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Volume 26(1); 1994
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Original Articles
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Prognostic Factors in Early Gastric Cancer
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Song Cheol Kim, Yoon Seok Hur, Jin Pok Kim
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J Korean Cancer Assoc. 1994;26(1):1-9.
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- A retrospective study of 797 cases of early gastric cancer(EGC) operated from 1981 to 199l at Seoul National University Hospital was performed to evaluate its prognostic factors for 9 clinicopathologic factors(sex, age, tumor location, gross type, histology, depth of invasion, lymph node metastasis, resection type). The incidence of EGC in gastric cancer was 20.l% and overall 5 year survival rate was 93%. In univariate and multivariate analysis af the above mentioned 9 factors, stastically significant prognostic factor was only regional lymph node metastasis(P<0.05). In addition, signet ring cell carcinoma was more prevalent in EGC(2.9 times) than in AGC and had a good prognosis than other histalogic type. In conclusion, extensive lymphadenectomy(R2 or R2+a) is needed only in AGC but also in EGC. And more extensive study on the prognostic factors of the signet ring cell carcinoma that has been considered as a poor prognostic type is further necessory to clarify the good effect in EGC and bad effect in AGC.
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A Phase 2 Study on Combined 5 - Fluorouracil , Etoposide , Doxorubicin and Cisplatin ( F - EAP ) in Patients with Advanced Gastric Cancer
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J Korean Cancer Assoc. 1994;26(1):9-16.
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- 5-Fluorouracil(5-FU), as a single agent, has a modest but reproducible activity against gastric cancer and continuous infusion of 5-FU is associated with less myelosuppresion. It has been reported that combination of etoposide, doxorubicin, and cisplatin(EAP) was very active in advanced gastric carcinoma with an overall response rate of 64% including 21% complete response from the German investigators. A phase II study of the combination of 5-FU infusion, etoposide, doxorubicin and cisplatin(F-EAP), which regimen has been demonstrated to have the different mechanisms of action and synergism between each of drugs in vitro and in vivo, was performed in attempts to evaluate the antitumor activity in patients with advanced gastric cancer. Fifty-five previously untreated patients with surgically unreasectable or metastatic advanced gastric adenocarcinoma were treated with 5-FU(800 mg/m, days 2, 3, and 4), etoposide(70 mg/m, days 2, 3, and 4), doxorubicin(30 mg/m, day 1), and cisplatin(60 mg/m(2), day 1) repeated every 26 days. Objective responses were observed in 14 of 47(30%) evaluable patients, and the median duration of response was 21 weeks(l3~60+ ). The median survival time of 47 evaluable patients was 40 weeks(16~62). F-EAP therapy was associated with mild myelosuppression. The common non-hematologic toxieities were nausea/vomiting(94%), mucositis(32%), peripheral neuropathy (15%), and infection(11%), but the majority of these toxicities were mild to moderate and well tolerated. These results suggest that F-EAP regimen has a modest antitumor activity in terms of response rate and duration of response, and is relatively well tolerated in advanced gastric cancer.
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Complication of Intraoperative Radiation Therapy ( IORT ) Combined with External Irradiation and Chemotherapy in Gastric and Colorectal Cancer
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Myung Se Kim, Seong Kyu Kim, Sun Kyo Song, Jae Hwang Kim, Hong Jin Kim, Min Chul Chim, Koing Bo Kwun, Heung Dae Kim
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J Korean Cancer Assoc. 1994;26(1):16-24.
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- Although local recurrence is most troublesome problem even in early gastric and colorectal cancer, distant metastasis is the other cause of death among survivors. Department of Therapeutic Radiology & General Surgery in Yeungnam Medical Center tried prospective protocol which includes IORT and external irradiation for local control and various chemotherapy for systemic treatment since June 15, 1988. Total sixty eight patients(59 gastric, 9 colorectal) entered in our protocol. Fhysical examination, CBC, Chest X-Ray, and other biochemical examinations were performed on monthly basis, if it is necessary, CT, MRI and endoscopy were ordered. Sixty-one patients(53 gastric, 8 colorectal) were performed IORT(89.7%). Treatment related complications were found in 14 patients(23%) including 4 patients of gastro-intestinal bleedings (6.6%), 2 patients of bone marrow depressions(3.3%). 1 patient of perioperative abscess and sepsis(1.6%), 4 patients of intestinal obstructions(6.6%) and 4 patients of hand & leg edema(6.6%). Six of 14 patients with complications were dead(9.8%), probably due to complication. Our results are very encouraging, because only one patients with rectal cancer had local failure(1.6%) and complication rate is comparable with other published reports, in spite of our aggressive treatment. But reduced dose of chemotherapeutic agents, compromising of treatment sequence between chemotherapy and external irradiation and judicious perioperative care should be considered for further better results.
