Results in the Treatment of Nasopharyngeal Carcinoma Using Combined Radiotherapy

정수미,윤세철,신경섭,박용휘,김훈교,이경식,조승호,Chung Su Mi,Yoon Sei Chul,Shinn Kyung Sub,Bahk Yong Whee,Kim Hoon Kyo,Lee Kyung Shik,Cho Seung Ho The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2

Thirty-one patients with previously untreated and locally advanced nasopharyngeal cancer were retrospectively reviewed for comparing the effects of radical radiotherapy alone with that of combining chemotherapy and radiotherapy from 1983 to 1989 at Kangnam 51. Mavy's hospital.23/31 were evaluable for recurrence and suwival. There were 8 patients for stage III, and 15 patients for stage IV. Eleven patients were treated with radical radiation therapy done (arm I). Twelve patients were given 1~3 courses of cisplatin-5FU or cisplatin-bleomycin-vincristine prior to radiation therapy (arm II). The two arms were comparable in patient characteristics Of 11 radiotherapy Patients, complete response was 55%(6/11) and Partial response 45%(5/11). Among 12 patients after induction chemotherapy, complete response was 25%(3/12) and partial response 75%(9/12). After subsequent radiotherapy, complete response was increased to 83%(10/12) and partial response was 17%(2/12). Treatment failure was 30%(local recurrence; 3/11, and regional recurrence; 1/11) in arm 1 and 33% (local recurrence; 1/12, regional recurrence; 2/12 and distant metastasis; 1/12) in arm ll . There was no significant difference in survival between arm I and arm II (p> 0.05). The toxicities of treatment were acceptable. More controlled clinical trials must be completed before acceptance of chemotherapy as part of a standard radical treatment for locally advanced nasopharyngeal cancer. 1983년에서 1989년까지 가톨릭의대 부속 성모병원 방사선치료실에서 비인강종양으로 확진되어 치료를 시행한 환자 31명중 치료가 불완전했던 환자 8명을 제외한 23명의 치료성적으로 후향조사 하였다. 이들 중 11명의 환자에 있어서는 방사선 단독요법을 시행하였으며, 12명의 환자에소는 cispiatin+5-fluorouracil 혹은 cisplatin-bleomycin-vincristine을 이용하여 1회 내지 3회에 걸친 유도 화학요법후 방사선치료를 시행하였다. 방사선 단독요법으로 치료된 11명의 환자에서 완전 관해율은 55%(6/11), 부분관해율은 45%(5/11)였다. 유도화학요법을 시행한 12명의 환자중 약물 치료후 완전관해율은 25%(3/12)였으며, 부분관해율은 75%(9/12)였고, 연속적으로 시행된 방사선 치료후에는 완전 관해율이 83%(10/12)로 증가되었으며, 부분 관해율은 17%(2/12)였다. 유도 항암요법에 부분관해를 보였던 환자중 stage 111 환자 1명과 stage IV 환자 6명이 추가 방사선 치료후 완전 관해를 보였다. 방사선 단독요법군에서는 4명에 국소재발이 발생했으며,-약물요법과 방사선치료를 병행했던 군에서는 국소재발 3명과 폐로의 원격전이가 1명에서 발생되었다. 방사선단독으로 치료한 환자군과 유도화학요법과 방사선 치료를 병행한 환자군에서의 생존율의 차이가 통계적으로 유의하지 않았다. $28.55{\pm}15$ and $M{\pm}SD=28.588{\pm}25.39$, p>0.05) 치료환자군의 수가 적은 이유로 통계분석 결과 큰 의의를 발견할 수 없었다.

Total Body Irradiation for Allogeneic Bone Marrow Transplantation in Chronic Myelogenous Leukemia

정수미,최일봉,강기문,김인아,신경섭,김춘추,김동집,Chung Su Mi,Choi Ihl Bohng,Kang Ki Mun,Kim In Ah,Shinn Kyung Sub,Kim Choon Choo,Kim Dong Jip The Korean Society for Radiation Oncology 1994 Radiation Oncology Journal Vol.12 No.2

