This study was designed to evaluate the worth of preoperative chemoradiation therapy in the management of locally advanced rectal cancer. Between march 1993 and January 1997, 64 patients with adenocarcinoma of the rectum were treated with preoperative irradiation followed by operation by one surgeon at department of surgery, Chungnam national university hospital. Cancers were treated with high-dose radiation (45 to 54 Gy) with (group 2) or without (group 1) chemotherapy Preoperatively 64 Patients were analysed prospectively, of these, 15 cases were preoperative radiotherapy alone arm and 49 cases were preoperative radiotherapy plus chemotherapy arm. The average age of the patients were 56 years (range 38~67) in group 1 and 57 years (range 27~80) in group 2. Male to female ratio was 8 : 7 in group 1 and 30 : 19 in group 2. Most clinical stage of the primary tumor mass were 73 (80% in Group 1,96% in group 2), being palpated slightly fixed (40% in group 1, 43% in group 2) or fixed (13.3% in group 1, 24.5% in group 2). As to distance of tumor from anal verge, most patients ranged from 4 to 8 cm (53% in group 1, 63.3% in Group 2). Chemotherapy consisted of 2 cycles of 5-fluorouracil (500 mg/m2/day for S days) delivered as a continuous infusion or bolus therapy and low-dose leukovorin (20 mg/m2/day for 5 days). After six weeks resting period of radiation, definitive surgical approach was performed. Overall treatment related toxicity rate was similar in both group except erythema on perineal skin, which was more frequent in group 2 than in group 1. Most frequent postoperative complication was intestinal obstruction (7.8%) followed by wound infection (6.3%), but there was no significant difference between two groups. There was one case of postoperative mortality in group 2 patients at 44 days after operation due to pneumonia and sepsis combined with liver cirrhosis. Tumor depth was downstaged in 38.5% of group 1 and 70% of group 2 patients on preoperative CT staging, and nodal downstaging was more effective on the respect of postoperative pathological report. Overall recurrence rate was 38.5% in group 1 and 20.5% in group 2. Of these, failure occured first as a distant metastasis more frequently than as a local recurrence in both group. These data do suggest that the preoperative chemotherapy and radiotherapy used are as safe as preoperative radiotherapy alone. Futhermore, tumor and lymph node downstaging are more effective in combined arm. Preoperative chemotherapy will more promising in prevention of distant metastasis when treated in the period of least metastatic tumor burden. Whether combined arm will have greater or lesser survival awaits the completion of this relevant study.
Adenocarcinoma ; Arm ; Chungcheongnam-do ; Drug Therapy ; Erythema ; Female ; Fluorouracil ; Humans ; Intestinal Obstruction ; Leucovorin ; Liver Cirrhosis ; Lymph Nodes ; Male ; Mortality ; Neoplasm Metastasis ; Pneumonia ; Postoperative Complications ; Prospective Studies ; Radiotherapy ; Rectal Neoplasms* ; Rectum ; Recurrence ; Sepsis ; Skin ; Tumor Burden ; Wound Infection

No abstract available.
Brachial Artery

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis for early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10+LN). Breast cancer patients who had 10+LN clearly have a strikingly high risk of tumor recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients who had more than 10 positive axillary lymph nodes. METHODS: Of the 587 breast cancer patients who were operated on at Chungnam National University Hospital from February 1992 to November 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and the differences in survival according to the clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50+/-4 years. A mastectomy was done in 28 cases (90.3%), and a breast conserving operation was done in 3 cases (9.7%). The mean tumor size was 4.8+/-.5 cm. The mean number of removed axillary Lymph Nodes was 23.5+/-0.2 (range:10-52), and the mean number of positive axillary LNs was 20.0+/-10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 23 cases (69.6%) showed distant metastases as the first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up taking their adjuvant chemotherapy than for those patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in those patients who were treated using a combination chemotherapy with taxane plus cisplatin after their tumor recurrence. CONCLUSION: Breast cancer patients with 10+LNs have a strikingly high risk of tumor recurrence. Six cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of tumor recurrence. A combination chemotherapy with taxane and cisplatin was also a controllable variable for increasing survival after tumor recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cisplatin ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Recurrence

