제48차 대한내과학회 추계학술대회초록집 : 심포지움 ; 새로운 항암제

김훈교 ( Hoon Kyo Kim ) 대한내과학회 1996 대한내과학회지 Vol.51 No.-

제48차 대한내과학회 추계학술대회초록집 : 심포지움 ; 새로운 항암제

김훈교 ( Hoon Kyo Kim ) 대한내과학회 1996 대한내과학회지 Vol.51 No.2S

국소진행성 두경부암환자에서 5 - Fluorouracil 과 Cisplatin 의 선행항암화학요법과 방사선 치료

김훈교(Hoon Kyo Kim),한지연(Ji Youn Han),강진형(Jin Hyung Kang),송호철(Ho Cheol Song),문한림(Han Lim Moon),홍영선(Young Seon Hong),이경식(Kyung Shik Lee),김동집(Dong Jip Kim),김민식(Min Sik Kim),조승호(Seung Ho Cho),서병도(Byung Do S 대한내과학회 1995 대한내과학회지 Vol.49 No.4

N/A Objectives: The efficacy and problems of sequential induction chemotherapy (IC) using cisplatin and 5 FU, and radiotherapy in locally advanced head and neck cancer patients were analyzed. Methods: Seventy--four locally advanced head and neck cancer patients were treated with a combination of 5-FU 1,000mg/m² lV continuous infusion on days 1 to 5 and cisplatin 100mg/m² IV on day 1 every 3 weeks for 3 cycles and radiotherapy of 6,500 to 7,000cGy in 45 patients to primary site and neck area from 1987 to 1991. The response rate and toxicity of induction chemotherspy, response rate of subsequent radiotherapy and survival data based on response to chemoradiotherapy were evaluated. Results: A 82.9% overall response rate including 30% of complete response was achieved in 70 patients evaluable for response and toxicity of IC. In stage III patients, complete response rate was higher (50.0%). Dose limiting toxicities was oral mucositis, leukopenia, thrombocytopenia, and nephrotoxicity. Additional complete response after subsequent radiotherapy was achieved in 14 of 21(51.9%) partial responders to IC and no better response was seen in non-responders to IC. Survival was followed in 67 patients. Overall survival was 23+months (7-65+) and 1, 2 and 3 year survival were 73.1%, 49.3% and 28.4%, respectively. Survival of complete responders was longer than that of partial responders (30+ and 23+months respectively, p=0.0001). Survival of complete responders after planned radiotherapy was longer than that of partial and non-respondres (31, 14 and 8months, respectively, p=0.0001). Conclusion: Induction chemotherapy with full doses of 5-FU and cisplatin for 3 cycles was very effective to achieve high response in locally advanced head and neck cancer patients without life threatening serious toxicity, and could define the subgroup of possible further responder to subsequent radiotherapy. Longer survival was observed in complete responders to IC and IC-radiotherapy. New therapeutic strategy is required for the patients with poor responders or non responders.

암환자의 통증 치료에 대한 펜타닐 - TTS 의 유효성과 안정성

김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),홍영선(Young Seon Hong),이복근(Bok Keun Lee),송치원(Chi Won Song),박진노(Jin No Park),조석구(Suk Ku Cho),김재유(Jae Yoo Kim) 대한내과학회 1999 대한내과학회지 Vol.57 No.3

N/A The transdermal administration of narcotics is one of the alternative ways of providing adequate pain relief for the patients with chronic cancer pain. A Phase 4 trial was conducted to evaluate the efficacy and safety of Fentanyl-TTS in adult patients with cancer-related pain in Korea. Methods : Patients with histologically confirmed malignancy, who have pain related to the cancer and/or therapy, pain necessitating the use of opoid analgesics, age of 18 yr or older, ability to communicate effectively with study personnel, and signed on informed consent were included. The patients were titrated with a short-acting narcotic to control their cancer pain before they are converted to a fentanyl-transdermal therapeutic system(TTS). Short acting parenteral morphine and MS contin were used as rescue medications. All patients were evaluated initially and were followed up with a pain visual analogue scale(VAS), quality of life(QOL)-VAS. Patients were asked to keep the daily record for 21 days about pain VAS, QOL-VAS, amount of rescue morphine used, and side effects. Results : Twenth two patients were enrolled from January 1996 to October 1997. The dose of fentanyl-TTS required, ranged between 25 and 75 ug/hr (25 ㎍/hr in 13, 50 ㎍/hr in 4, and 75 ㎍/hr in 2). The mean dose of morphine required before the use of the fentanyl-TTS was 135.3 mg (20-285 mg/day), but it was decreased after the use of the fentanyl-TTS. Pain VAS and QOL-VAS were in adquate level during the fentanyl- TTS treatment. Patients favored continuous use of fentanyl after the study was finished. Side effect of fentanyl-TTS was minimal. Conclusion : Transdermal fentanyl seems to be a convenient and effective analgesic for the control of cancer related pain in Korean. A controlled trial comparing fentanyl-TTS to morphine needs to be followed. (Korean J Med 57:348-356, 1999)

