• Radiation Oncology Journal
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• v.13 no.2
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• pp.149-156
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• 1995

Purpose : Since February 1991 a Prospective study for non-small cell lung cancer patients who underwent radical resection and had a risk factor of positive resection margin or regional lymph node metastasis has been conducted to evaluate the effect of MVP chemotherapy and radiotherapy on the pattern of failure, disease free and overall survival. and tolerance of combined treatment. Materials and Methods: Twenty nine patients were registered to this study until Sep. 1993; of these 26 received planned therapy Within 3 weeks after radical resection, two cycles of MVP(Mitomycin C $6mg/m^2,$ Vinblastin $6mg/m^2,$ Cisplatin $60mg/m^2$) chemotherapy was given with 4 weeks intervals. Radiotherapy (5040cGy tumor bed dose and 900cGy boost to high risk area) was started 3 to 4 weeks after chemotherapy. Results: One and two year overall survival rates were $76.5\%\;and\;58.6\%$ respectively. Locoregional failure developed in 6 patients$(23.1\%)$ and distant failure in 9 patients$(34.6\%)$ Number of involved lymph nodes, resection margin positivity showed some correlation with failure pattern but T-stage and N-stage showed no statistical significance. The group of patients who received chemotherapy within 2 weeks postoperatively and radiotherapy within 70 days showed lower incidence of distant metastasis. Postoperative combined therapy were well tolerated without definite increase of complication rate, and compliance rate in this study was $90\%$. Conclusion: 1) MVP chemotherapy showed no effect on locoregional recurrence, but appeared to decrease the distant metastasis rate and 2) combined treatments were well tolerated in all patients. 3) The group of patients who received chemotherapy within 2 weeks postoperatively and radiotherapy within 70days showed lower incidence of distant metastasis. 4) Addition of chemotherapy to radiotherapy failed to increase the overall or disease free survival.

• Radiation Oncology Journal
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• v.33 no.2
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• pp.126-133
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• 2015

Purpose: To evaluate the outcomes of adjuvant radiotherapy (RT) and to analyze prognostic factors of survival in the International Federation of Gynecology and Obstetrics (FIGO) IB-IIA uterine cervical cancer. Materials and Methods: We retrospectively reviewed the medical records of 148 patients with FIGO IB-IIA uterine cervical cancer who underwent surgery followed by adjuvant RT at the Yonsei Cancer Center between June 1997 and December 2011. Adjuvant radiotherapy was delivered to the whole pelvis or an extended field with or without brachytherapy. Among all patients, 57 (38.5%) received adjuvant chemotherapy either concurrently or sequentially. To analyze prognostic factors, we assessed clinicopathologic variables and metabolic parameters measured on preoperative 18F-fluorodeoxyglucose (FDG) positron emission tomography/computed tomography (PET/CT). To evaluate the predictive performance of metabolic parameters, receiver operating characteristic curve analysis was used. Overall survival (OS) and disease-free survival (DFS) were analyzed by the Kaplan-Meier method. Results: The median follow-up period was 63.2 months (range, 2.7 to 206.8 months). Locoregional recurrence alone occurred in 6 patients, while distant metastasis was present in 16 patients, including 2 patients with simultaneous regional failure. The 5-year and 10-year OSs were 87.0% and 85.4%, respectively. The 5-year and 10-year DFSs were 83.8% and 82.5%, respectively. In multivariate analysis, pathologic type and tumor size were shown to be significant prognostic factors associated with both DFS and OS. In subset analysis of 40 patients who underwent preoperative PET/CT, total lesion glycolysis was shown to be the most significant prognostic factor among the clinicopathologic variables and metabolic parameters for DFS. Conclusion: Our results demonstrated that adjuvant RT following hysterectomy effectively improves local control. From the subset analysis of preoperative PET/CT, we can consider that metabolic parameters may hold prognostic significance in early uterine cervical cancer patients. More effective systemic treatments might be needed to reduce distant metastasis in these patients.

