Treatment Patterns and Changes in Quality of Life during First-Line Palliative Chemotherapy in Korean Patients with Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study was to evaluate chemotherapy patterns and changes in quality of life (QOL) during first-line palliative chemotherapy for Korean patients with unresectable or metastatic/recurrent gastric cancer (GC). MATERIALS AND METHODS: Thiswas a non-interventional, multi-center, prospective, observational study of 527 patients in Korea. QOL assessments were conducted using the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaires (QLQ)-C30 and QLQ-STO22 every 3 months over a 12-month period during first-line palliative chemotherapy. The specific chemotherapy regimens were selected by individual clinicians. RESULTS: Most patients (93.2%) received combination chemotherapy (mainly fluoropyrimidine plus platinum) as their first-line palliative chemotherapy. The median progression-free survival and overall survival were 8.2 and 14.8 months, respectively. Overall, “a little” changes (differences of 5-10 points from baseline)were observed in some of the functioning or symptom scales; none of the QOL scales showed either “moderate” or “very much” change (i.e., ≥ 11 point difference from baseline). When examining the best change in each QOL domain from baseline, scales related to some aspects of functioning, global health status/QOL, and most symptoms revealed significant improvements (p < 0.05). Throughout the course of first-line palliative chemotherapy, most patients' QOL was maintained to a similar degree, regardless of their actual response to chemotherapy. CONCLUSION: This observational study provides important information on the chemotherapy patterns and QOL changes in Korean patientswith advanced GC. Overall, first-line palliative chemotherapy was found to maintain QOL, and most parameters showed an improvement compared with the baseline at some point during the course.

Phase II Study of Dovitinib in Patients with Castration-Resistant Prostate Cancer (KCSG-GU11-05) / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Fibroblast growth factor (FGF) signals are important in carcinogenesis and progression of prostate cancer. Dovitinib is an oral, pan-class inhibitor of vascular endothelial growth factor receptor (VEGFR), platelet-derived growth factor receptor, and fibroblast growth factor receptor (FGFR). We evaluated the efficacy and toxicity of dovitinib in men with metastatic castration resistant prostate cancer (mCRPC). MATERIALS AND METHODS: This study was a single-arm, phase II, open-label, multicenter trial of dovitinib 500 mg/day (5-days-on/2-days-off schedule). The primary endpoint was 16-week progression-free survival (PFS). Secondary endpoints were overall survival (OS), toxicity and prostate-specific antigen (PSA) response rate. Biomarker analyses for VEGFR2, FGF23, and FGFR2 using multiplex enzyme-linked immunosorbent assay was performed. RESULTS: Forty-four men were accrued from 11 hospitals. Eighty percent were post-docetaxel. Median PSA was 100 ng/dL, median age was 69, 82% had bone metastases, and 23% had liver metastases. Median cycles of dovitinib was 2 (range, 0 to 33). Median PFS was 3.67 months (95% confidence interval [CI], 1.36 to 5.98) and median OS was 13.70 months (95% CI, 0 to 27.41). Chemotherapy-naïve patients had longer PFS (17.90 months; 95% CI, 9.23 to 28.57) compared with docetaxel-treated patients (2.07 months; 95% CI, 1.73 to 2.41; p=0.001) and the patients with high serum VEGFR2 level over median level (7,800 pg/mL) showed longer PFS compared with others (6.03 months [95% CI, 4.26 to 7.80] vs. 1.97 months [95% CI, 1.79 to 2.15], p=0.023). Grade 3 related adverse events were seen in 40.9% of patients. Grade 1-2 nausea, diarrhea, fatigue, anorexia, and all grade thrombocytopenia are common. CONCLUSION: Dovitinib showed modest antitumor activity with manageable toxicities in men with mCRPC. Especially, patients who were chemo-naïve benefitted from dovitinib.

