Serum levels of bone sialoprotein, osteopontin, and β2-microglobulin in stage I of multiple myeloma

Context: The fluctuations of proteins in multiple myeloma (MM) are well-known markers for checking the status of the patients. Aims: The objective of this study was to examine three proteins that have an important role in disease progression. Subjects and Methods: The study was performed with two groups: 30 MM stage I patients' (14 females/16 males; aged 60.83 ± 12.38 years) as case group and 40 healthy individuals (18 females/22 males; aged 57.65 ± 6.43 years) as control group. Both groups have been matched in gender and age. Bone sialoprotein (BSP), osteopontin (OPN), and β2-microglobulin (β2M) were measured with an enzyme-linked immunosorbent assay. Results: Serum BSP levels of MM-I patients was significantly higher than that of healthy controls (29.24 ± 5.57 vs. 20.89 ± 3.67, P = 0.001). OPN levels of MM-I patients were significantly lower than that of healthy individuals (12.03 ± 3.45 vs. 19.35 ± 4.67, P = 0.001). β2M levels of patients and controls were similar (1.49 ± 0.67 vs. 1.29 ± 0.55, P = 0.193). Conclusions: The results suggested that myeloma cells may affect the production of BSP and OPN, which possibly contributes to osteoclastic bone resorption in MM-I patients. Their levels may be a useful biomarker for assessing bone destruction in MM-I patients and distinguishing MM-I from healthy individuals

Effects of cardiac rehabilitation combined with psychological invention on clinical efficacy in high-risk patients with acute myocardial infarction after emergent percutaneous coronary intervention / 中华行为医学与脑科学杂志

Objective@#To investigate the effects of stage I cardiac rehabilitation combined with structural psychological invention high-risk patients with acute myocardial infarction (AMI) treated by emergent percutaneous coronary intervention (PCI).@*Methods@#Totally 120 patients with AMI that received emergent PCI were randomized into experimental group(n=60) and control group(n=60). The experimental group started stage I cardiac rehabilitation combined with structural psychological invention after emergency PCI.The control group received routine treatment.Self-rating Anxiety Scale (SAS) and Self-rating depression Scale (SDS) scores were compared in both groups at before PCI and 1 week after PCI.Left ventricular ejection fraction (LVEF) and left ventricular end-diastolic diameter (LVEDD) were compared in both groups at before PCI and 1 week, 1 month and 6 months after PCI.The incidence of adverse cardiac events including cardiac death and recurrence myocardial infarction were compared between the two groups at 6 months after PCI.@*Results@#The SAS score in the experimental group (36.38±5.15) was lower than that in the control group (42.10±5.79) in 1 week after PCI (t=2.313, P<0.05). The SDS score in the experimental group(37.09±5.56) was lower than that in the control group (43.85±5.33) in 1 week after PCI (t=2.330, P<0.05). The LVEF in the experimental group( (45.08±4.41)%) was significantly higher than that in the control group ((42.81±3.83)%) in 1 week after PCI ( t=2.209, P<0.05). The LVEF in the experimental group ((48.93±4.39)%) was significantly higher than that in the control group ((44.61±4.35)%) in 1 month after PCI (t=2.224, P<0.05). The LVEDD in the experimental group ((54.74±4.01)mm) was significantly lower than that in the control group ((57.81±4.49)mm) in 1 month after PCI (t=2.413, P<0.05). The LVEDD in the experimental group ((52.21±2.82)mm) was significantly lower than that in the control group ((55.65±3.88)mm) in 6 month after PCI (t=2.297, P<0.05). And there were no significant difference between the two groups at other time point(all P>0.05). The follow-up results after 6 months showed that the experimental group (8.9%) had lower incidence of cardiac death than that in the control group (24.1%) (HR(95%CI): 0.317(0.128-0.835), P<0.05). The follow-up results after 6 months showed that the experimental group (14.2%) had lower incidence of recurrence myocardial infarction than that in the control group (42.2%) (HR(95%CI): 0.263(0.125-0.548), P<0.05).@*Conclusion@#Stage I cardiac rehabilitation improved the cardiac function in high-risk patients with AMI treated by emergent PCI and reduced the incidence of cardiac death and recurrence myocardial infarction.

