A Comparison between Asia-Pacific Region Criteria and Entropy Model Criteria about Body Mass Index of Elderly Females Using Morbidity of Chronic Disease / 대한지역사회영양학회지

OBJECTIVES: This study was conducted to propose the need of re-establishing the criteria of the body weight classification in the elderly. We compared the Asia-Pacific Region Criteria (APR-C) with Entropy Model Criteria (ENT-C) using Morbidity rate of chronic diseases which correlates significantly with Body Mass Index (BMI). METHODS: Subjects were 886 elderly female participating in the 2007-2009 Korea National Health and Nutrition Examination Survey (KNHANES). We compared APR-C with those of ENT-C using Receiver Operating Characteristics (ROC) curve and logistic regression analysis. RESULTS: In the case of the morbidity of hypertension, the results were as follows: Where it was in the T-off point of APR-C, sensitivity was 67.5%, specificity was 43.1%, and Youden's index was 10.6. While in the cut-off point of ENT-C, it was 56.7%, 56.6%, and 13.3 respectively. In the case of the morbidity of diabetes, the results were as follows: In the cut-off point of APR-C, Youden's index was 14.2. While in the cut-off point of ENT-C, it was 17.2 respectively. The Area Under the ROC Curve (AUC) of the subjects who had more than 2 diseases among hypertension, diabetes, and dyslipidemia was 0.615 (95% CI: 0.578-0.652). Compared to the normal group, the odds ratio of the hypertension group which will belong to the overweight or obesity was 1.79 (95% CI: 1.30-2.47) in the APR-C, and 2.04 (95% CI: 1.49-2.80) in the ENT-C (p > 0.001). CONCLUSIONS: We conclude that the optimal cut-off point of BMI to distinguish between normal weight and overweight was 24 kg/m2 (ENT-C) rather than 23 kg/m2 (APR-C).

Thoracic Radiotherapy Combined with Chemotherapy in Patients with Limited-stage Small-cell Lung Cancer

PURPOSE : We evaluated the optimal combination of thoracic radiotherapy with chemotherapy in patients with limited-stage small cell lung cancer (L-SCLC). MATERIALS AND METHODS : We retrospectively analyzed the data of 95 patients with L-SCLC who completed the planned thoracic radiotherapy combined with chemotherapy between January 1998 and March 2004. Thoracic radiotherapy was done with conventional fractionation to the median dose of 60Gy. Radiotherapy was combined with chemotherapy concurrently (n=67), alternating (n=19), or sequentially (n=9). Chemotherapy consisted of EP or EC (etoposide 100 mg/m2, cisplatin 60 mg/m2 or carboplatin 5~6xAUC ). The median cycle of chemotherapy was 6 with the range of 2 to 8. RESULTS : The median survival of all 95 patients was 20 months and 2-, 3-, and 5-year overall survival rate was 39%, 26%, and 19%, respectively. Radiation dose above 55 Gy did not show better survival result than dose below 55 Gy (p=0.59). The median survival and 5-year survival rate of 67 patients with concurrent chemoradiation was 23 months and 24% while those of 28 patients with alternating or sequential chemoradiation was 16 months and 8%, respectively (p=0.007). Concurrent thoracic radiotherapy combined after 2 cycles of chemotherapy showed the best survival results among the combination methods (p=0.29). The survival was improved in patients with chemotherapy more than 5 cycles comparing to patients with less than 5 (p=0.03). Patients with PCI showed the median survival of 43 months and 5-year survival rate of 35% vs. 18 months and 16% in patients without PCI, respectively (p=0.02). In multivariate analysis, the concurrent chemoradiation was the only significant prognostic factor affecting to the survival. CONCLUSION : Concurrent chemoradiation after 2 cycles of chemotherapy showed the best survival results in our study group. Full dose of chemotherapy to 6 cycles needed to be proceeded in tolerable patients. PCI can be recommended to the patients with complete response after chemoradiation

A Case of Pulmonary Thromboembolism Developed during Chemotherapy with Gemcitabine and Cisplatin for NonsmallCell Lung Cancer : A case report

