Emerging Ethical Issues in Managing Real World Data / 대한의료정보학회지

No abstract available.

A Case of Achieving Complete Remission with Combination of Sorafenib and Tegafur in Patients with Hepatocellular Carcinoma with Progression of Disease after Sorafenib Therapy

Sorafenib is the only approved targeted agent as the first line systemic therapy for treatment of advanced hepatocellular carcinoma (HCC). However, the improvement of survival duration under 3 months is far from clinical satisfactory and most patients experience disease progression within 6 months after sorafenib therapy. Unfortunately, second line systemic therapy after treatment failure of sorafenib was not established and there were no clear guidelines for salvage treatment modalities. Recently, studies suggests that combination of sorafenib and single cytotoxic agent can be relatively effective and safe strategy that achieves promising rates of local and systemic control in advanced HCC patients. Based on above suggestions, we herein offer our experience of a case achieved complete remission by combination therapy of sorafenib and tegafur in the patient with progressed disease after sorafenib therapy.

A Survey of Stereotactic Body Radiotherapy in Korea / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: The purpose of this study is to investigate the current status of stereotactic body radiotherapy (SBRT) in Korea. A nationwide survey was conducted by the Korean Stereotactic Radiosurgery Group of the Korean Society for Radiation Oncology (KROG 13-13). MATERIALS AND METHODS: SBRT was defined as radiotherapy with delivery of a high dose of radiation to an extracranial lesion in < or = 4 fractions. A 16-questionnaire survey was sent by e-mail to the chief of radiation oncology at 85 institutions in June 2013. RESULTS: All institutions (100%) responded to this survey. Of these, 38 institutions (45%) have used SBRT and 47 institutions (55%) have not used SBRT. Regarding the treatment site, the lung (92%) and liver (76%) were the two most common sites. The most common schedules were 60 Gy/4 fractions for non-small cell lung cancer, 48 Gy/4 fractions for lung metastases, 60 Gy/3 fractions for hepatocellular carcinoma, and 45 Gy/3 fractions or 40 Gy/4 fractions for liver metastases. Four-dimensional computed tomography (CT) was the most common method for planning CT (74%). During planning CT, the most common method of immobilization was the use of an alpha cradle/vacuum-lock (42%). CONCLUSION: Based on this survey, conduct of further prospective studies will be needed in order to determine the appropriate prescribed doses and to standardize the practice of SBRT.

Phospholipase D inhibitor enhances radiosensitivity of breast cancer cells

Radiation and drug resistance remain the major challenges and causes of mortality in the treatment of locally advanced, recurrent and metastatic breast cancer. Dysregulation of phospholipase D (PLD) has been found in several human cancers and is associated with resistance to anticancer drugs. In the present study, we evaluated the effects of PLD inhibition on cell survival, cell death and DNA damage after exposure to ionizing radiation (IR). Combined IR treatment and PLD inhibition led to an increase in the radiation-induced apoptosis of MDA-MB-231 metastatic breast cancer cells. The selective inhibition of PLD1 and PLD2 led to a significant decrease in the IR-induced colony formation of breast cancer cells. Moreover, PLD inhibition suppressed the radiation-induced activation of extracellular signal-regulated kinase and enhanced the radiation-stimulated phosphorylation of the mitogen-activated protein kinases p38 and c-Jun N-terminal kinase. Furthermore, PLD inhibition, in combination with radiation, was very effective at inducing DNA damage, when compared with radiation alone. Taken together, these results suggest that PLD may be a useful target molecule for the enhancement of the radiotherapy effect.

Effects of White Radish (Raphanus sativus) Enzyme Extract on Hepatotoxicity

Raphanus sativus (Cruciferaceae), commonly known as radish is widely available throughout the world. From antiquity it has been used in folk medicine as a natural drug against many toxicants. The present study was designed to evaluate the hepatoprotective activity of radish (Raphanus sativus) enzyme extract (REE) in vitro and in vivo test. The IC50 values of REE in human liver derived HepG2 cells was over 5,000 microg/ml in tested maximum concentration. The effect of REE to protect tacrine-induced cytotoxicity in HepG2 cells was evaluated by MTT assay. REE showed their hepatoprotective activities on tacrine-induced cytotoxicity and the EC50 value was 1,250 microg/ml. Silymarin, an antihepatotoxic agent used as a positive control exhibited 59.7% hepatoprotective activitiy at 100 microg/ml. Moreover, we tested the effect of REE on carbon tetrachloride (CCl4)-induced liver toxicity in rats. REE at dose of 50 and 100 mg/kg and silymarin at dose of 50 mg/kg were orally administered to CCl4-treated rats. The results showed that REE and silymarin significantly reduced the elevated levels of serum enzyme markers induced by CCl4. The biochemical data were supported by evaluation with liver histopathology. These findings suggest that REE, can significantly diminish hepatic damage by toxic agent such as tacrine or CCl4.

