비호지킨 림프종에서 CHEP 복합화학요법의 치료효과

이원식 ( Won Sik Lee ),주영돈 ( Young Don Joo ),손창학 ( Chang Hak Sohn ) 대한내과학회 2007 대한내과학회지 Vol.72 No.1

목적: 비호지킨 림프종에서 지난 30여년간 CHOP 복합화학요법이 표준항암화학요법으로 인정받고 있었으나, 완전반응률과 장기생존률에 있어 만족스러운 성적을 내지 못하여, 좀 더 효과적인 항암화학요법의 개발이 필요하다. 이에 저자는 보다 효과적인 복합화학요법에 대하여 연구해보고자 CHOP 복합화학요법에서 vincristine을 생략하고, etoposide를 추가하여 cyclophosphamide, adriamycin, etoposide, prednisolone (CHEP) 복합화학요법을 시행하였다. 방법: 1997년 3월부터 2003년 4월까지 조직학적으로 확인된 비호지킨 림프종 환자 36명에 대하여 CHEP 복합화학요법을 매 3~4주마다 적어도 총 4회 이상 시행하였다. 결과: 전체반응률은 86.1%였고, 완전반응률은 72.2%, 부분반응률은 13.9%였다. I, II병기와 운동능력이 1~2인 경우가 완전 반응률이 유의하게 높았다. 3년 전체생존률과 무진행생존률은 각각 61.9%, 54.7%였다. 단변량분석에서 병기, 림프절외 침범정도, 완전반응 여부가 전체생존률의 중요한 예후인자였고, 병기, 혈청 LDH, 림프절외 침범정도, IPI, 완전반응 여부가 무진행생존률의 중요한 예후인자였다. 주된 부작용은 골수 독성이었고, 신경독성은 관찰되지 않았다. 결론: CHEP 복합화학요법은 비호지킨 림프종에서 비교적 반응률과 생존률이 높고 독성은 비교적 적어 비호지킨 림프종의 치료에 있어서 유용하나 앞으로 보다 높은 치료효과를 얻기 위해 rituximab을 추가한 복합화학요법에 대한 연구가 필요하리라 생각된다. Background: The CHOP regimen has been the standard therapy for non-Hodgkin`s lymphoma (NHL) for the past 30 years, but its effect on complete response and long-term survival rates were unsatisfactory. Therefore, more effective chemotherapeutic regimens are required. We attempted to treat non-Hodgkin`s lymphoma with a newly developed cyclophosphamide, adriamycin, etoposide, prednisolone (CHEP) combination chemotherapy which substitutes etoposide for vincristine in a preexisting cyclophosphamide, adriamycin, prednisolone, vincristine (CHOP) regimen. Methods: Between March 1997 and April 2003, 36 patients with a histologically confirmed NHL were enrolled in the study. All patients received CHEP chemotherapy as a first-line treatment. Tratment courses were repeated every 34 weeks for at least 4 cycles, pending response to the treatment. Results: The overall response rate achieved was 86.1% for all of the patients. The complete response (CR) and partial response (PR) rates were 72.2% and 13.9%, respectively. The CR rate was significantly higher in patients with stage III disease, and a PS score of 02 (p<0.0001, p=0.017, respectively). The three year overall (OS) and failure-free survival (FFS) rates were 61.2%, 58.2%, respectively. Stage, extranodal involvement, and the attainment of CR influenced OS significantly (p=0.027, p=0.047, p=0.0001, respectively) as determined by univariate analysis. Stage, serum LDH level, extranodal involvement, the international prognostic index (IPI), and the attainment of CR influenced FFS significantly (p=0.0013, p=0.048, p=0.020, p=0.018, p=0.0001, respectively) as determined by univariate analysis. The dose-limiting toxicity was due to myelosuppression. Nno neurologic side effects were seen, which frequently occur after using vincristine. Conclusions: The CHEP regimen in patients with aggressive NHL is effective as a first-line therapy, and possesses an acceptable toxicity profile. We suggest a trial that adds rituximab to the CHEP regimen as afirst-line therapy for aggressive NHL in the future. (Korean J Med 72:52-61, 2007)

제 3기 비소세포 폐암에서 유도 화학 요법의 효과

조흥래(Heung Lae Cho),주영돈(Young Don Joo),손승창(Seung Chang Sohn),손창학(Chang Hak Sohn) 대한방사선종양학회 1998 Radiation Oncology Journal Vol.16 No.3

