국소적으로 진행된 위암의 수술후 방사선 치료성적

이명자,전하정,김인순,정태준,Lee Myung Za,Chun Ha Chung,Kim Insoon,Chung Tejune 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2

Purpose : Radical gastrectomy is main treatment of gastric cancer. But the result is not satisfactory with surgery alone. Most of pattern of failure remain locoregional recurrence. To improve 5 year survival postoperative chemotherapy with or without radiotherapy has been used. We analyzed patients with stage III and IV stomach cancer who had radical operation and received postoperative radiation therapy combined with or without chemotherapy retrospectively. Material and Method : From March 1985 to June 1993, 68 patients treated with curative resection and received postoperative adiuvant radiotherapy with 36Gy or more were evaluated. Median age was 60 years(range 28-66 yrs) . Patients were followed from 3 to 133 months with median follow up of 48 months. Thirty seven patients had non signet ring adenocarcinoma, 29 signet ring cell, 2 other cell. Patients with stage IIIA, IIIB, IV disease were 19, 25 and 24 respectively Chemotherapy was given to all patients except two. Results : Five-year overall survival and disease-free survival rate were 36.6% and 33.6%, respectively. Prognostic factor affecting survival were assessed. High ratio of jnvolved/dissected Iymph node, signet ring histology showed Poor Prognosis with statistical significance. Presence of residual tumor after surgery, stageIV. split course of radiation therapy, age, number of involved Iymph node, number of Iymph node dissection and grade of tumor affected survival without statistical significance, Type of chemotherapy did not affect survival. Recurrence was documented in 34 patients. High recurrence was seen in omentum and peritoneum with 23.5%, and remnant stomach, anastomosis site, A-loop and I-loop had also high recurrence with 13.2%. In field locoregional recurrence was 20.7% and total distant metastases were 39.7%. Total intraabdominal failure was 47.1% and extraabdominal failure was 13.2%. Treatment toxicity was considered to be acceptable. 22.1% of patients had grade 3 and only 1 patient had grade 4 leukopenia. Six Patients(8.8%) had weigh loss more than 10%. Conclusion : Treatment toxicity was acceptable with combined treatment with chemotherapy and radiotherapy. Locoregional recurrence was relatively low compared to distant failure with addition of irradiation. Peritoneal and omental seeding was high Five-rear surival was increased with combined modality. Radiation may eradicate minimal residual disease and improve survival, To evaluate role of radiation Prospective randomized study employing chemotherapy alone and chemotherapy plus radiation is necessary. Futhermore to reduce intraabdominal failure, role of intraabdominal chemotherapy in addition to combined chemotherapy plus radiation has to be explored. 목적 : 국소적으로 진행된 위암치료는 수술이 주 치료로 5년 생존율은 그리높지 않아 좀더 완치율을 높이기 위하여 화학요법이나 화학요법과 병용하여 방사선치료 등이 시행되고 있다 저자들은 위암환자에서 수술후 방사선치료를 받은 환자의 치료성적을 후향적으로 분석하였다. 방법 : 1985년 3월부터 1993년 6월까지 한양대학병원 치료방사선과에서 위절제수술후 방사선 치료를 3500cGy 이상 받고 병기 3및 4기인 68명을 대상으로 후향적인 분석을 하였다. 연령분포는 28세부터 66세였고 중앙연령은 50세였다. 추적기간은 3개월에서 133개월(3명이 36개월 미만)로 중앙값은 50개월이었다. 조직병리상 37명이 non signet ring adenocarclnoma였고 29명이 signet ring cell이었다. 병기로 IIIA가 19명, IIIB가 25명, IV가 24명이었다. 항암화학요법은 65명의 환자에게 투여되었으며 FAM계통의 치료가 28예 cispiatln, 5FU계통이 26예이었다. 결과 : 5년생존율은 36.6% 5년무병생존율은 33.6%였다. 예후인자로 병소침입 임파선개수, 조직세포 종류 등이 생존율에 통계적으로 유의하게 영향을 주었고 잔존세포의 유무, 병기, 나이, 세포분화도 및, 방사선치료 총 기간 등도 생존율에 영향을 주었으나 통계적인 유의성은 없었고 항암화학제의 종류에따른 생존율의 차이는 없었다. 37명환자에서 재발이 있었고 위치로는 장망(omentum) 및 복막에 23.5%로 가장 재발율이 놀았으며 남은 위나 봉합부위에 13.2%의 재발율을 보였다. 전체 국소재발은 20.7% 전체 원격전이는 39.7%였다. 방사선치료로 인한 부작용은 22.1%에서 grade 3의 백혈구감소가 있었고 1.5%에서 grade 4 부작용이 있었다. 치료중 10% 이상의 체중감소는 8.8%였다. 결론 : 본 연구결과 수술후 화학요법과 방사선치료요법은 큰 부작용이 없었으며 실패양상은 주로 장망 및 복막이었고 치료부위내 국소재발율이 다음으로 많았다. 국소재발은 원격전이에 비해 많이 낮아지는 추세를 보였다 방사선역할에 평가를 조금 더 명확하게 규명하기위해 향후 재발 위험이 큰 환자에서 수술후 화학요법만 한 군과 화학요법 및 방사선치료를 병용한 군과의 재발 양상 및 생존율 등의 전향적 비교 연구가 필요할 것으로 생각되며 더 나아가 수술후 항암화학요법 및 방사선 병용요법에 복강내 약물치료도 고려되어야 하겠다.

