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심병용,박진노,한지연,홍영선,김훈교,이경식,김민식,조승호,정수미,이연수,강진형,Shim Byoung-Yong,Park Jin-No,Han Ji-Youn,Hong Young-Sun,Kim Hoon-Kyo,Lee Kyung-Shick,Kim Min-Sik,Cho Seung-Ho,Chung Su-Mi,Lee Youn-Soo,Kang Jin-Hyoung 대한두경부종양학회 2000 대한두경부 종양학회지 Vol.16 No.2
Objectives: Esthesioneuroblastoma is a rare malignant neoplasm that originates from the olfactory sensory cells. This tumor grows from the upper nasal cavity and ethmoid sinus and invades surrounding structures through the cribriform plate into intracranium or orbit in advanced stage. Even though there has been some controversies in determining standard treatment due to rarity of this tumor, the combination treatment of surgery and adjuvant radiation has been recommended for the locally advanced esthesioneuroblastomas. However, the recent clinical experiences of advanced cases showed that combination chemotherapy is highly effective to reduce tumor mass and improve clinical outcomes. Materials and Methods: The authors conducted a retrospective analysis of 6 esthesioneuroblastoma patients who were treated in our hospital from 1986. Results: The age of these patients was between 19 and 86 year-old. Among the 6 cases, 2 were diagnosed at stage B and 4 at stage C, according to Kadish classification. Anti-tumor treatments were performed in 5 patients. One patient refused active treatment and was lost to follow-up. Better survival outcome were observed in 3 patients who were treated with combination chemotherapy alone or combined modality treatment including chemotherapy. Conclusion: Based on our retrospective study, the combined treatment consisting of surgery, radiotherapy, and combination chemotherapy should be used to improve treatment results. And furthermore, innovative clinical approaches such as neoadjuvant chemotherapy, high-dose chemotherapy and autologous peripheral stem cell transplantation, which have been reported to have good therapeutic results, should be considered and applied actively.
악성 림프종 환자에서 BEAM 고용량화학요법과 자가조혈모세포이식
박진노(Jin No Park),홍영선(Young Seon Hong),송치원(Chee Won Song),조석구(Seok Goo Cho),이종욱(Jong Wook Lee),민우성(Woo Sung Min),김춘추(Chun Choo Kim),이경식(Kyung Shick Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.3
N/A Background : The long-term survival in patients with non-Hodgkin's lymphoma (NHL) after conventional chemotherapy is about 35% and the rest of the patients tend to have relapse. So, in relapsed or refractory NHL, the outcome of patients undergoing high-dose chemotherapy and autologous peripheral stem cell transplantation (APBSCT) was evaluated, and the main prognostic factors were determined. Methods : 17 patients with relapsed or resistant NHL (5 complete response group, 7 partial response group, 4 primary refractory group, 1 resistant relapse) underwent BEAM (carmustine, etoposide, cytarabine, melphalan) chemotherapy and APBSCT between July 1997 and February 1999. Results : The median follow-up duration was 17 months (range: 4-47). The response rate was 58.3% (complete response 33.3%, partial response 25.0%) in 12 patients in whom complete response group was not included. The 2-year, 3-year overall response rate were 41.2%, 27.5%, respectively. And 2-year progression free survival was 35.3%. The disease status before high-dose chemotherapy was the only significant prognostic factor in determining overall survival (univariate p=.024, multivariate p=.059) and progression free survival (univariate p=.013, multivariate p=.026). Patients with complete response to salvage regimen had better overall survival (p=.021) and progression free survival (p=.008) than patients with refractory response. WBC (≥ 1,000/uL) was recovered at the median 11 days (range; 8-24), and platelet (≥ 50,000/uL) was recovered at the median 18 days (range; 9-44). There was no treatment-related death and no grade 3 and 4 toxicity. Neutropenic infection was in 4 patients (1 Herpes zoster, 1 typhlitis, 1 perianal infection, 1 otitis externa). Conclusion : The pre-transplant disease status was the main prognostic factor. Patients with complete response to salvage regimen had the significant benefit in survival from high-dose chemotherapy and APBSCT, but patients with refractory or resistant relapsed NHL did not have any significant benefit.(Korean J Med 61:255-263, 2001)
재발 및 불응성 비호즈킨 림프종 환자의 치료에서 IVAM ( Ifosfamide , VP-16 , Ara-C , Methotrexate ) 복합화학요법의 치료 효과
송치원(Chi Won Song),박진노(Jin No Park),조석구(Seok Goo Cho),이종욱(Jong Wook Lee),홍영선(Young Seon Hong),민우성(Woo Sung Min),김춘추(Chun Choo Kim),이경식(Kyung Shick Lee) 대한내과학회 2001 대한내과학회지 Vol.61 No.2
