소적정원산(消積正元散) 및 옻나무 추출물 투여로 체중증가 및 일반활동도의 개선을 보인 진행성 위암환자 1례

안지혜,정의민,정종수,박재우,윤성우,An, Ji-Hye,Jerng, Ui-Min,Jeong, Jong-Soo,Park, Jae-Woo,Yoon, Seong-Woo 대한암한의학회 2009 大韓癌韓醫學會誌 Vol.14 No.1

Advanced gastric cancer is the most common type of all cancers in Korea, which account for approximately 18.1% of all incident cancers, and mortality from advanced gastric cancer is estimated at nearly 15.6% of death that caused by all cancer. In the conventional medicine, treatments of advanced gastric cancer include chemotherapy such like FOLFOX. In this case report, we introduce a case of advanced gastric cancer with greater omentum, thyroid, supraclavicular lymph node metastasis who had received chemotherapy. Chemotherapy was stopped because of weight loss and neurologic symptom such like cognitive disorder. The patient visited $M{\cdot\mu}$ Integrative cancer center in 2008, and was treated by Sojeukjungwon-san and allergen removed Rhus verniciflua stokes(aRVS). There was no evidence of brain metastasis. The patient showed improvement of cognitive disorder and gained weight. Further case study will be needed in order to determine the effects of Sojeukjungwon-san and allergen removed Rhus verniciflua stokes(aRVS) for the quality of life of advanced gastric cancer patients after chemotherapy.

Detectability of T-Measurable Diseases in Advanced Gastric Cancer on FDG PET-CT

Oh, Sun Young,Cheon, Gi Jeong,Kim, Young Chul,Jeong, Eugene,Kim, Seungeun,Choe, Jae-Gol The Korea Society of Nuclear Medicine 2012 핵의학 분자영상 Vol.46 No.4

Purpose Usefulness of FDG PET-CT in monitoring response in locally advanced gastric cancer has been reported. The purpose of this study was to evaluate the related factors to detect measurable diseases in advanced gastric cancer on FDG PET-CT. Methods We retrospectively reviewed 38 patients diagnosed as having advanced gastric cancer. We defined the measurable diseases when there was visualized tumor of which maximum standardized uptake value (SUVmax) was higher than $1.35^*SUVmax$ of liver + $2^*SD$ of liver SUV. We evaluated what kinds of factors from the clinicopathologic features were related to identifying measurable diseases. Results Of 38 patients with advanced gastric cancer, 18 (50 %) had measurable tumors on FDG PET-CT. Measurable tumors were significantly more frequent in well or moderately differentiated adenocarcinoma (70.5 % vs 35.3 %, p<0.05), in the tumors located at antrum or angle (66.7 % vs 29.4 %, p<0.05) and in the elderly group (age of 55 years old or more, 72.0 % vs 8.3 %, p<0.001) than the others, respectively. By multivariate analysis, age at diagnosis was the only independent predictor for the measurable disease on FDG PET-CT. Conclusion We found that age at diagnosis, as well as histologic types and location of tumors, were the affecting factors to detect measurable disease on FDG PET-CT in patients with advanced gastric cancer. Our study suggests that elderly patients of age of 55 years old or more can frequently have T-measurable disease on FDG PET-CT in advanced gastric cancer and FDG PET-CT will be helpful to monitor measurable disease.

Early Gstric Cancer-Like Advanced Gastric Cancer versus Advanced Gastric Cancer-Like Early Gastric Cancer

박현식,이선영,홍성노,김정환,성인경,박형석,심찬섭,진춘조 대한소화기내시경학회 2013 Clinical Endoscopy Vol.46 No.2

Background/Aims: Improvements in the endoscopic evaluation and management of gastric cancer have made it possible to determine the depth of invasion during endoscopic examination. The aim of this study was to elucidate the differences between early gastric cancer (EGC) that resembles advanced gastric cancer (AGC) and AGC that resembles EGC. Methods: We retrieved cases of EGC-like AGC and AGC-like EGC from consecutive gastric cancers that had been completely resected. The endoscopic diagnoses and clinicopathological findings were analyzed. Results: AGC-like EGCs were located mainly in the distal part of the stomach, whereas EGC-like AGCs were located mainly in the proximal part of the stomach (p<0.001). Sixty percent of AGC-like EGCs were moderately differentiated adenocarcinomas, while 64% of EGC-like AGCs were poorly differentiated adenocarcinomas (p=0.015). According to Lauren’s classification, 68% of AGC-like EGCs were intestinal type, whereas 71% of EGC-like AGCs were diffuse type (p=0.020). Conclusions: AGC-like EGCs predominate in the distal part of the stomach, while EGC-like AGCs predominate in the proximal part. When evaluating the depth of a gastric cancer, care should be taken not to underestimate measurements in proximal gastric cancers since they tend to be poorly-differentiated adenocarcinomas, in Laurens’s diffuse type, and invade deeper than their endoscopic appearance might suggest.