An Open-Label, Randomized, Parallel, Phase III Trial Evaluating the Efficacy and Safety of Polymeric Micelle-Formulated Paclitaxel Compared to Conventional Cremophor EL-Based Paclitaxel for Recurrent or Metastatic HER2-Negative Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Genexol-PM is a Cremophor EL–free formulation of low-molecular-weight, non-toxic, and biodegradable polymeric micelle-bound paclitaxel. We conducted a phase III study comparing the clinical efficacy and toxicity of Genexol-PM with conventional paclitaxel (Genexol). MATERIALS AND METHODS: Patients were randomly assigned (1:1) to receive Genexol-PM 260 mg/m² or Genexol 175 mg/m² intravenously every 3 weeks. The primary outcome was the objective response rate (ORR). RESULTS: The study enrolled 212 patients, of whom 105 were allocated to receive Genexol-PM. The mean received dose intensity of Genexol-PM was 246.8±21.3 mg/m² (95.0%), and that of Genexol was 168.3±10.6 mg/m² (96.2%). After a median follow-up of 24.5 months (range, 0.0 to 48.7 months), the ORR of Genexol-PM was 39.1% (95% confidence interval [CI], 31.2 to 46.9) and the ORR of Genexol was 24.3% (95% CI, 17.5 to 31.1) (p(non-inferiority)=0.021, p(superiority)=0.016). The two groups did not differ significantly in overall survival (28.8 months for Genexol-PM vs. 23.8 months for Genexol; p=0.52) or progression-free survival (8.0 months for Genexol-PM vs. 6.7 months for Genexol; p=0.26). In both groups, the most common toxicities were neutropenia, with 68.6% occurrence in the Genexol-PM group versus 40.2% in the Genexol group (p < 0.01). The incidences of peripheral neuropathy of greater than grade 2 did not differ significantly between study treatments. CONCLUSION: Compared with standard paclitaxel, Genexol-PM demonstrated non-inferior and even superior clinical efficacy with a manageable safety profile in patients with metastatic breast cancer.

Triple Combination Chemotherapy in Elderly Metastatic Gastric Cancer Patients / 계명의대학술지

This study was conducted in order to evaluate the response rate, progression free survival (PFS), overall survival (OS), safety and prognostic factors of weekly S-1, paclitaxel plus cisplatin chemotherapy in patients older than 65 years. We administered the triple regimen to patients older than 65 years with recurrent or metastatic gastric cancer. The response rate, PFS, safety of triple combination chemotherapy was evaluated. Clinical outcomes of the elderly group (≥65 years old; n = 28) were compared with those of the non-elderly group (<65 years old; n = 68). The common metastatic lesions were abdominal lymph nodes (57.1%). The median number of cycle was 3.3 cycles (range; 1~9). The disease response rate was 50.0%. The median PFS was 6.2±0.46 months and median OS was 7.6±1.46 months. This treatment was moderately tolerated with grade 3/4 neutropenia in 67.9%, grade 3 anemia in 21.4%. Non-hematologic toxicities were grade 3 general weakness in 25.0% of patients. Compare to younger patients, more grade 3/4 neutropenia, anemia and general weakness were observed. Treatment related mortality was 3.6%. Only body mass index (BMI) was correlated with overall survival by cox regression analysis (p = 0.043). Triple regimen in elderly gastric cancer patients showed relatively high disease response rate and survival duration similar to younger patients, but more frequent neutropenia, anemia and general weakness were seen as barriers to treatment in elderly patients. Especially in low BMI elderly patients, triple regimen chemotherapy must be used with caution.