Lung cancer patients have increased risk of thromboembolism (TE) due to various factors such as by hypercoagulability, tumor thrombosis, decrease of ambulation, and chemotherapy etc. Among these factors, chemotherapy associated TEs have been reported, although the causes and pathomechanisms of TEs were not clear. Recently, reports proposed the potential role of platelets in endothelial damage by the chemotherapeutic agents. We have experienced a case of pulmonary TE after systemic chemotherapy with gemcitabine and cisplatin. The patient complained aggravated exertional dyspnea after chemotherapy and diagnosed as pulmonary TE by computerized tomogram. After anticoagulation and interruption of the chemotherapy, improvement of exertional dyspnea and resolution of the pulmonary TE were observed

Carotid Intima-Media Thickness Measurement in Obese Children / 소아과

PURPOSE: The aim of the present study was to ascertain whether the increase of carotid intima- media thickeness (cIMT) as one of premature pathologic changes of atherosclerosis, was present in obese children compared to normal weight children. METHODS: The obese group consisted of 21 obese/overweight (body mass index (BMI) above 85 percentile of age, sex standards) children and the control group of 11 normal weight children. None of the children had any chronic illnesses or previous medication history. We investigated the age, sex, height, weight, and systolic/diastolic blood pressure. We measured cIMT by ultrasonogram. In 19 of the obese group, we tested the serum glucose level, liver transaminase level, and cholesterol level etc. RESULTS: The increase of cIMT in obese group did not achieved statistical significance (obese group vs. control group; 0.42 vs. 0.40 mm, P=0.0592). In addition, cIMT showed no significant correlation with any physical/laboratory variables including BMI (P=0.0585). CONCLUSION: To our knowledge, this is the first study to measure the cIMT in Korean children. Though the results approached statistical significance, we could not prove an increase of cIMT in obese children or an association between cIMT and BMI, due to the study's small sample size. In the future, larger and more extensive trials are needed.

Results of Curative Radiation Therapy with or without Chemotherapy for Stage III Unresectable Non-Small Cell Lung Cancer / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: We retrospectively analyzed the patients who received curative radiotherapy for unresectable stage III NSCLC to investigate the impact of chemotherapy. MATERIALS AND METHODS: From 1998 to 2001, the records of 224 patients who completed curative radiotherapy for NSCLC were reviewed. There were 210 males and 14 females, and their median age was 64 years (range 38 ~83). 54 patients had stage IIIA disease and 170 patients had stage IIIB disease. Conventional radiotherapy was given and the radiation dose ranged from 50~70 Gy with a median of 60 Gy, and chemotherapy was combined for 116 patients (52%). RESULTS: The median survival, the 2-year, and 5-year actuarial survival rates of all 224 patients were 15 months, 30%, and 7%, respectively. The median survival of the patients with stage IIIA and IIIB disease were 21 months and 13 months, respectively (p=0.14). The median survival of patients who received chemoradiation was 18 months compared to 14 months for the patients who received RT alone (p=0.02). Among the chemoradiation group of patients, the median survival time of the patients who received 1 to 3 cycles of chemotherapy was 16 months and that for the patients who received more than 3 cycles was 22 months (p=0.07). We evaluated the effects of the timing of chemoradiation in 57 patients who received more than 3 cycles of chemotherapy. The median survival of the patients with the concurrent sequence was 25 months and that for the patients with the sequential chemotherapy was 19 months (p=0.81). CONCLUSIONS: For advanced stage III non-small cell lung cancer patients who completed the curative radiotherapy, the addition of chemotherapy improved the survival compared to the patients who received radiotherapy alone.

