Serum CA 125 was measured during early chemotherapy in 34 patients from January, 1991 to December, 1994 with ovarian cancer to investigate if serial measurmemts of antigen level could be used as a prognostic parameter. Serum CA 125 was determined after the first, second, and third course of chemotherapy. There was significant correlation between high serum CA 125 levels(>35U/ml) after the third course of chemotherapy and advanced FIGO stage, large residual tumor volume after cytoreductive surgery, but there was no significant correlation with patient age, tumor differentiation, and hitologic type. And high serum level of CA 125 after the third course of chemotherapy was significantly correlate with poor response to chemotherapy(p<0.0001), but there was no significant correlation with the finding of second-look laparotomy. CA 125 was a significant parameter in all three courses of chemotherapy but its correlation with 5-year survival was improved with the number of courses of the chemotherapy. Patientswith high serum CA 125 level(>35U/ml) after the third course had a 0% 5-year survival. This should be compared with a 89.5% 5-year survival in patients who had serum CA 125 level of 35U/ml or less(p<0.0001). As a consequence of this study, chemotherapy of patients with high CA 125 levels after the third course may be discontinued and replaced by other chemotherapy or palliative therapy.
Drug Therapy* ; Humans ; Laparotomy ; Neoplasm, Residual ; Ovarian Neoplasms* ; Palliative Care

Acute lymphoblastic leukemia is the commonest pediatric malignancy caused by the disturbed differentiation of hematopoietic stem cells. Due to the effective measure of individualized therapy, the outcome of ALL therapy has been improved dramatically in recent decades. The reduction of treatment intensity in favorable patient groups decreases acute and long-term toxicity, only for the high-risk groups the intensive chemotherapy is of value, and the different therapies should be used, depending on their different biologic features.Even with intensive therapy or new drugs, the outcome of relapsed ALL remains poor, the treatment could be turned to the molecularly defined targeted drugs and stem cell transplantation. What is more, the progress in the detection technique for minimal residual disease and pharmacogenomics help to estimate the sensitivity of chemotherapy and judge the prognosis, so as to provide the reliable objective foundation for the individualized therapy.In this review, the present states of individualized therapy in childhood acute lymphoblastic leukemia is discussed and summarized.
Child ; Genomics ; Humans ; Neoplasm, Residual ; drug therapy ; Precision Medicine ; Precursor Cell Lymphoblastic Leukemia-Lymphoma ; drug therapy

This review discusses the production of alpha-particle-emitting radionuclides in radioimmunotherapy. Radioimmunotherapy labeled with alpha-particle is expected to be very useful for the treatment of monocellular cancer (e.g. leukemia) and micrometastasis at an early stage, residual tumor remained in tissues after chemotherapy and tumor resection, due to the high linear energy transfer (LET) and the short path length in biological tissue of alpha particle. Despite of the expected effectiveness of alpha-particle in radioimmunotherapy, its clinical research has not been activated by the several reasons, shortage of a suitable a-particle development and a reliable radionuclide production and supply system, appropriate antibody and chelator development. Among them, the establishment of radionuclide development and supply system is a key factor to make an alpha-immunotherapy more popular in clinical trial. Alpha-emitter can be produced by several methods, natural radionuclides, reactor irradiation, cyclotron irradiation, generator system and elution. Due to the sharply increasing demand of 213Bi, which is a most promising radionuclide in radioimmunotherapy and now has been produced with reactor, the cyclotron production system should be developed urgently to meet the demand.
Alpha Particles ; Cyclotrons ; Drug Therapy ; Linear Energy Transfer ; Neoplasm Micrometastasis ; Neoplasm, Residual ; Radioimmunotherapy* ; Radioisotopes*

OBJECTIVE: This study is performed in order to compare the outcomes of surgical management and to define the role of adjunctive therapy in the management of optic pathway glioma in children. METHODS: Sixteen children with optic pathway glioma had been managed in various treatment methods during the last 8 years. The patients aged from 5 months to 14 years. The patients presented with progressive visual loss, increased ICP symptoms, endocrine dysfunction, seizure, and motor weakness. Optic pathway glioma associated with neurofibromatosis was excluded. Tumor involved chiasmatico-hypothalamus(12 patients), optic chiasm(3), and optic nerve(1). The extent of surgical resection were radical(3 patients), subtotal(12), and partial(1). RESULTS: Three patients treated with radical resection showed no evidence of tumor recurrence. Among 12 patients treated with subtotal resection and without adjunctive therapy, 6 patients(50%) developed recurrence in the postoperative period of average 20.5 months. Those patients with recurrence were managed by reoperation(3 patients), irradiation therapy(2), and chemotherapy(1). However three patients with residual tumors after subtotal(2), or partial(1) resection were treated with adjunctive chemotherapy in the postoperative period showed no evidence of recurrence. CONCLUSION: Although radical resection of optic pathway glioma might offer long-term control of tumor, adjunctive chemotherapy could be effective to prevent tumor recurrence in children with subtotally or partially resected optic pathway glioma. More experience is necessary to determine the optimal method of treatment of optic pathway gliomas in children.
Child* ; Drug Therapy ; Glioma* ; Humans ; Neoplasm, Residual ; Neurofibromatoses ; Postoperative Period ; Radiotherapy ; Recurrence ; Seizures

