One-Week versus Two-Week Chemoradiotherapy Followed by Curative Surgery in Rectal Cancer: Long-Term Comparative Pooled Analysis of Two Prospective Multicenter Phase II Trials

성수윤,김대용,장홍석,김태현,박희철,지의규,남택근,김성환,이종훈 대한암학회 2023 Cancer Research and Treatment Vol.55 No.3

Purpose The optimal short-course chemotherapeutic regimen for rectal cancer has not been clearly defined until now. KROG 10-01 and KROG 11-02 prospective trials investigated the efficacy and safety of 1- and 2-week chemoradiotherapy (CRT), respectively. Materials and Methods Patients eligible for KROG 10-01 and KROG 11-02 involved those with clinical T3-4N0-2M0 rectal cancers. They received preoperative CRT and total mesorectal excision. Patients in KROG 10-01 received radiation of 25 Gy in 5 fractions during 1 week with 5-fluorouracil/leucovorin. Patients in KROG 11-02 received radiation of 33 Gy in 10 fractions for 2 weeks with oral capecitabine. Results A total of 150 patients consisting of 70 patients from KROG 10-01 and 80 patients from KROG 11-02 were collectively analyzed. With a median follow-up time of 89.2 months, the 5-year overall survival rate was 86.5% in 1-week CRT and 85.3% in 2-week CRT (p=0.841). The 5-year recurrence-free survival rate was 83.5% in 1-week CRT and 77.1% in 2-week CRT (p=0.448). One patient (1.4%) in 1-week CRT and 11 patients (13.8%) in 2-week CRT exhibited pathologic complete regression (ypT0N0M0) after radiotherapy (p=0.006). One-week CRT had significantly higher acute hematologic (12.8% vs. 3.8%, p=0.040) and nonhematologic (38.6% vs. 16.3%, p=0.002) toxicity than 2-week CRT. Conclusion Both 1- and 2-week schedules of CRT showed favorable survival outcomes after 7 years of follow-up. But, 2-week course achieved more increased tumor response and decreased acute toxicity than 1-week course.

Patterns of care for patients with nasopharyngeal carcinoma (KROG 11-06) in South Korea

성수윤,강민규,계철승,금기창,김성환,김연실,김원택,김지윤,김진희,문성호,안용찬,오영택,우홍균,이창걸,정웅기,조관호,조문준,최진화 대한방사선종양학회 2015 Radiation Oncology Journal Vol.33 No.3

Purpose: To investigate the patterns of care for patients with nasopharyngeal carcinoma (NPC) in South Korea. Materials and Methods: A multi-institutional retrospective study was performed (Korean Radiation Oncology Group [KROG] 11-06) on a total of 1,445 patients from 15 institutions. Results: Of the 1,445 patients, more than half were stages III (39.9%) and IV (35.8%). In addition to patterns of care, we also investigated trends over time with the periods 1988–1993, 1994–2002, and 2003–2011. The frequencies of magnetic resonance imaging and positron emission tomography-computed tomography were markedly increased in the third period compared to previous 2 periods. Concurrent chemoradiation (CCRT) was performed on 894 patients (61.9%), neoadjuvant chemotherapy on 468 patients (32.4%), and adjuvant chemotherapy on 366 patients (25.3%). Of stage II–IV patients, CCRT performed on 78.8% in 2003–2011 compared to 15.0% in 1988–1993. For patients treated with CCRT, cisplatin was the most commonly used agent in 81.3% of patients. Over the periods of time, commonly used radiotherapy (RT) techniques were changed from 2-dimensional RT (1988–1993, 92.5%) to 3-dimensional RT (2003–2011, 35.5%) or intensity-modulated RT (IMRT; 2003–2011, 56.5%). Median RT doses given to primary tumors, high-risk lymphatics, and low-risk lymphatics were 70.0 Gy, 58.1 Gy, and 48.0 Gy, respectively. Adoption of IMRT increased the dose per fraction and escalated total radiation dose. Conclusion: Assessment of the patterns of care for NPC patients in South Korea demonstrated that management for NPC including diagnostic imaging, treatment regimen, RT techniques and dose schedule, advanced in accordance with the international guidelines.