Assessment of solid components of borderline ovarian tumor and stage I carcinoma: added value of combined diffusion- and perfusion-weighted magnetic resonance imaging / 영남의대학술지

BACKGROUND: We sought to determine the value of combining diffusion-weighted (DW) and perfusion-weighted (PW) sequences with a conventional magnetic resonance (MR) sequence to assess solid components of borderline ovarian tumors (BOTs) and stage I carcinomas.METHODS: Conventional, DW, and PW sequences in the tumor imaging studies of 70 patients (BOTs, n=38; stage I carcinomas, n=32) who underwent surgery with pathologic correlation were assessed. Two independent radiologists calculated the parameters apparent diffusion coefficient (ADC), K(trans) (vessel permeability), and V(e) (cell density) for the solid components. The distribution on conventional MR sequence and mean, standard deviation, and 95% confidence interval of each DW and PW parameter were calculated. The inter-observer agreement among the two radiologists was assessed. Area under the receiver operating characteristic curve (AUC) and multivariate logistic regression were performed to compare the effectiveness of DW and PW sequences for average values and to characterize the diagnostic performance of combined DW and PW sequences.RESULTS: There were excellent agreements for DW and PW parameters between radiologists. The distributions of ADC, K(trans), and V(e) values were significantly different between BOTs and stage I carcinomas, yielding AUCs of 0.58 and 0.68, 0.78 and 0.82, and 0.70 and 0.72, respectively, with ADC yielding the lowest diagnostic performance. The AUCs of the DW, PW, and combined PW and DW sequences were 0.71±0.05, 0.80±0.05, and 0.85±0.05, respectively.CONCLUSION: Combining PW and DW sequences to a conventional sequence potentially improves the diagnostic accuracy in the differentiation of BOTs and stage I carcinomas.

Effects of stage I heart rehabilitation exercises on risk of falling in patients with acute myocardial infarction after percutaneous coronary intervention / 现代临床护理

Objective To investigate the effect of seven-step exercise regurgitation in stage I exercises on the risk of fall in patients with acute ST-elevation myocardial infarction. Methods At the time of admission, 119 patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly divided into control group (n=58) and intervention group (n=61). All patients were given routine nursing within 7 days after operation. The patients in the intervention group were given the first three-step exercises based on the seven-step exercise regurgitation in stage I exercise apart from routine nursing within 7 days after operation. The risk of fallings was assessed on the 7th day after operation for the two groups. Result Compared with the control group, the risk of fallings on day five after operation in the intervention group was significantly lower than that in the control group (P<0.05). Conclusion The seven-step exercise of stage I cardiac rehabilitation can effectively reduce the risk of falling in patients with acute myocardial infarction after PCI.

Effects of stage I heart rehabilitation exercises on risk of falling in patients with acute myocardial infarction after percutaneous coronary intervention / 现代临床护理

Objective To investigate the effect of seven-step exercise regurgitation in stage I exercises on the risk of fall in patients with acute ST-elevation myocardial infarction. Methods At the time of admission, 119 patients with acute ST-segment elevation myocardial infarction undergoing percutaneous coronary intervention (PCI) were randomly divided into control group (n=58) and intervention group (n=61). All patients were given routine nursing within 7 days after operation. The patients in the intervention group were given the first three-step exercises based on the seven-step exercise regurgitation in stage I exercise apart from routine nursing within 7 days after operation. The risk of fallings was assessed on the 7th day after operation for the two groups. Result Compared with the control group, the risk of fallings on day five after operation in the intervention group was significantly lower than that in the control group (P<0.05). Conclusion The seven-step exercise of stage I cardiac rehabilitation can effectively reduce the risk of falling in patients with acute myocardial infarction after PCI.