목적 : 1987년 7월부터 1992년 12월까지 가톨릭의과대학 부속 성모병원 치료방사선과에서 만성골수성백혈병으로 진단되어 동종골수이식을 위한 전신방사선치료를 받은 환자 22명을 대상으로 생존율 및 재발율에 영향을 미치는 요소들을 알아보기 위하여 후향분석을 시행하였다. 대상 및 방법 : 22명중 14명은 만성기였으며 8명은 이행기 혹은 급전기였고 진단 후 골수이식까지의 기간은 4-36개월 (중간값, 8개월)이었으며, 모든 환자들은 HLA 완전일치의 동종골수이식을 위한 전처치로 화학요법과 전신방사선조사가 시행되었다. 전신방사선조사는 6예에서는 1200cGy/6 fractions/3days, 16예에서는 1320cGy/8fractions/4days로 시행되었다. 화학요법은 8명에서는 cyclophosphamide(CTX), 5명에서는 CTX과 Daunorubicin, 그리고 9명에서는 CTX과 Adriamycin이 병용되었다. 또한 골수이식전 비장이 절제된 경우는 14예였고 6예에서는 비장에 방사선조사 (250-800 cGy/2-8fractions)가 시행되었으며 2예에서는 비장 방사선조사후 비장절제술이 시행되었다. 이식편대숙주병을 예방하기 위해 4명에서는 cyclosporine A가 단독투여되었고 18명에서는 methotrexate가 추가 투여되었다. 결과 : 전체환자의 4년 생존율은 $58.8\%$였고 22명중 8명이 재발되었으며 4년 무병생존율은 $41.2\%$였다. 생존율 및 재발율, 이식편대숙주병에 있어서 환자의 성별, 연령, 진단에서 골수이식까지의 기간, 골수이식 당시의 병기, 비장상태, 골수공여자와의 성별 혹은 혈액형 일치여부, 골수 공여자의 연령, 전처치 항암제의 종류, 방사선치료방법, 이식편대숙주병의 억제를 위한 화학요법의 방법 등이 어떤 영향을 미치는지 분석한 결과 골수이식당시의 병기만이 생존율에 유의한 차이를 보였다. 또한 이식편대숙주병과 재발율 사이에도 유의한 연관성을 보이지 않았다. 결론적으로 동종골수이식을 위한 전처치 및 면역억제방법에 따라 생존율 및 재발율이 크게 다르지 않았으며 HLA 일치 혈연자중 골수공여자가 있는 만성기의 만성골수성 백혈병 관자에서 동종골수이식을 위한 전처치로서 화학요법과 함께 전신방사선 분할조사는 중요한 역할을 담당함을 알 수 있었으나 보다 많은 환자를 대상으로 한 전향적 연구가 필요할 것으로 사료된다. Between July 1987 and December 1992, we treated 22 patients with chronic myelogenous leukemia; 14 in the chronic phase and 8 with more advanced disease. All were received with allogeneic bone marrow transplantation from HLA-identical sibling donors after a total body irradiation(TBI) cyclophosphamide conditioning regimen. Patients were non-randomly assigned to either 1200 cGy/6fractions/3days (6 patients) or 1320 cGy/8 fractions/4days (16 patients) by dose of TBI. Of the 22 patients, 8 were prepared with cyclophosphamide alone, 14 were conditioned with additional adriamycin or daunorubicin. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with methotrexate. The actuarial survival and leukemic-free survival at four years were $58.5\%$ and $41.2\%$, respectively, and the relapse rate was $36\%$ among 22 patients. There was a statistically significant difference in survival between the patients in chronic phase and more advanced phase ($76\%\;vs\;33\%$, p=0.05). The relapse rate of patients receiving splenectomy was higher than that of patients receiving splenic irradiation ($50\%\;vs\;0\%$, p=0.04). We conclude that the probability of cure is highest if transplantation is performed while the patients remains in the chronic phase.

Results of Total Body Irradiation in Allogeneic Bone Marrow Transplantation for Acute Non-Lymphocytic Leukemia

정수미(Su Mi Chung),최일봉(Ihl Bohng Choi),김인아(In Ah Kim),김성환(Sung Hwan Kim),강기문(Ki Mun Kang),신경섭(Kyung Sub Shinn),김춘추(Choon Choo Kim),김동집(Dong Jip Kim) 대한방사선종양학회 1992 Radiation Oncology Journal Vol.10 No.2

