초기 자궁경부암 수술 후 재발 고위험 군에서 보조적 동시 항암화학 방사선치료의 적정성 및 효용성 평가

장혜진 ( Hye Jin Chang ),유희석 ( Hee Sug Ryu ),전미선 ( Mi Sun Chun ),박재선 ( Jae Sun Park ),권종희 ( Jong Hee Kwon ),장기홍 ( Ki Hong Chang ),이정필 ( Jung Pil Lee ) 대한산부인과학회 2004 Obstetrics & Gynecology Science Vol.47 No.6

목적 : 초기 자궁경부암 (병기 IA, IB, IIA) 환자에서 근치적자궁적출술과 골반림프절절제술 후에 치료실패율이 높은 고위험군에게 보조적 동시 항암화학방사선치료 (GOG #109 protocol)에 따른 치료의 효용성 및 적정성을 알아보고자 하였다. 연구 방법 : 1994년 7월부터 2001년 6월까지 아주대학교 병원에서 초기 자궁경부암 (병기 IA2, IB, IIA)으로 진단 받고, 근치적 자궁적출술과 부대동맥 및 골반림프절절제술을 시행한 환자 151명 중에서 부대동맥림프절 전이가 있거나 선행화학요법 혹은 방사선치료를 시행한 환자들을 제외한 144명을 대상으로 연구를 시행하였다. 이들 중에서 암세포의 골반림프절 전이, 절단면 침윤 혹은 자궁방 침윤을 보인 30명을 치료군으로 하여 보조적 동시 항암화학방사선요법 (adjuvant concurrent chemoradiotherapy)을 시행하고 치료 효과와 부작용을 후향적으로 임상 분석하였다. 보조적 치료는 수술 후 2-3주 이내에 항암화학치료를 시작하였고, 매 4주마다 총 4주기를 시행하였고, 제 1일에 cisplatin 70 mg/m^2, 2일에서 5일까지 5-FU (1000 mg/m^2)를 주사하였다. 2주기에서 3주기에 방사선치료는 5주간 병용되었다. 결과 : 수술적 치료를 받은 144명의 환자 중에서 9명 (6.3%)이 재발하였고, 치료군에서 3명 (10%), 대조군에서 6명 (5.3%) 이었다. 5년 생존율은 치료군이 100%, 대조군이 96.8%로 통계적인 차이는 없었고, 5년 재발률 (9.5% vs 6.3%)과 5년 무병생존율 (90.5% vs 93.7%)에서도 치료군과 대조군의 유의한 차이는 보이지 않았다. (p>0.05) 결론 : 본 연구로 근치적자궁적출술 및 림프절절제술 후 치료 실패 고위험 인자를 가진 초기 자궁경부암환자에서 보조적 동시 항암화학방사선치료를 함으로써 5년 재발률 및 5년 무병생존율을 위험인자가 없는 대조군 수준으로 향상 시킬 수 있음을 확인하였다. Objective : This study was undertaken to evaluate the efficacy of postoperative concurrent chemoradiotherapy (CCRT) and to investigate the recurrence and survival rates after adjuvant CCRT in high risk early cervical cancer (stage IA2, IB, IIA) patients who were treated by radical hysterectomy and pelvic lymphadenectomy. Methods : From July 1994 to June 2003, we reviewed the chart of 146 patients who underwent radical abdominal hysterectomy and pelvic lymphadenectomy at Ajou University Hospital for early cervical cancer (stage IA2, IB, IIA). CCRT was performed in 30 patients with high risk factors such as positive pelvic lymph node, positive parametrial involvement, or positive surgical margins. Chemotherapy consisted of cisplatin ( 70 mg/m^2 on day 1) and 5-FU (1000 mg/m^2 on day 2-5) for 4 cycles every 4 weeks beginning 2-3 weeks after operation. Pelvic radiotherapy were started with 2nd and 3rd cycle of chemotherapy concurrently. We compared the recurrence rate and survival rate with 114 patients who received no adjuvant therapy after operation. The mean follow up period was 49 months (24-94 months). Results : Disease recurred in 9 of 144 patients treated with surgery (6.3%). There were recurrences in 3 patients after CCRT (10.0%), and in 6 patients in the control group (5.3%) respectively. The actuarial 5- year overall survival rates for patients with adjuvant CCRT, and with no adjuvant treatment were 100%vs. 96.8% (p>0.05). The recurrence and progression-free survival rates were 9.5% vs 6.3%, 90.5% vs. 93.7% (p>0.05). Conclusion : This study shows good local control and 5 years overall and progreesion free survival rates in the high-risk cervical cancer patients after CCRT which is similar results seen in control group. Our results indicate that adjuvant concurrent chemoradiotherapy seems to be effective in stage IA2-IIA cervical concer patients with high risk.

