재발성 상피성 난소암 및 원발성 복막 암종증 환자에서의 Topotecan/Platinum 복합요법의 효용성과 독성

유항조 ( Hang Jo You ),김용만 ( Yong Man Kim ),이신화 ( Shin Wha Lee ),이정남 ( Jung Nam Lee ),김대연 ( Dae Yeon Kim ),서대식 ( Dae Shik Suh ),김종혁 ( Jong Hyeok Kim ),김영탁 ( Young Tak Kim ),남주현 ( Joo Hyun Nam ),목정은 ( Jun 대한산부인과학회 2008 Obstetrics & Gynecology Science Vol.51 No.1

목적: 이 연구의 목적은 camptothecin 유도체로서 DNA topoisomerase I 억제제인 topotecan을 platinum제제와 복합요법으로 사용하였을 때, 재발성 상피성 난소암과 원발성 복막 암종증 환자에서의 효용성과 독성을 평가하는 것이다. 연구방법: 2000년 1월부터 2007년 6월까지 서울아산병원에서 topotecan과 platinum의 복합 항암화학요법으로 치료받은 환자들을 대상으로 하였다. 51명의 재발성 상피성 난소암과 원발성 복막 암종증 환자가 있었으며 이들 각 환자들의 의무기록과 병리 및 진단 검사 보고서를 통하여 분석하였다. 치료에 대한 반응은 측정 가능한 재발성 종괴가 있는 경우에는 RECIST 기준을 적용하였고 측정 가능한 재발성 종괴가 없는 경우에는 CA-125 기준을 적용하였다. 부작용은 미국 NCI Common Toxicity Criteria version 3.0 기준에 따라 평가하였다. 결과: 환자군의 진단 당시 평균 나이는 53.4세였다. RECIST 기준으로 평가한 44명의 환자군에서 전체 반응률을 22.8% (10/44)이었으며, 6명에서 완전관해를 보이고 4명에서 부분관해를 나타냈다. Platinum 반응군에서는 26.9%, platinum 저항군에서는 16.7%의 반응률을 보였으나 통계적으로 유의하지는 않았고 (p=0.425), 반응기간과 진행까지의 기간을 볼 때 platinum 반응군에서 의미있게 길게 나타났다 (p=0.022, p=0.042). 이전에 3회 이상의 다른 항암화학요법을 시행 받은 환자군에서는 그렇지 않은 환자군과 치료반응에 있어 의미있는 차이를 보이지 않았다. 골수억제가 가장 흔한 부작용으로서, 전체 265회 시행한 항암화학요법에서 Grade 3/4의 호중구 감소증이 30.6%, 빈혈이 42.7%, 혈소판 감소증이 8.7%로 나타났으나 모두 회복 가능한 정도였고 그 이외의 부작용은 모두 경미하거나 회복 가능한 정도였다. 결론: Topotecan과 platinum의 복합요법은 platinum 제제를 기본으로 한 일차 항암화학요법 후 재발한 상피성 난소암과 원발성 복막 암종증 환자에서 치료 효과를 기대할 수 있을 것으로 생각된다. 향후 기존의 항암화학요법과의 효과를 비교하는 무작위 대조군 연구를 통한 치료 효과의 확인이 필요할 것이다. Objective: The aim of this study was to evaluate the efficacy and toxicity of topotecan, camptothecin analogue topoisomerase I inhibitor, as the combination therapy with platinum in patients with recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis. Method: In this study, patients who were treated with topotecan between January 2000 and June 2007 at Asan Medical Center, Seoul, Korea were reviewed. Fifty-one patients with recurrent ovarian carcinoma and peritoneal carcinomatosis were included. These patients` data were analyzed by review of medical records and pathologic and laboratory reports retrospectively. Response was assessed by Response Evaluation Criteria in Solid Tumors (RECIST) criteria for patients with measurable disease and CA-125 response criteria for patients with non-measurable disease. The toxicities were evaluated according to NCI CTC (Common Toxicity Criteria) version 3.0. Results: The mean age of patients was 53.4 years (ranged between 37 and 69). Forty-four patients had been evaluated by RECIST criteria. The overall response rate was 22.8% (10/44). Platinum-sensitive patients showed more favorable response rate (26.9%) than platinum-resistant patients (16.7%), however, it was not significant statistically (p=0.425). Platinum-sensitive group had significantly longer response duration (12.14 vs. 3.33 months, p=0.022) and time-to-progression (11.34 vs. 7.33 months, p=0.042) than platinum-resistant group. Heavily pretreated group, three or more prior regimens were used, had no significant differences from another group. The most common adverse effect of topotecan in combination with platinum was hematologic toxicity; grade 3/4 neutropenia was 30.6%, anemia was 42.7%, and thrombocytopenia was 8.37% in total 265 cycles of chemotherapy, however, it was tolerable. Conclusion: Topotecan in combination with platinum is considered as effective regimen with acceptable toxicity in treating recurrent epithelial ovarian carcinoma and primary peritoneal carcinomatosis who have failed previous treatment with platinum-containing chemotherapy.

