Outcomes of Salvage Therapy for Oropharyngeal Cancer Recurrence Following Upfront Radiation Therapy and Prognostic Factors

최나연,김학정,이희준,김희정,김태환,정한신,손영익,백정환,오동렬,안용찬,정만기 대한암학회 2023 Cancer Research and Treatment Vol.55 No.4

Purpose This study aimed to investigate the oncologic outcomes and prognostic factors of salvage treatments in patients with recurrent oropharyngeal squamous cell carcinoma (OPSCC) after radiotherapy (RT)-based treatment. Materials and Methods A cancer registry was used to retrieve the records of 337 patients treated with definitive RT or concurrent chemoradiotherapy (CRT) from 2008 to 2018 at a single institution. The poor-responder group (PRG) was defined as patients with residual or recurrent disease after primary treatment, and the oncologic outcomes for each salvage treatment method were analyzed. In addition, prognostic indicators of recurrence-free survival (RFS) and overall survival (OS) were identified in patients who underwent salvage treatment. Results After initial (C)RT, the PRG comprised 71 of the 337 patients (21.1%): 18 patients had residual disease, and 53 had recurrence after primary treatment (mean time to recurrence 19.5 months). Of these, 63 patients received salvage treatment (surgery 57.2%, re-(C)RT 23.8%, and chemotherapy 19.0%), and the salvage success rate was 47.6% at the last follow-up. The overall 2-year OS for salvage treatments was 56.4% (60.8% for the salvage surgery group and 46.2% for the salvage re-(C)RT). Salvage surgery patients with negative resection margins had better oncologic outcomes than those with close/positive resection margins. Using multivariate analyses, locoregional recurrence and residual disease after primary surgery were associated with poor outcome after salvage treatment. In Kaplan-Meier analyses, p16 status was significantly associated with OS in the initial treatment setting but not in the salvage setting. Conclusion In recurrent OPSCC after RT-based treatment, successful salvage was achieved in 56.4% patients who had undergone salvage surgery and radiation treatment. Salvage treatment methods should be selected carefully, given recurrence site as a prognostic factor for RFS.

Complex Partial Seizure as a Presentation of Lemierre’s Syndrome

최나연,정유진,이길준 대한이비인후과학회 부산,울산,경남 지부회 2019 임상이비인후과 Vol.30 No.1

Lemierre’s syndrome is difficult to treat with early suspicion because of its various clinical presentations. We demonstrated unusual presentation of Lemierre’s syndrome as a complex partial seizure. A 17 year-old female had aggravated symptoms of upper respiratory infection for 2 weeks followed by complex partial seizure during one hour. Laboratory test revealed acute inflammatory state and radiologic images including computed tomography and angiography demonstrated right lateral neck inflammation with internal jugular vein occlusion. She underwent debridement of inflammatory tissue and ligation of internal jugular vein under diagnosis of Lemierre’s syndrome. Because of progression of thrombosis of distal internal jugular vein, she had anticoagulation therapy for 3 months. After that, she followed-up without any discomfort. Lemierre’s syndrome could be successfully managed by combined surgical and medical treatment. Proper treatment with early suspicion is crucial because it could present various clinical features and cause serious complications.

A Case of Isolated Complete Oculomotor Nerve Palsy Following Endoscopic Sinus Surgery

최나연,홍상덕,조현진,박경아 대한비과학회 2014 Journal of rhinology Vol.21 No.2

Orbital complications after endoscopic sinus surgery (ESS), such as optic nerve or medial rectus injuries, arewell known, but isolated complete oculomotor nerve palsy has never been reported. In this case, a 31-year-oldmale was transferred to our hospital after ESS. Physical examination showed complete left oculomotor nervepalsy, with a bony defect on the sellar floor, which had not fully recovered after more than 1 year. We hypoth-esized that blunt trauma could be the main cause of the oculomotor palsy. Surgeons performing ESS must keepin mind the possibility of oculomotor palsy due to blunt trauma, especially when operating around the sphenoidand posterior ethmoid sinus

비전정에서 발생한 각화극세포종 1례

최나연,정승규,동헌종,김효열 대한비과학회 2013 Journal of rhinology Vol.20 No.2

Keratoacanthoma is the epidermal tumor characterized by the benign course such as rapid growth and spontaneous resolution. Rarely keratoacanthoma invades adjacent structures. Therefore, controversies have arisen about the biologic behavior whether keratoacanthoma is a benign tumor or a variant of low grade cutaneous squamous cell carcinoma. We report a case of the recurred keratoacanthoma at the nasal vestibule treated with the surgical excision and the reconstruction by local bilobed rotation flap in a 54-year old female whose final pathology was confirmed as well differentiated squamous cell carcinoma. Keratoacanthoma is the epidermal tumor characterized by the benign course such as rapid growth and spontaneous resolution. Rarely keratoacanthoma invades adjacent structures. Therefore, controversies have arisen about the biologic behavior whether keratoacanthoma is a benign tumor or a variant of low grade cutaneous squamous cell carcinoma. We report a case of the recurred keratoacanthoma at the nasal vestibule treated with the surgical excision and the reconstruction by local bilobed rotation flap in a 54-year old female whose final pathology was confirmed as well differentiated squamous cell carcinoma.

