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강석윤 ( Seok Yun Kang ) 대한내과학회 2017 대한내과학회지 Vol.92 No.3
The treatment of metastatic breast cancer depends on the patient`s condition, site of metastasis, and molecular subtype of cancer. Hormone receptor-positive patients, which account for 60-70% of all breast cancer patients, have the advantage of having an effective, less-toxic, hormone therapy treatment. Hormone therapy should be used actively because it is very useful in terms of the patient`s quality of life, by increasing the response rate and delaying the progression of cancer. Recently, studies have examined the mechanism of resistance to hormone therapy. We need to combine various target therapies to overcome resistance. The development of therapeutic agents based on molecular biological characteristics should help to improve the survival of patients with metastatic breast cancer. (Korean J Med 2017;92:251-258)
장현수(Hyunsoo Jang),강승희(Seung-Hee Kang),이선영(Sunyoung Lee),조선미(Sun Mi Jo),오영택(Young Taek Oh),전미선(Mison Chun),최진혁(Jin Hyuk Choi),강석윤(Seok Yun Kang) 대한방사선종양학회 2009 Radiation Oncology Journal Vol.27 No.2
목 적: 동시적 항암화학방사선치료를 받은 식도암 환자의 치료성적과 예후인자를 분석하였다. 대상 및 방법: 1994년 1월부터 2007년 7월까지 식도암으로 방사선치료를 받은 환자 246명 중 근치적 목적으로 45Gy이상의 방사선치료와 함께 동시적 항암화학요법을 받았으며 생존확인이 가능하였던 78명을 대상으로 후향적 분석을 시행하였다. AJCC 병기 IIA∼IVB까지의 환자를 대상으로 하였는데, IVB는 상부식도암이 아닌 환자에서 쇄골상부림프절 전이가 있거나 하부식도암이 아닌 환자에서 복강림프절 전이가 있는 경우만을 포함시켰다. 방사선치료는 중앙값 54 Gy를 조사하였고, 항암화학요법은 대부분의 환자(88%)에서 5-FU와 cisplatin (FP) 병합요법으로 시행되었다. 추적관찰기간은 2∼117개월(중앙값 14개월)이었다.결 과: 흉부단층촬영이나 식도내시경을 통해 치료에 대한 반응을 확인할 수 있었던 54명의 환자중 완전관해가 17 명, 부분관해가 18명이었다. 완전관해를 보인 환자에서 재발할 때까지의 기간은 중앙값 20개월이었고 첫 재발부위로 국소재발이 3명, 원격전이가 7명이었다. 1년, 2년, 5년 전체 생존률은 각각 58.9%, 21.7%, 12.2%이었고 중앙생존기간은 14개월이었다. 전체 생존률에 대한 단변량분석에서 치료에 대한 반응과 FP병합요법의 횟수가 통계적인 유의성을 보여주었다. 환자의 숫자가 적었으나 방사선감작제로 일단위 혹은 주단위의 cisplatin이 FP 병합요법보다 좋은 결과를 보였다. 결 론: 원격장기로의 전이가 없는 국소진행성 식도암 환자에서 동시적 항암화학방사선치료는 기존의 연구와 유사한 결과를 보여주었다. 일단위 혹은 주단위의 cisplatin이 전신상태가 FP 병합요법에 적절하지 않은 환자에서 대안으로 사용될 수 있을 것으로 생각된다. Purpose: We investigated the outcome and the prognostic factors of patients with locally advanced esophageal cancer who were treated with concurrent chemo-radiotherapy. Materials and Methods: Two hundred forty six patients with esophageal cancer that were treated by radiotherapy between January 1994 and July 2007. Of these, 78 patients who received radiotherapy of ≥45 Gy with concurrent chemotherapy were retrospectively enrolled in this study. We included patients stages IIA, IIB, III, IVA, and IVB with supraclavicular metastasis in the middle/lower esophageal cancer or celiac node metastasis in cervical or upper/middle thoracic esophageal cancer. The median radiation dose was 54 Gy and the combination chemotherapy with 5-FU and cisplatin (FP chemotherapy) was given concurrently with radiotherapy in most patients (88%). Results: The follow-up period ranged from 2 to 117 months (median 14 months). The treatment response of the 54 patients could be evaluated by computerized tomography or endoscopy. A complete response (CR) was observed in 17 patients, whereas a partial response was observed in 18 patients. In patients with a CR, the median recurrence time was 20 months and the first relapse sites constituted a locoregional failure in 3 patients and a distant failure in 7 patients. The 1-, 2-, and 5-year overall survival (OS) rates were 58.9%, 21.7%, and 12.2%, respectively. The median survival period was 14 months. A univariate analysis indicated that the treatment response and cycles of FP chemotherapy were significant prognostic factors for OS. Daily or weekly administration of cisplatin as a radiosensitizer showed a better treatment response than FP chemotherapy. Conclusion: This study has shown that results of concurrent chemo-radiotherapy in patients with locally advanced esophageal cancer is comparable to those of other studies. Daily or weekly cisplatin administration may be considered as an alternative treatment in patients that are medically unfit for FP chemotherapy.