Effect of Microalgal Extracts of Tetraselmis suecica against UVB-Induced Photoaging in Human Skin Fibroblasts

Exposure of cells to ultraviolet B (UVB) radiation can induce production of free radicals and reactive oxygen species (ROS), which damage cellular components. In addition, these agents can stimulate the expression of matrix metalloproteinase (MMP) and decrease collagen synthesis in human skin cells. In this study, we examined the anti-photoaging effects of extracts of Tetraselmis suecica (W-TS). W-TS showed the strongest scavenging activity against 2,2-difenyl-1-picrylhydrazyl (DPPH) and peroxyl radicals, followed by superoxide anions from the xanthine/xanthine oxidase system. We observed that the levels of both intracellular ROS and lipid peroxidation significantly increased in UVB-irradiated human skin fibroblast cells. Furthermore, the activities of enzymatic antioxidants (e.g., superoxide dismutase) and the levels of non-enzymatic antioxidants (e.g., glutathione) significantly decreased in cells. However, W-TS pretreatment, at the maximum tested concentration, significantly decreased intracellular ROS and malondialdehyde (MDA) levels, and increased superoxide dismutase and glutathione levels in the cells. At this same concentration, W-TS did not show cytotoxicity. Type 1 procollagen and MMP-1 released were quantified using RT-PCR techniques. The results showed that W-TS protected type 1 procollagen against UVB-induced depletion in fibroblast cells in a dose-dependent manner via inhibition of UVB-induced MMP-1. Taken together, the results of the study suggest that W-TS effectively inhibits UVB-induced photoaging in skin fibroblasts by its strong anti-oxidant ability.

Absorbed Dose Determination for a Biological Sample Irradiated by Gamma Rays from a Cs-137 Source / 의학물리

In this study the dosimetric evaluation for a biological sample irradiated by gamma rays from Cs-137 irradiator (Gamma Irradiator, Chiyoda Technol Co., Japan) was performed for radiobiological experiment. A spherical water with a diameter of 3 cm was assumed as a biological sample. The absorbed dose were determined by the air kerma based dosimetric calculation system. The theoretical and Monte Carlo calculations (MCNPX) were performed and compared to evaluate measured air kerma and determined absorbed dose respectively. As a result of comparison with theoretical calculation, the measured air kerma was in good agreement within 3.1% at the distance of 100 and 200 cm from the source. In comparison with Monte Carlo results the determined absorbed dose along the central axis was in good agreement within 1.9% and 3.7% at 100 cm and 200 cm respectively. Although the preliminary results were obtained in this study these results were used as a basis of dosimetric evaluation for radiobiological experiment. Extended study will be performed to evaluate the dose in various conditions of biological samples.

Stereotactic Body Radiotherapy for Isolated Para-aortic Lymph Node Recurrence after Curative Resection in Gastric Cancer

The aim of this study was to investigate whether stereotactic body radiotherapy (SBRT) can salvage gastric cancer patients with para-aortic lymph node (PALN) recurrence. From January 2003 to December 2006, 7 patients were treated for isolated PALN recurrence from gastric cancer after curative resection. Follow up durations ranged from 19 to 33 months (median; 26 months), and SBRT doses from 45 Gy to 51 Gy (median 48 Gy) in 3 fractions. Disease progression-free and overall survivals and toxicities were recorded. Response to treatment was assessed by computed tomography. Final patient outcomes were as follows: 2 were alive without evidence of disease, 3 remained alive with disease, and 2 patients died of disease. Five of 7 patients showed complete response and 2 patients partial response between 3 and 11 months after SBRT. Three-year overall and disease progression-free survival rates post-SBRT were 43% and 29%, respectively. No severe complication was detected during follow-up. Selected patients with isolated PALN recurrence can be salvaged by SBRT without severe complications.

