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Leptomeningeal metastasis (LM) is a rare but fatal clinical condition with a short survival time. The incidence of LM from epidermal growth factor receptor mutant (EGFRm) non–small cell lung cancer (NSCLC) has increased due to the limited efficacy of first- or second-generation epidermal growth factor receptor (EGFR) tyrosine kinase inhibitors (TKIs) in the central nervous system (CNS). Osimertinib is a third-generation, irreversible, CNS penetrant, oral EGFR TKI that demonstrates promising efficacy in CNS metastases regardless of T790M. Herein, we report four cases of T790M-negative EGFRm NSCLC patients treated with osimertinib combined with systemic chemotherapy, who progressed on prior EGFR TKI and developed LM with extracranial lesions. The combination treatment was well tolerated, and the mean overall survival from LM diagnosis was 14.7 months (95% confidence interval, 10.4 to 19.0). These results suggest that osimertinib combined with systemic chemotherapy would be a reasonable treatment option for T790M-negative EGFRm NSCLC patients who develop LM with extracranial progression to prior EGFR TKI. A further prospective study is warranted.
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Purpose@#The impact of epidermal growth factor receptor (EGFR) mutation in locally advanced non–small cell lung cancer (NSCLC) remains controversial. This study was conducted to investigate the clinical outcomes and recurrence patterns after definitive chemoradiotherapy (CRT) in patients with unresectable stage III non-squamous-cell lung cancer according to EGFR mutation status. @*Materials and Methods@#We retrospectively reviewed 604 patients with pathologically confirmed stage III NSCLC who were treated with definitive CRT and were examined for EGFR mutation at Samsung Medical Center, Korea, from January 2013 to December 2018. Among them, we identified 236 patients with stage III non-squamous-cell lung cancer who were treated with definitive CRT and were examined for EGFR mutation status. We analyzed the frequency of EGFR mutation, progression-free survival (PFS), overall survival (OS), objective response rate (ORR), and recurrence pattern. @*Results@#Among 236 patients, EGFR mutation was detected in 71 patients (30.1%) and the median follow-up duration was 41.7 months. There were no significant differences in PFS (9.9 vs. 10.9 months, p=0.236), and ORR to CRT (93.0% vs. 90.3%, p=0.623) according to EGFR mutation status. However, the EGFR mutant group showed significantly higher recurrence (88.7% vs. 75.2%, p=0.022), distant metastasis (76.1% vs. 61.2%, p=0.036) rates, especially brain (38.0% vs. 12.7%, p < 0.001), and better median OS (59.2 vs. 41.3 months, p=0.037) compared with patients without EGFR mutation. @*Conclusion@#Patients with EGFR mutation–positive unresectable stage III non-squamous lung cancer exhibited higher recurrence and distant metastasis rates, especially brain metastasis.
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Purpose@#The activity and safety of neoadjuvant nivolumab plus gemcitabine/cisplatin (N+GC) were tested in patients with muscle-invasive bladder urothelial carcinoma (MIBC). @*Materials and Methods@#In a prospective phase II trial, patients with cT2-T4a N0 MIBC who were eligible for cisplatin and medically appropriate to undergo radical cystectomy (RC) were enrolled. Treatment with nivolumab 3 mg/kg on days 1 and 15 plus GC (cisplatin 70 mg/m2 on day 1, and gemcitabine 1,000 mg/m2 on days 1, 8, and 15) was repeated every 28 days up to 3 or 4 cycles, depending on the surgery schedules. The primary endpoint was pathologic complete response (pCR, ypT0). Secondary endpoints included pathologic downstaging (≤ ypT1), disease-free survival (DFS), and safety. @*Results@#Between September 2019 and October 2020, 51 patients were enrolled. Neoadjuvant N+GC was well tolerated. Among 49 patients who completed neoadjuvant N+GC, clinical complete response (cCR) was achieved in 59% of intent-to-treat (ITT) population. RC was performed in 34 (69%) patients. pCR was achieved in 24% (12/49) of ITT population and 35% (12/34) of RC patients. Median DFS was not reached. Over a median follow-up of 24 months, 12 patients experienced disease recurrence and were treated with palliative therapy or surgery. Although 12 patients declined surgery and were treated with concurrent chemoradiotherapy, DFS was longer in patients with cCR after neoadjuvant therapy than those without. Preoperative programmed death-ligand 1 (PD-L1) did not correlate with pCR or pathologic downstaging rates. @*Conclusion@#Neoadjuvant N+GC was feasible and provided meaningful pathologic responses in patients with MIBC, regardless of baseline PD-L1 expression (ONO-4538-X41; CRIS.nih.go.kr, KCT0003804).
