Cancer Research and Treatment

Baek Yeol Ryoo

17 Articles

Primary Gastric Choriocarcinoma: Two Case Reports and Review of the Literatures: Jung Ho Yoon, Min Soo Kim, Eun Hee Kook, Se Han Ahn, Se Young Jeong, Min Sung Han, Jung Kwon Huh, Hye Jin Kang, Im Il Na, Soo Youn Cho, Sang Bum Kim, Baek Yeol Ryoo, Sung Hyun Yang; Cancer Res Treat. 2008;40(3):145-150. Published online September 30, 2008; DOI: https://doi.org/10.4143/crt.2008.40.3.145

Primary gastric choriocarcinoma (PGC) is a rare tumor, and its pathogenesis is still uncertain. Most PGCs have been reported to possess an adenocarcinoma component of variable extent, and pure PGC is especially rare. The diagnosis of PGC is confirmed by exhibition of choriocarcinomatous components on biopsy and exhibition of β-hCG positive cell on immunohistochemical stain and elevation of the serum β-hCG. Moreover it must be confirmed that no other site including gonads displays any tumor masses. The PGC tends to be more invasive and to have early metastasis. The median survival is known to be less than several months. We report two cases. The first case was a 62 year-old man who was diagnosed as advanced gastric cancer (AGC) by endoscopic biopsy with hepatic metasasis and received palliative chemotherapy with modified FOLFOX regimen and Genexol plus cisplatin regimen. He underwent subtotal gastrectomy due to perforation of the stomach during chemotherapy. On post-operative biopsy, He was re-diagnosed as PGC and received another palliative chemotherapy modified FOLFIRI, BEP, EMACO, VIP. However, multiple liver metastases were aggravated, and also serum AFP level increased. Ultimately, the paient died 10 months after initial diagnosis. Another case was a 45 year-old man. On endoscopic biopsy, he was diagnosed as AGC of adenocarcinoma. On Chest and Abdomen CT, multiple pulmonary and hepatic metastasis were also confirmed. On liver biopsy, He was diagnosed as PGC. The immunohistochemical stains were performed and the results were cytokeratin positive, EMA negative and β-hCG weak positive. The serum β-hCG level was highly elevated. BEP, VIP and EMA/CO combination therapy were administered, but he died at 12th months after the initial diagnosis.

