Is noncurative gastrectomy always a beneficial strategy for stage IV gastric cancer?

PURPOSE: The purpose of this study is to suggest a treatment strategy for stage IV gastric cancer by investigating the behavioral difference between initially and recurrent metastatic disease. METHODS: We reviewed the medical records of the patients who underwent chemotherapy alone for metastatic gastric cancer between January 2006 and September 2013. Patients were divided into those who underwent chemotherapy for metastatic disease since initial diagnosis (IM group) and for metastatic recurrence after curative surgery (RM group). Survival and causes of death were compared between the 2 groups, and significant prognostic factors were also investigated. RESULTS: A total of 170 patients were enrolled in this study. Of these patients, 104 were included in the IM group and 66 in the RM group. Overall survival of the IM group did not differ from that of RM (P = 0.569). In the comparison of the causes of death, the IM group had a greater tendency to die from bleeding (P = 0.054) and pneumonia (P = 0.055). In multivariate analysis, bone metastasis (P < 0.001; HR = 2.847), carcinoma peritonei (P = 0.047; HR = 1.766), and the frequency of chemotherapy (P < 0.001; HR = 0.777) were significantly associated with overall survival of IM group. CONCLUSION: Disease-burden mainly contributes to the prognosis of metastatic gastric cancer, although noncurative gastrectomy may be helpful in reducing the mortality of initially metastatic disease. Therefore, disease-burden should be also prioritized in determining the treatment strategies for stage IV gastric cancer.

Modified MVAC as a Second-Line Treatment for Patients with Metastatic Urothelial Carcinoma after Failure of Gemcitabine and Cisplatin Treatment / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: There is no established standard second-line chemotherapy for patients with advanced or metastatic urothelial carcinoma (UC) who failed gemcitabine and cisplatin (GC) chemotherapy. This study was conducted in order to investigate the efficacy and toxicity of modified methotrexate, vinblastine, doxorubicin, and cisplatin (MVAC) in patients with metastatic UC previously treated with GC. MATERIALS AND METHODS: We retrospectively analyzed 28 patients who received modified MVAC between November 2004 and November 2012. All patients failed prior, first-line GC chemotherapy. RESULTS: The median age of patients was 64.0 years (range, 33.0 to 77.0 years), and 23 (82.1%) patients had an Eastern Cooperative Oncology Group performance status of 0 or 1. The overall response rate and the disease control rate were 36.0% and 64.0%, respectively. After a median follow-up period of 38 weeks (range, 5 to 182 weeks), median progression free survival was 21.0 weeks (95% confidence interval [CI], 6.3 to 35.7 weeks) and median overall survival was 49.0 weeks (95% CI, 18.8 to 79.3 weeks). Grade 3 or 4 hematological toxicities included neutropenia (n=21, 75.0%) and anemia (n=9, 32.1%). Grade 3 or 4 non-hematological toxicities did not occur and there was no treatment-related death. CONCLUSION: Modified MVAC appears to be a safe and active chemotherapy regimen in patients with stable physical status and adequate renal function after GC treatment.

Clinical Factors Related to Suspected Second Primary Lung Cancer Development in Patients with Head and Neck Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The rate of second primary lung cancer development for patients with head and neck cancer (HNC) has been noted. The aim of our study was to evaluate the incidence and clinical features of suspected second primary lung cancer that developed in patients with primary HNC. MATERIALS AND METHODS: We conducted a retrospective study of 469 patients who were newly diagnosed with HNC at the Korea University Medical Center between January 2000 and December 2006. RESULTS: A total of 469 patients were included (389 men and 80 women). Eighteen patients (3.8%) had suspected second primary lung cancers. Statistically significant clinical variables for lung cancer development included the origin site for the primary HNC (oro-hypopharynx and larynx) (p=0.048), abnormal chest x-ray findings (p=0.027) and the histological HNC type (squamous cell carcinoma) (p=0.032). When the second primary lung cancers were combined with HNCs, the adjusted overall survival of patients with a second primary lung cancer was 16 months (p<0.001). CONCLUSIONS: Considering the relative risk factors for a second primary lung cancer developing in patients with HNC, advanced diagnostic tools, such as chest CT or PET CT scan, should be applied for the early detection of a second primary lung cancer.

