두경부 종양환자에서 경부 림프절의 예기치 않은 병리적 소견

오경균(Kyung Kyoon Oh),이국행(Guk Haeng Lee),임상무(Sang Moo Lim),심윤상(Yoon Sang Shim) 대한두경부종양학회 1994 대한두경부 종양학회지 Vol.10 No.1

Neck dissection has become an integral part of the staging and management of head and neck tumors. This paper reports a series of head and neck patients who had pathological findings in their neck dissection specimens, which were unrelated to their primary tumors. In 7 cases, there was unexpected pathology in the cervical lymph nodes which was not related to the primary tumor. Four cases were squamous cell carcinomas and 3 were thyroid carcinomas. In 3 cases of squamous cell carcinomas, there were no evidence of metastatic squamous cell carcinoma in neck dissection specimen; however, the lymph nodes were found to be involved by metastatic papillary carcinoma in one larynx cancer, metastatic adenocarcinoma in the other larynx cancer, tuberculosis in one nasopharynx cancer. In three of neck dissection specimen of carcinoma(two thyroid carcinomas, one laryngeal carcinoma), dual nodal pathology was found: Each of these specimen contained carcinoma with tuberculosis of the lymph nodes in three cases. In one thyroid carcinoma, there was no evidence of metastasis; however, the lymph nodes were found to be involved by tuberculosis. Preoperative assessment did not reveal any findings to alert us to the possibility of a synchronous pathological process in the cervical nodes of this group of 7 patients. In particular, there was no evidence of active pulmonary tuberculosis in the 5 patients with active lymph node disease.

악성 혼합종의 임상적 고찰

오경균(Kyung Kyoon Oh),이국행(Guk Haeng Lee),이종호(Jong Ho Lee),심윤상(Yoon Sang Shim) 대한두경부종양학회 1993 대한두경부 종양학회지 Vol.9 No.2

For malignant neoplasms of salivary tissues. two of the better determinants of progosis are histologic classification and size of the neoplasm. Proper management of these tumors requires an accurate diagnosis by the pathologist and correct interpretation by the surgeon. Malignant mixed tumors account for between 3 and 13 precent of all cancers of the salivary glands and 2 percent of all tumors in these locations. The typical history of these tumors is that of slowly growing mass demonstrating a sudden increase in growth. The duration of onset of the tumor mass and the diagnosis of malignancy has been demonstrated to be 10 to 18 years. The risk of malignat transformation of a benign mixed tumor increases with the duration of the tumor. We analyzed retrospectively 13 cases of malignant mixed tumor who visited from Jan. 1985 to Dec. 1992. Mean age of the patients was 56.5 years. The origin of tumors were parotid gland 7 cases, submandibular gland 2 cases, and minor salivary gland 4 cases(palate 3 cases, tonsil pillar 1 case). According to the criteria of the AJCC on staging, stage I was 1 case, stage II 1 case, stage III 2 cases, and stage IV 9 cases. Histopathologically, carcinma ex pleomorphic adenoma were 12 cases and the true malignant mixed tumor was 1 case. The major treatment modalities were curative surgery, and radiation therapy followed. In conclusion, aggressive therapy of combined surgery and postoperative radiation therapy is required for these lesions, and patients with known or suspected benign tumor should be encouraged to undergo surgery early on in their disease to avoid malignant degeneration at a later dete.

유리공장을 이용한 인두 및 경부식도 재건술

오경균(Kyung Kyoon Oh),심윤상(Youn Sang Shim),이용식(Yong Sik Lee),박혁동(Hyuk Dong Park),김기환(Gi Hwan Kim),심영목(Young Mog Shim),조재일(Jae Ill Zo) 대한두경부종양학회 1991 대한두경부 종양학회지 Vol.7 No.2

Reconstruction of the pharynx and cervical esophagus presents a tremendous surgical challenge to the Head and Neck Surgeon. Because life expectancy of patients with advanced carcinoma of the hypopharynx, and cervical esophagus is limited, treatment must be aimed at palliation. A variety of techiques have been proposed over the years with none proving entirely satisfactory. These techiques include prosthesis; skin graft; cervical flaps; tubed cutaneous and myocutaneous chest flaps; visceral reconstruction with stomach, colon. and jejunum; and jejunal free autografts. Many factors dictate the best method of reconstruction in any given clinical situation. The goal of the surgery is a one-stage reconstruction of swallowing function with minimal morbidity to allow as short a hospital stay as posible. Nine patients underwent the free jejunal autograft reconstruction of the pharyngoesophagus after the ablative surgery for the advanced hypopharyngeal cancer. Postoperative complications included one perioperative death, two abdominal wound dehiscences, two neck hematomas, one carotid rupture, one funtional dysphagia, one late strictures. There were no graft failure, no immediate stenosis and no fistula. An oral diet was started between days 8 and 16, with an average of 9 days and median of 8 days. Patients left the hospital between days 9 and days 38, with an average of 23.4 days and median of 23 days. This method of reconstruction is advocated as reliable palliative procedure with short-term follow-up. In conclusion, we at Korea Cancer Center Hospital are of the opinion that the free jejunal autograft offers an excellent, safe and relative easy method of the pharyngeal and cervical esophageal reconstruction with significant advantages over other techiques.

