복합 화학-면역치료

정동섭 ( Dong Sup Chung ),홍용길 ( Yong Kil Hong ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.1

Cytotoxic chemotherapy has been an important treatment modality in human malignancy as well as surgery and radiotherapy. Chemotherapeutic agents have continued to improve in efficacy, but there are few cases in which a single drug or treatment modality has sufficien+t activity to cure the malignancy by itself. The active immunotherapeutic strategy to induce an immune response against tumors is quite attractive because it offers the potential for high tumor-specific toxicity, minimal side effects, and a durable antitumor effect. However, its clinical effects on patients with malignancy have not been up to the expectation because of immune tolerance, sheer physical burden of tumor antigens, tumor escape mechanisms from the immune surveillance system and so on. Although the combined chemotherapy and immunotherapy would seem to be contradictory, preclinical and clinical data have shown that many chemotherapeutic agents such as cyclophosphamide, gemcitabine and temozolomide enhance the efficacy of immunotherapy when used prior to immunotherapy. Explainable mechanisms of action are lessening of inhibitory immune effect by tumors, improvement of the effector T cell:tumor ratio, inhibition of regulatory T cells, enhancement of antigen presentation by tumors, alteration of tumor microenvironment, or some yet unknown method. Recent developed targeted therapies such as the monoclonal antibodies cetuximab, bevacizumab and trastuzumab, seem to be more effective when given with chemotherapy or other targeted therapies. More experimental and clinical trials are needed to evoke the full potential of the synergistic antitumor effects of chemotherapy combined with immunotherapy.

CEA 발현 수지상 세포를 이용한 CEA 특이 살해 T 세포의 유도

원은하,김창현,박미영,조현일,오승택,홍용길,김태규,Won, Eun-Ha,Kim, Chang-Hyun,Park, Mi-Young,Cho, Hyun-Il,Oh, Seong-Taek,Hong, Yong-Kil,Kim, Tai-Gyu 대한면역학회 2003 Immune Network Vol.3 No.4

Background: Carcinoembryonic antigen (CEA) is well-known soluble tumor marker frequently detectable in peripheral blood of carcinoma patients and considered as good target for antigen-specific immunotherapy. In this study, we used a replication-deficient adenovirus containing CEA to study CTL induction in vitro after adenovirus-mediated gene transfer into DC. Methods: DC were obtained from mouse bone marrow and cultured with IL-4 and GM-CSF. For measuring CTL activity, splenocytes were harvested from the mice, which were immunized with DC that had been infected AdV-CEA or pulsed with CEA peptide. Untreated DC was used as a control. Splenocytes were re-stimulated in vitro with DC pulsed with CEA peptide for 7 days and CTL activity with CEA peptide-pulsed EL-4 cells were assessed in a standard $^{51}Cr$-release assay. The frequencies of antigen-specific cytokine-secreting T cell were determined with $mIFN-{\gamma}$ELISPOT. Results: DC infected with recombinant adenovirus expressing CEA induced CEA-specific CTL responses in vivo. Splenocyte induced from mice immunized with AdV-CEA-infected DC increase in the number of $IFN-{\gamma}$ secreting T cells compared with those from mice immunized with CEA peptide-pulsed DC. Conclusion: These results suggested that DC infected with recombinant adenovirus has advantages over other forms of vaccination and could provide an alternative approach vaccination therapies.

양성자 화학적 이동영상기법(¹H-CSI)을 이용한 정위적 뇌생검

장경술,손병철,김문찬,최병길,김의녕,김범수,최보영,백현만,홍용길,강준기,Chang, Kyung-Sool,Son, Byung-Chul,Kim, Moon-Chan,Choi, Byung-Gil,Kim, Euy-Neying,Kim, Bum-Soo,Choe, Bo-Young,Baik, Hyun-Man,Hong, Yong-Kil,Kang, Joon-Ki 대한신경외과학회 2000 Journal of Korean neurosurgical society Vol.29 No.12