Targeted therapy of ovarian cancer including immune check point inhibitor

Epithelial ovarian cancer is the eighth most common cause of cancer-related deaths in women because most patients present with advanced stage disease at the time of diagnosis. Although cytoreductive surgery and platinum-based chemotherapy remain the gold standards of treatment, the recurrence rate of ovarian cancer remains high. Attempts to improve this standard two-drug chemotherapy by adding a third cytotoxic drug have failed to affect either progression-free survival or overall survival and have resulted in an increase in toxic side effects. Some anti-angiogenic agents, poly(ADP-ribose) polymerase, and immune checkpoint inhibitors have shown efficacy in early stages of development for the treatment of epithelial ovarian cancer. As demonstrated in recent clinical trials, the use of bevacizumab, cediranib, pazopanib, olaparib, and rucaparib, either alone or in combination with conventional cytotoxic agents, improves progression-free survival. Trials on immune checkpoint inhibitors such as nivolumab have revealed prolonged responses in a small set of ovarian cancer cases but require further exploration. In this review, we discuss the role of targeted therapies against ovarian cancer, including the use of immune checkpoint inhibitors.

Circulating Plasma Biomarkers for TSU-68, an Oral Antiangiogenic Agent, in Patients with Metastatic Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study analyzed the role of plasma biomarkers for TSU-68 in a previous phase II trial comparing TSU-68 plus docetaxel and docetaxel alone in patients with metastatic breast cancer. MATERIALS AND METHODS: A total of 77 patients were eligible for this study (38 in the TSU-68 plus docetaxel arm and 39 in the docetaxel alone arm). Blood samples were collected prior to the start of each cycle, and vascular endothelial growth factor (VEGF), platelet-derived growth factor (PDGF)-AA, -AB, -BB, fibroblast growth factor, M30, C-reactive protein (CRP), and interleukin 6 (IL-6) levels were measured using enzyme linked immunosorbent assay. The primary endpoint was progression-free survival (PFS). RESULTS: In patients with baseline PDGF-AA ≥ median, median PFS was significantly worse in the TSU-68 plus docetaxel group than in the docetaxel alone group (5.4 months vs. 13.7 months, p=0.049), while a trend toward a PFS benefit was observed in those with baseline PDGF-AA < median (9.7 months vs. 4.0 months, p=0.18; p for interaction=0.03). In the TSU-68 plus docetaxel group, PFS showed significant association with fold changes in CRP (p=0.001), IL-6 (p < .001), PDGF-BB (p=0.02), and VEGF (p=0.047) following the first treatment cycle. CONCLUSION: Baseline PDGF-AA levels and dynamics of VEGF, PDGF-BB, CRP, and IL-6 levels were predictive for the efficacy of TSU-68.

Metachronous Double Primary Cancer after Treatment of Breast Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The pattern of double primary cancer after treatment for breast cancer is important for patient survival. MATERIALS AND METHODS: We analyzed 108 cases of metachronous double primary cancer in breast cancer patients treated from 1999 to 2012. RESULTS: Metachronous double primary cancers occurred in 108 of 2,657 patients (4.1%) with breast cancer. The median time to the occurrence of second cancer after diagnosis of the first was 58.4+/-41.2 months (range, 6.9 to 180.2 months). The most common cancer was thyroid cancer, which occurred in 45 patients (41.7%). This was followed by gastric cancer in 16 patients (14.8%), endometrial cancer in 10 patients (9.3%), and cervical cancer in seven patients (6.5%). The relative risk showed a significant increase in endometrial (4.78; 95% confidence interval [CI], 1.66 to 13.79), gastric (2.61; 95% CI, 1.68 to 4.06), and thyroid cancer (1.95; 95% CI, 1.37 to 2.79). At 5 years after diagnosis of breast cancer, secondary cancer occurred in 48 patients (44.4%), with 50.0% of the endometrial, 56.3% of the stomach, and 37.8% of the thyroid cancer cases being diagnosed after 5 years. Median survival after diagnosis of the second cancer was 123.9+/-11.2 months. The prognosis was mainly influenced by the anatomic site. CONCLUSION: The incidence of endometrial, stomach, and thyroid cancer increased significantly after treatment with primary breast cancer, and survival was dependent on early detection and the type of second primary cancer. A prolonged follow-up examination for metachronous double primary cancer is needed to provide early detection and improve survival time in patients with breast cancer.

