5-fluorouracil 이 근간이 된 화학요법에 실패한 진행성 위암에서 Docetaxel 과 Cisplatin 복합화학요법

이효락(Hyo Rak Lee),박세훈(Se Hoon Park),송서영(Seo Young Song),박준오(Joon Oh Park),이순일(Soon Il Lee),김기현(Ki Hyun Kim),김원석(Won Seog Kim),정철원(Chul Won Jung),임영혁(Young Hyuck Im),이홍기(Hong Ghi Lee),박근칠(Keun Chil Park 대한내과학회 2002 대한내과학회지 Vol.62 No.1

N/A Background: There is no effective treatment in patients with advanced gastric cancer failed to first-line chemotherapy. Taxane is one of new drugs identified as having substantial activity in gastric cancer. We performed a phase II trial to evaluate the efficacy and toxicity of docetaxel plus cisplatin regimen as a salvage chemotherapy for advanced gastric cancer failed to 5-fluorouracil (5-FU)-based chemotherapy. Methods: Metastatic or recurrent gastric cancer patients failed to 5-FU-based regimen with an Eastern Cooperative Oncology Group (ECOG) performance score≤2 were eligible in this trial. Docetaxel (60mg/㎡) was infused over 1 hour , before cisplatin (60 mg/㎡) infused over 2 hours on day 1, once every 3 weeks until disease progression or unacceptable toxicity was detected. Response to treatment was assessed every two or three cycles. Results: From October 1999 to December 2000, forty-one patients were enrolled in this study. Twenty-eight of forty-one patients were assessable for response. Partial response was observed in seven patients and stable disease in four patients. The response rate was 25.0% (95% confidence interval: 20.4-29.6%) and median duration of response was 22 weeks (range: 11-53 weeks). The median survival of all enrolled patients was 24 weeks (range: 7-65 weeks). For a total of 112 cycles of chemotherapy, grade 3 and 4 toxicity was 8.9% for neutropenia, 4.5% for nausea/vomiting and 1.8% for mucositis. Conclusion: Salvage chemotherapy with docetaxel plus cisplatin regimen in gastric cancer was active with acceptable toxicities. (Korean J Med 62:83-89, 2002)

TACE와 Sorafenib 치료 후 수술을 시행한 간세포암종

노금엽 ( Geum Youb Noh ),한철주 ( Chul Ju Han ),김연주 ( Youn Joo Kim ),양기영 ( Ki Young Yang ),박수철 ( Su Cheol Park ),김진 ( Jin Kim ),김유철 ( Yu Cheol Kim ),최윤희 ( Yoon Hee Choi ),이효락 ( Hyo Rak Lee ) 대한간암학회 2011 대한간암학회지 Vol.11 No.1

Surgical resection for hepatocellular carcinoma (HCC) is one of the managements, showing improved long term survival. Nowadays, it is being accepted as the main curative treatment. However, the biggest problem we used to face is that surgery cannot be applied at the point of presentation in many patients due to advanced stage. Here we present a case of 54 years old female, who had transarterial chemoembolization (TACE) and sorafenib due to advanced stage of HCC, and later underwent curative surgery due to remarkable response. She had a CT scan of abdomen, which showed multiple huge masses. HCC was confirmed by ultrasonography-guided liver biopsy. TACE was performed once. After TACE, the size of masses increased. Therefore, sorafenib was administered and then continued for 9 months. As partial response was obtained at that time, surgical resection was successfully done. In the pathological report of removed tumor, we could confirm total necrosis of tumor. Now, it`s been 6 months and she is followed up without any recurrence.

비소세포폐암에서 동시화학방사선요법을 받는 중 생긴 기관폐루1례

강건희,조성우,김성록,유영진,이효락 인제대학교 2008 仁濟醫學 Vol.29 No.-

최근 근치적 절제가 불가능한 국소진행성 비소세포 폐암에서 화학요법을 방사선요법과 동시에 투여하는 치료방법에 대한 연구가 활발이 이루어지고 있으며 이러한 치료과정 중 생긴 여러 부작용에 대한 연구도 이루어지고 있지만 아직까지 기관폐루가 생겼다고 보고는 없다. 따라서 치료과정 중 기관폐루가 의심되는 소견이 있을 경우 이에 대한 조기 진단과 치료를 통하여 부작용에 따른 사망률을 최소화하여야 하겠다. The incidence of lung cancer is increasing steadily and various methods have been attempted to enhance the cure rate of locally advanced non small cell lung cancer, which is hardly removable surgically, but the results are not satisfactory yet. Recently, research is being made actively on the simultaneous application of chemotherapy and radiotherapy for locally advanced non small cell lung cancer that cannot be radically resected and the we experienced a case of patient diagnosed with bronchopulmonary fistula during the treatment process, and therefore report it here.