Objective : To obtain more reliable sample in stereotactic biopsy, authors adopted proton chemical shift imaging ($^1H$-CSI)-directed biopsy. Until now, proton single voxel spectroscopy($^1H$-SVS) technique has been reported as a technique using metabolic information in stereotactic biopsy. The authors performed $^1H$-CSI with a stereotactic headframe in place and evaluated the pathologic results obtained from local metabolic information through $^1H$-CSI. Methods : $^1H$ CSI-directed stereotactic biopsy was performed in four patients. $^1H$-CSI and conventional Gd-enhancement stereotactic MRI was done simultaneously after application of the stereotatic frame. After reconstruction of metabolic maps of NAA/Cr, Cho/Cr, and Lactate/Cr ratios, the focal areas of increased Cho/Cr ratios and decreased NAA/Cr ratios were selected for target sites in the MR images Results : There was no difficulty in performing $^1H$-CSI with the stereotactic headframe in place. In pathologic examinations, the samples taken in area of increased Cho/Cr ratios and decreased NAA/Cr ratios showed the features of increased cellularity, mitoses and cellular atypism, thus facilitated the diagnosis. The pathologic samples taken from the area of increased Lactate/Cr ratios showed prominent feature of necrosis. Conclusion : $^1H$-CSI was feasible with stereotactic head frame in place. The final pathologic results obtained in our samples were concordant with the local metabolic informations from $^1H$-CSI. Authors believe that $^1H$ CSI-directed stereotactic biopsy may provide us advantages in obtaining more reliable tissue specimen in stereotactic biopsy.

중앙 두개 기저부 종양에 대한 맞춤형 추체골 절제술

한영민(Young-Min Han),양승호(Seung-Ho Yang),홍용길(Yong-Kil Hong),장경술(Kyoung-Sool Chang),김종태(Jong-Tae Kim),정동섭(Dong-Sup Chung),박영섭(Young-Sup Park) 대한두개저학회 2006 대한두개저학회지 Vol.1 No.2

Different combinations of anterior and posterior petrosal approaches can be proposed for central skull base tumors. We investigated the usefulness and limitations of combining various petrosal approaches. Six operations were performed in five patients who harbor the central skull base tumor. The patients included 4 females and 1 male, and the average age was 39.3 (range, 29-53) years. Four operations were performed via combined petrosal approach preserving the labyrinth, one was via the similar approach but sacrificing the labyrinth. We used a combined petrosal and temporopolar approach in a patient with recurrent meningioma invloving the petroclival area, posterior cavernous sinus and suprasellar areas. Fontopolar approach combined in that case made a direct vision from the suprasellar to the lower brainstem area. Furthermore, it could reduce morbidity associated with an upward retraction of the temporal lobe which needed to obtain a working space to remove the tumor extending to the suprasellar area via subtemporal avenue which was afforded by a petrosal approach. The anterior petrosal approach was more useful to reach the midline and/or contralateral petroclival junction. The posterior petrosal approach can provide good control of the cranial nerves, the brainstem and the vertebrobasilar artery which are displaced posteriorly by the tumor so they are susceptible to injury via the anterior approach. Retrosigmoid approach was combined in a patient whose tumor extended below the lower cranial nerves. Gross total resection was achieved in one, subtotal resection in three and partial resection in one patient. No operative death occurred. Combining various approaches according to the extent of tumor allows better visualization of the surrounding vital structures and more room for a safe removal. It is necessary to tailor various petrosectomy in the patient with a central skull base tumor.

내시경을 이용한 경접형동 접근 수술 중에 시행한 비강내 세균 배양 검사 및 그에 대한 항생제 감수성 결과 분석과 3세대 세팔로스포린의 예방적 항생제로서의 임상적 효과에 대한 분석

이민기(Min-Gi Lee),박재성(Jae-Sung Park),김도현(Do Hyun Kim),김성원(Sung Won Kim),전신수(Sin Soo Jeun),홍용길(Yong-Kil Hong) 대한두개저학회 2018 대한두개저학회지 Vol.13 No.2

Background : We analyzed the distribution of identified micro-organisms from the nasal cavity during EETS and their antibiotic susceptibility testing (AST) results. In addition, we evaluated the clinical outcomes of antibiotic prophylaxis with third-generation cephalosporins for endoscopic transsphenoidal surgery. Methods : From November 2014 to October 2017, a total of 225 EETS cases with available nasal cavity culture results were reviewed to identify the clinical data relevant to CNS infection. Ceftriaxone was used for antibiotic prophylaxis, and the patients were divided into subgroups according to the AST results. Results : Gram-positive cocci were the most commonly identified micro-organisms. The patient population was divided into the following three groups: prophylaxis-appropriate, prophylaxis-inappropriate, and Undetermined group, each amounting to 132 (59.5%), 34 (15.3%), and 56 (25.2%) cases, respectively. CNS infection was observed in 2 (0.9%) cases. But, statistical analyses did not show significant differences in the occurrence of CNS infection among the studied groups. Conclusions : Antibiotic prophylaxis with third-generation cephalosporins showed that most (85%) patients received appropriate prophylaxis, and the clinical outcomes regarding the CNS infection were also comparable to other previous reports. Future larger-scale studies are mandatory to establish the relationship between prophylaxis-appropriateness and the occurrence of CNS infection.