Correlation Between Response to Induction Chemotherapy and Subsequent Radiotherapy in Previously Untreated Patients with Squamous Cell Carcinomas of the Head and Neck

박우윤,류성렬,고경환,조철구,박영환,심윤상,오경균,이용식,Park Woo Yoon,Yoo Seong Yul,Koh Kyoung Hwan,Cho Chul Koo,Park Young Hwan,Shim Youn Sang,Oh Kyung Kyoon,Lee Yong Sik The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.2

유도화학요법과 방사선치료후 종양 관해의 상호 관련성을 파악하고자 1986년부터 1989년까지 원자력병원에서 소정의 충분한 유도화학요법과 근치적 방사선치료를 받은 국소적으로 진행된 두경부 악성종양 환자 60예에 대한 후향적 분석을 시도하였다. 유도화학요법은 CDDP를 기본으로한 복합요법을 2 내지 3회 시행한바, 20예에서 Bleomycin+CDDP(BP), 37예에서 5-FU+CDDP(FP), 그리고 3예에서 BP/FP의 교대요법을 시행하였으며, 방사선은 병소에 따라서 65 Gy 내지 75 Gy 또는 그이상을 조사하였다. 유도화학요법에 의한 종양의 관해율은원발병소에서는 $80\%$(48/60), 경부임파절에서는 $79\%$(31/39)였으며, 약제, T-병기, 그리고 N-병기에 의한 통계적 유의성은 관찰되지 않았다. 방사선조사 6개월후 원발부위에서는 $67\%$(40/60)의 완전관해를, 경부임파절에서는 $77\%$(30/39)의 완전관해를 보인바, 이를 유도화학요법에 의한 관해 유무에 따른 차이를 분석한 결과 원발부위에서는 유도화학요법에 의한 관해(완전관해 또는 부분 관해)를 얻었던 48예중 39예에서 완전관해를 얻었으나($81\%$), 관해를 얻지못한 12예에서는 1예에서만이 방사선 치료에 의해 완전관해를 얻을 수 있었으며 ($8\%$) (p<0.0005), 경부임파절에서는 유도화학요법에 의해 관해를 얻었던 32예중 28예에서 완전관해를 얻은 반면 ($90\%$), 관해를 얻지 못한 8예에서는 2예에서만이 방사선 치료에 의해 완전관해를 얻을 수 있었던바($25\%$) (p<0.001), 모두 통계적으로 유의한 차이를 보였다. 한편 이를 원발부위, T-병기 그리고 N-병기에 따라 분석해본 결과, 특히 T-병기중 T3, 4에서는 유의한 차이가 관찰되었으나(p<0.0005), T1, 2에서는 유의한 차이가 관찰 되지 않았다(0.3<p), 따라서 유도화학요법과 방사선치료에 의한 종양의 관해 정도는 대체적으로 상호연관성이 관찰되고 있으나, 초기 병변에서는 이러한 현상이 관찰되지 않는바 유도화학요법에 의해 관해가 없더라도 방사선 치료에 의해 완전관해를 얻을 수 있을 것이다. To determine the correlation between the response to induction chemotherapy and subsequent radiotherapy we analyzed the clinical records of 60 patients with locally advanced carcinoma of the head and neck retrospectively who had completed a full course ($2\~3$ cycle) of induction chemotherapy and curative radiotherapy in Korea Cancer Center Hospital between 1986 and 1989. Chemotherapy was administeredd with CDDP+Bleomycin (BP) in 20, CDDP+5-FU (FP) in 37, and hybrid of BP and FP in three patients. Radiotherapy was giver conventionally with a dose of 65 to 75 Gy or more over seven to eight weeks according to the size of lesion. Response rates following induction chemotherapy were $80\%$ for the tumors and $879\%$ for the nodes whereas complete reponse rates were $12\%\;and\;13\%$, respectively. Six months after radiotherapy $67\%$ of the tumors and $77\%$ of the nodes achieved a complete response. Among the 48 tumor responders and the 31 nodal responders to chemotherapy,39 ($81\%$) and 28 ($90\%$), respectively, achieved complete response after radiotherapy. Thus, whether or not the tumor and node respond to induction chemotherapy was predictive of the response to subsequent radiotherapy (p<0.0005 in tumor, p<0.0001 in node). By reanalyzing according to disease subsets (i.e. primary site, T-stage, N-stage) this relationship was not observed at T1-T2 disease (p>0.3). Therefore the tumor or node's response to induction chemotherapy is a predictor for subsequent radiotherapy except in T1-T2 tumors, and complete response to radiotherapy can be expected despite the failure of induction chemotherapy in $T_1-T_2$ tumors.

