• Asian Pacific Journal of Cancer Prevention
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• 제14권8호
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• pp.4843-4846
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• 2013

Background: The infusion rate is considered to affect incidence and severity of infusion reactions (IRs) caused by protein formulations. Trastuzumab (TRS) is approved for 90-minute infusion as the initial dose followed by 30-minute infusion with 250 ml saline. In the study, we evaluated the safety of TRS intravenously administered over 30 minutes with 100 ml saline to reduce burden of patients, safety of infusion with 250 ml saline already being established. Materials and Methods: Women with HER2 positive breast cancer, ${\geq}18$ years and ${\geq}55%$ left ventricular ejection fraction (LVEF), were registered in the study. Patients received 8mg/kg of TRS 250 ml over 90 minutes followed by 6mg/kg of TRS 100ml over 30 minutes in a three-week cycle. Results: A total of 31 patients were recruited, 24 for adjuvant therapy and seven with metastases. The median age was 59 years (range 39 to 82). The total number of TRS doses ranged from 5 to 17 with the median of 15. Mild IR occurred in two patients at the first dose. However, no IR was observed after reducing to 100 ml saline. No decrease of LVEF, increase of serum brain natriuretic peptide or any other adverse events were reported. Conclusions: Intravenous infusion of TRS with 100 ml saline over 30 minutes in breast cancer patients can be considered safe based on results from the study. It can be given on an outpatient basis as with the currently recommended dilution in 250 ml saline.

• Tuberculosis and Respiratory Diseases
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• 제51권6호
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• pp.579-584
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• 2001

저자들은 호흡기계 증상 없이 오른쪽 팔과 얼굴의 이상감각을 주소로 내원한 49세 여자환자에서 폐종괴에 대한 세침흡인생검과 상악동에서의 조직검사로 폐 선암의 우측 상악동 전이를 진단한 1예를 경험하여 보고하는 바이다.

• 대한두경부종양학회지
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• 제34권2호
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• pp.17-21
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• 2018

Background/Objectives: Cancers of the abdominal or pelvic organ rarely metastasize to the cervical lymph nodes. Although it indicates distant metastasis, perceivable prolongation of survival or cure may be possible in selected cases. We sought to identify patients with cervical metastasis from cancers below the diaphragm and identify patients who may benefit from aggressive treatment. Materials & Methods: From 2009 to 2017, patients with pathologically confirmed metastatic cervical lymph nodes originating from below the diaphragm were included for analysis. Patient demographics, cancer characteristics, treatment course, and clinical outcomes were analyzed. Results: 208 patients were identified. Left supraclavicular node (Virchow's node) was the most frequently involved. Irrespective of treatment, survival for uterine cervical and ovarian cancers was significantly longer than that of other primaries. Patients with isolated cervical metastasis (oligometastasis) had significantly longer median survival compared to patients with concomitant bone, lung, brain, and mediastinal metastases. Conclusion: Although cervical metastasis from cancers of the abdominal and pelvic organ represent distant metastasis, patients with uterine cervix and ovary primary and oligometastatic lesions may benefit from aggressive treatment. Prudent patient selection and further investigation is warranted.

• Asian Pacific Journal of Cancer Prevention
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• 제15권4호
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• pp.1811-1815
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• 2014

