E1A/E1B 이중변이형 종양 선택적 살상 아데노바이러스의 개선된 암세포 살상 효과 및 항종양 효과

김재성(Jaesung Kim),최경주(Kyung-Ju Choi),김평환(Pyung-Hwan Kim),김주항(Joo-Hang Kim),손주혁(Joo-Hyuk Sohn),윤채옥(Chae-Ok Yun) 대한미생물학회 2005 Journal of Bacteriology and Virology Vol.35 No.2

비소세포 폐암에 대한 Cisplatinum , VP - 16 복합화학요법의 효과

김영준(Young Joon Kim),김주항(Joo Hang Kim),노재경(Jae Kyung Roh),정현철(Hyun Chul Chung),임세중(Se Jooung Rim),박용준(Yong Joon Park),장준(Joon Chang),김성규(Sung Kyu Kim),이원영(Won Young Lee),김병수(Byung Soo Kim) 대한내과학회 1989 대한내과학회지 Vol.36 No.5

N/A We initiated a phase II trial for non-small cell lung cancer (NSCLC). The therapy consisted of 2 cycles of cisplatin (80 mg/m2) and VP-16 (100 mg/m2) given every 3~4 weeks. After the initial 2 cycles of chemotherapy, the patients received radiotherapy consisting of 5,500~6,500 cGy/5.5~6.5 weeks, and then were on maintenace chemotherapy. The above trial was applied to 57 patients during the period of February 1986 to December 1987. The following results were obtained: 1) There were 3 patients (5.3%) with complete remission, 31 patients (54.4%) with partial remission, 13 patients (22.8%) with stable disease and 10 patients (17. 5%) with progressive disease. The overall response rate was 59.7% and the overall median duration of remission was 38.8 weeks (range, 10~55+weeks). 2) The overall median survival was 38 weeks (range, 13~91+weeks). A median survival of 57 weeks (range, 16~92+ weeks) for responders and 33 weeks (range, 13~55+weeks) for non-responders were achieved and there was a significant difference in duration of survival by response (p < 0.001). 3) The tumor response was significantly correlated with histology (squamous and large cell carcinoma greater than adenocarcinoma) and performance status (p<0.001, respectively), and the survival correlated with the extent of disease, performance status and histology. Combined radiotherapy achieved an increased response rate 4) The side effects were acceptable and reversible. We concluded that cisplation plus VP-16 chemotherapy is a useful regimen in the treatment of non-small cell lung cancer and a prospective randomized trial and long term follow-up is warranted.

국한성병기 소세포폐암 환자에서 조기 혹은 지연 교대 방사선-항암제치료의 전향적 비교연구

이창걸,김주항,김성규,김세규,김귀언,서창옥,Lee Chang Geol,Kim Joo Hang,Kim Sung Kyu,Kim Sei Kyu,Kim Gwi Eon,Suh Chang Ok 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.2