1987년 8월부터 1991년 7월까지 급성골수성 백혈병으로 가톨릭의대 치료방사선과에서 동종골수이식을 위한 전신방사선치료를 받은 22명의 환자를 대상으로 성별, 연령, 골수이식당시병기, FAB아형, 초기말초혈액백혈구수, 항암치료방법, 방사선치료방법에 따라 2년 생존율, 2년무병생존율, 재발율과 간질성폐염 및 이식편대숙주병 (GVHD)의 발생빈도를 후향분석하였다. 22명중 12명은 제1완전관해기, 10명은 제2완전관해기이후 혹은 재발기였으며, 모든 환자들은 HLA 완전일치의 동종골수이식을 위한 전처치로 다제병용화학요법과 전신방사선조사가 시행되었다. 화학요법은 13명에서 cyclophosphamide(60 mg/kg) 단독으로, 9명에서는 복합화학요법으로 시행되었으며 전신방사선조사는 8명에서는 850 cGy를 1일 1회로 단일조사되었고, 14명에서는 150~200 cGy를 1일 2회 분할조사하여 3~4일간 총 1200~1320 cGy로 치료되었다. 추적관찰기간은 8개월에서 64.5개월로 중간값을 24개월이었다. 전체 환자의 2년 생존율은 58%였으며 중간생존기간은 31개월이었고 평균 생존기간은 23.2개월이었다. 2년 생존율은 환자의 연령이 20세 이상인 경우가 20세 미만인 경우보다 높게 나타났으며 (79.4% vs 14.3%, p=0.0008), 전신방사선치료 및 골수이식이 완전관해기에 시행된 경우가 제2관해기 이후 혹은 재발기에 시행된 경우보다 2년 생존율이 높게 나타났다(83.8% vs 30%, p=0.01). 화학요법이 cyclophosphamide 단독으로 시행된 경우 병용화학요법이 시행된 경우보다 2년 생존율이 더 좋았으며 (76.9% vs 33.3%, p=0.04), 전신방사선조사는 분할조사로 치료된 군에서 1일 1회 단일조사를 받은 군보다 2년 생존율이 높게 나타났다(70.7% vs 37.5%, p=0.05). 재발율에 있어서 FAB아형은 유의한 차이를 보이지 않았으나, 초기말초혈액 백혈구 수는 20000/㎣ 이상인 경우 이하인 경우보다 재발율이 높게 나타났다(42.9% vs 22.0%). 또한 방사선치료방법에 따라 재발율과 방사선폐렴 및 이식편대숙주병 빈도를 조사한 결과 분할조사시 재발율이 낮게 나타났으며 (21.4% vs 50.0%), 방사선에 의한 폐렴 및 이식편대 숙주병의 빈도도 낮게 나타났다(14.3% vs 25.0%, 14.3% vs 50.5%). 이로써 HLA 일치혈연자중 공수공여자가 있는 제1완전관해기의 급성골수성백혈병환자에서 동종골수이식을 위한 전처치로써 화학요법과 함께 전신방사선 분할조사는 중요한 역할을 담당함을 알 수 있었으나 보다 많은 환자를 대상으로 한 전향적 연구가 필요할 것으로 사료된다. Between August 1987 and July 1991, 22 patients with acute nonlymphocytic leukemia have received allogeneic bone marrow transplantation (BMT) with non-T-lymphocyte-depleted marrow obtained from matched sibling donors. Of these patients, 12 patients were in first complete remission (CR) and 10 patients in second CR or greater or in relapse. All patients were treated with a preparative regiment consisted of cyclophosphamide (CTX, 60 mg/kg) or combined drugs, and 850 cGy single-dose or 150~200 cGy fractionated total body irradiation (TBI) administered twice daily for a total dose of 1200~1320 cGy. Survivors have been followed from 8 to 64.5 months(median, 24 months). The overall 2 year survival rate, relapse rate and incidence of radiation pneumonitis and graft versus host disease (GVHD) have been evaluated by age, phase of disease, initial WBC count, modality of TBI or conditioning chemotherapy. Overall 2 year survival was 58%. The median survival was 31 months and mean survival was 23.2 months. Overall survival have significant impact in patients of age > 19 years old (p=0.008), patients in first CR(p=0.09). Two year survival rate is significantly correlated with age (>19 vs ≤19, 79.45 vs 14.3%, p=0.0008), resimen of chemotherapy (CTX vs combined drug, 76.9% vs 33.3%, p=0.04), phase of disease 91st CR vs ≥2nd Cr or relapse, 83.3% vs 30%, p=0.01) and method of TBI (fractionated vs single dose, 70.7% vs 37.5%, p=0.05). The influence of French-American-British (FAB) subtypes on relapse rate is not significant, but initial WBC count > 20000/㎣ is associated with increased relapse rate. There is difference in the rate of radiation pneumonitis (14.3% vs 25%), GVHD (14.3% vs 50%) and relapse (21.4% vs 50%) according to fractionated versus single-dose TBI. As mentioned above, fractionated TBI is compatible for the preparative regimen combined with chemotherapy in allogeneic BMT of first CR patients under 41 years of age with suitable donor. Those results from a retrospective, non-randomized study clearly need additional clinical data, ideally from a randomized study.

