initially found as small mass confined to the submucosa, which can be removed completely through various endoscopic treatments with good prognosis. In this review, we summarize the treatment options focusing on localized T1 rectal NEN by comparing representative international guidelines and discuss current controversies on the management. We also discuss various resection techniques focusing on endoscopic resection.

• 대한방사선치료학회지
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• 제18권1호
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• pp.13-19
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• 2006

목 적: 재발한 vulva 종양의 근접 치료 시 정상조직의 장애와 종양 체적 내의 선량 균등도를 개선하기 위해 modified MUPIT applicator를 자체 고안하였으며 이에 대한 유용성을 평가하고자 한다. 대상 및 방법: Modified MUPIT applicator는 template, cylinder, interstitial needle로 구성 되었으며, 종양 체적을 정하기 위하여 치료 전 CT를 시행하였다. CT 영상을 이용하여 Interstitial needle의 삽입 위치를 결정하고, 수술실에서 template를 치료 부위에 고정을 시키고, cylinder를 vaginal cavity에 삽입한 후, interstitial needle을 종양 체적 내에 삽입하였다. 삽입된 interstitial needle의 정확한 위치를 확인하기 위하여 확인용 CT를 시행하였으며, simulation을 통하여 얻어진 orthogonal film을 이용하여 치료 계획을 수립하였다. 일일 종양 선량은 600 cGy, BID로 3,000 cGy를 조사하였으며, 치료 시 직장 선량을 평가하기 위하여 TLD를 이용하여 anal verge를 기준으로 5개 지점에서의 직장 선량을 측정하였다. 결 과: Modified MUPIT applicator 대한 유용성을 평가하기 위하여 측정된 직장 선량은 34.1 cGy, 57.1 cGy, 103.8 cGy, 162.7 cGy, 165.7 cGy로 측정되었으며, 외부방사선치료(EBRT: External Beam Radiation Therapy), 강내방사선치료(ICR: Intracavitary radiotherapy)와 중첩되는 지점은 34.1 cGy, 57.1 cGy로 매우 우수하게 평가되었다. 결 론: 자체 제작한 modified MUPIT applicator 사용하여 조직 내 근접치료(Interstitial brachytherapy)를 시행함으로써, 외부방사선치료로 접근하기 어려운 종양에 대하여 선량 균등도를 효율적으로 개선할 수 있었고, 직장 선량을 최소화하여 직장의 부작용 발생 확률을 현저히 감소시킬 수 있었다.

• Korean Journal of Radiology
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• 제25권4호
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• pp.351-362
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• 2024

Objective: To measure inter-reader agreement and identify associated factors in interpreting complete response (CR) on magnetic resonance imaging (MRI) following chemoradiotherapy (CRT) for rectal cancer. Materials and Methods: This retrospective study involved 10 readers from seven hospitals with experience of 80-10210 cases, and 149 patients who underwent surgery after CRT for rectal cancer. Using MRI-based tumor regression grading (mrTRG) and methods employed in daily practice, the readers independently assessed mrTRG, CR on T2-weighted images (T2WI) denoted as mrCR_T2W, and CR on all images including diffusion-weighted images (DWI) denoted as mrCR_overall. The readers described their interpretation patterns and how they utilized DWI. Inter-reader agreement was measured using multi-rater kappa, and associated factors were analyzed using multivariable regression. Correlation between sensitivity and specificity of each reader was analyzed using Spearman coefficient. Results: The mrCR_T2W and mrCR_overall rates varied widely among the readers, ranging 18.8%-40.3% and 18.1%-34.9%, respectively. Nine readers used DWI as a supplement sequence, which modified interpretations on T2WI in 2.7% of cases (36/1341 [149 patients × 9 readers]) and mostly (33/36) changed mrCR_T2W to non-mrCR_overall. The kappa values for mrTRG, mrCR_T2W, and mrCR_overall were 0.56 (95% confidence interval: 0.49, 0.62), 0.55 (0.52, 0.57), and 0.54 (0.51, 0.57), respectively. No use of rectal gel, larger initial tumor size, and higher initial cT stage exhibited significant association with a higher interreader agreement for assessing mrCR_overall (P ≤ 0.042). Strong negative correlations were observed between the sensitivity and specificity of individual readers (coefficient, -0.718 to -0.963; P ≤ 0.019). Conclusion: Inter-reader agreement was moderate for assessing CR on post-CRT MRI. Readers' varying standards on MRI interpretation (i.e., threshold effect), along with the use of rectal gel, initial tumor size, and initial cT stage, were significant factors associated with inter-reader agreement.