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Establishment of Patient-Derived Organoids Using Ascitic or Pleural Fluid from Cancer Patients
Wonyoung Choi, Yun-Hee Kim, Sang Myung Woo, Yebeen Yu, Mi Rim Lee, Woo Jin Lee, Jung Won Chun, Sung Hoon Sim, Heejung Chae, Hyoeun Shim, Keun Seok Lee, Sun-Young Kong
Cancer Res Treat. 2023;55(4):1077-1086.   Published online June 12, 2023
DOI: https://doi.org/10.4143/crt.2022.1630
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Patient-derived tumor cells can be a powerful resource for studying pathophysiological mechanisms and developing robust strategies for precision medicine. However, establishing organoids from patient-derived cells is challenging because of limited access to tissue specimens. Therefore, we aimed to establish organoids from malignant ascites and pleural effusions.
Materials and Methods
Ascitic or pleural fluid from pancreatic, gastric, and breast cancer patients was collected and concentrated to culture tumor cells ex vivo. Organoids were considered to be successfully cultured when maintained for five or more passages. Immunohistochemical staining was performed to compare the molecular features, and drug sensitivity was assayed to analyze the clinical responses of original patients.
Results
We collected 70 fluid samples from 58 patients (pancreatic cancer, n=39; gastric cancer, n=21; and breast cancer, n=10). The overall success rate was 40%; however, it differed with types of malignancy, with pancreatic, gastric, and breast cancers showing 48.7%, 33.3%, and 20%, respectively. Cytopathological results significantly differed between successful and failed cases (p=0.014). Immunohistochemical staining of breast cancer organoids showed molecular features identical to those of tumor tissues. In drug sensitivity assays, pancreatic cancer organoids recapitulated the clinical responses of the original patients.
Conclusion
Tumor organoids established from malignant ascites or pleural effusion of pancreatic, gastric, and breast cancers reflect the molecular characteristics and drug sensitivity profiles. Our organoid platform could be used as a testbed for patients with pleural and peritoneal metastases to guide precision oncology and drug discovery.

Citations

Citations to this article as recorded by  
  • The use of patient-derived xenografts and patient-derived organoids in the search for new therapeutic regimens for pancreatic carcinoma. A review
    Emin Gayibov, Tomáš Sychra, Alžběta Spálenková, Pavel Souček, Martin Oliverius
    Biomedicine & Pharmacotherapy.2025; 182: 117750.     CrossRef
  • Precision Medicine for Peritoneal Carcinomatosis—Current Advances in Organoid Drug Testing and Clinical Applicability
    Harleen Kaur, Josephine A. Wright, Daniel L. Worthley, Elizabeth Murphy, Susan L. Woods
    Organoids.2025; 4(1): 2.     CrossRef
  • Three-dimensional models: from cell culture to Patient-Derived Organoid and its application to future liposarcoma research
    SAYUMI TAHARA, SYDNEY RENTSCH, FERNANDA COSTAS CASAL DE FARIA, PATRICIA SARCHET, ROMA KARNA, RAPHAEL E. POLLOCK, FEDERICA CALORE
    Oncology Research.2025; 33(1): 1.     CrossRef
  • PRMT1 promotes pancreatic cancer development and resistance to chemotherapy
    Bomin Ku, David Eisenbarth, Seonguk Baek, Tae-Keun Jeong, Ju-Gyeong Kang, Daehee Hwang, Myung-Giun Noh, Chan Choi, Sungwoo Choi, Taejun Seol, Hail Kim, Yun-Hee Kim, Sang Myung Woo, Sun-Young Kong, Dae-Sik Lim
    Cell Reports Medicine.2024; 5(3): 101461.     CrossRef
  • Establishment and Advancement of Pancreatic Organoids
    Dong Hyeon Lee
    Keimyung Medical Journal.2024; 43(1): 3.     CrossRef
  • Organoid as a promising tool for primary liver cancer research: a comprehensive review
    Xuekai Hu, Jiayun Wei, Pinyan Liu, Qiuxia Zheng, Yue Zhang, Qichen Zhang, Jia Yao, Jingman Ni
    Cell & Bioscience.2024;[Epub]     CrossRef
  • The use of organoids in creating immune microenvironments and treating gynecological tumors
    Ling-Feng Zhou, Hui-Yan Liao, Yang Han, Yang Zhao
    Journal of Translational Medicine.2024;[Epub]     CrossRef
  • The pros and cons of mechanical dissociation and enzymatic digestion in patient-derived organoid cultures for solid tumor
    Jing Ren, Mengli Liu, Mingjie Rong, Xuan Zhang, Gang Wang, Yihan Liu, Haijun Li, Shichao Duan
    Cell Organoid.2024;[Epub]     CrossRef
  • Organoid: Bridging the gap between basic research and clinical practice
    Guihu Weng, Jinxin Tao, Yueze Liu, Jiangdong Qiu, Dan Su, Ruobing Wang, Wenhao Luo, Taiping Zhang
    Cancer Letters.2023; 572: 216353.     CrossRef
  • 5,677 View
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  • 5 Web of Science
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A Multicenter, Prospective, Observational Study to Evaluate Ethanol-Induced Symptoms in Patients Receiving Docetaxel Chemotherapy
Young-Woong Won, Jin-Hyoung Kang, Jung Hye Kwon, Dong-Hoe Koo, Jung Hun Kang, Chi Hoon Maeng, Hee Kyung Ahn, Sung Yong Oh, Dae-Won Lee, Joohyuk Sohn, So Yeon Oh, Kyung Hee Lee, Su-Jin Koh, Keun Seok Lee, Chan-Kyu Kim, Ji-Yeon Kim, Jun Ho Ji, Sung-Bae Kim, Joo Young Ha, Ho Young Kim
Cancer Res Treat. 2023;55(4):1096-1103.   Published online April 7, 2023
DOI: https://doi.org/10.4143/crt.2022.1565
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
Several previous studies and case reports have reported ethanol-induced symptoms in patients receiving anticancer drugs containing ethanol. Most docetaxel formulations contain ethanol as a solvent. However, there are insufficient data on ethanol-induced symptoms when docetaxel-containing ethanol is administered. The primary purpose of this study was to investigate the frequency and pattern of ethanol-induced symptoms during and after docetaxel administration. The secondary purpose was to explore the risk factors for ethanol-induced symptoms.
Materials and Methods
This was a prospective, multicenter, observational study. The participants filled out ethanol-induced symptom questionnaire on the day of chemotherapy and the following day.
Results
Data from 451 patients were analyzed. The overall occurrence rate of ethanol-induced symptoms was 44.3% (200/451 patients). The occurrence rate of facial flushing was highest at 19.7% (89/451 patients), followed by nausea in 18.2% (82/451 patients), and dizziness in 17.5% (79/451 patients). Although infrequent, unsteady walking and impaired balance occurred in 4.2% and 3.3% of patients, respectively. Female sex, presence of underlying disease, younger age, docetaxel dose, and docetaxel-containing ethanol amount were significantly associated with the occurrence of ethanol-induced symptoms.
Conclusion
The occurrence of ethanol-induced symptoms was not low in patients receiving docetaxel-containing ethanol. Physicians need to pay more attention to the occurrence of ethanol-induced symptoms and prescribe ethanol-free or low-ethanol-containing formulations to high-risk patients.

Citations

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  • Evaluation of self-assembling properties of paclitaxel-biotin conjugates
    Dmitry V. Beigulenko, Anna Yu. Belyaeva, Ekaterina S. Kazakova, Maria M. Antonova, Aleksander S. Peregudov, Aleksey A. Nikitin, Tatyana S. Kovshova, Yulia V. Ermolenko, Konstantin A. Kochetkov
    Nano-Structures & Nano-Objects.2024; 40: 101375.     CrossRef
  • 3,687 View
  • 219 Download
  • 1 Crossref
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Breast cancer
Eflapegrastim versus Pegfilgrastim for Chemotherapy-Induced Neutropenia in Korean and Asian Patients with Early Breast Cancer: Results from the Two Phase III ADVANCE and RECOVER Studies
Yong Wha Moon, Seung Ki Kim, Keun Seok Lee, Moon Hee Lee, Yeon Hee Park, Kyong Hwa Park, Gun Min Kim, Seungtaek Lim, Seung Ah Lee, Jae Duk Choi, Eunhye Baek, Hyesun Han, Seungjae Baek, Seock-Ah Im
Cancer Res Treat. 2023;55(3):766-777.   Published online January 19, 2023
DOI: https://doi.org/10.4143/crt.2022.987
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
We investigated the consistent efficacy and safety of eflapegrastim, a novel long-acting granulocyte-colony stimulating factor (G-CSF), in Koreans and Asians compared with the pooled population of two global phase 3 trials.
Materials and Methods
Two phase 3 trials (ADVANCE and RECOVER) evaluated the efficacy and safety of fixed-dose eflapegrastim (13.2 mg/0.6 mL [3.6 mg G-CSF equivalent]) compared to pegfilgrastim (6 mg based on G-CSF) in breast cancer patients who received neoadjuvant or adjuvant docetaxel/cyclophosphamide. The primary objective was to demonstrate non-inferiority of eflapegrastim compared to pegfilgrastim in mean duration of severe neutropenia (DSN) in cycle 1, in Korean and Asian subpopulations.
Results
Among a total of 643 patients randomized to eflapegrastim (n=314) or pegfilgrastim (n=329), 54 Asians (29 to eflapegrastim and 25 to pegfilgrastim) including 28 Koreans (14 to both eflapegrastim and pegfilgrastim) were enrolled. The primary endpoint, DSN in cycle 1 in the eflapegrastim arm was non-inferior to the pegfilgrastim arm in Koreans and Asians. The DSN difference between the eflapegrastim and pegfilgrastim arms was consistent across populations: –0.120 days (95% confidence interval [CI], –0.227 to –0.016), –0.288 (95% CI, –0.714 to 0.143), and –0.267 (95% CI, –0.697 to 0.110) for pooled population, Koreans and Asians, respectively. There were few treatment-related adverse events that caused discontinuation of eflapegrastim (1.9%) or pegfilgrastim (1.5%) in total and no notable trends or differences across patient populations.
Conclusion
This study may suggest that eflapegrastim showed non-inferior efficacy and similar safety compared to pegfilgrastim in Koreans and Asians, consistently with those of pooled population.