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Morphological and molecular pathological features of the breast carcinoma with choriocarcinomatous features: A case report and a literature review
Jingchun Xu, Yi Xu, Cheng Xu, Cong Wang
Frontiers in Oncology.2023;[Epub] CrossRef
Case Report: a rare primary gastric choriocarcinoma revealed on 18F-FDG PET/CT
Yi Zhao, Wei Diao, Suping Li, Mengxi Yang, Zhuzhong Cheng
Frontiers in Oncology.2023;[Epub] CrossRef
Severe thyrotoxicosis as initial presentation of gastric choriocarcinoma: a case report
Nicole M. Iñiguez-Ariza, Dalia Cuenca, Juvenal Franco-Granillo, Alberto Villalobos-Prieto, Janet Pineda-Díaz, Javier Baquera-Heredia
Journal of Medical Case Reports.2022;[Epub] CrossRef
Primary gastric choriocarcinoma: A case report
Zhang Xusheng, Yan Yuke, Meng Yun, Guo Huijun, Peng Jiangshan, Du Xueqin, Yang Xiaojun
Frontiers in Surgery.2022;[Epub] CrossRef
Successful treatment of a high-risk nonseminomatous germ cell tumor using etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine: A case report
Jina Yun, Sang W Lee, Sung H Lim, Se H Kim, Chan K Kim, Seong K Park
World Journal of Clinical Cases.2020; 8(21): 5334. CrossRef
Primary Gastric Choriocarcinoma Coexisting with Adenocarcinoma
Joo Hyun Lee, Jeong Kyun Lee, Dong Baek Kang
The Korean Journal of Gastroenterology.2019; 73(6): 350. CrossRef
Primary gastric choriocarcinoma with multiple metastases – A case report and literature review of carcinogenesis
Yiqin Xiong, Michelle X. Yang
Human Pathology: Case Reports.2019; 18: 200330. CrossRef
Collision tumor of choriocarcinoma and small cell carcinoma of the stomach: A case report
Shuichi Fukuda, Yoshinori Fujiwara, Tomoko Wakasa, Keisuke Inoue, Kotaro Kitani, Hajime Ishikawa, Masanori Tsujie, Masao Yukawa, Yoshio Ohta, Masatoshi Inoue
International Journal of Surgery Case Reports.2017; 37: 216. CrossRef
Primary Choriocarcinoma of the Stomach. A Case Report and Review of the Literature
Rahul Raghavapuram, Fadl H Veerankutty, M Anandakumar
Indian Journal of Surgical Oncology.2016; 7(1): 119. CrossRef
A Case of a Duodenal Papilla Adenosquamous Carcinoma with Trophoblastic Differentiation
Daichi KITAGUCHI, Shingo SAKASHITA, Shinji HASHIMOTO, Tatsuya ODA, Nobuhiro OHKOHCHI, Masayuki NOGUCHI
Nihon Rinsho Geka Gakkai Zasshi (Journal of Japan Surgical Association).2016; 77(6): 1440. CrossRef
Biochemical remission by chemoradiotherapy in male mediastinal choriocarcinoma with diffuse lung metastasis: A case report
JING ZHANG, ZHI-JUN WANG, BIN YANG, YOU-YING WEI, LING YANG, YANG HU, YAN-PING HU
Oncology Letters.2016; 11(4): 2615. CrossRef
Primary gastric choriocarcinoma: A rare case
Vilma Florença Martins, Filipa Moreno, J. Ramón Vizcaíno, Jorge Santos
International Journal of Surgery Case Reports.2015; 14: 44. CrossRef
Resectable Primary Gastric Choriocarcinoma with Solitary Synchronous Liver Metastasis
Masafumi Tomita, Eisei Nishino, Tomoya Takami, Yu Oshima, Kotaro Hatano, Satoshi Wakama, Hayato Furue, Yasuhiro Matsuda, Naoki Kataoka, Tomoyuki Yamaguchi
The Japanese Journal of Gastroenterological Surgery.2015; 48(6): 488. CrossRef
Endometrioid adenocarcinoma with choriocarcinomatous differentiation: A case report and review of the literature
MITSUAKI ISHIDA, HIDETOSHI OKABE
Oncology Letters.2013; 6(3): 655. CrossRef
Gastric adenocarcinoma with choriocarcinomatous and hepatoid differentiation
Seong Wook Hwang, Sun Jae Lee, Po Eun Park, Mee Seon Kim, Han‐Ik Bae
Basic and Applied Pathology.2012; 5(1): 22. CrossRef
Pathological Complete Response and Two-year Disease-free Survival in a Primary Gastric Choriocarcinoma Patient with Advanced Liver Metastases Treated with Germ Cell Tumor-based Chemotherapy: A Case Report
Y. Waseda, Y. Komai, A. Yano, Y. Fujii, N. Noguchi, K. Kihara
Japanese Journal of Clinical Oncology.2012; 42(12): 1197. CrossRef
Gastric cancer with choriocarcinoma and yolk sac tumor components: Case report
Nobuo Satake, Motoya Chikakiyo, Toshiyuki Yagi, Yasuhiro Suzuki, Takanori Hirose
Pathology International.2011; 61(3): 156. CrossRef
A Coexistent Case of Primary Gastric Choriocarcinoma and Alpha Fetoprotein-producing Gastric Cancer which Caused Rapid Postoperative Progression
Naoya Sasaki, Yoshiharu Shirakata, Hisashi Shinohara, Kazumi Itoi, Atsuhiko Maki, Yoshifumi Mizuno, Rokuro Mimura, Koushou Takasu
The Japanese Journal of Gastroenterological Surgery.2011; 44(12): 1535. CrossRef

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A Case of Extraskeletal Ewing's Sarcoma Arising from Duodenum: Sang Il Kim, Yeon Hee Park, Seong Jun Choi, Baek Yeol Ryoo, Seung Sook Lee, Hyun Bae Son, Yo Ahn Suh, Dae Han Kim, Sung Ho Kim, Kui Sung Choi, Yoong Ju Kweon; Cancer Res Treat. 2002;34(6):461-465. Published online December 31, 2002; DOI: https://doi.org/10.4143/crt.2002.34.6.461

Abstract PDF

Extraskeletal Ewing's sarcomas (EES) are rare. Recently, Ewing's sarcoma of the bone, primitive neuroectodermal tumor (PNET), Askin tumor and EES have been included into the family of Ewing's tumors, due to the overlapping features relating to their clinico-pathological and cytogenetic appearance. We experienced a case of an EES arising from the duodenum in a 14-year-old girl who presented with hematemesis and epigastric discomfort. A duodenal biopsy specimen revealed the infiltration of small round cells and rich vasculatures, with immunohistochemical finding of MIC-2 (CD99) (+), vimentin (+), CD56 (NCAM) (+), LCA (-), T-cell (-), B-cell (-), CD43 (-) and CD68 (-). She was treated with several cycles of multiagent chemotherapy, and achieved an initial partial response, but rapid progression of tumor followed, so she was treated with surgical excision. This is the first case report of an EES arising from the duodenum in the literature.

