Masseter nerve-based facial palsy reconstruction

Facial paralysis is a devastating disease, the treatment of which is challenging. The use of the masseteric nerve in facial reanimation has become increasingly popular and has been applied to an expanded range of clinical scenarios. However, appropriate selection of the motor nerve and reanimation method is vital for successful facial reanimation. In this literature review on facial reanimation and the masseter nerve, we summarize and compare various reanimation methods using the masseter nerve. The masseter nerve can be used for direct coaptation with the paralyzed facial nerve for temporary motor input during cross-facial nerve graft regeneration and for double innervation with the contralateral facial nerve. The masseter nerve is favorable because of its proximity to the facial nerve, limited donor site morbidity, and rapid functional recovery. Masseter nerve transfer usually leads to improved symmetry and oral commissure excursion due to robust motor input. However, the lack of a spontaneous, effortless smile is a significant concern with the use of the masseter nerve. A thorough understanding of the advantages and disadvantages of the use of the masseter nerve, along with careful patient selection, can expand its use in clinical scenarios and improve the outcomes of facial reanimation surgery.

Masseter nerve-based facial palsy reconstruction

Facial paralysis is a devastating disease, the treatment of which is challenging. The use of the masseteric nerve in facial reanimation has become increasingly popular and has been applied to an expanded range of clinical scenarios. However, appropriate selection of the motor nerve and reanimation method is vital for successful facial reanimation. In this literature review on facial reanimation and the masseter nerve, we summarize and compare various reanimation methods using the masseter nerve. The masseter nerve can be used for direct coaptation with the paralyzed facial nerve for temporary motor input during cross-facial nerve graft regeneration and for double innervation with the contralateral facial nerve. The masseter nerve is favorable because of its proximity to the facial nerve, limited donor site morbidity, and rapid functional recovery. Masseter nerve transfer usually leads to improved symmetry and oral commissure excursion due to robust motor input. However, the lack of a spontaneous, effortless smile is a significant concern with the use of the masseter nerve. A thorough understanding of the advantages and disadvantages of the use of the masseter nerve, along with careful patient selection, can expand its use in clinical scenarios and improve the outcomes of facial reanimation surgery.

Effects of Add-On Therapy with NDC-052, an Extract from Magnoliae Flos, in Adult Asthmatic Patients Receiving Inhaled Corticosteroids

BACKGROUND/AIMS: There is a need for new anti-asthmatic medications with fewer side effects. NDC-052, an extract of the medicinal herb Magnoliae flos, which has a long history of clinical use, was recently found to have anti-inflammatory effects. Herein, we evaluated the effects of NDC-052 as an add-on therapy in patients with mild to moderate asthma using inhaled corticosteroids (ICS). METHODS: In a non-comparative, multi-center trial, 148 patients taking ICS received NDC-052 for eight weeks. We evaluated their forced expiratory volume in one second (FEV1), morning and evening peak expiratory flow rate (AM and PM PEFR), AM/PM asthma symptom scores, visual analogue symptom (VAS) scores, night-time wakening, frequency of short-acting beta2-agonist usage, and adverse events. RESULTS: After eight weeks, both AM and PM PEFRs were significantly improved. Asthma symptom scores, VAS scores, the frequency of nights without awakening, and the frequency of beta2-agonist use were also reduced. Most of the adverse drug reactions were mild and resolved spontaneously. CONCLUSIONS: The addition of NDC-052 to ICS had a beneficial effect on asthma control in patients with mild to moderate asthma, with good tolerability and fewer side effects. Further studies are necessary to evaluate the effects of NDC-052 in patients with severe and/or refractory asthma.

One Case of Sustemic Arterialization of Lung Without Sequestration / 결핵

Sustemic arterialization of the lung without sequestration is the rarest from of congenital anomalous systemic arterial supply to the lung, where an anomalous systemic artery arising from aorta supplies a normal unsequestrated segment of the lung. The non-sequestrated lung parenchyma which is supplied by an aberrant artery, has no parenchyma or bronchial abnormalities, and there is a normal connection with the bronchial trees. The symptoms of this disease varies. In most patients, it is often asymptomatic, but symptoms including dyspnea, hemoptysis, and central nervous system complications are possible. Here, we report a case of systemic arterialization of the lung without sequestration, which confirmed by angiography, with a review of the literature.