PURPOSE: Axillary lymph node (ALN) status is the single most reliable indicator of the prognosis in early-stage breast cancer. However, downstaging of both the primary tumor and ALN involvement by neoadjuvant chemotherapy results in loss of traditional prognostic criteria. This study was performed to evaluate the prognostic significance of various clinicopathologic features in patients with operable breast cancer treated with neoadjuvant chemotherapy. METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancers (tumor size>3 cm, or clinically axillary node positive) were treated with preoperative combination chemotherapy comprised of preoperative 3 cycles and postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months. To analyze the potential simultaneous effect of the significant predictors of disease-free survival (DFS) and overall survival (OS) identified by univariate analysis, those factors were entered into a Cox multivariate regression model. RESULTS: Clinical responses to neoadjuvant chemotherapy were as follows, CR, 17.8% (13/73); PR, 57.5% (42/73); SD, 21.9% (16/73); and PD, 2.7% (2/72). The clinical response to neoadjuvant chemotherapy and the number of residual metastatic ALN were the only independent predictors of disease-free survival and overall survival. Patients with clinically complete response to neoadjuvant chemotherapy had a excellent 3-year DFS (100%) and 5-year OS (100%). In patients with a partial response, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.003). Also, in patient with a stable disease, the number of metastatic ALN further stratified the patients with respect to DFS (p=0.000) and OS (p=0.000). Those with a progressive disease had a poor DFS and OS. CONCLUSION: Only the clinical response to neoadjuvant chemotherapy and the absolute number of metastatic ALN identified at surgical staging were the independent predictors of DFS and OS. Thus patients with partial or minor response can be further stratified with respect to DFS and OS by the number of involved ALNs.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy* ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes ; Prognosis

PURPOSE: Nodal involvement has long been known to represent the single most reliable indicator of the prognosis in early-stage breast cancer. In common parlance, high-risk node-positive breast cancer has generally been used to describe patients who have involvement of ten or more axillary lymph nodes (10 LN). Patients with 10 LN clearly have a strikingly high risk of recurrence and death. Thus we tried to evaluate the clinical courses of breast cancer patients with more than 10 positive axillary lymph nodes. METHODS: Of 587 breast cancer patients operated on at Chungnam National University Hospital from Feb. 1992 to Nob. 1999, 31 cases (5.3%) showed involvement of more than 10 axillary lymph nodes. We evaluated the clinical courses of these patients and differences in survival related to clinical and pathologic vaiables. Survival was calculated using the Kaplan-Meier method. RESULTS: The mean age of the patients was 50 14 years. A mastectomy was performed in 28 cases (90.3%), and a breast conserving operation in 3 cases (9.7%). The mean tumor size was 4.8 2.5 cm. The mean number of removed axillary LN was 23.5 10.2 (10-52), and the mean number of positive axillary LN was 20.0 10.1 (10-51). At a median follow-up of 30.5 months, 23 cases (74.2%) of recurrence were noted. Among these 69.6% (16/23) showed distant metastases as a first recurrence. The 3-year and 5-year disease-free survivals were 28.6% and 22.9%, respectively. The 3-year and 5-year expected overall survivals were 53.7% and 41.8%, respectively. There were significantly more recurrences in patients who had given up adjuvant chemotherapy than patients who had completed 6 cycles of FEC or MMM. Also, significant survival benefits were noted in patients who were treated using combination chemotherapy with taxane plus cisplatin after recurrence. CONCLUSION: Breast cancer patients with 10 LN have a strikingly high risk of recurrence. Six (6) cycles of adjuvant chemotherapy with FEC or MMM was a controllable variable for lowering the risk of recurrence. Also, combination chemotherapy with taxane and cisplatin was a controllable variable for increasing survival after recurrence.
Breast Neoplasms* ; Breast* ; Chemotherapy, Adjuvant ; Chungcheongnam-do ; Cisplatin ; Disease-Free Survival ; Drug Therapy, Combination ; Follow-Up Studies ; Humans ; Lymph Nodes* ; Mastectomy ; Neoplasm Metastasis ; Prognosis ; Recurrence