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Ewing’s sarcoma of the duodenum: a rare clinical condition managed with surgical resection
Saniya Saiyed, Omar A Mownah, Matthew J Bowles, Aditya Kanwar
BMJ Case Reports.2023; 16(6): e249686. CrossRef

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The Effect of Intensified Induction Using Vanderbilt Regimen in Patients with an Intermediate Grade Non-Hodgkin's Lymphoma Having 2 or 3 Adverse Factors on the Age-adjusted International Prognostic Index: Yoong Ju Kweon, Seong Jun Choi, Baek Yeol Ryoo, Yeon Hee Park, Bong Seog Kim, Dae Han Kim, Sang Il Kim, Sung Ho Kim, Yo Ahn Suh, Hyun Bae Son, Kui Sung Choi, Seung Sook Lee, Yoon Koo Kang; Cancer Res Treat. 2002;34(5):326-333. Published online October 31, 2002; DOI: https://doi.org/10.4143/crt.2002.34.5.326

Abstract PDF: PURPOSE
The purpose of our study was to evaluate the outcome of intensified induction therapy using the Vanderbilt regimen in patients with a poor prognosis non-Hodgkin's lymphoma (NHL).
MATERIALS AND METHODS
We retrospectively analyzed the results of two pilot studies, which enrolled the patients aged 60 years or less, with a previously untreated NHL of intermediate grade on the Working formulation, having 2 or 3 adverse prognostic factors on the age- adjusted International Prognostic Index. Patients received an intensified induction, with the regimen described by the Vanderbilt group.
RESULTS
Thirty-five patients were analyzed. After induction, 29 patients (83%) achieved more than partial response (PR): 22 (63%) complete response (CR) and 7 (20%) PR. Three of the PRs were subsequently converted to CR following consolidation therapy. The overall CR rate, following the completion of treatment, was 71%. The 3-year overall survival (OS) rate of all patients was 53%. In the univariate analysis, age (50 years) was the only factor affecting the OS. The 3-year disease-free survival (DFS) rate of patients with CR was 68%. In the univariate analysis, age and bone marrow involvement were the factors affecting the DFS. Two patients died from the treatment-related toxicity of the induction therapy: one due to sepsis and the other due to congestive heart failure.
CONCLUSION
Although the CR rate was relatively high, the OS or DFS of patients with a poor prognosis NHL, who had received the intensified induction using the Vanderbilt regimen, were no different from those that had received the conventional chemotherapy, as reported by the International Prognostic Index Project. However, the OS or DFS in the young patient groups were encouraging. To test the hypothesized benefits of our approach in the young patient groups, a larger cohort of patients aged 50 years or less should be studied.

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A Phase II Trial of UFT-E and Oral Leucovorin in Advanced Colorectal Cancer: Won Sup Lee, Keun Seok Lee, Ki Hyun Kim, Baek Yeol Ryoo, Won Seog Kim, Won Ki Kang, Yoon Koo Kang, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim; Cancer Res Treat. 2001;33(3):225-228. Published online June 30, 2001; DOI: https://doi.org/10.4143/crt.2001.33.3.225

Abstract PDF: PURPOSE
To determine the efficacy and toxicity of UFT-E plus oral calcium leucovorin in the treatment of patients with advanced colorectal cancer.
MATERIALS AND METHODS
Forty-three patients with advanced, bidimensionally measurable colorectal adenocarcinoma were enrolled in the trial. No patients had received prior palliative chemotherapy. The patients that had received previous adjuvant chemotherapy were enrolled when more than 6 months had elapsed after the completion of adjuvant therapy. Patients were treated with 300 mg/m2/day of UFT-E (tegafur-based) plus 90 mg/day of leucovorin administered orally in three divided daily doses, every 8 hours for 28 days followed by a 7-day rest period. Response was evaluated after two or three courses of therapy.
RESULTS
Thirty-six of forty-three patients were evaluable for response; seven dropped out due to infection, toxicity and patients' refusal. Ten patients had partial responses and one patient complete response (response rate, 31%; 95% confidence interval, 16~46%). The median response duration for the UFT-E plus leucovorin regimen was 28 weeks. Grade III toxicity was seen in one case, with diarrhea.
CONCLUSION
This oral regimen proved effective and well tolerated. This schema also avoided inconveniences, such as hospitalization and the use of infusion pumps, which are associated with 5-FU infusion regimens. The regimen used showed minimal toxicity, especially in the upper digestive tract, with good patient compliance.

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Chemotherapy with Five-Day Continuous Infusion of 5-Fluorouracil (5-FU) Plus Cisplatin for Advanced Gastric Cancer; Significance of 5-FU Concentration Monitoring: Yeon Hee Park, Bong Seog Kim, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Ho Sang Shin, Yoon Koo Kang; J Korean Cancer Assoc. 2000;32(3):516-523.

