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Volume 27(5); 1995
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Original Articles
In Vitro Chemosensitivaty Test of SK-302 on Human Gastric Carcinoma Cell Lines
Soo Kie Kim, Woon Seob Shin, Yoon Sun Park, Sun Ju Choi, Kyung Ho Lee, Joo Young Park, Choon Myung Koh, Chan Mug Ahn, Weon Sub Park
J Korean Cancer Assoc. 1995;27(5):703-711.
AbstractAbstract PDF
SK-30ZB with quinomycin-related structure is considered to be potent antitumor antibiotic. There were several reports that quinomycins and their derivatives showed wide spectrum of anti-tumor activity. But there were no reports on anti-gastric tumor activity. We fould SK- 302B with anti-gastric tumor activity in vitro using our established anti-tumorsubstance screening system. Recent attention has been focused on the possibility of predicting the effectiveness of anti-cancer drugs on individual tumor through chemosensitivity tests. However, optimal conditions for in vitro chemosensitivity test on human gastric carcinoma cell lines were not well established. We attempted to establish optimal conditions and to evaluate compara- tively in vitro tumor cell cytotoxicity between SK-302B and adriamycin, using 7 human gastric carcinoma celi lines. The optimal cell number and culture duration for in vitro tumor cell cytotoxicity(TCC) and colony formation inhibition assay(CFIA) is 5x10(3) - 1x10(4) cells/well (TCC) and 2.510(3) - 10(3) cells/well(CFIA), 4 days(TCC) and 10 - l4 days(CFIA), respectively, for all gestric cancer cell lines. Under these conditions, we performed chemosensitivity test. Measurement of cytotoxicity(IC50) and colony forming efficiency revealed higher tumoricidal activity of SK-302 B against all tested gastric cancer cell lines than compared to that of adriamycin. In conclusion, we preseneted optimal conditions for in vitro chemosensitivity test on human gastric carcinoma cell lines. Using optimal conditions of this sytem, it could be demonstrated that SK-302B exerted a potent gastric cancer cell growth inhibition in vitro. Therefor, These data suggest that SK-302B may have a possibility of development as promising candidate of anti-gastric cancer chemotherapeutic agent.
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Comparison of In Vitro Bioassay for the Screeing of Antitumor Substances
Kyung Ho Lee, Chang Han Kim
J Korean Cancer Assoc. 1995;27(5):711-721.
AbstractAbstract PDF
The puryose of this study was to decide the optimal screening method for the detection of antitumor substances, to suggest the stage of screening for unknown compounds as to antitumor agents. Using an established screening system of clonogenic and colorimetric assay(MTT assay, BCA asssy, and SRB assay), the sensitivity of known antitumor agents was measured against twenty-four t.umor cell lines. In the result of compared data gener- ated with each colorimetric assay and clonogenic essay, Good correlation for MTT versus clonogenic assay against eaeh antitumor agents(ADR, BLM, and MMC)was 40%, 50%, and 67%. In the result, optimal screening method for the detection of antitumos substances was MTT & clonogenic assay. In order to take optimazied screening system, two-stage strategy can be used. In the first stage, substances would be tested in the MTT assay. In the scecond stage, the first stage-positive substances would be tested in the clonogenic assay.
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c-erbB-2 Oncoprotein Overexpression in Breast Carcinoma - Correlation of clinical prognostic factor , proliferative activity , hormonal receptor status and histologic findi
Hae Kyung Ahn, Yun Jung Kim, Jung Weon Shim, Young Euy Park, Kyung Suk Chung
J Korean Cancer Assoc. 1995;27(5):721-730.
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Proliferating Cell Nucleolar Antigen and Argyrophilic Nucleolar Organizer Regino in Breast Carcinoma - Correlation with tumor grade -
Ho Lee, Sun Kyung Lee, Sang Soon Kim
J Korean Cancer Assoc. 1995;27(5):730-738.
AbstractAbstract PDF
Authors investigated the expression of proliferationg cell nuclear antigen(PCNA) and the numbers of nucleolar arganizer region(NOR) in breast carcinomas correlation with tumor grade. The specimens used in this study were 14 cases of invasive ductal carciomas, 3 cases of invasive carcinomas with predominent intraductal component, 1 case of mucinous carcinoma, 2 cases of invasive papillary carcinomas and 1 case of medullary carcinoma. All cases were graded using modified grading system according to Bloom and Richardson. The grade I, II and III were 7 cases, respectively. PCNA was recognized immunohistochemically in paraffin sections by the monoclonal antibody PC-l0. On the other hand, NOR was demonstrated in paraffin sections using argyrophillic mehod(AgNOR). The present study showed a significant correlation of PCNA index and of AgNOR number with the histological grade(PCNA: I vs II, P<0.05; II vs III, p<0.05 and AgNOR: I vs II, p>0.05; II vs III, p >0.05; I vs III, p<0.05). The overall expression of PCNA was significantly correlated with AgNOR number(Spearman r=0.624, p<0.05). On the basis of above findings it wss considered that degree of the expression of PCNA and mean AgNOR number may be successefully applied as routine makers to the assessment of the growth potential of breast carcinomas.
