Radiation Results and Survival Rate of Small Cell Lung Cancer / 대한치료방사선과학회지

PURPOSE: To improve treatment modality and results by analysis of clinical characteristics. local control, survival and resurrence rate in limited stage small cell lung cancer. METHODS AND MATERIALS : 26 patients with limited stage small cell lung cancer were treated with combined radiation and chemotherapy from Feb. 1986 to Dec. 1992 at the National Medical Center. We followed up on 21 patients (81%) , who were mostly irradiated with 4,000-5,000cGy (75% of all patients) in the results by the analysis retrospectively. Survival rate was evaluated by the Kaplan-Meier method. RESULTS: Mean survival of irradiated patients with limited small cell lung cancer was 12 months. 1-year and 2-year survival rate were 65.3% and 15.4%. Tumor response rate and median survival after combined chemotherapy and irradiation were the following ; 50% and 15 months of complete response, and 23% and 11 months of partial response respectively. Response rates by radiation dose were 66% for below 4,000cGy. 69% for between 4,000-5,000cGy and 86% for above 5,000cGy. 21 of all patients showed treatment failure(81%), which as appeared 9 of local failure.9 of distant failure and 3 of local and distant failure. CONCLUSION: Local response rate after induction chemotherapy alone in limited stage of small cell lung cancer was 54%. Furthermore it was increased to 73% after adding of radiation. We have to increase radiation dose above 5,000cGy and need to try new effective chemotherapy agents for the improvement of local control and survival rate and also will try concurrent chemoradiotherapy in near time.

Local Control and Survival in Radiation Treatment of Locally Advanced Non-Small Cell Lung Cancer / 대한치료방사선과학회지

The retrospective analysis was performed on 37 patients with stage III non small cell lung cancer who received the radiotherapy from Feb. 1986 to Dec. 1990 at the Dept. of Radiation Oncology, National Medical Center. This analysis, with 29 patients (78.4%) having been followed from 10 to 60 months, was done to know the survival rate and significant prognostic factor. The actuarial 2, 5-year survival rates were 20.6%, 6.9% in our all patients and Median survival time was 10 months. Of patients with KPS(Karnofsky performance status) greater than 80%, the 2, 5 year survival rate and median survival time were 29.2%, 9.7% and 13 months, respectively. The 2-year survival rate and median survival time of patients with KPS less than 80% were 13.7% and 7 months, respectively. The survival difference according to performance status was statistically significant(29.2% vs. 13.7%)(p0.1). Of the prognostic factors, the difference of survival rate by initial performance status was statistically significant (p<0.05). But the difference of survival rates by pathologic cell type, stage, total radiation dose, radiotherapy response, and combination with chemotherapy were not statistically significant.

Radiation Treatment for Malignant Small Cell Tumor of the Thoracopulmonary RegionPrimitive Pluripotent Histogenesis and Differential Diagnosis: A Case Report and Review of Literatures / 대한치료방사선과학회지

Malignant small round cell tumor (SRCT) of the thoracopulmonary region appears to originate in the soft tissues of the chest wall or the peripheral lung. A differential diagnosis of poorly differentiated small round cell tumors which include Ewing's sarcoma of bone and soft tissue, embryonal rhabdomyosarcoma, Askin tumor, neuroblastoma, peripheral neuroectodermal tumor, small cell osteogenic sarcoma and lymphoma are after difficult by light microscopy alone. In recent, by the extensive studies electron microscopic examination, histochemical study, immunochemical study, cytogenetics and gene analysis, these tumors may be derived from the primitive and pluripotential cells, differentiating into mesenchymal, epithelial and neural features in variable proportions. Treatment for SRCT of thoracopulmonary regin is not determined because of massive involvement of the lung, pleura or soft tissues of the chest wall resulted in a dismal outcome despite aggressive surgery, irradiation and chemotherapy.