A Retrospective Review of Tracheobronchial Foreign Bodies / 결핵및호흡기질환

BACKGROUND: The development of bronchoscopic equipment along with the precision of radiographic techniques had reduced the mortality rate of patients with tracheobronchial foreign bodies but has been no change in the incidence of tracheobronchial foreign bodies since their introduction. The aim of this study was to assess the clinical characteristics of a tracheobronchial foreign body aspiration and to evaluate the efficacy of the treatment modality in children and adults. METHODS: This is a retrospective review of 64 patients who underwent bronchoscopic procedures for the treatment of aspirated foreign bodies from December 1994 through March 2004 at the Chonnam national university hospital. RESULTS: There were 47 males and 17 females, aged from 1 month to 78 years. Most of the patients had no underlying illness except for one patient with a cerebrovascular accident that contributed to the foreign body aspiration. The most common symptom was cough, which was noted in 54 patients (84.3%). The other presenting symptoms were dyspnea (48.8%), fever (20.3%), sputum (14%), vomiting (7.8%), and chest pain (4.6%). Those whose tracheobronchial foreign bodies were diagnosed more than 2 days after the aspiration (21 patients) were more likely to have pneumonia than those whose foreign bodies were diagnosed within 2 days (p=0.009). Foreign bodies were visualized in the plain chest radiographs in 12 cases (18.8%), while others showed air trapping (21, 32.8%), pneumonia (15, 23.4%), atelectasis (7, 10.9%), and normal findings (9, 14.1%). The foreign bodies were more frequently found in the right bronchial tree (36) compared with the left bronchial tree (22, p=0.04). In order to remove the foreign bodies, twenty (31.2%) cases were removed using flexible bronchoscopy, while 42 (65.6%) and 2 (3.2%) cases required rigid bronchoscopy and surgery, respectively. CONCLUSIONS: Tracheobronchial Foreign body aspiration had a bimodal age distribution in the infancy and old age around 60 years. They were found more frequently in the right bronchial tree. In addition, patients whose foreign bodies were diagnosed more than 2 days after the aspiration were more likely have a infection. Rigid bronchoscopy is the procedure of choice for uncooperative children and for those with foreign bodies lodged deeply in the small bronchial tree.

Diffuse Pulmonary Alveolar Hemorrhage and Interstitial Pneumonitis after Subcutaneous Injection of Atelocollagen for Cosmetic Purpose: Two Case Reports / 결핵

Atelocollagen have been used recently in skin and other soft tissue defect regions more than silicone fluid because of the low incidence of an immune reaction and complications. Several cases of acute pneumonitis after a subcutaneous injection of silicone have been reported. The symptoms were dyspnea, fever, chest pain and hemoptysis. Previous reports have explained the pathophysiology of acute pneumonitis to a pulmonary microembolism and cellular inflammation. We experienced two cases of an acute interstitial pneumonitis and pulmonary hemorrhage after a subcutaneous injection of atelocollagen. They were all healthy young women and complained of dyspnea, fever and blood tinged sputum. The chest radiography and computerized tomography showed a bilateral ground glass opacity in both lung fields. One case recovered completely with conservative treatment but the clinical course of the other case was aggravated to the degree that invasive positive pressure ventilation therapy was required. We report a rare case of a diffuse pulmonary alveolar hemorrhage and an interstitial pneumonitis after the subcutaneous injection of atelocollagen for cosmetic purposes.

Endobronchial Leiomyoma: Report of a Case Removed by Fiberoptic Bronchoscope

An endobronchial leiomyoma is extremely rare benign tumor of the lung. Most endobronchial leiomyomas reported in the literature have been resected by either a lobectomy or a pneumonectomy. Herein is report a case whose tumor was successfully removed using a fiberoptic bronchoscope without surgical resection. A 64-year-old female presented with a fever, and a cough with purulent sputum of 10 days duration. The bronchoscopy revealed a 1cm sized, glistening, light yellow colored mass lesion totally obstructing the orifice of the superior segment of the right lower lobe. During the bronchoscopic biopsy procedures, the mass lesion was completely removed. A diagnosis of a leiomyoma was made from a histological examination of the obtained specimen. The early diagnosis and appropriate treatment including bronchoscopic removal may prevent respiratory complications.

Endovascular Stenting as a First Choice for the Palliation of Superior Vena Cava Syndrome

To assess the effectiveness of endovascular stenting for the palliation of superior vena cava (SVC) syndrome, endovascular stent insertion was attempted in 10 patients with symptomatic occlusion of the SVC. All the patients had known malignant disease of the thorax. Eight patients had been treated previously with chemotherapy and radiotherapy (n=5), chemotherapy alone (n=2), or pneumonectomy and radiotherapy (n=1). After developing SVC syndrome, all the patients were stented before receiving any other treatment. After single or multiple endovascular stents were inserted, five of eight patients were treated with chemotherapy and radiotherapy (n=2) or chemotherapy alone (n=3). Resolution of symptoms was achieved in nine patients within 72 hr (90%). In one patient, the symptoms did not disappear until a second intervention. At follow up, symptoms had recurred in two of ten patients (20%) after intervals of 15 and 60 days. Five patients have died from their cancers, although they remained free of symptoms of SVC occlusion until death. In conclusion, endovascular stent insertion is an effective treatment for palliation of SVC syndrome. Endovascular stent insertion can be considered the first choice of treatment, due to the immediate relief of symptoms and excellent sustained symptomatic relief.

