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Purpose@#To evaluate the role of postmastectomy radiation therapy (PMRT) in patients with node-negative breast cancer of 5cm or larger tumors undergoing mastectomy @*Materials and Methods@#Medical records of 274 patients from 18 institutions treated with mastectomy between January 2000 and December 2016 were retrospectively reviewed. Among these, 202 patients underwent PMRT, while 72 did not. Two hundred and forty-one patients (88.0%) received systemic chemotherapy, and 172 (62.8%) received hormonal therapy. Patients receiving PMRT were younger, more likely to have progesterone receptor-positive tumors, and received adjuvant chemotherapy more frequently compared with those without PMRT (p <0.001, 0.018, and <0.001, respectively). Other characteristics were not significantly different between the two groups. @*Results@#With a median follow-up of 95 months (range, 1-249), there were 9 locoregional recurrences, and 20 distant metastases. The 8-year locoregional recurrence-free survival rates were 98.0% with PMRT and 91.3% without PMRT (p=0.133), and the 8-year disease-free survival (DFS) rates were 91.8% with PMRT and 73.9% without PMRT (p=0.008). On multivariate analysis incorporating age, histologic grade, lymphovascular invasion, hormonal therapy, chemotherapy, and PMRT, the absence of lymphovascular invasion and the receipt of PMRT were associated with improved DFS (p=0.025 and 0.009, respectively). @*Conclusion@#Locoregional recurrence rate was very low in node-negative breast cancer of 5cm or larger tumors treated with mastectomy regardless of the receipt of PMRT. However, PMRT was significantly associated with improved DFS. Further investigation is needed to confirm these findings.
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Purpose@#This study was conducted to evaluate prognosis of patients with level I/II axillary lymph node metastases from occult breast cancer (OBC). @*Materials and Methods@#Data of 53 patients with OBC who received axillary lymph node dissection (ALND) positiveegative (+/–) breast-conserving surgery between 2001 and 2013 were retrospectively collected at seven hospitals in Korea. The median number of positive lymph nodes (+LNs) was 2. Seventeen patients (32.1%) had >3 +LNs. A total of 48 patients (90.6%) received radiotherapy. Extents of radiotherapy were as follows: whole-breast (WB; n = 11), regional lymph node (RLN; n = 2), and WB plus RLN (n = 35). @*Results@#The median follow-up time was 85 months. Recurrence was found in four patients: two in the breast, one in RLN, and one in the breast and RLN. The 5-year and 7-year disease-free survival (DFS) rates were 96.1% and 93.5%, respectively. Molecular subtype and receipt of breast radiotherapy were significantly associated with DFS. Patients with estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 negative (ER-/PR-/HER2-) subtype had significantly lower 7-year DFS than those with non-ER-/PR-/HER2- tumor (76.9% vs. 100.0%; p = 0.03). Whole breast irradiation (WBI) was significantly associated with a higher 7-year DFS rate (94.7% for WBI group vs. 83.3% for non-WBI group; p = 0.01). Other factors including patient’s age, number of +LNs, taxane chemotherapy, and RLN irradiation were not associated with DFS. @*Conclusion@#Patients with OBC achieved favorable outcome after ALND and breast-targeting treatment. Molecular subtype and receipt of WBI was significant factors for DFS.
