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1 ICD-11 . 2010 .. 3 2007 . 1994 . 1993 . 1997 .. 50 .. NSAID .. 1 .. 1 . ,32(6):743-749,2005. 2 Robert Twycross Andrew Wilcock .. ap o p t o s i s . Programmed cell death .. DNA .. necrosis .. mRNA ( ) mRNA .. DNA . RNA RNaseH hnRNA, mRNA .. d u ra ti on o f s tab l e d i sease .. dys p las ia .. -1- .. intraepitherial neoplasia . intraepitherial neoplasia high grade low grade . carcinoma in situe .. atypia . , 112 1996 . 2 1997 . 9 1999 .. p r i ma ry d e b u l k i n g su r ge ry .. 2007.. en b l o c r ese c ti o n . En bloc .. gene ti c c o u nse l i n g .. gene . DNA 1 DNA . DNA RNA . DNA .. genotype gene cloning gene duplication gene amplification -2- genetic map gene recombination oncogene tumor suppressor gene 1992 .. gene ti c d ia gn o s is .. polymerase chain reaction (PCR) DNA.. HLA .. clone minimum residual disease MRD .. DNA 1995 . Pennisi E From genes to genome biology. Science 272 1736-1738 1996 . Yasui W Yokozaki H and Tahara E Molecular diagnosis of gastrointestinal cancer.

2 In Molecular Pathology of Gastroenterological Cancer, Application to Clinical practice. E Tahara eds., Springer-Verlag Tokyo 187-207 . 1997 . gene the rapy .. HIV .. Mulligan RC The basic science of gene therapy. Science 260 926-932 1993 . Shimada T Current status and future prospects of human gene therapy. Acta Paediatr .Jpn 38 176-181 1996 . Roth JA and Cristiano RJ Gene therapy for cancer what have we done and where are we going? J .Natl. Cancer Inst. 89 21-39 1997 . Runnebaum IB Basics of cancer gene therapy. Anticancer Res. 17 2887-2890 1997 . Verma IM and Somia N Gene therapy - promises, problems and prospects Nature 89 239-242 1997 . heal i n g . cure , ,32(5) 443,1997 Heal . health . in f o r me d c o nsent .. -3- .. GCP . ( in f o r me d c h o i ce). (informed consent) .. informed choice . V i r o the ra py .. 1 .. juxta - re gi o na l l y mph n o des .. ( o d d s rati o).. !"#$%+,)*. =. !"#$%&'()*. 4 4 2 .. "#$%&'(. &'() =.

3 !"#$%&'(. 1 .. -4- ( ) .. che m o the ra py .. che m o ra d i o the rapy .. concurrent chemoradiotherapy CCRT . ac c e l e rate d f ra c ti onati o n . 2 .. von Hippel-Lindou . Li-Fraumeni . pe r f o r mance s tatus (PS) . PS .. Grade . Grade .. Grade 50 . -5- . Grade 50 . Grade . Toxicity and response criteria of the Eastern Cooperative Oncology Group:Am J Clin Oncol 5:649-655,1982. hype r f rac ti onati o n . 1920 30 . 1 . 1 2Gy . 50Gy 1970. 80 1 2Gy . 1 2Gy . 1 .. 1 1 .. 1 1 2 2 . 6 1980 1 2Gy . 1 1 2 60Gy 72Gy 1 .. Car c in o i d . carcinoid . Carcinoid .. Carcinoid . 5-HIAA 5-hydroxyindole acetic acid .. l i m b sa lvage s u r ge ry .. pa l l ia tive me d i c i ne pa l l ia ti ve car e . QOL . terminal . Oxford Textbook of Palliative Medicine .. -6- . 2008 . 1976 St. Thomas Hospital 80 90 .. - .. Cintron, A. and Meier, : The palliative care consult team. In: (eds), Bruera, E., Higginson, , Ripamonti, C. et al. Textbook of Palliativ Medicine.)