국소적으로 진행된 위암의 수술후 방사선 치료성적

이명자(Myung Za Lee0, 전하정(Ha Chung Chun),김인순(Insoon Kim),정태준(Tejune Chung) 대한방사선종양학회 1997 Radiation Oncology Journal Vol.15 No.2

목 적 : 국소적으로 진행된 위암치료는 수술이 주 치료로 5년 생존율은 그리높지 않아 좀더 완치율을 높이기 위하여 화학요법이나 화학요법과 병용하여 방사선치료 등이 시행되고 있다. 저자들은 위암환자에서 수술후 방사선치료를 받은 환자의 치료성적을 후향적으로 분석하였다 방 법 : 1985년 3월부터 1993년 6월까지 한양대학병원 치료방사선과에서 위절제수술후 방사선치료를 3500cGy 이상 받고 병기 3및 4기인 68명을 대상으로 후향적인 분석을 하였다. 연령분포는 28세부터 66세였고 중앙연령은 50세였다. 추적기간은 3개월에서 133개월(3명이 36개월 미만)로 중앙값은 50개월이었다. 조직병리상 37명이 non signet ring adenocarcinoma였고 29명이 signet r ing cell이었다. 병기로 ⅢA가 19명, ⅢB가 25명, Ⅳ가 24명이었다. 항암화학요법은 65명의 환자에게 투여되었으며 FAM계통의 치료가 28예 cisplatin, 5FU계통이 26예이었다. 결 과 : 5년생존율은 36.6% 5년무병생존율은 33.6%였다. 예후인자로 병소침입 임파선개수, 조직세포 종류 등이 생존율에 통계적으로 유의하게 영향을 주었고 잔존세포의 유무, 병기, 나이, 세포분화도 및, 방사선치료 총 기간 등도 생존율에 영향을 주었으나 통계적인 유의성은 없었고 항암화학제의 종류에따른 생존율의 차이는 없었다. 37명환자에서 재발이 있었고 위치로는 장망(omentum) 및 복막에 23.5%로 가장 재발율이 높았으며 남은 위나 봉합부위에 13.2%의 재발율을 보였다. 전체 국소재발은 20.7% 전체 원격전이는 39.7%였다. 방사선치료로 인한 부작용은 22.1%에서 grade 3의 백혈구감소가 있었고 1.5%에서 grade 4 부작용이 있었다. 치료중 10% 이상의 체중감소는 8.8%였다. 결 론 : 본 연구결과 수술후 화학요법과 방사선치료요법은 큰 부작용이 없었으며 실패양상은 주로 장망 및 복막이었고 치료부위내 국소재발율이 다음으로 많았다. 국소재발은 원격전이에 비해 많이 낮아지는 추세를 보였다. 방사선역할에 평가를 조금 더 명확하게 규명하기위해 향후 재발 위험이 큰 환자에서 수술후 화학요법만 한 군과 화학요법 및 방사선치료를 병용한 군과의 재발 양상 및 생존율 등의 전향적 비교 연구가 필요할 것으로 생각되며 더 나아가 수술후 항암화학요법 및 방사선 병용요법에 복강내 약물치료도 고려되어야 하겠다. Purpose : Radical gastrectomy is main treatment of gastric cancer. But the result is not satisfactory with surgery alone. Most of pattern of failure remain locoregional recurrence. To improve 5 year survival postoperative chemotherapy with or without radiotherapy has been used. We analyzed patients with stage Ⅲ and Ⅳ stomach cancer who had radical operation and received postoperative radiation therapy combined with or without chemotherapy retrospectively. Material and Method : From March 1985 to June 1993, 68 patients treated with curative resection and received postoperative adjuvant radiotherapy with 36Gy or more were evaluated. Median age was 60 years(range 28-66 yrs). Patients were followed from 3 to 133 months with median follow up of 48 months. Thirty seven patients had non signet ring adenocarcinoma, 29 signet ring cell, 2 other cell. Patients with stage ⅢA, ⅢB, Ⅳ disease were 19, 25 and 24 respectively. Chemotherapy was given to all patients except two. Results : Five-year overall survival and disease-free survival rate were 36.6% and 33.6%, respectively. Prognostic factor affecting survival were assessed. High ratio of involved/dissected lymph node, signet ring histology showed poor prognosis with statistical significance. Presence of residual tumor after surgery, stageⅣ, split course of radiation therapy, age, number of involved lymph node, number of lymph node dissection and grade of tumor affected survival without statistical significance. Type of chemotherapy did not affect survival. Recurrence was documented in 34 patients. High recurrence was seen in omentum and peritoneum with 23.5%, and remnant stomach, anastomosis site, A-loop and E- loop had also high recurrence with 13.2%. In field locoregional recurrence was 20.7% and total distant metastases were 39.7%. Total intraabdominal failure was 47.1% and extraabdominal failure was 13.2%. Treatment toxicity was considered to be acceptable. 22.1% of patients had grade 3 and only 1 patient had grade 4 leukopenia. Six patients(8.8%) had weigh loss more than 10%. Conclusion : Treatment toxicity was acceptable with combined treatment with chemotherapy and radiotherapy. Locoregional recurrence was relatively low compared to distant failure with addition of irradiation. Peritoneal and omental seeding was high. Five-year surival was increased with combined modality. Radiation may eradicate minimal residual disease and improve survival. To evaluate role of radiation prospective randomized study employing chemotherapy alone and chemotherapy plus radiation is necessary. Futhermore to reduce intraabdominal failure, role of intraabdominal chemotherapy in addition to combined chemotherapy plus radiation has to be explored.