Clinical outcomes of stage I endometrial carcinoma patients treated with surgery alone: Siriraj Hospital experiences / 부인종양

OBJECTIVE: To evaluate the recurrence rates and patterns of failure in patients with stage I endometrial carcinoma after surgical staging without adjuvant therapy. METHODS: Medical records of 229 patients with stage I endometrial carcinoma, treated with surgery alone between 2002 and 2010 at Siriraj Hospital were retrospectively reviewed. The primary objective of this study was recurrence rates. The secondary objectives were patterns of failure, disease-free survival, overall survival, and prognostic factors related to outcomes. RESULTS: During median follow-up time of 53.3 months, 11 recurrences (4.8%) occurred with a median time to recurrence of 21.2 months (range, 7.7 to 77.8 months). Vaginal recurrence was the most common pattern of failure (8/11 patients, 72.7%). Other recurrences were pelvic, abdominal and multiple metastases. Factors that appeared to be prognostic factors on univariate analyses were age and having high intermediate risk (HIR) (Gynecologic Oncology Group [GOG] 99 criteria), none of which showed significance in multivariate analysis. The recurrence rates were higher in the patients with HIR criteria (22.2% vs. 4.1%, p=0.013) or patients with stage IB, grade 2 endometrioid carcinoma (9.4% vs. 4.3%, p=0.199). Five-year disease-free survival and 5-year overall survival were 93.9% (95% CI, 89.9 to 5.86) and 99.5% (95% CI, 97.0 to 99.9), respectively. CONCLUSION: The patients with low risk stage I endometrial carcinoma had excellent outcomes with surgery alone. Our study showed that no single factor was demonstrated to be an independent predictor for recurrence.

Treatment outcome and prognostic factors in intermediate risk stage I endometrial carcinoma.

Introducton: The aim of this study was to evaluate the clinical characteristics, post-surgery adjuvant treatment approach and posttreatment disease course in patients with intermediate risk stage I endometrium cancer and also to assess the effects of known prognostic factors on this group of patients. Patients and Methods: A total of 148 patients followed up postoperatively or after adjuvant treatment between 1996 and 2007 were evaluated retrospectively. Median follow-up duration was 67 months (range: 7-166). Among the study population 14.9% had Ib and 83.1% had stage Ic disease. 72 were treated by external beam radiotherapy (EBRT), 7 by intracavitary radiotherapy (ICRT), 65 by external + intracavitary radiotherapy (EBRT + ICRT), and one by chemoradiotherapy (CRT). Results: Vaginal vault is found to be the most common site of recurrences. Five and 10-year local control (LC) rates were 96.6% and 95.9%, respectively, while 5 and 10-year distant control (DC) rates were 94.6% and 91.9%, respectively. One, 5 and 10-year overall survival rates (OS) were 99.3%, 87.6% and 71.2%, respectively, while 1, 5 and 10-year progression-free survival rates (PFS) were 97.3%, 87.6% and 71.2%, respectively. Univariate analysis has revealed that prognostic factors as age (P = 0.0001), menopausal status (P = 0.049) and EBRT duration (P = 0.003) statistically significantly affected OS; while age (P = 0.0001) and EBRT duration (P = 0.006) affected PFS. Multivariate analysis has revealed that only age (P = 0.001) (P = 0.0001) and ERT duration (P = 0.021) (P = 0.027) affected both OS and PFS. Conclusion: LC and OS rates are high in the intermediate risk group. Age over 60 years and EBRT duration of 35 days and over both have negative effects on outcome in this group.

The research progress on stereotactic body radiation therapy for stageⅠnon-small cell lung cancer / 实用肿瘤学杂志

Image guided stereotactic body radiation therapy ( SBRT) has emerged as a promising technolo-gy for early-stage non-small cell lung cancer ( NSCLC) increasingly ,particularly for patients that are unable to tolerate or deny operation ,with a trend to replace surgical resection .Abundant clinical research results have dem-onstrated that SBRT is safe to yield local control rate of more than 90%without excessive toxicity in early -stage NSCLC.In this review ,we discuss the research progress on treating stage I NSCLC with SBRT .

