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1.
Article in English | WPRIM | ID: wpr-899715

ABSTRACT

Background@#Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. @*Methods@#We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. @*Results@#For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). @*Conclusion@#Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

2.
Article in English | WPRIM | ID: wpr-892011

ABSTRACT

Background@#Although international guidelines recommend palliative care approaches for many serious illnesses, the palliative needs of patients with serious illnesses other than cancer are often unmet, mainly due to insufficient prognosis-related discussion. We investigated physicians' and the general public's respective attitudes toward prognostic disclosure for several serious illnesses. @*Methods@#We conducted a cross-sectional survey of 928 physicians, sourced from 12 hospitals and the Korean Medical Association, and 1,005 members of the general public, sourced from all 17 administrative divisions in Korea. @*Results@#For most illnesses, most physicians (adjusted proportions – end-organ failure, 99.0%; incurable genetic or neurologic disease, 98.5%; acquired immune deficiency syndrome [AIDS], 98.4%; stroke or Parkinson's disease, 96.0%; and dementia, 89.6%) and members of the general public (end-organ failure, 92.0%; incurable genetic or neurologic disease, 92.5%; AIDS, 91.5%; stroke or Parkinson's disease, 92.1%; and dementia, 86.9%) wanted to be informed if they had a terminal prognosis. For physicians and the general public, the primary factor to consider when disclosing terminal status was “the patient's right to know his/her condition” (31.0%). Yet, the general public was less likely to prefer prognostic disclosure than physicians. Particularly, when their family members were patients, more than 10% of the general public did not want patients to be informed of their terminal prognosis. For the general public, the main reason for not disclosing prognosis was “psychological burden such as anxiety and depression” (35.8%), while for the physicians it was “disclosure would have no beneficial effect” (42.4%). @*Conclusion@#Most Physicians and the general public agreed that disclosure of a terminal prognosis respects patient autonomy for several serious illnesses. The low response rate of physicians might limit the generalizability of the results.

3.
Yonsei Medical Journal ; : 452-459, 2020.
Article | WPRIM | ID: wpr-833364

ABSTRACT

Purpose@#Allogeneic hematopoietic stem cell transplantation (HSCT) with optimal conditioning has helped better long-term survival in acute lymphoblastic leukemia (ALL). This study investigated the efficacy and safety of reduced-intensity conditioning (RIC) with busulfan and fludarabine in adult ALL patients unfit for myeloablation. @*Materials and Methods@#Records of 78 patients who underwent HSCT with RIC consisting of 3.2 mg/kg/day of busulfan for 2 or 3 days and 30 mg/m2/day of fludarabine for 5 or 6 days were analyzed. @*Results@#The median age at diagnosis was 49 years. Over a median follow-up of 22 months, 2-year estimates of relapse-free survival (RFS) and overall survival were 57.4% and 68.7%, respectively. Multivariate analysis showed a trend of improved RFS in patients with chronic graft-versus-host disease (GVHD) (hazard ratio, 0.53; 95% confidence interval, 0.26–1.08; p=0.080). The cumulative incidences of relapse and non-relapse mortality were 42.9% and 19.6%, respectively and one case of central nervous system relapse was noted. No hepatic veno-occlusive disease was reported. Grade II–IV acute GVHD and any grade chronic GVHD occurred in 21.1% and 41.7%, respectively. @*Conclusion@#RIC with busulfan and fludarabine is an effective and safe conditioning regimen for adult ALL patients unfit for myeloablation.