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Purpose@#This study was conducted to evaluate prognosis of patients with level I/II axillary lymph node metastases from occult breast cancer (OBC). @*Materials and Methods@#Data of 53 patients with OBC who received axillary lymph node dissection (ALND) positiveegative (+/–) breast-conserving surgery between 2001 and 2013 were retrospectively collected at seven hospitals in Korea. The median number of positive lymph nodes (+LNs) was 2. Seventeen patients (32.1%) had >3 +LNs. A total of 48 patients (90.6%) received radiotherapy. Extents of radiotherapy were as follows: whole-breast (WB; n = 11), regional lymph node (RLN; n = 2), and WB plus RLN (n = 35). @*Results@#The median follow-up time was 85 months. Recurrence was found in four patients: two in the breast, one in RLN, and one in the breast and RLN. The 5-year and 7-year disease-free survival (DFS) rates were 96.1% and 93.5%, respectively. Molecular subtype and receipt of breast radiotherapy were significantly associated with DFS. Patients with estrogen receptor negative, progesterone receptor negative, and human epidermal growth factor receptor 2 negative (ER-/PR-/HER2-) subtype had significantly lower 7-year DFS than those with non-ER-/PR-/HER2- tumor (76.9% vs. 100.0%; p = 0.03). Whole breast irradiation (WBI) was significantly associated with a higher 7-year DFS rate (94.7% for WBI group vs. 83.3% for non-WBI group; p = 0.01). Other factors including patient’s age, number of +LNs, taxane chemotherapy, and RLN irradiation were not associated with DFS. @*Conclusion@#Patients with OBC achieved favorable outcome after ALND and breast-targeting treatment. Molecular subtype and receipt of WBI was significant factors for DFS.
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Objectives@#This study compared the psychological autopsies of suicide victims through interviews of the bereaved family members and investigations of the police death records. @*Methods@#A psychological autopsy was performed using both the Korea Psychological Autopsy Checklist (K-PAC) through an interview of the bereaved family members and the Korea Psychological Autopsy Checklist for Police Record (K-PAC-PR) from the police death records at the same suicide victims. The frequency and percentage of each analysis item were checked, and the information collected was compared. @*Results@#Of 129 victims, information from two methods showed no significant differences in marital status, employment status, cohabitation status and relationship, location of suicide, method of suicide, and main cause. Among the stress information at the time of death, interpersonal and mental health problems were consistent, but the occupational, economy, family-related, physical health problems were estimated to have greater impact according to the interview methods. The estimates of depression, schizophrenia, bipolar disorder, and dementia were consistent, but the investigation method estimated more sleep disorders and anxiety disorders, and the interview methods estimated more drug use disorders. @*Conclusion@#Based on the analysis results, the two methods of a psychological autopsy should be properly utilized, and effective suicide prevention using the psychological autopsy information was discussed.
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Purpose@#The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. @*Materials and Methods@#We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. @*Results@#Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. @*Conclusion@#Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.
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Purpose@#The details of breast reconstruction and radiation therapy (RT) vary between institutions; therefore, we sought to investigate the practice patterns of radiation oncologists who specialize in breast cancer. @*Materials and Methods@#We identified the practice patterns and inter-hospital variations from a multi-center cohort of women with breast cancer who underwent post-mastectomy RT (PMRT) to the reconstructed breast at 16 institutions between 2015 and 2016. The institutions were requested to contour the target volume and produce RT plans for one representative case with five different clinical scenarios and answer questionnaires which elicited infrastructural information. We assessed the inter-institutional variations in RT in terms of the target, normal organ delineation, and dose-volume histograms. @*Results@#Three hundred fourteen patients were included; 99% of them underwent immediate reconstruction. The most irradiated material was tissue expander (36.9%) followed by transverse rectus abdominis musculocutaneous flap (23.9%) and silicone implant (12.1%). In prosthetic-based reconstruction with tissue expander, most patients received PMRT following partial deflation. Conventional fractionation and hypofractionation RT were used in 66.6% and 33.4% patients, respectively (commonest: 40.05 Gy in 15 fractions [17.5%]). Furthermore, 15.6% of the patients received boost RT and 53.5% were treated with bolus. Overall, 15 physicians responded to the questionnaires and six submitted their contours and RT plans. There was a significant variability in target delineations and RT plans between physicians, and between clinical scenarios. @*Conclusion@#Adjuvant RT following post-mastectomy reconstruction has become a common practice in Korea. The details vary significantly between institutions, which highlights an urgent need for standard protocol in this clinical setting.