Abstract PDF: PURPOSE
To investigate the therapeutic effects and toxicities of 5-day continuous infusion of 5-FU plus cisplatin FP chemotherapy in advanced gastric adendegrees Carcinoma and to elucidate the relationship between the pharmacokinetic (PK) parameters and therapeutic outcome.
MATERIALS AND METHODS
Patients with previously untreated advanced stomach cancer were treated with FP chemotherapy. Plasma concentrations of 5-FU were measured using gas chro matography method for 5 days. Correlation of PK parameters of 5-FU with clinical outcome after FP chemotherapy was studied.
RESULTS
Response rate of FP chemotherapy was 46% (95% C.I.: 30~62%). There was a wide range of difference in the concentration and area under the curve (AUC) of 5-FU from patient to patient. We could find significant differences in AUC of 5-FU between the responders and the non-responders (p<0.05).
CONCLUSION
We could confirm that FP chemotherapy was effective and tolerable for the treatment of advanced stomach cancer. The monitoring of plasma 5-FU concentration after chemotherapy and the adjustment of subsequent 5-FU dose seems to be necessary to improve the treatment outcome of FP chemotherapy.

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Drug Resistance to 5 - Fluorouracil and Overexpression of Thymidylate Synthase mRNA in Human Gastrointestinal Malignancies: Tae You Kim, Baek Yeol Ryoo, Yung Hyuck Im, Yoon Koo Kang, Sang Jae Lee, Yung Jue Bang, Noe Kyeong Kim; J Korean Cancer Assoc. 2000;32(1):44-52.

Abstract PDF: PURPOSE
The cytotoxicity by 5-fluorouracil (5-FU) is mediated by inhibition of thymi- dylate synthase (TS), which is a rate-limiting enzyme for DNA synthesis. To test whether the resistance to 5-FU would be associated with cellular TS activity, we analyzed TS gene expression from human gastrointestinal cancer cell lines.
MATERIALS AND METHODS
We established the experimental conditions for quantitating TS mRNA expression by competitive RT-PCR using mimic DNA. Based on this method, we compared TS mRNA expression between 5-FU resistant cell line and parent cell line and investigated the expression of TS mRNA following 5-FU administration in 6 human gas- trointestinal cancer cell lines.
RESULTS
Competitive RT-PCR using mimic DNA seemed to be more effective than Northern blot analysis for quantitation of TS gene expression. The quantity of TS mRNA and IC50 value of 5-FU in 5-FU resistant H630 was found to be 2.5 and 10 times higher than in parent cell line, respectively. And also, we observed linear relationship between TS mRNA level and IC50 value of 5-FU (r 0.76) in 6 gastrointestinal cancer cell lines.
CONCLUSION
These results suggest that overexpression of TS mRNA may play a role in the development of 5-FU resistance in human gastrointestinal malignancies

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The Effect of Combination Chemotherapy with Vinorelbine, Carboplatin, and Ifosfamide in Patients with Advanced Non-Small Cell Lung Cancer: Young Woo Lee, Baek Yeol Ryoo, Tae You Kim, Bong Seog Kim, Yeon Hee Park, Hyun Ju Hong, Jin Young Kwag, Sang Won Lee, Yoon Koo Kang; J Korean Cancer Assoc. 1999;31(6):1227-1235.

Abstract PDF: PURPOSE
Despite recent advances in chemotherapy, the treatment outcome of advanced non-small cell lung cancer (NSCLC) remains poor and NSCLC is still the predominant source of cancer-related mortality in worldwide. Thus, we evaluated the efficacy and safety of a combination chemotherapy with vinorelbine, carboplatin, and ifosfamide (NCI) in advanced NSCLC patients.
MATERIALS AND METHODS
A total of 26 patients was enrolled in this study between December 1997 and June 1998. All entered patients were treated with NCI combination chemotherapy (vinorelbine 25 mg/m2/day i.v. days 1 and 8; carboplatin 300 mg/m2/day i.v. day 1; ifosfamide 3 g/m2/day i.v. day I; and mesna 2.4 g/m2/day i.v. day 1 after completion of ifosfamide infusion, treatment repeated every 4 weeks).
RESULTS
Among 26 patients, 23 patients were evaluable. Nine out of 23 evaluable patients had a partial response (response rate 39%; 95% confidence interval 19~59%). The median survival of the total 23 evaluable patients was 7.4 (range; 3~9.3+) months. The median progression-free survival was 2.8 (range; 0~7.7+) months. Among total 70 cycles of chemotherapy, leukopenia of grade II or more was observed in 6%, and tbrombo- cytopenia of grade II or more in 1%. There was no treatment-related death. Main non-hematologic toxicities were nausea/vomiting, stomatitis and peripheral phlebitis, almost of which were tolerable.
CONCLUSION
NCI chemotherapy seemed to be moderately active and well tolerated in patients with advanced NSCLC.

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Clinicopathologic Charcteristics of Korean Non - Hodgkin's Lymphomas Based on REAL Classification: Yoon Koo Kang, Bong Seog Kim, Tae Won Kim, Mon Hee Ryu, Seung Sook Lee, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Kyoo Hyung Lee, Jooryung Huh, Dae Seog Heo, Yung Jue Bang, Chulwoo Kim, Jung Shin Lee, Byoung Kook Kim, Woo Kun Kim, Sang Hee Kim, Noe Kveong Kim; J Korean Cancer Assoc. 1999;31(4):641-652.