한 대학병원 위암 환자의 위험요인과 조기검진 효과

이태용(Lee, Tae-Yong),민경훈(Min, Gyung-Hun) 한국산학기술학회 2014 한국산학기술학회논문지 Vol.15 No.5

진행성위암의 위험요인을 파악하고 조기검진의 효과를 평가하고자 2007년 6월부터 2011년 12월까지 대전 소재 1개 대학교병원에서 위암으로 최초 진단과 수술을 받은 조기위암 171명과 진행성위암 환자 342명,총 580명을 대상으로 설문조사 와 의무기록 조사를 실시하였다.두 군간에 카이제곱 검정과 로지스틱 회귀분석으로 교차비를 계산한 결과 진행성위암은 조기위암에 비하여 70세 이상에서(OR2.393;95%CI1.329-4.310),과거 흡연자(OR1.612;95%CI0.970-2.680),혈액형 A형 (OR1.784;95%CI1.035-3.075)및 H.pylori균 감염(OR1.699;95%CI0.905-3.191)에서 상대적으로 높았다.또한 체중감소 (OR2.752;95%CI1.333-5.684)와 소화불량(OR1.574;95%CI1.069-2.319)이 중요한 증상과 징후였다.조기진단의 효과는 파악할 수 없었지만 조기진단이 성공적인 치료의 기회를 높이고 생존율을 향상시킨다는 것을 감안할 때 집단을 대상으로 조기검진을 고취시키는 교육과 선별검사가 요구된다. to December 2011, 580 newly diagnosed gastric cancer (342 advanced gastric cancer, 171 early gastric cancer) patients were enrolled at the department of general surgery in a university hospital. History of gastric examinations and possible risk factors were collected through interviews with structured questionnaire and reviewed medical chart. Comparing advanced cancer and early gastric cancer were analysed by chi-square test and logistic regression. The results showed that aged 70 and over (OR 2.393; 95%CI 1.329-4.310), Ex-smoker (OR 1.612; 95%CI 0.970-2.680), blood type A (OR 1.784; 95%CI 1.035-3.075), and H. pylori infection (OR 1.699; 95%CI 0.905-3.191) were important risk factors for advanced gastric cancer compared to early gastric cancer. Weight loss (OR 2.752; 95%CI 1.333-5.684) and indigestion (OR 1.574; 95%CI 1.069-2.319) were also important sign and symptom. Although the results cannot find effect of screening, national policies on early cancer detection must conduct.

Scalp metastasis of advanced gastric cancer

Ryu, Hyeong Rae,Lee, Da Woon,Choi, Hwan Jun,Kim, Jun Hyuk,Ahn, Hyein Korean Cleft Palate-Craniofacial Association 2021 Archives of Craniofacial Surgery Vol.22 No.3

Head and neck cutaneous metastasis of advanced gastric cancer is uncommon, and scalp metastasis is particularly rare. We present the case of a 60-year-old man who was diagnosed with cutaneous metastasis on the scalp originating from advanced gastric cancer. The patient was referred to the plastic surgery department for a scalp mass near the hairline. He had been diagnosed with advanced gastric cancer and undergone total gastrectomy and Roux esophagojejunostomy 3 years previously. The differential diagnosis for a single flesh-colored nodule on the scalp included benign tumors such as epidermal cyst or lipoma; therefore, the patient underwent excision and biopsy. In the operative field, the mass was found to be located in the frontalis muscle. The biopsy result showed that the mass was a metastatic lesion of advanced gastric cancer. Whole-body computed tomography revealed a gastric tumor with blood vessel infiltration, peritoneal carcinomatosis, liver metastasis, and multiple disseminated subcutaneous metastases. Although scalp metastasis originating from an internal organ is extremely rare, plastic surgeons should always consider a metastatic lesion in the differential diagnosis if a patient with a scalp lesion has a history of malignant cancer.