Background: In clinical trials with no upper age limit, the proportion of older patients is usually small, probably reflecting the more conservative approach adopted by clinicians when treating the elderly. An exploratory analysis of elderly patients in the RECORD-1 Trial showed that patients ${\geq}$ 65 y.o. had superior median PFS than overall RECORD-1 population (5.4 months and 4.9 months, respectively). We investigated the efficacy, relative benefit and safety of Everolimus (EVE) as sequential therapy after failure of VEGFr-TKI therapy for older patients with metastatic renal cell cancer (mRCC), in daily practice. Materials and Methods: 172 consecutive IRB approved patients with mRCC (median age 65, M:F 135/37, 78% clear cell) who received salvage EVE at 39 tertiary institutions between October 2009 and August 2011 were included in this analysis. Some 31% had progressed on sunitinib, 22% on sorafenib, 1% on axitinib, 41% on sequential therapy, and 5% had received other therapy. Patients with brain metastases were not included and 95% of the patients had a ECOG (Eastern Cooperative Oncology Group) performance status (PS) of 0 or 1. Previous radiotherapy was an exclusion criterion, but prior chemotherapy was permitted. Adequate organ function and hematologic parameters were mandatory. EVE administration was approved by the institutional review board at each participating institution and signed informed consent was obtained from all patients. Results: Median time of the whole cohort to last follow-up was 3.5 months (range 0.4-15.2 months). Forty four percent were continuing to take EVE at last followup. There were 86 (50%) patients ${\geq}$ 65 y.o. and 86 (50%) <65 y.o. The percentage of patients who showed PR/SD was higher in the older group than in the younger one (5.9%/61.2% vs 1.2%/46.5%, respectively). Median survival of older patients was also significantly longer (3.5 +/- 0.31 vs 3.1 +/- 0.34, hazard ratio=0.45, CI; 0.255-0.802). Analysis using Cox regression model adjusted for gender, PS, number of metastases, site of metastases, histology, smoking history and age detected an association between age and PFS (p=0.011). The frequency of adverse events in elderly patients treated with EVE was no greater than that in younger patients, although such toxicity may have had a greater impact on their quality of life. Conclusions: Older patients should not generally be excluded from accepted therapies (mTOR inhibitors after failure of VEGFr-TKI therapy) for mRCC.

• Journal of Korean Neurosurgical Society
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• 제61권5호
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• pp.592-599
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• 2018

Objective : Metastatic brain tumors (MBTs) often present with intracerebral hemorrhage. Although Gamma Knife surgery (GKS) is a valid treatment option for hemorrhagic MBTs, its efficacy is unclear. To achieve oncologic control and reduce radiation toxicity, we used a radiosurgical targeting technique that confines the tumor core within the hematoma when performing GKS in patients with such tumors. We reviewed our experience in this endeavor, focusing on local tumor control and treatment-associated morbidities. Methods : From 2007 to 2014, 13 patients with hemorrhagic MBTs were treated via GKS using our targeting technique. The median marginal dose prescribed was 23 Gy (range, 20-25). GKS was performed approximately 2 weeks after tumor bleeding to allow the patient's condition to stabilize. Results : The primary sites of the MBTs included the liver (n=7), lung (n=2), kidney (n=1), and stomach (n=1); in two cases, the primary tumor was a melanoma. The mean tumor volume was $4.00cm^3$ (range, 0.74-11.0). The mean overall survival duration after GKS was 12.5 months (range, 3-29), and three patients are still alive at the time of the review. The local tumor control rate was 92% (tumor disappearance 23%, tumor regression 46%, and stable disease 23%). There was one (8%) instance of local recurrence, which occurred 11 months after GKS in the solid portion of the tumor. No GKS-related complications were observed. Conclusion : Our experience shows that GKS performed in conjunction with our targeting technique safely and effectively treats hemorrhagic MBTs. The success of this technique may reflect the presence of scattered metastatic tumor cells in the hematoma that do not proliferate owing to the inadequate microenvironment of the hematoma. We suggest that GKS can be a useful treatment option for patients with hemorrhagic MBTs that are not amenable to surgery.

• Clinical and Experimental Pediatrics
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• 제51권1호
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• pp.84-88
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• 2008