목 적 : 국소 진행된 비소세포 폐암에서 방사선치료 전 시행하는 유도화학요법의 효과를 분석하기 위하여 본 연구를 시행하였다. 대상 및 방법 : 1989년 부터 1995년 까지 본원에서 국소 진행된 비소세포 폐암으로 진단받은 환자 중 80명의 환자를 대상으로 후향적으로 분석하였다. 21명의 환자는 유도화학요법후 방사선치료를 시행하였고 59명의 환자는 방사선 단독으로 치료를 시행하였다. 항암제는 cispatin 에 기초한 약물로 시행하였다. 모든 환자는 Co-60 또는 6 MV 선형가속기로 하루 1.8 Gy 씩 50 Gy 내지 80Gy (중앙값, 64.8 Gy) 조사하였다. 두 군간에 반응율, 생존율, 실패양상을 분석하였다. 결 과 : 전체 반응율은 유도화학요법 군에서 48%, 방사선 단독 군에서 44% 였다. 80명의 환자중 치료실패에 대한 평가가 46예에서 가능하였다. 유도화학요법 군에 대한 초기 실패 양상은 국소재발 8예 (67%), 원격전이 4예 (33%)가 있었다. 방사선 단독 군은 국소재발 24예 (71%), 원격전이 5예 (29%)가 있었다. 두 군간의 재발 유형에 있어 통계학적 차이는 없었다. 1년 및 2년 생존율은 유도화학요법 군에서 각각 43%, 14% 였고 방사선 단독군에서 31%, 7%였다 (p= 0.13). 결 론 : 제 3기 비소세포 폐암에서 유도화학요법과 방사선 치료의 병합요법이 방사선 단독 치료에 비해 생존율에 있어서 좀더 나은 경향을 보였으나 통계적으로 차이는 없었다. 원격 전이는 두 군간에 차이가 없는 것으로 나타났으며 이것은 유도화학요법이 원격전이를 효과적으로 조절하지 못하는 것을 의미하는 것으로 추정된다. Department of Radiation Oncology*, Internal Medicine†, Inje University, College of Medicine, Pusan, Korea Purpose : This study was performed to analyze the efficacy of induction chemotherapy followed by radiation therapy in locally advanced non-small cell lung cancer. Materials and Methods : Eighty patients with locally advanced non - small cell lung cancer treated from 1989 to 1995 at Pusan Paik hospital were analyzed retrospectively. Twenty - one patients were treated with induction chemotherapy followed by r adiation therapy and Fifty- nine patients were treated with radiation therapy alone. Chemotherapy regimen consisted of cisplatin - based combination (2 or 3 drugs). All patients were treated by Co- 60 or 6 MV linear accelerators. Radiation dose ranged from 50 Gy to 80 Gy (median, 64.8 Gy). We evaluated response rate, survival rate, and pattern of failure in both treatment groups. Results : Overall response rate in induction chemotherapy group and radiotherapy alone group were 48% and 45%, respectively. Of the 80 patients, 46 patients were evaluable for pattern of failure. Initial failure pattern in induction chemotherapy group was as follows: 8 (67%) at locoregional, 4 (33) in distant metastasis. Radiation alone group was 21 (71%) and 5 (29%), respectively. Results showed no difference of distant failure between induction chemotherapy group and radiation alone group. The 1 and 2 year survival rate in induction chemotherapy group were 43% and 14%, respectively and in radiotherapy alone group, 31% and 7%, respectiv ely (p=0.135). Conclusion : In stage Ⅲ non-small cell lung cancer, induction chemotherapy and radiation therapy showed increased tendency in survival with no statistical significance. Induction chemotherapy seems to have no effect of decreasing distant fa ilure and no survival advantage compared with radiotherapy alone.

증례 : 원발성 식도 T 세포 악성림프종 1예

한양천 ( Yang Chun Han ),강명주 ( Myoung Joo Kang ),박정하 ( Jeong Ha Park ),이원석 ( Won Sik Lee ),손창학 ( Chang Hak Sohn ),김찬환 ( Chan Hwan Kim ),주영돈 ( Young Don Joo ) 대한내과학회 2006 대한내과학회지 Vol.71 No.6