4.
Article in English | WPRIM | ID: wpr-831569

ABSTRACT

Background@#Hodgkin's lymphoma (HL) constitutes 10%–20% of all malignant lymphomas and has a high cure rate (5-year survival, around 90%). Recently, interest has increased concerning preventing secondary complications (secondary cancer, endocrine disorders) in long-term survivors. We aimed to study the epidemiologic features and therapeutic outcomes of HL in children, adolescents, and young adults in Korea. @*Methods@#We performed a multicenter, retrospective study of 224 patients aged < 25 years diagnosed with HL at 22 participating institutes in Korea from January 2007 to August 2016. @*Results@#A higher percentage of males was diagnosed at a younger age. Nodular sclerosis histopathological HL subtype was most common, followed by mixed cellularity subtype.Eighty-one (36.2%), 101 (45.1%), and 42 (18.8%) patients were classified into low, intermediate, and high-risk groups, respectively. Doxorubicin, bleomycin, vinblastine, dacarbazine was the most common protocol (n = 102, 45.5%). Event-free survival rate was 86.0% ± 2.4%, while five-year overall survival (OS) rate was 96.1% ± 1.4%: 98.7% ± 1.3%, 97.7% ± 1.6%, and 86.5% ± 5.6% in the low, intermediate, and high-risk groups, respectively (P = 0.021). Five-year OS was worse in patients with B-symptoms, stage IV disease, highrisk, splenic involvement, extra-nodal lymphoma, and elevated lactate dehydrogenase level.In multivariate analysis, B-symptoms and extra-nodal involvement were prognostic factors for poor OS. Late complications of endocrine disorders and secondary malignancy were observed in 17 and 6 patients, respectively. @*Conclusion@#This is the first study on the epidemiology and treatment outcomes of HL in children, adolescents, and young adults in Korea. Future prospective studies are indicated to develop therapies that minimize treatment toxicity while maximizing cure rates in children, adolescents, and young adults with HL.

5.
Kosin Medical Journal ; : 127-132, 2017.
Article in English | WPRIM | ID: wpr-149273

ABSTRACT

Use of recombinant tissue plasminogen activator (rt-PA) for the treatment of acute cerebral infarction secondary to aortic dissection is challenging because of a narrow time window and potential life-threatening complications. An 80-year-old woman with right middle cerebral artery infarction was treated with rt-PA. Although she had no history, symptoms, or sign of aortic dissection, carotid CT angiography revealed aortic arch dissection. Mediastinal widening, which did not show on initial chest X-ray, developed on follow-up chest X-ray. This observation indicates that physicians should monitor patient symptoms for signs of aortic dissection during thrombolysis and perform chest X-ray or carotid angiography immediately after thrombolysis even if the patient has no symptoms or signs of aortic dissection on onset of acute cerebral infarction.


Subject(s)
Aged, 80 and over , Angiography , Aorta, Thoracic , Cerebral Infarction , Female , Follow-Up Studies , Humans , Infarction, Middle Cerebral Artery , Thorax , Thrombolytic Therapy , Tissue Plasminogen Activator
6.
Article in English | WPRIM | ID: wpr-198399

ABSTRACT

PURPOSE: This study was conducted to evaluate outcomes in adult patients with Burkitt lymphoma (BL) or Burkitt-like lymphoma treated with an rituximab plus hyper-CVAD (R-hyper-CVAD) regimen by focusing on tolerability and actual delivered relative dose intensity (RDI). MATERIALS AND METHODS: Patients > or = 20 years of age and pathologically diagnosed with BL or Burkitt-like lymphoma were treated with at least one cycle of R-hyper-CVAD as the first-line treatment in this study. Eligible patients' case report forms were requested from their physicians to obtain clinical and laboratory data for this retrospective study. RESULTS: Forty-three patients (median age, 51 years) from 14 medical centers in Korea were analyzed, none of which were infected with human immunodeficiency virus. The majority of patients had advanced diseases, and 24 patients achieved a complete response (75.0%). After a median follow-up period of 20.0 months, 2-year event-free and overall survival rates were 70.9% and 81.4%, respectively. Eleven patients (25.6%) were unable to complete the R-hyper-CVAD regimen, including six patients due to early death. The RDIs of adriamycin, vincristine, methotrexate, and cytarabine were between 60% and 65%, which means less than 25% of patients received greater than 80% of the planned dose of each drug. Poor performance status was related to the lower RDIs of doxorubicin and methotrexate. CONCLUSION: R-hyper-CVAD showed excellent treatment outcomes in patients who were suitable for dose-intense chemotherapy. However, management of patients who are intolerant to a dose-intense regimen remains problematic due to the frequent occurrence of treatmentrelated complications.