Purpose : A randomized prospective study was conducted to compare the efficacy of early or late alternating schedules of radiotherapy, and carboplatin and ifosfamide chemotherapy in patients with limited-disease small cell lung cancer. Materials and Methods: From August 1993 to August 1996, a total of 44 patients with newly diagnosed, limited-disease small cell lung cancer, PS $H0\~2$, wt $loss<10\%$ were enrolled in a randomized trial which compared early alternating radiotherapy (RT)/chemotherapy (CT) and late alternating RT/CT. The CT regimen included ifosfamide $1.5\;g/m^2$ IV, d1-5 and carboplatin AUC 5/d IV, d2 peformed at 4 week intervals for a total of 6 cycles. RT (54 Gy/30 fr) was started after the first cycle of CT (early arm, N=22) or after the third cycle of CT (late arm, N=22) with a split course of treatment. Results : The pretreatment characteristics between the two arms were well balanced. The response rates in the early $(86\%)$ and late $(85\%)$ arm were similar. The median survival durations and 2-year survival rates were 15 months and $22.7\%$ in the early arm, and 17 months and $14.9\%$ in the late arm (p=0.47 by the log-rank test). The two-year progression free survival rates were $19.1\%$ in the early arm and $19.6\%$ in the late arm (p=0.52 by the log-rank test). Acute grade 3 or 4 hematologic and nonhematologic toxicities were similar between the two arms. Eighteen patients $(82\%)$ completed 6 cycles of CT in the early arm and 17 $(77\%)$ in the late arm. Four patients received less than 45 Gy of RT in the early arm and two in the late arm. There was no significant difference in the failure patterns. The local failure rate was $43\%$ in the early arm and $45\%$ in the late arm. The first site of failure was the brain in $24\%$ of the early arm patients compared to $35\%$ in the late arm (p=0.51). Conclusion : There were no statistical differences in the overall survival rate and the pattern of failure between the early and late alternating RT/CT in patients with limited-disease small cell lung cancer. 목적 : 국한성병기 소세포폐암의 교대 방사선-항암제 병행치료(alternating radio-chemotherapy)에서 방사선치료의 시기의 차이에 따른(조기 혹은 지연) 치료반응률, 생존율, 재발양상, 치료에 따른 부작용을 비교하기 위해 전향적 무작위 비교연구를 시행하였다. 대상 및 방법 : 1993년 8월부터 1996년 8월까지 국한성병기 소세포폐암으로 진단받은 환자들은 연세암센터에서 조기(early arm) 혹은 지연(delayed arm) 교대 방사선-항암제치료군으로 무작위 분류되었다. 총 56명의 환자 중 44명이 비교분석 되었다. 환자들의 특성은 양군간에 차이가 없었다. 교대 방사선-항암제치료는 항암제치료기간 중 방사선 치료를 쉬는 방법으로 교대로 쉬지 않고 치료를 하는 방법으로 조기방사선치료군(N=22)은 항암제 1차치료 후 방사선치료를 시작하였고 지연방사선치료군(N=22)은 3차 항암제치료후 방사선치료를 시작하였다. 방사선치료는 1.8 Gy/fr으로 54 Gy/30 fr을 조사하였고 항암제치료는 Ifosfamide $1.5\;g/m^2$, 정맥주사로 제1일에서 5일까지 투여하였고 Carboplatin AUC (area under the concentration-time eurve) 5/day, 정맥주사로 제 2일째 투여하였으며 4주 간격으로 총6회 시행하였다. 관해율은 방사선치료 종료 한달 뒤 판정하였고 부작용의 빈도와 정도는 RTOG 등급체계를, 생존율은 Kaplan-Meier 법을 사용하였고, 비교는 Log-rank test를 이용하였다. 결과 : 치료에 대한 반응률은 조기군 $86\%$, 지연군 $85\%$로 차이가 없었다. 전체환자의 2년 생존율은 $18.9\%$, 중앙생존기간 15개월이었다. 치료시기별 2년 생존율, 중앙생존기간은 조기군 $22.7\%$와 15개월, 지연군 $14.9\%$와 17개월로 통계적으로 유의한 차이가 없었다(p=0.47). 2년 무재발생존율은 조기군 $19.1\%$, 지연군 $19.6\%$로 차이가 없었다(p=0.52), 국소재발은 조기군 $43\%$, 지연군 $45\%$로 차이가 없었고, 원격전이는 조기군 $81\%$, 지연군 $70\%$으로 재발양상에서도 차이가 없었다. 첫 재발부위로 뇌전이는 조기군 $23\%$, 지연군 $35\%$로 차이가 없었다(p=0.51). 치료에 따른 부작용(RTOG 등급 $3\~4$)도 양군간에 차이가 없었다. 치료에 대한 순응도를 비교해볼 때 항암제치료를 6회 이상 시행받은 환자가 조기군 $82\%$, 지연군 $77\%$, 방사선치료를 45 Gy 이상 받은 환자가 조기군 $82\%$, 지연군 $91\%$로 양군간에 차이가 없었고 양군에서 대부분의 환자들은 치료에 잘 순응하였다. 결론 : 국한성병기 소세포폐암의 교대 방사선-항암제치료시 방사선치료를 조기 혹은 지연하여 시행하였을 때 치료 반응률, 생존율, 재발양상, 부작용에는 차이가 없었으며 교대 방사선-항암제치료에 대한 환자들의 순응도는 높았다.