A Case of Small Cell Lung Cancer Metastasis to the Gingiva / 결핵

The incidence of lung cancer and its mortality rate are increasing in Korea. At the time of diagnosis, 40% patients of lung cancer patients had metastatic lesions. The common metastatic sites are the contralateral lung, bone, liver, adrenal gland and the brain. Metastasis to oral mucosa is rarely encountered in lung cancer and metastasis to the gingiva is more uncommon. Approximately 1% of malignant carcinomas in the oral cavity are the result of metastases, and 10-25% of metastatic cancers originate from lung cancer. Clinically metastatic gingival lesions are benign including hemangioma, pyogenic granuloma, giant-cell granuloma or a peripheral fibroma. Often metastases to the gingiva are diagnosed too late and by the time they are detected, they have metastases to other organs. Here we report a case of small cell lung carcinoma that had metastased to the gingiva with review of relevant literature.

Korean Standardization of General Medical Health Rating on Dementia Patients

Concurrent medical problem is common in dementia patients and critical to their care. Despite its importance, there was no bedside global rating scale for the seriousness of medical comorbidity. Lykestos et al. newly developed a reliable bedside scale, the General Medical Health Rating(GMHR). The objective of this study was to standardize the GMHR in form of Korean version(KGMHR). The study population consisted of 35 dementia patients in nursing home. Rating was performed by 1 physician and 2 nurses. Forty percent(14/35) of patients had one or more unstable medical illnesses. KGMHR ratings no more than 3 were 71.5%(25/35) of patients. The value of interrater reliability coefficient alpha was 0.9121. Correlations between KGMHR ratings and number of unstable medi-cal illnesses were high(r=-0.487, p<0.01). KGMHR ratings were also correlated with number of medications being taken for comorbid conditions(r=-0.542, p<0.01). In conclusion, KGMHR is a very reliable and simple rating scale for medical comorbidity in dementia patients. So the KGMHR could be a useful tool for evaluation of comorbidity in dementia patients. To verify the prognostic value of KGMHR, further large sized long-term study are needed.

Prophylactic cranial irradiation in limited small-cell lung cancer: incidence of brain metastasis and survival and clinical aspects / 결핵

PURPOSE: Brain metastases are present in approximately 10-16% of small cell lung cancer patients at diagnosis. Brain metastasis is an important clinical problem associated with increasing the survival rate, with a cumulative incidence of up to 80% in patients surviving 2 years. Prophylactic cranial irradiation(PCI reduces the incidence of brain matastasis and may prolong survival in patients with limited small-cell lung cancer who achieved complete remission. This study was performed to analyze the incidence of brain metastasis, survival and clinical aspects after PCI in patients with limited small-cell lung cancer who achieved complete remission. METHODS: Between 1989 and 1999, forty-two patients with limited small-cell lung cancer who achived achieved complete remission after therapy were enrolled into this study retrospectively. All patients received etoposide and cisplatin(VPP) alternating with cytoxan, adriamycin, and vincristine(CAV) every 3 weeks for at least 6 cycles initially. All patients received thoracic radiotherapy:concurrent(38.1%) and sequentia(61.9%). All patients received late PCI. RESULTS: Most patients(88.1%) were men, and the median age was 58 years. The median follow-up duration was 18.1 months. During the follow-up period, 57.1% of the patients developed relapse. The most frequent site of relapse was chest(35.7%), followed by brain(14.3%), liver(11.9%), adrenal gland(4.4%), and bone(2.2%). With the Kaplan-Meier method, the average disease-free interval was 1,090 days(median 305 days). The average time to development of brain relapse after PCI and other sites relapse(except brain) were 2,548 days and 1,395 days(median 460 days), respectively. The average overall survival was 1,233 days(median 634 days, 21.1 months), and 2-year survival rates was 41.7%. The average overall survival in the relapse group was 642 days(median 489 days) and in the no relapse group was 2,622 days(p<0.001). The average overall survival in the brain relapse guoup was 928 days(median 822 days) and in the no brain relapse group was 1,308 days(median 634 days)(p=0.772). In most patients(85.7%), relepse(expect brain) or systemic disease was the usual cause of death. Brain matastasis was the cause of death in 14.3% of the cases. CONCLUSIONS: We may conclude that PCI reduces and delays brain metastasis in patients with limited small-cell lung cancer who achieved complete remission. We found decreased survival in relapse group but, no significant survival difference was noted according to brain matastasis. And relapse(except brain) or systemic disease was the usual cause of death. In order to increase survival, new treatment strategies for control methods for relapse and systemic disease are required.

