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재생불량성 빈혈 환자의 생존 기간 및 예후 인자 : 224 예의 분석
서철원(Cheol Won Suh),양성현(Sung Hyun Yang),이홍복(Hong Bock Lee),허대석(Dae Seog Heo),박선양(Seon Yang Park),김병국(Byoung Kook Kim),김노경(Noe Kyeong Kim),이문호(Mun Ho Lee),유근영(Keun Young Yoo),안윤옥(Yoon Ok Ahn) 대한내과학회 1988 대한내과학회지 Vol.34 No.6
N/A Aplastic anemia is characterized by peripheral pancytopenia with bone marrow hypoplasia, There have been many suggestions that the clinical features of the patients with aplastic anemia in Korea would be somewhat different from that of western countries. But there is no reports regarding the survival rates and prognostic factors in the aplastic anemia patients of Korea. Thus clinical study was performed with 224 patients who were diagnosed as aplastic anemia at the department of internal medicine, Seoul National University Hospital (SNUH) during the past 10 years. The results are as the followings. 1) By Kaplan-Meier product limit estimation, median survival time of total patients was 72 months with estimated 5year survival rate of 54% and 10 year survival was 45.7%. 2) Severe aplastic anema patients showed median survival time of 8.3 months with 43.3% of 1 year survival rate and 32.7% of 5 year survival rate. 3) Non-severe cases had 1 year survival rate of 87.6% 5 year survival rate of 69.5% and 10 year survival rate was 58,1%. 4) In univariate data analysis by log rank test, severity, presence of infection, requirements of platelet transfusion, mean corpuscular volume of red cells, granulocyte count, platelet count, and corrected reticulocyte count had influence on the prognosis of the patients. 5) In multivariate data analysis by Cox regression hazard model, platelet and corrected reticulocyte count among the above prognostic factors had no statistically significant influence on the prognosis independently. These results from the retrospective study of our own patients showed some differences from the reported data of aplastic anemia patients in the western countries, and therefore confirmitive prospective studies concerning the survival and prognostic factors of Korean patients with this disease are needed.
대장암에 대한 5 - Flurouracil 지속주입 및 Cisplatin ( FP ) 복합화학요법의 치료효과
서철원(Cheol Won Suh),김시영(Si Young Kim),방영주(Yung Ju Bang),김노경(Noe Kyeong Kim),박재갑(Jae Gahb Park),이건욱(Kuhn Uk Lee),홍성국(Sung Kuk Hong),최국진(Kuk Jin Choe),김수태(Soo Tae Kim),하성환(Sung Hwan Ha),박찬일(Chan Il Park) 대한내과학회 1988 대한내과학회지 Vol.35 No.4
N/A Between August 1986 and February 1988, 60 patients with metastatic or recurrent colorectal cancer were treated with a combination chemotherapy consisting of 5-fluorouracil, 1,000 mg/m² iv continuous infusion over 12 hours on Days 1-5 and cisplatin,.60 mg/m² iv on Day 1; cycled every 3 weeks, Among 36 patients with measurable disease, none achieved complete response and 9 (25%) had partial responses, thus this combination chemotherpay regimen showed modest action on the advanced colorectal cancer. The median duration of response was 20 weeks. Median survival was 52 weeks for all patients who could be evaluated for response and/or toxicity; 61 weeks for patients with response, 48 weeks for those with stable disease and 17 weeks for those with progressive disease. In the analysis of the response according to the various pretreatment characteristics of the patients, those without a history of previous anticancer chemotherapy showed response rate of 36% which is better than 7% for those with prior chemotherapy. The patients with metastatic sites in the liver had a response rate of 47%, which is significantly better than 7 96 for those with metastatic site in the lung and 0% for those with any other sites of metastasis. Toxicity was common, but generally mild to moderate and rapidly reversible.
