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흡입 기관지 확장제의 기도반응 판정을 위한 폐기능 검사 지표에 관한 연구
김주옥(Ju Ock Kim),심영수(Young Soo Shim),한성구(Sung Koo Han),김건열(Keun Youl Kim),한용철(Yong Chol Han),김선영(Sun Young Kim) 대한내과학회 1987 대한내과학회지 Vol.33 No.5
N/A Bronchodilator inhalation test is a useful method to detect the bronchial hyperreactivity and many kinds of pulmonary function parameters have been used to quantify this change of post-bronchodilator inhalation. Although FEV1.0 has long been used most commonly for this purpose, there become available more various kinds of pulmonary function parameters, recently, such as FVC time, MEF50, MEF75, airway resistance etc for the evaluation of these ventilatory function. Hewlett-Packard computer pulmonary calculation system (HP 47804A) provide 18 parameters of pulmonary ventilatory function and we have evaluated the relation between FEV1.0 and other available 17 parameters of HP 47804A system for the evaluation of bronchodilator response. 190 subjects who have shown positive bronchodilator test (15% increase of FEV1.0 after inhalation of fenoterol) were collected for the study and obtained the following results. 1) All of the parameters showed significant change after bronchodilator inhalation, however, the magnitude of change are more significant in order of following parameters: FEV2.0, FEV1.0, FEV3.0, FVC time, FVC, PF, FEF0.2-1.2, FEF25-75, MEF50, and FEV0.5. 2) In pre-bronchodilator test, FEV1.0 is more closely correlated with FEV2.0 (r=0.986), FEV3.0 (r=0.967), FEF0.2-1.2 (r=0.930), and FEF25-75 (r=0.91). 3) In post-bronchodilator test, FEV1.0 is mare closely correlated with FVC time (r=0.987) and FEV2.0 (r=0.987), and subsequent orders are as follows: FEV0.5 (r=0.977), FEV3.0 (r=0.964), FEF0.2-1.2 (r=0.954), FEF25-75 (r=0.917), MEF50 (r=0.908), and FVC (r=0.818). 4) Regression equations between FEV1.0 and various other parameters are expressed in pre- and post-bronchodilator inhalation test.
폐암에서 5-aminolevulinic acid를 이용한 광역동내시경의 유용성
김주옥 ( Ju Ock Kim ) 대한내과학회 2009 대한내과학회지 Vol.77 No.5
Lung cancer remains the leading cause of cancer death despite 50 years of antismoking efforts and advances in treatment. Overall, the 5-year survival remains disappointing at 15%. The majority of lung cancers are inoperable at presentation, thereby limiting treatment options and the potential to cure. The best prognosis for lung cancer is expected when the diagnosis is made at an early stage of the disease. At present, the best way to diagnose lung cancer is a combination of three different screening tools: low-dose computed tomography (CT), sputum analyses, and fluorescence bronchoscopy. The tumor marking ability of 5-aminolevulinic acid (5-ALA) has been demonstrated. Inhalation of 5-ALA has been used to detect early lung cancer and is safe and reliable. The data of Yoon et al. in this issue describe the usefulness of photodynamic diagnosis with ALA inhalation. (Korean J Med 77:?-?, 2009)
김주옥 ( Ju Ock Kim ) 대한결핵 및 호흡기학회 2006 Tuberculosis and Respiratory Diseases Vol.61 No.3
기존의 폐암 발생의 고위험군(나이. 흡연력, FEV1, 가족력, 직업적 발암물질의 노출력, 기존의 폐암 및 두경부 종양)에 대한 저선량 나선식 CT와 기관지 내시경 검사로 선별 검사 시 폐암의 유병률은 높아야 2%내외이고 대부분 그보다 낮은 것으로 알려져 있다. 특이도는 49-90%, 양성예측률은 10%이하로 선별검사 시 불필요한 검사를 초래하고 그에 따른 이환률과 사망률을 증가시키며 비용적인 문제를 야기하는 것으로 알려져 있다. 이에 기존의 고위험군에 대해 대상 환자를 더욱 더 좁힐 필요가 있으며, 이는 실제 임상적으로 이용 가능한 생물학적 표지자의 개발의 필요성이 있다고 하겠다. 그러나 현재까지 알려진 폐암조기검진에 대한 각종 진단 수기 중애서 상기의 3가지 방법(저선량 MDCT, 자가형광기관지경 및 객담내 MAGE)을 한꺼번에 시 행하는 program은 비용적인 문제는 있지만 시도해 볼 만한 방법이라고 생각된다.