Clinical Response to Etoposide Plus Carboplatin and Topotecan Chemotherapy in Small Cell Lung Cancer / 결핵

BACKGROUND: This study assessed the efficacy and toxicity of etoposide and carboplatin(EC) combination regimen as a first line therapy for small cell lung cancer(SCLC), and determined the efficacy and toxicity of topotecan for relapsed SCLC. METHODS: One hundred and ten patients with previously untreated SCLC received etoposide(100mg/m2 i.v., day 1 to 3) and carboplatin(300mg/m2 i.v., day 1) combination chemotherapy every 3 weeks. For patients with relapsed SCLC after EC therapy, topotecan(1.5mg/m2) was administered for 5 consecutive days every 3 weeks. Response rate, survival and toxicity profiles were assessed. Response was recorded as CR(complete remission), PR(partial remission), SD(stable disease) and PD(progressive disease). RESULTS: One hundred and one patients were assessed for response to EC. Overall response rate to EC was 57.4%(CR 15.8%, PR 41.6%) with a time to progression of 10.3 months(median). The toxicity was tolerable and there was no treatment-related death. Twenty one relapsed SCLC patients were treated with topotecan. Of those who relapsed within 3 months of EC(refractory relapse, RR), 15.4%(2/13) showed PR, while of those who relapsed after 3 months(sensitive relapse, SR), 25%(2/8) exhibited PR. Grade 4 neutropenia was noted in 9.5% and 14.3% showed thrombocytopenia(G4). CONCLUSION: The EC regimen showed a moderate response rate for SCLC with minimal toxicity. The use of topotecan for relapsed SCLC warrants further investigation.

Genetic Polymorphism of Epoxide Hydrolase and GSTM1 in Lung Cancer Susceptibility of Korean Population / Journal of the Korean Cancer Association, 대한암학회지

PURPOSE: Although 80~90% of patients with lung cancer are smokers, only 11% of smokers develop lung cancer. Genetic susceptibility according to the polymorphism of the epoxide hydrolase (mEPHX) gene and homozygous deletion of GSTM1 (M1 subunit of Glutathione S transferase) was studied in this case control study. MATERIALS AND METHODS: Genomic DNA from 76 subjects with lung cancer (40 squamous cell carcinoma, 13 adenocarcinoma, 10 subtype undetermined non-small cell lung cancer, and 13 small cell lung carcinoma) and 62 age- matched controls were extracted from peripheral white blood cells. PCR and RFLP (restriction fragments length polymorphism) with restriction enzyme (RsaI) and automatic sequencing were used for mEPHX genotyping (T-->C, Tyr113His) in exon 3 and (A-->G, His139Arg) in exon 4. Looking for homozygous deletions of GSTM1, multiplex PCR with primers for the GSTM1 gene and coagulation factor V gene (as positive control) were performed. RESULTS: The age distribution between the cancer and control groups were similar (63.6 7.2 vs. 61.1 7.9 years). The lung cancer group, however, had more smokers (73.3%, 44/60) than the control group (21/54, 38.9%, p<0.001). The rate of homozygous deletion of the GSTM1 gene was significantly higher in the lung cancer group (65.8%, 50/76) than in the control group (46.8%, 29/62, p<0.05), causing the relative risk of GSTM1 deletion for lung cancer as 2.19 (95% CI: 1.10~4.35, p=0.02). Among 118 subjects whose mEPHX gene polymorphisms were studied, 62 (52.5%) subjects showed genotypes with slow enzyme activity while 45 (38.1%) showed normal enzyme activity and 11 (9.3%) showed fast enzyme activity. There was no significant difference in the distribution of mEPHX gene polymorphisms between the two groups. CONCLUSION: The homozygous deletion of the GSTM1 gene was associated with high lung cancer susceptibility, whereas the mEPHX genotype showed no significant connection with risk of lung cancer in a sample Korean population.