최은경,장혜숙,서철원,이규형,이정신,김상희,최철준,고윤석,김우성,김원동,김삼현,손광현,Choi, Euk-Kyung,Chang, Hye-Sook,Suh, Cheol-Won,Lee, Kyoo-Hyung,Lee, Jung-Shin,Kim, Sang-Hee,Choi, Chul-Joon,Koh, Youn-Suck,Kim, Woo-Sung,Kim, Won-Dong,K The Korean Society for Radiation Oncology 1991 Radiation Oncology Journal Vol.9 No.2
제3기의 진행성 비소세포 폐암에서의 MVP항암 요법과 다분할 방사선 치료의 효과를 판정하기 위하여 1991년 1월부터 전향성 임의선택 연구(prospective randomized study)를 시작하였다. 본 연구는 제III기의 비소세포 폐암중 절제가 불가능한 환자를 대상으로 하여 MVP 항암요법(Mitomycin C 6mg/$m^2$, Vinblastine 6 mg/$m^2$, Cisplatin 60 mg/$m^2$)을 3회 시행한 후 다분할 방사선치료 (120 cGy/ft BID)를 6500 cGy까지 조사하였다. 방사선치료가 끝난 1개월 후 관해정도를 확인하여 추가 항암요법을 시행하는 군과 계속 관찰하는 군으로 임의 분류하였다. 1991년 8월까지 18명의 환자가 등록 되었으며 이중 2명은 2cycle의 항암요법 후 치료를 포기하여 16명의 환자에 대한 분석을 시행하였다. MVP항암요법에 대한 관해율은 $62.5\%$로 $50\%$에서는 부분관해 $12.5\%$에서는 minimal response를 보였다. 항암요법에 부분관해를 보인 3명중 1명에서는 방사선 치료후 완전관해를 보였으며 항암요법으로 병이 진행된 6명의 환자중 4명에서는 방사선 치료후에도 역시 병이 진행되는 것을 알 수 있었다. 모든 환자는 다분할 방사선 치료를 잘 견뎠으나 한 환자가 방사선 치료 한달 후 항암요법과 관련된 부작용으로 사망하였다. 아직 추적관찰 기간이 짧고 대상 환자가 많지 않다는 문제점은 있으나 본 연구를 계속 진행함으로써 유의한 결과를 얻을 수 있을 것으로 기대된다. To evaluate the effect of MVP chemotherapy and hyperfractionated radiotherapy in Stage III unresectable non small cell lung cancer (NSCLC), authors have conducted a prospective randomized study since January 1991, Stage IIIa or IIIb unresectable NSCLC patients were treated with hyperfractionated radiotherapy (120 cGy/fx BID) up to 6500 cGy following 3 cycles of induction MVP (Mitomycin C 6 mg/$m^2$, Vinblastine 6 mg/$m^2$, Cisplatin 60 mg/$m^2$) and randomized for either observation or 3 cycles of maintenance MVP chemotherapy. Until August 1991, 18 patients were registered to this study. 4 cases were stage IIIa and 14 were stage IIIb. Among 18 cases 2 were lost after 2 cycles of chemotherapy, and 46 were analyzed for this preliminary report. The response rate of induction chemotherapy was $62.5\%$ : partial response, $50\%$ and minimal response, $12.5\%$. Residual tumor of the one partial responder was completely disappeared after radiotherapy. Among 6 cases who were progressed during induction chemotherapy, 4 of them were also progressed after radiotherapy. All patients were tolerated BID radiotherapy without definite increase of acute complications, compared with conventional radiotherapy group. But at the time of this report, one patient expired in two month after the completion of the radiotherapy because of treatment related complication. Although the longer follow up is needed, authors are encouraged with higher response rate and acceptable toxicity of this treatment. Authors believe that this study is worthwhile to continue.
김태원 ( Tae Won Kim ),이정신 ( Jung Shin Lee ),정병학 ( Byung Hak Jung ),윤환중 ( Hwan Jung Yun ),장대영 ( Dae Young Zang ),이제환 ( Je Hwan Lee ),김성배 ( Sung Bae Kim ),김상위 ( Sang We Kim ),서철원 ( Cheol Won Suh ),이규형 ( K 대한내과학회 1998 대한내과학회지 Vol.54 No.5
Objectives: The poor survival rates among patients receiving surgery alone for stages II and III non-small cell lung cancer prompted several trials of adjuvant therapy after resection. We performed a prospective phase II study in patients with stage II-IIIA non-small cell lung cancer after resection to evaluate the feasibility, activity and toxicity of the postoperative sequential MVP chemotherapy and radiotherapy. Methods: Between February 1991 and May 1995, 60 patients with resected stage II, IIIA non-small cell lung cancer received 2 cycles of MVP combination chemotherapy (Mitomycin-C 6 mg/m², Vinblastine 6 mg/m², Cisplatin 60 mg/m) within 3 weeks after surgery, followed by thoracic irradiation (5,040 cGy after complete resection and 900 cGy booster to microscopically positive resection margin at 1.8 Gy per fraction) within 3-4 weeks after chemotherapy. Results: Forty nine men and 11 women with a median age of 60.5 years (range 33-81 years) were included. During the median follow-up period of 828 days (61-2,015 days), 25 patients had developed recurrence. Among the 25 failures, 3 were local relapse only and 20 were distant metastasis only and 2 had both local and distant sites of recurrence. Three-year overall survival and event-free survival were 43% and 37%, respectively. Neutropenia of grade I-II was observed only in 13 patients. Eleven patient showed grade I-II radiation pneumonitis and 32 had grade I-II radiation esophagitis, Conclusion: Postoperative sequential MVP chemotherapy and radiotherapy in resected stage II-IIIA non-small cell lung cancer is well-tolerated and shows interesting activity,
진행성 비소세포폐암에서 Navelbine , Ifosfamide , Cisplatin 복합항암화학요법