Subject(s)
Adult , Burkitt Lymphoma , Cytarabine , Doxorubicin , Drug Therapy , Follow-Up Studies , HIV , Humans , Korea , Lymphoma , Methotrexate , Retrospective Studies , Survival Rate , Vincristine
7.
Keimyung Medical Journal ; : 120-126, 2015.
Article in English | WPRIM | ID: wpr-79179

ABSTRACT

Chronic myeloid leukemia (CML) is a clonal myeloproliferative disorder of the primitive hematopoietic stem cells. CML is characterized by the overproduction of myeloid cells, which results in marked splenomegaly and leukocytosis. CML presented by multiple chloromas is extremely rare. Multiple chloromas in the skin and brain are quite rare as the initial presentation of CML. These rare manifestation should alert clinicians to include CML in the differential diagnosis of patients presenting with multiple non-pruritic skin nodules or neurologic symptoms. Dasatinib has promising therapeutic potential for managing intracranial leukemic disease. Here, we report the case of a patient who visited the hospital with multiple chloroma which is unusual presentation of CML, and treated with dasatinib successfully.


Subject(s)
Brain , Diagnosis, Differential , Hematopoietic Stem Cells , Humans , Leukemia, Myelogenous, Chronic, BCR-ABL Positive , Leukocytosis , Myeloid Cells , Myeloproliferative Disorders , Neurologic Manifestations , Sarcoma, Myeloid , Skin , Splenomegaly , Dasatinib
8.
Article in English | WPRIM | ID: wpr-76676

ABSTRACT

BACKGROUND/AIMS: The purpose of this study was to determine the correlations between inflammatory factors-including absolute lymphocyte count, lactate dehydrogenase, beta2-microglobulin, albumin, C-reactive protein, and ferritin-and the prognosis for survival in patients with multiple myeloma (MM) treated with induction chemotherapy containing thalidomide and who underwent autologous stem cell transplantation (ASCT). METHODS: Data from patients at 13 university hospitals in South Korea were collected retrospectively between December 2005 and May 2013. RESULTS: The median age of the 232 patients was 57 years (range, 33 to 77) and the male to female ratio was 1.09:1. In the multivariate analysis, fewer than two combined abnormal inflammatory factors was the only independent prognostic factor for superior progression-free survival (relative risk [RR], 0.618; 95% confidence interval [CI], 0.409 to 0.933; p = 0.022), and platelet count > 100 x 109/L and fewer than two combined abnormal inflammatory factors were independent prognostic factors for superior overall survival (RR, 4.739; 95% CI, 1.897 to 11.839; p = 0.001 and RR, 0.263; 95% CI, 0.113 to 0.612; p = 0.002, respectively). CONCLUSIONS: Patients with two or more than two combined inflammatory factors who were treated with thalidomide induction chemotherapy and who underwent ASCT showed significantly shorter survival compared to those with fewer than two combined inflammatory factors. These results could be helpful for predicting prognosis in patients with MM.


Subject(s)
Adult , Aged , Antineoplastic Agents/adverse effects , Biomarkers, Tumor/blood , Chemotherapy, Adjuvant , Disease-Free Survival , Female , Hospitals, University , Humans , Induction Chemotherapy , Inflammation Mediators/blood , Kaplan-Meier Estimate , Male , Middle Aged , Multiple Myeloma/blood , Multivariate Analysis , Neoadjuvant Therapy , Odds Ratio , Proportional Hazards Models , Republic of Korea , Retrospective Studies , Risk Factors , Stem Cell Transplantation , Thalidomide/adverse effects , Time Factors , Transplantation, Autologous , Treatment Outcome
9.
Article in English | WPRIM | ID: wpr-84040

ABSTRACT

Umbilical cord blood is an attractive source of hematopoietic stem cells in allogeneic hematopoietic stem cell transplantation. Umbilical cord blood transplantation has merits of rapid availability and low risk of severe acute graft versus host disease. Umbilical cord blood should be an important source of stem cell transplantation for patients who have no suitable human leukocyte antigen-matched bone marrow, or peripheral stem cell donor. Transplantation of umbilical cord blood is limited by insufficient cell doses. This had led to the alternative concept of attempting to increase the number of cell doses using two cord blood units from different donor. We report a case of double-unit cord blood transplantation for 55-year-old male with primary refractory acute myeloid leukemia.