Prognostic impact of serum albumin levels on the recurrence of stage I non-small cell lung cancer

Objective: Patients with stage I non-small cell lung cancer who have undergone complete surgical resection harbor a 30% risk for tumor recurrence. Thus, the identification of factors that are predictive for tumor recurrence is urgently needed. The aim of this study was to test the prognostic value of serum albumin levels on tumor recurrence in patients with stage I non-small cell lung cancer. Methods: Stage I non-small cell lung cancer patients who underwent complete surgical resection of the primary tumor at Zhejiang Hospital were analyzed in this study. Serum albumin levels were measured before surgery and once again after surgery in 101 histologically diagnosed non-small cell lung cancer patients. Correlations between the pre- and post-operative serum albumin levels and various clinical demographics and recurrence-free survival rates were analyzed. Results: Patients with pre-operative hypoalbuminemia (<3.5 g/dl) had a significantly worse survival rate than patients with normal pre-operative serum albumin levels (≥3.5 g/dl) (p=0.008). Patients with post-operative hypoalbuminemia had a worse survival rate when compared with patients with normal post-operative serum albumin levels (p=0.001). Cox multivariate analysis identified pre-operative hypoalbuminemia, post-operative hypoalbuminemia and tumor size over 3 cm as independent negative prognostic factors for recurrence. Conclusion: Serum albumin levels appear to be a significant independent prognostic factor for tumor recurrence in patients with stage I non-small cell lung cancer who have undergone complete resection. Patient pre-treatment and post-treatment serum albumin levels provide an easy and early means of discrimination between patients with a higher risk for recurrence and patients with a low risk of recurrence. .

Minimal and mild endometriosis negatively impact on pregnancy outcome / Endometriose mínima e leve e seu impacto negativo sobre a gravidez

Endometriosis, a highly prevalent gynecological disease, can lead to infertility in moderate to severe cases. Whether minimal stages are associated with infertility is still unclear. The purpose of this systematic review is to present studies regarding the association between pregnancy rates and the presence of early stages of endometriosis. Studies regarding infertility, minimal (stage I, American Society of Reproductive Medicine [ASRM]) and mild (stage II, ASRM) endometriosis were identified by searching on the MEDLINE database from 1985 to September 2011 using the following MESH terms: endometriosis; infertility; minimal; mild endometriosis; pregnancy rate. 1188 articles published between January of 1985 and November of 2011 were retrieved; based on their titles, 1038 citations were excluded. Finally, after inclusion and exclusion criteria, 16 articles were selected to be part of this systematic review. Several reasons have been discussed in the literature to explain the impact of minimal endometriosis on fertility outcome, such as: ovulatory dysfunction, impaired folliculogenesis, defective implantation, decrease embryo quality, abnormal immunological peritoneal environment, and luteal phase problems. Despite the controversy involving the topic, the largest randomized control trial, published by Marcoux et al. in 1997 found a statistically different pregnancy rate after resection of superficial endometrial lesions. Earlier stages of endometriosis play a critical role in infertility, and most likely negatively impact pregnancy outcomes. Further studies into stage I endometriosis, especially randomized controlled trials, still need to be conducted.