증례 : 특발성후복막섬유증 2예에 대한 양전자방출단층촬영의 유용성
박태진 ( Tae Jin Park ),이명희 ( Myoung Hee Lee ),김형일 ( Hyoung Il Kim ),강석윤 ( Seok Yun Kang ),최진혁 ( Jin Hyuk Choi ),김효철 ( Hugh Chul Kim ),윤석남 ( Seok Nam Yoon ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6
Idiopathic retroperitoneal fibrosis is a relatively rare disease that is characterized by the proliferation of fibrous tissue with an inflammatory process in the retroperitoneal cavity. It can cause an obstruction and compression of the ureter, abdominal aorta, and finally progress to renal failure. During the initial stages, the histology shows active inflammation. However, in the late stages, fibrous scarring occurs and the tissue becomes relatively avascular and acellular. Increased 18F-FDG accumulation was observed in our patient at the time of disease onset, which was attributed to the presence of inflammatory cells and actively metabolizing fibroblasts. We describe two patients with idiopathic retroperitoneal fibrosis, who were examined by 18F-FDG-PET, and discuss the efficiency of positron emission tomography in the diagnosis and management of idiopathic retroperitoneal fibrosis patients. (Korean J Med 71:688-693, 2006)
2기(T3 또는 N1) 췌장암 환자들의 수술 후 방사선치료의 성적 및 고찰
김상원(Sang Won Kim),전미선(Misun Chun),김명욱(Myung Wook Kim),김욱환(Wook-Hwan Kim),강석윤(Seok Yun Kang),강승희(Seung Hee Kang),오영택(Young Taek Oh),이선영(Sunyoung Lee),양주노(Juno Yang) 대한방사선종양학회 2007 Radiation Oncology Journal Vol.25 No.4
목 적: 근치적 절제술을 받고 AJCC 병기 2기(T3 또는 N1)로 진단된 췌장암 환자들 중 수술 후 방사선치료를 받은 이들을 대상으로 국소 제어율 및 생존율을 분석하고자 한다. 대상 및 방법: 1996년 1월부터 2005년 12월까지 수술 후 보조적 요법으로 방사선치료 단독 내지는 동시 항암화학방사선치료를 받은 28명의 환자들의 기록을 후향적으로 분석하였다. 모든 환자들에게서 병리 소견상 췌장 주변 조직으로의 침윤이 있거나 췌장 주변 또는 후복강 내 대동맥 주변 임파절 전이가 확인되었다. 방사선치료는 수술 전영상학적인 자료에서 침범된 종양의 위치 및 수술 변연 부위를 중심으로 40∼57.6 Gy (중앙값 50 Gy)를 조사하였으며 병리 소견상 주변 임파절 전이가 확인된 경우엔 제 3 요추부위까지의 대동맥 주변 임파절 부위도 조사야에 포함시켰다. 동시 항암화학요법은 10명의 환자들에게서 병용되었다. 결 과: 최초의 실패 양상이 국소 재발이었던 환자는 13명(46%)였으며 이들 중에서 원격 전이가 같이 동반된 환자는 5명이었다. 호발 부위는 복강축(4명)과 대동맥 주변 임파절 부위였다. 또한 원격 전이가 최초의 실패 양상으로 나타난 환자는 국소재발이 동반된 환자들을 포함하여 12명이었다. 원격전이가 가장 흔히 나타난 곳은 간(10명)이었으며 복강전이, 폐전이 순이었다. 임파절 전이가 있는 환자들은 없는 환자에 비해 원격 전이의 가능성이 높았다(57.1%). 수술 변연 부위에 종양이 남아있는 환자들은 없는 환자들보다 국소 재발의 가능성이 높았다(57.1%). 전체 환자들의 무병 생존기간의 중앙값은 6개월이었으며 1년 및 2년 무병생존율은 각각 27.4%와 8.2%였다. 전체 생존기간의 중앙값은 11개월이었고 2년, 3년 생존율은 31.6%, 15.8%였다. 