국소진행된 식도암에서 동시적 항암화학방사선요법의 결과

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.

1998년도 우리나라 유방암 치료 현황 조사

신현수(Hyun Soo Shin),이형식(Hyung Sik Lee),장세경(Sei Kyung Chang),정은지(Eun Ji Chung),김진희( Jin Hee Kim),오윤경(Yoon Kyung Oh),전미선(Mi Sun Chun),허승재(Seung Jae Huh),노준규(John Jun Kyu Loh),서창옥(Chang-Ok Suh) 대한방사선종양학회 2004 Radiation Oncology Journal Vol.22 No.3

목 적: 유방암의 치료에서 표준화된 치료와 방사선치료의 적정 사용을 제고하기 위하여 유방암으로 진단받은 환자 들의 치료 현황을 전국적으로 조사하였다. 특히 유방암의 최신 치료법이고 방사선치료가 필수적인 유방보존술의 시행 빈도를 분석함으로써 우리나라 유방암 치료 수준을 평가하고 개선점을 찾고자 하였다. 대상 및 방법: 1998년 1월부터 1998년 6월까지 유방암으로 최초 진단받은 환자들의 임상 특성과 치료 상황을 조사하였다. 조사대상 병원은 전국 병원을 지역별, 병원군별(3차병원 대 종합병원), 방사선치료시설 유무로 구별하여 표본병원으로 선정하였다. 총 27개 병원에 연구원들이 직접 방문하여 의무기록지와 암등록지를 토대로 조사표를 작성하였다. 결 과: 유방암환자 총 1,048명에 대한 조사결과는 다음과 같다. 연령별 분포는 40대가 33.4%로 가장 많았고 50대가 28.5%, 30대가 22%이었으며 평균연령은 46.4세였다. 수술 후 병기 분포는 AJCC stage II가 58.4%, stage I이 23.5%, stage 0가 6%이었으며 stage II 이하로 조기에 진단되는 비율이 87.8%였다. 전체 환자의 64.8%가 전유방적출술을 받았고 26%의 환자가 유방보존적 수술을 받았으며 4.5%는 항암화학요법을 받은 후 수술을 하였고 4.6%의 환자들은 수술을 시행하지 않았다. AJCC 병기 0기에서는 47.5%, 1기에서는 54.4%, II기에서는 20.3%가 유방보존술을 받았다. 유방보존술 후 방사선치료 시행율은 1기 93.4%, II기 89.9%, III기 33.3%이었고 유방절제술 후 방사선치료는 III기의 45%에서 시행되었다. 지역과 방사선치료시설 유‧무에 따라서 유방보존술 비율이 달랐다. 결 론: 방사선치료의 활용도가 적정 수준에 미흡했는데 이는 의료진의 인식 부족과 주변에 활용가능한 방사선치료 시설의 부족, 경제적 여건 등이 원인으로 생각된다. 유방보존술의 활용도 역시 선진국 수준에는 미치지 못하고 있는데 이는 우리나라 유방암환자들이 유방을 보존하고자 하는 욕구가 적고 유방보존술의 장점에 대한 인식이 부족하기 때문으로 생각된다. 또한 방사선치료 시설이 없는 종합병원에서 유방보존술 시행 빈도가 상대적으로 적은 것을 관찰할 수 있었는데 주변 여건에 따라서 치료 방침이 결정될 수 있음을 알 수 있었다. Purpose: In order to improve the proper use of radiotherapy and breast-conserving treatment (BCT) in the management of breast cancer, current status of breast cancer treatment in Korea was surveyed nationwide and the use of BCT were evaluated. Materials and Methods: Patients characteristics and treatment pattern of 1048 breast cancer patients from 27 institutions diagnosed between January, 1998 and June, 1998 were analyzed. The incidence of receiving BCT was analyzed according to the stage, age, geography, type of hospital, and the availability of radiotherapy facility. Results: Radical mastectomy was performed in 64.8% of total patients and 26% of patients received breastconserving surgery (BCS). The proportions of patients receiving BCT were 47.5% in stage 0, 54.4% in stage I, and 20.3% in stage II. Some of the patients (6.6% of stage I, 10.1% of stage II and 66.7% of stage III) not received radiotherapy after BCS. Only 45% of stage III patients received post-operative radiotherapy after radical mastectomy. The proportion of patients receiving BCT was different according to the geography and availability of radiotherapy facilities. Conclusion: Radiotherapy was not fully used in the management of breast cancer, even in the patients received breast-conserving surgery. The proportion of the patients who received BCT was lower than the report of western countries. To improve the application of proper management of breast cancer, every efforts such as a training of physicians, public education, and improving accessibility of radiotherapy facilities should be done. The factors predicting receipt of BCT were accessibility of radiotherapy facility and geography. Also, periodic survey like current research is warranted.