4 Hodder Arnold, London, , 2006.. 1.. 2.. 3.. 2 . exte rna l (b ea m) i r r ad iati o n in tracavi te ry i r ra d i ati o n .. 3D-CRT(3 ) IMRT .. cancer carcinoma . cancer carcinoma .. o n c o gene . -7- . v-onc proto-onc . c-onc .. tumor suppressor gene( ) .. 1.. 25 . 2.. 65 . 65 74 . 75 84 . 85 . 3.. 35 . 1997 .. s c reen in g f o r can ce r .. h i gh r i s k gr o u p . UICC (1) . (2) (3) (4) (5) .. 50 HBV HCV .. 1 3 . 1 3 .. 1 . 2 . 3 . natu ra l h i st o ry . Natural history . -8- .. s p on tane o us r e gress i o n .. G IST gas tr o i n tes tina l str o ma l tu m o r . KIT KIT . interstitial cells of Cajal(ICCs) KIT . KIT GIST . GIST .. Pseudo . 1978 pseudomucinous 3 . cystadenoma . in tens i f i ca ti o n the rapy .. consolidation therapy . IM R T in tens i ty m o d u la te d ra d i ati o n the ra py . IMRT . * . IMRT . IMRT .. * .. l o ca l r e c u r r enc e .. pa l l ia tive se dati o n thera py . -9- .. c l u s te r in g .. DNA.

5 Nd 1 .Knudsen S. Guide to analysis DNA microarray data. 2 ed. 2004, John Wiley & Sons, Hobson, New Jersey, USA. 2. 2001, , . ( c l i n i ca l r esear ch c o o r d inato r: C RC).. 19. 5 .. SMO SoCRA . AACR .. (Kur). (course) (cycle) .. Kr u k en be r g tu m o r . Krukenberg(1896 ) fibrosarcoma ovarii mucocellulare(carcinomatodes) . Krukenberg .. -10- . 2008. care . Cure . Cure .. angiogenesis . vasculogenesis .. VEGF(Vascular Endothelial Growth Factor) . EGF(Epidermal Growth Factor) .. (data and safe ty m o n i t o r in g c o m m i ttee i n de p enden t da ta m o n i t o r i n g c o m m i ttee ). GCP .. data monitoring committee .. independent data monitoring committee . h i gh l o w d o se the rapy . 2 1/2 large small dose therapy . wi d e ma r gin . Curative margin . 2 1990.. etc.. prognostic factor .. PS0/1 PS2/3 . PS0/1 PS2/3 PS . Cox . -11- .. confounding .. interaction . predictive factor HER2/neu . HER2/neu . HER2/neu .. s o l i d tu m o r.

6 14 6 17 . 50 .. rad i c a l s u r ge ry pa l l ia tive s u r ge ry .. reduction surgery .. Radical surgery curative surgery Curative surgery . -12- surgical curability comprehensive curability . A(pA) R0 Dnumber N pN number . B pB A(pA) C(pC) . C(pC) R1 R2 . A,B,C . A,pB,pC . D D0 ; D1; 1 D2; 1 . 2 D3; 1 2 3 . R0 R1 R2; . de f in i t ive ra d ia ti on thera py . gross tumor volume;GTV (clinical target volume;CTV) .. (planning target volume;PTV) .. c o m p a r t ment . (barrier) 1 . 1 Enneking . intracompartmental(T1) . extracompartmental(T2) . curative margin . Enneking WF A System of staging musculoskeletal neoplasms 204 9-24,1986 . c o m p l i ance .. re c ons tr u c tive s u r ge ry .. psych o - o n c o l o gy . (oncology) . Quality of life (QOL) .. -13- . 2002 .. m in i ma l ly invasive the r apy MI T . interventional radiology . nad i r .. ( ) . 1 .. re c u r r ent can ce r .. relapsing relapsing .. relapse .. re c u r r ence an d me tas tas is.