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Thymidine Kinase Activity and Expression of PCNA in Carcinoma of Digestive Organs
Hae Hyeon Suh, Young Jin Kim, Hyun Jong Kim, Shin Kon Kim, Ji Yun Kook, Tai Ju Hwang
J Korean Cancer Assoc. 1995;27(5):738-746.
AbstractAbstract PDF
Thymidine kinase(TK) and proliferating cell nuclear antigen(PCNA) are similar in the aspect that both are a part of protein complex group of cellular DNA synthesis and expression period during cell cycle is Gl-S phase. From 30 surgically resected cancers of digestive organs(20 gastric adenocarcinomas and 10 hepatocellular carcinomas), we evaluated TK activity and PCNA labeling index in normal and tumor tissues in order to know the correlation between them and the value as an independent prognostic factor. TK activity of tumor tissue(5.14 nmol/hr/mg) was higher than that of normal tissue(2. 95 nmol/hr/mg). PCNA labeling index of tumor tissue(54.3%) was higher than that of normal tissue(21.4%). According to the originated organ, both gastric and hepatic malignancies revealed higher TK activity and PCNA labeling index than normal tissues. There was a significant correlation between TK activity and PCNA labeling index. In gastric adenocarcinoma, ratio of TK activity between normal and tumor tissue was higher in poorly differentiated group than well or moderately differentiated group. In hepatocellular carcinoma, ratio of TK activity between normal and tumor tissue was higher in the positive capsular invasion group than the nagative. As a conclusion, the TK activity and PCNA labeling index represented the biologic activity of tumor cells and could be used as independent prognostic factors.
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Immunohisochemical study on the Role of TGF-α / EGFR Autocrine Loop in the Cellular Proliferation and Progression of Gastric Adenocarcinoma
Seong Heum Park, Sung Ock Suh, Young Jae Mok
J Korean Cancer Assoc. 1995;27(5):746-761.
AbstractAbstract PDF
Immunoreacivities for transforming growth factor-alpha(TGF-a) and epidermal grouwth factor receptor(RGFR) were assessed retrospectively in 81 cases of gastric adenocarcinomas to clarify the role of the autocrine mechanism in the cellular proliferation and progression of gas- tric cancer and to evaluate their value as the prognosticators of patients with gastric cancers. In addition to TGF-a and EGFR, also assessed in this study were such clinicopathologic features as differentiation, tumor size, gross apperance, serosal invasion, nodal status, distant metastasis and AJC(American loint Committee on Cancer) stage. Proliferative potential of the tumor was measured by calculating proliferating cell nuclear antigen labeling index(PCNA L. I.), the mean of which was 42.l +-l9.4(range, 6 to 85). The results were: 1) TGF-a and EGFR were overexpressed in 37(45.7%) and 35(43.2%) cases, respectively. 2) Concurrent overexpression of TGF-a and EGFR was found in 16(19.8%) cases. 3) There was no significant relationship between TGF-a, EGFR immunoreactivities and clinicopathologic feature. 4) Tumors belonging to high PCNA L.I. group(greater than or equal to 42.1) were significantly more for cases with synchronous overexpression of TGF-a and EGFR than cases with either TGF-a or EGFR overexpression and with normal expression of both.(p<0.05) 5) Neither TGF-a nor EGFR immunoreactivity was associated with 5 year survival rate. The above results show that the gastric cancer cells gain some advantage in proliferation via an autocrine loop between the TGF-a and EGFR. But, the potential role of autocrine mechanism in the progression of gastric cancer was not demonstrated in this study. TGFG-and EGFR were inadequate as prognosticators of patients with gastric cancers. Prospective randomized study is required to confirm these results.
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A Study for PLC-γl Expression in Exprimentally Induced Cirrhosis and Hepatocellular Carcinoma
Jung Weon Shim, Sung Sook Kim, Woon Sup Han, Hae Kyung Ahn, Young Euy Park, Pann Ghill Suh
J Korean Cancer Assoc. 1995;27(5):761-773.