Subject(s)
Bone Marrow , Fetal Blood , Graft vs Host Disease , Hematopoietic Stem Cell Transplantation , Hematopoietic Stem Cells , Humans , Leukemia, Myeloid, Acute , Leukocytes , Male , Middle Aged , Stem Cell Transplantation , Stem Cells , Tissue Donors
10.
Yonsei Medical Journal ; : 9-18, 2014.
Article in English | WPRIM | ID: wpr-188829

ABSTRACT

PURPOSE: To identify prognostic factors for the outcomes of empirical antifungal therapy, we performed a multicenter, prospective, observational study in immunocompromised patients with hematological malignancies. MATERIALS AND METHODS: Three hundred seventy-six patients (median age of 48) who had neutropenic fever and who received intravenous (IV) itraconazole as an empirical antifungal therapy for 3 or more days were analyzed. The patients with possible or probable categories of invasive fungal disease (IFD) were enrolled. RESULTS: The overall success rate was 51.3% (196/376). Age >50 years, underlying lung disease (co-morbidity), poor performance status [Eastern Cooperative Oncology Group (ECOG) > or =2], radiologic evidence of IFD, longer duration of baseline neutropenic fever (> or =4 days), no antifungal prophylaxis or prophylactic use of antifungal agents other than itraconazole, and high tumor burden were associated with decreased success rate in univariate analysis. In multivariate analysis, age >50 years (p=0.009) and poor ECOG performance status (p=0.005) were significantly associated with poor outcomes of empirical antifungal therapy. Twenty-two patients (5.9%) discontinued itraconazole therapy due to toxicity. CONCLUSION: We concluded that empirical antifungal therapy with IV itraconazole in immunocompromised patients is effective and safe. Additionally, age over 50 years and poor performance status were poor prognostic factors for the outcomes of empirical antifungal therapy with IV itraconazole.


Subject(s)
Antifungal Agents/adverse effects , Female , Hematologic Neoplasms , Humans , Immunocompromised Host , Itraconazole/adverse effects , Male , Middle Aged , Prospective Studies , Republic of Korea
11.
Korean Journal of Medicine ; : 535-539, 2013.
Article in Korean | WPRIM | ID: wpr-144657

ABSTRACT

Neurofibromatosis type 1 (NF1) is a genetic disease characterized by neoplastic and non-neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. NF1 is caused by mutations in the NF1 gene, which is found on chromosome 17q11.2. Patients with NF1 are at increased risk of developing soft tissue sarcomas that arise within the stromal compartment of the gastrointestinal tract, termed gastrointestinal stromal tumors (GISTs). GISTs associated with neurofibromatosis differ from sporadic GISTs, particularly with respect to their lower response rate to imatinib. We recently experienced a case involving a 45-year-old man with NF1 who was admitted to the hospital with epigastric pain and vomiting. Abdominal computed tomography revealed a duodenal GIST with pancreatic invasion. He had a base substitution mutation involving replacement of 2041 cytosine with thymine. He was treated successfully with a surgical operation and adjuvant imatinib therapy.


Subject(s)
Benzamides , Cytosine , Gastrointestinal Stromal Tumors , Gastrointestinal Tract , Genes, Neurofibromatosis 1 , Humans , Middle Aged , Neural Plate , Neurofibromatoses , Neurofibromatosis 1 , Piperazines , Pyrimidines , Sarcoma , Thymine , Vomiting , Imatinib Mesylate
12.
Korean Journal of Medicine ; : 535-539, 2013.
Article in Korean | WPRIM | ID: wpr-144644

ABSTRACT

Neurofibromatosis type 1 (NF1) is a genetic disease characterized by neoplastic and non-neoplastic disorders involving tissues of neuroectodermal and mesenchymal origin. NF1 is caused by mutations in the NF1 gene, which is found on chromosome 17q11.2. Patients with NF1 are at increased risk of developing soft tissue sarcomas that arise within the stromal compartment of the gastrointestinal tract, termed gastrointestinal stromal tumors (GISTs). GISTs associated with neurofibromatosis differ from sporadic GISTs, particularly with respect to their lower response rate to imatinib. We recently experienced a case involving a 45-year-old man with NF1 who was admitted to the hospital with epigastric pain and vomiting. Abdominal computed tomography revealed a duodenal GIST with pancreatic invasion. He had a base substitution mutation involving replacement of 2041 cytosine with thymine. He was treated successfully with a surgical operation and adjuvant imatinib therapy.


