신경종양학 분야에서 항경련제의 임상적 적용

김영준 ( Young Zoon Kim ),유헌 ( Heon Yoo ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.1

Epileptic seizures are common in patients with brain tumor, even if the tumor is under control. Miltiple factors affect the mechanism of seizure in brain tumors, including changes of morphology, pH, ion level, amino acid, and enzyme in peritumoral brain tissue, role of glutaminergic N-methyl-D-aspartate(NMDA) receptor, damage of peritumoral brain immunology, and change of intercellular communication. Additionally, traditional anti-epileptic drug(AED) can cover only a few mechanisms of epileptogensis in brain tumors. Tumor progression or recurrence may make seizures reappear during AED. Owing to combined treatment modality with chemotherapy or other drugs, insufficient levels of AEDs have been reported in the many patients with brain tumor. Therefore, comprehensive understand about pathophysiology of epileptogensis in the brain tumor and drug interactions between AEDs and other drugs, which are widely used in the field of neurooncology, can give an aids to manage brain tumor related epilepsy.

임상 : 비소세포암의 뇌전이에 대한 개두술 및 종양절제술 후 보조적 치료의 결과

김영준 ( Young Zoon Kim ),유헌 ( Heon Yoo ),양희석 ( Hee Seok Yang ),신상훈 ( Sang Hoon Shin ),이승훈 ( Seung Hoon Lee ) 대한뇌종양학회 2006 대한뇌종양학회지 Vol.5 No.2

Purpose:This study was aimed to compare the survival and recurrence according to postoperative adjuvant therapeutic modalities for brain metastasis. Methods:From June 2002 to December 2005, 49 patients with brain metastasis from non-small cell lung cancer(NS CLC) underwent adjuvant systemic chemotherapy or whole brain radiotherapy(WBRT) or both after metastatectomy. In Group A, 13 patients were treated with systemic chemotherapy and WBRT after brain surgery. In Group B, 11 patients were treated with WBRT only after brain surgery and in Group C, 25 patients with systemic chemotherapy only after brain surgery. Results:Median survival times were 12.7 months in Group A, 5.0 months in Group B, and 11.6 months in Group C. Median time to progression of local disease were 7.7 months in Group A, 4.0 months in Group B, and 4.4 months in Group C. There were no statistical differences in survivals and local recurrences according to postoperative adjuvant therapeutic modalities. Favor factor for the survival was RPA class I only. And favor factors for the local recurrence were metachronoous presentation, RPA class, extensive surgical resection, gender and Sawaya grade. Conclusion:In this study, we suggest that postoperative systemic chemotherapy for brain metastasis after brain metastatectomy, instead of adjuvant WBRT, can control primary cancer and brain disease simultaneously and prevent neurocognitive dysfunction originating from WBRT.

임상 : 악성 뇌교종의 유전자 검사 : 방사선학적 특징과 예후와의 관계

유재원 ( Jae Won Yu ),김영준 ( Young Zoon Kim ),송영진 ( Young Jin Song ),김대철 ( Dae Cheol Kim ),한진영 ( Jin Yeong Han ),김기욱 ( Ki Uk Kim ) 대한뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.2

Objectives:Numerous genetic alterations are related to tumorigenesis and influence the radiological features of malignant glial tumor. We performed a cytogenetic analysis from a fresh tumor specimen and analyzed its relationship with radiological features and prognosis. Materials and Methods:Among the 29 patients with malignant glial tumor involved in cytogenetic analysis, 19 cases showing chromosomal abnormality were analyzed. Cytogenetic analysis was performed with pathologically proven fresh surgical specimen. Both medical records and radiological findings were reviewed to define the tumor, to evaluate peritumoral edema and to assess treatment results. Results:The most frequent genetic abnormality was observed in chromosome 7 (57.8 %). Complex karyotype presenting three or more abnormalities was noted in 11 cases (57.8 %). Chromosomal abnormalities, noted in more than three cases, were whole loss of Y (7 cases), whole gain of 7 (6 cases), whole gain of 2, whole gain of 5, whole gain of 12, 19q gain, 6p loss, 9p loss, and whole gain of 13 (3 cases). We reported that loss of chromosome 7 related to MDR-1 (Multidrug resistant gene) were correlated with good response of chemotherapy. Conclusions:A chromosomal analysis of malignant glioma can be perfomed to discover tumorigenic factors and to evaluate radiological features. Results of karyotyping is closely related to the clinical outcome and may be utilized in developing new therapeutic modalities.

악성 뇌교종의 유전자 검사 : 방사선학적 특징과 예후와의 관계

유재원 ( Jae Won Yu ),김영준 ( Young Zoon Kim ),송영진 ( Young Jin Song ),김대철 ( Dae Cheol Kim ),한진영 ( Jin Yeong Han ),김기욱 ( Ki Uk Kim ) 대한뇌종양학회 대한신경종양학회 2014 Brain Tumor Research and Treatment Vol.2 No.1

Objectives:Numerous genetic alterations are related to tumorigenesis and influence the radiological features of malignant glial tumor. We performed a cytogenetic analysis from a fresh tumor specimen and analyzed its relationship with radiological features and prognosis. Materials and Methods:Among the 29 patients with malignant glial tumor involved in cytogenetic analysis, 19 cases showing chromosomal abnormality were analyzed. Cytogenetic analysis was performed with pathologically proven fresh surgical specimen. Both medical records and radiological findings were reviewed to define the tumor, to evaluate peritumoral edema and to assess treatment results. Results:The most frequent genetic abnormality was observed in chromosome 7 (57.8 %). Complex karyotype presenting three or more abnormalities was noted in 11 cases (57.8 %). Chromosomal abnormalities, noted in more than three cases, were whole loss of Y (7 cases), whole gain of 7 (6 cases), whole gain of 2, whole gain of 5, whole gain of 12, 19q gain, 6p loss, 9p loss, and whole gain of 13 (3 cases). We reported that loss of chromosome 7 related to MDR-1 (Multidrug resistant gene) were correlated with good response of chemotherapy. Conclusions:A chromosomal analysis of malignant glioma can be perfomed to discover tumorigenic factors and to evaluate radiological features. Results of karyotyping is closely related to the clinical outcome and may be utilized in developing new therapeutic modalities.