Large Cell Carcinoma of the Lung: An analysis of clinical features and survival / 대한치료방사선과학회지

This is a retrospective review of 33 patients with large cell lung carcinoma treated at Yonsei University Cancer Center between Jan. 1985 and Dec. 1989. Of the thirty-three patients, twenty eight were men and five women. Median age was 59 years. Large cell undifferentiated carcinoma was the most common pathologic type, 78.8%. Twenty one of thirty three patients had far advanced diseases, stage IIIB-IV at the time of initial diagnosis. Pleural effusion was initially presented in 12 patients, and SVC syndrome appeared in 5 patients. As to location of the primary tumor, 19(57.6%) appeared in the right lung and 14 (42.4%) in the left. Patients with a centrally located primary tumor mass were nearly the same as those peripherally located (17 vs. 16). Fifteen of thirty three patients developed metastasis involving not only bone, brain, the opposite lung, adrenal gland but also soft tissue, skin, pancreas and appendix. Treatment was individualized with 19 treated radically and 14 palliatively. After treatment, only two patients showed a complete response. Long term survival was observed in 4 patients: 1 (24 mo.), 2 (41 mo.) and 1 (54 mo.). The overall 2 year survival rate was 14.3% while the median survival time was 6.0 months. Through the analysis of the various factors affecting survival, we observed that pleural effusion-absent group and complete response group had a statistical significant better survival rate (p<0.01).

Radiation Treatment for Primary Adenocarcinoma of Bartholin's Gland: A Case Report and Review of Literature / 대한치료방사선과학회지

A patient with primary adenocarcinoma of Bartholin's gland is reported and the literatures relevant to this disease reviewed. Not only this disease is very rare but also primary carcinomas of Bartholin's gland are misdiagnosed as cysts or abscesses in half of the cases, leading to considerable delay in diagnosis. And so, It was wasted long time before definitive therapy. However, because of a different clinical behavior, cancer of the Bartholin's gland should be distinguished from other vulvar carcinomas. Histologically, squamous cell carcinoma and adenocarcinoma are the most common. Virtually all histologic types of Bartholin's gland carcinoma metastasize to lymph node, bone, lung and liver in distant sites. The authors data and a review of the literature support the concept that radical vulvectomy with or without bilateral inguina1-femoral lymphadenectomy is required. On the other hand, except primary radiation treatment for small or medium sized cancers, the results obtained by radiation therapy in carcinoma of the vulva including Bartholin's gland are generally discouraging. A role for postoperative adjuvant radiation therapy suggests because of high incidence of positive inguinal-femoral lymph nodes. In the near time, natural history and biological behavior of Bartholin's gland cancer must be disclosed in detail. And also optimal treatment modality and prognostic factors shall be determine.

Radical Radiotherapy with Lympectomy (Wide excisional biopsy) for Early Breast Cancer: A Case Report and Review of Literature / 대한치료방사선과학회지

However, long-term results of retrospective studies suggest that, for the great majority of individuals, mastectomy or conservative surgery with radiation therapy were be equally effective. The results at 5 and 10 years from prospective randomized trials indicate that survival following primary radiation therapy for early breast cancer is equivalent to that following mastectomy. When competently performed, primary radiation therapy gives highly satisfactory cosmetic results and acceptably low rates of local tumor recurrence. A number of controversial issues remain concerning patient evaluation and selection and the optimal techniques of treatment, both surgical and radiotherapeutic. In addition, further work is needed to clearity the best way to integrate primary radiotherapy with adjuvant systemic treatment. And further follow-up these patients with primary radiation therapy for early breast cancer will be required for ultimate proof of the relative merits. A case which was conservative surgery and radical irradiation of early breast cancer with review of literatures will be done.

Hysterosalpingographic evaluation in infertility

H.S.G. has been proven to be an important diagnsotic method in clinical gyencology for under 50 yrs. It isvaluable in the investigation of the uterine and tubal factors of female infertility. Hysterosalpingograms of 81 patients with infertility were analysed and following brief results were obtained. 1. Ratio between primary andsecondary infertility was 3:5, 2ndary infertility was more frequent. 2. Age distribution was more frequnet under 30 years of age than over 30 years of age. 3. Abnormal uterine finding was only seen in 18 cases, abnormal tubalfinding was only seen in 25 cases and combined uterine and abnormalities were seen in 14 cases. 4. Abnormaluterine findings were malposition (12 cases), filling defect (5), spastic uterus(5), irregular contour (3),arcuate uterus(3), dideplphia(1), in order of frequency. 5. Abnormal tubal findings were hydrosalpinx (21 cases), occlusion(19), intravasation (6), beaded appearance(3), & diverticula(2) , in order of frequency. 6. Negativefinding in both uterus and tube was seen in 23 cases. 7. In 2 cases, pregnancy after the H.S.G. examination wasconfirmed.