Pulmonary Oxalosis Caused by Aspergillus Niger Infection / 결핵

The Aspergillus species produces metabolic products that play a significant role in the destructive processes in the lung. We experie nced a case of chronic necrotizing pulmonary aspergillosis caused by an Aspergillus niger infection, which contained numerous calcium oxalate crystals in the necrotic lung tissue. A 46-year-old man, who had a history of pulmonary tuberculosis, presented with high fever, intermittent hemoptysis and pulmonary infiltrations with a cavity indicated by the chest radiograph. Despite being treated with several antibiotics and anti-tuberculosis regimens, the high fever continued. The sputum cultures yielded A. niger repeatedly, and intravenous amphotericin B was then introduced. The pathological specimen obtained by a transbron chial lung biopsy revealed numerous calcium oxalate crystals in a background of acute inflam matory exudates with no identification of the organism. Intravenous amphotericin B was con tinued at a total dose of 1600 mg, and at that time he was afebrile, although the intermittent hemoptysis continued. On the 63rd hospital day, a massive hemoptysis (about 800 mL) developed, which could not be controlled despite embolizing the left bronchial artery. He died of respiratory failure the next day. It is believed that the oxalic acid produced by A. niger was the main cause of the patient's pulmonary injury and the ensuing massive hemoptysis.

Utility of FDG-PET in Solitary Pulmonary Nodules and the Relationship Between Standardized Uptake Values of PET and Serum Glucose / 결핵

BACKGROUND: The solitary pulmonary nodule(SPN) presents a diagnostic dilemma to the physician and the patients in the our nation with high incidence of tuberculoma. We could not exclude whether the SPN was benign or malignant by the change of the size at chest radiograph and findings of chest CT. Recently, positron emission tomography(PET) have been tried as the differential diagnostic method of SPN. We evaluated the efficacy of PET for differentiating malignant from benign SPN and the relationship between standardized uptake values(SUV) of PET and serum glucose. METHODS: Between January 2001 and July 2002, sixty-one patients with pulmonary nodule were examined by the chest CT and PET. The SPN has been finally diagnosed by the transthorasic needle aspiration and biopsy, bronchoscopic biopsy, and open lung biopsy. RESULTS: Forty eight patients had a malignant nodule(23 squamous cell lung carcinoma, 16 adenocarcinoma, 9 small cell lung cancer) and thirteen patients had a benign nodule(3 tuberculoma, 9 inflammatory granuloma, 1 cryptococcosis). The mean size of malignant and benign nodule was 40.6 mm and 20.0 mm, respectively. All malignant nodules showed a marked increase in 18 fluorodeoxyglucose (FDG) uptake. Mean SUV of malignant was 9.52+/-5.20 and benign nodule was 1.61+/-3.60. There were false positive cases with an increase in 18-FDG uptake (2 tuberculoma, 1 inflammatory granuloma). The SUV of malignant nodule in diabetes patients has no difference in non diabetes patients(9.10+/-4.51 vs 9.65+/-5.46). The sensitivity and specificity of the PET scan for SPN were 100%, 77%, respectively. The positive and negative predictive values were 94% and 100%. CONCLUSION: PET scanning showed highly accurate result in differentiating the malignant and benign SPN. There were no significant differences between the SUV and serum glucose in the patients with lung cancer.

Genetic Polymorphism of Epoxide Hydrolase and GSTM1 in Chronic Obstructive Pulmonary Disease / 결핵

