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Volume 30(1); February 1998
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Original Articles
Expression of p53 and MHC Class I According to HPV Infection in Laryngeal Squamous Cell Carcinomas
Chan Seung Hwang, Hoon Kim, Mi Kyung Kim
J Korean Cancer Assoc. 1998;30(1):1-11.
AbstractAbstract PDF
PURPOSE
We evaluated the HPV type 16, 18 infection and p53 expression and MHC class Iantigen expression, and analyzed he relationship between HPV infection and p53 expression and MHC class I expression in laryngeal squamous cell carcinomas.
MATERIALS AND METHODS
Thirty-nine cases of laryngeal squamous cell carcinomas and ten cases of laryngeal nodules were analyzed for detection of HPV DNA by in situ hybridization and the detection of p53 and MHC class I antigen by immunohistochemical technique.
RESULTS
HPV DNA was detected in 10(26%), and p53 expression was detected in 19(49%) out of 39 cases in laryngeal squamous cell carcinomas. HPV positive cases showed 50% of p53 expression whereas HPV negative cases showed 48% expression. MHC class I down-regulation (heterogenous and negative expression) in HPV positive lesions was higher than HPV negative lesions, but there was no statistically significance. The expression of MHC class I was related to cellular differentiation regardless of T-stage and nodal involvement.
CONCLUSION
There was no reiationship between HPV infection and p53 expression and MHC class I expression in laryngeal squamous cell carcinomas. Also these results suggest that MHC class I expression can make it possible to presume indirectly the malignant potentiality of the tumor.
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p53 Mutation of Head and Neck Squamous Cell Carcinoma Cell Lines
Chung Hwan Baek, Ye Jeung Ko, Young Ik Sun, Sung Wha Hong, Kwang Chol Chu
J Korean Cancer Assoc. 1998;30(1):12-19.
AbstractAbstract PDF
PURPOSE
Structural alterations of p53 and overexpression of the p53 protein are the most common genetic abnormalities in various kinds of human cancers. In this study, we examined the mutational status and the frequency of p53 mutations in head and neck squamous cell carcimona (HNSCC) cell lines.
MATERIALS AND METHODS
7 human head and neck squamous cell carcinoma cell lines were included in this analysis. Using polymerase chain reaction(PCR), single strand confonmation polymorphism(SSCP) and PCR-DNA sequencing analysis, we tested the mutational status of 7 cell lines. Exon 4~9 of the p53 gene was amplified for the direct DNA sequencing analysis.
RESULTS
Our results showed 100% nuclear p53 immunostaining and 3 electrophoretic abnomalities by PCR-SSCP in three cancer cell lines and mutations of the p53 gene including 2 base substitutions and 1 base deletion were detected in 3 cancer cell lines using PCR directed DNA sequencing analysis.
CONCLUSION
7 HNSCC cell lines examined in this study provide excellent systems for study of gene therapy using p53 gene.
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Gene Transfer Effects of Thymidine Kinase Gene of Herpes Simplex Type 1 on Ganciclovir Cytotoxicity in Gastric Cancer Cell Line
Jae Kyung Roh, Soo Jung Gong, Joo Hang Kim, Hyo Dong Um, Nae Chun Yoo, Jin Hyuk Choi, Jae Jin Song, Sun Young Rha, Hyun Cheol Chung, Jin Sik Min, Byung Soo Kim
J Korean Cancer Assoc. 1998;30(1):20-30.
AbstractAbstract PDF
PURPOSE
Gastric cancer is the most common malignancy in Korea. Although treatment such as surgery, chemotherapy, and immunotherapy has greatly improved, the mortality rate of gastic cancer is still high, A new therapeutic trial is necessary to improve the cure rate of gastric cancer. Therefore we investigated the pre-clinical significance of HSV-tk gene therapy using retroviral vector for gastric cancer cell lines.
MATERIALS AND METHODS
LNC/HSV-tk retroviral vector and PA317/LNC/HSV-tk producer cell line were constructed. HSV-tk gene transduction and expression were detected by PCR. An in vitro ganciclovir(GCV) sensitivity test was performed by MTT assay. To evaluate in vivo GCV sensitivity, GCV was intraperitoneally injected after tumor formation in the nude mice. Bystander effect was observed in vitro MTT assay using YCC- S-2 cell line and in vivo using N87 and YCC-S-2 cell lines.