AbstractAbstract PDF
Phospholipase C-rl(PLC-rl) plays a significant role in signal transduction for cellular activity, such as proliferation and differentiation. The concept that PLC-rl may be involved in carcinogenesis is supported by recent observations: its expression is highly increased in breast and colon cancer, but decreased in hepatocellular carcinoma(HCC). The aim of present study was to analyze the role of PLC-rl in hepatic carcinogenesis. PLC-rl expression was studied chronologically in cirrhotic and neoplastic lesion and the preventive effect of vitamin A in HCC was examined. Seventy five Sprague-Dawley rats were treated with NNM in drinking water(20 mg/100 ml) and were divided into four groups: group I received NNM alone, group II, NNM+vitamin A. group III, vitamin A alone, and group IV received no treatment. The liver tissue obtained was investigated by gross and microscopic examination, and expression of PLC-rl was studied with immunohistochemistry, immunoprecipitation and immunoblot. Results are as follows: l) The first identifiable pathologic lesion could be found at 4 months in the group I and at 5 months in the group II. 2) The overexpression of FLC-rl was detectable in cirrohtic lesion but, negative expression in HCC, in immunohistochemical study. 3) More expression of PLC-rl was detectable in cirrhotic lesion, but, less in HCC, in immunoprecipitation and immunoblot study. 4) The development of HCC was so eignificantly low(P<0.00l) in group II comparing to group I that preventive effect of vitamin A in the development of HCC could be suggested. In conclusion, an important role of FLC-rl in hepatic carcinogenesis could be suggested as demonstration of the alternation of PLC-rl expression in preneoplastic and neoplastic lesion.
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The Assessment of Proliferation cell Uncear Antigen ( PCNA ) in Cervical Carcinoma Patients Infected with Human Papillomavirus types 16 and 18
Soo Nyung Kim, Tchan Kyu Park, Ho Gune Kim, Kyung Sup Kim
J Korean Cancer Assoc. 1995;27(5):773-783.
AbstractAbstract PDF
Proliferating cell nuciear antigen (PCNA) is a nuclear protein sssociated with the cell prolif- erative state. The relationship between the presence of human papillomavirus (HPV) and proliferative indices (PI) was studied. Determination of PI was done by immunohistochemical staining via the avidin-biotin-complex immunoperoxidase method and HPV 16 and HPV 18 status by Southern blot hybridization on paraffin-embedded material from 49 patients with carcinoma of the uterine cervix. HPV 16 was present in 15 cases, HPV 18 wes observed in 6 cases, and both HPV 16 and HPV 18 were found in 4 cases. There was significant correlation between PI and HPV types. PI was 59.7+-9.0% in HPV 16 positive lesion, 67.4+-10.6% in HPV 18 positive lesion, 79.4+-4.2% in both HPV 16 and HPV 18 positive lesion, and 57.5+-16.9% in HPV negative lesion. Among cervical adenocarcinomas, PI was 72.5+-5 14.9% in HPV l6 or HPV 18 positive lesion, as compared to 39.8+-15.1% in HPV negative leaion. No correlation was found between HPV-DNA positivity and PI in relation to clinical stages, histologic typea, and lesion size.
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Cell Kinetics Studies of Human Epithelial Cancers with Bromodeoxyuridine Labeling
Jin Sil Seong, Jung Woon Lee, Eun Ji Chung, Yung Tae Kim, Jae Wook Kim, Nam Kyu Kim, Sung Joon Hong, Eun Chan Choi, Won Sang Lee, Oh Hun Kwon, Gwi Eon Kim
J Korean Cancer Assoc. 1995;27(5):783-790.
AbstractAbstract PDF
Cell kinetic parameters of labeling index (LI), duration of S-phase (Ts), and potential doubling time (Tpot) were analyzed following infusion of bromodeoxyuridine (BUdR) in 33 patients with various epithelial cancers. Twelve uterine cervical cancers, 9 rectal cancers, 7 head and neck caneers, and 5 bladder cancers were included. Biopsies were taken about 4-6 h after 200 mg/m(2) BUdR infusion and the samples were anaiyzed with bivariate DNA /BUdR flow cytometry. The distribution of cell kinetic parameters for the 33 epithelial cancers showed a large range of values for each parameter. The median LI, Ts, and Tpot were 4.5%, 10.8 h, and 242.3 h, respectively. Eight among 33 patients (24.2%) showed aneuploidy. In aneuploid tumors the distribution of LI, Ts, and Tpot was in relatively small range. Aneupliod tumors appeared to show higher LI and shorter Tpot than those in diploid tumors. In diploid tumors, the poesibility of normal cell contamination could not be ruled out. The results of this study would be a basis for future trial to predict which ones would show tumor clonogen repopulation during radiotherapy so that benefit from altered fractionated radiotherapy.
