A Case of Carcinoma of the Thyroid and Cervical Esophagus Following Irradiation / 대한소화기학회지

It is well recognized that radiation can be carcinogenic for a wide variety of tumors, especially, in breast, thyroid, and bone marrow which appear to be radiosensitive. The criteria for establishing the dignosis of radiation- induced malignancy are the knowledge of prior irradiation and the appearance of a malignancy in the irradiated area. We report a case of carcinoma of the thyroid and esophagus following prior neck irradiation for thyroid mass.

The Clinical Meaning of the Emergence of Viral Breakthrough during Lamivudine Treatment in Patients with Hepatitis B Virus Related Chronic Liver Disease / 대한간학회지

BACKGROUND/AIMS: Viral breakthrough has been considered a major limitation of lamivudine in the treatment of hepatitis B virus related chronic liver disease. Its clinical meaning has not been thoroughly assessed. METHODS: 64 patients who showed viral breakthrough during lamivudine treatment were retrospectively reviewed. We evaluated the rate of HBeAg seroconversion and hepatic decompensation after viral breakthrough. RESULTS: After viral breakthrough, serum alanine transaminase (ALT) elevation more than 1.2X upper limit of normal (ULN) was noticed in 40 patients (62.5%). Acute flare (serum ALT elevation >X5 ULN, or serum bilirubin >3 mg/dL) occured in 15 patients (23.4%). During the period of follow up (15.0 +/- 9.7 months; range, 0-31 months) since viral breakthrough, decreased serum HBV-DNA level to below the detection limit and serum ALT normalization was seen in 15 patients (23.4%). HBeAg seroconversion was noticed in 7 (13.7%) of a total of 51 HBeAg positive patients at base line; in 4 (15.4%) of 26 patients with non-hepatic failure (chronic hepatitis or Child-Pugh class A liver cirrhosis) at base line; and in 2 (40.0%) of 5 patients with non-hepatic failure at base line and acute flare after viral breakthrough. During this period, terminal hepatic decompensation (Child-Pugh class C) or death was noticed in 9 (90.0%) of 10 patients who had hepatic decompensation (Child-Pugh class B or C) at baseline and acute flare after viral breakthrough. CONCLUSIONS: Acute flare after viral breakthrough seemed to continue during HBeAg seroconversion and rarely developed into terminal hepatic decompensation or death in patients with non-hepatic decompensation at baseline. Its incidence is not only high but lethal to most patients with hepatic decompensation at baseline.

Analysis of Prognostic Factors Related to Survival Time for Patients with Small Cell Lung Cancer / 결핵

BACKGROUND: Small cell lung cancer represents approximately 20% of all carcinomas of the lung, and is recognized as having a poor long term outcome compared to non-small cell lung cancers. Therefore, this study investigated the prognostic factors in small cell lung cancer patients in order to improve the survival rate by using the proper therapeutic methods. MATERIAL AND METHOD: The clinical data from 394 patients, who diagnosed with small cell lung cancer and treated from 1993 to 2001 at the Kosin University Gospel Hospital, were analyzed. RESULT: There were 314 male patients (79.7%), and 80 female patients (20.3%). The number of those with limited disease was 177 (44.9%), and the number of those with extensive disease was 217 (55.1%). Overall, 366 out of 394 enrolled patients had died. The median survival time was 215 days (95% CI : 192-237days). The disease stage, Karnofsky performance state, 5% body weight loss for the recent 3 months, chemotherapy regimens, and the additive chest radiotherapy were identified as being statistically significant factors for the survival time. The median survival times of the supportive care group, one anticancer therapy, and two or more treatment groups were 71 days, 211 days, and 419 days, respectively (p<0.001). The data emphasizes the importance of anticancer treatment for improving the survival time for patients. The group of concurrent chemoradiotherapy regimens (30 patients) showed a significantly longer survival time than the group given sequential chemoradiotherapy (55 patients) (528 days versus 373 days, p=0.0237). The favorable prognostic factors of the laboratory study were groups of leukocytes =8,000/mm3, ALP=200 U/L, LDH=450 IU/L, NSE=15 ng/mL, s-GOT=40 IU/L. In extensive disease, there was no difference according to the number of metastatic sites. However, the median survival time of the patients with an ipsilateral pleural effusion was longer than the patients with other metastatic sites. According to the survey periods, three groups were divided into 1993-1995, 1996-1998, and 1999-2001. The median survival time was significantly prolonged after 1999 in comparison to previous groups (177 days, 194 days, 289 days, p=0.001, 0.002, respectively). CONCLUSION: Disease stage and 5% body weight loss for the recent 3 months at the diagnostic state were significant prognostic factors. In addition, the performance status, serum ALP, LDH, NSE, CEA levels also appear to be prognostic factors. The survival time of those patients with small cell lung cancer has been prolonged in recent years. It was suggested that the use of the EP (etoposide and cisplatin) chemotherapy method and concurrent chemoradiotherapy for patients with a limited stage contributed to the improved survival time.

