OBJECTIVES: Smoking is one of the most important leading causes of lung cancer. Smoking habit is recognized as nicotine dependence, which consists of physical and psychosocial dependence. To evaluate social nicotine dependence, the Kano Test for Social Nicotine Dependence (KTSND) working group developed a new questionnaire. We examined the social nicotine dependence among high school students, university students and patients with lung cancer. METHODS: We applied Korean version of KTSND(KTSND-K) questionnaire to high school students, university students and patients with lung cancer. Complete data obtained from the 1333 responders were analyzed. RESULTS: Among the responders, current smokers, past-smokers, and never-smokers were 17.3%, 16.4%, and 66.3% respectively. According to smoking status, the total KTSND-K scores of current smokers were significantly higher than those of past-smokers, and of never-smokers (17.7+/-6.6 versus 13.7+/-5.7, and 10.9+/-5.15, P<0.001). The total KTSND-K scores of males were higher than those of females, suggesting that males have a propensity for depending nicotine socially much more than females (13.2+/-6.2 and 11.7+/-5.7 respectively, P<0.05). And the total KTSND scores of the patients with lung cancer, medical students, nursing students, and high school students were 11.2+/-3.8, 14.9+/-4.8, 14.6+/-5.8 and 15.6+/-5.9 respectively. The scores of patients with lung cancer were significantly lower than non-cancer people(P<0.01). Our study suggested that the KTSND-K questionnaire could be a useful method to evaluate psychosocial aspects of smoking in patients with lung cancer and non-cancer people.
Female ; Humans ; Lung Neoplasms* ; Male ; Nicotine ; Surveys and Questionnaires* ; Smoke ; Smoking ; Students, Medical ; Students, Nursing ; Tobacco Use Disorder*

BACKGROUND: This study was designed to analyze the efficacy of gefitinib as a second-line therapy, according to the clinical characteristics in Korean patients with non-small-cell lung cancer (NSCLC). METHODS: In this Phase IV observational study, we recruited patients, previously failed first-line chemotherapy, who had locally advanced or metastatic NSCLC, and who were found to be either epidermal growth factor receptor (EGFR) mutation-positive or satisfied 2 or more of the 3 characteristics: adenocarcinoma, female, and non-smoker. These patients were administered with gefitinib 250 mg/day, orally. The primary endpoints were to evaluate the objective response rate (ORR) and to determine the relationship of ORRs, depending on each patient's characteristics of modified intent-to-treat population. RESULTS: A total of 138 patients participated in this study. One subject achieved complete response, and 42 subjects achieved partial response (ORR, 31.2%). The subgroup analysis demonstrated that the ORR was significantly higher in patients with EGFR mutation-positive, compared to that of EGFR mutation-negative (45.8% vs. 14.0%, p=0.0004). In a secondary efficacy variable, the median progression-free survival (PFS) was 5.7 months (95% confidence interval, 3.9~8.4 months) and the 6-month PFS and overall survival were 49.6% and 87.9%, respectively. The most common reported adverse events were rash (34.4%), diarrhea (26.6%), pruritus (17.5%), and cough (15.6%). CONCLUSION: Gefitinib was observed in anti-tumor activity with favorable tolerability profile as a second-line therapy in these selected patients. When looking at EGFR mutation status, EGFR mutation-positive showed strong association with gefitinib by greater response and prolonged PFS, compared with that of EGFR mutation-negative.
Adenocarcinoma ; Carcinoma, Non-Small-Cell Lung ; Cough ; Diarrhea ; Disease-Free Survival ; Exanthema ; Female ; Humans ; Lung ; Lung Neoplasms ; Pruritus ; Quinazolines ; Receptor, Epidermal Growth Factor