RESUMO O objetivo desta revisão sistemática é apresentar estudos sobre a associação entre as taxas de gravidez e a presença de fases iniciais de endometriose. Estudos relacionados com a infertilidade e estágios mínimos e leves (estágios I,II, American Society of Reproductive Medicine [ASRM]) foram identificados por busca na base de dados MEDLINE, de 1985 a setembro de 2011. Os seguintes termos foram usados como palavras-chave: endometriose, infertilidade, taxa de gravidez; estágio mínimo; estágio leve de endometriose. Entre janeiro de 1985 e novembro de 2011, 1188 artigos foram recuperados; com base no título, 1038 citações foram excluídas e, finalmente, depois de critérios de inclusão e exclusão, 18 artigos foram selecionados para fazer parte desta revisão sistemática. Várias razões têm sido discutidas na literatura na tentativa de explicar o impacto da endometriose mínima no resultado da fertilidade, tais como: disfunção ovulatória, foliculogênese alterada prejudicada, defeito na implantação, baixa qualidade embrionária, ambiente peritoneal inflamatório e hostil e problemas da fase lútea. Apesar de toda polêmica envolvendo o tópico, o maior ensaio clínico randomizado foi publicado por Marcoux et al. Os autores encontraram uma taxa de gravidez estatisticamente significante após a ressecção de lesões superficiais de endometriose. Estágios iniciais de endometriose desempenham um papel crítico relacionado à infertilidade e, provavelmente proporcionam um impacto negativo nas taxas de gravidez em pacientes com endometriose. Outros estudos envolvendo estágios iniciais de endometriose, especialmente ensaios clínicos randomizados, ainda precisam ser realizados.

Incidence and Multiplicities of Adenomatous Polyps in TNM Stage I Colorectal Cancer in Korea

PURPOSE: In recent years, the incidence of early-stage colorectal cancer (CRC) has markedly increased in the population within the Republic of Korea. The aim of this study was to evaluate the clinicopathologic features of adenomatous polyps in TNM stage I CRC patients and in the general population. METHODS: Between March 2003 and September 2009, 168 patients with stage I CRC were enrolled in this study. In addition, the records of 4,315 members of the general population without CRC, as determined by colonoscopy during a health check-up, were reviewed. RESULTS: Of the 168 patients with stage I CRC, 68 (40.5%) had coexisting colorectal adenomatous polyps and of the 4,315 members of the general population, 1,112 (26.0%) had coexisting adenomatous polyps (P = 0.006). The prevalences of adenomatous polyp multiplicity in early CRC and in the general population were 32% and 15%, respectively (P = 0.023). Patients with coexisting adenomatous polyps had a higher frequency of tubulovillous or villous adenomas than members of the general population with polyps (7.5% vs. 2.0%, P = 0.037). Furthermore, a subgroup analysis showed that the occurrence (44% vs. 34%, P = 0.006) and the multiplicity (32% vs. 15%, P = 0.023) of adenomatous polyps were greater for T2 than T1 cancer. CONCLUSION: The prevalence and the multiplicity of adenomatous polyps in TNM stage I CRC is higher than it is in the general population. The findings of this study suggest that depth of invasion of early stage CRC affects the prevalence and the number of adenomatous polyps in the remaining colon and rectum.

Adenosquamous Carcinoma of the Pancreas: A Case Report / 대한소화기내시경학회지

Adenosquamous carcinoma of the pancreas is a rare tumor, which is difficult to diagnose. A 65-year-old man was admitted complaining of abdominal pain. Abdominal computed tomography (CT) demonstrated a cystic mass in the pancreatic body. Endoscopic ultrasound (EUS) showed an approximate 1.0 cm-sized hypoechoic cystic mass with a solid portion in the pancreatic body and narrowing of the main pancreatic duct. Under the impression of acute pancreatitis with a pseudocyst diagnosis, medical therapy including pancreatic stent insertion was administered to the patient for 4 weeks. A distal pancreatectomy was performed with the suspicion of pancreatic cancer due to the remaining mass on a follow-up CT scan, and the tumor was histopathologically diagnosed as stage I (TNM classification) adenosquamous carcinoma of the pancreatic body. The patient was discharged without any problems and has been on follow-up without recurrence. We report a case of adenosquamous carcinoma of the pancreas that was diagnosed relatively early with the help of EUS.

Radiotherapy for stage I seminoma of the testis.

