Concurrent Chemoradiotherapy Shows Long-Term Survival after Conversion from Locally Advanced to Resectable Hepatocellular Carcinoma

이익재,성진실,김준원,한광협,김자경,김경식,최진섭,박영년 연세대학교의과대학 2014 Yonsei medical journal Vol.55 No.6

Purpose: For locally unresectable hepatocellular carcinoma (HCC) patients, concurrentchemoradiotherapy (CCRT) has been applied as a loco-regional treatment. After shrinkage of tumors in selected patients, surgical resection is performed. The aim of this study was to evaluate prognostic factors and long-term survivors in such patients. Materials and Methods: From January 2000 to January 2009, 264 patients with HCC were treated with CCRT (45 Gy with fractional dose of 1.8 Gy), and intra-arterial chemotherapy was administered during radiotherapy. Eighteen of these patients(6.8%) underwent hepatic resection after showing a response to CCRT. Cases were considered resectable when tumor-free margins and sufficient remnant volumeswere obtained without extrahepatic metastasis. Prior to operation, there were six patients with complete remission, 11 with partial remission, and six with stable disease according to modified Response Evaluation Criteria in Solid Tumors. Results:In pathologic review, four patients (22.2%) showed total necrosis and seven patients (38.9%) showed 70‒99% necrosis. A high level of necrosis (≥80%) was correlatedwith low risk for extrahepatic metastasis and long-term survival. In univariate analyses, vessel invasion and capsular infiltration were significantly correlated with disease free survival (DFS) (p=0.017 and 0.013, respectively), and vessel invasion was significantly correlated with overall survival (OS) (p=0.013). In multivariate analyses, capsule infiltration was a significant factor for DFS (p=0.016) and vessel invasion was significant for OS (p=0.015). Conclusion: CCRT showed favorable responsesand locally advanced HCC converted into resectable tumor after CCRT in selected patients. Long-term survivors showed the pathological features of near total necrosis, as well as negative capsule and vessel invasion.

Altered Biological Potential and Radioresponse of Murine Tumors in Different Microenvironments

이익재,이은정,박효진,김원우,하상준,신유근,성진실 대한암학회 2016 Cancer Research and Treatment Vol.48 No.2

Purpose This study was conducted to evaluate the biological features of murine hepatocarcinoma according to different tumor microenvironmental models and to determine the change in molecular and immunologic responses after radiation. Materials and Methods Tumor models were established in the liver (orthotopic) and thigh (heterotopic) of male C3H/HeN mice. Tumor growth and lung metastasis were assessed in these models. To evaluate the radiation effect, the tumors were irradiated with 10 Gy. Factors associated with tumor microenvironment including vascular endothelial growth factor (VEGF), cyclooxygenase- 2 (COX-2), transforming growth factor beta1 (TGF-!1), CD31, and serum interleukin- 6 (IL-6) were evaluated. Tumor-infiltrating regulatory immune cells, regulatory T cells (Tregs), and myeloid-derived suppressor cells (MDSCs) were also analyzed. Results A higher number of lung metastases were observed in the orthotopic tumor model than in the heterotopic tumor model. VEGF, CD31, COX-2, and TGF-!1 expression was more prominent in the orthotopic tumor model than in the heterotopic tumor model. Expression of the angiogenic factor VEGF and key regulatory molecules (TGF-!1 and COX-2) decreased following radiation in the orthotopic tumor model, while the serum IL-6 level increased after radiation. In the orthotopic tumor model, the number of both Tregs and MDSCs in the tumor burden decreased after radiation. Conclusion The orthotopic tumor model showed higher metastatic potential and more aggressive molecular features than the heterotopic tumor model. These findings suggest that the orthotopic tumor mouse model may be more reflective of the tumor microenvironment and suitable for use in the translational research of radiation treatment.

군신좌사론에 의한 계지탕의 계지 생약명

이익재,김인락 동의대학교 한의학연구소 2000 동의한의연구 Vol.4 No.-

계지탕의 去皮柱枝가 오늘날의 桂枝인지 桂心인지를 君臣佐使論에 근거하여 판별하였다. 상한론과 금궤요락에서 탐제이면서 구성약재는 3종이상이고 구성약재중 하나가 처방명인 처방들은 모두 24종이고, 이들에서 공통점은 처방명을 이루는 약재가 君藥이고 分量도 가많다. 계지탕에서 去皮계지가 작약, 생강과 동량으로 3兩이다. 거피계지가 君藥의 조건에 합당하려면 柱心이어야지 去皮전의 육계는 3냥이상이 된다. 뇌공포자론에 의하면 계심 3냥은 肉桂로서는 9.6냥이며 최대량이 된다. 계지는 發散하고 계심은 溫??한다는 학설은 재고의 여지가 있다. The purpose of this study is to discriminate whether barked gyeji in Gyejitang is Cassiae cortex interior or Ranmulus cinnamoni. The types of herb prescription in Sanghanron and Gumgueyoryak, which is boiled in water and is composed of more than three herbs and of which the name is compsed with one of composing hertbal name, were analyzed by the theory of principal, adjuvant, auxillary and conducant ingrediants in a prescription.