PURPOSE: Neoadjuvent chemotherapy is being used increasingly in the treatment of patient with large or locally advanced breast cancer with the aim of downstaging and eliminating micrometastasis. We report the correlation between tumor response to preoperative primary chemotherapy and patient outcome in the consecutive series of a 73 patients with breast cancer METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancer(tumor size>3 cm, or clinically axillary node positive) were treated with multimodality therapy including sandwitch type of chemotherapy comprised of preoperative 3 cylcles and postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months. RESULTS: The overall objective clinical response rate(complete & partial response) of the primary tumor to chemotherapy was 75.5%(standard UICC criteria). The pathologic complete response rates was 9.6%.The overall 5- year survival rate was 86.8%, and the overall 5-year disease free survival rate 82.6%. As with increasing the tumor size, the response rates to chemotherapy was declined. But there was no relationship between clinical response to chemotherapy and menopausal status, chemotherapeutic regimen, and histopathologic type. Breast conserving operation was done in 64.4% as a result of decrease in tumor size. CONCLUSION: Neoadjuvent chemotherapy enables breast conserving operation more frequently in large or locally advanced breast cancer. Responses to neoadjuvent chemotherapy is a powerful prognostic factor on overall survival and disease free survival in breast cancer patients.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Neoplasm Micrometastasis ; Survival Rate

PURPOSE: In T1 tumors, the reported incidence of lymph node metastasis ranges from 6% to 31%. The authors analyzed the clinical and the pathological parameters of T1 tumors for their association with the likelihood of axillary lymph node metastases (ALNM). METHODS: The authors reviewed data from 57 patients with T1 breast carcinomas who had undergone a level I/II axillary dissection from January 1996 to March 2000. The association between the incidence of ALNM and clinical/pathologic factors (age, site, size, neoadjuvant chemotherapy, histologic grade, lymphovascular invasion, estrogen receptor status, progesterone receptor status, p53, and c-erbB-2) were analyzed by using chi-square tests. RESULTS: Approximately 42% of the 57 patients with a T1 breast carcinoma had ALNM. Chi-square tests showed that lymph node metastases were associated with tumor size (P=0.043), lymphovascular invasion (P=0.001), and expression of c-erbB-2 (P=0.026). CONCLUSION: The authors conclude that the charac teristics of the primary tumor can be used to estimate the risk of ALNM in patients with a T1 breast carcinoma. Such a risk assessment might facillitate appropriate management.
Breast Neoplasms* ; Breast* ; Drug Therapy ; Estrogens ; Humans ; Incidence ; Lymph Nodes* ; Neoplasm Metastasis* ; Receptors, Progesterone ; Risk Assessment

PURPOSE: The therapeutic options for MBC patients who have been previously treated with taxane and anthracycline are limited. Capecitabine (Xeloda(R)) is a novel tumor- selective oral fluoropyrimidine, and it provides effective and well tolerated therapy for patients with MBC who are resistant to or are failing with anthracycline and taxane therapy. We present our experiences with oral capecitabine that was given as monotherapy for taxane and anthracycline pre-treated MBC patients from CNU hospital. METHODS: The study subjects were 32 female patients having MBC that progressed after anthracycline and taxane treatment, and they were then treated with oral capecitabine monotherapy from 1999 to 2002. The median disease free survival period was 26 months. All the patients had good ECOG perfomance status (>2) and normal renal function. The primary end points were the response rate, time to progression (TTP) and overall survival. The response rate was assessed with standard UICC criteria, and toxicity was assessed with NCI toxicity criteria. RESULTS: The sites of first metastasis were bone in 17 cases (53.1%); cervical LN 5 (15.6%); liver 3 (9.4%); lung 3 (9.4%); chest wall 2 (6.3%); brain 1 (3.1%); and contralateral axillary LN 1 (3.1%). The clinical response rates to therapy were 1 case of CR (3.1%); 13 cases of PR (40.6%); 11 cases of stable disease (34.4%); 6 cases of progressive disease (18.8%). The median TTP was 6.0 months (95% CI: 5.53~8.47). The median overall survival was 15.0 months (95% CI: 11.90~16.10). Toxicities related to therapy were 5 cases of hand-foot skin reaction (15.6%); 3 cases of diarrhea (9.4%); and 1 case of stomatitis (3.1%). There was no bone marrow depression or alopecia. All treatment related toxicities were improved by a short period of drug interruption or dose reduction (2, 500 mg/m2/day to 2, 000 mg/m2/day). CONCLUSION: Taxane resistant MBC has a poor prognosis. Oral capecitabine monotherapy provided activity in this subgroup of patients with an overall response rate of 43.7% and a stable disease rate of 34.4%. Oral capecitabine is well tolerated with an acceptable toxicity profile in this population.
Alopecia ; Bone Marrow ; Brain ; Breast Neoplasms* ; Breast* ; Capecitabine ; Depression ; Diarrhea ; Disease-Free Survival ; Female ; Humans ; Liver ; Lung ; Neoplasm Metastasis ; Prognosis ; Skin ; Stomatitis ; Thoracic Wall