후각 이상을 동반하지 않은 후구신경초종 증례보고

우종윤 ( Jong Yun Woo ),이근수 ( Kun Soo Lee ),이태규 ( Tae Kyu Lee ),이관성 ( Kwan Sung Lee ),전신수 ( Sin Soo Jeun ),김문찬 ( Moon Chan Kim ),박춘근 ( Chun Kun Park ),홍용길 ( Yong Kil Hong ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2007 대한뇌종양학회지 Vol.6 No.2

A 38-year old male patient visited our hospital because of decreased visual acuity. Brain magnetic resonance(MR) images revealed a 4.7×4.9×3.7 cm sized lobulated cystic mass which was well enhanced in olfactory groove. The patient underwent left subfrontal approach and total tumor removal was done. Pathology revealed neurilemmoma and postoperative magnetic resonance images showed no residual mass.

The Efficiency of Radiation Therapy in the Treatment of Intracranial Oligodendrogliomas : Factors Influencing the Prognosis

윤세철(Sei Chul Yoon),계철승(Chul Seung Kay),정수미(Su Mi Chung),유미령(Mi Ryung Ryu),김연실(Yeon Shil Kim),홍용길(Yong Kil Hong),김문찬(Moon Chan Kim),강준기(Joon Ki Kang) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.3

목적 : 희돌기교종은 천천히 자라는 낮은 빈도의 뇌 종양으로서 수술로 치유되지만 완전절제가 어려워 수술후 방사선치료가 추천되고 있다. 희돌기교종 환자의 방사선치료후 생존율과 이 생존율에 영향을 미치는 예후 인자들을 알아보기 위해 이 연구를 하였다. 대상 및 방법 : 1983년 3월 부터 1997년 12월 까지 177개월 동안에 가톨릭대학교 강남성모병원 치료방사선과에서는 조직학적 진단이 확진된 총 42예(남:여 = 25:17)의 희돌기교종 환자에 대한 방사선치료를 실시하였다. 방사선치료는 6 MV 선형가속기를 이용하여 180 cGy/일, 주 5회 씩, 총 조사선량 39.6~75.6 Gy (중앙값 54 Gy)를 실시하였다. 환자의 나이는 5~62세(중앙값 39세)에 분포하였으며 추적조사 기간은 8~152개월(평균 63.4개월)이었다. 방사선치료 종료일을 기준으로 생존율(Kaplan-Meier법)과 이 생존율에 영향을 미치는 인자들을 후향적으로 분석하였다. 결과 : 방사선치료후 5년 생존율(5YSR)은 65.3% 이었다(중앙값 90개월). 종양의 수술적 제거를 실시한 경우가 조직 생검 만을 한 경우 보다 생존율이 좋았으며(5YSR; 69.9% vs 26.7% p0.05). 결론 : 희돌기교종 환자의 방사선치료는 국소적으로 병소부위에 수술후 4주 이내에 실시하여 생존율 증가를 관찰 할 수 있었다. 또한 전통적인 분할 방사선치료 시 총 방사선조사선량이 60 Gy 이상은 생존율을 증가시키지 못하였다. urpose : Oligodendrogliomas (ODG) are a rare, slow growing, tumor in the brain, which can be cured by complete surgical resection, but as yet it is not known if postoperative adjuvant radiation therapy (RT) is essential, We analyzed the treatment results of patients with irradiated ODG to investigate the efficacy of RT in terms of survival rates and other influencing prognostic factors. Methods and Materials : Between March 1983 and December 1997, 42 patients with ODG were treated with RT at our hospital. The RT was peformed dally at a dose of 1.8~2.0 Gy, at 5 fractions per week, to a total dose of between 39.6 Gy and 64.8 Gy (mean 53.3 Gy). The ages of the patients ranged between 5 and 62 years, with a median age of 39 years. The mean follow-up period was 63.4 months (8-152 months). The Kaplan-Meier method was used to assess the survival, and 5 year survival rates (5-YSR). Log rank tests and Cox regression analyses were used to define the significance of prognostic factors. Results : The majority of ODG in this study were located in the cerebral hemisphere (83.3%). ODG are slightly more common in men than women, and commonly occurs in middle age, between the 3rd and 4th decades. It has been recommended that RT is commenced within 4 weeks following surgery (5-YSR; 86% vs. 49%; p0.05). Conclusion : A local involved field irradiation with conventional fractionation, commencing within 4 weeks following surgical excision of the tumor, was beneficial for the 5-YSR, but a total radiation dose exceeding 60 Gy did not improve the 5-YSR.