Association of Single Nucleotide Polymorphisms in PIM-1 Gene with the Risk of Korean Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The expression of the PIM-1 gene, which is a proto-oncogene that encodes a serine/threonine kinase, is associated with multiple cellular functions such as proliferation, differentiation, apoptosis and tumorigenesis. In particular, several studies have reported that the PIM-1 gene is associated with the development of lymphoma, leukemia and prostate cancer. Therefore, this study was conducted to evaluate the association between the single nucleotide polymorphisms in the PIM-1 gene and the risk of lung cancer occurrence in the Korean population. MATERIALS AND METHODS: To evaluate the role of the PIM-1 gene in the development of lung cancer, the genotypes of the PIM-1 gene were determined in 408 lung cancer patients and 410 normal subjects. RESULTS: We found that the T-C-T-C haplotypes of the PIM-1 gene (-1196 T>C, IVS4 +55 T>C, IVS4 +1416 T>A and +3684 C>A) were associated with an increased risk of lung cancer [adjusted odds ratio (aOR): 3.98; 95% CI: 1.24~12.75, p-value: 0.020]. In particular, these haplotypes showed an increased risk of lung cancer in males (aOR: 5.67; 95% CI: 1.32~24.30, p-value: 0.019) and smokers (aOR: 7.82; 95% CI: 1.75~34.98, p-value: 0.007). CONCLUSIONS: The present results suggest that the T-C-T-C haplotype of the PIM-1 gene could influence the risk of developing smoking-related lung cancer in the Korean population. Additional functional studies with an larger sample sized analysis are warranted to reconfirm our findings.

Treatment Outcomes and Toxicities of ABVD Combination Chemotherapy Compared with CVPP in Hodgkin's Disease

BACKGROUND: We retrospectively evaluated the treatment outcomes and toxicities of Hodgkin's disease (HD) patients treated by ABVD (adriamycin, bleomycin, vinblastine, and dacarbazine) combination chemotherapy, and compared them with those of a historical group treated with a CVPP (cyclophosphamide, vinblastine, procarbazine, and prednisone) regimen. METHODS: The medical records of patients who had been diagnosed with HD histologically and treated by either ABVD or CVPP from 1997 to 2006 at the Korea University Medical Center were retrospectively reviewed. RESULTS: Thirty patients were eligible. Nineteen patients received ABVD and eleven patients were treated with CVPP. The response rates for ABVD and CVPP were 84.21% and 54.55%, respectively. Median overall survival was 43.17 months for ABVD and 43.27 months for CVPP (P=.570). Median event-free survival was 39.03 months for ABVD and 16.73 months for CVPP (P=.088). There was no significant difference in median survival or in event-free survival between the two regimens. Hematologic toxicities were significantly more common in the CVPP group than in the ABVD group. Grade 3 or 4 neutropenia was observed in 72.72% of the CVPP group and in 36.84% of the ABVD group (P=.050). CONCLUSION: ABVD for HD showed significantly lower hematologic toxicities and moderately better treatment outcomes than did CVPP.

Diffuse alveolar damage during chemotherapy with oxaliplatin, 5-fluorouracil and leucovorin / 대한내과학회지

The combination chemotherapy of oxaliplatin with 5-fluorouracil and leucovorin (FOLFOX regimen) has been recently proved to be beneficial in advanced colorectal and gastric cancer. Side effects of this regimen include neutropenia, diarrhea, and neurosensory toxicity. However, the case reports about pulmonary toxicities of this regimen are very limited. Herein is the reported case of a patient treated with oxaliplatin, 5-fluorouracil and leucovorin combination chemotherapy in whom diffuse alveolar damage developed and the disease improved after steroid pulse therapy.

Pulmonary Fibrosis Under Chemotherapy with Oxaliplatin, 5-fluorouracil, and Leucovorin / 결핵및호흡기질환

The combination of oxaliplatin, 5-fluorouracil and leucovorin (FOLFOX) has recently been shown to be beneficial in advanced colorectal and gastric cancers. The side effects of this regimen include neutropenia, diarrhea and neurosensory toxicity. However, case reports on the pulmonary toxicities of this regimen are very limited. Especially, the development of pulmonary fibrosis has never been cited in the literature. Herein is reported the case of a patient treated with oxaliplatin, 5-fluorouracil and leucovorin combination chemotherapy in whom pulmonary fibrosis developed, but which improved after steroid pulse therapy.