암 조기진단

김훈교(Hoon Kyo Kim),이경식(Kyung Shik Lee),홍영선(Young Seon Hong) 대한내과학회 1999 대한내과학회지 Vol.56 No.6

Cancer is the leading cause of death in Korea. Stomach cancer, hepatocellular carcinoma, lung cancer are the three most prevalent cancers in Korean man, and cervical cancer, stomach cancer, breast cancer are the three most prevalent cancers in Korean women. The goal of cancer screening is to detect cancer when it is early and treatable, if not curable. And most of the developed countries had developed the national recommendation for cancer screening which has increased the cure rate and survival of cancer patients. So we need to develop our own recommendation for the screening of prevalent cancers in Korea. Methods : We reviewed the articles on cancer screening which has been reported in various medical journals including the abstrcts from the symposium of Catholic Cancer Center on cancer screening, which was held in 1996. Results : We summerized recommendations for screening of stomach cancer, hepatocellular carcinoma, cervical cancer as well as breast cancer, which might not be able to reflect the consensus idea from all specialists working in this field. Conclusion : The cancer screening should include informations on the adequate time to start the screening test as well as the interval and types of tests required. It would be ideal if government took initiative in providing those recommendations together with the reimbursement from the medical insurance for the screening tests. We need to continue our efforts to establish the national consensus for the recommendations for prevalent cancers.

폐암의 항암 요법

김훈교 ( Hoon Kyo Kim ) 대한결핵 및 호흡기학회 1990 Tuberculosis and Respiratory Diseases Vol.37 No.4

국소진행성 두경부암 환자에서 선행항암화학요법

김훈교(Hoon Kyo Kim) 대한두경부종양학회 1996 대한두경부 종양학회지 Vol.12 No.1

Retrospective Analysis of Chemoradiotherapy for Limited-Stage Small-Cell Lung Cancer

Jong Hoon Lee(이종훈),Sung Hwan Kim(김성환),Su Zy Kim(김수지),Joo Hwan Lee(이주환),Hoon Kyo Kim(김훈교),Byoung Yong Shim(심병용) 대한방사선종양학회 2009 Radiation Oncology Journal Vol.27 No.3

목 적: 제한병기 소세포암 환자의 흉부방사선치료 및 항암치료의 성적과 부작용을 분석하고자 연구를 진행하였다. 대상 및 방법: 제한병기 소세포암으로 진단받고 동시항암화학방사선요법 혹은 순차적항암화학방사선요법을 받은 35명의 환자를 후향적으로 조사하였다. 방사선치료선량은 하루 1.8∼2 Gy 분할선량으로 원발병소에 총 50∼66 Gy 조사하였다. 환자군은 4주기 시스플라틴 및 에토포사이드 복합 항암치료를 받았다. 동시항암화학방사선요법군은 항암 제 1주기 첫 날에 흉부방사선치료를 시작하였고 순차적항암화학방사선요법군은 항암 제 4주기를 마친 후에 흉부방사선치료를 시작하였다. 결 과: 순차적항암화학방사선요법군의 무진행생존시간의 중앙값은 16.5개월이었고 동시항암화학방사선요법군의 무진행생존시간의 중앙값은 26.3개월이었다. 동시항암화학방사선요법군의 2년 무진행생존율은 50.0%이었고 순차적항암화학방사선요법군의 2년 무진행생존율은 16.0%이었다(p=0.0950). 백혈구감소증의 정도와 빈도는 동시 항암화학방사선요법군에서 유의하게 높았다. 하지만, 심한 식도염의 빈도는 양군에서 모두 높지 않았다. 동시항암화학방사선요법군은 순차적항암화학방사선요법군에 비하여 빈번하게 혈액학적독성으로 치료가 중단되었다(p=0.001). 결 론: 본 연구에서는 동시항암화학방사선요법이 제한병기 소세포암 치료에서 순차적항암화학방사선요법보다 효과적이었다. 하지만, 동시항암화학방사선요법은 부작용을 유의하게 증가시켰다. Purpose: This study was designed to analyze the outcome and toxicity of thoracic radiation therapy (TRT) and chemotherapy for patients who suffer with limited-stage small-cell lung cancer (LS-SCLC). Materials and Methods: We retrospectively studied 35 patients with LS-SCLC. TRT was administered once daily (1.8 to 2 Gy per fraction) and it was directed to the primary tumor for a total 50 to 66 Gy in 6 to 7 weeks. The patients received four cycles of etoposide plus cisplatin. TRT was begun on day 1 of the first cycle of chemotherapy in the concurrent arm and after the fourth cycle in the sequential arm. Results: The median progression-free survival time was 16.5 months (95% confidence interval [CI], 9.0 to 24.1 months) for the sequential arm, and 26.3 months (95% CI, 16.6 to 35.9 months) for the concurrent arm. The 2-year progression-free survival rate was 16.0 percent for the sequential arm and 50.0 percent for the concurrent arm (p=0.0950 by log-rank test). Leukopenia was more severe and more frequent in the concurrent arm than in the sequential arm. However, severe esophagitis was infrequent in both arms. The radiotherapy was interrupted more frequently in the concurrent arm than in the sequential arm due to hematologic toxicities (p=0.001). Conclusion: This study suggests that concurrent TRT with etoposide plus cisplatin is more effective for the treatment of LS-SCLC than sequential TRT. However, there is a significant increase in the risk of toxicities, and radiotherapy was frequently interrupted in the concurrent arm due to hematologic toxicities.

