• Journal of Yeungnam Medical Science
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• 제23권2호
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• pp.193-204
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• 2006

Purpose: Various postoperative adjuvant chemotherapy regimens have been proposed for the patients with advanced gastric cancer. The majority of clinical trials have shown no significant difference in the survival benefit. The aim of this study was to compare the survival rates of postoperative adjuvant chemotherapies used in stage III gastric cancer patients who received curative gastrectomy. Materials and Methods: Between 1990 and 1999, a survival analysis was performed in 260 patients who received curative gastric resection and postoperative adjuvant chemotherapy. The patients were divided into four groups according to the chemotherapeutic regimens received. The groups were: the F group: furtulon alone, FM group: furtulon and mitomycin, FAM group: 5-FU, adriamycin and mitomycin, FLEP group: 5-FU, leucovorin, etoposide and cisplatin. The survival rates were analyzed using the Kaplan-Meier method and the Cox proportional hazards model. Results: There were no differences among the groups of patients with regard to tumor characteristics except for lymph node metastasis and the ratio of metastasis to lymph nodes. In the FLEP group, the ratio of metastasis to lymph nodes was higher than in the other groups. The five and ten year survival rates of F, FM, FAM and FLEP were 51.9%, 28.9%, 59.5%, 49.8%, 66.1%, 57.4% and 30.0%, 27.5%, respectively. The univariate analysis showed that age, Borrmann type, lymph node metastasis, ratio of metastasis to lymph nodes, postoperative adjuvant chemotherapy and recurrence were significant factors for survival. For the multivariate analysis, recurrence, age, Borrmann type, ratio of lymph node metastasis and lymph node dissection were independent prognostic factors; however, the postoperative adjuvant chemotherapy was not an independent prognostic factor. Conclusion: The FAM regimen was the most beneficial postoperative adjuvant chemotherapy for improved survival rates; the FM regimen was the second and the FLEP regimen was the last. In order to determine the effectiveness of postoperative adjuvant chemotherapy in stage III gastric cancer, well designed prospective studies including a surgery only group will be needed.

• Radiation Oncology Journal
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• 제31권3호
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• pp.118-124
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• 2013

Purpose: The optimal treatment of advanced maxillary sinus cancer has been challenging for several decades. Intra-arterial chemotherapy (IAC) for head and neck cancer has been controversial. We have analyzed the long-term outcome of neoadjuvant IAC followed by radiation therapy (RT) and surgery. Materials and Methods: Twenty-seven patients with advanced maxillary sinus cancer were treated between 1989 and 2002. Five-fluorouracil (5-FU, $500mg/m^2$) was infused intra-arterially, and followed by RT (total 50.4 Gy/28 fractions). A planned surgery was performed 3 to 4 weeks after completion of IAC and RT. Results: At a median follow-up of 77 months (range, 12 to 169 months), the 5-year rates of overall survival in all patients were 63%. The 5-year rates of overall survival of stage T3/T4 patients were 70.0% and 58.8%, respectively. Seven of fourteen patients with disease recurrence had a local recurrence alone. The 5-year actuarial local control rates in patients with stage T3/T4, and in all patients were 20.0%, 32.3%, and 27.4%, respectively. Overall response rate after the completion of IAC and RT was 70.3%. During the follow-up, seven patients (25.9%) showed mild to moderate late complications. The tumor extent (i.e., the involvement of either orbit and/or base of skull) appeared to be related with local recurrence. Conclusion: Neoadjuvant IAC with 5-FU followed by RT and surgery may be effective to improve local tumor control in the patients with advanced maxillary sinus cancer. However, local failure was still the major cause of death. Further investigations are required to determine the optimal treatment schedule, radiotherapy techniques and chemotherapy regimens.