Wernicke’s Encephalopathy in Advanced Gastric Cancer

정은석,권오빈,이수현,이기병,김주훈,윤상현,김건민,정희철,라선영 대한암학회 2010 Cancer Research and Treatment Vol.42 No.2

Purpose With their prolonged survival and malnutrition, cancer patients, and especially gastrointestinal (GI) tract cancer patients, can develop Wernicke’s encephalopathy (WE). The aim of this study is to remind physicians of the importance of WE and prompt management in patients with GI tract cancer. Materials and Methods This study is a retrospective review of 2 cases of WE in advanced gastric cancer (AGC) patients, and we review the literature for cases of GI tract cancer related to WE. Results A 48-year-old female with AGC presented dizziness and diplopia for 5 days and a 20 kg weight loss. Neurologic exam showed nystagmus and gaze disturbance. Her symptoms improved after daily parenteral injection of thiamine 100 mg for 17 days. A 58-year-old female with AGC presented with sudden disorientation, confusion and 15 kg weight loss. Neurologic exam showed gaze limitation and mild ataxia. Despite daily parenteral injection of thiamine 100 mg for 4 days, she died 5 days after the onset of neurologic symptoms. Combining the cases noted in the literature review with our 2 cases, the 7 gastric cancer cases and 2 colorectal cancer cases related to WE showed similar clinical characteristics; 1) a history of long-period malnutrition and weight loss, 2) relatively typical neurologic signs and symptoms and 3) specific magnetic resonance image findings. Except for 2 patients who had irreversible neurologic symptoms, the other 7 patients were improved with prompt thiamine treatment. Conclusion It is important to consider WE in GI tract cancer patients with acute neurologic symptoms and who are in a state of malnutrition. Thiamine should be given as soon as possible when WE is suspected.

진행위암에 대한 5-Fluorouracil , Cisplatin ( FP ) 복합화학요법의 치료 효과

신종민(Jong Min Shin),김효진(Hyo Jin Kim),김종성(Jong Seong Kim) 대한내과학회 1993 대한내과학회지 Vol.45 No.4

Background: Patients with unresectable or advanced gastric cancer require palliative systemic chemotherapy. Recently, cisplatin has been reported to be an effective agent against gastric cancer. And in vitro synergism between 5-fluorouracil and cisplatin was demonstrated in the L1210 leukemia model. Therefore we performed a phase II trial to assess the response rate and toxicity of the combination regimen with 5-fluorouracil infusion and cisplatin for patients with advanced gastric cancer. Method: Thirty-six patients with previous untreated gastric cancer and measurable diseases were treated with a combination of 5-fluorouracil and cisplatin. The regimen consisted of 5-fluorouracil, 1,000mg/m2/day, by a 12-hour continuous infusion on day 1 to 5 and cisplatin, 60 mg/m2/day, iv bolus on day 1, and the treatments were repeated every 3 weeks. Result: 1) Among 34 evaluable patients, 21 patients (62%) achieved partial responses, and the median duration of response was 5.7 months. 2) The median survival of overall patients was 8.1 months. The median survival of the responders was 9.3 months and that for nonresponders, 3.8 months. 3) Age, sex, gastrectomy, weight loss, histologic grade did not influenced prognosis. Among the performance status, 0-1 groups were more responsive to the treatment and longer survival time than 2-3 group (p<0.005). 4) Toxicites were common but well tolerated. Conclusion: A combination chemotherapy of 5-fluorouracil and cisplatin in patients with advanced gastric cancer seems to be effective and well tolerated.