RESULTS
The in vitro GCV sensitivity test showed that the growth inhibition was 30~32% with 0.5 uM GCV and 52~77% with 500 uM GCV in the HSV-tk transduced cell line in comparison with 0- 5% with 0.5 and 500 uM GCV in the parent cell line. The in vivo GCV administration showed that the tumors induced by HSV-tk transduced N87 cell line and YCC-S-2 cell line decreased completely, while the tumors with the parent cell lines continued to grow in nude mice. We observed no tumor cells in tissue specimen of the tumor induced by the N87/HSV-tk cell line after. GCV administration. In vitro and in vivo bystander effects were observed in HSV-tk/GCV system due to the resultant cell death exceeding the proportion of HSV-tk transduced cells in the mixtures of HSV-tk transduced and parent cells.
CONCLUSION
HSV-tk transduced gastric cancer cell lines showed sensitivity to GCV and a bystander effect was observed. These results suggested that HSV-tk/GCV system should be evaluated in the clinical settings.
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Prognostic Value of p53 and Proliferating Cell Nuclear Antigen ( PCNA ) in Stage 3 Gastric Carcinoma
Hyung Tae Oh, Duk Su Lee, Dong Ho Han, Sang Young Kim, Byung Yi Ahn, Min Chul Kim, Myung Jin Joo, Kwang Min Lee, Woo Young Kim, Sung Hye Sin
J Korean Cancer Assoc. 1998;30(1):31-39.
AbstractAbstract PDF
PURPOSE
We evaluated the prognostic significance of p53 and proliferating cell nuclear antigen(PCNA) in stage III gastric carcinoma to determine the correlation between the p53 and PCNA expression and various clinicopathological parameters.
MATERIALS AND METHODS
The expression of p53 and PCNA were studied immunohistochemically in 64 cases of stage III gastric carcinomas with paraffin-embedded tissue specimens which were obtained surgically at the department of surgery, Presbyterian Medical Center from 1991 to 1992. Both expression were compared with known factors of prognosis. Survival rate and other clinicopathological parameters were analysed.
RESULTS
Expression rates of p53 and high PCNA group were 40.6% and 26.6%, respectively. There was no significant correlation between the p53 and PCNA expression and various clinicopathological variables such as age, sex, stage, histology, tumor depth, number of metastatic node, tumor size, site and method of operation. To analyse survival, we evaluated overall survival according to the extent of p53 and PCNA expression. No significant correlations between the p53 and PCNA expression and overall survival were found. CONCLUSION: These results suggest that the p53 and PCNA expression seems to be hard to use as a prognostic indicator in stage III gastric carcinoma.
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Immunohistochemical Analysis of MHC Class 2 (HLA-DR / DP), ICAM-1, CD68(+) Macrophage Expression in Gastric Adenocarcinoma
Eon Sub Park, Seong Nam Kim, Tae Jin Lee, Im Joong Yoon, Yong Kyoo Shin, Jae Hyung Yoo
J Korean Cancer Assoc. 1998;30(1):40-54.
AbstractAbstract PDF
PURPOSE
Gastric adenocarcinoma is the most common malignant tumor in Korea and immunochemotherapy can be alternative method of the treatment for it. So we evaluated several immunologic markers, Major Histocomatibility (MHC) Antigen and Intercellular Adhesion Molecule (ICAM)-1 which play an important roles in cellular immune response of the host to the tumar cells, HLA-DR/DP antigens, one of the MHC class II which is expressed in various conditions, CD 68 antigen which are also important factor in immune response to the tumor cells.
MATERIALS AND METHODS
We compared the expression of MHC class II (HLA-DR/DP) antigens, ICAM-1 and the number of tumor-infiltrating macrophages presenting CD68 antigen in formalin-fixed paraffin-embedded tissue sections of 95 gastric adenocarcinomas using immunohistochemistry. In addition to analyze the relationship between expression of these antigens in gastric adenocarcinoma, histolopathologic findings such as tumor invasion, regional lymph node metastasis and histologic differentiation are evaluated.
RESULTS
The rate of HLA-DR/DP expression was 60% and strongly associated with tumor differentiation, invasion and regional lymph node metastasis. ICAM-1 was expressed in 15% and slightly increased in well-differentiated carcinoma. The lack of expression of ICAM-1 was observed in high invasive tumor (T 4). CD 68(+) macrophages counts were significantly increased in around the tumor cells, compared to normal epithelia. HLA-DR/DP expression and infiltrating CD 68(+) macrophage numbers were significantly associated (p<0.05), but there was no correlationship between ICAM-1 and CD 68(+) macrophage numbers.
