하인두암의 내과적 치료

윤환중 대한두경부종양학회 2009 대한두경부종양학회 학술대회 논문집 Vol.2009 No.1

급성골수백혈병에 대한 관해유도화학요법 후의 Granulocyte Colony-stimulating Factor의 효과

윤환중,최지영,전의건,길준영,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Granulocyte colony-stimulating factor(G-CSF) have been shown to hasten the recovery of neutropenia following anti-cancer chemotherapy. There are controversial opinions on the use of G-CSF in acute myelogenous leukemia(AML) because clonogenic studies have shown that G-CSF stimulates leukemic colonies as well as granulocyte colonies. In this study, we evaluated the effectiveness and safety of recombinant human G-CSF after induction chemotherapy with DAV regimen(Ara-C 100mg/㎡ day 1-8, Doxorubicin 45mg/㎡ day 3-5, VP-16 100mg/㎡ day 6-8) in 9 patients with AML. G-CSF therapy(200 ㎍/㎡/day) was begun 2 days after the end of chemotherapy and continued for 10 days. 17 AML patients who recieved the same chemotherapy before the onset of this study were used as historical control. G-CSF shortened the duration of granulocytopenia (less than 500/㎣) significantly (13 vs 23 days, p<0.001), but it had no effect on platelet recovery. Although the incidence of febrile episodes was almost the same, the duration of febrile episodes was shorter in the group treated with G-CSF( 5 vs 12 days, p=0.03). There was no evidence that G-CSF accelerated the regrowth of leukemic cells and the complete remission rates between the 2 groups were not different. These results show that G-CSF accelerates the recovery of granulocytopenia and shortens the febrile days after chemotherpy in patients with AML, without affecting the regrowth of leukemic cells.

포스터 전시 발표 순서 : 혈액종양 ; 여러 내장에 재발한 다발고립형질세포종 1예 (초)

진선아,윤각원,양영준,이효진,윤환중,김삼용,조덕연,송익찬,백승우 대한내과학회 2009 대한내과학회지 Vol.77 No.4S

진행암 환자에서 Cisplatin 병용화학요법시 Ondansetron의 오심 구토 조절 효과

전의건,윤환중,길준영,조덕연,김삼용 최신의학사 1992 最新醫學 Vol.35 No.12

구인두 캔디다증에 대한 Fluconazole의 치료효과

전의건,윤환중,길준영,조덕연,김삼용 최신의학사 1993 最新醫學 Vol.36 No.5

백혈병의 분자생물학적 연구 -암유전자를 이용한 백혈병의 진단-

박철신,윤환중,전의건,길준영,조덕연,김삼용,이복수,백상기 大韓血液學會 1992 大韓血液學會誌 Vol.27 No.2

Cyclosporine에 혈액학적 반응을 보인 Refractory Anemia 1예

길준영,윤환중,전의건,오덕연,김삼용,김종완,박종우 大韓血液學會 1992 大韓血液學會誌 Vol.27 No.2

저자들은 refractory anemia로 진단받고 23개월간 지속적인 적혈구 수혈(매월 2units씩 총 47units)을 필요로 했던 58세 여자 환자에 cyclosporine을 투여하여 21개월간 혈액학적 반응 을 경험하였고 이 기간에는 수혈이 필요치 않았다. Refractory anemia의 발병기전은 아직 분명치 않으나 일부 환자에선 면역억제제에 반응함으로써 일부 면역기전이 작용한다고 생각된다. The myelodysplastic syndromes which encompass refractory anemia are characterized by ineffective hematopoiesis, refractory cytopenias, and an increased risk of leukemic transformation. No currently available treatment has been shown to be consistently effective in producing sustained improvement in hematopoiesis or in delaying leukemic evolution. Cyclosporine has been used for the therapy of patients with aplastic anemia. We report a case of refractory anemia who responded to cyclosporine(Sandimun®). A 58-year-old woman was admitted to the Chungnam National University Hospital for the evaluation of pancytopenia. Blood examination showed 2,600/㎣ of white blood cells, 5.9g/dL of hemoglobin, and 38,000/㎣ of platelets. Reticulocyte index was 0.2%. The levels of serum iron, iron-binding capacity, vitamin B_l2, and folic acid were in normal range. Bone marrow biopsy revealed hypercellularity, dysmyelopoiesis, dyserythropoiesis, myeloid hyperplasia. The hematologic findings were compatible with the diagnosis of refractory anemia and the diagnosis of aplastic anemia could be excluded. Treatment with oxymetholone(50㎎/day) and pyridoxine(300㎎/day) was started. Packed red cells transfusions(total of 47 units) were required over a period of 23 months. An oral cyclosporine(Sandimun®) therapy was started at a dosage of 300㎎ per day. One month after cyclosporine therapy hemoglobin level began to increase and reached 11.6g/dL after 12 weeks. The dose of cyclosporine was reduced to 200㎎ per day and discontinued after total of 19 weeks of therapy. Her hemoglobin level remained stable between 13 and 15g/dL without transfusion. After a 21 months of hematological remission, she was readmitted because of progressive dyspnea after undergoing a cataract operation 2 months ago. Despite transfusion of packed red cells and plateletpheresis to which she was refractory. Her hemoglobin level was around 3g/dL and platelet count decreased progressively. Retrial of cyclosporine(900㎎/day for 2 weeks) and a trial of GM-CSF(400㎍/day for 7 days) were of no benefit. She succummed to gastrointestinal and intraperitoneal bleeding. The exact mechanism of cyclosporine in this case is uncles but it is reasonable to ascribe the striking hematologic improvement to cyclosporine. As some reports showed responses to immunosuppressive therapy in refractory anemias, in some proportion of patients with refractory anemia, immune mechanism may be involved in the pathogenesis. The role of immunosuppressive therapy in refractory anemia should be further clarified.