Effect Of Vpp/Cav Alternating Chemotherapy Versus Carboplatin/Etoposide(Ce) Chemotherapy For Extensive Stage Small Cell Lung Cancer / 결핵

BACKGROUND: To compare the efficacies and side effects of etoposide, cisplatin/cyclophosphamide, adriamycin, vincristine(VPP/CAV) with that those of carboplatin etoposide(CE) in extensive stage small cell lung cancer patients. METHOD: Patients with extensive stage small cell lung cancer who has measurable disease were eligible. VPP/CAV group(n=22) was treated with cisplatin(60mg/m2 iv. D1) etoposide(100mg/m2 iv. D1-3),after and 3 weeks later cyclophosphamide(1000mg/m2 iv. D1), adriamycin(40mg/m2 iv. D1), and vincristine(1.4mg/m2 iv. D1), were administered alternatively. CE group (n=22) was treated with carboplatin (325mg/m2 iv. D1) and etoposide (100mg/m2 iv. D1-3)(;) repeated treatment was performed every 3 weeks. RESULT: Forty four patients were eligible for the study. Overall The overall response rate was 61.4% (complete remission rate 0%, partial response rate 61.4%, stable disease rate 25%, progressive disease rate 13.6%), and median survival was 10.8 months. In VPP/CAV group, response rate was 54.5%(complete remission rate 0%, partial response rate 54.4%, stable disease rate 27.3%, progressive disease rate 18.2%), and, in carboplatin/etoposide group, the response rate was 68.2%(complete remission rate 0%, partial response rate 68.2%, stable disease rate 22.7%, progressive disease rate 9.1%). The median survival time was 9.5 months in the VPP/CAV group and 11 months in CE group. The toxicity of both group was moderate, and anemia was more frequent in the CE group. CONCLUSION: VPP/CAV regimen and CE regimen produced similar response rate and survival time rates and survival times in extensive stage small cell lung cancer patients. We may suggest that CE regimen are effective may be effective as part of the initial therapy of for extensive stage small cell lung cancer.

The Clinical study of Lung Cancer in Patients Younger than 40 Years of Age / 결핵

BACKGROUND: Bronchogenic carcinoma is generally considered as a disease that predominantly affects middle-aged and elderly men. A small percentage of patients with lung cancer are diagnosed in the third or fourth decade of life or earlier. The current study was performed to review the clinical characteristics of bronchogenic carcinoma in patients younger than 40 years of age at Chungnam National University Hospital. METHOD: To determine the clinicopathologic characteristics including survival rates of lung cancer patients younger than 40 years of age and to compare them with those of patients older than 40 years of age at diagnosis, data of 905 patients diagnosed as lung cancer from January 1990 to March 1997 were analyzed. RESULT: Twenty-three of 805 patients(2.5%) belonged to the young age group (less than 40 years). Male to female ratios of young age group and control group were 2.8 : 1 and 5.3 : 1, respectively. The mean duration of symptoms from onset to the definite diagnosis was 3.2 months in the young age group. The most common initial symptoms in the young age group were cough(52.2%) and dyspnea(43.5%). Adenocarcinoma(43.5%) was more frequent in the young age group than in the control group(20.1%). Stage III and IV(70%) tumors were more frequent in the young age group than in the control group(52.3%). Distant metastasis rae of the young age group(56.6%) was higher than that of the control group(22.3%). CONCLUSION: The predominance of adenocarcinoma, the lower male-female ratio, and the high incidence of advanced stage tumor at diagnosis are the characteristics of lung cancer in patients younger than 40 years of age.

