1.Feasibility of Selective Neck Irradiation with Lower Elective Radiation Dose in Treating Nasopharynx Cancer Patients
Won Kyung CHO ; Dongryul OH ; Eonju LEE ; Tae Gyu KIM ; Hyebin LEE ; Heerim NAM ; Jae Myoung NOH ; Yong Chan AHN
Cancer Research and Treatment 2019;51(2):603-610
PURPOSE: This study aimed to report the clinical outcomes following selective neck irradiation (SNI) with lower elective radiation therapy (RT) dose in treating nasopharyngeal cancer (NPC) patients. MATERIALS AND METHODS: A total of 347 NPC patients received definitive RT according to our SNI policy and were retrospectively analyzed. The clinical target volumes (CTVs) were subdivided into CTV at high risk (CTV-HR) and CTV at low risk (CTV-LR). The typical doses to gross tumor volume (GTV), CTV-HR, and CTV-LR were 68.4-70.0 Gy, 54.0-60.0 Gy, and 36.0 Gy. RESULTS: With the median follow-up of 68.1 months (range, 2.3 to 197.1 months), the 5-year rates of loco-regional control and progression-free survival in all the patients were 85.0% and 70.8%, respectively. Thirty patients developed regional failure and the regional control rates at 3 and 5 years were 92.6% and 91.4%, respectively. The sites of regional failure in relation to the target volume were exclusively inside GTV/CTV-HR in 20, inside and outside GTV/CTVHR in three, and exclusively outside GTV/CTV-HR in seven, which were 5.7%, 0.9%, and 2.0% of total patients, respectively. CONCLUSION: The clinical outcomes by the current SNI policy were feasible and comparable to those following classic elective nodal irradiation policy.
Disease-Free Survival
;
Follow-Up Studies
;
Humans
;
Lymphatic Irradiation
;
Nasopharyngeal Neoplasms
;
Nasopharynx
;
Neck
;
Radiotherapy
;
Retrospective Studies
;
Tumor Burden
2.Causes of Death and Risk Factors for Mortality among HIV-Infected Patients Receiving Antiretroviral Therapy in Korea.
Sun Hee LEE ; Kye Hyung KIM ; Seung Geun LEE ; Heerim CHO ; Dong Hwan CHEN ; Joo Seop CHUNG ; Ihm Soo KWAK ; Goon Jae CHO
Journal of Korean Medical Science 2013;28(7):990-997
A retrospective study was conducted to determine the mortality, causes and risk factors for death among HIV-infected patients receiving antiretroviral therapy (ART) in Korea. The outcomes were determined by time periods, during the first year of ART and during 1-5 yr after ART initiation, respectively. Patients lost to follow-up were traced to ascertain survival status. Among 327 patients initiating ART during 1998-2006, 68 patients (20.8%) died during 5-yr follow-up periods. Mortality rate per 100 person-years was 8.69 (95% confidence interval, 5.68-12.73) during the first year of ART, which was higher than 4.13 (95% confidence interval, 2.98-5.59) during 1-5 yr after ART. Tuberculosis was the most common cause of death in both periods (30.8% within the first year of ART and 16.7% during 1-5 yr after ART). During the first year of ART, clinical category B and C at ART initiation, and underlying malignancy were significant risk factors for mortality. Between 1 and 5 yr after ART initiation, CD4 cell count < or = 50 cells/microL at ART initiation, hepatitis B virus co-infection, and visit constancy < or = 50% were significant risk factors for death. This suggests that different strategies to reduce mortality according to the time period after ART initiation are needed.
Anti-Retroviral Agents/*adverse effects/*therapeutic use
;
Antiretroviral Therapy, Highly Active/adverse effects
;
CD4 Lymphocyte Count
;
Cause of Death
;
Coinfection
;
Female
;
HIV Infections/*drug therapy/*mortality/virology
;
Humans
;
Male
;
Middle Aged
;
Republic of Korea
;
Retrospective Studies
;
Risk Factors
;
Treatment Outcome
3.The Effect of Cyclooxygenase-2 Expression on Tumor Volume Response in Patients Treated with Radiotherapy for Uterine Cervical Cancer.