N/A Background : Patients with non-Hodgkin's lymphoma who do not respond to first-line chemotherapy or those who relapse after obtaining a complete response have a poor prognosis and are rarely cured with usual salvage chemotherapy. We investigated the treatment responses, toxicities, prognostic factors and mobilization efficacy of peripheral blood stem cells (PBSC) used as salvage chemotherapy. Methods : 55 patients with refractory (36) or relapsed (19) NHL were treated from Novembr 1997 to October 1999 with IVAM (ifosfamide, etoposide, cytarabine, methotrexate) regimen. Each patients was scheduled to receive one to three cycles of chemotherapy. When the leukocyte count reached 5×109/L after chemotherapy, PBSC collection was performed. The treatment was repeated every 4 weeks. Results : The median age was 48 years (range, 19-76). Median 2.1 cycles of chemotherapy were administered. 15 patients (27.3%) achieved complete response and 29 (52.7%) partial response, with an overall response rate of 80.0%. Myelosuppression was the major toxicity, with 98.2% of grade 3, 4 neutropenia and thrombocytopenia, but there was no serious hemorragic event. Neutropenic fever occurred in 25.5% of the patients with one treatment-related death due to sepsis. Non-hematologic toxicity was modest. PBSC was collected in 36 patients for high dose chemotherapy and autologous stem cell transplantation. The median number of mononuclear cells collected was 9.9×108/kg and the median number of CD34(+) cells collected was 11.9×106/kg. After a median follow-up of 13 months (range, 3-26), median progression free survival were 12 months and median overall survival has not been reached yet. 1-year overall survival and progression free survival were 61.9% and 46.1%, respectively. In univariate analyses, unfavorable prognosis was associated with poor performance status (p=0.001), high LDH (p=0.041), stage III,IV (p=0.04), extralymphatic lesion (p=0.027), B sx (p=0.034), bone marrow involvement (p=0.039) and performing high dose chemotherapy (p=0.005). Multivariate analysis showed that performance status(p=0.0042), B sx(p=0.049) was a significant independent risk factors for death. Conclusion : These results suggest that IVAM is an effective salvage chemotherapy for refractory or relapsed NHL and allow effective PBSC collection for high dose chemotherapy and autologous PBSCT.(Korean J Med 61:141-150, 2001)
사혈치료 중 다발성 비장경색을 동반한 진성다혈증 1 례
김현숙,김재영,한지연,박은정,이경식,조돈현 대한내과학회 1998 대한내과학회지 Vol.55 No.6
Polycythemia vera(PV) is a chronic myeloproliferative disease characterized by an increase in the total mass of red cells. Leukocyte and platelet counts are often elevated as well. The most common complication is thrombosis, which usually involves brain, heart, gastrointestinal tract, and kidneys, but rarely involves spleen. The cornerstone of therapy for this disease is phlebotomy and it is associated with an increased risk of thrombosis, especially for patients older than 70 years, those with a history of thrombosis, and those requiring an increased frequency of phlebotomy. Concurrent treatment with myelosuppressive agents decreases the risk of thrombotic complications. Recently we experienced a case of multiple splenic infarction in PV treated phlebotomy alone in a 42-year old woman who had complained of massive splenomegaly, left upper quadrant abdominal pain and fever. CT scan of abdomen showed multiple hypodense areas suggesting splenic infarction. She was managed with hydroxyurea and salicylate instead of phlebotomy and showed a clinical improvement with lowering the platelet count and reducing splenomegaly. PV with a massive splenomegaly is prone to thrombosis and phlebotomy in such patients may contribute to the thrombotic complications by increasing platelet counts. When it is necessary to lower the platelet count or reduce splenomegaly, hydroxyurea may be more useful than phlebotomy.
호염구성발증(basophilic crisis)을 보인 만성 골수성 백혈병 1 예
김희정,김기원,박석영,김명숙,이경식 대한내과학회 2001 대한내과학회지 Vol.61 No.3
Chronic myelogenous leukemia (CML) is a clonal disorder of pluripotent hematopoietic stem cell. Transformation of CML can take place at different stages of stem cell development. The common terminal event in CML is blastic crisis in the majority of cases. Basophilic crisis of CML is very rare event and we experienced a case in 48-year-old patient with philadelphia chromosome positive CML. He had received conservative treatment for 3 years. In the basophilic crisis phase, the WBC count was 64,800 /mm3 with 70 % basophils in the peripheral blood and 43.6% in bone marrow. These basophils had left-shifted maturation. Cytogenetic study revealed the philadelphia chromosome without other abnormalities. (Korean J Med 61:293-297, 2001)
악성림프종 환자에서 고용량화학요법 후 발생한 흉선과형성
박종원,김학희,김춘추,지정선,김훈교,이경식,조석구,송선화 대한내과학회 2002 대한내과학회지 Vol.62 No.3
Thymic hyperplasia results from thymic regrowth after atrophy during a stressful period. Differentiation from recurrent or residual neoplasm may be an important consideration. Thymic hyperplasia is most problematic when it is observed in patients with malignant lymphoma. We report a case of thymic hyperplasia in which thymic enlargement is developed in a malignant lymphoma patient with high-dose chemotherapy and autologous peripheral blood stem cell transplantation and this condition is confirmed by the findings of serial chest computed tomography without chemotherpy. (Korean J Med 62:293-296, 2002)