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전이성 또는 재발성 식도암에 대한 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 복합화학요법의 치료 효과
류백렬(Baek Yeol Ryoo),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),정상훈(Sang Hoon Jeong),김현각(Hyun Kag Kim),이창희(Chang Hee Lee),윤종길(Jong Kil Yoon),천영국(Young Kug Cheon),김서운(Seo Woon Kim),김유철(You Cheoul Kim),김창민(C 대한내과학회 1996 대한내과학회지 Vol.51 No.4
Esophageal cancer is widely disseminated in more than 80% of patients at the time of diagnosis and the prognosis of advanced esophageal cancer is dismal with a median survival of 5 to 8 months. Therefore, systemic chemotherapy has assumed an important role in the treatment of these patients. Among various combination chemotherapy regimens, the combination of cisplatin and 5-fluorouracil has been one of the most effective for esophageal cancer because of their synergism. Etoposide, although reported ineffective as a single agent, has been shown to be synergistic with cisplatin in vitro and in vivo. So, we conducted a phase 2 trial to evaluate the effect of a combination of cisplatin, etoposide and 5- FU (PEF) in patients with metastatic or recurrent esophageal cancer. Thirty-four patients with measurable lesion(s) received cisplatin (20㎎/㎡ i.v. Day 1~5), etoposide (100㎎/㎡ i.v. Day 1, 3 & 5) and 5-FU (800㎎/㎡ continuous i.v. for 12 hours, Day 1~5). Of 30 evaluable patients, 1(3.3%) had a complete response and 11(37%) had partial responses. The median duration of response was 29 weeks. The overall median survival was 34 weeks and the survival time in the responders was longer significantly than that of the non-responders. There was no significant prognostic factor influencing the response rate. Among total 135 cycles of chemotherapy, leukopenia was observed in 36% and thrombocytopenia in 4%. There was no treatment-related death. Main non-hematologic toxicities were neurotoxicity (17%), nephrotoxicity (3%), and stomatitis (10%) and diarrhea (10%). All the toxicities were mild and well tolerated. Conclusion: A combination chemotherapy of cisplatin, etoposide and 5-FU (PEF) was effective and well tolerated in patients with metastatic or recurrent esophageal cancer.
치료의 전력이 없는 다발성 골수종에 대한 Vincristine , Doxorubicin 및 Dexamethasone ( VAD ) 복합화학요법의 효과
김성환(Seong Whan Kim),류백렬(Baek Yeol Ryoo),김태유(Tae You Kim),임영혁(Young Hyuck Im),박연희(Yeon Hee Park),김봉석(Bong Seog Kim),최병국(Byung Kook Choi),김경현(Kyung Hyun Kim),강윤구(Yoon Koo Kang) 대한내과학회 1999 대한내과학회지 Vol.56 No.1
Objective : The combination of vincristine and doxorubicin by continuous infusion was reported to reduce tumor mass more rapidly than standard regimens, which maybe a result of effect on more slowly proliferating plasma cells. We conducted a phase II study to determine the activity and safety of VAD (vincristine, doxorubicin, dexamethasone) chemotherapy, in which vincristine and doxorubicin are administered as a continuous infusion, for previously untreated multiple myeloma. Methods : VAD chemotherapy (vincristine 0.4 mg/day 24 hour-continuous infusion, days 1∼4; doxorubicin 9 mg/m2/day 24 hour-continuous infusion, days 1∼4; dexamethasone 40 mg/day p.o. days 1∼4) was given to eligible patients every 4 weeks and we assessed response and toxicity of the regimen. Results : Between January 1991 and March 1997, total 25 patients entered this trial and 22 were evaluable. The complete response rate was 14%(3/22) and overall response rate was 59%(13/22, 95% C.I.: 38∼80%). The time to response was 1.0∼6.8(median 2.9) months. Progression free survival was 2∼39+(median 11.5) months and the overall survival was 3+∼42+(median 19.7) months. Toxicities of VAD regimen were leukopenia, infection, stomatitis and neurotoxicity, but there was no treatment-related death. Conclusion : VAD chemotherapy was tolerable, but not more active than the alkylating agent-based chemotherapy as a front-line treatment for the patients with multiple myeloma. But, because of its rapid response and relatively mild myelotoxicity, it could play a role for advanced or highly complicated disease and for remission induction before consolidation with high-dose chemotherapy.
