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류헌모 ( Hun Mo Ryoo ) 대한내과학회 2011 대한내과학회지 Vol.81 No.3
The lung is a common site for metastasis of malignant tumors from other organs. The metastatic cascade is a complex process that involves a series of events. Tumors can spread to the lung through hematogenous or lymphangitic routes. In the absence of extrathoracic metastasis, complete resection is associated with increased survival, regardless of histology. With appropriate patient selection, life expectancy is often improved with pulmonary metastasectomy. Stereotactic body radiation therapy (SBRT) and radiofrequency ablation (RFA) are 2 approaches that have been increasingly reported for pulmonary tumors. Although these new therapies have yet to match the long-term success rates of surgical therapy, the techniques demonstrate good results in treating high-risk surgical candidates with metastatic lesions to the lungs that would otherwise be considered with resection. This review will focus on the role of local therapy in oligometastasis that arise in the lung. (Korean J Med 2011;81:289-299)
진행성 비소세포폐암 환자에서 제1차 요법으로서 매주요법 Docetaxel/Platinum 복합항암화학요법의 효과
김소연 ( So Yeon Kim ),류헌모 ( Hun Mo Ryoo ),배성화 ( Sung Hwa Bae ),정현영 ( Hyun Young Jung ),김경찬 ( Kyung Chan Kim ),현대성 ( Dae Sung Hyun ),이상채 ( Sang Chae Lee ),김경옥 ( Kyeong Ok Kim ),이경희 ( Kyung Hee Lee ),현명수 대한내과학회 2007 대한내과학회지 Vol.72 No.6
목적: 비소세포폐암은 최근 지속적으로 증가하며 대다수의 환자가 질병 경과 중에 항암화학요법이 필요하다. Docetaxel과 platinum의 복합항암화학요법이 비소세포폐암의 치료에 효과적이지만 표준적인 3주요법은 심각한 골수 억제 독성이 있다. 주 단위 저용량의 docetaxel을 투여할 경우 효과를 유지하면서 골수 억제 독성을 감소시킨다고 한다. 이에 저자들은 진행성 비소세포폐암 환자에서 주 단위 저용량 docetaxel과 platinum 복합항암화학요법의 효과와 독성을 알아보기 위해 본 연구를 시행하였다. 방법: 2004년 7월부터 2005년 12월까지 총 29명의 완치가 불가능한 비소세포폐암 환자를 대상으로 docetaxel 35 mg/m2를 제 1, 8, 15일에 1시간 동안 정맥점적주사하고, 제1일에 cisplatin 75 mg/m2 (60세 미만) 또는 carboplatin (AUC 6, 60세 이상)을 docetaxel 투여 후 정맥점적주사하였다. 결과: 총 29명 중 남자 25명, 여자 4명이었고, 중앙 연령 66세, 60세 이상 65.5%, 일상생활수행능력(ECOG) 2가 55.2%였다. 편평상피세포암 48%, 선암 38%였다. 제IIIB병기 21%, 제IV병기 72%, 수술 후 재발한 환자 7%였다. 복합항암화학요법은 총 95회를 투여하였다. 평가 가능한 26명에서 부분반응 44.8%, 안정성 병변 10.3%, 진행성 병변 34.5%로 전체종양반응률 44.8%였다. 중앙 생존기간 11.3개월(95% 신뢰구간, 23-67주), 무진행생존기간 5.3개월(95% 신뢰구간, 11-31주), 1년 추정 생존률 37%였다. 연령, 성별, 병기, 일상생활수행능력 및 조직학적 아형에 따른 생존률은 통계학적으로 의미있는 차이는 없었다. 결론: 진행성 비소세포폐암 환자에서 저용량의 docetaxel 매주요법과 platinum 제제의 복합항암화학요법은 3주요법과 대등한 전체 종양 반응률과 중앙생존기간을 보이면서 낮은 혈액학적 독성을 보여 일상생활수행능력이 불량하거나 고령인 환자를 포함하여 비소세포폐암의 새로운 치료법이 될 수 있을 것으로 생각한다. Background: Docetaxel is a highly effective chemotherapeutic agent with proven efficacy for non-small cell lung cancer (NSCLC). However, myelosuppression can be a substantial concern when docetaxel is administered every 3 weeks. Weekly administration of low-dose docetaxel has demonstrated a comparable efficacy together with a distinct toxicity profile with reduced myelosuppression. We conducted a phase Ⅱ study of weekly administration of docetaxel and cisplatin or carboplatin in patients with advanced NSCLC to evaluate efficacy and safety. Methods: Twenty-nine patients with advanced or metastatic NSCLC who had not received prior treatment were enrolled in the study. The patients received intravenous infusions of docetaxel (35 mg/m2 on days 1, 8, 15) and