• Radiation Oncology Journal
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• v.35 no.3
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• pp.208-216
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• 2017

Purpose: To evaluate the feasibility of simultaneous integrated boost intensity-modulated radiotherapy (SIB-IMRT) for preoperative concurrent chemoradiotherapy (PCRT) in locally advanced rectal cancer (LARC), by comparing with 3-dimensional conformal radiotherapy (3D-CRT). Materials and Methods: Patients who were treated with PCRT for LARC from 2015 January to 2016 December were retrospectively enrolled. Total doses of 45 Gy to 50.4 Gy with 3D-CRT or SIB-IMRT were administered concomitantly with 5-fluorouracil plus leucovorin or capecitabine. Surgery was performed 8 weeks after PCRT. Between PCRT and surgery, one cycle of additional chemotherapy was administered. Pathologic tumor responses were compared between SIB-IMRT and 3D-CRT groups. Acute gastrointestinal, genitourinary, hematologic, and skin toxicities were compared between the two groups based on the RTOG toxicity criteria. Results: SIB-IMRT was used in 53 patients, and 3D-CRT in 41 patients. After PCRT, no significant differences were noted in tumor responses, pathologic complete response (9% vs. 7%; p = 1.000), pathologic tumor regression Grade 3 or higher (85% vs. 71%; p = 0.096), and R0 resection (87% vs. 85%; p = 0.843). Grade 2 genitourinary toxicities were significantly lesser in the SIB-IMRT group (8% vs. 24%; p = 0.023), but gastrointestinal toxicities were not different across the two groups. Conclusion: SIB-IMRT showed lower GU toxicity and similar tumor responses when compared with 3D-CRT in PCRT for LARC.

• Archives of Plastic Surgery
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• v.33 no.6
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• pp.764-768
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• 2006

Purpose: Parotid neoplasia are relatively frequent, representing approximately 3% of all tumors in the head and neck regions. But incomplete resection and misdiagnosis of parotid gland is followed by multiple tumor invasion, tumor recurrence, and other iatrogenic tumor formation. In patients undergoing parotidectomy for confirmed or suspected malignancy, the traditional or modified rhytidectomy incision may prove suboptimal because it does not easily lend itself to a continuous neck dissection. Similarly, patients with tumors of the anterior accessory lobe or patients with large anterior tumors may also require the modified Blair incision for adequate surgical exposure. This report serves to revisit the topic of accessory and parotid gland neoplasms to emphasize proper management, particularly the surgical aspects, so that consequences of recurrence are avoided. Methods: This is a retrospective review of our experience with two cases of parotid tumors; one accessory parotid gland neoplasm and one parotid gland neoplasm. We report the case of parotid tumor and epidermal cyst in a 54-year old male patient and the case of case of recurrent parotid tumor with local invasion in 30-year old male patient. Results: All were removed through a modified Blair incision. Pathologic report notified that One was found pleomorphic adenoma and epidermal cyst, and the other one pleomorphic adenoma with subcutenous invasion. The patients recovered well without any complication such as infection, hematoma, facial nerve palsy, and necrosis of skin flap. Patients were discharge POD#7. Patients were followed up to for 1 year and they have no sign of recurrence. Conclusions: A high index of suspicion, prudent diagnostic skills(including fine-needle aspiration biopsy, CT, US), and meticulous surgical approach are the keys to a successful management of these lesions. We experienced two cases of parotid neoplasia, in the treatment of tumor reccurence & iatrogenic tumor arising from the parotid gland and are presented with the review of literatures.