Differentiation Culture of Hematopoietic Stem Cells from Embryonic Stem Cells / 대한혈액학회지

BACKGROUND: This study was designed to verify the effective culture condition for the differentiation of human hematopoietic stem cells from SNU-3 embryonic stem cell line. METHODS: Control group was that of which embryonic stem cells were directly cultured to LTC-IC assay. Study group was that of which an embryonic body manufactured from embryonic stem cells was cultured to LTC-IC assay. CD34+ cells were separated by MACS method at 1, 3, 5, 7, 10, 14, 21 days of LTC-IC assay in both groups. Thereafter, CD34+ cell were cultured to semisolid methyl-cellulose media to count CFUs. CD34+CD45- cell percentage was measured with FACS method at 5 days of LTC-IC assay. This study was repeated for 14 times. RESULTS: In control group, CD34+ cells were hardly separated in any period of LTC-IC assay. In study group, the median count of CD34+ cells was 0.7 (0.4-1.2)x10(4), 1.8 (1.4-2.6)x10(4), 0.6 (0.5-0.7)x10(4) and the median count of CFUs was 0.5 (0.2-0.8)x10(2), 1.0 (0.6-1.3)x10(2), 0.2(0.1-0.4)x10(2) at 3, 5, 7 days of LTC-IC assay, respectively. Median CFUs count per CD34+ cell was 0.0071, 0.0056, 0.0033 at 3, 5, 7 days of LTC-IC assay, respectively. In study group, the count of CD34+ cells and CFUs was significantly higher at 5 days of LTC-IC assay than at any other days (P<0.01). CFUs count per CD34+ cell was significantly higher at 3 days of LTC-IC assay than at any other days (P<0.01). CD34+CD45- cells detected by FACS method of study group(1.16%(0.92-1.97) was significantly higher than that of control group (0.09% (0.00-0.23)) (P<0.01). CONCLUSION: The differentiation of hematopoietic stem cells from SNU-3 embryonic stem cell line is effective in the condition of which an embryonic body manufactured from embryonic stem cells is cultured to LTC-IC assay. The period of which embryonic stem cells differentiate to hematopoietic stem cells is between 3 to 7 days of LTC-IC assay.

Comparison of the Activities of Platelets with Different Cryopreservation Methods / 대한혈액학회지

BACKGROUND: The limit and the optimal method of the cryopreservation of platelets have not been determined. Moreover, the functional changes platelets after cryopreservation were not clearly defined. This study was conducted to determine the limit and optimal method for cryopreservation of platelet concentrates. METHODS: We compared the recovery, expression of membrane GpIb, GpIIb/IIIa, and aggregatory function of the platelets preserved in three different conditions. Platelet samples were collected from four healthy volunteer donors by apheresis, and placed in 22degrees C agitator for standard preservation. For cryopreservation, after treating 5% DMSO, platelets were either inserted directly in -80degrees C freezer or in liquid nitrogen after computer-controlled rate freezing. After storage for 5 days, 1 week, 2 weeks, 3 weeks, 4 weeks, and 12 weeks, platelets were thawed and analyzed for the evaluation of in vitro functions. RESULTS: Platelets preserved at 22degrees C or cryopreserved with each condition displayed equivalent recovery (90%). With each cryopreservation procedures, platelets showed moderate loss of GpIb and retained more than 90% of GpIIb/IIIa in comparison with fresh platelets. At the third week, loss of GpIb in the directly frozen platelets was augmented compared with those of controlled rate frozen group. The aggregatory response to ristocetin began to decrease drastically after storage for 5 days in platelets frozen by each procedures and to less than 5% at 12 weeks of storage. However, controlled rate frozen platelets retained more aggregatory response to ristocetin and surface GpIb expression than those of directly frozen platelets at 3, 4, 12 weeks of storage. CONCLUSION: This study showed the possibility of moderate preservation of in vitro functions of frozen-thawed platelets after 12 weeks of storage compared with those of the liquid stored 5-day old platelets.