cisplatin (75 mg/m2 on day 1) or carboplatin (AUC 6), followed by a week of rest. Results: Twenty-six patients were assessable for efficacy and all patients were assessable for toxicity determination. The overall response rate of the regimen was 44.8%. The median survival was 11.3 months, and the 1-year survival rate was 37%. Of the hematologic toxicities, grade 3/4 neutropenia were observed in 12.6% of the patients, but there were no episodes of neutropenic fever. Non-hematologic toxicities were mild. Conclusions: With this weekly dosing regimen, although efficacy is comparable, myelosuppression is substantially less, and the overall tolerability profile is better than with dosing every 3 weeks. (Korean J Med 72:625-631, 2007)
백상아 ( Sang Ah Baek ),류헌모 ( Hun Mo Ryoo ),배성화 ( Sung Hwa Bae ),조윤영 ( Yoon Young Cho ),김성규 ( Seong Gyu Kim ),김가영 ( Ga Young Kim ),김민근 ( Min Keun Kim ) 영남대학교 의과대학 2015 Yeungnam University Journal of Medicine Vol.32 No.2
Polyneuropathy, organomegaly, endocrinopathy, monoclonal gammopathy, and skin changes (POEMS) syndrome is a monoclonal plasma cell disorder. Patients with POEMS syndrome also have various clinical manifestations including generalized edema, pleural effusion, ascites, papilledema, and sclerotic bone lesions. These manifestations can lead to a misdiagnosis or delayed diagnosis. We recently experienced a 51-year-old male patient with POEMS syndrome whose sclerotic bone lesion was misdiagnosed as malignant bone metastasis of papillary thyroid carcinoma. We reassessed the patient and found polyneuropathy, hepatosplenomegaly, hypothyroidism, partial hypopituitarism, immunoglobulin G lambda-type monoclonal gammopathy, hypertrichosis, ascites, and multiple sclerotic bone lesions, all of which led us to a diagnosis of POEMS syndrome. Treatment with thalidomide and dexamethasone resulted in clinical and radiological improvement. The patient has remained in remission after peripheral blood stem cell transplantation.
혈액종양 : 미만성 거대 B세포 림프종의 중추신경계 재발 후 장기 생존한 2예
김성규 ( Seong Gyu Kim ),배성화 ( Sung Hwa Bae ),류헌모 ( Hun Mo Ryoo ) 대한내과학회 2015 대한내과학회지 Vol.88 No.2
A central nervous system (CNS) relapse is a rare but mostly fatal complication in patients with diffuse large B cell lymphoma (DLBCL). CNS involvement can occur as an isolated event or can be combined with progression of systemic disease. There are limited data on treatment outcomes of patients with DLBCL and secondary CNS involvement. We report the clinical data, treatments, and outcomes of two DLBCL patients with isolated CNS relapses involving the brain parenchyma. Isolated CNS disease involving the brain parenchyma may be potentially treatable as the initial relapse site after complete remission from systemic treatment. (Korean J Med 2015;88:218-223)
B형 간염 바이러스 감염과 동반된 비장의 원발성 악성 림프종 2예
배성화 ( Sung Hwa Bae ),박성훈 ( Sung Hoon Park ),류헌모 ( Hun Mo Ryoo ),김호각 ( Ho Gak Kim ),조창호 ( Chang Ho Cho ),이재련 ( Jae Lyun Lee ),이경희 ( Kyung Hee Lee ),현명수 ( Myung Soo Hyun ) 대한소화기학회 2003 대한소화기학회지 Vol.41 No.6