결 론: 2기 췌장암 환자들은 국소 재발 및 원격 전이의 가능성이 높은 고위험군으로 국소 제어율 및 전체 생존율의 향상을 위해서 수술 후 효과적인 방사선치료의 적극적인 시행 및 이후의 보조적인 전신 항암화학요법을 권고하여 시행하는 것이 바람직하다. Purpose: To analyze retrospectively the outcome of postoperative radiation therapy with or without concurrent chemotherapy for curatively resected stage II pancreatic cancer with T3 or N1 disease. Materials and Methods: Between January 1996 and December 2005, twenty-eight patients completed adjuvant radiation therapy at Ajou University Hospital. The patients had either pathologic T3 stage or N1 stage. The radiation target volume encompassed the initial tumor bed identified preoperatively, resection margin area and celiac nodal area. In the case of N1 patients, the radiation field extended to the lower margin of the L3 vertebra for covering both para-aortic lymph nodes bearing area. The median total radiation dose was 50 Gy. Ten patients received concurrent chemotherapy. Results: Thirteen patients (46%) showed loco-regional recurrences. The celiac axis nodal area was the most frequent site (4 patients). Five patients showed both loco-regional recurrence and a distant metastasis. Patients with positive lymph nodes had a relatively high probability of a distant metastasis (57.1%). Patients that had a positive resection margin showed a relatively high local failure rate (57.1%). The median disease-free survival period of all patients was 6 months and the 1- and 2-year disease free survival rates were 27.4% and 8.2%, respectively. The median overall survival period was 9 months. The 2- and 3-year overall survival rates were 31.6% and 15.8%, respectively. Conclusion: The pancreatic cancer patients with stage II had a high risk of local failure and a high risk of a distant metastasis. We suggest the concurrent use of an effective radiation-sensitizing chemotherapeutic drug and adjuvant chemotherapy after postoperative radiation therapy for the treatment of patients with stage II pancreatic cancer.
혈액질환치료에 있어 동종말초조혈모세포와 배양확장된 간엽모세포(Mesenchymal Stem Cell)의 동시이식 2예
강석윤,김재홍,박준성,김현수,최진혁,임호영,양말숙,김영진,김효철 대한조혈모세포이식학회 2001 대한조혈모세포이식학회지 Vol.6 No.1
Human bone marrow contain two kinds of stem cells. One is hematopoietic stem cell, and the other is multipotential mesenchymal stem cells which are capable of differentiating into a number of mesenchymal cell lineages. These mesenchymal stem cells are shown to secrete hematopoietic cytokines and support hematopietic progenitors in vitro. Animal models suggest that the transplantation of healthy stromal elements, including mesenchymal stem cells, may enhance the ability of the bone marrow microenvironment to support hematopoiesis after stem cell transplantation. Therefore, We hypothesized that cotransplantation of hematopoietic stem cells and mesenchymal stem cells after high dose chemotherapy would facilitate engraftment of hematopietic stem cells and reduce complications caused by delayed engraftments. And we investigated the safety, feasibility, side effects and hematopoietic effects of in vitro-expanded mesenchymal stem cells in hematologic malignancies receiving allogeneic peripheral stem cell transplantation.