성대 용종의 예후 인자와 음성 위생법 치료 효과 분석

최나연,김동규,이길준 대한후두음성언어의학회 2021 대한후두음성언어의학회지 Vol.32 No.1

Background and Objectives s Vocal polyp is one of the most common benign diseases of vocal fold caused by overuse of voice. Laryngeal microsurgery is the first treatment of choice for vocal polyp. However, surgery has many risks such as side effects of general anesthesia, injury of tooth and psychological burden. And we often experience reduction of vocal polyps without surgical procedure. The purpose of study is to evaluate the effect of non-surgical treatment such as vocal hygiene education and proton pump inhibitor (PPI) in patients with vocal polyp. Materials and Method We performed retrospective study for seventy-three patients of vocal polyp who treated with non-surgical modalities such as vocal hygiene education and PPI over three months. Treatment outcomes and risk factors such as age, sex, polyp size, position, symptom duration, presence of laryngopharyngeal reflux (LPR) symptoms, smoking history, voice abuse history and vocal hygiene education were evaluated by comparison between polyp size improved group and non-improved group. Results 5.5% of enrolled patients showed complete response and 23.3% showed partial response without surgery. Polyp size improved group significantly carried out more practice of vocal hygiene education treatment than the non-improved group (p=0.040). And the presence of LPR symptoms [hazard ratio (HR) 3.368, confidence interval (CI) 1.055–10.754, p=0.040] and not performing of vocal hygiene education (HR 3.664, 95% CI 1.078–12.468, p=0.038). Conclusion Vocal hygiene education can be a useful treatment option when making a decision to treat with vocal polyp.

다양한 후두 질환에서의 보툴리늄 독소 주입술

최나연,손영익 대한이비인후과학회 부산,울산,경남 지부회 2016 임상이비인후과 Vol.27 No.2

한국복지패널 자료를 이용한 아동기 공격성에 대한 경시적 자료 분석

최나연,허집,Choi, Nayeon,Huh, Jib 한국데이터정보과학회 2014 한국데이터정보과학회지 Vol.25 No.6

한국 학생들의 아동기 혹은 청소년기의 공격성에 대한 연구들은 대부분 횡단자료를 이용한 것들이다. 경시적 자료를 이용한 연구가 있지만, 반복측정된 자료들이 서로 독립이라는 가정 하에 연구되었다. 본 연구에서는 2006년부터 2012년까지 세 차례 반복측정에 의해 얻어진 한국복지패널 자료를 이용하여, 횡단자료 분석 연구의 결과인 아동 혹은 청소년의 공격성에 영향을 미치는 요인들로 알려진 학교 적응, 자아존중감, 우울 및 불안, 비행, 학교 폭력 피해 경험, 부모로부터 학대 경험과 인터넷 사용시간이 경시적 자료 분석에서도 공격성에 영향을 주는 지를 분석하고자 한다. 한국복지패널 자료의 결측치는 임의결측을 가정하고, 제한적 최우추정량을 이용한 선형혼합모형을 적합하고자 한다. Most of literatures on Korean child aggression are based on using the cross-sectional data sets. Although there is a related study with a longitudinal data set, it is assumed that the data sets measured repeatedly in the longitudinal data are mutually independent. A longitudinal data analysis for Korean child aggression is then necessary. This study is to analyze the effect of child development outcomes including academic achievement, self-esteem, depression anxiety, delinquency, victimization by peers, abuse by parents and internet using time on child aggression with Korea Welfare Panel Study data observed three times between 2006 and 2012. Since Korea Welfare Panel Study data have missing values, the missing at random is assumed. The linear mixed effect model and the restricted maximum likelihood estimation are considered.

