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조요한(Yo Han Joh),최인실(In Sil Choi),이근욱(Keun Wook Lee),오도연(Do Youn Oh),김병수(Byung Su Kim),이대호(Dae Ho Lee),김태유(Tae You Kim),방영주(Yung Jue Bang),우홍균(Hong Gyun Wu),성명훈(Myung Whun Sung),이철희(Chul Hee Lee),김광현(N 대한두경부종양학회 2001 대한두경부 종양학회지 Vol.17 No.2
Objective: The role of chemotherapy in locally advanced head and neck cancer has been established in nasopharynx and larynx as definitive therapy and organ preserving therapy, respectively. Oral cavity cancers are relatively uncommon and local recurrence is the main cause of treatment failure. We planned this retrospective study to evaluate the role of neoadjuvant chemotherapy in locally advanced oral cavity cancer patients. Materials and Methods: From 1988 March to 2001 February, locally advanced, previously untreated oral cavity cancer patients who received neoadjuvant chemotherapy were examined. Chemotherapy had been done in the following patients: Histologically proven squamous cell or poorly differentiated carcinoma, stage 3 or 4, and performance state 0-2 patients. Chemotherapy regimen consisted of cisplatin and infusional 5-fluorouracil. Response was evaluated after 2 cycles and in case of no response, definitive local therapy was done; otherwise 3 cycles was done before local treatment. Results: 48 patients were treated and 47 patients were evaluable for responses. Complete response rate was 6.4%(3/47) and partial response 80.0%(38/47), scoring overall response rate of 87.2%. Median time to progression was 27.0 months (95% CI : 0-58months) and overall 5 year survival was 54.8%. 5-year disease-free survival in the patients in remission after local treatment was 51.9%. In multivariate analysis, contributing factor to the survival were response to neoadjuvant chemotherapy and local treatment modalities. Extensive surgery was done in 10 patients and 25 patents (52.1%) was followed up with preserved function. With median follow-up of 57.0 months, 19 recurrences were detected, most of which were local or regional type. Conclusion: Neoadjuvant chemotherapy followed by local treatment in oral cavity cancer showed high response rate and was thought to be effective therapeutic approach especially in view of organ preservation.
이상윤(Sang Yoon Lee),최인실(In Sil Choi),박숙련(Suk Ryun Park),김도연(Do Yeon Kim),김광현(Kwang Hyun Kim),김노경(Noe Kyeong Kim),허대석(Dae Seog Heo) 대한두경부종양학회 2002 대한두경부 종양학회지 Vol.18 No.2
Malignant glomus tumor is a very rare disease originating from the paraganglia system through the body. Glomus tumor, also known as paraganglioma, usually are considered benign, and arises in a variety of head and neck locations, most of which include the carotid body, the vagus nerve, and the jugulotympanic area. The most widely accepted management of benign glomus tumor is surgical extiration. Here, we report a case of recurrent laryngeal glomus tumor which is proven malignant and metastatic to the brain and the lungs. We have treated the patient with combination chemotherapy and radiation to the brain, the result of which is partial response in terms of decreased size of metastatic lung lesions.