Background : After orchiectomy in stage I seminoma the standard is adjuvant radiation therapy. We analyzed the patients retrospectively to evaluate the contributions of the treatment volume and dosage to treatment outcomes. Materials and Methods : Between January 1999 and December 2005, 91 stage I seminoma patients with a median age 36 (range;22-62) applied to our center, who were treated using anterior-posterior parallel opposed fields with linear accelerator or Co60 after orchiectomy. Twenty-five (27.5%) patients received irradiation to the paraaortic and ipsilateral pelvic nodes, and 66 (62.5%) patients only received to paraaortic nodes. Results : With a follow up time of median 57 months (range; 27-104), paraaortic nodes treated group had 4 relapses (6%) - 3 of them pelvic, one of them both pelvic and paraaortic. Both paraaortic and ipsilateral nodes irradiated patients had only one relapse (4%) (P = 0.726). While the 5 year overall survival (OS) is 98.8%, it is 100% in the dog-leg group and 98.4% in the paraaortic group (P = 0.548). Univariate analyses of OS and Disease Free Survival (DFS) showed that there is no statistically significant difference related to factors as age, histologic subgroup, tumor size, rete testis involvement, radiotherapy (RT) fields, dose ranges and the therapy device. Conclusion : Adjuvant RT approach is the preferred for non-compliant low risk patients as well as intermediate and high risk patient in stage I seminoma. 20 Gy/ 10 fractions/ 2 weeks RT is the adequate treatment.

Clinical Analysis and Mechanism Study of Conditioning of Postoperative Endometrial Carcinoma in Staging Ⅰ with Integrated Traditional Chinese and Western Medicine / 国际中医中药杂志

Objective To investigate if the anticancer prescription Fuzhengyiaitang in combination with progestogen matching chems can have better clinical effects than progestogen alone.Methods Collecting 60 patients and grouped into two randomly.One group named the experimental group and the other is named the control.The experimental group is given Fuzhengyiaitang and progestogen and the control ine is given the progestogen alone.The clinical effects are investigated.Results The experimental group had better clinical effects than the other one and the results had statistical significance.The experimental group are stronger,had better immunal functions and less side effects.Conclusion Fuzhengyiaitang and progestogen match cbems Can have better clinical effects in treating the stage I's operation.

The effect of lymphadenectomy on the survival rate of clinical stage I endometrial cancer / 부인종양

OBJECTIVE: To evaluation of the effect of pelvic or paraaortic lymphadenectomy on survival rates in the management of clinical stage I endometrial cancer METHODS: A retrospective analysis was performed on a total 303 clinical stage I endometrial cancer patients from 1989 to 2004 at Asan Medical Center. Two hundred-sixty-three (86.8%) underwent a total hysterectomy and bilateral salpingo-oophorectomy with pelvic or paraaortic lymphadenectomy, while forty (13.2%) underwent a total hysterectomy and bilateral salpingo-oophorectomy only. Characteristics of patients and 5-year survival rate of each patients group were analyzed. RESULTS: Seventeen (6.5%) showed lymph node metastases and overall 5-year survival rate of clinical stage I endometrial cancer was 96.9%. The 5-year and 10-year survival rate of a group with lymphadenectomy were 96.4% and 86.6%, and those of a group without lymphadenectomy were 100% and 75.2%, respectively (p=0.48). The 5-year survival rate of a group with positive lymph nodes was 73.3%, that of a group with negative lymph nodes was 97.7% (p<0.05). CONCLUSION: The complete staging operation including lymphadenectomy did not improve the survival rates in a group with lymphadenectomy significantly. But the debates regarding the necessarity of lymphadenectomy in clinical stage I endometrial cancer still remains and a large randomized prospective study is needed.

Results of the Definitive Radiation Therapy for the Early Stage (Stage I) Non-small Cell Lung Cancer