동종조혈모세포이식 환자에서의 거대세포바이러스 감염 및 질환의 임상양상에 대한 고찰 : Analysis of Risk Factors

박세훈,이홍기,최성철,이효락,김기현,남은미,김원석,윤성수,강원기,박찬형,김선우,박근칠 대한조혈모세포이식학회 2000 대한조혈모세포이식학회지 Vol.5 No.1

배경:동종조혈모세포이식에서 이식 전 CMV 항체(IgG) 양성률을 알고, CMV 감염 및 질환의 발병률을 구하며, CMV 감염 및 질환의 위험인자를 분석하고자 하였다. 또한, 현재 시행되고 있는 CMV 선제요법의 효율성을 판단하고자 단일 기관에서 경험한 50례의 동종조혈모세포이식 환자를 후향적으로 분석하였다. 방법:동종조혈모세포이식을 시행받은 50명의 성인 환자 중 이식편 생착 이전에 사망한 5명을 제외한 45명을 대상으로 이식 전 수혜자와 기증자 모두에서 CMV 혈청검사를 시행하였고, 조혈모세포이식 후 백혈구수가 500개 이상이 되는 시점부터 면역억제제 사용이 종료되는 시점까지 매주 1회씩 CMV 혈액배양검사와 CMV 항원혈 검사를 시행하였다. CMV 감염의 진단은 CMV 혈액배양검사와 CMV 항원혈 검사 중 어느 하나라도 양성인 경우로 하였고, 이 경우 선제요법을 시행하였으며 위의 두 가지 검사가 모두 음전된 후 일주일까지 투여하였다. CMV 질환으로 진단된 경우에는 먼저 유도요법을 21일간 시행한 후 유지요법을 면역억제제 사용이 종료된 시점까지 투여하였다. CMV 감염 환자가 CMV 선제요법에도 불구하고 CMV 질환으로 진행된 경우를 선제요법의 실패로 정의하였다. 또한, 고연령, 원인질환, 이식시 원인질환의 진행상태, 전신방사선 조사, T cell depletion, GvHD 예방을 위한 스테로이드의 사용, 그리고 비혈연간일치 기증자 혹은 혈연간부분불일치 기증자 등에서 CMV 감염 및 질환의 위험도가 증가한다는 가설을 검증하고자 하였다. 결과:총 45명 환자 중 이식 전 CMV 항체(IgG)는 모든 수혜자(100%)와 기증자의 93.3% (42명)에서 양성이었다. CMV 감염은 17명(37.8%)의 환자에서 발생하였고 이 중 7명이 CMV 질환으로 진행되어 CMV 질환의 발병률은 15.6%였다. 시행된 선제요법의 실패율은 41.2%였다. CMV 감염의 위험인자로 통계적 의의가 있는 것은 기증자의 형태였으며, CMV 질환의 위험인자로 통계적 의의가 있는 것은 T cell depletion, GvHD 예방을 위한 스테로이드의 사용, 기증자의 형태 등이었다. 다중로지스틱 회귀분석 결과 CMV 감염의 위험인자로 통계적 의의를 찾을 수 있는 것은 없었고, CMV 질환의 위험인자로 통계적 의의가 있는 것은 T cell depletion이었다. 통계적으로 의의는 없었으나 비혈연간 기증자 혹은 혈연간부분불일치 기증자인 경우에 CMV 질환의 위험이 증가하는 경향을 보였다. 결론:본 연구에서 이식 전 CMV 항체는 모든 수혜자(100%)와 대부분의 기증자(93.3%)에서 양성으로 서구의 CMV 항체 양성률에 비해 매우 높았다. 다중로지스틱 회귀분석에서 CMV 질환의 위험인자로 통계적 의의가 있는 것은 단지 T cell depletion 뿐이었다. 기증자의 형태에 따라 CMV 질환의 위험이 증가하는 양상을 보였는데, 대부분의 CMV 질환은 비혈연간 기증자 혹은 혈연간부분불일치 기증자에 의한 동종조혈모세포이식에서 발생하였다. 이는 조혈모세포이식 후 면역기능의 회복과 관계가 있는 것으로 추정된다. 본 연구에서 사용된 CMV 선제요법은 그 성공률이 58.8%에 지나지 않아 향후 보다 나은 방법이 개발되어야 할 것으로 생각된다. Background:Cytomegalovirus (CMV) is the major cause of infection-related mortality and morbidity in patients undergoing allogeneic hematopoietic stem cell transplantation (HSCT). We conducted a retrospective study to determine the