Until mid-1990s, fluorouracil was the only chemotherapeutic agent available for the treatment of colorectal cancer. The treatment of advanced colorectal cancer has evolved considerably over the last decade. Considerable improvements in survival as well as quality of life have been achieved with the application of oxaliplatin and irinotecan with fluoropyrimidine as a first and subsequent line therapy for colorectal cancer. Development of oral fluoropyrimidines as an alternative to intravenous administration provides an additional option for combination cytotoxic therapy, which is currently being assessed in phase III trials in advanced settings. The appearance of biologic agents in mid-2000s, namely cetuximab and bevacizumab, and their integration with conventional cytotoxic therapy for the treatment of colorectal cancer has additionally expanded the options for the treatment. Their dramatic success has led to further clinical studies of targeted therapy in colorectal cancer, making it one of the most promising areas of cancer research. Although considerable improvement was achieved by incorporating oxaliplatin in adjuvant chemotherapy for the treatment of colon cancer, there has been no phase III trial incorporating new agents in adjuvant setting for rectal cancer. However, many phase II trials on the efficacy of new agents in the setting of concurrent chemoradiation are in progress. Based on their results, randomized phase III clinical trials evaluating new agents in preoperative or postoperative setting will be carried out.
Antineoplastic Agents/therapeutic use ; Colorectal Neoplasms/drug therapy ; Humans ; Rectal Neoplasms/*drug therapy

PURPOSE: We reviewed the treatment outcomes and prognostic factors for patients with anal canal carcinoma who were treated with curative intent chemoradiotherapy (CRT) at Severance Hospital from 2005 to 2011. MATERIALS AND METHODS: Data for 38 eligible patients treated during this period were reviewed. All patients were treated with curative intent using radiotherapy (RT) with (n = 35) or without concomitant chemotherapy (n = 3). Among 35 patients who received CRT, most of the chemotherapeutic regimens were either 5-fluorouracil (5-FU) plus mitomycin C (23 patients) or 5-FU plus cisplatin (10 patients). Recurrence-free survival (RFS), colostomy-free survival (CFS), overall survival (OS), and locoregional control (LRC) rates were calculated using the Kaplan-Meier method and survival between subgroups were compared using the log-rank test. Cox's proportional hazard model was used for multivariate analysis. RESULTS: Over a median follow-up period of 44 months (range, 11 to 96 months), 3-year RFS, CFS, OS, and LRC were 80%, 79%, 85%, and 92%, respectively. In multivariate analysis, tumor size >4 cm was an independent predicting factor for poorer RFS (hazard ratio [HR], 6.35; 95% confidence interval [CI], 1.42 to 28.5; p = 0.006) and CFS (HR, 6.25; 95% CI, 1.39-28.0; p = 0.017), while the presence of external iliac lymph node metastasis was an independent prognosticator for poorer OS (HR, 9.32; 95% CI, 1.24 to 70.3; p = 0.030). No treatment-related colostomies or deaths occurred during or after treatment. CONCLUSION: Curative intent CRT resulted in excellent outcomes that were comparable to outcomes in previous randomized trials. No severe treatment-related toxicities were observed.
Anal Canal ; Anus Neoplasms ; Carcinoma, Squamous Cell ; Chemoradiotherapy ; Cisplatin ; Colostomy ; Fluorouracil ; Follow-Up Studies ; Humans ; Lymph Nodes ; Mitomycin ; Multivariate Analysis ; Neoplasm Metastasis ; Proportional Hazards Models