Coronary Event Analysis in Breast Cancer Patients Who Received Breast-Conserving Surgery and Post-Operative Radiotherapy: a Korean Nationwide Cohort Study

성수윤,이종훈,양기화,서윤예,강미연 한국유방암학회 2020 Journal of breast cancer Vol.23 No.3

Purpose: Adjuvant breast radiotherapy (RT) following breast-conserving surgery (BCS) has been reported to induce cardiac toxicity in breast cancer patients. We investigated the incidence and risk factors of major coronary events after breast RT using Korean nationwide Health Insurance Review and Assessment data. Methods: Using data from a nationwide quality assessment of breast cancer treatment, we identified 3,251 patients who received breast RT after BCS in 2013. Data about major coronary events were additionally collected from national claims data. We defined major coronary events according to the International Classification of Diseases, 10th revision (ICD-10) codes I20-25. Results: A total of 172 major coronary events (5.3%) occurred among 3,251 breast cancer patients. The 1-year, 2-year, and 3-year coronary event-free survival rates were 98.1%, 96.4% and 95.2%, respectively. Patients with underlying diabetes mellitus (88.6% vs. 95.7%, p < 0.001), high blood pressure (HBP) (89.4% vs. 96.3%, p < 0.001), and cerebrovascular accident (CVA) (84.0% vs. 95.4%, p < 0.001) showed significantly worse 3-year coronary event-free survival rates than those without comorbidities. Multivariate analysis revealed that patient age (p < 0.001), HBP (p < 0.001), CVA (p = 0.025), adjuvant hormonal therapy (p = 0.034), and Herceptin therapy (p < 0.001) were significantly associated with major coronary events in breast cancer patients. Conclusion: The incidence of major coronary events after breast RT may be higher in breast-cancer patients with risk factors such as underlying HBP or CVA, or who were in receipt of adjuvant Herceptin therapy. Heart-sparing RT techniques or intensity-modulated RT should be considered for breast-cancer patients with risk factors for heart toxicity.

Displacement of Surgical Clips during Postoperative Radiotherapy in Breast Cancer Patients Who Received Breast-Conserving Surgery

성수윤,이주환,이종훈,김성환,전예원,곽유강,이시원,서영진 한국유방암학회 2016 Journal of breast cancer Vol.19 No.4

Purpose: Surgical clips are used as a target for postoperative breast radiotherapy, and displacement of surgical clips would result in inaccurate delivery of radiation. We investigated the displacement range of surgical clips in the breast during postoperative radiotherapy following breast-conserving surgery. Methods: A total of 178 patients who received breast-conserving surgery and postoperative radiation of 59.4 Gy in 33 fractions to the involved breast for 6.5 weeks were included. Surgical clips were used to mark the lumpectomy cavity during breast-conserving surgery. Patients undertook planning computed tomography (CT) scan for whole breast irradiation. Five weeks after beginning radiation, when the irradiation dose was 45 Gy, planning CT scan was performed again for a boost radiotherapy plan in all patients. The surgical clips were defined in both CT images and compared in lateromedial (X), anteroposterior (Y), superoinferior (Z), and three-dimensional directions. Results: The 90th percentile of displacement of surgical clips was 5.31 mm (range, 0.0– 22.2 mm) in the lateromedial direction, 7.1 mm (range, 0.0–14.2 mm) in the anteroposterior direction, and 6.0 mm (range, 0.0– 10.0 mm) in the superoinferior direction. The 90th percentile of three-dimensional displacement distance was 9.8 mm (range, 0.0–28.2 mm). On the multivariate analysis, seroma ≥15 mL was the only independent factor associated with the displacement of surgical clips. In patients with seroma ≥15 mL, the 90th percentile of displacement of surgical clips was 15.1 mm in the lateromedial direction, 12.7 mm in the anteroposterior direction, 10.0 mm in the superoinferior direction, and 21.8 mm in the three-dimensional distance. Conclusion: A target volume expansion of 10 mm from surgical clips may be sufficient to compensate for the displacement of clips during postoperative radiotherapy after breast-conserving surgery. For patients who had a seroma, a replanning CT scan for a boost radiation should be considered to ensure exact postoperative radiotherapy in breast cancer.