Subject(s)
Benzamides , Cytosine , Gastrointestinal Stromal Tumors , Gastrointestinal Tract , Genes, Neurofibromatosis 1 , Humans , Middle Aged , Neural Plate , Neurofibromatoses , Neurofibromatosis 1 , Piperazines , Pyrimidines , Sarcoma , Thymine , Vomiting , Imatinib Mesylate
13.
Article in English | WPRIM | ID: wpr-97207

ABSTRACT

PURPOSE: We investigated the clinical outcome of bone marrow (BM) involvement in patients with diffuse large B-cell lymphoma (DLBCL) who received rituximab-based therapy. MATERIALS AND METHODS: A total of 567 consecutive patients with newly diagnosed DLBCL treated with rituximab-CHOP (RCHOP) between November 2001 and March 2010 were included in the current study. All of the patients underwent a BM study at the initial staging and the clinical characteristics and prognosis of these patients with or without BM involvement were analyzed retrospectively. RESULTS: The total cohort included 567 patients. The overall incidence of BM involvement was 8.5%. With a median follow-up duration of 33.2 months (range, 0.1 to 80.7 months) for patients who were alive at the last follow-up, the five-year overall survival (OS) and event-free survival (EFS) rate in patients without BM involvement (76.3% and 67.5%, p<0.001) was statistically higher than that in patients with BM involvement (44.3% and 40.1%, p<0.001). In multivariate analysis, among total patients, BM involvement showed a significant association with OS and EFS. In univariate and multivariate analyses, even among stage IV patients, a significant association with worse EFS was observed in the BM involvement group. CONCLUSION: BM involvement at diagnosis affected the survival of patients with DLBCL who received RCHOP. Although use of RCHOP can result in significant improvement of the therapeutic effect of DLBCL, BM involvement is still a negative prognostic factor of DLBCL patients in the era of rituximab.


Subject(s)
Antibodies, Monoclonal, Murine-Derived , B-Lymphocytes , Bone Marrow , Cohort Studies , Disease-Free Survival , Follow-Up Studies , Humans , Incidence , Lymphoma, B-Cell , Multivariate Analysis , Prognosis , Rituximab
14.
Article in English | WPRIM | ID: wpr-68142

ABSTRACT

PURPOSE: The pattern of double primary cancers after treatment for gastric cancer is important for a patient's survival. MATERIALS AND METHODS: We analyzed the clinicopathologic data of 214 gastric cancer patients from October 1996 to November 2007 with regard to metachronous second primary cancers. RESULTS: Out of 5,778 patients with gastric cancer, metachronous second primary cancers occurred in 214 patients. The median age was 61.8 years, the number of male and female patients was 140 (65.4%), 74 (34.6%), respectively. The median time to the occurrence of second cancers after diagnosis of the first was 39.2 months (standard deviation, 31.2 months). The most common cancer was colorectal cancer, which occurred in 44 patients (20.6%), and lung cancer in 33 patients (15.4%), hepatocellular carcinoma in 26 patients (12.1%), ovarian cancer in 15 patients (7.0%), cervical cancer in 12 patients (7.0%), breast cancer in 11 patients (5.1%), and esophageal cancer in 11 patients (5.1%). The observed/expected (O/E) ratio showed a significant increase in colorectal (1.25), male biliary (1.60), ovarian (8.72), and cervical cancer (3.33) with primary gastric cancer. After five years from diagnosis of gastric cancer, secondary cancer occurred in 50 patients (23.4%), and breast cancer, prostate cancer, laryngeal cancer, lung cancer, and hepatocellular carcinoma were the most frequent. CONCLUSION: The O/E ratio showed a significant increase in colorectal, male biliary, ovarian, and cervical cancer with primary gastric cancer, and second primary cancer as the main cause of death for these patients. A follow-up examination for metachronous double primary cancer is needed in order to improve the survival time in patients with gastric cancer.