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Purpose@#Metachronous brain-only oligorecurrence in patients with non–small cell lung cancer (NSCLC) is a rare event with favorable prognosis, but the clinical outcome has not been fully determined. We retrospectively analyzed clinical outcomes and prognostic factors in metachronous brain-only oligorecurrence in patients with NSCLC who underwent definitive treatment. @*Materials and Methods@#We reviewed 4,437 NSCLC patients without oncogenic driver mutations who underwent definitive treatment between 2008 and 2018. Among them, we identified 327 patients who developed 1 to 5 brain metastases with or without systemic metastasis. Of the 327 patients, 71 had metachronous brain-only oligorecurrence without extracranial progression and were treated with local therapy to the brain. Overall survival (OS), progression-free survival (PFS), and prognostic factors affecting OS were analyzed. @*Results@#The median OS was 38.9 months (95% confidence interval [CI], 21.8 to 56.1 months) in 71 patients. The 2-year OS rate was 67.8% and the 5-year OS rate was 33.1%. The median PFS was 25.5 months (95% CI, 12.2 to 14.4 months). The longest surviving patient had a survival period of 115 months. Through multivariate analysis, Eastern Cooperative Oncology Group ≥ 1 (hazard ratio, 5.33; p=0.005) was associated with poor survival. There was no significant difference in OS between patients with local therapy and those with local plus systemic therapy (18.5 months vs. 34.7 months, p=0.815). @*Conclusion@#Metachronous brain-only oligorecurrence NSCLC patients who underwent definitive treatment experienced long-term survival with local therapy, highlighting the unique patient population. The role of systemic chemotherapy in this patient population requires further investigation.
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The Korean Medical Association (KMA) operates two organizations dedicated to healthcare policy research: the Research Institute for Healthcare Policy, which was launched in 2002, and the KMA Policy Special Committee, which was launched in 2017 as an administrative subunit of the board of representatives. Some members of the KMA have criticized the coexistence of two organizations for policy development. They argue that it would be preferable to unify these organizations, pointing out that having duplicate organizations for policy development wastes financial resources, disperses professionals, and produces different opinions on policies, which could be a source of confusion in the policy activities of the KMA. The author was a director in charge of policy at the KMA in 2002, when the Research Institute for Healthcare Policy was founded, and has also been an active member of the KMA Policy Special Committee since its launch in 2017. Having been involved in both policy development organizations, the author suggests that unifying these two organizations would not be desirable for the medical profession. The Research Institute for Healthcare Policy and the KMA Policy Special Committee are similar in that they deal with healthcare policy, but their approaches are quite distinct. The former organization must thoroughly research healthcare policy from a theoretical perspective, while the latter approaches healthcare policy by advocating for the interests of the members of the KMA. For instance, if the two organizations simultaneously research the possibility of a global budget payment system, the Research Institute for Healthcare Policy should address both its advantages and disadvantages, while the KMA Policy Special Committee would instead organize a policy initiative opposing a global budget payment system by focusing on its disadvantage of restricting the autonomy of healthcare providers. However, if the former organization provides a theoretical base and the latter organization coordinates policy advocacy in the interest of members of the KMA, the two organizations will make a major contribution to improving the medical environment in a complementary manner. In 2018, the two organizations jointly held a workshop with the theme of “shared growthâ€in Cheonan, demonstrating their ongoing efforts to collaborate. The author suggests that instead of becoming enmeshed in controversies about whether it should continue to exist as a separate organization, the KMA Policy Special Committee should instead focus on becoming the KMA's center for healthcare policy advocacy as soon as possible.