표준 항암화학요법에 실패한 진행성 비소세포폐암에서 ZD1839 ($Iressa^{TM}$)의 효과
이승환,김덕룡,이상대,이종신,박연희,류백렬,김흥태,박선후,김봉석,김철현,이재철,Lee, Seung Whan,Kim, Duck Ryung,Lee, Sang Dae,Lee, Jong Sin,Park, Yeon Hee,Ryoo, Baek-Yeol,Kim, Heung Tae,Park, Sunhoo,Kim, Bong Seog,Kim, Cheol Hyeon,Lee, 대한결핵및호흡기학회 2004 Tuberculosis and Respiratory Diseases Vol.57 No.2
배 경 : 비소세포폐암에서 2차 항암화학요법에 대한 치료반응과 역할은 아직 정립되어 있지 못한 실정이다. 한편, 최근 개발된 ZD1839는 상피세포성장인자 수용체 억제제로서 악성 고형 종양, 특히 비소세포폐암에서 항종양효과를 보이는 것으로 알려져 있다. 저자들은 기존의 표준 항암화학요법에 실패한 진행성 비소세포폐암 환자들을 대상으로 ZD1839를 투여하여 그 반응 및 안전성을 평가하고자 하였다. 대상 및 방법 : 원자력병원에서 비소세포폐암으로 조직학적 진단을 받고 임상 병기 IIIB 이상인 환자들 중에서 1차 이상의 항암화학요법을 시행 받은 후 치료실패로 판정된 환자들을 대상으로 2002년 1월부터 2003년 9월까지 ZD1839를 투여 하였다. 투여 용량은 하루 250 mg이었고, 반응 및 부작용을 평가하기 위해 1개월 간격으로 흉부 방사선 검사 및 외래 추적 검사를 실시하였다. 이 환자들 중 반응 및 독성의 평가가 가능하였던, 1개월 이상 투여 받은 83명의 환자들을 대상으로 하였다. 환자들의 중앙 연령은 59(33-76)세였고, 임상 병기는 IIIB가 12명, IV가 71명이었으며, ECOG 전신수행상태는 0-1이 10명, 2는 42명, 3은 31명이었다. ZD1839 투여일수는 중앙값이 90일이었다. 결 과 : ZD1839 투여 후 부분 반응은 12명(14.5%), 불변은 31명(37.3%), 진행은 40명(48.2%)이었고, 전체 생존기간과 병의 진행까지 기간의 중앙값은 각각 9.2 개월과 3.1 개월이었다. ZD1839의 부작용으로는 피부 발진을 보인 환자가 25명(25.8%)으로 가장 많았으며, 구토 및 설사를 보인 환자가 15(15.5%), 비정상적 간효소수치 상승 및 혈소판 감소를 보인 환자가 각각 1명(1.03%)이었다. Performance status 0, 1인 전신 상태와 선암종을 가진 환자군에서 반응률 및 생존률이 통계적으로 유의한 증가를 보였다. 결 론 : 기존의 항암화학요법에 실패한 일부 진행성 비소세포폐암 환자들에서 ZD1839 투여는 비교적 높은 반응률을 보였으며 부작용은 비교적 경미하였다. 향후 보다 대규모의 연구 결과에 대한 추시가 필요할 것으로 생각된다. Background : The role of second-line chemotherapy in the treatment of advanced non-small cell lung cancer (NSCLC) is known to be limited. Recently, ZD1839, the small molecule epidermal growth factor receptor-tyrosine kinase inhibitor, has been developed and has shown anti-tumor activity in patients with solid malignant tumors including lung cancer. We evaluated the response rate and toxicities of ZD1839 in patients with advanced NSCLC which has progressed after previous chemotherapy. Patients and Methods : We examined 83 patients with advanced NSCLC treated with ZD1839 for more than 1 month in Korea Cancer Center Hospital during the period from January 2002 to September 2003. All the patients were enrolled in the international expanded access program (EAP) with ZD1839 by AstraZeneca. The administered dose of ZD1839 was 250 mg once daily. Chest radiography and laboratory tests were followed-up. We evaluated the response rate, median survival, and toxicity after treatment. Results : Median age of the patients was 59 years (range 33-76). The most predominant cell type was adenocarcinoma and the most stage of the patients was IV. ECOG performance status was as follows; grade 0-1 in 10, grade 2 in 42, and grade 3 in 31 patients. Partial response was achieved in 12 patients (14.5%). Median overall survival was 9.2 (range 1.3-21.6+) months and median time to progression was 3.1 (range 1-21.2+) months. The most common adverse effect of ZD1839 was skin eruption which developed in 25 patients (25.8%). Significantly higher response rate and survival was found in patients with adenocarcinoma or good performance status. Conclusion : ZD1839 showed modest activity and tolerable toxicity in the treatment for patients with NSCLC which has progressed after previous chemotherapy.