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PURPOSE: The purpose of this study was to investigate the effect of hospital case volume on clinical outcomes in patients with nasopharyngeal carcinoma (NPC). MATERIALS AND METHODS: Data on 1,073 patients with cT1-4N0-3M0 NPC were collected from a multi-institutional retrospective database (KROG 11-06). All patients received definitive radiotherapy (RT) either with three-dimensional-conformal RT (3D-CRT) (n=576) or intensity-modulated RT (IMRT) (n=497). The patients were divided into two groups treated at high volume institution (HVI) (n=750) and low volume institution (LVI) (n=323), defined as patient volume ≥ 10 (median, 13; range, 10 to 18) and < 10 patients per year (median, 3; range, 2 to 6), respectively. Endpoints were overall survival (OS) and loco-regional progression-free survival (LRPFS). RESULTS: At a median follow-up of 56.7 months, the outcomes were significantly better in those treated at HVI than at LVI. For the 614 patients of propensity score-matched cohort, 5-year OS and LRPFS were consistently higher in the HVI group than in the LVI group (OS: 78.4% vs. 62.7%, p < 0.001; LRPFS: 86.2% vs. 65.8%, p < 0.001, respectively). According to RT modality, significant difference in 5-year OS was observed in patients receiving 3D-CRT (78.7% for HVI vs. 58.9% for LVI, p < 0.001) and not in those receiving IMRT (77.3% for HVI vs. 75.5% for LVI, p=0.170). CONCLUSION: A significant relationship was observed between HVI and LVI for the clinical outcomes of patients with NPC. However, the difference in outcome becomes insignificant in the IMRT era, probably due to the standardization of practice by education.
Subject(s)
Humans , Cohort Studies , Disease-Free Survival , Education , Follow-Up Studies , Nasopharyngeal Neoplasms , Radiotherapy , Radiotherapy, Intensity-Modulated , Retrospective Studies , Treatment OutcomeABSTRACT
PURPOSE: We aimed to assess prognostic value of metastatic pelvic lymph node (mPLN) in early-stage cervical cancer treated with radical surgery followed by postoperative chemoradiotherapy. Also, we sought to define a high-risk group using prognosticators for recurrence. MATERIALS AND METHODS: A multicenter retrospective study was conducted using the data from 13 Korean institutions from 2000 to 2010. A total of 249 IB-IIA patients with high-risk factors were included. We evaluated distant metastasis-free survival (DMFS) and disease-free survival (DFS) in relation to clinicopathologic factors including pNstage, number of mPLN, lymph node (LN)ratio (number of positive LN/number of harvested LN), and log odds of mPLNs (log(number of positive LN+0.5/number of negative LN+0.5)). RESULTS: In univariate analysis, histology (squamous cell carcinoma [SqCC] vs. others), lymphovascular invasion (LVI), number of mPLNs (≤ 3 vs. > 3), LN ratio (≤ 17% vs. > 17%), and log odds of mPLNs (≤ -0.58 vs. > -0.58) were significant prognosticators for DMFS and DFS. Resection margin involvement only affected DFS. No significant survival difference was observed between pN0 patients and patients with 1-3 mPLNs. Multivariate analysis revealed that mPLN > 3, LVI, and non-SqCC were unfavorable index for both DMFS (p 3 in early-stage cervical cancer affects DMFS and DFS. A scoring system using mPLNs > 3, LVI, and non-SqCC could stratify risk groups of recurrence in surgically resected early-stage cervix cancer with high-risk factors.