진행암 환자에서 Cisplatin 병용화학요법 시 Ondansetron의 오심 구토 조절 효과

조문준,윤환중,전의건,길준영,조덕연,김삼용 충남대학교 의과대학 지역사회의학연구소 1993 충남의대잡지 Vol.20 No.2

Ondansetron is a novel agent that selectively binds to the 5-hydroxytryptamine_3 receptor, and has been reported to have a prominent effect in the prevention of anti-neoplastic agent induced nausea and vomiting. Twenty solid tumor patients who were scheduled to receive cisplatin containing combination chemotherapy participated in a prospectively open-labeled study to evaluate the antiernetic efficacy and safety of ondansetron. The male to female ratio was 11 : 9 and median age was 49(16-70). The sites of primary neoplasms and number of patients were as following : head and neck 4, metastatic carcinoma of unknown primary site 3, stomach 3, osteosarcoma 2, ovary 2, esophagus 1, melanoma 1, penile 1, bladder 1, cervix 1, and extragonadal germ cell 1. Ondansetron was given as an 8mg loading dose IV before chemotherapy followed by 8mg IV every 8 hours until 24 hours after chemotherapy completion. Complete or major control(0 to 2 emetic episodes) of emesis was achieved in 17 of 20 patients(85%;complete 50%, major 35%) receiving ondansetron during the first 24hrs of chemotherapy. During the period of day 2 through clay 5 of chemotherapy, 14 of 20(75%) patients had complete or major control of emesis(complete 35%, major 35%). No severe side reactions were recorded in ondansetron treated patients, while mild to moderate headache was noted in 20% of patients. These results show that ondansetron is effective in the control of cisplatin induced nausea and emesis, and can be administered safely with minimal side effects.

포스타 전시 발표 : 내분비-대사 ; 편평상피 세포암과 동반된 소세포 폐암에서 발생한 항이뇨 호르몬 부적절 분비 증후군 1례

장재식,윤환중,이창우,이영현,유석동,장태정 대한내과학회 1999 대한내과학회 추계학술대회 Vol.57 No.-

TRIUMPH Trial: One Small Step Could Become One Giant Leap for Precision Oncology in Head and Neck Cancer

김범석,김혜련,윤환중 대한암학회 2019 Cancer Research and Treatment Vol.51 No.1

Recent remarkable progress in the fields of cancer genomics, computational analysis and drug discovery have changed the whole paradigm in cancer research. So called precision oncology, defined as molecular profiling of tumors to identify druggable alterations, is rapidly developing and waiting for entering the mainstream of cancer research as well as practice [1]. In the era of precision oncology, traditional classification based on organ or pathology do not have clinical meaning anymore. Molecular subtype base on next-generation sequencing (NGS) will lead us to appropriate molecular targeted agents. Head and neck squamous cell carcinoma (HNSCC) is not a specific disease entity, but rather a broad category of diverse tumor types arising from various anatomic structures including oral cavity, oropharynx, hypopharynx, larynx and paranasal sinus. HNSCC is highly heterogeneous group of disease arises from the mucosal lining of the upper aerodigestive tract, demonstrates squamous differentiation, and involves older men with a long history of smoking. The prognosis by anatomic subsite quite differ. Human papilloma virus positive oropharyngeal cancer showed very good prognosis while oral cavity cancer had worst prognosis. In the era of NGS, HNSCC become more heterogeneous by mutational status [2-4]. Traditional design of clinical trials has faced big challenge for these heterogeneity and rarity. One solution is umbrella trial. In an umbrella trial, patients with specified cancer type are centrally screened and assigned to one of several molecularly defined subtrials where they receive matched targeted agents [5]. Some novel umbrella trials such as BATTLE trial [6] or MOSCATO trial [7] suggest that such a biomarker driven clinical trial can give appropriate benefit to the patients. To perform an umbrella trial, precise NGS based molecular phenotyping should be practical and working in the level of clinic. To date, there was surprisingly few study deals with the feasibility of molecular phenotyping for umbrella trial. We should answer the questions whether precision oncology is just a theory or whether it is realistically feasible. We should answer how we implement the precision oncology into the clinic and prove the patients’ benefit. In this issue of Cancer Research and Treatment, Lim et al. [8] reported the feasibility of targeted NGS to guide the treatment of HNSCC. The authors tested the feasibility from tissue sample process to analysis of NGS and mRNA expression at the practical level. Mutation profiles were similar with prior reports [2-4] and the authors found several targetable alterations such as PIK3CA, CDKN2A and CCND1. Based on this success, KCSG (Korean Cancer Study Group) Head and Neck Cancer and Esophageal Cancer Committee launched novel umbrella trial: Translational bIomarker Driven UMbrella Project for Head and Neck (TRIUMPH, NCT 03292250), which is the first umbrella trial for HNSCC in the world. TRIUMPH trial is for recurred/metastatic HNSCC, consisting of 5 targeted therapies including phosphoinositide 3-kinase inhibitor BYL719, pan-HER inhibitor poziotinib, fibroblast growth factor receptor inhibitor nintedanib, CDK4/6 inhibitor abemaciclib, andd immune checkpoint inhibitor durvalumab+/– tremelimumab. TRIUMPH trial is investigator-initiated trial, and Korean Cancer Study Group affiliated 37 institutes participate. We think TRIUMPH trial is one small step for head and neck cancer, but hope to be one giant leap for precision oncology in HNSCC.