Bronchiolo-alveolar cell carcinoma a review of 11 cases

Eleven patients with proved Bronchiolo-aveolar cell carcinoma were found in the chest department of thenational menical center from 1975 to 1981. The incidence of Bronchiolo-alveolar cell carcinoma is recentlyincreased as primary lung carcinoma. The result as follow. 1. The ratio of male and female was 5:6 and anincidence of 4.4% among total primary lung cancer patients. The highest incidence (3 of cases) was seen in thesixth decade, and the remaining cases were evenly distributed in the third, fourth, and fifth decades of life.Among them youngest was 29 years old and the oldest was 66 years old. 2. Clinical and radiological initialdiagnosis prior to the final diagnosis were as follows; pulmonary tuberculosis; 7 cases, pneumonia; 1 case,bronchiectasis; 1 case, and lung cancer; 2 cases. 3. Radiological examination of chest presented several pictures;most commonly, homogenous or patchy infiltrations; 6 cases, nodular or mass like densities; 2 cases, disseminatednodular or military patterns; 2 cases, and reticular pattern; 1 case. 4. Bronchogram reveald no contributablefindings except one case of complete tappering obstruction of the segmental bronchus. Therefore we arrive at theconclusion that early diagnosis will result in increased resectability and improved survival so aggressivediagnositic work-up for suspicious pulmonary infiltrate is necessary.

Computed tomographic evaluation of brain abscess

The use of CT is most reliable in diagnosis and management of brain abscess. Authors analized 17 cases of pathologically and clinically proven brain abscess during the period of 39 months from Jan. 1978 to Mar, 1982 at National Medical Center. The results were as follows; 1. The sex ration 9 males to 8 females, and no sexdifference was seen, and the greatest number of cases were seen below the age of 30(65%). 2. The otogenicinfection was the most frequent predisposing factors(8 cases). Other predisposing factors were postoperative infection (2 cases), pulmonary infection (2 cases), and congenital heart disease(2 cases). The most common site ofinvolvement was posterior fossa(5 cases). Next was temporal lobe (4 cases), and temporoparietal lobe (3 cases). 3.Most common presenting symptoms were headache, fever, focal neurological signs, and dizziness. 4. Among the 22 brain abscesses of 17 patients, the msot frequent CT finding in precontrast scan was a low density surrounded by afaint dense or dense ring (11 cases). Next was purely low density (6 cases). Associated hydrocephalus was found in4 cases, and multiple or multiloculated abscess was seen in 4 cases. 5. In post contrast scan, brain abscessusually show complete, oval or round shaped, thin, evening righ enhancement with mild or moderate surroundingedema, but there was no specific enhancement.

Radiological study of primary lung cancer

The incidence of primary lung cancer is increasing in our country. This presentation is an attempt to correlate a useful diagnosis with radiological findings of primary lung cancer. Histologically proved 210 cases of primary lung cancer are as follow: Epidermoid Ca. 65%, Adeno Ca. 18%, Small cell Ca. 9.5%, Large cell Ca. 2%, Unclassified Ca. 3.3%, Mucoepidermoid Ca. 2.4%, Mixed Ca. 0.5%. 3. In smoking history; 91% of epidermoid Ca, 17%of small cell Ca. 30% of adeno Ca. has smoking history. 4. In mass size; Average diameter of mass was most was5.3cm. Hilar mass was seen in 48 cases. Hilar mass was most frequent finding in small cell Ca. and the peripheral mass in adeno Ca. 5. Cavitary lung Ca. was 26 cases (12.4%) and most cases had relative thick wall and its mean thickness was 3.6mm. 6. Coexistence of pulmonary tuberculosis and lung cancer was 22 cases (10.5%), and most common in epidermoid cell Ca. as 16 cases. 7. Other findings include metastasis to lymph node, bone and other organ, and pleural effusion.