Tumor diameter assessed by pretreatment MRI in the prediction of outcome for surgically treated invasive cervical cancer

유항조 ( Hang Jo Yoo ),( You Young Bae ),( Mi Kyung Kim ),( Dae Yeon Kim ),( Jong Hyeok Kim ),( Yong Man Kim ),( Young Tak Kim ),( Jung Eun Mok ),( Joo Hyun Nam ) 대한산부인과학회 2003 대한산부인과학회 학술대회 Vol.89 No.-

자궁경부에서 발생한 림프상피양 암종

김미령 ( Mi Lyoung Kim ),유항조 ( Hang Jo You ),윤은숙 ( Eun Suk Yoon ),심승혁 ( Sung Hyuk Sim ),구본상 ( Bon Sang Koo ),주원덕 ( Won Duk Joo ),차희정 ( Hee Jeong Cha ),이현우 ( Hyun Woo Lee ) 대한산부인과학회 2007 Obstetrics & Gynecology Science Vol.50 No.1

Lymphoepithelioma-like carcinoma (LELC) of the uterine cervix is a rare tumor with 0.7% of all primary cervical malignancies. It may grossly range from no visible cervical lesion to a large exophytic cervical mass and histologically similar neoplasms occur in the nasopharynx. It has been classified as a subtype of squamous cell carcinoma. But, after reviewing the literature, this tumor is a distinct carcinoma of the cervix that differs from squamous cell carcinoma. LELC is composed of undifferentiated cells surrounded by a marked inflammatory infiltrate, characterized by plasma cells and lymphocytes in the stroma. It may represent a better prognostic group than the more common squamous cell carcinoma of the cervix because of lack of lymph node metastasis. Typically affects a younger population of women, is more prevalent in noncaucasian population (especially, those of Asian descent). However, it is not clearly understood, Epstein-Barr virus play in the pathogenesis of cervical LELC while humam papilloma virus (HPV) is a risk factor for squamous cell carcinoma. The prognosis is good only by surgical treatment. Radiation therapy also appears to be effective in eradicating localized, low-stage disease (radiosensitive). The authors have experienced one case of LELC of the uterine cervix. We report a case with a brief review.

양수 주입술 후 산전 진단된 인어다리증

윤준 ( Jun Yoon ),윤은숙 ( Eun Sook Yoon ),김미령 ( Mi Ryung Kim ),구본상 ( Bon Sang Koo ),유항조 ( Hang Jo You ),김영민 ( Young Min Kim ),차희정 ( Hee Jeong Cha ),이현우 ( Hyun Woo Lee ) 대한산부인과학회 2005 Obstetrics & Gynecology Science Vol.48 No.2

Sirenomelia, also known as the mermaid syndrome, is a rare and usually lethal congenital malformation of uncertain etiology. It is characterized by fusion of the lower limbs and commonly associated with severe urogenital and gastrointestinal malformations

폐경기 여성에서 혈중 에스트라디올 농도 및 골밀도와 청력 기능과의 연관성

박은주 ( Eun Ju Park ),이동선 ( Dong Sun Lee ),김성훈 ( Sung Hoon Kim ),채희동 ( Hee Dong Chae ),김정훈 ( Chung Hoon Kim ),강병문 ( Byung Moon Kang ),전대준 ( Dae Joon Cheon ),박견 ( Kyun Park ),유항조 ( Hang Jo You ),음현진 ( Hy 대한산부인과학회 2001 Obstetrics & Gynecology Science Vol.44 No.7