비인강암의 방사선 치료

고경환,박우윤,조철구,류성렬,심윤상,오경균,Koh Kyoung Hwan,Park Woo Yoon,Cho Chul Koo,Yoo Seong Yul,Shim Youn Sang,Oh Kyung Kyoon The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.1

Total of 154 patients of pathologically proven and previously untreated nasopharyngeal carcinoma who were treated in the Department of Therapeutic Radiology, Korea Cancer Center Hospital during the period from 1964 to 1984 were analyzed. Minimal follow-up period of survivors was 3 years. Thirteen percent of the patients had $T_4$ primary lesions and $65\%$ had stage IV disease. Total radiation dose to the primary site was $1550\~1750$ ret in 82 and above 1750 ret in 72 patients. Local control was obtained in $79\%$ of patients. Significant prognostic factors for the survival were tumor dose (above vs. below 1750 ret), age (below vs. above 30 years), stage (AJCC I-III vs. IV), T stage ($T_1\;vs.\;T_2-4$), and N stage (NO vs. $N^+$). 1964년부터 1984년까지 원자력병원 치료방사선과에서 비인강암으로 근치적 목적의 방사선치료를 받은 154명의 환자에 대한 임상적 특성과 치료결과를 분석하였다. 생존자의 최소추적기간은 3년이었다. 환자의 $13\%$가 $T_4$의 원발병소를 가졌고, $65\%$가 AJCC병기 제 4 기였다. 병소부위의 총방사선량은 82명에서 $1550\~1750$ret였고, 72명에서 1750ret이상이었다. 국소적 완전관해율은 $79\%$이었다. 유의한 예후인자로는 방사선량(1750ret이상 또는 이하), 나이 (30세이하 또는 이상), 병기 (AJCC 제 $1\~3$기 또는 제 4기), 원발병 소정도 ($T_1$ 또는 $T_2\~T_4$병기), 경부임파절유무 (NO 또는 $N^+$)이었다.

악성 타액선 종양의 방사선 치료 성적에 대하여 -원자력 병원의 10년 경험 ($1975.1{\sim}1984.12$)-

조철구,고경환,류성렬,박영환,박우윤,심윤상,오경균,Cho Chul Koo,Koh Kyoung Hwan,Yoo Seong Yul,Park Young Hwan,Park Woo Yoon,Shim Young Sang,Oh Kyung Kyoon The Korean Society for Radiation Oncology 1990 Radiation Oncology Journal Vol.8 No.1