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The Effect of Ethanol on the Experimental Hepatocarcinogenesis Induced by 3'-methyl-4-dimethylaminoazobenzene
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Hee Jeong Ahn, Charn Il Park
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J Korean Cancer Assoc. 1994;26(1):24-41.
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- It has been generally accepted that sequential histological changes develop during the course of hepatocarcinogenesis as the precancerous lesions. However, the exact pathogenic mechanism and the relationship between these precancerous lesions and carcinoma remain contro- versiaL In 3'-methyl-4-dimethylaminoazobenzene(3'-MeDAB) induced hepatocarcinogenesis, the intermediate metabolites produced by cytochrome P, oxidase system of hepatocytes are thought to be the ultimate carcinogen, and conceivably such drugs as ethanol which is also oxidized by the same hepatic oxidase system may affect the 3-MeDAB induced hepatocarcinogenesis. The present study aimed to elucidate that the cytokinetic nature of the hepatic lesions developed by 3'-MeDAB administration and the effect of ethanol on the course of hepatocarcinogenesis. Sprague-Dawley male rats about 180 g were used for the experiment, and divided into 8 groups according to the duration and doses of 3-MeDAB and ethanol administered: I. normal control, IL 3-MeDAB only for 6 weeks, III. 3'-MeDAB only for 9 weeks, IV. 3'-MeDAB with a small dose(4 g/kg) of ethanol, V. 3'-MeDAB with a large dose(ll g/kg) of ehtanol, VL ethanol pretreatment for 3 weeks followed by 3'-MeDAB plus ethanol for 9 weeks, VII. Ethanol only for 9 weeks in a small dose, VIII. Ethanol only for 9 weeks in a large dose. Animals were sacrificed at 3, 6, 9, 12 and 15 weeks. The liver weight, the gross and microscopical changes of the liver were compered between the experimental groups. Cell kinetics of the various hepatic lesions developed in the hepatocarcinogenesis was examined by applying the immunohistochemical method for bromodeoxyuridine(BrdU). The results are as follows: 1) Liver weights tended to increase gradually in the experimental groups treated with 3'- MeDAB with or without ethanol, whereas it decreased in the animals given ethanoi alone. 2) The number and size of hepatic granules, nodules and masses continued to increaae in the
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Hepatocelluar Carcinomas Presenting as Bone Metastasis
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Jun Myeong Kim, Woo Ick Jang, Sa Joon Hong, Jong Inn Lee, Kwang Seon Song, Dong Ki Lee, Sang Ok Kwon, Young Hak Shim
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J Korean Cancer Assoc. 1994;26(1):41-46.
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- We report here five cases of hepatocellular carcinoma with symptomatic bone meatastasis as initial presentation. All patients were men ranging from 60 to 73 years of age. Initial presentations were the result of pelvic mass(l case), chest wall mass(1 case), spinal cord compression (2 case) and pathologic fracture of femur(l case). Of these 5 cases, bone metastasis commonly involved in ribs(5 cases) and in spine(4 cases). Actually, hepatocellular carcinoma presented as symptomatic bone metastasis is extremely rare, eventhough bone metastasis from hepatocellular carcinoma is found in 3% to 20% at autopsy. Prognosis is generally poor but palliative treatment with surgery and/or radiation can be considered.
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The Suppressive Effect of Dehydroepiandrosterone on the Induction of Preneoplastic Lesion in Murine Hepatocarcinogenesis
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Chung Yong Kim, Soo Tae Kim, Sang Chul Park, Kye Yong Song, Kuhn Uk Lee
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J Korean Cancer Assoc. 1994;26(1):46-62.
