The Effects of Neck Irradiation on Thyroid Gland for Tumors of the head and Neck / 대한치료방사선과학회지

Seventy-five patients with tumors of the head and neck treated with either radiation therapy alone or combined with surgery or chemotherapy were studied prospectively to evaluate the effects of radiation therapy to the neck on thyroid gland between September 1986 and October 1992. All patients were serially monitored for thyroid function tests before and after radiation therapy. Radiation dose to the thyroid gland ranged from 35 to 60 Gy with a median dose of 50 Gy. Median follow-up time was 30 months with a range of 11 to 85 months. The incidence of thyroid dysfunction was 40%; forty-five patients (60%) euthyroid, 2 patients (3%) clinical hypothyroidism, 27 patients (36%) subclinical hypothyroidism and 1 patient (1%) hyperthyroidism. No thyroid nodules or thyroid cancer were detected in any patients. Thyroid dysfunction appeared earlier in patients who underwent surgery than in those patients treated with radiation therapy alone or combination of chemotherapy and radiation therapy (p=0.0013). By multivariate analysis, risk factors that significantly influenced a higher incidence of thyroid dysfunction were female sex (p=0.0293) and combination of total larygectomy and radiation therapy (p=0.0045). In conclusion, evaluation of thyroid function before and after radiation therapy with periodic thyroid function tests are recommended to detect thyroid dysfunction in time and thyroid hormone replacement therapy is recommended whenever thyroid dysfunction develops.

The Radiotherapeutic Significance of Serum NSE Level in Non-Small Cell Lung Cancers (NSCLC) / 대한치료방사선과학회지

From December 1989 to February 1993, 108 patients with Non-Small Cell Lung Cancers(NSCLC) were studied retrospectively to evaluate radiotherapeutic significance of serum levels of NSE. We considered elevated serum neuron specific pathologic evaluation revealed 86 squamous cell carcinomas, 11 adenocarcinomas, 3 large cell carcinomas, 3 mucoepidermoid carcinomas, and 5 unknown pathology. Eight patients had stageI, 40 stage III A, and 60 stageIII B. S-NSE level greater than 15 ng/ml was considered as elevated, and below this considered as normal. All patients received radiotherapy as primary treatment modality. The responders to radiotherapy had significantly higher mean S-NSE level than on-responders (28.5 ng/ml vs 20 ng/ml, p=0.01). Overall 2-year survival rate (YSR) was 23.6%. According to radiotherapy response, 2 YSR for patients with CR, PR, and NR were 39.2%, 28.6%, and 6.2% respectively (p=0.001). 2 YSR for patients with elevated and normal S-NSE were 14.6% and 31.7%(p=0.02). The patients with NR showed no difference in survival according to S-NSE level. When we considered all patients, S-NSE level showed no significant impact on response. But for squamous cell cardinomas alone, patients with elevated S-NSE had more patients with higher nodal stage. Based on our and other data, NSCLSC with neuroendocrine features have different response to treatment and clinical behavior compared to other NSCLSC. Thus, this subgroup may need different treatment modality, and S-NSE level may have prognostic significance.

Sequential Chemotherapy and Radiation Therapy for Advanced Nasopharyngeal Carcinoma / 대한치료방사선과학회지

Between January 1985 and July 1592, 52 patients with locally advanced nasopharyngeal carcinoma were studied retrospectively for the effectiveness of sequential chemotherapy and radiation therapy. The male to female ratio was 3.3:1 with a median age of 41 years. Forty patients had squamous cell carcinoma and the remaining 12 had undifferentiated carcinoma. Seven patients had stage III disease and the remainder had stage IV disease at time of presentation. All patients were treated two courses of chemotherapy followed by radiation therapy Chemotherapy consisted of either CVB(cisplatin, vincristine and bleomycin) of CF(cisplatin and 5-FU). Total radiation dose to the primary site ranged from 6000 cGy to 7500 cGy. Neck nodes were given booster treatment to maximum of 7000 cGy, depending on the extent of disease. Local control, overall survival and disease-free survival rates were analyzed. The complete response(CR) rate to chemotherapy was 15%, and the partial response(PR) rate was 46% for overall major response rate of 61%. The CR rate was 87% after radiation therapy. Median follow-up time was 51 months. The overall survival and disease-free survival rates at 36 months were 54% and 49%, respectively. Median time to relapse was 15 months. The patterns of initial relapse in CR patients was as follows: locoregional failure only, 12 patients; distant metastasis only, 11; both, 2. Cox's multivariate regression model revealed that nodal status was the single most important independent prognostic factor influencing disease-free survival(p=0.001). Comparison of these results with other published reports with radiation therapy alone showed that a high rate of initial response to chemotherapy did not translate into local control or survival. At present time radiation therapy alone remains the standard treatment for locoregional cancer of the nasopharyngeal cancer. More controlled clinical trials must be completed before acceptance of chemotherapy as a part of treatment of advanced nasopharyngeal carcinoma.