Two Cases of Pulmonary Complications Following Intravesical Bacillus Calmette-Guerin Immunotherapy in Patients with Superficial Bladder Cancer / 결핵

Intravesical instillation of the bacillus Calmentte-Gu rin(BCG), an attenuated strain of Mycobacterium bovis, is an approved method for the treatment of superficial bladder cancer. Because BCG is a living organism, the potential for infection exists. BCG is generally well tolerated, with complications in less than 5% of those treated with use of current practices. The most frequent symptoms of toxicity associated with intravesical BCG immunotherapy include bladder irritation, frequency, and dysuria. Systemic reactions are less common but more serious than local side effects, and include fever, chills, malaise, rash, hepatitis, pneumonitis, arthritis and sepsis. In rare cases, BCG treatment can result in a systemic infection that requires antituberculous therapy. The pulmonary toxicity that results from intravesical BCG treatment is generally characterized by one of two types : systemic allergic reaction with pulmonary reticulonodular opacities depicted on chest radiographs with cellular findings consisting of activated lymphocytes, and actual BCG mycobacteremia with a miliary pattern depicted on chest radiographs and granuloma formation which rarely results in positive acid-fast stain or culture results. Recently we experienced two types of pulmonary complications following intravesical BCG immunotherapy in patients with superficial bladder cancer. We report two cases with a review of literatures.

The Clinical significance of STAT-PAT-PAK ULTRA FAST(R) and ICT Tuberculosis for Serologic Diagnosis of Tuberculosis / 결핵

BACKGROUND: In recent years, tuberculosis has re-emerged as a major health problem in both industrialized and developing countries. Recent advances in identifying and purifying antigens secreted in active tuberculosis infection have lead to the development of serological assays based on a number of immunodominant antigens. To date, the most sensitive and specific of these antigens has been the 38-kDa antigen. METHOD: Two rapid membrane-based serologic assays using antigen(38-kDa) from mycobacterium tuberculosis for the diagnosis of tuberculosis were evaluated in 22 patients with smear-positive pulmonary tuberculosis, 14 patients with inactive pulmonary tuberculosis, and 9 patients with non-tuberculous lung disease. RESULT: The evaluation of validity(sensitivity, specificity, positive predictive value, negative predictive value, false positivity and false negativity) of STAT-PAK ULTRA FAST(R) were 77.3%, 28.6%, 63.0%, 44.4%, 71.4%, and 22.7% for differential diagnosis of active pulmonary tuberculosis and inactive pulmonary tuberculosis, respectively. The evaluation of validity of STAT-PAK ULTRA FAST(R) were 77.3%, 33.3%, 73.9%, 37.5%, 66.7%, and 22.7% for differential diagnosis of active pulmonary tuberculosis and non-tuberculosis. The evaluation of validity of ICT Tuberculosis were 54.5%, 57%, 66.7%, 44.4%, 42.9%, and 45.5% for differential diagnosis of active pulmonary tuberculosis and inactive pulmonary tuberculosis. The evaluation of validity of ICT Tuberculosis were 54.5%, 100%, 100%, 47.4%, 0%, and 45.4% for differential diagnosis of active pulmonary tuberculosis and non-tuberculosis. CONCLUSION: We concluded no effectiveness of STAT-PAK ULTRA FAST(R) and ICT tuberculosis on serologic diagnosis of pulmonary tuberculosis. In the future, further large-scale study should be needed for serologic diagnosis of pulmonary tuberculosis.

Two cases of Pulmonary Alveolar Proteinosis Improved by Whole Lung Lavage / 결핵

Pulmonary alveolar proteinosis(PAP) is a disorder in which an insoluble, proteinaceous material, rich in phospholipid, is deposited on alveoli and bronchioles. Several cases were reported since 1986, and the numbers of patients is increasing in Korea. Although the pathogenesis and causative treatment of PAP is not well known, whole lung lavage is the only consistently successful treatment. We report 2 cases of PAP which were confirmed by open lung biopsy with electron microscopy and clinically improved by whole lung lavage with a review of literature.

