Pathologic and Oncologic Outcomes in Locally Advanced Gastric Cancer with Neoadjuvant Chemotherapy or Chemoradiotherapy

PURPOSE: Although neoadjuvant therapy has been accepted as a treatment option in locally-advanced gastric cancer, its prognostic value has been difficult to evaluate. MATERIALS AND METHODS: Seventy-four gastric cancer patients who underwent gastrectomy after neoadjuvant treatment were divided into two groups according to the pathologic response: favorable (ypT0) and others (ypT1-4). The clinicopathologic characteristics, predictive factors for pathologic response, and oncologic outcome were evaluated. RESULTS: Eleven patients (14.8%) demonstrated ypT0 and the remaining 63 patients (85.2%) were ypT1-4. Chemoradiotherapy (CCRTx) rather than chemotherapy (CTx) was the only predictive factor for a favorable pathologic response. Chemotherapeutic factors and tumor marker levels did not predict pathologic response. The 1-, 2-, and 3-year disease-free survivals were 83.4%, 70%, and 52.2%. The 1-, 3-, 5-year overall survivals were 88.5%, 67.5%, and 51.2%, respectively. Although a complete pathologic response (ypT0N0M0) was achieved in 7 patients, 28.6% of them demonstrated recurrence of the tumor within 6 months after curative surgery. CONCLUSION: CCRTx rather than CTx appears to be more effective for achieving good pathologic response. Although favorable pathologic response has been achieved after neoadjuvant treatment, the survival benefit remains controversial.

Low Grade MALT Lymphoma of the Stomach: Treatment Outcome with Radiotherapy Alone

In order to evaluate the role of radiation therapy in the management of low-grade mucosa-associated lymphoid tissue lymphoma of the stomach (MLS), in patients with no evidence of Helicobacter pylori (H. pylori) or who had not responded to H. pylori eradication treatment, we analyzed the treatment outcome of patients who had received radiotherapy alone. Between Jan 1995 and May 2001, 6 patients with low- grade MLS were treated with radiotherapy alone. The median radiation dose was 30.6 Gy (range; 30 - 39 Gy) in a daily fractions of 1.5 - 1.8 Gy. Each patient had an endoscopic esophago-gastro-duodenoscopy with biopsy, 4 weeks after the completion of radiotherapy and every 6 months thereafter. A complete response was obtained in all patients. All patients were followed-up without evidence of disease, and no patient suffered a relapse. There was neither perforation nor hemorrhage of the stomach in any of the patients. No renal or hepatic toxicity were noted, and no secondary malignancies developed. In conclusion, radiotherapy should be considered as the preferred treatment method for low-grade MLS, in patients with no evidence of H. pylori infection, or who do not respond to antibiotic therapy, due to the significant benefits in gastric preservation and low morbidity.

The Role of Postoperative Adjuvant Radiotherapy in Resected Esophageal Cancer / 대한방사선종양학회지

OBJECTIVE: A retrospective study was performed to evaluate whether postoperative adjuvant radiotherapy can improve survival and decrease recurrence as compared with surgery alone in resected esophageal cancer. MATERIALS AND METHODS: From Jan. 1985 to Dec. 1993, among 94 esophageal cancer patients treated with surgery, fifty-one patients were included in this study. Transthoracic esophagectomy was performed in 35 patients and transhiatal esophagectomy in 16. Postoperative adjuvant radiotherapy was performed 4 weeks after surgery in 26 among 38 patients in stage II and III. A total dose of 30~60 Gy in 1.8 Gy daily fraction, median 54 Gy over 6 weeks, was delivered in the mediastinum+both supraclavicular lymph nodes or celiac lymph nodes according to the tumor location. Forty-seven patients(92%) had squamous histology. The median follow-up period was 38 months. RESULTS: The overall 2-year and 5-year survival and median survival were 56.4%, 36.8% and 45 months. Two-year and 5-year survival and median survival by stage were 92%, 60.3% for stage I, 63%, 42% and 51 months for stage II and 34%, 23% and 19 months for stage III (p=0.04). For stage II and III patients, 5-year survival and median survival were 22.8%, 45 months for the surgery alone group and 37.8%, 22 months for the postoperative RT group (p=0.89). For stage III patients, 2-year survival and median survival were 0%, 11 months for the surgery alone group and 36.5%, 20 months for the postoperative RT group (p=0.14). Local and distant failure rates for stage II and III were 50%, 16% for the surgery alone and 39%, 31% for the postoperative RT group. For N1 patients, local failure rate was 71% for the surgery alone group and 37% for the postoperative RT group (p=0.19). Among 10 local failures in the postoperative RT group, in-field failures were 2, marginal failures 1, out-field 5 and anastomotic site failures2. CONCLUSION: There were no statistically significant differences in either the overall survival or the patterns of failure between the surgery alone group and the postoperative RT group for resected stage II and III esophageal cancer. But this study showed a tendency of survival improvement and decrease in local failure when postoperative RT was performed for stage III or N1 though statistically not significant. To decrease local failure, a more generous radiation field encompassing the supraclavicular, mediastinal, and celiac lymph nodes and anastomotic site in postoperative adjuvant treatment should be considered.

