간세포암 환자에서 doxorubicin과 cisplatin 복합 화학 요법에 대한 제 2상 임상연구

강보리 ( Bo Lee Kang ),유영진 ( Young Jin Yuh ),김성록 ( Sung Rok Kim ),송홍석 ( Hong Suk Song ),이순남 ( Soon Nam Lee ),신동복 ( Dong Bok Shin ),안명주 ( Myung Ju Ahn ),박연희 ( Yeon Hee Park ) 대한내과학회 2005 대한내과학회지 Vol.68 No.2

목적 : 국소요법이 불가능한 진행성 간세포암 환자를 대상으로 doxorubicin과 cisplatin 복합화학요법의 효과와 안전성을 알아보기 위하여 전향적 2상 연구를 시행하였다. 방법 : 진행성 간세포암으로 근치적 국소요법이 불가능한 환자를 대상으로 연구를 진행하였다. 치료는 doxorubicin 50 ㎎/㎡과 cisplatin 100 ㎎/㎡을 각각 제 1일에 정주하였으며, 이 치료를 매 3주마다 반복하였다. 그러나 치료 독성으로 인한 사망 환자가 발 Background : There still is no standard treatment for the patients with advanced hepatocellular carcinoma. Both doxorubicin and cisplatin have modest activity with the response rates less than 20%, but have synergistic effect. This prospective phase II tr

전이성 위암환자에서 2 선 요법으로서의 leucovorin 과 5 - FU 혼합지속주입요법( LF 지속요법 ) 의 효과

김현지(Hyun Jee Kim),남영진(Young Jin Nam),유영진(Young Jin Yuh),김성록(Sung Rok Kim) 대한내과학회 2002 대한내과학회지 Vol.63 No.2

목적: 5-FU 급속 주입을 근간으로 하는 항암화학요법에 반응하지 않은 진행성 위암 환자에서 5-FU와 leucovorin의 혼합지속정주 요법(LF)의 효과와 안전성을 알아보고자 이 연구를 시행하였다. 방법: 대상환자는 조직학적으로 위암으로 진단되어, 5-FU 급속 주입 요법에 반응이 없으며, 활동도가 ECOG 기준으로 3 이하인 환자로 하였다. LF복합요법은 leucovorin 50 mg/m2/day와 5-FU 1,000 mg/m2/day를 혼합하여 4일간 지속 정주하는 것으로 하였으며, 이 치료는 3주 간격으로 반복 시행하였다. 결과: 1996년 3월부터 2001년 7월까지 모두 25례의 환자가 등록되었으며, 연령 분포는 37∼74세(중앙값 58세), 남녀 비는 15:10이었다. 완전 관해는 없었고, 부분 관해 1예, 불변 9예, 진행 15예로 반응율은 4%(95% 신뢰구간: 0∼11.8%)이었다. 진행까지의 기간은 25+-111+일로 중앙값은 73일이었고, 생존 기간은 20∼902일로 중앙값은 140일이었다. 총 92회의 항암화학요법 중 WHO 기준으로 3도 이상의 혈액학적 부작용은 백혈구 감소증이 7회(7.6%), 과립구 감소증이 11회(12.0%), 혈소판 감소증이 13회(14.1%)에서 나타났다. 비혈액학적 부작용으로는 3도 이상의 오심 및 구토가 5예(5.4%), 3도 이상의 점막염이 12예(13.1%)에서 나타났으나, 3도 이상의 설사를 보인 경우는 없었다. 결론: 이상에서 위암환자에서 2선 요법으로서의 LF지속요법은 그 부작용은 감내할만 하였으나, 효과는 높지 않아 보다 효과적인 치료법의 개발이 시급하다고 사료된다. Background: Most patients with gastric cancer have metastatic disease at first diagnosis and need palliative chemotherapy. Unfortunately, the response duration of the first line chemotherapy is usually short and most patients need the second line therapy during their disease process. The action mechanism of continuous infusion of 5-FU is different from bolus 5-FU and we can expect that among patients who failed on bolus 5-FU, some patients will achieve response to infusional 5-FU. So, we planned to evaluate the efficacy and safety of leucovorin and infusional 5-FU as a second line regimen for the metastatic gastric cancer refractory to regimen containing bolus 5-FU. Methods: Patients with recurred or metastatic gastric cancer unresponsive to regimen containing bolus 5-FU were entered into this study. The mixture of 5-FU 1,000 mg/m2/day and leucovorin 50 mg/m2/day was infused continuously for four days and this treatment was repeated by every three weeks. Results: From March, 1996 to July 2001, 25 patients were enrolled in this study. One patient showed a partial remission, 9 stable disease and 15 progressive disease. The overall response rate was 4%. The median time to progression was 73 days and the median duration of overall survival was 140 days. Among total of 92 cycle chemotherapy, leukopenia, granulocytopenia and thrombocytopena of WHO grade 3 or 4 were observed in 7.6%, 12.0% and 14.1%, respectively. Stomatitis, nausea or vomiting of WHO grade 3 or 4 were 13.1%, 5.4%, respectively. Neutropenic infection occurred in two patients. Conclusion: The LF regimen was well tolerated with minimal toxicities and showed low effect as the second line chemotherapy for the patients with gastric cancer. (Korean J Med 63:203-208, 2002)