Subject(s)
Humans , Chemoradiotherapy , Cohort Studies , Combined Modality Therapy , Disease-Free Survival , Lymph Nodes , Lymphatic Metastasis , Multivariate Analysis , Recurrence , Retrospective Studies , Risk Factors , Uterine Cervical NeoplasmsABSTRACT
BACKGROUND: Trichophyton mentagrophytes complex is a heterogeneous group. A new classification, based on molecular biology, has replaced the one based on morphology, physiology, and mating behavior. OBJECTIVE: T. mentagrophytes isolates from Korean patients were classified using the new method and compared with the classic classification. METHODS: During 2010-2011, fungal isolates were collected at the Catholic skin clinic from 562 patients infected with T. mentagrophytes; clinical characteristics were reviewed. Patients were divided into four groups based on the morphological characteristics of the isolates. Thirty-four strains of T. mentagrophytes were randomly selected from the four groups for mycological and molecular biology analyses, including analyses of morphological characteristics, ribosomal DNA (rDNA) internal transcribed spacer (ITS) sequence, and rDNA nontranscribed spacer (NTS) typing. RESULTS: Among the 562 isolates, persicolor (41.6%) was the most common strain type, followed by the powdery (38.4%), downy (11.2%), and granular (8.7%) types. The granular type differed from the other three with respect to the isolation site, patient's age, seasonal variation, and microscopic characteristics. Among the selected 34 strains, the microscopic characteristics varied for each strain. The powdery, persicolor, and downy types had ITS sequences identical to those of the anthropophilic T. interdigitale/A. vanbreuseghemii. The ITS sequence of granular type was similar to that of zoophilic T. interdigitale/A. vanbreuseghemii. The granular type had different NTS types than the other types did. CONCLUSION: The T. mentagrophytes strains isolated were classified as T. interdigitale/A. vanbreuseghemii; the majority (91.7%) was anthropophilic and 8.3% were zoophilic and granular type.
Subject(s)
Humans , Classification , DNA, Ribosomal , Methods , Molecular Biology , Physiology , Seasons , Skin , TrichophytonABSTRACT
PURPOSE: Laser therapy for retinopathy of prematurity (ROP) is commonly performed under general anesthesia (GA). However, the use of GA for laser therapy in neonates who have already undergone invasive ventilation may lead to postoperative complications such as severe apnea or the development of ventilator dependency. This study aimed to examine the safety of administering only sedatives instead of GA in extremely low birth weight (ELBW) infants, who are the usual recipients of laser therapy for ROP. METHODS: Among ELBW infants who were admitted to the neonatal intensive care unit (NICU) at Samsung Medical Center between January and December 2012, we studied 30 patients treated with laser therapy for ROP. RESULTS: The mean gestational age of the patients was 24.6±1.9 weeks, with a mean birth weight of 646±140 g. The mean age and weight of patients at the time of laser therapy for ROP was 36.3±2.3 weeks and 1,470±423 g. In terms of sedatives, 14 patients (46.7%) were administered chloral hydrate alone, 14 (46.7%) were administered a combination of chloral hydrate and midazolam, one was administered midazolam alone, and one received fentanyl. Prior to laser therapy, 16 patients (53.5%) had established self-respiration, 13 (43.3%) relied on non-invasive ventilation and one patient relied on invasive mechanical ventilation. Following laser therapy, two patients who initially had exhibited self-respiration required respiratory assistance via non-invasive positive pressure ventilation and no patient required intratracheal intubation. CONCLUSIONS: We conclude that the use of sedatives may be safe for ELBW infants who undergo laser therapy for ROP.
Subject(s)
Humans , Infant , Infant, Newborn , Anesthesia, General , Apnea , Birth Weight , Chloral Hydrate , Fentanyl , Gestational Age , Hypnotics and Sedatives , Infant, Low Birth Weight , Intensive Care, Neonatal , Intubation, Intratracheal , Laser Therapy , Midazolam , Noninvasive Ventilation , Positive-Pressure Respiration , Postoperative Complications , Respiration, Artificial , Retinopathy of Prematurity , Ventilation , Ventilators, MechanicalABSTRACT
PURPOSE: We evaluated the role of adjuvant therapy in stage IIIA endometrioid adenocarcinoma patients who underwent surgery followed by radiotherapy (RT) alone or chemoradiotherapy (CTRT) according to risk group. MATERIALS AND METHODS: A multicenter retrospective study was conducted including patients with surgical stage IIIA endometrial cancertreated by radical surgery and adjuvant RT or CTRT. Disease-free survival (DFS) and overall survival (OS) were analyzed. RESULTS: Ninety-three patients with stage IIIA disease were identified. Nineteen patients (20.4%) experienced recurrence, mostly distant metastasis (17.2%). Combined CTRT did not affect DFS (74.1% vs. 82.4%, p=0.130) or OS (96.3% vs. 91.9%, p=0.262) in stage IIIA disease compared with RT alone. Patients with age ≥ 60 years, grade G2/3, and lymphovascular space involvement had a significantly worse DFS and those variables were defined as risk factors. The high-risk group showed a significant reduction in 5-year DFS (≥ 2 risk factors) (49.0% vs. 88.0%, p < 0.001) compared with the low-risk group (< 2). Multivariate analysis confirmed that more than one risk factor was the only predictor of worse DFS (hazard ratio, 5.45; 95% confidence interval, 2.12 to 13.98; p < 0.001). Of patients with no risk factors, a subset treated with RT alone showed an excellent 5-year DFS and OS (93.8% and 100%, respectively). CONCLUSION: We identified a low-risk subset of stage IIIA endometrioid adenocarcinoma patients who might be reasonable candidates for adjuvant RT alone. Further randomized studies are needed to determine which subset might benefit from combined CTRT.