An evaluation of treatment effects of modified teuscher appliance in Class II division 1 malocclusion / 대한치과교정학회지

The purpose of this study was to evaluate treatment effects of the modified Teuscher appliance (MTA) in early Class II division 1 malocclusion. For this purpose, treatment effects of the bionator were compared with those of the MTA. The twenty subjects who were treated excellently with bionator and MTA were selected in each group. In pre- and post-treatment lateral cephalograms, 50 variables were measured, and then the differences between pretreatment and posttreatment data of the bionator and the MTA were statistically evaluated by t-test. The results were as follows : 1. The linear measurements that showed large difference between the bionator group and the MTA group are U1 to FH, U1 to PP, U6 to FH, U6 to PP, Ar-Pog, ramus height, L1 to A-Pog, L1 to facial plane (p0.05). These results suggest that the bionator influence the mandiblar growth and lower dentoalveolar structures more than the MTA, and the MTA influence upper jaw and upper dentoalveolar structures more than the bionator comparatively in early Class II division I malocclusion.

Surgical Treatment of Posterior Hypopharyngeal Wall Cancer / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Posterior hypopharyngeal wall cancer is rarely encountered. There are diverse surgical approa-ches for this lesion. MATERIALS AND METHODS: We have reviewed our 5-year experience with 12 patients treated for squamous carcinoma of the posterior hypopharyngeal wall. Surgery was the definitive therapy for the primary tumor in all patients. All but one were previously untreated. Seven patients had limited resections that preserved the larynx, involving suprahyoid pharyngotomy (1 patient), transoral and suprahyoid pharyngotomy (1 patient), lateral pharyngotomy (1 patient), suprahyoid and lateral pharyngotomy (2 patients), mandibular swing and lateral pharyngotomy (2 patients). The second group consisted of 5 patients with more extensive tumors who required a laryngectomy and complex reconstruction. All in this group required flap reconstruction. RESULTS: Eight were NED, one was lost postoperatively and three patients developed local recurrence. CONCLUSION: Our experience highlights the variety of treatment approaches available in patients with pharyngeal carcinoma confined to the posterior wall.

Meanings and Indications of pretreatment assessment of esophageal carcinoma with bronchoscopy / 대한내과학회지

OBJECTIVES: To determine the yield of bronchoscopy for evaluating tracheobronchial spread in esophageal carcinoma and to identify the conditions for bronchoscopy in patients with newly diagnosed esophageal carcinoma, who planned to be operated. METHODS: From March 1989 to June 1997, 115 patients with esophageal carcinoma had received bronchoscopy. Bronchoscopic findings were classified into three types: Type I: no definitive endobronchial lesion, Type II: indirect effects(hyperemia and compression), Type III: invasion. CT findings were classified into three classes: Class A: tumor separated from tracheobronchial tree, Class B: abutting tree, Class C: compressing tree. We investigated the correlations of clinical presentation and non-invasive tests (including esophagogram) with bronchoscopic findings. RESULTS: 1) Among 115 patients, bronchoscopic findings were Type I in 67(58.3%), Type II in 34(29.6%), Type III in 14(12.2%). 2) Abnormal bronchoscopic findings are related with length of lesion by esophagogram.(p < 0.05) 3) Class C lesion by chest CT scan were closely correlated with abnormal bronchoscopic findings. 4) Chest symptoms were frequently associated with type III lesion of bronchoscopy CONCLUSION: We could recommend preoperative bronchoscopy in recently diagnosed as esophageal carcinoma who got more than 2 of 3 variables listed below: 1) patients who had chest symptoms, such as cough with sputum, hemoptysis, and dyspnea 2) length of tumor is long in esophagogram(above 5 cm in length), 3) tracheobronchial compressed lesion by chest CT scan. Bronchoscopy is not needed in cases with no chest symptom, short lesion length(below 5 cm) and normal chest CT finding for preoperative evaluation of esophageal carcinoma.

