3-Hydroxy-3-methylglutaryl-CoA (HMG-CoA) reductase inhibitory effect of Vitis vinifera

Koo, M.,Kim, S.H.,Lee, N.,Yoo, M.Y.,Ryu, S.Y.,Kwon, D.Y.,Kim, Y.S. Inverni Della Beffa S.p.A ; Elsevier Science 2008 Fitoterapia Vol.79 No.3

Activity-guided fractionation of the methanol extract of Vitis vinifera bark led to the isolation of ε-viniferin, ampelopcin A, vitisin A and vitisin B. Vitisin A and vitisin B showed a remarkable inhibitory activity against 3-hydroxy-3-methylglutaryl-Coenzyme A (HMG-CoA) reductase with IC<SUB>50</SUB> value of 42.1 μM and 23.9 μM, respectively.

SMART (Simultaneous Modulated Accelerated RadioTherapy) for locally advanced nasopharyngeal carcinomas

Koom, Woong Sub,Kim, Tae Hyun,Shin, Kyung Hwan,Pyo, Hong Ryull,Kim, Joo-Young,Kim, Dae Yong,Yoon, Myonggeun,Park, Sung Yong,Lee, Dae Ho,Ryu, Jun Sun,Jung, Yoo Seok,Lee, Sang Hyun,Cho, Kwan Ho Wiley Subscription Services, Inc., A Wiley Company 2008 Head & neck Vol.30 No.2

<B>Background.</B><P>Concurrent chemoradiotherapy is commonly used for locally advanced nasopharyngeal carcinoma (NPC). We retrospectively analyzed the clinical outcomes of simultaneous modulated accelerated radiotherapy (SMART) with concurrent chemotherapy.</P><B>Methods.</B><P>Between January 2003 and May 2005, 24 patients with stage IIB to IVB NPC underwent SMART encompassing 3 targets: gross tumor volume (GTV), high-risk subclinical disease (CTV1), and low-risk subclinical disease (CTV2). Daily fractions of 2.4, 2.15, and 1.9 Gy were delivered to GTV, CTV1, and CTV2 to a total dose of 64.8, 58.05, and 51.3 Gy in 27 fractions over 5.5 weeks, respectively. Fifteen patients received concurrent cisplatin (DDP group), and 9 received 5-fluorouracil plus cisplatin (FP group).</P><B>Results.</B><P>With a median follow-up of 26 months (range, 17–45 months), 3-year overall and local-, regional-, and distant-progression-free survivals were 96% and 93%, 87%, and 88%, respectively. Grade 3 acute mucositis and pharyngitis were observed in 16 (67%) and 14 (59%) patients, respectively. Severe acute mucositis (100% vs 47%) and pharyngitis (100% vs 34%) were more frequently observed in the FP group than the DDP group (p < .01).</P><B>Conclusions.</B><P>Despite short follow-up with a small number of patients, our preliminary results demonstrated encouraging local-regional control and survival at the cost of modest increase in treatment related toxicities. The total dose and fractionation scheme of SMART used in our study is feasible with no life-threatening or fatal complications. However, the administration of fluorouracil in addition to cisplatin during SMART was associated with increased acute and late toxicities, and it should be administered with caution. © 2007 Wiley Periodicals, Inc. Head Neck, 2008</P>

Combination of Radiotherapy and Adenovirus-Mediated <i>p53</i> Gene Therapy for MDM2-Overexpressing Hepatocellular Carcinoma

KOOM, Woong Sub,PARK, Soo-Yeon,KIM, Wonwoo,KIM, Minjung,KIM, Ji-Seong,KIM, Hyunki,CHOI, Il-Kyu,YUN, Chae-Ok,SEONG, Jinsil Journal of Radiation Research Editorial Committee 2012 JOURNAL OF RADIATION RESEARCH Vol.53 No.2