The incidence of primary splenic lymphoma is less than 1% of all non-Hodgkin`s lymphoma. Lymphotrophism of hepatitis C virus may play a important role in the development of primary splenic lymphoma. However, there is no report about primary splenic lymphoma associated with hepatitis B virus infection. We present two cases of primary splenic lymphoma associated with hepatitis B virus infection. They suffered from left upper quadrant abdominal pain and underwent diagnostic splenectomy. In case 1, the spleenhada10×10×9 cm lobulated tumor mass that replaced the splenic parenchyma. In case 2, the spleen contained two lobulated macronodular white tumors, measuring 3×2 cm and 2×2 cm. Splenic tumors were confirmed pathologically to be intermediate and high grade of B cell lymphoma. The patients received combination chemotherapy with CHOP. They are still alive without recurrence 23 months and 15 months after splenectomy. (Korean J Gastroenterol 2003;41:519-522)
증례 : 혈액종양 ; 16번 염색체 역위를 가진 급성 골수성 백혈병의 복막 골수성 육종 1예
김지윤 ( Ji Yoon Kim ),박병규 ( Byeong Kyu Park ),배성화 ( Sung Hwa Bae ),류헌모 ( Hun Mo Ryoo ),성우정 ( Woo Jung Sung ),이아진 ( A Jin Lee ) 대한내과학회 2015 대한내과학회지 Vol.89 No.5
골수성 육종(Myeloid sarcoma)은 골수 외를 침범하는 질환으로 급성 골수성 백혈병에서 발생하는 드문 종양이다. inv (16) 염색체 이상을 가진 골수성 육종은 대부분 복강 내에서, 특히 소화관을 침범하는 종괴의 형태로 나타나지만 본 증례에서는 복막의 침윤 및 복수의 형태로 나타나 1예가 있어 보고하는 바이다. Myeloid sarcoma is an extramedullary myeloid neoplasm that usually involves the skin, soft tissues, and lymph nodes. Myeloid sarcoma is found in 2.5-9.1% of acute myeloid leukemia patients, usually those with t (8,21), while inv (16) is rarely associated with myeloid sarcoma. Consequently, little is known of the characteristics and incidence of inv (16) in myeloid sarcoma. Myeloid sarcoma in acute myeloid leukemia patients with inv (16) is most often found in the abdominal lesions, the intestinal tract is involved most commonly, in the form of a mass. Here, we report an unusual myeloid sarcoma presenting as peritoneal carcinomatosis in acute myeloid leukemia with inv (16) that appeared to be ascites. (Korean J Med 2015,89:581-584)
칼시토닌 분비 췌장 내분비 종양을 동반한 다발내분비샘종양 1형 1예
김홍익 ( Hong Ik Kim ),최준혁 ( Jun Hyeok Choi ),오훈규 ( Hoon Kyu Oh ),배성화 ( Sung Hwa Bae ),류헌모 ( Hun Mo Ryoo ),김성규 ( Seong Gyu Kim ),강선미 ( Sun Mi Kang ) 대한내과학회 2012 대한내과학회지 Vol.83 No.6
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant hereditary disorder characterized by the combined occurrence of tumors of the parathyroid gland, exocrine pancreas, and anterior pituitary gland. Calcitonin-secreting pancreatic endocrine tumors are rare, and calcitonin-secreting pancreatic endocrine tumors with MEN1 have not been reported in Korea. A 46-year-old woman was admitted for a right breast cancer operation. Abnormal blood chemistry findings were hypercalcemia and elevated calcitonin. The patient was diagnosed with a calcitonin-secreting pancreatic endocrine tumor, left thyroid papillary carcinoma, right breast invasive ductal carcinoma, a thymic carcinoid tumor, left adrenal adenoma, uterine myoma, and adenomyosis by computed tomography scan, and with pituitary macroadenoma by brain magnetic resonance imaging. We present this case with a review of the literature, because it is the first reported calcitonin-secreting pancreatic endocrine tumor with MEN 1 in Korea. (Korean J Med 2012;83:817-822)
국소진행성 비소세포폐암 환자에서 weekly paclitaxel을 이용한 화학 방사선 동시요법의 효과