CONCLUSION
It was considered that enhanced expression of HLA-DR/DP antigens, ICAM-1 and CD68(+) macrophages in gastric adenocarcinomas may be an immunophenotypic deviation. HLA-DR/DP and CD68(+) macrophages infiltration showed correlationship with tumor invasion and regional lymph node metastasis, that they may be used as a prognostic factor of the tumor growth.
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Phase 2 Trial of FLP ( 5-FU , Leucovorin , Cisplatin ) Combination Chemotherapy for Advanced Gastric Cancer
Young Iee Park, Moon Hee Lee, Sung Woo Han, Woo Jung Park, Dong Gyu Kim, Jin Lee, Jin Seok Ahn, Jung Ae Rhee, In Sook Woo, Young Suk Park
J Korean Cancer Assoc. 1998;30(1):55-62.
AbstractAbstract PDF
PURPOSE
Advanced gastric cancer, the most common malignancy in Korea is a kind of systemic disease. At dignosis, 50~80% of patients have systemic cancer. Therefore, the most patients require systemic chemotherapy. Cisplatin and 5-FU have been suggested to be active in the treatment of gastric cancer, a high response rate was observered with a combination of 5-FU infusion and cisplatin, and the biochemical modulation of 5-FU by leucovorin has been demonstrated to enhance the activity of 5-FU in gastrointestinal tract cancer.
MATERIALS AND METHODS
The patients with advanced gastric cancer whose disease had relapsed or unresectable were treated with 5-FU(800 mg/m2 12 hr IV infusion, D 1~5), leucovorin(20 mg/m2 IV, D 1~5, max. 30 mg), cisplatin(100 mg/m2 15min IV dripping, D1). The cycles of treatment were repeated at 3-weeks intervals.
RESULTS
Between Sep. 1994 and Aug. 1996, previously untreated 44 patients(39 eligible patients) were admitted to this study, the median age was 55 years(range 17~73) and male to female ratio was 20:19. The rate of complete remission was 5%(2/39), the rate of partial remission was 21%(8/39). The median-response duration was 26 weeks(5+~38+ ). The median-time to progression was 25 weeks(4+~62+). The range of overall survival time was from 4 to 62+ weeks. 24 weeks survival rate was 71.5% but the median survival time was not reached. The leukopenia and anemia were the main hematologic toxicities. Non-hematologic side effects were nausea, vomiting, diarrhea, stomatitis, peripheral neuropathy. These toxicities were observed commnonly, but tolerable. Two treatment-related deaths were associated with sepsis.
CONCLUSION
Based on these results, FLP combination chemotherapy seems to be a moderate efficacy for advanced gastric cancer with tolerable toxicities. To confirm the efficacy further, the long-term follow up and a large scale of clinical studies are needed.
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Clinical Analysis of 329 Cases of Total Gastrectomy
Woo Sung Lee, Nam Sun Paik, Seon Mi Moon, Woo Chul Noh, Ho Yoon Bang, Dong Wook Choi, Jong Inn Lee, Nan Mo Moon
J Korean Cancer Assoc. 1998;30(1):63-71.
AbstractAbstract PDF
PURPOSE
This study was designed to evaluate the safety including the morbidity and mortality of total gastrectomy and combined organ resection, to examine the survival rate and the prognostic factors of gastric cancer following the total gastrectomy and to assess the prognostic predictability of new UICC staging system after surgery in gastric cancer patients. MATERIAL AND METHOD: To evaluate demographic features, clinical presentations, preoperative diagnostic accuracy, postoperative complications and prognostic factors, we analyzed 329 patients who underwent the total gastrectomy or the total gastrectomy with combined resection for gastric malignancy at KCCH from Jan. 1990 to Dec. 1993 retrospectively.
RESULTS
The early postoperative complication rates of overall patients and combined resection group were 9.1% and 8.9%. Mortality of these were 0.9% and 1.1%(p>0.05). The overall 5YSR was 52.8% and there was no significant differrence in the survival rate between the total gastrectomy only group and the combined resection group. The accuracy of preoperative UGIS and abdominal CT for determiantion of resectability were over 80%. The depth of invasion and lymph node metastasis were independent prognostic factors.
CONCLUSION
The total gastrectomy with combined resection should be considered when indicated, because the postoperative morbidity and mortality is low and long term survival is expected. The new UICC staging system seems to be good to predict prognosis in gastric cancer patients.
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Pancreaticoduodenectomy for gastric Cancer
Jae Cheol Byun, Joo Ho Lee, Hang Jong Yu, Soo Jin Kim, Kuhn Uk Lee, Jin Pok Kim
J Korean Cancer Assoc. 1998;30(1):72-79.