Quality Assessment and Trend for Breast Cancer Treatment Practice Across South Korea Based on Nationwide Analysis of Korean Health Insurance Data During 2013-2017

최규혜,성수윤,이시원,전예원,김성환,이종훈 대한암학회 2023 Cancer Research and Treatment Vol.55 No.2

Purpose Quality assessment of breast cancer treatment in South Korea showed the upward standardization of the grade since 2013, but treatment disparities still have existed. This study analyzed the 5-year trend between 2013 and 2017 in the assessment of breast cancer treatment practice using the Korean health insurance data. Materials and Methods All the medical records including surgery, chemotherapy, and radiotherapy for 7,354 patients a year on average were evaluated. Twenty indices consisted of one structural, 17 process-related, and two result-related factors. We calculated the coefficient of variation (CV) annually to determine the variation in adherence rate of evaluation indices according to the type of institution (advanced vs. general hospital vs. clinic). Results Based on the initial assessment in 2013, 10 out of 20 indicators showed significant variation among the types of institutions with a CV of less than 0.1%. Six of them had a CV decline of less than 0.1%. The CV was still 0.1% or higher in the four indicators, including the composition of professional staff, the implementation of target therapy, the average length of hospital stay, and the hospitalization cost. Regarding the first grade of assessment, there was a statistically significant relationship between the institution type (p=0.029) and region (metropolitan vs. province, p < 0.001). Conclusion There were disparities in the structural and systemic treatment factors depending on the institutional type. The quality improvement of the regional institutions and multidisciplinary experts for breast cancer is necessary.

TFF1 유전자의 C/T 다형성과 위암 민감성과의 연관성

맹은재,송재휘,성수윤,박원상,Cao Zhang 대한위암학회 2008 Journal of gastric cancer Vol.8 No.3

목적: TFF1 유전자의 -2bp에 위치하고 있는 단일염기다형 성의 유전자형 및 대립형질 빈도와 H. pylori 감염 및 위암 발생 민감성과의 연관성을 조사하고자 하였다. 대상 및 방법: 2000년 1월부터 2003년 12월까지 위 샘암종 으로 근치적 수술을 시행 받은 167명과 정상 건강인 299명 의 DNA를 이용하였다. TFF1 유전자의 단일염기다형성의 유전자형은 중합효소연쇄반응 후 제한효소를 이용한 제한 분절길이다형성과 single strand conformation polymorphism의 방법으로 분석하였다. 또한, H. pylori 감염은 Giemsa 염색으 로 조사하였다. 결과: 정상 건강인의 TFF1 단일염기다형성에 대한 유전자 형 및 대립형질의 빈도를 위암 환자군과 비교한 결과 통 계적으로 의의가 없었다(P=0.715 & P=0.595). 위암 환자군을 성별로 나누어 정상 건강인과 비교한 경우에도 통계적 의 의를 발견할 수 없었다. 또한, 위암 조직의 조직학적 소견 및 환자 연령과 TFF1 단일염기다형성의 유전자형 및 대립 형질 빈도를 조사한 결과, 위암 조직의 조직학적 소견 및 연령은 TFF1 유전자 단일염기다형성과 무관하였다(P=0.088 & P=0.551). 한편, H. pylori 감염은 모두 39예에서 관찰되었 는데 TFF1 유전자형과는 통계적으로 연관성이 없었다(P= 0.7200). 결론: TFF1 유전자의 -2bp에 존재하는 단일염기다형성은 TFF1 단백의 합성에 큰 영향이 없으며 H. pylori 감염과 위 암의 발생과는 무관하다는 것을 의미한다.

TFF1 유전자의 C/T 다형성과 위암 민감성과의 연관성

맹은재,송재휘,성수윤,박원상,Maeng, Eun Jae,Song, Jae Hwi,Sung, Soo Yoon,Cao, Zhang,Park, Won Sang 대한위암학회 2008 대한위암학회지 Vol.8 No.3