Results in the Treatment of Nasopharyngeal Carcinoma Using combined Radiotherapy

Su Mi Chung(정수미) , Sei Chul Yoon(윤세철) , Kyung Sub Shinn(신경섭) , Yong Whee Bahk(박용휘) , Hoon Kyo Kim(김훈교) , Kyung Shik Lee(이경식) , Seung Ho Cho(조승호) 대한방사선종양학회 1991 Radiation Oncology Journal Vol.9 No.1

1983년에서 1989년까지 가톨릭의대 부속 성모병원 방사선치료실에서 비인강종양으로 확진되어 치요를 시행한 환자 31명중 치료가 불완전했던 환자 8명을 제외한 23명의 치료성적으로 후향조사 하였다. 이들 중 11명의 환자에 있어서는 방사선 단독요법을 시행하였으며, 12명의 환자에소는 cisplatin+5-fluorouracil 혹은 cisplatin-bleomycin-vincristine을 이용하여 1회 내지 3회에 걸친 유도 화학요법후 방사선치료를 시행하였다. 방사선 단독요법으로 치료된 11명의 환자에서 완전 관해율은 55%(6/11). 부분관해율은 45%(5/11)였다. 유도화학요법을 시행한 12명의 환자중 약물 치료후 완전관해율은 25%(3/12)였으며, 부분 관해율은 75%(9/12)였고, 연속적으로 시행된 방사선 치료후에는 완전 관해율이 83%(10/12)로 증가되었으며, 부분 관해율은 17%(2/12)였다. 유도 항암요법에 부분관해를 보였던 환자중 stage Ⅲ 환자 1명과 stage Ⅳ 환자 6명이 추가 방사선 치료후 완전 관해를 보였다. 방사선 단독요법군에서는 4명에 국소재발이 발생했으며, 약물요법과 방사선치료를 병행했던 군에서는 국소재발 3명과 폐로의 원격전이가 1명에서 발생되었다. 방사선단독으로 치료한 환자군과 유도화학요법과 방사선 치료를 병행한 환자군에서의 생존율의 차이가 통계적으로 유의하지 않았다. (M±SD=28.55±17.15 and M±SD=28.588±25.39, p>0.05) 치료 환자군의 수가 적은 이유로 통계분석 결과 큰 의의를 발견할 수 없었다. Thirty-one patients with previously untreated and locally advanced nasopharyngeal cancer were retrospectively reviewed for comparing the effects of radical radiotherapy alone with that of combining chemotherapy and radiotherapy from 1983 to 1989 at Kangnam St. Mary's hospital. 23/31 were evaluable for recurrence and survival. There were 8 patients for stage Ⅲ, and 15 patients for stage Ⅳ. Eleven patients were treated with radical radiation therapy alone (arm I). Twelve patients were given 1~3 courses of cisplatin-5FU or cisplatin-bleomycin-vincristine prior to radiation therapy (arm Ⅱ). The two arms were comparable in patient characteristics Of 11 radiotherapy patients, complete response was 55% (6/11) and partial response 45% (5/11). Among 12 patients after induction chemotherapy, complete response was 25% (3/12) and partial response 75% (9/12). After subsequent radiotherapy, complete response was increased to 83% (10/12) and partial response was 17% (2/12). Treatment failure was 36% (local recurrence; 3/11, and regional recurrence; 1/11) in arm I and 33% (local recurrence; 1/12, regional recurrence; 2/12 and distant metastasis; 1/12) in arm Ⅱ. There was no significant difference in survival between arm I and arm Ⅱ (p>0.05). The toxicities of treatment were acceptable. More controlled clinical trials must be completed before acceptance of chemotherapy as part of a standard radical treatment for locally advanced nasopharyngeal cancer.