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- Tumor suppressive effect of dehydroepiandrosterone(DHEA) on the experimentally induced hepatocellular carcinoma was illustrated, for which the molecular mechanism was studied in the aspect of cellular re#gulation of preneoplastic lesion, especially focusing on apoptosis. For the purpose, we used the murine chemical hepatocarcinogenic procedure of Solt-Farber on Sprague-Dawley rats. Experimental groups were divided into control, AA, AD and AAD groups. The AA group was the standard diethylnitrosamine(DEN) and 2-acetylaminofluorene (AAF) group, while the AD group was DHEA added group simultaneously with AAF and the AAD group was DHEA added group after the treatment with AAF. Each group was divided into nine subgroups according to the time schedule with four weeks interval after the administration of DEN. The results were analyzed by body weight, apoptotic bodies, immunohistochemical studies with anti-glutathione-S-transferase-P(GST-P) antibody and anti-TGase antibody, and biochem- ical methods. The results were summarized as follows; 1) AD and AAD groups compared with control groups showed the less increaae of body weight during DHEA treatment. 2) GST-P positive foci were detected in all subgroups, but AD groups showed the significantly decreased area of GST-P positive foci than AA groups, and this effect last to G 9(P<0.05). AAD groups showed the similar effect of decreasing. GST-P positive foci as AD groups in G 9. 3) Western blot analysis of GST-P positive foci showed comparable outcome to immunohistochemical study. 4) Anti-TGase antibody staining of apoptotic bodies(ABs) in GST-P positive foci were confirmed by pathologic and immunohistochemical studies. 5) In G 1 and G 2, AD groups showed higher activities of TGase than AA groups(P<0.05), which was confirmed by Western blot analysis using anti-TGase antibody. These results suggest that the suppressive effect of DHEA on the experimentally induced murine hepatocellular carcinoma is operating on the promotion process of carcinogenesis probably through induction of apoptosis in the Preneoplastic lesion in relation with activation of transglutaminase Rene. Words: DHEA, Apoptosis, Hepatocellular carcinoma, TGase, GST-P
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Complications Following Pancreaticoduodenectomy
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Hyuk Jai Jang, Sung Gyu Lee, Duck Jong Han, Hong Suck Joon, Kwang Min Park, Tae Won Kwon, Pyung Chul Min
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J Korean Cancer Assoc. 1994;26(1):62-70.
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- Pancreaticoduodenectomy is a complex operation that previously carried high postoperative morbidity and mortality, but the operative mortality has decreased recently due to improvement in operative technique and perioperative care. This paper analyzes the postoperative complications after 64 pancreaticoduodenectomies performed during the past 3years and Gmonths from August, l989 to February, 1993 in the Department of Surgery, Asan Medical Center. 1) Postoperative major complications developed in 12 patients(l8.8%), including 3 intra-ab-dominal hemorrhage(4.7%), 3 gastrointestinal tract bleeding(4.7%), 3 intra-abdominal abscess (4.7% ), 2 pancreatic leakage(3.1%), and 1 bile leakage(1.6%). 2) The complications requiring relaparotomy in 3 patients(l intra-abdominal hemorrhage, 1 gastrointestinal tract bleeding, 1 Pancreatic leakage) ended fatally in 1 patient who died of gastrointestinal tract bleeding. Therefore, the overall martality rate was 1.6 percent. 3) A1though most complications could be managed conservatively, early reintervention should be done in dangerous complications such as uncontrolled pancreatic leaks and massive intraabdominal or gastrointestinal bleeding. 4) Based on our data, pancreaticoduodenectomy can be performed safely by experienced surgeons and can be used widely for suspicious periampullary tumorous lesions.
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Clinical Characteristics of Korean Breast Cancer According to the Pathologic Type
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Jong Suck Lee, You Sah Kim
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J Korean Cancer Assoc. 1994;26(1):70-82.
