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김익용 ( Ik Yong Kim ) 대한임상종양학회 2011 Korean Journal of Clinical Oncology Vol.7 No.1
Neuropathy in cancer patients or patients with peripheral neuropathy is a common and often difficult and debilitating complication of cancer or the treatment-related. Chemotherapy-Induced Peripheral Neuropathy (CIPN) is most widely reported and has been the focus of research efforts among the various types of neuropathies in cancer patients. Platinum-based drugs, such as cisplatin and oxaliplatin, are well-known for inducing chronic sensory neuropathies, but their acute and motor neurotoxicities are less well characterized. Multidisciplinary team was charged with the review the literature and discussion intervention strategies currently available to patients as well as areas that require research efforts for the possible prevention, diagnosis, and management of peripheral neuropathy. Effective management of neuropathy or CIPN depends on early diagnosis and an understanding of its underlying causes in the individual patient. Patients with neuropathic pain (NP) are also challenging to manage and evidence-based clinical recommendations for pharmacologic management are needed. The objectives of this article are to discuss: Systematic literature reviews, randomized clinical trials, and existing guidelines were evaluated in prevention, assessment and treatment of the various types of neuropathies in cancer patients.
유수영 ( Soo Young Yoo ),김익용 ( Ik Yong Kim ),강병욱 ( Byung Wook Kang ),임경수 ( Kyung Soo Lim ),강성준 ( Seong Joon Kang ) 대한외상학회 1990 大韓外傷學會誌 Vol.3 No.2
Trauma is the leading cause of death in the Korean pediatric population. Initial correct assessment of injury severity is necessary to reduce preventable traumatic deaths and it can help the appropriate patient to be referred to the appropriate facility. Injury Severity Score(ISS) system widly used for categorizing the severity of injury requires many clinical datas including radiologic modalities, therefore, it does not provide a quick assessment. Five hundreds and eighty-four injury patients less than sixteen years of age were prospectively assessed for 6 month from May 1, 1990 to October 31, 1990. All patients were initially assessed for mechanism of injury, age, direct or referred admission, time from injury, anatomical site of injury, blood cell count and pediatric trauma score(PTS). After diagnostic procedure or operation, the patients were reevaluated with ISS. Motor vehicle related injuries accounted for 42.9% of all deaths and pedestrian injuries of them caused the greatest number of deaths. The patients referred from local hospitals had the prolonged time interval from injury to arrival and higher mortality rate. We have observed a significantly higher death rate among trauma patients younger than 8 year-old. Anatomically, thoracic or abdominal injury presented higher mortality rate than the other site did. All mortality cases had PTS 4 or below, and ISS above 20. A decreasing PTS was directly associated with an increasing ISS. Count of leucocyte, band-form neutrophil or lymphocyte presented linear relationship with ISS and the parients with total leucocyte count more than 20,000/mm3, lymphocyte more than 4,000/mm3, band-form neutrophil more than 500/mm3 disclosed far more death rate (p< 0.0001). We have concluded that quick assessment of injury patients with evaluation of anatomical injury site, severity scoring with PTS, and blood cell count are readily available means of identifying the high risk patients.