The Modified Method of Splenic Irradiation

정수미(Su Mi Chung),장홍석(Hong Seok Jang),최일봉(Ihl Bohng Cgoi),김춘열(Choon Yul Kim),박용휘(Yong Whee Bahk) 대한방사선종양학회 1988 Radiation Oncology Journal Vol.6 No.2

만성 골수성 백혈병 치료에 있어서 비장의 방사선 조사는 화학요법에 반응이 없거나, 비종대가 심하여 비장 절제술을 시행할 수 없는 환자 그리고 통증을 동반한 비종대 환자에서 증상완화를 위하여 사용되고 있다. 가톨릭의대 성모병원 방사선과에서는 만성 골수성 백혈병에 있어 비장의 방사선 조준시 초음파를 이용하여 치료범위를 정하는 새로운 방법을 개발하여 이에 보고 하는 바이다. 이 방법의 장점은 기존의 방사선 조준기를 사용하여 결정하는 방사선치료범위보다 작으며 비장만을 정확하게 포함 할 수 있으므로 효과적인 비장 조사 및 주변 장기의 방사선 보호, 그리고 부작용 등을 감소시킬 수 있다. Splenic irradiation in chronic myelogenous leukemia is reserved for patients who have painful splenomegaly despite chemotherapy and/or inoperable splenomegaly because of huge size. The role of splenic irradiation is diminution of painful splenomegaly and indirect effect of splenic irradiation on unirradiated hematopoietic and lymphoreticular tissue such as reduction of leukocyte count and increase of hemoglobin level. We report on a useful clinical method for splenic irradiation in chronic myelogenous leukemia. We have used sonography as the tool of simulation. The portal size using modified method is smaller than the field size of conventional simulation, and so this method suggests that useful to irradiation of huge splenomegaly, effective shielding of critical organ and the downfall of complication during irradiation of spleen.

폐종양 환자에서 방사선치료에 의한 폐손상

정수미(Su Mi Chung),최일봉(Ihl Bohng Choi),강기문(Ki Mun Kang),김인아(In Ah Kim),신경섭(Kyung Sub Shinn) 대한방사선종양학회 1993 Radiation Oncology Journal Vol.11 No.2

Purpose: A retrospective analysis was performed to evaluate the incidence of radiation induced lung damage after the radiation therapy for the patients with carcinoma of the lung. Method and Materials: Sixty-six patients with lung cancer (squamous cell carcinoma 27, adenocarcinoma 14, large cell carcinoma 2, small cell carcinoma 13, unknown 10) were treated with definitive, postoperative or palliative radiation therapy with or without chemotherapy between July 1987 and December 1991. There were 50 males and 16 females with median age of 63 years (range: 33~80 years). Total lung doses ranged from 500 to 6,660 cGy (median 3960 cGy) given in 2 to 38 fractions (median 20) over a range or 2 to 150 days (median in days) using 6 MV or 15 MV linear accelerator. To represent different fractionation schedules of equivalent biological effect, the estimated single dose (ED) model, ED=D․N-0.377․T-0.058 was used in which D was the lung dose in cGy, N was the number of fractions, and T was the overall treatment time in days. The range of ED was 370 to 1357. The endpoint was a visible increase in lung density within the irradiated volume on chest X-ray as observed independently by three diagnostic radiologists. Patients were grouped according to ED, treatment duration, treatment modality and age, and the percent incidence of pulmonary damage for each group was determined. Result: In 40 of 66 patients, radiation induced change was seen on chest radiographs between 11 days and 314 days after initiation of radiation therapy. The incidence of radiation pneumonitis was increased according to increased ED, which was statistically significant (p=0.001). Roentgenographic changes consistent with radiation pneumonitis were seen in 100% of patients receiving radiotherapy after lobectomy or pneumonectomy, which was not statistically significant. In 32 patients who also received chemotherapy, there was no difference in the incidence of radiation induced change between the group with radiation alone and the group with radiation and chemotherapy, among the sequence of chemotherapy No correlation was seen between incidence of radiation pneumonitis and age or sex. Conclusions: The occurrence of radiation pneumonitis varies. The incidence of radiation pneumonitis depends on radiation total dose, nature of fractionation, duration of therapy, and modifying factors such as lobectomy or pneumonectomy.