• Radiation Oncology Journal
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• v.30 no.4
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• pp.173-181
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• 2012

Purpose: To evaluate the prognostic value of preoperative neck lymph node (LN) assessment with $^{18}F$-fluorodeoxyglucose positron emission tomography ($^{18}F$-FDG PET), computed tomography (CT), and magnetic resonance imaging (MRI) in oral cavity squamous cell carcinoma (OSCC) patients with pathologically positive LN. Materials and Methods: In total, 47 OSCC patients with pathologically positive LN were retrospectively reviewed with preoperative $^{18}F$-FDG PET and CT/MRI. All patients underwent surgical resection, neck dissection and postoperative adjuvant radiotherapy and/or chemotherapy between March 2002 and October 2010. Histologic correlation was performed for findings of $^{18}F$-FDG PET and CT/MRI. Results: Thirty-six (76.6%) of 47 cases were correctly diagnosed with neck LN metastasis by $^{18}F$-FDG PET and 32 (68.1%) of 47 cases were correctly diagnosed by CT/MRI. Follow-up ranged from 20 to 114 months (median, 56 months). Clinically negative nodal status evaluated by $^{18}F$-FDG PET or CT/MRI revealed a trend toward better clinical outcomes in terms of overall survival, disease-free survival, local recurrence-free survival, regional nodal recurrence-free survival, and distant metastasis-free survival rates even though the trends were not statistically significant. However, there was no impact of neck node standardized uptake value ($SUV_{max}$) on clinical outcomes. Notably, $SUV_{max}$ showed significant correlation with tumor size in LN (p < 0.01, $R^2$ = 0.62). PET and CT/MRI status of LN also had significant correlation with the size of intranodal tumor deposit (p < 0.05, $R^2$ = 0.37 and p < 0.01, $R^2$ = 0.48, respectively). Conclusion: $^{18}F$-FDG PET and CT/MRI at the neck LNs might improve risk stratification in OSCC patients with pathologically positive neck LN in this study, even without significant prognostic value of $SUV_{max}$.

• Korean Journal of Head & Neck Oncology
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• v.12 no.2
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• pp.217-223
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• 1996

A retrospective analysis was performed to assess the relationship between the treatment modalities and treatment results in patients with adenoid cystic carcinoma of the maxillary sinus. From Feb. 1977 to March 1994, 10 patients with the disease were treated at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine. Six men and 4 women were presented with median age of 57 years. According to AJCC TNM system, all patients except one had advanced T3 and T4 disease. Only one patient had the regional metastasis to lymph node but none of them had hematogenous metastasis on initial admission. One patient(Group 1) was treated with surgery alone, 3 patients(Group 2) were treated with definitive radiotherapy and 6 patients(Group 3) were treated with combination of surgery and radiotherapy. One patient who was treated with surgery alone had experienced a locoregional recurrence 9 months later and 3 patients who were treated with radiation therapy alone had PRs(partial response) followed by the subsequent progression of the local disease. Whereas all patients who were treated with combination of surgery and radiation therapy had CRs(complete response). Among them, only one patient was recurred in the primary site, who was salvaged by reoperation and reirradiation therapy. In conclusion, combination of surgery and radiotherapy resulted in the best treatment modality for adenoid cystic carcinoma of the maxillary sinus. Improved radiotherapy technique and development of multimodality treatment are needed to improve the local control and the survival rate in patients with advanced adenoid cystic carcinoma of the maxillary sinus.

• Journal of Chest Surgery
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• v.35 no.5
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• pp.381-386
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• 2002

Background: Bronchial carcinoids account for approximately 2% of all pulmonary tumor and consist of typical carcinoids and atypical carcinoids. An atypical carcinoids is considered to be an intermediate form of tumor between a low-grade malignant typical carcinoid and a high-grade malignant small cell lung carcinoma. There is still controversy with regard to the extent of resection and the value of systemic adjuvant therapy in atypical carcinoids. We performed a retrospective review of our experiences at Severance Hospital. Material and Method: Between 1990 and 2000, 15 patients with bronchial carcioids were operated, and 5 of these had atypical carcinoids. Histologic diagnosis was established un the criteria of WHO/IASLC(1999). Result: There were 3 pneumonectomies, 11 lobectomies, and 1 segmentectomy. In typical carcinoids, one patient had regional lymph node metastasis, and 3 patients in atypical carcinoids had mediastinal lymph node metastases. Distant metastases developed in one patient of typical carcinoid, but developed in 4 patients of atypical carcinoids(p=0.0017). The 5-year survival rate in patients with atypical carcinoids was 20%, versus the 100% 5-year survival rate observed in patients with topical carcinoids(p=0.0039). Conclusion: In atypical carcincids, because of many lymph node metastases on diagnosis and a low long-term survival rate, lobectomy constitutes a mininal procedure. Adjuvant systemic therapy is recommended fur patients with lymph node and distant metastasis.