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Study on the Immunomodulatory Effect of Thymulin in the Patients under Radiotherapy
Sung Ja Ahn, Woong Ki Chung, Byung Sik Nah, Taek Keun Nam, l Gyoon Cho, Sang Woo Juhng
J Korean Cancer Assoc. 1995;27(5):790-797.
AbstractAbstract PDF
In order to evaluate the effect of Thymulin, which is a thymic extract and known as one of the immunomodulating agents, 20 patients were prescribed the drug, orally one capsule(80 mR) twice a day during the radiation therapy(Thymulin group) and 28 patients were treated with radiotherapy only(RT grouP) randomly. The treatment field was medias- tinum in 29 patients and pelvis in 19, respectively. Age ranged from 36 to 73 years (mean and median; 57) and the male to female ratio was 1.3(27: 21). We evaluated the CBC with D/C, the blood chemistry, the lymphocyte subsets, and serum immunoglobulin level as parameters of the patient's immunological status. Drug intolerance was not observed in any patients. In the Thymulin group, the postirradiation decrease of white blood cell(WBC), lymphocyte, neutrophil, and basophil count was less than that of the RT group, and there was a statistical significance in the difference of the absolute lymphocyte count between two groups. In the peripheral bload lymphocyte subset study, the absolute number of CD4(helper T cell) and CD19(B cel1) were less reduced in the Thymulin group with statistical significance and the change of the other parameters was also less than that of the RT group. In the serum immunoglobulin level, the gostirradiation decrease was less in the Thymulin group and there was a marginal statistical significance in the difference of Ig A between two groups. From the above data, we can reach the conclusion that the combination of Thymulin may reduce the harmful effect of radiation therapy on immunity in cancer patients.
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Strontium - 89 Treatment for Painful Bone Matastasis
Jin Sil Seong, Jong Doo Lee, Sung Joon Hong, Gwi Eon Kim
J Korean Cancer Assoc. 1995;27(5):797-804.
AbstractAbstract PDF
There are few options for treating painful bone metastasis in multiple sites. Hemibody irradiation, although effective, is limited due to the serious hematologic toxicity. Therefore, use of radiophamaceuticals has been attemyted particularly for the osteoblastic bone metastasis. Strontium-89 (Sr-89) ia a pure beta emitter with its energy 1.4 MeV. It follows the biochemical pathways of calcium and selectively concentrates at the metastatic bone sites with minimai hematologic toxicity. From l993 to 1994, Sr-89 treatment has been performed in 8 patients with painful bone metastaeis from either prostate (6 patients) or breast cancers (2 patients) The patients had the initial level of WBC 3000/L, platelets 100,000/L, and normal renal function. Four mCi(l48 MBq) of Sr-89 was intravenously iniected and the patients were regularly followed with blood cell count test, simple bone x-ray, and radioisotpe bone scan. The changes of subjective pain were scored in 6 patients until the time of this report. Excellent pain relief was achieved in all except 1 patient, who died 1 month after Sr-89 treatment due to advanced disease. Accordingly, the amount of the analgesics intake by the patients showed corresponding decrease. There was slight decrease in the level of WBCs and plateletes at 2-6 weeks after Sr-89 treetment, however those soon recovered with conservative management. Above results show that the Sr-89 treatment can provide effective palliation in petients with painful bone metastasis with acceptable toxicity. However, further study is urgent to establish its indication, timinh and combination with local radiotherapy.
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A Phase 3 Clinical Trial of Recombinant Human Granulocyte - Macrophage Colony Stimulating
Kyung Hee Lee, Sun Young Rha, Jae Kyung Roh, Jong In Lee, Hae Ran Lee, Jun Oh Park, Jae Woong Cho, Hyun Cheol Chung, Joo Hang Kim, Jee Sook Hahn, Yun Woong Ko, Byung Soo Kim, Ho Young Lim, Jin Hyuk Choi
J Korean Cancer Assoc. 1995;27(5):804-816.