BACKGROUND: Although smoking is a major cause of chronic obstructive pulmonary disease (COPD), only 10-20% of cigarette smokers develop symptomatic COPD, which suggests the presence of genetic susceptibility. This genetic susceptibility to COPD might depend on variations in the activities of the enzyme that detoxify hazardous chemical products, such as microsomal epoxide hydrolase (mEPHX) and glutathione-S transferase M1 subunit (GSTM1) genes. METHODS: The genotypes of 58 patients with COPD, and 79 age matched control subjects, were determined by a polymerase chain reaction, followed by restriction fragment length polymorphism (PCR-RFLP) for the mEPHX, and multiplex PCR for the GSTM1. RESULTS: GSTM1 was deleted in 53.3% of the subjects. There was no difference in GSTM1 deletion rates between the COPD patients (32/58, 55.2%) and the control subjects (41/79, 51.9%). The combination patterns of two polymorphisms of mEPHX showed slow enzyme activity in 29(21.2%), normal in 73(53.3%) and fast in 32(23.4%). The COPD group (7/57, 12.3%) showed a significantly lower incidence of slow enzyme activity compared to the control subjects (22/77, 28.6%, p<0.05). However, when the COPD and control groups were compared with smokers only, there were no significant differences in the genotypes of GSTM1 and mEPHX. CONCLUSION: The genotypes of GSTM1 and mEPHX were not significant risk factors of COPD in this cohort of study.

Clinical Response of Docetaxel Plus Cisplatin and Paclitaxel Plus Carboplatin Chemotherpy in Non-Small Cell Lung Cancer

PURPOSE: Almost 80% of primary lung cancers are non-small cell lung cancer (NSCLC), and their prognosis is very poor since only one-fourth of patients with NSCLC present with a resectable disease at the time of diagnosis. During the last 10 years, the role of chemotherapy for NSCLC has been expanding as an adjunctive to radiation and surgery, as well as to palliative therapy for stage IV NSCLC. This study is a retrospective analysis of two chemotherapeutic regimens for the treatment of advanced NSCLC. MATERIALS AND METHODS: Between January 1999 and December 2001, 109 patients with histologically proven NSCLC (> or = stage IIIA), who received either the DP (Docetaxel 75 mg/m2 +Cisplatin 75 mg/m2, n=63, 57.8%) or the TC (Paclitaxel 175 mg/m2+ Carboplatin 5* AUC mg, n=46, 42.2%) combination chemotherapies were included. RESULTS: The patients ages ranged from 46 to 77 years, and the patients in the DP group (56.3+/-8.6 years) were younger than those in the TC group (62.1+/-8.8 years) (p0.05). Grade 3~4 peripheral neuropathy occurred in 5 patients (7.9%) in the DP group and in 8 (17.4%) in the TC group (p>0.05). CONCLUSION: The combination chemotherapies of docetaxel plus cisplatin and paclitaxel plus carboplatin are active against advanced stage NSCLC, with acceptable toxicities. As there are differences in the baseline characteristics between the two groups, no differences in survivals or response rates could be concluded.

A Case of Bronchial Glomus Tumor / 결핵

An 18-year-old female was admitted because of dyspnea at rest. A chest computed tomography (CT) scan and fiberoptic bronchoscopy demonstrated a polypoid tumor in the left main bronchus, 0.5cm distal from the carina. Surgical resection of the tumor was performed, along with. A pathological evaluation and the immunohistochemical findings led to the diagnosis of a glomus tumor, which originated from the bronchus, an area where this type of tumor has rarely been reported.

Transient Cortical Blindness: A Rare Complication of Bronchial Artery Embolization / 결핵

Bronchial artery embolization (BAE) is a well accepted and effective treatment for massive and recurrent hemoptysis. However, several complications of BAE have been reported. Cortical blindness is defined as a loss of vision caused by bilateral occipital lobe lesions with normal pupillary light reflexes and a normal fundus. The reported incidence of transient cortical blindness (TCB) after cerebrovertebral angiography is approximately 1%. Two cases of TCB after BAE were found from a Medline search. Here, we report another case of TCB who was treated with BAE for a massive hemoptysis.

Transient Cortical Blindness: A Rare Complication of Bronchial Artery Embolization / 결핵

Bronchial artery embolization (BAE) is a well accepted and effective treatment for massive and recurrent hemoptysis. However, several complications of BAE have been reported. Cortical blindness is defined as a loss of vision caused by bilateral occipital lobe lesions with normal pupillary light reflexes and a normal fundus. The reported incidence of transient cortical blindness (TCB) after cerebrovertebral angiography is approximately 1%. Two cases of TCB after BAE were found from a Medline search. Here, we report another case of TCB who was treated with BAE for a massive hemoptysis.