PURPOSE: For treating advanced non-small cell lung cancer (NSCLC), epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are known to be very effective in nonsmokers, women, Asian and person with EGFR mutations. The efficacy of EGFR-TKI was analyzed based on the radiologic studies and the serum levels of carcinoembryonic antigen (CEA) to evaluate whether serum CEA can be used as a predicative marker of the response to EGFR-TKI therapy. MATERIALS AND METHODS: Forty-one patients with NSCLC treated with gefitinib at Kosin Medical Center from January 2007 to August 2009 were the subjects of this study. We assayed the serum CEA levels before and after gefitinib therapy with concomitant assessments of the tumor response by serial chest X-ray and chest computer tomograms (CT). RESULTS: The median age of the patients was 62.6 years (range, 32~77 years), 29 patients were women, 36 had adenocarcinoma (87.8%) and the baseline serum CEA was equal or above 5 ng/mL in 31 patients (75.6%). These 31 patients were more responsive to the gefitinib therapy (p=0.021). The overall response rate of the patients was 51.2%, the median survival time was 21.9 months and the time to progression was 8.3 months. Among the 21 responding patients, the serum CEA was decreased after 2 months in 17 (80.9%), and among the 14 progressed patients, the serum CEA was increased in 12 (85.7%) (p=0.000). CONCLUSION: The changes of serum CEA at 2 months after gefitinib therapy were closely related to the radiologic changes. The serum CEA could be used as a complimentary tool for monitoring the tumor response to EGFR-TKI in the advanced NSCLC patients.
Adenocarcinoma ; Asian Continental Ancestry Group ; Carcinoembryonic Antigen ; Carcinoma, Non-Small-Cell Lung ; Female ; Humans ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Thorax ; Biomarkers, Tumor

PURPOSE: Female lung cancers have different clinical features and therapeutic results as compared to those of male lung cancers. The aim of this study was to analyze the differences of Korean men and women with lung cancer. MATERIALS AND METHODS: We re-analyzed the results of a national survey of lung cancer conducted by the Korean Association for the Study of Lung Cancer in 2005. RESULTS: Of the 8,788 patients, 2,124 (24.2%) were female. The mean age at the diagnosis was 62.5 years for the females and 64.8 years for the males and the difference was significant (p<0.001). An age <50 years was more frequent for the women than for the men (16.2% vs. 7.9%, respectively; p=0.001). The stages between genders were different for the patients with non-small cell carcinoma (NSCLC) (p<0.001), but not for the patients with small cell carcinoma. The overall survival time was longer for woman than that for the man (p<0.001). However, the male patients had longer survival for the smokers with adenocarcinoma and the smokers with squamous cell carcinoma. The never smoker female patients had a better survival time than did the smoking female patients, but the male patient' survival was not influenced by the smoking status. The stage-specific survival rates were better for the women at all stages of NSCLC (p<0.001). The women who received chemotherapy had a longer survival time did the men who received chemotherapy (p<0.001). CONCLUSION: Women with lung cancer were relatively overrepresented among the younger patients and they smoked less intensively, raising the question of gender- specific differences in the carcinogenesis of lung cancer. Over-representation of adenocarcinoma was observed in the women regardless of their smoking status. Women with lung cancer had a better prognosis than men; however, the smoking females showed the worst prognosis. Gender and the smoking status are clearly important factors in the therapeutic approach to lung cancer.
Adenocarcinoma ; Carcinoma, Small Cell ; Carcinoma, Squamous Cell ; Female ; Humans ; Korea ; Lung ; Lung Neoplasms ; Male ; Prognosis ; Republic of Korea ; Smoke ; Smoking ; Survival Rate