Analysis of Prognostic Factors Related to Survival Time for Patients with Small Cell Lung Cancer / 결핵

BACKGROUND: Small cell lung cancer represents approximately 20% of all carcinomas of the lung, and is recognized as having a poor long term outcome compared to non-small cell lung cancers. Therefore, this study investigated the prognostic factors in small cell lung cancer patients in order to improve the survival rate by using the proper therapeutic methods. MATERIAL AND METHOD: The clinical data from 394 patients, who diagnosed with small cell lung cancer and treated from 1993 to 2001 at the Kosin University Gospel Hospital, were analyzed. RESULT: There were 314 male patients (79.7%), and 80 female patients (20.3%). The number of those with limited disease was 177 (44.9%), and the number of those with extensive disease was 217 (55.1%). Overall, 366 out of 394 enrolled patients had died. The median survival time was 215 days (95% CI : 192-237days). The disease stage, Karnofsky performance state, 5% body weight loss for the recent 3 months, chemotherapy regimens, and the additive chest radiotherapy were identified as being statistically significant factors for the survival time. The median survival times of the supportive care group, one anticancer therapy, and two or more treatment groups were 71 days, 211 days, and 419 days, respectively (p<0.001). The data emphasizes the importance of anticancer treatment for improving the survival time for patients. The group of concurrent chemoradiotherapy regimens (30 patients) showed a significantly longer survival time than the group given sequential chemoradiotherapy (55 patients) (528 days versus 373 days, p=0.0237). The favorable prognostic factors of the laboratory study were groups of leukocytes =8,000/mm3, ALP=200 U/L, LDH=450 IU/L, NSE=15 ng/mL, s-GOT=40 IU/L. In extensive disease, there was no difference according to the number of metastatic sites. However, the median survival time of the patients with an ipsilateral pleural effusion was longer than the patients with other metastatic sites. According to the survey periods, three groups were divided into 1993-1995, 1996-1998, and 1999-2001. The median survival time was significantly prolonged after 1999 in comparison to previous groups (177 days, 194 days, 289 days, p=0.001, 0.002, respectively). CONCLUSION: Disease stage and 5% body weight loss for the recent 3 months at the diagnostic state were significant prognostic factors. In addition, the performance status, serum ALP, LDH, NSE, CEA levels also appear to be prognostic factors. The survival time of those patients with small cell lung cancer has been prolonged in recent years. It was suggested that the use of the EP (etoposide and cisplatin) chemotherapy method and concurrent chemoradiotherapy for patients with a limited stage contributed to the improved survival time.

A Case of Mantle Cell Lymphoma Presenting as Multiple Lymphomatous Polyposis Involving Skeletal Muscles / 대한소화기내시경학회지

Multiple lymphomatous polyposis (MLP) is an uncommon type of primary non-Hodgkin's gastrointestinal B cell-lymphoma characterized by the presence of multiple lymphomatous polyps along the gastrointestinal tract. Unlike MALT-lymphoma, MLP has a strong tendency for histologically monomorphic character, extra-digestive localization, rare lymphoepithelial lesion and poor prognosis. The malignant cells of MLP share morphological, immunohistologic and cytogenetic similarities with cells of node-based mantle cell lymphoma. We report a case of mantle cell lymphoma presenting with MLP involving various segments of the gastrointestinal tract, skeletal muscles of the right thigh and bone marrow observed in a 71-year-old woman who complained of lower abdominal pain and a palpable right thigh mass.

Gemcitabine/Cisplatin Combination Chemotherapy in Advanced non-Small Cell lung Cancer / 결핵

BACKGROUND: To evaluate the efficacy and safety of gemcitabine and cisplatin chemotherapy in advanced non-small cell lung cancer (NSCLC). MATERIALS AND METHODS: Forty patients (21 men, 19 women ; age range, 37 to 73 years; median, 63 years) with unresectable stage IIIB to IV NSCLC were evaluated. Patients received cisplatin 60mg/m2 (Day 1), gemcitabine 1200mg/m2 (Day 1 and 8) every 21 days. Eighteen patients had stage IIIB disease and 22 had stage IV. There were 28 patients of adenocarcinoma (70.0%), 11 of squamous cell carcinoma (27.5%), and one of large cell carcinoma (2.5%). RESULTS: Of 40 patients, no patients showed complete response while 15(37.5%) showed partial response, 7(17.5%) had stable diseases, 18(45%) had progressive diseases. During a total of 195 courses of chemotherapy, grade 3 or more granulocytopenia and thrombocytopenia occured in 12.5% and 2.5% of patients respectively. Non-hematologic toxicity was mild and easily controlled. There was one case of treatment-related death by pneumomia. The median survival was 55 weeks (95% CI, 34~75weeks), and the time to progression was 19 weeks (95% CI, 16~23weeks). One year survival rate was 55% and 2 year survival rate was 10%. CONCLUSION: The efficacy of cisplatin and gemcitabine combination chemotherapy was acceptable in the treatment of advanced NSCLC.