Interim Analysis of Docetaxel, Oxaliplatin and 5-Fluorouracil Combination Chemotherapy in Patients with Advanced Gastric Cancer

( Mi Jin Ryu ),( Sung Rok Kim ),( Young Jin Yuh ),( Byeong Seok Sohn ),( Hye Ran Lee ),( Seong Yoon Lee ) 대한내과학회 2011 대한내과학회 추계학술발표논문집 Vol.2011 No.1

Introduction: The combination chemotherapy of docetaxel, cisplatin and 5-fluorouracil(5-FU) has shown better survival and response rate than 5-FU/Cisplatin, however the toxicity was substantial. The aim of this study is to determine the efficacy and toxicity of docetaxel, oxaliplatin and 5-FU(DOF) combination chemotherapy in patients with advanced gastric cancer. Methods: Seventeen patients with advanced gastric cancer were treated with the following regimen every 21days: docetaxel 60 mg/m2 IV on day1, oxaliplatin 100 mg/m2 IV on day1, and 5-FU 850 mg/m2 continuous infusion on days1-4. Results: Ten(58.8%) patients showed partial response, 5(29.4%) patients showed stable disease. The overall response rate was 58.8%(95% CI: 35.9-78.4%) and the disease control rate was 88.2%(95% CI: 64.4-97.9%). A total of 100 cycles of chemotherapy was administrated and the dose intensity was 92.4% in docetaxel, 90.9% in oxaliplatin, and 96.6% in 5-FU. The median progression free survival was 6.7months(95% CI, 6.2-7.2 months). Grade3/4 neutropenia and thrombocytopenia occurred in 28cycles(28%) and 1cycle(1%). Grade3 stomatitis, diarrhea and neutropathy occurred in 1cycle(1%), 4cycles(4%) and 5cycles(5%), respectively. Conclusions: The combination chemotherapy of docetaxel, oxaliplatin and 5-FU (DOF) is effective for the treatment of advanced gastric cancer and well tolerated. This result support the continuation of the phaseII trial until target recruitment(n=50).

Does the Retrieval of at Least 15 Lymph Nodes Confer an Improved Survival in Patients with Advanced Gastric Cancer?

Kim, Yong Il The Korean Gastric Cancer Association 2014 Journal of gastric cancer Vol.14 No.2

Purpose: The standard surgical procedure recommended to treat gastric cancer in advanced cases is dissection of D2 lymph nodes (LNs). However, the optimum number of LNs that should be retrieved in advanced gastric cancer (AGC) remains debatable. Therefore, this study aimed to investigate the optimum number of retrieved LNs and determine the clinical implications of retrieved LN numbers on the treatment of AGC. Materials and Methods: Of 575 AGC patients reviewed, 369 who underwent open curative gastrectomy with D2 or more extensive LN dissection at our institution were analyzed according to their clinicopathologic characteristics and number of LNs retrieved. Results: Multivariate regression analysis revealed that tumor size (P=0.006), depth of invasion (P=0.000), LN metastasis (P=0.000), and stage (P=0.000) were independent variables with predictive value. The 5-year survival rates were differed significantly according to the numbers of LNs retrieved ([1] 15~25 vs. >25 and [2] 15~39 vs. ${\geq}40$) in patients with differentiated carcinoma. Conclusions: Tumor size, depth of invasion, LN metastasis, and stage were independent predictive factors for survival. The number of retrieved LNs was significantly associated with a long-term survival benefit in patients with differentiated carcinoma. Therefore, our data suggest that the retrieval of a minimum of 15 LNs may not be sufficient to warrant a recommendation for further curative surgery and that extensive LN dissection should be considered in advanced carcinoma of the differentiated type.

Further Study on Pemetrexed based chemotherapy in Treating Patients with Advanced Gastric Cancer (AGC)

Liu, Jin,Huang, Xin-En,Feng, Ji-Feng Asian Pacific Journal of Cancer Prevention 2014 Asian Pacific journal of cancer prevention Vol.15 No.16

Objective: To further observe the efficacy and safety of pemetrexed, combined with Irinotecan or oxaliplatin or cisplatin in treating patients with advanced gastric cancer as second-line or third-line chemotherapy. Methods: From September 2013 to February 2014 we recruited 50 patients with advanced gastric cancer, with stage IV disease or postoperative recurrence, or unresectable. Then treated with pemetrexed based chemotherapy. After two cycles of treatment, efficacy and toxicity were evaluated. Results: Pemetrexed based chemotherapy was used as second-line in 33 patients, RR(CR+PR) is 41.2%. And achieved 36.4% when used as third-line. Overall response rate of 50 patients treated with Pemetrexed based treatment was 38% (CR+PR). Treatment related side effects were bone marrow suppression, vomiting, hepatic dysfunction and malaise.No treatment related death occurred. Conclusions: Treatment with pemetrexed based chemotherapy is active and is well tolerated in patients with advanced gastric cancer.