절제 가능한 위암에서의 수술 전후 치료법

박숙련,강윤구 대한의사협회 2015 대한의사협회지 Vol.58 No.3

Although surgical resection remains the only curative treatment for gastric cancer, locoregional and distant recurrence are still common after surgical resection with curative intent underscoring the importance of a multimodal approach. In recent decades, there have been notable improvements in multidisciplinary treatments for gastric cancer that influence clinical decision and treatment algorithms; these include surgery, chemotherapy, and radiotherapy. Notably, multimodal and multidisciplinary approaches to gastric cancer have developed in various ways according to geographical regions in the context of variations in disease incidence, etiology/epidemiology, clinical features, and treatment outcome. Differences in surgical techniques, curative resection rate, survival outcomes after curative resection, and relapse patterns between the East and West lead to different perioperative multidisciplinary strategies. In Western countries, low rates of curative resection and high rates of locoregional recurrence following suboptimal surgery, in addition to systemic spread after surgery, provide a rationale for perioperative chemotherapy (preoperative and postoperative chemotherapy) and postoperative chemoradiation. In contrast, Eastern countries have focused on reducing systemic failures by emphasizing postoperative chemotherapy after curative resection. To further improve perioperative treatment in localized gastric cancer, more sophisticated risk stratification and novel therapeutic strategies such as molecularly targeted agents need to be investigated, based on an understanding of the molecular pathogenesis of the disease.

Severe Imatinib-Associated Skin Rash in Gastrointestinal Stromal Tumor Patients: Management and Clinical Implications

박숙련,류민희,류백렬,백모율,이인순,최미정,이미우,강윤구 대한암학회 2016 Cancer Research and Treatment Vol.48 No.1

Purpose This study evaluated the incidence of imatinib-associated skin rash, the interventional out- comes of severe rash, and impact of severe rash on the outcomes of imatinib treatment in gastrointestinal stromal tumor (GIST) patients. Materials and Methods A total of 620 patients were administered adjuvant or palliative imatinib for GIST at Asan Medical Center between January 2000 and July 2012. This analysis focused on a group of 42 patients who developed a severe rash requiring major interventions, defined as dose interruption or reduction of imatinib or systemic steroid use. Results Of the 620 patients treated with imatinib, 148 patients (23.9%) developed an imatinib- associated skin rash; 42 patients (6.8%) developed a severe rash requiring major interven- tion. Of these, 28 patients (66.8%) successfully continued imatinib with interventions. Serial blood eosinophil levels during imatinib treatment were associated with skin rash and sever- ity. A significant association was observed between successful intervention and blood eosinophil level at the time of intervention initiation. In metastatic settings, patients with severe rash requiring major interventions tended to show poorer progression-free survival than patients who did not require major intervention and patients with no rash, although this finding was not statistically significant (p=0.326). Conclusion By aggressive treatment of severe rash through modification of imatinib dose or use of sys- temic steroid, the majority of patients can continue on imatinib. In particular, imatinib dose intensity can be maintained with use of systemic steroid. Measuring the blood eosinophil levels may be helpful in guiding the management plan for skin rash regarding the intensity and duration of interventions.

구연 : 혈액종양 ; 단일기관에서의 VPD(L) 관해유도요법을 이용한 성인 급성 림프구성 백혈병 환자의 치료성적

박숙련,김지현,김도연,이세훈,윤성수,박선양,김병국,김노경 대한내과학회 2001 대한내과학회 추계학술대회 Vol.61 No.-

Anthracycline-based chemotherapy in anaplastic Large cell Lymphoma

박숙련,백지연,김상일,최인실,김동완,김태유,윤성수,허대석,방영주,박선양,김병국,김노경 대한내과학회 2003 대한내과학회 추계학술대회 Vol.65 No.10

진행성 위암에서 Genexol(R)(paclitaxel)/cisplatin 복합요법의 다기관 2상 임상연구

박숙련,오도연,김동완,임석아,김태유,허대석,방영주,김노경,강원기,김홍태,서재홍,김학균,김훈교 대한내과학회 2004 대한내과학회 추계학술대회 Vol.2004 No.1