Drug-resistant pulmonary tuberculosis in a tertiary referral hospital in Korea

OBJECTIVES: To estimate the resistance rate and to correlate the clinical characteristics of resistant tuberculosis with the patients of pulmonary tuberculosis who were referred to the university hospital. METHODS: We prospectively performed sensitivity tests for all patients who were diagnosed as active tuberculosis by sputum smear or sputum culture from January, 1995 to June, 1996. Patients profile, previous treatment history, patterns of drug resistance, initial chest films and other clinical findings were analysed. RESULTS: Overall, 24(26.0%) of the 92 patients had resistance to at least one drug and 8(8.6%) had resistance to isoniazid(INH) and rifampin(RFP). Among the 66 patients without previous tuberculosis therapy, 11(16.6%) were drug-resistant and 2(3.0%) were multi-drug resistant. Among the 26 patients with previous therapy, 13(50.0%) were drug-resistant and 6(23.0%) were multi-drug resistant. For all 92, resistance to INH was most common (19.5%), followed by RFP (9.7%) and ethambutol (9.7%). Drug resistance was significantly high in previously treated patients and in cavity-positive patients. Treatment failure was also high in previously treated patients with resistant tuberculosis. In patients with primary resistance, treatment failure was not observed. CONCLUSION: Sensitivity tests are strongly recommended in all culture positive patients with previous therapy but, in patients with primary resistance, sensitivity tests are not required. Proper combination chemotherapy should be given under careful surveillance.

Clinical effects of neoafjuvant chemotherapy in stage IIIA non-small cell lung cancer / 대한내과학회지

BACKGROUND: Surgical therapy remains the only curative treatment of localized non-small cell lung cancer(NSCLC). But the efficacy of surgery for patients with NSCLC is limited, although recent studies suggest that neoadjuvant chemotherapy may improve survival. Many studies also demonstrated benefit for neoadjuvant therapy. However very few studies about neoadjuvant chemotherapy were reported in Korea. We conducted this study to examine the possible benefit of neoadjuvant chemotherapy in patients with operable stage IIIA NSCLC. METHODS: Twenty seven patients(25 men and 2 women) with clinical stage IIIA NSCLC were analyzed. The patients received 2 to 4 courses of cisplatin based chemotherapy and followed by surgery. To compare the resection rate and survival, 12 patients(10 men, 2 women) with clinical stage IIIA and initially treated operation were also anayzed. RESULTS: The radiologically assessed response rate to the neoadjuvant therapy was 59.3%. Twelve seven patients underwent gross tumor resection with 24(88.9%) having complete resection and 21(77.8%) having postaperative stage I ar II. Pathologically defined response in nodal staging was more higher(85.2%). There was no difference of relapse free interval in recurred patients between two groups. But in patients treated with neoadjuvant therapy, distant recurrence is less higher than local recurrence. The median period of survival was 42 months in the patients treated with neoadjuvant therapy, and 27 months in the patients initially treated with surgery(p=0.287). CONCLUSION: The neoadjuvant chemotherapy improves local tumor control and lowers the distant recurrence. There was a possible trend improving median survival. So neoadjuvant chemotherapy might be considered as a standard therapy in stage IIIA NSCLC.

Prospective Study for Treatment Method of Cervical Tuberculous Lymphadenitis / 결핵

BACKGROUND: Tuberculous cervical lymphadenitis is one of the common causes of cervical mass in adult (espe cially in woman) in korea. Sometimes it appears to be difficult in defining the role of surgery and duration of antituberculous chemotherapy. METHOD: To clarify the proper duration and/or combination of regimens, we analyzed the clinical data of 31 patient with cervical lymphadenitis diagnosed at Chungnam National University Hospital from March 1996 to December 1996 and all patients were prospectively randomized into two groups(2HREZ/4HRE and 6HREZ) by treatment method. RESULT: Prevalent age, male to female ratio, association with pulmonary tuberculosis and history of previous antituberculous medication were not statiscally different between two groups. The average size of the largest lymph node before teatment was 2.43+/-0.98cm and 3.15+/-1.74cm, respectively and was 0.63cm and 0.6cm after treatment, respectively. In both groups, 2 patients have engrowing node or not changed node during tratment and no recurrence was found during follow up period upto 12 months. In both groups, no significant side reaction resulting in discotinuation or changing the regimens was noticed. CONCLUSION: Short course antituberculosis therapy(2HREZ/4HRE) could be recommanded as effective standard therapy for superficial lymph node tuberculosis. Longterm follow up at least 36 months to observe recurrence might be needed to confirm this conclusion.