흉선암종과 동반된 전신홍반루푸스의

이영주 ( Young Joo Lee ),최상태 ( Sang Tae Choi ),김세현 ( Se Hyun Kim ),정경수 ( Kyung Soo Jung ),윤설희 ( Sul Hee Yoon ),정수진 ( Soo Jin Jeung ),이승우 ( Seung Woo Yi ),김주항 ( Joo Hang Kim ) 대한결핵 및 호흡기학회 2007 Tuberculosis and Respiratory Diseases Vol.62 No.1

A thymic carcinoma is a rare malignant neoplasm of the thymus epithelium, which can be distinguished from a benign or invasive thymoma. Contrary to a thymoma, the association of a thymic carcinoma and autoimmune disease is rare, with only a few cases having been reported. Herein, a case of thymic carcinoma diagnosed concurrently with systemic lupus erythematosus (SLE) is reported. A 49 year-old man presented at our clinic with myalgia. He was diagnosed with SLE, based on an oral ulcer, lymphopenia, and positive ANA and anti-Sm antibodies. Incidentally, a routine chest X-ray showed a large mediastinal mass. Pathological examination of the mediastinal mass revealed an undifferentiated thymic carcinoma, of WHO classification type C. Further work-up for staging showed multiple bone and lung metastases. With a palliative aim, he received systemic chemotherapy, but refused further chemotherapy after the 2(nd) course. Currently, the patient has not been followed up since the chemotherapy. (Tuberc Respir Dis 2007; 62: 67-70)

비소세포 폐암의 근치적 절제술 후 예후 인자 분석 및 IIIa 병기에서의 보조 요법의 효과에 대한 연구

조세행,정경영,김주항,김병수,장준,김성규,이원영,Cho, Se Haeng,Chung, Kyung Young,Kim, Joo Hang,Kim, Byung Soo,Chang, Joon,Kim, Sung Kyu,Lee, Won Young 대한결핵및호흡기학회 1996 Tuberculosis and Respiratory Diseases Vol.43 No.5