임상 : 다형성 교모세포종에 대한 적극적인 치료를 거부한 환자군에 대한 분석

이재일 ( Jae Il Lee ),김영준 ( Young Zoon Kim ),김준수 ( Joon Soo Kim ),김규홍 ( Kyu Hong Kim ) 대한뇌종양학회 2008 대한뇌종양학회지 Vol.7 No.2

Objective:Because of dismal prognosis of glioblastoma multiforme(GBM), some patients choose not to undergo active treatment and opt instead for supportive care, and thus, survival is further reduced. This study shows the reasons why GBM patients choose not to undergo active treatment. Material and Methods:The subjects are 67 patients who were diagnosed as having GBM. Among them, 35(group A) received supportive care only, and 32 patients(group B) underwent active treatment, which included surgical resection followed by radiotherapy and/or chemotherapy. They were analyzed in terms of patient`s features, tumor`s features, and socio-economic characteristics. Results:Sixteen patients(45.7%) in group A and 26 patients(81.2%) in group B had a Karnofsky Performance Scale score of ≥70. Twenty-seven patients(77.1%) had a chronic underlying disease in group A, and 9 patients(28.1%) had a chronic underlying disease in group B. Six patients(17.1%) in group A and 13 patients(40.6%) in group B were economically independent. Median survival time was 4.7 months(range;2.80-7.40 months) in group A, and 13.1 months (7.6-21.3 months) in group B. Conclusion:Reasons for choosing not to undergo active treatment for GBM were;an advanced age, chronic underlying disease, a poorer functional status, and greater economic dependency.

임상 : 뇌종양에 대한 보조적 항암치료 동안 발생하는 뇌종양 연관성 간질에 대한 연구

박성훈 ( Sung Hoon Park ),김영준 ( Young Zoon Kim ),조용운 ( Yong Woon Cho ) 대한뇌종양학회 2009 대한뇌종양학회지 Vol.8 No.2

Objective:Topiramate is a new anti-epileptic drug with few drug interactions and side effects, which are important obstacles to chemotherapy. The purpose of this prospective observational study was to determine the efficacy of topiramate for the treatment of brain tumor associated epilepsy(BTAE) during adjuvant chemotherapy, and to examine the risk factors for development of BATE. Methods:From March 2006 to February 2009, 81 patients who underwent adjuvant chemotherapy with concomitant topiramate administration after surgery for a brain tumor were enrolled. The authors determined the number of patients that experienced BTAE and the number of BTAE attacks during chemotherapy according to the following comparative groups:presence versus absence of previous history of BTAE;high risk group versus low risk group;progressive disease versus stable disease. Results:Overall 73 of the 81 patients(90.1%) remained seizure-free during chemotherapy. Seizure-free rates were 89.3% and 90.6% among patients with or without a previous history of BTAE, respectively(p=0.527), 88.1% and 94.9% among high and low risk patients(p=0.083), and 58.8% and 98.4% among patients with a progressive or a responsive brain tumor(p=0.000). Total 18 seizure attacks occurred. Although the side effects of topiramate were found in 16 patients, they were well tolerable to patients. Conclusion:Topiramate was found to achieve adequate seizure-control with tolerable side effects during adjuvant chemotherapy in brain tumor patients after surgery. However, responsiveness of brain tumor to chemotherapy importantly modulated the effects of BTAE.

례악성 송과체 종양의 연수막 파종과 유사한 발현을 가진 송과체 세포종 환자에서 발생한 유방암의 종양성 뇌수막염 -증례보고-

장지환 ( Ji Hwan Jang ),김규홍 ( Kyu Hong Kim ),양근영 ( Geun Young Yang ),김영준 ( Young Zoon Kim ) 대한뇌종양학회·대한신경종양학회·대한소아뇌종양학회 2012 대한뇌종양학회지 Vol.11 No.1

Neoplastic meningitis is a relatively rare, but serious late-stage complication of brain metastasis from systemic cancer. A 37-year-old woman presented with complaints of altered mentation, nausea and vomiting. Computed tomography (CT) and magnetic resonance imaging of brain revealed a patchy enhancement with gadolinium contrast of leptomeninges over the cerebral convexities and in basilar cistern, insulae, all the recesses, and ventricular walls. By neuroendoscopy, we performed third ventriculostomy and biopsy of pineal mass, which revealed a histopathologically-pure pineocytoma. The unexpected observation of cells floating in the ventricle was consistent with adenocarcinoma. In systemic work up, Cancer Antigen (CA) 15-3 was markedly increased in serum, and multiple enhanced masses were found in the breast, lung, axial lymph node, and vertebrae on positron emission tomography-CT. Ultrasonography-guided biopsy of breast mass suggested poorly differentiated adenocarcinoma. Herein, we report a rare case of neoplastic meningitis of breast cancer in the patients with a pineocytoma.