Stereotactic Body Radiotherapy for Isolated Para-aortic Lymph Node Recurrence after Curative Resection in Gastric Cancer

The aim of this study was to investigate whether stereotactic body radiotherapy (SBRT) can salvage gastric cancer patients with para-aortic lymph node (PALN) recurrence. From January 2003 to December 2006, 7 patients were treated for isolated PALN recurrence from gastric cancer after curative resection. Follow up durations ranged from 19 to 33 months (median; 26 months), and SBRT doses from 45 Gy to 51 Gy (median 48 Gy) in 3 fractions. Disease progression-free and overall survivals and toxicities were recorded. Response to treatment was assessed by computed tomography. Final patient outcomes were as follows: 2 were alive without evidence of disease, 3 remained alive with disease, and 2 patients died of disease. Five of 7 patients showed complete response and 2 patients partial response between 3 and 11 months after SBRT. Three-year overall and disease progression-free survival rates post-SBRT were 43% and 29%, respectively. No severe complication was detected during follow-up. Selected patients with isolated PALN recurrence can be salvaged by SBRT without severe complications.

A Comparison of Outcomes for the Patients with Pathologically Node-negative Breast Cancer and Who Were Treated Either with Sentinel Lymph Node Biopsy Only or with Conventional Axillary Lymph Node Dissection / 한국유방암학회지

PURPOSE: False negative results obtained with the use of a sentinel lymph node biopsy (SLNB) can result in down staging of tumors, whereas the use of a more elaborated pathological examination of sentinel lymph nodes might lead to upstaging of tumors. The purpose of this study was to compare results after performing only an SLNB as compared with performing conventional axillary lymph node dissection (ALND) without an SLNB in pathologically node negative (pN0) breast cancer patients. METHODS: From April 2004 to June 2007, SLNBs were performed for patients with primary breast cancer who had no clinical evidence of a lymph node metastasis. A total of 272 patients were treated with only an SLNB. During the same period, 278 patients were confirmed as pN0 after conventional ALND without an SLNB. A prospectively collected database and medical records of these patients were reviewed. RESULTS: For patients that had undergone only an SLNB, there was no local or regional recurrence. A distant metastasis developed in four patients (1.5%). In patients that had undergone ALND without an SLNB, a recurrence was found in 13 patients (4.7%). Patients that had undergone only an SLNB showed significantly better disease-free survival as compared to patients that had undergone ALND without an SLNB (p=0.032). CONCLUSION: pN0 patients treated with only an SLNB showed a significantly better outcome as compared to patients treated with conventional ALND without an SLNB. These results suggest that performing an SLNB might result in the upstaging of a subset of patients who would have been understaged by the use of conventional ALND.

The Usefulness of 18F-FDG PET/CT for Predicting the Response of Locally Advanced Rectal Cancer to Neoadjuvant Chemoradiation Therapy / 대한방사선종양학회지

PURPOSE: This study aimed at assessing the value of fluorine-18 fluorodeoxyglucose positron emission tomography (18F-FDG PET) for predicting the response of locally advanced rectal cancer to neoadjuvant CRT. MATERIALS AND METHODS: Between August 2006 and January 2008, we prospectively enrolled 20 patients with locally advanced rectal cancer and who were treated with neoadjuvant CRT at the Korea Institute of Radiological and Medical Sciences. The treatment consisted of radiation therapy and chemotherapy, and this was followed by curative resection 6 weeks later. All the patients underwent 18F-FDG PET/CT both before CRT and 6 weeks after completing CRT. The measurements of the FDG uptake (SUV(max)), the absolute difference (DeltaSUV(max)) and the percent SUV(max) difference (response index, RI(SUV)) between the pre- and post-CRT 18F-FDG PET/CT scans were assessed. The measurements of the metabolic volume, the absolute difference (Delta metabolic volume) and the percent metabolic volume difference (response index, RI(metabolic volume)) were also assessed. RESULTS: Of the 20 patients who underwent surgery, 11 patients (55%) were classified as responders according to Dworak's classification. The post-CRT SUV(max) was significantly lower than the pre-CRT SUV(max). However, there were no significant differences in the SUV(max) and the metabolic volume reduction between the responders and non-responders. We used a minimum SUV(max) reduction of 67% as the cut-off value for defining a response, with a sensitivity of 45.5%, a specificity of 88.9%, a positive predictive value of 77% and a negative predictive value of 53.8%. CONCLUSION: Although there were no statistically significant results in this study, other studies have revealed that 18F-FDG PET/CT has the potential to assess the tumor response to neoadjuvant CRT in patients with locally advanced rectal cancer.