AbstractAbstract PDF
Background
Recombinant human granulocyte-macrophage colony stimulating factor(rhGM- CSF, LBD-005) may reduce chemotherapy induced myelosuppression, and thus reduce the incidence of neutropenic fever and infection after the dose intensive chemotherapy. In previous phase I and II studies, clinical efficacies and side effects of rhGM-CSF were evaluated, and the dose of 250ug/m(2)/day for 10 consecutive days subcutaneous administration was recommended for the further clinical triaL Methods: In this phase III trial, we evaluated the efficacy and safety of rhGM-CSF in 35 advanced cancer pstients after combination chemotherapy. Every eligible patients received at least 2 cycles of chemotherapy with the same dose and schedule. At the first cycle, control period, scheduled chemotherapy was given without rhGM-CSF, and at the second cycle, treatment period, rhGM-CSF was administered for 10 consecutive days subcutaneously with the dose of 250u/m(2)/day after the same chemotherapy given previously. During observation and treatment period, clinical and pathoiogical effects were monitered. Resnlta: All enrolled 35 patients were evaluable, and 14 patients(40%) had stomach cancer. The hematologic parameters were compared between two periods; mean nadir of WBC(neutrophil) counts during the control period and treatment period were 1,154+-485/mm(3)(241/mm(3)+ 242) and 2,486+1,554/mm(3)(912+-1,186/mm(3)) respectively(P<0.0001). Also the recovery time of neutropenia was shortened(P<0.0001). Incidence of infection and the necessities of antibiotics administration were decreased(days of antibiotics adminiatration: 7 days during control period and 10 days during treatment period). Most petients showed mild, talerable toxicities like chest tightness and general malaise, except 2 patients with the reduced dose of 150 ug/m(2)/day due to grade II toxicities of chest tightness and abdominal pain. Conclnsion: Above results suggested that the administration of rhGM-CSF after chemotherapy can reduce the degree of neutropenia and the side effects of rhGM-CSF were acceptable.
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Accuracy of Properative Pathologic Diagnosis and Clinical Staging for Clinically Staged 3A Non - Small Cell Lung Cancer
Mi Sook Kim, Kyoung Hwan Koh, Seong Yul Yoo, Chul Koo Cho, Jae Ill Zo, Young Soo Do, Kyung Ja Cho
J Korean Cancer Assoc. 1995;27(5):816-822.
AbstractAbstract PDF
The clinical staging of lung cancer, especially stage IIIA, provides important information for clinical analysis and treatment method to surgeon ar radiation oncologist. The aim of this analysis is to evaluate of difference between clinical staging and pathologic staging and determine to accuracy of preoperative pathologic diagnosis and clinical staging for clinically staged IIIA NSCLC. Analysis was performed on 138 patients who has been staged IIIA NSCLC. Pathologic diagnosis was performed using sputum cytology, bronchoscopy or percutaneous needle aspiration. All patients were evaluated by CT and staged according to American Joint Commit- tee on Cancer staging classification. All patients received the thoracotomy. The pathologic diagnosis was changed after surgery in 9 patients(6.5%). The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in dis- tinguishing T3 from Tl-T2 were 62.5%, 89.7%, 47.6%, 87.5%, and 75.3%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CT in distinguishing N2 from NO-Nl were 91.8%, 24.3%, 42.7%, 78.3%, and 54.8% respec- tively. According to pathologic staging, there were 27(19.6%) patients in stage I, 24(17.4%) in stage II, 64(46.4%) in stage IIIA, 21(15.2%) in stage IIIB, and 2(1.5%) in stage IV. Comparing clincal staging with pathologic staging, concordant results were found in 46.4%, 37.0% were clinically overestimated and 16.7% underestimated. Preoperative pathologic diagnosis was well correlate postoperative pathologic finding. But CT accuracy was low in both primary tumor and mediastinal lymph node. Especially to diagnose malignant involvement of mediastinal nodes, CT is not a valid means. Patients would not be denied the opportunity for curative surgery on the basis of CT signs.
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Clinical Analysis of Ductal Carcinoma in Situ of the Breast
Jong Mu Lee, Nam Sun Paik, Yong Kyu Kim, Nan Mo Moon, Jong Inn Lee, Dong Wook Choi, Dae Yong Hwang, Kyung Ja Cho
J Korean Cancer Assoc. 1995;27(5):822-829.
AbstractAbstract PDF
Ductal carcinoma in situ has become clinically important with the advent of the rautine use of high quality mammography in western country. Literally, DCIS represent 15 to 20% of newly detected cases of breast cancer. At least half of these patients have treatment options other than conventional modified radical mastectomy, i.e. breast conserving surgery with radiotherapy. To determine clinical and histopathologic characteristics, the outcomes of 51 women with ductal carcinoma in situ treated at KCCH between l983 and 1993 are studied ret- rospectively. The results were as fo11ows; 1)The incidence of DCIS was 2.1%(51/2333) 2)The incidence of DCIS during 1980s was 2.0%, and 2.9% during 1990s. 3)The mean age of DCIS was 44.4 years old and peak age group was the 5th decade. 4)The most common clinical manifestation was a mass, followed by nipple discharge, Paget's disease, and pain in order. 5)The tumor size less than 2cm was the most common(26 out of 51 cases). 6)Cribriform type was the most common(15/51) and comedo-form represents 17.6%(9/51) of DCIS. 7)The ER positivity of DCIS was 70%(14/20). 8)Author experienced only one case of systemic recurrence at 24 months after modified radical mastectomy and at last she died 5 years after operation. Authors could not conclude the prognostic significance of DCIS according to the subtypes of DCIS or treatment modalities because of a little number of cases and a short term follow-up period. In conclusion, the incidence of DCIS in this study is not so high as in western countries, however for earlier detection of DCIS, it is better to make a screening mammography at least 2-years interval for women older than forty years old. Conservative procedures as an operative option may be considered in selected cases of DCIS.