<P>The <I>p53</I> gene plays a determinant role in radiation-induced cell death and its protein product is negatively regulated by MDM2. We investigated whether adenovirus-mediated modified <I>p53</I> gene transfer, which blocks p53-MDM2 binding, is effective for radiation-induced cell death in hepatocellular carcinoma (HCC) at different MDM2 cellular levels. Human hepatocellular carcinoma cell lines expressing MDM2 at low levels (Huh7) and high levels (SK-Hep1) were used. Ad-p53 and Ad-p53vp are replication-deficient adenoviral vectors containing human wild-type or modified p53, respectively. The anti-tumor effect was highest for Ad-p53 + radiotherapy (RT) in the low-level MDM2 cells, whereas this effect was highest for Ad-p53vp + RT in the MDM2-overexpressing cells. In Huh-7 cells, Ad-p53 + RT decreased cell viability (32%) <I>in vitro</I> and inhibited tumor growth (enhancement factor, 1.86) <I>in vivo</I>. Additionally, p21 expression and apoptosis were increased. In contrast, in SK-Hep1 cells, Ad-p53vp + RT showed decreased cell viability (51%) <I>in vitro</I> and inhibition of tumor growth (enhancement factor, 3.07) <I>in vivo</I>. Caspase-3 expression and apoptosis were also increased. Adenovirus-expressing modified p53, which blocks p53-MDM2 binding, was effective in killing tumor cells overexpressing MDM2. Furthermore, the combination strategy for disruption of the p53-MDM2 interaction with RT demonstrated enhanced anti-tumor effects both <I>in vitro</I> and <I>in vivo</I>.</P>

Art therapy using famous painting appreciation maintains fatigue levels during radiotherapy in cancer patients

Koom, Woong Sub,Choi, Mi Yeon,Lee, Jeongshim,Park, Eun Jung,Kim, Ju Hye,Kim, Sun-Hyun,Kim, Yong Bae The Korean Society for Radiation Oncology 2016 Radiation Oncology Journal Vol.34 No.2

Purpose: The purpose of this study was to evaluate the efficacy of art therapy to control fatigue in cancer patients during course of radiotherapy and its impact on quality of life (QoL). Materials and Methods: Fifty cancer patients receiving radiotherapy received weekly art therapy sessions using famous painting appreciation. Fatigue and QoL were assessed using the Brief Fatigue Inventory (BFI) Scale and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) at baseline before starting radiotherapy, every week for 4 weeks during radiotherapy, and at the end of radiotherapy. Mean changes of scores over time were analyzed using a generalized linear mixed model. Results: Of the 50 patients, 34 (68%) participated in 4 sessions of art therapy. Generalized linear mixed models testing for the effect of time on mean score changes showed no significant changes in scores from baseline for the BFI and FACIT-F. The mean BFI score and FACIT-F total score changed from 3.1 to 2.7 and from 110.7 to 109.2, respectively. Art therapy based on the appreciation of famous paintings led to increases in self-esteem by increasing self-realization and forming social relationships. Conclusion: Fatigue and QoL in cancer patients with art therapy do not deteriorate during a period of radiotherapy. Despite the single-arm small number of participants and pilot design, this study provides a strong initial demonstration that art therapy of appreciation for famous painting is worthy of further study for fatigue and QoL improvement. Further, it can play an important role in routine practice in cancer patients during radiotherapy.

Nutritional status of patients treated with radiotherapy as determined by subjective global assessment

Koom, Woong Sub,Ahn, Seung Do,Song, Si Yeol,Lee, Chang Geol,Moon, Sung Ho,Chie, Eui Kyu,Jang, Hong Seok,Oh, Young-Taek,Lee, Ho Sun,Keum, Ki Chang The Korean Society for Radiation Oncology 2012 Radiation Oncology Journal Vol.30 No.3

Purpose: The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. Materials and Methods: A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). Results: The mean age of patients in this study was $59.4{\pm}11.9$ years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss ${\geq}5%$ (OR, 2.299). Conclusion: SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.

Art therapy using famous painting appreciation maintains fatigue levels during radiotherapy in cancer patients

Woong Sub Koom,Mi Yeon Choi,Jeongshim Lee,Eun Jung Park,Ju Hye Kim,Sun-Hyun Kim,Yong Bae Kim 대한방사선종양학회 2016 Radiation Oncology Journal Vol.34 No.2

Purpose: The purpose of this study was to evaluate the efficacy of art therapy to control fatigue in cancer patients during course of radiotherapy and its impact on quality of life (QoL). Materials and Methods: Fifty cancer patients receiving radiotherapy received weekly art therapy sessions using famous painting appreciation. Fatigue and QoL were assessed using the Brief Fatigue Inventory (BFI) Scale and the Functional Assessment of Chronic Illness Therapy-Fatigue (FACIT-F) at baseline before starting radiotherapy, every week for 4 weeks during radiotherapy, and at the end of radiotherapy. Mean changes of scores over time were analyzed using a generalized linear mixed model. Results: Of the 50 patients, 34 (68%) participated in 4 sessions of art therapy. Generalized linear mixed models testing for the effect of time on mean score changes showed no significant changes in scores from baseline for the BFI and FACIT-F. The mean BFI score and FACIT-F total score changed from 3.1 to 2.7 and from 110.7 to 109.2, respectively. Art therapy based on the appreciation of famous paintings led to increases in self-esteem by increasing self-realization and forming social relationships. Conclusion: Fatigue and QoL in cancer patients with art therapy do not deteriorate during a period of radiotherapy. Despite the single-arm small number of participants and pilot design, this study provides a strong initial demonstration that art therapy of appreciation for famous painting is worthy of further study for fatigue and QoL improvement. Further, it can play an important role in routine practice in cancer patients during radiotherapy.

