Higher thoracic radiation dose is beneficial in patients with extensive small cell lung cancer

Yoon, Han Gyul,Noh, Jae Myoung,Ahn, Yong Chan,Oh, Dongryul,Pyo, Hongryull,Kim, Haeyoung The Korean Society for Radiation Oncology 2019 Radiation Oncology Journal Vol.37 No.3

Purpose: The effectiveness of thoracic radiation therapy (TRT) in extensive-stage small cell lung cancer (ES-SCLC) patients is increasingly reported, but there is no definite consensus on its application. The aim of this study was to identify factors associated with better outcomes of TRT among patients with ES-SCLC, focusing on whether a higher TRT dose could improve treatment outcome. Materials and Methods: The medical records of 85 patients with ES-SCLC who received TRT between January 2008 and June 2017 were retrospectively reviewed. Eligibility criteria were a biological effective dose with α/β = 10 (BED) higher than 30 Gy₁₀ and completion of planned radiotherapy. Results: During a median follow-up of 5.3 months, 68 patients (80.0%) experienced disease progression. In univariate analysis, a BED >50 Gy₁₀ was a significant prognostic factor for overall survival (OS; 40.8% vs. 12.5%, p = 0.006), progression-free survival (PFS; 15.9% vs. 9.6%, p = 0.004), and intrathoracic PFS (IT-PFS; 39.3% vs. 20.5%, p = 0.004) at 1 year. In multivariate analysis, a BED >50 Gy₁₀ remained a significant prognostic factor for OS (hazard ratio [HR] = 0.502; 95% confidence interval [CI], 0.287-0.876; p = 0.015), PFS (HR = 0.453; 95% CI, 0.265-0.773; p = 0.004), and IT-PFS (HR = 0.331; 95% CI, 0.171-0.641; p = 0.001). Response to the last chemotherapy was also associated with better OS in both univariate and multivariate analysis. Conclusion: A TRT dose of BED >50 Gy₁₀ may be beneficial for patients with ES-SCLC. Further studies are needed to select patients who will most benefit from high-dose TRT.

Higher thoracic radiation dose is beneficial in patients with extensive small cell lung cancer

Han Gyul Yoon,Jae Myoung Noh,Yong Chan Ahn,Dongryul Oh,Hongryull Pyo,Haeyoung Kim 대한방사선종양학회 2019 Radiation Oncology Journal Vol.37 No.3

Purpose: The effectiveness of thoracic radiation therapy (TRT) in extensive-stage small cell lung cancer (ES-SCLC) patients is increasingly reported, but there is no definite consensus on its application. The aim of this study was to identify factors associated with better outcomes of TRT among patients with ES-SCLC, focusing on whether a higher TRT dose could improve treatment outcome. Materials and Methods: The medical records of 85 patients with ES-SCLC who received TRT between January 2008 and June 2017 were retrospectively reviewed. Eligibility criteria were a biological effective dose with α/β = 10 (BED) higher than 30 Gy10 and completion of planned radiotherapy. Results: During a median follow-up of 5.3 months, 68 patients (80.0%) experienced disease progression. In univariate analysis, a BED >50 Gy10 was a significant prognostic factor for overall survival (OS; 40.8% vs. 12.5%, p = 0.006), progression-free survival (PFS; 15.9% vs. 9.6%, p = 0.004), and intrathoracic PFS (IT-PFS; 39.3% vs. 20.5%, p = 0.004) at 1 year. In multivariate analysis, a BED >50 Gy10 remained a significant prognostic factor for OS (hazard ratio [HR] = 0.502; 95% confidence interval [CI], 0.287–0.876; p = 0.015), PFS (HR = 0.453; 95% CI, 0.265–0.773; p = 0.004), and IT-PFS (HR = 0.331; 95% CI, 0.171–0.641; p = 0.001). Response to the last chemotherapy was also associated with better OS in both univariate and multivariate analysis. Conclusion: A TRT dose of BED >50 Gy10 may be beneficial for patients with ES-SCLC. Further studies are needed to select patients who will most benefit from high-dose TRT.