김태원(Tae Won Kim),김상희(Sang Hee Kim),최성준(Sung Jun Choi),최종수(Jong Soo Choi),김상위(Sang We Kim),최은경(Eun Kyung Choi),서철원(Cheol Won Suh),이정신(Jung Shin Lee),김우성(Woo Sung Kim),김동순(Dong Soon Kim),김원동(Won Dong Ki 대한내과학회 2001 대한내과학회지 Vol.60 No.5
N/A Background : We performed a phase 2 study to determine the activity and toxicity of Navelbine, Ifosfamide, and Cisplatin (NIP) combination in patients with stage IIIB-4 non-small cell lung cancer (NSCLC). Methods : Thirty-two chemotherapy naive patients were enrolled from 2 centers between February 1997 and December 1997. The median age was 57 years (range, 29-71) ; stage IIIB/IV 6/26; male/female 23/9. The regimen consisted of navelbine (25 mg/m2 day 1 and 5), ifosfamide (3 g/m2 day 5 with uroprotective mesna), and cisplatin (80 mg/m2 day 5) every 3 weeks. Results : Twenty-six were evaluable for response and 31 for toxicity. One patient was lost to follow up, one patient refused to continue, and 4 patients could not continue due to poor performance. Total of 120 cycles have been given, with median of 4 cycles per patient (range ; 1-6). Sixteen patients achieved partial response (response rate on an intention-to-treat basis, 50%; 95% C.I:32-68% ). Neutropenia was the most common toxicity. Grade 3-4 neutropenia was observed in 39% of courses ; thrombocytopenia 4% of courses ; anemia 14% of courses. Three patients developed febrile neutropenia; there was no treatment-related death. The median time to progression was 6.9 months and the median overall survival 8.0 months. The probability for 1-year survival was 25%.
김태원(Tae Won Kim),이정신(Jung Shin Lee),최성준(Sung Jun Choi),최종수(Jong Soo Choi),장대영(Dai Young Zang),이제환(Je Hwan Lee),김성배(Sung Jun Choi),김상위(Sang We Kim),서철원(Cheol Won Suh),이규형(Kyoo Hyung Lee),김우건(Woo Kun Ki 대한내과학회 1997 대한내과학회지 Vol.52 No.2
N/A Objectives: The advent of intense combination chemotherapy has transformed aggressive non-Hod-gkins lymphoma from a disease that was once uniformly fatal to one that is now often curable. Remission rates and survival may be improved by using intensive chemotherapy regimens. However, this more aggressive approach is inevitably associated with increased toxicity, and an accurate pretreament prognostic assessment of patients is required to guide the physician in selecting the most appropriate therapeutic regimen. Many studies have reported prognostic factors of non-Hodgkins lymphoma in western countries, but there are few reports on prognostic factors in Koreans and it is suggested that clinical characteristcs of non-Hodgkins lymphoma in Korea differ from those in western countries. The purpose of this study was to illustrate clinical characteristics, prognostic factors and treatment outcome in non-Hodgkins lymphoma in Korea. Methods: Clinical features of 151patients (age over 15years) with non-Hodgkins lymphoma registered at Asan Medical Center from March 1989 to December 1993 were retrospectively reviewed. Prognostic factors and treatment outcome were evaluated among 121previously untreated patients. Multi variate analysis of potential pretreatment prognostic factors was performed using Coxs proportional hazards model. Results: Of the 151patients evaluated, 55% had diffuse large cell type, while low-grades were encountered in less than 1% of the patients. Extranodal involvement was noted in 76% of the patients. Cental nervous system was the commonest primary extranodal site, followed by stomach. Complete remission was achieved in 73 of 121patients (60%). The median follow-up for 121patients was 24months and the actuarial overall survival was 48% at 3years and 44N at 5years with a median overall survival of 33months. At the median followup of 32months, the actuarial 5year disease-free survival rate among 73patient with complete remission was 65% and median remission duration was not reached. Presence of systemic B symptoms and advanced clinical stages were associated with a low complete remission rate. None turned out to be associated with the remission duration. The Coxs proportional hazards model identified age above 60years, presence of systemic B symptoms and elevated LDH level as significant independent poor prognostic factors influencing overall survival. Conclusion: This study reveals a low prevalence rate of the low-grades lymphoma and a higher propensity of diffuse large cell type. These results suggest that clinical characteristics of non-Hodgkins lymphoma in Korea are different from those in the western countries. Our data also show that certain pretreatment clinical factors can help in predicting survival and in planning treatment.