pre-transplantation seropositivity of CMV and risk factors for CMV infection and disease, and to evaluate the efficacy of the pre-emptive therapy and CMV treatment currently used. Methods:Forty-five patients who underwent allogeneic HSCT at a single institution from Feb '96 through Sep '99 were screened for CMV infection by CMV blood culture and CMV antigenemia assay every week following HSCT. The screening tests were performed during continued immunosuppression. CMV infection was defined as positive CMV antigenemia or blood culture. CMV disease was diagnosed when the clinical evidence of CMV disease was present and CMV was discovered in blood or other specimens. Once the CMV infection or disease was diagnosed, pre-emptive therapy or CMV treatment was performed, respectively. Results:All recipients (100%) and most donors (93.3%) were CMV seropositive before HSCT. Seventeen patients (37.8%) were infected with CMV, and CMV disease developed in 7 patients (15.6%). Success rate of pre-emptive therapy was 58.8%. We analyzed the previously described risk factors for CMV infection such as age, underlying disease, disease status, total body irradiation, T cell depletion, steroid use for GvHD prophylaxis and alternative donors. Of these, only variable of statistic significance was alternative donors. Among the risk factors for CMV disease, T cell depletion, steroid use for GvHD prophylaxis and alternative donors were found to be significant statistically. Multivariate logistic analysis showed that the risk for CMV disease was raised significantly by T cell depletion. Conclusion:This study confirms that CMV seropositivity in Korean is higher than in Western people. CMV infection and disease developed in 37.8% and 15.6% respectively, which is similar to other studies. Most CMV diseases were developed in patients receiving HSCT from alternative donors. Since the failure rate of CMV pre-emptive therapy was high (41.2%), it is recommended to provide a better way in preventing CMV disease.