배성화 ( Sung Hwa Bae ),김경찬 ( Kyung Chan Kim ),이선아 ( Sun Ah Lee ),김소연 ( So Yeon Kim ),류헌모 ( Hun Mo Ryoo ),현대성 ( Dae Sung Hyun ),이상채 ( Sang Chae Lee ),예지원 ( Ji Won Yei ),배종엽 ( Jong Yup Bae ),정경재 ( Kyung J 대한내과학회 2005 대한내과학회지 Vol.69 No.4
목적 : 절제 불가능한 국소진행성 비소세포폐암 환자에서 paclitaxel을 이용한 화학 방사선 동시요법의 효과를 조사하기 위해 본 연구를 시행하였다. 방법 : 화학 방사선 동시요법 기간동안 paclitaxel을 매주 60㎎/㎡의 용량으로 1시간 동안 정맥으로 투여하였다. 방사선치료는 일일 1회 1.8Gy 분할량으로 주 5회 조사하였으며, 총 63Gy까지 조사하였다. 동시치료 이후 4주기의 paclitaxel/carboplatin 복합화학요법을 시행하였다. 결과 : 28명의 환자가 등록되었고, 남자가 25명, 여자가 3명이었고, 나이의 중앙값은 60세(범위: 41~73세)였다. 19명의 환자에서 계획된 화학 방사선 동시치료를 마쳤다. 완전관해는 5명, 부분관해는 15명으로 전체 관해율은 71.4%이었고, 7명의 환자에서 3도 이상의 폐렴이 발생하였는데 이 중 3명이 치료 관련 사망하였다. 중앙 생존기간은 17.5개월(95% 신뢰구간 12.5~22.5개월)이었고 무진행 생존기간의 중앙값은 8.0개월(95% 신뢰구간 4.1~11.9개월)이었다. 결론 : 국소진행성 비소세포폐암에서 paclitaxel을 포함한 화학 방사선 동시치료는 효과적이지만 폐의 부작용이 문제가 되며 환자 대상 선택과 추적에 주의를 요한다. Background : Combined modality therapy is standard treatment of unresectable, locally advanced stage III non-small cell lung cancer (NSCLC). However, the optimal chemotherapy regimen and duration of chemotherapy remain a matter of debate. We evaluated the efficacy and feasibility of concurrent chemoradiation therapy (CCRT) in patients with locally advanced NSCLC. Methods : PS 0-2 patients with histologically proven inoperable stage III NSCLC were eligible for this trial. The patients received paclitaxel (60㎎/㎡) on days 1, 8, 15, 22, 29, 36 with a concurrent radiotherapy (5days/week, 1.8Gy/day) starting day 1 with a total dose of 63 Gy. After CCRT, four cycles of consolidation chemotherapy with paclitaxel (140㎎/㎡) and carboplatin (AUC 5) was administered to patients with a partial, complete remission or stable disease. Results : Twenty eight patients with locally advanced NSCLC enrolled in this study. The median age of the patients was 60 years. Of the 28 patients, 19 received scheduled CCRT. Overall response rate was 71.4% including 5 complete responses and 15 partial responses. Grade 3 or 4 pulmonary complication was observed in 7 patients and 3 patients died of pneumonitis. The median overall survival was 17.5 months (95% CI, 12.5-22.5). The median progression free survival was 8.0 months (95% CI, 4.1-11.9). Conclusions : CCRT including paclitaxel in patients with locally advanced NSCLC led to an encouraging response rate and survival, but resulted in high incidence of severe pulmonary complication.(Korean J Med 69:379-386, 2005)
증례 : 혈액종양 ; 필라델피아 양성 급성골수성 백혈병에서 imatinib mesylate 투여로 완전관해 유도된 1예
장샛별 ( Saet Byul Jang ),배성화 ( Sung Hwa Bae ),정혜련 ( Hye Ryun Jung ),윤소연 ( So Yeon Yoon ),전언주 ( Eon Ju Jun ),강건우 ( Gun Woo Kang ),류헌모 ( Hun Mo Ryoo ) 대한내과학회 2010 대한내과학회지 Vol.78 No.1
Philadelphia chromosome-positive acute myeloid leukemia (Ph+AML) is a rare disease characterized by a poor prognosis with resistance to standard chemotherapy. We report a patient with Ph+AML with a minor BCR-ABL-positive mRNA transcript who achieved a hematologic, cytogenetic, and major molecular complete response after cytarabine-based chemotherapy followed by imatinib. After more than 6 months of continuous imatinib therapy, the patient is in continuous complete remission. Our results show that imatinib mesylate is effective in treating Ph+AML. (Korean J Med 78:132-137, 2010)