후천성 면역부전증의 증상과 치료

정태준 한양대학교 의과대학 1997 한양의대 학술지 Vol.17 No.2

AIDS is a global epidemic with virtually every country in t4he world reporting cases. In addition to the United States, areas of the world with the highest incidence include western Europe, central Africa, South America, and Asia. The clinical consequences of HIV infection form a spectrum ranging from the asymptomatic state to severe disease. The majority of individuals experience no recognizable symptoms or signs at the time of initial infection, but some patients develop an acute illness approximately 3 to 6 weeks following primary infection. It is characterized by nonspecific signs and symptoms including fevers, rigors, arthralgias, maculopapular rash, diarrhea, and aseptic meningitis. The syndrome lasts 2 to 3 weeks and resolves spontaneously. Seroconversion usually occurs 8 to 12 weeks after presumed exposure. The most common clinical manifestation of AIDS is opportunistic infection. It is not unusual for an AIDS patient to have more than one opportunistic infection simultaneously. Pneumocystis carinii pneumonia is the most common opportunistic infection, occurring in approximately 80% of patients at some point during the course of their illness. However, neurologic diseases, Koposi's sarcoma, certain lymphoid neoplasms, and second malignancis impose another clinical obstacles to overcome. The development of a vaccine to prevent infection and disease with HIV will be an important tool in the strategy for world-wide containment of the AIDS epidemic. Several candidate vaccines are undergoing clinical trials in humans. These studies lend optimism to the feasibility of developing a safe and effective vaccine for HIV in the future.