A Comparision of Radiotherapy Alone with Induction Chemotherapy-Radiotherapy in Inoperable Head and Neck Cancer / 대한치료방사선과학회지

In order to determine the value of induction chemotherapy (CT) for inoperable head and neck cancer, the authors conducted a retrospective study. Fifty-five patients were treated with CT and radiotherapy(RT)(CT + RT group). This group was compared with a group of 54 patients treated RT alone (RT alone group). The CT regimen used were CF (cis-platine + 5-FU), CVB(cyclophos-phamide + vincristine + bleomycin), CAP (cyclophosphamide + adriamycin + prednisolone) or PVBM(cis-platine + vincristine + bleomycin + methotrexate). Toxicity from induction chemotherapy was minimal, and toxicity was limited primarily to nausea and vomiting, mucositis and myelosuppression. The complete response (CR) rate to CT was 14.5% and the partial response (PR) rate was 47.3% for an overall major response rate of 61.8%. The major response rate at the completion of loco-regional therapy was 87.3% (48/55) with 32 CR (58.2%) and 16 PR (29.1%) for CT-RT group and 81.5% (44/55) with 27 CR(50.0%) and 17 PR (31.5%) for RT alone group (p=0.57). Median follow-up of CT-RT group was 17 months and 11 months for RT alone group. Median survival was 36 months for CT-RT group and 24 monts for RT alone group (p=0.3). The overall survival rate at 2 years, 3years and 5 years, respectively was 60.9%, 48.6% and 42.5% for CT-RT guoup, and 54.9%, 49.9% for RT alone group (p=0.33). Comparision between patients in both groups, stratified by overall stage, T and N stage, site, and pathology, all failed to show any significant difference in survival rates. We conclude that this retrospective study failed to demonstrate an advantage for induction chemotherapy in inoperable head and neck cancer.

Results of Radiotherapy With and Without Chemotherapy for Esophageal Cancers / 대한치료방사선과학회지

This is a retrospective study of 62 patients with unresected squamous cell carcinoma of the esophagus treated by radiotherapy alone (25 patients) or combined chemotherapy and radiotherapy (37 patients). Of these, 14 of 25 patients treated by radiation therapy alone and 25 of 37 patients treated by combined chemotherapy and radiotherapy completed radiotherapy consisting of 55 to 60 Gy in 5 to 6 weeks and were analyzed for local control rate and survival rate. Follow up ranged from 6 days to 58 months. Three (8%) of 39 patients had a complete response, twenty-eight(72%) a partial reponse and eight(20%) minimal or no resonse. Overall median survival was 11 months for all stages. The 1 year and 2 year actuarial survival rates were 48.6% and 13% respectively. Age and stage had prognostic significances (p<0.05, p<0.05 respectively). The 1 year survival rate was 70.1% for stage I, 47.6% for stage II, and 28.4% for stage III. The median survival was 19 months for stage I, 11 months for stage II, 6 months for stage III, and 5.5 months for stage III with distant metastases. The 1 year survival rate of patients 55 years and above was 69.6%, 54 years and below was 0%. There was no significant difference in survival rate between treatment modalities, locations of tumor, and responses of tumor.

Radioprotective Effect of Mesna on Mouse Testis / 대한치료방사선과학회지

Mesna has been used with ifosfamide to prevent urotoxicity in the treatment of testicular cancers. This drug also protected the toxicities of adriamycin without compromising cytostatic activity. With n idea of radioprotective role of sulfhydryl group of radioprotectors and of mesna decreasing the toxic effect of adriamycin which produces free radicals, mesna and radiation were administered to mice to study the protective effect of this drug and to identify the difference in regenerative capacity of the germ cells in the testis between radiation-treated and both mesna- and radiation-treated groups. The shape and numbers of spermatogenic cells in the seminiferous tubules were examined every week after irradiation. In both groups, initial reduction and later recovery in germ seel numbers and shape was observed. The lowest germ cell number was found around three weeks after irradiation. Mean germ cell number of the mesna-treated group was significantly higher than radiation-treated group at all observed periods (p<0.05). More competent regeneration was present in mesna-treated group. These results suggest that mesna protect the testis from radiation injury. Further study will be necessary to identify whether mesna protects other tissues from radiation and it does not hamper tumor control.

Analysis of Treatment Result of Nasopharyngeal Cancer / 대한치료방사선과학회지

From 1984 to 1988, fourt two patients with nasopharyngeal cancer were treated at the Department of Radiation Oncology in Kyungpook National University Hospital. Thirteen patients refused treatment and the median survival time was 7.8 months. Twenty nine patients received a full course of radiation at least 70 gy to the primary site and 60 gy to the nodal sites. These patients were all belonged to stage III or IV. The local control rate was 75% in squamous cell carcinomas, and all the patients with lymphoepithelioma showed a complete response. Overall locoregional failure was 27.6%. Distant metastasis was the predominant pattern of failures; 4/6 in lymphoepithelioma, 4/10 in squamous cell carcinoma. The Three-year-survival rate for squamous cell carcinoma was 40.5%, and for lymphoepithelioma 25.9%, respectively. This may be due to the more frequent distant metastases in lymphoepithelioma and ineffective chemotherapy. No survival correlation was found with the level of neck node involvement. Though adjuvant chemotherapy was found to be of no benefit in overall survival, more prudent and aggressive chemotherapy would be necessary.