조혈모세포이식 환자에서의 기계 환기의 위험 인자 : Assessment of Risk Factors

안중경,이홍기,황정혜,박세훈,이효락,송서영,이순일,박준오,김기현,김원석,정철원,임영혁,강원기,박근칠 대한조혈모세포이식학회 2002 대한조혈모세포이식학회지 Vol.7 No.1

연구배경: 조혈모세포이식을 시행한 환자에서 집중 치료 시 예후가 매우 나쁜 것으로 알려져 있고, 기계 환기는 강력한 사망 예측 인자로서 보고되고 있다. 그러나 현재까지 이식 환자에서 기계 환기의 위험 인자를 밝힌 연구는 매우 드물다. 따라서 기계 환기를 시행한 조혈모세포이식 환자의 임상적 특징을 살펴보고 기계 환기에 대한 위험 인자를 알아보고자 하였다. 방법: 삼성서울병원에서 조혈모세포이식을 시행한 환자 중 기계 환기를 시행한 23명과 기계 환기를 시행하지 않은 142명을 대상으로 후향적 연구를 시행하였다. 기계 환기에 대한 위험 인자의 여부에 관해서는 chi-square 또는 Fisher's exact 검정을 시행하였으며 기계 환기에 대한 각 위험 인자의 영향에 관해서는 다중로지스틱 회귀분석을 시행하였다. 결과: 기계 환기를 시행한 23명의 환자 중 30일째 생존자는 1명이었고 6개월째 생존율은 0%였다. 생존자와 사망자 모두에서 다기관 기능부전이 관찰되었으며, APACHE II 점수와 SAPS II 점수에 의한 예측 사망률은 각각 56%, 59%였다. 조혈모세포이식 후 기계 환기의 위험 인자로는 선행 질환이 혈액질환, 부분불일치 동종이식, 간정맥폐색성질환, 이식 전 질병 상태가 재발하였거나 약물에 반응하지 않는 경우였다. 다중로지스틱 회귀분석 결과 기계 환기의 위험 인자로 통계적으로 유의한 차이를 나타낸 것은 단지 부분불일치 동종이식을 시행한 경우였다. 결론: 현재까지 조혈모세포이식 환자에서 집중 치료의 역할에 대해서는 확실히 정립되어 있지는 않으며, 이식 환자에서 기계 환기는 강력한 사망 예측 인자이다. 따라서, 조혈모세포이식을 시행한 환자에서 기계 환기의 위험 인자와 불량한 예후 인자를 고려하여 기계 환기 여부에 대한 신중한 결정을 내려야 한다. Background: Respiratory failure requiring mechanical ventilation is a frequent, critical complication of hematopoietic stem cell transplantation (HSCT). Patients who require mechanical ventilatory support after HSCT generally have a very poor prognosis. Mechanical ventilation in HSCT recipients is a strong predictive factor of mortality. The objectives of this study are to describe clinical characteristics of HSCT recipients undergoing mechanical ventilation and to identify the risk factors for mechanical ventilatory support after HSCT. Methods: We performed a retrospective chart review of all patients >15 yrs old who received HSCT at Samsung Medical Center and subsequently required mechanical ventilatory support between 1996 and 2001. Results: Thirty-day mortality rate in HSCT recipients undergoing mechanical ventilation was 95.6%. The mean predictive mortality rates of APAHCE II score and SAPS II score were 56% and 59%, respectively. Reasons for mechanical ventila-tion were sepsis (47.8%) followed by fungal infection (13%) and diffuse alveolar hemorrhage (8.7%). Univariate analysis identified relapsed or refractory diseases at HSCT, hematologic disease, hepatic venoocclusive disease and allogeneic or HLA-mismatched transplant as significant risk factors for mechanical ventilation. On multivariate logistic regression analysis, only allogeneic mismatched transplant remained significant. Conclusion: Overall outcome of HSCT recipients undergoing mechanical ventilation is very poor. Therefore, the risk factors and the poor prognostic factors for mechanical ventilation should be taken into account in making further treatment decision for HSCT recipients requiring mechanical ventilation.

수양성 설사로 발현된 다발성 내분비 선종증 1예

최원혁,박유정,홍일철,이한철,박세훈,최성철,이효락,정인경,정재훈,민용기,이명식,이문규,김광원,김원석 대한내분비학회 2001 Endocrinology and metabolism Vol.16 No.2

MEN1 is characterized by the combined occurrence of tumors of the parathyroids, pancreatic islet cells and the anterior pituitary. Pancreatic islet cell tumors occur in 40% of MEN1 patients. Pancreatic polypeptidomas occur most commonly but they are asymptomatic. Gastrinomas are the second most common type. VIPomas are rare and there has been no report of a case in Korea so far. We encountered a case of pancreatic VIPoma in MEN Type I. A 49 year old man was referred from his local hospital presenting with a sudden onset of an explosive watery diarrhea of 3 months duration. Abnormal findings in his blood chemistry were hypercalcemia and hypokalemia. The ^99mTc-sestamibi sintigraphy showed an increased uptake in right lower parathyroid gland. Abdominal CT demonstrated a mass of 6×4 ㎝ in tail of the pancreas and multiple lesions in both hepatic lobes. Serum levels of VIP hormones were elevated. Subtotal parathyroidectomy and subtotal pancreatectomy were done. Postoperatively his symptoms were improved transiently, however the patient showed repetitive attacks of watery diarrhea. So in order to palliate his symptoms, an RF ablation of the metastatic liver masses was performed. After that therapy his clinical symptoms were reduced dramatically. Unfortunately, the patients condition worsened again. Despite of continuous octreotide therapy, interferon and two courses of combination chemotherapy, the hepatic metastases failed to regress and the patient died 10 months after the diagnosis of a metastatic VIPoma. This is the first report of pancreatic VIPoma in MEN type I in Korea