1950~1960년대 앤디 워홀의 작품에 나타난 젠더 정체성 연구

정수미(Chung Su-Mi) 서양미술사학회 2011 서양미술사학회논문집 Vol.34 No.-

This thesis is the study to elucidate the gender identity, revealed in works of Andy Warhol(1928~1987) in 1950s and 1960s. Warhol appeared in art society with a Can of Campbell’s Soup in 1962, and he was bestowed designation a ‘superstar’ of Pop Art or ‘master’ of Pop Art. As a result, studies on Warhol have been conducted by focusing on silk screen technique or the image of death in a broad framework to introduce popular culture and consumption culture. Besides his great art works, he is also known as a homosexual. In this sense, this research focuses on gender identity of Warhol, which is homosexuality. As a artists, Warhol produced considerable works expressing his gender identity compared to any other contemporary artists of the late 20th century. Warhol’s art works from 1950s have been exclueded in the art history as it was considered as commercial design. However his work from this period had continually influenced his entire activity significantly. The works of Warhol showed different aspects according to each period. 1950s was the period that Warhol was engaged in commercial art society and most male artists in commercial art were homosexuals. On the account that Warhol did not need to conceal his gender identity, he revealed his identity comparatively frankly. Warhol embodied homosexuality through shoes, and expressed the beauty of homosexuality through the sexuality of boys. Contrary to 1950s, 1960s was the period that Warhol worked in the society of fine arts. At that time, the society of high arts was male-oriented and was not friendly to the minority of homosexuals. Accordingly, Warhol inevitably hided his gender identity and secretly encoded his gender identity instead of completely oppressing it. He concealed his homosexual meaning in comics that was the typical popular culture in those days, and released his homosexual desire through the tough image of male like an outrageous fellow or a cowboy. Works of Warhol implying homosexuality received occasional censorship. However, he was not silent like other homosexual artists such as Jasper Johns or Robert Rauschenberg. Warhol symbolically indicated that white male-oriented heterosexuality in the context of ‘Abstract Expressionism’ is oppressive. Through this symbolic representation, he disassociated the concept of gender as well as ridicule toward gender division by exposing the absurdity of it. Warhol became an artist to be free from high culture which represents visual culture and fine arts by putting up homosexuality which was a sub-culture in those days and communicating between commercial arts and fine arts freely. This distinction makes Warhol and his works important and suggests the way for understanding contemporary culture.

상안검 피지선암의 수술후 방사선 치료 1례

정수미(Su mi Chung),최병옥(Byung Ock Choi),최일봉(Ihl Bohing Choi),신경섭(Kyung Sub Shinn),변준희(Jun Hee Byoun) 대한두경부종양학회 1995 대한두경부 종양학회지 Vol.11 No.1

Sebaceous carcinomas of the eyelids are uncommon but lethal tumors. Lesions are usually seen in the elderly, predominantly women. The meibomian glands of the tarsus are the most frequent site of origin. Less commonly, the tumor arises in other sebaceous glands, e.g., the gland of Zeis, eyebrow or caruncle. Regardless of the location, sebaceous malignancies must be considered aggressive neoplasms with a potential for regional and distant metastasis. Diagnosis may be difficult, given the low incidence and inconsistencies in histopathologic classification. Treatment requires wide surgical excision with removal of involved regional lymph nodes and exenteration is reserved for those patients with orbital involvement or diffuse intraepithelial neoplasia. Opinions are divided regarding the use of postoperative irradiation or chemotherapy. Recently we experienced 46-year-old male patient with a 12-month history of painless, firm nodule and conjunctivitis due to sebaceous carcinoma of the left upper eyelid. After surgery, serial sections of the entire conjunctiva and eyelids showed a positive cut margin in medial and lateral border. We report herein this patient that supports irradiation as the postoperative treatment of these tumors in selected patients with a review of literatures.

Total Body Irradiation for Allogeneic Bone Marrow Trasplantation in Chronic Myelogenous Leukemia

정수미(Su Mi Chung),최일봉(Ihl Bohng Choi),강기문(Ki Mun Kang),김인아(In Ah Kim),신경섭(Kyung Sub Shinn),김춘추(Choon Choo Kim),김동집(Dong Jip Kim) 대한방사선종양학회 1994 Radiation Oncology Journal Vol.12 No.2