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Multiple Primary malignant Tumors following Stomach Cancer Daignosis
In Keun Choi, Soo Sang Sohn, Joong Shin Kang
J Korean Cancer Assoc. 1995;27(5):829-836.
AbstractAbstract PDF
As progressively larger percentage of long-term survivors are being reported, the proportion of patients with subsequent primary lesions are increasing. This study is the clinical analysis of 17 cases of multiple primary malignant tumors confirmed fillowing the pathologic diagnosis of gastric cancer at the Department of Surgery, Keimyung University School of Medicine during the past 10 years from 1984 through 1994. These deta show that, when cancer first appears at a specific anetomic site, certain organs are more susceptible to second primary lesions than other sites. The ratio between male and female was 2:1 and mean age of incidence was 60 years. The ratio between synchronous and metachronous lesions was 1:2. The average time interval between first and second cancer was 3.0 years in metachronous cases. After the diagnosis of stomach cancer, the most frequently involved second organ was colorectum, others were liver, cervix, thyroid, and neck in decreasing order. Pathologic stage, tumor differentiation, tumor size, lymph node metastasis of the first lesions were unrelated to subsequent malignant tumor after stomach cancer diagnosis.
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The Usefuness of laparoscope for the Staging of Gastric Cancer
Jae Bok Lee, Young Jae Mok, Ho Sang Ryu, Young Chul Kim, Jin Hai Hyun, Sae Min Kim
J Korean Cancer Assoc. 1995;27(5):836-846.
AbstractAbstract PDF
The purpose of this study is to evaluate the usefulness of preoperative laparoscopic examination in gastric cancer. A more accurate preoperative cancer staging may allow a better prepared setting in which to avdoid unnecessary laparotomy, decide preoperative neoadjuvant chemotherapy and prepare the operation far combined resections or intraoperative radiotherapy. The subjects of this study were the 105 patients who were diagnosed preoperatively by gastrofiberscopic examination with biopsy and had received gastric resections in our department from 1986 to 1993. We performed laparoscopy preoperatively in all patients to characterize the location of the tumor and its and regional infiltration. Abdomi- nal CT staging, preoperative laparoscopic staging, and staging with CT and laparoscopy were compared for serosal infiltration, lymph node metastasis, peritoneal seeding and hepatic me- tastasis. The diagnostic indices such as sensitivity, specificity, accuracy, prevalence and predictive value of each staging were calculated and compared. For the statistical interpretation of the results, diagnostic indexes were calculated in two-way contingency tables of the frequencies of positive and negative results construed as either true or false upon surgical and histo- logic evaluation. The sensitivities for laparoscopic examination of serosal invasion, lymph node metastasis, peritoneal seeding and liver metastasis were 87.3%, 26.8%, 37.5% and 10.5% respectivelym and the specificity of the above findings were 61.8%, 76.5%, 100% and 94.2% respectively. The sensitivities of CT staging for above findings were 50.7%, 39.4%, 0%, 15.8% respectively, and the specificity was 73.5% 97.1%, 99.0%, 93.0% respectively. The sensitivity of combined modalities for above findings were 94.4%, 59.2%, 50.0%, 15.8% respectively, and the specificity was 70.6%, 70.6%, 99%, 94.2% respectively, and which indicates that seosal invasion, lymph node metastasis and peritoneal seeding could be detected accurately, while liver metas- tasis could not be. 1) Serosal infiltration was more accurately diagnosed by preoperative laparoscopy (sensitivity 87.3%, specificity 61.8%, p=0.024). 2) Diagnostic indices of lymph node metastasis, peritoneal seeding and liver metastasis were not different between preoperative laparoscopy and CT (p > 0.05).