Two cases of acute toxic hepatitis and renal failure after ingestion of the extract of elm bark in lung cancer patients / 대한내과학회지

Traditional remedies, especially the extract of elm bark, are frequently used in Korea. But the exact efficacy and adverse effects are not known. Cancer patients are frequently recommended various traditional remedies by family members. However such remedies may lead to life-threatening complications. We observed two cases of severe hepatic and renal toxicities that developed after ingestion of elm extract. One patient was a 67-year-old man diagnosed with stage IV non-small cell lung cancer (NSCLC). He ingested the bark extract of elm for 2 weeks during routine work-up prior to chemotherapy. He abruptly showed acute toxic hepatitis with cardiac tamponade. The other patient was a 57-year-old woman diagnosed with extensive disease-small cell lung cancer (ED-SCLC). She consumed the extract of root bark of elm for 5 months during complete remission status and developed acute renal failure. These cases suggest that use of the extract of elm bark in cancer patients must be more careful.

Effect of Splenectomy in Adult Patients with Idiopathic Thrombocytopenic Purpura (ITP) / 대한혈액학회지

No abstract available.

A Lung Abscess Combined with Mediastinal Air Shadow / 결핵

No abstract available.

Combination Chemotherapy with Cisplatin, Ifosfamide, and Etoposide in Small Cell Lung Cancer / 대한암학회지

PURPOSE: Although chemotherapy is considered as the mainstay of treatment for small cell lung cancer, long-term survival is not expected in the majority of patients. Until more effective drugs are developed, optimization of available chemotherapeutic regimens and the combination with radiotherapy will be required to improve the survival of small cell lung cancer patients. We conducted a phase II trial to evaluate the effect of a combination chemotherapy of cisplatin, ifosfamide, and etoposide. MATERIALS AND METHODS: From January 1994 to December 1997, 34 untreated small cell lung cancer patients were enrolled in this study. The treatment schedule included etoposide 80 mg/m/day, ifosfamide 1.5 g/m'/day, cisplatin 20 mg/m/day iv continuous infusion on day 1-3. Cycles were repeated every 4 weeks. RESULTS: The objective response rate was 58% [localized disease (LD), 100%; extensive disease (ED), 48%]. And complete remission rate was 19% (LD, 38%; ED, 13%). The median survival of all patients was 12 months (LD, 17 months; ED, 12 months). The median duration of response was 7 months. There was one treatment-related death. The hematologic toxicities were tolerable: Leukopenia greater than Grade III was 25%, and thrombocytopenia greater than Grade III was 6%. Nausea and vomiting were seen in most patients, but they were controllable. CONCLUSION: The combination chemotherapy with cisplatin, ifosfamide, and etoposide as a first line therapy seemed effective with tolerable toxicity in patients with small cell lung cancer.

A Case of Aplastic Anemia Spontaneously Recovered after Delivery / 대한혈액학회지

A 26-year-old female was admitted for the evaluation of thrombocytopenia, who complained easy bruisy and multiple petechiae at 22 weeks of gestation. Bone marrow examination was recommended, but refused. Steroid therapy was tried under the impression of idiopathic thrombocytopenic purpura. But pancytopenia developed at 37 weeks of gestation. Considering aplastic anemia associated with pregnanacy, Caesarian section with supplementation of platelet rich plasma and packed red blood cells was done in order to terminate pregnancy. Bone marrow findings at 1 week after delivery were compatible with aplastic anemia. At 8 weeks after delivery, recovery of pancytopenia was noticed with normalization of bone marrow cellularity and maturation of hematopoietic cells.

Results of CHOP-Bleo / CMED Alternating Chemotherapy for Aggressive Non - Hodgkin's Lymphoma / 대한암학회지