위암 환자의 수술 전 림프절 전이 평가를 위한 PET-CT의 진단적 유용성
박성혁,조민수,류훈,배금석,김익용,김대성,Park, Sung-Hyuk,Cho, Min-Su,Ryu, Hoon,Bae, Keum-Seok,Kim, Ik-Yong,Kim, Dae-Sung 대한위암학회 2008 대한위암학회지 Vol.8 No.4
목적: PET-CT가 림프절 전이를 발견하는데 있어 그 정확도를 조사하여 수술 전 진단 도구로써의 유용성을 평가하였다. 대상 및 방법: 2006년 6월부터 2008년 7월까지 원주기독병원에서 위암으로 수술 전 복부(위)전산화단층촬영술 및 PET-CT를 시행 후 근치적 위절제술을 시행한 환자를 대상으로 복부(위)전산화단층촬영술과 PET-CT의 민감도, 특이도, 양성예측률, 음성예측률 그리고 정확도를 비교 평가하였다. 결과: 전체 119명의 PET-CT의 민감도는 32.6%, 복부(위)전산화단층촬영술의 민감도는 39.5%였다. 특이도는 PET-CT 86.8%였으며 복부(위)전산화단층촬영술은 76.3%였다. 양성예측률은 PET-CT 58.3%, 복부(위)전산화단층촬영술 48.6%, 음성예측률은 PET-CT 69.5%, 복부(위)전산화단층촬영술 69.0%였다. 정확도는 PET-CT 67.2%, 복부(위)전산화단층촬영술 63.0%였다. 조기 위암의 경우 PET-CT와 복부(위)전산화단층 촬영술의 특이도는 98.0%와 88.2%, 음성예측률 80.6%와 80.4%, 정확도 67.2%와 63.0%이었다. 진행성 위암인 경우에는 PET-CT와 복부(위)전산화단층촬영술의 민감도는 45.2%와 51.6%, 특이도 64.0%와 52.0%, 양성예측률 60.9%와 57.1%, 음성예측률 48.5%와 46.4%, 정확도 53.6%와 51.8%였다. 결론: 수술 전 PET-CT를 이용한 림프절 전이 여부 평가는 복부(위)전산화단층촬영술에 비해 치료 지침을 결정하는데 더 많은 도움을 줄 수 있을 것으로 사료된다. Purpose: The purpose of this study was to assess the diagnostic value of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT) for detecting the lymph node (LN) metastasis of gastric cancer. Materials and Methods: 119 patients (M : F=89 : 30; mean age: 64) with gastric cancer were referred for preoperative FDG-PET/CT scanning and spiral enhanced abdominal pelvic CT from June 2006 to July 2008, and these were the subjects of our study. All the patients underwent curative radical gastrectomy and lymph node dissection. A final diagnosis was made for all the patients by the histology of the surgical specimens. Results: Both PET/CT and enhanced CT showed similar sensitivity for detecting regional lymph node metastasis (32.6% vs 39.5%, respectively). PET/CT was more accurate than enhanced CT for detecting regional lymph node metastasis (67.2% vs 63.0%, respectively), and PET/CT showed better specificity (86.8% vs 76.3, respectively) and a better positive predictive value (PPV) (58.3% vs 48.6%, respectively). PET/CT showed better specificity (98.0% vs 88.2%, respectively) and accuracy (79.4% vs 73.9%, respectively) than enhanced CT for detecting early gastric cancer. PET/CT showed better specificity (64.0% vs 52.0%, respectively), a better PPV (60.9% vs 57.1%), a better negative predictive value (NPV) (48.5% vs 46.4%, respectively) and better accuracy (53.6% vs 51.8%, respectively) than enhanced CT for detecting advanced gastric cancer. Conclusion: FDG-PET/CT is more usefulness than enhanced CT for making the preoperative diagnosis of regional LN metastases from gastric cancers.
직장암의 근치적 절제술 후 보조 화학요법과 보조 화학방사선 병용요법
이강규(Kang Kyoo Lee),박경란(Kyung Ran Park),이익재(Ik Jae Lee),김익용(Ik Yong Kim),심광용(Kwang Yong Sim),김대성(Dae Sung Kim),이종영(Jong Young Lee) 대한방사선종양학회 2002 Radiation Oncology Journal Vol.20 No.4