Nutritional status of patients treated with radiotherapy as determined by subjective global assessment

Woong Sub Koom,Seung Do Ahn,Si Yeol Song,Chang Geol Lee,Sung Ho Moon,Eui Kyu Chie,Hong Seok Jang,Young-Taek Oh,Ho Sun Lee,Ki Chang Keum 대한방사선종양학회 2012 Radiation Oncology Journal Vol.30 No.3

Purpose: The purpose of this prospective multi-institutional study was to evaluate the nutritional status of patients undergoing radiotherapy (RT) for treatment of head and neck, lung, or gastrointestinal cancer. Materials and Methods: A total of 1,000 patients were enrolled in this study at seven different hospitals in Seoul, Korea between October 2009 and May 2010. The nutritional status of patients after receiving 3 weeks of RT was evaluated using subjective global assessment (SGA). The nutritional status of each patient was rated as well nourished (A), moderately malnourished (B), or severely malnourished (C). Results: The mean age of patients in this study was 59.4 ± 11.9 years, and the male to female ratio was 7:3. According to the SGA results, 60.8%, 34.5%, and 4.7% of patients were classified as A, B, or C, respectively. The following criteria were significantly associated with malnutrition (SGA B or C; p < 0.001): loss of subcutaneous fat or muscle wasting (odds ratio [OR], 11.473); increased metabolic demand/stress (OR, 8.688); ankle, sacral edema, or ascites (OR, 3.234); and weight loss ≥5% (OR, 2.299). Conclusion: SGA was applied successfully to assess the nutritional status of most patients. The prevalence of malnutrition in a radiation oncology department was 39.2%. The results of this study serve as a basis for implementation of nutrition intervention to patients being treated at radiation oncology departments.

국한성 두경부 대세포성(Diffuse Large Cell) 림프종의 적정 방사선 조사선량

금웅섭(Woong Sub Koom),서창옥(Chang Ok Suh),김용배(Yong Bae Kim),심수정(Su Jung Shim),표홍렬(Hongryull Pyo),노재경(Jae Kyung Roh),정현철(Hyun Cheol Chung),김귀언(Gwi Eon Kim) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.4