두개강내 동맥류 환자의 신경안과적 분석

윤한결(Han Gyul Yoon),김대현(Dae Hyun Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.11

목적: 두개강내 동맥류 환자에서 발생한 신경안과 진단 및 임상양상에 대해서 알아보고자 하였다. 대상과 방법: 2008년 4월부터 2016년 12월까지 두개강내 동맥류로 진단 받은 환자 중에서 신경안과 검사가 시행된 환자 33명을 대상 으로 후향적인 분석을 시행하였다. 영상검사 및 신경외과, 신경안과 의무기록을 통해 안과에서 동맥류를 발견한 빈도, 신경안과 진단및 예후, 동맥류의 위치, 동맥류 파열 여부 등을 알아보았고 터슨증후군이 동반된 환자의 신경학적 예후도 조사하였다. 결과: 전체 환자 33명에서 2명만이 안과에서 두개강내 동맥류를 먼저 발견하였고, 대부분의 환자 31명(94%)은 신경외과에서 동맥류를 발견하였다. 신경안과 진단으로는 3번뇌신경마비가 10명(30%)으로 가장 많았고 핵간안근마비, 시야결손, 시신경위축, 6번뇌신경마비, 안구진탕 등이 발생하였다. 동맥류 위치는 전교통동맥이 13예(39%)로 가장 많았고 12예, 후교통동맥 5예 순이었다. 전체 33명 중 10명 에서 터슨증후군이 동반되었고, 최종 관찰 시 6명(60%)에서 인지장애, 보행장애 등의 영구적인 신경학적 장애가 발생하였다. 결론: 두개강내 동맥류 환자에서 가장 많이 발생하는 신경안과 질환은 3번뇌신경마비였다. 신경안과 질환의 예후는 비교적 양호하였 으나, 터슨증후군이 동반된 환자의 신경학적 예후는 좋지 않았다. Purpose: To investigate the neuro-ophthalmic diagnosis and clinical manifestations of intracranial aneurysm. Methods: A retrospective survey of 33 patients who were diagnosed with intracranial aneurysm and underwent neuro-ophthalmic examination from April 2008 to December 2016. Frequency of the first diagnosis of intracranial aneurysm in ophthalmology, neuro-ophthalmic diagnosis, location of intracranial aneurysm, examination of intracranial aneurysm rupture, and neurologic prognosis of Terson’s syndrome patients were analyzed by image examination, neurosurgery, and ophthalmology chart review. Results: Of the 33 patients, most patients (n = 31, 94%) were diagnosed with intracranial aneurysm at the neurosurgical department and only 2 patients were diagnosed initially at the ophthalmology department. Causes and association were: Terson’s syndrome (n = 10, 30%), third cranial nerve palsy (n = 10, 30%), internclear ophthalmoplegia (n = 4, 12%), visual field defect (n = 3, 9%), optic atrophy (n = 3, 9%), sixth cranial nerve palsy (n = 2, 6%), and nystagmus (n = 1, 3%). The location of intracranial aneurysms were: anterior communicating artery (n = 13, 39%), medial communicating artery (n = 12, 36%), and posterior communicating artery (n = 5, 15%). Ten of 33 patients had Terson’s syndrome, and 6 patients (60%) with Terson’s syndrome had a permanent neurological disorder such as agnosia, gait disorder and conduct disorder. Conclusions: Third cranial nerve palsy was the most common neuro-ophthalmic disease in patients presenting with intracranial aneurysm. The neuro-ophthalmic prognoses for those diseases were relatively good, but, if Terson’s syndrome was present, neurological disorders (agnosia, gait disorder, conduct disorder) were more likely to remain after treatment. J Korean Ophthalmol Soc 2017;58(11):1276-1281

전방축농을 동반한 반복적인 헤르페스포도막염 의증 1예

윤한결(Han Gyul Yoon),정진호(Jinho Jeong),김진영(Jin Young Kim,) 대한안과학회 2018 대한안과학회지 Vol.59 No.10

