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문희석,강윤세,김연수,박기오,이엄석,성재규,이병석,노승무,송규상,조준식,신경숙,정현용,Moon Hee-Seok,Kang Yoon-Sae,Kim Yeon-Soo,Park Ki-Oh,Lee Eum-Seok,Sung Jae-Kyu,Lee Byong-Seok,Noh Seung-Moo,Song Kyu-Sang,Cho June-Sick,Shin Kyung-Sook,J 대한위암학회 2003 대한위암학회지 Vol.3 No.3
Purpose: The incidence rate and the mortality rate of gastric cancer have decreased in developed countries over the last several decades. On the other hand, they remain high in far eastern countries such as Korea, Japan, China and in many developing countries. The cure of patients with gastric carcinomas can be achieved mostly through complete surgical resection, but most gastric cancer patients are in advanced stages when diagnosed and have poor prognoses. therefore, the development of an effective systemic therapy is essential for far advanced gastric cancer patients. Until recently, the most commonly used combination chemotherapy was based on 5-flurouracil or cisplatin, but the results were not satisfactory, so recently etoposide, adriamycin and cisplatin (EAP-II) combination chemotherapy was introduced in patients with advanced gastric cancer. Early studies showed a high response rate and the ability to convert unresectable cases to resectable ones, but later studies couldn't duplicate the result. the purpose of this study was to evaluate the relative efficacy & toxicity of EAP-II chemotherapy and ELF chemotherapy which is based on 5-flurouracil. Materials and Methods: Between July 1992 and July 2002, sixty-five patients with inoperable advanced gastric cancer were enrolled for this study. Thirty-seven patient received EAP-II chemotherapy:etoposide (20 mg/$m^{2}$ IV for $1\∼5 days$), adriamycin (20 mg/$m^{2}$ IV for $1\∼5 days$) and cisplatin (20 mg/$m^{2}$ IV for $1\∼5 days$) and Twenty-eight patients receieved ELF chemotherapy : etoposide (100 mg/$m^{2}$ IV for $1\∼3 days$), leucovorin (20 mg/$m^{2}$ IV for $1\∼5 days$) and 5-FU (500 mg/$m^{2}$ IV for $1\∼5 days$). Each treatment schedule for each group was repeated every four weeks: EAP-II means 3.4 cycles per patient..ELF means 4.1 cycles per patient Results: Total respones rates were $5.4\%$ in the ELF group and $3.6\%$ in the EAP group (P-value>0.05). The median times to progression were 144 days in the ELF group and 92 days in the EAP-II group (P-value<0.05), and themedian overall survival times were 189 days in the ELF group and 139 days in the EAP-II group (P-value>0.05). The difference in the survival curves for the two regimens was not statistically significant. Non-hematologic toxicitis & hematologic toxicitis were more frequently observed for the EAP-II regimen. Anemia: $27.6\%$ in ELF vs $54\%$ in EAP-II; Leukopenia: $8.5\%$ in ELF vs $19\%$ in EAP-II; nausea & vomiting: $45.9\%$ in ELF vs $67.8\%$ in EAP-II. Conclusion: EAP-II regimen is not superior to ELF regimen in the tratment of inoperable advanced gastric cancer (J Korean Gastric Cancer Assoc 2003;3:122-127)
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문희석 대한의사협회 2022 대한의사협회지 Vol.65 No.5
Background: Gastric cancer is a global health problem, and the incidence and geographical distribution of different types of gastric cancer varies. Particularly, noncardiac gastric cancer is more prevalent in East Asia, Central and Eastern Europe, Latin America, and Africa. Infection with Helicobacter pylori, which was discovered in 1982, is a common cause of chronic gastritis, and the association between H. pylori infection and gastric adenocarcinoma is well established. Current Concepts: Gastric cancer is histologically divided into 2 types: intestinal and diffuse. H. pylori infection is considered as the main risk factor for the development of both types of gastric tumors. The most documented course of development of stomach cancer is following cellular metaplasia due to chronic inflammation, damage, and repair. Various molecular alterations caused by H. pylori are identified not only in gastric cancer but also in precancerous lesions. Recently, many studies have attempted to diagnose H. pylori gastritis and precancerous lesions using endoscopy. Discussion and Conclusion: Recent studies have shown that eradication therapy stabilizes or reduces the risk of developing gastric cancer. Therefore, the diagnosis and understanding of gastritis and precancerous lesions caused by H. pylori are the first step in the prevention of gastric cancer.
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후천성 면역 결핍증 환자에서 위, 십이지장을 침범한 카포시 육종 1예
문희석,박기오,이엄석,김선문,성재규,김연숙,송규상,정현용 대한소화기내시경학회 2003 Clinical Endoscopy Vol.27 No.3
Kaposi's sarcoma, a rare tumor, usually presents itself with skin lesions. There is, however, an increased incidence in patients using immunosupressive drugs and with the acquired immunodeficiency syndrome (AIDS). Gastrointestinal Kaposi's sarcoma is usually asymptomatic, but may cause massive intestinal hemorrhage, perforation, intestinal obstruction, intussusception, protein-losing enteropathy, or sepsis. The gastroscopic appearances of Kaposi's sarcoma range from reddish purple maculopapules to polypoid, umbilicated nodule. In Korea, 3 case's of gastrointestinal kaposi's sarcoma have been reported so far. We experienced a 45-year-old man, who was positive for human immunodeficiency virus (HIV) antibodiy and developed Kaposi's sarcoma. A case of gastrointestinal Kaposi's sarcoma treated with paclitaxel is herein reported with the endoscopic findings before and after chemotherapy. (Korean J Gastrointest Endosc 2003;27:148-152) Kaposi 육종은 피부에서 기원하는 매우 드문 종양 중 하나로 10%의 환자에서는 소화기, 림프절 및 폐실질 등의 내부 장기를 침범하는 신생물로 알려져 있다. 그러나 최근 장기 이식 후 면역억제제를 투여받는 환자와 후천성 면역결핍증(AIDS) 환자의 증가와 더불어 그 발생빈도가 증가하고 있으며 특히 위장관 Kaposi 육종은 AIDS 환자의 대략 반수에서 발생한다. 위장관 Kaposi 육종은 대부분 증상이 없어 부검 시에 발견되는 예가 많으나 드물게 장관내 출혈, 천공, 장폐색, 장중첩, 단백유출장질병을 유발하거나 패혈증을 동반하기도 하며 내시경적 소견은 반점구진상 병변에서 결절이나 용종성 병변까지 다양하게 나타날 수 있다. Kaposi 육종에 대한 국내보고 15예 중 위장관을 침범한 예는 3예가 있었고 항암제 치료 전후의 내시경 소견에 대한 보고는 1예만이 보고된 실정이다. 이에 저자들은 AIDS 항체 검사가 양성인 피부의 Kaposi 육종 환자에서 내시경 검사에서 위와 십이지장에 발생한 Kaposi 육종을 진단하였고 paclitaxel로 치료 후 병변이 호전된 1예를 경험하였기에 문헌 고찰과 함께 보고하는 바이다.
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