K-ras Gene Mutation in Non-Small Cell Lung Cancer

PURPOSE: Point mutation of the K-ras gene causes irreversible binding of GTP to the P21-ras protein, which induces nuclear transcription factors and enhances cellular proliferation. Point mutation of the K-ras gene is known to be a poor prognostic marker of an adenocarcinoma of the lung. As about 30% of adenocarcinomas harbor the K-ras mutation, studies are being undertaken trying to use the K-ras mutation as a marker for the early detection of lung cancer. In Korea, squamous cell carcinomas are more prevalent than adenocarcinomas, but the incidence of the K-ras mutation has not been properly investigated. MATERIALS AND METHODS: Using 25 surgically resected lung cancer specimens (10 squamous cell lung carcinomas, 10 adenocarcinomas and 5 non-small cell lung cancers), 25 pairs of DNA were extracted from cancerous and normal lung tissues. After PCR, with two sets of primers flanking codons 12~13 and 61 of the K-ras gene, the mutation was screened using single strand conformational polymorphism (SSCP). To verify the SSCP findings, automatic sequencing was also performed for all DNA's from the tumor and normal lung tissues. RESULTS: No samples with a band shift in SSCP were observed. In the sequencing of the 25 pairs of DNA, there were no mutations in codons 12, 13 or 61 of the K-ras gene. CONCLUSION: As there were no mutations in the K-ras codons 12, 13 and 61 in this study, the incidence of the K-ras mutation, in Korean lung cancer, may well be very low. However, further investigations on a larger population will be required, as we only studied 25 non-small cell lung cancer specimens, with only 10 adenocarcinomas.

Outcomes after Radiotherapy in Inoperable Patients with Squamous Cell Lung Cancer / 대한방사선종양학회지

PURPOSE: We evaluated retrospectively the outcomes of inoperable squamous cell lung cancer patients treated with radiotherapy to find out prognostic factors affecting survival. MATERIALS AND METHODS: Four hundred and eleven patients diagnosed as squamous cell lung cancer between November 1988 and December 1997 were the basis of this analyses. The planned dose to the gross tumor volume was ranged from 30 to 70.2 Gy. Chemotherapy was combined in 72 patients (17.5%) with the variable schedule and drug combination regimens. Follow-up period ranged from 1 to 113 months with the median of 8 months and survival status was identified in 381 patients (92.7%). Overall survival rate was calculated using the Kaplan-Meier method. RESULTS: Age ranged from 23 years to 83 years with the median 63 years. The male to female ratio was about 16:1. For all 411 patients, the median overall survival was 8 months and the 1-year survival rate (YSR), 2-YSR, and 5-YSR were 35.6%, 12.6%, and 3.7%, respectively. The median and 5-YSR were 29 months and 33.3% for Stage IA, 13 months and 6.3% for Stage IIIA, and 9 months and 3.4% for Stage IIIB, respectively( p=0.00). The median survival by treatment aim was 11 months in radical intent group and 5 months in palliative, respectively ( p=0.00). Of 344 patients treated with radical intent, median survival of patients (N=247) who received planned radiotherapy completely was 12 months while that of patients (N=97) who did not was 5 months ( p=0.0006). In the analyses of the various prognostic factors affecting to the survival outcomes in 247 patients who completed the planned radiotherapy, tumor location, supraclavicular LAP, SVC syndrome, pleural effusion, total lung atelectasis and hoarseness were statistically significant prognostic factors both in the univariate and multivariate analyses while the addition of chemotherapy was statistically significant only in multivariate analyses. The acute radiation esophagitis requiring analgesics was appeared in 49 patients (11.9%) and severe radiation esophagitis requiring hospitalization was shown in 2 patients (0.5%). The radiation pneumonitis requiring steroid medication was shown in 62 patients (15.1%) and severe pneumonitis requiring hospitalization was occurred in 2 patients (0.5%). During follow-up, 114 patients (27.7%) had progression of local disease with 10 months of median time to recur (range : 1~87 months) and 49 patients (11.9%) had distant failure with 7 months of median value (range : 1~52 months). Second malignancy before or after the diagnosis of lung cancer was appeared in 11 patients. CONCLUSION: The conventional radiotherapy in the patients with locally advanced squamous cell lung cancer has given small survival advantage over supportive care and it is very important to select the patient group who can obtain the maximal benefit and to select the radiotherapy technique that would not compromise the life quality in these patients.