목적 : 1987년 7월부터 1992년 12월까지 가톨릭의과대학 부속 성모병원 치료방사선과에서 만성골수성백혈병으로 진단되어 동종골수이식을 위한 전신방사선치료를 받은 환자 22명을 대상으로 생존율 및 재발율에 영향을 미치는 요소들을 알아보기 위하여 후향분석을 시행하였다. 대상 및 방법 : 22명중 14명은 만성기였으며 8명은 이행기 혹은 급전기였고 진단 후 골수이식까지의 기간은 4-36개월 (중간값, 8개월)이었으며, 모든 환자들은 HLA 완전일치의 동종골수이식을 위한 진처치로 화학요법과 전신방사선조사가 시행되었다. 전신방사선조사는 6예에서는 1200 cGy/6fractions/3days (6 patients), 16예에서는 1320 cGy/8 fractions/4days로 시행되었다. 화학요법은 8명에서는 cyclophosphamide(CTX), 5명에서는 CTX와 Daunorubicin, 그리고 9명에서는 CTX과 ADriamycin이 병용되었다. 또한 골수이식전 비장이 절제된 경우는 14예였고 6예에서는 비장에 방사선조사 (250-800 cGy/2-8fractions)가 시행되었으며 2예에서는 비장 방사선조사후 비장절제술이 시행되었다. 이식편대숙주병을 예방하기 위해 4명에서는 cyclosporine A가 단독투여되었고 18명에서는 methotrexate가 추기 투여되었다. 결과 : 전체환자의 4년 생존율은 58.8%였고 22명중 8명이 재발되었으며 4년 무병생존율은 41.2%였다. 생존율 및 재발율, 이식편대숙주병에 있어서 환자의 성별, 연령, 진단에서 골수이식까지의 기간, 골수이식 당시의 병기, 비장상태, 골수공여자와의 성별 혹은 혈액형 일치여부, 골수 공여자의 연령, 전처치 항암제의 종류, 방사선치료방법, 이식편대숙주병의 억제를 위한 화학요법의 방법 등이 어떤 영향을 미치는지 분석한 겨로가 공수이식당시의 병기만이 생존율에 유의한 차이를 보였다. 또한 이식편대숙주병과 재발율 사이에도 유의한 연관성을 보이지 않았따. 결론적으로 동종골수이식을 위한 전처치 및 명역억제방법에 따라 생존율 및 재발율이 크게 다르지 않았으며 HLA 일치 혈연자중 골수공여자가 있는 만성기의 만성골수성 백혈병 환자에서 동종골수이식을 위한 전처치로서 화학요법과 함께 전신방사선 분할조사는 중요한 역할을 담당함을 알 수 있었으나 보다 많은 환자를 대상으로 한 전향적 연구가 필요할 것으로 사료된다. Between July 1987 and December 1992 we treated 22 patients with chronic myelogenous leukemia; 14 in the chronic phase and 8 with more advanced disease. All were received with allogeneic bone marrow transplantation from HLA-identical sibling donors after a total body irradiation(TBI) cyclophosphamide conditioning regimen. Patients were non-randomly assigned to either 1200 cGy/6fractions/3days (6 patients) or 1320 cGy/8 fractions/4days (16patients) by dose of TBI. Of the 22 patients, 8 were prepared with cyclophosphamide alone14 were conditioned with additional adriamycin or daunorubicin. To prevent graft versus host disease, cyclosporine was given either alone or in conjunction with methotrexate. The actuarial survival and leukemic-free survival at four years were 58.5% and 41.2%, respectively and the relapse rate was 36% among 22 patients. There was a statistically significant difference in survival between the patients in chronic phase and more advanced phase (76% vs 33%, p=0.05). The relapse rate of patients receiving splenectomy was higher than that of patients receiving splenic irradiation (50% vs 0%, p=0.04). We conclude that the probability of cure is highest if transplantation is performed while the patient remains in the chronic phase.

수술 후 국소재발한 자궁경부암에서의 방사선치료 성적

유미령(Mi Ryeong Ryu),계철승(Chul Seung Kay),강기문(Ki Moon Kang),김연실(Yeon Shil Kim),정수미(Su Mi Chung),남궁성은(Sung Eun Namkoong),윤세철(Sei Chul Yoon) 대한방사선종양학회 1999 Radiation Oncology Journal Vol.17 No.3