Min Kyu KANG ; Won PARK ; Yoon La CHOI ; Eun Yoon CHO ; Geunghwan AHN ; HeeRim NAM ; Seung Jae HUH ; Yong Chan AHN ; Do Hoon LIM ; Dong Ryul OH ; Duk Soo BAE ; Byoung Gie KIM
Journal of Korean Medical Science 2009;24(6):1170-1176
We investigated the correlation between Cyclooxygenase-2 (COX-2) expression and the tumor response in patients with cervical cancer that were treated with curative radiotherapy (RT). Fifty-seven patients with squamous cell carcinoma were treated with concurrent radiochemotherapy (CRCT, n=29) or RT alone (n=28). The response of each patient was evaluated by three serial Magnetic Resonance Imaging examinations: before the start of RT, at four weeks after the start of RT (mid-RT) and at four weeks after the completion of RT (post-RT). Forty-three patients had positive COX-2 expression. The COX-2 negative patients achieved a higher rate of complete response (CR) at mid-RT than did the COX-2 positive patients (28.6% vs. 7.0%, P=0.054), but not at post-RT (64.3% vs. 69.8%). The initial tumor volume was a significant predictor of CR at mid-RT (P=0.003) and post-RT (P=0.004). The multivariate analysis showed that the initial tumor volume (at mid-RT and post-RT) and CRCT (at post-RT) were significant predictors of CR; however, the COX-2 expression was not. In conclusion, the COX-2 expression status has no significant correlation with the tumor response. Further studies on the changes in COX-2 expression levels during RT may be helpful for determination of its role in the tumor response to treatment and patient prognosis.
*Carcinoma, Squamous Cell/enzymology/pathology/radiotherapy
;
Cyclooxygenase 2/*metabolism
;
Female
;
Humans
;
Middle Aged
;
Multivariate Analysis
;
Neoplasm Staging
;
*Uterine Cervical Neoplasms/enzymology/pathology/radiotherapy
4.Human Papillomavirus Prevalence and Genotype Distribution among HIV-Infected Women in Korea.
Eun Kyoung PARK ; Heerim CHO ; Sun Hee LEE ; Seung Geun LEE ; Sang Yeup LEE ; Ki Hyung KIM ; Chang Hun LEE ; Joo Seop CHUNG ; Ihm Soo KWAK
Journal of Korean Medical Science 2014;29(1):32-37
The epidemiology on human papillomavirus (HPV) among human immunodeficiency virus (HIV)-infected women in Korea is not well established. A retrospective study was conducted to determine the prevalence and genotype distribution of HPV infection among HIV-infected women in Korea. HPV DNA genotype and cervical cytology were examined in 60 HIV-positive women and 1,938 HIV-negative women. HPV genotypes were analyzed by using a HPV DNA chip. HIV-infected women had higher prevalence of high-risk HPV (hr-HPV) infection (30% vs 4.9%, adjusted odds ratio [AOR], 6.96; 95% confidence interval [CI], 3.63-13.34, P<0.001) and abnormal cervical cytology (18.3% vs 1.8%, AOR, 10.94; 95% CI, 5.18-23.1, P<0.001) compared with controls. The most common hr-HPV genotype detected in HIV-infected women was HPV 16 (10%), followed by 18 (6.7%) and 52 (5%). Prevalence of quadrivalent vaccine-preventable types (HPV 6, 11, 16, and 18) was 21.7% and 2.3% in HIV-positive women and HIV-negative women, respectively. Age was a significant risk factor for hr-HPV infection in HIV-infected women (P=0.039). The presence of hr-HPV was significantly associated with abnormal cervical cytology (P<0.001). These findings suggest that HPV testing for cervical cancer screening in HIV-infected women would be necessary, particularly among young age group.
Adult
;
Age Factors
;
Cervix Uteri/virology
;
DNA Probes, HPV/diagnostic use
;
DNA, Viral/genetics
;
Female
;
Genotype
;
HIV Infections/complications/*epidemiology/genetics
;
HIV-1/genetics
;
Human papillomavirus 11/genetics/isolation & purification
;
Human papillomavirus 16/genetics/isolation & purification
;
Human papillomavirus 18/genetics/isolation & purification
;
Human papillomavirus 6/genetics/isolation & purification
;
Humans
;
Middle Aged
;
Papillomavirus Infections/complications/*epidemiology/*genetics
;
Prevalence
;
Republic of Korea/epidemiology
;
Retrospective Studies
;
Risk Factors
;
Uterine Cervical Neoplasms/epidemiology/genetics/virology
5.Incidence and risk factors of hepatitis C virus infection among human immunodeficiency virus (HIV) patients in a large HIV clinic in South Korea.