• Archives of Craniofacial Surgery
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• v.21 no.4
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• pp.229-236
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• 2020

Background: Oncologic resection of the scalp confers several obstacles to the reconstructive surgeon dependent upon patient-specific and wound-specific factors. We aim to describe our experiences with various reconstructive methods, and delineate risk factors for coverage failure and complications in the setting of scalp reconstruction. Methods: A retrospective chart review was conducted, examining patients who underwent resection of fungating scalp tumors with subsequent soft-tissue reconstruction from 2003 to 2019. Patient demographics, wound and oncologic characteristics, treatment modalities, and outcomes were recorded and analyzed. Results: A total of 189 patients were appropriate for inclusion, undergoing a range of reconstructive methods from skin grafting to free flaps. Thirty-three patients (17.5%) underwent preoperative radiation. In all, 48 patients (25.4%) suffered wound site complications, 25 (13.2%) underwent reoperation, and 47 (24.9%) suffered from mortality. Preoperative radiation therapy was an independent risk factor for wound complications (odds ratio [OR], 2.85; 95% confidence interval [CI], 1.1-7.3; p=0.028) and reoperations (OR, 4.45; 95% CI, 1.5-13.2; p=0.007). Similarly, the presence of an underlying titanium mesh was an independent predictor of wound complications (OR, 2.49; 95% CI, 1.1-5.6; p=0.029) and reoperations (OR, 3.40; 95% CI, 1.2-9.7; p=0.020). Both immunosuppressed status (OR, 2.88; 95% CI, 1.2-7.1; p=0.021) and preoperative radiation therapy (OR, 3.34; 95% CI, 1.2-9.7; p=0.022) were risk factors for mortality. Conclusion: Both preoperative radiation and the presence of underlying titanium mesh are independent risk factors for wound site complications and increased reoperation rates following oncologic resection and reconstruction of the scalp. Additionally, preoperative radiation, along with an immunosuppressed state, may predict patient mortality following scalp resection and reconstruction.

• Tuberculosis and Respiratory Diseases
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• v.81 no.4
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• pp.330-338
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• 2018

Background: We developed an additional laser guidance system to improve the efficacy and safety of conventional computed tomography (CT)-guided percutaneous transthoracic needle biopsy (PTNB), and we conducted this study to evaluate the efficacy and safety of our system. Methods: We retrospectively analyzed the medical records of 244 patients who underwent CT-guided PTNB using our additional laser guidance system from July 1, 2015, to January 20, 2016. Results: There were nine false-negative results among the 238 total cases. The sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of our system for diagnosing malignancy were 94.4% (152/161), 100% (77/77), 100% (152/152), 89.5% (77/86), and 96.2% (229/238), respectively. The results of univariate analysis showed that the risk factors for a false-negative result were male sex (p=0.029), a final diagnosis of malignancy (p=0.033), a lesion in the lower lobe (p=0.035), shorter distance from the skin to the target lesion (p=0.003), and shorter distance from the pleura to the target lesion (p=0.006). The overall complication rate was 30.5% (74/243). Pneumothorax, hemoptysis, and hemothorax occurred in 21.8% (53/243), 9.1% (22/243), and 1.6% (4/243) of cases, respectively. Conclusion: The additional laser guidance system might be a highly economical and efficient method to improve the diagnostic efficacy and safety of conventional CT-guided PTNB even if performed by inexperienced pulmonologists.

• Archives of Craniofacial Surgery
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• v.21 no.5
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• pp.288-293
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• 2020

Background: Pilomatrixoma is a benign tumor that originates from the hair follicle matrix. It usually presents as a hard, slow growing, solitary mass that can be easily misdiagnosed as other skin masses. The aim of this study was to clinically analyze a case series of pilomatrixoma in pediatric patients from Korea. Methods: A total of 165 pediatric patients from 2011 to 2018 with a histological diagnosis of pilomatrixoma were included. A retrospective review was performed using the electronic medical records, including patient demographics, number and location of the mass, clinical and imaging presentation, and postoperative outcomes. Results: There were 61 male and 104 female patients with 152 solitary and 13 multiple pilomatrixomas. Among solitary pilomatrixomas, the lesion commonly occurred in the head and neck (84.2%), followed by upper limbs (11.2%), lower limbs (3.3%), and trunk (1.3%). The pilomatrixoma lesion presented as the following types based on our clinical classification: mass (56.02%), pigmentation (25.31%), mixed (12.65%), ulceration (4.82%), and keloid-like (1.2%). Ultrasonography showed a high positive predictive value (95.56%). There were no specific complications observed except for two cases of recurrence. Conclusion: Pilomatrixoma has various clinical feature presentations and commonly occurs in the head and neck. Ultrasonography is a helpful diagnostic tool. Surgical removal of the lesion is the main treatment method with a low recurrence rate.