Citations

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  • Comparison of Prophylactic Efficacy of Eflapegrastim and Pegteograstim for Chemotherapy-induced Neutropenia in Pancreatic Cancer Patients Receiving FOLFIRINOX/mFOLFIRINOX
    Eui Seon Lee, Min Jung Geum, Jong Hee Ko, Jae Song Kim, Eun Sun Son, Yun Mi Yu
    Journal of Korean Society of Health-System Pharmacists.2024; 41(3): 253.     CrossRef
  • 4,855 View
  • 274 Download
  • 1 Crossref
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A Phase II Trial of S-1 and Oxaliplatin in Patients with Metastatic Breast Cancer Previously Treated with Anthracycline and Taxane (KCSG-BR07-03)
Dae-Won Lee, Bhumsuk Keam, Keun Seok Lee, Jin-Hee Ahn, Joohyuk Sohn, Jin Seok Ahn, Moon Hee Lee, Jee Hyun Kim, Kyung Eun Lee, Hyo Jung Kim, Si-Young Kim, Yeon Hee Park, Chan-Young Ock, Kyung-Hun Lee, Sae-Won Han, Sung-Bae Kim, Young Hyuck Im, Hyun Cheol Chung, Do-Youn Oh, Seock-Ah Im
Cancer Res Treat. 2023;55(2):523-530.   Published online November 8, 2022
DOI: https://doi.org/10.4143/crt.2022.1360
AbstractAbstract PDFPubReaderePub
Purpose
This single-arm phase II trial investigate the efficacy and safety of S-1 plus oxaliplatin (SOX) in patients with metastatic breast cancer.
Materials and Methods
Patients with metastatic breast cancer previously treated with anthracyclines and taxanes were enrolled. Patients received S-1 (40-60 mg depending on patient’s body surface area, twice a day, day 1-14) and oxaliplatin (130 mg/m2, day 1) in 3 weeks cycle until disease progression or unacceptable toxicity. The primary endpoint was objective response rate (ORR) according to Response Evaluation Criteria in Solid Tumor 1.1. Secondary endpoints included time-to-progression (TTP), duration-of-response (DoR), overall survival (OS), and adverse events.
Results
A total of 87 patients were enrolled from 11 institutions in Korea. Hormone receptor was positive in 54 (62.1%) patients and six (6.9%) had human epidermal growth factor receptor 2–positive disease. Forty-eight patients (85.1%) had visceral metastasis and 74 (55.2%) had more than three sites of metastases. The ORR of SOX regimen was 38.5% (95% confidence interval [CI], 26.9 to 50.0) with a median TTP of 6.0 months (95% CI, 5.1 to 6.9). Median DoR and OS were 10.3 months (95% CI, 5.5 to 15.1) and 19.4 (95% CI, not estimated) months, respectively. Grade 3 or 4 neutropenia was reported in 28 patients (32.1%) and thrombocytopenia was observed in 23 patients (26.6%).
Conclusion
This phase II study showed that SOX regimen is a reasonable option in metastatic breast cancer previously treated with anthracyclines and taxanes.

Citations

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  • Unraveling the immune landscape and therapeutic biomarker PMEPA1 for oxaliplatin resistance in colorectal cancer: A comprehensive approach
    Zhengguang Zhang, Tianming Lu, Zhe Zhang, Zixian Liu, Ruoning Qian, Ruogu Qi, Fuqiong Zhou, Min Li
    Biochemical Pharmacology.2024; 222: 116117.     CrossRef
  • Efficacy and safety of utidelone plus capecitabine in advanced first-line therapy for metastatic breast cancer: A multicenter real-world study
    Pingping Bi, Xi Wang, Rui Liu, Xiuqin Li, Shanrong Wei, Jiawen Zhao, Xin Tan, Fan Zhang, Qing Mao, Ying Zhang, Baoyan Tang, Xueqiong Xun, Rong Guo, Kai Zheng, Shaoqiang Zhou, Shicong Tang
    Surgery Open Science.2023; 16: 171.     CrossRef
  • 4,893 View
  • 170 Download
  • 2 Web of Science
  • 2 Crossref
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Androgen Receptor as a Predictive Marker for Pathologic Complete Response in Hormone Receptor–Positive and HER-2–Negative Breast Cancer with Neoadjuvant Chemotherapy
Eun-Gyeong Lee, Dong-Eun Lee, Hyun hee Kim, Jai Hong Han, Seeyoun Lee, Han-Sung Kang, Eun Sook Lee, Heejung Chae, Sung Hoon Sim, Keun Seok Lee, Youngmee Kwon, So-Youn Jung
Cancer Res Treat. 2023;55(2):542-550.   Published online September 8, 2022
DOI: https://doi.org/10.4143/crt.2022.834
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study investigated pathological complete response (pCR) according to androgen receptor (AR) in breast cancer patients undergoing neoadjuvant chemotherapy and estimated the relationship between AR expression and clinicopathological factors.
Materials and Methods
We identified 624 breast cancer patients who underwent surgery after neoadjuvant chemotherapy at the National Cancer Center in Goyang, Korea from April 2016 to October 2019. We retrospectively collected the clinicopathologic information and AR expression results and analyzed the data according to cancer stage, hormonal receptor (HR) status, human epidermal growth factor receptor 2 (HER2) status, tumor subtype, and pCR.
Results
Among the 624 breast cancer patients, 529 (84.8%) were AR-positive (AR+) patients and 95 (15.2%) were AR-negative (AR–) patients. AR+ patients showed more estrogen receptor (ER) positivity, progesterone receptor (PR) positivity, HER2-positivity, and HR-positive and HER2-negative (HR+/HER2–) subtype. The rate of pCR was 31.4% (196/624). AR– patients had a significantly higher rate of pCR than AR+ patients (AR– 43.2% vs. AR+ 29.3%, p=0.007). The tumor factors associated with pCR were early stage, histologic grade 3, ER-negative, PR-negative, AR-negative, HER2-positive, and high Ki-67 values. In univariable analysis, AR+ significantly decreased the state of pCR (odds ratio, 0.546; 95% confidence interval, 0.349 to 0.853; p=0.008). According to tumor subtype, AR– tumor showed higher pCR rate in HR+/HER2– subtype (AR– 28.6% vs. AR+ 7.3%, p=0.022).
Conclusion
AR expression is predominant in the HR+/HER2– subtype. AR– is significantly associated with the pCR rate in breast cancer patients, especially within HR+/HER2– subtype. When determining neoadjuvant chemotherapy for the HR+/HER2– subtype, AR expression can be considered as a pCR predictive marker.