Shinwon LEE ; Sun Hee LEE ; Su Jin LEE ; Kye Hyung KIM ; Jeong Eun LEE ; Heerim CHO ; Seung Geun LEE ; Joo Seop CHUNG ; Ihm Soo KWAK
The Korean Journal of Internal Medicine 2016;31(4):772-778
BACKGROUND/AIMS: Increasing incidences of hepatitis C virus (HCV) infection in human immunodeficiency virus (HIV)-infected men who have sex were reported in the United States and Europe. However, few studies regarding the epidemiology of HCV infection in HIV-infected patients in Asian countries have been reported. METHODS: To determine the prevalence and incidence of HCV infection in HIV-infected patients, a retrospective cohort study was conducted. All HIV-infected patients who visited a tertiary care hospital in Korea from 2000 to 2013 were identified. Patients with ≥ 1 HCV antibody (Ab) test were included and observed until December 2014. RESULTS: Among 996 HIV-infected patients, 790 patients (79%) had baseline HCV Ab tests and 41 (5.2%) were positive at baseline and four at follow-up. Experience of injecting drug use (IDU; adjusted odds ratio, 16.20; 95% confidence interval [CI], 1.56 to 167.89; p < 0.01) was significantly associated with prevalent HCV infection. Conversion to HCV Ab positivity was observed in four of 384 included patients, with an incidence rate of 2.22 (95% CI, 0.60 to 5.80)/1,000 person-years (PYs); 164.89 (95% CI, 34.00 to 481.88)/1,000 PYs in patients with IDU, and 1.40 (95% CI, 0.35 to 7.79)/1,000 PYs in men who have sex with men who denied IDU. There was no significant increase in incidence rate of HCV in HIV-infected patients from 2009 to 2014 (p = 0.119). Among 19 patients who were positive for HCV RNA, genotype 1b (73%) was the most common following 2a/2c (20%). CONCLUSIONS: IDU was an independent risk factor for prevalent HCV infection. Prevalence of HCV infection was low and incidence of HCV infection was not significantly increased in HIV-infected patients in South Korea.
Asian Continental Ancestry Group
;
Cohort Studies
;
Epidemiology
;
Europe
;
Follow-Up Studies
;
Genotype
;
Hepacivirus*
;
Hepatitis C*
;
Hepatitis*
;
HIV Infections
;
HIV*
;
Humans*
;
Incidence*
;
Korea*
;
Male
;
Odds Ratio
;
Prevalence
;
Retrospective Studies
;
Risk Factors*
;
RNA
;
Substance-Related Disorders
;
Tertiary Healthcare
;
United States
6.Predictors of Poor Retention in Care of HIV-infected Patients Receiving Antiretroviral Therapy in Korea: Five-Year Hospital-based Retrospective Cohort Study.
Shinwon LEE ; Sun Hee LEE ; Su Jin LEE ; Kye Hyung KIM ; Jeong Eun LEE ; Heerim CHO ; Seung Geun LEE ; Dong Hwan CHEN ; Joo Seop CHUNG ; Ihm Soo KWAK
Journal of Korean Medical Science 2016;31(3):376-381
Poor retention in care (RIC) is associated with higher antiretroviral therapy (ART) failure and worse survival. Identifying high risk patients for poor RIC is important for targeted intervention. A retrospective cohort study was conducted at a tertiary care hospital in Korea. HIV-infected patients initiating ART during 2002-2008 were included. 5 year-RIC was measured by hospital visit constancy (HVC) at 5 years after initiating ART. Among 247 enrolled patients, 179 (72.5%) remained in care, 20 (8.1%) were transferred to other hospitals, 9 (3.6%) died and 39 (15.8%) were lost to follow-up. We compared the demographic, psychosocial, and clinical characteristics between the groups with 100% HVC (n = 166, 67.2%) and < or = 50% HVC (n = 33, 13.4%). In multivariable analysis, ART-starting age < or = 30 years (odds ratio [OR] 4.08 vs. > 50; 95% confidence interval [CI] 1.10-15.15, P = 0.036), no non-HIV related comorbidity (OR 2.94 vs. comorbidity > or = 1; 95% CI 1.02-8.49, P = 0.046), baseline CD4 cell count > 300 cells/muL (OR 3.58 vs. < or = 200; 95% CI 1.33-9.65, P = 0.012) were significant predictable factors of poor RIC. HIV/AIDS care-givers should pay attention to young patients with higher baseline CD4 cell counts and no non-HIV related comorbidity.
Adult
;
Anti-HIV Agents/*therapeutic use
;
CD4 Lymphocyte Count
;
CD4-Positive T-Lymphocytes/cytology
;
Cohort Studies
;
Comorbidity
;
Demography
;
Female
;
HIV Infections/*drug therapy/mortality/psychology
;
Hospitals
;
Humans
;
Male
;
*Medication Adherence/psychology
;
Middle Aged
;
Multivariate Analysis
;
Odds Ratio
;
Republic of Korea
;
Retrospective Studies