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- Clinical characteristics of 411 patients with breast cancer, who were seen between March of 1983 and February of 1993 at the Keimyung University Dongsan Hospital, were analysed ac- cording to their pathological classification. Those with incomplete medical records and with in- complete follow up were not included in this study. Pathological classification was made ac- cording the final pathological report at the time of biopsy or surgery. 1) Of 411 patients, 405 were female and six were male. The most common pathological type was invasive ductal carcinoma with 298 patients(73.58%), followed by medullary carcinoma (7.16%), lobular carcinoma(4.20%), Paget's disease(4.20%), mucinous carcinoma(3.21%), intraduc- tal carcinoma(2.72%), and other rare types. 2) Average age of the patients was 46.1 years and there was no significant difference in average ages among the different pathologic types except in the patients with secretory carcinoma. 3) The average duration of symptoms of the entire patients was seven months. 4) The average size of the tumors was 4.2 cm and there was no difference in the average sizes among the histologic types. 5) The hormone receptor was positive in 95 patients(53.4%) of 178 patients tested. In patients with invasive ductal carcinoma the positivity for the hormonal receptor was 54.9%. Nine of 10 patients with lobular carcinoma was positive for hormonal receptor but all of the seven patients with medullary carcinoma was hormone receptor negative. 6) Axillary lymph nodes were involved in 66.1% of the entire patients. Positive axillary nodes were found in 71.4% of patients with invasive ductal carcinoma, 76.5% with lobular carcinoma, 64.7% with Paget's disease and 55.2% with medullary carcinoma. 7) In the six male patients, invasive ductal carcinoma was found in three patients, intraductal carcinoma in one patient, papillary carcinoma in one patient, and hemangio- pericytoma in one patient. The patient with intraductal carcinoma was 39 years old but average age of the remaining 5 patients was 54.2% years.
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Second - line , Chemotherapy with 5 - Fluorouracil Etoposide , Doxorubicin , Cisplatin , Cyclophosphamide , Adriamycin , Vincristine , Predais
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Heung Moon Chang, Hyun Ah Kim, Won Seok Kim, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim
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J Korean Cancer Assoc. 1994;26(1):82-89.
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- There is no effective second-line chemotherapy for the advanced breast cancer. Previously CALGB reported that CAFVP combination chematherapy was more effective than the CMF or CMFVP combination chemotherapy for the advanced breast cancer. So we treated 38 advanced breast cancer patients with CAFVP combination chemotherapy, who had received previous chemotherapy, between June 1979 and September 1992. Median age was 41. 23 patients had prior mastectamy with adjuvant chemotherapy, 9 patients had prior mastectomy without adjuvant chemotherapy and 6 patients had initially stage IV lesions. All had been received prior chemotherapy. The menopausal status was as follows; 29 patients were premenopausal, 9 postmenopausaL The perfomance status was grade 0 to 1(ECOG) in 2l patients, 2 in 17. Treatment was cyclophosphamide 100 mg/m(2) po, day 1 l4, adriamycin 25 mg/m(2) iv, day 1 and 8, 5-fluorouracil 400 mg/m(2) iv, day 1 and 8, vincristine 1.4 mg/m iv, day 1 and 8, and pred- nisolone 60 mg/day po, day 1-14. The treatment was recycled every 4 weeks until the progression of the disease. Amang 26 patients with measurable lesions, 8(31%) achieved responses(l CR and 7 PR). Median duration of response was 7 months. Median survival for all patients was 20 months. Toxicity was as follows: leukopenia 35/, anemia 37%, thrombocytopenia 1%, N/V 21%. No treatment related death was observed during the treatment. It was concluded that CAFVP combination chemotherapy is not superior to other combination chemotherapy regimens, and myelosuppression is a major dose-limiting toxicity.
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Distribution of Major Histocompatibility Antigen Class 1 in Patientw with Thyroid Carcinoma
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Nung Soo Chung, Young Chul Kim, Young Chul Kim, Shung Chull Chae, Won Hee Jang, In Sun Lee, Tai Ho Chung
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J Korean Cancer Assoc. 1994;26(1):89-100.
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- This study was carried out to see if there are any peculiar pattern of HLA distribution in patients with thyroid carcinoma. Analysis of tissue antigens were done with Park and Terasaki method on the 25 cases of papillary cancer, 24 cases of follicular cancer, and 1S cases of medullary cancer. In order to comparison with benign tumor and healthy person, 21 cases of thyroid adenoma and 30 students were tested. Compared to the control group, papillary cancer showed high frequencies in HLA-B7, B46, and C6. In follicular cancer, high frequencies occgrred in HLA-A33 and HLA-B7. In medullary cancer, distribution was high on HLA-A3 and low an HLA-A24, In HLA-B locus, high was shown in B38, B4l, and B75 antigens while for HLA-C, C2, and CB were showed high frequencies. In follicuiar adenoma, a benign tumor, HLA-A1, A33 turned out with high frequencies. In HLA-B locus, HLA-B7 and B60 were high in distribution. In HLA-C locus, C6 showed high frequenices. In papillary caneer and follicular adenoma, HLA-B7 and HLA-C6 were commonly high.