A Randomized Double-Blind, Double-Dummy, Multicenter Trial of Azasetron versus Ondansetron to Evaluate Efficacy and Safety in the Prevention of Delayed Nausea and Vomiting Induced by Chemotherapy / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: This study was conducted to evaluate the efficacy and safety of azasetron compared to ondansetron in the prevention of delayed chemotherapy-induced nausea and vomiting. MATERIALS AND METHODS: This study was a multi-center, prospective, randomized, double-dummy, double-blind and parallel-group trial involving 12 institutions in Korea between May 2005 and December 2005. A total of 265 patients with moderately and highly emetogenic chemotherapy were included and randomly assigned to either the azasetron or ondansetron group. All patients received azasetron (10 mg intravenously) and dexamethasone (20 mg intravenously) on day 1 and dexamethasone (4 mg orally every 12 hours) on days 2-4. The azasetron group received azasetron (10 mg orally) with placebo of ondansetron (orally every 12 hours), and the ondansetron group received ondansetron (8 mg orally every 12 hours) with placebo of azasetron (orally) on days 2-6. RESULTS: Over days 2-6, the effective ratio of complete response in the azasetron and ondansetron groups was 45% and 54.5%, respectively (95% confidence interval, -21.4 to 2.5%). Thus, the non-inferiority of azasetron compared with ondansetron in delayed chemotherapy-induced nausea and vomiting was not proven in the present study. All treatments were well tolerated and no unexpected drug-related adverse events were reported. The most common adverse events related to the treatment were constipation and hiccups, and there were no differences in the overall incidence of adverse events. CONCLUSION: In the present study, azasetron showed inferiority in the control of delayed chemotherapy-induced nausea and vomiting compared with ondansetron whereas safety profiles were similar between the two groups.

Clinical Outcome of Rituximab-Based Therapy (RCHOP) in Diffuse Large B-Cell Lymphoma Patients with Bone Marrow Involvement / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We investigated the clinical outcome of bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL) who received rituximab-based therapy. MATERIALS AND METHODS: A total of 567 consecutive patients with newly diagnosed DLBCL treated with rituximab-CHOP (RCHOP) between November 2001 and March 2010 were included in the current study. All of the patients underwent a BM study at the initial staging and the clinical characteristics and prognosis of these patients with or without BM involvement were analyzed retrospectively. RESULTS: The total cohort included 567 patients. The overall incidence of BM involvement was 8.5%. With a median follow-up duration of 33.2 months (range, 0.1 to 80.7 months) for patients who were alive at the last follow-up, the five-year overall survival (OS) and event-free survival (EFS) rate in patients without BM involvement (76.3% and 67.5%, p<0.001) was statistically higher than that in patients with BM involvement (44.3% and 40.1%, p<0.001). In multivariate analysis, among total patients, BM involvement showed a significant association with OS and EFS. In univariate and multivariate analyses, even among stage IV patients, a significant association with worse EFS was observed in the BM involvement group. CONCLUSION: BM involvement at diagnosis affected the survival of patients with DLBCL who received RCHOP. Although use of RCHOP can result in significant improvement of the therapeutic effect of DLBCL, BM involvement is still a negative prognostic factor of DLBCL patients in the era of rituximab.

Gastrointestinal Stromal Tumors in a Patient with Neurofibromatosis Type 1 / 대한내과학회지

Neurofibromatosis type 1 (NF1) is a genetic disease characterized by neoplastic and non-neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. NF1 is caused by mutations in the NF1 gene, which is found on chromosome 17q11.2. Patients with NF1 are at increased risk of developing soft tissue sarcomas that arise within the stromal compartment of the gastrointestinal tract, termed gastrointestinal stromal tumors (GISTs). GISTs associated with neurofibromatosis differ from sporadic GISTs, particularly with respect to their lower response rate to imatinib. We recently experienced a case involving a 45-year-old man with NF1 who was admitted to the hospital with epigastric pain and vomiting. Abdominal computed tomography revealed a duodenal GIST with pancreatic invasion. He had a base substitution mutation involving replacement of 2041 cytosine with thymine. He was treated successfully with a surgical operation and adjuvant imatinib therapy.