N/A Objective: To clarify whether hearing sensitivity in postmenopausal women is associated with serum estradiol level or bone mineral density (BMD) Materials and Methods: From January 1999 to December 1999, serum concentration of estradiol, bone mineral densities of the lumbar vertebrae and femoral neck, and hearing sensitivity were measured in 1162 postmenopausal women. Serum concentration of estradiol was measured by radioimmunoassay. Dual energy X-ray absorptiometry (DEXA) was used to measure bone mineral densities of the lumbar vertebrae and femoral neck. Pure tone thresholds were evaluated by screening pure tone audiometry. All data were analyzed with Student`s t-test, multiple logistic regression analysis, and multiple linear regression analysis. Results: A total of 1155 patients were analyzed; 155 patients were in the hearing-loss group and 1000 patients were in the control group. On univariate analysis, significant differences were found in mean age, concentration of serum estradiol, and BMD of the fernoral neck between the two groups (mean±SD, 58.1±5.2 vs 56.0±4.3, 11.6±6.0 vs 13.1±12.0, 0.67±0.11 vs 0.70±0.11; p-value: 0.0001, 0.01, 0.02). On multiple logistic regression analysis and multiple linear regression analysis, significant association was found between age and hearing loss and between age and pure tone threshold (p-value: 0.0001, 0.0001, respectively). However, neither seum concentration of estradiol nor BMD was associated with hearing loss or pure tone threshold. Conclusion: This study suggests that hearing sensitivity in postmenopausal women is not directly associated with serum estradiol level or BMD.

배꼽을 통한 단일공 복강경하 자궁외 임신 수술

엄정민 ( Jeong Min Eom ),노현진 ( Hyun Jin Roh ),이수정 ( Soo Jeong Lee ),주원덕 ( Won Duk Joo ),이미영 ( Mi Young Lee ),유래미 ( Rae Mi You ),유항조 ( Hang Jo Yoo ) 대한산부인과학회 2010 Obstetrics & Gynecology Science Vol.53 No.8

목적: 본 연구는 배꼽을 통한 단일공 복강경하 자궁외 임신 수술의 방법, 유용성과 안전성을 평가하기 위함이다. 연구 방법: 2009년 10월부터 2010년 2월까지 울산대학교병원 산부인과에서 자궁외 임신으로 단일공 복강경 수술을 시행 받은 총 6명의 환자들의 의무기록지를 후향적 연구 방법으로 분석하였다. 결과: 환자의 나이의 중앙값은 33.5세 (범위, 32~36)였고 BMI의 중앙값은 20.6 kg/m2 (범위, 16.5~28.7)이었다. 자궁외 임신낭의 가장 큰 직경의 중앙값은 4.8 cm (범위, 3.0~5.4)이었고 모든 환자에서 임신낭 파열과 복강내 출혈을 보였다. 수술에 소요시간의 중앙값은 77.5분 (범위, 59~95)이었고, 수술 중 실혈량의 중앙값은 40 mL (범위, 20~50)이었다. 수술 후 재원 기간의 중앙값은 2일 (범위, 1~3)이었고, 재원기간과 마지막 추적 관찰 기간 동안에 합병증이 발생한 경우는 없었다. 결론: 배꼽을 통한 단일공 복강경하 자궁외 임신 수술은 자궁외 임신 치료에서 안전하고 유용하였고, 기존 다공법 복강경하 수술에 대안이 될 가능성이 있다. Objective: To evaluate the effectiveness of transumbilical single-port access laparoscopic surgery of ectopic pregnancy. Methods: Retrospective analysis was performed on six patients who underwent transumbilical single-port access laparoscopic management of ectopic pregnancies. Results: The median age of 6 cases was 33.5 years (range, 32 to 36), and the median body mass index was 20.6 kg/m2 (range, 16.5 to 28.7). The median largest diameter of G-sac was 4.8 cm (range, 3.0 to 5.4). Intracorporeal rupture and hemoperitoneum were accompanied in all cases. The median time needed for the surgery was 77.5 minutes (range, 59 to 95). The median estimated blood loss was 40 mL (range, 20 to 50). The median postoperative hospital day was 2 days (range, 1 to 3). There were no complications on postoperative course and follow-up. Conclusion: Transumbilical single-port access laparoscopic surgery for ectopic pregnancy was feasible and safe. This approach might be reasonable alternative to conventional laparoscopic surgery using 3 or 4 port in the management of ectopic pregnancy.

Endometrial stromal sarcoma의 임상병리학적 고찰

나성훈,김미경,김대연,유항조,김종혁,김용만,김영탁,목정은,남주현 대한부인종양 콜포스코피학회 2002 Journal of Gynecologic Oncology Vol.13 No.2