A Clinical Study on Tuberculous Cervical Lymphadenitis / 대한내과학회지

OBJECTIVES: Tuberculous cervical lymphadenitis is one of the common cause of cervical mass in young adult in Korea. Sometimes it appears to be difficult in defining the role of surgery and duration of antituberculous treatment. To clarify the duration of medical treatment and to define the cause of prolonged treatment duration METHODS: we analyzed the clinical data of 62 patients with tuberculous cervical lymphadenitis diagnosed at the Chungnam National University Hospital from Jan. 1994 to July 1996 and all patients were divided into two groups (standard and prolonged) by treatment duration. RESULTS: The most prevalent age group was 20 to 39 years old (67%) and male to female ratio was 1:2.6. The most common physical finding was painless swelling on neck, standard group was 52%, prolonged group was 42%. The average size of lymph node was 2.7cm and 3.2cm, respectively (p<0.05). In prolonged group, incidence of associated pulmonary tuberculosis and previous antituberculous treatment history were higher than that in standard group (27%, 35% respectively). The most common affected site was right side of neck , whereas 19% of prolonged regimen group were involved in both side of neck. Bacteriological study from node aspirates showed relatively higher positivity in prolonged group (27%) than in standarded group (5%). The causes of prolonged treatment were increased mass(27%) or remnant mass(23%) and the develoment of new node formation and existing nodes after completion of treatment were found in both groups(10% of standard group , 19% of prolonged group). CONCLUSION: A new, prospective trial for proper regimens or duration of antituberculosis treatment is strongly needed.

Delayed Diagnosis of Primary Lung Cancer / 결핵

BACKGROUND: Lung cancer is an important public health problem because of rapidly increasing malignancy in both sexes in relation with high smoking rate in Korea. Despite advances in therapeutic modalities and supportive cares, 5-year survival rate has improved only marginally during the past 2 decades. Therefore, the early detection of lung cancer is strongly needed for batter prognosis and we conducted this study to review the clinical factors resulting in delayed diagnosis of lung cancer. METHOD: The clinical data such as presenting symptoms duration for diagnosis disease entities causing misdiagnosis or delayed diagnosis, were analyzed retrospectively in 154 patients with primary lung cancer diagnosed at Chungnam National university hospital from January to December in 1995. RESULTS: 63 patients(40.9%) out of 154 patients were delayed diagnosed with the duration of 6.3 months compared with 3.6 months in patients diagnosed without delay. In delayed diagnosed group, Cough & sputum and dyspnea as presenting symptom were more critical than hemoptysis and chest pain, and doctor's delay was more critical than patient's delay. Tuberculosis(30/63) was most frequent disease entity causing delayed diagnosis, followed by pneumonia(9/63), COPD(6/63), heart diseases(5/63), etc.. CONCLUISON: It should be emphasized that any respiratory symptom be checked with chest X-ray to differentiate lung cancer and periodic check of chest X-ray be also needed for the longterm patients with any disease, especially with high risk group.

Immunohistochemical Detection of p53, erbB-2 and CEA Oncoprotein in Lung Cancer Clinical Correlations / 결핵

BACKGROUND: The prognosis of patients with lung cancer is still poor. Lung cancer exhibits a variable clinical outcome, even in those patients with same stage Numerous reports suggest that oncogene expression night play a role in explaining the variability of response and survival But many of these reports are still under debete. So we studied the clinical relevance of oncogene expression in Korean lung cancer patients. lmmunohistochemistry of p53, erbB-2, CEA expression was performed. METHOD: From March, 1992 until March, 1997, 120 patients with lung cancer were reviewed. p53, erbB-2, and CEA expression were detected on paraffin-embedded tumor blocks with the use of monoclonal antibodies. The survival arid response has correlated with the expressibility of p53, erbE-2, arid CEA oncoprotein. RESULTS: Overall, the expression rates of p53 erbB-2, and CEA were 33.7%, 59.3%, and 32.6% respectively. Expression rates were not con-elated to cell type or stage. Compared with response to chemotherapy, no correlation was found. The expression of p53, erbB-2, or CEA was not correlated with 2-year survival. With simultaneous applications of p53. erbB-2, and CEA, patients with 2 or more expressions also did not show poor response to chemotherapy. CONCLUISON: We conclude the p53, erbB-2, and CEA expression are clinically less useful in predicting response to chemotherapy or survival.