• Korean Journal of Head & Neck Oncology
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• v.19 no.1
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• pp.41-46
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• 2003

Background and Objectives: Surgical ablation of tumors in the oral cavity and the oropharynx results in a three dimensional defect because of the needs to resect the adjacent area for the surgical margin. Although a variety of techniques are available, radial forearm free flap has been known as an effective method for this defect, which offers a thin, pliable, and relatively hairless skin and a long vascular pedicle. We report the clinical results of our 54 consecutive radial forearm free flaps used for oral cavity and oropharynx cancers. Materials and Methods: We reviewed the medical records of patients who were offered intraoral reconstruction with a radial forearm free flap after ablative surgery for oral cavity and oropharyngeal cancers from August 1994 to February 2003 and analyzed surgical methods, flap survival rate, complication, and functional results. Among these, 20 cases were examined with modified barium swallow to evaluate postoperative swallowing function and other 8 cases with articulation and resonance test for speech. We examined recovery of sensation with two-point discrimination test in 15 cases who were offered sensate flaps. Results: The primary sites were as follows : mobile tongue (18), tonsil (17), floor of mouth (4), base of tongue (2), soft palate (2), retromolar trigone (3), buccal mucosa (1), oro-hypopharynx (6), and lower lip (1). The paddles of flaps were tailored in multilobed designs from oval shape to tetralobed design and in variable size according to the defects after ablation. This procedures resulted in satisfactory flap success rate (96.3%) and showed good swallowing function and social speech. Eight of 15 cases (53.3%) who had offered sensate flap showed recovery of sensation between 1 and 6 postoperative months (average 2.6 month). Conclusion: The reconstruction with radial forearm free flap might be an excellent method for the maximal functional results after ablative surgery of oral cavity and oropharyngeal cancers that results in multidimensional defect.

• Radiation Oncology Journal
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• v.28 no.4
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• pp.205-210
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• 2010

Purpose: To evaluate the predictive factors for treatment response and prognostic factors affecting survival outcomes after concurrent chemoradiotherapy (CCRT) for patients with anal squamous cell carcinoma. Materials and Methods: Medical records of forty two patients with histologically confirmed analsquamous cell carcinoma, who had complete CCRT between 1993 and 2008, were reviewed retrospectively. Median age was 61.5 years (39~89 years), and median radiotherapy (RT) dose was 50.4 Gy (30.0~64.0 Gy). A total of 36 patients had equal to or less than T2 stage (85.7%). Fourteen patients (33.3%) showed regional nodal metastasis, 36 patients (85.7%) were treated with 5-fluorouracil (5-FU) plus mitomycin, and the remaining patients were treated by 5-FU plus cisplatinum. Results: The median follow-up time was 62 months (2~202 months). The 5-year overall survival, loco regional relapse-free survival, disease-free survival, and colostomy-free survival rates were 86.0%, 71.7%, 71.7%, 78.2%, respectively. Regarding overall survival, the Eastern Cooperative Oncology Group (ECOG) performance status and complete response were found to be significant prognostic factors on univariate analysis. For multivariate analysis, only the ECOG performance status was significant. No significant factor was found for locoregional relapse-free survival or disease-free survival and similarly for treatment response, no significant factor was determined on logistic regression analysis. There were 7 patients who had local or regional recurrences and one patient with distant metastasis. The only evaluable toxicity in all patients was radiation dermatitis of perianal skin (grade 3), which developed in 4 patients (9.5%) and grade 2 in 22 patients (52.4%). Conclusion: This study revealed that patients with a performance score of ECOG 0-1 survived significantly longer than those with a poorer score. Finally, there was no significant predicting factors tested for treatment response.