Distortion of the Dose Profile in a Three-dimensional Moving Phantom to Simulate Tumor Motion during Image-guided Radiosurgery / 대한방사선종양학회지

PURPOSE: Respiratory motion is a considerable inhibiting factor for precise treatment with stereotactic radiosurgery using the CyberKnife (CK). In this study, we developed a moving phantom to simulate three-dimensional breathing movement and investigated the distortion of dose profiles between the use of a moving phantom and a static phantom. MATERIALS AND METHODS: The phantom consisted of four pieces of polyethylene; two sheets of Gafchromic film were inserted for dosimetry. Treatment was planned to deliver 30 Gy to virtual tumors of 20, 30, 40, and 50 mm diameters using 104 beams and a single center mode. A specially designed robot produced three-dimensional motion in the right-left, anterior-posterior, and craniocaudal directions of 5, 10 and 20 mm, respectively. Using the optical density of the films as a function of dose, the dose profiles of both static and moving phantoms were measured. RESULTS: The prescribed isodose to cover the virtual tumors on the static phantom were 80% for 20 mm, 84% for 30 mm, 83% for 40 mm and 80% for 50 mm tumors. However, to compensate for the respiratory motion, the minimum isodose levels to cover the moving target were 70% for the 30~50 mm diameter tumors and 60% for a 20 mm tumor. For the 20 mm tumor, the gaps between the isodose curves for the static and moving phantoms were 3.2, 3.3, 3.5 and 1.1 mm for the cranial, caudal, right, and left direction, respectively. In the case of the 30 mm tumor, the gaps were 3.9, 4.2, 2.8, 0 mm, respectively. In the case of the 40 mm tumor, the gaps were 4.0, 4.8, 1.1, and 0 mm, respectively. In the case of the 50 mm diameter tumor, the gaps were 3.9, 3.9, 0 and 0 mm, respectively. CONCLUSION: For a tumor of a 20 mm diameter, the 80% isodose curve can be planned to cover the tumor; a 60% isodose curve will have to be chosen due to the tumor motion. The gap between these 80% and 60% curves is 5 mm. In tumors with diameters of 30, 40 and 50 mm, the whole tumor will be covered if an isodose curve of about 70% is selected, equivalent of placing a respiratory margin of below 5 mm. It was confirmed that during CK treatment for a moving tumor, the range of distortion produced by motion was less than the range of motion itself.

The Clinicopathologic Characteristics of Breast Carcinoma associated with Nipple Discharge / 한국유방암학회지

PURPOSE: Breast carcinoma presenting with nipple discharge is not uncommon. However, few studies have addressed the clinicopathological characteristics and optimal surgical management of breast carcinoma with nipple discharge. The aims of this study were to determine the clinicopathologic characteristics of breast carcinoma that presents with nipple discharge and the feasibility of breast conservation for these patients. METHODS: We retrospectively reviewed the medical records of the patients with breast carcinoma who presented with nipple discharge and who also underwent curative surgery at Korea Cancer Center Hospital between January 1999 and December 2003. RESULTS: During the study periods, 40 of 1,442 (2.7%) breast cancer patients presented with nipple discharge, and among them, 28 (70%) patients were accompanied by a palpable breast mass. Their median age was 44 yr. Thirty-seven (93%) patients were treated with mastectomy and only 3 (7%) patients were treated with breast conservation. Eleven patients had ductal carcinoma in situ, 17 had stage I disease, 8 had stage II disease and 4 had stage III disease. On the pathologic evaluation, multifocality or multicentricity were found in 7 of 37 (19%) mastectomy specimens, and occult nipple-areola complex (NAC) involvement was found in 3 (8%) cases. In 23 of 37 (62%) mastectomy specimens, we didn't find any evidence of extensive disease (stage III, multicentricity or multifocality or occult NAC involvement) that may preclude breast conservation. Locoregional recurrence was not detected in any of these cases, and 37 of 40 patients are free of disease with a median follow-up of 55 months. CONCLUSION: In this retrospective study, we found that 23 of 37 (62%) women with breast carcinoma associated with nipple discharge and who also underwent mastectomy had no evidence of extensive disease. Thus, we suggest that breast conservation can be done for these patients with performing careful patient selection and appropriate adjuvant therapy.