Synchronous Expression of Circulating Intercellular Adhesion Molecule-1 (ICAM-1) and Vascular Cell Adhesion Molecule-1 (VCAM-1) During Gastric Cancer Progression / 대한암학회지

PURPOSE: The circulating forms of ICAM-1 (cICAM-1) and VCAM-1 (cVCAM-1) has been reported from supernatant of cytokine activated endothelial cells, cancer cells and from cancer patient serum even though the biological significance of the cCAMs are not fully elucidated. MATERIALS AND METHODS: To evaluate the correlation of the expression of cICAM-1 and cVCAM-1 and prognosis in gastric cancer, we measured cICAM-1 and cVCAM-1 levels in 20 healthy volunteers and 142 gastric cancer patients' sera by ELISA assay. Also we compared cCAMs levels with vascular endothelial growth factor (sVEGF) and FP. Ninety-five patients were operable and 47 patients were advanced or relapsed state at the time of the study. In 28 operable patients, we simultaneously sampled portal and peripheral vein and measured the cCAMs. RESULTS: The cCAMs level and positive rate in serum increased with cancer progression from healthy control, operable to advanced or relapsed gastric cancer. In advanced cancer, cICAM-1 level increased with liver metastasis. The cICAM-1 level in portal blood was correlated modestly with that in peripheral blood. And in cVCAM-1 positive subgroup, cCAM-1 level correlated with cVCAM-1 level. The peripheral cICAM-1 level decreased in 6% compared to that of portal cICAM-1 level while peripheral cVCAM-1 level increased in 1% compared to that of portal level. Synchronous expression of both cCAMs was found in 58.3% of the patients with liver metastasis and 22.9% of the patients without liver metastasis (p=0.03). But, there were no correlation between cCAMs and FP expression regardless of liver metastasis. The sVEGF level correlated with neither cICAM-1 nor cVCAM-1 level regardless of liver metastasis. The median disease-free and overall survival of patients with synchronous cICAM-1 and cVCAM-1 expression was 8 months and 9 months, while in patients without co-expression it was more than 24 months and 23 months respectively. CONCLUSION: We suggest that synchronous cICAM-1 and cVCAM-1 elevation may be a useful monitor of tumor burden and progression in gastric cancer, especially in liver metastasis.

A Operated Case of Primary Melanoma of the Esophagus / 대한소화기내시경학회지

Malignant melanoma is a malignant neoplasm originated from melanocyte. Primary malignant melanoma of the esophagus is a very rare disease comprising 0.1% of all primary neoplasms of the esophagus. As with other primary mucosal malignant melanoma, primary malignant melanoma of the esophagus has poor prognosis because of the tendency to present as an advanced neoplasm with aggressive biological behavior. We present an operated case of primary malignant melanoma of the esophagus confirmed by the adjacent squamous mucosa contained junctional nests of tumor cells showing focal pagetoid spread consistent with melanoma in situ, with a clinicopoathological review of the literatures.

A study on the initial reaction of craniofacial complex to maxillary headgear traction by laser holography / 대한치과교정학회지

The purpose of this study is to examine the initial reaction of craniofacial complex to the traction of headgears which are frequent used in clinical practice by using holographic interference method. Changes In the fringe pattern according to the traction conditions (outer bow length, load amount, direction) were compared. Human dry skull was used as experimental material, the results were as follows. 1. The density of fringes Increased with an increase in load. 2. Maxillary headgear affected circummaxillary bones-temporal bone, zygomatic bone, nasal bone, frontal bone, sphenoid bone as well as maxilla. 3. The most upward-backward displacement was observed in a high pull head gear (30degrees), this is though to be a optimal direction for supressing the growth of the maxilla.

A study on the maxillary dental arch and palatal vault with malocculsions / 대한치과교정학회지

This study was based on the study models of 32 subjects with normal occlusion, 40 with Class I malocclusion, 32 with Class II, Division 1 malocclusion and 38 with Class III malocclusion, aged 12 to 20 years (mean age 16.4 years). The purpose of present study was to define the difference between normal and malocclusion groups in maxillary dental arch palate. On the basis of findings of this study, the following results were obtained. 1. The intermolar widths and the intercanine widths in Class II, Div. 1 malocclusion group were smaller than in normal occlusion group significantly. 2. The arch lengths measured in both Class I and Class II, Div. 1 malocclusion groups were larger than in normal occlusion group. 3. The palates in Class I and Class II, Div. 1 malocclusion groups were longer and narrower than in normal occlusion, but the palates in Class III maloccusion group were shorter than in normal occlusion group significantly. 4. The palatal depths measured at level 1 in Class III malocclusion group were significantly higher than in normal occlusion and in Class II, Div. 1 group they were significantly higher than in normal occlusion at level 2 and 3. 5. The measurements of palatal areas at varions levels showed no significant difference between malocclusion and normal occlusion groups. 6. The palatal indice 1(palatal pength / palatal width) measured in both Class I and Class II, Div. 1 malocclusion groups were significantly greater than in normal occlusion and the palatal indice 2(palatal depth at level 1/palatal width) measured in all malocclusion groups are greater than in normal occlusion. 7. It was determined from findings of this study that the meaxurements of maxillary dental ardh and palate were influenced to a considerable extent by the molar relationship.