Gastrointestinal Stromal Tumors in a Patient with Neurofibromatosis Type 1 / 대한내과학회지

Neurofibromatosis type 1 (NF1) is a genetic disease characterized by neoplastic and non-neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. NF1 is caused by mutations in the NF1 gene, which is found on chromosome 17q11.2. Patients with NF1 are at increased risk of developing soft tissue sarcomas that arise within the stromal compartment of the gastrointestinal tract, termed gastrointestinal stromal tumors (GISTs). GISTs associated with neurofibromatosis differ from sporadic GISTs, particularly with respect to their lower response rate to imatinib. We recently experienced a case involving a 45-year-old man with NF1 who was admitted to the hospital with epigastric pain and vomiting. Abdominal computed tomography revealed a duodenal GIST with pancreatic invasion. He had a base substitution mutation involving replacement of 2041 cytosine with thymine. He was treated successfully with a surgical operation and adjuvant imatinib therapy.

Metachronous Double Primary Cancer after Diagnosis of Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The pattern of double primary cancers after treatment for gastric cancer is important for a patient's survival. MATERIALS AND METHODS: We analyzed the clinicopathologic data of 214 gastric cancer patients from October 1996 to November 2007 with regard to metachronous second primary cancers. RESULTS: Out of 5,778 patients with gastric cancer, metachronous second primary cancers occurred in 214 patients. The median age was 61.8 years, the number of male and female patients was 140 (65.4%), 74 (34.6%), respectively. The median time to the occurrence of second cancers after diagnosis of the first was 39.2 months (standard deviation, 31.2 months). The most common cancer was colorectal cancer, which occurred in 44 patients (20.6%), and lung cancer in 33 patients (15.4%), hepatocellular carcinoma in 26 patients (12.1%), ovarian cancer in 15 patients (7.0%), cervical cancer in 12 patients (7.0%), breast cancer in 11 patients (5.1%), and esophageal cancer in 11 patients (5.1%). The observed/expected (O/E) ratio showed a significant increase in colorectal (1.25), male biliary (1.60), ovarian (8.72), and cervical cancer (3.33) with primary gastric cancer. After five years from diagnosis of gastric cancer, secondary cancer occurred in 50 patients (23.4%), and breast cancer, prostate cancer, laryngeal cancer, lung cancer, and hepatocellular carcinoma were the most frequent. CONCLUSION: The O/E ratio showed a significant increase in colorectal, male biliary, ovarian, and cervical cancer with primary gastric cancer, and second primary cancer as the main cause of death for these patients. A follow-up examination for metachronous double primary cancer is needed in order to improve the survival time in patients with gastric cancer.

FOLFOX-4 Combination Chemotherapy as a First-line Treatment in Patients with Advanced Gastric Cancer / 대한내과학회지

The FOLFOX-4 regimen as first-line treatment in patients with advanced gastric cancer has not evidence of category 1 for prolongation of survival in patients with advanced gastric cancer. Therefore, the use is preferred in the second line. But, especially in elderly patients, FOLFOX regimen was active and well tolerated with lower toxicities. Further phase III study is warranted to evaluate the evidence for prolongation of survival in elderly patients or combination therapy with target agents in advanced gastric cancer.