재발성 또는 난치성 소세포폐암에 대한 topotecan, vincristine 복합요법

안효승 ( Hyo Seung Ahn ),원혜진 ( Hye Jin Won ),이효락 ( Hyo Rac Lee ),유영진 ( Young Jin Yuh ),김성록 ( Sung Rok Kim ) 대한내과학회 2007 대한내과학회지 Vol.72 No.6

목적: 항암화학요법에 불응하거나 또는 관해 후 재발된 소세포폐암 환자를 대상으로 topotecan과 vincristine 복합화학요법의 효과와 안전성에 대하여 알아보기 위하여 연구를 시행하였다. 방법: 조직학적으로 증명된 소세포폐암 환자로 이전 항암화학요법에 불응하거나 관해 후 재발된 환자를 대상으로 연구를 진행하였다. 치료는 topotecan 1.5 mg/m2/day를 3일간, vincristine 1.5 mg/m2 (maximum 2 mg)를 홀수 주기에는 2일간, 짝수 주기에는 1일간 투여하였다. 이 치료는 감내할 수 없는 독성이 발생하거나 병변이 진행될 때까지 3주 간격으로 반복하였다. 결과: 총 19예가 이 연구에 등록 되었다. 등록된 환자 연령의 중앙값은 63세이었다. 평가 가능한 19예 중 3예에서 부분관해가 관찰되어 반응률은 15.8% (95% 신뢰구간: 0~32.5%)이었다. 생존기간의 중앙값은 199일이었고, 진행까지의 기간 중앙값은 51일이었다. 전체 52회의 치료 중 NCI-CTC 3도 이상의 백혈구감소가 25.0%, 호중구감소가 11.5%에서 나타났다. NCI-CTC 2도의 신경독성이 15.4%에서 관찰되었으나 치료와 연관된 사망은 관찰되지 않았다. 결론: 난치성 또는 재발성 소세포폐암에서 topotecan과 vincristine 복합화학요법은 효과가 있었고 안전하였다. 그러나 topotecan 단독요법과의 비교연구가 필요하다고 생각된다. Background: Small cell lung cancer (SCLC) is a chemotherapy-sensitive tumor. However, the duration of response is usually short and most patients experience relapses. Topotecan is commonly used for treatment of these patients. Nevertheless, the response rate of topotecan as a single regimen is only about 20% and the resulting severe myelosuppression is troublesome. Vincristine is also an active agent, and it does not compromise the marrow function. In this background, we evaluated the efficacy and toxicities of topotecan and vincristine combination chemotherapy. Methods: Patients with pathologically confirmed SCLC refractory to or recurrent after platinum-based chemotherapy were eligible for this study. The treatment regimen was as follows; topotecan 1.5 mg/m2/day IV bolus on day 1, 2 and 3 and vincristine 1.5 mg/m2 (maximum 2 mg on day 1 (on every cycle)) and day 2 (on odd cycles only). This regimen was repeated every 3 weeks. The efficacy was evaluated in terms of response rate, time to progression and overall survival duration. The toxicities were assessed according to NCI-CTC version 3.0. Results: A total of 19 patients were entered into this study. The median age was 63 years (range 43-85 years). Partial response was obtained for 3 patients (response rate 15.8%, 95% CI: 0-32.5%). The median time to progression and survival duration was 51 days and 199 days, respectively. For a total of 52 cycles of treatment, grade 3 or 4 neutropenia and thrombocytopenia were observed in 25.0% and 11.5% of the patients, respectively. Grade 2 neurotoxicities were observed in 15.4% of the patients. There was no treatment-related mortality. Conclusions: The topotecan and vincritine combination is active and safe for patients with recurrence or refractory SCLC. However, the benefit of adding vincristine to topotecan needs to be confirmed in further studies. (Korean J Med 72:632-638, 2007)