CyberKnife for the Treatment of Nonmetastatic Prostate Cancer: Preliminary Results / 대한비뇨기과학회지

Purpose: Herein is reported our initial experience of the CyberKnife to show its safety and feasibility as a treatment modality for non-metastatic prostate cancer. Materials and Methods: Twenty patients, with biopsy-proven prostate cancers, were recruited into a phase I clinical trial using the CyberKnife. The distribution of clinical risks, as assessed using the ASTRO criteria, was as follows: low (4), intermediate (5) and high (11). The mean age and follow up of the patients were 71.4 years and 15 months, respectively. The patients received 7.5-9Gy of radiation in a single fraction for 4-5 days. The total radiation dose to the prostate was 34-37.5Gy, which approximates to 86.4Gy in 2Gy fractions. The rectal and bladder acute toxicities were graded using the criteria of the Radiation Therapy Oncology Group (RTOG). The results of acute toxicities were compared to those of the historical control, which had been treated with conventional four field box techniques (received median dose 70.2Gy). The prostate-specific antigen (PSA)- based short-term efficacy was described. Results: The acute rectal toxicity scores were 0, 1 and 2 in 13, 5, and 2 patients, respectively. The acute bladder toxicity scores were 0, 1 and 2 in 16, 3 and 1 patient, respectively. No grade 3 or 4 acute toxicity was noted. These figures contrast sharply with those found for the historical control. All toxicities spontaneously subsided within 3 months after treatment. Continuous PSA reduction was noted in all patients, and no PSA failure was noted during the follow up period. Conclusions: Our data show the feasibility of the CyberKnife in terms of its efficacy and acute toxicity. Moreover, the capability of using a hypo-fractionation schedule lead to marked improvement in patient convenience, with substantial resource savings.

Internet Based Multi-institute Prostate Research System: Pilot Experience with a Convenient, Secure and Efficient System / 대한비뇨기과학회지

PURPOSE: The process of transferring data from one medical center to another and sharing the results can be time-consuming and inconvenient. So, we introduce the multi-institutional clinical research that uses the Internet for conducting faster, safer and more convenient research. MATERIALS AND METHODS: Patients with benign prostatic hyperplasia (BPH) were prospectively enrolled from 3 remote participating medical centers by means of the Internet. When a patient with BPH came to the hospital, the BPH profile, medications and adverse events were entered into the Internet Based Multi-institute Prostate Research System (IBMPRS). Six investigators were educated on the use of the IBMPRS and we measured the mean data entering time and the user satisfaction. RESULTS: 763 patients with BPH from three institutions were enrolled and their data was collected through the Internet for 1 year. It took an average of 2 minutes 43 seconds to enter the information of one patient. All the investigators were satisfied about the IBMPRS and the system was very stable and safe. CONCLUSIONS: An Internet-based clinical research system has the advantage of being able to instantly share patient information and full-time access to the interim results is available if a large number of institutions participate in the clinical research. Clinical research using the Internet would be an invaluable method that is free to use with easy accessibility, and it could play the role of an excellent secretary on the web.

Contralateral Testicular Single Metastasis from Renal Cell Carcinoma / 대한비뇨기과학회지

Approximately one-third of all patients with renal cell carcinoma have metastases at the time of diagnosis. Metastasis of renal cell carcinoma (RCC) to the testis is a rare finding. The cases of testicular metastasis from renal cell carcinoma that have been reported in the literature are predominantly ipsilateral, and they are invariably found on the left side through the retrograde venous spread along the gonadal artery. We experienced a case of contralateral testicular metastasis from a right side renal cell carcinoma, so we discuss the clinical feature and pathophysiology of this case with a review of the related literature.

Locally Advanced, Unresectable Pancreatic Cancer Treated by Stereotactic Radiation Therapy / 대한방사선종양학회지

PURPOSE: In order to find out whether stereotactic radiation therapy (RT) using CyberKnife (CK) could improve survival rate and lower acute toxicity compared to conventional RT. MATERIALS AND METHODS: From April 2003 through April 2004, 19 patients with Eastern Cooperative Oncology Group (ECOG) performance status 80 cc (p-value80 cc showed better survival rate. CONCLUSION: In terms of survival, the efficacy of stereotactic radiation therapy using CK was found to be superior or similar to other recent studies achieved with conventional RT with intensive chemotherapy, high dose conformal RT, intraoperative RT (IORT), or intensity modulated RT (IMRT). Furthermore, severe toxicity was not observed. Short treatment time in relation to the short life expectancy gave patients more convenience and, finally, quality of life would be increased. Consequently, this could be regarded as an effective novel treatment modality for locally advanced, unresectable pancreas cancer. PTV would be a helpful prognostic factor for CK.