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Adjuvant Chemotherapy with ' 5-Fluorouracil Plus Low - dose Leucovorin Following Surgical Resection of Stage 2 , 3 Colon Cancer
Je Hwan Lee, Tae Won Kim, Jong Soo Choi, Dai Young Zang, Ho Young Pyun, Sung Bae Kim, Sang We Kim, Cheol Won Suh, Kyoo Hyung Lee, Jung Shin Lee, Woo Kun Kim, Sang Hee Kim, Jin Cheon Kim, Suk Koo Kim
J Korean Cancer Assoc. 1995;27(5):846-857.
AbstractAbstract PDF
Obtivea: About seventy-five percent of the individuals with colon cancer will have a primary surgical resection with the hope of complete tumor eradication. Despite the high resectability rate and a general improvement in therapy, nearly half of all patients with colon cancer still die of metastatic tumor. Over the past three decades, many clinical studies have failed to demonstrate benefits from adjuvant therapy. Recently, new data from several studies have demonstrated delays in tumor recurrence and increases in survival for specific groups of patients. The objective of this study was to evaluate the effective- ness of 5-fluorouracil(5-FU) and low-dose leucovorin in reducing the recurrence rate and improving the survival of the patients with surgically resected colon cancer in stage II and III. Methods: One hundred and fifty six with surgically resected colon cancer in stage II and 1II from Nov 1989 to Dec 1993 were included in this study and were divided into two groups. First group(LF arm) included eighty five Patients who received combination chemotherapy of '5-FU and low-dose 1eucovorin' following resection of colon cancer, and second group(control arm) included seventy one patients who received only oral UFT or no adjuvant treatment. '5-FU and low-dose leucovorin' chemotherapy consisted of leucovorin 20 mg/m(2), intravenously, plus 5-FU 400 mg/m(2), intravenously, on days 1-5 every 4 weeks for 6 cycles. Results: I) There were significantly more recurrences and distant failure in control arm than LF arm. 2) The estimated 4-year disease-free survival was 82.5% in LF arm and 59.8% in control arm(p = 0.007). 3) The estimated 4-year overall survival was 94.3% in LF arm and 63.9% in control arm (p = 0.001). 4) The survival differences between LF arm and control arm were significant in stage II and III respectively. 5) Number of metastatic lymph nodes, histologic differentiation, and whether or not pa- tients received 5-FU/leucovorin chemotherapy, were each found to have prognostic significance. Concluslon: This study strongly suggests that 5-FU and low-dose leucovorin adjuvant chemotherapy is effective in patients with surgically resected stage II and III colon cancer.
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A Study on Cancer Frequent Families and Their Hereditary Tendency
Minyoung Kim, Soo Tae Kim, Jin Pok Kim, Kwi Won Park, Hyo Seop Ahn, Seung Keun Oh, Kyk Jin Choe, Kyu Joo Park, Jae Hwan Oh, Jae Gagb Park
J Korean Cancer Assoc. 1995;27(5):857-869.
AbstractAbstract PDF
Authors have defined "Cancer Frequent Family (CFF)" as a family that yresents with clustering of different types of cancers among its members, but does not satisfy the arite- ria of any known hereditary cancer syndromes. The inclusion criteria for CFF are: three or more cancer patients (1) among siblings or (2) in more tbsn two successive generations or (3) in 3 or more cousins, with at least one of the patients diagnosed before the age of 50. Gastric cancer after age of 45 and primary liver cancer were excluded. By screening family history of cancer patients admitted to Seoul National University Hospital since l992, nine families fulfiling the CFF criteria were identified. Among 294 family members from these 9 families, thirty-six(12%) were affected with cancer. A total of 41 primary cancers affecting 10 different organs were found, with the average age at diaenosis of the first primary cancer being 47. Five members were affected with double primary cancers; four with 2 colorectal cancers and one with a rectal cancer and a malignant thymoma. Colorectal cancer was by far the most common malignancy encountered, accounting for 5l% of all the malignancies found. The average age at diagnosis of colorectal cancers in CFF was significantly younger than that of sporedic cases(43 vs 56, P<0.01). The incidence of metachronous colorectal cancer was aleo high(24%) in this group. On the basis of familial aggregation, younger age of onset, and multiplicity of tumors in affected individuals, hereditary backgrounds can be suspected in colorectal cancer patients of CFF families. Our resuits indicate that clustering of different malignancies in a family may suggest possible hereditary causes and that regular screening may aid in the early detection of other affected individuals in CFF families
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A Clinical Study on Multiple Myelom
Jin Woo Jung, Jeong Hee Kim, Si Young Kim, Hwi Joong Yoon, Kyung Sam Cho
J Korean Cancer Assoc. 1995;27(5):869-879.