• The Korean Journal of Nuclear Medicine
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• v.20 no.1
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• pp.59-65
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• 1986

Clinical features of 406 patients with histologically verified thyroid carcinomas were investigated from May, 1978 to April, 1985 at the Seoul National University Hospital with the following results. 1) The incidence of thyroid cancer according to their histological classification was 79.8% of papillary carcinoma, 14.5% of follicular carcinoma, 1.5% of medullary carcinoma, 2.2% of anaplastic carcinoma, 2 cases of squamous carcinoma and 3 cases of lymphoma. 2) The age distribution showed the peak incidence in the fourth decade (25.1%), followed by the fifth and the third decade. 3) The ratio of male to female patients was 1 : 6.1. The ratio is 1 : 5.9 in papillary carcinoma and 1 : 8.8 in follicular carcinoma. 4) The mean age was 40.2 year in papillary carcinoma, 37.4 year in follicular carcinoma. 36.5 year in medullary carcinoma, 60.3 year in anaplastic carcinoma, 62.0 year in squamous carcinoma, 59.7 year in lymphoma. 5) The diameter of the thyroid masses was smaller than 1.5cm in 19.9% of the patients, from 1.5cm to 5cm in 50.5%, from 5cm to 10cm in 25.4% and larger than 10cm in 25.4%. 6) Metastasis to the regional lymph nodes at diagnosis was noted in 44.2% of total patients, and distant metastasis was 5%, and local infiltration was 44.2%. 7) The clinical staging was revealed 42.1% of the patients in stage I, 9.1% in stage II, 35.7% in stage III, 5.2% in stage IV, and 7.9% in undetermined stage.

• Journal of Gastric Cancer
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• v.8 no.4
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• pp.204-209
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• 2008

Purpose: The goal of this study was to review the clinicopathologic characteristics of neuroendocrine tumor (NET) of the stomach. Materials and Methods: We retrospectively reviewed the medical records of 13 patients who were diagnosed with neuroendocrine tumor from January 1999 to August 2007 at Kosin Medical Center; 4,159 gastric cancer patients were treated surgically during the same time. The average follow up period was 14.3 months. Results: The majority of 13 patients were men (male-female ratio: 11:2) and the average age of patients with NET was 59.4 years (range: 42~72 years). The presenting symptoms were mostly epigastric pain and soreness. The tumor was limited to the mucosa or submucosa in two cases, and the tumor extended beyond the muscle layer in 11 cases. The mean size of the tumor was 7.0 cm, ranging from 0.7 cm to 15 cm. The type of the NEC (according to the WHO classification) was type 3 for eight patients, type 4 for four patients and type 1 for one patient. Regional lymph node metastasis was noted in 11 patients. Four cases showed recurrence of disease and the site of recurrence included liver in two patients, multiple organs (including the peritoneum and lung) in one patient and multiple organs (including liver, pancreas and duodenum) in one patient. The recurrent cases were type 3 and type 4 and the average survival period of the recurrent patients was 12.8 months. Conclusion: The majority of neuroendocrine tumors of the stomach were at an advanced stage at the time of diagnosis. These tumors frequently recurred in the liver and they have a poor prognosis.