Background: Surgical resection is the only way to cure non-small cell lung cancer(NSCLC) and the prognosis of NSCLC in patients who undergo a complete resection is largely influenced by the pathologic stage. After surgical resection, recurrences in distant sites is more common than local recurrences. An effective postoperative adjuvant therapy which can prevent recurrences is necessary to improve long tenn survival Although chemotherapy and radiotherapy are still the mainstay in adjuvant therapy, the benefits of such therapies are still controversial. We initiated this retrospective study to evaluate the effects of adjuvant therapies and analyze the prognostic factors for survival after curative resection. Method: From 1990 to 1995, curative resection was perfomled in 282 NSCLC patients with stage I, II, IIIa, Survival analysis of 282 patients was perfonned by Kaplan-Meier method. The prognostic factors, affecting survival of patients were analyzed by Cox regression model. Results: Squamous cell carcinoma was present in 166 patients(59%) ; adenocarcinoma in 86 pmients(30%) ; adenosquamous carcinoma in II parients(3.9%); and large cell undifferentiated carcinoma in 19 patients(7.1%). By TNM staging system, 93 patients were in stage I; 58 patients in stage II ; and 131 patients in stage rna. There were 139 postoperative recurrences which include 28 local and 111 distant failures(20.1% vs 79.9%). The five year survival rate was 50.1% in stage I ; 31.3% in stage II ; and 24.1% in stage IIIa(p <0.0001). The median survival duration was 55 months in stage I ; 27 months in stage II ; and 16 months in stage rna. Among 131 patients with stage rna, the median survival duration was 19 months for 81 patients who received postoperative adjuvant chemotherapy only or cherne-radiotherapy and 14 months for the other 50 patients who received surgery only or surgery with adjuvant radiotherapy(p=0.2982). Among 131 patients with stage IIIa, the median disease free survival duration was 16 months for 21 patients who received postop. adjuvant chemotherapy only and 4 months for 11 patients who received surgery only(p=0.0494). In 131 patients with stage IIIa, 92 cases were in N2 stage. The five year survival rate of the 92 patients with N2 was 25% and their median survival duration was 15 months. The median survival duration in patients with N2 stage was 18 months for those 62 patients who received adjuvant chemotherapy and 14 months for the other 30 patients who did not(p=0.3988). The median survival duration was 16 months for those 66 patients who received irradiation and 14 months for the other 26 patients who did not(p=0.6588). We performed multivariate analysis to identify the factors affecting prognosis after complete surgical resection, using the Cox multiple regression model. Only age(p=0.0093) and the pathologic stage(p<0.0001) were significam prognostic indicators. Conclusion: The age and pathologic stage of the NSCLC parients are the significant prognostic factors in our study. Disease free survival duration was prolonged with statistical significance in patients who received postoperative adjuvant chemotherapy but overall survival duration was not affected according to adjuvant therapy after surgical resection. 연구 배경: 비소세포 폐암의 근치적 치료는 수술적 절제에 주로 의존하고 있고 근치적 수술을 받은 환자의 예후는 수술당시의 병기가 중요하며 진행된 병기의 환자일수록 총 생존기간 및 무병생존기간이 현저하게 단축됨이 많은 연구자에 의해 보고되었다. 또한 근치적 수술 후의 재발은 수술부위보다는 원격 전이에 의한 재발이 많으므로 수술 후의 생존율을 향상시키기 위해서는 원격전이에 의한 재발을 억제할 수 있는 효과적인 수술 후 보조요법이 필요하다. 수술 후의 보조요법은 방사선 치료 및 항암제 투여가 있으나 각각의 치료 방법에 따른 생존율의 보고는 연구자에 따라 상이 한 결과를 보이고 있으며 국내 연구보고는 거의 없는 실정이다. 이에 연구자등은 1990년 1월부터 1995년 12월까지 연세대학교 의과대학 부속 세브란스 병원 흉부외과에서 근치적 절제술을 시행받은 282 명의 비소세포 폐암 환자를 대상으로 수술 후 보조요법의 효과 및 예후인자에 대한 분석을 시행하였다. 방법: 후향적 연구였으며 환자의 생존율은 Kaplan-Meier방법으로 분석하였다. 환자생존에 영향을 미치는 예후인자에 대한 분석은 Cox regression model에 의한 단일 및 다중 변수분석에 준하였다. 결과: 대상 환자의 조직학적 유형으로는 편평상피암이 166예(59%), 선암이 86예(30%), 편평상피선암이 11예(3.9%), 미분화 거대세포암이 19예(7.1%)이었다. 병기는 TNM분류에 따라 l기 93명, II기 58명, IIIa기 131명이었다. 수술 후 재발한 환자는 139명이었고 국소 재발이 28예(20.1%), 원격전이가 111예(79.9)이었다. 병기에 따른 5년 생존율은 I기 50.1%, II기 3 1.3%, IIIa기 24.1%였고(p<0.0001) 병기에 따른 중앙 생존 기간은 I기 55개월, II기 27개월, IIIa기 16개월로 나타났다(p<0.0001). IIIa병기의 환자중 수술 후 항암제만을 투여받거나 항암제와 방사선치료를 받은 환자는 81명이었고 이들의 중앙 생존 기간은 19개월이었으며 수술만을 받거나 수술후 방사선 치료만을 받은 환자는 50명이었는데 이들의 중앙 생존 기간은 14개월로서 양군간에 통계적으로 유의한 차이는 없었다(p=0.2982) 또한 IIIa 병기의 환자중 수술만을 받은 환자는 11명이었고 이들의 중앙무병 생존기간은 4개월이었으며 수술후 항암제 투여만을 받은 환자는 21명이었고 이들의 중앙무병 생존기간은 16개월로 양군간에 통계적으로 의미있는 생존기간의 차이를 보였다(P=0.0494) IIIa 병기중 N2기의 환자는 92명으로 5년 생존율은 25%, 중앙 생존 기간은 15개월이었다. 이들 중 수술 후 항암제 투여군은 62명으로 중앙 생존 기간은 18개월이었고 비투여군은 30명으로 이들의 중앙 생존기간은 14개월이었으며 양군간에 통계적으로 유의한 차이는 없었다(p=0.3988). N2기 환자중 수술후 방사선 치료를 받은 환자는 66명으로 이들의 중앙 생존 기간은 16개월이었고 방사선 치료를 받지 않은 환자는 26명으로 이들의 중앙 생존 기간은 14개월이었다. 양군간에 통계적으로 유의한 생존 기간의 차이는 없었다(p=0.6588). Cox Multiple Regression Model을 이용하여 수술 후 환자의 생존율에 영향을 미치는 예후 인자에 대하여 분석한 결과 환자의 연령(p=0.0093)과 병기(p<0.0001)만이 통계적으로 유의하였다. 결론: 비소세포 폐암 환자의 연령과 병기가 유의한 예후 인자이었으며, 보조 요법에 따른 생존율에 유의한 차이는 없었다. 따라서 수술 후 환자의 생존율을 향상시키기 위해서는 더욱 효과적인 보조요법의 개발이 필요할 것으로 생각된다.