임상 : 악성뇌교종의 항암 및 방사선 병합치료의 효과와 독성

임동환 ( Dong Hwan Lim ),전신수 ( Shin Soo Jeun ),박춘근 ( Chun Geun Park ),강준기 ( Joon Gi Kang ),김문찬 ( Moon Chan Kim ),홍용길 ( Yong Kil Hong ) 대한뇌종양학회 2005 대한뇌종양학회지 Vol.4 No.1

Objective￡ºConcurrent chemotherapy and radiotherapy trials have been reported to increase anti-tumoral effect and toxicity in several solid cancers, but little has been known in brain tumors. We analyzed clinical efficacy and toxicity of the concurrent therapy as a first line modality in malignant glioma patients. Methods￡ºFrom March 1998 to December 2003, twenty- five patients were enrolled in this study. They are composed of 11 glioblastomas(GBM), 8 anaplastic astrocytomas(AA), 5 anaplastic oligodendrogliomas(AO), and 1 anaplastic oligoastrocytoma(AOA). Mean age was 45.3(19-67) years old with 14 females and 11 males. Both radiotherapy and chemotherapy, composed of BCNU(120mg/m2) or CCNU(75-110mg/m2), procarbazine(60mg/m2) and vincristine(1.4 mg/m2), started simultaneously within 2 weeks after surgery. Results￡ºMedian progression-free survival time(PFS) was 9 months for the patients with GBM, and 19 months for the patients with Non-GBM. Grade III/IV leukopenia developed in 7 of 25(28%) patients and thrombocytopenia in 2 of 25 (8%). Radiation necrosis occurred in 3 patients(12%). Conclusion￡ºConcurrent chemoradiotherapy improved PFS in high-grade glioma patients and its toxicity was tolerable. These preliminary results suggest that further studies would be warranted to improve the clinical efficacy of this therapy in malignant gliomas.

BCNU 를 함유한 생분해성 PLGA 웨이퍼의 특성분석

강희정(Hui Jung Kang),이진수(Jin Soo Lee),성하수(Ha Soo Seong),정제교(Je Kyo Jeong),강길선(Gil Son Khang),이해방(Hai Bang Lee),홍용길(Yong Kil Hong),안태군(Tae Kun An) 한국고분자학회 2002 폴리머 Vol.26 No.5

기전대뇌동맥의 거대뇌동맥류 : 증례 보고 Case Report

홍용길,최승진,윤석훈,최창락,송진언 대한신경외과학회 1990 Journal of Korean neurosurgical society Vol.19 No.1

A case of large aneurysm of azygos anterior cerebral artery(Azygos ACA) is reported. This 52-year-old male patient became unconscious suddenly on working. The CT scan demonstrated small amount of hemorrhage in the interhemispheric fissure and basal cistern and huge intraventricular hematoma with marked dilatation of all ventricles. Emergency extraventricular drainage was done and his consciousness recovered to the level of possible spontaneous eye opening, 4-vessels angiography done a moth later revealed a large fusiform aneurysm at the bifurcation of distal end of azygos ACA. Authors preferred interhemispheric approach and clipped the aneurysmal neck uneventfully. Despite the successful clipping of the aneurysm confirmed by postoperative angiography, preoperative mutism, spastic weakness of lower extremities and urinary incontinence didn't recovered. This case suggests that preoperative neurological status is no less critical to the postoperative outcome than surgical technique. This is the first case of large aneurysm at this site so far as we know.