B16BL6마우스 흑색종양 세포주에서 Adriamycin 내성 세포주의 수립 및 그의 특성에 관한 연구

정태준,조양자,김정목 한양대학교 의과대학 1990 한양의대 학술지 Vol.10 No.1

The successful treatment of human malignancies is often hampered by the emergence of drug-resistant tumor clones. Adriamycn (Adr), one of the anthracycline antibiotics, is widely used in the treatment of a number of human malignancies. In spite of its potent antitumor activity, resistance of Adr (??) along with its cross resistance to the other antibumor agents often emerges with repeated courses of therapy. To understand the biological mechanisms of multidrug resistance in tumor cells, we established an ?? clone from B16BL6 mouse melanoma cells and examined the biological characteristics of the ?? clone including the expression of Pglycoprotein, and cytotoxicity against lymphokine-activated killer (LAK) cells. In addition the tumorigenicity and formation of pulmonary metastates in the ?? clone-bearing C57BL/6 mice were observed. Effect of verapamil (Vp) on the activity of Adr as an antitumor agent was also investigated. When the B16BL6 mouse melanoma cells were exposed to a continuous gradient of increasing concentraions of Adr from 0.001-0.2μg/ml over a five-month period, the Adr?? clones with the ?? values of 0.2μg/ml were obtained. Immunochemical detection of P-glycoprotein revealed the presence of a plasma membrane glycoprotein(MW 170,000-180,000) in the ?? clones. LAK cell mediated cytotoxicity against the ?? target cells was no different from that against the ?? cells. Tumorigenicity in the C57BL/6 mice of the ?? clones was similar to that of the ?? cells but a mean survival time of the ??-bearing hose was significantly longer than that of the ?? cells. Rates of the tumor growth and pulmonary metastases in the mouse model were lower in the ?? clones than in the ?? cells with the significance level of p<0.001. Activity of Adr as an antitumor agent was shown to be enhanced by Vp, a calcium antagonist, in ?? clones. The ?? B16BL6 mouse melanoma cells we established can be a useful model for studying the biological mechanisms of multiple drug resistance.

중증 감염증에서 정주용 면역글로불린의 치료효과에 대한 연구

정태준,이영열,최일영 대한감염학회 1989 감염 Vol.21 No.3

In case of servere infection, depressed host immunity and nutritional deficit may make antibiotic therapy alone insufficient for getting satisfactory outcome. Theoretically, combined use of intravenous immunoglobulin(IVIG) with antibiotics is a good alternative not only for temporary relief of symptoms through its anti-endotoxic effect but also for atibody substitution purpose. However, IVIG therapy can block the monocyte function by the interaction of the IgG with Fc receptors, which causes decreased phagocytosis and ADCC of infected organisms. We have compared the antibiotic therapy alone with combined use of IVIG and antibiotics to investigate the role of IVIG for the treatment of severe infection. 100㎎/㎏ of IVIG for 5 days was our protocol to study and was enough to increase and maintain the serum concentration of IgG above normal range for at least 14 days. Overall response rate of IVIG treated group was 95.2% compared to 83.3% of antibiotic therapy alone group. Febrile period was also shortened by IVIG combination (9.1 vs 12.0 days). But ADCC activity of the peripheral blood monocytes was not affected by our therapy protocol with IVIG (33.4±16.7% in IVIG group vs 32.8±10.1% in control). Our results suggest that IVIG therapy in combination with antibiotics is superior to antibiotic therapy alone for the effective management of severe infection.

Clinical Use of Cytokines in Bone Marrow Transplantation

Chung, Tejune 한국BRM학회 1996 한국 BRM학회지 Vol.6 No.2

사람 말초 혈액 임파구의 interleukin-2 수용체(Tac 항원)발현 및 증식능의 조절에 대한 연구

김태근,조양자,정태준,김정목 한양대학교 의과대학 1990 한양의대 학술지 Vol.10 No.1

Proliferation of T lymphocytes has been determined by a threshold of signals generated by the interaction between interleukin-2 (IL-2) and its spedific membrane receptor (IL-2R). Regulation of IL-2R expression on the surface of lymphocytes is important in the generation of cytototocix T cells and lymphokine-activated killer (LAK) cells carrying anti-tumor effector functions in the body. To obtain the ideas in designing in vivo immunotherapy using biological response modifiers, this study examined the effects of the interferon(IFN)s, steroid, or colchicine on the IL-2R expression and proliferation of human peripheral blood lymphocytes(PBL). As incubation time was lengthened up to 72 hours, the number of Tac-positive cells and prolongation potential of human PBL upon stimulation wit IL-2 or mitogens were increased. IFN-α resulted in a significant inhibition of IL-2R expression induced by IL-2 but IFN-Υ had no effect. Colchicine or dexaamethasone also inhibited IL-2R expression and cell proliferation induced by IL-2 or mitogens. These findings suggest that IL-2R expression and proliferation of human PBL are inhibited by IFN-α, colchicine, or dexamethasone.