Citations

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  • The prevalence and clinical significance of residual occult breast cancer after neoadjuvant chemotherapy: reassessing surgical pathology in cases initially described as pathological complete response
    Di Ai, Eliel N Arrey, Lauren M Postlewait, Yuan Gao, Xiaoxian Li
    Histopathology.2025;[Epub]     CrossRef
  • Neo-adjuvant therapies for ER positive/HER2 negative breast cancers: from chemotherapy to hormonal therapy, CDK inhibitors, and beyond
    Athina Stravodimou, Ioannis A. Voutsadakis
    Expert Review of Anticancer Therapy.2024; 24(3-4): 117.     CrossRef
  • Luminal androgen receptor subtype and tumor-infiltrating lymphocytes groups based on triple-negative breast cancer molecular subclassification
    Miseon Lee, Tae-Kyung Yoo, Byung Joo Chae, Ahwon Lee, Yoon Jin Cha, Jieun Lee, Sung Gwe Ahn, Jun Kang
    Scientific Reports.2024;[Epub]     CrossRef
  • Evaluating the Clinico-Pathological Relationship Between Stromal Tumor-Infiltrating Lymphocytes and Androgen Receptor Expression Across Molecular Subtypes of Invasive Breast Carcinoma
    Adil Aziz Khan, Sana Ahuja, Kiruthikasri G., Sufian Zaheer
    Indian Journal of Surgical Oncology.2024; 15(4): 802.     CrossRef
  • Biomarkers and translational research approaches in breast cancer—an update
    Angelika M. Starzer, Anna S. Berghoff, Rupert Bartsch
    memo - Magazine of European Medical Oncology.2023; 16(1): 42.     CrossRef
  • Evaluation of predictive and prognostic value of androgen receptor expression in breast cancer subtypes treated with neoadjuvant chemotherapy
    Zhendong Shi, Yingxue Liu, Shichao Zhang, Shuanglong Cai, Xu Liu, Jie Meng, Jin Zhang
    Discover Oncology.2023;[Epub]     CrossRef
  • 5,342 View
  • 177 Download
  • 6 Web of Science
  • 6 Crossref
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Impacts of Subtype on Clinical Feature and Outcome of Male Breast Cancer: Multicenter Study in Korea (KCSG BR16-09)
Jieun Lee, Keun Seok Lee, Sung Hoon Sim, Heejung Chae, Joohyuk Sohn, Gun Min Kim, Kyung-Hee Lee, Su Hwan Kang, Kyung Hae Jung, Jae-ho Jeong, Jae Ho Byun, Su-Jin Koh, Kyoung Eun Lee, Seungtaek Lim, Hee Jun Kim, Hye Sung Won, Hyung Soon Park, Guk Jin Lee, Soojung Hong, Sun Kyung Baek, Soon Il Lee, Moon Young Choi, In Sook Woo
Cancer Res Treat. 2023;55(1):123-135.   Published online March 24, 2022
DOI: https://doi.org/10.4143/crt.2021.1561
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The treatment of male breast cancer (MBC) has been extrapolated from female breast cancer (FBC) because of its rarity despite their different clinicopathologic characteristics. We aimed to investigate the distribution of intrinsic subtypes based on immunohistochemistry, their clinical impact, and treatment pattern in clinical practice through a multicenter study in Korea.
Materials and Methods
We retrospectively analyzed clinical data of 248 MBC patients from 18 institutions across the country from January 1995 to July 2016.
Results
The median age of MBC patients was 63 years (range, 25 to 102 years). Among 148 intrinsic subtype classified patients, 61 (41.2%), 44 (29.7%), 29 (19.5%), and 14 (9.5%) were luminal A, luminal B, human epidermal growth factor receptor 2, and triple-negative breast cancer, respectively. Luminal A subtype showed trends for superior survival compared to other subtypes. Most hormone receptor-positive patients (166 patients, 82.6%) received adjuvant endocrine treatment. Five-year completion of adjuvant endocrine treatment was associated with superior disease-free survival (DFS) in patients classified with an intrinsic subtype (hazard ratio [HR], 0.15; 95% confidence interval [CI], 0.04 to 0.49; p=0.002) and in all patients (HR, 0.16; 95% CI, 0.05 to 0.54; p=0.003).
Conclusion
Distribution of subtypes of MBC was similar to FBC and luminal type A was most common. Overall survival tended to be improved for luminal A subtype, although there was no statistical significance. Completion of adjuvant endocrine treatment was associated with prolonged DFS in intrinsic subtype classified patients. MBC patients tended to receive less treatment. MBC patients should receive standard treatment according to guidelines as FBC patients.

Citations

Citations to this article as recorded by  
  • HER2 expression and pathway status in male breast cancer patients: results of an integrated analysis among 6,150 patients
    Boqiang Lyu, Shidi Zhao, Hui Wang, Shouping Gong, Biyuan Wang
    Scientific Reports.2025;[Epub]     CrossRef
  • Male breast cancer - a single center experience
    Igor Djurisic, Milan Zegarac, Milan Kocic, Vladimir Jokic, Nikola Vucic, Ognjen Petrovic, Nada Santrac, Jovana Koncar, Andjela Ivezic, Srdjan Nikolic
    Srpski arhiv za celokupno lekarstvo.2025; 153(1-2): 53.     CrossRef
  • Clinicopathologic Features and Prognoses of Male Patients With Breast Cancer
    Meiling Huang, Jingjing Xiao, Changjiao Yan, Rui Ling, Ting Wang
    American Journal of Men's Health.2024;[Epub]     CrossRef
  • 5,995 View
  • 181 Download
  • 3 Web of Science
  • 3 Crossref
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Randomized Open Label Phase III Trial of Irinotecan Plus Capecitabine versus Capecitabine Monotherapy in Patients with Metastatic Breast Cancer Previously Treated with Anthracycline and Taxane: PROCEED Trial (KCSG BR 11-01)
In Hae Park, Seock-Ah Im, Kyung Hae Jung, Joo Hyuk Sohn, Yeon Hee Park, Keun Seok Lee, Sung Hoon Sim, Kyong-Hwa Park, Jee Hyun Kim, Byung Ho Nam, Hee-Jun Kim, Tae-Yong Kim, Kyung-Hun Lee, Sung-Bae Kim, Jin-Hee Ahn, Suee Lee, Jungsil Ro
Cancer Res Treat. 2019;51(1):43-52.   Published online February 14, 2018
DOI: https://doi.org/10.4143/crt.2017.562
AbstractAbstract PDFPubReaderePub
Purpose
We investigated whether irinotecan plus capecitabine improved progression-free survival (PFS) compared with capecitabine alone in patients with human epidermal growth factor 2 (HER2) negative and anthracycline and taxane pretreated metastatic breast cancer (MBC).
Materials and Methods
A total of 221 patients were randomly assigned to irinotecan (80 mg/m2, days 1 and 8) and capecitabine (1,000 mg/m2 twice a day, days 1-14) or capecitabine alone (1,250 mg/m2 twice a day, days 1-14) every 3 weeks. The primary endpoint was PFS.
Results
There was no significant difference in PFS between the combination and monotherapy arm (median, 6.4 months vs. 4.7 months; hazard ratio [HR], 0.84; 95% confidence interval [CI], 0.63 to 1.11; p=0.84). In patients with triple-negative breast cancer (TNBC, n=90), the combination significantly improved PFS (median, 4.7 months vs. 2.5 months; HR, 0.58; 95% CI, 0.37 to 0.91; p=0.02). Objective response rate was numerically higher in the combination arm, though it failed to reach statistical significance (44.4% vs. 33.3%, p=0.30). Overall survival did not differ between arms (median, 20.4 months vs. 24.0 months; p=0.63). While grade 3 or 4 neutropenia was more common in the combination arm (39.6% vs 9.0%), hand-foot syndrome was more often observed in capecitabine arm. Quality of life measurements in global health status was similar. However, patients in the combination arm showed significantly worse symptom scales especially in nausea/vomiting and diarrhea.
Conclusion
Irinotecan plus capecitabine did not prove clinically superior to single-agent capecitabine in anthracycline- and taxane-pretreated HER2 negative MBC patients. Toxicity profiles of the two groups differed but were manageable. The role of added irinotecan in patients with TNBC remains to be elucidated.

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  • The Survival and Financial Benefit of Investigator-Initiated Trials Conducted by Korean Cancer Study Group
    Bum Jun Kim, Chi Hoon Maeng, Bhumsuk Keam, Young-Hyuck Im, Jungsil Ro, Kyung Hae Jung, Seock-Ah Im, Tae Won Kim, Jae Lyun Lee, Dae Seog Heo, Sang-We Kim, Keunchil Park, Myung-Ju Ahn, Byoung Chul Cho, Hoon-Kyo Kim, Yoon-Koo Kang, Jae Yong Cho, Hwan Jung Yu
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    Sara A. Hurvitz, Aditya Bardia, Kevin Punie, Kevin Kalinsky, Lisa A. Carey, Hope S. Rugo, Véronique Diéras, See Phan, Rosemary Delaney, Yanni Zhu, Sara M. Tolaney
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    Tingting Tang, Naiyu Liu, Lingjuan Wang, Kaiyue Zuo, Xinjie Zhu
    ChemBioChem.2024;[Epub]     CrossRef
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    Antonello Pinto, Chiara Guarini, Marianna Giampaglia, Valeria Sanna, Assunta Melaccio, Laura Lanotte, Anna Natalizia Santoro, Francesca Pini, Antonio Cusmai, Francesco Giuliani, Gennaro Gadaleta-Caldarola, Palma Fedele
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    Yoichi Naito, Seigo Nakamura, Nobuko Kawaguchi-Sakita, Takanori Ishida, Takahiro Nakayama, Yutaka Yamamoto, Norikazu Masuda, Koji Matsumoto, Takahiro Kogawa, Kazuki Sudo, Akihiko Shimomura, Catherine Lai, Danjie Zhang, Yuki Iwahori, Dianna Gary, Danh Huyn
    International Journal of Clinical Oncology.2024; 29(11): 1684.     CrossRef
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    Binghe Xu, Fei Ma, Tao Wang, Shusen Wang, Zhongsheng Tong, Wei Li, Xinhong Wu, Xiaojia Wang, Tao Sun, Yueyin Pan, Herui Yao, Xian Wang, Ting Luo, Jin Yang, Xiaohua Zeng, Weihong Zhao, Xiuyu Julie Cong, Jiongjie Chen
    International Journal of Cancer.2023; 152(10): 2134.     CrossRef
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    Salvatore Greco, Nicolò Fabbri, Riccardo Spaggiari, Alfredo De Giorgi, Fabio Fabbian, Antonio Giovine
    Biomedicines.2023; 11(6): 1772.     CrossRef
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    Jiao Xie, SiNi Li, YaMin Li, JianHe Li
    BMC Health Services Research.2023;[Epub]     CrossRef
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    Fernando Henao Carrasco, Sara Leal Sánchez
    Revisiones en Cáncer.2023;[Epub]     CrossRef
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    Rebecca A Dent, David W Cescon, Thomas Bachelot, Kyung Hae Jung, Zhi-Ming Shao, Shigehira Saji, Tiffany A Traina, Petra Vukovic, Darlington Mapiye, Micah J Maxwell, Peter Schmid, Javier Cortés
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Prognostic Impact of Elective Supraclavicular Nodal Irradiation for Patients with N1 Breast Cancer after Lumpectomy and Anthracycline Plus Taxane-Based Chemotherapy (KROG 1418): A Multicenter Case-Controlled Study
Haeyoung Kim, Won Park, Jeong Il Yu, Doo Ho Choi, Seung Jae Huh, Yeon-Joo Kim, Eun Sook Lee, Keun Seok Lee, Han-Sung Kang, In Hae Park, Kyung Hwan Shin, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha
Cancer Res Treat. 2017;49(4):970-980.   Published online January 4, 2017
DOI: https://doi.org/10.4143/crt.2016.382
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
This study was conducted to evaluate the impact of supraclavicular lymph node radiotherapy (SCNRT) on N1 breast cancer patients receiving post-lumpectomy whole-breast irradiation (WBI) and anthracycline plus taxane-based (AT) chemotherapy.
Materials and Methods
We performed a case-control analysis to compare the outcomes of WBI and WBI plus SCNRT (WBI+SCNRT). Among 1,147 patients with N1 breast cancer who received post-lumpectomy radiotherapy and AT-based chemotherapy in 12 hospitals, 542 were selected after propensity score matching. Patterns of failure, disease-free survival (DFS), distant metastasis-free survival (DMFS), and treatment-related toxicity were compared between groups.
Results
A total of 41 patients (7.6%) were found to have recurrence. Supraclavicular lymph node (SCN) failure was detected in three patients, two in WBI and one in WBI+SCNRT. All SCN failures were found simultaneously with distant metastasis. There was no significant difference in patterns of failure or survival between groups. The 5-year DFS and DMFS for patients with WBI and WBI+SCNRT were 94.4% versus 92.6% (p=0.50) and 95.1% versus 94.5% (p=0.99), respectively. The rates of lymphedema and radiation pneumonitis were significantly higher in the WBI+SCNRT than in the WBI.
Conclusion
We did not find a benefit of SCNRT for N1 breast cancer patients receiving AT-based chemotherapy.