수술이 불가능한 제 III기 비소세포폐암에서 Cisplatin 및 Etoposide(EP)의 화학요법과 방사선요법의 병행요법(2상 임상연구)
허남현,이춘택,김재학,장재진,남승모,박연희,류백렬,김태유,임영혁,강윤구,김미숙,류성렬,이진오,강태웅,Hur, Nam-Hyun,Lee, Choon-Taek,Kim, Jae-Hag,Jang, Jae-Jin,Nam, Seung-Mo,Park, Yeon-Hee,Ryoo, Baek-Yeol,Kim, Tae-You,Im, Young-Hyuck,Kang, Yoon-Ko 대한결핵및호흡기학회 1997 Tuberculosis and Respiratory Diseases Vol.44 No.4
서 론 : 비소세포폐암은 전체 폐암의 약 75%를 차지하고 있으며 조기 발견에 이은 외과적 절제가 유일한 완치방법으로 알려져 있다. 그러나 병기 III기에서는 정립된 치료방법이 없고 여러 종류 및 조합의 치료방법이 시도되고 있다. 이에 연구자들은 수술이 불가능한 병기 IIIA 및 악성흉수를 제외한 병기 IIIB의 과거 치료력이 없는 비소세포폐암 환자에서 cisplatin, etoposide 이용한 복합화학요법을 동시에 시행하여 그의 효과 및 순응성을 조사하였다. 대상 및 방법 : 1995년 10월부터 1996년 12월까지 원자력병원에 입원하여 조직학적으로 비소세포폐암으로 진단된 병기 III기의 환자중 수술이 불가능한 IIIA 및 IIIB의 환자를 대상으로 하였다. 복합화학요법은 cisplatin 30mg/$m^2$/D, etoposide 80mg/$m^2$/D를 방사선요법과 동시에 시작하여 3일간 투여후 4주 간격으로 총 3회 투여하였고, 방사선요법은 5940cGy까지 진행후 치료효과를 평가하였다. 결 과 : 총 대상환자 32명 중 조기종료한 3명을 제외한 29명에서 평가가 가능하였으며, 완전관해는 없었고 부분관해 22명(75.9%), 불변 5명(17.2%), 치료중 진행하였던 경우가 2명(6.9%)으로 전체관해율은 75.9%, 중앙 생존기간 12.1개월, 1년 생존률은 50.6%로 나타났다. 치료에 의한 주된 독성은 백혈구감소로 WHO기준으로 3등급이상이 13명(45%)에서 나타났고 혈소판감소는 3등급이상이 3명(11%)에서 나타났으나 모두 회복되었고, 그밖에 오심과 구토는 대부분의 환자에서 2등급이하이었으며 방사성폐렴은 13명(46%)에서 나타났다. 결 론 : 수술이 불가능한 병기 IIIA 및 악성흉수를 제외한 병기 IIIB기 비소세포폐암환자에서 EP 복합화학요법과 방사선요법을 동시 병행한 치료는 비교적 안전하면서 효과적이었으며, 이에 대한 평가는 방사선요법을 단독으로한 치료와의 3상 연구를 요할 것으로 사료된다. Background : Various combinations of treatment modalities have been reported in stage III non-small cell lung cancer (NSCLC). however, the standard treatment modality has not established yet. Recently, the efficacy of concurrent chemotherapy and radiation therapy has been reported in locally advanced lung cancer. We evaluate the response rate, toxicity, and survival of concurrent chemotherapy with etoposide and cisplatin(EP) and radiation therapy for unresectable stage III NSCLC. Method : Between October 1995 and December 1996, 32 patients with histologically proven unresectable stage III NSCLC without malignant pleural effusion were entered into this study. Twenty-nine patients were eligible for the response, survival, and toxicity analysis. Induction was two cycles of chemotherapy with etoposide and cisplatin plus concurrent chest RT to 4500cGy. Resection was attempted if the clinical response offered surgical resectability. Boost radiation therapy upto 5940cGy and one cycle of EP were performed if the disease were stable or responsive but still unresectable. Results : Of 29 eligible patients, 22(75.9%) showed partial response(PR). The progression free interval was 6.3months(range 1.1 to 19.5months). Surgical resection was performed in one patient. The median survival was 12.1months and one-year survival rate was 50.6%. The major toxicity was leukopenia($\geq$ grade 3, 46%). Thrombocytopenia over grade 3 was found in 11%. Radiation pneumonitis occurred in 13 patients(46%). Conclusion : Concurrent chemotherapy(EP) plus radiotherapy was effective and tolerable in the treatment of unresectable stage III NSCLC.