위장관에 발생하는 T세포 악성림프종은 발생 빈도가 낮고, 특히 식도에 발생하는 원발성 T세포 악성림프종은 극히 드문 것으로 보고되고 있다. 저자들은 60세 남자로 수 주 간의 연하곤란을 주소로 내원하여 상부위장관 내시경 검사 및 방사선학적 검사상 T세포 악성림프종으로 진단받은 후 복합항암요법을 통해 성공적으로 치료된 예를 경험하였기에 문헌고찰과 함께 보고하는 바이다. Gastrointestinal tract (GIT) lymphomas usually originate from B-lymphocytes but rarely from T-lymphocytes. The stomach is the most common site for extranodal GIT lymphoma but the esophagus is a rare site. In addition, a primary esophageal T-cell lymphoma is an uncommon disorder. We encountered a case of a primary esophageal T-cell lymphoma in a 11 60-year-old man, who had swallowing difficulties and multiple ulcers in the upper and lower esophageal mucosa on gastroscopy. Immunohistochemical staining for the biopsy material from the multiple esophageal ulcers tested positive for LCA and CD45RO (pan T-cell marker) and negative for cytokeratin and CD20 reactivity, respectively. No other abnormal lesions were observed on a computed tomography scan of the neck, chest, abdomen and pelvis. After six cycles of combination chemotherapy with cyclophosphamide, adriamycin, vincristin, prednisolone, etoposide and gemcitabine, the multiple esophageal ulcers had completely disappeared suggesting a complete clinical response. We report this case with a review of the relevant literature(Korean J Med 71:694-698. 2006)

BIM기반 케이블교량 공유데이터 환경 및 자산정보관리 시스템

김성민(Kim, Seong-Min),설가영(Seol, Ga-Yung),주영돈(Joo, Young-Don),송종화(Song, Jong Hwa),노한성(Roh, Han Sung) 대한토목학회 2021 대한토목학회 학술대회 Vol.2021 No.10

항공 하이퍼스펙트럴 영상의 대기보정 효과 분석 및 토지피복 분류

이진덕(Jin-Duk Lee),방건준(Kon-Joon Bhang),주영돈(Young-Don Joo) 한국콘텐츠학회 2016 한국콘텐츠학회논문지 Vol.16 No.7

하이퍼스펙트럴 영상을 이용하여 토지피복 분류를 정확히 수행하기 위해서는 전처리 작업으로서 대기보정을 거쳐야 한다. 항공 하이퍼스펙트럴 영상에 대하여 대기보정을 실시하고 대기보정 유·무에 따른 해수, 갯벌, 식생, 아스팔트, 콘크리트 등의 토지피복 항목별 분광반사율 특성을 비교하여 대기보정의 뚜렷한 효과를 확인할 수 있었다. 대기보정 후의 영상에 대하여 최대우도법, 분광각맵퍼법 등의 화소기반 감독분류기법으로 각각 토지피복 분류를 행하고 그 결과를 비교하였다. 분광각맵퍼법의 경우 임계각 0.4°에서 노이즈를 최소화하면서 해수영역을 가장 양호하게 분류해 낼 수 있었다. 같은 개체라도 다양한 분광특성을 나타내는 하이퍼스펙트럴 영상의 경우 연안지역에서는 종래의 화소기반 분류기법보다는 축척, 분광 정보, 형태, 결 등을 종합적으로 고려하는 객체기반 분류기법이 더 우월할 것으로 사료된다. Atmospheric correction as a preprocessing work should be performed to conduct accurately landcover/landuse classification using hyperspectral imagery. Atmospheric correction on airborne hyperspectral images was conducted and then the effect of atmospheric correction by comparing spectral reflectance characteristics before and after atmospheric correction for a few landuse classes was analyzed. In addition, land cover classification was first conducted respectively by the maximum likelihood method and the spectral angle mapper method after atmospheric correction and then the results were compared. Applying the spectral angle mapper method, the sea water area were able to be classified with the minimum of noise at the threshold angle of 4 arc degree. It is considered that object-based classification method, which take into account of scale, spectral information, shape, texture and so forth comprehensively, is more advantageous than pixel-based classification methods in conducting landcover classification of the coastal area with hyperspectral images in which even the same object represents various spectral characteristics.

항암화학요법을 받는 혈액암 환자에서 조기난소기능부족증 예방을 위한 성선자극호르몬분비호르몬작용제의 병합 사용

전성욱 ( Sung Wook Chun ),지용일 ( Yong Il Ji ),주영돈 ( Young Don Joo ) 대한폐경학회 2013 대한폐경학회지 Vol.19 No.2