PURPOSE: To assess the efficacy and toxicity of a new protocol that consists of CHOP- Bleo alternated with a new regimen of Cyclophosphamide, methotrexate, etoposide, and dexamethasone(CMED) for aggressive Non-Hodgkin's Lymphoma(NHL). PATIENTS AND METHODS: Between January 1991 and December 1996, forty-six patients with Ann Arbor stages II-IV aggressive NHL were treated with alternating cycles of CHOP-Bleo and CMED for a total of 12 cycles. All eligible patients were evaluated for response, disease-free survival, and overall survival. RESULTS: Twenty-two patients(47.8%) achieved a complete response and overall response rate was 83.9%. The range of survival duration was 1-68+months and the median survival time was 42 months. Overall 3-year survival rate was 54%. The range of disease-free survival time was 6-63+months and 3-year disease-free survival rate was 61%. The most common hematologic toxicity was leukopenia and the incidence of severe leukopenia(<1,000/mm3) was 11%. And alopecia(84.8%) was the most common non-hematologic toxicity. CONCLUSION: The results of CHOP-Bleo/CMED alternating chemotherapy for patients with aggressive Non-Hodgkin's Lymphoma is not superior to other results of previous studies. Therefore further study will be warranted to determine clinical effectiveness of alternating chemotherapy.

5-Fluorouracil , Cisplatin , and Pirarubicin Combination Chemotherapy for Advanced Gastric Cancer / 대한암학회지

PURPOSE: Gastric cancer is the most common malignacy in Korea, However, standard systemic combination chemotherapy regimen has not been settled for advanced gastric cancer. 5-FU, Cisplatin, and Pirarubicin combination chemotherpay regimen has been tried to evaluate the response rate and toxicity in advanced gastric cancer patients. MATERIALS AND METHODS: Elligibility included biopsy proven inoperable or relapsed adenocarcinoma of stomach with adequate bone marrow, hepatic, and renal functon. Thirty seven patients with histologically confinned locally advanced or metastatic gastric cancer were treated with cisplatin 15 mg/m2 IV day 1~5, pirarubicin 60 mg/m2 day 1, 5-fluorouracil 750 mg/m2 day 1~5 as a continuous intravenous infusion. RESULTS: Twenty nine patients had measurable disease, 5 had received prior chemotherapy. Performance status was 0~1 in 24 and 2 in 13. There was 1 complete response and 13 partial response with an overall response rate of 48.3%(95% confidence interval 29.9~67.1%). The median survival is 7 months(95% confidence interval 5.4~8.6 months) and median response duration is 6 months. 19 patients experienced severe(WHO grade 3~4) leucopenia, 7 was thrombocytopenia, 13 was nausea and vomiting during chemotherapy. 11 patients experienced chemotherapy dose reduction or chemotherapy time delay due to severe hematologic or non-hematologic toxicities. There was no clinically recognizable cardiac toxicities. CONCLUSION: We experienced 48.3% overall response rate, 7 months median survival, and 51.3% severe hematologic toxicities with 5-fluorouracil, pirarubicin and cisplatin combination chemotherapy regimen in advanced or metastatic gastric cancer patients.

Sarcoid Dactylitis / 결핵

The reports of sarcoidosis have increased in Korea since 1968. Osseous sarcoidosis is 3%-5% of sarcoidosis, but it is not reported upto date in Korea. So, we report a case of sarcoid dactylitis. A 47-year old woman who complained of painful swelling in her fingers was admitted in Korea University Guro Hospital. She had visited local clinics 3 years ago for chronic cough, multiple subcutaneous nodules and erythematous elevated regions on extensor sides of both extremities, and taken medicine under the diagnosis of pulmonary tuberculosis for 3 years. On admission her distal phalanges showed fusiform swelling, and multiple 1 cm-sized papules were found on the extensor area of extremities. The chest CT scan and the skin biopsy which had been performed in local clinics were reviewed to examine whether it was tuberculosis or not, but the results were compatible to sarcoidosis. So, under the impression of sarcoidosis chest CT and biopsy of hand lesions were performed again. And the patient was prescribed prednisolone 30 mg, and Hydroxychloroquine 400 mg per day, and then showed improvement of pain and skin lesions.