AbstractAbstract PDF
PURPOSE
We purpose of this retrospective study is to evaluate the role of pancreaticoduadenectomy (PD) in gastric cancer which invades neighboring organs.
MATERIALS AND METHODS
We analysed 28 patients with locally advanced gastric cancer which invaded to pancreas and/or duodenum who received surgical resection from Jan. 1989 to Dec. 1996. Patients were divided into two groups: Group A (n=12) who received PD and Group B (n=16) who received gastrectomy only. Indication of PD in group A is locally advanced gastric cancer which invaded to pancreas and/or duodenum but had no evidence of widespread nodal involvement, extended hepatic metastasis, or peritoneal dissemination.
RESULTS
The operation time, amount of blood loss during operation, and postoperative hospital stay were greater in group A than in group B. Operative mortality was found in 1 case in group B but none in group A. Postoperative complications were similar in both groups. Four patients had liver metastases in both group during follow up period, whereas 2 and 4 patients had disseminated peritoneal seeding in group A and B, respectively. When survival rates were compared, Group A shows better survival than Group B (p= 0.043).
CONCLUSION
These results suggest that PD is a rational and safe method for treatment of gastric cancer infiltrating into pancreatic head and/or duodenum.
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Microvessel Count and Overexpression of p53 in Early Colorectal Cancer
Young Min Kim, Gyeong Hoon Kang, Suk Kyun Yang, Chang Sik Yu, Jin Cheon Kim
J Korean Cancer Assoc. 1998;30(1):80-88.
AbstractAbstract PDF
PURPOSE
Angiogenesis, playing a critical role in tumor growth, development, and metastatic process, is alleged to be related to the prognostic factors and patient's survival of the colo-rectal cancer. The p53 gene, present in short arm of chromosome 17, is involved in multistep colo-rectal carcinogenesis. The correlation of p53 gene and angiogenesis has been recently reported. So, we designed to assess (1) the rate of p53 overexpression, (2) the prognostic significance of microvessel count, and (3) the relationship of p53 overexpression and angiogenesis in early colo-rectal cancer(ECC) patients. MATERIAL AND METHODS: The study material included 68 ECC from 65 patients, 40 mucosal (m-ECC) and 28 submucosal ECCs (sm-ECC). Immunostainings against p53 and factor VIII-related antigen were done and the results were analyzed with respect to tumor depth, site, and differentiation. And also the correlation between p53 overexpression and microvessel counts(MVC) was performed.
RESULT
The rate of p53 overexpression was higher in sm-ECC than in m-ECC (p < 0.05). The rate of p53 overexpression was highest in sigmoid colon and statistically significantly different compared with other sites. The differentiation of the tumor was closely correlated with p53 overexpression and the poorer the differentiation, the more overexpression of p53 (p<0.05). There was no significant difference between MVCs of m-ECC and sm-ECC (27.2+/-5.5 and 29.8 +/-6.0,respectively). However, MVC were higher in sigmoid colon than in any other sites (p<0.05). MVC did not show significant correlation with tumor differentiation or p53 overexpression.
CONCLUSION
These data indicate that p53 overexpression is correlated with tumor depth and differentiation but not MVC. The significance of higher MVC and p53 overexpression in sigmoid colon are reserved for further studies.
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bcl-2 and p53 Gene Expression in Colonic Adenoma and Carcinoma
Chang Young Lim, Jeong Won Kim, Il Han Song, Young Joo Jin, Im Whan Rho, Dong Kook Park, Jeong Hee Cho, Sung Bae Choi
J Korean Cancer Assoc. 1998;30(1):89-99.
AbstractAbstract PDF
PURPOSE
Recently, it is suggested that the inhibitian of apoptosis is associated with tumorigenesis of colon. Bcl-2 gene is an important inhibitory regulator of apoptosis, and bcl-2 acts antagonistly with the wild type p53 gene, one of the tumor suppressor genes, in apoptosis. To detnmine the role of bcl-2 and p53 gene in colonic tumorigenesis, we performed the study.
MATERIALS AND METHODS
We tested the tissue obtained by polypectomy and surgical resection by immunohistochemical staining for Bcl-2 and p53.
RESULTS
We found that in normal colonic tissue, the Bcl-2 was sparcely expressed, and the p53 was expressed sporadically. The rate of positivity of staining was below 5%. However, in colonic adenoma and colon cancer tissue, Bcl-2 and p53 were expressed more than in nonnal colonic tissue(p<0.05). (Scoring in Colonic adenoma: Bcl-2 6.2+/-1.1, p53 5.7+/-1.0; Scoring in Colonic carcinoma: Bcl-2 4.7+/-1.0, p53 8.3+/-0.9) CONCLUSION: Our results suggested that the bcl-2 and p53 play an important role in colonic tumorigenesis.