증 례 : 혈청 단클론단백 상승 없이 골수외 병변이 진행한 다발골수종

김설희 ( Sul Hee Kim ),지영근 ( Young Geun Jee ),여욱현 ( Wook Hyun Yeo ),손병석 ( Byeong Seok Sohn ),김성록 ( Sung Rok Kim ),김현정 ( Hyun Jung Kim ),유영진 ( Young Jin Yuh ) 대한내과학회 2016 대한내과학회지 Vol.90 No.1

다발골수종의 치료 효과 판정 및 관해 이후 추적관찰에 이용되는 단클론단백은 골수외형질세포종 부위의 재발 및 악화를 정확하게 반영하지 못할 개연성이 있다. 최근 다발골수종의 치료에 bortezomib이 도입되어 치료 반응 및 생존율의 개선이 있었으나, 골수외형질세포종을 함께 보이는 다발골수종 환자에서 치료 반응에 대한 보고는 적어 이에 대한연구가 필요해 보인다. 저자들은 VMP 항암화학 치료 이후 부분 관해를 보였으나, 골수외형질세포종의 악화에도 불구하고 혈청 단클론단백 상승이 관찰되지 않았던 환자를 경험하였고, 이후 이차 항암화학요법으로 VAD를 진행하면서 안정적인 경과를 보이는 증례를 경험하여 보고하는 바이다. A 76 year-old female who was diagnosed with multiple myeloma (IgG, lambda) had received bortezomib, melphalan and prednisolone as first-line treatment. After completing six cycles of chemotherapy, her serum monoclonal protein level decreased from 7.28 g/dL to 0.65 g/dL, indicating a partial response. However, at the next scheduled visit she complained of slowly progressing dyspnea. On chest X-ray, newly developed pleural effusion was found, and rapidly progressing extramedullary plasmacytoma was detected in the anterior mediastinum on chest computerized tomography. However, there was no change in her serum monoclonal protein level. In Korea, extramedullary involvement is encountered in 5% of patients with multiple myeloma. However, evaluation of treatment response using solely the serum monoclonal protein level may not accurately reflect disease status in these patients. (Korean J Med 2016;90:55-58)

담도 : 진행 췌장암의 젬시타빈, 5-FU, 시스플라틴 복합화학요법에 관한 2상 연구

최상봉 ( Sang Bong Choi ),이활연 ( Hwal Youn Lee ),유영진 ( Young Jin Yuh ),김성록 ( Sung Rok Kim ) 대한소화기학회 2005 대한소화기학회지 Vol.45 No.5