목적: TFF1 유전자의 -2bp에 위치하고 있는 단일염기다형성의 유전자형 및 대립형질 빈도와 H. pylori 감염 및 위암발생 민감성과의 연관성을 조사하고자 하였다. 대상 및 방법: 2000년 1월부터 2003년 12월까지 위 샘암종으로 근치적 수술을 시행 받은 167명과 정상 건강인 299명의 DNA를 이용하였다. TFF1 유전자의 단일염기다형성의 유전자형은 중합효소연쇄반응 후 제한효소를 이용한 제한 분절길이다형성과 single strand conformation polymorphism의 방법으로 분석하였다. 또한, H. pylori 감염은 Giemsa 염색으로 조사하였다. 결과: 정상 건강인의 TFF1 단일염기다형성에 대한 유전자형 및 대립형질의 빈도를 위암 환자군과 비교한 결과 통계적으로 의의가 없었다(P=0.715 & P=0.595). 위암 환자군을 성별로 나누어 정상 건강인과 비교한 경우에도 통계적 의의를 발견할 수 없었다. 또한, 위암 조직의 조직학적 소견 및 환자 연령과 TFF1 단일염기다형성의 유전자형 및 대립형질 빈도를 조사한 결과, 위암 조직의 조직학적 소견 및 연령은 TFF1 유전자 단일염기다형성과 무관하였다(P=0.088 & P=0.551). 한편, H. pylori 감염은 모두 39예에서 관찰되었는데 TFF1 유전자형과는 통계적으로 연관성이 없었다(P=0.7200). 결론: TFF1 유전자의 -2bp에 존재하는 단일염기다형성은 TFF1 단백의 합성에 큰 영향이 없으며 H. pylori 감염과 위암의 발생과는 무관하다는 것을 의미한다. Purpose: This study investigated whether a single nucleotide polymorphism (SNP) located at position -2 in the Kozak sequence of the TFF1 gene is associated with H. pylori infection and the development of gastric cancer in Koreans. Materials and Methods: We enrolled 167 patients with gastric cancer from January 2000 to December 2003 and also 299 healthy controls during the same period. The genotype of the TFF1 SNP was analyzed by polymerase chain reaction-restriction fragment length polymorphism and single strand conformation polymorphism. We also examined the H. pylori infection by Giemsa staining. Results: No significant difference in the allele or the TFF1 SNP genotype frequency was observed between the patients with gastric cancer and the control subjects (P=0.595 and P=0.715, respectively). When stratified by the histological subtype of gastric cancer and the age of the patients, the risk was not statistically significant between the two study groups (P=0.088 and P=0.551, respectively). H. pylori infection was detected in 39 cases and it was not associated with the TFF1 genotype. Conclusion: These findings suggest that this TFF1 gene polymorphism is not associated with H. pylori infection and gastric cancer in Koreans and so it doesn't contribute to the susceptibility to gastric cancer in Koreans.

SUVmax Predicts Disease Progression after Stereotactic Ablative Radiotherapy in Stage I Non-small Cell Lung Cancer

곽유강,박희현,최규혜,박은영,성수윤,이시원,홍지현,이효춘,유이령,김연실 대한암학회 2020 Cancer Research and Treatment Vol.52 No.1

Purpose Fluorodeoxyglucose positron emission tomography–computed tomography (PET-CT) is gaining evidence as a predictive factor in non-small cell lung cancer (NSCLC). Stereotactic ablative radiotherapy (SABR) is the standard treatment in early-stage NSCLC when a patient is unsuitable for surgery. We performed a study to assess the prognostic clinical significance of PET-CT after SABR in early-stage NSCLC. Materials and Methods Seventy-six patients with stage I NSCLC treated with SABR were investigated. Total radiation dose ranged from 36 to 63 Gy in three to eight fractions depending on tumor location and size. Respiratory motion control was implemented at simulation and during treatment. PETCT prior to SABR was performed in 66 patients (86.8%). Results Median follow-up time was 32 months (range, 5 to 142 months). Local control rate at 1, 2, and 5 years were 95.9%, 92.8%, and 86.7%, respectively. Overall survival (OS) at 1, 2, and 5 years were 91.0%, 71.3%, and 52.1% respectively. Cause-specific survival at 1, 2, and 5 years were 98.6%, 93.1%, and 84.3% respectively. Tumor size and pre-SABR maximal standardized uptake value (SUVmax) demonstrated statistical significance in the Kaplan-Meier survival analyses with log-rank test. In multivariate analyses pre-SABR SUVmax remained statistically significant in correlation to OS (p=0.024; hazard ratio [HR], 3.2; 95% confidence interval [CI], 1.2 to 8.8) and with marginal significance in regards to regional progressionfree survival (p=0.059; HR, 32.5; 95% CI, 2.6 to 402.5). Conclusion Pre-SABR SUVmax demonstrated a predictive power in statistical analyses. Tumors with SUVmax above 6 at diagnosis were associated with inferior outcomes.