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Mutation of K - ras Oncogene in Non - Small Cell lung Cancer
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Choon Taek Lee, Keun Chil Park, Chang Min Kim, Jae Ill Zo, Young Mog Shim, Weon Seon Hong, Jhin Oh Lee, Taik Koo Yun
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J Korean Cancer Assoc. 1994;26(1):100-106.
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- The mutations of K-ras oncogenes have been detected in about 20~30% of non-small cell lung cancer(NSCLC). In some reports K-ras activations are associated with smoking and poor prognosis in NSCLC patients who undergo curative resection. The ras oncogenes are usually activated by point mutations. The development of polymerase chain reaction-single strand conformation polymorphism(PCR-SSCP) enables us to detect the subtle nucleotide changes such as point mutations. In SSCP the electrophoretic mobility of single strand nucleotide de- pends on not only its size but also its conformation determined by DNA sequences. We analysed genomic DNAs of 41 human NSCLC obtained by thoracotomy using PCR-SSCP of K- ras codon 12, 13 and K-ras codon 61, and compared the results with clinical informations. The electrophoretic mobility changes were found in 10 of 41 NSCLCs(24.4%) in K-ras codon 12, 13. Those changes were found in six of 25 squamous cell carcinomas(24% ) and four of 16 adenocarcinomas(25%). But no change was found in K-ras codon 61. Comparisans of clinical parameters including age, sex, stage, smoking, and survival showedno significant differences between two groups with or without K-ras mutation. These results suggest that the mutation of K-ras oncogene may play an important role in the pathogenesis of some group of NSCLC though the clinical significances of these molecular events are open to further investigations.
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Bilateral Mediastinal Lymph Nodes Dissection via Median Sternotomy in Lung Cancer
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Man Sil Park, Doo Yun Lee, Gi Man Bae, Hyo Chae Paik, Sang Jin Kim
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J Korean Cancer Assoc. 1994;26(1):106-113.
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- Prom July 1992 through May 1993, 32 lung cancer patients underwent bilateral mediastinal lymph node dissection in conjunction with pulmonary resection via median sternotomy with or without thoracotomy. Operations were limited to clinically negative contralateral mediastinal lymph nodes metastasis. The locations of cancer were in the right upper lobe in 7 patients, right middle lobe in 2 patients, right lower lobe in 11 patients, left upper lobe in 6 patients, and in left lower lobe in 6 patients. Histological diagnosis was epidermoid cell carcinoma in 12 pa- tients, adenocarcinoma in 12 patients, bronchioloalveolar cell carcinoma in 3 patients, adenosquamous cell carcinoma in 2 patients, and one case each of small cell carcinama, double lung cancer(adenocarcinoma and small cell carcinoma), and intraepithelial dysplasia after radiotherapy. Right pneumonectomy was performed in 10 patients, left pneumonectomy in 7 patients, right lower and middle lobectomy in 4 patients, right upper and middle lobectomy in 3 patients, left lower lobectomy in 4 patients, right upper lobectomy in 2 patients and left upper lobectomy in 2 patients. Operative approaches were as follows; 21 cases of median sternotomy alone, 2 cases of median sternotomy with right posterolateral thoracotomy, 4 cases of median sternotomy with left anterolateral thoracotomy, 4 cases of median sternotomy with left posterolateral thoracotomy and I case of thoracoscopic left upper lobectomy and median sternotomy, Six patients(one patient with right upper lobe lesion and five patients with right lower lobe lesion) were proved to have contralateral mediastinal lymph node metastases which were not recognized preoperatively. There were 2 early postoperative deaths which were not related to the operation. Median sternotomy in lung cancer surgery provide bilateral mediastinal lymph nodes dissection which is useful in postoperative staging and postoperative adiuvant therapy.
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Effect of Retinoic Acid on the Growth of Subcutaneously Injected C1300 Neuroblastoma and on the Survival of the Host A / J Mice
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Hee Boong Park, Byeong Jun, Seung Hoon Choi
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J Korean Cancer Assoc. 1994;26(1):113-119.