BACKGROUND: An increase in oxidative stress has been suggested to play major roles in the complications of diabetes. The bulk of the experimental data favors enhanced free radicals in diabetes and antioxidant defense mechanisms may be reduced in diabetes. Melatonin, the major secretory product of the pineal gland has been shown to be a potent and specific hydroxyl radical scavenger. The purpose of our study was to determine the antioxidative effeet of melatonin in streptozotocin-induced diabetic rats. METHODS: Sprague-Dawley rats weighing 200-240 g were divided into 3 groups: normal controls(n-7), diabetic contmls(n-9), melatonin-treated diabetic animals(n-9). Diabetes was induced by intraperitoneal injection of streptozotoein(55 mg/kg body weight) and melatonin(6 mg/kg body weight) was orally administered for 20 days. At day 20 after streptozotocin administration, blood was collected for the assay of glucose, albumin and cholesterol. Erythrocyte membrane lipid peroxidation was determined by malonyldialdehyde(MDA) reactivity. RESULTS: 1) The MDA resctivity of erytbrocyte membrane in melatonin-treated diabetic animals (meanstandard deviation: 5.52+-1.52nmol/ml packed cells) were lower(p<0.05) than that in diabetic controls(7.68+-1.16nmol/mL packed cells). But, there was no significant difference between melatonin-treated diabetic animals and normal contls(4.93+-1.19 nmol/mL packed cells). 2) There were no significant differences of blood glucose and body weight between diabetic controls and melatonin-treated diabetic animals. CONCLUSION: These results show the antioxidative effect of melatonin in streptozotocin-induced diabetic rats. Further clinical and long-term experimental studies are needed to assess the effect of melatonin on development and progression of diabetic complications.
Animals ; Blood Glucose ; Body Weight ; Cholesterol ; Defense Mechanisms ; Diabetes Complications ; Erythrocyte Membrane ; Free Radicals ; Glucose ; Hydroxyl Radical ; Injections, Intraperitoneal ; Lipid Peroxidation ; Melatonin* ; Membranes ; Oxidative Stress ; Pineal Gland ; Rats* ; Rats, Sprague-Dawley ; Streptozocin

BACKGROUND: Approximately 90%~99% of ultraviolet A (UVA) ray reaches the Earth's surface. The deeply penetrating UVA rays induce the formation of reactive oxygen species (ROS), which results in oxidative stress such as photoproducts, senescence, and cell death. Thus, UVA is considered a primary factor that promotes skin aging. OBJECTIVE: Researchers investigated whether pretreatment with ferulic acid protects human dermal fibroblasts (HDFs) against UVA-induced cell damages. METHODS: HDF proliferation was analyzed using the water-soluble tetrazolium salt assay. Cell cycle distribution and intracellular ROS levels were assessed by flow cytometric analysis. Senescence was evaluated using a senescence-associated β-galactosidase assay, while Gadd45α promoter activity was analyzed through a luciferase assay. The expression levels of superoxide dismutase 1 (SOD1), catalase (CAT), xeroderma pigmentosum complementation group A and C, matrix metalloproteinase 1 and 3, as well as p21 and p16 were measured using quantitative real-time polymerase chain reaction. RESULTS: Inhibition of proliferation and cell cycle arrest were detected in cells that were irradiated with UVA only. Pretreatment with ferulic acid significantly increased the proliferation and cell cycle progression in HDFs. Moreover, ferulic acid pretreatment produced antioxidant effects such as reduced DCF intensity, and affected SOD1 and CAT mRNA expression. These effects were also demonstrated in the analysis of cell senescence, promoter activity, expression of senescent markers, and DNA repair. CONCLUSION: These results demonstrate that ferulic acid exerts protective effects on UVA-induced cell damages via anti-oxidant and stress-inducible cellular mechanisms in HDFs.
Aging ; Animals ; Antioxidants ; Catalase ; Cats ; Cell Aging ; Cell Cycle ; Cell Cycle Checkpoints ; Cell Death ; Complement System Proteins ; DNA Repair ; Fibroblasts* ; Humans* ; Luciferases ; Matrix Metalloproteinase 1 ; Oxidative Stress ; Reactive Oxygen Species ; Real-Time Polymerase Chain Reaction ; RNA, Messenger ; Skin Aging ; Superoxide Dismutase ; Ultraviolet Rays ; Xeroderma Pigmentosum