Subject(s)
Breast Neoplasms , Carcinoma, Hepatocellular , Cause of Death , Colorectal Neoplasms , Esophageal Neoplasms , Female , Follow-Up Studies , Humans , Laryngeal Neoplasms , Lung Neoplasms , Male , Neoplasms, Second Primary , Ovarian Neoplasms , Prostatic Neoplasms , Stomach Neoplasms , Uterine Cervical Neoplasms
15.
Article in English | WPRIM | ID: wpr-720646

ABSTRACT

No abstract available.


Subject(s)
Adult , Humans , T-Lymphocytes
16.
Article in English | WPRIM | ID: wpr-46543

ABSTRACT

BACKGROUND/AIMS: The clinical efficacy and safety of a three-drug combination of melphalan, prednisone, and thalidomide were assessed in patients with multiple myeloma who were not candidates for high-dose therapy as a first-line treatment. Because the side effects of thalidomide at a dose of > or = 100 mg daily can be a barrier to effective treatment for these patients, we evaluated the efficacy and safety of a reduced dose of thalidomide, 50 mg, for non-transplant candidates. METHODS: Twenty-one patients were treated in 4-week cycles, receiving 4 mg/m2 melphalan and 40 mg/m2 prednisone on days 1-7 and 50 mg thalidomide daily. The primary efficacy outcome was the overall response rate. Aspirin (100 mg daily) was also provided as prophylactic treatment for thromboembolism. RESULTS: The overall response rate was 57.1%; a complete response was seen in 23.8% of patients, a partial response in 33.3%, and stable disease in 9.5%. After a median follow-up time of 16.1 months, the median time to progression was 11.4 months (95% confidence interval, 2.1 to 20.6); the median overall survival was not reached. Grades 3 and 4 adverse events included infection (10%), peripheral neuropathy (5%), diarrhea (5%), thrombosis (10%), and loss of consciousness (10%). Two patients discontinued treatment due to loss of consciousness and neuropathy. CONCLUSIONS: Low-dose thalidomide (50 mg) plus melphalan and prednisone is an effective combination drug therapy option for newly diagnosed myeloma patients who are ineligible for high-dose chemotherapy.


Subject(s)
Aged , Angiogenesis Inhibitors/therapeutic use , Antineoplastic Agents, Alkylating/therapeutic use , Antineoplastic Agents, Hormonal/therapeutic use , Confidence Intervals , Disease Progression , Drug Therapy, Combination , Female , Humans , Kaplan-Meier Estimate , Korea , Male , Melphalan/therapeutic use , Middle Aged , Multiple Myeloma/drug therapy , Prednisone/therapeutic use , Risk , Thalidomide/therapeutic use , Time Factors , Treatment Outcome
17.
Article in English | WPRIM | ID: wpr-146796

ABSTRACT

We experienced a case in which yeasts in blood sample from a patient with cervical cancer with hepatic metastasis and multiple intraperitoneal cysts interfered with platelet morphology flag in automated blood analyzer. The peripheral blood smear was performed to confirm the flag and revealed intracellular and extracellular yeasts, which were subsequently identified as Candida parapsilosis by blood culture.


Subject(s)
Blood Platelets , Candida , Humans , Neoplasm Metastasis , Uterine Cervical Neoplasms , Yeasts
18.
Article in English | WPRIM | ID: wpr-17150