Abstract PDF: PURPOSE
Non-Hodgkins lymphoma (NHL) is recognized as not a single disease but a group of diseases heterogeneous in biology and clinical characteristics. Recently, a new pathologic classification system, the REAL classification, has been introduced into the clinic. Although REAL classification has tried to define the subtypes biologically more correctly, its clinical usefulness has not been established yet. A retrospective study was performed to define the clinical characteristics of Korean NHLs according to the REAL classification and to determine its clinical usefulness.
MATERIALS AND METHODS
Pathologies of NHLs managed at 3 major hospitals in Korea between 1989 and 1995 were reviewed with immunophenotyping to determine the pathologic subtypes according to REAL classification. Clinical characteristics at the presentation and treatment outcomes of the eligible patients were analyzed. To determine the differences from the NHLs in the western countries, data of Non-Hodgkins Lymphoma Classification Project (NHLCP) were also compared.
RESULTS
Total 802 cases were eligible for this study. Although it was similar to NHLCP study that B-cell subtypes were the majority and diffuse large B-cell lymphoma was the most common subtype, the proportion of T-cell subtypes were much higher in our patient population than in the western population. It was because peripheral T-cell lymphomas, angiocentric lymphoma in particular, were more common and follicular lymphomas were less common in our patients. Eleven common pathologic subtypes could be classified into 3 prognostic groups. Marginal zone B-cell lymphoma and lymphoplasmacytoid lymphoma of which 5-year overall survival rate (5-yOSR) were > 80% were classified in the good prognostic group. Precursor T-lymphoblastic lymphoma was classified in the poor prognostic group because its 5-yOSR was less than 30%. The other 9 subtypes were classified in the intermediate prognostic group with S-yOSR of 30-79%.
CONCLUSION
The clinical. character' tics and prognoses of Korean NHLs could be defined according to REAL classification. These information would be helpful for the clinicians in formulating treatment strategies of Korean NHLs according to REAL classification.

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A Phase 2 Trial of Verapamil for Reversal of Drug Resistance in Refractory Non - Hodgkin's Lymphoma: Keun Chil Park, Baek Yeol Ryoo, Young Hyuk Im, Sung Wook Kang, Jhin Oh Lee, Taik Koo Yun, Ho Sang Shin; J Korean Cancer Assoc. 1999;31(2):313-319.

Abstract PDF: PURPOSE
Drug resistance is one of the major obstacles to treatment of cancer. Multidrug resistance (MDR) caused by overexpression of p-glycoprotein (Pgp) in cancer cell membrane is a well-known mechanism of drug resistance in in vitro system and was reported to be a significant mechanism of resistance in non-Hodgkins lymphoma (NHL). Verapamil, a calcium channel blocker, is proven in vitro to overcome the MDR caused by Pgp. We performed a phase II trial of verapamil in patients with NHL refractory to EPOCH regimen (etoposide, prednisolone, vincristine, cyclophosphamide, and doxorubicin) to overcome the MDR caused by Pgp.
MATERIALS AND METHODS
Verapamil was administered via intravenous route from 1 hour before to 12 hour after the 96-hour infusion of etoposide, doxorubicin, and vincristine which were known to be substrates of Pgp in EPOCH regimen. The dose of verapamil was 0.15 mg/Kg in bolus and 0.2 mg/Kg/hr in infusion at the beginning and escalated by 0.05 mg/Kg/hr every 24 hours if there was no dose-limiting toxicities such as 2nd or 3rd degree AV block, hypotension, or congestive heart failure. Plasma verapamil concentrations were measured every 24 hour by gas chromatography. Mdrl expression level in tumor tissues was measured by RT-PCR.
RESULTS
From Feb. to Nov. 1994, 14 patients were treated with this protocoL However, poor tolerability and no response in these patients led to early closure of the study at this 1st stage of patient accrual according to Gehans method. Among 14 patients, 12 experienced 2nd or 3rd degree AV block and/or hypotension and required temporary cessation of infusion and reduction of verapamil dose. However, there was no congestive heart failure or treatment-related death. The peak concentrations of verapamil were 0.29-1.94 pM (mean 0.93 pM) and mean concentrations during the 4-day infusion were 0.22-1.21 pM (mean 0.6 pM). Mdrl expression levels measured in 6 patients were 0.99-14.43 U (median 4.39).
CONCLUSION
These results suggest that verapamil in this dose and schedule was neither tolerable nor effective for the reversal of drug resistance in NHL patients.

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Primary CHOP Chemotherapy Followed by Involved Field Radiation Therapy in Clinical Stage I or II Aggressive Non-Hodgkin's Lymphomas: Chang Hee Lee, Young Hyuck Im, Baek Yeol Ryoo, Seung Mo Nam, Mi Sook Kim, Yong Sik Lee, Kyung Kyun Oh, Yoon Sang Shim, Seong Yul Yoo, Jhin Oh Lee, Tae Woong Kang, Yoon Koo Kang; J Korean Cancer Assoc. 1998;30(4):809-817.