OBJECTIVE: This study was carried out to investigate the relationship between DNA ploidy, S-phase fraction (SPF), expression of cyclin A and clinical prognostic factors including stage, grade, CA-125 and residual tumor size in epithelial ovarian cancer, and to evaluate the association between DNA ploidy, SPF, expression of cyclin A and 3-year survival. METHODS: Study group consisted of 31 cases of epithelial ovarian cancer, 10 of borderline ovarian tumor and 5 of benign ovarian tumor diagnosed at the department of Obstet. and Gynecol. in Yonsei University College of Medicine, Seoul, Korea from Feb. 2000 to Jan. 2003. All patients underwent staging-laparotomy and postoperative chemotherapy. The level of CA-125 was assessed after 6th postoperative chemotherapy with cut-off value of 35 U/mL. DNA ploidy and SPF were evaluated by flow-cytometry of fresh ovarian tissue obtained at the operative field. The expression of cyclin A was evaluated by immuno-histochemical stain. Expression of 5% was considered as positive. Statistical analysis was done by two-sample t-test, chi-square test, and Kaplan-Meier survival curve using SPSS ver 11.0 software. RESULTS: In 46 ovarian tumors aneuploidy, SPF and expression of cyclin A were significantly higher in epithelial ovarian cancer as compared with benign and borderline tumors (p=0.004, 0.001, 0.001, respectively). Number of aneuploidy, SPF and expression of cyclin A were significantly higher in patients with higher grade, more advanced stage, higher level of CA-125 (more than 35 U/mL) and more than 2 cm of residual tumor size (p=0.004, 0.009, 0.05, 0.002 in aneuploidy; p=0.06, 0.01, 0.04, 0.007 in SPF; p=0.03, 0.004, 0.06, 0.02 in cyclin A). Aneuploidy and expressions of more than 10% of SPF and cyclin A were also associated with poorer overall survival (p=0.02, 0.02, <0.0001, respectively). Significantly positive correlations were observed among these factors. CONCLUSION: Number of aneuploidy, percentage of SPF and expression of cyclin A were higher in more advanced stage, higher grade, higher CA-125 and more than 2 cm of residual tumor size and associated with poorer overall survival. Thus DNA flow-cytometry and estimation of expression of cyclin A may provide major information about prognosis of disease in epithelial ovarian cancer patients.
Aneuploidy ; Cyclin A* ; Cyclins* ; DNA* ; Drug Therapy ; Humans ; Korea ; Neoplasm, Residual ; Ovarian Neoplasms* ; Ploidies ; Prognosis ; Seoul

Intraperitoneal carcinomatosis accounts for 25~35% of recurrences of colorectal cancer, and peritoneal carcinomatosis from colorectal cancer has been regarded as a lethal condition. However, a combination of aggressive cytoreductive surgery and intraperitoneal chemotherapy has been tried and appears to be beneficial in selected patients. The primary goal of cytoreductive surgery is to remove all visible tumor within the peritoneal cavity. The goal of intraperitoneal chemotherapy is to eradicate the microscopic residual tumor and to prevent its recurrence. There are various ways to perform intraperitoneal chemotherapy. One is postoperative intraperitoneal chemotherapy, and another is intraoperative hyperthermic chemotherapy during surgery. Hyperthermia increases the penetration of chemotherapy into tissues and the level of chemotherapy cytotoxicity. The timing of surgery in cases of intraperitoneal chemotherapy and the optimal dosage of drugs must be evaluated in further studies. In colorectal cancer, the peritoneum should be regarded as an intra-abdominal organ, like the liver. Therefore, intraperitoneal carcinomatosis must be treated by using a combination of aggressive surgical treatment and intraperitoneal chemotherapy. Eventually, the long-term overall survival will be increased.
Carcinoma* ; Colorectal Neoplasms* ; Drug Therapy ; Fever ; Humans ; Liver ; Neoplasm, Residual ; Peritoneal Cavity ; Peritoneum ; Recurrence