• 대한후두음성언어의학회지
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• 제28권2호
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• pp.100-105
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• 2017

Background and Objectives : Adductor type spasmodic dysphonia (ADSD) is neurogenic disorder and focal laryngeal dystonia, while muscle tension dysphonia (MTD) is caused by functional voice disorder. Both ADSD and MTD may be associated with excessive supraglottic contraction and compensation, resulting in a strained voice quality with spastic voice breaks. The aim of this study was to determine the utility of spectrogram analysis in the differentiation of ADSD from MTD. Materials and Methods : From 2015 through 2017, 17 patients of ADSD and 20 of MTD, underwent acoustic recording and phonatory function studies, were enrolled. Jitter (frequency perturbation), Shimmer (amplitude perturbation) were obtained using MDVP (Multi-dimensional Voice Program) and GRBAS scale was used for perceptual evaluation. The two speech therapist evaluated a wide band (11,250 Hz) spectrogram by blind test using 4 scales (0-3 point) for four spectral findings, abrupt voice breaks, irregular wide spaced vertical striations, well defined formants and high frequency spectral noise. Results : Jitter, Shimmer and GRBAS were not found different between two groups with no significant correlation (p>0.05). Abrupt voice breaks and irregular wide spaced vertical striations of ADSD were significantly higher than those of MTD with strong correlation (p<0.01). High frequency spectral noise of MTD were higher than those of ADSD with strong correlation (p<0.01). Well defined formants were not found different between two groups. Conclusion : The wide band spectrograms provided visual perceptual information can differentiate ADSD from MTD. Spectrogram analysis is a useful diagnostic tool for differentiating ADSD from MTD where perceptual analysis and clinical evaluation alone are insufficient.

• Journal of the Korean Association of Oral and Maxillofacial Surgeons
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• 제27권5호
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• pp.468-473
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• 2001

본 교실에서는 우측 악하부와 우측 안와 하부의 종창으로 내원한 53세 여자 환자에서 Fine Needle Aspiration Biopsy로 림프절의 반응성 과증식으로 진단되어 다시 절제 생검을 시행하여 multi-centric Castleman's disease로 진단하였다. 조직 검사상 유리질 혈관형과 형질세포형이 공존하는 복합형으로 나타났으며 병소의 적출술만을 시행한 후 1년이 지난 지금까지는 별다른 소견없이 좋은 경과를 나타내고 있으며 앞으로도 계속 주의깊은 관찰이 필요로 한다.

• 대한임상검사과학회지
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• 제50권4호
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• pp.470-476
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• 2018

다중펄스경두개전기자극(mpTES)을 이용한 안면운동유발전위(FMEP)는 자유 진행 근전도와 직접적인 안면 신경 자극법의 한계점을 보완하고 소뇌교각 종양 수술 중에 안면 신경의 기능적인 완전성을 예측할 수 있다. 본 논문의 목적은 이 검사의 표준화된 검사방법과 안면 신경의 기능예측인자로서의 유용성을 알아보고 수술 후 중대한 후유증인 안면마비 발생률을 최소화하는 것이다. Mz (음극)-M3, M4 (양극) 전극으로 경두개전기자극을 주고 안면운동유발전위의 단일펄스반응(SPR)의 부재와 10 ms이상의 잠복기를 확인해서 직접적인 두개 외 말초 안면 근육 자극을 배제하고 구륜근(orbicularis oris)과 턱근(mentalis)에서 동시에 측정하면 구륜근에서만 측정했을 때보다 안면운동유발전위의 정확도와 성공률을 높일 수 있다. 본 논문에서는 안면운동유발전위의 50% 진폭감소를 경고기준으로 해서 수술 직후 안면 신경의 결과를 효과적으로 예측할 수 있었다. 결론적으로, 소뇌교각 종양 수술 중에 FMEP는 자유 진행 근전도와 직접적인 안면 신경 자극법과 더불어서 수술 후 중대한 후유증인 안면 마비 발생률을 최소화 할 수 있는 유용한 검사방법이다.

• Journal of Gastric Cancer
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• 제18권4호
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• pp.348-355
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• 2018