목 적 : 근치적 수술 후 국소재발한 자궁경부암 치료에 있어서 방사선치료의 역할 및 치료 결과에 영향을 미치는 인자들을 분석하고자 본 연구를 시행하였다. 대상 및 방법 : 1983년 10월부터 1996년 7월까지 가톨릭대학교 강남성모병원 치료방사선과에서 FIGO병기 I, II 자궁경부암의 근치적 수술 후 국소재발한 환자 중 방사선치료를 받았던 53명을 대상으로 치료결과에 대한 후향적 분석을 시행하였다. 환자의 연령은 33세에서 69세 사이(중앙값 53세)였으며, 병리조직학적 분류로는 편평상피암이 45명(84.9%), 선암이 7명(13.2%), 편평상피선암이 1명(1.9%)이었다. 수술 후 재발까지의 기간은 2 개월에서 25년 사이로 평균 34.4 개월이었다. 재발한 병소의 위치에 따라서 질 절제단(vaginal stump )이 41명(77.4%), 골반외벽(pelvic side wall)이 12명(22.6%)이었고, 재발한 병소를 크기에 따라 나누었을 때 3cm 이하인 경우가 43명(81.1%), 3 cm보다 큰 경우가 10명(18.9%)이었다. 방사선치료는 대부분 환자에서 전골반에 외부 방사선치료를 하루 1.8 Gy 의 양으로 주 5회씩 치료하여 46.8∼50.4 Gy 까지 치료한 후, 18명(34%)에서는 병소부위에 외 부방사선치료를, 24명(45.3%)의 환자에서는 강내근접치료를 각각 추가하여 총방사선량 46.8∼111 Gy(중앙값 70.2 Gy)까지 치료하였다. 추적조사 기간은 2 개월에서 153 개월 사이(중앙값 35 개월)였다. 결 과 : 방사선치료후 초기관해율은 66% (35/53) 이었고, 이 중 6명(17.1%)에서 방사선치료후 7 개월에서 116 개월사이(평균 47.7 개월)에 다시 국소재발하여 전체환자의 국소재발율은 45.3%였다. 전체환자의 5년 생존율은 78.9%였으며, 원격전이율은 10% (5/50)로 발생부위별로는 폐 2명, 뇌 1명, 원격 임파절 2명이었다. 생존율에 영향을 미치는 인자로는 수술후 재발까지의 기간( p=0.0055), 재발 병소의 크기( p=0.0039), 방사선치료에 대한 초기반응 유무( p=0.0428) 등으로 분석되었으며, 그 외에 초기 병기, 연령, 조직학적 유형, 재발병소의 위치, 방사선 조사량, 약물치료 유무 등은 영향이 없는 것으로 나타났다( p>0.05). 방사선치료의 합병증은 10명(20%)에서 발생하였으나, 대부분 경미하거나 중등도의 하부위장관 또는 비뇨기계, 피부 합병 증이었고, 한명이 강내 방사선치료 직후 폐전색증으로 사망하였다. 결 론 : 근치적 수술 후 국소재발한 자궁경부암 환자에서 방사선치료는 매우 효과적이며, 수술 후 재발까지의 기간, 재발병소의 크기, 방사선치료에 대한 초기반응 등이 예후에 영향을 미치는 인자로 나타났다. Purpose : To evaluate prognostic factors and survival rates of the patients who received radiation therapy for locally recurrent uterine cervical cancer after curative surgery. Materials and Methods : Between October 1983 and July 1996, fifty three patients who received radiation therapy for locally recurrent cervical cancer after curative surgery at the Department of Therapeutic Radiology, Kangnam St. Mary's Hospital, The Catholic University of Korea were analysed retrospectively. Age at diagn osis ranged from 33 to 69 years (median 53 years). Pathological analysis showed that forty five (84.9%) patients had squamous cell carcinoma, seven (13.2%) patients had adenocarcinoma, and one (1.9%) patient had adenosquamous cell carcinoma. The interval between hysterectomy and tumor recurrence ranged from 2 months to 25 years (mean 34.4 months). The recurrent sites were vaginal stump in 41 patients (77.4%) and pelvic side wall in 12 patients (22.6%). Recurrent tumor size was devided into two groups : less than 3 cm in 43 patients (81.1%) and more than 3cm in 10 patients (18.9%). External beam irradiation of whole pelvis was done first up to 46.8 Gy to 50.4 Gy in 5 weeks to 6 weeks, followed by either external beam boost to the recurrent site in 18 patient s (34%) or intracavitary irradiation in 24 patients (45.3%). Total dose of radiation ranged from 46.8 Gy to 111 Gy (median 70.2 Gy). Follow up period ranged from 2 to 153 months with a median of 35 months. Results : Overall response rate was 66% (35/53). Among them, six patients (17.1%) relapsed between 7 months and 116 months after radiation therapy (mean 47.7 months). Therefore overall recurrence rate was 45.3%. Overall five-year actuarial survival rate was 78.9% and distant failure rate was 10% (5/50). The significant prognostic factors affecting survival rate were interval between primary surgery and tumor recurrence ( p=0.0055), recurrent tumor size (p=0.0039), and initial response to radiation therapy (p=0.0428). Complications were observed in 10 (20%) patients, which included mild to moderate lower gastrointestinal, genitourinary, or skin manifestations. One patient died of pulmonary embolism just after intracavitary irradiation. Conclusion : Radiation therapy is the effective treatment for the patients with locally recurrent cervical cancer after curative surgery. These results suggest that interval between primary surgery and tumor recurrence, recurrrent tumor size, and initial response to radiation therapy were significant prognostic factors for recur rent cervical cancer.