The Study of Combined Treatment in Locally Advanced Non - Small Cell Lung Cancer / 대한내과학회지

BACKGROUND: The majority of patients with locally advanced, unresectable, non-small cell lung cancer(NSCLC) were treated with conventional thoracic radiation therapy Throcic radiation therapy produces tumor regression in most patients but few cures and dismal 5-year survival rate. Several randomized studies have demonstrated that systemic chemotherapy controls micrometastasis and improve survival ratNes for patients who have locally advanced NSCI.C. Hut the optimal frequency of chemotherapy and sequence for chemotherapy and radiotherapy are yet to be determined. In this study, we analyzed response rate, median survival time, side effects and prognostic variables according to the frequency of chemotheray in locally advanced NSCLC patients. METHODS: We separated locally advanced, unresectable, NSCLC patients into two groups according to given number of chemotherapy cycles. Among 28 patients evaluated, eleven patients were classified to group A, receiving above 3 cycled chemotherapy and seventeen patients, classified to group B, receiving 3 cycled chemotherapy. In both groups, thoracic irradiation of 5940 cGy was given to all patients after chemotherapy. RESULTS: 1) Median survival time was 12.9 months for group A, 12.8 months for group B but there was no statistically significant difference(P>0.05), 2) Overall response rates were not significantly different between two groups(P>0.05). 3) Frequency rate of local failure and distant metastasis were not significantly different between two groups (P>0.05). 4) The grade and frequency of toxicities during treatment were not significantly different between two groups (P>0.05). 5) Clinical stage was the only major prognostic factor for overall survival (P<0.05). CONCLUSION: Median survival time, response rate, toxicities and frequency of local failure and distant metastasis were not significantly different between two groups. So, when we treat locally advanced, unresectable, NSCLC patients in sequential combined treatement, we should consider planned therapy(limiting chemotherapy cycles given), because planned therapy reduces many troubles of patients, that is, economic loss and time consuming, psychiatric anxiety etc, during treatment period. The optimal frequency of chemotherapy is remained to be validated in large scale study in the future in the setting of combined treatment.

The effects according to the timing of thoracic radiotherapyin limited stage small cell lung cancer / 결핵

Background: Combination chemotherapy is now considered to be the cornerstone of small cell lung cancer (SCLC). management but the optimal management of limited SCLC is not well defined. The role of thoracic radiotherapy (TRT) is less well established. Recent meta-analyses reports revealed that TRT combined with chemotherapy produce "good" local control and prolonged survival. But other reports that survival was not changed. The timing, dose, volume and fractionation for TRT with the combined chemotherapy of SCLC remains unsettled. In this study, we analyzed the effects according to the timing of thoracic radiotherapy in limited SCLC. Method: All fifty one patients received cytoxan, adriamycin and vincristine(CAV) alternating with etoposide and cisplatin(VPP) every 3 weeks for 6 cycles were randomized prospectively into two groups: concurrent and sequential. 27 patients received 4500cGy in 30 fractions(twice daily 150cGy fractional dose) over 3 weeks to the primary site concurrent with the first cycle of VPP(concurrent gorup). 24 patients received 4000 to 5000cGy over 5 or 6 weeks after completion of sixth cycles of chemotherapy(sequential group). Results: 1. Response rates and response duration: Response rates were not significantly different between two groups(p=0.13). But response duration was superior in the concurrent group(p=0.03). 2. Survival duration was not different between two groups(p=0.33). 3. Local control rate was superior in the concurrent group(p=0.00). 4. Side effects and toxicities: Hematologic toxicides, especially leukopenia, infection and frequency of radiation esophagitis were higher in the concurrent group(p=0.00, 0.03, 0.03). Conclusion: The concurrent use of TRT with chemotherapy failed to improve the survival of limited stage SCLC patients compared with the sequential use of TRT but response duration and local control rate were superior in the concurrent group. Frequency of radiation esophagitis, life threatening hematologic toxicities and infection were more frequent in the concurrent group than sequential group. So, the selection of an optimal schedule of chemotherapy combined with TRT that would lead to a major increase in survival with minimal toxicity is remained to be validated in large scale study in the future.