Purpose: We aimed to discuss the roles of radiation and chemotherapy as adjuvant treatment in patients with staged IB GC who were enrolled in the adjuvant chemoradiotherapy in stomach tumors (ARTIST) trial. Materials and Methods: Among the 458 patients who were enrolled in the ARTIST trial, 99 had stage IB disease. The patients were randomly assigned to receive either adjuvant chemoradiotherapy with capecitabine plus cisplatin (XP, n=50) or chemoradiotherapy (XPRT, n=49). Survival analyses were performed in accordance with the AJCC 2010 staging system. Results: According to the AJCC 2010 system, stage migration from IB to II occurred in 71% of the patients; 98% of the T2 N0 cases were reclassified as T3 N0, and 42% of the T1 N1 cases were reclassified as T1 N2. When comparing survival outcomes between the XPRT and XP arms for stage IB cancer (AJCC 2002), no significant difference in 5-year disease-free survival (DFS) between the 2 arms was found. (median 5-year DFS, not reached, P=0.256). The patients classified as having stage IB cancer (AJCC 2002) and reclassified as having stage II cancer (AJCC 2010) exhibited worse prognoses than those who remained in stage IB, although the difference was not statistically significant (5-year DFS rate, 83% vs. 93%). When we compared 5-year DFS in 70 patients with stage II (AJCC 2010), the addition of radiotherapy to XP chemotherapy did not show better outcome than XP alone (P=0.137). Conclusions: The role of adjuvant chemoradiotherapy in the treatment of stage IB GC (AJCC 2002) warrants further investigation.

• 대한임상검사과학회지
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• 제52권4호
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• pp.317-326
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• 2020

마취는 의식의 차단 역할을 하는 주 마취제와 감각, 운동, 반사의 차단을 하는 부 마취제인 근이완제로 구분된다. 깊은 의식의 차단만으로는 심한 자극에 대한 반응을 막을 수 없고, 다량의 진통제만으로는 무의식을 보장할 수 없다. 그러므로 마취는 동시에 두 가지를 모두 만족시켜야 한다. 근 이완제는 흡입 또는 정맥마취제의 투여 용량을 감소시키면서 기관지내 삽입관, 수술 시야 및 수술적 환경(operating conditions)을 향상시킬 수 있으며, 수술 중 기계적 조절 환기(controlled mechanical ventilation) 시 호흡 관리를 위하여 매우 중요하다. 이러한 근이완제는 투여 용량이 과다하면 수술 중 신경 검사가 안 되는 영향을 줄 수 있고, 투여 용량이 부족하게 되면 환자가 수술 중 움직일 수 있어서 근 이완 마취 심도와 수술 중 감시 검사는 밀접한 관계가 있다. 근 이완제를 많이 사용하면, 수술 중 신경생리학적 검사가 원활하게 되지 않는 단점과 수술 이후에 완전히 근 이완효과를 제거하기 어렵다는 단점도 갖고 있다. 수술 중 감시 검사를 하는 수술에서 마취과에서는 어떠한 기준으로 근 이완제를 투여하며 유지하는지에 대하여 국내뿐만 아니라 전 세계적인 동향을 살펴 봄으로써 보다 원활한 수술 중 신경 검사가 되길 바란다.

• Asian Pacific Journal of Cancer Prevention
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• 제14권4호
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• pp.2377-2381
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• 2013

A total of 285 patients with stage Ib2 and IIa2 cervical cancer were categorized into three groups, and received preoperative neoadjuvant chemotherapy combined with vaginal intracavitary irradiation, neoadjuvant chemotherapy alone or radiotherapy, respectively. The effective rate of 70.6 % in group 1 was much higher than 41.4% in group 2 (P=0.000) and 46.9 % in group 3 (P=0.000); The percentage of patients receiving postoperative adjuvant therapy was 44.1% in group 1, much lower than 67.8% in group 2 (P=0.001) and 64.6% in group 3 (P=0.004); The percentage of patients with no postoperative risk factor in group 1 was 52.0%, much higher than 32.2% in group 2 (P=0.006) and 35.4% in group 3 (P=0.019); The occurrence rate of surgery-related complications in groups 1, 2 and 3 were 29.4%, 28.7%, and 33.3%, respectively, with no statistical differences among the groups (P=0.981). Regarding preoperative neoadjuvant complications, none were obvious in group 3, while occurrence rates of myelosuppression in groups 1 and 2 were 89.1% and 86.6%, of nausea and vomitting were 78.4% and 78.2%, but without significant differences (all P>0.05). Among 166 patients who received postoperative adjuvant therapy in the three groups, the occurrence rates were: 65.4%, 64.3% and 61.1% respectively for myelosuppression; 42.3%, 38.1%, and 38.9% for nausea and vomiting; 9.6%, 9.5% and 9.7% for urocystitis; and 63.5%, 69.0% and 65.3% enteritis and rectitis. There were no statistically significant differences among them (all P>0.05). The five-year disease-free survival rates (DFS) in groups 1, 2, 3 were 78.3%, 75.1%, 80.9%, respectively; the five-year overall survival rates (OS) were 81.4%, 78.2%, and 81.1%, respectively. The five-year OS of 166 patients receiving postoperative in the three groups were 72.4%, 69.5%, and 71.8%, respectively, with no significant variation (all P>0.05). Although there were no differences among three groups in DFS and OS, preoperative neoadjuvant chemotherapy combined with intracavitary radiotherapy may increase the effective rate and the percentage of patients with no postoperative risk factors and decrease the percentage of patients receiving postoperative adjuvant therapy, thereby decreasing complications indirectly and increasing quality of life.