목적: 외상 후 전방축농을 동반한 반복적인 헤르페스포도막염 의증 1예를 경험하였기에 이를 보고하고자 한다. 증례요약: 82세 남자 환자가 과거 병력상 좌안의 수지상 각막염으로 헤르페스각막염 진단하 항바이러스제 치료 후 병변이 소실되었다. 그러나 환자는 1년 후에 외상 후 발생한 좌안의 시력저하, 통증, 눈물흘림을 주소로 재내원하였다. 시력은 안전수지, 안압은 27 mmHg였으며, 세극등검사에서 중심부 각막미란, 중증도의 각막 실질부종 및 2 mm의 전방축농이 관찰되었다. 이에 외상에 의해 급격히 진행된 세균성 안내염으로 판단하여 배양검사 및 유리체강 내 항생제주입술을 시행하였다. 또한 병변의 임상 양상 및 과거 헤르페스각막염 치료력을 고려할 때 헤르페스 바이러스 감염도 배제할 수 없어서 항바이러스제 치료를 함께 시행하였다. 배양검사상 균이 검출되지 않았고 증상이 호전되어 2개월간 항바이러스제 치료를 서서히 중단하였다. 그러나 항바이러스제 치료를 중단한 지 5일째에 전방축농을 동반한 재발 소견이 관찰되었으며, 재발성 헤르페스포도막염으로 의심하에 다시 항바이러스제 및 스테로이드 치료를 하였고, 증상 및 시력이 회복되었다. 결론: 외상 후 급격한 전방축농이 발생한 환자에서 세균성 홍채염 및 안내염뿐만 아니라, 바이러스성 전안부 포도막염 또한 감별 진단으로 반드시 고려하여야 한다. Purpose: We report an unusual case of presumptive diagnosis of herpes-induced anterior uveitis with acute hypopyon after trauma. Case summary: A 82-year-old male was diagnosed with herpes keratitis due to dendritic keratitis in the left eye, and the lesion disappeared after antiviral treatment. However, 1 year later, the patient visited again with visual loss, pain, and tearing of the left eye after trauma. At the examination, best-corrected visual acuity was counting fingers and the intraocular pressure was 27 mmHg in the left eye. Slit-lamp examination revealed corneal epithelial erosion, moderate corneal edema, and prominent inflammation with 2 mm high hypopyon in the anterior chamber. We thought that bacterial endophthalmitis had rapidly progressed after trauma, so we performed bacterial cultures and an intravitreal antibiotics injection. Considering the clinical manifestations of lesions and herpes keratitis in the past, we could not exclude herpes virus infection. Cultures were negative and the symptoms improved, so the antiviral treatment was gradually reduced and stopped at 2 months. However, recurrence was observed on day 5 after stopping antiviral therapy. We therefore assumed that recurrent herpes virus caused anterior uveitis, and then, antiviral and steroid therapy was resumed. The patient subsequently showed improvement in his symptoms and recovered his visual acuity. Conclusions: When acute hypopyon is observed in the anterior chamber after trauma, not only bacterial iritis and endophthalmitis but also viral-induced anterior uveitis should be considered in the differential diagnosis.

Liquid biopsy using cfDNA to predict radiation therapy response in solid tumors

Won Kyung Cho(Won Kyung Cho),Junnam Lee(Junnam Lee),Sung-Min Youn(Sung-Min Youn),Dongryul Oh(Dongryul Oh),Do Hoon Lim(Do Hoon Lim),Han Gyul Yoon(Han Gyul Yoon),Eun-Hae Cho(Eun-Hae Cho),Jae Myoung Noh( 대한방사선종양학회 2023 Radiation Oncology Journal Vol.41 No.1

Purpose: This study explored the potential feasibility of cell-free DNA (cfDNA) in monitoring treatment response through the measurement of chromosomal instabilities using I-scores in the context of radiation therapy (RT) for other solid tumors. Materials and Methods: This study enrolled 23 patients treated with RT for lung, esophageal, and head and neck cancer. Serial cfDNA monitoring was performed before RT, 1 week after RT, and 1 month after RT. Low-depth whole-genome sequencing was done using Nano kit and NextSeq 500 (Illumina Inc.). To measure the extent of genome-wide copy number instability, I-score was calculated. Results: Pretreatment I-score was elevated to more than 5.09 in 17 patients (73.9%). There was a significant positive correlation between the gross tumor volume and the baseline I-score (Spearman rho = 0.419, p = 0.047). The median I-scores at baseline, post-RT 1 week (P1W), and post-RT 1 month (P1M) were 5.27, 5.13, and 4.79, respectively. The I-score at P1M was significantly lower than that at baseline (p = 0.002), while the difference between baseline and P1W was not significant (p = 0.244). Conclusion: We have shown the feasibility of cfDNA I-score to detect minimal residual disease after RT in patients with lung cancer, esophageal cancer, and head and neck cancer. Additional studies are ongoing to optimize the measurement and analysis of I-scores to predict the radiation response in cancer patients.

Different patterns in the risk of newly developed fatty liver and lipid changes with tamoxifen versus aromatase inhibitors in postmenopausal women with early breast cancer: A propensity score–matched cohort study

Hong, Namki,Yoon, Han Gyul,Seo, Da Hea,Park, Seho,Kim, Seung Il,Sohn, Joo Hyuk,Rhee, Yumie Elsevier 2017 European journal of cancer Vol.82 No.-