7 C e l l a dhes i on m o l e c u l e s . -14- .. (So u the rn b l o tt in g & n o r th en b l o tt in g). DNA . Southern . RNA . DNA RNA .. Salvage che m o the rapy , , .. , BEP (bleomycin, etoposide, cisplatin) . 70-80% , 20-30% etoposide, ifosfamyde, cisplatin VIP . , gemcitabine salvage chemotherapy .. exp l o ra to ry la pa r o t o my .. 2008.. 2 3 3 . 1 2 MAP FFP . MAP FFP 3 . FFP . 2 3 1 .. 800ml 2 3 1 400ml 4-6 . Hb 11g/dl . MAP 42 . -15- .. 3 1 . 1,000ml . 2 .. 3 2 3 .. 1 2 3 . 1 2 .. 1998 3 .. 2 .. s u p p o r t ive the ra py . , . , G-CSF .. s p on tane o us ca r c i n o ma .. mu l t i d i s c i p l inary m u l t i m o d a l th e rapy . -16- multidisciplinary multimodal .. multidisciplinary . multimodal .. standard surgery .. extended surgery .. modified surgery .. function preserving surgery .. de b u l k in g ( cyt o r e d u c tive ) s u r ge ry . primary debulking surgery interval debulking surgery . secondary debulking surgery.

8 2007. in tra les i o na l ma r gin . 100 .. 2 1990 .. 5 . proliferation ( proliferation hyperplasia multi plication . cell proliferation number . growth tumor growth size . invasion infiltration . extension progress progress .. doubling time 2 .. ma r gina l ma r gi n .. -17- intralesional margin . 60 . 2 1990.. , .. heavy par ti c l e ra d ia ti o n thera py .. ( ) .. X .. 1/3 1/4 . (charged particle beam radiation therapy, particle beam radiation therapy), . (heavy ion particle radiation therapy).. (dendritic cell: DC) . ( ) ( ) . (major histocompatibility complex: MHC) . T .. p re o p e rative c he m o th e rapy . down staging .. ( b rachythera py). -18- mm . 60 137 198 192 125 . (1) . (2) (3) .. 100 .. 1cm 100% 2cm 25% 3cm 11% .. 3-4cm . remote controlled afterloading system .. remote controlled afterloading system . RALS.. adenocarcinoma in situ . 1996. in trae p i the l i a l ne o p las ia .. 3 .. re gi o na l l y mph n o d es.)

9 Advanced cancer .. -19- phys i ca l f i n d in g .. 43 30 1981 . G C P G P M SP. GCP Good Clinical Practice 28 9 3 27 . GPMSP Good Post-Marketing Surveillance Practice 10 9 3 10 . GCP GCP 1997 . s k i p me tas tas is .. 3 2000. Sq ua m o u s c e l l c a r c in o ma e p i d e r m o i d ca r c i n o ma Squamous cell carcinoma . epidermoid . Stagin g la pa r o t o my . 2007.. WHO .. DSM IV TR . "Religious or Spiritual Problem" ( ) .. res tr i c t i on f ra g men t l en gth p o ly m o r p h i s m RF LP . DNA .. -20- . 3 12% . 4 35 . QOL .. National Comprehensive Cancer Network Guideline .. ove ra l l s u rviva l OS .. s u rvival t i me .. s u rvival ra te .. 1970 .. se c on d l o o k o p e rati o n .. -21- interval cytoreductive surgery 2 second look operation . in c i s i o na l b i o p sy exc i s i o na l b i o p sy .. Sensitive r e la p se , , , . , , . ,sensitive relapse , .. Barrett .. dysplasia . carcinoma in situ .. preinvasive cancer.

10 Occult latent occult carcinoma . latent carcinoma .. 1985 p 79 . Cl inical carcin oma .. Occ u lt carcin o ma .. Incidental carcin oma .. Latent carcin oma .. 3 . 1996 p 1 3 .. 1) .. 2) . chr o m o s o m e . sister chromatid centromere . Q G .. -22- . aneuploidy . 3 triploidy trisomy . monosomy . mosaic . deletion inversion duplication . insertion marker . ring chromosome . translocation .. telomere .. TTTAGG .. 15-30 . 40-85 .. p re c l i n i ca l s tu dy .. potentially curable cancer potentially curable cancer Wilms .. res p onse d u ra ti o n .. (re la tive r i s k).. -23- "#$%&'(. )*+,- =. !"#$%&'(. 4 4 .. stage PS .. stage II PS0 .. 50% .. stage II PS0 .. III .. stratified randomization . se c on d ma l i gnant ne o p las m .. Living will .. phase .. 4 phase .. -24- .. 1 1 .. study .. ICH-E8 .. human . pharmacology .. therapeutic . exploratory .. / . therapeutic . confirmatory .. / .. therapeutic use / .. phase .. tolerability adverse reaction.