1975년 1월부터 1984년 12월까지 원자력병원 치료 방사선과에서 악성 타액선 종양으로 방사선 치료를 받은 58명의 환자를 대상으로 하여 이들의 생존율을 후향적으로 분석하였다. 이들은 수술후 재발했거나, 수술이 불가능한 환자들이었다. 58명의 환자중 mucoepidermoid carcinoma를 가진 환자가 $43.1\%$, adenoid cystic carcinoma를 가진 환자는 $41.3\%$였다. 주 타액선 종양의 5년 보험생존율은 $68.2\%$, 10년 생존율은 $31.8\%$였으나, 무병생존율은 각각 $43.2\%\;13.0\%$로써 치료 후 재발된 상태에서도 비교적 오래 산다는 것을 알 수 있었다. TNM staging에 의한 생존율도 $T_1$의 5년 생존율이 $86.5\%,\;T_2+T_3$가 $40.0\%,\;T_4$가 $0\%$로, T stage가 높아지면 질수록 생존율도 현저히 감소하였다. 병리조직학적 관점에서 볼 때, adenoid cystic carcinoma의 5년 무병생존율은 $40.1\%$로써, mucoepidermoid ca.의 $49.8\%$보다 낮았으나, 전체적인 생존율은 $77.3\%$로써, mucoepidermoid ca.의 $51.5\%$보다 현저히 높았다. 따라서, adenoid cystic carcinoma는 치료실패후 병을 가진 상태에서도 상당 기간 생존할 수 있다는 것을 알았으며, 평균 생존기간은 2년 이었다. 또한 mucoepidermoid ca.인 경우에는 세포의 분화정도에 따라 생존율이 달라졌는데, 저등도 분화세포의 5년 생존율이 $78.8\%$로 고등도 분화세포의 $38.2\%$보다 거의 2배나 높았다. 암의 위치와 성별에 따른 생존율의 차이는 없었다. Minor salivary gland tumor는 6명으로 5년 보험생존률은 $32.3\%$였다. 따라서 주 타액선 종양의 생존율에 영향을 끼칠 수 있는 예후 인자는 1) 병리조직학적 세포종류, 2) T와 N stages (AJCC), 3) mucoepidermoid carcinoma에 있어서 분화 정도 였다. Retrospective analysis of survival rates was undertaken in the patients of 58 cases treated with conventional radiation therapy for malignant salivary gland tumors between January 1975 and December 1984 in Korea Cancer Center Hospital (KCCH). They were patients whose long-term follow-up was possible and who had refused surgery or had had recurrences postoperatively. Out of 58 patients, 25 patients ($43.1\%$) had mucoepidermoid carcinomas and 24 patients ($41.3\%$) adenoid cystic carcinoma. Total actuarial survival rates at 5 years and 10 years were $68.2\%\;and\;31.8\%$ respectively, but disease-free survival rates, $43.2\%\;and\;13.0\%$, respectively. According to TNM stage, the survival rates at 5 years were $86.5\%$ in $T_1,\;40.0\%\;in\;T_2+T_3,\;and\;0\%\;in\;T_4$. In terms of histologic types, 5 years disease-free survival rate of adenoid cystic carcinomas ($40.1\%$) was lower than that of mucoepidermoid carcinomas ($49.8\%$) but overall survival rate ($77.3\%$) was much higher than that of mucoepidermoid carcinomas ($51.5\%$). There-fore, we concluded that the patients, who had had disease after failure of treatment, could survive during a certain period of time and their alive times were 2 years on the average. There was a difference in survival rates in the mucoepidermoid carcinomas in terms of histological grade of differentiation and it was a arbiter in prognosis: 5 YSR of low-grade was $78.8\%$ and higher 2 times than that of high-grade. There was no difference in survival rates according to location and sex. The number of patients having minor salivary gland tumors was 6 cases and their actuarial 5 YSR was $32.3\%$. Consequently, prognostic factors which influence the survival rates of patients with malignant salivary gland tumors are thought to be 1) histological subtypes 2) T and N staging (AJCC) 3) histological grade, especially in mucoepidermoids.

주타액선부위에 발생한 종괴의 비교분석

박미향(Mi Hyang Park),장경만(Kyung Man Chang),오경균(Kyung Kyoon Oh) 대한두경부종양학회 1994 대한두경부 종양학회지 Vol.10 No.2

It is the purpose of this paper to determine the relative frequency of the neoplastic vs. non-neoplastic disease in a series of surgically removed parotid and submandibular masses. The study was conducted a retrospective review of 249 consecutive, operated patients' records seen over a 9-year period from 1985 through 1993 at Department of Otolaryngology-Head and Neck Surgery, Korea Cancer Center Hospital. One hundred and fifteen patients had parotid mass and 134 patients had submandibular mass. All the specimen surgically removed were studied histopathologically. The numbers and percentages of patients are reported along with a pathological classification of the lesions encountered: neoplastic(benign, malignant) and non-neoplastic (inflammatory, non-inflammatory). There were 59 benign, 46 malignant, 6 inflammatory, 4 non-inflammatory in 115 parotid mass, and 33 benign, 48 malgnant, 47 inflammatory, 6 non-inflammatory in 134 submandibular mass. One-hundred-eighty-six of entire 249 patients had tumor involvement, for a 74.7% incidence of neoplasia. There was a neoplastic predominance in parotid mass(91.3%) and a relative inflammatory predominance in submandibular mass(35.1%).