Placental site trophoblastic tumor (PSTT) is a rare form of gestational trophoblastic tumor (GTT) that has different behavior in disease process. The hysterectomy is general for PSTT, but hysterectomy is undesirable for patients who wish to remain fertile. We planned to preserve fertility of a young patient by first administering EMA/CO (Etoposide, methotrexate, actinomycin D/cyclophosphamide, vincristine) chemotherapy and then performing an open uterine surgery to remove residual tumor. The patient who attempted primary chemotherapy for PSTT must be undergone a hysterectomy because this conservative regimen showed sign of chemoresistance. We report a case of chemoresistant PSTT with trial to preserve fertility with a brief review of literatures.
Dactinomycin ; Drug Therapy ; Fertility ; Humans ; Hysterectomy ; Methotrexate ; Neoplasm, Residual ; Trophoblastic Neoplasms ; Trophoblastic Tumor, Placental Site*

The authors report a case of esthesioneuroblastoma with intracranial extension treated by craniofacial resection. The tumor was resected by transbasal approach and repaired the dural defect using pericranial flap. The defect of floor of anterior cranial fossa was repaired with splitted calvarium and pericranial flap. Otorhinolaryngologist removed the residual tumor mass located at paranasal sinuses using lateral rhinotomy. Using cranifacial resection, the authors could remove the mass completely. The patient was referred to hemato-oncologist for chemotherapy.
Cranial Fossa, Anterior ; Drug Therapy ; Esthesioneuroblastoma, Olfactory* ; Humans ; Neoplasm, Residual ; Paranasal Sinuses ; Skull

The standard treatment for epithelial ovarian cancer is maximal cytoreductive surgery and adjuvant chemotherapy. Neoadjuvant chemotherapy can be considered as an alternative treatment strategy when unacceptable primary surgery, in terms of gross residual tumor remaining at the end of cytoreduction, is expected or in cases where poor general condition renders extensive cytoreductive surgery unsuitable. Intraperitoneal chemotherapy is ideal for epithelial ovarian cancer because its spread is mainly limited to the peritoneal cavity. Several randomized controlled trials have reported a survival gain with intraperitoneal chemotherapy. However, disadvantages such as port-related complications, abdominal pain, and neurotoxicity hinder its wide use. Hyperthermic intraperitoneal chemotherapy (HIPEC) after cytoreductive surgery has been suggested as an alternative treatment strategy for intraperitoneal chemotherapy. Ongoing clinical trials of hyperthermic intraperitoneal chemotherapy will quantify clinical outcomes in the future, such as the survival benefit in epithelial ovarian cancer.
Abdominal Pain ; Chemotherapy, Adjuvant ; Drug Therapy* ; Neoplasm, Residual ; Ovarian Neoplasms* ; Peritoneal Cavity

OBJECTIVE: The objective of this study was to explore the association of longitudinal CA-125 measurements with overall survival (OS) time by developing a flexible model for patient-specific CA-125 profiles, and to provide a simple and reliable prediction of OS. METHODS: A retrospective study was performed on 275 patients with ovarian cancer who underwent at least one cycle of primary chemotherapy in our institute. Serial measurements of patients' CA-125 levels were performed at different frequencies according to their clinical plans. A statistical model coupling the Cox proportional hazards and the mixed-effects models was applied to determine the association of OS with patient-specific longitudinal CA-125 values. Stage and residual tumor size were additional variables included in the analysis. RESULTS: A total of 1,601 values of CA-125 were included. Longitudinal CA-125 levels, stage, and the residual tumor size were all significantly associated with OS. A patient-specific survival probability could be calculated. Validation showed that, in average, 85.4% patients were correctly predicted to have a high or low risk of death at a given time point. Comparison with a traditional model using CA-125 half-life and time to reach CA-125 nadir showed that the longitudinal CA-125 model had an improved predicative value. CONCLUSION: Longitudinal CA-125 values, measured from the diagnosis of ovarian cancer to the completion of primary chemotherapy, could be used to reliably predict OS after adjusting for the stage and residual tumor disease. This model could be potentially useful in clinical counseling of patients with ovarian cancer.
Counseling ; Diagnosis ; Drug Therapy ; Half-Life ; Humans ; Models, Statistical ; Neoplasm, Residual ; Ovarian Neoplasms* ; Retrospective Studies