지방세포와 태반조직에서 분리한 인슐린 수용체의 Autophosphorylation 및 Tyrosine Kinase Activity에 관한 연구

김태화,김목현,정태준,최웅환 한양대학교 의과대학 1990 한양의대 학술지 Vol.10 No.1

Insulin resistance at tissue level has been well documented in target tissue of type II DM. Although insulin binding to target cell of type II DM may be decreased, many others have found that the decrease in insulin sensitivity in target cell is not related to changes in insulin binding, suggesting postbinding cause for insulin resistance. The impairment of tyrosine specific protein kinase is one of the postbinding mechanism found in type II DM. We purified insulin receptors from human placenta and adipocyte, and measured parameters of the biologic viability of the insulin receoptors. The results were as follows: 1. Insulin receptor was purified from placenta and adipocytes utilizing WGA and insulin agarose. 2. The dose dependent displacement curve was found by plotting purified insulin against receptor bindings which showed two receptor model in scatchard analysis. 3. The ??I-Insulin binding α-subunit was autoradiographed at MW. 135 KD region in SDS-PAGE. 4. The β-subunit band, MW 95KD, was phosphorylated only in the presence of insulin. The amount of the phosphorylated β-subunit band (MW, 95K) was related to increased insulin concentration. 5. The tyrosine kinase activity was maximally stimulated at 10??M insulin concentration found in the exogenous substrate POLY (glu 4:tyr 1). The method we have established here can be utilized for the study and diagnosis of postbinding defect in the mechnism of insulin resistance.

B16BL6 마우스 흑색 종양에 대한 항암 면역 치료 및 화학 요법의 병용 투여에 대한 연구

박종희,김정목,정태준,조양자 한양대학교 의과대학 1990 한양의대 학술지 Vol.10 No.1

The adoptive immunotherapy using lymphokine-activated killer (LAK) cells and/or interleukin-2(IL-2) has been shown to be effective in the treatment of metastatic lung and liver tumors in mice. Clinical use of IL-2, however, is limited by a serious sideeffect, a vascular leak syndrome. Previous studies by other showed that the vascular leak syndrome induced by the IL-2 might be reduced by simultaneous use of cyclophosphamide (Cy). This study was carried out to: 1) examine the serum level of IL-2 achieved by an intraperitoneal (ip), intravenous (iv), or intramuscular (im) route; and 2) observe the combined effects of chemotherapy and adoptive immunotherapy in the B16BL6 melannoma-bearing mice. The most effective and safe way to maintain the proper serum IL-2 level was shown to be the ip route. In the B16BL6 melanoma-bearing mice, the administration of IL-2 (2.5×10??U/ml) alone resulted in prolongation of mean survival time (MST) significantly (p<0.001). No significant increase of the MST was observed in Cy (5, 10, or 50mg/kg) or LAK cell (1×10?? cells) receivers (p>0.05). The combined therapy of IL-2 plus(+) LAK cels, IL-2+Cy(50mg/kg), IL-2+LAK cells +Cy, increased the MST of tumor-bearing mice (p<0.001). The number of pulmonary metastases was decreased both in the mice with IL-2 alone or in those with the combination of IL-2+LAK, IL-2+Cy, or IL-2+LAK+Cy(p<0.001), although the administration of Cy or LAK cells alone did not affect the number of metastases(p>0.05). Either in primary tumor or in pulmonary metastases, the combined therapy with LAK and/or Cy on IL-2 turned out to be better than IL-2 alone for improving the survival time. Our results warrent for further investigation in human trials of combined therapy with IL-2 and LAK/Cy.

중증 감염증에 대한 Mobactam의 임상효과

손정일,최일영,정태준,최태열 대한감염학회 1993 감염 Vol.25 No.2

Mobactam,a new synthetic monobactam, was administered to 27 aptients with severe infections. Clinical evaluations were made after monotherapy according to UTI criteria, as excellent in 5 patients, moderate in 14 patients and poor in 8 patients. Overall clinical effectiveness rate was 70.4%. For those who did not completely cured with mobactam monotherapy (22 patients), addition of ceftriaxone brought 18 more patients including 11 cure patients in clinical effectiveness group. Antibiotic sensitivity tests was performed using 96 gram-negative strains isolated from patients in intensive care units. Mobactam has shown sensitivity of 78% to Pseudomonas spp. which was comparable to amikacin and superior to other available antibiotics tested. For Klebsiella pnaeumoniae, mobactam was the most effective and the prevalence of resistant strains. Overall, mobactam was an effective antibiotic for eradicating gram-nega tive bacilli such as Pseudomonas spp., Klebsiella spp., Enterobacter spp., and Proteus spp. Based on this results, we conclude that mobactam can be safely used as a primary antibiotic in patients with severe infections.