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- Deficiency of vitamin A and/or its precursors has been associated with increased cancer risk in animals and humans. Therapeutic trials of vitamin A and related compounds(retinoids) have demonstrated activities in several cancerous and precancerous conditions. We measured the effects of a retinoic acid on the growth of subcutaneously injected C1300 neuroblastoma and on the survival of the host A/J mice. The fifty A/J mice were inoculated with 10' of C- 1300 neuroblastoma cell in the right back. They were divided into five groups. One group received saline as a control. Two groups recieved 2 mg/kg and 5 mg/kg of retinoic acid. The other two groups recieved low dose(50 mg/kg and 100 mg/kg) cysclophosphamide. Tumor volume and survival were assessed. The survivals were significantly increased(p<0.05) in three groups, mice recieved 5 mg/kg of retinoic acid, 50 mg/kg and 100 mg/kg of cyclophosphamide. Tumor volumes of the mice treated with 5 mg/kg of retinoic acid were significantly lower than the control group(p<0.05). Retinoic acid suppressed the growth of neuroblastoma, it increased the survival of the treated mice if adequate doses were used.
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EAP - 2 ( etoposide , adriamycin , cisplatin ) Combination Chemotherapy for Metastatic Cancer of Unknown Origin
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Eui Gun Chun, Jee Young Choi, Hwan Jung Yun, Jun Young Kil, Deog Yeon Jo, Sam Yong Kim
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J Korean Cancer Assoc. 1994;26(1):119-127.
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- Background
Optimal management of patients with metastatic cancer of unknown origin (MUO) requires appropriate clinical and pathologic eveluation to identify treatable subgroups and administer specific therapy for each patients subgroup. But, the best treatment in a large population of patients with MUO still remain a problem. Cisplatin-based combination chemotherapy has not been completely studied in Korea. A total of 14 patients with metastatic cancer of unknown origin were studied to evaluate the effectiveness and toxicity of EAP-II combination chemotherapy. Methods: All patients were treated with etoposide 20 mg/m continous IV on Dayl-5, Adriamycin 10 mg/m bolus on Day 1, 5 and cisplatin 20 mg/m(2) continous IV on Day 1-5, every 4 weeks. Results: Of 12 patients evaluable for response, 1(8%) had complete response and 6(50%) showed partial response with a objective response rate of 58%. The median duration of response was 9.7(8-20hnonths and the median survival of all patients was 15.5(4-25hnonths, In the analysis of the response according to various characteristics of the patients, there was no significant difference according to various parameters(P>0.05). Toxicity was generally mild. Whereas nausea and vomiting were mild, neuropathy was the dose limiting toxicity. Conclusion: This study indicates that EAP-II regimen is an active therapy against metaatatic cancer of unknown origin but is associated with significent neurotoxicity. Less toxic and more effective treatment protocol is anticipated.
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Mechanism of Ahtitumor Activity of DA - 125 , a New Anthracycline Antiviotics ( 1 )
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Mi Won Son, Jae Kyung Roh, Won Bae Kim, JunnIck Yang, Byung Soo Kim
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J Korean Cancer Assoc. 1994;26(1):127-136.
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- From various new anthracylines containing fluorine in their sugar moieties, 7-0-(2,6-dideoxy- 2-fluoro-e-1-talopyranosyl)-adriamycinone-l4-0-alaninate HC10A-125) has been selected for ciinicai investigation, because of its excellent antitumor acitivity and low toxicity. In this paper the mechanism whereby DA-125 exhibits good antitumor activity in viw was studied through in vitro experiments in comparison with doxorubicin(DXR). DA-125 had stronger activity than DXR in single and double strand scission in P388 cells and in inhibition of nucleic acid synthesis in L1210 cells. But DA-125 had weaker activity than DXR in binding to calf thymus DNA. DA-125 was taken up by P388 cells faster than DXR and accumulated reaching at 2. 7 fold higher leveL
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Effect of Filgrastim ( rhG - CSF ) on Chemotherapy Induced Neutropenia in Pediatric Acute Myelogenous Leukemia Patients
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Hee Young Shin, Hee Young Shin, Seong Hoon Hah, Hong Hoe Koo, Hyo Seop Ahn
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J Korean Cancer Assoc. 1994;26(1):136-144.