비소세포성 폐암의 예후인자로서 Flow Cytometric Nuclear DNA Content 와 S - phase Fraction 의 의의

강석민(Suck Min Kang),김주항(Joo Hang Kim),김성규(Sung Kyu Kim),이원영(Won Young Lee),정경영(Kyong Young Jung),이이형(Yi Hyeong Lee) 대한내과학회 1997 대한내과학회지 Vol.52 No.4

N/A Objectives: In surgically treated non-small cell lung cancer, patients have a wide difference in prognosis even though they may be in the same stage. Therefore it is difficult to establish the prognosis for individual lung cancer patients. In this study, by using flow cytometric analysis of nuclear DNA content and S-phase fraction(SPF) of surgically treated non-small cell lung cancer patients, we proposed to establish other prognostic factors and their validity in comparison with the existing ones. Methods: Paraffin-embedded tissue specimens from 81 surgically treated patients, diagnosed with non-small cell lung cancer ranging from stage I to stage IIIa, were analyzed by flow cytometrically determined nulear DNA content and S-phase fraction. Cellular DNA content stained with propidium iodide was analyzed by flow cytometry: histograms with a coefficient of variation exceeding 8% were not used. Results: 1) DNA content analysis was carried out for 59 of 81 patients. Of the 59 patients who were investigated by flow cytometry, 45 (76.3%) of the tumors were DNA aneuploidy and 14 (23.7%) were DNA diploidy. The proportion of DNA aneuploidy tumors showed no significant difference between cell types or stage. 2) S-phase fraction was evaluated for 36 of 81 patients. Mean value of SPF was 19.2% (±12.62)%. The value of SPF had nothing to do with stage. 3) The proportion of the high SPF group (more than 10% of cell proliferation cycle) was 75% With advance staging, the proportion of the high SPF group increased. 4) Significant difference in the median survival time was observed between the low SPF group and the high SPF group (32 months in low SPF, 12 months in high SPF) (p<0.05). No significant difference in the median survival time was observed between the aneuploidy group and the diploidy group (19 months in aneuploidy, 34 months in diploidy). 5) Significant difference in the disease free median survival time was observed between the low SPF group and the high SPF group (5 months in low SPF, 19 months in high SPF) (p<0.05). No significant difference in the disease free median survival time was observed between the aneuploidy group and the diploidy group (12 months in aneuploidy, 34 months in diploidy). 6) Upon multivariate analysis, stage and high SPF (more than 10% of cell proliferation cycle) were significant prognostic factors in surgically treated non-small cell lung cancer patients. Conclusion: The TNM stage and high SPF were significant as prognostic factors in surgically treated non-small cell lung cancer patients. There- fore new treatment plan should be needed in the patients who have high SPF.

간암 특이적 복제 가능 아데노바이러스의 개발

하태영(Tae-Young Ha),김주항(Joo-Hang Kim),김민정(Min-Jung Kim),윤채옥(Chae-Ok Yun) 대한미생물학회 2003 Journal of Bacteriology and Virology Vol.33 No.4

간세포암의 간동맥 화학색전술 후 발생한 급성 폐손상

조세행 ( Se Haeng Cho ),김주항 ( Joo Hang Kim ),김병수 ( Byung Soo Kim ),장준 ( Joon Jang ) 대한결핵 및 호흡기학회 1995 Tuberculosis and Respiratory Diseases Vol.42 No.5

국한성 두경부 혈관 중심위 림프종에서 화학방사선 병용치료법과 방사선치료 단독요법의 비교

장세경(Sei Kyung Chang),김귀언(Gwi Eon Kim),이상욱(Sang-wook Lee),박희철(Hee Chul Park),표홍렬(Hong Ryull Pyo),김주항(Joo Hang Kim),문성록(Sun rock Moon),이형식(Hyeong Sik Lee),최은창(Eun Chang Choi),김광문(Kwang Moon Kim) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.1