Once vs. Twice Daily Thoracic Irradiation in Limited Stage Small Cell Lung Cancer
김준상(Jun Sang Kim),김재성(Jae Sung Kim),김주옥(Ju Ock Kim),김선영(Sun Young Kim),조문준(Moon June Cho) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.3
목 적 : 국한성 병기 소세포폐암으로 복합 화학요법과 방사선치료를 받은 환자들에서 통상적 방사선치료와 다분할 방사선치료 간의 종양 관해율, 생존율, 재발율 및 부작용에 대해 비교 분석하고자 하였다. 대상 및 방법 : 1989년 11월부터 1996년 12월까지 충남대학교 병원 치료방사선과에서 국한성 병기 소세포폐암으로 치료받았던 78명 환자 중 고식적 방사선치료 및 재발성 병변으로 치료받았던 10명을 제외한 68명을 대상으로 후향성 분석을 하였다. 대상환자 중 통상적 방사선치료군 (A군)은 26명, 다분할 방사선치료군 (B군)은 42명 이었다. 전체 환자의 연령, 성별 및 ECOG 활동지수는 각각 32-75세 (중앙값 58세), 남자 58명 여자 10명, ECOG 0-1이 58명 2 이상이 10명이었으며 두군 간에 유사한 분포를 보였다. 방사선치료로서 A군은 총 조사선량 5040-6940 cGy(중앙값 5040 cGy), 180 cGy/fx 로 치료하였고 B군은 총 조사선량 4320-5100 cGy (중앙값 4560 cGy)으로 29명 (69%)은 120 cGy/fx 로, 13명 (31%)은 150 cGy/fx 로 1일 2회 조사하였다. 화학요법은 전체 68명 중 65명에서 VPP (cisplatin 60 mg/m2, etoposide 100 mg/m2) 요법과 CAV (cytoxan 1000 mg/m2, adriamycin 40 mg/m2 , vincristine 1 mg/m2) 요법을 교대로 시행하였으며, 화학요법 횟수는 A군 3-10회 (중앙값 6회), B군은 1-11회 (중앙값 6회) 시행하였다. 화학요법 시기는 A군에서 23명이 연속 화학요법을, B군에서는 39명이 동시 화학요법을 시행하였다. 예방적 전뇌조사는 두군 모두에서 완전관해 후 시행하였는데 A군 8명, B군 16명에서 조사선량 2500 cGy/10fx 로 조사하였다. 추적기간은 2-99개월 (중앙값 14개월)였다. 결 과 : 종양 관해는 완전관해율, 부분관해율이 각각 A군 35% (9/26), 54% (14/26), B군 43%(18/42), 55% (23/42)(p=0.119) 였다. 중앙생존기간 및 2년 생존율은 전체환자에서 15개월, 26.8%였고, A군 17개월, 26.9%, B군 15개월, 28% (p=0.51)였다. 전체환자 중 완전관해 및 부분 관해 환자의 2년 생존율은 각각, 35% 와 24.2% (p=0.06)였다. 실패양상으로 두 군간에 국소재발 및 원격전이의 통계적인 차이는 없었다 (p=0.125, 0.335). 방사선치료중 발생한 급성합병증으로 RTOG criteria상 중등도 이상의 식도염 및 백혈구 감소가 B 군에서 더 높게 나타났다(p=0.028, 0.003). 결 론 : 국한성 병기 소세포폐암의 복합 화학요법과 방사선치료시 종양의 부분관해 이상의 반응율이 연속화학요법을 받은 통상적 방사선 치료군과 동시화학요법을 받은 다분할 방사선 치료군 모두에서 높게 나타났다. 그러나 두 군간의 생존율에는 통계적인 차이를 보이지 않았다. 급성합병증으로서 식도염과 백혈구 감소가 동시화학요법을 받은 다분할 방사선치료군에서 더 높게났지만, 국한성 병기 소세포폐암에서 동시화학요법과 다분할 방사선치료가 적절한 치료의 한 방법이 될수 있을 것으로 사료된다. 그러나 국한성 병기 소세포폐암에서 다분할 방사선치료의 장점을 밝히기 위하여 좀더 많은 대상환자와 추적관찰이 필요할 것으로 사료된다. Purpose : A retrospective study was conducted comparing single daily fraction (SDF) thoracic radiotherapy (TRT) with twice daily (BID) TRT to determine the potential benefit of BID TRT in limited-stage small cell lung cancer (SCLC). Endpoints of the study were response, survival, pattern of failure, and acute toxicity. Materials and Methods : Between November 1989 to December 1996, 78 patients with histologically proven limited-stage SCLC were treated at the Department of Therapeutic Radiology, Chungnam National University Hospital. Of these, 9 were irradiated for palliative intent, and 1 had recurrent disease. Remaining 68 patients were enrolled in this study. There were 26 patients with a median age of 58 years, and 22 (85%) ECOG performance score of less than 1 in SDF TRT. There were 42 patients with a median age