AbstractAbstract PDF
Clinical findings and results were analysed in 56 cases diagnosed as multiple myeloma between October 1981 and June l994 at Kyung Hee University Hospital. The resuts were as followings: 1) The incidence reached a peak during 7th decade and male to female ratio was 1.2:l. 2) The chief complaints at initial presentation were bone pain(50%), pathologic fracture (14%) and anemia(14%), 3) Hematologic findings showed anemia in 77%, leukopenia in 25% and thrombocytopenia in 23%. ESR was elevated in 91% of patients. Hypercalcemia was noted in l3% and renal failure in 29%. 4) X-ray findings showed pathologic fracture in 39%, osteolytic lesion in 70% and osteo-porosis in 32% but normal finding was found in 5% of patients. 5) Clinical stage was stage I in 8%, stage II in 19% and stage III in 73% of patients. Fifteen of sixteen patients with renal insufficiency were in stage III. 6) Serum protein electrophoresis showed a M-peak in 89%. Mean M-protein concentration was 4.55 g/dl. M-protein was IgG in 57%, IgA in 24%, IgD in 2% and light chain only in 17% . Kappa to lambda ratio was 1.4: l. 7) Varisnt forms of multiple myeloma were 2 cases of nonsecretory myeloma, 1 case of solitary plasmacytoma and 1 case of plasma cell leukemia. 8) Response rate to primary chemotherapy was 37% for MP regimen and 60% for M2 regimen. There was statistically significant survival difference between responders and non-responders(p<0.01). The overall median survival of patients was 76 weeks.
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Pimary small Cell Carcinoma of the Esophagus
Kyung Ho Chang, Sung Ki Kim, Jong Woon Ahn, Ho Sik Choo, Eun Hoo Hong, Mi Young Park, Kyung Tae Park
J Korean Cancer Assoc. 1995;27(5):879-887.
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Small cell carcinoma of the esophagus is a rare tumor. There has been about 180 cases world-widely and 7 cases in Korea since McKeown reported the first 2 cases of small cell carcinoma of the esophagus in 1952. Small cell carcinoma of the esophagus has a poor prognosis because of rapid progress and widespread dissemination such as small cell carcinoma of the lung. So it can be regarded as a systemic disease, and multimodality treatment including chemotherapy should be used. Using small cell lung cancer as a model, limited disease patients should receive multimodality therapy including chemotherapy followed by surgery and/or radiation and extensive disease patients receive chemotherapy only. Here we report the study of a 52-year-old male patient with primary small cell carcinoma of esophagus metastasized to liver and left supraclaviculer lymph node. We treated him with a multi-drug regimen (VP-16, ifosfamide and cisplatin) being used in small cell carcinoma of the lung at our hospital After two cycles of combination chemotherapy, the primary and metastatic lesions. as evaluated by esophagoscopy, barium esophagogram and abdominal CT scan, had markedly improved, and we evaluated as partial response. And we will treat him with four more cycles of chemotherapy.
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A Case of Synchronous Primary Triple Cancers Including Thyoid , Lung and Stomach
Jin Ho Park, Sang Chul Oh, Jae Hong Seo, Young Jin Nam, Byung Soo Kim, Sang Won Shin, Yeul Hong Kim, Jin Seok Kim
J Korean Cancer Assoc. 1995;27(5):887-893.
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Multiple primary cancer means that more than 2 cancers are independently developed in one individual. The incidence of multiple primary cancer is increasing gradually due to accurate cancer stastistics, earlier diagnosis and treatment, progressive increase in the number of individuals living in the "cancer age" group and aggressive therapy for primary cancers. Here, we report a case of synchronous primary triple cancers including thyroid, lung and stomach. The 60-year-old woman complained the three palpable masses on cervical area and we confirmed the papillary cancer of thyroid by fine needle aspiration biopsy. Whild we performed the further study for the possibilities of other lesion or metastasis, we found the adenocarcinoma of stomach and squamous cell carcinoma of lung. After the operation on stomach and thyroid cancer, radiotherapy and adjvunctive chemotherapy for lung had been done. Our case is a multiple primary cancer of different organs.
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A Case of Multiple Cutaneous Metastasis from Gastric Adenocarcinoma
Hun Sik Jeong, Kwang Ho Kim, Yeon Suk Kim, In Suk Song, Dong Gu Choi, Dong Bok Shin
J Korean Cancer Assoc. 1995;27(5):893-897.
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Cutaneous multiple metastases from internal carcinoma are relatively rare, especially from gastric cercinoma. We report a case of multiple cutaneous metastasis from gastric adenocarcinoma in 51 year old male patient who have multiple variable sized erythromatous nodules and macule on the trunk, left axilla, and right thigh.
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Cancer Res Treat : Cancer Research and Treatment
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