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The Korean Medical Association (KMA) operates two organizations dedicated to healthcare policy research: the Research Institute for Healthcare Policy, which was launched in 2002, and the KMA Policy Special Committee, which was launched in 2017 as an administrative subunit of the board of representatives. Some members of the KMA have criticized the coexistence of two organizations for policy development. They argue that it would be preferable to unify these organizations, pointing out that having duplicate organizations for policy development wastes financial resources, disperses professionals, and produces different opinions on policies, which could be a source of confusion in the policy activities of the KMA. The author was a director in charge of policy at the KMA in 2002, when the Research Institute for Healthcare Policy was founded, and has also been an active member of the KMA Policy Special Committee since its launch in 2017. Having been involved in both policy development organizations, the author suggests that unifying these two organizations would not be desirable for the medical profession. The Research Institute for Healthcare Policy and the KMA Policy Special Committee are similar in that they deal with healthcare policy, but their approaches are quite distinct. The former organization must thoroughly research healthcare policy from a theoretical perspective, while the latter approaches healthcare policy by advocating for the interests of the members of the KMA. For instance, if the two organizations simultaneously research the possibility of a global budget payment system, the Research Institute for Healthcare Policy should address both its advantages and disadvantages, while the KMA Policy Special Committee would instead organize a policy initiative opposing a global budget payment system by focusing on its disadvantage of restricting the autonomy of healthcare providers. However, if the former organization provides a theoretical base and the latter organization coordinates policy advocacy in the interest of members of the KMA, the two organizations will make a major contribution to improving the medical environment in a complementary manner. In 2018, the two organizations jointly held a workshop with the theme of “shared growth”in Cheonan, demonstrating their ongoing efforts to collaborate. The author suggests that instead of becoming enmeshed in controversies about whether it should continue to exist as a separate organization, the KMA Policy Special Committee should instead focus on becoming the KMA's center for healthcare policy advocacy as soon as possible.
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Humans , Academies and Institutes , Budgets , Delivery of Health Care , Education , Health Personnel , Health Policy , Policy Making , ProfessionalismABSTRACT
Purpose: This multiinstitutional study was to investigate the accuracy of the Kattan nomograms for the prediction of recurrence after definitive surgery for renal cell carcinoma (RCC) in Korean patients and develop a nomogram revised to complement the shortcomings. Materials and Methods: Clinical and pathological data of 1,866 patients with RCC who had been followed for at least 2 years after surgery in each participating institutes were reviewed as well as evidence of disease recurrence, defined to include local recurrence and distant metastasis. Accuracy of the Kattan nomograms' predictability in tumors 7cm or less was tested by calculating the area under the receiver-operating characteristics curve (AUC) and actuarial recurrence-free survival by Kaplan- Meier method. We used the Cox proportional hazard analysis to identify significant variables and develop prediction nomogram, and internally validated by bootstrapping method. Mean follow-up was 56.5 months (24-184). Results: Recurrence occurred in 12.5% of the patients and correlated with the pathological stage, with 4.3%, 7.9%, 15.0%, 22.6%, 38.4%, 58.3% for stages T1a, T1b, T2, T3a, T3b/c and T4, respectively (p<0.001). The AUC of the Kattan nomograms was 0.276. Factors significantly predictive of recurrence were T stage (p<0.0001), presentation (p=0.006), preoperative hemoglobin (p=0.023) and gender (p=0.032). Actuarial 60-month recurrence- free survival was 87.9% and using the prognostic factors, nomogram predicting 60-month recurrence-free survival was constructed. Conclusions: Korean nomogram complementing the preexisting nomograms for the prediction of recurrence-free survival after definitive surgery for RCC has been constructed, which may be useful in patient prognostication, counseling and follow-up planning.