The Result of Combined Modality Treatment for Non-Hodgkin's Lymphoma of Head and Neck / 대한치료방사선과학회지

From April 1985 to September 1989, 26 patients with stage IandII non-Hodgkin's lymphoma of unfavorable histology localized in head and neck region were treated with combined modality (combination chemotherapy plus radiotherapy) at the Department of Therapeutic Radiology in Kyungpook National University Hospital. Of the 26 patients, 23 showed complete response and 3 partial response. Between these two groups there were no statistical differences according to the variables. Three-year survival and disease-free survival rate were 62.4% and 65.2%, respectively. Unilateral involvement of neck node (p<0.05), radiation dose over 5000 cgy (p<0.01,) and 6 or more cycles chemotherapy (p=0.06) had a favorable effect on 3-year survival rate. There were 8 recurrences including 3 partial responders, 1 local failure, 1 distant failure, 1 contiguous failure, and 2 simultaneous local and distant failure. It could be suggested that combined modality treatment might be necessary for the treatment of stage IandII Non-Hodgkin's lymphoma of unfavorable histology.

A Clinical Observation on the Effect of Intrathecal Morphine Hydrochloride in Abdominal Surgery / 대한마취과학회지

The author made a clinical study of postoperative respiratory function and analgesic effect of intrathecal morphine HCI which had been administered to 40 of a total 80 adult male and female patients who underwent abdorminal operation with spinal anesthesia from March, 1980 to September, 1981 at Department of Anesthesiology, Pusan National University Hospital. The results obtained were as follows: 1) Vital capacity during 6 to 12 hours after operation was significantly increased in patients given intrathecal morphine as compared with other groups of patients. 2) Patients given intrathecal morphine showed a significant increase in tidal volume during 6 hours after operation. 3) There was no significant change in the level of arterial oxygen tension at pre-and postoperative period in all groups of patients. 4) The average duration of postoperative analgesia was 33.6 and 33.8 hours respectively in patients who were given intrathecal morphine.

The Clinical Observation on the Volume of Blood Transfused during Anesthesia / 대한마취과학회지

To avoid untoward reactions from blood transfusions and to make the best use the limited supply of blood, anesthesiologists must seek the most logical indications for blood transfusion. The study was carried out on 973 patients who received blood transfusion during anesthesia among a total of 3510 operative cases, from January to December 1980. The results obtained were as follows: 1) In the age distribution of the 973 cases who received transfusion 599(61.6%) case were in the 3rd, 4th and 5th decade. 2) Among the 973 cases, the department of orthopedic surgery had 274 cases(23.2%) general surgery 211 cases(21.7%) and neurosurgery 162 cases(16.6%). 3) For the preperative hemoglobin level, 641 cases(65.9%) were within the 10~15 gm/dl range and 273 cases(23.4%) had 5~10gm/dl. 4) In the total of 2684 units of transfused whole blood, 1138 units(42.4%) were in elective and emergency surgery of the abdomen. *Unit (Whole blood 320ml, ACD solution 80ml). 5) The amount of transfused whole blood for elective and emergency surgery was 1596 units(59.5%) and 1088 units(40.5%) respectively. 6) Of the 47,480 units from the Blood Bank of Pusan Red Cross, 9435 units(19.9%) were supplied to BNU hospital and 2684 units(5.7%) were used during anesthesia in the surgical theater. 7) In the total of 2931 units of whole blood 247 units were not used in the operative theater. 8) In the comparison of the number of transfused units of blood, one unit of whole blood was given to 266 cases(27.3%), 2~5 units for 536 cases(55.1%), 6~10 units in 75 cases(7.7%), and more than 11 units were given in 19 cases(2.0%), 77 cases(7.9%) were not transfused during anesthesia. 9) In the total of 896 recipients, urticaria occurred in 78 cases(8.7%).

Recovery of Respiratory Paralysis due to Tetradotoxin Poisoning / 대한마취과학회지

A 54 year old man who had taken puffer fish and noticed generalized weakness 1 hour and 30 minutes afterward was admitted to our I.C.U. due to respiratory arrest and cardiac arrhythmia. He was treated with artificial respiration via pressure cycled respirator, supportive therapy including frequent endotracheal suctioning. fluid administration, correction of acid base imbalance, change of position and antibiotics for prevention of secondary infection. 31 hours afterward, he resumed normal respiration and clear mentality. After 5 days of total admission days, he was discharged without any sequelae.