• Radiation Oncology Journal
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• 제32권3호
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• pp.147-155
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• 2014

Purpose: This study was conducted to observe the outcomes of postoperative radiotherapy (PORT) with or without concurrent chemotherapy in resected non-small cell lung cancer (NSCLC) in single institution. Materials and Methods: From 2002 to 2013, 78 patients diagnosed with NSCLC after curative resection were treated with radiotherapy alone (RT, n = 48) or concurrent chemoradiation (CCRT, n = 30). The indications of adjuvant radiation therapy were N2 node positive (n = 31), close or involved resection margin (n = 28), or gross residual disease due to incomplete resection (n = 19). The median radiation dose was 57.6 Gy (range, 29.9 to 66 Gy). Results: Median survival time was 33.7 months (range, 4.4 to 140.3 months). The 5-year overall survival (OS) rate was 49.5% (RT 46% vs. CCRT 55.2%; p = 0.731). The 3-year disease-free survival rate was 45.5% (RT 39.4% vs. CCRT 55.3%; p = 0.130). The 3-year local control rate was 68.1% (RT 64.4% vs. CCRT 77.7%; p = 0.165). The 3-year DMFS rate was 56.1% (RT 52.6% vs. CCRT 61.7%; p = 0.314). In multivariate analysis, age ${\geq}66$ years and pathologic stage III were significant poor prognostic factors for OS. Treatment failure occurred in 40 patients. Four patients had radiologically confirmed grade 3 radiation pneumonitis. Conclusion: In NSCLC, adjuvant RT or CCRT after curative surgery is a safe and feasible modality of treatment. OS gain was seen in patients less than 66 years. Postoperative CCRT showed a propensity of achieving better local control and improved disease-free survival compared to RT alone according to our data.

• 생명과학회지
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• 제18권9호
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• pp.1257-1262
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• 2008

본 연구에서는 두경부 암세포 주에서 genistein의 증식억제 효과를 알아보고, genistein을 광역학 치료와 병행 치료 시 나타나는 세포 독성능 및 세포고사 유발에 대해 연구 하였다. 두경부 암세포 주에서 genistein의 세포독성능을 확인한 결과, 농도 및 시간 의존적으로 세포 독성능이 나타났다. 이에 genistein을 photofrin을 이용한 광역학 치료와 병행 치료 시 더 많은 세포 독성능이 나타났다. Genistein과 광역학 치료의 병행 치료 시 나타나는 형태적 변화는 광역학 치료시에는 주로 세포괴사의 형태가 관찰 되었으나, genistein과 병행 치료 시에는 세포고사가 관찰 되었다. 시간별로 관찰하였을 때, 광역학 치료를 $IC_{80}$으로 처리하였을 때 3시간 때에 apoptotic body가 약 3배정도 증가하였다. 세포 내 ROS를 확인한 결과 genistein과 광역학 치료를 단독으로 처리하였을 때 세포 내 존재하는 ROS가 각각 증가 하였으며, 병행 치료하였을 때는 더 많은 ROS가 형성되는 것으로 나타났다. 즉, genistein이 세포 내 ROS를 유발하여 mitochondria가 손상되고, 또한 photofrin에 의한 광역학 치료도 mitochondria를 손상시켜 세포고사를 유도하는 것으로 추측되어 진다.