Citations

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  • Patient-Reported Outcomes Between Whole-Breast Plus Regional Irradiation and Whole-Breast Irradiation Only in pN1 Breast Cancer After Breast-Conserving Surgery and Taxane-Based Chemotherapy: A Randomized Phase 3 Clinical Trial (KROG 17-01)
    Nalee Kim, Won Park, Haeyoung Kim, Won Kyung Cho, Sung Ja Ahn, Mi Young Kim, Shin-Hyung Park, Ik Jae Lee, Inbong Ha, Jin Hee Kim, Tae Hyun Kim, Kyu Chan Lee, Hyung-Sik Lee, Tae Gyu Kim, Kyung Hwan Shin, Jong Hoon Lee, Jinhong Jung, Oyeon Cho, Yong Bae Kim
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    Haeyoung Kim, Heejung Kim, Won Park, Jong Yun Baek, Sung Ja Ahn, Mi Young Kim, Shin-Hyung Park, Ik Jae Lee, Inbong Ha, Jin Hee Kim, Tae Hyun Kim, Kyu Chan Lee, Hyung-Sik Lee, Tae Gyu Kim, Jin Ho Kim, Jong Hoon Lee, Jinhong Jung, Oyeon Cho, Jee Suk Chang,
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    Jaeho Kim, Won Park, Jin Kim, Doo Choi, Yeon-Joo Kim, Eun Lee, Kyung Shin, Jin Kim, Kyubo Kim, Yong Kim, Sung-Ja Ahn, Jong Lee, Mison Chun, Hyung-Sik Lee, Jung Kim, Jihye Cha
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    Kyubo Kim, Hae Jin Park, Kyung Hwan Shin, Jin Ho Kim, Doo Ho Choi, Won Park, Seung Do Ahn, Su Ssan Kim, Dae Yong Kim, Tae Hyun Kim, Jin Hee Kim, Jiyoung Kim
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Postmastectomy Radiotherapy in Patients with pT1-2N1 Breast Cancer Treated with Taxane-Based Chemotherapy: A Retrospective Multicenter Analysis (KROG 1418)
Yeon-Joo Kim, Won Park, Boram Ha, Boram Park, Jungnam Joo, Tae Hyun Kim, In Hae Park, Keun Seok Lee, Eun Sook Lee, Kyung Hwan Shin, Haeyoung Kim, Jeong Il Yu, Doo Ho Choi, Seung Jae Huh, Chan Woo Wee, Kyubo Kim, Kyung Ran Park, Yong Bae Kim, Sung Ja Ahn, Jong Hoon Lee, Jin Hee Kim, Mison Chun, Hyung-Sik Lee, Jung Soo Kim, Jihye Cha
Cancer Res Treat. 2017;49(4):927-936.   Published online December 26, 2016
DOI: https://doi.org/10.4143/crt.2016.508
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study was to evaluate the impact of postmastectomy radiotherapy (PMRT) on loco-regional recurrence-free survival (LRRFS), disease-free survival (DFS), and overall survival (OS) in pT1-2N1 patients treated with taxane-based chemotherapy.
Materials and Methods
We retrospectively reviewed the medical data of pathological N1 patients who were treated with modified radical mastectomy and adjuvant taxane-based chemotherapy in 12 hospitals between January 2006 and December 2010.
Results
We identified 714 consecutive patients. The median follow-up duration was 69 months (range, 1 to 114 months) and the 5-year LRRFS, DFS, and OS rates were 97%, 94%, and 98%, respectively, in patients who received PMRT (PMRT [+]). The corresponding figures were 96%, 90%, and 96%, respectively, in patients who did not receive PMRT (PMRT [–]). PMRT had no significant impact on survival. Upon multivariable analysis, only the histological grade (HG) was statistically significant as a prognostic factor for LRRFS and DFS. In a subgroup analysis of HG 3 patients, PMRT (+) showed better DFS (p=0.081).
Conclusion
PMRT had no significant impact on LRRFS, DFS, or OS in pT1-2N1 patients treated with taxane-based chemotherapy. PMRT showed a marginal benefit for DFS in HG 3 patients. Randomized studies are needed to confirm the benefit of PMRT in high risk patients, such as those with HG 3.

Citations

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Effects of Postoperative Radiotherapy on Leptomeningeal Carcinomatosis or Dural Metastasis after Resection of Brain Metastases in Breast Cancer Patients
Boram Ha, Seung Yeun Chung, Yeon-Joo Kim, Ho-Shin Gwak, Jong Hee Chang, Sang Hyun Lee, In Hae Park, Keun Seok Lee, Seeyoun Lee, Tae Hyun Kim, Dae Yong Kim, Seok-Gu Kang, Chang-Ok Suh
Cancer Res Treat. 2017;49(3):748-758.   Published online October 31, 2016
DOI: https://doi.org/10.4143/crt.2016.303
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
In this retrospective study, we compared the incidence of leptomeningeal carcinomatosis or dural metastasis (LMCDM) in patients who received whole brain radiotherapy (WBRT), partial radiotherapy (PRT), or no radiotherapy (RT) following resection of brain metastases from breast cancer.
Materials and Methods
Fifty-one patients with breast cancer underwent surgical resection for newly diagnosed brain metastases in two institutions between March 2001 and March 2015. Among these, 34 received postoperative WBRT (n=24) or PRT (n=10) and 17 did not.
Results
With a median follow-up of 12.4 months (range, 2.3 to 83.6 months), 22/51 patients developed LMCDM at a median of 8.6 months (range, 4.8 to 51.2 months) after surgery. The 18-months LMCDM-free survival (LMCDM-FS) rates were 77.5%, 30.0%, and 13.6%, in the WBRT, PRT, and no RT groups, respectively (p=0.013). The presence of a tumor adjacent to cerebrospinal fluid flow and no systemic treatment after treatment for brain metastases were also associated with poor LMCDM-FS rate. Multivariate analysis showed that WBRT compared to PRT (p=0.009) and systemic treatment (p < 0.001) were independently associated with reduced incidence of LMCDM.
Conclusion
WBRT improved LMCDM-FS rate after resection of brain metastases compared to PRT in breast cancer patients.

Citations

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An Open-Label, Randomized, Parallel, Phase III Trial Evaluating the Efficacy and Safety of Polymeric Micelle-Formulated Paclitaxel Compared to Conventional Cremophor EL-Based Paclitaxel for Recurrent or Metastatic HER2-Negative Breast Cancer
In Hae Park, Joo Hyuk Sohn, Sung Bae Kim, Keun Seok Lee, Joo Seop Chung, Soo Hyeon Lee, Tae You Kim, Kyung Hae Jung, Eun Kyung Cho, Yang Soo Kim, Hong Suk Song, Jae Hong Seo, Hun Mo Ryoo, Sun Ah Lee, So Young Yoon, Chul Soo Kim, Yong Tai Kim, Si Young Kim, Mi Ryung Jin, Jungsil Ro
Cancer Res Treat. 2017;49(3):569-577.   Published online September 12, 2016
DOI: https://doi.org/10.4143/crt.2016.289
AbstractAbstract PDFPubReaderePub
Purpose
Genexol-PM is a Cremophor EL–free formulation of low-molecular-weight, non-toxic, and biodegradable polymeric micelle-bound paclitaxel. We conducted a phase III study comparing the clinical efficacy and toxicity of Genexol-PM with conventional paclitaxel (Genexol).
Materials and Methods
Patients were randomly assigned (1:1) to receive Genexol-PM 260 mg/m2 or Genexol 175 mg/m2 intravenously every 3 weeks. The primary outcome was the objective response rate (ORR).
Results
The study enrolled 212 patients, of whom 105 were allocated to receive Genexol-PM. The mean received dose intensity of Genexol-PM was 246.8±21.3 mg/m2 (95.0%), and that of Genexol was 168.3±10.6 mg/m2 (96.2%). After a median follow-up of 24.5 months (range, 0.0 to 48.7 months), the ORR of Genexol-PM was 39.1% (95% confidence interval [CI], 31.2 to 46.9) and the ORR of Genexol was 24.3% (95% CI, 17.5 to 31.1) (pnon-inferiority=0.021, psuperiority=0.016). The two groups did not differ significantly in overall survival (28.8 months for Genexol-PM vs. 23.8 months for Genexol; p=0.52) or progression-free survival (8.0 months for Genexol-PM vs. 6.7 months for Genexol; p=0.26). In both groups, the most common toxicities were neutropenia, with 68.6% occurrence in the Genexol-PM group versus 40.2% in the Genexol group (p < 0.01). The incidences of peripheral neuropathy of greater than grade 2 did not differ significantly between study treatments.
Conclusion
Compared with standard paclitaxel, Genexol-PM demonstrated non-inferior and even superior clinical efficacy with a manageable safety profile in patients with metastatic breast cancer.