Abstract PDF: PURPOSE
Although radiation therapy had been the treatment of choice for localized non-Hodgkin's lymphoma(NHL), recent studies have revealed that treatment result after radiation therapy alone is not successful for localized aggressive NHL, if it is not pathologically but clinically staged. A prospective phase II trial was conducted to evaluate the therapeutic results of 4 cycles of CHOP chemotherapy followed by involved field radiation therapy in clinically staged localized aggressive NHL.
MATERIALS AND METHODS
Patients with a diagnosis of aggressive NHL(all intermediate grade and immunoblastic histology in NCI working formulation), Ann Arbor stage I or II without poor prognostic factors(presence of B symptoms, bulky diseases, or 2 or more extranodal involvement) were treated with 4 cycles of CHOP(cyclophosphamide, doxorubicin, vincristine, prednisolone) followed by involved field radiation therapy of 3,000~6,000(median: 4,500) cGy.
RESULTS
Between April 1990 and March 1995, 62 consecutive patients entered this trial. Forty six patients with measurable diseases were evaluable for response. Complete response was achieved in 41(89.1%) patients after CHOP chemotherapy and 4 more patients after subsequent radiation therapy, making total CR rate of 98%. Progression free survival(PFS) of all 62 patients were 2.2+~73+ months and 5 year PFS rate was 64.6%. Overall survival(OS) were 2.4+~75+ months and 5 year OS rate was 75.2%. Old age (> 60) was the only significant prognostic factor, which-affected overall survival negatively. Treatment was relatively well tolerated, but 3 patients died associated with treatment.
CONCLUSIONS
Four cycles of CHOP chemotherapy followed by involved field radiation therapy is highly curative and safe treatment for clinically staged, localized aggressive NHLs.

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A Phase 2 Trial of EPOCH (Etoposide, Vincristine, Doxorubicin, Cyclophophamide and Prednisolone) Chemotherapy for Previously Treated Non - Hodgkin's Lymphoma: Baek Yeol Ryoo, Tae You Kim, Young Hyuk Im, Jhin Oh Lee, Taik Koo Yun, Keun Chil Park; J Korean Cancer Assoc. 1998;30(1):127-136.

Abstract PDF: PURPOSE
As a new strategy to modulate drug resistance in the treatment of relapsed or refractory non-Hodgkin's lymphoma(NHL), continuos infusion of drugs has been incorporated into the chemotherapy. We conducted a phase II study to determine the activity and safety of EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide, prednisolone) chemotherapy, in which the natursl products are administered as a continuous infusion, for previously treated NHL's of intermediate grade.
MATERIALS AND METHODS
EPOCH chemotherapy (etoposide 50 mg/m2/day 24 hour- continuous infusion, days 1~4, vincristine 0.4 mg/m2/day 24 hour-continuous infusion, days 1~4, doxorubicin 10 mg/m2/day 24 hour-continuous infusion, days 1~4, cyclophosphamide 750 mg/m2 i.v., day 5, prednisolone 60 mg/m2/day p.o. days 1-5) was given to eligible patients every 3 weeks and we assessed response and toxicity of the regimen.
RESULTS
Between June 1993 and December 1995, total 56 patients entered this trial and 49 were evaluable. The complete response rate was 41%(95% C.I.: 27-55%). After follow up of 9~50(median 38) months, progression free survival was 0~39+(median 7) months and the overall survival was 1~44+(median 14) months. The prognostic factor analyses showed that B symtoms and serum LDH level before treatment and response to previous treatment affected complete response rate, and patients' performance status and response to previous treatment affected progression free survival and overall survival. Toxicities of EPOCH regimen were leukopenia, stomatitis, nausea/vomiting and neurotoxicity, but they were tolerable. There was 1 case of treatment-related death due to sepsis. CONDUSION: EPOCH chemotherapy was safe and effective for the patients with relapsed NHL. However, the results of patients with NHL refractory to previous treatment were so poor that more intensive, novel treatment would be needed for this category of patients.

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High-Dose Chemotherapy with Vandervilt Regimen and CSF Support for High-Risk Aggressive Non-Hodgkin's Lymphoma: Bong Seog Kim, Jeong Hoon Yang, Kyung Tae Kim, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Jhin Oh Lee, Tae Woong Kang, Yoon Koo Kang; J Korean Cancer Assoc. 1998;30(1):137-149.