목적: 국한성 두경부 혈관 중심위 림프종에서 화학방사선 병용치료법과 방사선치료 단독용법의 치료성적을 비교하여 화학방사선 병용치료법의 임상적 유용성 여부를 알아보고자 하였다. 대상 및 방법: 1976년부터 1995년까지 연세암센터에서 병기 Ⅰ,Ⅱ기의 두경부 혈관 중심위 림프종으로 치료받은 143예를 대상으로 하였다. 방사선치료단독(104예)의 경우 20~70 Gy(중앙갑 50.4 Gy)를 병소 부위에 국소적으로 조사하였고 화학방사선 병용치료(39예)의 경우에는 1~6회(중앙값 3회)의 화학요법을 시행한 후 병소 부위에 국소적으로 방사선치료를 시행하였다. 치료방법에 따른 반응율, 치료실패양상, 후유증, 생존율 등을 비교하여 보았다. 결과: 치료에 대한 높은 반응율에도 불구하고 국소치료실패가 치료실패양상의 가장 흔한 원인이었고 화학요법의 시행에 따른 치료실패양상의 변화는 없었다. 치료방법에 따른 환자들의 순응도에는 차이가 없었으나 혈구포식세포증후군(hemophagocytic syndrome), 폐혈증, 난치성 출혈(intractable bleeding), 2차 암(new primary cancer) 등의 발생빈도는 화학방사선 병용치료법을 시행한 경우에 방사선치료 단독용법을 시행한 경우보다 높은 경향을 나타냈다. 방사선 단독으로 치료한 경우의 5년 생존율과 무병 생존율은 각각 38%와 32%로 저조하였고 화학요법의 병용 여부는 생존율에 영향을 미치지 못했다. 결론: 국한성 두경부 혈관 중심위 림프종의 치료에서 화학방사선 병용치료법이 방사선치료 단독요법보다 유용하다는 사실이 입증되지 못하였다. Purpose: To Clarify the clinical benefit derived from the combined modality therapy (CMT) consisting of chemotherapy (CT) and involved field radiotherapy (RT) for stage Ⅰ and Ⅱ angiocentric lymphomas of the head and neck. Materials and Methods: Of 143 patients with angiocentric lymphoma of the head and neck treated at our hospital between 1976 and 1995, 104 patients (RT group) received involved field RT alone with a median dose of 50.4 Gy(range: 20~70 Gy), while 39 Patients (CMT group) received a median 3cycles(range: 1~6 cycles) of CT before involved field RT. The response rate, patterns of failure. complications, and survival data of the RT group were compared with those of the CMT group. Results: Despite a higher response rate, local failure was the most common pattern of failure in patients of both groups. The patterns of failure, including the systemic relapse rate were not influenced by the addition of combination CT. Although both modalities were well tolerated by the majority of patients, aberrant immunologic disorders or medical illnesses, such as a hemophagocytic syndrome, sepsis, intractable hemorrhage, or the evolution of second primary malignencies were more frequently observed in patients of the CMT group. The prognosis of patients in the RT group was relatively poor, with a 5-year overall actuarial survival rate of 38% and disease-free survival rate of 32%, respectively. However, their clinical outcome was not altered by the addition of systemic CT. Achieving complete remission was the most important prognostic factor by univariate and multivariate analyses, but treatment modality was not found to be a prognostic variable influencing survival. conclusions: Involved field RT alone for angiocentric lymphoma of the head and neck was insufficient to achieve an improved survival rate, but the addition of CT to involved field RT failed to demonstrate any therapeutic advantage over involved over involved field RT alone.

악성고형종양 환자에 있어서 Neoplastic Fever 와 Infectious Fever 의 감별을 위한 Naproxen 의 투여

송시영(Si Young Song),김준명(June Myeong Kim),김주항(Joo Hang Kim),김웅(Eung Kim),홍천수(Chein Soo Hong) 대한내과학회 1989 대한내과학회지 Vol.37 No.4

N/A Recurrent unexplained fever as a manifestion of certain malignancies is a well described phenomenon and is usually attributed to infection related to the immunocompromised state, from either the cancer itself or chemotherapy. However, fever might originate from the tumor per se, namely neoplastic fever, and the differential diagnosis of the infectious fever and the neoplastic fever becnmes a true challenge to the clinician due to its urgency and necessity for appropriate treatment. Thus, we evaluated the antipyretic effect of naproxen in 18 febrile patients who were diagnosed with a malignant solid tumor for the purpose of differentiation of the neoplastic fever and the infectious fever. All 10 patients with neoplastic fever showed complete lysis and an afebrile stafe was sustained while the patients were maintained on naproxen. Among 8 patients with infectious fever, 4 patients showed no lysis, 3 patients partial response, and 1 patient complete lysis. Even though the naproxen dosage was increased to a dose of 250 mg every 6 or H hours in the patients who showed no response, partial response was noticed only in two patients and the remaining two patients continued to show no response. Naproxen is well known to cause gastrointestinal side effects and functional platelet defects. However, in our experience, the side effects have been minimal because most of the patients have received a relatively short course of therapy. In conclusion, naproxen appears to be a very effective tool in assisting in the differential diagnosis of infectious fever and neoplastic fever in patients with a malignant solid tumor.