Subject(s)
Humans , Academies and Institutes , Area Under Curve , Carcinoma, Renal Cell , Complement System Proteins , Counseling , Follow-Up Studies , Kidney Neoplasms , Neoplasm Metastasis , Nomograms , RecurrenceABSTRACT
PURPOSE: There are many medical treatments for enuresis. However, it is not known the effect of enuresis management according to when medication was started in the clinical field. Therefore, this study was conducted to determine the results of treating enuresis according to different starting points of the medication. MATERIALS AND METHODS: During March 2001 to May 2004, 331 patients among the 412 primary monosymptomatic enuresis patients were studied for over 6 months: they were treated to a combination of medical treatments and then the reduction of medication dose was taped. Patients less than 5 years old were in group A, the 6-7 years old were in group B, and the patients older than 8 years old were in group C. Successful medication was defined as 14 days of no enuresis without relapse, and failure was defined as 2 or more incidence of enuresis in 2 weeks or loss to follow up after 6 months of treatment. RESULTS: Group A included a total of 105 patients; 81(77.1%) patients experienced successful treatment. Group B included a total of 111 patients, and 86 (77.5%) patients had a successful treatment. Group C included a total of 115 patients, and 79 (68.7%) patients had successful treatment. The mean medication period was 6.5+/-5.2 months for group A, 8.5+/-6.8 months for group B and 10.3+/-9.5 months for group C: these results showed statistical significance (p<0.05). CONCLUSIONS: Despite that spontaneous cure does occur, the study results showed that the patients who were medicated earlier had a higher success rate and a shortened medication period. Considering the results of this study, early treatment for enuresis should be suggested.
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Child , Child, Preschool , Humans , Enuresis , Follow-Up Studies , Incidence , RecurrenceABSTRACT
PURPOSE: We attempted to find out the useful urodynamic parameters for diagnosis of bladder outlet obstruction (BOO) in women, prospectively. MATERIALS AND METHODS: 219 patients were available for analysis, of whom 34 were obstructed by clinical definition, 137 with stress urinary incontinence (SUI) and 34 served as a control. To predict obstruction, comparisons were made; receiver operator characteristic (ROC) curve analysis was used to determine the optimum cut-off values for peak flow rate (Qmax), detrusor pressure at maximum flow (PdetQmax) and maximal urethral closing pressure (MUCP). RESULTS: On the basis of ROC curves between control and BOO groups, using single cut-off value at pressure-flow study, sensitivities and specificities of BOO were 97.1% and 77.9% (Qmax30cmH2O), 79.4% and 88.2% (MUCP>80cmH2O). By combined cut-off values, sensitivities and specificities of BOO were 85.3% and 92.6% (Qmax30cmH2O), and 73.5% and 94.1% (Qmax30cmH2O, and MUCP>80cmH2O). CONCLUSIONS: Our results show that BOO might be diagnosed by the criteria of Qmax30cmH2O, and MUCP>80cmH2O.
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Female , Humans , Diagnosis , Prospective Studies , ROC Curve , Urinary Bladder Neck Obstruction , Urinary Bladder , Urinary Incontinence , UrodynamicsABSTRACT
PURPOSE: The interest has been growing in the investigation and management of lower urinary tract symptoms, but their prevalence in the general population has so far been based on the estimates made in selected groups of women in Korea. The object of this study was to determine the prevalence of stress urinary incontinence and bladder irritative symptoms of women in rural region in Korea through a community based survey. Also, we investigated the relationship between age, parity, oral contraception, smoking, menopause and obesity and the prevalence of stress urinary incontinence. MATERIALS AND METHODS: A questionnaire survey was performed in a sample of randomly selected 1162 women aged 30 years and over, in 31 villages in the town of Jeong-Eup, Korea. From February 4th to February 22nd, 1997, trained field workers visited every home and interviewed every eligible individual with the questionnaires, which included data on stress urinary incontinence, bladder irritative symptoms, quality of life, reproductive and menstrual history, and use of oral contraceptives. Among 1162 women, 857 responded to questionnaires, and 827 questionnaires were available for analysis. The response rate was 73.5%. The prevalence of stress urinary incontinence was defined as the proportion of the women in the population surveyed who experienced stress urinary incontinence at least twice a week. We defined diurnal frequency as the episodes of voiding again within 2 hours after initial voiding in the series of 5 consecutive voidings during one month period. The urgency was defined as she found it difficult to hold urination, once or more in the series of 5 consecutive voidings and nocturia twice or more per night. RESULTS: The prevalence of stress urinary incontinence was 20.4%. Only seven(4.1%) women carried a sanitary towel or diaper as protection against urinary leakage. The prevalence of stress incontinence among age groups revealed no significant difference. Statistically significant correlation was noted between obesity and the prevalence of stress incontinence. Diurnal frequency was recorded by 375 women(45.3%); 171(20.6%) experienced this symptom more than three times. Urgency was reported by 268 women(32.4%) and 63(7.6%) were always troubled by this symptom. Nocturia 3 times or more every night was recorded by 341 women(42.2%) and 83(10.0%) had nocturia 5 times or more. The severity of nocturia increased significantly with age. CONCLUSIONS: The prevalence of stress urinary incontinence and irritative symptoms in this study is similar to previous studies performed in other countries while the rate of nocturia is much higher in this study. Although stress urinary incontinence and bladder irritative symptoms are relatively common in this community, only few people are seeking for care of these symptoms. Therefore, it is very important to educate the public and promote awareness of this medical problem in this community.