입원중인 암환자에 대한 통증관리의 적절성평가 - 한 3차 의료기관 내과 전공의를 대상으로 -
김국회,장원일,조요한,최인실,박숙련,이상윤,김지현,김도연,이세훈,김태유,방영주,김노경,허대석,Kim, Kuk-Hyoe,Jang, Won-Il,Joh, Yo-Han,Choi, In-Sil,Park, Sook-Ryun,Lee, Sang-Yoon,Kim, Jee-Hyun,Kim, Do-Yeun,Lee, Se-Hoon,Kim, Tae-You,Bang, Yung-J 한국호스피스완화의료학회 2001 한국호스피스.완화의료학회지 Vol.4 No.2
목적 : 암환자에서 가장 흔히 겪게 되고, 심각한 증세는 통증이다. 진행성 암인 경우 $60{\sim}90%$의 환자들이 통증으로 고상하게 되며, WHO통계에 따르면 전세계적으로 4백만 정도의 암환자들이 통증으로 고생하고 있다. 통증관리원칙에 따르면 환자 $70{\sim}90%$이상에서 적절한 통증조절이 이루어질 수 있음에도 불구하고 이들 중 $60{\sim}70%$의 암환자들이 적절한 통증치료를 받지 못하고 있다. 본 연구는 1) 암환자의 통증 빈도 2) 환자와 담당전공의에서 통증인지의 일치 여부 3) 암환자의 통증치료에서 진통제 투약의 적절성 등을 조사함으로써, 암환자 통증에 대한 이해와 통증관리에 대한 지침을 마련하는데 기초자료를 제공하고자 하였다. 대상 및 방법 : 서울대학교병원 내과병동에 입원한 암환자들의 통증 빈도, 담당전공의와 환자의 통증인지 일치도, 통증 관리의 적절성 등을 평가하기 위해서 환자와 담당전공의를 대상으로 설문조사를 시행하고, 진료기록을 평가하였다. 결과 : 7일 이상 내과병동에 입원해 있는 암환자 59명중 43명(62.8%)이 통증을 호소하였다. 전공의들은 담당 암환자들의 통증을 실제보다 과소평가하고 있었으며, 진통제 투약 원칙이 지켜지지 않은 경우도 상당수 있었고, 환자의 통증이 심해질수록 통증에 대한 치료가 더 불충분한 경향이 있었다. 결론 : 암환자에 있어서 통증은 아직까지 낮게 평가되고 있으며 통증 치료는 여전히 불충분하다, 이와 같은 점을 고려할 때, 통증의 평가 및 치료에 대한 더 많은 교육이 필요할 것으로 생각된다. Purpose : Pain is the most serious symptom that cancer patients experience. About $60{\sim}90%$ of advanced cancer patients and four million patients worldwide, according to the WHO statistics, are reported to suffer from cancer pain. Although about $70{\sim}80%$ of the pain could be controlled according to the pain control principles, to our regret, only $30{\sim}40%$ are managed appropriately. This research was aimed to (1) investigates the prevalence of pain among cancer patients, (2) compare patients' perception of pain with physician's recognition and (3) evaluate appropriateness of the doctor's prescription of analgesic. Materials and Methods : Patients with advanced or terminal cancers admitted at department of internal medicine of Seoul National University Hospital for at least 7 days were enrolled. A questionnaire for the patients and the physicians in charge were given and the answers were compared for each other. We also examined their medical records and the physician's orders. Results : Total 59 patients were enrolled. Among them, 43 patients answered the questionnaire, and 27 patients (62.8%) suffered hem cancer pain. The survey also showed that physicians underestimated the severity of pain, overlooked frequently analgesic prescription principle, and that as the patients' pain became severe, the less adequate was pain managements. Conclusion : For cancer patients, pain was frequently overlooked, and treatment still inadequate. Based on this evidence, it seemed that more active practice and education about evaluation and management of cancer pain are needed.
재발성 및 전이성 대장암에 대한 Irinotecan, 고용량 Leucovorin, 5-Fluorouracil 복합 화학요법의 치료결과
김지현 ( Jee Hyun Kim ),김도연 ( Do Yeun Kim ),이세훈 ( Se Hoon Lee ),박숙련 ( Sook Ryun Park ),이상윤 ( Sang Yoon Lee ),최인실 ( In Sil Choi ),김태유 ( Tae You Kim ),허대석 ( Dae Seog Heo ),방영주 ( Yung Jue Bang ),김노경 ( Noe K 대한내과학회 2003 대한내과학회지 Vol.64 No.4
목적 : Irinotecan은 진행성 대장암에서 5-FU, leuco-vorin과 복합하여 1차 요법으로 사용하였을 때, 약 30~40%의 반응율을 보이는 효과적인 약제이다. 아직 irinotecan과 5-FU/leucovorin을 어떤 용량과 방법으로 복합하는 것이 우월한지는 정립되지 않은 실정이다. 저자들은 진행성 대장암 환자를 대상으로 irinotecan/LV5FU2 복합 화학요법의 효과와 독성을 평가하고자 하였다. 방법 : 2000년 6월 1일부 Background : Irinotecan is an active agent in colorectal cancer, producing 30~40% response rates when combined with 5-fluorouracil and leucovorin in metastatic colorectal cancer as first line therapy, however, the best combination schedules are not determ