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- To determine the safety and efficacy of rhG-CSF on chemotherapy induced neutropenia in pediatric AML patients, we conducted a prospective controlled study in 17 patiens with AML at Seoul National University Childrens Hospital from July, 1993 to January, 1994. High dose cytosine arabinoside(Ara-C, 3gm/m for four times every 12 hours) with L-asparaginase 6,000 u/m) were given to 13 patients as Group I control and after the recovery of WBC, same chemo- therapy followed by G-CSF(50 ug/m for 10 days) were given as Group I study. In Group II study, high dose Ara-C(3gm/m(2) for 8 times every 12 hours) were given to 11 patients with AML followed by G-CSF(150 ug/m for 10 days). Recovery of the absolute neutrophil counts to more than 1,000/mm' was significantly faster in the G-CSF group than in the control group(P< 0.01) and the absolute neutrophil counts on day 14 of chemotherapy was significantly higher in G-CSF group(P<0.01). The toxicity of G-CSF was minimal and there was no evidence of accel- erated growth of leukemic blasts during the G-CSF treatment. In conclusion, Filgrastim(rhG- CSF) promotes the recovery of neutrophils and shortens the duration of neutropenia induced by the chemotherapy in pediatric acute myelogenous leukemia.
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The Effects of Granulocyte Colony Stimulating Factor on Neutropenia Induced by the Chemotherapy in the Solid Tumor Patient
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Sang Won Shin, Young Jin Nam, Chul Won Choi, Gwan Gyu Song, Jun Suk Kim, Soon Duck Kim, Yeul Hong Kim
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J Korean Cancer Assoc. 1994;26(1):144-151.
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- We evaluated the effect of aranulocyte colony stimulating factor (G-CSF) to prevent chemo- therapy induced neutropenia and fever development during neutropenic period. The twenty patients with solid tumor were treated with various cytotoxic chemotherapeutic agents at least two cycles. The patients were given G-CSF 75pg/day after 2nd cycle chemotherapy for least 14 consecutive days and clinical, laboratory results were compared to the first cycle's results. Treatment with G-CSF resulted in increase of mean neutrophil count(320+-230/mm(3) vs 1030 +-1020/mm(2)), reduced the duration of neutropenic days(4.25 dyas vs 1.30 days, absolute neutrophil count less than 500/mm) snd reduced the incidence of neutropenic fever(75% vs 25% ). The side effect af G-CSF was not so significant. These results demonsrated that the use of G-CSF as an adjunct to chemotherapy with various solid cancer patients was well tolerated and led to reduction in the incidence of neutropenic fever; in the terms of incidence, duratian, and severity of neutropenia.
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Anti - Emetic Effect of Ondansetron Combined with Dexamethasone in Cisplatin Induced Nausea and Vomiting
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Wook Bum Pyun, Seong Nam Kim, Sung Ae Jung, Soon Nam Lee
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J Korean Cancer Assoc. 1994;26(1):151-158.
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- Cisplatin, an agent highly effective against a variety of cancers, produces the most severe nausea and vomiting of any chemotherapeutic agents. Recently, the role of 5-HT,(serotonin) in cisplatin induced nausea and vomiting was introduced and ondansetron a selective 5-HT, receptor antagonist, was administered to prevent cisplatin induced nausea and vomiting. Remarkable effects on acute emesis was obtained but effects on delayed emesis was not controlled by ondansetron only. This study was done to investigate the effectiveness and side effects of ondsnsetron combined with dexamethasone in cisplatin induced nausea and vomitiog. To evaluate the effetiveness of ondansetron combined with dexamethasone in preventing cisplatin induced nause and vomiting, 16 cancer patients who were treated with intravenous cisplatin containing chemotherapy as the first anticancer therapy were administered 20 mg dexamethasone i.v. 20 minutes before and 8 mg ondansetron i.v. 15 minutes before, 4 hour and 8 hour after ciaplatin infusion respectively on day 1, and 8 mg ondansetron was administered orally three times a day on day 2-4. On the first day, the complete response and major response were noted in 75%(12/16 patients), and 19%(3/l6 patients) respectively, minor response in 6%(l/16 patients), and none showed failure. On the second day, the complete response and major response were noted in 44 %(7/16 patients) and 25%(4/16 Patients) respectively, minor response in 19%(3/16 patients), and 12%(2/16 patients) showed failure. On the third to fourth day, complete response was noted in 29%(4/14 patients), major response 29%(4/14 patients), and minor response and failure were noted in 21%(3/l4 patientsl respectively. Two patients complained headache, dizziness respectively and the other two patients complained abdominal pain and diarrhea, but the degree was mild and subsided by conservative management. With these results, the administration of ondansetron and dexamethasone to prevent the cisplatin induced nausea and vomiting was effective for acute emesis but not so effective in delayed emesis even with combination of dexamethasone. Further study would be necessary to overcome the low effectiveness on the control of delayed emesis.