위암에서의 수술 전 선행항암화학요법(in the View of Pros)

박숙련,Park, Sook Ryun 대한위암학회 2008 대한위암학회지 Vol.8 No.2

현재 국소 위암에서 유일한 완치적 치료법은 수술적 절제이나 적절한 수술적 치료에도 불구하고 상당 수의 환자들이 재발을 경험한다. 이에 다학제적 병용 치료 전략에 대해 많은 관심이 있어왔고 특히 최근에는 암의 병기 감소, 근치적 절제률의 증가, 미세 원격전이의 조기 치료 등의 가능성을 가지는 수술 전 선행항암화학요법에 대한 관심이 증대되고 있다. 최근의 3상 임상 연구인 MAGIC trial은 수술 전후 항암화학요법이, 수술 단독에 비해, 병리학적 병기를 감소시키며 국소 재발과 원격 전이를 감소시켜 생존율을 향상시킴을 보고하였고 또 다른 3상 연구인 FNLCC 94012/FFCD 9703 trial 역시, 수술 전후 항암화학요법이 근치적 절제율과 생존율을 향상시킴을 보고하였다. 두 연구는 수술 전후 항암화학요법에 대한 것이지만 수술 후 보조항암화학요법의 불량한 치료 순응도에 비추어 볼 때 치료성적의 향상은 주로 수술 전 선행항암화학요법에 기인하는 것으로 생각된다. 상기 연구들이 이루어진 서양과 달리 광범위(D2) 림프절 절제술을 표준적 치료로 시행하고 있는 한국의 현실에서 이들 연구결과를 그대로 적용하기에는 어려움이 있으나 한국에서 이루어진, 국소 진행성 위암 환자를 대상으로 한 몇 가지 임상 연구 역시 선행항암화학요법을 통한 근치적 절제률의 증가 및 병기 감소 효과를 시사하였다. 이러한 고무적인 치료 성적에 근거하여 향후 수술 전 또는 수술 전후 항암화학요법이 국소 위암에서 표준적인 치료 전략으로 자리잡을 수 있을 지 결론을 짓기 위해서는 대규모 임상 연구가 시행되어야 할 것이다. In gastric cancer, the only potentially curative treatment is surgery that attempts to achieve curative (R0) resection. However, despite the use of curative resection, a recurrence develops in a high percentage of patients, especially in cases of serosa and/or lymph node involvement. As a strategy to improve the survival of the patients with resectable advanced gastric cancer, neoadjuvant chemotherapy has been evaluated in several phase II trials and a few phase III trials. The results of these trials have confirmed the feasibility and safety of this approach with no apparent increase in surgical complications. Recently, the findings of a large phase III randomized trial (MAGIC trial) have indicated that compared to the use of surgery alone, perioperative chemotherapy, using both a neoadjuvant and adjuvant strategy, decreased the number of T and N stage cancers and improved survival. The results of another recent phase III trial (FNLCC 94012/FFCD 9703) also showed that compared to the use of surgery alone, perioperative chemotherapy improved the R0 resection rate and survival. In both trials, the improved outcomes may be attributed to the use of neoadjuvant chemotherapy because of poor compliance with adjuvant chemotherapy. These results cannot be directly translated to clinical practice in Korea due to differences in surgical techniques and outcomes. However, the findings of a few small phase II and III trials performed in patients with locally advanced gastric cancer in Korea have also suggested that neoadjuvant chemotherapy would result in the improvement of the R0 resection rate and down-staging of the disease. More effective chemotherapy regimens are needed in future large randomized trials to determine the subset of patients that will benefit from neoadjuvant chemotherapy and to determine the extent of benefit.

