종설 : 진행성 방광암의 항암화학요법

심선진 ( Sun Jin Sym ) 대한내과학회 2015 대한내과학회지 Vol.89 No.5

Metastatic bladder cancer is generally incurable, with a median survival of 14 to 15 months under a modern chemotherapy regimen. Cisplatin-based chemotherapy, including the combination regimens methotrexate-vinblastine-doxorubicin-cisplatin and gemcitabine-cisplatin, are the standard first-line therapy. Despite response rates of 40% to 60% achieved, most patients’ cancers progress after about 8 months. Second-line single agents have only marginal efficacy after cisplatin-based treatment failure, with objective response rates of 5% to 20% and a median progression-free survival of only 3 to 4 months. Moreover, there is little evidence that second-line systemic treatment can substantially improve overall survival or quality of life. Agents targeting growth, survival, and proliferation pathways have been added to cytotoxic therapy with limited added benefits to date. Drugs that modulate the host immune response to cancer-associated antigens, including immunologic checkpoint blockade by antibodies against programmed cell death protein-1 or its ligands, appear promising, and multiple new therapeutic approaches are being pursued. In addition, the receptor tyrosine kinase/Ras pathway and the phosphatidylinositol 3-kinase/protein kinase B/mammalian target of the rapamycin pathway represent potential therapeutic targets for advanced disease, and novel agents are in development. (Korean J Med 2015,89:515-521)

운동유발성 기관지천식으로 오인된 성대 기능 이상 1례

조창래,심선진,박상현,남순열,고윤석,Jo, Chang-Lae,Sym, Sun-Jin,Park, Sang-Hyun,Nam, Soon-Yuhl,Koh, Youn-Suck 대한결핵및호흡기학회 2002 Tuberculosis and Respiratory Diseases Vol.52 No.3

운동유발성 호흡곤란으로 내원하여 운동유발성 천식으로 치료 하였으나 증상 호전이 없어 운동후 기관지 내시경을 시행하여 성대기능이상을 확진하고 치료한 운동유발성 성대기능이상 1례를 문헌고찰과 함께 보고하는 바이다. Vocal cord dysfunction (VCD) is respiratory disorder characterized by paradoxical closure of the vocal cord during the respiratory cycle leading to obstructive airway symptoms. The clinical presentation of VCD is often dramatic and its misdiagnosis as asthma or exercise-induced brochospasm(EIB) has led to inappropriate treatment including high dose corticosteroids, intubation, and tracheostomy. Many VCD patients are asymptomatic at rest and require exercise challenge to elicit symptoms and vocal cord abnormalities. The "gold standard" for the diagnosis of VCD remains laryngoscopy or bronchoscopy with direct visualization of paradoxical adduction of the vocal cords. We report a case of exercise-induced Vocal cord masqueraded as exercise-induced asthma unresponsive to corticosteroids. And bronchodilator confirmed by typical bronchoscopic findings with paradoxial adduction of the vocal cords.

알코올 간경화 환자에서 진단된 일차성 삼출 림프종 1예

최지영 ( Ji Young Choi ),박찬정 ( Chan Jung Park ),류민희 ( Min Hee Ryu ),조재철 ( Jae Cheol Jo ),강병욱 ( Byung Wook Kang ),심선진 ( Sun Jin Sym ),강윤구 ( Yoon Koo Kang ) 대한내과학회 2008 대한내과학회지 Vol.75 No.3