<P><B>Abstract</B></P> <P><B>Background</B></P> <P>Management of metabolic complications of long-term adjuvant endocrine therapy in early breast cancer remained an unmet need. We aimed to compare the effects of tamoxifen (TMX) and aromatase inhibitors (AIs) on the risk of fatty liver in conjunction with longitudinal changes in the serum lipid parameters.</P> <P><B>Methods</B></P> <P>Among 1203 subjects who were taking adjuvant TMX or AI (anastrozole or letrozole) without fatty liver at baseline, those taking TMX or AI were 1:1 matched on the propensity score. The primary outcome was newly developed fatty liver detected on annual liver ultrasonography.</P> <P><B>Results</B></P> <P>Among 328 matched subjects (mean age 53.5 years, body mass index 22.9 kg/m<SUP>2</SUP>), 62 cases of fatty liver in the TMX group and 41 cases in the AI group were detected in a total of 987.4 person-years. The incidence rate of fatty liver was higher in the TMX group than in the AI group (128.7 versus 81.1 per 1000 person-years, P = 0.021), particularly within the first 2 years of therapy. TMX was associated with an increased 5-year risk of newly developed fatty liver (adjusted hazard ratio 1.61, P = 0.030) compared with AI independent of obesity and cholesterol level. Subjects who developed fatty liver had higher triglycerides (TGs) and lower high-density lipoprotein cholesterol (HDL-C) level at baseline than those without, which was sustained during follow-up despite the serum cholesterol–lowering effect of TMX.</P> <P><B>Conclusions</B></P> <P>TMX independently increased the 5-year risk of newly developed fatty liver compared with AI in postmenopausal women with early breast cancer. Our findings suggest the need for considering the risk of fatty liver as a different adverse event profile between AI and TMX, particularly in patients with obesity, high TGs and low HDL-C.</P> <P><B>Highlights</B></P> <P> <UL> <LI> Tamoxifen (TMX) use increased the risk of newly developed fatty liver compared to aromatase inhibitors (AIs). </LI> <LI> TMX was related to more severe fatty liver with elevated liver enzyme than AIs. </LI> <LI> The effect of TMX on fatty liver was independent of obesity and insulin resistance. </LI> <LI> High baseline body mass index, triglycerides and low high-density lipoprotein cholesterol were risk factors for incident fatty liver. </LI> </UL> </P>

이중관 의치에 관한 문헌 고찰 및 증례 보고

성한결,조은혜,고경호,허윤혁,박찬진,조리라,Sung, Han-Gyul,Jo, Eun-Hye,Ko, Kyung-Ho,Huh, Yoon-Hyuk,Park, Chan-Jin,Cho, Lee-Ra 대한치과보철학회 2018 대한치과보철학회지 Vol.56 No.4

Telescopic denture has advantages such as transfer the occlusal force to the long axis of the abutment, easiness of oral hygiene management, increase of retention and stability, splint effect due to secondary fixation between abutments and have been reported a higher success rates than conventional removable partial denture (RPD). However, there are disadvantages such as complex laboratory procedures, long treatment periods and high costs, and high incidence of complications. This clinical report describes two cases, a 4-point supported telescopic denture using telescopic crown and a 2-point supported telescopic denture using conical crown with functionally satisfactory results. Frequent complications of telescopic denture, which are reported in various literature were reviewed. Clinical and laboratory procedures were performed in consideration of complications that reported. 이중관 의치는 지대치 장축 방향으로의 교합력 전달, 구강위생관리 용이, 유지 및 안정의 증가, 지대치 간의 2차적인 연결 고정으로 인한 부목효과 등의 장점을 가지며 일반적인 국소의치에 비해 높은 성공률이 보고되고 있으나 기공과정이 복잡하고 치료기간 및 비용이 증가하며 합병증의 발생이 많은 단점이 있다. 본 증례보고는 기능적으로 만족스러운 결과를 얻은 상악의 4점 지지의 텔레스코프관을 이용한 이중관 의치를 제작한 증례와 상악의 2점 지지의 원추관을 이용한 이중관 의치를 제작한 증례를 보고하고자 한다. 여러 문헌을 통하여 보고되는 이중관 의치의 합병증을 고찰하고, 이와 관련하여 임상 및 기공과정에서 주의할 점을 고려하여 치료를 진행하였다.

후천성매독환자에 발생한 급성 사이질각막염 1예

김태진(Tae Jin Kim),윤한결(Han Gyul Yoon),고재웅(Jae Woong Koh) 대한안과학회 2017 대한안과학회지 Vol.58 No.2