목적 : 두경부에 국한된 1기, 2기 대세포성(diffuse large cell) 비호치킨 림프종의 항암화학방사선 병용요법 시 방사선 조사영역 내의 재발을 예방하기 위한 적정 방사선 조사선량을 알아보고자 하였다. 대상 및 방법 : 1985년 5월부터 1998년 12월까지 국한성 두경부 대세포성 림프종으로 항암화학요법 후 방사선치료를 받은 53명을 대상으로 하였다. 나이는 13세부터 69세까지였으며 중앙값은 49세였다. 남녀 비는 1.65대 1이었고 1기, 2기 환자가 각각 27명, 26명이었다. 종양 크기별로 5cm 미만이 30명, 5cm 이상이 23명이었다. 원발부위는 경부림프절 22명, 편도 20명, 비인두 4명, 설기저부 3명, 부비동 2명, 후두 1명, 연구개 1명이었다. 항암화학요법은 1명을 제외하고 3회 이상 시행되었으며 방사선치료는 48명이 원발부위와 경부임파선을, 5명이 원발부위만 치료하였다. 생존율, 무병생존율, 조사영역 내 무재발생존율과 방사선 조사선량에 따른 방사선 조사영역 내에서의 재발빈도를 조사하였다. 결과 : 항암화학요법 후 44명(83%)이 완전관해 되었고 연이은 방사선치료 후 53명 모두 완전관해 되었다. 12명(23%)이 재발하였고 그중 2명은 방사선 조사영역 내 재발이었고 방사선 조사영역 바깥 재발은 11명으로 복강 및 ㄱ 반 내 림프절이 가장 많았다. 방사선 조사선량 별 조사영역 내 재발은 30~35 Gy에서 7명 중 1명, 35~40 Gy에서 16명중 1명이었고 40 Gy 이상에서는 재발이 없었다. 방사선 조사영역 내 재발은 30~35 Gy에서 7명 중 1명, 35~40 GY에서 16명중 1명이었고 40 Gy 이상에서는 재발이 없었다. 방사선 조사영역 내 재발에 유의한 예후인자는 없었으나 5cm 이상인 종양에서 재발하였고 5cm 미만인 종양은 30 Gy에서도 재발하지 않았다. 10년 방사선 조사영역내 무재발 생존율, 무병생존율, 전체생존율은 각각 96%, 76%, 75%였다. 결론 : 국한성 두경부 대세포성 림프종서 함암화학방사선 병용요법 시 종양의 크기가 5cm 미만은 경우에는 30 Gy의 방사선 조사선량으로도 국소제어를 할 수 있다. 따라서 방사선치료에 따르는 구강건조증을 최소화시킬 수 있을 것이다. 5cm 이상의 종양에서는 30 Gy 이상의 방사선 조사 선량이 필요하리라 생각된다. Purpose : To determine the optimal radiation dose in a localized non-Hodgkin's lymphoma of the head and neck in the treatment setting for combined chemoradiotherapy. Materials and Methods : Fifty-three patients with stage Ⅰ and Ⅱ diffuse large cell non-Hodgkin's lym-phoma of the head and neck, who were treated with combined chemoradiotherapy between 1985 and 1998 were retrospectively reviewed. The median age was 49 years, and the male-to-female ratio was ap-proximately 1.6. Twenty-seven patients had stage I disease and 26 had stage Ⅱ. Twenty-three patients had bulky tumors (≥5 cm) and 30 had non-bulky tumors (<5 cm). The primary tumors arose mainly from an extranodal organ (70%), most cases involving Waldeyer's ring (90%). All patients except one were initially treated with 3~6 cycles of chemotherapy, which was followed by radiotherapy. Radiation was de-livered either to the primary tumor area alone (9%) or to the primary tumor area plus the bilateral neck nodes (91%) with a minimum does of 30 Gy (range 30~60 Gy). The failure patterns according to the radiation field were analyzed, and the relationship between the dose and the in-field recurrence was evaluated. Results : The 10-year overall survival and the 10-year disease free survival rates were similar at 75% and 76%, respectively. A complete response (CR) after chemotherapy was achieved in 44 patients (83%). Subsequent radiotherapy showed a CR in all patients. Twelve patients (23%) had a relapse of the lym-phoma after the initial treatment. Two of these patients had a recurrence inside the radiation field. No clear dose response relationship was observed and no significant prognostic factors for the in-field recur-rence <5 cm in diameter, there were no in field recurrences after a radiation dose 30 Gy. The 2 in-field recurrences encoutered occurred in patients with a tumor ≥5 cm. conclusion : A dose of 30 Gy is sufficient for local control in patients with a non-bulky (<5 cm), lo-calized, diffuse large cell non-Hodgkin's lymphoma when combined with chemotherapy. An additional boost dose in the primary site is recommended for patients with bulky tumors (≥5 cm).

A practical review of watch-and-wait approach in rectal cancer

Hwa Kyung Byun(Hwa Kyung Byun),Woong Sub Koom(Woong Sub Koom) 대한방사선종양학회 2023 Radiation Oncology Journal Vol.41 No.1

Rectal resection surgery after neoadjuvant treatment has been the mainstay treatment of locally advanced rectal cancer. However, functional outcomes and quality of life after radical resection of the rectum remain suboptimal. The excellent oncologic outcomes in patients who achieved pathologic complete response after neoadjuvant treatment questioned the need for radical surgery. The watch-and-wait approach is a noninvasive therapeutic alternative for organ preservation and avoiding operative morbidity. In the watch-and-wait approach, patients with locally advanced rectal cancer who achieve excellent clinical response after neoadjuvant treatment undergo active surveillance rather than rectal cancer surgery. In this practical review, we summarized the main results of studies on the watch-and-wait approach and provided a practical method for implementing the watch-and-wait approach.