고형암 환자에서 항암화학요법 후 호중구감소증에 대한 류코업(R) (Filgrastim, rhG-CSF)의 안전성 및 유효성: 그라신(R)과의 다기관 비교 임상시험
이소영 ( So Young Lee ),장흥문 ( Heung Moon Chang ),허대석 ( Dae Seog Heo ),류백렬 ( Baek Yeol Ryoo ),김태원 ( Tae Won Kim ),류민희 ( Min Hee Ryu ),김태유 ( Tae You Kim ),박연희 ( Yeon Hee Park ),이재훈 ( Jae Hoon Lee ),박근칠 ( K 대한내과학회 2005 대한내과학회지 Vol.69 No.1
호지킨 림프종과 역형성 대세포 림프종의 세침흡인 세포소견 비교
고재수,박선후,김민석,조수연,정수영,유한석,김정순,하화정,류백렬,이승숙,Koh, Jae-Soo,Park, Sun-Hoo,Kim, Min-Suk,Cho, Soo-Youn,Chung, Soo-Young,Ryu, Han-Suk,Kim, Jung-Soon,Ha, Hwa-Jung,Ryoo, Baek-Youl,Lee, Seung-Sook 대한세포병리학회 2006 대한세포병리학회지 Vol.17 No.2
To study the differentiating cytomorphological features of Hodgkin lymphoma (HL) and anaplastic large cell lymphoma (ALCL) using fine needle aspiration cytology (FNAC), cytomorphological features of 16 patients with HL (n=8) or ALCL (n=8) were analyzed. In the initial cytological diagnosis prior to biopsy, HLs were properly diagnosed in 4 out of 8 cases (4 HL, 2 atypical, 2 benign), whereas all ALCL were diagnosed as malignancies. However, correct diagnosis of non-Hodgkin lymphoma (NHL) was made in only two ALCL patients (2 NHL, 1 HL, 1 sarcoma, 4 malignancy without specific type). Overall, the percentage of large abnormal cells ranged from 30% to 90% in ALCL except for one case, whereas it was less than 5% in all 8 HL. A spectrum of atypical cells was more characteristic of ALCL. In contrast, HL showed an sharp difference between reactive lymphoid cells and neoplastic ones (bimorphic pattern). Moreover, the emergence of kidney-shaped abnormal cells or wreath-like multinucleated cells was helpful in diagnosing ALCL. The combination of thesefeatures would be useful in differentiating HL and ALCL. Nevertheless, these two types of lymphomas cannot be definitely distinguished based on cytomorphological features alone. Therefore, the aim of FNAC would be to suggest a specific diagnosis and indicate the need for a biopsy.
악성 갈색세포종 및 갑상선수질암의 131I - MIBG 을 이용한 치료
최창운(Chang Woon Choi),임상무(Sang Moo Lim),홍성운(Sung Woon Hong),윤종길(Jong Kil Yoon),류백렬(Baek Yeol Ryoo),이창희(Chang Hee Lee),정상훈(Sang Hoon Jeong),천영국(Young Kug Cheon) 대한핵의학회 1995 핵의학 분자영상 Vol.29 No.3
N/A 131I-metaiodobenzylguanidine(MIBG) has been used for the diagnosis and treatment of neural crest tumors. We report our experience with this agent in 8 patients[l multiple endocrine neoplasia(MEN) type IIb; 2 malignant pheochromocytoma; 5 medullary thyroid carcinoma(MTC)]. The therapeutic procedure consisted of 30-200 mCi of 131I-MIBG administered by slow I.V. infusion, given at 3-6 months intervals. Cummulative activity ranged from 150 mCi to 410 mCi, in 1 to 4 courses. 131I-MIBG therapy resulted in significant disease free interval in 1 malignant pheochromocytoma(no measurable lesion)after sugery; complete hormonal and tumoral response in 2 MTC(1 MEN IIb); stable disease in 1 recurred pheochromocytoma(MEN IIb); stable disease but symptomatic improvement in 1 MTC; progressive disease in 1 malignant pheochromocytoma and 2 MTC. The patients who showed progression appeared to have large inoperable tumors or postoperative remnant tumors.