PURPOSE: To investigate the effectiveness and safety of definitive radiation therapy for Stage I non-small cell lung cancer patients who were medically inoperable or refused surgery. Material and M ethods: A retrospective study was conducted of 36 patients who received definitive radiation therapy for pathologically proven Stage I non-small cell lung cancer in the Department of Radiation Oncology, Asan Medical Center, between July 1989 and July 2003. Twenty three patients received conventional radiation therapy with a fraction size of 1.2~3.0 Gy, with a total dose of 50.0~70.2 Gy (CRT group). Thirteen patients received stereotactic radiosurgery with a fraction size of 10~12 Gy, with a total dose of 30~48 Gy using a Stereotactic Body Frame (Precision TherapyTM, SRS group). RESULTS: The two- and 5-year overall survival rates (OS) of all the patients were 79 and 44%, respectively. The two- and 5-year OS of the CRT and SRS groups were 43 and 53%, and 7 and 27%, respectively, but showed no statistically significant difference (p=0.5173). The two- and 5-year cause-specific survival rates (CSS) of the SRS group were superior to those of the CRT group (2YCSS: 100 vs. 70%, 5YCSS: 50 vs. 39%), but were not statistically significant (p=0.2086). The two- and 5-year local progressionfree survival rates (LPFS) of all the patients were 67 and 57%, respectively. The 5-year LPFS of the SRS group was superior to that of the CRT group (66 vs. 54%), but was not statistically significant (p=0.3937). The T-stage, tumor size, treatment method (CRT vs. SRS) and tumor dose did not affect the 2-year LPFS. Grade 2~3 radiation pneumonitis developed in 5 patients (14%), all in the CRT group. The omission of elective nodal irradiation (ENI) did not affect the incidence of Grade 2~3 radiation pneumonitis in the CRT group (ENI group 17%, no ENI group 25%, p=0.538). CONCLUSION: Definitive radiation therapy for Stage I non-small cell lung cancer patients that were medically inoperable or who refused surgery was considered effective and safe. Stereotactic radiosurgery was proven to be superior to that of conventional radiation therapy, although no statistically significant difference was shown. To investigate the optimal radiation dose and fractionation scheme of SRS, a prospective study, including more patients, is mandatory

Clinical Analysis of Stage I and II Breast Cancer / 한국유방암학회지

PURPOSE: The combination of conservative surgery and radiotherapy is currently accepted as the preferred treatment for most patents with clinical stage I or II breast cancer. However, there is large amount of controversy concerning the optimal means of selecting patients and the details of the treatment technique. Breast cancer patients are being treated both in university hospitals and in community hospitals. Generally, the radiation therapy is not available in many community hospitals. Radiation therapy, which generally follows either a mastectomy or conservative surgery, is an important procedure. Therefore, the type of hospital facilities may influence which surgical procedures are selected. The authors conducted this study to analyse the current patterns of care for early invasive breast cancer in a hospital without a radiation therapy unit, even though the patient could receive such treatment from another affiliated hospital. METHODS: 131 cases of stage I and II breast cancer patients were reviewed between 1987 and 1997, and the types of treatments including surgery, radiation therapy and systemic therapy, were analysed retrospectively. RESULTS: The surgical procedures used were mainly a modified radical mastectomy (124/131, 94.7%), followed by breast conservation surgery (4/131, 3.1%), a total mastectomy (2/131, 1.5%) and a radical mastectomy (1/131, 0.8%). Radiation therapy was applied to 19 stage II patients (N=105), but not to any of the stage I patients (N=26). Systemic adju-vant therapy was done with chemotherapy (39/131, 29.8%), hormone therapy (17/131, 13.0%) and a combination of both modalities (67/131, 51.1%), with an exception of 8 cases. CONCLUSION:Breast c0onservation therapy for breast cancer patients was underutilized. The selection of the therapeutic method may be influenced by the facilities of the particular hospital. For proper treatment of early stage breast cancer, a surgeon must keep in close contact with bothe a radiologist and a radiotherapist, even in other affiliated hospitals.