Background/Aims: Gemcitabine has been the standard regimen for advanced pancreatic cancer, but the effect on the response rate and survival is still disappointing, leading to many trials of combination chemotherapy. 5-FU and cisplatin were combined with g

울혈성 간병증으로 발현한 심장내 흉선암종 1예

김현정 ( Hyun Jung Kim ),장기준 ( Ki Jun Chang ),김민희 ( Min Hee Kim ),유영진 ( Young Jin Yuh ),황진태 ( Jin Tae Hwang ),장효정 ( Hyo Jeong Chang ),유성인 ( Sung In Yu ) 대한내과학회 2012 대한내과학회지 Vol.83 No.5

Thymic carcinoma is a rare but aggressive epithelial neoplasm with a strong propensity for early local invasion and widespread metastasis. It is common for thymic carcinomas to invade the lungs, pericardium, and great vessels. However, invasion of thymic carcinoma into the right atrium, right ventricle, mediastinum, and superior vena cava is very rare. There have been sporadic reports on intracardiac thymic carcinomas globally and only one case report in South Korea to date. We herein report a case of intracardiac thymic carcinoma presenting as right-sided heart failure with congestive hepatopathy. (Korean J Med 2012;83:668-673)

악성 종양 환자에 사용된 중심정맥카테터의 안정성에 대한 임상 연구

김형건(Hyung Gun Kim),손태용(Tae Yong Son),유영진(Young Jin Yuh),이상구(Sang Goo Lee),천은미(Eun Mee Cheon),송재관(Jae Kwan Song),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),조재일(Jae Ill Zo),심영목(Young Mog Shim) 대한내과학회 1995 대한내과학회지 Vol.49 No.3

N/A Objectives: As the central venous catheters (CVCs) have been inserted frequent,ly in patients with advanced malignant disease, it becomes necessary to investigate the safety and the complications of the CVCs and to search for the ways to improve them. Methods: The complications related with CVCs and the durations of function of them were analyzed via retrospective review of medical records of 87 patients to whom CVCs were inserted for the treatment of cancer at the departrnent. of internal medicine, Korea Cancer Center Hospital. Results: Acute complications of catheter inser1ion were pneumothorax and pain at the insertion site. Infection, thrombosis and mechanical teraring were the major long term complications. 32(36.8%) catheters were removed by development of complications. Among 87 evaluable cases, CVCs could be maintained with function for 4+to 878+days (median 401 days). There were significantly less infection (40 % vs. 72% ) and longer duration of function(median not. reached vs. 151 days) with Chemoport than with Hickman catheter(p=0.002). Conclusion. CVCs could be inserted and maintained safely for considerahle period of time in patients with advanced malignancy. Further effort should be given to prevent catheter-related complications such as infection and thrombosis and to provide the long term patency.

증례 : 혈액종양 ; 일차성 중추신경계 림프종의 경막 내 Rituximab 치료 2예

장용호 ( Yong Ho Jang ),하태환 ( Tae Hwan Ha ),김덕희 ( Deok Hee Kim ),김성록 ( Sung Rok Kim ),유영진 ( Young Jin Yuh ),손병석 ( Byeong Seok Sohn ),이혜란 ( Hye Ran Lee ) 대한내과학회 2014 대한내과학회지 Vol.87 No.2

일차성 중추 신경계 림프종(PCNSL)은 완전 관해 이후에도 재발이 흔하고 대부분 뇌연수막 전이에 의해 불량한 예후를 나타내는데 rituximab 경막 내 투여를 통해 PCNSL의 안정 병변 기간 연장 및 부작용은 거의 나타나지 않은 임상증례 2례를 경험하여 보고하며 rituximab 경막 내 투여에 대한 임상 시험 및 연구가 좀 더 필요할 수 있겠다. Primary central nervous system lymphoma (PCNSL) is an aggressive non-Hodgkin`s lymphoma (NHL), usually composed of diffuse large B-cells. Although rituximab is known for its curative effect on B-cell NHL, data on the use of intrathecal rituximab for PCNSL are limited. In this report, we present two patients showing relapsed PCNSL with lymphomatous meningitis. Both patients were refractory to conventional methotrexate-based intrathecal chemotherapy. However, after intrathecal rituximab with or without conventional intrathecal chemotherapy, both patients showed stable disease on magnetic resonance brain imaging and cerebrospinal fluid analysis. There were no serious adverse events during each of 3 and 6 cycles with intrathecal rituximab immunotherapy. (Korean J Med 2014;87:224-228)