목 적 : 방사선조사는 망막모세포종의 국소적 치료에 효과적인 방법이나 장기 생존자에서 안면발육장애, 각막과 시신경 손상, 이차적인 암의 발생 등의 합병증을 유발하며 방사선조사로 인한 안면발육부전은 나이가 들수록 더욱 심각한 미용적 장애를 초래하고 환자의 삶의 질을 저하시킨다. 진행된 안구 내 망막모세포종과 안와 내 망막모세포종 환자에서 안구적출술과 항암화학치료 및 안와방사선조사를 받은 경우와 받지 않은 경우의 치료성적과 장기예후를 분석하고자 본 연구를 시도하였다. 방 법 : 1985년 10월부터 2006년 12월까지 영남대학교병원에서 망막모세포종으로 진단받은 35명의 환자를 대상으로 병록지를 후향적으로 분석하였다. 안구 내 병변은 Reese-Ellsworth(RE)의 분류에 따라, 안구 외로 진행된 경우는 Grabowski-Abramson (GA)의 분류에 따라 분류하여 RE group III, IV, V인 진행된 안구 내 종양과 GA stage II인 안와 내 종양 환자를 연구 대상으로 하였다. 결 과 : 연구에 포함된 환자는 18명이었고, 진단당시 나이의 중앙값은 27개월(범위 2-69개월), 추적기간의 중앙값은 73.5개월(범위 6-219개월)이었다. 안구 내에 국한된 경우는 6명이었고(RE group III; 2명, IV; 1명, V; 3명) 안와 내로 진행된 경우는 12명이었다(GA stage II). 대상 환아 모두에서 안구적출술을 시행한 후 항암화학치료를 시행하였는데 2001년 이전에는 vincristine, adriamycin, cyclophosphamide, cisplatin, VM-26을, 2001년 이후로는 vincristine, etoposide, carboplatin을 사용하였다. 9명의 환자에서는 국소적으로 방사선조사를 병행하였고, 총 방사선 조사량의 중앙값은 4,500 cGy(범위 3,500-5,000 cGy)이었다. 방사선조사를 병행하여 치료 받은 환아 9명 중 7명은 재발이나 전이 없이 장기생존하였으며, 장기 생존자 모두에서 심한 안면 골격의 비대칭적 발육부전이 나타났다. 방사선조사 없이 치료받은 9명 중에서는 재발이나 전이가 한명도 없이 모두 장기생존하였으며, 안구적출술 이후 인공안와삽입물을 삽입하였으며 안면 골격 발달은 모두 대칭적으로 정상 발육을 하였다. 결 론 : 시신경의 절제면을 침범하지 않은 안와내에 국한된 망막모세포종의 치료에 있어 방사선조사를 제외하고 안구적출술, 항암화학치료, 국소적 치료를 병행함으로써 높은 생존율을 유지하면서 안면발육부전과 같은 심각한 부작용을 줄여 삶의 질을 향상시킬 수 있을 것으로 생각된다. 그러나 시신경의 절제면을 침범한 경우에는 재발의 가능성이 있으므로 후기 후유증의 위험이 있더라도 안구적출술 후 방사선조사와 항암화학치료를 병행한 치료를 시행함으로써 생존률을 높일 수 있을 것으로 생각된다.

• Asian Pacific Journal of Cancer Prevention
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• 제16권2호
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• pp.647-652
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• 2015

Background: Lung cancer was one of the most common cancers in both men and women all over the world. In this study, we aimed to clarify who could survive after long term chemotherapy in patients with advanced non-small cell lung cancer (NSCLC). Methods: We enrolled 186 patients with stage IV NSCLC after long term chemotherapy from Jun 2006 to Nov 2014 diagnosed in Jiangsu Cancer Hospital. Multiple variables like age, gender, smoking, histology of adenocarcinoma and squamous-cell cancer, number of metastatic sites, metastatic sites (e.g. lung, brain, bone, liver and pleura), hemoglobin, lymphocyte rate (LYR), Change of LYR during multiple therapies, hypertension, diabetes, chronic bronchitis, treatments (e.g.radiotherapy and targeted therapy) were selected. For consideration of factors influencing survival and response for patients with advanced NSCLC, logistic regression analysis and Cox regression analysis were used in an attempt to develop a screening module for patients with elevated survival after long term chemotherapy become possible. Results: Of the total of 186 patients enrolled, 69 survived less than 1 year (short-term group), 45 one to two years, and 72 longer than 3 years (long-term group). For logistic regression analysis, the short-term group was taken as control group and the long-term group as the case group. We found that age, histology of adenocarcinoma, metastatic site (e.g. lung and liver), treatments (e.g. targeted therapy and radiotherapy), LYR, a decreasing tendency of LYR and chronic bronchitis were individually associated with overall survival by Cox regression analysis. A multivariable Cox regression model showed that metastatic site (e.g. lung and liver), histology of adenocarcinoma, treatments (e.g. targeted therapy and radiotherapy) and chronic bronchitis were associated with overall survival. Thus metastatic site (e.g. lung and liver) and chronic bronchitis may be important risk factors for patients with advanced NSCLC. Gender, metastatic site (e.g. lung and liver), LYR and the decreasing tendency of LYR were significantly associated with long-term survival in the individual-variable logistic regression model (P<0.05). On multivariate logistic regression analysis, gender, metastatic site (e.g. lung and liver) and the decreasing tendency of LYR associated with long-term survival. Conclusions: In conclusion, female patients with stage IV adenocarcinoma of NSCLC who had decreasing tendency of LYR during the course therapy and had accepted multiple therapies e.g. more than third-line chemotherapy, radiotherapy and/or targeted therapy might be expected to live longer.