Subject(s)
Female , Humans , Contraception , Contraceptives, Oral , Health Personnel , Korea , Lower Urinary Tract Symptoms , Menopause , Nocturia , Obesity , Parity , Prevalence , Quality of Life , Surveys and Questionnaires , Smoke , Smoking , Urinary Bladder , Urinary Incontinence , UrinationABSTRACT
PURPOSE: Numerous operative techniques have been developed to correct proximal hypospadias. Transverse preputial island flap urethroplasty have provided reliable results for the repair of proximal hypospadias, and the versatility of the preputial flap led to its adaptation as an onlay flap that could be sewn onto an intact or preserved urethral plate. Recently, tubularized incised plate urethroplasty(Snodgrass procedure) have been reported with good results. We retrospectively analyzed our experiences with these three techniques to know which procedure is recommendable for repair of proximal hypospadias. MATERIALS AND METHODS: Between January, 1994 and June, 1998, 44 patients underwent repair for the proximal hypospadias by a single surgeon using an transverse preputial island flap(21), onlay flap(16) and tubularized incised plate(7) procedure. We analysed the surgical outcome such as surgical complications according to each procedures. RESULTS: Postoperative complication rate was 57% for transverse preputial island flap, 13% for onlay flap and 14% for tubularized incised plate procedure. The rate of fistula formation were 42%, 13% and 14%, respectively. One diverticulum and two strictures were developed in three patients who underwent transverse preputial island flap procedure, whereas no diverticulum or stricture was developed after onlay or tubularized incised plate procedure. Cosmetic results were excellent in tubularized incised plate urethroplasty. CONCLUSIONS: Onlay or tubularized incised plate urethroplasty using an preserved urethral plate had better outcomes compared to the transverse preputial island flap procedure. The technique using urethral plate could be recommendable as first choice for proximal hypospadias although transverse preputial island flap procedure is worthy to be considered for more complicated cases.
Subject(s)
Female , Humans , Male , Constriction, Pathologic , Diverticulum , Fistula , Hypospadias , Inlays , Postoperative Complications , Retrospective StudiesABSTRACT
PURPOSE: Radical cystectomy has been a standard method in the treatment for invasive bladder cancer. Recently the orthotopic substitutions have been generally performed for urinary diversion. Ghoneim introduced a new method for orthotopic substitution which has used relatively short segment of ileum, and the method is regarded to have few complications. We performed this method for our study and analyzed the results and complications. MATERIALS AND METHODS: Among total 29 patients underwent ileal W-neobladder with serous-lined extramural tunnel, 27 patients had invasive bladder cancer and the remaining two patients had contracted bladder with vesicoureteral reflux. There were 25 male patients with the mean age of 59.2 years(45-70) and 4 female patients with 61.8 years(51-68). Mean follow-up period for the entire group was 8.4 months(3?17 month). History taking, physical examination, and complete laboratory tests were performed postoperatively and IVP or CT scan was taken at 3 month and 9 month after the operation for the evaluation of recurrence and upper tract change. RESULTS: The average operating time was 8 hours 35 minutes(420-670 min). Paralytic ileus developed in two patients and wound dehisced in 4. In all 29 patients, vesicoureteral reflux was not detected. Stricture of ureteroileal anastomosis was observed in 4 left renal units. We performed percutaneous nephrostomy and antegrade double J stenting on all the patients with stricture primarily, but one patient underwent neoureteroileostomy because of the failure of the primary management. Four patients complained enuresis, but no daytime incontinence was observed. There were no clinical symptoms of complications in all 29 patients and no metabolic acidosis was observed in laboratory tests. CONCLUSIONS: Serous-lined extramural tunnel method of orthotopic substitution showed an acceptable and safe reservoir with a large capacity at low pressure and absence of reflux with relatively short segment of ileum.