Concurrent Chemoradiotherapy in Locally Advanced Esophageal Cancer / 대한방사선종양학회지

PURPOSE: This study was designed to evaluate the results of local control, survival rate, prognostic factors, and failure pattern in locally advanced esophageal cancer. MATERIALS AND METHODS: We retrospectively studied 50 patients with locally advanced esophageal cancer treated with concurrent chemoradiotherapy at Keimyung University Dongsan Medical Center from June of 1999 to August of 2008. Seven patients with inappropriate data were excluded, and 43 patients were analyzed. There were 39 males and four female patients ranging in age from 43 to 78 years (median, 63 years). There were seven patients with stage IIA and 36 with stage III. Irradiation from 46 Gy to 63 Gy (median, 54 Gy) was carried out 5 days per week, 1.8 Gy once a day. There were eight patients with neo-adjuvant chemotherapy, and we mostly used 5-fluorouracil, cisplatin with 3 cycles for concurrent chemotherapy. The range of follow up periods was from 2 to 82 months (median, 15.5). RESULTS: There were nine patients that exhibited a complete response, 23 that exhibited a partial response, 9 that exhibited no response, and 2 that exhibited disease progression. The median survival time was 15 months. Two-year and 5-year survival rates were 36.5% and 17.3%, respectively. Two-year and 5-year disease-free survival rates were 32.4% and 16%, respectively. Treatment failure occurred in 22 patients (51.2%). Patterns of failure were categorized as local failure in 18 patients and distant metastasis in four patients. In a univariate analysis for prognostic factors related to overall survival and disease-free survival, the hemoglobin levels during chemoradiotherapy (> or =12 vs. <12, p=0.02/p=0.1) and the response to the treatments (CR/PR vs. NR/PD, p=0.002/p<0.0001) were statistically significant. In a multivariate analysis, only response to the treatments was revealed to be statistically significant. There was no statistical significance associated with patient age, gender, disease stage, T-stage, smoking history, tumor location, or neo-adjuvant chemotherapy. CONCLUSION: Our survival rate was similar to those of other institutions. Local recurrence was the main reason for failure. It is suggested that further prospective studies should be performed to improve local control.

Randomized, Multicenter, Phase III Trial of Heptaplatin 1-hour Infusion and 5-Fluorouracil Combination Chemotherapy Comparing with Cisplatin and 5-Fluorouracil Combination Chemotherapy in Patients with Advanced Gastric Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.

A case of small cell carcinoma of the uterine cervix / 대한내과학회지

Small cell carcinoma of the uterine cervix is a rare malignancy representing less than 5% of all cases of cervical carcinoma. It is clinically characterized by frequent early nodal and distant metastasis. Survival is relatively poor with hysterectomy alone. Currently, there is no consensus for the optimal management of small cell carcinoma of the uterine cervix. Most patients are treated with a multimodality approach, using chemotherapy and radiotherapy. We treated a 32-year-old woman with primary small cell carcinoma of the uterine cervix. The pelvic MR imaging showed a 3 cm mass in the uterine cervix and no evidence of other abnormalities in the adnexa. The patient treated with a radical hysterectomy alone and adjuvant therapy was not provided. Five months later, the patient had recurrent disease with multiple bone and liver metastases. We treated the patient with cisplatin and etoposide combination chemotherapy. Here we report the case of a primary small cell carcinoma of the uterine cervix with rapid progression after surgical treatment alone and review the medical literature.

A case of primary thymic MALT lymphoma / 대한내과학회지

Primary thymic MALT lymphoma is a rare thymic tumor, with only eight previous cases having been described worldwide to date. We report a case of a 60-year-old Korean woman diagnosed as primary thymic MALT lymphoma. She was found to have an anterior mediastinal tumor during a medical check-up in 2006 and was referred to our hospital for further examination and treatment. The thymus was resected through a median sternotomy and pathology revealed primary thymic MALT lymphoma. Two months later, a follow-up chest CT showed a residual mediastinal soft tissue mass and increased FDG uptake was detected on PET CT scan. The patient was irradiated with 4,140 cGy. After radiation therapy, no evidence of residual soft tissue was found in follow-up chest CT scan and the patient is alive and well 15 months after treatment. We report the details of this case of primary thymic MALT lymphoma treated with irradiation and also offer a review of the literature.