Abstract PDF: PURPOSE
To detennine the therapeutic effect and toxicities of high-dose chemotherapy with Vanderbilt regimen and colany-stimulating factors(CSF) support for high-risk aggressive non-Hodgkin's lymphoma(NHL).
MATERIALS AND METHODS
Between Aug. 1995 and Mar. 1997, 40 patients with high-risk aggressive NHLs were treated with high-dose chemotherapy with Vandebilt regimen and CSF support. If the complete response(CR) was induced, four cycles of CHOP were administered for the maintenance of response. In cases of lymphoblastic lymphomas, CNS prophyiaxis with cranial irradiation and intrathecal methotrexate was done after CR.
RESULTS
CR was achieved after Vanderbilt regimen in 62.5%(25/40) of the total patients. CR rste in refractory group(12.5%: 1/8) was significantly lower than in other groups (75%: 24/32)(p=0.001). With a median follow-up of 14 months, the failure free survival (FFS) was 0~18+ months(median 6.1 months). The overall FFS rate at one year was 31.7%. The 1-year FFS rate in refractory group(0%) was significantly lower than in other patients groups(41%)(p=0.001). The range of survival time was 0.5~18+ months, and median survival time was 6.2 months. Grade 4 leukopenia was observed in 100% of chemotherapy cycles and its median duration was 7 days. However, only one patient died due to treatment-relate sepsis. Non-hematological toxicities were tolerable and all reversible.
CONCLUSION
High-dose chemotherapy with Vanderbilt regimen was effcctive for induction of CR in high-risk aggressive NHL patients and safe with the CSF support. However, poor CR rate in reftactory group and poor FFS in other groups indicate that a new, more intensive approach is needed for the induction of CR in refractory group and for the maintenance of CR in other high-risk patient groups.

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Prognostic Factor Analysis of Small Cell Lung Cancer: Appropriateness of Two Staging System: Jae Jin Chang, Tae You Kim, Choon Taek Lee, Seung Mo Nam, Jae Hag Kim, Eun Jeong Song, Seong Hwan Kim, Bong Seog Kim, Baek Yeol Ryoo, Young Hyuck Im, Jhin Oh Lee, Tae Woong Kang, Yoon Koo Kang; J Korean Cancer Assoc. 1997;29(6):1000-1010.

Abstract PDF: PURPOSE
The two staging system, which divides the tumors into limited disease (LD) and extensive disease (ED) has been widely accepted as a major prognostic determinant in small cell lung cancer (SCLC). However this system has provoked several controversial issues in defining stage categories, for instance, ipsilateral pleural effusion as LD or ED. Furthermore, identification of favorable subgroups in the same stage has been recognized as an important factor to determine appropriate treatment strategies. In this study, we performed a retrospective analysis in an attempt to resolve the controversial issues about staging and identify the patient group with favorable prognosis based on this two staging system.
MATERIALS AND METHODS
The clinical data of 233 patients with SCLC treated from 1990 to 1996 at Korea Cancer Center Hospital were retrospectively analyzed for this study. All patients were treated with chemotherapy containing cisplatin and/or radiotherapy. The independent prognostic factors for survival were identified by multivariate analysis using Cox's proportional hazards model.
RESULTS
Performance status (relative risk of death [RR]:2.89), number of metastasis (RR:2.2), response to treatment (RR:2.2) as well as stage (RR:1.77) were identified as independent prognostic factors for survival in patient with SCLC. The median survival of patients with ipsilateral pleural effusion (13 months) which was categorized as ED was similar to that of patients with contralateral mediastinal or supraclavicular lymph nodes (13.8 months) or other LD patients (13.7 months). This result suggests that ipsilateral pleural effusion should be categorized as LD. In LD, response to treatment was the only independent prognostic factor (RR:2.34) and thoracic radiotherapy moderately improved survival as compared with combination chemotherapy alone (17.7 months vs. 10.4 months, p=0.06). In ED, the patient group with a good performance status (ECOG 0-1), normal range of serum alkaline phophatase, and metastasis less than 2 sites showed significantly prolonged survival, comparing with other ED patients (11.2 months vs. 7.2 months, p=0.0001).
CONCLUSION
As a result of survival analysis, we confirmed independent prognostic factors such as stage and performance status in SCLC. We could recommend that LD category include patients with ipsilateral pleural effusion as well as those with contralateral lymphadenopathy. In ED, the survival in patients with favorable prognostic factors was comparable to LD, suggesting this patient group may be a candidate for aggressive therapy.

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A Case of Pyloric Obstruction Caused by Self-expandable Metallic Stent for Palliation of Malignant Dysphagia: Yeon Hee Park, Young Soo Do, Yoon Koo Kang, Nam Hyun Hur, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Jhin Oh Lee, Tae Woong Kang; J Korean Cancer Assoc. 1997;29(3):534-539.

Abstract PDF: Placement of the self-expandable metallic stents for palliative treatment of malignant esophagogastric strictures has been thought to be easy, fast and effective method than conventional methods (bypass procedures, radiation therapy, laser treatment, esophageal intubation, etc.). The expandable metallic stent tubes were found to overcome some of the limitations of nonexpandable conventional tubes. Their implantation is better tolerated and safer than that of nonexpandable tubes, because the risks of migration and perforation are lower.On our knowledge, there has been no report of pyloric obstruction after this metallic stent insertion.We hereby report a case of pyloric obstruction caused by a migrated self-expandable metallic stent for palliative treatment of malignant esophageal stricture.