High-mobility group box 1 (HMGB1) protein has been demonstrated to play an important role in chronic inflammatory diseases including rheumatoid arthritis, and systemic lupus erythematosus. This study investigated the association between extracellular HMGB1 expression and disease activity, and clinical features of Behcet's disease (BD). Extracellular HMGB1 expression in the sera of 42 BD patients was measured and was compared to that of 22 age- and sex-matched healthy controls. HMGB1 expression was significantly increased in BD patients compared to healthy controls (78.70 +/- 20.22 vs 10.79 +/- 1.90 ng/mL, P = 0.002). In addition, HMGB1 expression was significantly elevated in BD patients with intestinal involvement compared to those without (179.61 +/- 67.95 vs 61.89 +/- 19.81 ng/mL, P = 0.04). No significant association was observed between HMGB1 concentration and other clinical manifestations, or disease activity. It is suggested that extracellular HMGB1 may play an important role in the pathogenesis of BD.
Adult ; Aged ; Behcet Syndrome/genetics/*metabolism/pathology ; Extracellular Space/metabolism ; Female ; HMGB1 Protein/genetics/*metabolism ; Humans ; Inflammation ; Intestinal Diseases/blood/genetics ; Male ; Middle Aged ; Young Adult

Cancer care can be complex with increased specialization within disciplines and more-sophisticated treatment techniques. Multidisciplinary care (MDC) is an integrated team approach to bring together a group of health professionals with appropriate skills to consider patient's treatment and care options. MDC are now conducted worldwide and is recommended as best practice for the management of patients with cancer. There is increasing evidence that MDC improves quality of care, treatment outcomes of patient with cancer and. other clinical outcomes, but concerns are raised over the paucity of good-quality evidence on their overall impact. In this review, we described available evidence on the impact of cancer MDC, and also reviewed focused on cancer MDC strategy depending on countries.
Health Occupations ; Humans ; Practice Guidelines as Topic

Malignant obstruction develops frequently in advanced gastric cancer. Although it is primarily the gastric outlet that is obstructed, there are occasional reports of colonic obstruction. Treating intestinal obstruction usually requires emergency surgery or stent insertion. There are several kinds of complications with stent insertion, such as bowel perforation, stent migration, bleeding, abdominal pain and reobstruction. Nevertheless, endoscopic stent insertion could be a better treatment than emergency surgery in cases of malignant bowel obstruction in cancer patients with poor performance status. We report a case of advanced gastric cancer with carcinomatosis in which a recurrent colonic stent was inserted at the same site because of cancer growth into the stent. The patient maintained a good condition for chemotherapy, thus improving their chances for survival.
Aged ; Female ; Humans ; Intestinal Obstruction/etiology/radiography/*surgery ; Neoplasm Recurrence, Local ; Prosthesis Implantation/*methods ; *Stents ; Stomach Neoplasms

PURPOSE: The purpose of this study is to investigate dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI) and plasma cytokines and angiogenic factors (CAFs) as pharmacodynamic and prognostic biomarkers of bevacizumab monotherapy in colorectal cancer with liver metastasis (CRCLM). MATERIALS AND METHODS: From July 2011 to March 2012, 28 patients with histologically confirmed CRCLM received bevacizumab monotherapy followed by combined FOLFOX therapy. The mean age of the patients was 57 years (range, 30 to 77 years). DCE-MRI (K(trans) and IAUC₆₀) was performed at baseline, first follow-up (3 days after bevacizumab monotherapy), and second follow-up (3 days after combined therapy). CAF levels (vascular endothelial growth factor [VEGF], placental growth factor [PlGF], and interleukin-8) were assessed on the same days. Progression-free survival (PFS) time distributions were summarized using the Kaplan-Meier method and compared using log-rank tests. RESULTS: The median PFS period was 11.2 months. K(trans), IAUC₆₀, VEGF, and PlGF values on the first follow-up day were significantly different compared with baseline values. No differences were observed on the second follow-up day. A > 40% decrease in K(trans) from baseline to first follow-up was associated with a longer PFS (hazard ratio, 0.349; 95% confidence interval, 0.133 to 0.912; p=0.032). Changes in CAFs did not show correlation with PFS time. CONCLUSION: DCE-MRI parameters and CAFs are pharmacodynamic biomarkers of bevacizumab for CRCLM. In our study, change in K(trans) at 3 days after bevacizumab monotherapy was a favorable prognostic factor; however, the value of CAFs as a prognostic biomarker was not found.
Angiogenesis Inducing Agents ; Bevacizumab* ; Biomarkers ; Colorectal Neoplasms* ; Cytokines ; Disease-Free Survival ; Endothelial Growth Factors ; Follow-Up Studies ; Humans ; Liver* ; Magnetic Resonance Imaging* ; Methods ; Neoplasm Metastasis* ; Plasma ; Vascular Endothelial Growth Factor A