Primary small cell carcinoma of the ovary and the long-term survival after systemic chemotherapy / 대한내과학회지

Ovarian small cell carcinoma is a rare type of ovarian carcinoma with a poor prognosis.The hypercalcemic type is a tumor of unknown histogenesis, and small cell carcinoma of the pulmonary type may be a component of a typical ovarian surface epithelial-stromal tumor. We experienced a case of primary ovarian small cell carcinoma and lung metastasis. The patient was a 65-year old woman who complained of rectal heaviness. The chest x-ray and chest CT scan revealed multiple pulmonary metastases. Abdominal MRI showed a well defined heterogenous solid mass with central necrosis arising from the right ovary and hydronephrosis of the right kidney. Biopsy of the ovarian mass showed small cell carcinoma of the pulmonary type. After 4 cycles of cisplatin (80 mg/m2, on day 1, iv), etoposide (100 mg/m2, on day 1 to 3, iv), the patient achieved a complete response. The follow up chest CT scan 5 years after treatment revealed no evidence of disease. We report here in a case of primary small cell carcinoma of the ovary with lung metastasis and we include a review of the literature.

The efficacy of concurrent chemoradiotherapy for patients with inoperable esophageal cancer / 대한내과학회지

BACKGROUND: Carcinoma of the esophagus traditionally has been treated with surgery or radiation therapy. The aim of this study was to assess the effect and safety of chemoradiation therapy on patients with advanced esophageal cancer. METHODS: We performed a retrospective study of twenty eight cases with inoperable carcinoma of the esophagus treated with definitive chemoradiation at single institute between April 2001 and December 2004. Twenty eight patients with esophageal squamous cell carcinomas were treated with concurrent chemoradiation therapy. Of 28 patients, 22 had stage III disease, 6 had stage II disease, and 26 were males and 2 were females. The median age of the patients was 63.0 years (range, 4475 years). The regimen involved four cycles of chemotherapy, cisplatin, 75 mg/m2 intravenously on the first day of weeks 1, 5, 9, and 13, and 5-fluorouracil, 1,000 mg/m2 per day on the first 4 days of weeks 1, 5. 9. and 13, concurrently with a dose of 5,400 cGy external beam radiotherapy. RESULTS: The overall response rate was 89%. The median overall survival was 24.7 months, the 1-year and 3-year overall survival rate was 71% and 32%, respectively. The 1-year and 3-year progression-free survival rate was 86% and 54%, respectively. Grade 3/4 hematological toxicities included neutropenia in 50% of the patients, anemia in 25%, and thrombocytopenia in 14%. Grade 3 and 4 non-hematological toxicities were less common. CONCLUSIONS: These results suggest that concurrent chemoradiotherapy is an effective regimen.

An inoperable osteosarcoma of the maxillary sinus with long-term survival after chemotherapy and radiotherapy / 대한내과학회지

Maxillary osteosarcoma is an aggressive disease with a high mortality rate. Extensive surgical resection is accepted as the standard treatment for the disease. The beneficial role of chemotherapy and radiotherapy in the treatment of the disorders is uncertain. We experienced a case of an osteosarcoma of the maxillary sinus. Paranasal sinus computed tomography showed a huge solid mass lesion at the left maxillary sinus walls. An endoscopic biopsy showed an osteoblastic type osteosarcoma. In this case, radical surgery was impossible, and the patient was treated with chemotherapy and radiotherapy. This regimen involved four cycles of chemotherapy, cisplatin, 100 mg/m2 intravenously on the first day of weeks 1, 4, 7, and 10, and doxorubicin, 25 mg/m2 per day on the first 3 days of weeks 1, 4. 7. and 10, followed by external beam radiotherapy with a total dose of 6,600 cGy. We report here a case of an inoperable osteosarcoma of the maxilla with long-term survival after chemotherapy and radiotherapy with an accompanying review of the literature.