• Journal of Chest Surgery
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• 제25권1호
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• pp.86-95
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• 1992

We have performed surgical operations for 184 primary lung carcinomas over a 10 year period from December, 1979 to December, 1990 at the department of Thoracic and Cardiovascular Surgery, Yonsei University College of Medicine, Seoul, Korea. We have reviewed 77 cases confirmed to be dead in the post-operative follow-up period among 184 cases. There were 68 males and 9 females [M: F=7.56: 1], with 76.62% ranging between 50 to 70 years old There were 50 cases[64.94%] of squamous cell carcinoma, 15[19.48%] of adenocarcinoma, 4[5.19%] of large cell carcinoma, 4[5.19%] of mixed cell carcinoma 3 [3.90%] of small cell carcinoma % 1 case of bronchoalveolar cell carcinoma. There were 25 cases[32.47%] in stage I, 12 [15.58%] in stage II 32 [41.56%] in stage IIIa and 8 [10.39%] in stage IIIb according to the new international staging system for lung cancer. The operative methods were left pneumonectomy in 38 cases, right pneumonectomy in 21, bilobectomy in 5, lobectomy in 12, and wedge resection in one case.ase. There were 9 operative mortalities; one case by bleeding, 5 cases by respiratory failure, one case by bleeding & renal failure, one case by empyema thoracis with BPF and one case by brain metastases. The actuarial mean survival length was 14.636$\pm$18.188months overall and 16.441$\pm$18. 627months in 68 cases excluding 9 operative deaths. The actuarial mean survival length was 18.568$\pm$11.057 months in 43 squamous cell carcinomas, 14.385$\pm$11.057 months in 14 adenocarcinomas, 10.250$\pm$8.884months in 4 large cell carcinomas and 12.250$\pm$17.193months in 4 mixed cell carcinomas. The actuarial mean survival length was 14.051$\pm$16.963months in 59 pneumonectomy cases, 15.200$\pm$12.478 months in 5 bilobectomy cases, 18.417$\pm$26.026months in 12 lobectomy cases. The actuarial mean survival length was 28.952$\pm$25.738months in 22 stage I cases, 19. 455$\pm$16.723months in ll stage II cases, 8.633$\pm$6.584months in 29 stage IIIa cases and 6. 167$\pm$4.355months in 6 stage IIIb cases. The differences of actuarial mean survival length according to the stages were statistically significant [a=0.003]

• Journal of Chest Surgery
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• 제56권1호
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• pp.25-32
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• 2023

Background: We reviewed the clinical outcomes of patients with oligometastatic (OM) non-small cell lung cancer (NSCLC) who received multimodal therapy including lung surgery. Methods: We retrospectively analyzed 117 patients with OM NSCLC who underwent complete resection of the primary tumor from 2014 to 2017. Results: The median follow-up duration was 2.91 years (95% confidence interval, 1.48-5.84 years). The patients included 73 men (62.4%), and 76 patients (64.9%) were under the age of 65 years. Based on histology, 97 adenocarcinomas and 14 squamous cell carcinomas were included. Biomarker analysis revealed that 53 patients tested positive for epidermal growth factor receptor, anaplastic lymphoma kinase, or ROS1 mutations, while 36 patients tested negative. Metastases were detected in the brain in 74 patients, the adrenal glands in 12 patients, bone in 5 patients, vertebrae in 4 patients, and other locations in 12 patients. Radiation therapy for organ metastasis was performed in 81 patients and surgical resection in 27 patients. The 1-year overall survival (OS) rate in these patients was 82.8%, and the 3- and 5-year OS rates were 52.6% and 37.2%, respectively. Patients with positive biomarker test results had 1-, 3-, and 5-year OS rates of 98%, 64%, and 42.7%, respectively. These patients had better OS than those with negative biomarker test results (p=0.031). Patients aged ≤65 years and those with pT1-2 cancers also showed better survival (both p=0.008). Conclusion: Surgical resection of primary lung cancer is a viable treatment option for selected patients with OM NSCLC in the context of multimodal therapy.