• Radiation Oncology Journal
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• v.9 no.1
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• pp.59-63
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• 1991

Thirty-one patients with previously untreated and locally advanced nasopharyngeal cancer were retrospectively reviewed for comparing the effects of radical radiotherapy alone with that of combining chemotherapy and radiotherapy from 1983 to 1989 at Kangnam 51. Mavy's hospital.23/31 were evaluable for recurrence and suwival. There were 8 patients for stage III, and 15 patients for stage IV. Eleven patients were treated with radical radiation therapy done (arm I). Twelve patients were given 1~3 courses of cisplatin-5FU or cisplatin-bleomycin-vincristine prior to radiation therapy (arm II). The two arms were comparable in patient characteristics Of 11 radiotherapy Patients, complete response was 55%(6/11) and Partial response 45%(5/11). Among 12 patients after induction chemotherapy, complete response was 25%(3/12) and partial response 75%(9/12). After subsequent radiotherapy, complete response was increased to 83%(10/12) and partial response was 17%(2/12). Treatment failure was 30%(local recurrence; 3/11, and regional recurrence; 1/11) in arm 1 and 33% (local recurrence; 1/12, regional recurrence; 2/12 and distant metastasis; 1/12) in arm ll . There was no significant difference in survival between arm I and arm II (p> 0.05). The toxicities of treatment were acceptable. More controlled clinical trials must be completed before acceptance of chemotherapy as part of a standard radical treatment for locally advanced nasopharyngeal cancer.

• Asian Pacific Journal of Cancer Prevention
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• v.13 no.5
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• pp.2101-2107
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• 2012

Treatment responses of $N_0$ stage nasopharyngeal carcinoma were firstly analyzed comprehensively to evaluate long term outcomes of patients and identify prognostic factors. A total of 610 patients with $N_0$ NPC, undergoing definitive radiotherapy to their primary lesion and prophylactic radiation to upper neck, were reviewed retrospectively. Concomitant chemotherapy was administrated to 65 out of the 610. Survival rates of the patients were calculated using the Kaplan-Meier method and compared by log-rank test. Prognostic factors were identified by the Cox regression model. The study revealed the 5-year and 10-year overall, disease-free, disease-specific, local failure-free, regional failure-free, locoregional failure-free and distant metastasis-free survival rates to be 78.7% and 66.8%, 68.8% and 55.8%, 79.9% and 70.4%, 81.2% and 72.5%, 95.8% and 91.8%, 78.3% and 68.5%, 88.5% and 85.5%, respectively. There were 192 patients experiencing failure (31.5%) after radiotherapy or chemoradiotherapy. Of these, local recurrence, regional relapse and distant metastases as the first event of failure occurred in 100 (100/610, 16.4%), 15(15/610, 2.5%) and 52 (52/610, 8.5%), respectively. Multivariate analysis showed that T stage was the only independent prognostic factor for patients with $N_0$ NPC (P=0.000). Late T stage (P=0.000), male (P=0.039) and anemia (P=0.007) were independently unfavorable factors predicting disease-free survival. After treatment, satisfactory outcome wasgenerally achieved in patients with $N_0$ NPC. Local recurrence represented the predominant mode of treatment failure, while T stage was the only independent prognostic factor for overall survival. Late T stage, male gender, and anemia independently predicted lower possibility of the disease-free survival.

• Radiation Oncology Journal
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• v.34 no.1
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• pp.34-44
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• 2016

Purpose: A prospective phase II trial was conducted to evaluate the effectiveness and toxicity of regional hyperthermia and whole liver irradiation (WLI) for numerous chemorefractory liver metastases from colorectal cancer. Materials and Methods: Enrolled patients had numerous chemorefractory hepatic metastases from colorectal cancer. Five sessions of hyperthermia and seven fractions of 3-gray WLI were planned. Health-related quality of life (HRQoL) was determined using the Korean version of the European Organization for Research and Treatment of Cancer quality of life questionnaire C-30 and the Functional Assessment of Cancer Therapy-Hepatobiliary version 4.0. Objective and pain response was evaluated. Results: A total of 12 patients consented to the study and the 10 who received WLI and hyperthermia were analyzed. WLI was completed as planned in nine patients and hyperthermia in eight. Pain response was partial in four patients and stable in four. Partial objective response was achieved in three patients (30.0%) and stable disease was seen in four patients at the 1-month follow-up. One patient died 1 month after treatment because of respiratory failure related to pleural metastasis progression. Other grade III or higher toxicities were detected in three patients; however, all severe toxicities were related to disease progression rather than treatment. No significant difference in HRQoL was noted at the time of assessment for patients who were available for questionnaires. Conclusion: Combined WLI and hyperthermia were well tolerated without severe treatment-related toxicity with a promising response from numerous chemorefractory hepatic metastases from colorectal cancer.