하나님 / 하나님의 뜻과 사람의 뜻

이익재 기독교대한성결교회 활천사 1958 활천 Vol.292 No.-

The Optimal Selection of Radiotherapy Treatment for Hepatocellular Carcinoma

이익재,성진실 거트앤리버 소화기연관학회협의회 2012 Gut and Liver Vol.6 No.2

The majority of patients who present with hepatocellular carcinoma (HCC) are already at an advanced stage, and the tumors are unresectable. Radiotherapy (RT) technology can safely provide focused high-dose irradiation to these patients. A wide spectrum of RT technologiesis currently available, including internal RT consisting of Yttrium-90(90Y), Iodine-131 (131I) anti-ferritin antibody and Homium-199(199Ho) and external RT, such as three-dimensional conformal RT, intensity-modulated RT, helical tomotherapy, stereotactic body RT, and image-guided RT. However, it may be diffi cult for physicians to understand all of the available options and to select the optimal RT treatment. Physicians frequently query radiation oncologists on the practical indications of RT for managing patients with HCC. According to the Korean Liver Cancer Study Group practice guidelines, RT is considered appropriate for unresectable, locally advanced HCC without extrahepatic metastasis, a Child-Pugh class A or B, and tumors that occupy less than two-thirds of the liver with level II evidence. In this review, we discuss the application of various RT modalities based on disease status and the detailed indications for RT according to the Barcelona Clinic Liver Cancer staging system.

병기 IB 자궁경부암에서 혈관내피세포성장인자(VEGF)의 발현이 예후에 미치는 영향

이익재,박경란,이종영,이강규,송지선,이광길,차동수,최현일 대한방사선종양학회 2001 Radiation Oncology Journal Vol.19 No.4

포장과 환경 -롯데제과 상품포장 현황

이익재 (사)한국포장협회 2002 包裝界 Vol.105 No.-

Effect of Oral Supplementation with Branched-chain Amino Acid (BCAA) during Radiotherapy in Patients with Hepatocellular Carcinoma: A Double-Blind Randomized Study

이익재,성진실,배정임,유세환,이유미,이종호 대한암학회 2011 Cancer Research and Treatment Vol.43 No.1

Purpose The present study evaluated whether oral supplementation with a branched-chain amino acid (BCAA) improves the biochemical and amino acid profiles of liver tumor patients undergoing radiotherapy. Materials and Methods Patients were randomly assigned to one of 2 groups: a group given oral supplementation with BCAA granules (LIVACT granules; Samil Pharm Co., Korea, each granule containing Lisoleucine 952 mg, L-leucine 1,904 mg, and L-valine 1,144 mg) during radiotherapy, or a placebo group. Physical and biochemical examinations and measurements, including subjective symptoms, Child-Pugh class, body mass index, plasma albumin concentration, and plasma amino acid profiles were monitored. Results Fifty were enrolled between November 2005 and November 2006. We also analyzed data from 37 hepatocellular carcinoma (HCC) patients in order to evaluate a more homogenous group. The two groups of patients were comparable in terms of age, gender, Child-Pugh score, and underlying hepatitis virus type. Serum albumin, total protein, liver enzymes, and cholesterol showed a tendency to increase in the BCAA group. In this group, the percentage of cases that reverted to normal serum albumin levels between 3 and 10 weeks after administration of BCAA was significantly higher (41.18%) than in the placebo group (p=0.043). Conclusion Oral supplementation with a BCAA preparation seems to help HCC patients undergoing radiotherapy by increasing the BCAA concentration.

우측대장게실염

이익재,송국현,장중길,배옥석,박성대 대한대장항문학회 1993 Annals of Coloproctolgy Vol.9 No.4

3차원입체조형방사선치료 계획 시 간종괴의 위치에 따른 최적 조사 방향의 결정

이익재,성진실,정경근,조광환,심수정 대한방사선방어학회 2006 방사선방어학회지 Vol.31 No.4

본 연구는 간암 환자의 방사선치료 시에 정상 조직과 간암의 위치에 따른 적절한 조사 방향을 찾고자 하였다. 간암의 위치는 Couinaud에 의한 분류법을 이용하여 4군으로 나누었고, 각 군의 용적을 가상의 표적 용적으로 정해서 여러 개의 방사선 치료계획을 세워 정상조직합병증발생률(normal tissue complication probability, NTCP)을 비교하였다. 그룹 I에서는 조사 수를 늘릴수록 정상 간의 NTCP가 감소되었으나 6개 이상부터는 일정하였다. 그룹 II에서는 PA(posterior to anterior) 조사가 추가 되었을 때 정상 간의 NTCP가 증가하였다. 그룹 III는 표적용적 주변에 정상조직이 많아 조사 방향의 설정에 어려움이 있었고 여러 방향에서의 조사 보다는 RAO(right anterior oblique)와 PA를 이용한 2개의 조사만이 시행되었을 때 정상 간의 NTCP가 가장 낮았다. 그룹 IV에서도 RAO와 PA의 2개 조사로 이루어진 치료계획에서 정상 간의 NTCP가 가장 낮았다. 본 연구를 통해 간암의 방사선 치료계획 시 간암의 위치와 정상조직의 위치에 따라 NTCP가 다양하게 나타남을 알 수 있었고, 간암의 방사선치료 계획 시 최적 조사 방향의 설정을 통해 임상적으로 방사선치료를 적용하는 데 유용한 지침이 될 수 있을 것으로 생각된다.