PURPOSE: Neoadjuvant chemotherapy is being used increasingly in the treatment of patients with large or locally advanced breast cancer with the aims of downstaging and eliminating micrometastasis. We report a correlation between tumor response to preoperative primary chemotherapy and patient outcome in a series of 73 consecutive patients with breast cancer. METHODS: From Feb. 1991 to Oct. 1998, 73 patients with breast cancer (tumor size>3 cm or clinically axillary node positive) were treated with multimodality therapy, including a sandwich type of chemotherapy, comprised of 3 preoperative cycles and 3 postoperative 3 cycles of FEC or MMM. The median follow-up period was 53 months. RESULTS: The overall objective clinical response rate (complete & partial response) of the primary tumor to chemotherapy was 75.5% (standard UICC criteria). The pathologic complete response rate was 9.6%. The overall 5-year survival rate was 86.8%, and the overall 5-year disease free survival rate was 82.6%. The response rate to chemotherapy declined with increasing tumor size, but there was no relationship between the clinical response to chemotherapy and menopausal status, chemotherapeutic regimen, or histopathologic type. A breast-conserving operation could be done in 64.4% of the patients as a result of a decrease in the tumor size. CONCLUSION: Neoadjuvant chemotherapy allows a breast-conserving operation to be performed more frequently in cases of large or locally advanced breast cancer. The responses to neoadjuvant chemotherapy is a powerful prognostic factor for the overall survival and the disease free survival in breast cancer patients.
Breast Neoplasms* ; Breast* ; Disease-Free Survival ; Drug Therapy* ; Follow-Up Studies ; Humans ; Neoplasm Micrometastasis ; Survival Rate

PURPOSE: Conventional surgery for thyroid disease requires long skin incisions and can lead to prominent scars of the neck, adhesions, hypoesthesia, and paresthesia. To overcome these problems we performed an endoscopic thyroidectomy via an axillo-bilateral breast approach. METHODS: Seventy patients with benign thyroid nodules by fine needle aspiration were selected. Patients underwent endoscopic thyroidectomy via axillo-bilateral breast approach from May, 2003, through November, 2007. RESULTS: Operations included 67 lobectomies, 1 isthmectomy, and 2 total thyroidectomies. Two cases were converted to an open thyroidectomy because of bleeding. The mean operating time was 90.6 min (range, 60~170). The mean length of hospital stay was 6.39 days (range, 4~12), and the mean duration of drainage was 3.87 days (range, 2~9). Postoperative hematoma for 3 patients was observed, but absorbed spontaneously. Two patients complained of hoarseness and 1 patient had vocal cord palsy, but these disappeared during follow-up. CONCLUSION: This approach resulted in satisfactory cosmetic results and no significant complications. We believe that endoscopic thyroidectomy via an axillo-bilateral breast approach is feasible and safe.
Biopsy, Fine-Needle ; Breast* ; Cicatrix ; Drainage ; Follow-Up Studies ; Hematoma ; Hemorrhage ; Hoarseness ; Humans ; Hypesthesia ; Length of Stay ; Neck ; Paresthesia ; Skin ; Thyroid Diseases ; Thyroid Nodule ; Thyroidectomy* ; Vocal Cord Paralysis