Effects of REtinoic Acid and Radiation on the Growth of Cell Lines of Human Head and Neck Squamous Cell Carcinoma / 대한암학회지

PURPOSE: Mammalian tumor cells differ in their response to ionizing radiation to a degree that some patients are readily curable with conventional doses of radiation, while others are rarely controlled. In experimental systems, it is possible to demonstrate differences between cell lines both in intrinsic radiosensitivity and in the apparent capacity to repair damage. Retinoic acid is a substance that has previously been reported to increase radiosensitivity, but at concentrations likely to have cytostatic effects or induce cellular differentiation. We chose several head and neck cancer cell lines to investigate radiation sensitivity and synergism in combination with retinoic acid. Material and Methods: Seventeen head and neck cancer cell lines (MDA886, P1, P13, A-431, PCI-50, UMSCC-10A, UMSCC-10B, UMSCC-11A, UMSCC-11B, UMSCC-17A, UMSCC-17B, UMSCC-19, UMSCC-22B, UMSCC-30, UMSCC-38, 1YA, 1YB) are irradiated with variable dose of radiation (1 Gy, 5 Gy, 9 Gy) for determination of radiosensitivity of each cell lines. The less radiosensitive cell lines are treated with retinoic acid for evaluation of the effects of retinoic acid on cellular X-ray sensitivity and recovery from X ray-induced potentially lethal damage. RESULTS: Lowest growth inhibition rates are seen UMSCC-11A and 1YA cell lines in 1 Gy, so that we treated with retinoic acid such cell lines. We obtained the following RESULTS: 1) two cell lines appear not inhibitory effect on recovery from X-ray induced potentially lethal damage but growth inhibition synergism when irradiated with retinoic acid in 1 Gy of radiation dose. 2) two cell lines were little effect on radiosensitivity and inhibitory effect on recovery from X-ray damage in 0.5 Gy radiation dose. CONCLUSION: We found that direct radiosensitizing effects of retinoic acid on 1 Gy of radiation dose may act synergistically for cell growth inhibition in vitro study(three cell lines: UMSCC-11A, 1YA, UMSCC-11B). Further in vitro and in vivo experiments are now necessary to evaluate retinoic acid as radiosensitizer for head and neck cancer radiation therapy.

The Evaluation of Auto-Transfusion with Red Blood Cells Thawed after Freezing at -80degrees C / 대한혈액학회지

BACKGROUND: The need for auto-transfusion has been increased because the allo-transfusion has many problems such as infection and allo-immunization. But, the maximal storage period of blood at 4degrees C is 28~35 days. For long-term storage, the cryopreservation of blood is essential. However, the cryopreservation research of blood has been done rarely in Korea. Therefore, we evaluated the effects of auto-transfusion of RBCs thawed after freezing at -80degrees C. METHODS: Twelve healthy donors of allogeneic bone marrow transplantation were participated in this study. Control group was composed with 6 persons auto-transfused with 4degrees C stored blood collected at 3, 2, and 1 week prior to bone marrow harvest. Study group was composed with 6 persons auto-transfused with -80degrees C stored frozen-thawed RBCs, employing a high glycerol technique, collected at 5, 4, and 3 week prior to bone marrow harvest. To evaluate the effects of auto-transfusion at both group, the amount of harvested bone marrow and the changes of hemoglobin (Hb) and hematocrit (Hct) between pre-harvest and post-transfusion 24 hours were compaired. To assess the efficacy of cryopreservation, the studies for RBC recovery rate, the level of K+ and plasma Hb, bacterial culture and complications of transfusion were performed. RESULTS: 1) The amount of harvested bone marrow and the changes of Hb and Hct: The harvested bone marrow (mL) was 1,350+/-87 in control group and 1,300+/-70 in study group. At pre-bone marrow harvest, the Hb (g/dL) and Hct (%) levels were 13.2+/-0.60, 40.1+/-2.7 in control group and 12.8+/-0.50, 38.3+/-1.9 in study group, respectively. After 24 hours of auto-transfusion, the Hb (g/dL) and Hct (%) levels were 12.9+/-0.42, 38.1+/-1.1 in control group and 12.6+/-0.56, 37.3+/-1.2 in study group, respectively. There were no significant differences in Hb and Hct between pre-harvest and post-transfusion of control and study groups. 2) The efficacy of cryopreservation: The RBC recovery rates were 72~80% and the levels of K+ and plasma Hb were 1.5~3.5mEq/L and 251~840mg/dL, respectively. There was no bacterial growth of frozen-thawed blood culture and no complication associated with transfusion of frozen-thawed blood. CONCLUSION: It could be suggested that the method of RBC cryopreservation at -80degrees C with high glycerol technique was practically applicable to auto-transfusion.