연구목적: 혈액 암으로 진단 받고 항암화학요법을 시행 받는 환자에서 난소 기능 보존을 위한 성선자극분비호르몬작용 제 병합요법의 효과를 분석하고자 하였다. 연구재료 및 방법: 2010년 3월부터 2012년 2월까지 대학병원에서 혈액 암으로 처음 진단 받고 항암화학요법을 시행 받은 폐경 전 젊은 여성을 연구 대상에 포함하였다. 결과: 29명 (15-39세)의 환자가 연구 대상에 포함되었으며, 이 중 5명은 항암화학요법 중 leuprolide를 병합투여 받았고 24명은 항암화학요법만 시행 받았다. 항암화학요법만 단독으로 시행 받은 24명 중에서 17명이 치료 종료 1년 이내 조기난소기능부족 증으로 진단 받았으며 leuprolide 병합 투여군 5명 중에서는 1명만 치료 종료 1년 이내 조기난소기능부족 증으로 진단 받았으나, 두 군간 통계적으로 유의한 차이는 보이지 않았다 (P = 0.054). Leuprolide 병합 투여 군에서 혈청 항뮐러리안호르몬 농도는 치료 전 (5.57 ± 0.18 ng/mL)에 비해 치료 후 (1.84 ± 0.22 ng/mL) 유의한 감소를 보였다 (P < 0.001). 결론: 성선자극분비호르몬작용 제는 조기폐경 예방을 위해 유용한 방법이 될 수 있으나 아직까지 그 효과는 논란의 여지가 있다. 향후 충분한 추적관찰 기간을 가지는 대규모의 다기 관 전향적 연구가 필요할 것으로 생각된다. Objectives: The aim of this study was to assess the effect of gonadotropin-releasing hormone (GnRH) agonist co-treatment for gonadal protection in patients with hematologic neoplasms undergoing chemotherapy. Methods: Young premenopausal women who were diagnosed with leukemia or lymphoma between March 2010 and February 2012 and undergoing chemotherapy in a university hospital were included in this study. Results: Twenty-nine patients aged 15-39 years participated in this study. Among the patients, five patients were receiving leuprolide concomitant with chemotherapy, and twenty-four patients were receiving chemotherapy alone. Seventeen patients in the chemotherapy alone group stopped menstrating and were diagnosed with primary ovarian insufficiency (POI) within one year after chemotherapy; and only one patient had POI in the chemotherapy plus leuprolide group, but these differences were not statistically significant (P = 0.054). In the chemotherapy plus leuprolide group, serum anti-mullerian hormone (AMH) levels were significantly lower than basal serum AMH levels (5.57 ± 0.18 ng/mL) (P < 0.001) after treatment (1.84 ± 0.22 ng/mL). Conclusion: GnRH agonist may be a promising option for the prevention of POF, but the effectiveness of GnRH agonist is still debatable. A large prospective multi-center trial with adequate follow-up is needed. (J Korean Soc Menopause 2013; 19:93-100)

만성 C형간염 환자에서 간세포암종과 병발한 B세포 비호지킨림프종

이순일 ( Soon Il Lee ),허내윤 ( Nae Yun Heo ),박승하 ( Seung Ha Park ),주영돈 ( Young Don Joo ),김일환 ( Il Hwan Kim ),박정익 ( Jeong Ik Park ),김지연 ( Ji Yeon Kim ),김승호 ( Seung Ho Kim ),심혜경 ( Hye Kyung Shim ) 대한소화기학회 2014 대한소화기학회지 Vol.64 No.3

Hepatitis C virus (HCV) is one of the main viral causes of hepatocellular carcinoma (HCC) and is associated with lymphoproliferative disorder such as non-Hodgkin``s lymphoma (NHL). However, there are only few case reports on concomitantly induced NHL and HCC by HCV. Herein, we report a case of synchronous NHL and HCC in a patient with chronic hepatitis C which was unexpectedly diagnosed during liver transplantation surgery. This case suggests that although intrahepatic lymph node enlargements are often considered as reactive or metastatic lymphadenopathy in chronic hepatitis C patients with HCC, NHL should also be considered as a differential diagnosis. (Korean J Gastroenterol 2014;64:168-172)

증례 : 소화기 ; 골수를 침범한 다발성 위장관 MALT 림프종

김형준 ( Hyung Jun Kim ),박종하 ( Jong Ha Park ),주영돈 ( Young Don Joo ),이순일 ( Soon Il Lee ),이은지 ( Eun Ji Lee ),김현태 ( Hyun Tae Kim ),김지연 ( Ji Yeon Kim ) 대한내과학회 2014 대한내과학회지 Vol.86 No.5

