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김미숙(Mi Sook Kim),류성렬(Seoung Yul Yoo),조철구(Chul Koo Cho),유형준, 김재영(Jae Young Kim),심재원(Jae Won Shim),이춘택(Choon Taek Lee),강윤구(Yoon Koo Kang),김태유(Tae You Kim) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.3
목 적 : 비소세포폐암으로 근치적 방사선치료를 시행받은 환자의 생존율 및 예후인자를 알아보기 위하여 본 연구를 시행하였다. 방 법 : 1992년 1월부터 1993년 12월까지 수술이 불가능한 비소세포폐암으로 원자력병원 치료방사선과에서 40Gy 이상의 근치적 방사선치료를 시행받은 62명의 환자에 대해 후향적으로 치료 결과를 분석하였다. 병기별 분포는 병기 IIIA 14예, 병기 IIIB 48예였다. 방사선치료는 일일 선량 1.8-2.0Gy씩 주 5회로 원발병소에 총 40.0-70.2Gy의 방사선을 조사하였다. 환자중 37예에서 유도 화학요법을 시행하였다. 결 과 : 방사선 치료 후 반응은 완전 관해가 3예, 부분관해가 34예였다. 그외는 무반응이였다. 전체환자의 중앙 생존기간은 11개월이었으며 1년 생존율은 45.0%, 2년 생존율은 14.3%였고 5년 생존율은 6.0%였다. 병기에 따른 1년 생존율 및 중간 생존기간은 각각 병기 IIIA에서 28.6%, 6.5개월, 병기 IIIB에서 50.3%, 13개월이였다. 단변수 분석에서 생존율에 영향을 미치는 예후인자로는 T 병기, 병기, 방사선 치료 직후의 반응이 통계학적으로 의미가 있었고(P<0.05) 연령, 성별, 병리학적 소견, N 병기, 쇄골상 림프절 전이 유무, 화학 요법 시행유무 등은 통계학적으로 의미가 없었다(P>0.1). 그외 치료전 전신상태는 통계학적 의미는 없었지만 생존율에 영향을 주는 경향을 보여주었다(0.05<P<0.1). 다변수 분석상 병리학적 소견, 방사선치료직후의 반응이 의미있는 예후인자였고 T 병기는 통계학적으로 의미는 없었지만 생존율과 관련된 경향을 보여주었다. 추적기간 중 20예에서 원격전이가 관찰되었으며 그중 골전이가 10예, 뇌 전이 3예, 간 전이 3예, 폐전이 1예였고 그외는 다발적으로 발생하였다. 결 론 : 비소세포폐암 환자에서 전통적인 방사선 단독 치료 또는 유도화학요법을 병행하는 것만으로는 장기생존율을 기대하기 어려우며 좀더 적극적인 치료방법의 도입이 필요한다. 저자들의 병원에서는 국소 제어율을 높이기 위하여 방사선치료와 함께 병행화학요법을 시행한후 가능한환자를 대상으로 하여 수술의 적용을 시행하고 있어 그 결과가 주목된다. Purpose : This study was done to evaluate the survival rate and prognostic factors of patients with inoperable non-small cell lung cancer(NSCLC) treated with radiation therapy. Materials and Methods : A retrospective analysis was undertaken of 62 patients who had inoperable NSCLC treated with radiation therapy from January 1991 through December 1993. According to AJCC staging, stage ⅢA was 14 patients and stage ⅢB was 48 patients. Forty Gy to 70.2Gy to the primary tumor site was delivered with daily fractions of 1.8Gy or 2Gy, 5 days per week. Thirty-seven patients received neoadjuvant chemotherapy. Results : Complete, partial and no response to radiation therapy were 3 patients, 34 patients and 25 patients, respectively. The median survival period of all patients was 11 month. One year survival rate, 2 year survival rate and 5 year survival rate for all patients were 45.0%, 14.3%, and 6.0% respectively. The median survival period was 6.5 months in stage ⅢA and 13 months in stage ⅢB. One year survival rates were 28.6% in stage ⅢA and 50.3% in stage ⅢB. In univariaite analysis, prognostic factors affecting survival were T-staging, AJCC staging, and response after radiation therapy (P<0.05). Pretreatment peformance status affected survival but was not statistically significant (0.05<P<0.1). Survival was not affected by age, sex, pathologic finding, N staging, supraclavicular lymph node status, and neoadjuvant chemotherapy (P>0.1). In multivariate analysis, pathology and response to radiation therapy are independently significant prognostic factor. T stage was marginally significant (P=0.0809). During follow -up duration, distant metastasis developed in 20 patients-bone metastasis in 10 patients, brain metastasis in 3 patients, liver mentastasis in 3 patients, contralateral lung metastasis in 1 patients and multiple metastases in 3 patients. Conclusion : Conventional radiotherapy alone or combined chemoradiotherapy are unlikely to achieve long term survival in patients with NSCLC. Surgery after concurrent chemoradiotherapy is tried to improve the local control in our hospital
( Ji Hyun Lee ),( Ki Nam Shim ),( Min Sun Ryu ),( Kwang Jin Woo ),( Jeon Mi Lee ),( Hey Won Yoon ),( Chung Hyun Tae ),( Chang Mo Moon ),( Seoung Eun Kim ),( Hye Kyung Jung ),( Sung Ae Jung ) 대한내과학회 2014 대한내과학회 추계학술대회 Vol.2014 No.1
Primary malignant melanoma of the esophagus is an extremely rare disease which counts for approximately 0.1-0.2% of all esophageal malignancies. It is also a very aggressive disease with a poor prognosis, with its 5yr survival rate ranging from 2.2% - 37.5%. Here we report a case of primary malignant melanoma of the esophagus in a patient whose diagnosis was made relatively early and thus total resection by an Ivor Lewis procedure was possible. A 51 year old Asian woman visited our hospital with epigastric discomfort. The patient had no noticeable medical history. She complained of mild nausea and dyspepsia, but there was no vomiting or weight loss. Physical examination showed no palpable lymph nodes in the head and neck region. There was no tenderness or rebound tenderness on the abdomen. For evaluation of her upper gastrointestinal symptoms, she had the upper endoscopy done. Endoscopy identifi ed a few dark pigmented, polypoid lesions scattered from 22cm to 30cm from the incisor tooth. The lesions were various in size, ranging from 0.2cm to 4-5cm and were fl at, slightly elevated with a irregular base. Biopsy done from two spots showed a well demarcated, slightly elevated and black pigmented tumor. For stage work-up, additional examinations were performed. The chest CT showed no abnormal thickening of the esophagus or any enlarged lymph nodes in the mediastinum. The PET-CT showed a mild focal abnormal uptake in the upper thoracic esophagus. The patient underwent an Ivor-Lewis procedure in June, 2013. Pathologic examination revealed spindle shaped malignant melanocytes with hyperchromated nucleis and black pigmentation. The lesion had invaded the submucosal layer. Thus the patient was diagnosed as esophageal malignant melanoma, stage T2N0M0. She is now under close observation at the out-patient department and has been disease free for 13 months.e