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Case Report
A Rare Case of Phyllodes Tumor Metastasis to the Stomach Presenting as Anemia
Do Il Choi, Ho Seok Chi, Sang Ho Lee, Youngmee Kwon, Seog Yun Park, Sung Hoon Sim, In Hae Park, Keun Seok Lee
Cancer Res Treat. 2017;49(3):846-849.   Published online September 1, 2016
DOI: https://doi.org/10.4143/crt.2016.188
AbstractAbstract PDFPubReaderePub
Metastasis of a phyllodes tumor to the stomach is an extremely rare condition with important clinical implications. A 44-year-old woman was initially diagnosed with a phyllodes tumor in her right breast in 2008, and subsequently presented to an outpatient clinic with dizziness on December 16, 2013. We found that she had severe anemia (hemoglobin levels, 6.7 g/dL), and we quickly performed esophagogastroduodenoscopy to identify the cause. This procedure revealed large ulcerofungating masses with active bleeding in the stomach. Histopathological examination revealed that the masses were consistent with phyllodes tumor metastases. In patients with a metastatic phyllodes tumor presenting as anemia, gastric metastasis should be considered as one of the differential diagnoses because overlooking the possibility might have dire consequences if cytotoxic chemotherapy were administered.

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Original Articles
Prognostic Value of Axillary Nodal Ratio after Neoadjuvant Chemotherapy of Doxorubicin/Cyclophosphamide Followed by Docetaxel in Breast Cancer: A Multicenter Retrospective Cohort Study
Se Hyun Kim, Kyung Hae Jung, Tae-Yong Kim, Seock-Ah Im, In Sil Choi, Yee Soo Chae, Sun Kyung Baek, Seok Yun Kang, Sarah Park, In Hae Park, Keun Seok Lee, Yoon Ji Choi, Soohyeon Lee, Joo Hyuk Sohn, Yeon-Hee Park, Young-Hyuck Im, Jin-Hee Ahn, Sung-Bae Kim, Jee Hyun Kim
Cancer Res Treat. 2016;48(4):1373-1381.   Published online March 23, 2016
DOI: https://doi.org/10.4143/crt.2015.475
AbstractAbstract PDFSupplementary MaterialPubReaderePub
Purpose
The purpose of this study is to investigate the prognostic value of lymph node (LN) ratio (LNR) in patients with breast cancer after neoadjuvant chemotherapy.
Materials and Methods
This retrospective analysis is based on the data of 814 patientswith stage II/III breast cancer treated with four cycles of doxorubicin/cyclophosphamide followed by four cycles of docetaxel before surgery. We evaluated the clinical significance of LNR (3 categories: low 0-0.20 vs. intermediate 0.21-0.65 vs. high 0.66-1.00) using a Cox proportional regression model.
Results
A total of 799 patients underwent breast surgery. Pathologic complete response (pCR, ypT0/isN0) was achieved in 129 patients (16.1%) (hormone receptor [HR] +/human epidermal growth factor receptor 2 [HER2] –, 34/373 [9.1%]; HER2+, 45/210 [21.4%]; triple negative breast cancer, 50/216 [23.1%]). The mean numbers of involved LN and retrieved LN were 2.70 (range, 0 to 42) and 13.98 (range, 1 to 64), respectively. The mean LNR was 0.17 (low, 574 [71.8%]; intermediate, 170 [21.3%]; high, 55 [6.9%]). In univariate analysis, LNR showed significant association with a worse relapse-free survival (3-year relapse-free survival rate 84.8% in low vs. 66.2% in intermediate vs. 54.3% in high; p < 0.001, log-rank test). In multivariate analysis, LNR did not show significant association with recurrence after adjusting for other clinical factors (age, histologic grade, subtype, ypT stage, ypN stage, lymphatic or vascular invasion, and pCR). In subgroup analysis, the LNR system had good prognostic value in HR+/HER2– subtype.
Conclusion
LNR is not superior to ypN stage in predicting clinical outcome of breast cancer after neoadjuvant chemotherapy. However, the prognostic value of the LNR system in HR+/HER2– patients is notable and worthy of further investigation.

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Locoregional Recurrence by Tumor Biology in Breast Cancer Patients after Preoperative Chemotherapy and Breast Conservation Treatment
Eunjin Jwa, Kyung Hwan Shin, Ja Young Kim, Young Hee Park, So-Youn Jung, Eun Sook Lee, In Hae Park, Keun Seok Lee, Jungsil Ro, Yeon-Joo Kim, Tae Hyun Kim
Cancer Res Treat. 2016;48(4):1363-1372.   Published online February 18, 2016
DOI: https://doi.org/10.4143/crt.2015.456
AbstractAbstract PDFPubReaderePub
Purpose
The purpose of this study is to determine whether breast cancer subtype can affect locoregional recurrence (LRR) and ipsilateral breast tumor recurrence (IBTR) after neoadjuvant chemotherapy (NAC) and breast-conserving therapy (BCT). Materials and Methods We evaluated 335 consecutive patients with clinical stage II-III breast cancer who received NAC plus BCT from 2002 to 2009. Patients were classified according to six molecular subtypes: luminal A (hormone receptor [HR]+/HER2–/Ki-67 < 15%, n=113), luminal B1 (HR+/HER2–/Ki-67 ≥ 15%, n=33), luminal B2 (HR+/HER2+, n=83), HER2 with trastuzumab (HER2[T+]) (HR–/HER2+/use of trastuzumab, n=14), HER2 without trastuzumab (HER2[T–]) (HR–/HER2+, n=31), and triple negative (TN) (HR–/HER2–, n=61).
Results
After a median follow-up period of 7.2 years, 26 IBTRs and 37 LRRs occurred. The 5-year LRR-free survival rates were luminal A, 96.4%; B1, 93.9%; B2, 90.3%; HER2(T+), 92.9%; HER2(T–), 78.3%; and TN, 79.6%. The 5-year IBTR-free survival rates were luminal A, 97.2%; B1, 93.9%; B2, 92.8%; HER2(T+), 92.9%; HER2(T–), 89.1%; and TN, 84.6%. In multivariate analysis, HER2(T–) (IBTR: hazard ratio, 4.2; p=0.04 and LRR: hazard ratio, 7.6; p < 0.01) and TN subtypes (IBTR: hazard ratio, 6.9; p=0.01 and LRR: hazard ratio, 8.1; p < 0.01) were associated with higher IBTR and LRR rates. A pathologic complete response (pCR) was found to show correlation with better LRR and a tendency toward improved IBTR controls in TN patients (IBTR, p=0.07; LRR, p=0.03). Conclusion The TN and HER2(T–) subtypes predict higher rates of IBTR and LRR after NAC and BCT. A pCR is predictive of improved IBTR or LRR in TN subtype.

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Effect of Time Interval between Breast-Conserving Surgery and Radiation Therapy on Outcomes of Node-Positive Breast Cancer Patients Treated with Adjuvant Doxorubicin/Cyclophosphamide Followed by Taxane
Hyeon Kang Koh, Kyung Hwan Shin, Kyubo Kim, Eun Sook Lee, In Hae Park, Keun Seok Lee, Jungsil Ro, So-Youn Jung, Seeyoun Lee, Seok Won Kim, Han-Sung Kang, Eui Kyu Chie, Wonshik Han, Dong-Young Noh, Kyung-Hun Lee, Seock-Ah Im, Sung Whan Ha
Cancer Res Treat. 2016;48(2):483-490.   Published online June 5, 2015
DOI: https://doi.org/10.4143/crt.2015.111
AbstractAbstract PDFPubReaderePub
Purpose
This study evaluated the effect of surgery-radiotherapy interval (SRI) on outcomes in patients treated with adjuvant radiotherapy (RT) after breast-conserving surgery (BCS) and adjuvant four cycles of doxorubicin/cyclophosphamide (AC) followed by four cycles of taxane. Materials and Methods From 1999 to 2007, 397 eligible patients were diagnosed. The effect of SRI on outcomes was analyzed using a Cox proportional hazards model, and a maximal chi-square method was used to identify optimal cut-off value of SRI for each outcome.
Results
The median SRI was 6.7 months (range, 5.6 to 10.3 months). A SRI of 7 months was the significant cut-off value for distant metastasis-free survival (DMFS) and disease-free survival (DFS) using a maximal chi-square method. For overall survival, a significant cut-off value was not found. The patients with SRI > 7 months had worse 6-year DMFS and DFS than those with SRI ≤ 7 months on univariate analysis (DMFS, 81% vs. 91%, p=0.003; DFS, 78% vs. 89%, p=0.002). On multivariate analysis, SRI > 7 months did not affect DMFS and DFS. Conclusion RT delayed for more than 7 months after BCS and adjuvant four cycles of AC followed by four cycles of taxane did not compromise clinical outcomes.