목적: 잠복매독 환자에서 급성 사이질각막염이 첫 임상 증후로 나타난 1예를 경험하여 이를 보고하고자 한다. 증례요약: 23세 여자 환자가 3일 전부터 시작된 우안 시력저하 및 불편감을 주소로 내원하였다. 우안 시력은 나안시력 0.1, 교정시력 0.2로 관찰되었고, 세극등 검사상 우안 각막 중심부 원형 혼탁과 함께 각막부종 및 각막 신생혈관 소견이 관찰되었다. 혈액검사를 포함한 전신검사를 시행하였고, 급성 사이질각막염 진단하에 항생제와 스테로이드를 하루 4번 점안하였다. 혈청학적 검사상 venereal disease research laboratory (VDRL), fluorescent treponemal antibody absorption test IgG (FTA-ABS IgG) 검사에서 양성소견을 보여 잠복매독에 의한 급성 사이질각막염으로 확진하였다. 4주간 독시사이클린 200 mg을 복용하였고, 항생제 치료 시작 2주일 후 우안 시력은 1.0으로 호전되었으며 안구증상은 소실되었다. 결론: 잠복매독에서 급성 사이질각막염이 임상증후로 나타난 증례로 치료 효과를 얻었기에 이를 보고하고자 한다. Purpose: To report a case of acute interstitial keratitis as the first clinical sign in a patient with latent syphilis. Case summary: A 23-year-old female presented with visual impairment and discomfort in her right eye that developed 3 days earlier. The visual acuity in the right eye was 20/200 and corrected to 20/100, and slit lamp examination showed round sub-epithelial opacification in the central cornea with stromal edema and neovascularization on the cornea of the right eye. Whole body tests including serological tests were performed. Under the suspicion of acute interstitial keratitis, topical antibiotics and steroids were applied 4 times a day initially. Serological tests were reactive for venereal disease research laboratory test (VDRL). Under the suspicion of acute interstitial keratitis due to syphilis, fluorescent treponemal antibody absorption test IgM/IgG (FTA-ABSIgM/IgG) was performed; a positive result for FTA-ABS IgG led to diagnosis of acute interstitial keratitis with latent syphilis. During treatment, systemic doxycycline 200 mg for 4 weeks with topical antibiotics and steroids were administered, the opacity and edema of the cornea regressed after 2 weeks of treatment, and visual acuity in the patient’s right eye improved to 20/20. Conclusions: We report an unusual case of acute interstitial keratitis as the first clinical manifestation of latent syphilis in an immunocompetent patient.

원발항인지질항체 증후군에서 발생한 양안 황반부 경색 1예

김현주(Hyun Ju Kim),윤한결(Han Gyul Yoon),김성택(Seong Taeck Kim) 대한안과학회 2017 대한안과학회지 Vol.58 No.10

목적: 원발항인지질항체 증후군 환자에서 발생한 양안의 황반부 경색을 경험하였기에 보고하고자 한다. 증례요약: 융모양막염으로 응급 제왕절개술을 시행받은 29세 산모가 양안 시력저하를 주소로 본과에 협진의뢰되었다. 내원 당시 교정시력은 우안 안전수지, 좌안 0.05였고, 안저검사에서 양안의 황반부 경색 소견을 보였다. 혈액응고 이상을 포함한 전반적인 혈액학적 검사를 시행하였고, 12주 간격으로 시행한 항인지질항체 검사에서 루푸스항응고 수치가 증가되어 있었다. 원발항인지질항체 증후군에 의한 양안 황반경색으로 진단하고, 테논낭하 트리암시놀론 아세토나이드 주사를 시행하였으나, 큰 호전을 보이지 않았다. 결론: 원발항인지질항체 증후군은 혈전 및 색전을 유발하여 망막의 동정맥폐쇄가 발생할 수 있으며, 심한 경우 황반부 경색을 초래할 수도 있다. 기저질환이 없는 건강한 젊은 사람에서 양안의 황반부 경색이 발생한 경우 항인지질항체 검사를 시행해 보는 것이 필요하다. Purpose: We report a rare case of bilateral macular infarction as an ocular presenting sign of primary antiphospholipid syndrome. Case summary: A 29-year-old woman who had undergone a cesarean section for chorioamnionitis in the department of Obsterics was referred to the department of ophthalmology for bilateral visual loss. At examination, best-corrected visual acuity (BCVA) of the right eye was counting fingers, and for the left was 0.05. Fundus examination revealed extensive macular edema and cotton- wool spots in both eyes. We performed hematologic tests including thrombophilia examination. Antinuclear antibody and rheumatoid factor were negative but lupus anticoagulant presented high titers on two occasions 12 weeks apart. She was administered sub-Tenon’s injections of triamcinolone acetonide 50 mg/week in both eyes under the diagnosis of bilateral macular arteriolar occlusion in primary antiphospholipid syndrome. Her BCVA remained 0.025 in her right eye and improved to 0.125 in her left eye. Conclusions: Macular infarction is an uncommon but severe complication of antiphospholipid syndrome. Early and regular fundus exam in patients with antiphospholipid syndrome is necessary to avoid progression of severe ocular complications.