목적 : 본 연구는 AJCC 병기 Ⅱ기와 Ⅲ기의 국소진행성 직장암으로 근치적 절제술을 받은 환자들을 대상으로 각 병기에서 보조 화학요법 단독에 비해 화학방사선 병행요법이 생존율 및 무병생존율을 향상시키는지에 대하여 알아보고자 하였다. 대상 및 방법 : 1989년 1월부터 1999년 12월까지 AJCC 병기 Ⅱ기와 Ⅲ기의 직장암으로 근치적 절제술이 시행된 144명을 대상으로 하였다. 그 중 보조 치료방법에 따라 분류를 하면 화학요법 단독군이 72명이었고, 화학방사선 병행용법군은 72명이었다. 화학요법은 수술 후 UFT를 매일 경구복용하거나 (중앙값 12개월) 5-FU를 기초로 한 항암제를 4주 간격으로 정맥주사하였고, 투여기간은 1~18차례 (중앙값 6차례)이였다. 방사선치료는 직장과 골반 내 영역 림프절 영역에 4,500 cGy를 조사한 후 수술 부위에 540~1,440 cGy (중앙값 540 cGy) 추가조사를 시행하였다. 추적관찰 기간은 20~150개월로 중앙값은 44개월이었다. 결과 : 5년 생존율은 화학요법 단독군과 화학방사선 병행요법군에서 각각 60.9%와 68.9% (p=0.0915)였고, 5년 무병 생존율은 각각 56.1%와 63.8% (p=0.3510)로 두 군사이에 유의한 차이를 보이지 않았다. 병기별로 분석하였을 때 Ⅱ기에서의 5년 생존율은 화학요법 단독군이 71.1%, 화학방사선 병행요법군은 92.2%로 두 군간에 통계적으로 유의한 차이를 보였으나(p=0.0379), 5년 무병생존율에서는 화학요법 단독군이 57.3%, 화학방사선 병행요법군은 85.4%로 두 군간에 통계적으로 유의한 차이를 보이지 않았다(p=0.1482). Ⅲ기에서는 5년 생존율과 무병생존율이 화학요법 단독군에서는 52.0%와 47.8%였고, 화학방사선 병행요법군에서는 55.0%와 49.8%로 두 군 사이에는 유의한 차이를 보이지 않았다. (p=0.4280, p=0.7891). 국소재발율은 화학요법 단독군이 16.7%, 화학방사선 병행요법군은 12.5%였고, 원격 재발율은 화학요법 단독군이 25.0%, 화학방사선 병행요법군은 26.4%였다. 결론 : 본 연구에서는 Ⅱ기에서 보조 화학요법에 방사선치료를 병행함으로써 보조 화학요법 단독 치료시와 비교하여 생존율의 유의한 증가를 보였고, 비록 통계적으로 유의한 차이를 보이지는 못했지만 국소재발율의 감소를 보였다. Purpose : The aim of this study was to determine if postoperative adjuvant chemotherapy (CT) alone and concurrent chemoradiation (CCRT), following radical surgery, improved the disease free survival (DFS) and overall survival (OS) in rectal cancer AJCC stage Ⅱ and Ⅲ patients. Materials and Methods : A total of 144 patients with AJCC stage Ⅱ and Ⅲ rectal cancer who had had radical surgery between 1989 and 1999 were include in the study. Of these patients, 72 had been treated with postoperative CT, and the other 72 with postoperative CCRT. The chemotherapy regimen consisted of oral UFT on a daily basis for 1~12 months (median 12 months) or 5-FU (500 mg/㎡ for 5 days) intravenous (Ⅳ) chemotherapy with 4 week intervals for 1~18 cycles (median 6 cycles). Radiation of 4,500 cGy was delivered to the surgical bed and regional pelvic lymph nodes area, followed by 540~1,440 cGy (median 540 cGy) boost to the surgical bed. The follow-up period ranged from 20 to 150 months, with a median of 44 months. Results : The 5-year OS was 60.9% and 68.9% (p=0.0915), and the 5-year DFS was 56.1% and 63.8%(p=0.3510) for postoperative CT and postoperative CCRT, respectively. In the stage Ⅱ patients, the 5-year OS was 71.1% and 92.2%, and the 5-year DFS was 57.3% and 85.4% for postoperative CT and CCRT respectively. The OS was significantly improved (p=0.0379) but the DFS was not with postoperative CCRT compared to the postoperative CT (p=0.1482). In the stage Ⅲ patients, the 5-year OS was 52.0% and 55.0%, and the 5-year DFS was 47.8% and 49.8% for postoperative CT and postoperative CCRT. There were no statistically significant differences between postoperative CT and CCRT (p=0.4280 and p=0.7891) in OS and DFS. The locoregional relapses were 16.7 and 12.5% for postoperative CT and CCRT, respectively. The distant relapses were 25.0% and 26.4% for postoperative CT and CCRT, respectively. Conclusion : These results showed that postoperative CCRT compared with CT alone improved OS in stage Ⅱ patients. Although there was no statistical significance, the addition of postoperative RT to CT reduced locoregional relapses compared to CT alone