성주병(Ju Byeung Sung),김용조(Yong Cho Kim),권교선(Gyo Seon Kwun),장은정(Eun Jung Jang),류백렬(Baek Yeol Ryoo),김태유(Tae You Kim),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),김창민(Chang Min Kim),이승숙(Seung Sook Lee),이진오(Jhin 대한내과학회 1997 대한내과학회지 Vol.53 No.4
Multiple primary malignant neoplasms (MPMN) are defined by the presence of multiple primary cancers of multicentric origin and/or different tissues. The incidence of MPMN is less than 1% in Korea and recently seems to be increased due to early detection of cancer and prolonged survival of cancer patients. Previous investigations suggest that non-Hodgkin's lymphoma (NHL) may be associated with chronic liver disease and hepatocellular carcinoma (HCC). The pathogenesis of this association is thought to be due to chronic antigenic stimulation, the presence of HBsAg, and immunosuppressive therapy. We report a case of synchronous NHL and HCC in a 54-year-old man which is thought to be associated with hepatitis B virus infection. Pathological examination and immunohistochemical study of neck lymph node and liver mass biopsies showed diffuse large cell lymphoma and HCC, respectively. He was treated initially with EPOCH (etoposide, vincristine, doxorubicin, cyclophosphamide and prednisolone) chemotherapy for NHL and transarterial chemoembolization with doxorubicin, mitomycin-c, lipiodol, and gelfoam for HCC.
국소적으로 진행된 식도암 환자에서 Cisplatin , Etoposide 및 5 - Fluorouracil ( PEF ) 선행화학요법의 효과 ; A Pilot Study
정상훈(Sang Hoon Jeong),임영혁(Young Hyuck Im),강윤구(Yoon Koo Kang),손태용(Tae Yong Son),곽영임(Young Im Kwak),천영국(Young Kug Cheon),김현각(Hyun Kag Kim),류백렬(Baek Yeol Ryoo),김유철(You Cheoul Kim),이춘택(Choon Taek Lee),김창민( 대한내과학회 1996 대한내과학회지 Vol.51 No.4
The prognosis of esophageal cancer is very poor. Even for those with localized disease who are potentially curable, 5-year survival rates are under 20% in almost all series. We conducted a pilot study to evaluate the safety and possibility of efficacy of neoadjuvant chemotherapy followed by surgery in patients with locally advanced esophageal cancer. Two or three cycles of neoadjuvant combination chemotherapy with cisplatin (20㎎/㎡/day i.v., D1-5), etoposide (100㎎/㎡/day i.v., D1,3,5), and 5-fluorouracil (800㎎/㎡/day continuous i.v., D1-5) were planned to be given before surgery. Total 21 patients entered this trial. Three patients were lost to follow-up after 1 cycle of chemotherapy to make eighteen patients evaluable. Thirteen out of eighteen patients (72%) had objective improvement after neoadjuvant chemotherapy and four (22%) had no change and one (6%) had progression. Among 18 evaluable patients, surgery was performed in 11 patients. Surgery could not be done in 7 patients because of patient's refusal (5), progression of disease (1), and development of lung abscess (1). In 13 patients who were candidates for surgery, curative resection was done in 10 patients to make curative resection rate 10/13 (77%). One of eleven patients having surgical resection had no pathologic evidence of tumor (pathologic complete remission 9%). Postoperative complications of wound dehiscence and anastomotic site fistula developed in 2 patients. Three courses of postoperative adjuvant chemotherapy with PEF regimen were administered to 9 patients. The median survival time for all 18 patients was 60 weeks. Toxicities of PEF neoadjuvant chemotherapy were leukopenia, nausea/vomiting and alopecia, but they were mild and reversible. There was no treatment-related deaths. In conclusion, neoadjuvant chemotherapy with PEF regimen were tolerable, safe and possibly effective in locally advanced esophageal cancer. Based on this study, we will perform phase 2 or 3 study to assess the efficacy of PEF neoadjuvant chemotherapy for locally advanced esophageal cancer.