Primary Systemic Anaplastic Large Cell Lymphoma in a Single Korean Institution: Clinical Characteristics and Treatment Outcome

박숙련,백지연,김동완,임석아,김태유,방영주,김노경,전윤경,김철우,허대석 대한의학회 2006 Journal of Korean medical science Vol.21 No.4

Despite advances in the characterization of anaplastic large cell lymphoma (ALCL), little data is available on Asian patients. We report here upon single Korean institu-tion’s experience regarding the clinical characteristics and outcomes of ALCL. We performed a retrospective study of 32 adults with ALCL. Most of the patients received anthracycline-based chemotherapy. Ann Arbor stage III-IV, B symptoms, high-inter-mediate/ high International Prognostic Index (IPI), and extranodal disease at diagno-sis were present in 56%, 44%, 41%, and 63%, respectively. Compared with Western studies, the male/female ratio (4.3) was markedly higher and skin (9%) and bone involvement (9%) were less frequent. The staining results for anaplastic lymphoma kinase were positive in 6 (33%) of 18 cases available. The complete response (CR) rate was 62% (95% CI, 44-80%). With a median follow-up of 51.0 months, 5 yr overall survival was 40 ±11%. The 3 yr relapse-free survival for the 18 patients who achieved CR was 74 ±12%. Age, performance status, lactate dehydrogenase, extranodal disease sites number, and IPI were correlated with treatment response and survival. Our data suggest that Korean ALCL patients appear to have a higher male/female ratio, less frequent skin/bone involvement, and lower CR rate compared with those of Western studies.

위암에서의 수술 전 선행항암화학요법(in the View of Pros)

박숙련 대한위암학회 2008 Journal of gastric cancer Vol.8 No.2

현재 국소 위암에서 유일한 완치적 치료법은 수술적 절제 이나 적절한 수술적 치료에도 불구하고 상당 수의 환자들 이 재발을 경험한다. 이에 다학제적 병용 치료 전략에 대 해 많은 관심이 있어왔고 특히 최근에는 암의 병기 감소, 근치적 절제률의 증가, 미세 원격전이의 조기 치료 등의 가능성을 가지는 수술 전 선행항암화학요법에 대한 관심 이 증대되고 있다. 최근의 3상 임상 연구인 MAGIC trial은 수술 전후 항암화학요법이, 수술 단독에 비해, 병리학적 병기를 감소시키며 국소 재발과 원격 전이를 감소시켜 생 존율을 향상시킴을 보고하였고 또 다른 3상 연구인 FNLCC 94012/FFCD 9703 trial 역시, 수술 전후 항암화학요법이 근치 적 절제율과 생존율을 향상시킴을 보고하였다. 두 연구는 수술 전후 항암화학요법에 대한 것이지만 수술 후 보조항 암화학요법의 불량한 치료 순응도에 비추어 볼 때 치료 성적의 향상은 주로 수술 전 선행항암화학요법에 기인하 는 것으로 생각된다. 상기 연구들이 이루어진 서양과 달리 광범위(D2) 림프절 절제술을 표준적 치료로 시행하고 있는 한국의 현실에서 이들 연구결과를 그대로 적용하기에는 어려움이 있으나 한국에서 이루어진, 국소 진행성 위암 환 자를 대상으로 한 몇 가지 임상 연구 역시 선행항암화학 요법을 통한 근치적 절제률의 증가 및 병기 감소 효과를 시사하였다. 이러한 고무적인 치료 성적에 근거하여 향후 수술 전 또는 수술 전후 항암화학요법이 국소 위암에서 표준적인 치료 전략으로 자리잡을 수 있을 지 결론을 짓 기 위해서는 대규모 임상 연구가 시행되어야 할 것이다.

구연 : 혈액종양 ; 성인 만성 특발성 혈소판 감소증에서 비장절제술의 장기 성적

박숙련,백지연,김상일,최인실,오도연,윤성수,이종석,박선양,김병국,김노경 대한내과학회 2003 대한내과학회 추계학술대회 Vol.65 No.10

구연 : 혈액종양 ; DNA microarray를 이용한 급성백혈병의 분류와 예후 예측

박숙련,윤성수,박선양,김병국,김노경,박한수,서정선,공현중,김희찬,김호 대한내과학회 2002 대한내과학회 추계학술대회 Vol.63 No.-