Correlation Between Response to Induction chemotherapy and Subsequent Radiotherapy in Previously Untreated Patients with Squamous Cell Carcinomas of the Head and Neck

Woo Yoon Park(박우윤),Seong Yul Yoo(류성렬),Kyong Hwan Koh(고경환),Chul Koo Cho(조철구),Young Hwan Park(박영환),Youn Sang shim(심윤상),Kyung Kyoon Oh(오경균),Yong Sik Lee(이용식) 대한방사선종양학회 1990 Radiation Oncology Journal Vol.8 No.2

유도화학요법과 방사선치료후 종양 관해의 상호 관련성을 파악하고자 1986년부터 1989년까지 원자력병원에서 소정의 충분한 유도화학요법과 근치적 방사선치료를 받은 국소적으로 진행된 두경부 악성종양 환자 60예에 대한 후향적 분석을 시도하였다. 유도화학요법은 CDDP를 기본으로한 복합요법을 2내지 3회 시행한바, 20에에서 Bleomycin + CDDP(BP), 37예에서 5-FU+CDDP(FP), 그리고 3예에서 BP/FP의 교대요법을 시행하였으며, 방사선은 병소에 따라서 65Gy 내지 75GY 또는 그 이상을 조사하였다. 유도화학요법에 의한 종양의 관해율은 원발병소에서는 80%(48/60), 경부임파절에서는 79%(31/39)였으며, 약제, T-병기, 그리고 N-병기에 의한 통계적 유의성은 관찰되지 않았다. 방사선조사 6개월후 원발부위에서는 67%(40/60)의 완전관해를, 경부임파절에서는 77%(30/39)의 완전관해를 보인바, 이를 유도화학요법에 의한 관해 유무에 따른 차이를 분석한 결과 원발부위에서는 유도화학요법에 의한 관해(완전관해 또는 부분관해)를 얻었던 48예중 39예에서 완전관해를 얻었으나(81%), 관해를 얻지 못한 12예에서는 1예에서만이 방사선 치료에 의해 완전관해를 얻을 수 잇었으며(8%)(p<0.0005), 경부임파절에서는 유도화학요법에 의해 관해를 얻었던 32예중 28예에서 완전관해를 얻은 반면(90%), 관해를 얻지 못한 8예에서는 2예에서만이 방사선 치료에 의해 완전관해를 얻을 수 있었던바 (25%)(p<0.001), 모두 통계적으로 유의한 차이를 보였다. 한편 이를 원발부위, T-병기 그리고 N-병기에 따라 분석해본 결과, 특히 T-병기중 T3,4에서는 유의한 차이가 관찰되었으나 (p<0.0005), T1,2에서는 유의한 차이가 관찰되지 않았다(0.3<p). 따라서 유도화학요법과 방사선치료에 의한 종양의 관해정도는 대체적으로 상호연관성이 관찰되고 있으나, 초기 병변에서는 이러한 현상이 관찰되지 않는바 유도화학요법에 의해 관해가 없더라도 방사선 치료에 의해 완전관해를 얻을 수 있을 것이다. To determine the correlation between the response to induction chemotherapy and subsequent radiotherapy we analyzed the clinical records of 60 patients with locally advanced carcinoma of the head and neck retrospectively who had completed a full course(2~3 cycle) of induction chemotherapy and curative radiotherapy in Korea Cancer Center Hospital between 1986 and 1989. Chemotherapy was administered with CDDP+Bleomycin (BP)in 20, CDDP+5-FU(FP) in 37, and hybrid of BP and FP in three patients. Radiotherapy was given conventionally with a dose of 65 to 75 Gy or more over seven to eight weeks according to the size of lesion. Response rates following induction chemotherapy were 80% for the tumors and 79% for the nodes whereas complete response rates were 12% and 13%, respectively. Six months after radiotherapy 67% of the the tumors and 77% of the nodes achieved a complete response. Among the 48 tumor responders and the 31 nodal responders to chemotherapy. 39(81%) and 28(90%), respectively, achieves complete response ofter radiotherapy. Thus, whether or not the tumor and node respond to induction chemotherapy was predictive of the response to subsequent radiotherapy (p<0.0005 in tumor, p<0.0001 in node). By reanalyzing according to disease (p>0.3). Therefore the tumor of node's response to induction chemotherapy is a predictor for subsequent radiotherapy except in T1-t2 tumors, and complete response to radiotherapy can be expected despite the failure of induction chemotherapy in T1-T2 tumors.

기관절개술

오경균 중앙대부설한국의과학연구소 1982 한국의과학 Vol.14 No.2

상기도의 유두종에 대한 임상적 고찰

오경균,장경만,이국행,심윤상,추무진 釜算慶南耳鼻咽喉科學會 1993 임상이비인후과 Vol.4 No.2