Paclitaxel 매주 투여 및 방사선치료 동시요법을 받은 국소진행성 비소세포폐암 환자들의 치료 결과

김수지(Suzy Kim),김성환(Sung Whan Kim),심병용(Byoung Yong Shim),김치홍(Chi Hong Kim),송소향(So Hyang Song),안명임(Meyung Im Ahn),조덕곤(Deog Gon Cho),조규도(Kyu Do Cho),유진영(Jinyoung Yoo),김훈교(Hoon Kyo Kim) 대한방사선종양학회 2006 Radiation Oncology Journal Vol.24 No.4

목 적: 국소진행성 비소세포폐암 환자에 대한 매주 paclitaxel 항암화학요법과 방사선치료 동시 요법의 안정성과 효 과를 알아보고 재발 양상 및 생존율을 분석하고자 하였다. 대상 및 방법: 1999년 10월부터 2004년 9월까지 국소진행성 비소세포폐암으로 진단받고 근치적 목적으로 항암화 학방사선 동시요법을 시행 받은 환자 23명을 대상으로 후향적 분석을 시행하였다. 방사선치료는 일일 1회 1.8 Gy 씩 주5회 분할 조사하여 7∼8주에 걸쳐 총 선량 55.8∼64.8 (median 64.8) Gy를 조사하였다. 항암화학요법은 매주 paclitaxel 50 또는 60 mg/m2 용량으로 방사선치료 1일, 8일, 15일, 22일, 29일 36일째에 투여하였다. 항암화학방사선동시요법을 마친 4주 후부터 paclitaxel 135 mg/m2와 cisplatin 75 mg/m2 용량으로 3주 간격으로 3주기의 공고 항암화학요법을 추가 시행하였다. 결 과: 동시 항암화학방사선요법을 시행받은 23명의 환자 중 3명이 도중에 환자 임의로 치료를 중단하였고 1명이 5,580 cGy까지 방사선치료를 시행 받고 세균성 폐렴으로 사망하였다. 주된 급성 부작용은 방사선 식도염으로 4명(17%)의 환자에서 2도의 식도염이 관찰되었으며 3도 이상의 부작용은 관찰되지 않았다. 16명의 환자가 추가 공고항암화학요법을 시행 받았으며 공고 항암화학요법 중의 급성 부작용으로 3도 이상의 호중구 감소증이 8명(50%)의 환자에서 관찰되었으며 그중 한 명은 패혈증으로 사망하였다. 동시 항암화학방사선요법을 끝까지 시행 받은 20명의 환자에서 치료에 대한 반응을 조사할 수 있었으며 완전 관해 4명(20%), 부분 관해 14명(70%)으로 전체 관해율은 90%이었다. 관해를 보인 환자들 중 추적 관찰이 가능했던 16명 중 14명에서 재발이 확인되었고 국소 재발이 9명(56%), 국소 재발과 원격 전이가 3명(19%), 원격 전이가 2명(13%)이었다. 동시 항암화학방사선요법을 끝까지 시행받은 환자들에서의 무진행 생존 기간의 중앙값은 9.5개월이었으며, 2년 무진행 생존율은 18%이었다. 재발된 환자중 11명에서 2차(second-line) 또는 3차(third-line) 항암화학요법이 시행되었다. 전체 환자 23명의 중앙 생존 기간은 21개월, 2년 및 5년 생존율은 각각 43%, 33%였다. 다변량 분석을 시행했을 때 환자의 나이, 수행 능력, 종양의 크기는 무진행 생존율에 영향을 주는 유의한 예후 인자로 나타났다. 결 론: 국소진행성 비소세포폐암 환자에서 paclitaxel 매주 투여 항암화학요법과 방사선치료 동시요법은 안전하고 종양의 관해율도 높았다. 그러나 국소 재발률이 높고 특히 종양의 크기가 큰 환자에서 예후가 나쁜 것을 알 수 있었다. 따라서 향후 부작용은 증가시키지 않으면서 국소제어율을 향상시키기 위한 노력이 필요하다. Purpose: To analyze the response, toxicity, patterns of failure and survival rate of patients with locally advanced non-small cell lung cancer who were treated with concurrent chemoradiotherapy with weekly paclitaxel. Materials and Methods: Twenty-three patients with locally advanced non-small cell lung cancer patients who received radical chemoradiotherapy from October 1999 to September 2004 were included in this retrospective study. Patients received total 55.4∼64.8 (median 64.8) Gy (daily 1.8 Gy per fraction, 5 days per weeks) over 7∼8 weeks. 50 or 60 mg/m2 of paclitaxel was administered on day 1, 8, 15, 22, 29 and 36 of radiotherapy. Four weeks after the concurrent chemoradiotherapy, three cycles of consolidation chemotherapy consisted of aclitaxel 135 mg/m2 and cisplatin 75 mg/m2 was administered every 3 weeks. Results: Of the 23 patients, 3 patients refused to receive the treatment during the concurrent chemoradiotherapy. One patient died of bacterial eumonia during the concurrent chemoradiotherapy. Grade 2 radiation esophagitis was observed in 4 patients (17%). Sixteen patients received consolidation chemotherapy. During the consolidation chemotherapy, 8 patients (50%) experienced grade 3 or 4 neutropenia and one of those patients died of neutropenic sepsis. Overall response rate for 20 evaluable patients was 90% including 4 complete responses (20%) and 14 partial responses (70%). Among 18 responders, 9 had local failure, 3 had local and distant failure and 2 had distant failure only. Median progression-free survival time was 9.5 months and 2-year progression-free survival rate was 19%. Eleven patients received second-line or third-line chemotherapy after the treatment failure. The median overall survival time was 21 months. 2-year and 5-year survival rate were 43% and 33%, respectively. Age, performance status, tumor size were significant prognostic factors for progression-free survival. Conclusion: Concurrent chemoradiotherapy with weekly paclitaxel revealed high response rate and low toxicity rate. But local failure occurred frequently after the remission and large tumor size was a poor prognostic factor. Further investigations are needed to improve the local control.