ABSTRACT

PURPOSE: Heptaplatin (Sunpla) is a cisplatin derivative. A phase IIb trial using heptaplatin resulted in a 34% response rate with mild nephrotoxicity. We conducted a randomized phase III trial of heptaplatin plus 5-FU compared with cisplatin plus 5-FU in patients with advanced gastric cancer. MATERIALS AND METHODS: One hundred seventy-four patients (heptaplatin, n=88; cisplatin, n=86) from 13 centers were enrolled. The eligibility criteria were as follows: patients with pathologically-proven adenocarcinoma, chemonaive patients, or patients who had received only single adjuvant chemotherapy, and who had a measurable or evaluable lesion. On day 1, heptaplatin (400 mg/m2) or cisplatin (60 mg/m2) was given over 1 hour with 5-FU (1 gm/m2) on days 1~5 every 4 weeks. RESULTS: At the time of survival analysis, the median overall survival was 7.3 months in the 5-FU + heptaplatin (FH) arm and 7.9 months in the 5-FU + cisplatin (FP) arm (p=0.24). Of the FH patients, 34.2% (complete response [CR], 1.3%; partial response [PR], 32.9%) experienced a confirmed objective response compared with 35.9% (CR 0%, PR 35.9%) of FP patients (p=0.78). The median-time-to-progression was 2.5 months in the FH arm and 2.3 months in the FP arm. The incidence of neutropenia was higher with FP (28%) than with FH (16%; p=0.06); grade 3~4 nausea and vomiting were more frequent in the FP than in the FH arm (p=0.01 and p=0.05, respectively). The incidence of increased proteinuria and creatininemia was higher with FH than with FP; however, there was no statistical difference. There were no treatment-related deaths. CONCLUSION: Heptaplatin showed similar effects to cisplatin when combined with 5-FU in advanced gastric cancer patients with tolerable toxicities.


Subject(s)
Adenocarcinoma , Arm , Chemotherapy, Adjuvant , Cisplatin , Drug Therapy, Combination , Fluorouracil , Humans , Incidence , Malonates , Nausea , Neutropenia , Organoplatinum Compounds , Proteinuria , Stomach Neoplasms , Vomiting
19.
Korean Journal of Medicine ; : 343-348, 2008.
Article in Korean | WPRIM | ID: wpr-181624

ABSTRACT

Primary thymic MALT lymphoma is a rare thymic tumor, with only eight previous cases having been described worldwide to date. We report a case of a 60-year-old Korean woman diagnosed as primary thymic MALT lymphoma. She was found to have an anterior mediastinal tumor during a medical check-up in 2006 and was referred to our hospital for further examination and treatment. The thymus was resected through a median sternotomy and pathology revealed primary thymic MALT lymphoma. Two months later, a follow-up chest CT showed a residual mediastinal soft tissue mass and increased FDG uptake was detected on PET CT scan. The patient was irradiated with 4,140 cGy. After radiation therapy, no evidence of residual soft tissue was found in follow-up chest CT scan and the patient is alive and well 15 months after treatment. We report the details of this case of primary thymic MALT lymphoma treated with irradiation and also offer a review of the literature.


Subject(s)
Female , Follow-Up Studies , Humans , Lymphoma , Lymphoma, B-Cell, Marginal Zone , Middle Aged , Sternotomy , Thorax , Thymus Gland , Thymus Neoplasms
20.
Korean Journal of Medicine ; : 208-213, 2008.
Article in Korean | WPRIM | ID: wpr-222774

ABSTRACT

Small cell carcinoma of the uterine cervix is a rare malignancy representing less than 5% of all cases of cervical carcinoma. It is clinically characterized by frequent early nodal and distant metastasis. Survival is relatively poor with hysterectomy alone. Currently, there is no consensus for the optimal management of small cell carcinoma of the uterine cervix. Most patients are treated with a multimodality approach, using chemotherapy and radiotherapy. We treated a 32-year-old woman with primary small cell carcinoma of the uterine cervix. The pelvic MR imaging showed a 3 cm mass in the uterine cervix and no evidence of other abnormalities in the adnexa. The patient treated with a radical hysterectomy alone and adjuvant therapy was not provided. Five months later, the patient had recurrent disease with multiple bone and liver metastases. We treated the patient with cisplatin and etoposide combination chemotherapy. Here we report the case of a primary small cell carcinoma of the uterine cervix with rapid progression after surgical treatment alone and review the medical literature.


Subject(s)
Adult , Carcinoma, Small Cell , Cervix Uteri , Cisplatin , Consensus , Etoposide , Female , Humans , Hysterectomy , Liver , Neoplasm Metastasis
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