HIV 감염 증거가 없고, HHV-8 음성, EBV 음성, HCV 음성인 일차성 삼출 림프종의 예는 국내 및 국외에서도 매우 드물다. 저자들은 복수를 동반한 간경화로 치료 받다가 갑자기 복수 양이 증가하고 치료에 잘 반응하지 않아 내원한 환자에서 HIV 음성, HHV-8 음성인 일차성 삼출 림프종을 진단하고, 항암화학요법을 시행하여 비교적 좋은 예후를 보인 환자 1예를 경험하였기에 이에 문헌고찰과 함께 보고하는 바이다. Primary effusion lymphoma (PEL) is a distinct clinical and pathologic entity characterized by malignant lymphomatous effusion in body cavities, without a detectable tumor mass. The tumor is usually associated with human herpes virus 8 (HHV-8) infection and occurs principally in immunodeficient patients, most commonly those with human immunodeficiency virus (HIV) infection. We report a rare case of PEL in an elderly patient negative for HHV8 and HIV. The patient had a history of alcoholic liver cirrhosis and presented with abdominal distention. The patient was treated with three courses of chemotherapy. In spite of the generally poor prognosis associated with this disease, our patient is still alive with no malignant lymphomatous cells in the peritoneal cavity 24 months after treatment. (Korean J Med 75:354-357, 2008)

부갑상선암의 고칼슘혈증에 의한 만성 췌장염 1 예

박상현(Sang Hyun Park),김인(In Kim),박이내(I Nae Park),김태협(Tae Hyup Kim),조영환(Young Whan Cho),박덕우(Duk Woo Park),강혜진(Hye Jin Kang),심선진(Sun Jin Sym),신상효(Sang Hyo Shin),조창래(Chang Lae Jo),이상수(Sang Soo Lee),이성구(Sun 대한소화기학회 2002 대한소화기학회지 Vol.39 No.6

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흉선종에 대한 방사선치료 성적 및 예후인자분석

이석호(Seok Ho Lee)ㆍ이규찬(Kyu Chan Lee)ㆍ최진호(Jin-Ho Choi)ㆍ이재익(Jae-Ik Lee)ㆍ심선진(Sun Jin Sym)ㆍ조은경(Eun Kyung Cho) 대한방사선종양학회 2010 Radiation Oncology Journal Vol.28 No.1