유방암 치료후에 발생한 속발성 급성 전골수성 백혈병

김용주(Young Joo Kim),문한림(Han Lim Moon),김병욱(Byung Wook Kim),김희열(Hee Yeol Kim),방승호(Seung Ho Bang),안중현(Joong Hyun Ahn),한상국(Sang Kook Han),강진형(Jin Hyung Kang),홍영선(Young Seon Hong),김훈교(Hoon Kyo Kim),이경식(Kyun 대한내과학회 1995 대한내과학회지 Vol.48 No.5

N/A Acute leukemia after chemotherapy and/or radio- therapy for malignant disorder is called secondary acute leukemia(SAL) or therapy related leukemia. Typically, SAL is preceded by a prodrome phase or myelodysplastic syndrome (MDS) resulting in trilineage dysplasia manifested by pancytopenia, associated with cytogenetic abnormalities involving chromosome 5 and 7, and carries a poor prognosis. Although FAB M3 type(acute promyelocytic leukemia) of SAL had been rarely reported, recently there was a report on 16 cases of therapy-related acute promyelocytic leukemia. We hereby report a case of secondary acute promyelocytic leukemia after treatment of advanced breast cancer. A 62-year-old woman was admitted because of pancytopenia, purpura of legs and gingival bleeding. Since six years before admission when she was diagnosed as infiltrating ductal carcinoma of breast with metastases to lung, She had received CMF(cyclophosphamide, methotrexate, 5-fluorouracil) chemotherapy and radiotherapy, and underwent modified radical mastectomy after complete disappearance of pulmonary nodules, She had received further chemotherapy with cumulative doses of chemotherapeutic agents as following; 21g of cyclophosphamide, 410mg of doxorubicin, 21g of 5-fluorouracil, and 600 mg of methotrexate. Radiation doses to chest wall, axilla and supraclavicular area were 2880 to 3400cGy. The examination of bone marrow aspiration and biopsy showed acute promylocytic leukemia(FAR M3). Cytogenetic analysis of peripheral blood demonstrated 46XX[1]/46XX, t(7; 11) (p15; p15) [12]. The patient did not achieved a complete remission despite retinoic acid therapy and intensive chemotherapy with Ara-C and AMSA, and died 10 months after diagnosis of acute promyelocytic leukemia.