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Clinical Trial
High Dose Cyclophosphamide, Thiotepa, and Carboplatin followed by Autologous Peripheral Stem Cell Rescue in Patients with Responsive Metastatic or High - Risk Primary Breast Cancer
Se Haeng Cho, Sang Hee Kim, Young Joo Min, Sung Joon Choi, Jung Kyun Kim, Tae Won Kim, Jong Soo Choi, Dai Young Zang, Je Hwan Lee, Sung Bae Kim, Cheol Won Suh, Kyoo Hyung Lee, Jung Shin Lee, Woo Kun Kim, Se Hyun Ahn, Jung Mi Park, Sang We Kim
J Korean Cancer Assoc. 1998;30(1):100-105.
AbstractAbstract PDF
PURPOSE
Positive correlation between dosage of antineoplastic agents and tumor response is well demonstrated in advanced breast cancer. But severe bone marrow depression limit the clinical application of high dose chemotherapy. Autologous peripheral blood stem cell transplantation(PBSCT) after high dose chemotherapy(HDC) was introduced to promote rapid bone marrow recovery. This study was designed to establish the feasibility of combining high dose cyclophosphamide, thiotepa, and carboplatin chemotherapy followed by stem cell rescue in patients with responsive metastatic or high risk primary breast cancer.
MATERIALS AND METHOD
Eligibility criteria included the presence of high risk primary breast cancer(10 or more involved axillary lymph node, n=4), recurrent disease after curative resection(n=6) or stage IV disease at the time of diagnosis(n=1). The responses of recurrent disease to initial chemotherapy were 4 complete responses and 1 partial responses. One recurrent case with solitary pulmonary metastasis underwent metastasectomy and got chemotherapy after operation. Colony stimulating factor was administered to mobilize stem cells from bone marrow to peripheral blood. The stem cell collection was performed 4~10 times(median 4) and the number of collected stem cell was 1.95~7.34x10(8)kg(median 4.87x10(8)/kg). High dose chemotherapy with CTCb (cyclophosphamide 1,500 mg/m2/day, thiotepa 125 mg/m2/day, carboplatin 200 mg/m2/ day) was performed from day -7 to day -4 and peripheral stem cell infusion was performed on day 0 as planned.
RESULT
Eleven patients were enrolled in this study. Their median age was 39 years old. The median time for bone marrow recovery was 11 days for neutrophil(>500/mm2) and 28 days for platelet(>50,000/mm2). Packed red blood cell and platelet transfusion were performed in 11 patients. The group whose infused mononuclear cell count was less than 4.0 x 10(8)/kg(n=9) needed longer time for bone marrow recovery than those(n=2) who had more than 4.0 x 10(8)/kg( 20 vs 13 day, p < 0.05 ). For non-hematologic toxicity, none have experienced toxicity more than grade III. There were 2 recurrences of 4 cases with high risk breast cancer at the 22 th, and 25 th month but they are still alive at the 28 th, and 29 th month each. The other 2 cases are alive without recurrences at the 18 th, and 20 th months each. In the recurrent disease group, one case who showed partial response to initial chemotherapy recurred at the 4 th month and died at the 13 th month after PBSCT. The other 5 cases are alive without recurrence at the 1st, 3 rd, 3 rd, 5 th, and 31 th month each. One case with stage IV disease(bone metastasis) is alive without evidence of progression at the 3 rd month.
CONCLUSION
High dose chemotherapy with PBSCT can be performed safely. Long term survival of patients with advanced breast cancer would be possible by PBSCT after HDC. Further clinical trials based on larger patient population is required to evaluate clinical efficacy of PBSCT after HDC in high risk and recurrent breast cancer.
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Original Articles
Clinicopathologic Analysis of 40 Mucinous Breast Carcinomas
Woo Jin Choe, Han Sung Kang, Ji Soo Kim, Dong Young Noh, In Ae Park, Yeo Kyu Yong, Seung Keun Oh, Kuk Jin Choe
J Korean Cancer Assoc. 1998;30(1):106-112.
AbstractAbstract PDF
PURPOSE
Mucinous carcinoma of breast was known to have a lower lymph node metastasis and better prognosis than other type of breast cancer. This study was performed to clarify the clinicopathologic features and prognosis of mucinous breast carcinoma.
MATERIALS AND METHODS
We reviewed clinicopathologic features of 40 patients diagnosed mucinous breast carcinoma from Jan. 1985 to Dec. 1995 and compared 31 patients of unmixed mucinous breast carcinoma with 1128 patients of infiltrating ductal carcinoma group.