목 적: 흉선종환자에서 방사선치료 효과를 평가하고 생존율에 영향을 미치는 예후인자를 파악하기 위하여 후향적 분석을 시행하였다. 대상 및 방법: 2002년 3월부터 2008년 1월까지 본원에서 흉선종으로 진단 받고 방사선치료를 시행 받은 21명의 환자를 분석하였다. 대상환자의 추적관찰 기간은 3∼89개월(중앙값, 37개월)이었다. 남녀 구성비는 4:3이었고 연령분포는 24∼77세(중앙값, 57세)이었다. Masaoka병기는 II기 10명(47.6%), III기 7명(33.3%), IVa기 4명(19.1%)이었다. 전체 21명 중 15명(완전절제[흉선절제술], 14명; 불완전절제, 1명)에서 수술이 시행되었고, 시험적 개흉술 (exploratory thoracotomy), 경부림프절 생검 등을 포함한 조직검사만 시행한 경우는 6명(28.6%)이었다. 병리학적으 로 WHO 세포형 A 1명(4.8%), B1-3 10명(47.6%), C 10명(47.6%)이었다. 방사선치료는 3차원입체조형기법으로 시행하였고 총 방사선선량은 52∼70.2 Gy (중앙값, 54 Gy)이었다. 성별, 연령, 종양의 크기, 병리학적 분류, Masaoka병기, 수술시행 여부, 근무력증 유무 및 방사선량 등에 따른 전체 및 무진행생존율의 차이를 분석하였다.결 과: 전체 환자에서 3년 생존율은 80.7%이었고 3년 무진행생존율은 78.2%이었다. WHO 세포형 C 10명에서 완전절제를 시행한 4명 중 3명(75%)이 생존하였고, 조직검사만 시행한 6명 중 3명(50%)이 생존하였다. 수술을 시행받은 15명 중 방사선조사 범위 내에서의 재발은 없었다. 4명(19.1%)에서 원격전이가 확인되었다. 조직검사만 시행받은 6명의 치료반응은 부분관해 4명(66.6%), 불변 1명(16.7%) 그리고 진행 1명(16.7%)이었다. 치료 후 방사선폐렴이 Radiation Therapy Oncology Group (RTOG) grade 1이 1명(4.8%), grade 2가 2명(9.5%), grade 3과 grade 4가각각 1명(4.8%) 있었다. 단변량 분석상 생존율에 유의한 예후인자는 연령(60세 이상, 58.3%; 60세 미만, 100%;p=0.0194), 병리학적 분류(WHO 세포형 A-B3, 100%; C, 58.3%; p=0.0194), 수술시행여부(시행, 93.3%; 미시행,50%; p=0.0096)이었다.결 론: 수술 후 보조적으로 방사선치료를 시행 받은 15명 모두 방사선치료 조사야 내 재발이 없었고 WHO 세포형C에서 방사선치료 전 수술이 시행된 경우 조직검사만 시행된 경우보다 좋은 성적을 보였다. 이에 저자들은 흉선종환자들을 대상으로 한 방사선치료 경험을 보고하는 바이다. Purpose: This retrospective study was performed to evaluate the efficacy of radiation therapy (RT) and to investigate the prognostic factors for thymoma when treated with RT. Materials and Methods: We analyzed 21 patients with thymoma and also received RT from March 2002 to January 2008. The median follow-up time was 37 months (range, 3 to 89 months). The median patient age was 57 years (range, 24 to 77 years) and the gender ratio of males to females was 4:3. Of the 21 patients, complete resections (trans-sternal thymectomy) and R2 resections were performed in 14 and 1 patient, respectively. A biopsy was performed in 6 patients (28.7%). The WHO cell types in the 21 patients were as follows: 1 patient (4.8%) had type A, 10 patients (47.6%) had type B1-3, and 10 patients (47.6%) had type C. Based on Masaoka staging, 10 patients (47.6%) were stage II, 7 patients (33.3%) were stage III, and 4 patients (19.1%) were stage IVa. Three-dimensional RT was adminstered to the tumor volume (planned target volume), including the anterior mediastinum and the residual disease. The total RT dose ranged from 52.0 to 70.2 Gy (median dose, 54 Gy). Consistent with the WHO criteria, the response rate was only analyzed for the 6 patients who received a biopsy only. The prognostic factors analyzed for an estimate of survival included age, gender, tumor size, tumor pathology, Masaoka stage, the possibility of treatment by performing surgery, the presence of myasthenia gravis, and RT dose. Results: The 3-year overall survival rate (OS) and the progression free survival rate (PFS) were 80.7% and 78.2%, respectively. Among the 10 patients with WHO cell type C, 3 of 4 patients (75%) who underwent a complete resection and 3 of 6 patients (50%) who underwent a biopsy survived. Distant metastasis developed in 4 patients (19.1%). The overall response rate in the 6 patients who received biopsy only were as follows: partial remission in 4 patients (66.7%), stable disease in 1 patient (16.6%), and progressive disease in 1 patient (16.6%). Acute RTOG radiation pneumonitis occurred in 1 patient (4.8%), grade 2 occurred in 2 patients (9.5%), grade 3 occurred in 1 patient (4.8%), and grade 4 occurred in 1 patient (4.8%). A univariate analysis revealed that the significant prognostic factors for OS were age (≥60, 58.3%; <60, 100%; p=0.0194), pathology (WHO cell type A-B3, 100%; C, 58.3%; p=0.0194) and, whether the patient underwent surgery (yes, 93.3%; no, 50%; p=0.0096). Conclusion: For the 15 patients who received surgery, there was no local failure within the radiation field. In patients with WHO cell type C, surgical procedures could have resulted in a more favorable outcome than biopsy alone. We report here our clinical experience in 21 patients with thymoma who were treated by radiation therapy.

거동 가능한 정읍지역 노인층에서 영양 지표의 정상분포

이은주,심선진,김정호,이무송,이영수 대한노인병학회 2002 대한노인병학회지 Vol.6 No.1