Clinical Analysis of Stage I and II Breast Cancer

PURPOSE: The combination of conservative surgery and radiotherapy is currently accepted as the preferred treatment for most patents with clinical stage I or II breast cancer. However, there is large amount of controversy concerning the optimal means of selecting patients and the details of the treatment technique. Breast cancer patients are being treated both in university hospitals and in community hospitals. Generally, the radiation therapy is not available in many community hospitals. Radiation therapy, which generally follows either a mastectomy or conservative surgery, is an important procedure. Therefore, the type of hospital facilities may influence which surgical procedures are selected. The authors conducted this study to analyse the current patterns of care for early invasive breast cancer in a hospital without a radiation therapy unit, even though the patient could receive such treatment from another affiliated hospital. METHODS: 131 cases of stage I and II breast cancer patients were reviewed between 1987 and 1997, and the types of treatments including surgery, radiation therapy and systemic therapy, were analysed retrospectively. RESULTS: The surgical procedures used were mainly a modified radical mastectomy (124/131, 94.7%), followed by breast conservation surgery (4/131, 3.1%), a total mastectomy (2/131, 1.5%) and a radical mastectomy (1/131, 0.8%). Radiation therapy was applied to 19 stage II patients (N=105), but not to any of the stage I patients (N=26). Systemic adjuvant therapy was done with chemotherapy (39/131, 29.8%), hormone therapy (17/131, 13.0%) and a combination of both modalities (67/131, 51.1%), with an exception of 8 cases. CONCLUSION: Breast conservation therapy for breast cancer patients was underutilized. The selection of the therapeutic method may be influenced by the facilities of the particular hospital. For proper treatment of early stage breast cancer, a surgeon must keep in close contact with bothe a radiologist and a radiotherapist, even in other affiliated hospitals.

Tumor Angiogenesis and Its Correlation with Survival at the Same Stage in Gastric Carcinomas

BACKGROUND: In order to evaluate the clinical relevance of angiogenesis in patients with gastric cancer, we investigated the microvessel count in gastric cancer tissues and compared the results with several clinicopathologic factors and the prognosis for the same stage. METHODS: A total of 256 patients with gastric cancer were included in this study. The microvessel count was determined by using immunohistochemical staining monoclonal antibody against factor- VIII-related antigen. RESULTS: The microvessel density determined by using immunohistochemical staining for factor-VIII- related antigen had statistical significance with survival between the higher (> or =42: microvessel counts) and lower the (<42: microvessel counts) groups. However in the same stage, except stage I, it had not significant correlation with survival. CONCLUSION: The tumor angiogenesis of a gastric carcinoma in stage I is an independent factor that impacts on the prognosis.

Radiotherapy Results of Stage I Glottic Cancer / 대한방사선종양학회지

PURPOSE: This study was to evaluate survival, failure patterns, and prognostic factors of stage I squamous cell carcinoma of the glottic larynx after curative radiation therapy. MATERIALS AND METHODS: A retrospective analysis was done for 57 patients with glottic cancer who were treated with curative radiation therapy from June 1985 to November 1992. There were 55 male and two female patients. Patients' age ranged from 17 to 71 years (median 39 years). Radiation therapy was delivered five times a week, 2 Gy daily, total 66 Gy using 6 MV X- ray. RESULTS: Complete response (CR) was noted in 51 out of 57 patients (89.5%) and persistent disease (PER) in six out of 57 patients (10.5%). The disease-free survival rates at 3 and 5 years were 72.9% and 63.8%, respectively. Seven failures were observed among 51 CR patients during follow-up. Salvage total laryngectomy for six recurred patients and partial laryngectomy for one recurred patient were done with successful results, i.e., all of them were actually salvaged. Among six PER patients, salvage total laryngectomy for two patients and partial laryngectomy for two patients were done and two patients refused operation. Following salvage surgery for the four PER patients, three were salvaged and one failed locoregionally. Among the 13 failures 10 (76.9%) were salvaged with surgery. The ultimate local control rate at 5 years was 92.3% and overall 47 out of 57 (82.5%) patients were able to preserve their larynx. The 5-year disease-free survival rates were 85.5% for posterior lesions, and 61.6% for anterior lesions (p<0.05). Cord mobility, involvement of anterior commissure, field size, and T stage did not impact on disease-free survival. CONCLUSION: Considering the high percentage of voice preservation with initial radiotherapy, radiotherapy should be the first choice in the treatment of stage I glottic carcinoma.