of 57 years, and 36 (86%) ECOG performance score of less than 1 in BID TRT. By radiation fractionation regimen, there were 26 in SDF TRT and 42 in BID TRT. SDF TRT consisted of 180 cGy, 5 days a week. BID TRT consisted of 150 cGy BID, 5 days a week in 13 of 42 and 120 cGy BID, in 29 of 42. And the twice daily fractions were separated by at least 4 hours. Total radiotherapy doses were between 5040 and 6940 cGy (median, 5040 cGy) in SDF TRT and was between 4320 and 5100 cGy (median, 4560 cGy) in BID TRT. Prophylactic cranial irradiation (PCI) was recommended for patients who achieved a CR. The recommended PCI dose was 2500 cGy/10 fractions. Chemotherapy consisted of CAV (cytoxan 1000 mg/m2, adriamycin 40 mg/m2, vincristine 1 mg/m2) alternating with VPP (cisplatin 60 mg/m2, etoposide 100 mg/m2) every 3 weeks in 25 (96%) of SDF TRT and in 40 (95%) of BID TRT. Median cycle of chemotherapy was six in both group. Timing for chemotherapy was sequential in 23 of SDF TRT and in 3 BID TRT, and concurrent in 3 of SDF TRT and in 39 of BID TRT. Follow -up ranged from 2 to 99 months (median, 14 months) in both groups. Results : Of the 26 SDF TRT, 9 (35%) achieved a complete response (CR) and 14 (54%) experienced a partial response (PR). Of the 42 BID TRT, 18 (43%) achieved a CR and 23 (55%) experienced a PR. There was no significant response difference between the two arms ( p=0.119). Overall median and 2-year survival were 15 months and 26.8%, respectively. The 2-year survivals were 26.9% and 28% in both arm, respectively (p=0.51). The 2-year survivals were 35% in CR and 24.2% in PR, respectively. The grade 2 to 3 esophageal toxicities and grade 2 to 4 neutropenias were more common in BID TRT (p=0.028, 0.003). There was no difference in locoregional and distant metastasis between the two arms (p=0.125 and 0.335, respectively). The most common site of distant metastasis was the brain. Conclusion : The median survival and 2-year survival were 17 months and 26.9% in SDF TRT with sequential chemotherapy, and 15 months and 28% in BID TRT with concurrent chemotherapy, respectively. We did not observe a substantial improvement of long-term survival in the BID TRT with concurrent chemotherapy compared with standard schedules of SDF TRT with sequential chemotherapy. The grade 2 to 3 esophageal toxicities and grade 2 to 4 neutropenias were more common in BID TRT with concurrent chemotherapy. Although the acute toxicities were more common in BID TRT with concurrent chemotherapy than SDF TRT with sequential chemotherapy, a concurrent chemotherapy and twice daily TRT was feasible. However further patient accrual and long-term follow up are needed to determine the potential benefits of BID TRT in limited-stage SCLC.