Subject(s)
Female , Humans , Adenocarcinoma , Carcinoma, Endometrioid , Chemoradiotherapy , Chemoradiotherapy, Adjuvant , Disease-Free Survival , Endometrial Neoplasms , Multivariate Analysis , Neoplasm Metastasis , Radiotherapy , Radiotherapy, Adjuvant , Recurrence , Retrospective Studies , Risk FactorsABSTRACT
BACKGROUND: Dermatofibrosarcoma protuberance (DFSP) must be differentiated from dermatofibroma (DF). However, especially in cases of superficial biopsy and cellular dermatofibroma, this is difficult by using histopathology alone since both are composed of neoplastic spindle cells. Although a panel of immunostains is useful, the expressions of conventional markers often overlap. A previous study showed that novel D2-40 immunostain may be useful for differentiating between DF and DFSP. OBJECTIVE: To evaluate the usefulness of D2-40 immunohistochemical staining for differentiating DFSP from DF and compare the results with other commonly used immunostains (CD34 and factor XIIIa). METHODS: Twenty-eight cases of DF and 15 cases of DFSP were selected from clinicopathologically proven cases reviewed by the Department of Dermatology at our medical center and Daegu Catholic University Medical Center. D2-40, CD34, and factor XIIIa immunohistochemical staining was performed. The immunopositivity was measured throughout the entire lesion. RESULTS: Seventeen cases (60.7%) of DF and no cases of DFSP showed immunoreactivity to D2-40 in the spindle cells. Three (10.7%) cases of DF and 13 (86.7%) cases of DFSP showed immunoreactivity to CD34 in the spindle cells. Twenty-five (89.3%) cases of DF and four (26.7%) cases of DFSP showed immunoreactivity to factor XIIIa in the spindle cells. A total of 60.7% of cases of DF were positive on D2-40 staining, 89.3% were negative on CD34 staining, and 89.3% were positive on factor XIIIa staining. All cases (100%) of DFSP were negative by D2-40 staining, 86.7% were positive by CD34 staining, and 73.3% were negative by factor XIIIa staining. CONCLUSION: D2-40 immunostaining may be useful for distinguishing between DF and DFSP since the immunoreactivity of DF was significantly higher than that of DFSP (p=0.001). However, the results of our study were not as useful as those of a previous study. Therefore, further studies are needed to address this issue.
Subject(s)
Academic Medical Centers , Biopsy , Dermatofibrosarcoma , Dermatology , Factor XIIIa , Histiocytoma, Benign FibrousABSTRACT
Primary myelofibrosis (PMF) is a chronic myeloproliferative disorder that is characterized by clonal proliferation of myeloid cells in the bone marrow. PMF should be distinguished from other chronic myeloproliferative neoplasms. Leukemia cutis is defined as cutaneous infiltration of malignant hematopoietic cells. The clinical features of leukemia cutis are variable, and the lesions may be localized or disseminated. A 53-year-old male individual presented with a month's history of several erythematous papules on the trunk. The number of lesions had increased, but he had no subjective symptom. He was diagnosed with PMF 3 years ago. For the last 5 months, he has suffered from inguinal lymph node enlargement, myalgia, and abdominal discomfort. Laboratory test showed leukocytosis in the peripheral blood (blast cells: 18%). Histopathologic examination of skin lesions showed perivascular infiltration of immature myeloid cells in the dermis. The infiltrative cells showed positivity for myeloperoxidase. We diagnosed the condition as leukemia cutis from primary myelofibrosis.