위는 위장관 림프종의 75% 이상을 차지하는 가장 흔한 발생 장소이지만 위와 십이지장에서 동시에 발생한 MALT 림프종은 1983년부터 2013년까지 4예밖에 보고되지 않았을 정도로 매우 드물다. 저자들은 위와 십이지장을 침범한 다발성 위장관 MALT 림프종이 골수와 비장을 침범한 증례를 경험하였으며 향후에 다발성 위장관 MALT 림프종의 경우에 골수 생검을 더 적극적으로 해야 할 것을 제안하는 바이다. The stomach is the most common site of gastrointestinal tract lymphoma, while synchronous mucosa-associated lymphoid tissue (MALT) lymphomas of the stomach and duodenum are very rare. A literature review found no reported case of synchronous gastroduodenal MALT lymphomas with involvement of the bone marrow and spleen. Here, we describe the case of a 62-year-old male who was diagnosed with synchronous MALT lymphomas of the stomach and duodenum based on upper gastrointestinal endoscopy and pathology. Other staging evaluations, including colonoscopy, abdominopelvic and chest computed tomography (CT), 18F fludeoxyglucose- positron emission tomography (FDG-PET), and a bone marrow examination, showed involvement of the bone marrow and spleen. We diagnosed stage EIV MALT lymphoma and began systemic chemotherapy. We report the first case of MALT lymphomas arising synchronously in both the stomach and duodenum with bone marrow involvement and review the literature. (Korean J Med 2014;86:593-597)

하이퍼스펙트럴 영상으로부터 객체기반 영상분류방법에 의한 토지피복도 및 수애선 추출

이진덕(Lee jin-duk),방건준(Bhang kon-joon),주영돈(Joo young-don),한승희(Han seung-hee) 한국콘텐츠학회 2014 한국콘텐츠학회 종합학술대회 논문집 Vol.2014 No.11

위 십이지장 질환들의 위액내 Bile Acid 와 Lysolecithin 농도에 관한 관찰

정정명(Jung Myung Chung),정봉균(Bong Kun Jeon),김수찬(Soo Chan Kim),주영돈(Young Don Joo),설상영(Sang Young Soel),최하진(Ha Jin Choi) 대한내과학회 1989 대한내과학회지 Vol.37 No.3

N/A A peptic ulcer is a benign ulcerative lesion in the alimentary tract developed by corrosive and digestive action of acid and pepsin in gastric juice and its cause is thought to be due to the imbalance of aggressive factors and defense mechanisms in gastric juice. But there are many controversies about the etiologic factors of peptic ulcer and further studies are needed for understanding of the pathophysiologic mechanisms. Recently it has been reported that bile and pancreatic juice could be refluxed into the upper duodenum or stomach under certain conditions, so gastric and duodenal ulcers could be induced by those digestive actions. This reflux phenomenon is supposed to be an important etiologic factor of gastric ulcer. More specifically, bile acid and lysolecithin of the refluxed duodenal contents increase back diffusion of hydrogen ions in the stomach and this back diffusion of hydrogen ions could induce acute or chronic gastritis and gastric ulcer. Moreover, it is carefully presumed that this reflux-induced acute and chronic gastritis acts as a factor of non-ulcer dyspepsia, and chronic stimulation of refluxed bile acid and lysolecithin seems likely to be an etiological factor for the development of stump cancer in gastrectomized patients. In this study, we have investigated the levels of bile acid and lysolecithin concentration in gastric juice for the evaluation of some influences of gastroduodena1 reflux on several gastroduodenal diseases. The results were as follows: 1) Bile acid concentration of gastric juice was 46.5±31.0 μmol/l in 13 normal controls, 202.2±109,2 μmol/l in 20 cases of duodenal ulcer, 329.1±101.5 μmol/1 in 28 cases of gastric ulcer 241.8±147.7 μmon/1 in 14 cases of stomach cancer and 352.1±88.7 μmol/1 in 18 cases of non-ulcer dyspepsia. 2) Lysolecithin concentration in gastric juice was 81.0±22.9 μmol/1 in 10 normal controls, 114.3±40.1 μmol/ l in 12 cases of duodenal ulcer, 170.4±43.9 μmol/1 in 10 cases of gastric ulcer, 230.3±172.0 μmol/1 in 6 cases of stomach cancer and 238.9±187.6 μmol/l in 7 cases of non-ulcer dyspepsia. 3) Average bile acid concentration in gastric juice showed a significant increase in each disease group and it was more prominent in gastric diseases including non-ulcer dyspepsia and gastric ulcer than in other groups. 4) Lysolecithin concentration in gastric juice also showed a significant increase in each disease group and it was more prominent in gastric ulcer than in duodenal ulcer. Lysolecithin concentration in the non-ulcer dyspepsia and stomach cancer groups showed a more prominent increase than the control group and duodenal ulcer group but we could not apprehend the clinical significance because the number of cases was negligible. 5) There was no specific correlation between bile acid and lysolecithin concentration of gastric juice in 20 cases of gastric and duodenal ulcers, From our findings, the constant increase of bile acid or lysolecithin concentration in gastric juice might be one of the etiologic factors in development of gastroduodenal diseases, particularly in gastric diseases. However, further study about this problem is thought to be needed.