RESULTS
Of total 40 mucinous ca., 31 cases were unmixed type showing no component of invasive ductal component(IDC) and 9 cases were mixed type showing IDC. The average age of the patients was 47 ranging from 31 to 71 years. The most common symptom was palpable breast mass(38 cases, 95%). According to TNM classification, the numbers of unmixed type were following, stage I 14 cases(45%), stage II 15 cases(48%), and stage III 2 cases(7%), and of mixed type, stage I 1 cases(11%), and stage II was 8 cases(89%). Axillary lymph node metastasis was shown to be negative in 26 cases of unmixed mucinous carcinoma(84%), whereas it did in 544 cases of infilterating ductal carcinoma(48%)(p<0.05). Because all patients with unmixed mucinous carcinoma survived except 2 patients who died of cancer unrelated causes, it was impossible to analyze the difference of outcome in unmixed mucinous carcinoma and infilterating ductal carcinoma(5YSR: 81%).
CONCLUSION
Considering unmixed mucinous carcinoma had fewer axillary lymph node metatasis than infiterating ductal carcinoma, it may be concluded that unmixed mucinous carcinoma had better prognosis.
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Clinical Analysis of Typical Medullary Carcinoma of the Breast
Kyu Hwan Choi, Woo Chul Noh, Nam Sun Paik, Nan Mo Moon, Ho Yoon Bang, Dong Wook Choi, Jong Inn Lee, Seon Mi Moon
J Korean Cancer Assoc. 1998;30(1):113-118.
AbstractAbstract PDF
PURPOSE
Medullary carcinoma of the breast is an uncommon subtype of infiltrating ductal carcinoma and its incidence in different series ranges between 2% and 8% of all breast canoers. The histopathologic criteria for medullary carcinoma of the breast used by most pathologists today were delineated by Ridolfi et al. in 1977. The criteria of typical medullary carcinoma include all of followings: 75% or more of syncytial growth pattern, microscopically completely circumscribed, no intraductal component, moderate to marked diffuse mononuclear stromal invasion, nuclear grade 1 or 2. Medullary carcinoma has a more favorable prognosis than usual invasive breast cancer. MATERIALS & METHODS: To determine clinical characteristics of this tumor, the medical records of 15 women with typical medullary carcinoma treated at KCCH between 1985 and 1996 were reviewed retrospectively.
RESULTS
The incidence of typical medullary carcinoma in KCCH was 0.51%(15/2946) of all breast cancers. Age ranged from 27 to 56 years and mean age was 40.1 years. The peak age group was 4th decade(46.6%), followed by 5 th decade(40%). Most of the patients were premenopausal status(14/15). The major clinical manifestation of all patients was a palpable mass. Twelve patients were investigated for ER status, but all were negative. Preoperative fine needle aspiration cytology was checked in 6 patients, all cases showed positive findings for malignancy. The mean size of tumor was 3.01 cm in diameter and the rate of lymph node positivity was 40%(6/15). There was one case of systemic recurrence at 38 months after operation and the patient expired at 3 months after detection of recurrence. The others were alive without evidence of disease for mean follow-up period of 64.7 months.
CONCLUSIONS
The mean age of the patients of medullary carcinoma was relatively younger than that of the patients with other usual invasive breast cancer. The incidence of medullary carcinoma in this study was slightly lower than western series. Medullary carcinoma showed good prognosis, even if estrogen receptors were negative, but to determine clinical characteristics of Korean medullary carcinoma of the breast, multicenter data should be collected.
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Clinical Review of Familial and Hereditary Breast Cancer
Young Joon Ahn, Han Sung Kang, Ji Soo Kim, Dong Young Noh, Yeo Kyu Youn, Jae Gahb Park, Seung Keun Oh, Kuk Jin Choe
J Korean Cancer Assoc. 1998;30(1):119-126.
AbstractAbstract PDF
PURPOSE
Family history of breast cancer can increase woman's risk of having the disease two to threefold. Patients with familial breast cancer affect the younger at diagnosis and have higher frequency of bilateral disease than those with sporadic cases. We evaluated the characteristics of familial breast cancer(FBC) patients including hereditary breast cancer(HBC) and compared those to sporadic breast cancer(SBC). MATERIALS & METHODS: Of the 885 patients operated on for breast cancer from January 1991 to December 1995 in Seoul National University hospital, 18 patients(2.0%) were classified as familial breast cancer and 5 patients as hereditary breast cancer by definition.