급성백혈병의 관해수도시 trimethoprim sulfamethoxazole 의 간염예방효과에 관한 연구
최강원(Kang Won Choe),우준희(Jun Hee Woo),방영주(Yung Jue Bang),배현주(Hyun Joo Bae),서철원(Cheol Won Suh),김시영(Si Young Kim),박선양(Seon Yang Park),김병국(Byoung Kook Kim),김노경(Noe Kyeong Kim),김승택(Seung Taik Kim) 대한내과학회 1988 대한내과학회지 Vol.35 No.1
N/A Fifty patients with acute leukemia were studied during remission induction treatment in a prospectively radnomized trial to assess the effect of prophylactic trimethoprim/sulfamethoxazole on infection and fever rate. Twenty-three patients randomly received two single-strength trimethoprim/sulfamethoxazole tablets twice daily and twenty-seven patients did not receive any drugs. There were no significant differences in the duration of granulocytopenia, number of febrile days, or use of parenteral antibiotics. But trimethorpim/sulfamefhoxazole prophylaxis resulted in a reduced incidence of microbiologically documented infections (8 versus eighteen; p<0.05). This was mainly the result of a reduction in the episodes of bacteremia in the treatment group as compared with the contirol group. The number of patients without fever in the treatment group was eight compared to only 2 in the control group (p<0.05). Thus, trimethoprim/sulfamethoxazole prophylaxis during granulocytopenia reduced the incidence of microbiologically docummented infection and had more patients afebrile.
피부과 관점에서 본 안와 부속기 림프절외 변연부 B세포 림프종의 임상적 고찰
이형민 ( Hyung Min Lee ),서철원 ( Cheol Won Suh ),사호석 ( Ho Seok Sa ),원종현 ( Chong Hyun Won ),장성은 ( Sung Eun Chang ),이미우 ( Mi Woo Lee ),최지호 ( Jee Ho Choi ),문기찬 ( Kee Chan Moon ) 대한피부과학회 2012 대한피부과학회지 Vol.50 No.5
Background: The ocular adnexal extranodal marginal zone B-cell lymphoma has been known as the 2nd most common extranodal marginal zone B-cell lymphoma, which presents as the dermatologic symptom and sign, such as orbital mass and swelling. However, the ocular adnexal extranodal marginal zone B-cell lymphoma has been few reported in the dermatologic literature. Objective: We described the clinical and histopathological features of ocular adnexal extranodal marginal zone B-cell lymphoma from the perspective of dermatology. Methods: Ninety-nine cases of ocular adnexal extranodal marginal zone B-cell lymphoma patients were included in this study, among the 352 patients, who were diagnosed with extranodal marginal zone B-cell lymphoma between March 1998 and February 2011. Their medical records and histopathologic slides were retrospectively reviewed. Results: Among the 352 patient of extranodal marginal zone B-cell lymphoma, ocular adnexal extranodal marginal zone B-cell lymphoma occurred in 99 patients (28.1%). The ratio between male and female was 1: and the mean age was 50 years (range; 20∼54 years). Ocular adnexal extranodal marginal zone B-cell lymphoma presented as orbital mass (39.1%), conjunctival injection (25.6%), orbital swelling (19.5%), and etc. In most patients, lesions were located in conjunctiva (63.8%) or orbit (14.5%). 76.7% of patients presented with Ann Arbor stage I disease. Relapses occurred in 8.4% of patients during the follow-up period. Conclusion: When dermatologists meet patients presenting with orbital mass and swelling, dermatologists consider the possibility of ocular adnexal extranodal marginal zone B-cell lymphoma and consultation with the ophthalmologists. (Korean J Dermatol 2012;50(5):403∼412)