종양표지자로서 Lactate dehydrogenase의 임상적 의의

이현경(Hyun Kyung Lee),박연희(Yoeon Hee Park),남궁준(Nam Kook Cho),조남국(Nam Kook Cho),유영진(Young Jin Yuh),김성록(Sung Rok Kim) 대한내과학회 2000 대한내과학회지 Vol.58 No.5

N/A Background : As a tumor marker, lactate dehydrogenase is widely used as a prognostic factor in malignant lymphomas and a therapeutic monitor in ovarian dysgerminoma. But in other tumors, the clinical role of lactate dehydrogenase is not clear yet. To investigate the role of LD as a tumor marker, we analyzed patients with various cancers and high LD level. Methods : The serum LD level was assayed in the cancer patients who visited our hospital. For the patients with high LD level, isoenzyme was also assayed. The response of chemotherapy was classified according to the WHO criteria into remission, which covers complete and partial remission, stable disease and progressive disease. The relationship between the tumor response and the LD response was examined in terms of sensitivity, specificity and positive predictive value. Results : A total of 100 cancer patients were found to have high LD level; among them, 76 patients underwent chemotherapy. There were 38 patients with LD increased and 38 patients with LD decreased after chemotherapy. No patient was in remission, 6 patients in stable disease, and 32 patients in progressive disease among 38 patients with increased LD level; 18 patients in remission, 10 patients in stable disease, and 10 patients in progressive disease among 38 patients with decreased LD level.The sensitivity of LD increase in the patients with tumor progression is 76.2%, the specificity 73.7%, and the positive predictive value 84.2%(71.4%, 25.0% and 76.9% respectively in stomach cancer patients). The sensitivity of LD decrease in the responsive patients is 100%, the specificity 65.5% and the positive predictive value 47.4%.(100%, 64.7% and 14.3% in stomach cancer patients respectively). The LD isoenzyme pattern was not specific in this study. Conclusion : Serum LD measurement may be helpful in monitoring tumor response, especially for stomach cancer, after chemotherapy.(Korean J Med 58:575-581, 2000)

증례 : 혈액종양 ; 재발한 무거대핵세포혈소판감소증의 Cyclosporine 치료

배수야 ( Soo Ya Bae ),한태희 ( Tae Hee Han ),손병석 ( Byeong Seok Sohn ),오현호 ( Hyun Ho Oh ),최성진 ( Seong Jin Choi ),박문 ( Moon Park ),유영진 ( Young Jin Yuh ) 대한내과학회 2016 대한내과학회지 Vol.90 No.3

Acquired amegakaryocytic thrombocytopenia (AAMT) is an unusual disease characterized by severe thrombocytopenia resulting from a marked decrease in bone marrow megakaryocytes. Various pathogenic mechanisms have been suggested, and several treatments have been tried, with varying outcomes. In some case reports, cyclosporine and anti-thymocyte globulin have had good clinical results in the treat of AAMT. There are few reports on the treatment of relapsed AAMT with cyclosporine. We report a patient with relapsed AAMT who was treated successfully with an additional course of cyclosporine. The initial remission was achieved with cyclosporine 4 years earlier and a second remission was induced by cyclosporine. Cyclosporine may be effective for relapsed AAMT that previously responded to cyclosporine. (Korean J Med 2016;90:258-261)