RESULTS
The mean age of the patients was 45.7 years in FBC, 47.0 years in HBC and 46.8 years in SBC. The bilateral disease were more frequent in family history positive group(FBC; 22.2%, HBC; 60%) than SBC(1.5%) (p<0.01). In this series, there were no statistical differences in the age at onset, tumor location, histopathologic types and clinical stages amomg the different groups of the breast cancer, but bilateral cancer were seen more often in the familial history positive group than the other groups.
CONCLUSION
As the frequency of familial and hereditary breast cancer was relatively low compared to that seen in other western countries, it would be necessary for the physician to inquire the family history of pateints with the breast cancer more carefully.
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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.
AbstractAbstract 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.
AbstractAbstract 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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Clinical Analysis of Surgically Treated Primary Gastric Lymphoma
Choong Sik Kim, Nam Sun Paik, Nan Mo Moon, Jong Inn Lee, Dong Wook Choi, Dae Yong Hwang, Ho Yoon Bang, Woo Cheol Noh, Seon Mi Moon, Seung Sook Lee
J Korean Cancer Assoc. 1998;30(1):150-157.
AbstractAbstract PDF
PURPOSE
The incidence of primary gastric lymphoma is a relatively rare and is 2~5% of all gastric malignant lesion. Because of its rarity, there are few report in Korea. Therefore, to elucidste the clinicopathological characteristics and prognosis of primary gastric lymphoma and to investigate MALT(Mucosa-associated lymphoid tissue) lymphoma, we studied in primary gastric lymphoma. MATERIALS & METHODS: we evaluated retrospectively primary gastric lymphoma patients who underwent gastric resection from Jan. 1990 to Dec. 1994 in KCCH.
RESULTS
There were 20 patients with primary gastric lymphoma and the incidence is 0.54% of all gastric malignant lesion. Abdominal pain, primarily epigastric, was the most common presenting complaint and the most common location was the distal third of the stomach. The overall 5-year survival rate was 71%. Factor significantly influencing 5-year survival rate was the serosal invasion. Age, gender, tumor size, histologic grade, nodal status and Ann-Arbor staging system did not influence survival.
CONCLUSION
So,we suggest that the depth of invasion should be included in staging system of gastric lymphoma because Ann Arbor staging system might be inadequate when applied to primary gastric lymphoma. Also, we suggest that the multicenter study should be performed to elucidate the characteristics of Korean gastric lymphoma because of its low incidence.
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Primary Intestinal Lymphoma Treatment Results and prognostic Factors in 52 Cases
In Chul Hong, Chang Hak Yoo, Sung Hoon Noh, Chang Hwan Cho, Kyung Shik Lee
J Korean Cancer Assoc. 1998;30(1):158-168.
AbstractAbstract PDF
PURPOSE
In spite of many published reports about the primary gastrointcstinal lymphoma in Korea, the majority of them unfortunately involved a small number of patients with diverse results conceming treatment, patient survival, and prognostic factors. There also were few reports mainly focusing on primary intestinal lymphoma alone. Therefore we studied the patient-survival and prognostic factors in 52 cases of intestinal lymphomas.
MATERIALS AND METHODS
We reviewed fifty two patients who received treatment due to primary intestinal lymphoma at Severance hospital, from January 1980 to June 1995.
RESULTS
The intestinal lymphomas were located in descending order of frequency at the terminal ileum, i1eocecal region, right colon, and the jejunum. The most common histologic type was diffuse large cell type and the majority showed an intermediate grade of differentiation. The average survival time was 40.7 months with a 5 year survival rate of 41.4%. The overall and complete remission rate of the intestinal lymphoma were 76.2%, 64.3%, respectively. Additional chemotherapy or radiotherapy to surgery improved remission rate. The overall 5 year survival rates were 50.4%, 47.3%, 33.3%, and 25.0% in stage I, II1, II2 and III~IV, respectively. The 5 year survival rate after curative resection was 57.0% and 16.6% after incomplete resection. The significant prognostic factors were residual tumor, site of the lesion, multiplicity, and adjacent organ invasion. However, the site of the lesion alone (worst in the jejunum) was the sole independent variable on multivariate analysis.
CONCLUSION
We concluded that early diagnosis and curative resection were important to improve survival rates in the primary intestinal lymphoma. More number of such cases are needed for further comparison of various treatment methods and results.
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Treatment Result of Pediatric Osteosarcoma with Intraarterial Cisplatin
Hyoung Soo Choi, Hyoung Jin Kang, Jun Ah Lee, Hyo Heong Han, Hyeon Jin Park, Eun Sun Yoo, Woo Sun Kim, Hee Young Shin, In One Kim, Sang Hoon Lee, Hyo Seop Ahn, Han Koo Lee
J Korean Cancer Assoc. 1998;30(1):169-177.