BACKGROUND/AIMS: Lung cancer is the leading cause of cancer death worldwide. There are significant gender differences in lung cancer: most females with lung cancer are non-smokers and they are diagnosed with adenocarcinoma. Epidermal growth factor receptor tyrosine kinase inhibitors (EGFR-TKIs) are more effective in female lung cancer patients, but the results with gefitinib and erlotinib differ. This study compared the therapeutic response and toxicity of gefitinib and erlotinib in female lung cancer patients. Method: We retrospectively reviewed the clinical information on patients treated with gefitinib or erlotinib for more than one month at Kosin University Gospel Hospital from February 2004 to November 2007. RESULTS: Forty-two patients (26 gefitinib vs. 16 erlotinib) were enrolled during this period. Their median age was 58 years. Thirty-six patients (85%) were non-smokers and 35 patients (83%) had adenocarcinoma. There were 24% at stage IIIb and 76% at stage IV. The median survival time was 793 days. In the gefitinib group, 69% of the patients received 3rd-line chemotherapy, while 12 of 16 (87.5%) in the erlotinib group received 2nd-line chemotherapy. There were no significant differences in the overall response rate (gefitinib 39% vs. erlotinib 31%, p=0.524), median survival time (gefitinib 605 days vs. erlotinib 510 days, p=0.455), and time to progression (gefitinib 186 days vs. erlotinib 262 days, p=0.660). Rashes were more common in the erlotinib group (73.3% vs. 27%, p<0.001). CONCLUSIONS: There were no significant differences in the response rate, overall survival, and time to progression between the two groups. Rashes were more common in the erlotinib group.
Adenocarcinoma ; Exanthema ; Female ; Humans ; Lung ; Lung Neoplasms ; Protein-Tyrosine Kinases ; Quinazolines ; Receptor, Epidermal Growth Factor ; Retrospective Studies ; Erlotinib Hydrochloride

Hydrocarbons are a broad group of organic bodies consisting of hydrogen and carbon. They are commonly found in the environment in the form of gasoline (e.g., butane and propane) and are also used in stain removers, adhesives, lubricants, and a variety of paints. Ingestion of the compound accounts for approximately 3% of all poisoning cases in the United States, but such reports of poisoning are rare in Korea. Hydrocarbon poisoning has many adverse effects. In addition to potentially causing major damage to the respiratory and central nervous systems, direct exposure to hydrocarbons can also cause cardiac arrhythmia, hepatic dysfunction, renal failure, neuropathy, and other injuries. We present the case of a 20-year-old soldier who accidentally ingested a small amount of gasoline. He developed chemical pneumonitis, but recovered with no serious complications.
Adhesives ; Arrhythmias, Cardiac ; Butanes ; Carbon ; Central Nervous System ; Eating ; Gasoline ; Humans ; Hydrocarbons ; Hydrogen ; Korea ; Lubricants ; Military Personnel ; Paint ; Pneumonia ; Renal Insufficiency ; United States ; Young Adult

PURPOSE: In cases of locally advanced non-small cell lung cancer (NSCLC), concurrent chemoradiotherapy (CCRT) is the leading therapeutic modality. However, much controversy exists about the chemotherapeutic regimens and radiation methods. MATERIALS AND METHODS: During concurrent chemoradiotherapy, three or four cycles of gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were administered every two weeks while 50.4 Gy of irradiation was administered in 28 fractions (once/day, 5 treatment days/week) to the tumor site, mediastinum, and the involved lymph node region. In addition, a booster irradiation dose of 18 Gy in 10 fractions was administered to the primary tumor site unless the disease progressed. Two or three cycles of consolidation chemotherapy were performed with gemcitabine (1,200 mg/m2, 1st and 8th day) and cisplatin (60 mg/m2) every three weeks. RESULTS: A total of 29 patients were evaluable for modality response. Response and treatment toxicities were assessed after concurrent chemoradiotherapy and consolidation chemotherapy, respectively. One patient (4%) achieved a complete response; whereas 20 patients (69%) achieved a partial response after concurrent chemoradiotherapy. Following the consolidation chemotherapy, three patients (10.3%) achieved complete responses and 21 patients (72.4%) achieved partial responses. The median follow-up period was 20 months (range 3m39 months) and the median survival time was 16 months (95% CI; 2.4m39.2 months). The survival rates in one, two, and three years after the completion of treatment were 62.7%, 43.9%, and 20%, respectively. Complications associated to this treatment modality included grade 3 or 4 esophagitis, which occurred in 15 patients (51.7%). In addition, an incidence of 24% for grade 3 and 14% for grade 4 neutropenia. Lastly, grade 2 radiation pneumonitis occurred in 6 patients (22%). CONCLUSION: The response rate and survival time of concurrent chemoradiotherapy with biweekly gemcitabine (500 mg/m2) and cisplatin (30 mg/m2) were encouraging in patients with locally advanced NSCLC. However, treatment related toxicities were significant, indicating that further modification of therapy seems to be warranted.
Incidence ; Chemoradiotherapy ; Lung Neoplasms