BACKGROUND: Recently, the incidence of acute myocardial infarction increased with prolongation of life spans, improvements in food and life styles in Korea, But only few studies were reported after the newly developed diagnostic methods and treatment modalities were introduced. So, the study on left ventricular ejection fraction, findings in coronary angiography, uses of thrombolytic agents was needed. METHOD: A retrospective clinical study was done on 654 patients with acute myocardial infarction who had been admitted to Severance hospital from January 1985 to December 1991 within 30 days after the onset of symptoms. Coronary angiogram and radionuclide ventriculography was done as usual methods. RESULT: The mean age was 58.5 years, and the ratio of males to females was 3.3:1, The major risk factors were smoking, hypertension and diabetes mellitus in males. and hypertension, diabetes mellitus and obesity in females. Arrhythmias were found in 360 patients(56.4%). The most frequent arrhythmia was premature ventricular contraction. Sinus bradycardia and atrioventricular were more frequent in inferior infarction but sinus tachycardia, ventricular tachycardia were more frequent in anterior infarction. The peak serum CK and CK-MB levels were higher in patients of anterior infarction than in those of inferior and non-Q wave infarction. The left ventricalar ejection fractions were higher in the patients with non-Q wave infarction, inferior infarction than in the patients with anterior infarction. There was no difference in left ventricular ejection fraction between patients who received thrombolytic therapy and not treated patients. Coronary angiograms were performed in 362 patients and 184 patients (50.8%) had one-vessel disease. The short-term mortality rate was 15.1%. The most common cause of death was cardiogenic shock(60.6%). Poor prognosis was found in patients with a history of previous myocardial infarction, those over 60 years old, those with a complete heart block and those of the female sex. The short-term mortality was higher in anterior infarction than inferior infarction and short-term mortality was higher in Q wave infarction than non-Q wave infarction. CONCLUSION: This study suggests that smoking was the most common risk factor but hypercholesterolemia and obesity were less significant. According to coronary angiogram, one-vessel disease was the most common, and the rate of insignificant reduction in luminal diameter was higher than western countries. The short-term mortality rate of acute myocardial infarction was higher than those of western countries. The cause of high mortality rate was considered due to delay in transportation of patients to hospital. The education about acute myocardial infarction should be done to public and transportation system must be improved.
Adult* ; Arrhythmias, Cardiac ; Bradycardia ; Cause of Death ; Coronary Angiography ; Diabetes Mellitus ; Education ; Female ; Fibrinolytic Agents ; Heart Block ; Humans ; Hypercholesterolemia ; Hypertension ; Incidence ; Infarction ; Korea ; Life Style ; Life Support Care ; Male ; Middle Aged ; Mortality ; Myocardial Infarction* ; Obesity ; Phenobarbital ; Prognosis ; Radionuclide Ventriculography ; Retrospective Studies ; Risk Factors ; Smoke ; Smoking ; Stroke Volume ; Tachycardia, Sinus ; Tachycardia, Ventricular ; Thrombolytic Therapy ; Transportation ; Transportation of Patients ; Ventricular Premature Complexes

Hepatoid carcinoma is a rare type of malignant tumor resembling hepatocellular carcinoma that arises in extrahepatic sites.(stomach, lung, ovary, pancreas, bladder and renal pelvis). Hepatoid carcinoma of the ovary is an extremely rare ovarian tumor, first described by Ishikura and Scully in 1987. Histologically it is important to differentiate this entity from other oxyphil tumors of the ovary as it requires aggressive treatment. We have experienced a case of hepatoid carcinoma of the ovary in 69-year-old postmenopausal woman, who has been treated with operation and adjuvant Taxol - cisplatin chemotherapy. We present this case with brief review of literatures.
Aged ; Carcinoma, Hepatocellular ; Cisplatin ; Drug Therapy ; Female ; Humans ; Lung ; Ovary* ; Paclitaxel ; Pancreas ; Urinary Bladder