Subject(s)
Humans , Male , Middle Aged , Bone Marrow , Dermis , Leukemia , Leukocytosis , Lymph Nodes , Myalgia , Myeloid Cells , Myeloproliferative Disorders , Peroxidase , Primary Myelofibrosis , SkinABSTRACT
Kaposi's sarcoma is an angioproliferative neoplasm that is derived from endothelial cells of blood and lymphatic vessels. Although the etiology is not yet clearly revealed, human herpes virus (HHV)-8 is believed to play an important role in the occurrence of Kaposi's sarcoma. A 57-year-old man presented with hyperpigmented patches on the right lower leg for 2 months. The patient received a kidney transplantation 19 years ago and has taken immunosuppressants since then. He had undergone a percutaneous coronary intervention twice, and his right lower leg was swollen for a year. We performed a skin biopsy on the right lower leg. Histopathological examination showed neovascularization and vascular dilatation in the dermis with perivascular proliferation of spindle cells. Immunohistochemistry revealed positive findings for CD31 and CD34. An HHV-8 test using polymerase chain reaction (PCR) showed positive findings. We report an interesting case of Kaposi's sarcoma presenting as hyperpigmented patches with percutaneous coronary intervention-induced lymphedema in an immunosuppressed patient.
Subject(s)
Humans , Middle Aged , Biopsy , Dermis , Dilatation , Endothelial Cells , Herpesvirus 8, Human , Immunohistochemistry , Immunosuppressive Agents , Kidney Transplantation , Leg , Lymphatic Vessels , Lymphedema , Percutaneous Coronary Intervention , Polymerase Chain Reaction , Sarcoma, Kaposi , SkinABSTRACT
No abstract available.
Subject(s)
Aged , Humans , Male , Biopsy , Chemotherapy, Adjuvant , Colectomy , Colonic Neoplasms/pathology , Liposarcoma/pathology , Neoplasms, Second Primary/pathology , Radiotherapy, Adjuvant , Retroperitoneal Neoplasms/pathology , Time Factors , Tomography, X-Ray Computed , Treatment OutcomeABSTRACT
Clear cell acanthoma (CCA) is an asymptomatic benign lesion of unknown origin that typically appears as a brownish, dome-shaped papule on the leg. It has an unusual clinical feature in that it appears as chronic eczema, Bowen disease, or Paget disease on the areola. Its histopathologic findings are well-demarcated psoriasiform acanthosis with pale keratinocytes (clear cells) that are rich in intracellular glycogen, which stain positively with Periodic acid-Shiff. We report herein on a young female patient with CCA on the areolar areas.
Subject(s)
Female , Humans , Acanthoma , Bowen's Disease , Eczema , Glycogen , Keratinocytes , Leg , NipplesABSTRACT
A 2-year-old girl presented with a month history of a tender, erythematous pyramidal protrusion on the perineum, anterior to the anus. She had suffered painful defecation due to the protrusion, but had no history of constipation. The family history was negative, and physical examination showed no evidence of associated anal fissuring or skin atrophy. Histological examination revealed epidermal hyperplasia, dermal edema, and hemorrhage with inflammatory cell infiltration. The patient was treated with a CO2 laser to relieve painful defecation. Infantile perianal pyramidal protrusion (IPPP) is characterized by a solitary protrusion observed in the perineal and perianal area. Since IPPP is predominantly observed in female children in the perineal area, it can be misdiagnosed as sexual abuse, anogenital warts, or hemorrhoids. The disease is generally benign and may resolve spontaneously, with the exception of the lichen sclerosus-associated type. Physicians should be aware of IPPP to make an accurate diagnosis.