Comparison of Endoscopic Tympanoplasty to Microscopic Tympanoplasty

최나연,노양섭,박우리,이정주,욱선현,최지은,정원호,조양선,홍성화,문일준 대한이비인후과학회 2017 Clinical and Experimental Otorhinolaryngology Vol.10 No.1

Objectives. This study aimed to compare the outcome of endoscopic and microscopic tympanoplasty. Methods. This was a retrospective comparative study of 73 patients (35 males and 38 females) who underwent type I tympanoplasty at Samsung Medical Center from April to December 2014. The subjects were classified into two groups; endoscopic tympanoplasty (ET, n=25), microscopic tympanoplasty (MT, n=48). Demographic data, perforation size of tympanic membrane at preoperative state, pure tone audiometric results preoperatively and 3 months postoperatively, operation time, sequential postoperative pain scale (NRS-11), and graft success rate were evaluated. Results. The perforation size of the tympanic membrane in ET and MT group was 25.3%±11.7% and 20.1%±11.9%, respectively (P=0.074). Mean operation time of MT (88.9±28.5 minutes) was longer than that of the ET (68.2±22.1 minutes) with a statistical significance (P=0.002). External auditory canal (EAC) width was shorter in the ET group than in the MT group (P=0.011). However, EAC widening was not necessary in the ET group and was performed in 33.3% of patients in the MT group. Graft success rate in the ET and MT group were 100% and 95.8%, respectively; the values were not significantly different (P=0.304). Pre- and postoperative audiometric results including bone and air conduction thresholds and air-bone gap were not significantly different between the groups. In all groups, the postoperative air-bone gap was significantly improved compared to the preoperative air-bone gap. Immediate postoperative pain was similar between the groups. However, pain of 1 day after surgery was significantly less in the ET group. Conclusion. With endoscopic system, minimal invasive tympanoplasty can be possible with similar graft success rate and less pain.

국내 한의학 학술지에 게재된 망막과 시신경질환 관련 논문들의 경향성 분석

최나연,서형식,김태권,권강 대한한방안이비인후피부과학회 2023 한방안이비인후피부과학회지 Vol.36 No.2

Objectives : This study was designed to examine and analyze the recent trend of Korean medicine research on retinal and optic nerve diseases, which is increasing. Methods : This study examines papers related to diseases occurring in the retina and optic nerve that were published in Korean journals of Korean medicine, and analyzes the results of research so far by classifying them by year, journal, disease type and type of paper. Results : 1. Since it was first published in 1995, a total of 17 articles have been published until 2018, with 2 articles(11.1%) each in 1997, 2014 and 2018, and 1 article(5.6%) each in other years. 2. The number of searched journals was 17 paper; 4 review articles, 1 original articles, 12 case reports. 3. Distribution of journals; the percentage of Journal of Korean Medicine Ophthalmology and Otolaryngology and Dermatology ranked the highest(41.2%). 4. Classification of 12 case reports into three categories; 7 retinal diseases, 3 optic nerve diseases, 2 other diseases. Conclusions : Currently, researches on retinal and optic nerve involvement in the Korean medicine journals have been conducted mainly through case reports. In the future, more clinical research and case reports are necessary to give practical application to patients. .

Analysis of Failure Causes of Open Airway Reconstruction in Children With Combined Subglottic and Posterior Glottic Stenosis

최나연,최재혁,박주현,허유진,김희정,정만기,정한신,백정환,손영익 대한이비인후과학회 2022 대한이비인후과학회지 두경부외과학 Vol.65 No.7

Background and Objectives Airway reconstruction surgery in children is still challenging,especially in cases of combined subglottic and posterior glottic stenosis (PGS). The aimof this study was to review the underlying reasons of failure in open airway reconstructionsurgeries performed for children with combined subglottic and PGS. Subjects and Method We reviewed medical records of seven children who received morethan two open airway reconstruction surgeries to finally achieve and maintain decannulationstatus for more than one year. Twenty-two reconstructive surgeries were performed and theyconsisted of 19 laryngotracheal reconstruction (LTR), 2 cricotracheal resection with end-toendanastomosis (CTR) and one extended CTR. For each patient, the following potentialcauses of failure were evaluated; preoperative evaluation (PE), type of reconstruction (TR),single vs. double staging (SDS), type of stent (TS), and perioperative optimization (PO). Results The median age of patients at the time of surgery was 32 months (range, 4-64months). Successful decannulation was achieved after the median open surgery of three (range,2-5 times for each patient). Recognized causes of failure were as follows: 8 insufficient PE,10 inadequate TR, 3 improper SDS, 8 ill-chosen TS, and 2 inappropriate PO. Conclusion PE of dynamic airway is important, especially vocal fold mobility and tracheomalacia. Types of reconstruction should be carefully decided after full consideration of potentialcauses of failure, and adequate laryngotracheal stent is essential.