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Antiemetic Effecacy of Ondansetron in Prevention of Acute Emesis Associated with Chemotheray in Pediatric Patients with Malignancies
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Jae Kyung Choi, Pil Soo Oh, Hahng Lee
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J Korean Cancer Assoc. 1994;26(1):158-169.
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- Chemotherapy-induced emesis is a major problem in the treatment of childhood malignancies and may result in increased patient morbidity and prolonged hospitalization. Currently available antiemetic regimens are not entirely effective and many are associated with unacceptable side effects in children. Ondansetron, a new specific 5HT3 receptor antagonist, has been shown to be highly effective in controlling chemotherapy-induced emesis in adult patients. We conducted a study in 24 children patients receiving 54 courses of chemotherapy for control of emesis. ondansetron(5 mg/m) was given only one time intravenously 15 min before chemotherapy. the number of emetic episodes were recorded during the 24 hours following chemotherapy. The results of the study are as follows 1) The antiemetic efficacies of ondansetron were 85% in total 54 courses of chemotherapy, 90 % in non-cisplatin group, 40% in cisplatin group. 2) We compaired the number of emetic episodes induced by chemotherapy with ondansetron to that previously without ondansetron and analyzed the results according to chemotherapy regimens and children patients. there were statisticaly significant differences(p < 0.001, p < 0.001). 3) The adverse events were observed in 3/54(5.6%) cases: headache(l case), loose stool(1 case) and abdominal pain(l case). In spite of the fact the efficacy of a single intravenous dose was studied due to the high cost of the antiemetic studied, we concluded that a single intravenous dose regimen of ondansetron prior to anticancer chemotherapy showed significant antiemetic efficacy and acceptable safety, and that multiple dose of ondansetron with or without other antiementic drug deserve further studies in children.
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Primary Hyperaldosteronism Due to Adrenocortical Carcinoma
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Kyung Sang Lee, Woong Hwan Choi, Tejune Chung, Il Young Choi, Pah Jong Jung, Chan Kum Park, Jung Dal Lee
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J Korean Cancer Assoc. 1994;26(1):169-176.
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Abstract
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- Primary hyperaldosteronism resulting from adrenocortical carcinoma is very rare. We have experienced a 39 year old man with adrenocortical csrcinoma presenting with hypertension, hypokalemia, and metabolic alkalosis. The patient had a 13 cm encapsulated mass in his left adrenal gland and multiple metastatic nodules in the lungs. Hyperaldosteronism was established as the cause of the hypertension on the basis of laboratory tests showing suppressed plasma renin activity and nonsuppressible high plasma aldosterone concentration. He has been placed on chemotherapy with cisplatin containing regimen and interferon-a for more than 6 months. He is in stable condition with no evidence of progress in the lung and recurrence in the adrenal gland. A review of the literature revealed only 8 cases with primary hyperaldosteronism resulting from pure aldosterone excess produced by adrenocortical carcinoma. In Korea, oui report is the first one showing clear histologic findings and endocrine tests.
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Granular Cell Tumor of the Scrotum - A case report -
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Chang Won Ha, Kyung Ja Cho, Hi Jung An, Ja June Jang
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J Korean Cancer Assoc. 1994;26(1):176-179.
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Abstract
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- Granular cell tumor is a benign neoplasm of uncertain origin which may affect tongue, skin and other vairous organs. Its scrotal location has not been described in the literaute. We report a granular cell tumor occurred in the scrotum of a 40-year-old man. Grossly the left scrotum showed a 5 x 4 x 2 cm sized well demarcated mass. On section, there was a subcutaneous tumor, showing grayish yellow trabeculated cut surface. Histologically, the neoplasm was consisted of diffuse sheets of large round to oval cells characterized by indistinct cell membranes, pale cytoplasm with eosinophilic granules, and small bland nuclei. Immunohistochemically, the cytoplasm of tumor cells are immunoreative for S-100. Electronmicroscopically, the cytoplasm of tumor cells are filled with numerous electron-dense phagolysosomes.
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