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    Si-Ye Chen, Yu Tang, Shu-Lian Wang, Yong-Wen Song, Hui Fang, Jian-Yang Wang, Hao Jing, Jiang-Hu Zhang, Guang-Yi Sun, Xu-Ran Zhao, Jing Jin, Yue-Ping Liu, Bo Chen, Shu-Nan Qi, Ning Li, Yuan Tang, Ning-Ning Lu, Hua Ren, Zi-Hao Yu, Ye-Xiong Li
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    Marissa C van Maaren, Reini W Bretveld, Jan J Jobsen, Renske K Veenstra, Catharina GM Groothuis-Oudshoorn, Hendrik Struikmans, John H Maduro, Luc JA Strobbe, Philip MP Poortmans, Sabine Siesling
    British Journal of Cancer.2017; 117(2): 179.     CrossRef
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Impact of Molecular Subtype Conversion of Breast Cancers after Neoadjuvant Chemotherapy on Clinical Outcome
Siew Kuan Lim, Moo Hyun Lee, In Hae Park, Ji Young You, Byung-Ho Nam, Byeong Nam Kim, Jungsil Ro, Keun Seok Lee, So-Youn Jung, Young Mee Kwon, Eun Sook Lee
Cancer Res Treat. 2016;48(1):133-141.   Published online April 7, 2015
DOI: https://doi.org/10.4143/crt.2014.262
AbstractAbstract PDFPubReaderePub
Purpose
The aim of this study was to examine molecular subtype conversions in patients who underwent neoadjuvant chemotherapy (NAC) and analyze their clinical implications.
Materials and Methods
We included consecutive breast cancer patients who received NAC at the National Cancer Center, Korea, between August 2002 and June 2011, and had available data on estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor 2 (HER2) receptor status prior to NAC. Molecular subtypes, hormone receptor (HR) status, and ER and PR Allred scores before and after NAC were compared, and the long-term outcomes were analyzed.
Results
Of 322 patients, 32 (9.9%) achieved a pathologic complete response after NAC. HR+/HER2– tumors tended to convert into triple negative (TN) tumors (10.3%), whereas 34.6% of TN tumors gained HR positivity to become HR+/HER2– tumors. Clinical outcomes of molecular subtype conversion groups were compared against patients who remained as HR+/HER2– throughout. The HR+/HER2– to TN group had significantly poorer recurrencefree survival (RFS) (hazard ratio, 3.54; 95% confidence interval [CI], 1.60 to 7.85) and overall survival (OS) (hazard ratio, 3.73; 95% CI, 1.34 to 10.38). Patients who remained TN throughout had the worst outcomes (for RFS: hazard ratio, 3.70; 95% CI, 1.86 to 7.36; for OS: hazard ratio, 5.85; 95% CI, 2.53 to 13.51), while those who converted from TN to HR+/HER2– showed improved comparable survival outcomes.
Conclusion
Molecular subtypes of breast cancers changed frequently after NAC, resulting in different tumor prognostication. Tumor subtyping should be repeated after NAC in patients with breast cancer.

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Breast Cancer–Related Lymphedema after Neoadjuvant Chemotherapy
Myungsoo Kim, In Hae Park, Keun Seok Lee, Jungsil Ro, So-Youn Jung, Seeyoun Lee, Han-Sung Kang, Eun Sook Lee, Tae Hyun Kim, Kwan Ho Cho, Kyung Hwan Shin
Cancer Res Treat. 2015;47(3):416-423.   Published online November 17, 2014
DOI: https://doi.org/10.4143/crt.2014.079
AbstractAbstract PDFPubReaderePub
Purpose
The risk for lymphedema (LE) after neoadjuvant chemotherapy (NCT) in breast cancer patients has not been fully understood thus far. This study is conducted to investigate the incidence and time course of LE after NCT. Materials and Methods A total of 313 patients with clinically node-positive breast cancer who underwent NCT followed by surgery with axillary lymph node (ALN) dissection from 2004 to 2009 were retrospectively analyzed. All patients received breast and supraclavicular radiation therapy (SCRT). The determination of LE was based on both objective and subjective methods, as part of a prospective database. Results At a median follow-up of 5.6 years, 132 patients had developed LE: 88 (28%) were grade 1; 42 (13%) were grade 2; and two (1%) were grade 3. The overall 5-year cumulative incidence of LE was 42%. LE first occurred within 6 months after surgery in 62%; 1 year in 77%; 2 years in 91%; and 3 years in 96%. In a multivariate analysis, age (hazard ratio [HR], 1.66; p < 0.01) and the number of dissected ALNs (HR, 1.68; p < 0.01) were independent risk factors for LE. Patients with both of these risk factors showed a significantly higher 5-year cumulative incidence of LE compared with patients with no or one risk factor (61% and 37%, respectively; p < 0.001). The addition of adjuvant chemotherapy did not significantly correlate with LE. Conclusion LE after NCT, surgery, and SCRT developed early after treatment, and with a high incidence rate. More frequent surveillance of arm swelling may be necessary in patients after NCT, especially during the first few years of follow-up.

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Case Report
A Case of Locally Advanced Breast Cancer Complicated by Pulmonary Tumor Thrombotic Microangiopathy
Hak Jin Kim, Mi Hyang Kwak, Sun-Young Kong, Moon-Woo Seong, Han-Sung Kang, Keun Seok Lee, Jungsil Ro
Cancer Res Treat. 2012;44(4):267-270.   Published online December 31, 2012
DOI: https://doi.org/10.4143/crt.2012.44.4.267
AbstractAbstract PDFPubReaderePub
Pulmonary tumor thrombotic microangiopathy (PTTM) is a rare, malignancy-related complication that causes marked pulmonary hypertension, right heart failure, and death. We report on a patient with locally advanced breast cancer whose course was complicated by fatal PTTM based on clinical and laboratory findings.

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Original Articles
Serum HER2 as a Response Indicator to Various Chemotherapeutic Agents in Tissue HER2 Positive Metastatic Breast Cancer
Sun-Young Kong, Do Hoon Lee, Eun Sook Lee, Susan Park, Keun Seok Lee, Jungsil Ro
Cancer Res Treat. 2006;38(1):35-39.   Published online February 28, 2006
DOI: https://doi.org/10.4143/crt.2006.38.1.35
AbstractAbstract PDFPubReaderePub
Purpose

The aim of study was to evaluate the usefulness of serum HER2 as a therapeutic response indicator in patients with HER2 positive metastatic breast cancer (MBC).

Materials and Methods

The levels of serum HER2 and CA15.3 were assayed in 148 serial serum samples from 50 HER2 positive MBC patients at both the baseline and follow-ups. The changes in the levels of serum HER2 and CA15.3 in relation to the tumor responses to the various chemotherapy regimens were monitored.

Results

The levels of serum HER2 and CA15.3 were elevated in 82% and 62% of tissue HER2 positive patients, respectively, prior to therapies, with the changes in both tumor markers showing statistical significance in relation to the tumor responses (p<0.01) in patients with elevated baseline serum markers.

Conclusion

The level of serum HER2 could be a valuable response indicator, not only for trastuzumab containing therapy, but also for other common MBC chemotherapeutic agents. Also, as it is more frequently elevated, the serum level of HER2 may also be a more useful tumor marker than CA15.3 in HER2 positive MBC.

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A Phase II Study of Paclitaxel and Cisplatin Combination Chemotherapy in Advanced Non-small-cell Lung Cancer
Jung Ae Lee, Keun Seok Lee, Jin Seok Ahn, Jae Ho Byun, Hun Ho Song, Dae Young Zang, Young Iee Park, Young Suk Park, Eun Kyung Mo, Dong Kyu Kim, Myung Goo Lee, In Gyu Hyun, Ki Suck Jung, Soo Mee Bang, Gye Young Park, Jeong Woong Park, Eun Kyung Cho, Seong Hwan Jeong, Dong Bok Shin, Jae Hoon Lee
Cancer Res Treat. 2003;35(3):239-244.   Published online June 30, 2003
DOI: https://doi.org/10.4143/crt.2003.35.3.239
AbstractAbstract PDF
PURPOSE
Paclitaxel and cisplatin, active drugs in the treatment of non-small-cell lung cancer (NSCLC), have been found to be synergistic and less myelotoxic in combination when the paclitaxel is given 24 hr prior to the cisplatin. Their antitumor activity and toxicity in patients with advanced NSCLC has been evaluated herein. MATERIALS AND METHODS: Seventy-four chemonaive patients, with advanced NSCLC, were enrolled. Paclitaxel, 175 mg/m2, was administered on day 1, followed 24 hr later by cisplatin, 75 mg/m2, on day 2. RESULTS: The overall response rate, median time to progression and median survival time were 51%, 7.1 months (95% confidence interval (CI), 5.5~8.7 months) and 13.7 months (95% CI, 11.3~16.1 months), respectively. There were significant differences in the overall survival rates in relation to stage and the ECOG performance status(PS). The toxicity was mainly nonhematological. Grade > or =3 neuropathy occurred in 2 (3%) patients, myalgia in 3 (4%), and bone pain in 3 (4%). The hematological toxicity was mild, and no grade 3 or 4 neutropenia was observed.
CONCLUSION
The combination of paclitaxel and cisplatin is an effective and tolerable treatment regimen for advanced NSCLC during first line chemotherapy. The main toxicity was nonhematological, such as peripheral neuropathy, myalgia and bone pain, whereas the hematological toxicity itself was mild.