The Clinicopathological Factors That Determine a Local Recurrence of Rectal Cancers That Have Been Treated with Surgery and Chemoradiotherapy / 대한방사선종양학회지

PURPOSE: To evaluate the pathological prognostic factors related to local recurrence after radical surgery and adjuvant radiation therapy in advanced rectal cancer. MATERIALS AND METHODS: Fifty-four patients with advanced rectal cancer who were treated with radical surgery followed by adjuvant radiotherapy and chemotherapy between February 1993 and December 2001 were enrolled in this study. Among these patients, 14 patients experienced local recurrence. Tissue specimens of the patients were obtained to determine pathologic parameters such as histological grade, depth of invasion, venous invasion, lymphatic invasion, neural invasion and immunohistopathological analysis for expression of p53, Ki-67, c-erb, ezrin, c-met, phosphorylated S6 kinase, S100A4, and HIF-1 alpha. The correlation of these parameters with the tumor response to radiotherapy was statistically analyzed using the chi-square test, multivariate analysis, and the hierarchical clustering method. RESULTS: In univariate analysis, the histological tumor grade, venous invasion, invasion depth of the tumor and the over expression of c-met and HIF-1 alpha were accompanied with radioresistance that was found to be statistically significant. In multivariate analysis, venous invasion, invasion depth of tumor and over expression of c-met were also accompanied with radioresistance that was found to be statistically significant. By analysis with hierarchical clustering, the invasion depth of the tumor, and the over expression of c-met and HIF-1 alpha were factors found to be related to local recurrence. Whereas 71.4% of patients with local recurrence had 2 or more these factors, only 27.5% of patients without local recurrence had 2 or more of these factors. CONCLUSION: In advanced rectal cancer patients treated by radical surgery and adjuvant chemo-radiation therapy, the poor prognostic factors found to be related to local recurrence were HIF-1 alpha positive, c-met positive, and an invasion depth more than 5.5 mm. A prospective study is necessary to confirm whether these factors would be useful clinical parameters to measure and predict a radio-resistance group of patients.

The Prognosis of Breast Cancer Patients with 10 or more Positive Lymph Nodes / 한국유방암학회지

PURPOSE: According to the staging system for breast cancer by the 2003 revised American Joint Committee on Cancer (AJCC), the patients with 10 or more positive axillary nodes are classified as N3 and also as a new stage, i.e., stage IIIC. The aim of this study was to investigate the prognosis of patients with 10 or more positive nodes. METHODS: The database of 125 patients with 10 or more positive axillary nodes who underwent surgery at Korea Cancer Center Hospital between 1997 and 2001 were reviewed. The age of the patients, the T stage, the number and site of the positive nodes, the hormone receptor status, the HER-2 over-expression, and the treatment modalities were examined in reference to the disease-free survival (DFS). RESULTS: At the median follow-up time of 40 months, 16 cases (13%) of locoregonal recurrence and 57 cases (46%) of systemic relapse had developed in 67 patients (54%). The DFS and overall survival rates at 5 years were 46% and 55%, respectively. On univariate analysis, the T stage (p<0.001), hormone receptor status (p=0.001), and neoadjuvant chemotherapy (p=0.014) were predictive factors of recurrence. On multivariate analysis, the T stage (p=0.002) and hormone receptor status (p=0.02) were independent predictors of recurrence. The patients with hormone receptor positive tumor had a 58%, 5-year DFS rate. On the contrary, in 9 of 10 patients with T4 tumor, recurrence developed within 2 years after the initial treatment. CONCLUSIONS: This study showed that stage IIIC according to the revised AJCC staging system was not a prognostically homogeneous group. Some notably high survival rates were observed in a subgroup of patients, and especially for those patients with hormone receptor positive tumor. In contrast, the prognosis of patients with T4 tumor was significantly worse than that of the patients with the other stage IIIC disease. Thus, we suggest that the stage IIIC group in the new AJCC staging system needs to be refined to provide more reliable prognostic information for the patients with advanced breast cancer.

Transperitoneal Laparoscopic Removal of Adrenal Ganglioneuroma / 대한비뇨기과학회지

Ganglioneuroma is generally considered to be a benign tumor arising from neural crest tissue. An adrenal ganglioneuroma is located within the substance of the adrenal medulla or along the sympathetic chain, thus may secrete catecholamines, and present with endocrine symptoms. However, nonfunctional growths remain silent until they reach a large size, and are usually discovered incidentally. Complete surgical excision of adrenal ganglioneuroma is the treatment of choice, and especially a laparoscopic adrenalectomy can be performed safely, and is an ideal substitute to an open procedure, with the added benefits associated with minimally invasive surgery. Herein, we report a case of an incidentally discovered adrenal ganglioneuroma.