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A Case of Synchronous Triple Primary Cancers in Larynx , Esophageu , and Stomach: Gyo Seon Kwun, Kyung Tae Kim, Yong Cho Kim, Ju Byeung Sung, Young Wo Lee, Eun Jung Jang, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Yoon Koo Kang, Seung sook Lee, Jim Oh Lee, Tae Woong Kang; J Korean Cancer Assoc. 1996;28(5):888-897.

Abstract PDF: Multiple primary cancers can occur in up to 20% of primary aerodigestive tract cancer patients. The multiplicity of cancer in aerodigestive tract suggests that the exposure to common carcinogen may be the cause of multiplicity(field cancerization). Continuous alcohol drinking and smoking are considered to be the major factors in development of multiple cancers. Also, high frequency of genetic alterations in multiple primary cancer patients implys that the genetic instability such as replication error or mutation of tumor suppressor gene may play a role in the development of multiple primary cancers. We report a case of a 61 year-old man who had triple synchronous cancers in larynx, esophagus, and stomach. He was a heavy smoker of 30-pack-years and a heavy drinker. Pathological examination showed squamous cell carcinoma of larynx and esophagus, and adenocarrinoma of stomach, respectively.

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A Case of Ph chromosome - Negative , bcr / abl Rearrangement - Positive Chronic Myelogenous Leukemia Prasenting with Dermopathy and Lymphadenopathy: Young Wo Lee, Gyo Seon Kwun, kyung Tae Kim, Young Cho Kim, Ju Byeung Sung, Eun Jung Jang, Choon Hong Hwnag, Baek Yeol Ryoo, Tae You Kim, Young Hyuck Im, Yoon Koo Kang, Jhin Oh Lee, Tae Woong Kagn; J Korean Cancer Assoc. 1996;28(5):927-936.

Abstract PDF: Chronic myelogenous leukemia(CML) is a clonal stem cell disorder, characterized by markedly increased myelopoiesis and the presence of the Philadelphia(Ph) chromosome. Ph chromosome, the result of a translocation between the abl proto-oncogene on chromosome 9 and the bcr gene on chromosome 22, is found in more than 95% of CML patients. The remaining 5% of patients are classified as Ph chromosome-negative CML and the bcr/abl gene rearrangement is detectable in approximately 50% of these patients. These Ph chromosome-negative, bcr/abl rearrangement-positive patients have clincal course and prognosis very similar to those of Ph chromosome-positive CML patients. We experienced a case of Ph chromosome-negative, bcr/abl rearrangement-positive CML presenting with multiple skin lesions and lymphadenopathy in a 59-years-old man. Bone marrow aspiration and biopsy showed typical features of CML in chronic phase. Skin and lymph node biopsies showed extramedullary leukemic cell infiltration, suggesting aggressive phase of CML. While the chramosome study revealed normal karyotype, RT-PCR analysis revealed bcr/abl fusion transcripts. In spite of chemotherapy, he expired 13 months after diagnosis.

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The Significance of Serum CA 19-9 Level Change after Biliary Drainage Procedures in Pancreatic and Biliary Tract Cancer: Hyun Kag Kim, Chang Hee Lee, Baek Yeol Ryoo, Sook Hyang Jung, You Cheoul Kim, Chang Min Kim, Jhin Oh Lee, Taik Koo Yun, Young Soo Do, Byung Hee Lee; J Korean Cancer Assoc. 1995;27(6):929-936.

Abstract PDF: Although CA 19-9 has been widely used as a tumor marker for the diagnosis of pancreatobiliary cancers, the pattern of CA l9-9 level change after biliary drainage has not been well characterized. Because biliary drainage procedures are frequently employed for the temporary or palliative measures in biliary obstruction, the precise understanding on the change of CA 19-9 level after biliary drainage may be very helpful for the follow-up evaluation of those cases. We prospectively analyzed the serum CA 19-9 level before and after percutaeous transhepatic biliary drainage (PTBD) and biliary stent in patients with pancreatic, biliary tract cancer and common bile duct stone. Serum CA 19-9 level was initially measured by radioimmunoassay in 69 patients with be nign and malignant pancreatobiliary diseases. In 22 of 69 patients, PTBD and/or the insertion of biliary stent were performed and serial checks of CA 19-9 levels were followed. The elevation of serum CA 19-9 level was highly associated with pancreatobiliary cancers, especially in the cases with biliary obstruction, and in the CBD stones complicated with acute cholangitis. The serum CA 19-9 levels in most cases were significantly decreased by PTBD. There was the trend that the decrease after PTBD in biliary tract cancer was more prominent than that of pancreatic cancer. The elevation of serum CA 19-9 level was highly associated with the presence of biliary obstruction in pancreatobiliary cancers. Because the biliary drainage procedures significantly decrease serum CA 19-9 level, this can not be used for the marker of cancer pragression after biliary drainage procedures.

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