Standard antituberculous therapy, including isoniazid (INH), rifampin, ethambutol, and pyrazinamide (PZA), is widely used to treat active tuberculosis. The most important side effect is hepatotoxicity. In a standard four-drug regimen, PZA was the most common cause of drug-induced hepatitis and was dose-related. The incidence of drug-induced hepatitis is high at doses of 40~70 mg/kg per day but has fallen significantly since the recommended dose was reduced. Liver toxicity induced by PZA is rare at doses of 25 mg/kg per day or less. PZA-induced fulminant hepatic failure is also rare but fatal. We report a case of fulminant hepatic failure caused by a re-challenge of PZA.
Drug-Induced Liver Injury ; Ethambutol ; Incidence ; Isoniazid ; Liver ; Liver Failure, Acute* ; Pyrazinamide* ; Rifampin ; Tuberculosis

The esophagus is a rate site for rarely involved site of tuberculosis. The most common cause of esophageal tuberculosis is secondary involvement from adjacent tuberculous lymphadenitis. Esophago-nodal or esophagobronchial fistulas may be formed when tuberculous lymph nodes erode the adjacent esophageal or bronchial wall. We report a patient diagnosed with esophageal tuberculosis, which was complicated by an esophago-mediastinal fistula, by endoscopy, sputum acid fast bacilli (AFB) stain, chest computed tomography (CT), and an esophagogram. The patient was treated with antituberculous agents and chest CT and endoscopy showed that the fistula had closed completely.
Cytochrome P-450 CYP1A1 ; Endoscopy ; Esophagus ; Fistula* ; Humans ; Lymph Nodes ; Sputum ; Thorax ; Tomography, X-Ray Computed ; Tuberculosis* ; Tuberculosis, Lymph Node

PURPOSE : Since the combination of cisplatin plus gemcitabine (CG) had a significant survival advantage for the treatment of patients with chemotherapynaive advanced or metastatic non-small cell lung cancer (NSCLC), CG combination have been evaluated with different schedules. However, the best schedule is still unclear. We designed to compare the efficacy and toxicity of CG combination chemotherapy in two different doses of gemcitabine (1,000 or 1,250 mg/m2 3-weekly). MATERIALS AND METHODS : We randomized patients with stage III or IV NSCLC into either gemcitabine 1,250 mg/m2 or gemcitabine 1,000 mg/m2. Patients received cisplatin 60 mg/m2 intravenously on day1 of each 3-week cycle. Gemcitabine was administered intravenously on days 1 and 8 of each 3-week cycle. RESULTS : From April 2002 until July 2004, 125 patients were enrolled from four university hospitals (55 patients in the gemcitabine 1,000 mg/m2 arm and 70 patients in the gemcitabine 1,250 mg/m2 arm). Response rates were not significantly different in both arms (56.4% vs. 55.7%). However, grade 3 neutropenia was significantly lower in gemcitabine 1,000 mg/m2 arm compared to gemcitabine 1,250 mg/m2 arm (11.0% vs. 15.8%). No differences in non-haematologic toxicities in both arms except anorexia were observed. The median survival was 13.4 months for gemcitabine 1,000 mg group compared with 15.8 months for gemcitabine 1,250 mg group. There were no statistically significant differences in survival between the groups. CONCLUSION : For stage III or IV non-small cell lung cancer, combination chemotherapy with gemcitabine 1,000 mg/m2 showed equivalent response rate with lesser neutropenia and anorexia compared to treatment with gemcitabine 1,250 mg/m2
Anorexia ; Appointments and Schedules ; Arm ; Carcinoma, Non-Small-Cell Lung* ; Cisplatin ; Drug Therapy, Combination ; Hospitals, University ; Humans ; Neutropenia