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  • The Efficacy and Safety of Padexol® (Paclitaxel) and Cisplatin for Treating Advanced Non-small Cell Lung Cancer
    Hoon-Kyo Kim, Jun Suk Kim, Hun Mo Ryoo, Dong Gun Shin, Byoung Young Shim, Kyong Hwa Park, Sung Hwa Bae, Chi Hong Kim
    Cancer Research and Treatment.2006; 38(2): 66.     CrossRef
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A Phase II Study of Ifosfamide, Carboplatin, and Epirubicin (ICE) Combination Chemotherapy for Extensive Disease of Small Cell Lung Cancer
Jae Ho Byun, In Sook Woo, Hun Ho Song, Keun Seok Lee, Jin Seok Ahn, Dae Young Jang, Jung Ae Lee, Young Lee Park, Young Suk Park
Cancer Res Treat. 2002;34(6):416-420.   Published online December 31, 2002
DOI: https://doi.org/10.4143/crt.2002.34.6.416
AbstractAbstract PDF
PURPOSE
To evaluate the efficacy and safety of ifosfamide, carboplatin and epirubicin (ICE) combination chemotherapy for extensive disease small cell lung cancer (SCLC) patients, who had received no previous chemotherapy, we performed phase II trial between August 1998 and January 2001.
MATERIALS AND METHODS
The study group comprised of 21 patients. Ifosfamide, 1,500 mg/m2, was given with mesna, 900 mg/m2, intravenously for 12 hours on days 1, 2 and 3, and carboplatin, 4.5 mg/ml/min, for target AUC, and epirubicin, 60 mg/m2, were given intravenously for 90 minutes on day 1. The cycle of treatment was repeated at 4 week intervals.
RESULTS
Twenty-one patients with extensive disease SCLC were treated at Hallym University between August 1998 and January 2001. One patient was unable to be evaluated because of lost to follow-up. Of the 20 patients able to be evaluated, an objective response was observed in 13 (65%). There were no complete responses. The median response duration, time to progression and median overall survival were 15.4, 18.3 and 34 weeks, respectively. Toxicities were acceptable, with dose reduction for myelosuppression necessary in only a minority of the patients. A total of 85 cycles of chemotherapy were given to the patients. The median number of cycles completed was 4. Grade III and IV hematological toxicities included anemia (4.7%), neutropenia (3.5%) and thrombocytopenia (3.5%). Most non-hematological toxicities were grade I or II.
CONCLUSION
These results suggested that ICE combination chemotherapy for extensive disease SCLC is effective, and can be safely administered with acceptable toxicities.
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A Phase II Trial of UFT-E and Oral Leucovorin in Advanced Colorectal Cancer
Won Sup Lee, Keun Seok Lee, Ki Hyun Kim, Baek Yeol Ryoo, Won Seog Kim, Won Ki Kang, Yoon Koo Kang, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim
Cancer Res Treat. 2001;33(3):225-228.   Published online June 30, 2001
DOI: https://doi.org/10.4143/crt.2001.33.3.225
AbstractAbstract PDF
PURPOSE
To determine the efficacy and toxicity of UFT-E plus oral calcium leucovorin in the treatment of patients with advanced colorectal cancer.
MATERIALS AND METHODS
Forty-three patients with advanced, bidimensionally measurable colorectal adenocarcinoma were enrolled in the trial. No patients had received prior palliative chemotherapy. The patients that had received previous adjuvant chemotherapy were enrolled when more than 6 months had elapsed after the completion of adjuvant therapy. Patients were treated with 300 mg/m2/day of UFT-E (tegafur-based) plus 90 mg/day of leucovorin administered orally in three divided daily doses, every 8 hours for 28 days followed by a 7-day rest period. Response was evaluated after two or three courses of therapy.
RESULTS
Thirty-six of forty-three patients were evaluable for response; seven dropped out due to infection, toxicity and patients' refusal. Ten patients had partial responses and one patient complete response (response rate, 31%; 95% confidence interval, 16~46%). The median response duration for the UFT-E plus leucovorin regimen was 28 weeks. Grade III toxicity was seen in one case, with diarrhea.
CONCLUSION
This oral regimen proved effective and well tolerated. This schema also avoided inconveniences, such as hospitalization and the use of infusion pumps, which are associated with 5-FU infusion regimens. The regimen used showed minimal toxicity, especially in the upper digestive tract, with good patient compliance.
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A Phase II Study of Oxaliplatin, 5-Fluorouracil, and Leucovorin in 5- Fluorouracil-Pretreated Metastatic Colorectal Cancer
Keun Seok Lee, Won Sup Lee, Hark Kyun Kim, Joo Young Jeong, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim
J Korean Cancer Assoc. 2001;33(2):99-105.
AbstractAbstract PDF
PURPOSE
To evaluate antitumor response, time to progression, and toxicities of oxaliplatin, 5- fluorouracil (5-FU), and leucovorin (LV) continuous infusion in patients with metastatic colorectal cancer who progressed during or after treatment with a 5-FU-containing regimen.
MATERIALS AND METHODS
Forty-eight patients with metastatic colorectal cancer, who progressed while receiving or after discontinuing palliative chemotherapy with 5- FU-based regimen, were enrolled in this study. Treatment consisted of oxaliplatin (85 mg/m2 on day 1) as a 2-hour infusion followed by bolus 5-FU (400 mg/m2 on day 1), and 5-FU 48-hour infusion 2.4~3 g/m2 concurrently with LV 48-hour infusion 150 mg/m2, without mixing. Cycles were repeated at 2-week intervals. The dose of 5-FU was modified, depending on the hematologic toxicity profile.
RESULTS
The objective response rate was 28% for 43 assessable patients (95% confidence interval, 14% to 42%), including one complete remission (2%). Seventeen additional patients (39%) had stable disease, and fourteen (33%) progressed. The median time to progression was 5.9 months and the median overall survival was 13.2 months from the start of the chemotherapy. From the 297 cycles analyzed, hematologic toxicities per course were: leukopenia; grade I 26.6%, grade II 3.4%, and grade III 0.3%, thrombocytopenia; grade I 10.8%, grade II 3.0%, grade III 1.0%, and grade IV 0.3%. The most frequent nonhematologic adverse reactions were nausea/vomiting and peripheral neuropathy, which were rated as WHO grade II in 13 patients (49%) and 11 patients (22%), respectively.
CONCLUSION
This phase II study of oxaliplatin, 5-FU, and LV continuous infusion showed enhanced antitumor activity in patients with 5-FU-pretreated metastatic colorectal cancer. Overall toxicity was acceptable; neurotoxicity and bone marrow suppression constituted the dose-limiting side effects.
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Prognostic Factors of Gastrointestinal Leiomyosarcoma in Korea
Se Hoon Lee, Hee Jeoung Cha, Jee Hyun Kim, Im Il Na, Jun Hee Lee, Hark Kyun Kim, Keun Seok Lee, Won Sup Lee, Chong Jai Kim, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim
J Korean Cancer Assoc. 2000;32(6):1022-1030.
AbstractAbstract PDF
PURPOSE
The clinicopathologic features and prognostic factors of gastrointestinal leiomyosarcoma have been a source of controversy.
MATERIALS AND METHODS
A retrospective study was made of 91 incident cases of gastrointestinal leiomyosarcoma from 1979 to 1998 to identify clinicopathologic features and prognostic factors.
RESULTS
The median age of study subjects was 56 years and 58.2% was male. Tumors consisted of 2 esophagus, 39 stomach, 38 small bowel, 12 large bowel leiomyosarcoma. Mean size of the tumors was 10.9 cm and 52.9% of them was larger than 10 cm. The tumors were classified as localized stage (42 cases), advanced stage (21 cases), and metastatic stage (28 cases). Again, the tumors were classified as low grade (48 cases) and high grade (18 cases). Median overall survival was 37.4 months and median disease-free survival was 28.2 months. In univariate analysis, the significant factors affecting the overall survival of patients with leiomyosarcoma were stage, size greater than 10 cm, performance status, and histologic grade. In multivariate analysis, stage, performance status, and histologic grade were independent factors affecting the overall survival. In univariate analysis, the significant factors affecting the disease-free survival were stage, performance status, and histologic grade. In multivariate analysis, histologic grade was the only independent factor affecting the disease-free survival.
CONCLUSION
Stage, performance status, and histologic grade were independent factors affecting the overall survival. Histologic grade was independent factor affecting the disease-free survival.
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Clinical Characteristics and Prognostic Factors of Metastatic Tumor of Unknown Primary
Eun Kyung Cho, Keun Seok Lee, Chul Won Jung, Won Seog Kim, Ki Hyeong Lee, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim
J Korean Cancer Assoc. 1999;31(3):607-616.
AbstractAbstract PDF
PURPOSE
For malignant diseases, predictions about tumor behavior and determination of appropriate therapy are based on the primary tumor sites, but 2-9% of cancer patients are diagnosed without identifiable primary tumor sites. Metastatic tumors of unknown primary origin (MUO) are a heterogeneous group of tumors with variable natural histories. The majority of these patients fall outside of treatable subjects and seldom respond to therapy. To define further the natural history of MUO and identify prognostic factors, we undertook a clinical analysis of 141 consecutive patients with a presumed diagnosis of MUO.
MATERIALS AND METHODS
One hundred forty-one patients were diagnosed with unknown primary tumor from Jan. 1, 1992 through Aug. 31, 1995. The primary end point for the study was survival, which was calculated from the first day of patient registration diagnosed histologically. The survival curves were estimated using the Kaplan-Meier method and compared using the log-rank test. To identify important prognostic factors, univariate and multivariate analyses were conducted.