안구돌출과 요붕증으로 나타난 Langerhans 세포 조직구증에 대한 증례 보고

김선신,박준성,신승수,김효철,전미선,박광화 아주대학교 의과학연구소 1999 아주의학 Vol.4 No.1

The authors experienced a case of Langerhans cell histiocytosis who presented with severe exophtalmus and central diabetes insipidus. A 26 year old female patient had exophthalmus on her left side due to Langerhans cell histiocytosis infiltrating the left petrosal and orbital bone demonstrated by MRI. Water deprivation test revealed diabetes insipidus of central type due to Langerhas cell histiocytosis involving the pituitary gland. Exophtalmus improved significantly with VP-16 150 ㎎/㎡/weekly for 6 weeks, vinblastin 6 ㎎/㎡ weekly for 6 weeks, and prednisolone 40 ㎎/㎡/daily for 4 weeks, while diabetes insipidus was controlled by nasal spray of DDAVP.

암 정보 보급을 위한 홈페이지 개발

김용순,조훈,김조자,전미선,전기홍,박지원 연세대학교 간호정책연구소 2000 간호학탐구 Vol.9 No.1

Purpose : This study developed a homepage program about cancer prevention and management for Internet site. Everyone accessible to this program can get the information about cancer prevention life styles, early detection methods, current and new trends of cancer management methods. Process : a comprehensive information booklet was developed to provide the content of the homepage program. Client/Server method was used to develop a web service database, and an homepage program was developed. Outcomes : 1. Developing a database for cancer information: Based on the PDQ at NCI, information which cancer patients and their family wanted to know were identified and classified as the cause of cancer, early detection, current treatment, and prevention. 2. Revision of the cancer information and test for its validation: new information was included after validation of the content by cancer experts. Behavioral study objectives were developed for all five chapters and provided as the guidelines for evaluation of the content. 3. Designing a homepage framework: an organized simple but attractive framework was designed to make people know where they are and not be boring when they read the homepage information. 4. Produced a homepage program: data analysis and organization, formatting, and text writing were done. Frontpage 98 was used to modified the developed homepage content. 5. Other cancer related web sites was reviewed and 7 valued web sites were selected to link with this web site.

다양한 악성 종양에서의 말초혈액조혈 모세포이식을 통한 고용량 항암치료

김현수,구성현,최소연,조요한,지석배,박준성,박희붕,황성철,유희석,전미선,조용관,김효철 대한조혈모세포이식학회 1996 대한조혈모세포이식학회지 Vol.1 No.1

High dose chemotherapy with autologous stem cell transplantation is a new therapeutic strategy for various malignancy, especially leukemia, lymphoma, breast cancer. Recently, increasing number of trials has been done in solid tumors responsive to conventional chemotherapy using high dose chemotherapy and autologous peripheral blood stem cell transplantation. At Ajou University Hospital, between August 1995 and September 1996, 60 patients received high dose chemotherapy with peripheral blood stem cell transplantation, which in cluded 20 stomach cancers, 16 breast cancers, 15 lymphomas, 4 lung cancers, 3 ovarian cancers, 1 cervix cancer and 1 cancer of unknown primary cancer. Median age of patients was 44 years(range, 19 to 66), and male to female ratio was 0.7:1. The median time to recovery to neutrophil count more than 0.5x109/L was 11 days, and platelet count more than 20x109/L and 50x109/L was 13 and 17 days. With high dose chemotherapy in 41 patients who had relapsed or refractory disease, the complete remission was achieved in 34%(14/41) of patients and overall response rate was 83%(34/41). There was high response rate in spite of various tumor and various status of disease. In with stomach cancer and breast cancer who were given HDCT with adjuvant treatment aim, high dose chemotherapy was well tolerated with minimal non-hematogic toxicity and morbidity. During high dose chemotherapy, there was three transplantation related death, 2 sepsis and 1 veno-occlusive disease. Our experience suggest is well tolerated procedure which confers that high dose chemotherapy with peripheral blood transplantation will be a promising treatment modality for the relapsed and refractory tumors, as well as for patients with high risk for relapse following curative surgical resection.