간세포암에서 유래한 골전이의 방사선치료

금웅섭,성진실,이민정,박희철,한광협,전재윤,문영명,서창옥 대한간학회 2002 Clinical and Molecular Hepatology(대한간학회지) Vol.8 No.3

목적: 간세포암의 골전이가 증가됨에 따라 이에 대한 치료의 중요성이 증가되고 있으며 본 연구는 간세포암에서 유래한 골전이 환자에서 방사선치료의 통증 조절 효과에 대하여 분석하였다. 대상과 방법: 1991년 1월부터 2000년 6월까지 간세포암에서 유래한 골전이로 방사선치료를 받은 55명의 환자 중 계획된 방사선치료를 마친 51명(77 골전이 병소) 을 대상으로 하였다. 대상환자 중 남자가 45명, 여자가 6명으로 남녀 비는 7.5 대 1 이었고 연령은 21세 에서 80세였고 중앙값은 55세였다. 방사선치료는 하루 1회 선량 2.5 Gy에서 4 Gy로 총선량 12.5 Gy에 서 50 Gy(중앙값 30 Gy)까지 시행되었다. 방사선치료에 대한 반응은 Wisconsin Brief Pain Questionnaire 검사로 분석하였으며 생존율 분석은 Kaplan-Meier법을 이용하였고 통계적 검증은 log rank test, Cox regression을 이용하였다. 결과: 원발 병소의 진단 당시 동시에 골전이가 있었던 경우가 20명 (39%), 원발 병소 진단 이후에 생긴 골전이는 31명 (61%)이었다. 골전이 진단시 골 이외의 전이 병소는 19명에서 관찰되었고 폐, 복강내 림프절, 부신 등이었다. 골전이 진단 당시 간내 병기는 IVA기가 37명 (73%)으로 대부분이었다. 골전이에 의한 증상은 통증이 주증상이었고(45명), 신경학적 이상을 동반한 경우가 13예, 촉지되는 종괴가 7예, 병적 골절이 5예 이었다. 단일 부위 골전이가 21명(41%), 다발성 골 전이가 30명(59%)이었으며 병소 수는 척추가 38예 로 가장 많았고 늑골 20예, 골반 19예 순 이었다. 골 전이 진단시로부터 생존율은 1년, 2년이 각각 15%, 4%였고 중앙생존기간은 5개월이었다. 예후 인자 단변량 분석에서 골전이 진단 당시 간내 병기 (p=0.014)와 골 이외 다른 부위 전이 유무(p=0.019)가 유의하였으나 다변량 분석에서는 독립적 예후 인자는 없었다. 총 51명 중 49명이 사망하였고 2명의 환자는 무병으로 추적 관찰되고 있다. 방사선치료 후 통증의 변화는 56 병소(73%)에서 호전되었으며, 14 병소(18%)에서는 변화가 없었고, 1 병소(1%) 는 치료 후에도 통증이 악화되었으며 6 병소(8%)는 평가할 수 없었다. 결론: 간세포암의 골전이 이후에 도 중앙생존기간은 약 5개월에 이르고 있다. 따라서 효과적인 증상완화 치료를 필요로 하며, 방사선 치료는 73%에서 통증의 호전을 보이는 유용한 치료로 생각된다 Background/Aim: Recent advances in both diagnosis and treatment have markedly improved the prognosis in patients with hepatocellular carcinoma (HCC). Bone metastasis has become a clinical problem in the treatment of HCC patients. The purpose of this study was to evaluate the palliative effect of radiotherapy for painful bone metastasis from HCC. Methods: From January 1991 to June 2000, 51 patients (77 sites) with painful bone metastasis from HCC were retrospectively analyzed. Ages ranged from 21 to 80 years (median 55 years). The male:female ratio was 7.5:1. Synchronous or metachronous bone metastasis was seen in 20 (39%) and 31 patients (61%), respectively. The most common symptom of bone metastasis was pain (45 patients, 88%). Twenty-one patients (41%) had a solitary bone metastasis while 30 (59%) had multiple ones. The sites of bone metastasis, in order of frequency, were the vertebra (38), rib (20), and pelvis (19). The total radiation dose ranged from 12.5 to 50 Gy (median 30 Gy). The Wisconsin Brief Pain Questionnaire was used to evaluate pain response. Results: The overall 1 and 2 year survival rates from the time of bone metastasis were 15% and 4%, respectively. The median survival time was 5 months. Intrahepatic stage(p=0.014), and metastasis to other organs(p=0.019) were significant prognostic factor for survival by univariate analysis. There was, however, no independent prognostic factor on multivariate analysis. Pain relief after radiotherapy was achieved for 56 sites (73%). Conclusion: The expected life span (median 5 months) in this group of patients suggests a strong necessity for effective treatment for symptomatic palliation. Radiation therapy was effective in pain palliation for bone metastasis from HCC, and this could improve patients' quality of life. (Korean J Hepatol 2002;8:304-311)