• Radiation Oncology Journal
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• 제10권1호
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• pp.7-14
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• 1992

연세대학교 의과대학 세브란스병원에서는 1988년 8월 10MV 선형 가속기를 이용한 방사선 뇌수술(radiosurgery, stereotactic external beam irradiation)을 시작한 이래 1991년 12월까지 총 24예의 두개강내 종양에 대하여 방사선 뇌수술을 시행하였다. 대상 환자들의 조직학적 유형은 뇌수막종이 5예, 두개인두종이 3예, 악성임파종이 1예, 전이성 뇌종양이 2예 있었다. 대상환자들은 몇가지 다른 질병상태에서 방사선 뇌수술을 받았는데, 10예는 뇌정위적 생검이나 신경방사선학적 영상만으로 진단을 한 후 일차적인 치료로 방사선 뇌수술을 시행했으며, 9예에서는 수술 후 잔류 종양에 대하여 방사선 뇌수술을 시행하였다. 또 3예에서는 방사선 치료후 재발한 종양에 대해 구제요법으로 시행하였고, 2예에서는 외부 방사선 조사와 함께 추가 방사선조사로써 시행되었다. 6개월 이상 추적 조사된 환자 16명 중에서 7명(뇌수막종 2예, 신경교종 4예, 악성임파종 1예)이 CT Scan 또는 MRI상 종양의 완전 소멸을 보였고 나머지 9예는 모두 종양 크기의 감소를 보였다. 방사선 수술시 급성 부작용은 없었고 4예에서 만성 합병증이 나타났는데 3예에서 신경학적 증상의 발현과 함께 CT Scan상 뇌부종이 나타났었고 1예의 두개인두종에서는 방사선에 의한 시신경 손상으로 생각되는 시력 소실이 있었다. 저자들의 경험 예들은 조직학적 유형이 다양하고 증례수가 많지 않고 추적 조사 기간이 짧기 때문에 결론을 얻기 어렵지만 정위적 방법으로 종양에 다량의 방사선을 일시에 조사함으로써 완전 관해까지의 우수한 종양 제어효과를 얻을 수 있었다. 그러나 여러가지 종류의 뇌종양의 치료에 있어서 방사선 뇌수술이 생존율 향상이나 삶의 질의 향상에 기여할 수 있는지를 알기 위해서는 더 많은 증례를 통하여 경험을 축적하여야 할 것이다. 각각 $48{\pm}20W$ 및 $39{\pm}19W$이었으며, 폐 가온군이 간 가온군 보다 높았다(p<0.05). 6) 가온에의한 식도내 온도가 폐의 온도보다 $1.1{\pm}0.9^{\circ}C$높았다(p<0.05). 이상과같은 결과는 기낭성기관인 폐도 RF의 보다 높은 출력 이 소요되기는 하나 온열요법을 시행하였을 때 충실성기관인 간과 마찬가지로 종양치료에 유효한 $42^{\circ}C$-$43^{\circ}C$까지 잘 가온될 수 있음을 입증 하였다. 또한 폐의 온열요법시 종격동은 보다 높은 온도에 도달함으로 종격동의 열손상에 대한 고려가 필요함을 시사한다.r=0.990)로 각각 표시되었으며 각 간의 기울기에 대한 유의차는 없었다.18. 혈청중 LH와 total protein과의 상관계수는 +0.947이다. 19. 혈청중 FSH와 total protein과의 상관계수는 +0.709이다. 20. 혈청중 FSH와 triglycerides와의 상관계수는 +0.549이다. 21. 혈청중 estradiol-$17{\beta}$와 triglycerides와의 상관계수는 +0.673이다. 22. positive feedback mechanism에 의해서 LH, FSH와 estradiol-$17{\beta}$는 간을 자극시켜 albumin, total protein 및 triglycerides를 분필시킴으로서 난황형성(vitellosenesis)에 관여하는 것으로 나타났다.$21.4\%$로 나타났고 이들을 제외한 나머지 사람들은 보통 속도 혹은 충분한 시간을 가지고 식사를 하였다. 평소 식사량은 조금 적게 혹은 적당하게 섭취하는 사람이 대부분이었으며 남자가 여자보다는 배부르게 먹는 경