RESULTS
Most of the 141 patients had histologic or cytologic evidence of adenocarcinoma and had more than one site metastatically involved. The predominant sites of tumor involvement were lymph node, peritoneum, bone, liver, lung, and pleura. Univariate and multivariate analyses identified numerous important prognostic factors with a significant influence on survival, including performance status (P 0.0001), specific organ sites involved (lung P 0.0076 or liver P 0.0310), and chemotherapy group (P- 0.0480).
CONCLUSION
This study validated clinical courses and important prognostic factors that had an impact on survival in MUO.
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COPP/ABV Hybrid Chemotherapy in Pateints with Hodgkin's Disease
Jin Seok Ahn, Keun Seok Lee, Jong Tae Lee, Seok Ah Lim, Dae Seok Heo, Young Joo Bang, Sun Yang Park, Byung Kook Kim, No Kyung Kim
J Korean Cancer Assoc. 1998;30(4):818-826.
AbstractAbstract PDF
PURPOSE
MOPP/ABV hybrid regimen incorporates MOPP and ABVD into a single regimen on the tenets of the Goldie-Coldman hypothesis. This study was performed to determine the efficacy of COPP/ABV hybrid regimen, in which cyclophosphamide was substituted for mechlorethamine, in patients with advanced Hodgkin's disease.
MATERIALS AND METHODS
Patients with advanced Hodgkin's disease were treated with cyclophosphamide(600 mg/m2 iv, Dl), vincristine(1.4 mg/m2 iv, D1), procarbazine(100 mg/m2/d po, D1-7), prednisolone(40 mg/m2/d po D1-14), doxorubicin(35 mg/m2 iv, D8), bleomycin(10 mg/m2 iv, D8) and vinblastine(6 mg/m2 iv, D8). The treatment was repeated every 4 weeks.
RESULTS
Between Aug. 1989 and Aug. 1996, 28 patients were enrolled. The median age was 33 years. Twenty one(75%) were previously untreated, newly diagnosed patients and 7(25%) were those who had relapsed after previous radiotherapy(RT). The common histologic types were nodular sclerosis(46%) and mixed cellularity(36%). Twenty three (82%) patients achieved complete remission(CR), three(11%) with the assistance of involved-field RT. Only one patient was primary treatment failure. The median follow-up duration was 56 months. Of the 23 patients achieving CR, three(13%) relapsed. Five-year relapse-free survival was 84.4%. Eight patients died. Five-year overall survival rate was 66.6% and 5-year failure-free survival rate was 66.3%. The survival rate of those who had relapsed after previous RT was significantly lower than that of newly diagnosed patients(P=0.03). The hematologic toxicities were common, but nonhernatologic toxicities were uncommon. Five patients died of treatment-related pneumonia or sepsis. Among them, four were those who had relapsed after previous RT.
CONCLUSION
COPP/ABV hybrid regimen could cure significant proportion of patients with advanced Hodgkin's disease but the treatment-related mortality was high, especially in those who had relapsed after previous RT. Another regimen should be considered for those who received previous RT.
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Peripheral T - cell Lymphomas Presenting as Fever of Unknown Origin
Dae Seog Heo, Keun Seok Lee, Joor Yung Huh, Yung Jue Bang, Seon Yang Park, Chul Woo Kim, Byoung Kook Kim, Noe Kyeong Kim
J Korean Cancer Assoc. 1998;30(2):329-337.
AbstractAbstract PDF
PURPOSE
Peripheral T-cell lymphomas(PTCL) show diverse clinical and histological characteristics and should be understood as mixtures of heterogeneous entities. Although many clinical and biological parameters have been proposed for classifying PTCL into different prognostic groups, few parameters have turned out to be appropriate for classification. To investigate the clinical significance of FUO presentation in PTCL, comparisons of clinical parameters were performed using non-FUO presentation as a control.
MATERIALS AND METHODS
66 cases of Korean PTCL were divided into FUO group and non-FUO group according to the presentation and compared with each other.
RESULTS
Among 66 patients of PTCL, 19 patients presented with FUO. Compared with non-FUO group, FUO group showed no significant age and sex ratio differences. FUO group showed more advanced stage, worse performance status than non-FUO group. Predominant sites of definite diagnosis were skin, gastrointestinal tract and liver in FUO group and nasal cavity and paranasal sinus in non-FUO group. There were no significant differences between histologic classifications of both groups. Survival analysis revealed significant differences between both groups. FUO group showed significantly shorter survival. Prognostic factor analysis(multivariate) was done with stage, LDH level, performance status, and FUO status. FUO status, stage and performance status were significant determinants of survival, but LDH level proved to have no prognostic implication.
CONCLUSION
PTCL with FUO presentation showed such distinct characteristics that the authors propose fever of unknown origin(FUO) as a clinical parameter for classifying PTCL. Further studies are needed to identify biological parameters which characterize PTCL with FUO presentation.
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Combination Chemotherapy with 5-Fluorouracil and Carboplatin for Advanced Head and Neck Cancer
Eun Kyung Cho, Won Sup Lee, Chul Won Jung, Keun Seok Lee, Won Seog Kim, Ki Hyeong Lee, Dae Seog Heo, Yung Jue Bang, Kwang Hyun Kim, Charn II Park, Noe Kyeong Kim
J Korean Cancer Assoc. 1996;28(1):94-104.
AbstractAbstract PDF
Twenty-nine patients with previously untreated, locally advanced head and neck cancer were treated with two or three cycles of combination chemotherapy consisting of 5- fluorouracil infusion and carboplatin, followed by surgery and/or curative radiotherapy. Nine patients with recurrent head and neck cancer were treated with the same combination chemotherapy. The results were as follows; 1) Among 28 evaluable patients, response rate was 71.4%(partial response) after neoadjuvant chemotherapy. Following local modality(surgery and/or radiotherapy), response rate was 79%(complete response 51.4%, and partial response 25%). 2) One year survival rate in neoadjuvant group was 83% and one year progression-free survival rate, 68.8%. The progression-free survival of responders was significantly prolonged in comparison with that of non-responders(p<0.05). 3) In palliative treatment group, one partial response(11%) was observed among nine patients. Median time to progression was 6.8 weeks and median survival was 17.7 weeks; there was no significant difference between responders and non-responders. 4) Nausea and vomiting were frequently observed but easily controlled. Hematologic toxicities-leukopenia and thrombocytopenia were observed but were reversible. In conclusion, combination chemotherapy with carboplatin and 5-FU was effective for locally advanced head and neck cancer in neoadjuvant setting, but it had limited benefits for recurrent diseases. Toxicities were tolerable and neurotoxicity, ototoxicity, and nephrotoxicity were not observed.
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Neoadjuvant Chemotherapy with High-dose Methotrexate , Adriamycin and Cisplatin for Non - Metastatic Osteosarcoma
Keun Seok Lee, Heung Moon Chang, Dae Seog Heo, Yung Jue Bang, Noe Kyeong Kim, Sang Hoon Lee, Eui Keun Ham, Han Ku Lee
J Korean Cancer Assoc. 1996;28(6):1092-1104.
AbstractAbstract PDF
three non-metastatic osteosarcoma patients were treated with high-dose methotrexate, adriamycin, and cisplatin from October 1987 to May 1993. Median age was 18. The ratio of male to female was 16: 7. The patients received methotrexate 8g/§³ IV, day 1 and 8 with leucovorin rescue, adriamycin 25mg/§³ IV day 16~18, and cisplatin 75mg/§³ IV day 16, After two cycles of neoadjuvant chemotherapy, operation was done and then six cycles of adjuvant chemotherapy were given with the same regimen. One patient developed lung metastasis after two cycles of neoadjuvant chemotherapy, and the other patient died from sepsis associated with chemotherapy-induced neutropenia before operation. Therefore, 21 patients underwent operation. Among them, l9 patients underwent limb salvage operation. Of the five patients who relapsed, two patients had lung metastasis and another two patients had local recurrence, and one patient had both lung and brain metastasis. One year, three year, and five year disease-free survival rate were 84%, 68%, and 68%. One year, three year, and five year survival rate were 91%, 64%, and 53%, respectively. The site of the primary lesion was the only significant prognosis factor. Patients with the lesion of distal femur had poor prognosis.Histologic responses were assessed in 17 patients. Observed histologic responses were grade I necrosis in 35%, grade II necrosis in 65%. There was no grade III or IV necrosis. The disease-free survival rates and overall survival rates were not significantly different between grade I necrosis group and grade II necrosis group. Toxicities grade III or IV were as follows: leukopenia 32%, thrombocytopenia 9%, hepatotoxicity 14%, and infection 6% with one chemotherapy-related death. The pharmacokinetics of high-dose methotrexate with leucovorin rescue were studied in l0 patients. The highest concentration was achieved at the end of infusion(6 hour). The decay of the plasma concentration of methotrexate after completion of the infusion followed a two-compartment model with a T(1/2)¥a of 3.4¡¾1.9 hours and T(1/2)¥a of 8.0¡¾2.6 hours. The clearance was 55¡¾13ml/min/§³ and the volume of distribution was 8.2¡¾3.0 L/§³. In conclusion, neoadjuvant chemotherapy with high-dose methotrexate, adriamycin, and cisplatin is effective for treatment of the patients of osteosarcoma with preserving the limb function.
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