AbstractAbstract PDF
PURPOSE
This study was performed to determine the outcome after treatment of osteosarcoma with intraarterial cisplatin as a preoperative chematherapy regimen.
MATERIALS AND METHODS
Twenty five patients with extremity osteosarcoma were treated with intraarterial cisplatin at Seoul National University Children's Hospital from January 1987 to April 1996. The dose of cisplatin was 130 mg/m2 and three to six courses were repeated two- to three-week intervals, Systemic doxorubicin was added to six of these patients. This was followed by surgical resection(limb salvage or amputation) and postoperative adjuvant chemotherapy.
RESULTS
Limb-salvage was possible in twenty of these twenty five patients. Pulmonary metastasis was present in five patients at diagnosis and developed later in three patients. In six patients treated with systemic doxorubicin, pulmonary metastasis was absent at diagnosis and during follow-up period. Local recurrence after limb salvage was occurred in one patient and treated with amputation and systemic chemotherapy. Seven patients died from pulmonary metastssis and one from unknown cause. The follow-up duration of these patients was three to eighty eight months(median twenty two months) and the overall five-year survival and event free survival rate were 62.1% and 57.5%, respectively.
CONCLUSION
These data demonstrate that intraarterial cisplatin can be used as an effective regimen preoperatively for pediatric patients with extremity osteosarcoma. The combined use of systemic doxorubicin is expected to improve survival in patients with pulmonary metastasis.
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The Effect of Pentoxifylline on Rat Spinal Cord Damage to Fractionated Irradiation
Won Dong Kim
J Korean Cancer Assoc. 1998;30(1):178-187.
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No abstract available.
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Restrospective Cohort Study of Survival and Prognostic Factors in Patients with Terminal Cancer
Young Ho Yun, Dae Seog Heo, Jong Myon Bae, Seock Ah Im, Tai Woo Yoo, Bong Yul Huh, Noe Kyeong Kim
J Korean Cancer Assoc. 1998;30(1):188-197.
AbstractAbstract PDF
PURPOSE
Cancer has become the major cause of deaths in Korea. Planning care for patients with terminal cancer is difficult. The prediction of length and prognostic factors of survival in the terminal cancer can facilitate the planning of a supportive care program aimed at patients' need. The aim of this study was to identify length and those related factor of survival in the patients with terminal cancer.
MATERIALS AND METHODS
This retrospective study was performed on 271 patients, who were diagnosed as terrninal cancer in Seoul National University Hospital from March 1991 to February 1996. For getting the further informations about the patient, we interviewed with surviving relatives by telephone, and we requested administrative helps in order to take the informations about date of death. We examined the relations of 10 factors with survival in pstients with terminal cancer.
RESULTS
We could confirm 229 patients death(84.5%) in 271 subjects. The median length of survival in patients with terminal cancer was 11 weeks(95%CI 10.0~14.0). By univariate analysis, history of surgery(p<0.01), performance(p<0.05), severity of pain(p<0.001), and dyspnes(p<0.05) were clinical factors in predicting survival. According to Cox's proportional hazard model including sex, age, history of surgery, performance, severity of pain, and dyspnea as variables, absence of surgery history(RR 1.398, 95%CI 1.038~1.882) and severity of pain(RR 1.398, 95%CI 1.044~1.872) showed independent prognostic value.
CONCLUSION
The median survival was 11 weeks, and absence of surgery history and severity of pain were the independent prognostic factors for patients with terminal cancer.
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Case Report
A Case of Acute Lymphocyic Leukemia with Bilarteral Breast Masses
Hun Sik Jeong, Hong Ghi Lee, Jong Tae Lee, Won Seng Kim, Sung Soo Yoon, Won Ki Kang, Keun Chil Park, Jeong Hyun Yang, Chan Hyung Park
J Korean Cancer Assoc. 1998;30(1):198-202.
AbstractAbstract PDF
We present a case of a 47-year-old female with acute lymphocytic leukemia with granulocytic sarcoma in her breasts. The presenting symptom was palpable bilateral breast masses. She underwent fine needle biopsy, and a diagnosis of granulocytic sarcoma was rendered. A bone marrow examination revealed acute lymphocytic leukemia. She received a course of induction chemotherapy with Daunorubicin, Vincristine, Prednisolone, and L-asparaginase.
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Cancer Res Treat : Cancer Research and Treatment
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